Comparative Summary and Analysis of the First Three Medical Inspection Cycles of Californias 33 Adult Institutions

Robert A. Barton Office of the Inspector General Inspector General COMPARATIVE SUMMARY AND ANALYSIS OF THE FIRST, SECOND, AND THIRD MEDICAL INSPECTION CYCLES OF CALIFORNIA'S 33 ADULT INSTITUTIONS July 2013 Office of the Inspector General COMPARATIVE SUMMARY AND ANALYSIS OF THE FIRST, SECOND, AND THIRD MEDICAL INSPECTION CYCLES OF CALIFORNIA’S 33 ADULT INSTITUTIONS Robert A. Barton Inspector General Roy W. Wesley Chief Deputy Inspector General James C. Spurling Chief Counsel Renee L. Hansen Executive Director, California Rehabilitation Oversight Board Public Information Officer 10111 Old Placerville Rd. Suite 110 Sacramento, CA 95827 Telephone: 916-255-1102 Facsimile: 916-255-1403 July 2013 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 and the Court-appointed Receiver, and authorized by California Penal Code section 6126, in 2007 the Office of the Inspector General (OIG) developed a Cycle 3 Key Statistics comprehensive inspection program in cooperation with Overall Score - All Components current key stakeholders to periodically review delivery of Average Score . . . . . . . . . . . . . . 87.0% medical care at each state prison and measure compliance Range of Scores . . . . . . . . 77.6-93.4% with health care policies and procedures. Variation . . . . . . . . . . . . . . . . . 15.8% Number of Institutions with: This report is a comparative summary and analysis of the High Adherence ................. 25 first, second, and third cycles of the OIG’s medical Moderate Adherence ............ 8 inspections of the 33 adult institutions operated by the Low Adherence .................... 0 California Department of Corrections and Rehabilitation (CDCR). This report compares differences in trends from the first, second, and third reporting cycles. 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 OIG’s individual medical inspection reports, this comprehensive report puts the institutions’ scores into a qualitative context. It does so by comparing the institutions’ average and individual scores to the Receiver’s scoring criteria for three levels of adherence to policies and procedures. The OIG’s published inspection reports contain an overall percentage score as well as percentage scores for component areas for each of the 33 adult institutions. The Receiver currently applies the following scoring criteria to measure each institution’s adherence to medical policies and procedures: • More than 85 percent: High Adherence Cycle 3 Key Statistics • 75 to 85 percent: Moderate Adherence Average Scores per Medical Category • Less than 75 percent: Low Adherence Medication Management . . . . . . . . . . . . . . 87.4% Access to Providers & Services . . . . . . . . . 87.1% Following each inspection, the Receiver requires Primary Care Provider Responsibilities . . 85.9% the institution to develop a Performance Continuity of Care . . . . . . . . . . . . . . . . . . . 91.0% Nurse Responsibilities . . . . . . . . . . . . . . . . 91.2% Improvement Work Plan containing specific strategies and actions that focus on core processes and causes for each deficiency. In providing a qualitative context to the percentage scores, it is not the intention of the OIG to determine that the percentage score meets a constitutional standard of medical care. That determination remains with the Court. Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page i Office of the Inspector General State of California Results by Medical Component The 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 compliance with health care policies and procedures among institutions, and provides information about each institution’s performance in specific component areas. According to the Receiver’s scoring criteria, all but one of the 33 institutions improved their overall medical care scores in cycle 3 compared to cycle 2. Overall scores and individual component scores are published in each institution’s medical inspection report and summarized in Appendix B of this report. An institution’s adherence to policies and procedures is measured based on a series of medical care questions and point values assessed on total points possible for each question. In the May 2011 cycle 1 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 (in order of importance): 75 percent level for moderate adherence. The average overall Chronic Care weighted score for cycle 1 was 71.9 percent, ranging from Clinical Services 62.4 percent to 83.2 percent. Health Screening Specialty Services Urgent Services In the July 2012 cycle 2 analysis report, 29 institutions met or Emergency Services exceeded the 75 percent level for moderate adherence, Prenatal Care/Childbirth/Post-Delivery including 4 institutions achieving high adherence. The average Diagnostic Services overall weighted score for cycle 2 was 79.6 percent, an Access to Health Care Information Outpatient Housing Unit increase of 7.7 percent from the cycle 1 average. Cycle 2 Internal Reviews institutions’ scores ranged from 73.0 percent to 89.5 percent. Inmate Transfers Clinic Operations By contrast, this comparative summary and analysis of cycle 1, Preventive Services Pharmacy Services cycle 2, and cycle 3 medical inspections indicates all Other Services 33 institutions met or exceeded the 75 percent score for Inmate Hunger Strikes moderate adherence, including 25 institutions achieving high Chemical Agent Contraindications adherence in cycle 3. The average overall weighted score for Staffing Levels and Training Nursing Policy cycle 3 was 87.0 percent, an increase of 7.4 percent from cycle 2, and 15.1 percent from cycle 1. Cycle 3 institutions’ scores ranged from 77.6 percent to 93.4 percent. Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page ii Office of the Inspector General State of California Charts 1A and 1B illustrate the differences in scores from cycle 1 to cycle 2 to cycle 3. Chart 1A displays the cycle 1, cycle 2, and cycle 3 overall medical inspection scores (sorted low to high), illustrating a significant increase in the number of institutions scoring at or above the high adherence level. Chart 1B displays the medical inspection scores (sorted by institution) for cycle 1, cycle 2, and cycle 3. Chart 1A: Cycle 1, Cycle 2, and Cycle 3 Overall Score Comparison, Sorted Low to High Each data point represents an institution’s cycle score. Overall, all 33 institutions have collectively received improved scores from cycle 1 through cycle 3. During cycle 3, all institutions scored above the minimum moderate adherence level threshold of 75 percent for the first time since the inspections began. Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page iii Office of the Inspector General State of California Chart 1B: Cycle 1, Cycle 2, and Cycle 3 Overall Score by Institution Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page iv Office of the Inspector General State of California Results by General Medical Category For the category analysis, this report examines how the disparate components of medical care function together to deliver health care at California’s 33 adult institutions. Ninety-one questions were identified and sorted into five general categories of medical care. 