OIG
Comparative Summary and Analysis of the First and Second Medical Inspection Cycles of Californias 33 Adult Institutions
MEDICAL INSPECTION RESULTS
COMPARATIVE SUMMARY AND ANALYSIS OF THE FIRST AND
SECOND MEDICAL INSPECTION CYCLES OF CALIFORNIA'S 33
ADULT INSTITUTIONS
OFFICE OF THE INSPECTOR GENERAL
ROBERT A. BARTON, INSPECTOR GENERAL
STATE OF CALIFORNIA
JULY 2012
Executive Summary
The Plata v. Brown federal court class action lawsuit resulted in the United States District Court for the
Northern District of California (Court) appointing a federal Receiver to raise medical care standards,
manage the delivery of medical care, and develop a sustainable system that provides constitutionally
adequate medical care to inmates at California’s 33 adult
correctional institutions. At the request of the federal Court
Cycle 2 Component Key Statistics
and the Court-appointed Receiver, and authorized by
California Penal Code section 6126, the Office of the Component Average: ...... 79.6%
Inspector General (OIG) developed a comprehensive Range of Component Scores:..73.0-89.5%
inspection program to evaluate the delivery of medical care Component Variation: .. 16.5%
at each of the California Department of Corrections and
Component Scores
Rehabilitation’s (CDCR) 33 adult correctional institutions.
Number of Institutions with:
High Adherence ................... 4
This report is a comparative summary and analysis of the
Moderate Adherence .......... 25
first and second cycles of the OIG’s medical inspections of
Low Adherence .................... 4
the 33 adult institutions operated by CDCR. In contrast to
the May 2011 first cycle analysis report1, this report
compares differences in trends from the first and second reporting cycles as well as highlights areas
with significant medical score increases or decreases among the 33 institutions. Medical inspection
scores are compared based on the institution’s overall score from 20 distinct medical components, as
well as across five general medical categories.
Unlike the individual medical inspection reports, this comprehensive report puts the institutions’ scores
into a qualitative context. We do so by comparing the institutions’ average and individual scores to the
Receiver’s scoring criteria for three levels of adherence to policies and procedures. Our published
inspection reports contain an overall percentage score as well as percentage scores for component areas
for each of the 33 adult institutions. Although the Court has yet to determine the percentage score
necessary for an institution to meet the constitutional standards, the Receiver currently applies the
following scoring criteria to measure each
institution’s adherence to medical policies and
Cycle 2 Category Key Statistics
procedures.
Average scores
• More than 85 percent: High Adherence
Medication Management: ……..75.0%
Access to Providers & Services: ……..78.4% • 75 to 85 percent: Moderate Adherence
Primary Care Provider Responsibilities: …..80.9%
Continuity of Care: .........82.4%
• Less than 75 percent: Low Adherence
Nurse Responsibilities: ... 82.5%
According to the Receiver’s scoring criteria, a score
above 85 percent reflects high adherence, a score of
75 percent is the minim um score for moderate adherence, while scores below 75 percent denote low
adherence. The Receiver requires each institution to develop a performance improvement plan following
1 The Medical Inspection Results Summary and Analysis of the First Cycle of Medical Inspections of California’s 33 Adult
Prisons can be viewed at the Office of the Inspector General's website at www.oig.ca.gov.
Executive Summary - Comparative Summary and Analysis of the
First and Second Medical Inspection Cycles of California’s 33 Adult Institutions Page - 1 -
Office of the Inspector General State of California
an inspection for all questions with scores under 75 percent. The performance improvement plan must
describe how the institution intends to remedy conditions that contributed to a score of less than 75
percent on each question. In providing a qualitative context to the percentage scores, it is not our
intention to determine or imply the percentage score that meets a constitutional standard of medical
care. That determination remains with the Court.
Results by Medical Component
Our component analysis compares the weighted inspection scores of all 33 institutions in each of the
20 component areas. This perspective provides a system-wide context, comparing health care delivery
performances among institutions, and provides information about each institution’s performance in
specific component areas. Using the Receiver’s scoring criteria; we found that all but one of the 33
institutions improved their overall medical care scores in cycle 2. Overall scores are published in each
institution’s medical inspection report. An institution’s adherence to policies and procedures is
measured on a series of medical care questions and point values assessed on total points possible for
each question.
In the May 2011 first cycle analysis report, only 8 of the 33
20 Components of the OIG’s
institutions met or exceeded the 75 percent score for moderate
Medical Inspections
adherence, and no institution achieved high adherence.
_____________________________________
Twenty-five of the 33 institutions performed below the 75
(in order of importance):
percent level for moderate adherence, but 12 were close with
Chronic Care
scores of 70.4 to 74.5 percent. The average overall weighted
Clinical Services
Health Screening score for cycle 1 was 71.9 percent. Institutions’ scores ranged
Specialty Services from a high of 83.2 percent for Folsom State Prison down to
Urgent Services 62.4 percent for High Desert State Prison.
Emergency Services
Prenatal Care/Childbirth/Post-Delivery
Diagnostic Services By contrast, this current comparative summary and analysis of
Access to Health Care Information cycle 1 and cycle 2 medical inspections indicates 29
Outpatient Housing Unit
institutions met or exceeded the 75 percent score for moderate
Internal Reviews
adherence, including 4 institutions achieving high adherence
Inmate Transfers
Clinic Operations in cycle 2.
Preventive Services
Pharmacy Services
Four of the 33 institutions performed slightly below the 75
Other Services
percent level for moderate adherence with scores of 73.0
Inmate Hunger Strikes
Chemical Agent Contraindications percent to 74.7 percent. The average overall weighted score
Staffing Levels and Training for cycle 2 was 79.6 percent, an increase of 7.7 percent from
Nursing Policy
the cycle 1 average. Institutions’ scores ranged from 89.5
percent for the California Correctional Center in Susanville
down to 73.0 percent for the Richard J. Donovan Correctional
Facility in San Diego.
Charts 1 and 1A demonstrate the differences in scores from cycle 1 to cycle 2. Chart 1 displays the
cycle 1 and cycle 2 medical inspection scores sorted from lowest to highest, illustrating a significant
increase in the number of institutions scoring at or above the moderate adherence level. Chart 1A
displays the medical inspection scores sorted by institution for both cycles 1 and 2.
Executive Summary - Comparative Summary and Analysis of the
First and Second Medical Inspection Cycles of California’s 33 Adult Institutions Page - 2 -
Office of the Inspector General State of California
Chart 1: Cycle 1 and Cycle 2 Medical Component Score Comparison, Sorted Low to High
Chart 1A: Cycle 1 and Cycle 2 Medical Component Score Comparison Grouped by Institution
*The list of institution names and initialisms is on page 3 of the report.
Executive Summary - Comparative Summary and Analysis of the
First and Second Medical Inspection Cycles of California’s 33 Adult Institutions Page - 3 -
Office of the Inspector General State of California
Results by General Medical Category
For our category analysis, we move from examining disparate components of medical care to
examining how these components function together to deliver health care at California’s 33 adult
institutions. Working with our lead physician, we identified 91 questions that fit into 5 general
categories of medical care. We sorted these questions into the medical care categories and analyzed the
results. The five medical categories which offer a broader perspective on the delivery of medical care
to inmates are: 1) Medication Management, 2) Access to Providers and Services, 3) Primary Care
Provider Responsibilities, 4) Continuity of Care, and 5) Nurse Responsibilities.
As demonstrated in chart 2, scores for each of the five categories increased during the second cycle of
medical inspections, despite the fact that some individual institutions had their scores decrease in cycle
2. Medication management and access to providers and services were the lowest scoring categories in
cycle 1. These two categories showed the greatest improvement in scores during cycle 2. Medication
management had the largest average percentage increase of 16.2 percentage points from 58.8 percent
in cycle 1 to an overall average score of 75 percent in cycle 2. Access to providers and services also
had a significant increase of 13.2 percentage points from 65.4 percent in cycle 1 to 78.6 percent in
cycle 2. In addition to the increased scores in medication management and access to providers and
services, overall average scores in primary care provider responsibilities increased from 72.1 percent in
cycle 1 to 81.0 percent in cycle 2, bringing the average scores in all five categories up to the 75 percent
moderate adherence level.
Chart 2: Scores by Category, Sorted Lowest to Highest
75.0%
Executive Summary - Comparative Summary and Analysis of the
First and Second Medical Inspection Cycles of California’s 33 Adult Institutions Page - 4 -
Office of the Inspector General State of California
Conclusion
Overall, the average scores for both the medical components and medical categories increased
significantly between cycles 1 and 2, indicating the Receiver and CDCR are showing improvement in
their management and delivery of medical care.
Institutions received higher medical inspection scores
Institutional medical component scores increased
overall by medical component, and the average scores
significantly in cycle 2. Specifically, 25 of the 33
for the five medical categories improved. However,
institutions scored in the moderate adherence level,
there is room for improvement in the consistent
with 4 achieving high adherence and 4 scoring low
management and delivery of medical care as
adherence. In cycle 1 only 8 institutions were in the
evidenced by decreases in scores in one or more
moderate adherence level and the remaining 25
medical categories at 22 institutions.
institutions scored in the low adherence level.
The cycle 2 overall medical category scores also improved. The average score for all five categories
was in the moderate adherence level, compared to only two categories achieving overall moderate
adherence in cycle 1. Although the average category scores improved in cycle 2, category scores
decreased at individual institutions in one or more of the following areas:
Medication Management: Four institutions received a lower cycle 2 score in medication management.
Access to Providers and Services: Two institutions received a lower cycle 2 score in access to
providers and services.
Primary Care Provider Responsibilities: Four institutions received lower cycle 2 scores in primary care
provider responsibilities.
Continuity of Care: Eight institutions’ scores decreased in the continuity of care category.
Nurse Responsibilities: Fifteen institutions received a lower score in the nurse responsibilities
category.
Overall, 22 institutions had lower scores in one or more medical categories in cycle 2. Although
average scores are increasing across the medical component and category areas, consistency varies as
evidenced by fluctuating scores in both component and category areas.
Robert A. Barton
Inspector General
Executive Summary - Comparative Summary and Analysis of the
First and Second Medical Inspection Cycles of California’s 33 Adult Institutions Page - 5 -
Office of the Inspector General State of California
Contents
Executive Summary ............................................................................................................... - 1 -
Results by Medical Component ................................................................................. - 2 -
Results by General Medical Category ........................................................................ - 4 -
Conclusion .................................................................................................................. - 5 -
OIG Medical Inspection Program ............................................................................................... 1
Objectives, Scope, and Methodology ................................................................................... 3
Overall Scores and Medical Components .................................................................................... 4
General Medical Categories ..................................................................................................... 10
Medical Category Analysis ........................................................................................... 13
Medication Management .............................................................................................. 16
Access to Providers and Services ................................................................................. 19
Primary Care Provider Responsibilities ........................................................................ 22
Continuity of Care ......................................................................................................... 25
Nurse Responsibilities .................................................................................................. 28
Conclusion ................................................................................................................................ 31
Appendices ............................................................................................................................... 32
A: Component Definitions .................................................................................................. 33
B: Institutions' Scores by Component .................................................................................. 35
C: Category Questions and Scores
C-1 Medication Management ........................................................................................ 40
C-2 Access to Providers and Services .......................................................................... 44
C-3 Primary Care Provider Responsibilities ................................................................. 52
C-4 Continuity of Care ................................................................................................. 58
C-5 Nurse Responsibilities ........................................................................................... 62
OIG Medical Inspection Program
We conduct consistently applied assessments of inmate medical care at all 33 institutions, and we
present independent and comparable results. The medical inspections identify instances of
noncompliance with CDCR medical policies and procedures, and assess whether the care meets
medical community standards of care. However, we neither attempt to identify the causes for
noncompliance nor recommend remedies for specific instances of inadequacy. Our inspection tool is
designed to present an objective and consistent assessment of medical care – to mirror back to the
institutions the reality of their health care delivery system. Consequently, our inspection scores may be
used by the institutions, CDCR, the Receiver, the plaintiff’s counsel, and the Court to determine what
the constitutional level of medical care should be, whether the constitutional level of inmate medical
care has been achieved, and to identify areas that must be improved to meet the mandated level of care.
In 2007, we developed a medical inspection program to assess the medical care provided at California
adult institutions. In devising the program, we obtained and reviewed:
• CDCR’s policies and procedures
• Relevant Court orders
• Guidelines developed by CDCR’s Quality Medical Assurance Team
• Guidelines and standards developed by the American Correctional Association and by
the National Commission on Correctional Health Care
• Professional literature on correctional medical care and medical community standards
of care
• Input from clinical experts, the Court, the Receiver’s office, CDCR, and plaintiffs’
(Prison Law Office)
Based on this research, we established an inspection program that contains up to 151 questions
covering 20 essential components of medical care delivery.2 Our inspection team consists of
physicians, registered nurses, deputy inspectors general, and analysts. The inspection tool we use
allows for a broadly scoped and consistent method of examining medical care at correctional
institutions.
For each of the 20 components of prison health care, we created questions with “yes” or “no” answers
designed to gauge performance. We worked with clinical experts to create a weighting system that
factors in the relative importance of each component as well as considers the relative importance of
questions within a component. This weighting ensures that components that pose the greatest medical
risk to the inmate-patient are given more weight than those that pose less risk. For example, we
assigned a high number of possible points to the chronic care component because inadequate care of
inmates with chronic conditions poses the most significant risk of all the components. Conversely, we
assigned proportionately fewer points to all other components. Component definitions are listed in
Appendix A.
2The second cycle of medical inspections has 151 questions. By prior agreement of all parties, we evaluated the medical
inspection program after the first cycle in 2010 and made some adjustments. These include eliminating a medical
emergency drill, adding and eliminating certain questions, and changing the weighting of certain questions.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 1
Office of the Inspector General State of California
All parties to the Plata lawsuit agreed that the OIG should primarily measure institutions’ compliance
with CDCR medical policies and procedures. By agreement with the Court and the Receiver, our
inspections do not conclude whether an institution has passed or failed an inspection. Instead, we
merely report each institution’s percentage of compliance with CDCR medical policies and procedures
and, in the absence of such policies and procedures, selected medical community standards.
In performing the inspections, we identify random samples of inmates receiving or requiring specific
medical services. We then review the medical file for each inmate in our sample to determine if the
medical care provided met established criteria. For these samples our inspection program assumes that
if an institution’s medical staff does not document an event in an inmate’s unit health record, the event
in question did not happen. For example, if an inmate’s record does not show that the inmate received
his medications on a specified date we assume that the inmate did not receive the medications. While it
is possible that the inmate received his medications and the staff neglected to document the event, our
program cannot assume that appropriate care was provided. The lack of proper documentation is an
additional problem in itself.
Our program also reviews staffing level reports, medical appeals summaries, nursing policies and
procedures, summaries of medical drills and emergencies, minutes from Quality Management
Committee and Emergency Medical Response Review Committee meetings, the contents of inmate
transfer envelopes, and assorted manual logs or tracking worksheets related to medical care delivery.
Turning from the examination of documents to the examination of people and their actions, we observe
the day-to-day medical operations at each institution.
Because the Plata lawsuit only addresses medical care, we do not assess the provision of dental care or
mental health services in institutions. Nor do we assess the care provided in licensed hospitals or
correctional treatment centers, which are subject to inspection and oversight by other regulatory
agencies.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 2
Office of the Inspector General State of California
Objectives, Scope, and Methodology
In September 2008, we began the first of our statewide medical inspections, and in May 2011, we
published our comparison report of the first cycle of inspections of the 33 institutions. This report
denotes the end of the second cycle of our medical inspection program and provides a comparative
summary and analysis between the first and second cycles. The report includes data from inspections
performed at the state's 33 adult institutions. The institutions are listed below:
• California State Prison, Sacramento (SAC) • R. J. Donovan Correctional Facility (RJD)
• California Institution for Women (CIW) • Deuel Vocational Institution (DVI)
• California Medical Facility (CMF) • Folsom State Prison (FSP)
• High Desert State Prison (HDSP) • California State Prison, Corcoran (COR)
• California Rehabilitation Center (CRC) • California Correctional Center (CCC)
• California State Prison, Centinela (CEN) • California State Prison, Los Angeles County (LAC)
• Pleasant Valley State Prison (PVSP) • Ironwood State Prison (ISP)
• San Quentin State Prison (SQ) • Pelican Bay State Prison (PBSP)
• California Men's Colony (CMC) • Salinas Valley State Prison (SVSP)
• Sierra Conservation Center (SCC) • California State Prison, Solano (SOL)
• North Kern State Prison (NKSP) • Mule Creek State Prison (MCSP)
• California Correctional Institution (CCI) • Avenal State Prison (ASP)
• Correctional Training Facility (CTF) • Calipatria State Prison (CAL)
• Valley State Prison for Women (VSPW) • Chuckawalla Valley State Prison (CVSP)
• Kern Valley State Prison (KVSP) • Wasco State Prison (WSP)
• California Substance Abuse Treatment • California Institution for Men (CIM)
Facility and State Prison, Corcoran (SATF) • Central California Women’s Facility (CCWF)
In analyzing and summarizing the results of our first 33 medical inspections, our objective was to
provide a practical interpretation of the data and an assessment of the quality of medical care provided
to inmates.3In doing so, we looked for significant trends and variations in data, compliance problems
common to or unique to institutions, and other data characteristics we deemed noteworthy.
Our objective in this second report is to compare and contrast the significant trends and variations in
data between the first and second cycles which we hope will assist the Receiver and CDCR in their
efforts toward continuous improvement in adherence to policies and procedures.
3 Each of the 33 inspection reports can be viewed at www.oig.ca.gov.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 3
Office of the Inspector General State of California
Overall Scores and Medical Components
Following our second cycle of medical inspections, we found 29 institutions’ overall scores met or
exceeded the 75 percent minimum score for moderate adherence. As shown in chart 3, the average
score for the 33 institutions was 79.6 percent; this score is 7.7 percentage points higher than the 71.9
percent average score we reported in our May 2011 first cycle analysis report. Of the 29 institutions
that met or exceeded the 75 percent minimum score for moderate adherence, California Correctional
Center's (CCC) score of 89.5 percent was the highest, while Folsom State Prison (FSP) achieved the
second-highest score of 89.1 percent. Two other institutions, Sierra Conservation Center (SCC) and
Avenal State Prison (ASP) also had scores in the high adherence level, scoring 87.5 and 86.9 percent
respectively. In addition, 25 institutions had scores in the moderate adherence level that ranged from
75.4 percent to 84.8 percent. The remaining 4 institutions had scores that ranged from 73.0 percent to
74.7 percent, slightly below the moderate adherence level.
