Statement by Greg Brooks, Deputy Comptroller, Office of
the New York City Comptroller before the New York City
Council Subcommittee on Juvenile Justice
April 29, 2002
(As Prepared For Delivery)
Good morning. My name is Greg Brooks and I am the Deputy Comptroller for Policy,
Audits, Contracts and Accountancy. With me is John Graham, Assistant Comptroller for
Contract Administration and Michael Skrak, Chief of Contractor and Procurement
On behalf of Comptroller Thompson, I would like to thank Council member James E.
Davis and the members of this subcommittee for providing the opportunity to testify on
the very important topic of medical and mental health care provided to children detained
in Department of Juvenile Justice (DJJ) facilities.
On January 22nd of this year, DJJ submitted for registration a six-month renewal of the
agency's contract with EMSA Correctional Care, Inc. (EMSA). Unfortunately, the
contract was submitted for registration long after it had commenced. In this instance, the
contract term was retroactive to October 1, 2001 with an expiration of March 31, 2002.
During the registration review, the Contract's staff found a previously unreported
affiliation between EMSA and Prison Health Services, Inc. (PHS). PHS is presently
providing medical care to inmates in the City's correctional facilities. PHS also has been
the subject of widespread criticism throughout the country for the medical and mental
health care services that it provides inmates in other states.
DJJ represented in the materials submitted for registration that EMSA's performance on
the recently expired contract was Satisfactory. The Comptroller’s Office requested that
DJJ provide the underlying materials it used to gauge EMSAS' contract performance.
Additionally, the office contacted other parties, such as the Legal Aid Society, the courts,
prison health certification organizations and other oversight agencies. We also requested
a tour of DJJ facilities and face-to-face meetings with relevant DJJ and EMSA officials.
This meeting occurred on February 14, 2002.
I would like to thank DJJ for its cooperation. DJJ has been extremely cooperative. It
opened its doors to the Comptroller’s staff and this was important for the Comptroller’s
However, the results of the review were not encouraging. Legal Aid told us numerous
stories of children in DJJ facilities taken off their psychotropic medications, or being
required to sit in court for long periods without their medication. Staff found that the DJJ
facilities were not medically accredited. DJJ provided no reports upon which it could
base any evaluation, much less one that was satisfactory. Significantly, the staff found
that EMSA was a corporation in name only and that PHS was actually managing the
contract and providing the mental and medical health care services to the children.
Accordingly, hereafter, I will refer to EMSA-PHS simply as PHS.
The monthly reports on performance indicators prepared by PHS to DJJ were not
believable. For instance, PHS reported that it administered no over-the-counter drugs to
any of the approximately 3000 children detained in Bridges, Horizon and Crossroads
from May 2001 through November 2001. Further, the number of children PHS reported
were admitted to the Medical Specialty Housing Unit, which is an isolation unit, did not
account for all children kept at the Unit (For example, administrative admissions were not
specified.). In addition, PHS reported that for the approximately 5000 troubled children
imprisoned in DJJ's secure facilities each year only two suicides were attempted.
The staff discovered that only one doctor, who worked only part-time and had other
duties, was available to care for the children. Also, DJJ had failed to require PHS to
provide it with the medical and mental health Quality Assurance reports of the care it
gave to the children. The Quality Assurance reports are required by the contract.
On February 22nd, with only five weeks remaining in the six-month renewal contract, the
contract was registered based upon assurances from DJJ that corrective action would be
taken by the agency. The Comptroller's Office confirmed the specific areas DJJ would
address, plus made additional recommendations in its March 11th letter to DJJ.
Let me review with you the four major items that DJJ will address:
1. Increased Counseling Services. During the meeting with Comptroller staff, DJJ
representatives stated that PHS currently has seven part-time psychiatric social
workers (the equivalent of 5.6 full time employees) and the full-time equivalent of 1.4
psychiatrists for the 5,000 children detained each year. A PHS supervisor told staff
that a more optimal staffing level number of psychiatrists are two Full Time
Equivalent (FTE) positions. Also, PHS' contract requires that it provide group-
counseling services, which it has not done. DJJ agreed to review the staffing levels
and to begin providing group counseling services either through PHS' contract or with
a different vendor.
2. Quality Assurance Reporting. PHS is contractually required to submit to DJJ an
annual Quality Assurance Plan, annual Quality Assurance Report and quarterly
Quality Assurance Minutes, as part of an on-going Quality Assurance program. We
understand that the Quality Assurance reports were discontinued at DJJ's request.
PHS stated that they would now submit to DJJ the Quality Assurance reports required
by the contract. The reports should include the results of peer reviews, including that
of PHS' Regional Medical Director. Quality assurance is one of the most basic steps
any healthcare program should take to maintain the services these children need and
3. "Goals Report" Performance Indicator Statistics. DJJ and PHS acknowledged that
confusion and inconsistencies were contained in the Goals Report and that DJJ had
recently amended the Goals Report to address these problems.
4. Independent Accreditation. When questioned about independent review of its medical
and mental health care, the PHS and DJJ representatives acknowledged the need for
accreditation. The PHS representative stated that PHS was committed to having its
DJJ facilities accredited by a nationally recognized accrediting agency before the end
of 2002. One organization mentioned was the National Commission on Correctional
We also recommended to DJJ that the agency take the following steps:
• Review whether the one doctor provided by PHS, on a part time basis, adequately
services the medical needs of the approximately 5,000 children that are in DJJ's care
• Formally amend the contract to include the new “Goals Report”;
• Require that PHS devise a means for providing medication to juvenile detainees who
are away from DJJ facilities during the day, but who nonetheless require medication
after the current 6:00 A.M. medication time. And this includes psychotropic drugs. It
includes children who are diabetic. It includes children who require drugs with a
normal regimen while they are in court.
• Investigate the use of drug screening to improve the detection of substance-abusive
detainees, to replace the self-reporting process currently in force;
• Ensure that PHS meets its contractually mandated requirement of conducting dental
screening within the required 72 hours of admission; and
• Begin imposing liquidated damages on PHS for any breeches of the contract,
including the failure to provide the monthly, quarterly and annual Quality Assurance
reporting cited above.
Additionally, staff has continued its review of PHS. They found that the New York State
Commission on Correction issued a number of reports resulting from serous incidents and
deaths attributed to sub-standard medical care provided by PHS to inmates in prison
upstate. In at least two instances, the Commission recommended that the county
responsible for the operation of the prison consider dropping PHS as their healthcare
provider. In at least one instance, the Commission stated that Prison Health Services'
“fitness to perform within the parameters of generally accepted good correctional medical
practice remains open to question." As such, the Comptroller's Office strongly believes
that DJJ must closely monitor the health care provided to this vulnerable population of
children to ensure that the fatal and near fatal errors identified by the State Commission
on Correction do not migrate to DJJ facilities.
I conveyed this information to DJJ on April 8th. I would be pleased to answer any
questions you may have.