OIG
California Correctional Institution Medical Inspection Results Cycle 1
CALIFORNIA CORRECTIONAL
INSTITUTION
MEDICAL INSPECTION RESULTS
BUREAU OF AUDITS AND INVESTIGATIONS
OFFICE OF THE
INSPECTOR GENERAL
DAVID R. SHAW
INSPECTOR GENERAL
STATE OF CALIFORNIA
September 2009
Contents
Executive Summary ......................................................................................… 1
Introduction …................................................................................................… 3
Background …....................................................................................… 3
About the Institution …......................................................................… 4
Objectives, Scope, and Methodology ….............................................. 4
Medical Inspection Results ….......................................................................… 7
California Prison Health Care Receivership
Corporation's Response …............................................................................. 30
Office of the Inspector General's Comments
on the Receiver's Response........................................................................... 40
Executive Summary
An April 2001 class action lawsuit filed by inmates represented by the Prison Law Office alleged
that the state provided constitutionally inadequate medical care at California state prisons in
violation of inmates’ constitutional rights. And, in October 2005, the U.S. Northern District Court of
California declared that California’s delivery system for prison medical care was “broken beyond
repair” and still not meeting constitutional standards. As a result, the federal court imposed a
receivership to raise the delivery of medical care to constitutional standards. To evaluate and
monitor the progress of medical care delivery to inmates, the receiver requested, and the Office of
the Inspector General (OIG) agreed, to establish an objective, clinically appropriate, and metric-
oriented medical program to annually inspect the delivery of medical care at each state prison.
In May 2009, we inspected California Correctional Institution (CCI). Our
Overall medical inspection encompassed 19 components of medical delivery and
Score comprised 153 questions. The questions are weighted based on their
64.3% importance to the delivery of medical care to inmates. CCI received 64.3
percent of the total weighted points possible.
The following summary table lists the components we inspected in order of importance (highest to
lowest), with the institution’s score and the definitions of each inspection component. The detailed
medical inspection results, with the questions for each component, begin on page 7 of this report.
While we are committed to helping each institution achieve a higher level of medical care, it is not
our intent to determine the percentage score needed by an institution to meet constitutional standards
—that is a legal matter for the federal court to determine.
Executive Summary Table
Component Weighted Definition
Score
Chronic Care 61.8% Examines how well the prison provided care and medication to inmates with specific chronic
care conditions, which are those that affect (or have the potential to affect) an inmate's
functioning and long-term prognosis for more than six months. Our inspection tests the
following chronic care conditions: asthma, Coumadin therapy, diabetes, HIV (Human
Immunodeficiency Virus), and hypertension.
Clinical Services 57.4% Evaluates the inmate's access to primary health care services and focuses on inmates who
recently received services from any of the prison's facility or administrative segregation unit
clinics. This component evaluates sick call processes (doctor or nurse line), medication
management, and nursing.
Health Screening 78.3% Focuses on the prison's process for screening new inmates upon arrival to the institution for
health care conditions that require treatment and monitoring, as well as ensuring inmates'
continuity of care.
Specialty Services 57.3% Focuses on the prison's process for approving, denying, and scheduling services that are outside
the specialties of the prison's medical staff. Common examples of these services include
physical therapy, oncology services, podiatry consultations, and neurology services.
Urgent Services 82.7% Addresses the care provided by the institution to inmates before and after they were sent to a
community hospital.
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Office of the Inspector General State of California
Component Weighted Definition
Score
Emergency Services 77.9% Examines how well the prison responded to medical emergencies. Specifically, we focused on
"man down" or "woman down" situations. Further, questions determine the adequacy of
medical and staff response to a "man down" or "woman down" emergency drill.
Prenatal Care/ N/A Focuses on the prenatal and post-delivery medical care provided to pregnant inmates. Not
Childbirth/Post-delivery applicable at men's institutions.
Diagnostic Services 60.4% Addresses the timeliness of radiology (x-ray) and laboratory services and whether the prison
followed up on clinically significant results.
Access to Health Care 54.9% Addresses the prison's effectiveness in filing, storing, and retrieving medical records and
Information medical-related information.
Outpatient Housing 73.3% Determines whether the prison followed department policies and procedures when placing
Unit inmates in the outpatient housing unit. This component also evaluates whether the placement
provided the inmate with adequate care and whether the physician's plan addressed the
placement diagnosis.
Internal Reviews 60.0% Focuses on the frequency of meetings held by the prison's Quality Management Committee
(QMC) and Emergency Response Review Committee (ERRC) and whether key staff attended
the meetings, the number of medical appeals filed, and the prison's death review process.
Inmate Transfers 43.2% Focuses on inmates pending transfer to determine whether the sending institution documented
medication and medical conditions to assist the receiving institution in providing continuity of
care.
Clinic Operations 90.6% Addresses the general operational aspects of the prison's facility clinics. Generally, the
questions in this component relate to the overall cleanliness of the clinics, privacy afforded to
inmates during nonemergency visits, use of priority ducats (slip of paper the inmate carries for
scheduled medical appointments), and availability of health care request forms.
Preventive Services 7.3% Focuses on inmate cancer screening and influenza immunizations.
Pharmacy Services 79.3% Addresses whether the prison's pharmacy complies with various operational policies, such as
conducting periodic inventory counts and maintaining the currency of medications in its night
lockers, keeping signature cards on file for doctors, and having valid permits. In addition, this
component also addresses whether the pharmacy has an effective process for screening
medication orders for potential adverse reactions/interactions.
Other Services 85.0% Examines additional areas that are not captured in the other components. The areas evaluated in
this component include the prison's provision of therapeutic diets, its handling of inmates who
display poor hygiene, and the availability of the current version of the department's Health
Services Policies and Procedures.
Inmate Hunger Strikes 45.8% Examines medical staff's monitoring of inmates participating in hunger strikes.
Chemical Agent 66.3% Addresses the prison's process of handling inmates who may be predisposed to an adverse
Contraindications outcome from calculated uses of force (cell extractions) involving Oleoresin Capsicum (OC),
which is commonly referred to as "pepper spray." For example, this might occur if the inmate
has asthma.
Staffing Levels and 90.0% Examines the prison's medical staffing levels and training provided.
Training
Nursing Policy 50.0% Determines whether the prison maintains written policies and procedures for the safe and
effective provision of quality nursing care. The questions in this component also determine
whether nursing staff review their duty statements and whether supervisors periodically review
the work of nurses to ensure they properly follow established nursing protocols.
Overall Score 64.3%
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Office of the Inspector General State of California
Introduction
Under the authority of California Penal Code section 6126, which assigns the Office of the Inspector
General (OIG) responsibility for oversight of the California Department of Corrections and
Rehabilitation, and at the request of the federal receiver, the OIG developed a comprehensive
inspection program to evaluate the delivery of medical care at each of the California Department of
Corrections and Rehabilitation’s 33 adult prisons.
In May 2009, we inspected California Correctional Institution (CCI). Our medical inspection
encompassed 19 components of medical delivery and comprised 153 questions. To help readers
understand the medical risk associated with certain components of medical delivery—which pose a
greater risk to an inmate-patient—we developed a weighting system and assigned points to each
question. Consequently, we assigned more total points to more critical components, such as chronic
care, clinical services, and health screening. We assigned fewer total points to less critical components,
such as inmate hunger strikes, staffing levels and training, and chemical agent contraindications. (For a
detailed description of the weighting system, see Objectives, Scope, and Methodology on the next
page.)
Background
In April 2001, inmates represented by the Prison Law Office filed a class action lawsuit, known as
Plata v. Schwarzenegger. The lawsuit alleged that the state provided constitutionally inadequate
medical care at California state prisons in violation of inmates’ constitutional rights. In June 2002, the
parties entered into a Stipulation for Injunctive Relief, and the state agreed to implement over several
years comprehensive new medical care policies and procedures at all institutions.
Nevertheless, the U.S. Northern District Court of California declared in October 2005 that California’s
delivery system for prison medical care was “broken beyond repair” and still not meeting constitutional
standards. Thus, the federal court imposed a receivership to raise the delivery of medical care to
constitutional standards. In essence, the court ordered the receiver to manage the state’s delivery of
medical care and restructure day-to-day operations to develop and sustain a system that provides
constitutionally adequate medical care to inmates. The court stated that it would remove the receiver
and return control to the state once the system is stable and provides for constitutionally adequate
medical care.
To evaluate and monitor the progress of medical care delivery to inmates, the receiver requested that
the OIG establish an objective, clinically appropriate, and metric-oriented medical inspection program.