In the first cycle, only 8 of the 33 institutions’ overall scores met or exceeded the 75 percent minimum
score for moderate adherence in the 20 components. In contrast, the second cycle scores demonstrated
significant improvement with 29 of the 33 institutions meeting or exceeding the 75 percent minimum
score for moderate adherence. The higher scores reveal that the Receiver and the institutions are
improving their management and delivery of medical care in an effort to uphold CDCR’s medical
policies and procedures and meet selected medical community standards, but improvement exists in
maintaining consistency of medical care. Chart 3 shows the medical score received at each institution
sorted lowest to highest for each component in cycle 2. Chart 4 indicates the outlying values of the top
four scores and lowest four scores of cycle 2, with a recalculated average score based on removing the
largest variations in medical scores. We removed the outlier values to gain a perspective for the
average score of the mid-point for the majority of institutions. Chart 5 provides an overview
comparison of medical scores received in cycle 1, sorted lowest to highest.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 4
Office of the Inspector General State of California
Chart 3: Cycle 2 Overall Inspection Scores Sorted Lowest to Highest
75.0%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 5
Office of the Inspector General State of California
Chart 4: Outlying Four High and Low Scores by Medical Component
The above chart contains the four outlying values at each end of the medical component score
distribution chart. Four scores were below the 75 percent minimum adherence level, and four scores
were above the 85 percent high adherence level. The remaining 25 overall component scores were
between 75 to 85 percent. The average score distribution after removing the outlier values on either
end is 75.9 percent, a 3.7 percent difference from the overall average of 79.6 percent. This average
percentage score is still above the 75 percent moderate adherence level.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 6
Office of the Inspector General State of California
Chart 5: Cycle 1 Overall Inspection Scores Sorted Lowest to Highest
75.0%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 7
Office of the Inspector General State of California
Table 1: Cycle 2 Component Scores
Medical Component High Low Average
Variat
H
io
ig
n
h
B
/L
e
o
tw
w
e en
Chronic Care 83.0 percent 58.9 percent 72.0 percent 24.1 percentage points
Clinical Services 92.5 percent 55.2 percent 74.2 percent 37.3 percentage points
Health Screening 96.4 percent 73.0 percent 82.1 percent 23.4 percentage points
Specialty Services 96.9 percent 59.7 percent 79.1 percent 37.2 percentage points
Urgent Services 92.4 percent 59.0 percent 78.1 percent 33.4 percentage points
Emergency Services 100.0 percent 57.4 percent 79.4 percent 42.6 percentage points
Prenatal Care/Childbirth/
81.3 percent 80.9 percent 81.1 percent 0.4 percentage points
Post-Delivery
Diagnostic Services 99.0 percent 60.4 percent 78.6 percent 38.6 percentage points
Access to Health Care
100.0 percent 39.2 percent 75.2 percent 60.8 percentage points
Information
Outpatient Housing Unit 100.0 percent 60.2 percent 91.4 percent 39.8 percentage points
Internal Reviews 100.0 percent 58.8 percent 76.8 percent 41.2 percentage points
Inmate Transfers 100.0 percent 64.0 percent 85.3 percent 36.0 percentage points
Clinic Operations 100.0 percent 81.2 percent 94.2 percent 18.8 percentage points
Preventive Services 100.0 percent 54.0 percent 80.4 percent 46.0 percentage points
Pharmacy Services 100.0 percent 65.5 percent 93.1 percent 34.5 percentage points
Other Services 100.0 percent 55.0 percent 91.2 percent 45.0 percentage points
Inmate Hunger Strikes 100.0 percent 48.9 percent 81.5 percent 51.1 percentage points
Chemical Agent
100.0 percent 48.2 percent 91.5 percent 51.8 percentage points
Contraindications
Staffing Levels and
100.0 percent 95.0 percent 99.2 percent 5.0 percentage points
Training
Nursing Policy 100.0 percent 50.0 percent 75.9 percent 50.0 percentage points
Two of the most heavily weighted components had average scores below the 75 percent minimum
moderate adherence level. The two most heavily weighted components in our medical inspection
program are chronic care and clinical services. Salinas Valley State Prison (SVSP) received a
disconcerting low score of 58.9 percent in chronic care, while Deuel Vocation Institution (DVI)
received a deficient score of 55.2 percent in clinical services. Only two institutions achieved scores of
75 percent or higher in all 20 component areas: Folsom State Prison (FSP) and California Correctional
Center (CCC). Although most institutions are improving their overall score, additional improvement
can be achieved. The considerably low scores along with the wide variations between scores
demonstrate a lack of consistency in medical care throughout CDCR’s 33 institutions.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 8
Office of the Inspector General State of California
All 33 institutions failed to achieve a score of 75 percent or higher on each component question in
cycle 2. The Receiver requires that each institution develop a performance improvement plan following
an inspection for all questions scoring less than 75 percent. The plan must describe how the institution
intends to remedy conditions that contributed to a score lower than 75 percent. Table 2 illustrates all
components in which an institution received a score of 74 percent or lower on at least one question,
requiring a specific performance improvement plan. Although many institutions received overall
component scores in the moderate to high adherence levels, not a single institution received an
acceptable score of 75 percent or higher on all questions in each component.
Table 2: Institutions Scoring Less Than 75 Percent on One or More Component Questions
Prenatal Access to Outpatient Inmate Staffing
Chronic Clinical Health Specialty Urgent Emergency Diagnostic Interal Inmate Clinic Preventive Pharmacy Other Chemical Agent Nursing
Care/Childbirth/P Healthcare Housing Hunger Levels and
Care Services Screening Services Services Services Services Reviews Transfers Operations Services Services Services Contraindications Policy
ost-Delivery Information Unit Strikes Training
SOL N/A N/A N/A N/A
CMF N/A N/A
RJD N/A N/A
CEN N/A N/A N/A
DVI N/A N/A
CCWF N/A N/A N/A N/A
CMC N/A N/A
SCC N/A N/A
LAC N/A N/A
PVSP N/A N/A
CCI N/A N/A
CRC N/A N/A N/A
CIW N/A
ASP N/A
HDSP N/A N/A
SQ N/A
CCC N/A N/A N/A
NKSP N/A N/A N/A
KVSP N/A N/A
FSP N/A N/A N/A
SAC N/A
SATF N/A N/A
VSPW N/A
ISP N/A N/A
CVSP N/A N/A N/A
COR N/A
CAL N/A
CTF N/A N/A
MCSP N/A N/A N/A
SVSP N/A N/A
CIM N/A
PBSP N/A N/A
WSP N/A N/A
The institution received a score of less than 75 percent on at least one question.
N/A This component is not applicable to the institution.
Yellow Box The institution received a score of 75 percent or higher on all questions in the component.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 9
Office of the Inspector General State of California
General Medical Categories
While our medical inspections and their resultant reports show institutions’ scores in 20 components of
medical care delivery, the inspection instrument’s questions can also be sorted and viewed from
various perspectives. One perspective recommended by our lead physician was to sort our inspection
questions into five general categories of medical care: medication management, access to providers
and services, primary care provider responsibilities, continuity of care, and nurse responsibilities. Of
the inspection instrument’s 151 questions, we identified 91 that applied to the five categories.
Table 3 describes each category, discloses the number of questions used in that category, and provides
an example question from the category. In identifying the questions for the five categories, we
determined that some questions were appropriate to more than one category. Therefore, we included
such questions in all of the categories to which they applied. An example is the following question:
If the inmate had an existing medication order upon arrival at the institution, did the inmate
receive the medications by the next calendar day, or did a physician document why the
medications were not to be continued?(Question 02.128)
The above question applies to the medication management category because it involves the
institutions’ delivery of medication to inmates. However, the question also applies to the continuity of
care category since it determines whether inmates continued to receive their medications at their new
institutions. Accordingly, while each of the five categories has a specific set of questions, individual
questions like the one above sometimes appear in multiple categories. See Appendix C for the
questions we assigned to each category.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 10
Office of the Inspector General State of California
Table 3: Description of Five General Medical Categories
Medical Category Description Example Question
Sick Call medication: Did the
institution administer or
Consists of 14 questions that determine if
deliver prescription
medications were properly administered and
Medication Management medications (new orders) to
delivered to inmates as required by CDCR’s
the inmate within specified
policies.
timeframes?
(Question 01.124)
Did the RN complete the
Consists of 32 questions that evaluate whether
face-to-face (FTF) visit within
Access to Providers and inmates were seen or provided services for routine,
one (1) business day after the
Services urgent, and emergency medical needs within the
Form 7362 was reviewed?
time frames specified by CDCR’s policies.
(Question 01.025)
Consists of 26 questions that determine whether At the next clinic visit
primary care providers (physicians, nurse following the report of a
Primary Care Provider practitioners, and physician assistants) properly clinically significant abnormal
Responsibilities provided care to inmates and whether processes diagnostic test, did the PCP
related to providing clinical care are consistent adequately manage the result?
with policy. (Question 06.263)
Upon the inmate’s discharge
from the community hospital,
Consists of 18 questions that determine whether
did the TTA RN document
inmates received care when moved within an
that he or she reviewed the
Continuity of Care institution or from one institution to another, or
inmate’s discharge plan and
were received from an outside care provider after
completed a FTF assessment
specialty services or hospitalization.
of the inmate?
(Question 21.248)
Did documentation indicate
Consists of 19 questions that evaluate whether that the RN reviewed all of
nurses properly provided care to inmates and the inmate’s clinically
Nurse Responsibilities
whether processes related to providing nursing care significant complaints listed
are consistent with policy. on Form 7362?
(Question 01.246)
As shown by the checked boxes in Table 4, we extract questions from 14 of the 20 components to
generate the five general medical categories. Access to health care information, internal reviews, other
services, chemical agent contraindications, staffing levels and training, and nursing policy are the only
components without at least one question that corresponds to one of the five general medical
categories.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 11
Office of the Inspector General State of California
Table 4: Distribution of Medical Component Questions within the Medical Categories
Access to Primary Care
Medication Continuity of Nurse
Medical Component Providers and Provider
Management Care Responsibilities
Services Responsibilities
Chronic Care √ √ √
Clinical Services √ √ √
Health Screening √ √ √ √ √
Specialty Services √ √
Urgent Services √ √ √ √ √
Emergency Services √ √
Prenatal Care/
√ √ √
Childbirth/Post-delivery
Diagnostic Services √ √
Outpatient Housing Unit √ √ √
Inmate Transfers √ √ √
Clinic Operations √ √ √
Preventive Services √ √
Pharmacy Services √
Inmate Hunger Strikes √ √ √
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 12
Office of the Inspector General State of California
Medical Category Analysis
The overall scores in each medical category indicate improvement during our second cycle of medical
inspections. In the first cycle, institutions scored particularly low on two of the five categories:
medication management and access to providers and services. The average score for medication
management in cycle 1 was 58.8 percent. The average score for medication management in cycle two
increased 16.2 points to 75 percent, indicating the institutions greatly improved their effectiveness in
delivering medications to inmates in a timely manner and documenting actions as required by policy.
The average score for access to providers and services in cycle 1 was 65.4 percent, whereas the
average score for cycle 2 was 78.6 percent, a 13.2 percent increase. This demonstrates institutions are
improving the timeliness for inmates to be seen or provided services for routine, urgent, and
emergency medical needs according CDCR policy.
Although these scores demonstrate progress, there is room for additional improvement in both of these
categories. Nineteen institutions scored below the 75 percent moderate adherence level in medication
management, with scores ranging from a low of 55.5 percent for California State Prison, Los Angeles
County (LAC) to a high of 94.0 percent for Folsom State Prison (FSP). In the access to providers and
services category, 11 institutions scored below the 75 percent moderate adherence level, with scores
ranging from a low of 65.8 percent for Pleasant Valley State Prison (PVSP) to a high of 91.2 percent
for Sierra Conservation Center (SCC). Improvement was also evident in the remaining three
categories.
Nurse responsibilities was the highest scoring category overall with 82.4 percent. This represents 10
institutions at the high adherence level, 20 institutions at the moderate adherence level, and 3
institutions below the minimum adherence level. The scores ranged from a low of 68.0 percent at Mule
Creek State Prison (MCSP) to a high of 95.4 percent at Avenal State Prison (ASP).
The second highest scoring category was continuity of care, with an average overall score of 82.5
percent. In this category, 14 institutions scored in the high adherence range, 14 institutions scored in
the moderate adherence range, and 5 institutions scored below the minimum adherence level. The
scores ranged from a low of 68.3 percent at High Desert State Prison (HDSP) to a high of 93.5 percent
at Avenal State Prison (ASP).
The third highest scoring category is primary care provider responsibilities, with an overall average
score of 81.0 percent. In this category, 8 institutions scored in the high adherence level, 21 institutions
scored in the moderate adherence level, and four institutions scored below the minimum adherence
level. The scores in this category ranged from a low of 68.6 percent at Salinas Valley State Prison
(SVSP) to a high of 87.7 percent at Pelican Bay State Prison (PBSP).
Although average scores are increasing across the medical category areas, consistency in care varies.
Twenty-two institutions had lower scores in at least one medical category in cycle 2 than they had
achieved in cycle 1, indicating they have not yet established consistent management and delivery of
medical care in accordance with policies and procedures and medical community standards. Two
institutions had lower category scores in three categories, and eight institutions had lower cycle 2
scores in two medical categories. Thirteen institutions received lower scores in at least one category in
cycle 2, for an overall total of 22 institutions that did not maintain or increase medical scores in each
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 13
Office of the Inspector General State of California
category across inspection cycles. Although scores decreased in at least one category among 22
institutions in cycle 2, 18 of those institutions remained at or above the 75 percent minimum moderate
adherence level, even though their overall category score in cycle 2 was lower than cycle 1.
Chart 6: Institutions Receiving Lower Scores by Category in Cycle 2
Medical Category - Institutions Receiving Lower Scores in Cycle 2
22 Institutions
decreased in 2 Institutions
one or more w/ 3 category 7 institutions w/ 2 category decrease 13 Institutions w/ 1 category decrease
medical decrease
categories
Medication
Management -4 CMF RJD SAC LAC
Cycle 2 71.4% 58.7% 63.8% 55.5%
Cycle 1 84.0% 68.1% 66.6% 61.7%
Access to
Providers -2 PBSP CIM
Cycle 2 70.3% 82.8%
Cycle 1 79.9% 86.7%
Primary Care
Provider
Responsibilities
-4 CEN CCWF CMF CIW
Cycle 2 78.1% 70.6% 79.4% 73.9%
Cycle 1 80.1% 84.1% 83.2% 77.1%
Continuity of
Care -8 CEN CCWF PBSP KVSP NKSP SVSP ISP HDSP
Cycle 2 80.2% 77.8% 81.3% 70.8% 73.7% 79.7% 75.2% 68.3%
Cycle 1 82.7% 83.1% 91.4% 75.5% 75.0% 84.9% 78.2% 73.8%
Nurse
Responsibilities
-15 CEN CCWF RJD SAC LAC KVSP NKSP FSP WSP CMC CAL DVI CVSP MCSP CRC
Cycle 2 84.1% 91.7% 81.7% 79.1% 80.3% 77.2% 76.1% 84.4% 82.3% 84.4% 77.8% 74.4% 72.3% 68.0% 87.6%
Cycle 1 90.7% 93.8% 85.8% 85.3% 81.0% 84.2% 79.5% 89.0% 85.4% 88.4% 81.2% 78.0% 73.3% 70.6% 89.5%
Eleven institutions received higher scores in cycle 2 across all five categories, but only four institutions
(California Correctional Center (CCC), Valley State Prison for Women (VSPW), Avenal State Prison
(ASP) and San Quentin (SQ)) achieved 75 percent or higher in all five categories. Seven institutions
still did not achieve the minimum 75 percent score in each category, and Pleasant Valley State Prison
(PVSP) only achieved 75 percent in two of the five categories. California Correctional Institution
(CCI), California Substance Abuse Treatment Facility and State Prison (SATF), California State
Prison, Corcoran (COR) and California State Prison Solano (SOL) improved their scores in each
category but only achieved at least 75 percent in three of the five categories.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 14
Office of the Inspector General State of California
Chart 7: Institutions Receiving Higher Scores by Category in Cycle 2
Medical Category - Institutions Receiving Higher Scores in Cycle 2
Med Management CCC VSPW ASP SQ PVSP SCC CCI CTF SATF COR SOL
Cycle 2 87.0% 83.1% 79.6% 77.9% 63.9% 73.0% 71.3% 71.3% 70.9% 70.6% 68.2%
Cycle 1 53.5% 56.9% 48.9% 40.3% 43.5% 54.6% 68.8% 62.4% 44.5% 54.0% 54.6%
Acce ss to Providers CCC VSPW ASP SQ PVSP SCC CCI CTF SATF COR SOL
Cycl e 2 89.8% 87.8% 85.4% 78.7% 65.8% 91.2% 74.1% 72.2% 69.1% 72.6% 69.5%
Cycle 1 67.3% 84.5% 68.6% 66.2% 52.1% 61.4% 49.6% 66.3% 55.6% 60.1% 65.6%
Primary Care Provider
Responsibilities CCC VSPW ASP SQ PVSP SCC CCI CTF SATF COR SOL
Cycle 2 86.2% 85.3% 81.7% 85.0% 74.1% 87.1% 85.7% 76.6% 78.9% 79.6% 79.5%
Cycle 1 66.2% 80.5% 72.1% 78.9% 73.6% 85.1% 76.1% 67.6% 71.6% 62.5% 55.5%
Cont inuity of Care CCC VSPW ASP SQ PVSP SCC CCI CTF SATF COR SOL
Cycl e 2 91.0% 91.9% 93.5% 82.9% 77.9% 88.8% 78.2% 87.9% 85.5% 79.8% 78.3%
Cycle 1 82.6% 75.4% 79.3% 68.1% 70.6% 80.3% 66.6% 63.8% 79.2% 74.0% 78.1%
Nurse Responsibilities CCC VSPW ASP SQ PVSP SCC CCI CTF SATF COR SOL
Cycl e 2 89.4% 90.2% 95.4% 76.4% 76.5% 86.1% 81.0% 79.1% 85.3% 85.4% 76.4%
Cycl e 1 82.3% 76.9% 83.8% 72.2% 65.8% 83.5% 66.7% 73.2% 80.8% 83.2% 73.7%
In the following sections, we provide a more in-depth analysis of the 33 institutions’ scores in each of
the five general medical categories.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 15
Office of the Inspector General State of California
Medication Management
The medication management category evaluates the timely delivery of medications to inmates and
certain elements of medication administration. These elements include the availability of medications,
maintenance of medications, and the screening of new medications for potential adverse reactions. To
develop our analysis, we used 14 questions from the following medical care components: chronic care,
clinical services, health screening, urgent services, inmate transfers, clinic operations, preventive
services, and pharmacy services.
Cycle 2 Key Statistics
Prisons have improved in properly administering and delivering Category Average: .......... 75.0%
medications to inmates; however, the majority of institutions remain Range of Scores: 55.5%-94.0%
in the low adherence level. The 33 institutions’ average score for Variation: ....................... 38.5%
medication management in cycle 1 was 58.8 percent. Cycle 2 scores
Number of Institutions with:
demonstrate a 16.2 percentage point increase for an overall average
High Adherence ................... 6
score of 75 percent. This places the average score for medication
Moderate Adherence ............ 8
management from low adherence in cycle 1 to moderate adherence in
Low Adherence .................. 19
cycle 2. Although cycle 2 scores indicate improvement, medication
management remains the lowest scoring category within the five
general medical categories.
In cycle 1, 30 of the 33 institutions scored below the 75 percent minimum score for moderate
adherence, and four institutions received lower scores in cycle 2 than the previous cycle, indicating
consistency in this category has not been achieved. Pelican Bay State Prison (PBSP) had the highest
cycle 1 score of 84.2 percent, whereas San Quentin (SQ), with a score of 40.3 percent, was the lowest
cycle 1 score in this category. In cycle 2, Pelican Bay State Prison (PBSP) raised their score to 93.5
percent and San Quentin (SQ) achieved 77.9 percent in this category.
Overall, 29 institutions improved their scores in cycle 2, with 14 of the 33 institutions exceeding the 75
percent minimum score for moderate adherence. Six institutions exceeded the 85 percent minimum
score for high adherence with Folsom State Prison (FSP) receiving the highest score of 94 percent.
Scores decreased in cycle 2 at four institutions: California Medical Facility (CMF), California State
Prison Sacramento (SAC), Richard J. Donovan Correctional Facility (RJD), and California State
Prison, Los Angeles County (LAC).
High Adherence Level
(85.1-100%)
FSP PBSP CIM CVSP CAL CCC
Cycle 2 94.0% 93.5% 91.6% 91.4% 87.7% 87.0%
Cycle 1 71.0% 84.2% 54.9% 56.2% 66.3% 53.5%
Opportunities for improvement in delivering medication within specified timeframes exist, including
properly administering Isoniazid, a medication prescribed to treat latent or active tuberculosis.
