After working for 6 weeks in a large urban jail, Marta, a night shift registered nurse, is told that court monitors will be arriving next week to evaluate health care related to a consent decree. They will be reviewing her documentation on early morning withdrawal rounds. As the days go by, tension is building for the stressful visit. Marta is not sure what to expect but she is particularly careful to follow the withdrawal protocol and complete all her documentation each shift.

Correctional nurses work in the criminal justice system but most of the time we focus on patient care rather than the legal environment. That usually works well for keeping the right perspective; however, sometimes the legal world and the healthcare world collide. That is certainly the case when it comes to consent decrees. These legal injunctions can involve any area of incarceration but often involve health care.

What is a Consent Decree?

A consent decree is an agreement or legal settlement reached between parties that allow for a dispute to be resolved without liability or an admission of guilt. In the criminal justice system, they can be used to settle a class action suit against a correctional system by a group of inmates and are most often about abridgment of civil rights.

Here are a few examples of recent consent decrees in jails and prisons

• Alabama Department of Corrections – Women Prisoners
• Arizona Department of Corrections – Sexual Harassment
• Riker’s Island Jail – Excessive Use of Force

Court Monitors

Court monitors are appointed by the presiding judge and are usually national experts in the area they will review. Because consent decrees often involve a wide array of processes and functions in a facility, there is usually a team of monitors appointed in a settlement. Sometimes lawyers for the plaintiff will accompany the monitors during the visit.

Monitors periodically survey care delivery to determine that the stipulations of the decree are being met. They will likely review written documentation such as policies, quality improvement activities, medical records (current and closed), and inmate grievances. They will also interview managers and frontline staff about current processes. Many times housing and healthcare units are toured and inmates questioned about health care processes such as how they request to see a health care provider. During tours, officers may be questioned about suicide precautions or emergency medical procedures. If suicide or inmate safety are at issue, housing areas may be viewed for structural conditions that could be unsafe.

Once a site visit is completed, monitors report to the court on compliance or improvement toward compliance for the specifics of the consent decree to the judge. This may be in the form of a verbal report but most definitely in writing. Continued compliance will lead to the lifting of judicial oversight. It is usually a lengthy process as noted in this article about Cook County Jail’s release from federal oversight after over 40 years.

Your Role in a Consent Decree

Frontline healthcare staff and managers have a role to play in addressing consent decrees. Quite simply, your role is to do your job to the best of your ability and per the policies and procedures at your site. There is no need to fear court monitors or site surveys. If you are asked questions, answer them honestly. Court monitors want the best for your patients and so do you. You are on the same team.

Here are a few do’s and don’t I would suggest to Marta regarding the upcoming court monitor visit at her facility.

• Do review policies and procedures to be sure you are correctly following them.
• Do maintain good documentation.
• Do attend any staff training that may occur in preparation for a monitor visit.
• Do honestly answer all questions from a monitor team member.
• Don’t be anxious or alarmed by an upcoming visit.
• Don’t consider monitors as the enemy.
• Don’t falsify or remove documentation.

Health care providers should be aware of any healthcare consent decrees in operation in a correctional setting in order to be attentive to any particulars of the decree when delivering healthcare.

Have you been involved in a consent decree or settlement agreement as a correctional nurse? Share your experiences in the comments section of this post.