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 illustrated in Chart 2, the resulting scores for each of the five categories increased to the high adherence level during cycle 3. In contrast, in cycle 2, all five categories scores were in the moderate adherence level, while cycle 1 scores ranged from the moderate to low adherence level. Chart 2: Cycle 1, Cycle 2, and Cycle 3 Medical Category Score Comparison Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page v Office of the Inspector General State of California Conclusion Overall, the average scores for both the medical components and medical categories increased significantly across cycles 1, 2, and 3, indicating the Receiver and CDCR are showing improvement in their adherence to medical care policies and procedures. For all but one institution, the overall medical In summary, institutions received higher overall component scores continually improved from medical inspection scores and the average cycles 1 to 2 to 3. In fact, all 33 institutions scored in scores for the five medical categories improved. the moderate to high adherence level in cycle 3. In cycle 2, only 25 of the 33 institutions scored in the moderate adherence level, and in cycle 1, only 8 institutions were in the moderate adherence level with the remaining 25 institutions scoring in the low adherence level. The cycle 3 overall medical category scores also improved. The average cycle 3 score for all five categories was in the high adherence level. In contrast, in cycle 2 all five categories were in the moderate adherence level, and in cycle 1, two categories were in the moderate adherence level, while three categories were in the low adherence level. These scores indicate that the Receiver and CDCR are improving their adherence to their medical policies and procedures. Robert A. Barton Inspector General Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page vi Office of the Inspector General State of California Table of Contents Executive Summary ................................................................................................................................... i Results by Medical Component ............................................................................................................ ii Results by General Medical Category .................................................................................................. v Conclusion ........................................................................................................................................... vi OIG Medical Inspection Program ............................................................................................................. 1 Objectives, Scope, and Methodology ................................................................................................... 3 Overall Scores and Medical Component Scores ...................................................................................... 4 General Medical Categories ................................................................................................................... 15 Medical Category Analysis ................................................................................................................. 18 Medication Management .................................................................................................................... 19 Access to Providers and Services ........................................................................................................ 24 Primary Care Provider Responsibilities ............................................................................................. 29 Continuity of Care .............................................................................................................................. 34 Nurse Responsibilities ........................................................................................................................ 39 Conclusion .............................................................................................................................................. 44 APPENDICES ........................................................................................................................................ 45 APPENDIX A Component Definitions .............................................................................................. 46 APPENDIX B Institutions’ Scores by Component – Cycles 3, 2, and 1 ............................................ 48 APPENDIX C: Category Questions and Scores ................................................................................. 54 C-1 Medication Management, Cycle 3 ........................................................................................... 55 C-2 Access to Providers and Services, Cycle 3 .............................................................................. 59 C-3 Primary Care Provider Responsibilities, Cycle 3 .................................................................... 67 C-4 Continuity of Care, Cycle 3 ..................................................................................................... 73 C-5 Nurse Responsibilities, Cycle 3 ............................................................................................... 77 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page vii Office of the Inspector General State of California OIG Medical Inspection Program The OIG conducts consistently applied assessments of inmate medical care delivery and CDCR’s compliance with their health care policies and procedures at all 33 institutions, and presents 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 if there is no policy in place. However, the OIG does not attempt to identify the causes for noncompliance nor recommend remedies for specific instances of inadequacy. The OIG inspection tool was designed, in collaboration with key stakeholders, to present an objective and consistent assessment of each institution’s health care delivery system. The inspection scores may be used by the institutions, CDCR, the Receiver, the plaintiff’s counsel, and the Court to assist in determining 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, the OIG developed a medical inspection program to assess CDCR’s compliance with policies and procedures for providing medical care at California adult institutions. In designing the program, the OIG 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’ counsel Based on this research, an inspection program was established that contains up to 151 questions covering 20 essential components of medical care delivery.1 The inspection team consists of physicians, registered nurses, deputy inspectors general, and analysts. The inspection tool 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, questions were created with “yes” or “no” answers designed to gauge performance. In conjunction with clinical experts, a weighting system was created 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, a high number of possible points were assigned to the chronic care component because inadequate care of inmates with chronic conditions poses the most significant risk of all the components. Conversely, proportionately fewer points were assigned to all other components. Component definitions are listed in Appendix A. 1Cycle 3 of medical inspections has 151 questions. However, one question merely displays staffing level information reported by the institution and is not scored. Comparative Summary and Analysis of the First, Second, and Third 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, the inspections do not conclude whether an institution has passed or failed an inspection. Instead, each institution’s percentage of compliance with CDCR medical policies and procedures is reported, and in some instances, compliance is reported based on selected medical community standards. Accordingly, the inspection methods employed do not attempt to measure the quality of care delivered to inmate- patients. In performing the inspections, random samples of inmates receiving or requiring specific medical services are identified. The medical file for each inmate in the sample is then reviewed to determine if the medical care provided meets established criteria. For these samples, the 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 medication on a specified date, it is assumed that the inmate did not receive the medication. While it is possible that the inmate received his medications and the staff neglected to document the event, it cannot be assumed that appropriate care was provided. Lack of proper documentation poses another potential problem. In addition to the review of medical files, medical appeal summaries, nursing policies and procedures, medical drill and emergency summaries, Quality Management Committee minutes, Emergency Medical Response Review Committee minutes, inmate transfer envelopes, and assorted manual logs or tracking worksheets related to medical care delivery are reviewed. Also, staff in their day-to-day delivery of medical care and certain administrative functions are observed at each institution. Although data is reported regarding each institution’s staffing levels, the data, adequacy of the staffing levels, or reasons for vacancies are not