Institutions can also improve the timely administration of existing and new prescription orders for sick
call medications. Charts 8 and 9 demonstrate overall scores in medication management for each
institution as well as the progress made across the two cycles.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 16
Office of the Inspector General State of California
Chart 8: Cycle 2 Medication Management
75.0%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 17
Office of the Inspector General State of California
Chart 9: Medication Management Scores by Institution, Cycles 1 and 2
Medication Management
12% of Institutions Scored Lower in Cycle 2
Four institutions received lower scores in this
88% of Institutions Scored Higher in Cycle 2 category in cycle 2. CMF scored at the low
adherence level, previously at moderate
12%
adherence in cycle 1. SAC, RJD, and LAC
remained at the low adherence level.
88%
See Appendix C-1 for detailed information on questions and scores for this category.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 18
Office of the Inspector General State of California
Access to Providers and Services
The access to providers and services category assesses the institutions’ effectiveness in ensuring that
inmates are seen by primary care providers or are provided services for routine, urgent, and emergency
medical needs according to timelines set by CDCR policy. Effective institution medical care depends on
inmates’ access to providers and services; a key indicator of appropriate access to providers and services
is timeliness. To develop our analysis, we used 32 questions related to access to providers and services
from the following medical care components: chronic care, clinical services, health screening, specialty
services, urgent services, emergency services, prenatal care/childbirth/post-delivery, diagnostic services,
outpatient housing unit, preventive services, and inmate hunger strikes.
Cycle 2 Key Statistics
The average score for access to providers and services meets the
Category Average: .......... 78.6%
moderate adherence level, and has improved. In cycle 2, the overall
Range of Scores: 65.8%-91.2%
average score for access to providers and services increased 13.2
Variation: ....................... 25.4%
percent (65.4 percent in cycle 1 to 78.6 percent in cycle 2). In cycle
1, 27 institutions scored below the 75 percent moderate adherence Number of Institutions with:
level, while in cycle 2 the number of institutions falling below High Adherence ................... 9
moderate adherence decreased to 11. In addition, two institutions Moderate Adherence .......... 13
reached the high adherence level in cycle 1, whereas nine Low Adherence .................. 11
institutions achieved high adherence in cycle 2. Encouragingly,
Sierra Conservation Center (SCC) and Folsom State Prison (FSP)
each received scores in the ninetieth percentile.
In cycle 1, the low adherence level scores ranged from 44.8 percent to 73.6 percent, while the low
adherence scores in cycle 2 ranged from 65.8 percent to 74.1 percent. While the 21 percent
improvement of the lowest score is notable, even more significant is the improvement five institutions
made from the low adherence level to the high adherence level. Three other institutions progressed
from the moderate adherence level to the high adherence level and only one institution dropped from
high to moderate.
High Adherence Level
(85.1-100%)
SCC FSP CCC VSPW CAL LAC CMF ASP WSP
Cycle 2 91.2% 90.9% 89.8% 87.8% 87.4% 87.3% 86.4% 85.4% 85.1%
Cycle 1 61.4% 86.0% 67.3% 84.5% 79.0% 52.2% 63.0% 68.6% 75.2%
Of the 33 institutions, 2 decreased in their adherence levels. California Institution for Men (CIM) went
from high to moderate and Pelican Bay State Prison (PBSP) went from moderate to low adherence. In
chart 11, the cycle comparisons demonstrate that although significant improvements have been made,
there are still 13 institutions performing at the moderate adherence level and 11 institutions performing
at the low adherence level, leaving room for improvement in providing inmates timely access to the
primary care providers and medical services they need. Thirty-two institutions scored in the low
adherence level for failing to ensure chronic care medical appointments were within the timeframe
required by policy. The majority of institutions also scored in the low adherence level for delays in
referring inmates to clinicians by the established timeframes.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 19
Office of the Inspector General State of California
Chart 10: Cycle 2 Access to Providers and Services Scores by Institution, Sorted Lowest to Highest
75.0%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 20
Office of the Inspector General State of California
Chart 11: Access to Providers and Services Scores by Institution, Cycles 1 and 2
Access to Providers and Services
6% of Institutions Scored Lower in Cycle 2 Two institutions received lower scores in
cycle 2; however, of the two, CIM remained
94% of Institutions Scored Higher in Cycle 2
in the moderate adherence level.
6%
94%
See Appendix C-2 for detailed information on questions and scores for this category.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 21
Office of the Inspector General State of California
Primary Care Provider Responsibilities
The primary care provider responsibilities category assesses how well the institutions’ physicians, nurse
practitioners, and physician assistants perform their duties and whether processes related to providing
clinical care are consistent with policy. To develop our analysis, we used 26 questions from the following
medical care components: chronic care, health screening, urgent services, prenatal care/childbirth/post-
delivery, diagnostic services, outpatient housing unit, and inmate hunger strikes.
Many of the institutions’ primary care providers improved their performance to achieve moderate
adherence, but 12 percent of institutions received a lower cycle 2
score in this category. In cycle 2, the overall average score for Cycle 2 Key Statistics
primary care provider responsibilities increased 8.9 percent (72.1 Category Average: ........... 81.0%
percent in Cycle 1 to 81.0 percent in Cycle 2). Range of Scores: 68.6%-87.7%
Variation: ....................... 19.1%
In cycle 1, 18 institutions scored below the 75 percent moderate
Number of Institutions with:
adherence level, while 4 institutions scored below moderate in
High Adherence ................... 8
cycle 2. Eight institutions reached the high adherence level in cycle
Moderate Adherence .......... 21
2 with Pelican Bay State Prison (PBSP) receiving the highest score
Low Adherence ................... 4
of 87.7 percent, whereas only one institution, Sierra Conservation
Center (SCC), reached high adherence in cycle 1. The following
five institutions increased their scores by more than 20 percentage
points in cycle 2 bringing four institutions up from low to moderate adherence and one institution from
low to high adherence: High Desert State Prison (HDSP), Richard J. Donovan Correctional Facility
(RJD), Ironwood State Prison (ISP), Kern Valley State Prison (KVSP), and California State Prison,
Solano (SOL). High Desert State Prison (HDSP) had an increase of 29.2 percentage points, the largest
increase of all 33 institutions, bringing their cycle 1 score of 54.7 percent up to 83.9 percent in cycle 2.
High Adherence Level
(85.1-100%)
PBSP CAL SCC CCC ISP FSP CCI VSPW
Cycle 2 87.7% 87.6% 87.1% 86.2% 86.1% 86.0% 85.7% 85.3%
Cycle 1 75.0% 84.7% 85.1% 66.2% 61.4% 84.4% 76.1% 80.5%
Overall, institutions received low scores in the chronic care component. The majority of institutions
did not adequately document the clinical history of chronic care conditions, resulting in an average
score of 67 percent in this component area. Twenty-one institutions received scores in the low
adherence level ranging from 44 percent to 72 percent, with only four institutions scoring in the high
adherence level for adequately documenting the clinical history of chronic care conditions.
Four institutions received a lower score in this category than was achieved in cycle I, indicating
deficiencies in consistency in primary care provider responsibilities. California Medical Facility
(CMF), California State Prison Centinela (CEN), California Institution for Women (CIW) and Central
California Women’s Facility (CCWF) had score decreases of 3.8, 2.0, 3.2, and 13.5 percentage points,
respectively.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 22
Office of the Inspector General State of California
Chart 12: Primary Care Provider Responsibilities Scores by Institution, Sorted Low to High
75.0%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 23
Office of the Inspector General State of California
Chart 13: Primary Care Provider Responsibilities Scores by Institution, Cycles 1 and 2
Four institutions received lower scores in
this category in cycle 2; however, of the
four, CMF and CEN remained at the
moderate adherence level.
See Appendix C-3 for detailed information on questions and scores for this category
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 24
Office of the Inspector General State of California
Continuity of Care
The continuity of care category evaluates the medical care inmates receive when they move within an
institution, move between institutions, or return from a specialty service or outside hospitalization. To
develop our analysis, we used 18 questions from the following medical
care components: health screening, specialty services, urgent services, Cycle 2 Key Statistics
outpatient housing unit, inmate transfers, and clinic operations. Category Average: .......... 82.5%
Range of Scores: 68.3%-93.5%
Most prisons met or exceeded the 75 percent minimum moderate Variation: ....................... 25.2%
adherence for continuity of care, but 24 percent of the institutions
Number of Institutions with:
received a lower cycle 2 score in this category. As shown in Chart 14,
High Adherence ................. 14
the 33 institutions’ average score for continuity of care for cycle 2 is
Moderate Adherence .......... 14
82.5 percent. This is a 6.4 percent increase from cycle 1 where
Low Adherence .................... 5
institutions scored an average of 76.1. Twenty-eight of the 33
institutions exceeded the 75 percent minimum moderate adherence,
while 14 reached high adherence with 85.1 percent or higher. Five
institutions, Avenal State Prison (ASP), Folsom State Prison (FSP), California Institution for Men
(CIM), Valley State Prison for Women (VSPW), and California Correctional Center (CCC), received
scores in the ninetieth percentile.
High Adherence Level
(85.1-100%)
ASP FSP CIM VSPW CCC CMC SCC CTF CIW CAL CRC SATF CVSP WSP
Cycle 2 93.5% 93.1% 92.2% 91.9% 91.0% 88.8% 88.8% 87.9% 87.4% 87.0% 86.5% 85.5% 85.4% 85.4%
Cycle 1 79.3% 86.5% 85.4% 75.4% 82.6% 72.3% 80.3% 63.8% 68.2% 83.3% 84.4% 79.2% 75.5% 78.5%
Three institutions, California Institution for Women (CIW), California Men’s Colony (CMC), and
California Training Facility (CTF), achieved improvement in scores raising their compliance from low
adherence in cycle 1 to high adherence in cycle 2. California Training Facility (CTF) had the largest
score increase of 24.1 percent, which raised their low adherence score of 63.8 percent in cycle 1 to a
high adherence score of 87.9 percent in cycle 2. Conversely, eight institutions had a poorer
performance in cycle 2 and decreased their scores.
Two questions related to the health screening and specialty services components yielded particularly
low scores by the majority of institutions in cycle 2. Institutions, on average, were unable to
demonstrate that they properly provided medication to inmates with existing medication orders upon
arrival at the institution. The average score for this health screening question was 61 percent. Also, the
majority of low adherence institutions failed to demonstrate that the primary care provider conducted a
follow-up appointment within specified timelines following completion of a specialty service.
Specifically, 25 institutions received scores below the moderate adherence level for this question.
There were, however, three institutions that received scores in the moderate to high adherence levels
for both questions. Those institutions are: Calipatria State Prison (CAL), Folsom State Prison (FSP),
and Valley State Prison for Women (VSPW). Noteworthy, Calipatria State Prison (CAL) received a
score of 100 percent on both questions.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 25
Office of the Inspector General State of California
Chart 14: Cycle 2 Continuity of Care Score by Institution, Sorted Lowest to Highest
75.0%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 26
Office of the Inspector General State of California
Continuity of Care
100.0%
95.0%
90.0%
85.0%
80.0%
75.0%
70.0%
65.0%
60.0%
55.0%
50.0%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 27
Office of the Inspector General State of California
PSA PSF MIC WPSV CCC CMC CCS FTC WIC LAC CRC FTAS PSVC PSW IVD QS CAS CAL PSBP NEC FMC ROC PSVS LOS ICC PSVP FWCC PSI PSKN PSCM PSVK DJR PSDH
High Adherence Level Moderate Adherence Level Low Adherence
(85.1-100%) (75%-85%) Level
(0-74.9%)
Three Adherence Levels
segatnecreP
Chart 15: Continuity of Care Scores by Institution, Cycles 1 and 2
Cycle 2
Cycle 1
Continuity of Care
Eight institutions received lower scores in
24% of Institutions Scored Lower in Cycle 2
cycle 2; however, of the eight, PBSP, CEN,
76% of Institutions Scored Higher in Cycle 2
SVSP, CCWF, and ISP remained at the
moderate adherence level.
24%
76%
See Appendix C-4 for detailed information on questions and scores for this category.
Nurse Responsibilities Category
The nurse responsibilities category evaluates how well the institutions’ registered nurses and licensed
vocational nurses perform their duties and whether processes related to
Cycle 2 Key Statistics
providing nursing care are consistent with policy. To develop our
Category Average: .......... 82.4%
analysis, we used 19 questions from the following medical care
Range of Scores: 68.0%-95.4%
components: clinical services, health screening, urgent services,
Variation: ....................... 27.4%
emergency services, prenatal care/childbirth/post-delivery, inmate
transfers, clinic operations, and inmate hunger strikes. Number of Institutions with:
High Adherence ................. 10
Although thirty institutions scored at or above moderate adherence, Moderate Adherence .......... 20
scores in this category decreased in 45 percent of institutions during Low Adherence .................... 3
cycle 2. The 33 institutions’ average score for nurse responsibilities in
cycle 1 was 80.2 percent. Scores decreased at 15 institutions in cycle
2, but the overall average score increased by 2.2 percentage points for a category average of 82.4
percent. Thirty of the 33 institutions exceeded the 75 percent minimum score for moderate adherence,
with ten institutions achieving high adherence scores of 85.1 percent or more. Avenal State Prison’s
(ASP) score of 95.4 percent was the highest among the 33 institutions. In cycle 1, ten institutions did
not achieve the minimum score for moderate adherence in this category, compared to only three
institutions in cycle 2 that did not reach the minimum score for moderate adherence: Deuel Vocational
Institution (DVI), Chuckawalla Valley State Prison (CVSP), and Mule Creek State Prison (MCSP),
with scores of 74.4, 72.3, and 68.0 percent, respectively.
Eighteen institutions increased their scores in cycle 2, with California Medical Facility (CMF)
receiving the largest increase of 14.8 percent. As in cycle 1, the nurse responsibilities category earned
the highest average score of all five categories.
High Adherence Level
(85.1-100%)
ASP CIM PBSP CCWF VSPW CCC CRC SCC COR SATF
Cycle 2 95.4% 93.2% 92.3% 91.7% 90.2% 89.4% 87.6% 86.1% 85.4% 85.3%
Cycle 1 83.8% 85.1% 88.5% 93.8% 76.9% 82.3% 89.5% 83.5% 83.2% 80.8%
The two lowest scoring components of this category were clinical services and inmate transfers.
Specifically, two questions related to registered nurse (RN) documentation in the clinical services
component received average scores of 59 percent and 65 percent, well below the minimum moderate
adherence level of 75 percent. Room for improvement exists in properly documenting patient
information during RN face-to-face triages. In the inmate transfers component, the majority of
institutions failed to accurately complete all applicable sections of the Health Care Transfer
Information Form. Twenty-one institutions received scores ranging from 0 percent to 67 percent
demonstrating a general deficiency in this area. Although the majority of institutions received low
scores on these particular questions, Pelican Bay State Prison (PBSP), Avenal State Prison (ASP), and
California Rehabilitation Center (CRC) received moderate to high adherence scores for all three
questions.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 28
Office of the Inspector General State of California
Chart 16: Cycle 2 Nurse Responsibilities Scores by Institution, Sorted Lowest to Highest
75.0%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 29
Office of the Inspector General State of California
Nurse Responsibilities
100.0%
95.0%
90.0%
85.0%
80.0%
75.0%
70.0%
65.0%
60.0%
55.0%
50.0%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 30
Office of the Inspector General State of California
PSA MIC PSBP FWCC WPSV CCC CRC CCS ROC FTAS PSI CMC PSF NEC FMC WIC PSVS PSW DJR ICC PSDH CAL CAS FTC LAC PSVK PSVP LOS QS PSKN IVD PSVC PSCM
High Adherence Level Moderate Adherence Level Low
(85.1-100%) (75%-85%) Adherence
Level
(0-74.9%)
Three Adherence Levels
segatnecreP
Chart 17: Nurse Responsibilities Scores by Institution, Cycles 1 and 2
Cycle 2
Cycle 1
Nurse Responsibilities
Fifteen institutions received lower scores in
45% of Institutions Scored Lower in Cycle 2
cycle 2. Despite the decrease in scores, CCWF
55% of Institutions Scored Higher in Cycle 2 and CRC remained at the high adherence
level, while CMC, FSP, CEN, WSP, RJD, and
45% SAC dropped from high adherence to the
moderate adherence level in cycle 2, and LAC,
55% CAL, KVSP, and NKSP remained at the
moderate adherence level.
See Appendix C-5 for detailed information on questions and scores for this category.
Conclusion
The overall comparative analysis between the cycle 1 and cycle 2 medical inspection scores indicates
that the Receiver and CDCR are making progress in improving institutional compliance with CDCR
medical policies and procedures and medical community standards. The overall scores by component
increased between cycle 1 and cycle 2, with four institutions (California Correctional Center (CCC),
Folsom State Prison (FSP), Sierra Conservation Center (SCC), and Avenal State Prison (ASP)
averaging high adherence. In contrast to cycle 1, the vast majority of institutions in cycle 2 achieved
the 75 percent moderate adherence level or better, with an average moderate score of 79.6. Only four
institutions were below the moderate adherence level, with scores ranging from 73.0 to 74.7 percent,
just missing the 75 percent minimum moderate adherence level.
Overall average scores also improved in each of the five categories, meeting or exceeding the 75
percent moderate adherence level. Although this upward trend indicates increased compliance with
medical policies and procedures, recurring low adherence levels in some areas indicate additional
improvement can be achieved. Medication management was the lowest scoring category within the
five general medical categories, and half of the component questions in this category scored in the low
adherence range (below 75 percent). Improvement can be achieved in timeliness of administering
medication including processing new and existing prescriptions. Follow-up of chronic care
medications within the timeframe established in departmental policy is another low scoring area.
Inmates’ access to providers and services was the second lowest scoring category; including timeliness
of access to a referred primary care provider, clinician or chronic care visit.
CDCR must be vigilant in preserving gains made in previous medical inspection cycles. Selective
adherence to show overall cosmetic improvement detracts from the goal of providing quality medical
care to inmates. Consistent adherence is possible as evidenced by the following eight institutions that
scored moderate to high adherence in all five category areas, improving their cycle 1 scores: Avenal
State Prison (ASP), Calipatria State Prison (CAL), California Correctional Center (CCC), California
Institution for Men (CIM), Folsom State Prison (FSP), San Quentin State Prison (SQ), Valley State
Prison for Women (VSPW), and Wasco State Prison (WSP).
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 31
Office of the Inspector General State of California
APPENDICES
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 32
Office of the Inspector General State of California
APPENDIX A: COMPONENT DEFINITIONS
Chronic Care: Examines how well the institution 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, anti-coagulation therapy, diabetes, HIV (Human
Immunodeficiency Virus), and hypertension.
Clinical Services: Evaluates the inmate's access to primary health care services and focuses on
inmates who recently received services from any of the institution's facilities or administrative
segregation unit clinics. This component evaluates sick call processes (doctor or nurse line),
medication management, and nursing.
Health Screening: Focuses on the institution'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: Focuses on the institution's process for approving, denying, and scheduling
services that are outside the specialties of the institution's medical staff. Common examples of
these services include cardiology services, physical therapy, oncology services, podiatry
consultations, and neurology services.
Urgent Services: Addresses the care provided by the institution to inmates before and after they
were sent to a community hospital.
Emergency Services: Examines how well the institution responded to inmate medical
emergencies.
Prenatal Care/Childbirth/Post-delivery: Focuses on the prenatal and post-delivery medical care
provided to pregnant inmates. This component is not applicable at men's institutions.
Diagnostic Services: Addresses the timeliness of radiology (x-ray) and laboratory services and
whether the institution followed up on clinically significant results.