Toward that end, the Inspector General agreed to inspect annually each state prison until the state’s
delivery of medical care to inmates meets constitutional standards. We are committed to helping each
institution achieve a higher level of medical care, but it is up to the federal court to determine the
percentage score necessary for an institution to meet constitutional standards.
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Office of the Inspector General State of California
About the Institution
The overall mission of the California Correctional Institution (CCI) is to incarcerate and control felons,
while providing opportunity for meaningful work, training and other programs. CCI is made up of four
separate facilities, including a reception center for short-term housing. Each facility houses inmates of
varying security levels, from minimum security inmates all the way up to inmates housed in CCI's
Security Housing Units (SHU), the highest-level of security in California state prisons. Each of the four
facilities houses a medical clinic where staff handle non-urgent requests for medical services. CCI also
treats inmates needing urgent or emergency care in its triage and treatment area (TTA). As of
August 19, 2009, the California Department of Corrections and Rehabilitation reported that CCI had
custody over 5,633 male inmates, including 1,484 reception center inmates and 772 SHU inmates.
According to information provided by the institution, CCI's vacancy rate among licensed medical
managers, primary care providers, supervisors, and rank and file nurses was 16.9 percent.
William Walsh, Ph.D., who serves as the prison's acting health care manager, and Arnel Joaquin, M.D.,
the prison's chief medical officer, are responsible for CCI's entire health care program.
Objectives, Scope, and Methodology
In designing the medical inspection program, we reviewed the California Department of Corrections
and Rehabilitation’s policies and procedures, relevant court orders, guidelines developed by the
department’s Quality Medical Assurance Team, and guidance developed by the American Correctional
Association. We also reviewed professional literature on correctional medical care, consulted with
clinical experts, and met with stakeholders from the court, the receiver’s office, the department, and the
Prison Law Office to discuss the nature and scope of the inspection program. Based on input from these
stakeholders, we developed a medical inspection program that evaluates medical care delivery. Within
each of 20 components, we created “yes” or “no” questions designed to gauge performance.
To make the inspection results meaningful to both a medical expert and a lay reader, we worked with
clinical experts to create a weighting system that factors the relative importance of each component
compared to other components. Further, the program considers the relative importance of each question
within a component to the other questions in that component. This weighting ensures that more critical
components—such as those that pose the greatest medical risk to the inmate-patient—are given more
weight compared to those considered less serious. For example, we assign a high number of possible
points to the chronic care component because we consider this the most serious of all the components.
Conversely, we assign very few points to the hygiene intervention component because we consider this
the least serious inspection component.
Each inspection question is weighted and scored. The score is derived from the percentage of “yes”
answers for each question from all items sampled. We then multiply the percentage of “yes” answers
within a given question by the question’s weight to arrive at a score. The following example shows how
this scoring system works.
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Office of the Inspector General State of California
Example Question: Institution X
Answers Weighting Points
Yes No Yes + No Yes % Possible Received Score % N/A Unk
Is the clinical history adequate? 40 10 50 80% 20 16 80.0% 0 0
If the institution receives 40 “yes” answers and 10 “no” answers, the percentage of “yes” answers to
this question equals 80 percent. We calculate the number of points the institution would receive by
multiplying the “yes” percent of 80 by the number of possible points for this question, which is 20, to
arrive at 16 points.
To arrive at the total score, we add the points received for each question and then for each program
component. Finally, we calculate the institution’s overall score by dividing the sum of the points
received by the sum of the points possible. We do not include in the institution’s overall score the
weight for questions that are not applicable or, in some cases, where a lack of documentation would
result in numerous “no” answers for one deviation from policy (unknown). For instance, an institution
may not be able to provide documentation that its emergency response review committee met for a
particular month. Therefore, when we evaluate whether meeting minutes document monthly meetings
for a particular month, the institution would receive a “no” answer for that question. However, when
we evaluate whether the meeting minutes document the warden’s attendance at the meeting, the answer
would be “unknown” so that the institution’s score is not penalized twice for the same reason, not
documenting the meeting.
To evaluate the institution’s delivery of medical care, we obtained various electronic data files
maintained by the institution for inmate medical scheduling and tracking, pharmacy, and census data.
We used these electronic data files only to identify random samples of inmates receiving or requiring
specific medical services. We then reviewed the medical file for each inmate in our sample. We did not
rely on the medical care information contained in these data files.
Our medical inspection at CCI encompassed 19 of the 20 components of medical delivery. One of the
components was not applicable during the period inspected. In total, we reviewed 187 inmate medical
files, which are referred to as unit health records. In addition, we reviewed staffing level reports,
medical appeals summaries, nursing policies and procedures, summaries of medical drills and
emergencies, minutes from Quality Management Committee and Emergency Response Review
Committee hearings, and assorted manual logs or tracking worksheets related to medical care delivery.
We also conducted a live medical emergency drill and evaluated the adequacy of the responding staff’s
actions. Finally, we interviewed medical and custody staff members about the delivery of medical care
to inmates, and we observed day-to-day medical delivery at the institution.
We do not test the care provided in the licensed hospitals or correctional treatment centers because they
are subject to inspections and oversight by other regulatory agencies.
Consistent with our agreement with the receiver, our report only addresses the conditions found related
to the medical care criteria. We do not discuss the causes of noncompliance, nor do we make specific
recommendations in this report. However, if we learn of an inmate-patient who needs immediate care,
we notify the chief medical officer and request a status report. Moreover, if we learn of significant
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Office of the Inspector General State of California
departures from community standards, we may report such departures to the institution’s chief medical
officer or the receiver’s office. Because these matters involve confidential medical information
protected by state and federal privacy laws, specific details related to these cases are not included in our
report.
For ease of reference, following is a table of abbreviations used in the remainder of this report.
Abbreviations used in this report
AED Automatic External Defibrillator
BLS Basic Life Support
CMO Chief Medical Officer
CTC Correctional Treatment Center
CTQ Confined to Quarters
ERRC Emergency Response Review Committee
FTF Face-to-Face
GACH General Acute Care Hospital
HCM Health Care Manager
INH Isoniazid (antituberculous medication)
LVN Licensed Vocational Nurse
MOD Medical Officer of the Day
OB Obstetrician
OC Oleoresin Capsicum (pepper spray)
OHU Outpatient Housing Unit
OIG Office of the Inspector General
PCP Primary Care Provider
QMC Quality Management Committee
RN Registered Nurse
SOAPE Subjective, Objective, Assessment, Plan, Education
SRN Supervising Registered Nurse
TB Tuberculosis
TTA Triage and Treatment Area
UHR Unit Health Record
UM Utilization Management
Bureau of Audits and Investigations Page 6
Office of the Inspector General State of California
OFFICE OF THE INSPECTOR GENERAL CALIFORNIA CORRECTIONAL INSTITUTION
Overall Score:
MEDICAL INSPECTION RESULTS
64.3%
05/18/2009 – 05/21/2009
Answers Weighting Points Questions Not Answered
Component Page Yes No Yes + No Yes % Points Possible Points Received Score % Not Applicable Unknown
Chronic Care 8 136 83 219 62.1% 133 82.2 61.8% 6 0
Clinical Services 9 176 103 279 63.1% 95 54.5 57.4% 44 4
Health Screening 11 178 32 210 84.8% 89 69.7 78.3% 184 16
Specialty Services 13 63 41 104 60.6% 71 40.7 57.3% 40 0
Urgent Services 14 115 29 144 79.9% 52 43.0 82.7% 50 6
Emergency Services 15 31 8 39 79.5% 58 45.2 77.9% 1 2
Diagnostic Services 17 27 24 51 52.9% 52 31.4 60.4% 13 1
Access to Health Care Information 18 8 4 12 66.7% 51 28.0 54.9% 0 0
Outpatient Housing Unit 19 49 16 65 75.4% 48 35.2 73.3% 11 6
Internal Reviews 20 22 8 30 73.3% 40 24.0 60.0% 4 0
Inmate Transfers 21 11 10 21 52.4% 38 16.4 43.2% 4 0
Clinic Operations 22 26 6 32 81.3% 33 29.9 90.6% 1 0
Preventive Services 23 3 25 28 10.7% 30 2.2 7.3% 0 0
Pharmacy Services 24 26 1 27 96.3% 29 23.0 79.3% 0 0
Other Services 25 6 1 7 85.7% 10 8.5 85.0% 2 0
Inmate Hunger Strikes 26 4 5 9 44.4% 19 8.7 45.8% 0 0
Chemical Agent Contraindications 27 2 1 3 66.7% 8 5.3 66.3% 3 0
Staffing Levels and Training 28 6 2 8 75.0% 16 14.4 90.0% 1 0
Nursing Policy 29 7 8 15 46.7% 14 7.0 50.0% 0 0
Totals 896 407 1303 68.8% 886 569.3 64.3% 364 35
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Office of the Inspector General State of California
Answers Weighting Points
Reference
Chronic Care
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
03.076 Was the inmate's most recent chronic care visit within the time frame required 17 8 25 68.0% 10 6.8 68.0% 0 0
by the degree of control of the inmate's condition based on his or her prior visit?