analyzed. Further, the OIG inspection program does not evaluate the adequacy of each institution’s health care budget or facility, nor does it review internal CDCR or Receiver audit reports. This report does not assess the provision of dental care or mental health services in institutions, nor does it 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, Second, and Third 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, the OIG began the first of its statewide medical inspections, and in May 2011, published its comparison report of the first cycle of inspections of the 33 institutions. In July 2012, the comparative summary and analysis report of the first and second medical inspection cycles was published. This report denotes the end of the third cycle of medical inspections and provides a comparative summary and analysis between the first, second, and third cycles. The report includes data from inspections performed at the state's 33 adult institutions. The institutions are listed alphabetically below: • Avenal State Prison (ASP) • Ironwood State Prison (ISP) • Calipatria State Prison (CAL) • Kern Valley State Prison (KVSP) • California Correctional Center (CCC) • California State Prison, Los Angeles County (LAC) • California Correctional Institution (CCI) • Mule Creek State Prison (MCSP) • Central California Women’s Facility (CCWF) • North Kern State Prison (NKSP) • California State Prison, Centinela (CEN) • Pelican Bay State Prison (PBSP) • California Institution for Men (CIM) • Pleasant Valley State Prison (PVSP) • California Institution for Women (CIW) • R. J. Donovan Correctional Facility (RJD) • California Men's Colony (CMC) • California State Prison, Sacramento (SAC) • California Medical Facility (CMF) • California Substance Abuse Treatment Facility and • California State Prison, Corcoran (COR) State Prison, Corcoran (SATF) • California Rehabilitation Center (CRC) • Sierra Conservation Center (SCC) • Correctional Training Facility (CTF) • California State Prison, Solano (SOL) • Chuckawalla Valley State Prison (CVSP) • San Quentin State Prison (SQ) • Deuel Vocational Institution (DVI) • Salinas Valley State Prison (SVSP) • Folsom State Prison (FSP) • Valley State Prison for Women (VSPW)2 • High Desert State Prison (HDSP) • Wasco State Prison (WSP) The objective in this third report is to compare and contrast the significant trends and variations in data between the first, second, and third cycles, which will hopefully assist the Receiver and CDCR in their efforts toward continuous improvement in adherence to policies and procedures. 3 2 As of October 8, 2012, Valley State Prison for Women converted to Valley State Prison, an all-male institution. 3 Each of the 33 inspection reports can be viewed at www.oig.ca.gov. Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 3 Office of the Inspector General State of California Overall Scores and Medical Component Scores All 33 institutions’ overall scores met or exceeded the 75 percent minimum score for moderate adherence in cycle 3. In fact, 25 institutions had scores higher than 85 percent, the score for high adherence. As shown in charts 3A, 3B, and 3C, the cycle 3 average score for the 33 institutions was 87 percent; a 7.4 percentage point improvement over the 79.6 percent average score for cycle 2 and a 15.1 percentage point improvement over the cycle 1 average score of 71.9 percent. For cycle 3, the three highest scores were Folsom State Prison (FSP) with a score of 93.4 percent, Sierra Conservation Center (SCC) with a score of 93 percent, and Valley State Prison for Women (VSPW) with a score of 92.6 percent. Conversely, the three lowest scores for cycle 3 were Kern Valley State Prison (KVSP) with a score of 77.6 percent, California Medical Facility (CMF) with a score of 79.1 percent, and California State Prison, Sacramento (SAC) with a score of 79.2 percent. The improvement in institutions’ overall scores from cycle 1 to cycle 3 can be attributed to steady improvement in the institutions’ scores for the individual 20 components. For cycle 3, nine of the institutions met or exceeded the 75 percent minimum score for moderate adherence in all 20 components. In contrast, in cycle 2, only two of the 33 institutions met or exceeded 75 percent in all 20 components, and in cycle 1, none of the institutions met the 75 percent level. These scores indicate that the Receiver and CDCR are improving their adherence to their medical policies and procedures. Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 4 Office of the Inspector General State of California Chart 3A: Cycle 3 Overall Inspection Scores Sorted Low to High Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 5 Office of the Inspector General State of California Chart 3B: Cycle 2 Overall Inspection Scores Sorted Low to High 75% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 6 Office of the Inspector General State of California Chart 3C: Cycle 1 Overall Inspection Scores Sorted Low to High Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 7 Office of the Inspector General State of California The number of average medical component scores falling under the 75 percent moderate adherence level has significantly improved since the completion of cycle 1. During cycle 1, eight of the 20 medical components had average scores that fell below the 75 percent level (see Table 1C). During cycle 2, the number improved to just two components that averaged below the 75 percent level (see Table 1B). Most recently, during cycle 3, all components had an average score that exceeded the 75 percent moderate adherence level (see Table 1A). Although most institutions improved their overall score, additional improvement can still be achieved. For example, as indicated in Appendix B, during cycle 3 twenty-four institutions received less than the 75 percent required to achieve a moderate adherence level score in one or more of the 20 components. Table 1A: Cycle 3 Component Scores Comparative Data Variation Between Medical Component High Low Average High/Low Chronic Care 93.2% 71.8% 82.9% 21.4 percentage points Clinical Services 93.6% 73.6% 86.4% 20.0 percentage points Health Screening 96.8% 77.1% 85.8% 19.7 percentage points Specialty Services 97.5% 61.5% 83.8% 36.0 percentage points Urgent Services 95.8% 66.9% 82.7% 28.9 percentage points Emergency Services 100.0% 62.4% 89.6% 37.6 percentage points Prenatal Care/Childbirth/Post-Delivery 100.0% 87.5% 93.8% 12.5 percentage points Diagnostic Services 99.0% 76.2% 89.5% 22.8 percentage points Access to Healthcare Information 100.0% 44.1% 76.6% 55.9 percentage points Outpatient Housing Unit 100.0% 86.3% 92.8% 13.7 percentage points Internal Reviews 100.0% 60.0% 84.5% 40.0 percentage points Inmate Transfers 100.0% 86.0% 96.0% 14.0 percentage points Clinic Operations 100.0% 86.1% 97.3% 13.9 percentage points Preventive Services 100.0% 61.0% 90.4% 39.0 percentage points Pharmacy Services 100.0% 76.9% 98.0% 23.1 percentage points Other Services 100.0% 70.0% 95.6% 30.0 percentage points Inmate Hunger Strikes 100.0% 38.9% 83.5% 61.1 percentage points Chemical Agent Contraindications 100.0% 58.8% 91.0% 41.2 percentage points Staffing Levels and Training 100.0% 95.0% 99.8% 5.0 percentage points Nursing Policy 100.0% 14.3% 87.6% 85.7 percentage points Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 8 Office of the Inspector General State of California Table 1B: Cycle 2 – Component Scores Comparative Data Variation Between Medical Component High Low Average High/Low Chronic Care 83.0 % 58.9 % 72.0 % 24.1 percentage points Clinical Services 92.5 % 55.2 % 74.2 % 37.3 percentage points Health Screening 96.4 % 73.0 % 82.1 % 23.4 percentage points Specialty Services 96.9 % 59.7 % 79.1 % 37.2 percentage points Urgent Services 92.4 % 59.0 % 78.1 % 33.4 percentage points Emergency Services 100.0 % 57.4 % 79.4 % 42.6 percentage points Prenatal Care/Childbirth/Post-Delivery 81.3 % 80.9 % 81.1 % 0.4 percentage points Diagnostic Services 99.0 % 60.4 % 78.6 % 38.6 percentage points Access to Healthcare Information 100.0 % 39.2 % 75.2 % 60.8 percentage points Outpatient Housing Unit 100.0 % 60.2 % 91.4 % 39.8 percentage points Internal Reviews 100.0 % 58.8 % 76.8 % 41.2 percentage points Inmate Transfers 100.0 % 64.0 % 87.3 % 36.0 percentage points Clinic Operations 100.0 % 81.2 % 94.2 % 18.8 percentage points Preventive Services 100.0 % 54.0 % 80.4 % 46.0 percentage points Pharmacy Services 100.0 % 65.5 % 93.1 % 34.5 percentage points Other Services 100.0 % 55.0 % 91.2 % 45.0 percentage points Inmate Hunger Strikes 100.0 % 48.9 % 81.5 % 51.1 percentage points Chemical Agent Contraindications 100.0 % 48.2 % 91.5 % 51.8 percentage points Staffing Levels and Training 100.0 % 95.0 % 99.2 % 5.0 percentage points Nursing Policy 100.0 % 50.0 % 75.9 % 50.0 percentage points Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 9 Office of the Inspector General State of California Table 1C: Cycle 1 – Component Scores Comparative Data Variation Between Medical Component High Low Average High/Low Chronic Care 83.6% 37.6% 61.5% 46.0 percentage points Clinical Services 87.1% 46.6% 65.4% 40.5 percentage points Health Screening 88.8% 61.0% 76.9% 27.8 percentage points Specialty Services 96.2% 42.6% 66.2% 53.6 percentage points Urgent Services 92.3% 61.0% 78.4% 31.3 percentage points Emergency Services 90.4% 47.5% 78.3% 42.9 percentage points Prenatal Care/Childbirth/Post-Delivery 80.8% 61.3% 71.1% 19.5 percentage points Diagnostic Services 89.2% 42.9% 68.8% 46.3 percentage points Access to Healthcare Information 100.0% 19.6% 63.8% 80.4 percentage points Outpatient Housing Unit 99.0% 61.7% 81.1% 37.3 percentage points Internal Reviews 100.0% 60.0% 78.0% 40.0 percentage points Inmate Transfers 100.0% 43.2% 87.8% 56.8 percentage points Clinic Operations 100.0% 81.8% 92.2% 18.2 percentage points Preventive Services 82.0% 7.3% 43.9% 74.7 percentage points Pharmacy Services 100.0% 57.8% 87.5% 42.2 percentage points Other Services 100.0% 50.0% 84.2% 50.0 percentage points Inmate Hunger Strikes 100.0% 10.5% 57.0% 89.5 percentage points Chemical Agent Contraindications 100.0% 60.0% 92.8% 40.0 percentage points Staffing Levels and Training 100.0% 80.0% 95.9% 20.0 percentage points Nursing Policy 100.0% 35.7% 76.8% 64.3 percentage points Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 10 Office of the Inspector General State of California Although they are improving, no institution in cycle 3 achieved a score of 75 percent or higher on every question within each of the 20 components. This is consistent with both cycles 1 and 2. Tables 2A, 2B, and 2C illustrate all components in which an institution received a score of 74.9 percent or lower on at least one question during cycles 1, 2, and 3. Most institutions’ overall component scores were in the moderate to high adherence levels, yet no institution has ever scored at least 75 percent on every question making up those components. Nonetheless, the institutions’ scores show improvement over the three cycles. For cycle 3, of the potential 660 components (20 components multiplied by 33 institutions), the institutions cumulatively received a score of 75 percent or higher on all questions within a component for 270 of the components. This is an improvement over cycle 2, in which institutions cumulatively scored 75 percent or higher on all component-related questions for 173 of the components. For cycle 1, the institutions cumulatively received 75 percent or higher on all component-related questions for 121 of the components. Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 11 Office of the Inspector General State of California Table 2A: Cycle 3 Institutions Scoring Less Than 75 Percent on One or More Component Questions Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 12 Office of the Inspector General State of California Table 2B: Cycle 2 Institutions Scoring Less Than 75 Percent on One or More Component Questions Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 13 Office of the Inspector General State of California Table 2C: Cycle 1 Institutions Scoring Less Than 75 Percent on One or More Component Questions Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 14 Office of the Inspector General State of California General Medical Categories While the 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 the OIG’s lead physician was to sort the 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, 91 were identified that applied to these 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, some questions were determined to be appropriate for more than one category. Therefore, such questions were included 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 within specified timeframes, 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 assigned to each category. Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 15 Office of the Inspector General State of California Table 3: Descriptions of the 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 a face- Consists of 32 questions that evaluate whether to-face (FTF) visit within one Access to Providers and inmates were seen or provided services for routine, (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) All diagnostic services: At the Consists of 26 questions that determine whether next clinic visit following the primary care providers (physicians, nurse report of a clinically Primary Care Provider practitioners, and physician assistants) properly significant abnormal Responsibilities provided care to inmates and whether processes diagnostic test, was the result related to providing clinical care are consistent adequately managed? 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, questions were extracted 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, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 16 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, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 17 Office of the Inspector General State of California Medical Category Analysis As summarized in Table 5 below, the overall average score for each medical category progressively improved from cycle 1 through cycle 3. In cycle 1, the institutions had an overall average score that fell into the low adherence level (less than 75 percent) for three of the five categories, and the moderate adherence level for the other two categories. In cycle 2, the institutions scored in the moderate adherence level in all five categories. In cycle 3, the institutions’ overall average category scores reached the high adherence level for all five categories. Table 5: Summary of Institutional Category Scores for all 3 Cycles4 Medication Access to Providers Primary Care Continuity Nurse Management and Services Provider Responsibilities of Care Responsibilities Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 ASP 94.3% 79.6% 48.9% 91.4% 85.4% 68.6% 85.5% 81.7% 72.1% 95.6% 93.5% 79.3% 99.3% 95.4% 83.8% CAL 93.2% 87.7% 66.3% 86.8% 87.4% 79.0% 84.3% 87.6% 84.7% 93.2% 87.0% 83.3% 87.3% 77.8% 81.2% CCC 85.8% 87.0% 53.5% 89.6% 89.8% 67.3% 85.4% 86.2% 66.2% 93.7% 91.0% 82.6% 94.7% 89.4% 82.3% CCI 87.3% 71.3% 68.8% 82.5% 74.1% 49.6% 82.8% 85.7% 76.1% 94.6% 78.2% 66.6% 84.1% 81.0% 66.7% CCWF 98.0% 71.3% 68.1% 93.5% 77.9% 73.6% 89.3% 70.6% 84.1% 96.9% 77.8% 83.1% 97.5% 91.7% 93.8% CEN 81.9% 67.8% 60.3% 92.0% 75.2% 59.9% 80.8% 78.1% 80.1% 90.7% 80.2% 82.7% 92.1% 84.1% 90.7% CIM 90.8% 91.6% 54.9% 93.8% 82.8% 86.7% 90.5% 83.0% 77.5% 97.3% 92.2% 85.4% 94.6% 93.2% 85.1% CIW 86.8% 68.6% 42.2% 89.2% 84.8% 65.4% 84.8% 73.9% 77.1% 92.7% 87.4% 68.2% 93.1% 82.7% 76.1% CMC 88.6% 71.8% 51.0% 83.1% 83.3% 71.9% 76.8% 75.2% 68.4% 92.1% 88.8% 72.3% 95.4% 84.4% 88.4% CMF 62.5% 71.4% 84.0% 81.2% 86.4% 63.0% 89.8% 79.4% 83.2% 79.3% 80.2% 66.8% 80.6% 83.5% 68.7% COR 86.6% 70.6% 54.0% 88.2% 72.6% 60.1% 86.5% 79.6% 62.5% 92.7% 79.8% 74.0% 90.6% 85.4% 83.2% CRC 94.4% 77.0% 61.0% 89.0% 71.3% 70.1% 79.4% 82.1% 78.1% 91.6% 86.5% 84.4% 93.9% 87.6% 89.5% CTF 92.7% 71.3% 62.4% 82.3% 72.2% 66.3% 84.8% 76.6% 67.6% 89.6% 87.9% 63.8% 93.1% 79.1% 73.2% CVSP 93.4% 91.4% 56.2% 89.8% 81.1% 73.0% 80.9% 83.4% 68.7% 92.7% 85.4% 75.7% 93.6% 72.3% 73.3% DVI 87.7% 71.2% 64.1% 88.0% 70.4% 61.5% 89.1% 83.5% 81.1% 88.1% 83.6% 63.7% 89.7% 74.4% 78.0% FSP 86.4% 94.0% 71.0% 94.9% 90.9% 86.0% 95.5% 86.0% 84.4% 91.7% 93.1% 86.5% 90.1% 84.4% 89.0% HDSP 79.4% 77.8% 54.9% 89.1% 77.9% 44.8% 88.5% 83.9% 54.7% 87.2% 68.3% 73.8% 84.7% 80.8% 74.3% ISP 90.5% 64.3% 46.5% 87.8% 75.8% 65.9% 85.9% 86.1% 61.4% 94.5% 75.2% 78.2% 86.4% 84.4% 81.8% KVSP 83.5% 74.8% 40.8% 74.3% 76.4% 58.0% 75.3% 75.4% 51.1% 87.7% 70.8% 75.5% 