Access to Health Care Information: Addresses the institution's effectiveness in filing, storing,
and retrieving medical records and medical-related information.
Outpatient Housing Unit: Determines whether the institution followed department policies and
procedures when placing inmates in the outpatient housing unit.1 This component also evaluates
whether the placement provided the inmate with adequate care and whether the physician's plan
addressed the placement diagnosis.
1 An outpatient housing unit (OHU) is a facility that provides outpatient health services to inmates and assists them
with the activities of daily living.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 33
Office of the Inspector General State of California
Internal Reviews: Focuses on the frequency of meetings held by the institution's Quality
Management Committee and Emergency Medical Response Review Committee and whether key
staff attended the meetings. This component also evaluates the timeliness of institution’s
responses to inmates’ medical appeals filed, and the institution’s death review process.
Inmate Transfers: 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: Addresses the general operational aspects of the institution's facility clinics.
Generally, the questions in this component relate to the cleanliness of the clinics, privacy
afforded to inmates during non-emergency visits, use of priority ducats (slips of paper the
inmates carries for scheduled medical appointments), and availability of health care request
forms.
Preventive Services: Focuses on inmate cancer screening, tuberculosis evaluation, and influenza
immunizations.
Pharmacy Services: Addresses whether the institution's pharmacy complies with various
operational policies, such as conducting periodic inventory counts, maintaining the currency of
medications in its crash carts and after-hours medication supplies, 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: Examines additional areas that are not captured in the other components. The
areas evaluated in this component include the institution's provision of therapeutic diets, its
handling of inmates who display poor hygiene, and the availability of the current version of the
department's Inmate Medical Services Policies and Procedures.
Inmate Hunger Strikes: Examines medical staff's monitoring of inmates participating in hunger
strikes lasting more than three days.
Chemical Agent Contraindications: Addresses the institution's process for handling inmates
who may be predisposed to an adverse 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 Training: Examines the institution's medical staffing levels and training
provided.
Nursing Policy: Determines whether the institution 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.
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California’s 33 Adult Institutions Page 34
Office of the Inspector General State of California
APPENDIX B
Component Scores, Cycles 1 and 2
Page 1 of 5
SAC CMF CIW RJD CCWF CEN CMC
Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2
Chronic Care 62.7% 72.9% 83.6% 68.3% 69.6% 72.6% 48.8% 66.9% 73.2% 64.4% 80.9% 71.7% 57.3% 71.1%
Clinical Services 67.0% 67.1% 87.1% 67.1% 61.7% 66.4% 67.2% 60.7% 74.1% 76.7% 80.1% 74.5% 74.2% 70.9%
Health Screening 76.4% 83.4% 86.8% 74.8% 69.8% 75.9% 68.0% 76.6% 84.3% 86.3% 77.8% 80.0% 73.2% 94.2%
Specialty Services 47.4% 62.8% 42.6% 75.7% 63.1% 88.0% 62.3% 81.8% 52.6% 73.3% 59.6% 83.2% 63.4% 76.1%
Urgent Services 82.5% 61.5% 79.1% 85.4% 75.4% 85.8% 73.2% 79.5% 89.4% 69.3% 80.2% 72.4% 83.7% 74.1%
Emergency Services 47.5% 82.2% 72.1% 79.5% 80.0% 67.6% 89.7% 77.6% 80.1% 66.9% 76.7% 78.3% 85.5% 85.2%
Prenatal
Care/Childbirth/Post- N/A N/A N/A N/A 61.3% 80.9% N/A N/A N/A N/A N/A N/A N/A N/A
Delivery
Diagnostic Services 68.1% 82.5% 72.2% 73.5% 70.6% 81.5% 64.0% 79.4% 83.8% 65.2% 74.4% 68.3% 70.0% 84.0%
Access to Healthcare
39.2% 75.5% 58.8% 72.5% 58.8% 58.8% 44.1% 43.1% 53.9% 82.4% 82.4% 49.0% 39.2% 77.5%
Information
Outpatient Housing Unit 75.6% 98.2% 85.5% 92.3% 63.3% 60.2% N/A N/A N/A N/A N/A N/A N/A N/A
Internal Reviews 70.4% 70.0% 68.8% 85.0% 95.1% 85.7% 100.0% 62.2% 97.9% 85.5% 60.8% 70.0% 70.4% 75.0%
Inmate Transfers 75.3% 94.7% 50.0% N/A 80.0% 100.0% 89.5% 74.5% 100.0% 95.3% 100.0% 84.1% 94.2% 100.0%
Clinic Operations 91.0% 93.9% 82.8% 100.0% 97.9% 100.0% 94.9% 81.2% 85.9% 100.0% 81.8% 91.5% 84.8% 86.4%
Preventive Services 32.1% 76.0% 43.7% 85.0% 32.6% 71.3% 24.0% 70.0% 58.7% 81.0% 19.0% 58.7% 53.0% 76.0%
Pharmacy Services 74.5% 90.3% 75.9% 97.6% 95.2% 97.6% 93.3% 93.1% 92.0% 100.0% 57.8% 86.2% 90.8% 65.5%
Other Services 90.6% 85.0% 100.0% 100.0% 57.1% 70.0% 100.0% 100.0% 100.0% 100.0% 100.0% 77.8% 90.9% 100.0%
Inmate Hunger Strikes 10.5% 60.0% 31.6% 92.6% N/A N/A 10.5% 93.7% 100.0% N/A 31.6% N/A 71.1% 100.0%
Chemical Agent
100.0% 84.7% 86.8% 100.0% 100.0% 100.0% 94.1% 100.0% 64.7% N/A 89.4% 100.0% 100.0% 100.0%
Contraindications
Staffing Levels and
95.0% 100.0% 95.0% 100.0% 85.0% 100.0% 100.0% 100.0% 85.0% 100.0% 100.0% 100.0% 100.0% 95.0%
Training
Nursing Policy 78.6% 50.0% 35.7% 60.0% 64.3% 77.1% 88.6% 50.0% 100.0% 80.0% 71.4% 80.0% 78.6% 90.0%
Overall Score 65.2% 76.3% 72.4% 79.0% 69.6% 77.5% 68.0% 73.0% 77.9% 77.5% 74.4% 74.7% 71.3% 80.0%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 35
Office of the Inspector General State of California
APPENDIX B
Component Scores, Cycles 1 and 2
Page 2 of 5
CRC PVSP SCC NKSP LAC SQ VSPW
Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2
Chronic Care 67.1% 66.4% 56.9% 61.7% 75.0% 77.4% 58.9% 66.3% 70.1% 76.5% 64.6% 75.6% 70.5% 81.7%
Clinical Services 70.2% 63.9% 46.7% 72.6% 71.1% 84.3% 64.0% 71.9% 65.5% 72.7% 46.6% 78.3% 65.7% 75.9%
Health Screening 74.2% 78.7% 67.1% 73.0% 61.0% 87.9% 71.9% 89.1% 68.8% 83.9% 76.5% 90.6% 85.8% 95.2%
Specialty Services 59.2% 78.9% 60.6% 76.2% 73.1% 84.2% 60.7% 81.5% 70.3% 85.4% 58.0% 83.4% 71.5% 92.0%
Urgent Services 81.2% 75.8% 80.5% 59.0% 89.1% 89.3% 79.8% 70.5% 80.2% 69.7% 62.9% 66.9% 66.9% 79.7%
Emergency Services 72.9% 90.2% 82.8% 96.9% 75.9% 100.0% 81.0% 82.1% 84.0% 72.4% 78.3% 58.3% 88.2% 78.8%
Prenatal
Care/Childbirth/Post- N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80.8% 81.3%
Delivery
Diagnostic Services 58.5% 60.4% 64.6% 89.8% 85.7% 99.0% 67.9% 85.2% 54.0% 82.7% 69.4% 70.8% 81.3% 76.9%
Access to Healthcare
77.5% 72.5% 62.7% 49.0% 82.4% 95.1% 72.5% 80.4% 72.5% 67.6% 53.9% 98.0% 75.5% 39.2%
Information
Outpatient Housing Unit 74.8% 86.1% N/A N/A 75.2% 98.5% N/A N/A N/A N/A 83.3% 100.0% 88.5% 88.3%
Internal Reviews 90.5% 65.5% 70.5% 67.5% 60.4% 79.3% 85.0% 87.5% 73.0% 63.3% 68.8% 85.0% 85.5% 85.7%
Inmate Transfers 100.0% 100.0% 76.0% 81.3% 95.3% 87.3% 95.8% 86.0% 100.0% 85.3% 100.0% 76.7% 100.0% 100.0%
Clinic Operations 86.4% 87.9% 92.7% 93.3% 87.9% 95.5% 90.0% 93.9% 90.0% 94.2% 100.0% 95.5% 100.0% 97.0%
Preventive Services 82.0% 81.0% 27.3% 66.0% 28.0% 96.0% 55.0% 67.7% 20.0% 75.3% 48.7% 70.0% 81.4% 92.0%
Pharmacy Services 79.3% 89.7% 72.4% 93.1% 90.8% 86.2% 93.1% 100.0% 100.0% 84.5% 86.2% 93.1% 86.2% 93.1%
Other Services 70.0% 100.0% 70.0% 100.0% 55.0% 100.0% 50.0% 100.0% 100.0% 100.0% 85.0% 100.0% 100.0% 100.0%
Inmate Hunger Strikes N/A N/A 36.8% 66.8% N/A N/A N/A N/A 42.1% 93.7% 53.7% 83.2% N/A N/A
Chemical Agent
100.0% N/A 66.3% 75.0% 100.0% 76.5% 100.0% 100.0% 90.6% 78.8% 89.4% 100.0% 100.0% 73.5%
Contraindications
Staffing Levels and
85.0% 100.0% 80.0% 100.0% 100.0% 95.0% 95.0% 100.0% 90.0% 95.0% 95.0% 100.0% 100.0% 100.0%
Training
Nursing Policy 75.7% 87.1% 100.0% 50.0% 94.3% 50.0% 71.4% 50.0% 57.1% 80.0% 70.0% 90.0% 100.0% 50.0%
Overall Score 74.3% 75.9% 64.5% 73.3% 76.1% 87.5% 72.2% 79.3% 71.7% 78.4% 68.2% 81.5% 80.0% 82.2%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 36
Office of the Inspector General State of California
APPENDIX B
Component Scores, Cycles 1 and 2
Page 3 of 5
CCI KVSP SATF HDSP DVI FSP COR
Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2
Chronic Care 61.8% 73.2% 37.6% 71.4% 57.8% 74.6% 45.0% 83.0% 73.5% 75.0% 78.8% 82.9% 57.5% 66.3%
Clinical Services 57.4% 72.4% 57.7% 72.4% 56.1% 73.7% 51.1% 72.6% 72.8% 55.2% 75.8% 82.1% 68.0% 79.9%
Health Screening 78.3% 76.0% 75.4% 77.2% 72.7% 77.4% 72.3% 80.0% 74.3% 80.4% 88.8% 96.4% 72.7% 83.6%
Specialty Services 57.3% 86.6% 61.7% 77.9% 61.5% 67.3% 53.2% 75.1% 53.4% 82.1% 80.1% 96.9% 55.1% 61.8%
Urgent Services 82.7% 76.4% 61.0% 69.2% 75.2% 76.9% 71.9% 80.5% 77.5% 63.6% 87.6% 79.3% 75.7% 78.6%
Emergency Services 77.9% 82.2% 71.9% 70.7% 69.6% 73.1% 72.1% 85.8% 71.0% 57.4% 83.6% 76.7% 88.2% 81.4%
Prenatal
Care/Childbirth/Post- N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
Delivery
Diagnostic Services 60.4% 78.3% 85.6% 80.0% 56.0% 67.9% 42.9% 67.7% 73.7% 79.6% 80.4% 84.8% 67.7% 80.0%
Access to Healthcare
54.9% 72.5% 72.5% 62.7% 56.9% 70.6% 58.8% 57.8% 58.8% 50.0% 77.5% 90.2% 72.5% 45.1%
Information
Outpatient Housing Unit 73.3% 92.7% N/A N/A N/A N/A N/A N/A 82.8% 100.0% N/A N/A 61.7% 91.9%
Internal Reviews 60.0% 76.3% 68.8% 73.0% 72.5% 63.0% 62.5% 73.0% 93.3% 83.2% 98.0% 100.0% 65.8% 58.8%
Inmate Transfers 43.2% 81.3% 100.0% 81.3% 100.0% 100.0% 100.0% 64.0% 78.9% 90.7% 95.3% 90.7% 86.7% 86.0%
Clinic Operations 90.6% 100.0% 96.6% 87.3% 98.5% 100.0% 90.9% 96.1% 87.9% 100.0% 93.9% 100.0% 90.3% 95.5%
Preventive Services 7.3% 62.3% 27.3% 93.8% 36.0% 69.3% 24.0% 72.0% 21.7% 54.0% 56.7% 100.0% 30.3% 84.3%
Pharmacy Services 79.3% 100.0% 82.8% 96.6% 90.0% 97.6% 100.0% 95.5% 92.0% 100.0% 100.0% 100.0% 86.2% 100.0%
Other Services 85.0% 100.0% 50.0% 82.4% 100.0% 100.0% 72.7% 70.0% 100.0% 100.0% 70.0% 100.0% 92.7% 55.0%
Inmate Hunger Strikes 45.8% N/A 46.3% 66.3% 78.9% 48.9% 44.2% 81.1% N/A N/A N/A N/A 30.0% 58.9%
Chemical Agent
66.3% 100.0% 60.0% 81.8% 100.0% 94.1% 100.0% 100.0% 89.4% 100.0% 100.0% 100.0% 100.0% 100.0%
Contraindications
Staffing Levels and
90.0% 100.0% 95.0% 100.0% 100.0% 95.0% 100.0% 100.0% 95.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Training
Nursing Policy 50.0% 80.0% 57.1% 90.0% 71.4% 60.0% 88.6% 60.0% 35.7% 90.0% 74.3% 100.0% 85.7% 100.0%
Overall Score 64.3% 79.8% 64.0% 76.1% 68.1% 75.7% 62.4% 77.8% 72.6% 75.4% 83.2% 89.1% 68.9% 76.2%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 37
Office of the Inspector General State of California
APPENDIX B
Component Scores, Cycles 1 and 2
Page 4 of 5
CCC SOL CTF MCSP PBSP SVSP ISP
Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2
Chronic Care 45.7% 80.8% 42.3% 64.8% 56.2% 60.1% 69.8% 72.0% 70.2% 77.5% 57.1% 58.9% 38.7% 69.2%
Clinical Services 65.9% 92.5% 59.9% 70.5% 59.2% 64.8% 68.7% 72.3% 69.1% 76.5% 61.1% 73.5% 60.8% 82.1%
Health Screening 80.6% 78.7% 76.9% 80.9% 64.2% 74.9% 81.0% 73.4% 85.1% 79.4% 83.7% 82.8% 82.3% 75.7%
Specialty Services 70.7% 89.6% 65.6% 66.2% 69.0% 59.7% 75.8% 69.0% 96.2% 85.9% 71.0% 70.4% 82.4% 82.8%
Urgent Services 83.7% 82.7% 70.4% 84.1% 74.8% 82.2% 74.6% 82.4% 92.3% 87.3% 83.8% 82.0% 70.2% 88.3%
Emergency Services 89.7% 100.0% 82.4% 75.9% 81.0% 58.3% 64.0% 78.6% 81.0% 81.0% 82.8% 87.1% 73.2% 87.6%
Prenatal
Care/Childbirth/Post- N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A
Delivery
Diagnostic Services 70.8% 80.8% 59.8% 66.9% 71.5% 76.7% 68.1% 84.6% 57.1% 77.9% 77.1% 72.1% 57.5% 79.6%
Access to Healthcare
77.5% 100.0% 57.8% 98.0% 77.5% 80.4% 72.5% 100.0% 100.0% 100.0% 88.2% 100.0% 49.0% 39.2%
Information
Outpatient Housing Unit 82.3% 97.1% N/A N/A 87.1% 96.0% N/A N/A N/A N/A N/A N/A 89.8% 85.0%
Internal Reviews 85.5% 83.2% 75.0% 83.0% 93.0% 87.5% 82.5% 95.5% 68.8% 75.0% 72.5% 65.0% 87.5% 76.8%
Inmate Transfers 92.6% 86.0% 78.9% 81.3% 67.9% 100.0% 68.4% 65.3% 92.9% 100.0% 85.3% 90.7% 95.3% 74.0%
Clinic Operations 97.0% 100.0% 83.9% 90.9% 90.9% 91.8% 100.0% 87.3% 92.6% 94.8% 95.5% 90.9% 97.0% 91.2%
Preventive Services 36.7% 90.0% 58.0% 72.0% 51.0% 63.0% 40.0% 72.3% 81.3% 98.3% 42.0% 96.7% 33.7% 88.0%
Pharmacy Services 69.0% 100.0% 89.0% 100.0% 88.6% 79.3% 93.1% 93.1% 93.4% 100.0% 100.0% 100.0% 82.8% 86.2%
Other Services 100.0% 100.0% 75.0% 70.0% 66.7% 83.3% 85.0% 70.0% 100.0% 85.0% 89.3% 83.3% 85.0% 83.3%
Inmate Hunger Strikes 68.4% N/A 87.9% N/A N/A 100.0% 81.6% N/A 100.0% 65.8% 26.3% 52.6% N/A 84.2%
Chemical Agent
100.0% N/A 100.0% N/A 100.0% N/A 100.0% 100.0% 78.8% 48.2% 100.0% 100.0% 100.0% N/A
Contraindications
Staffing Levels and
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 95.0%
Training
Nursing Policy 94.3% 100.0% 71.4% 80.0% 100.0% 100.0% 88.6% 100.0% 50.0% 50.0% 100.0% 71.4% 50.0% 90.0%
Overall Score 73.4% 89.5% 67.1% 76.7% 72.0% 74.5% 74.5% 79.8% 81.0% 82.8% 74.1% 78.0% 68.3% 78.6%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 38
Office of the Inspector General State of California
APPENDIX B
Component Scores, Cycles 1 and 2
Page 5 of 5
CAL ASP CVSP CIM WSP Average Score
Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2
Chronic Care 75.0% 82.0% 59.2% 73.2% 51.5% 77.7% 61.5% 72.0% 51.7% 67.9% 61.5% 72.0%
Clinical Services 60.1% 70.6% 64.4% 86.4% 60.6% 80.8% 74.0% 87.5% 74.0% 81.0% 65.4% 74.2%
Health Screening 80.0% 83.6% 80.7% 84.0% 75.9% 83.2% 86.1% 78.2% 86.3% 94.7% 76.9% 82.1%
Specialty Services 74.5% 89.6% 74.1% 89.6% 86.1% 78.7% 83.3% 84.5% 70.5% 74.5% 66.2% 79.1%
Urgent Services 88.3% 85.3% 70.2% 82.9% 77.9% 82.2% 79.6% 82.4% 85.2% 92.4% 78.4% 78.1%
Emergency Services 85.2% 87.8% 78.1% 79.8% 73.1% 76.7% 90.4% 85.5% 72.8% 78.3% 78.3% 79.4%
Prenatal
Care/Childbirth/Post- N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 71.1% 81.1%
Delivery
Diagnostic Services 57.5% 73.7% 86.7% 95.2% 56.2% 84.8% 67.7% 82.5% 89.2% 81.0% 68.8% 78.6%
Access to Healthcare
37.3% 95.1% 19.6% 90.2% 49.0% 85.3% 75.5% 100.0% 63.8% 75.2%
Information 77.5% 82.4%
Outpatient Housing Unit 92.5% 91.9% 71.3% 95.6% 99.0% 92.9% 93.1% 87.5% N/A N/A 81.1% 91.4%
Internal Reviews 75.0% 73.0% 65.5% 73.0% 67.5% 66.8% 95.7% 87.5% 87.5% 75.0% 78.0% 76.8%
Inmate Transfers 100.0% 76.7% 100.0% 100.0% 73.3% 68.2% 93.3% 100.0% 88.9% 92.3% 87.8% 87.3%
Clinic Operations 100.0% 93.9% 93.9% 100.0% 90.9% 88.8% 94.8% 93.3% 89.7% 97.9% 92.2% 94.2%
Preventive Services 48.3% 94.3% 60.3% 94.3% 48.3% 90.3% 70.7% 100.0% 70.0% 92.0% 43.9% 80.4%
Pharmacy Services 96.6% 69.0% 92.1% 93.1% 82.8% 100.0% 95.9% 100.0% 86.2% 93.1% 87.5% 93.1%
Other Services 100.0% 100.0% 70.0% 100.0% 100.0% 100.0% 100.0% 94.0% 68.8% 100.0% 84.2% 91.2%
Inmate Hunger Strikes 100.0% 100.0% N/A 100.0% N/A N/A 100.0% 100.0% N/A 100.0% 57.0% 81.5%
Chemical Agent
100.0% 78.8% 100.0% 100.0% N/A N/A 100.0% 100.0% 94.1% 87.1% 92.8% 91.5%
Contraindications
Staffing Levels and
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 80.0% 100.0% 95.9% 99.2%
Training
Nursing Policy 100.0% 50.0% 67.1% 100.0% 71.4% 80.0% 92.9% 60.0% 100.0% 100.0% 76.8% 75.9%
Overall Score 76.6% 83.0% 70.4% 86.9% 69.4% 82.2% 81.4% 84.8% 75.9% 84.3% 71.9% 79.6%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 39
Office of the Inspector General State of California
APPENDIX C-1
Medication Management
Page 1 of 4
Category Definition: The Medication Management category determines if medications were properly administered and delivered to inmates as required by
CDCR’s policies.