03.077 Were key elements on Forms 7419 (Chronic Care Follow-Up Visit) and 7392 13 12 25 52.0% 10 5.2 52.0% 0 0
(Primary Care Flow Sheet) filled out completely for the inmate's two most
recent visits?
03.082 Did the institution document that it provided the inmate with health care 20 5 25 80.0% 12 9.6 80.0% 0 0
education?
03.175 Did the inmate receive his or her prescribed chronic care medications during the 11 12 23 47.8% 18 8.6 47.8% 2 0
most recent three-month period or did the institution follow departmental policy
if the inmate refused to pick up or show up for his or her medications?
03.235 Is the clinical history adequate? 15 10 25 60.0% 18 10.8 60.0% 0 0
03.236 Is the focused clinical examination adequate? 19 6 25 76.0% 19 14.4 76.0% 0 0
03.237 Is the assessment adequate? 11 14 25 44.0% 19 8.4 44.0% 0 0
03.238 Is the plan adequate and consistent with the degree of control based on the 15 6 21 71.4% 19 13.6 71.4% 4 0
chronic care program intervention and follow up requirements?
03.262 Is the inmate's Problem List complete and filed accurately in the inmate's unit 15 10 25 60.0% 8 4.8 60.0% 0 0
health record (UHR)?
Components Subtotals: 136 83 219 62.1% 133 82.2 61.8% 6 0
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Office of the Inspector General State of California
Answers Weighting Points
Reference
Clinical Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
01.024 RN FTF Documentation: Did the inmate's request for health care get reviewed 23 2 25 92.0% 4 3.7 92.0% 0 0
the same day it was received?
01.025 RN FTF Documentation: Did the RN complete the face-to-face (FTF) triage 15 10 25 60.0% 6 3.6 60.0% 0 0
within one (1) business day after the Form 7362 was reviewed?
01.246 Did documentation indicate that the RN reviewed all of the inmate's complaints 16 9 25 64.0% 5 3.2 64.0% 0 0
listed on Form 7362 (Health Care Services Request Form)?
01.157 RN FTF Documentation: Did the RN's subjective note address the nature and 16 9 25 64.0% 7 4.5 64.0% 0 0
history of the inmates primary complaint?
01.159 RN FTF Documentation: Did the RN's objective note include vital signs and a 17 8 25 68.0% 6 4.1 68.0% 0 0
focused physical examination, and did it adequately address the problems noted
in the subjective note?
01.244 RN FTF Documentation: Did the RN's objective note include allergies, weight, 7 18 25 28.0% 3 0.8 28.0% 0 0
current medication, and where appropriate, medication compliance?
01.158 RN FTF Documentation: Did the RN's assessment provide conclusions based 17 8 25 68.0% 6 4.1 68.0% 0 0
on subjective and objective data, were the conclusions formulated as patient
problems, and did it contain applicable nursing diagnoses?
01.162 RN FTF Documentation: Did the RN's plan include an adequate strategy to 23 2 25 92.0% 7 6.4 92.0% 0 0
address the problems identified during the FTF triage?
01.163 RN FTF Documentation: Did the RN's education/instruction adequately address 20 5 25 80.0% 5 4.0 80.0% 0 0
the problems identified during the FTF triage?
01.027 If the RN determined a referral to a primary care physician (PCP) was 3 9 12 25.0% 8 2.0 25.0% 13 0
necessary, was the inmate seen within the timelines specified by the RN during
the FTF triage?
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Office of the Inspector General State of California
Answers Weighting Points
Reference
Clinical Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
01.247 Sick Call Follow-up: If the provider ordered a follow-up sick call appointment, 4 3 7 57.1% 7 4.0 57.1% 17 1
did it take place within the time frame specified?
01.124 Sick Call Medication: Did the institution administer or deliver prescription 9 13 22 40.9% 6 2.5 40.9% 3 0
medications (new orders) to the inmate within specified time frames?
15.234 Are clinic response bags audited daily and do they contain essential items? 1 1 2 50.0% 5 2.5 50.0% 0 0
21.278 Was there adequate prior management of pre-existing medical conditions that 5 6 11 45.5% 20 9.1 45.5% 11 3
contributed to the need for the TTA visit?
Components Subtotals: 176 103 279 63.1% 95 54.5 57.4% 44 4
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Office of the Inspector General State of California
Answers Weighting Points
Reference
Health Screening
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
02.016 Did the institution complete the initial health screening on the same day the 23 7 30 76.7% 9 6.9 76.7% 0 0
inmate arrived at the institution?
02.017 If yes was answered to any of the questions on the initial health screening 18 0 18 100.0% 8 8.0 100.0% 7 5
form(s), did the RN provide an assessment and disposition on the date of
arrival?
02.018 If, during the assessment, the RN referred the inmate to a clinician, was the 2 4 6 33.3% 8 2.7 33.3% 20 4
inmate seen within the time frame?
02.021 Reception center: Did the inmate receive a complete history and physical by a 10 0 10 100.0% 5 5.0 100.0% 20 0
Nurse Practitioner, Physician Assistant, or a Physician and Surgeon within 14
calendar days of arrival?
02.211 Reception center history and physical: Is the "History of Present Illness" section 8 1 9 88.9% 2 1.8 88.9% 1 0
of Form 7206 (History and Physical Examination) complete and appropriate to
the chief complaint(s), if any?
02.212 Reception center history and physical: Are the "Past History" and "Past Medical 10 0 10 100.0% 2 2.0 100.0% 0 0
History" sections of Form 7206 (History and Physical Examination) complete?
02.215 Reception center history and physical: Is the "Review Systems" section of Form 8 2 10 80.0% 2 1.6 80.0% 0 0
7206 (History and Physical Examination) complete?
02.213 Reception center history and physical: Is the "Family and Social History" 10 0 10 100.0% 2 2.0 100.0% 0 0
section of Form 7206 (History and Physical Examination) complete?
02.216 Reception center history and physical: Is the "Physical Examination" section of 10 0 10 100.0% 2 2.0 100.0% 0 0
Form 7206 (History and Physical Examination) complete and appropriate to the
history and review of systems?
02.217 Reception center history and physical: Is the "Diagnosis/Impression" section of 10 0 10 100.0% 2 2.0 100.0% 0 0
Form 7206 (History and Physical Examination) appropriate to the history and
physical examination?
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Office of the Inspector General State of California
Answers Weighting Points
Reference
Health Screening
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
02.218 Reception center history and physical: Is the "Plan of Action" section of Form 4 0 4 100.0% 2 2.0 100.0% 6 0
7206 (History and Physical Examination) appropriate to the
"Diagnosis/Impression" section of the form?
02.219 Reception center history and physical: Has required intake testing been ordered? 9 1 10 90.0% 4 3.6 90.0% 0 0
02.020 Did the LVN/RN adequately document the tuberculin test or a review of signs 24 6 30 80.0% 6 4.8 80.0% 0 0
and symptoms if the inmate had a previous positive tuberculin test?
02.015 Was a review of symptoms completed if the inmate's tuberculin test was 1 2 3 33.3% 7 2.3 33.3% 21 6
positive, and were the results reviewed by the infection control nurse?
02.022 Reception center: If the primary care provider (PCP) indicated the inmate 0 0 0 0.0% 0 0.0 0.0% 30 0
required a special diet, did the PCP refer the inmate to a registered dietician?
02.128 If the inmate had an existing medication order upon arrival at the institution, did 6 8 14 42.9% 8 3.4 42.9% 16 0
the inmate receive the medications by the next calendar day, or did a physician
explain why the medications were not to be continued?
02.007 Non-reception center: Does the health care transfer information form indicate 18 1 19 94.7% 7 6.6 94.7% 10 1
that it was reviewed and signed by licensed health care staff within one calendar
day of the inmate's arrival at the institution?
02.014 Non-reception center: If the inmate was scheduled for a specialty appointment 2 0 2 100.0% 7 7.0 100.0% 28 0
at the sending institution, did the receiving institution schedule the appointment
within 30 days of the original appointment date?
02.111 Non-reception center: Did the inmate receive medical accommodations upon 5 0 5 100.0% 6 6.0 100.0% 25 0
arrival, if applicable?