83.6% 77.2% 84.2% LAC 88.4% 55.5% 61.7% 84.8% 87.3% 52.2% 94.3% 83.3% 76.3% 88.3% 82.0% 78.2% 86.5% 80.3% 81.0% MCSP 96.0% 68.1% 63.8% 86.1% 76.3% 67.3% 87.0% 80.5% 73.3% 96.3% 72.3% 71.7% 89.2% 68.0% 70.6% NKSP 82.3% 77.9% 55.5% 81.2% 68.9% 68.6% 78.6% 75.9% 71.5% 81.8% 73.7% 75.0% 92.5% 76.1% 79.5% PBSP 97.9% 93.5% 84.2% 89.5% 70.3% 79.9% 82.5% 87.7% 75.0% 81.7% 81.3% 91.4% 94.4% 92.3% 89.0% PVSP 88.1% 63.9% 43.5% 83.0% 65.8% 52.1% 85.7% 74.1% 73.6% 91.0% 77.9% 70.6% 83.1% 76.5% 65.8% RJD 81.6% 58.7% 68.1% 87.3% 76.4% 47.0% 90.2% 80.4% 54.1% 86.7% 70.0% 69.9% 90.4% 81.7% 85.8% SAC 71.6% 63.8% 66.6% 78.3% 75.6% 54.0% 78.1% 80.9% 70.5% 85.7% 82.5% 72.4% 86.9% 79.1% 85.3% SATF 86.0% 70.9% 44.5% 79.4% 69.1% 55.6% 82.5% 78.9% 71.6% 87.5% 85.5% 79.2% 93.0% 85.3% 80.8% SCC 95.4% 73.0% 54.6% 98.2% 91.2% 61.4% 91.5% 87.1% 85.1% 96.4% 88.8% 80.3% 97.3% 86.1% 83.5% SOL 87.3% 68.2% 54.6% 83.3% 69.5% 65.6% 87.7% 79.5% 55.5% 89.3% 78.3% 78.1% 92.5% 76.4% 73.7% SQ 88.6% 77.9% 40.3% 80.5% 78.7% 66.2% 91.5% 85.0% 78.9% 86.5% 82.9% 68.1% 92.2% 76.4% 72.2% SVSP 85.7% 79.5% 77.2% 90.8% 71.1% 60.7% 88.2% 68.6% 64.8% 95.3% 79.7% 84.9% 97.3% 82.4% 73.0% VSPW 84.3% 83.1% 56.9% 94.7% 87.8% 84.5% 91.4% 85.3% 80.5% 97.1% 91.9% 75.4% 95.8% 90.2% 76.9% WSP 87.4% 80.9% 56.4% 89.8% 85.1% 75.2% 84.8% 82.8% 70.3% 92.4% 85.4% 78.5% 96.3% 82.3% 85.4% Average 87.4% 75.0% 58.8% 87.1% 78.6% 65.4% 85.9% 81.0% 72.1% 91.0% 82.5% 76.1% 91.2% 82.4% 80.2% Score Green Numbers - High Adherence: More than 85 percent Blue Numbers - Moderate Adherence: 75 to 85 percent Red Numbers - Low Adherence: Less than 75 percent 4 An in-depth analysis of the 33 institutions’ scores in each of the five medical categories begins on page 19. Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 18 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. Fourteen questions from the following medical care components were used to develop our analysis: chronic care, clinical services, health screening, urgent services, inmate transfers, clinic operations, preventive services, and pharmacy services. Over the three cycles, prisons continually improved in administering and delivering medications to inmates and the majority of institutions were in the high adherence level in cycle 3. The 33 institutions’ average score for Medication Management in Cycle 3 Key Statistics cycle 3 was 87.4 percent (a high adherence level) while the cycle 2 Category Average .......... 87.4% average was 75.0 percent (moderate adherence), and the cycle 1 Range of Scores 62.5%-98.0% average was 58.8 percent (low adherence). Variation ........................ 35.5% Number of Institutions with: Twenty-nine of the 33 institutions improved their scores from cycle 2 to High Adherence ................... 25 cycle 3 and all but two of the institutions exceeded the 75 percent Moderate Adherence .............. 6 minimum score for moderate adherence. This included 25 institutions that Low Adherence ...................... 2 exceeded the 85 percent minimum score for high adherence. The Central California Women’s Facility (CCWF) and Pelican Bay State Prison (PBSP) received the highest scores at 98.0 percent and 97.9 percent, respectively. The two lowest scoring prisons in cycle 3 were CMF and SAC, with scores of 62.5 percent and 71.6 percent, respectively, both of which were at the low adherence level. Medication Management Category Analysis Number of Institutions per Adherence Level Average Adherence Level Score, All Institutions Low Moderate High Low Moderate High Adherence Adherence Adherence Adherence Adherence Adherence (Below 75%) (75-85%) (85.1-100%) (Below 75%) (75-85%) (85.1-100%) Cycle 3 2 6 25 87.4% Cycle 2 19 8 6 75.0% Cycle 1 30 3 0 58.8% In analyzing the CMF and SAC results, opportunities for improvement were found to exist in several areas of medication management. Specifically, both CMF and SAC scored between zero and 65 percent in four questions related to untimely or improper administration of medication to inmate- patients, and one question related to improperly maintained crash cart inventories. In addition, nurses interviewed at CMF indicated they did not understand that medications must be administered on the same date as prepared, further compounding CMF’s low adherence score. Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 19 Office of the Inspector General State of California Net Change in Institutional Category Scores between Cycle 2 and Cycle 3 Medication Management As illustrated in the chart to the right, 29 institutions improved their overall Medication Management category scores from cycle 2 to Ending Net Net Cycle 3 Improvement Regression cycle 3. Nineteen of the 29 institutions improved Category From From their category scores by more than ten percent, Score Cycle 2 Cycle 2 including the California State Prison, Los CCWF 98.0% 26.7% Angeles County (LAC), which had a PBSP 97.9% 4.4% 32.9 percent category improvement. Only four MCSP 96.0% 27.9% institutions received a lower score in cycle 3 than SCC 95.4% 22.4% in cycle 2. Of these four institutions, CRC 94.4% 17.4% CMF decreased the most, by 8.9 percent, ASP 94.3% 14.7% maintaining their previous low adherence level. CVSP 93.4% 2.0% The remaining three institutions whose Medical CAL 93.2% 5.5% Management category scores also decreased CTF 92.7% 21.4% from cycle 2 to cycle 3 [FSP, California CIM 90.8% -0.8% Correctional Center (CCC), and California ISP 90.5% 26.2% Institution for Men (CIM)], still had category CMC 88.6% 16.8% scores over 85.0 percent, maintaining their high SQ 88.6% 10.7% adherence level. LAC 88.4% 32.9% PVSP 88.1% 24.2% Charts 5A, 5B, and 5C show all 33 institutions’ DVI 87.7% 16.5% scores in the Medication Management category, WSP 87.4% 6.5% for each of the three cycles. CCI 87.3% 16.0% SOL 87.3% 19.1% CIW 86.8% 18.2% COR 86.6% 16.0% FSP 86.4% -7.6% SATF 86.0% 15.1% CCC 85.8% -1.2% SVSP 85.7% 6.2% VSPW 84.3% 1.2% KVSP 83.5% 8.7% NKSP 82.3% 4.4% CEN 81.9% 14.1% RJD 81.6% 22.9% HDSP 79.4% 1.6% SAC 71.6% 7.8% CMF 62.5% -8.9% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 20 Office of the Inspector General State of California etaredoM woL ecnerehdA hgiH ecnerehdA ecnerehdA Chart 5A: Cycle 3 Medication Management Scores by Institution 75.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 21 Office of the Inspector General State of California Chart 5B: Cycle 2 Medication Management Scores by Institution 75.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 22 Office of the Inspector General State of California Chart 5C: Cycle 1 Medication Management Scores by Institution 75.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 23 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 this analysis, 32 questions related to access to providers and services were used 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. The institutions’ average score for the Access to Providers and Services category steadily improved from a low to a high adherence level over the Cycle 3 Key Statistics three cycles. The 33 institutions’ average score in cycle 3 for this Category Average ......... 87.1% Range of Scores 74.3%-98.2% category was 87.1 percent (high adherence), an improvement from the Variation ......................... 23.9% cycle 2 average score of 78.6 percent (moderate adherence), and the cycle 1 average score of 65.4 percent (low adherence). For cycle 3, Number of Institutions with: KVSP’s score decreased from a moderate adherence level of High Adherence ................... 21 76.4 percent to 74.3 percent, making it the only prison scoring in the Moderate Adherence ............ 11 low adherence level for this category. Low Adherence ...................... 1 Access to Providers and Services Category Analysis Number of Institutions per Adherence Level Average Adherence Level Score, All Institutions Low Moderate High Low Moderate High Adherence Adherence Adherence Adherence Adherence Adherence (Below 75%) (75-85%) (85.1-100%) (Below 75%) (75-85%) (85.1-100%) Cycle 3 1 11 21 87.1% Cycle 2 11 13 9 78.6% Cycle 1 27 4 2 65.4% In analyzing the KVSP results, opportunities for improvement were found in several areas including: timeliness of patient visits, monitoring patients on certain medications, and provisions for inmates on hunger strikes. Specifically, tests in four different component program areas were performed to determine if inmates were seen by a clinician within specified timeframes (as recommended by a registered nurse or as required by policy), and the institution scored in the lower 60th percentile on each of the four related questions. In addition, the institution scored zero percent when tested on its monitoring of five inmate-patients on INH (a medication used to treat tuberculosis). Further, KVSP scored only 20 percent on each of two questions regarding hunger strikes and whether a clinician performed daily assessments of hunger strike participants and offered them certain services as required by policy. Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 24 Office of the Inspector General State of California Net Change in Institutional Category Scores between Cycle 2 and Cycle 3 Access to Providers and Services As illustrated in the chart to the right, in addition to KVSP, five other institutions’ scores decreased from cycle 2 to cycle 3. Two institutions (CMF and LAC) Ending Net Net Cycle 3 Improvement Regression dropped from a high adherence level to a moderate Category From From adherence level in cycle 3. Three other institutions’ Score Cycle 2 Cycle 2 scores decreased by less than one percent, allowing SCC 98.2% 7.0% them to remain at their previous moderate or high FSP 94.9% 4.0% adherence levels. These three institutions were VSPW 94.7% 6.9% Calipatria State Prison (CAL), California Men’s CIM 93.8% 11.0% Colony (CMC), and CCC. CCWF 93.5% 15.6% CEN 92.0% 16.8% The remaining 27 institutions improved their Access ASP 91.4% 6.0% to Providers and Services category scores from cycle SVSP 90.8% 19.7% 2 to cycle 3. Sixteen of the 27 institutions improved WSP 89.8% 4.7% their category scores by more than 10 percent. Only CVSP 89.8% 8.7% six institutions received a lower score during cycle 3 CCC 89.6% -0.2% than during cycle 2. Of these, CMF had the biggest PBSP 89.5% 19.2% decrease (5.2 percent). CIW 89.2% 4.4% Charts 6A, 6B, and 6C show all 33 institutions’ scores HDSP 89.1% 11.2% in the Access to Providers and Services category, for CRC 89.0% 17.7% each of the three cycles. COR 88.2% 15.6% DVI 88.0% 17.6% ISP 87.8% 12.0% RJD 87.3% 10.9% CAL 86.8% -0.6% MCSP 86.1% 9.8% LAC 84.8% -2.5% SOL 83.3% 13.8% CMC 83.1% -0.2% PVSP 83.0% 17.2% CCI 82.5% 8.4% CTF 82.3% 10.1% NKSP 81.2% 12.3% CMF 81.2% -5.2% SQ 80.5% 1.8% SATF 79.4% 10.3% SAC 78.3% 2.7% KVSP 74.3% -2.1% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 25 Office of the Inspector General State of California etaredoM woL ecnerehdA hgiH ecnerehdA ecnerehdA Chart 6A: Cycle 3 Access to Providers and Services Scores by Institution, Sorted Low to High 75.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 26 Office of the Inspector General State of California Chart 6B: Cycle 2 Access to Providers and Services Scores by Institution, Sorted Low to High 75.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 27 Office of the Inspector General State of California Chart 6C: Cycle 1 Access to Providers and Services Scores by Institution, Sorted Low to High 75.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 28 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 this analysis, 26 questions were used 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. All 33 institutions achieved either moderate or high adherence in this category for cycle 3. While most of the institutions improved their performance in the Primary Care Provider Responsibilities category for cycle 3, nine institutions received a lower score than they did in the previous cycle. Cycle 3 Key Statistics No institution scored below the moderate adherence level in cycle 3. Category Average .......... 85.9% Of the 19 institutions achieving high adherence, FSP and LAC had the Range of Scores 75.3%-95.5% highest scores at 95.5 percent and 94.3 percent, respectively. Both FSP Variation ....................... 20.2% and LAC increased their scores from cycle 2 to cycle 3 by Number of Institutions with: approximately 10 percent. The institutions receiving the lowest scores High Adherence ................... 19 were KVSP at 75.3 percent and CMC at 76.8 percent. Moderate Adherence ............ 14 Low Adherence ...................... 0 Primary Care Provider Responsibilities Category Analysis Number of Institutions per Adherence Level Average Adherence Level Score, All Institutions Low Moderate High Low Moderate High Adherence Adherence Adherence Adherence Adherence Adherence (Below 75%) (75-85%) (85.1-100%) (Below 75%) (75-85%) (85.1-100%) Cycle 3 0 14 19 85.9% Cycle 2 4 21 8 81.0% Cycle 1 18 14 1 72.1% In cycle 3, with an average score of 72 percent, the lowest scoring question in this category applying to all 33 institutions was a question related to providers’ untimely documentation of significant abnormal diagnostic test results. Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 29 Office of the Inspector General State of California Net Change in Institutional Category Scores between Cycle 2 and Cycle 3 As illustrated in the chart to the right, 24 institutions Primary Care Provider Responsibilities improved their overall Primary Care Provider Responsibilities scores from cycle 2 to cycle 3, with Ending Net Net 6 of those improving their category scores by over Cycle 3 Improvement Regression Category From From 10 percent. While nine institutions received lower Score Cycle 2 Cycle 2 scores for cycle 3 than in cycle 2, three of them FSP 95.5% 9.5% decreased less than 1 percent, and only one LAC 94.3% 11.0% institution had a decrease greater than 5 percent. SQ 91.5% 6.5% However, all institutions with scores decreasing from SCC 91.5% 4.4% cycle 2 to cycle 3 were still at or above the moderate VSPW 91.4% 6.1% adherence level for this category. CIM 90.5% 7.5% RJD 90.2% 9.8% Charts 7A, 7B, and 7C show all 33 institutions’ CMF 89.8% 10.4% scores in the Primary Care Provider Responsibilities CCWF 89.3% 18.7% category for each of the three cycles. DVI 89.1% 5.6% HDSP 88.5% 4.6% SVSP 88.2% 19.6% SOL 87.7% 8.2% MCSP 87.0% 6.5% COR 86.5% 6.9% ISP 85.9% -0.2% PVSP 85.7% 11.6% ASP 85.5% 3.8% CCC 85.4% -0.8% WSP 84.8% 2.0% CIW 84.8% 10.9% CTF 84.8% 8.2% CAL 84.3% -3.3% CCI 82.8% -2.9% SATF 82.5% 3.6% PBSP 82.5% -5.2% CVSP 80.9% -2.5% CEN 80.8% 2.7% CRC 79.4% -2.7% NKSP 78.6% 2.7% SAC 78.1% -2.8% CMC 76.8% 1.6% KVSP 75.3% -0.1% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 30 Office of the Inspector General State of California ecnerehdA hgiH ecnerehdA etaredoM Chart 7A: Cycle 3 Primary Care Provider Responsibilities Scores by Institution, Sorted Low to High 75.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 31 Office of the Inspector General State of California Chart 7B: Cycle 2 Primary Care Provider Responsibilities Scores by Institution, Sorted Low to High 75.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 32 Office of the Inspector General State of California Chart 7C: Cycle 1Primary Care Provider Responsibilities Scores by Institution, Sorted Low to High 75.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 33 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 this analysis, 18 questions were used from the following medical care components: health screening, specialty services, urgent services, outpatient housing unit, inmate transfers, and clinic operations. Cycle 3 Key Statistics Every prison exceeded 75 percent, achieving a moderate or high Category Average .............91.0% adherence for Continuity of Care, and only two institutions received a Range of Scores ...79.3%-97.3% lower cycle 3 score in this category when compared to cycle 2. Variation ..........................18.0% The 33 institutions’ average cycle 3 score in this category was 91 Number of Institutions with: percent, an 8.5 percent increase from cycle 2, in which institutions High Adherence .......................30 scored an average of 82.5 percent. Of the 30 institutions receiving a Moderate Adherence ..................3 high adherence score of 85.1 percent or higher, 20 received scores in Low Adherence ..........................0 the 90th percentile. CIM and VSPW received the highest scores, at 97.3 and 97.1 percent, respectively. Only three institutions [CMF, PBSP, and North Kern State Prison (NKSP)] received scores below the high adherence level. Although CMF and PBSP received the lowest scores at 79.3 and 81.7 percent, respectively, they still scored within the moderate adherence level. Continuity of Care Category Analysis Number of Institutions per Adherence Level Average Adherence Level Score, All Institutions Low Moderate High Low Moderate High Adherence Adherence Adherence Adherence Adherence Adherence (Below 75%) (75-85%) (85.1-100%) (Below 75%) (75-85%) (85.1-100%) Cycle 3 0 3 30 91.0% Cycle 2 5 14 14 82.5% Cycle 1 13 17 3 76.1% Within the Continuity of Care category, the question that received the lowest average score (75 percent across all 33 institutions) related to specialty services. Six prisons scored below 60 percent when tested on whether a primary care provider reviewed specialists’ reports and saw the inmate for a follow-up appointment within specified timelines. Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 34 Office of the Inspector General State of California Net Change in Institutional Category Scores between Cycle 2 and Cycle 3 As shown in the chart to the right, 31 institutions Continuity of Care improved their overall Continuity of Care scores from cycle 2 to cycle 3. Twelve of those institutions Ending Net Net Cycle 3 Improvement Regression improved their category scores by more than Category From From 10 percent, including Mule Creek State Score Cycle 2 Cycle 2 Prison (MCSP), with the highest improvement rate CIM 97.3% 5.1% of 24 percent. CMF and FSP were the only VSPW 97.1% 5.2% institutions to receive lower scores for this category CCWF 96.9% 19.1% in cycle 3 than in cycle 2, yet both institutions had SCC 96.4% 7.6% less than a 1.5 percent decrease from their cycle 2 MCSP 96.3% 24.0% scores and still met or exceeded the moderate ASP 95.6% 2.1% adherence level. SVSP 95.3% 15.6% CCI 94.6% 16.4% Four institutions, High Desert State Prison (HDSP), ISP 94.5% 19.3% KVSP, MCSP, and RJ Donovan (RJD), achieved CCC 93.7% 2.7% notable improvement in the Continuity of Care CAL 93.2% 6.2% category, raising their compliance from low CIW 92.7% 5.3% adherence in cycle 2 to high adherence in cycle 3. COR 92.7% 12.9% CVSP 92.7% 7.3% Charts 8A, 8B, and 8C show all 33 institutions’ WSP 92.4% 7.0% scores in the Continuity of Care category, for each of CMC 92.1% 3.3% the three cycles. FSP 91.7% -1.4% CRC 91.6% 5.1% PVSP 91.0% 13.1% CEN 90.7% 10.5% CTF 89.6% 1.7% SOL 89.3% 11.0% LAC 88.3% 6.3% DVI 88.1% 4.5% KVSP 87.7% 16.9% SATF 87.5% 2.0% HDSP 87.2% 18.9% RJD 86.7% 16.7% SQ 86.5% 3.6% SAC 85.7% 3.2% NKSP 81.8% 8.1% PBSP 81.7% 0.4% CMF 79.3% -0.9% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 35 Office of the Inspector General State of California etaredoM ecnerehdA hgiH ecnerehdA Chart 8A: Cycle 3 Continuity of Care Score by Institution, Sorted Low to High 75.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 36 Office of the Inspector General State of California Chart 8B: Cycle 2 Continuity of Care Score by Institution, Sorted Low to High 75.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 37 Office of the Inspector General State of California Chart 8C: Cycle 1 Continuity of Care Scores by Institution, Sorted Low to High 75.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 38 Office of the Inspector General State of California Nurse Responsibilities The Nurse Responsibilities category evaluates how well the institutions’ registered nurses and licensed vocational nurses perform their duties and whether processes for providing nursing care are consistent with policy. To develop this analysis, 19 questions were used from the following medical care components: clinical services, health screening, urgent services, emergency services, prenatal care/childbirth/post-delivery, inmate transfers, clinic operations, and inmate hunger strikes. All but one institution improved their category score in cycle 3 Cycle 3 Key Statistics from cycle 2, and only five of 33 institutions scored below the high Category Average ......... 91.2% adherence level in this category. The 33 institutions’ average score Range of Scores 80.6%-99.3% for Nurse Responsibilities in cycle 3 was 91.2 percent, and 28 of the Variation ....................... 18.7% 33 institutions achieved scores in the high adherence level. Avenal Number of Institutions with: State Prison’s (ASP) score of 99.3 percent was the highest. Five High Adherence………………28 institutions achieved moderate adherence, and no institution scored Moderate Adherence………….5 below 75 percent (low adherence). Low Adherence………………..0 Only CMF received a lower score in cycle 3 than in cycle 2, declining by approximately 3 percent. CMF also received the lowest cycle 3 score in the Nurse Responsibilities category at 80.6 percent (moderate adherence level). Nurse Responsibilities Category Analysis Number of Institutions per Adherence Level Average Adherence Level Score, All Institutions Low Moderate High Low Moderate High Adherence Adherence Adherence Adherence Adherence Adherence (Below 75%) (75-85%) (85.1-100%) (Below 75%) (75-85%) (85.1-100%) Cycle 3 0 5 28 91.2% Cycle 2 3 20 10 82.4% Cycle 1 10 13 10 80.2% Within the Nurse Responsibilities category, the question that scored lowest was related to emergency services, with all institutions averaging 79 percent on this question. Contributing to this low average, eight institutions scored between 0 percent and 60 percent when tested on whether medical emergency responders used proper equipment to address emergencies and whether medical care provided was within the scope of the responder’s license. Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 39 Office of the Inspector General State of California Net Change in Institutional Category Scores between Cycle 2 and Cycle 3 As detailed in the chart to the right, 32 institutions Nurse Responsibilities improved their overall Nurse Responsibilities category scores from cycle 2 to cycle 3, with 12 of Ending Net Net those institutions improving their scores by over 10 Cycle 3 Improvement Regression Category From From percent. Only one institution (CMF) received a lower Score Cycle 2 Cycle 2 score in cycle 3 than in cycle 2, but the decrease was ASP 99.3% 3.9% only 2.9 percent, and the institution maintained the CCWF 97.5% 5.8% moderate adherence level it achieved in cycle 2. SVSP 97.3% 14.9% SCC 97.3% 11.2% Charts 9A, 9B, and 9C show all 33 institutions’ WSP 96.3% 14.0% scores in the Nurse Responsibilities category, for VSPW 95.8% 5.6% each of the three cycles. CMC 95.4% 11.0% CCC 94.7% 5.3% CIM 94.6% 1.4% PBSP 94.4% 2.1% CRC 93.9% 6.3% CVSP 93.6% 21.3% CTF 93.1% 14.0% CIW 93.1% 10.4% SATF 93.0% 7.7% NKSP 92.5% 16.4% SOL 92.5% 16.1% SQ 92.2% 15.8% CEN 92.1% 8.0% COR 90.6% 5.2% RJD 90.4% 8.7% FSP 90.1% 5.7% DVI 89.7% 15.3% MCSP 89.2% 21.2% CAL 87.3% 9.5% SAC 86.9% 7.8% LAC 86.5% 6.2% ISP 86.4% 2.0% HDSP 84.7% 3.9% CCI 84.1% 3.1% KVSP 83.6% 6.4% PVSP 83.1% 6.6% CMF 80.6% -2.9% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 40 Office of the Inspector General State of California etaredoM ecnerehdA hgiH ecnerehdA Chart 9A: Cycle 3 Nurse Responsibilities Scores by Institution, Sorted Low to High 75.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 41 Office of the Inspector General State of California Chart 9B: Cycle 2 Nurse Responsibilities Scores by Institution, Sorted Low to High 75.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 42 Office of the Inspector General State of California Chart 9C: Cycle 1 Nurse Responsibilities Scores by Institution, Sorted Low to High 75.