Ref
Number SOL CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP SQ CCC
01.124 Sick Call Medication: Did the institution administer or deliver prescription medications (new orders) to the inmate within specified
timeframes?
Score 60% 52% 20% 58% 40% 68% 45% 50% 33% 30% 32% 83% 27% 63% 62% 57% 93%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 3.6 3.1 1.2 3.5 2.4 4.1 2.7 3 2 1.8 1.9 5 1.6 3.8 3.7 3.4 5.6
02.128 If the inmate had an existing medication order upon arrival at the institution, did the inmate receive the medications by the next calendar day, or did a
physician document why the medications were not to be continued?
Score 54% 56% 35% 50% 45% 45% 84% 50% 40% 61% 45% 34% 0% 71% 30% 95% 66%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 4.3 4.5 2.8 4 3.6 3.6 6.7 4 3.2 4.9 3.6 2.7 0 5.7 2.4 7.6 5.3
03.175 Did the inmate receive his or her prescribed chronic care medications during the 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?
Score 28% 68% 50% 65% 59% 44% 63% 67% 28% 32% 69% 64% 67% 60% 78% 83% 59%
Points Possible 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16
Points Received 4.5 10.9 8 10.4 9.5 7 10 10.7 4.5 5.1 11.1 10.2 10.7 9.6 12.4 13.3 9.5
05.110 Do all appropriate forms in the transfer envelope identify all medications ordered by the physician; and, are the medications in the transfer
envelope?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 8 8 8 8 8 8 8 8 8 8 8
Points Received 8 8 8 8 8 8 8 8 8 8 8
10.228 Inmates prescribed INH: Did the institution properly administer the medication to the inmate?
Score 0% 50% 40% 40% 20% 40% 40% 80% 0% 60% 0% 100% 40% 80% 60% 0% 100%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 0 3 2.4 2.4 1.2 2.4 2.4 4.8 0 3.6 0 6 2.4 4.8 3.6 0 6
13.141 Does the institution properly maintain its emergency crash cart medications?
Score 100% 65% 0% 0% 100% 100% 0% 0% 0% 100% 100% 50% 100% 0% 35% 100% 100%
Points Possible 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Points Received 2 1.3 0 0 2 2 0 0 0 2 2 1 2 0 0.7 2 2
13.145 Does the pharmacist-in-charge have an effective process for screening new medication orders for potential adverse reactions?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
13.148 Does the pharmacist-in-charge monitor the quantity of medications on hand?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
13.252 Does the institution properly maintain medications in its after-hours medication supply(ies)?
Score 100% 100% 100% 0% 100% 100% 0% 0% 0% 0% 100% 0% 65% 100% 100% 0% 100%
Points Possible 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Points Received 2 2 2 0 2 2 0 0 0 0 2 0 1.3 2 2 0 2
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 40
Office of the Inspector General State of California
APPENDIX C-1
Medication Management
Page 2 of 4
Category Definition: The Medication Management category determines if medications were properly administered and delivered to inmates as required by
CDCR’s policies.
Ref Average
Number NKSP KVSP FSP SAC SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score
01.124 Sick Call Medication: Did the institution administer or deliver prescription medications (new orders) to the inmate within specified
timeframes?
Score 43% 45% 78% 43% 32% 83% 70% 92% 35% 78% 62% 67% 60% 88% 83% 80% 58%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 2.6 2.7 4.7 2.6 1.9 5 4.2 5.5 2.1 4.7 3.7 4 3.6 5.3 5 4.8 3.5
02.128 If the inmate had an existing medication order upon arrival at the institution, did the inmate receive the medications by the next calendar day, or did a
physician document why the medications were not to be continued?
Score 50% 66% 100% 64% 60% 75% 34% 100% 50% 100% 55% 75% 80% 100% 66% 80% 61%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 4 5.3 8 5.1 4.8 6 2.7 8 4 8 4.4 6 6.4 8 5.3 6.4 4.9
03.175 Did the inmate receive his or her prescribed chronic care medications during the 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?
Score 71% 60% 82% 54% 56% 68% 32% 76% 50% 83% 36% 59% 52% 68% 92% 56% 60%
Points Possible 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16
Points Received 11.3 9.6 13.1 8.7 9 10.9 5.1 12.2 8 13.2 5.8 9.5 8.3 10.9 14.7 9 9.6
05.110 Do all appropriate forms in the transfer envelope identify all medications ordered by the physician; and, are the medications in the transfer
envelope?
Score 100% 100% 100% 80% 100% 100% 75% 100% 100% 100% 40% 100% 100% 100% 96%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 8 8 8 6.4 8 8 6 8 8 8 3.2 8 8 8 7.7
10.228 Inmates prescribed INH: Did the institution properly administer the medication to the inmate?
Score 80% 100% 100% 20% 40% 80% 60% 100% 60% 80% 40% 20% 100% 100% 100% 60% 57%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 4.8 6 6 1.2 2.4 4.8 3.6 6 3.6 4.8 2.4 1.2 6 6 6 3.6 3.4
13.141 Does the institution properly maintain its emergency crash cart medications?
Score 100% 50% 100% 60% 65% 0% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 67%
Points Possible 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Points Received 2 1 2 1.2 1.3 0 0 2 2 2 2 2 2 2 2 2 1.3
13.145 Does the pharmacist-in-charge have an effective process for screening new medication orders for potential adverse reactions?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7.0
13.148 Does the pharmacist-in-charge monitor the quantity of medications on hand?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4.0
13.252 Does the institution properly maintain medications in its after-hours medication supply(ies)?
Score 100% 100% 100% 0% 100% 100% 0% 100% 100% 0% 100% 0% 100% 100% 100% 0% 63%
Points Possible 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2.0
Points Received 2 2 2 0 2 2 0 2 2 0 2 0 2 2 2 0 1.3
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 41
Office of the Inspector General State of California
APPENDIX C-1
Medication Management
Page 3 of 4
Ref
Number SOL CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP SQ CCC
13.253 Does the institution conduct monthly inspections of its emergency crash cart and after-hours medication supply(ies)?
Score 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Points Received 1 1 1 1 1 1 1 1 0.5 1 1 1 1 1 1 1 1
14.029 Does medical staff in the facility clinic know which inmates are on modified program or confined to quarters and does staff have an adequate
process to ensure those inmates receive their medication?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
14.131 Do medication nurses understand that the licensed staff member who prepares the medication, must also administer it on the same day it is
prepared?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
14.166 Were refrigerated drugs stored without food in the refrigerator, or were the drugs stored in a sealed container if food was present?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
Points Received 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
21.281 Upon the inmate's discharge from a community hospital, did the institution administer or deliver all prescribed medications to the inmate within
specified timeframes?
Score 87% 36% 30% 64% 67% 54% 50% 84% 50% 26% 61% 89% 69% 100% 73% 53% 94%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 6.1 2.5 2.1 4.5 4.7 3.8 3.5 5.9 3.5 1.8 4.3 6.2 4.8 7 5.1 3.7 6.6
Total Points Received 52.5 49.3 40.5 46.8 53.4 54.9 55.3 50.4 42.7 49.2 54.9 53.1 52.8 54.9 59.9 60 67
Total Points Possible 77 69 69 69 75 77 77 69 77 77 77 69 77 69 77 77 77
Total Score 68.2% 71.4% 58.7% 67.8% 71.2% 71.3% 71.8% 73.0% 55.5% 63.9% 71.3% 77.0% 68.6% 79.6% 77.8% 77.9% 87.0%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 42
Office of the Inspector General State of California
APPENDIX C-1
Medication Management
Page 4 of 4
Ref Average
Number NKSP KVSP FSP SAC SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score
13.253 Does the institution conduct monthly inspections of its emergency crash cart and after-hours medication supply(ies)?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 95%
Points Possible 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
Points Received 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1.0
14.029 Does medical staff in the facility clinic know which inmates are on modified program or confined to quarters and does staff have an adequate
process to ensure those inmates receive their medication?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 98%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4.0
Points Received 4 4 4 4 4 4 4 4 4 4 2 4 4 4 4 4 3.9
14.131 Do medication nurses understand that the licensed staff member who prepares the medication, must also administer it on the same day it is
prepared?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4.0
14.166 Were refrigerated drugs stored without food in the refrigerator, or were the drugs stored in a sealed container if food was present?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2.0
Points Received 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2.0
21.281 Upon the inmate's discharge from a community hospital, did the institution administer or deliver all prescribed medications to the inmate within
specified timeframes?
Score 47% 14% 94% 27% 46% 76% 84% 77% 39% 83% 94% 64% 41% 100% 100% 93% 66%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 3.3 1 6.6 1.9 3.2 5.3 5.9 5.4 2.7 5.8 6.6 4.5 2.9 7 7 6.5 4.6
Total Points Received 60 57.6 72.4 49.1 54.6 64 49.5 63.1 54.4 67.5 54.9 52.4 61.2 63.2 72 62.3 1855.8
Total Points Possible 77 77 77 77 77 77 77 69 77 77 77 77 77 69 77 77 2475
Total Score 77.9% 74.8% 94.0% 63.8% 70.9% 83.1% 64.3% 91.4% 70.6% 87.7% 71.3% 68.1% 79.5% 91.6% 93.5% 80.9% 75.0%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 43
Office of the Inspector General State of California
APPENDIX C-2
Access to Providers and Services
Page 1 of 8
Category Definition: Assesses the prisons' effectiveness in ensuring that inmates are seen by primary care
providers or provided services for routine, urgent, and emergency medical needs according to timelines set
by CDCR policy.
Ref
Number SOL CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP SQ CCC
01.025 Did the RN complete a face-to-face (FTF) visit within one (1) business day after the Form 7362 was reviewed?
Score 100% 100% 73% 90% 67% 88% 97% 90% 97% 90% 96% 70% 88% 93% 93% 89% 100%
Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
Points Received 10 10 7.3 9 6.7 8.8 9.7 9 9.7 9 9.6 7 8.8 9.3 9.3 8.9 10
01.027 If the RN determined a referral to a primary care provider (PCP) was necessary, was the inmate seen within the timelines specified by the RN during the
FTF triage?
Score 45% 77% 57% 71% 25% 58% 33% 80% 64% 40% 58% 20% 83% 65% 52% 100% 100%
Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
Points Received 4.5 7.7 5.7 7.1 2.5 5.8 3.3 8 6.4 4 5.8 2 8.3 6.5 5.2 10 10
01.247 Sick Call Follow-up: If the provider ordered a follow-up sick call appointment, did it take place within the time frame specified?
Score 66% 94% 72% 100% 20% 66% 72% 100% 100% 58% 88% 76% 76% 54% 86% 88%
Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
Points Received 3.3 4.7 3.6 5 1 3.3 3.6 5 5 2.9 4.4 3.8 3.8 2.7 4.3 4.4
02.015 Was a review of symptoms completed if the inmate's tuberculin test was positive, and were the results reviewed by the infection control nurse or the public
health nurse?
Score 100% 0%
Points Possible 7 7
Points Received 7 0
02.016 Did the insitution complete the initial health screening on the same day the inmate arrived at the institution?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 93% 100% 100% 100% 90% 100% 100%
Points Possible 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9
Points Received 9 9 9 9 9 9 9 9 9 9 8.4 9 9 9 8.1 9 9
02.017 If "Yes" was answered to any of the questions on the initial health screening form(s), did the RN provide an assessment and disposition on the date of arrival?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 94% 100% 100% 100% 100% 100%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 8 8 8 8 8 8 8 8 8 8 7.5 8 8 8 8 8
02.018 If, during the assessment, the RN referred the inmate to a clinician, was the inmate seen within the timeframe?
Score 50% 51% 29% 43% 33% 80% 91% 50% 77% 0% 54% 100% 42% 64% 78% 29%
Points Possible 9 8 9 9 9 9 9 9 9 9 9 9 9 9 9 9
Points Received 4.5 4.1 2.6 3.9 3 7.2 8.2 4.5 6.9 0 4.9 9 3.8 5.8 7 2.6
02.020 Did the LVN/RN adequately document the tuberculin test and timely reading of the test results; or, if the inmate did not have a TB test because of a previous
positive TB test, was a review of signs and symptoms completed?
Score 68% 85% 83% 80% 80% 100% 100% 90% 85% 50% 87% 95% 90% 95% 90% 100% 90%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 4.1 5.1 5 4.8 4.8 6 6 5.4 5.1 3 5.2 5.7 5.4 5.7 5.4 6 5.4
02.021 Reception center: Did the inmate receive a history and physical by a Nurse Practitioner, Physician Assistant, or a Physician and Surgeon within 14
calendar days of arrival?
Score 100% 96% 96% 100% 100% 56% 100%
Points Possible 7 7 7 7 7 7 7
Points Received 7 6.7 6.7 7 7 3.9 7
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 44
Office of the Inspector General State of California
APPENDIX C-2
Access to Providers and Services
Page 2 of 8
Category Definition: Assesses the prisons' effectiveness in ensuring that inmates are seen by primary care
providers or provided services for routine, urgent, and emergency medical needs according to timelines set by
CDCR policy.
Average
Ref Number NKSP KVSP FSP SAC SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score
01.025 Did the RN complete a face-to-face (FTF) visit within one (1) business day after the Form 7362 was reviewed?
Score 68% 91% 83% 73% 97% 100% 83% 100% 97% 97% 85% 95% 83% 92% 96% 100% 90%
Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
Points Received 6.8 9.1 8.3 7.3 9.7 10 8.3 10 9.7 9.7 8.5 9.5 8.3 9.2 9.6 10 9.0
01.027 If the RN determined a referral to a primary care provider (PCP) was necessary, was the inmate seen within the timelines specified by the RN during the FTF
triage?
Score 38% 71% 86% 62% 63% 93% 57% 54% 44% 75% 42% 100% 33% 57% 50% 71% 61%
Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
Points Received 3.8 7.1 8.6 6.2 6.3 9.3 5.7 5.4 4.4 7.5 4.2 10 3.3 5.7 5 7.1 6.1
01.247 Sick Call Follow-up: If the provider ordered a follow-up sick call appointment, did it take place within the time frame specified?
Score 42% 58% 100% 72% 60% 80% 58% 56% 72% 50% 66% 84% 100% 0% 66% 70%
Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
Points Received 2.1 2.9 5 3.6 3 4 2.9 2.8 3.6 2.5 3.3 4.2 5 0 3.3 3.5
02.015 Was a review of symptoms completed if the inmate's tuberculin test was positive, and were the results reviewed by the infection control nurse or the public health
nurse?
Score 50%
Points Possible 7
Points Received 3.5
02.016 Did the insitution complete the initial health screening on the same day the inmate arrived at the institution?
Score 100% 100% 100% 100% 96% 100% 100% 90% 96% 100% 96% 90% 90% 100% 100% 100% 98%
Points Possible 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9
Points Received 9 9 9 9 8.6 9 9 8.1 8.6 9 8.6 8.1 8.1 9 9 9 8.8
02.017 If "Yes" was answered to any of the questions on the initial health screening form(s), did the RN provide an assessment and disposition on the date of arrival?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8.0
02.018 If, during the assessment, the RN referred the inmate to a clinician, was the inmate seen within the timeframe?
Score 33% 100% 50% 7% 100% 50% 42% 62% 38% 16% 20% 67% 26% 57% 100% 53%
Points Possible 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9
Points Received 3 9 4.5 0.6 9 4.5 3.8 5.6 3.4 1.4 1.8 6 2.3 5.1 9 4.7
02.020 Did the LVN/RN adequately document the tuberculin test and timely reading of the test results; or, if the inmate did not have a TB test because of a previous positive
TB test, was a review of signs and symptoms completed?
Score 95% 90% 95% 90% 100% 100% 90% 70% 90% 70% 83% 68% 68% 95% 100% 100% 87%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 5.7 5.4 5.7 5.4 6 6 5.4 4.2 5.4 4.2 5 4.1 4.1 5.7 6 6 5.2
02.021 Reception center: Did the inmate receive a history and physical by a Nurse Practitioner, Physician Assistant, or a Physician and Surgeon within 14 calendar
days of arrival?
Score 100% 100% 60% 100% 92%
Points Possible 7 7 7 7 7
Points Received 7 7 4.2 7 6.4
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 45
Office of the Inspector General State of California
APPENDIX C-2
Access to Providers and Services
Page 3 of 8
Ref
Number SOL CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP SQ CCC
03.076 Was the inmate's most recent chronic care visit within the timeframe required by policy.
Score 40% 61% 54% 56% 48% 48% 67% 64% 72% 14% 40% 44% 68% 59% 72% 25% 80%
Points Possible 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20
Points Received 8 12.2 10.8 11.2 9.6 9.6 13.3 12.8 14.4 2.7 8 8.8 13.6 11.7 14.4 5 16
04.051 Did the PCP evaluate the inmate within one calendar day after placement?
Score 90% 100% 100% 100% 80% 100% 100% 100% 90%
Points Possible 5 5 5 5 5 5 5 5 5
Points Received 4.5 5 5 5 4 5 5 5 4.5
04.052 Did the RN complete an initial assessment of the inmate on the day of placement?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 5 5 5 5 5 5 5 5 5
Points Received 5 5 5 5 5 5 5 5 5
04.053 While the inmate was placed in the OHU, did the PCP complete the Subjective, Objective, Assessment, Plan and Education note at a minimum of every 14
days?