Components Subtotals: 178 32 210 84.8% 89 69.7 78.3% 184 16
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Office of the Inspector General State of California
Answers Weighting Points
Reference
Specialty Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
07.037 Did the institution approve or deny the PCP's request for specialty services 17 5 22 77.3% 8 6.2 77.3% 0 0
within the specified time frames?
07.038 Did the PCP see the inmate between the date the PCP ordered the service and 5 12 17 29.4% 8 2.4 29.4% 5 0
the date the inmate received it, in accordance with specified time frames?
07.035 Did the inmate receive the specialty service within specified time frames? 7 10 17 41.2% 9 3.7 41.2% 5 0
07.090 Physical therapy services: Did the physical therapist assess the inmate and 2 0 2 100.0% 8 8.0 100.0% 20 0
document the treatment plan and treatment provided to the inmate?
07.043 Did the PCP review the consultant's report and see the inmate for a follow-up 8 9 17 47.1% 9 4.2 47.1% 5 0
appointment after the specialty services consultation within specified time
frames?
07.260 Was the institution's denial of the PCP's request for specialty services consistent 4 1 5 80.0% 9 7.2 80.0% 0 0
with the "medical necessity" requirement?
07.259 Was there adequate documentation of the reason for the denial of specialty 3 2 5 60.0% 5 3.0 60.0% 0 0
services?
07.270 Did the specialty provider provide timely findings and recommendations or did 17 0 17 100.0% 6 6.0 100.0% 5 0
an RN document that he or she called the specialty provider to ascertain the
findings and recommendations?
07.261 Is the institution scheduling high-priority (urgent) specialty services within 14 0 2 2 0.0% 9 0.0 0.0% 0 0
days?
Components Subtotals: 63 41 104 60.6% 71 40.7 57.3% 40 0
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Office of the Inspector General State of California
Answers Weighting Points
Reference
Urgent Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
21.248 Upon the inmate's discharge from the community hospital, did the triage and 23 2 25 92.0% 7 6.4 92.0% 0 0
treatment area (TTA) registered nurse document that he or she reviewed the
inmate's discharge plan and completed a face-to-face assessment of the inmate?
21.250 Upon the inmate's discharge from the community hospital, did the inmate's 25 0 25 100.0% 7 7.0 100.0% 0 0
Primary Care Provider (PCP) provide orders for appropriate housing for the
inmate?
21.251 Upon the inmate's discharge from the community hospital, did the Registered 0 0 0 0.0% 0 0.0 0.0% 25 0
Nurse intervene if the inmate was housed in an area that was inappropriate for
nursing care based on the primary care provider's (PCP) housing orders?
21.249 Upon the inmate's discharge from the community hospital, did the inmate 11 12 23 47.8% 7 3.3 47.8% 2 0
receive a follow-up appointment with his or her primary care provider (PCP)
within five calendar days of discharge?
21.281 Upon the inmate's discharge from a community hospital, did the institution 16 8 24 66.7% 6 4.0 66.7% 1 0
administer or deliver all prescribed medications to the inmate within specified
time frames?
21.275 Was the documentation of the clinical care provided in the TTA adequate? 19 6 25 76.0% 10 7.6 76.0% 0 0
21.276 While the patient was in the TTA, was the clinical care rendered by the 20 1 21 95.2% 7 6.7 95.2% 0 4
attending provider adequate and timely?
21.279 For patients managed by telephone consultation alone, was the provider's 1 0 1 100.0% 8 8.0 100.0% 22 2
decision not to come to the TTA appropriate?
Components Subtotals: 115 29 144 79.9% 52 43.0 82.7% 50 6
Bureau of Audits and Investigations Page 14
Office of the Inspector General State of California
Answers Weighting Points
Reference
Emergency Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
08.183 Was the medical emergency responder notified of the medical emergency 4 0 4 100.0% 5 5.0 100.0% 0 0
without delay?
08.241 Did the first responder provide adequate basic life support (BLS) prior to 4 0 4 100.0% 6 6.0 100.0% 0 0
medical staff arriving?
08.184 Did the medical emergency responder arrive at the location of the medical 2 2 4 50.0% 4 2.0 50.0% 0 0
emergency within five (5) minutes of initial notification?
08.185 Did the medical emergency responder use proper equipment to address the 3 0 3 100.0% 7 7.0 100.0% 0 1
emergency and was adequate medical care provided within the scope of his or
her license?
08.242 Did licensed health care staff call 911 without unnecessary delay after a life- 3 1 4 75.0% 6 4.5 75.0% 0 0
threatening condition was identified by a licensed health care provider or peace
officer?
08.187 Did the institution provide adequate preparation for the ambulance's arrival, 2 1 3 66.7% 4 2.7 66.7% 0 1
access to the inmate, and departure?
08.186 Were both the first responder (if peace officer or licensed health care staff) and 4 0 4 100.0% 4 4.0 100.0% 0 0
the medical emergency responder basic life support (BLS) certified at the time
of the incident?
08.222 Were the findings of the institution's Emergency Response Review Committee 0 3 3 0.0% 7 0.0 0.0% 1 0
(ERRC) supported by the documentation and completed within 30 days?
15.240 Emergency Medical Response Drill: Did the responding officer activate the 1 0 1 100.0% 2 2.0 100.0% 0 0
emergency response system by providing the pertinent information to the
relevant parties, immediately and without delay?
15.255 Emergency Medical Response Drill: Did the responding officer carry and use 0 1 1 0.0% 1 0.0 0.0% 0 0
the proper equipment (protective shield or micro-mask, gloves) required by the
department?
Bureau of Audits and Investigations Page 15
Office of the Inspector General State of California
Answers Weighting Points
Reference
Emergency Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
15.256 Emergency Medical Response Drill: Did the responding officer properly 1 0 1 100.0% 1 1.0 100.0% 0 0
perform an assessment on the patient for responsiveness?
15.257 Emergency Medical Response Drill: Did the responding officer properly 1 0 1 100.0% 2 2.0 100.0% 0 0
perform CPR?
15.258 Emergency Medical Response Drill: Did the responding officer begin CPR 1 0 1 100.0% 2 2.0 100.0% 0 0
without unecessary delay?
15.282 Emergency Medical Response Drill: Did medical staff arrive on scene in five 1 0 1 100.0% 2 2.0 100.0% 0 0
minutes or less?
15.283 Emergency Medical Response Drill: Did the emergency medical responders 1 0 1 100.0% 1 1.0 100.0% 0 0
arrive with proper equipment (ER bag, bag-valve-mask, AED)?
15.284 Emergency Medical Response Drill: Did the responding officer provide 1 0 1 100.0% 1 1.0 100.0% 0 0
accurate information to responding medical staff?
15.285 Emergency Medical Response Drill: Did emergency medical responders 1 0 1 100.0% 1 1.0 100.0% 0 0
continue basic life support?
15.287 Emergency Medical Response Drill: Was 911 called without unnecessary delay? 1 0 1 100.0% 2 2.0 100.0% 0 0
Components Subtotals: 31 8 39 79.5% 58 45.2 77.9% 1 2
Bureau of Audits and Investigations Page 16
Office of the Inspector General State of California
Answers Weighting Points
Reference
Diagnostic Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
06.049 Radiology order: Was the radiology service provided within the time frame 4 1 5 80.0% 7 5.6 80.0% 0 0
specified in the physician's order?
06.245 Radiology order: Was the diagnostic report received by the institution within 14 5 0 5 100.0% 8 8.0 100.0% 0 0
days?
06.200 Radiology order: Did the primary care provider (PCP) review the diagnostic 0 5 5 0.0% 7 0.0 0.0% 0 0
report and initiate written notice to the inmate within two (2) business days of
the date the institution received the diagnostic reports?
06.188 All laboratory orders: Was the specimen collected within the applicable time 4 6 10 40.0% 6 2.4 40.0% 0 0
frames of the physician's order?
06.191 All diagnostic services: Did the PCP document the clinically significant 6 3 9 66.7% 7 4.7 66.7% 6 0
diagnostic test results on Form 7230 (Interdisciplinary Progress Notes)?
06.263 All diagnostic services: Did the PCP adequately manage clinically significant 7 0 7 100.0% 10 10.0 100.0% 7 1
test results?
06.202 All laboratory orders: Did the PCP review the diagnostic reports and initiate 1 9 10 10.0% 7 0.7 10.0% 0 0
written notice to the inmate within two (2) business days of the date the
institution received the diagnostic reports?
Components Subtotals: 27 24 51 52.9% 52 31.4 60.4% 13 1
Bureau of Audits and Investigations Page 17
Office of the Inspector General State of California
Answers Weighting Points
Reference
Access to Health Care Information
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
19.150 Is the medical records office current with its loose filing? 0 1 1 0.0% 9 0.0 0.0% 0 0
19.169 Did medical records staff make unit health records (UHR) available to clinic 2 0 2 100.0% 15 15.0 100.0% 0 0
staff for the inmates ducated for medical appointments the next day?
