behavioral health and medical care is considered the gold standard across the health care system, including in correctional settings. This is even more important in the context of the current opioid epidemic. In addition, the oral health needs of incarcerated populations are unique and are an essential part of overall health care. Ideally, future CT DOC analyses and service design efforts would include these important services. 10 Interview templates are included as Appendix 2. In addition, a high‐level narrative overview of the CT DOC health care system is included as Appendix 3. The timing of this Health Care Assessment is important. Governor Ned Lamont, based on legislative directive, has hired a consulting firm to make recommendations for a sweeping overhaul of state government operations designed to reduce costs by as much as $500 million a year. Recommendations will be made in February 20211 . It will be critical that CT DOC be able to reference its areas of strength and demonstrate its own ability to critically look at its own operation and self‐correct in order to ensure it is providing good health care for its inmates while providing a safe workplace for its staff. OPERATIONAL ASSESSMENT When applicable, HMA’s approach to communicating our operational assessment findings will focus on seven domains: Operations; Patient Access; Orders and Execution; Follow‐up, Tracking, and Reporting; Compliance with Standards; and Leadership and Oversight. This assessment includes high level summary information from the chart review to highlight certain issues, but the full chart review findings are addressed later in this report. Domains Operations Patient access Orders/ execution Follow up Tracking/ reporting Compliance with Standards Leadership and Oversight Interviews ü ü ü ü ü ü ü Document Review ü ü ü ü ü ü ü Chart Review ü ü ü ü ü ü 1 Harford Courant. Lamont taps Boston Consulting Group to prepare overhaul of state government, eliminating jobs and cutting $500M. Keith Phaneuf, Sept 28, 2020. 11 Introductory Observations and System Strengths Correctional health care, by its definition, is a specialty health care system. A correctional health care system must have infrastructure, standardized processes and procedures, commitment to performance improvement, and skill in responding to crises and threats. It encompasses preventive care, primary care, specialty care, and emergency care every day. Its population often includes individuals with chronic illnesses who have not had routine health care while in the community. Correctional health care must take place in a jail or prison environment where the security and safety of the incarcerated and its staff are primary. A correctional environment is very different than community‐based health care settings. Security threats, institutional procedures (e.g., counts), and many other factors can impact the smooth provision of health care. As such, an assessment of a correctional health care system should highlight those existing processes, initiatives and examples of good “care,” proactive initiatives and process improvements, along with the challenges and areas ripe for improvement. In the following report, HMA will address these areas and provide a series of short‐term, mid‐term, and long‐term recommendations. Overall System Strengths and Observations Overall, we found that most inmates of the CT DOC receive timely health care services in response to acute and chronic needs. 1. Medical autonomy, defined by the National Commission on Correctional Healthcare (NCCHC) as “clinical decisions and actions regarding health care provided to inmates to meet their serious medical needs are solely the responsibility of qualified health care professionals,” is generally intact across the health care system.2 2. The relationship between health care and custody functions professionally across the system. In most facilities and most shifts, custody staff are supportive of inmate needs for health care and collaborate closely with health care staff to ensure inmates get to on‐site and off‐site appointments. Custody staff provide secure environments in which health care staff deliver services, and health care staff report feeling safe in their work settings. Collaboration between custody and health care worked well in response to COVID‐19 and that experience can be built on moving forward. 3. CT DOC’s HSU leadership and health care staff across the facilities deserve much credit on their management of the first wave of COVID‐19 impacting the Department of Correction. Jurisdictions across the nation are reeling from the effects of the pandemic. CT DOC’s proactive 2 Custody officers determine infirmary bed occupancy in certain circumstances, which may be in conflict with medical autonomy. 12 approach and its efforts to date with mass testing and isolating patients have clearly made a difference. CT DOC’s medical care for patients with symptomatic COVID‐19 is based on available hospital standards and has allowed patients to remain in CT DOC facilities while accessing medical care rather than be sent to hospitals. For those patients that need hospitalization and a greater level of care, HSU has been able to use their labs and testing results to expedite care in the hospital. The Commissioner, Deputy Commissioners, Dr. Richeson (HSU Chief Operating Officer), his direct