Score 100% 100% 100% 100% 100% 100% 100%
Points Possible 4 4 4 4 4 4 4
Points Received 4 4 4 4 4 4 4
06.049 Radiology order: Was the radiology service provided within the timeframe specified in the physician's order?
Score 100% 80% 100% 80% 100% 100% 100% 100% 100% 100% 100% 60% 100% 100% 100% 100% 100%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 7 5.6 7 5.6 7 7 7 7 7 7 7 4.2 7 7 7 7 7
06.188 All laboratory orders: Was the specimen collected within the applicable timeframes of the physician's order?
Score 67% 80% 100% 88% 80% 80% 88% 100% 80% 100% 90% 70% 90% 100% 80% 50% 90%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 4 4.8 6 5.3 4.8 4.8 5.3 6 4.8 6 5.4 4.2 5.4 6 4.8 3 5.4
07.035 Did the inmate receive the specialty service within specified timeframes?
Score 53% 82% 71% 100% 88% 77% 94% 94% 100% 94% 82% 82% 88% 93% 82% 88% 100%
Points Possible 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9
Points Received 4.8 7.4 6.4 9 7.9 6.9 8.5 8.5 9 8.5 7.4 7.4 7.9 8.4 7.4 7.9 9
07.043 Did the PCP review the specialist's report and see the inmate for a follow-up appointment within specified timelines following the completion of the specialty
service?
Score 17% 87% 42% 50% 77% 18% 50% 82% 71% 64% 54% 57% 85% 69% 33% 62% 93%
Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
Points Received 1.7 8.7 4.2 5 7.7 1.8 5 8.2 7.1 6.4 5.4 5.7 8.5 6.9 3.3 6.2 9.3
08.184 Did the medical emergency responder arrive at the location of the medical emergency within eight minutes of initial notification?
Score 100% 100% 80% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 75% 100% 75% 100%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 6 6 4.8 6 6 6 6 6 6 6 6 6 6 4.5 6 4.5 6
09.066 New arrival only: Did the inmate receive a pregnancy test within three (3) business days of arrival at the institution to positively identify her pregnancy?
Score 50%
Points Possible 5
Points Received 2.5
09.067 New arrival only: Was the inmate seen by an OB physician or OB nurse practitioner within seven (7) business days of her arrival at the institution?
Score 100%
Points Possible 5
Points Received 5
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 46
Office of the Inspector General State of California
APPENDIX C-2
Access to Providers and Services
Page 4 of 8
Average
Ref Number NKSP KVSP FSP SAC SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score
03.076 Was the inmate's most recent chronic care visit within the timeframe required by policy.
Score 44% 64% 64% 55% 48% 56% 41% 67% 40% 68% 40% 60% 52% 52% 13% 52% 52%
Points Possible 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20
Points Received 8.7 12.8 12.8 10.9 9.6 11.2 8.2 13.3 8 13.6 8 12 10.4 10.4 2.5 10.4 10.5
04.051 Did the PCP evaluate the inmate within one calendar day after placement?
Score 100% 90% 100% 80% 100% 100% 90% 100% 95%
Points Possible 5 5 5 5 5 5 5 5 5
Points Received 5 4.5 5 4 5 5 4.5 5 4.8
04.052 Did the RN complete an initial assessment of the inmate on the day of placement?
Score 100% 100% 90% 100% 100% 100% 100% 100% 99%
Points Possible 5 5 5 5 5 5 5 5 5
Points Received 5 5 4.5 5 5 5 5 5 5.0
04.053 While the inmate was placed in the OHU, did the PCP complete the Subjective, Objective, Assessment, Plan and Education note at a minimum of every 14 days?
Score 100% 25% 75% 33% 75% 100% 60% 83%
Points Possible 4 4 4 4 4 4 4 4
Points Received 4 1 3 1.3 3 4 2.4 3.3
06.049 Radiology order: Was the radiology service provided within the timeframe specified in the physician's order?
Score 80% 100% 100% 100% 100% 76% 80% 100% 100% 100% 100% 80% 100% 100% 100% 80% 94%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 5.6 7 7 7 7 5.3 5.6 7 7 7 7 5.6 7 7 7 5.6 6.6
06.188 All laboratory orders: Was the specimen collected within the applicable timeframes of the physician's order?
Score 80% 80% 80% 80% 70% 88% 90% 100% 90% 100% 40% 100% 80% 90% 100% 78% 84%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 4.8 4.8 4.8 4.8 4.2 5.3 5.4 6 5.4 6 2.4 6 4.8 5.4 6 4.7 5.1
07.035 Did the inmate receive the specialty service within specified timeframes?
Score 94% 100% 100% 57% 77% 100% 100% 88% 59% 94% 88% 62% 81% 94% 100% 82% 86%
Points Possible 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9
Points Received 8.5 9 9 5.1 6.9 9 9 7.9 5.3 8.5 7.9 5.6 7.3 8.5 9 7.4 7.8
07.043 Did the PCP review the specialist's report and see the inmate for a follow-up appointment within specified timelines following the completion of the specialty service?
Score 36% 33% 87% 58% 46% 85% 27% 73% 18% 100% 36% 50% 33% 67% 20% 31% 55%
Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
Points Received 3.6 3.3 8.7 5.8 4.6 8.5 2.7 7.3 1.8 10 3.6 5 3.3 6.7 2 3.1 5.5
08.184 Did the medical emergency responder arrive at the location of the medical emergency within eight minutes of initial notification?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 80% 100% 100% 100% 97%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 6 6 6 6 6 6 6 6 6 6 6 6 4.8 6 6 6 5.8
09.066 New arrival only: Did the inmate receive a pregnancy test within three (3) business days of arrival at the institution to positively identify her pregnancy?
Score 100% 75%
Points Possible 5 5
Points Received 5 3.8
09.067 New arrival only: Was the inmate seen by an OB physician or OB nurse practitioner within seven (7) business days of her arrival at the institution?
Score 100% 100%
Points Possible 5 5
Points Received 5 5.0
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 47
Office of the Inspector General State of California
APPENDIX C-2
Access to Providers and Services
Page 5 of 8
Ref
Number SOL CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP SQ CCC
09.071 Did the inmate visit with an OB physician according to the applicable timeframes?
Score 86%
Points Possible 8
Points Received 6.9
09.074 Did the inmate receive her six-week check-up (post-delivery)?
Score 80%
Points Possible 7
Points Received 5.6
10.085 All inmates from the age of 51 through the age of 75: Did the inmate appropriately receive colorectal cancer screening?
Score 100% 70% 80% 10% 100% 60% 90% 100% 100% 40% 90% 70% 50% 90% 60% 40% 40%
Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
Points Received 5 3.5 4 0.5 5 3 4.5 5 5 2 4.5 3.5 2.5 4.5 3 2 2
10.086 All inmates age 65 or older: Did the inmate receive an influenza vaccination for the most recent influneza season?
Score 100% 100% 50% 80% 100% 100% 100% 100% 88% 100% 100% 30% 100% 100% 100% 100% 100%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 6 6 3 4.8 6 6 6 6 5.3 6 6 1.8 6 6 6 6 6
10.087 Female inmates from the age of 52 through the age of 74: Did the inmate receive a mammogram within the previous 24 months?
Score 80% 50%
Points Possible 5 5
Points Received 4 2.5
10.229 Annual TB Screening: Was the inmate appropriately screened for TB within the last year?
Score 100% 100% 80% 90% 40% 100% 90% 100% 90% 100% 100% 100% 90% 100% 60% 100% 100%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 7 7 5.6 6.3 2.8 7 6.3 7 6.3 7 7 7 6.3 7 4.2 7 7
10.232 Inmates prescribed INH: Did the institution monitor the inmate monthly for the most recent three months he or she was on the medication?
Score 60% 100% 100% 60% 20% 100% 60% 100% 100% 20% 20% 100% 80% 100% 80% 100% 100%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 3.6 6 6 3.6 1.2 6 3.6 6 6 1.2 1.2 6 4.8 6 4.8 6 6
10.274 Female inmates from the age of 24 through the age of 65: Did the inmate receive a Pap smear in compliance with policy?
Score 80% 80%
Points Possible 5 5
Points Received 4 4
11.097 Did the RN conduct a FTF triage of the inmate within two business 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?
Score 100% 100% 100% 100% 100% 100% 80% 100%
Points Possible 6 6 6 6 6 6 6 6
Points Received 6 6 6 6 6 6 4.8 6
11.099 After the first 48 hours, did an RN or PCP complete daily assessments documenting the inmate's weight, physical condition, emotional condition, vital signs,
and hydration status?
Score 100% 80% 100% 80% 33% 100% 60% 75%
Points Possible 6 6 6 6 6 6 6 6
Points Received 6 4.8 6 4.8 2 6 3.6 4.5
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 48
Office of the Inspector General State of California
APPENDIX C-2
Access to Providers and Services
Page 6 of 8
Average
Ref Number NKSP KVSP FSP SAC SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score
09.071 Did the inmate visit with an OB physician according to the applicable timeframes?
Score 57% 72%
Points Possible 8 8
Points Received 4.6 5.7
09.074 Did the inmate receive her six-week check-up (post-delivery)?
Score 60% 70%
Points Possible 7 7
Points Received 4.2 4.9
10.085 All inmates from the age of 51 through the age of 75: Did the inmate appropriately receive colorectal cancer screening?
Score 40% 70% 100% 100% 60% 80% 100% 90% 90% 90% 60% 90% 80% 100% 90% 100% 77%
Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
Points Received 2 3.5 5 5 3 4 5 4.5 4.5 4.5 3 4.5 4 5 4.5 5 3.8
10.086 All inmates age 65 or older: Did the inmate receive an influenza vaccination for the most recent influneza season?
Score 88% 100% 100% 100% 100% 100% 100% 90% 100% 80% 90% 100% 100% 100% 100% 94%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 5.3 6 6 6 6 6 6 5.4 6 4.8 5.4 6 6 6 6 5.6
10.087 Female inmates from the age of 52 through the age of 74: Did the inmate receive a mammogram within the previous 24 months?
Score 100% 77%
Points Possible 5 5
Points Received 5 3.8
10.229 Annual TB Screening: Was the inmate appropriately screened for TB within the last year?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 90% 100% 100% 100% 100% 100% 95%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 7 7 7 7 7 7 7 7 7 7 6.3 7 7 7 7 7 6.6
10.232 Inmates prescribed INH: Did the institution monitor the inmate monthly for the most recent three months he or she was on the medication?
Score 20% 100% 100% 60% 40% 100% 80% 60% 80% 100% 40% 60% 100% 100% 100% 100% 77%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 1.2 6 6 3.6 2.4 6 4.8 3.6 4.8 6 2.4 3.6 6 6 6 6 4.6
10.274 Female inmates from the age of 24 through the age of 65: Did the inmate receive a Pap smear in compliance with policy?
Score 80% 80%
Points Possible 5 5
Points Received 4 4.0
11.097 Did the RN conduct a FTF triage of the inmate within two business 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?
Score 100% 80% 75% 100% 80% 100% 100% 100% 100% 80% 100% 94%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 6 4.8 4.5 6 4.8 6 6 6 6 4.8 6 5.7
11.099 After the first 48 hours, did an RN or PCP complete daily assessments documenting the inmate's weight, physical condition, emotional condition, vital signs, and
hydration status?
Score 40% 40% 50% 50% 60% 100% 100% 20% 100% 40% 100% 70%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 2.4 2.4 3 3 3.6 6 6 1.2 6 2.4 6 4.2
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 49
Office of the Inspector General State of California
APPENDIX C-2
Access to Providers and Services
Page 7 of 8
Ref
Number SOL CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP SQ CCC
11.100 After the first 72 hours, did a physician perform a physical examination and order a metabolic panel and a urinalysis of the inmate?
Score 80% 100% 100% 100% 67% 100% 100% 76%
Points Possible 7 7 7 7 7 7 7 7
Points Received 5.6 7 7 7 4.7 7 7 5.3
21.249 Upon the inmate's discharge from the community hospital, did the inmate receive a follow-up appointment with his or her PCP within five calendar days of
discharge?
Score 71% 96% 84% 80% 56% 88% 88% 96% 95% 70% 59% 100% 100% 96% 67% 76% 100%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 5.7 7.7 6.7 6.4 4.5 7 7 7.7 7.6 5.6 4.7 8 8 7.7 5.3 6.1 8
Total Points Received 102.2 154.6 137.5 110.5 118.2 120.7 138.3 146.8 151 113.9 124.5 112 168.7 153.7 134.7 131.4 144.6
Total Points Possible 147 179 180 147 168 155 166 161 173 173 168 157 199 180 173 167 161
Total Score 69.5% 86.4% 76.4% 75.2% 70.4% 77.9% 83.3% 91.2% 87.3% 65.8% 74.1% 71.3% 84.8% 85.4% 77.9% 78.7% 89.8%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 50
Office of the Inspector General State of California
APPENDIX C-2
Access to Providers and Services
Page 8 of 8
Average
Ref Number NKSP KVSP FSP SAC SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score
11.100 After the first 72 hours, did a physician perform a physical examination and order a metabolic panel and a urinalysis of the inmate?
Score 60% 60% 26% 100% 40% 100% 100% 40% 100% 76% 100% 80%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 4.2 4.2 1.8 7 2.8 7 7 2.8 7 5.3 7 5.6
21.249 Upon the inmate's discharge from the community hospital, did the inmate receive a follow-up appointment with his or her PCP within five calendar days of
discharge?
Score 60% 73% 96% 80% 81% 80% 80% 96% 95% 80% 88% 73% 76% 80% 69% 95% 83%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 4.8 5.8 7.7 6.4 6.5 6.4 6.4 7.7 7.6 6.4 7 5.8 6.1 6.4 5.5 7.6 6.6
Total Points Received 99.9 122.3 133.6 133 114.7 178.2 136.4 130.6 130.6 157.3 129.9 112.2 114.5 154.9 116.7 147.2 4375.3
Total Points Possible 145 160 147 176 166 203 180 161 180 180 180 147 161 187 166 173 5566
Total Score 68.9% 76.4% 90.9% 75.6% 69.1% 87.8% 75.8% 81.1% 72.6% 87.4% 72.2% 76.3% 71.1% 82.8% 70.3% 85.1% 78.6%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 51
Office of the Inspector General State of California
APPENDIX C-3
Primary Care Provider Responsibilities
Page 1 of 6
Category Definition: Assesses how well the prisons' physicians, nurse practitioners, and physician assistants perform their duties and whether processes related to providing
clinical care are consistent with policy.
Ref Number SOL CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP SQ CCC
02.211 Reception center: Is the history of present illness section of the provider's intake history and physical examination complete and appropriate to the chief
complaint(s), if any?
Score 85% 85% 75% 100% 100% 80% 65%
Points Possible 2 2 2 2 2 2 2
Points Received 1.7 1.7 1.5 2 2 1.6 1.3
02.212 Reception Center: Is the past medical history complete?
Score 100% 95% 65% 60% 80% 75% 70%
Points Possible 2 2 2 2 2 2 2
Points Received 2 1.9 1.3 1.2 1.6 1.5 1.4
02.213 Reception Center: Is the family and social history complete?
Score 100% 100% 90% 80% 100% 80% 80%
Points Possible 1 1 1 1 1 1 1
Points Received 1 1 0.9 0.8 1 0.8 0.8
02.215 Reception Center: Is the review of systems complete?
Score 80% 95% 75% 100% 60% 40% 80%
Points Possible 2 2 2 2 2 2 2
Points Received 1.6 1.9 1.5 2 1.2 0.8 1.6
02.216 Reception Center: Is the physical examination complete and appropriate to the history and review of systems?
Score 90% 100% 100% 90% 100% 85% 60%
Points Possible 2 2 2 2 2 2 2
Points Received 1.8 2 2 1.8 2 1.7 1.2
02.217 Reception Center: Is the assessment appropriate to the history and physical examination?
Score 70% 93% 90% 90% 100% 93% 87%
Points Possible 3 3 3 3 3 3 3
Points Received 2.1 2.8 2.7 2.7 3 2.8 2.6
02.218 Reception Center: Is the plan appropriate to the assessment?
Score 80% 90% 90% 100% 100% 88% 100%
Points Possible 4 4 4 4 4 4 4
Points Received 3.2 3.6 3.6 4 4 3.5 4
02.219 Reception Center: Has required intake testing been completed?
Score 50% 87% 80% 90% 100% 70% 67% 87%
Points Possible 3 3 3 3 3 3 3 3
Points Received 1.5 2.6 2.4 2.7 3 2.1 2 2.6
03.082 Did the institution document that it provided the inmate with health care education?
Score 96% 67% 100% 63% 97% 80% 83% 100% 100% 88% 97% 100% 92% 80% 88% 97% 92%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 5.8 4 6 3.8 5.8 4.8 5 6 6 5.3 5.8 6 5.5 4.8 5.3 5.8 5.5
3.235 Is the clinical history adequate?
Score 58% 65% 63% 64% 50% 48% 46% 64% 60% 63% 64% 72% 84% 60% 76% 64% 80%
Points Possible 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18
Points Received 10.5 11.7 11.3 11.5 9 8.6 8.3 11.5 10.8 11.3 11.5 13 15.1 10.8 13.7 11.5 14.4
03.236 Is the focused clinical examination adequate?
Score 68.1% 55.0% 72.5% 65.0% 95.0% 51.9% 63.8% 85.0% 100.0% 66.9% 90.6% 80.0% 90.6% 72.5% 81.3% 79.4% 85.6%
Points Possible 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16
Points Received 10.9 8.8 11.6 10.4 15.2 8.3 10.2 13.6 16 10.7 14.5 12.8 14.5 11.6 13 12.7 13.7
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 52
Office of the Inspector General State of California
APPENDIX C-3
Primary Care Provider Responsibilities
Page 2 of 6
Category Definition: Assesses how well the prisons' physicians, nurse practitioners, and physician assistants perform their duties and whether processes related to providing clinical care
are consistent with policy.
Average
Ref Number NKSP KVSP FSP SAC SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score
02.211 Reception center: Is the history of present illness section of the provider's intake history and physical examination complete and appropriate to the chief complaint(s),
if any?