19.243 Was the institution able to account for the OIG's requested UHR files? 0 1 1 0.0% 12 0.0 0.0% 0 0
19.266 Does the institution properly file inmates' medical information? 1 0 1 100.0% 5 5.0 100.0% 0 0
19.271 While reviewing unit health records (UHR) as part of the OIG's inspection, 3 2 5 60.0% 5 3.0 60.0% 0 0
were the OIGs RN and MD inspectors able to locate all relevant documentation
of health care provided to inmates?
19.272 Does the institution promptly file blood pressure logs in unit health records 2 0 2 100.0% 5 5.0 100.0% 0 0
(UHR)?
Components Subtotals: 8 4 12 66.7% 51 28.0 54.9% 0 0
Bureau of Audits and Investigations Page 18
Office of the Inspector General State of California
Answers Weighting Points
Reference
Outpatient Housing Unit
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
04.052 Did the RN complete an initial assessment of the inmate on the day of 6 4 10 60.0% 5 3.0 60.0% 0 0
placement?
04.051 Did the primary care provider (PCP) evaluate the inmate within one calendar 8 2 10 80.0% 5 4.0 80.0% 0 0
day after placement?
04.053 While the inmate was placed in the OHU, did the PCP complete the Subjective, 1 2 3 33.3% 4 1.3 33.3% 7 0
Objective, Assessment, Plan and Education (SOAPE) at a minimum of every 14
days?
15.103 In the outpatient housing unit (OHU), are patient call buttons operational or 0 1 1 0.0% 3 0.0 0.0% 0 0
does medical staff make rounds every 30 minutes?
04.054 Did the utilization management (UM) nurse assess the inmate within one week 3 3 6 50.0% 4 2.0 50.0% 4 0
of the inmate's placement and every 30 days thereafter?
15.225 Does the OHU use disinfectant daily in common patient areas? 1 0 1 100.0% 3 3.0 100.0% 0 0
04.112 Was the PCP's initial evaluation adequate for the problem(s) requiring OHU 7 3 10 70.0% 5 3.5 70.0% 0 0
placement?
04.230 Was the PCP's initial assessment (or diagnoses) appropriate for the findings in 7 0 7 100.0% 5 5.0 100.0% 0 3
the initial evaluation?
04.056 Did the PCP's plan adequately address the initial assessment? 7 1 8 87.5% 5 4.4 87.5% 0 2
04.208 Was the level of care available in the OHU appropriate to the patient's clinical 9 0 9 100.0% 9 9.0 100.0% 0 1
presentation?
Components Subtotals: 49 16 65 75.4% 48 35.2 73.3% 11 6
Bureau of Audits and Investigations Page 19
Office of the Inspector General State of California
Answers Weighting Points
Reference
Internal Reviews
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
17.221 Did the institution complete a medical emergency response drill for each watch 0 1 1 0.0% 5 0.0 0.0% 0 0
and include participation from each medical facility during the most recent full
quarter?
17.174 Did the institution promptly process inmate medical appeals during the most 0 1 1 0.0% 5 0.0 0.0% 0 0
recent 12 months?
17.136 For each death sampled, did the institution complete the death review process? 4 1 5 80.0% 5 4.0 80.0% 0 0
17.132 Do the Emergency Response Review Committee (ERRC) meeting minutes 3 3 6 50.0% 5 2.5 50.0% 0 0
document monthly meetings for the last six (6) months?
17.138 Do the Emergency Response Review Committee (ERRC) meeting minutes 2 1 3 66.7% 5 3.3 66.7% 3 0
document the warden's (or his or her designee's) attendance?
17.118 Do the Quality Management Committee (QMC) meeting minutes document 5 1 6 83.3% 5 4.2 83.3% 0 0
monthly meetings for the last six (6) months?
17.119 Did the Quality Management Committee (QMC) report its findings to the 5 0 5 100.0% 5 5.0 100.0% 1 0
HCM/CMO each of the last six (6) meetings?
17.135 Did the last three Quality Management Committee (QMC) meeting minutes 3 0 3 100.0% 5 5.0 100.0% 0 0
reflect findings and strategies for improvement?
Components Subtotals: 22 8 30 73.3% 40 24.0 60.0% 4 0
Bureau of Audits and Investigations Page 20
Office of the Inspector General State of California
Answers Weighting Points
Reference
Inmate Transfers
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
05.108 Did Receiving and Release have the inmate's UHR and transfer envelope? 5 0 5 100.0% 7 7.0 100.0% 0 0
05.109 If the inmate was scheduled for any upcoming specialty services, were the 0 1 1 0.0% 8 0.0 0.0% 4 0
services noted on Form 7371 (Health Care Transfer Information)?
05.110 Do all appropriate forms in the transfer envelope identify all medications 5 0 5 100.0% 8 8.0 100.0% 0 0
ordered by the physician, and are the medications in the transfer envelope?
05.171 Did an RN accurately complete all applicable sections of Form 7371 (Health 1 4 5 20.0% 7 1.4 20.0% 0 0
Care Transfer Information) based on the inmate's UHR?
05.172 Did the Health Records Department maintain a copy of the inmate's Form 7371 0 5 5 0.0% 8 0.0 0.0% 0 0
(Health Care Transfer Information) and Form 7231A (Outpatient Medication
Administration Record) when the inmate transferred?
Components Subtotals: 11 10 21 52.4% 38 16.4 43.2% 4 0
Bureau of Audits and Investigations Page 21
Office of the Inspector General State of California
Answers Weighting Points
Reference
Clinic Operations
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
14.023 Does the institution make the Form 7362 (Health Care Services Request Form) 8 1 9 88.9% 4 3.6 88.9% 0 0
available to inmates?
14.164 Are areas available to ensure privacy during RN face-to-face assessments and 3 1 4 75.0% 3 2.3 75.0% 0 0
doctors' examinations for non-emergencies?
14.166 Was the medication stored in a sealed container if food was present in the clinic 2 0 2 100.0% 2 2.0 100.0% 0 0
refrigerator?
14.131 Do medication nurses understand that medication is to be administered by the 2 0 2 100.0% 4 4.0 100.0% 0 0
same licensed staff member who prepares it and on the same day?
14.106 Does clinical staff wash their hands (either with soap or hand sanitizer) or 4 0 4 100.0% 4 4.0 100.0% 0 0
change gloves between patients?
14.033 Does the institution have an adequate process to ensure inmates who are moved 2 0 2 100.0% 4 4.0 100.0% 0 0
to a new cell still receive their medical ducats?
14.032 Does medical staff understand the institution's priority ducat process? 1 0 1 100.0% 2 2.0 100.0% 1 0
14.160 Does the institution have a process to identify, review, and address urgent 2 0 2 100.0% 4 4.0 100.0% 0 0
appointments if a doctor's line is canceled?
14.029 Does medical staff in the facility clinic know which inmates are on modified 2 0 2 100.0% 4 4.0 100.0% 0 0
program or confined to quarters (CTQ) and does staff have an adequate process
to ensure those inmates receive their medication?
14.165 Are the clinic floors, waiting room chairs, and equipment cleaned with a 0 4 4 0.0% 2 0.0 0.0% 0 0
disinfectant daily?
Components Subtotals: 26 6 32 81.3% 33 29.9 90.6% 1 0
Bureau of Audits and Investigations Page 22
Office of the Inspector General State of California
Answers Weighting Points
Reference
Preventive Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
10.228 Inmates prescribed INH: Did the institution properly administer the medication 1 4 5 20.0% 6 1.2 20.0% 0 0
to the inmate?
10.232 Inmates prescribed INH: Did the institution monitor the inmate monthly for the 0 5 5 0.0% 6 0.0 0.0% 0 0
most recent three months he or she was on the medication?
10.229 Inmates with TB code 34: Was the inmate evaluated for signs and symptoms of 0 5 5 0.0% 7 0.0 0.0% 0 0
TB within the previous 12 months?
10.086 All inmates age 66 or older: Did the inmate receive an influenza vaccination 0 3 3 0.0% 6 0.0 0.0% 0 0
within the previous 12 months or was the inmate's refusal documented?
10.085 Male inmates age 51 or older: Did the inmate receive a fecal occult blood test 2 8 10 20.0% 5 1.0 20.0% 0 0
(FOBT) within the previous 12 months or was the inmate's refusal documented?