Score 85% 95% 57% 70% 82%
Points Possible 2 2 2 2 2
Points Received 1.7 1.9 1.1 1.4 1.6
02.212 Reception Center: Is the past medical history complete?
Score 80% 85% 95% 95% 82%
Points Possible 2 2 2 2 2
Points Received 1.6 1.7 1.9 1.9 1.6
02.213 Reception Center: Is the family and social history complete?
Score 90% 100% 80% 100% 91%
Points Possible 1 1 1 1 1
Points Received 0.9 1 0.8 1 0.9
02.215 Reception Center: Is the review of systems complete?
Score 95% 85% 25% 100% 76%
Points Possible 2 2 2 2 2
Points Received 1.9 1.7 0.5 2 1.5
02.216 Reception Center: Is the physical examination complete and appropriate to the history and review of systems?
Score 80% 100% 90% 100% 90%
Points Possible 2 2 2 2 2
Points Received 1.6 2 1.8 2 1.8
02.217 Reception Center: Is the assessment appropriate to the history and physical examination?
Score 90% 93% 80% 97% 89%
Points Possible 3 3 3 3 3
Points Received 2.7 2.8 2.4 2.9 2.7
02.218 Reception Center: Is the plan appropriate to the assessment?
Score 95% 100% 95% 100% 94%
Points Possible 4 4 4 4 4
Points Received 3.8 4 3.8 4 3.8
02.219 Reception Center: Has required intake testing been completed?
Score 97% 90% 90% 63% 81%
Points Possible 3 3 3 3 3
Points Received 2.9 2.7 2.7 1.9 2.4
03.082 Did the institution document that it provided the inmate with health care education?
Score 100% 83% 97% 88% 100% 100% 100% 83% 77% 95% 88% 83% 68% 100% 100% 88% 90%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 6 5 5.8 5.3 6 6 6 5 4.6 5.7 5.3 5 4.1 6 6 5.3 5.4
3.235 Is the clinical history adequate?
Score 44% 67% 80% 50% 64% 79% 86% 92% 80% 86% 56% 76% 44% 84% 88% 58% 67%
Points Possible 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18
Points Received 7.9 12 14.4 9 11.5 14.3 15.5 16.6 14.4 15.5 10.1 13.7 7.9 15.1 15.8 10.5 12.1
03.236 Is the focused clinical examination adequate?
Score 78.1% 63.8% 70.6% 100.0% 95.6% 95.0% 85.6% 76.3% 81.9% 75.0% 72.5% 76.3% 54.4% 71.3% 85.0% 70.0% 77.4%
Points Possible 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16
Points Received 12.5 10.2 11.3 16 15.3 15.2 13.7 12.2 13.1 12 11.6 12.2 8.7 11.4 13.6 11.2 12.4
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 53
Office of the Inspector General State of California
APPENDIX C-3
Primary Care Provider Responsibilities
Page 3 of 6
Ref Number SOL CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP SQ CCC
03.237 Is the assessment adequate?
Score 80% 70% 57% 88% 83% 79% 77% 71% 88% 68% 80% 75% 56% 75% 96% 96% 96%
Points Possible 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18
Points Received 14.4 12.6 10.2 15.8 15 14.3 13.9 12.8 15.8 12.2 14.4 13.5 10.1 13.5 17.3 17.2 17.2
03.238 Is the plan adequate?
Score 94% 63% 88% 83% 84% 89% 88% 92% 84% 82% 79% 75% 84% 86% 83% 88% 86%
Points Possible 21 16 16 16 16 16 16 16 16 16 16 16 16 21 16 16 21
Points Received 19.8 10 14.1 13.3 13.5 14.3 14 14.7 13.5 13.1 12.7 12 13.4 18.1 13.2 14.1 18.1
03.262 Is the inmate's Problem List complete and filed accurately in the inmate's UHR?
Score 96% 91% 88% 100% 100% 88% 96% 100% 96% 73% 100% 88% 48% 100% 96% 100% 96%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 7.7 7.3 7 8 8 7 7.7 8 7.7 5.8 8 7 3.8 8 7.7 8 7.7
04.056 Did the PCP's plan adequately address the patients medical needs?
Score 100% 100% 100% 100% 100% 50% 100% 100% 100%
Points Possible 7 7 7 7 7 7 7 7 7
Points Received 7 7 7 7 7 3.5 7 7 7
04.112 Was the PCP's initial evaluation adequate for the problem(s) requiring OHU placement?
Score 80% 100% 90% 70% 70% 0% 70% 100% 87%
Points Possible 7 7 7 7 7 7 7 7 7
Points Received 5.6 7 6.3 4.9 4.9 0 4.9 7 6.1
04.208 Was the level of care available in the OHU adequate for the patient's clinical needs?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 7 7 7 7 7 7 7 7 7
Points Received 7 7 7 7 7 7 7 7 7
04.230 Was the PCP's initial assessment (or diagnoses) appropriate for the findings in the initial evaluation?
Score 89% 100% 100% 80% 100% 0% 100% 100% 100%
Points Possible 7 7 7 7 7 7 7 7 7
Points Received 6.2 7 7 5.6 7 0 7 7 7
06.191 All diagnostic services: At the next clinic visit following report of a clinically significant abnormal diagnostic test result, did the PCP document the abnormal
test result in the progress note?
Score 54.3% 100.0% 100.0% 71.4% 80.0% 71.4% 64.3% 92.9% 72.9% 64.3% 57.1% 68.6% 91.4% 64.3% 61.4% 82.9% 35.7%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 3.8 7 7 5 5.6 5 4.5 6.5 5.1 4.5 4 4.8 6.4 4.5 4.3 5.8 2.5
06.263 All diagnostic services: At the next clinic visit following the report of a clinically significant abnormal diagnostic test, did the PCP adequately manage the
result?
Score 88% 100% 93% 90% 92% 63% 100% 100% 100% 100% 100% 100% 100% 100% 86% 90% 100%
Points Possible 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12
Points Received 10.5 12 11.1 10.8 11 7.6 12 12 12 12 12 12 12 12 10.3 10.8 12
09.069 Did medical staff promptly order extra daily nutritional supplements and food for the inmate?
Score 100%
Points Possible 5
Points Received 5
09.072 Is the problems/risks identified section of the prenatal flow record (e.g. Briggs Form 5703N or Hollister 5703) consistent with the prenatal screens and the
maternal physical examination?
Score 57%
Points Possible 7
Points Received 4
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 54
Office of the Inspector General State of California
APPENDIX C-3
Primary Care Provider Responsibilities
Page 4 of 6
Average
Ref Number NKSP KVSP FSP SAC SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score
03.237 Is the assessment adequate?
Score 72% 77% 88% 86% 77% 92% 90% 79% 77% 100% 83% 96% 80% 68% 91% 91% 81%
Points Possible 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18
Points Received 12.9 13.9 15.8 15.5 13.9 16.5 16.2 14.3 13.9 18 14.9 17.3 14.4 12.2 16.4 16.4 14.6
03.238 Is the plan adequate?
Score 75% 85% 88% 86% 85% 83% 90% 92% 70% 95% 71% 74% 100% 90% 78% 82% 84%
Points Possible 16 16 16 16 16 16 21 21 21 21 21 21 21 21 21 21 18
Points Received 12 13.6 14 13.8 13.6 13.2 18.9 19.3 14.6 20 15 15.5 21 18.8 16.4 17.2 15.1
03.262 Is the inmate's Problem List complete and filed accurately in the inmate's UHR?
Score 80% 84% 100% 100% 100% 100% 0% 24% 100% 30% 0% 24% 0% 36% 96% 71% 76%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 6.4 6.7 8 8 8 8 0 1.9 8 2.4 0 1.9 0 2.9 7.7 5.7 6.1
04.056 Did the PCP's plan adequately address the patients medical needs?
Score 89% 77% 100% 100% 83% 100% 100% 100% 94%
Points Possible 7 7 7 7 7 7 7 7 7
Points Received 6.2 5.4 7 7 5.8 7 7 7 6.6
04.112 Was the PCP's initial evaluation adequate for the problem(s) requiring OHU placement?
Score 100% 50% 90% 80% 100% 80% 80% 80% 78%
Points Possible 7 7 7 7 7 7 7 7 7
Points Received 7 3.5 6.3 5.6 7 5.6 5.6 5.6 5.5
04.208 Was the level of care available in the OHU adequate for the patient's clinical needs?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 7 7 7 7 7 7 7 7 7
Points Received 7 7 7 7 7 7 7 7 7.0
04.230 Was the PCP's initial assessment (or diagnoses) appropriate for the findings in the initial evaluation?
Score 100% 100% 100% 100% 100% 100% 100% 100% 92%
Points Possible 7 7 7 7 7 7 7 7 7
Points Received 7 7 7 7 7 7 7 7 6.5
06.191 All diagnostic services: At the next clinic visit following report of a clinically significant abnormal diagnostic test result, did the PCP document the abnormal test
result in the progress note?
Score 67.1% 68.6% 87.1% 71.4% 77.1% 77.1% 54.3% 77.1% 92.9% 64.3% 84.3% 85.7% 68.6% 78.6% 82.9% 68.6% 73.9%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 4.7 4.8 6.1 5 5.4 5.4 3.8 5.4 6.5 4.5 5.9 6 4.8 5.5 5.8 4.8 5.2
06.263 All diagnostic services: At the next clinic visit following the report of a clinically significant abnormal diagnostic test, did the PCP adequately manage the result?
Score 100% 100% 93% 100% 100% 90% 100% 100% 69% 100% 91% 100% 89% 100% 100% 100% 95%
Points Possible 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12
Points Received 12 12 11.1 12 12 10.8 12 12 8.3 12 10.9 12 10.7 12 12 12 11.4
09.069 Did medical staff promptly order extra daily nutritional supplements and food for the inmate?
Score 100% 100%
Points Possible 5 5
Points Received 5 5.0
09.072 Is the problems/risks identified section of the prenatal flow record (e.g. Briggs Form 5703N or Hollister 5703) consistent with the prenatal screens and the maternal
physical examination?
Score 57% 57%
Points Possible 7 7.0
Points Received 4 4.0
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 55
Office of the Inspector General State of California
APPENDIX C-3
Primary Care Provider Responsibilities
Page 5 of 6
Ref Number SOL CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP SQ CCC
09.223 Were the results of the inmate's specified prenatal screening tests documented on the prenatal flow record?
Score 58%
Points Possible 5
Points Received 2.9
11.100 After the first 72 hours, did a physician perform a physical examination and order a metabolic panel and a urinalysis of the inmate?
Score 80% 100% 100% 100% 67% 100% 100% 76%
Points Possible 7 7 7 7 7 7 7 7
Points Received 5.6 7 7 7 4.7 7 7 5.3
21.250 Upon the inmate's return from the community hospital, was the inmate placed in housing appropriate for his or her clinical status?
Score 100% 100% 100% 93% 100% 100% 100% 100% 93% 100% 100% 95% 100% 100% 100% 100% 100%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 4 4 4 3.7 4 4 4 4 3.7 4 4 3.8 4 4 4 4 4
21.276 While the patient was in the TTA, did the provider render adequate and timely clinical care, and adequately document that care?
Score 80% 92% 86% 76% 54% 59% 63% 84% 54% 71% 91% 74% 89% 73% 80% 63% 69%
Points Possible 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19
Points Received 15.2 17.5 16.4 14.5 10.2 11.2 11.9 16 10.2 13.5 17.3 14 17 13.8 15.2 11.9 13.1
Total Points Received 102.56 126.3 120.6 96.8 142.8 101 98.5 132.4 125 97.1 146.5 124.8 139 134 125.9 137.7 135.3
Total Points Possible 129 159 150 124 171 143 131 152 150 131 171 152 188 164 150 162 157
Total Score 79.5% 79.4% 80.4% 78.1% 83.5% 70.6% 75.2% 87.1% 83.3% 74.1% 85.7% 82.1% 73.9% 81.7% 83.9% 85.0% 86.2%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 56
Office of the Inspector General State of California
APPENDIX C-3
Primary Care Provider Responsibilities
Page 6 of 6
Average
Ref Number NKSP KVSP FSP SAC SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score
09.223 Were the results of the inmate's specified prenatal screening tests documented on the prenatal flow record?
Score 86% 72%
Points Possible 5 5
Points Received 4.3 3.6
11.100 After the first 72 hours, did a physician perform a physical examination and order a metabolic panel and a urinalysis of the inmate?
Score 60% 60% 26% 100% 40% 100% 100% 40% 100% 76% 100% 80%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 4.2 4.2 1.8 7 2.8 7 7 2.8 7 5.3 7 5.6
21.250 Upon the inmate's return from the community hospital, was the inmate placed in housing appropriate for his or her clinical status?
Score 100% 93% 100% 93% 100% 100% 100% 100% 100% 100% 96% 100% 100% 100% 100% 100% 99%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 4 3.7 4 3.7 4 4 4 4 4 4 3.8 4 4 4 4 4 4.0
21.276 While the patient was in the TTA, did the provider render adequate and timely clinical care, and adequately document that care?
Score 68% 67% 85% 47% 63% 68% 88% 72% 71% 84% 76% 86% 78% 81% 86% 91% 75%
Points Possible 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19
Points Received 13 12.7 16.2 8.9 11.9 13 16.8 13.6 13.5 16 14.5 16.3 14.9 15.4 16.3 17.2 14.2
Total Points Received 108.5 98.8 106.7 128.6 103.4 160.4 141.2 130.9 130.5 143.7 125.64 103.9 93.3 151.94 119.3 128.4 4061.4
Total Points Possible 143 131 124 159 131 188 164 157 164 164 164 129 136 183 136 155 5012
Total Score 75.9% 75.4% 86.0% 80.9% 78.9% 85.3% 86.1% 83.4% 79.6% 87.6% 76.6% 80.5% 68.6% 83.0% 87.7% 82.8% 81.0%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 57
Office of the Inspector General State of California
APPENDIX C-4
Continuity of Care
Page 1 of 4
Category Definition: Evaluates whether or not inmates continue to receive prescribed medical care when they move within a prison, move
between prisons, or return to prison from receiving specialty services or from being hospitalized.
Ref
Number SOL CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP SQ CCC
02.007 Non-reception center: Does the health care transfer information form indicate that it was reviewed and signed by licensed health care staff within one
calendar day of the inmate's arrival at the institution?
Score 100% 80% 86% 96% 70% 100% 86% 90% 86% 86% 96% 90% 80% 76% 96%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 7 5.6 6 6.7 4.9 7 6 6.3 6 6 6.7 6.3 5.6 5.3 6.7
02.014 Non-reception center: If the inmate was scheduled for a specialty appointment at the sending institution, did the receiving institution schedule the
appointment within 30 days of the original appointment date?
Score 50%
Points Possible 7
Points Received 3.5
02.111 Non-reception center: Did the inmate receive medical accommodations upon arrival, if applicable?
Score 100% 85% 60% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 6 5.1 3.6 6 6 6 6 6 6 6 6 6
02.128 If the inmate had an existing medication order upon arrival at the institution, did the inmate receive the medications by the next calendar day, or did a physician
document why the medications were not to be continued?
Score 54% 56% 35% 50% 45% 45% 84% 50% 40% 61% 45% 34% 0% 71% 30% 95% 66%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 4.3 4.5 2.8 4 3.6 3.6 6.7 4 3.2 4.9 3.6 2.7 0 5.7 2.4 7.6 5.3
04.051 Did the primary care provider (PCP) evaluate the inmate within one calendar day after placement?
Score 90% 100% 100% 100% 80% 100% 100% 100% 90%
Points Possible 5 5 5 5 5 5 5 5 5
Points Received 4.5 5 5 5 4 5 5 5 4.5
04.052 Did the RN complete an initial assessment of the inmate on the day of placement?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 5 5 5 5 5 5 5 5 5
Points Received 5 5 5 5 5 5 5 5 5
05.108 Did Receiving and Release have the inmate's UHR and transfer envelope?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
05.109 If the inmate was scheduled for any upcoming specialty services, were the services noted on Form 7371 (Health Care Transfer Information)?
Score 100%
Points Possible 8
Points Received 8
05.110 Do all appropriate forms in the transfer envelope identify all medications ordered by the physician; and are the medications in the transfer envelope?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 8 8 8 8 8 8 8 8 8 8 8
Points Received 8 8 8 8 8 8 8 8 8 8 8
05.171 Did an RN accurately complete all applicable sections of Form 7371 (Health Care Transfer Information) based on the inmate's UHR?
Score 20% 20% 50% 60% 80% 100% 60% 20% 20% 20% 100% 100% 100% 60% 0% 40%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 1.4 1.4 3.5 4.2 5.6 7 4.2 1.4 1.4 1.4 7 7 7 4.2 0 2.8
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 58
Office of the Inspector General State of California
APPENDIX C-4
Continuity of Care
Page 2 of 4
Category Definition: Evaluates whether or not inmates continue to receive prescribed medical care when they move within a prison, move between prisons, or return to
prison from receiving specialty services or from being hospitalized.
Ref Average
Number NKSP KVSP FSP SAC SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score
02.007 Non-reception center: Does the health care transfer information form indicate that it was reviewed and signed by licensed health care staff within one
calendar day of the inmate's arrival at the institution?
Score 80% 80% 89% 100% 86% 86% 96% 96% 90% 70% 90% 70% 56% 86%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 5.6 5.6 6.2 7 6 6 6.7 6.7 6.3 4.9 6.3 4.9 3.9 6.0
02.014 Non-reception center: If the inmate was scheduled for a specialty appointment at the sending institution, did the receiving institution schedule the
appointment within 30 days of the original appointment date?
Score 50%
Points Possible 7
Points Received 3.5
02.111 Non-reception center: Did the inmate receive medical accommodations upon arrival, if applicable?
Score 100% 100% 100% 100% 100% 100% 97%
Points Possible 6 6 6 6 6 6 6
Points Received 6 6 6 6 6 6 5.8
02.128 If the inmate had an existing medication order upon arrival at the institution, did the inmate receive the medications by the next calendar day, or did a physician
document why the medications were not to be continued?
Score 50% 66% 100% 64% 60% 75% 34% 100% 50% 100% 55% 75% 80% 100% 66% 80% 61%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 4 5.3 8 5.1 4.8 6 2.7 8 4 8 4.4 6 6.4 8 5.3 6.4 4.9
04.051 Did the primary care provider (PCP) evaluate the inmate within one calendar day after placement?
Score 100% 90% 100% 80% 100% 100% 100% 100% 96%
Points Possible 5 5 5 5 5 5 5 5 5
Points Received 5 4.5 5 4 5 5 5 5 4.8
04.052 Did the RN complete an initial assessment of the inmate on the day of placement?
Score 100% 100% 90% 100% 100% 100% 100% 100% 99%
Points Possible 5 5 5 5 5 5 5 5 5
Points Received 5 5 4.5 5 5 5 5 5 5.0
05.108 Did Receiving and Release have the inmate's UHR and transfer envelope?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7.0
05.109 If the inmate was scheduled for any upcoming specialty services, were the services noted on Form 7371 (Health Care Transfer Information)?
Score 100%
Points Possible 8
Points Received 8.0
05.110 Do all appropriate forms in the transfer envelope identify all medications ordered by the physician; and are the medications in the transfer envelope?
Score 100% 100% 100% 80% 100% 100% 75% 100% 100% 100% 40% 100% 100% 100% 96%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 8 8 8 6.4 8 8 6 8 8 8 3.2 8 8 8 7.7
05.171 Did an RN accurately complete all applicable sections of Form 7371 (Health Care Transfer Information) based on the inmate's UHR?
Score 40% 20% 60% 100% 100% 100% 40% 0% 40% 0% 100% 20% 60% 100% 100% 67% 56%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 2.8 1.4 4.2 7 7 7 2.8 0 2.8 0 7 1.4 4.2 7 7 4.7 3.9
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 59
Office of the Inspector General State of California
APPENDIX C-4
Continuity of Care
Page 3 of 4
Ref
Number SOL CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP SQ CCC
05.172 Did the medical records department maintain a copy of the inmate's Form 7371 (Health Care Transfer Information) and Form 7231A (Outpatient
Medication Administration Record) when the inmate transferred?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 8 8 8 8 8 8 8 8 8 8 8 8 8 0 8 8
07.043 Did the PCP review the specialist's report and see the inmate for a follow-up appointment within specified timelines following completion of the specialty
service?
Score 17% 87% 42% 50% 77% 18% 50% 82% 71% 64% 54% 57% 85% 69% 33% 62% 93%
Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
Points Received 1.7 8.7 4.2 5 7.7 1.8 5 8.2 7.1 6.4 5.4 5.7 8.5 6.9 3.3 6.2 9.3
07.270 Did the specialty provider provide timely findings and recommendations or did an RN document that he or she called the specialty provider to ascertain
the findings and recommendations?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
14.033 Does the institution have an adequate process to ensure inmates who are moved to a new cell still receive their medical ducats?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
21.248 Upon the inmate's discharge from the community hospital, did the TTA RN document that he or she reviewed the inmate's discharge plan and completed
a FTF assessment of the inmate?
Score 100% 92% 97% 97% 100% 97% 100% 100% 92% 95% 97% 92% 100% 100% 78% 100% 97%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 6 5.5 5.8 5.8 6 5.8 6 6 5.5 5.7 5.8 5.5 6 6 4.7 6 5.8
21.249 Upon the inmate's discharge from the community hospital, did the inmate receive a follow-up appointment with his or her primary care provider (PCP)
within five calendar days of discharge?
Score 71% 96% 84% 80% 56% 88% 88% 96% 95% 70% 59% 100% 100% 96% 66% 76% 100%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 5.7 7.7 6.7 6.4 4.5 7 7 7.7 7.6 5.6 4.7 8 8 7.7 5.3 6.1 8
21.250 Upon the inmate's return from the community hospital, was the inmate placed in housing appropriate for his or her clinical status?