Components Subtotals: 3 25 28 10.7% 30 2.2 7.3% 0 0
Bureau of Audits and Investigations Page 23
Office of the Inspector General State of California
Answers Weighting Points
Reference
Pharmacy Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
13.139 Does the institution conspicuously post a valid permit in its pharmacies? 1 0 1 100.0% 2 2.0 100.0% 0 0
13.141 Does the institution properly maintain its emergency crash cart medications? 6 0 6 100.0% 2 2.0 100.0% 0 0
13.252 Does the institution properly maintain medications in its drug night locker(s)? 5 0 5 100.0% 2 2.0 100.0% 0 0
13.253 Does the institution conduct monthly inspections of its emergency cart and drug 11 0 11 100.0% 1 1.0 100.0% 0 0
night locker(s)?
13.142 Is the Pharmacist in Charge's license current? 1 0 1 100.0% 5 5.0 100.0% 0 0
13.144 Does the institution have information to ensure that medications are prescribed 0 1 1 0.0% 6 0.0 0.0% 0 0
by licensed health-care providers lawfully authorized to do so?
13.145 Does the pharmacist in charge have an effective process for screening new 1 0 1 100.0% 7 7.0 100.0% 0 0
medication orders for potential adverse reactions?
13.148 Does the pharmacist in charge monitor the quantity of medications on hand, and 1 0 1 100.0% 4 4.0 100.0% 0 0
does the pharmacy conduct an annual inventory to ensure that the quantity of
medications in the system matches the quantity of medications on hand?
Components Subtotals: 26 1 27 96.3% 29 23.0 79.3% 0 0
Bureau of Audits and Investigations Page 24
Office of the Inspector General State of California
Answers Weighting Points
Reference
Other Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
15.059 Did the institution properly provide therapeutic diets to inmates? 0 0 0 0.0% 0 0.0 0.0% 1 0
20.092 Hygiene Intervention: Did custody staff understand the department's policies 4 0 4 100.0% 4 4.0 100.0% 0 0
and procedures for identifying and evaluating inmates displaying inappropriate
hygiene management?
15.058 If the institution does not offer therapeutic diets, does staff know the 1 0 1 100.0% 3 3.0 100.0% 0 0
department's procedures for transferring inmates who are determined to require
a therapeutic diet?
15.134 Did the institution properly respond to all active cases of TB discovered in the 0 0 0 0.0% 0 0.0 0.0% 1 0
last six months?
15.265 Is the most current version of the CDCR Health Services Policies and 1 1 2 50.0% 3 1.5 50.0% 0 0
Procedures available in the institution's law library?
Components Subtotals: 6 1 7 85.7% 10 8.5 85.0% 2 0
Bureau of Audits and Investigations Page 25
Office of the Inspector General State of California
Answers Weighting Points
Reference
Inmate Hunger Strikes
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
11.097 Did the RN conduct a face-to-face triage of the inmate within two (2) business 0 3 3 0.0% 6 0.0 0.0% 0 0
days of receipt of the Form 128-B and document the inmate's reasons for the
hunger strike, most recent recorded weight, current weight, vital signs, and
physical condition?
11.099 After the first 48 hours, did an RN or PCP complete daily assessments 2 1 3 66.7% 6 4.0 66.7% 0 0
documenting the inmate's weight, physical condition, emotional condition, vital
signs, and hydration status?
11.100 After the first 72 hours, did a physician perform a physical examination and 2 1 3 66.7% 7 4.7 66.7% 0 0
order a metabolic panel and a urinalysis of the inmate?
Components Subtotals: 4 5 9 44.4% 19 8.7 45.8% 0 0
Bureau of Audits and Investigations Page 26
Office of the Inspector General State of California
Answers Weighting Points
Reference
Chemical Agent Contraindications
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
12.062 Did the institution document that it consulted with an RN or primary care 0 0 0 0.0% 0 0.0 0.0% 3 0
provider (PCP) before a calculated use of OC?
12.064 Did the institution record how it decontaminated the inmate and did it follow 2 1 3 66.7% 8 5.3 66.7% 0 0
the decontamination policy?
Components Subtotals: 2 1 3 66.7% 8 5.3 66.3% 3 0
Bureau of Audits and Investigations Page 27
Office of the Inspector General State of California
Answers Weighting Points
Reference
Staffing Levels and Training
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
18.002 Information purposes only: Calculate the institution's average vacancy 0 0 0 0.0% 0 0.0 0.0% 1 0
percentages, the number of health care staff starting within six (6) months of the
OIG visit, and the number of health care staff hired from the registry.
The institution provided vacancy statistics within four licensed medical staffing
groups: (1) management; (2) primary care providers; (3) supervision; and (4)
rank and file nursing.
Total number of filled positions: 87
Total number of vacancies: 17.71
Total number of positions: 104.71
Vacancy percentage: 16.91%
Number of staff hired within last six months: 12
Total number of registry staff: 48
18.004 Did the institution have a registered nurse (RN) available on site 24 hours a day, 1 0 1 100.0% 4 4.0 100.0% 0 0
seven days a week, for emergency care?
18.005 Did the institution have a physician on site, a physician on call, or an MOD 1 0 1 100.0% 4 4.0 100.0% 0 0
available 24 hours a day, seven days a week, for the last 30 days?
18.006 Does the institution's orientation program for all newly hired nursing staff 1 0 1 100.0% 4 4.0 100.0% 0 0
include a module for sick call protocols that require face-to-face triage?
18.001 Are licensed health care staff current with their certifications and did they attend 3 2 5 60.0% 4 2.4 60.0% 0 0
required training?
Components Subtotals: 6 2 8 75.0% 16 14.4 90.0% 1 0
Bureau of Audits and Investigations Page 28
Office of the Inspector General State of California
Answers Weighting Points
Reference
Nursing Policy
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
16.231 Does the institution ensure that nursing staff review their duty statements? 2 3 5 40.0% 5 2.0 40.0% 0 0
16.154 Does the institution have written nursing policies and procedures that adhere to 5 0 5 100.0% 5 5.0 100.0% 0 0
the department's guidelines?
16.254 Does the institution's supervising registered nurse (SRN) conduct periodic 0 5 5 0.0% 4 0.0 0.0% 0 0
reviews of nursing staff?
Components Subtotals: 7 8 15 46.7% 14 7.0 50.0% 0 0
Bureau of Audits and Investigations Page 29
Office of the Inspector General State of California
California Prison Health Care
Receivership Corporation's
Response
Bureau of Audits and Investigations Page 30
Office of the Inspector General State of California
STATE OF CALIFORNIA J. Clark Kelso, Receiver
PRISON HEALTH CARE SERVICES
August 4, 2009
David R. Shaw, Inspector General
Office ofthe Inspector General
P.O. Box 348780
Sacramento, CA 95834-8780
Dear Mr. Shaw,
The purpose of this letter is to infonn you that the Office of the Receiver has reviewed the draft
report of the Office of the Inspector General's (OIG) Medical Inspection Results (MIR) for the
May 2009 inspection of California Correctional Institution (CCl). At this time, we would like to
address the following conditions raised as a result ofthe MIR.
Chronic Care - Reference Numbers 4)3.077,03.235 and 03.237
The OIG found the key elements on Fonn 7419 (Chronic Care Follow-up Visit) and Fonn 7392
(primary Care Flow Sheet) were not filled out completely. The Primary Care Providers (PCP's) at
CCI are instructed to ensure the clinical history is adequate and includes all items in the chief
complaint and items noted on previous visits. The Chief Physician and Surgeon will monitor these
fonns on an ongoing basis and complete a monthly sampling ofcharts for each provider until CCI is
at full compliance.
Chronic Care - Reference Numbers - 03.175
The OIG found the institution did not administer or deliver prescription medications to the
patient-inmates within specified timeframes as outlined in the Policy and Procedure (P&P). CCl's
Medication Management team will review the Local Operations Procedure (LOP) with staff. The
nurse educator will be scheduling continued training to all nursing staff to address Medication
Administration Record (MAR) documentation. Also, training will be held to educate custody and
patient-inmates regarding procedure to follow for refusals. Audits will be held with the MAR's
committee to ensure a report is sent to the Director ofNursing (DON). The DON will forward the
report to Pharmacy & Therapeutics monthly until CCI is compliant on this issue.
Chronic Care - Reference Number -03.262
The OIG found the PCP's completed the patient-inmates Problem List; however, this item was not
completely visible upon opening the Unit Health Record (UHR) as referenced in the P&P. The
ChiefPhysician and Surgeon will monitor this item on an ongoing basis and complete a sampling of
charts for each provider until full compliance is achieved for each quarter.
P.O. Box 4038. Sacramento, CA 95812-4038
David R. Shaw, Inspector General
August 4, 2009
Page 2
Clinical Services - Reference Number 01.025
The OIG found the Registered Nurse (RN) did not complete the Face-to Face (FTF) triage within
one business day after Fonn 7362 (Health Care Services Request Fonn) was reviewed. RN
shortages and the lack of available confidential consulting medical rooms contributed to a delay in
RN FTF triages. In-service training will be provided to nursing staffon FTF protocol. Additionally,
the SRN II will review 7362's daily in a huddle to ensure compliance.
Clinical Services -Reference Numbers 01.244
The OIG found during FTF triages the RN did not consistently document the patient-inmate's
allergies, weight, current medication and appropriate medication compliance as required in the P&P.
All RN's will be trained on the required elements for the documentation ofFTF triages. Audits will
be conducted every month by the yard SRN II. Ifneeded, further training will be provided to ensure
compliance.
Clinical Services -Reference Number 01.124
The OIG found the institution did not administer or deliver prescription medications to the
patient-inmates within the specified timeframes olltlined in the P&P. CCI will review the
Medication Management LOP with staff and provide medication delivery training and education to
ensure compliance.
Health Screening - Reference Number 02.015
The OIG found the Infection Control Nurse (ICN) did not evaluate signs and symptoms for TB and
did not provide documentation in the UHR to indicate a TB test was perfonned. In-service training
will be provided to all Infectious Control Disease (IFD) staff and all nurses regarding appropriate
documentation and evaluation of the signs and symptoms of the patient-inmates with a positive TB
skin test. The SRN II will conduct a random monthly audit to ensure conlpliance.
Health Screening - Reference Number 02.018
The OIG found that patient-inmates referred to a clinician as a result ofthe RN assessment were not
seen within the timeframes as outlined in the P&P. The OIG also noted. that Fonn 7277 was not in
the UHR. Due to CCI's shortage of PCP's, it has been difficult to schedule patient-inmates in the
appropriate time frames. CCI will provide training to PCP's to ensure patient-inmates are seen in a
timely basis. A monthly audit will be conducted by the SRN II to ensure time frames and
documentation are in accordance with the P&P.
David R. Shaw, Inspector General
August 4, 2009
Page 3
Health Screening - Reference Number 02.128
The OIG found that Form 7231-A (Olltpatient Medication Administration Record) was riot dated
and could not detennine whether patient-inmates received their prescribed medications within the
next business day. CCI's MAR Committee and Nursing staffwill monitor dates on Foml 7231-A to
ensure compliance. Additional monitoring will be completed by the Pharmacy and Therapeutics
Subcommittee on a monthly basis to ensure medications are given to patient-inmates within the next
calendar day.
Specialty Services - Reference Number 07.038 and 07.035
The OIG found patient-inmates who were referred and approved for specialty services were not seen
by their PCP while awaiting the specialty services and/or the specialty service provider within the
specified timeframes outlined in the P&P. CCI has experienced PCP shortages and is currently
utilizing Registry PCP's. CCI will conduct weekly and monthly audits on Request for Specialty
Services (RFS) to ensure patient-inmates are seen in accordance with the P&P. Additionally, CCI
will continue to canvas for more providers to allow a greater number of appointments and reduce
the vacancy rate ofPCP's.
Specialty Services - Reference Number 07.261
The OIG fOlmd patient-inmates were not scheduled for high-priority (urgent) specialty services
within 14 days. CCI will audit high priority requests to ensure patient-inmates are seen within
14 calendar days of the UM's approval as outlined in the P&P. Also, CCI will audit and monitor
RFS that are high priority and work with the CMO to ensure appointment scheduling is done in a
timely manner.
Urgent Services - Reference Number 21.278
The OIG found there was inadequate prior management of patient-inmates' pre-existing conditions
that contributed to Triage Treatment Area visits. CCI continues to struggle with PCP shortages and
inadequate clinical space. Vacant state positions are filled with registry providers causing a high
turnoverrate. Duetothe instability ofPCPpositions, continuity ofcare isoftencompromised. CCI
recently implemented the Primary Care Model and the Primary Care Teams are attending their daily
huddles to address chronic care issues. Also, the team will discuss steps to prevent future
unscheduled visits through appropriate regular care ofthe patient-inmates current chronic condition.
CCI will provide a monitoring system per the LOP and report the findings to the Quality
Management Committee (QMC).
David R. Shaw, Inspector General
August 4, 2009
Page 4
Urgent Services - Reference Number 21.249
The OIG found that patient-inmates were not seen by their PCP within five business days of being
discharged from a community hospital. CCI will train Receiving and Release (R&R) staffregarding
the process for returns to ensure follow up appointments are scheduled. Monthly audits will be
conducted until compliance is achieved and quarterly thereafter.
Emergency Services - Reference Number 08.222
The OIG found the institution's Emergency Response Review Committee (ERRC) findings were
not supported by documentation and were not completed within 30 days. CCI will ensure
documentation is complete and future ERRC meetings will be conducted within the time frames
outlined in the P&P.
Emergency Services -Reference Number 08.184
During an Emergency Medical Response drill, the OIG found the medical emergency responder did
not arrive at the emergency location within five minutes of the initial notification. Training will be
provided in accordance with the Emergency Medical Response System Policy; custody and nursing
staffwill be trained together to ensure adequate response time is achieved.
Diagnostic Services - Reference Number 06.200 ·and 06.202
The OIG found that CCI did not date stamp diagnostic reports for Radiology and Laboratory orders
and initiate written notice to the patient-inmate within the specified timeframes as outlined in the
P&P. CCI has implemented a new tracking and PCP review system. The Chief Physician and
Surgeon will monitor Fonn 7393 (Notification of Diagnostic Results) and complete a sampling of
charts on an on going basis until compliance is achieved and quarterly thereafter.
Diagnostic Services - Reference Number 06.188
The OIG found the specimen was not collected within the specified timeframes outlined in the P&P.
In-service training will be provided to all Phlebotomists, Schedulers, and Physicians to ensure
compliance. The Laboratory Supervisor Will audit these fonns monthly for accuracy.
Access to Health Care Information - Reference Number 19.150 and 19.271
The OIG found the Medical Records Office was not current with its loose filing and also was not
able to locate all relevant documentation of health care provided to patient-inmates. CCI will train
and hire Registry staff to assist with the backlog to ensure filing is in the UHR by close of business
each day as outlined in the P&P. Currently, each facility has a Medical Records Department and
CCI's future goal is to centralize the Medical Records Department.
David R. Shaw, Inspector General
August 4, 2009
Page 5
Outpatient Housing Unit-Reference Number 04.052
The OIG found the RN did not complete an initial assessment of the patient-inmate on the day of
placement as outlined in the P&P. Patient-inmate assessments take place upon arrival to the
institution and are filed in the most current volume of the UHR. Every chart reviewed by the OIG
had an initial assessment completed, however it was filed in a thinned OHU chart. CCI will create a
plan for the way Out Patient Housing Unit (OHU) charts are thinned. Additionally, CCI will
conduct audits and place thinned OHU charts in a specific location. Once the process is finalized,
staffwill be trained on this procedure.
Outpatient Housing Unit-Reference Number 04.054
The OIG found the Utilization Management (UM) Nurse did not complete an assessment of the
patient-inmate within one week of placement in the OHU as outlined in the P&P. The UM nurse
and OHU staff will be trained and an audit will completed to ensure patient-inmates are seen within
one week ofbeing placed in the OHU.
Internal Reviews -Reference Number 17.221
The OIG found the institution did not complete a medical emergency response drill for each watch
as outlined in the P&P. CCI will follow Vol. 4, Chapter 12-A1, subsection IV of the Emergency
Medical Response Program Policy and Procedures (2008) which states drills will be conducted
quarterly for each watch.
Inmate Transfers - Reference Number 05.171, 05.172 and 05.109
The OIG found the institution did not accurately .complete all applicable sections of Fonn 7371
(Health Care Transfer Form), including upcoming specialty services or maintain a copy of the 7471
and 7371 A when the patient-inmate was transferred. CCI will review patient-inmate health care
transfers to ensure compliance with P&P's. An audit tool will be developed and a monthly audit
will be completed until CCI is compliant. Once compliance is achieved audits will be completed
quarterly. Additionally, in service training will be provided to nursing staff to ensure accuracy in
completing all applicable sections ofFonn 7371 and maintaining a copy ofthe transfer forms.
Clinic Operations - Reference Number 14.165
The OIG found that CCI did not clean the clinic floors, waiting room chairs and equipment daily or
have appropriate cleaning materials available. At the time of the inspection CCI had janitorial
services for only certain areas within the institution. As of July 1, 2009, CCI has entered into
contract with a janitorial service that includes cleaning services for all facilities within the institution.