Score 100% 100% 100% 93% 100% 100% 100% 100% 93% 100% 100% 95% 100% 100% 100% 100% 100%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 4 4 4 3.7 4 4 4 4 3.7 4 4 3.8 4 4 4 4 4
21.281 Upon the inmate's discharge from a community hospital, did the institution administer or deliver all prescribed medications to the inmate within
specified timeframes?
Score 87% 36% 30% 64% 67% 54% 50% 84% 50% 26% 61% 89% 69% 100% 73% 53% 94%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 6.1 2.5 2.1 4.5 4.7 3.8 3.5 5.9 3.5 1.8 4.3 6.2 4.8 7 5.1 3.7 6.6
Total Points Received 75.2 66.6 61.6 70.6 88.6 64.6 85.2 87.0 85.3 74.8 78.2 79.6 81.3 91.6 65.6 87.9 91.0
Total Points Possible 96 83 88 88 106 83 96 98 104 96 100 92 93 98 96 106 100
Total Score 78.3% 80.2% 70.0% 80.2% 83.6% 77.8% 88.8% 88.8% 82.0% 77.9% 78.2% 86.5% 87.4% 93.5% 68.3% 82.9% 91.0%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 60
Office of the Inspector General State of California
APPENDIX C-4
Continuity of Care
Page 4 of 4
Ref Average
Number NKSP KVSP FSP SAC SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score
05.172 Did the medical records department maintain a copy of the inmate's Form 7371 (Health Care Transfer Information) and Form 7231A (Outpatient Medication
Administration Record) when the inmate transferred?
Score 100% 100% 100% 100% 100% 100% 80% 100% 100% 100% 100% 100% 100% 100% 100% 100% 96%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 8 8 8 8 8 8 6.4 8 8 8 8 8 8 8 8 8 7.7
07.043 Did the PCP review the specialist's report and see the inmate for a follow-up appointment within specified timelines following completion of the specialty
service?
Score 36% 33% 87% 58% 46% 85% 27% 73% 18% 100% 36% 50% 33% 67% 20% 31% 55%
Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
Points Received 3.6 3.3 8.7 5.8 4.6 8.5 2.7 7.3 1.8 10 3.6 5 3.3 6.7 2 3.1 5.5
07.270 Did the specialty provider provide timely findings and recommendations or did an RN document that he or she called the specialty provider to ascertain the
findings and recommendations?
Score 100% 93% 100% 93% 100% 100% 100% 100% 100% 93% 100% 93% 100% 100% 100% 94% 99%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 6 5.6 6 5.6 6 6 6 6 6 5.6 6 5.6 6 6 6 5.6 5.9
14.033 Does the institution have an adequate process to ensure inmates who are moved to a new cell still receive their medical ducats?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 50% 100% 100% 100% 100% 97%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 4 4 4 4 4 4 4 4 4 2 4 2 4 4 4 4 3.9
21.248 Upon the inmate's discharge from the community hospital, did the TTA RN document that he or she reviewed the inmate's discharge plan and completed a
FTF assessment of the inmate?
Score 95% 83% 100% 72% 100% 97% 97% 88% 100% 92% 92% 100% 92% 97% 92% 100% 95%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 5.7 5 6 4.3 6 5.8 5.8 5.3 6 5.5 5.5 6 5.5 5.8 5.5 6 5.7
21.249 Upon the inmate's discharge from the community hospital, did the inmate receive a follow-up appointment with his or her primary care provider (PCP) within
five calendar days of discharge?
Score 60% 73% 96% 80% 81% 80% 80% 96% 95% 80% 88% 73% 76% 80% 69% 95% 83%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 4.8 5.8 7.7 6.4 6.5 6.4 6.4 7.7 7.6 6.4 7 5.8 6.1 6.4 5.5 7.6 6.6
21.250 Upon the inmate's return from the community hospital, was the inmate placed in housing appropriate for his or her clinical status?
Score 100% 93% 100% 93% 100% 100% 100% 100% 100% 100% 95% 100% 100% 100% 100% 100% 99%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 4 3.7 4 3.7 4 4 4 4 4 4 3.8 4 4 4 4 4 4.0
21.281 Upon the inmate's discharge from a community hospital, did the institution administer or deliver all prescribed medications to the inmate within specified
timeframes?
Score 47% 14% 94% 27% 46% 76% 84% 77% 39% 83% 94% 64% 41% 100% 100% 93% 66%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 3.3 1 6.6 1.9 3.2 5.3 5.9 5.4 2.7 5.8 6.6 4.5 2.9 7 7 6.5 4.6
Total Points Received 61.2 63.7 83.8 87.4 82.1 85.5 75.2 83.7 84.6 87.0 93.2 69.4 71.7 84.8 73.2 70.9 2592.1
Total Points Possible 83 90 90 106 96 93 100 98 106 100 106 96 90 92 90 83 3142.0
Total Score 73.7% 70.8% 93.1% 82.5% 85.5% 91.9% 75.2% 85.4% 79.8% 87.0% 87.9% 72.3% 79.7% 92.2% 81.3% 85.4% 82.5%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 61
Office of the Inspector General State of California
APPENDIX C-5
Nurse Responsibilities
Page 1 of 4
Category Definition: Evaluates how well the prisons' registered nurses and licensed vocational nurses perform their duties and whether processes related to
providing nursing care are consistent with policy.
Ref
Number SOL CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP SQ CCC
01.024 RN FTF Documentation: Did the inmate's request for health care get reviewed the same day it was received?
Score 100% 100% 100% 97% 100% 100% 70% 100% 100% 97% 100% 100% 92% 97% 87% 100% 100%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 6 6 6 5.8 6 6 4.2 6 6 5.8 6 6 5.5 5.8 5.2 6 6
01.157 RN FTF Documentation: Did the RN's subjective note address the nature and history of the inmate's clinically significant complaint(s)?
Score 63% 47% 60% 90% 53% 83% 60% 70% 73% 80% 50% 55% 43% 97% 73% 60% 88%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 3.8 2.8 3.6 5.4 3.2 5 3.6 4.2 4.4 4.8 3 3.3 2.6 5.8 4.4 3.6 5.3
01.158 RN FTF Documentation: For the clinically significant complaints, did the RN's assessment provide appropriate conclusions based on subjective and objective
data?
Score 68% 76% 86% 96% 70% 92% 68% 70% 70% 86% 70% 76% 76% 100% 74% 68% 76%
Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
Points Received 3.4 3.8 4.3 4.8 3.5 4.6 3.4 3.5 3.5 4.3 3.5 3.8 3.8 5 3.7 3.4 3.8
01.159 RN FTF Documentation: Did the RN's objective note include vital signs and a focused physical examination, and did it adequately address the clinically
significant problems noted in the subjective note?
Score 52% 36% 54% 76% 50% 84% 32% 66% 60% 72% 42% 80% 60% 84% 46% 48% 76%
Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
Points Received 2.6 1.8 2.7 3.8 2.5 4.2 1.6 3.3 3 3.6 2.1 4 3 4.2 2.3 2.4 3.8
01.162 RN FTF Documentation: Did the RN's plan include an adequate strategy to address the clinically significant problems identified during the FTF triage?
Score 63% 70% 65% 87% 87% 100% 92% 75% 80% 77% 87% 85% 100% 97% 80% 88% 88%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 3.8 4.2 3.9 5.2 5.2 6 5.5 4.5 4.8 4.6 5.2 5.1 6 5.8 4.8 5.3 5.3
01.163 RN FTF Documentation: Did the RN's education/instruction adequately address the clinically significant problems identified during the FTF triage?
Score 85% 93% 93% 93% 93% 100% 100% 95% 88% 88% 88% 95% 88% 100% 88% 95% 100%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 3.4 3.7 3.7 3.7 3.7 4 4 3.8 3.5 3.5 3.5 3.8 3.5 4 3.5 3.8 4
01.244 RN FTF Documentation: Did the RN's objective note include allergies, weight, current medication, and where appropriate, medication compliance?
Score 43% 40% 37% 73% 57% 67% 7% 77% 80% 90% 77% 80% 33% 97% 53% 67% 87%
Points Possible 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Points Received 1.3 1.2 1.1 2.2 1.7 2 0.2 2.3 2.4 2.7 2.3 2.4 1 2.9 1.6 2 2.6
01.246 Did documentation indicate that the RN reviewed all of the inmate's clinically significant complaints listed on Form 7362?
Score 88% 98% 93% 100% 98% 95% 95% 95% 98% 98% 100% 95% 88% 93% 83% 98% 100%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 3.5 3.9 3.7 4 3.9 3.8 3.8 3.8 3.9 3.9 4 3.8 3.5 3.7 3.3 3.9 4
02.015 Was a review of symptoms completed if the inmate's tuberculin test was positive, and were the results reviewed by the infection control nurse or the public health
nurse?
Score 100% 0%
Points Possible 7 7
Points Received 7 0
02.017 If "Yes" was answered to any of the questions on the initial health screening form(s), did the RN provide an assessment and disposition on the date of arrival?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 94% 100% 100% 100% 100% 100%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 8 8 8 8 8 8 8 8 8 8 7.5 8 8 8 8 8
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 62
Office of the Inspector General State of California
APPENDIX C-5
Nurse Responsibilities
Page 2 of 4
Category Definition: Evaluates how well the prisons' registered nurses and licensed vocational nurses perform their duties and whether processes related to providing
nursing care are consistent with policy.
Ref Average
Number NKSP KVSP FSP SAC SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score
01.024 RN FTF Documentation: Did the inmate's request for health care get reviewed the same day it was received?
Score 77% 89% 97% 83% 63% 100% 100% 83% 89% 100% 80% 83% 93% 92% 55% 95% 91%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 4.6 5.3 5.8 5 3.8 6 6 5 5.3 6 4.8 5 5.6 5.5 3.3 5.7 5.5
01.157 RN FTF Documentation: Did the RN's subjective note address the nature and history of the inmate's clinically significant complaint(s)?
Score 40% 40% 77% 60% 78% 63% 90% 70% 85% 83% 85% 67% 70% 100% 95% 65% 70%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 2.4 2.4 4.6 3.6 4.7 3.8 5.4 4.2 5.1 5 5.1 4 4.2 6 5.7 3.9 4.2
01.158 RN FTF Documentation: For the clinically significant complaints, did the RN's assessment provide appropriate conclusions based on subjective and objective data?
Score 72% 74% 90% 68% 56% 68% 70% 70% 68% 76% 68% 26% 66% 92% 78% 86% 74%
Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
Points Received 3.6 3.7 4.5 3.4 2.8 3.4 3.5 3.5 3.4 3.8 3.4 1.3 3.3 4.6 3.9 4.3 3.7
01.159 RN FTF Documentation: Did the RN's objective note include vital signs and a focused physical examination, and did it adequately address the clinically significant
problems noted in the subjective note?
Score 36% 38% 44% 40% 66% 58% 76% 56% 60% 60% 68% 54% 46% 80% 86% 52% 59%
Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
Points Received 1.8 1.9 2.2 2 3.3 2.9 3.8 2.8 3 3 3.4 2.7 2.3 4 4.3 2.6 2.9
01.162 RN FTF Documentation: Did the RN's plan include an adequate strategy to address the clinically significant problems identified during the FTF triage?
Score 80% 83% 97% 80% 80% 80% 97% 93% 100% 90% 75% 100% 83% 100% 95% 92% 86%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 4.8 5 5.8 4.8 4.8 4.8 5.8 5.6 6 5.4 4.5 6 5 6 5.7 5.5 5.2
01.163 RN FTF Documentation: Did the RN's education/instruction adequately address the clinically significant problems identified during the FTF triage?
Score 93% 83% 93% 73% 95% 85% 88% 100% 98% 98% 93% 93% 93% 100% 100% 100% 93%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 3.7 3.3 3.7 2.9 3.8 3.4 3.5 4 3.9 3.9 3.7 3.7 3.7 4 4 4 3.7
01.244 RN FTF Documentation: Did the RN's objective note include allergies, weight, current medication, and where appropriate, medication compliance?
Score 67% 50% 83% 37% 67% 67% 53% 67% 87% 90% 50% 80% 60% 60% 87% 70% 65%
Points Possible 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
Points Received 2 1.5 2.5 1.1 2 2 1.6 2 2.6 2.7 1.5 2.4 1.8 1.8 2.6 2.1 1.9
01.246 Did documentation indicate that the RN reviewed all of the inmate's clinically significant complaints listed on Form 7362?
Score 93% 93% 98% 93% 85% 95% 93% 100% 98% 98% 93% 95% 93% 93% 100% 98% 95%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 3.7 3.7 3.9 3.7 3.4 3.8 3.7 4 3.9 3.9 3.7 3.8 3.7 3.7 4 3.9 3.8
02.015 Was a review of symptoms completed if the inmate's tuberculin test was positive, and were the results reviewed by the infection control nurse or the public health nurse?
Score 50%
Points Possible 7
Points Received 3.5
02.017 If "Yes" was answered to any of the questions on the initial health screening form(s), did the RN provide an assessment and disposition on the date of arrival?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8.0
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 63
Office of the Inspector General State of California
APPENDIX C-5
Nurse Responsibilities
Page 3 of 4
Ref
Number SOL CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP SQ CCC
02.020 Did the LVN/RN adequately document the tuberculin test and timely reading of the test results: or, if the inmate did not have a TB test because of a previous
positive TB test, was a review of signs and symptoms completed?
Score 68% 85% 83% 80% 80% 100% 100% 90% 85% 50% 87% 95% 90% 95% 90% 100% 90%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 4.1 5.1 5 4.8 4.8 6 6 5.4 5.1 3 5.2 5.7 5.4 5.7 5.4 6 5.4
05.109 If the inmate was scheduled for any upcoming specialty services, were the services noted on Form 7371 (Health Care Transfer Information)?
Score 100%
Points Possible 8
Points Received 8
05.110 Do all appropriate forms in the transfer envelope identify all medications ordered by the physician, and are the medications in the transfer envelope?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 8 8 8 8 8 8 8 8 8 8 8
Points Received 8 8 8 8 8 8 8 8 8 8 8
05.171 Did an RN accurately complete all applicable sections of Form 7371 (Health Care Transfer Information) based on the inmate's UHR?
Score 20% 20% 50% 60% 80% 100% 60% 20% 20% 20% 100% 100% 100% 60% 0% 40%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 1.4 1.4 3.5 4.2 5.6 7 4.2 1.4 1.4 1.4 7 7 7 4.2 0 2.8
08.185 Did the medical emergency responder use proper equipment to address the emergency and was adequate medical care provided within the scope of their license?
Score 80% 100% 100% 60% 0% 76% 80% 100% 40% 80% 100% 76% 40% 80% 80% 50% 100%
Points Possible 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9
Points Received 7.2 9 9 5.4 0 6.8 7.2 9 3.6 7.2 9 6.8 3.6 7.2 7.2 4.5 9
09.224 Was the inmate's weight and blood pressure documented at each clinic visit?
Score 100%
Points Possible 6
Points Received 6
11.097 Did the RN conduct a FTF triage of the inmate within two business 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?
Score 100% 100% 100% 100% 100% 100% 80% 100%
Points Possible 6 6 6 6 6 6 6 6
Points Received 6 6 6 6 6 6 4.8 6
14.131 Do medication nurses understand that the licensed staff member who prepares the medication must also administer it on the day it is prepared?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
21.248 Upon the inmate's discharge from the community hospital, did the TTA RN document that he or she reviewed the inmate's discharge plan and completed a FTF
assessment of the inmate?
Score 100% 93% 97% 97% 100% 97% 100% 100% 92% 95% 97% 92% 100% 100% 78% 100% 97%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 6 5.6 5.8 5.8 6 5.8 6 6 5.5 5.7 5.8 5.5 6 6 4.7 6 5.8
Total Points Received 66.5 65.1 75.2 66.4 64.7 79.8 78.5 68.0 81.1 76.5 70.5 69.2 76.9 81.1 75.1 64.9 77.8
Total Points Possible 87 78 92 79 87 87 93 79 101 100 87 79 93 85 93 85 87
Total Score 76.4% 83.5% 81.7% 84.1% 74.4% 91.7% 84.4% 86.1% 80.3% 76.5% 81.0% 87.6% 82.7% 95.4% 80.8% 76.4% 89.4%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 64
Office of the Inspector General State of California
APPENDIX C-5
Nurse Responsibilities
Page 4 of 4
Ref Average
Number NKSP KVSP FSP SAC SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score
02.020 Did the LVN/RN adequately document the tuberculin test and timely reading of the test results: or, if the inmate did not have a TB test because of a previous positive TB
test, was a review of signs and symptoms completed?
Score 95% 90% 95% 90% 100% 100% 90% 70% 90% 70% 83% 68% 68% 95% 100% 100% 87%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 5.7 5.4 5.7 5.4 6 6 5.4 4.2 5.4 4.2 5 4.1 4.1 5.7 6 6 5.2
05.109 If the inmate was scheduled for any upcoming specialty services, were the services noted on Form 7371 (Health Care Transfer Information)?
Score 100%
Points Possible 8
Points Received 8.0
05.110 Do all appropriate forms in the transfer envelope identify all medications ordered by the physician, and are the medications in the transfer envelope?
Score 100% 100% 100% 80% 100% 100% 75% 100% 100% 100% 40% 100% 100% 100% 96%
Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
Points Received 8 8 8 6.4 8 8 6 8 8 8 3.2 8 8 8 7.7
05.171 Did an RN accurately complete all applicable sections of Form 7371 (Health Care Transfer Information) based on the inmate's UHR?
Score 40% 20% 60% 100% 100% 100% 40% 0% 40% 0% 100% 20% 60% 100% 100% 67% 56%
Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
Points Received 2.8 1.4 4.2 7 7 7 2.8 0 2.8 0 7 1.4 4.2 7 7 4.7 3.9
08.185 Did the medical emergency responder use proper equipment to address the emergency and was adequate medical care provided within the scope of their license?
Score 60% 80% 50% 80% 80% 100% 80% 50% 80% 33% 0% 40% 80% 80% 100% 20% 68%
Points Possible 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9
Points Received 5.4 7.2 4.5 7.2 7.2 9 7.2 4.5 7.2 3 0 3.6 7.2 7.2 9 1.8 6.1
09.224 Was the inmate's weight and blood pressure documented at each clinic visit?
Score 100% 100%
Points Possible 6 6
Points Received 6 6.0
11.097 Did the RN conduct a FTF triage of the inmate within two business 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?
Score 100% 80% 75% 100% 80% 100% 100% 100% 100% 80% 100% 94%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 6 4.8 4.5 6 4.8 6 6 6 6 4.8 6 5.7
14.131 Do medication nurses understand that the licensed staff member who prepares the medication must also administer it on the day it is prepared?
Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4.0
21.248 Upon the inmate's discharge from the community hospital, did the TTA RN document that he or she reviewed the inmate's discharge plan and completed a FTF
assessment of the inmate?
Score 95% 83% 100% 72% 100% 97% 97% 88% 100% 92% 92% 100% 92% 96% 92% 100% 95%
Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
Points Received 5.7 5 6 4.3 6 5.8 5.8 5.3 6 5.5 5.5 6 5.5 5.8 5.5 6 5.7
Total Points Received 66.2 71.8 73.4 73.6 79.3 83.9 78.5 57.1 79.4 72.4 73.6 59.2 76.6 79.3 85.8 76.5 2423.9
Total Points Possible 87 93 87 93 93 93 93 79 93 93 93 87 93 85 93 93 2940
Total Score 76.1% 77.2% 84.4% 79.1% 85.3% 90.2% 84.4% 72.3% 85.4% 77.8% 79.1% 68.0% 82.4% 93.2% 92.3% 82.3% 82.4%
Comparative Summary and Analysis of the First and Second
Medical Inspection Cycles of California's 33 Adult Institutions Page 65
Office of the Inspector General State of California