David R. Shaw, Inspector General
August 4, 2009
Page 6
Preventive Services - Reference Number 10.085
The OIG found that CCI did not document the patient-inmate refusal of a Fecal Occult Blood Test
(POBT) and also did not provide a test for all applicable patient-inmates within specified timeframes
outlined in the P&P. CCI will ensure that patient-inmates 51 years and older will be offered the
FOTB; all patient-inmate's refusals of the FOTB will be noted in the UHR. Res~lts will be placed
on Fonn 7392 (Primary Care Flow Sheet) to reflect the patient-inmate received an FOTB within the
previous 12· months. Compliance will be monitored on an ongoing basis thru the Inmate Medical
Scheduling Tracking System. .
Preventive Service -Reference Number 10.086
The OIG found the institution did not provide an influenza vaccination to patient-inmates age
66 years and older, nor was appropriate documentation of the patient-inmate's refusal noted. CCI
gave all patient-inmates the opportunity to receive ali influenza shot during the influenZa campaign
in October 2008. At the time of the inspection consent and refusal fonns were not being ~ubmitted
for entry into the respective UHR. At this time, all fonns have been submitted to
Medical Records. Future COl1sent and refusal forms will be submitted to Medical Records for entry
into the UHR within one week ofthe influenza vaccination.
Preventive Services - Reference Number 10.228
The OIG found that CCI did not properly administer the prescribed Isoniazid (lNH) medications to
the patient-inmates. All INH medications will be adnlinistered under Direct Observation Therapy
(DOT) dailyorata minimum oftwicea week. The pill line staffwill be responsible for counseling
any patient-inmate who fails to appear at the medication line within 24 hours.
Patient-inmates who missed, refused, or are a no-show for two consecutive doses ofTB medication
shall be referred to the prescriber, Public Health Nurse or the MOD on an urgent basis. Any
patient-innlate who misses, refuses, or is a no-show for TB Medication twice in 30 days shall be
ducated to the Public Health staff, nurse, or physician for further counseling.
Inmates refusing any TB medication will sign the CDCR Fonn 7225/7338 (Infonnation for
ConsentlRefusal for TB Evaluation or Treatment). This fonn will be filed in the UHR. In-service
training will be provided to nursing staffon proper medication administration.
Preventive Services - Reference Number 10.232
The OIG found that CCI did not properly monitor the patient-inmates who were prescribed INH
monthly as outlined in the P&P. Patient-inmates prescribed INH will be seen monthly by the FTF
nurse for the duration oflatent TB therapy. The nurse will utilize the CDCR fonn TBRX to monitor
any signs and symptoms ofmedication toxicity and this fonn will be filed in the UHR.
David R. Shaw, Inspector General
August 4, 2009
Page 7
Other Services-Reference Number 15.103
The OIG found the OHU call buttons were not operational and there were no logs documenting
rounds every 30 minutes. The call system in the OHU is antiquated, and is only partially
operational. A new call system was ordered and is pending arrival and installation. A cell to cell
checklist will be used to document contact until a new call system is installed. The SRN II will
provide a monitoring tool with education and training to medical and custody staff regarding the 30
minute checklist.
Other Services - Reference Number 15.265
The OIG fowld that CCI did not have the most current version of the California Department of
Corrections and Rehabilitation (CDCR) Health Services P&P available in two ofthe institutions law
libraries. CCI has since mailed a copy to all the law libraries within the institution to ensure
compliance.
Other Services - Reference Number 15.255
During an Emergency Medical Response drill, the OIG found that Custody Staff did not carry and
use the proper equipment required by the Department for an emergency response. CCI will provide
an in-service training with all custody staff to ensure proper emergency equipment is being used.
Additionally, CCI currently has micro-masks available for staff
Other Services -Reference Numbers 15.234
The OIG found that some clinic response bags are audited daily, but did not contain all essential
items. The SRN II will audit the response bags for content and check the daily audit list weekly to
ensure compliance. The fmdings will be reported to the EMRRC monthly.
Inmate Hunger Strike -Reference Numbers 11.097
The OIG found the institution did not conduct FTF triages within two business days, document the
reason for the hunger strike, and note the patient-inmate's most recent recorded weight.
Contributing factors in delay were due, to RN shortages and extended staff sick leave. CCI will
review the LOP with all nursing staff and train custody. In-service training will be provided
regarding hunger-strike protocol. The SRN II's shall audit and monitor the UHR on a daily basis to
ensure conlpliance.
Staffmg Levels and Training - Reference Number'18.001
The OIG found that some institution staff had not completed New Employee Orientation (NEO).
CCI managers will ensure all state employees attend NEG as a condition ofemploynlent.
David R. Shaw, Inspector General
August 4, 2009
PageS
Nursing Policy - Reference Number 16.254
The OIG found that the SRN II's did not conduct periodic reviews of nursing staff. CCI will
implement an audit schedule for the SRN's to complete. The SRN's will audit the documentation
regarding FTF triages. and urgent/emergency protocols weekly and complete a work review prior to
completing the staffs yearly evaluation. The DON will also conduct a monthly compliance audit.
Nursing Policy-Reference Numbers -16.231
The OIG found the institution did not ensure nursing staffreviewed their duty statements as outlined
in tile P&P. The SRN II's will be trained on the Duty Statement Policy. Duty Statements will be
audited quarterly using an internal tracking tool to ensure compliance.
In addition to the items identified above, the OIG draft report contains other fmdings with a low
reported rate of compliance. A number of findings are being addressed by statewide initiatives or
other resources designed to achieve a constitutional level of health care. For those items that are not
addressed by a statewide initiative, California Prison Health Care Services (CPHCS) staffwill work
with the institution to develop a Corrective Action Plan (CAP). Once a CAP is submitted and
approved, CPHCS staffwill monitor and follow-up on any corrective action identified.
Thank you for preparing the report. Your efforts have advanced our mutual objective of ensuring
transparency and accountability in the CPHCS operations. Should you have any questions or
concerns, please contact Theresa Kimura-Yip, Deputy Director, Policy and Program Compliance
Branch at (916) 327-1205. .
Sincerely,
IS, Director
Policy, Planning and Ev tion Division
California Prison Health Care Services
David R. Shaw, Inspector General
August 4, 2009
Page 9
cc: J. Clark Kelso, Receiver
Elaine Bush, ChiefDeputy, Office ofthe Receiver
.Starr Babcock, Special Assistant to the Court
:William Walsh, Health Care Manager, i(CCI)
Arne Joaquin, ChiefMedical Officer, (CCI)
Theresa Kimura-Yip, Deputy Director, Policy and Program Compliance Branch
Olga Durette, Health Program Manager II, Program Compliance Section
Steve Fama, Attorney, Prison Law Office
,Mary Jo Bruns, Southern Regional Administrator
Elizabeth Dos Santos Chen (A)), 'Sollthern Regional Medical Director
Nancy Faszer, Deputy Inspector General In-Charge
Bernie Fernandez, Deputy Inspector General Senior
Rob Hughes, Deputy Inspector General
Dwight W. ,Winslow,M.D., ChiefMedical Officer (A), Medical Services
Susan Scott, ,Southern Regional ChiefNurse Executive
Office of the Inspector General’s Comments on the
Receiver’s Response
Emergency Services – Reference Number 08.184
The receiver’s response mistakenly states that the score for question number 08.184 was based
on an OIG conducted emergency response drill. The score, in fact, is based on a review of four
actual emergencies that occurred at the institution. Specifically, we found that in two of the four
emergencies evaluated, the medical responder did not arrive at the location of the emergency
within five minutes of the initial notification. On the positive side, we found in conducting our
emergency drill and answering question number 15.282 that the medical responder arrived in less
than five minutes.
Outpatient Housing Unit –Reference Number 04.052
We are concerned that CCI does not intend to ultimately place all outpatient housing inmate
medical documents in the unit health record as required by Health Care Services Policy. In our
review of the outpatient housing unit, we reviewed unit health records for ten randomly selected
inmates who were placed in the outpatient housing unit. We found that for four of the ten
inmates, the unit health record did not contain documentation of an initial assessment of the
inmate. The receiver’s response indicates that the missing assessments were conducted, but not
filed in the unit health records and were instead kept in a thinned outpatient housing unit chart.
The response further states that CCI will create a plan for the way outpatient housing unit charts
are thinned and will place thinned charts in a specific location. We appreciate the receiver’s
attention to this matter; however, this solution leads us to believe that CCI does not intend to
place these documents in the unit health records.
Bureau of Audits and Investigations Page 40
Office of the Inspector General State of California