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 43 Office of the Inspector General State of California Conclusion Most institutions’ overall scores increased significantly across the three cycles of medical inspections. This indicates the Receiver and CDCR are showing improvement in their adherence to health care policies and procedures. Overall scores are based on testing in 20 components of medical care delivery. Thus, improvements in overall scores from cycle 1 to cycle 3 indicate improvements in the scores for the individual 20 components. For example, in cycle 3, nine of the 33 institutions met or exceeded the 75 percent minimum score for moderate adherence in all 20 components. This compares favorably to cycle 2 where only two institutions met or exceeded 75 percent and contrasts with cycle 1 where no institution achieved at least 75 percent in all 20 components. For cycle 3, all 33 institutions achieved overall inspection scores exceeding the 75 percent minimum score for moderate adherence, and 25 of these institutions achieved high adherence scores exceeding 85 percent. In cycle 3, the highest scoring institutions were FSP with a score of 93.4 percent, SCC with a score of 93 percent, and VSPW with a score of 92.6 percent. The lowest scoring prisons were KVSP with a score of 77.6 percent, CMF with a score of 79.1 percent, and SAC with a score of 79.2 percent. This range of scores represents a significant improvement over previous cycles. In cycle 2, the scores ranged from 73 percent to 89.5 percent, and in cycle 1, no scores reached the high adherence level, with scores ranging from 62.4 percent to 83.2 percent. When the medical component results were examined based on how the components function together to deliver health care in the five general medical care categories, scoring improvements were again demonstrated over the three cycles. The average category scores for cycle 3 are: Continuity of Care - 90.7 percent, Access to Providers and Services - 88.1 percent, Nurse Responsibilities - 86.8 percent, Medication Management - 87.4 percent, and Primary Care Provider Responsibilities - 87.1 percent. As illustrated above, the average scores for all five categories are at the high adherence level in cycle 3, compared to moderate adherence average scores in cycle 2. In cycle 1, institutions’ average scores were at the low adherence level for three of the five categories, and at the moderate adherence level for the other two categories. Consistency in medical care and adherence to policies and procedures is steadily improving. The upward trend in both overall scores and individual medical category scores indicates continued progress in providing health care that adheres to CDCR’s medical policies and procedures. Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 44 Office of the Inspector General State of California APPENDICES Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 45 Office of the Inspector General State of California APPENDIX A Component Definitions Page 1 of 2 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. The inspection tests anti- coagulation therapy and the following chronic care conditions: asthma, 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 prison followed up on clinically significant results. Access to Health Care Information: Addresses the prison'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.5 This component also evaluates whether the placement provided the inmate with adequate care and whether the physician's plan addressed the placement diagnosis. 5 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, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 46 Office of the Inspector General State of California APPENDIX A Component Definitions Page 2 of 2 Internal Reviews: Focuses on the activities of the prison’s Quality Management Committee and Emergency Medical Response Review Committee. This component also evaluates the timeliness of the inmates’ medical appeals, and the prison’s use of inmate death reviews 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, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 47 Office of the Inspector General State of California APPENDIX B Institutions’ Scores by Component – Cycles 3, 2, and 1 Page 1 of 6 1 2 3 4 5 6 ASP CAL CCC CCI CCWF CEN COMPONENT Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Chronic Care 83.2% 73.2% 59.2% 80.9% 82.0% 75.0% 78.3% 80.8% 45.7% 82.0% 73.2% 61.8% 91.4% 64.4% 73.2% 75.7% 71.7% 80.9% Clinical Services 93.6% 86.4% 64.4% 91.4% 70.6% 60.1% 91.1% 92.5% 65.9% 90.1% 72.4% 57.4% 88.1% 76.7% 74.1% 89.3% 74.5% 80.1% Health Screening 96.8% 84.0% 80.7% 77.5% 83.6% 80.0% 92.1% 78.7% 80.6% 79.1% 76.0% 78.3% 95.6% 86.3% 84.3% 87.4% 80.0% 77.8% Specialty Services 87.3% 89.6% 74.1% 89.9% 89.6% 74.5% 89.7% 89.6% 70.7% 72.1% 86.6% 57.3% 81.1% 73.3% 52.6% 96.2% 83.2% 59.6% Urgent Services 91.0% 82.9% 70.2% 78.8% 85.3% 88.3% 86.4% 82.7% 83.7% 76.8% 76.4% 82.7% 82.5% 69.3% 89.4% 83.9% 72.4% 80.2% Emergency Services 96.6% 79.8% 78.1% 76.6% 87.8% 85.2% 85.9% 100.0% 89.7% 89.7% 82.2% 77.9% 91.0% 66.9% 80.1% 96.9% 78.3% 76.7% Prenatal Care/Childbirth/ N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 100.0% N/A N/A N/A N/A N/A Post-Delivery Diagnostic Services 93.1% 95.2% 86.7% 79.6% 73.7% 57.5% 94.6% 80.8% 70.8% 90.4% 78.3% 60.4% 93.3% 65.2% 83.8% 83.8% 68.3% 74.4% Access to Healthcare 51.0% 90.2% 19.6% 90.2% 95.1% 37.3% 80.4% 100.0% 77.5% 82.4% 72.5% 54.9% 66.7% 82.4% 53.9% 82.4% 49.0% 82.4% Information Outpatient Housing Unit 95.4% 95.6% 71.3% 99.2% 91.9% 92.5% 86.3% 97.1% 82.3% 100.0% 92.7% 73.3% N/A N/A N/A N/A N/A N/A Internal Reviews 78.0% 73.0% 65.5% 79.3% 73.0% 75.0% 100.0% 83.2% 85.5% 87.5% 76.3% 60.0% 100.0% 85.5% 97.9% 68.3% 70.0% 60.8% Inmate Transfers 94.7% 100.0% 100.0% 100.0% 76.7% 100.0% 100.0% 86.0% 92.6% 95.3% 81.3% 43.2% 93.6% 95.3% 100.0% 100.0% 84.1% 100.0% Clinic Operations 100.0% 100.0% 93.9% 95.5% 93.9% 100.0% 97.6% 100.0% 97.0% 95.5% 100.0% 90.6% 100.0% 100.0% 85.9% 100.0% 91.5% 81.8% Preventive Services 100.0% 94.3% 60.3% 93.3% 94.3% 48.3% 88.7% 90.0% 36.7% 86.3% 62.3% 7.3% 94.0% 81.0% 58.7% 94.3% 58.7% 19.0% Pharmacy Services 93.1% 93.1% 92.1% 100.0% 69.0% 96.6% 100.0% 100.0% 69.0% 99.0% 100.0% 79.3% 100.0% 100.0% 92.0% 100.0% 86.2% 57.8% Other Services 100.0% 100.0% 70.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 85.0% 100.0% 100.0% 100.0% 100.0% 77.8% 100.0% Inmate Hunger Strikes N/A 100.0% N/A 100.0% 100.0% 100.0% N/A N/A 68.4% 53.7% N/A 45.8% N/A N/A 100.0% 100.0% N/A 31.6% Chemical Agent N/A 100.0% 100.0% 88.2% 78.8% 100.0% N/A N/A 100.0% 81.2% 100.0% 66.3% N/A N/A 64.7% 100.0% 100.0% 89.4% 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% 90.0% 100.0% 100.0% 85.0% 100.0% 100.0% 100.0% Training Nursing Policy 71.4% 100.0% 67.1% 70.0% 50.0% 100.0% 100.0% 100.0% 94.3% 70.0% 80.0% 50.0% 100.0% 80.0% 100.0% 100.0% 80.0% 71.4% Overall Score 88.6% 86.9% 70.4% 86.9% 83.0% 76.6% 89.2% 89.5% 73.4% 85.3% 79.8% 64.3% 90.7% 77.5% 77.9% 88.0% 74.7% 74.4% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 48 Office of the Inspector General State of California APPENDIX B Institutions’ Scores by Component – Cycles 3, 2, and 1 Page 2 of 6 7 8 9 10 11 12 CIM CIW CMC CMF COR CRC COMPONENT Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Chronic Care 87.5% 72.0% 61.5% 78.9% 72.6% 69.6% 71.8% 71.1% 57.3% 82.3% 68.3% 83.6% 86.8% 66.3% 57.5% 78.8% 66.4% 67.1% Clinical Services 89.6% 87.5% 74.0% 85.8% 66.4% 61.7% 81.1% 70.9% 74.2% 76.7% 67.1% 87.1% 82.1% 79.9% 68.0% 73.6% 63.9% 70.2% Health Screening 92.7% 78.2% 86.1% 83.7% 75.9% 69.8% 82.6% 94.2% 73.2% 83.4% 74.8% 86.8% 82.3% 83.6% 72.7% 90.0% 78.7% 74.2% Specialty Services 93.7% 84.5% 83.3% 90.3% 88.0% 63.1% 82.1% 76.1% 63.4% 63.1% 75.7% 42.6% 92.1% 61.8% 55.1% 87.7% 78.9% 59.2% Urgent Services 85.3% 82.4% 79.6% 87.8% 85.8% 75.4% 80.0% 74.1% 83.7% 70.7% 85.4% 79.1% 85.4% 78.6% 75.7% 74.9% 75.8% 81.2% Emergency Services 100.0% 85.5% 90.4% 79.3% 67.6% 80.0% 93.8% 85.2% 85.5% 90.7% 79.5% 72.1% 90.7% 81.4% 88.2% 66.6% 90.2% 72.9% Prenatal Care/Childbirth/ N/A N/A N/A 87.5% 80.9% 61.3% N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Post-Delivery Diagnostic Services 90.6% 82.5% 67.7% 91.7% 81.5% 70.6% 93.5% 84.0% 70.0% 76.2% 73.5% 72.2% 90.2% 80.0% 67.7% 91.5% 60.4% 58.5% Access to Healthcare 58.8% 82.4% 77.5% 86.3% 58.8% 58.8% 82.4% 77.5% 39.2% 58.8% 72.5% 58.8% 50.0% 45.1% 72.5% 95.1% 72.5% 77.5% Information Outpatient Housing Unit 98.5% 87.5% 93.1% 93.8% 60.2% 63.3% N/A N/A N/A 91.7% 92.3% 85.5% 90.2% 91.9% 61.7% 86.7% 86.1% 74.8% Internal Reviews 73.3% 87.5% 95.7% 87.5% 85.7% 95.1% 87.5% 75.0% 70.4% 87.5% 85.0% 68.8% 95.5% 58.8% 65.8% 78.8% 65.5% 90.5% Inmate Transfers 95.3% 100.0% 93.3% 100.0% 100.0% 80.0% 100.0% 100.0% 94.2% N/A N/A 50.0% 100.0% 86.0% 86.7% 100.0% 100.0% 100.0% Clinic Operations 100.0% 93.3% 94.8% 97.6% 100.0% 97.9% 86.1% 86.4% 84.8% 86.1% 100.0% 82.8% 100.0% 95.5% 90.3% 100.0% 87.9% 86.4% Preventive Services 88.7% 100.0% 70.7% 94.0% 71.3% 32.6% 94.3% 76.0% 53.0% 71.3% 85.0% 43.7% 90.3% 84.3% 30.3% 98.3% 81.0% 82.0% Pharmacy Services 95.9% 100.0% 95.9% 97.6% 97.6% 95.2% 100.0% 65.5% 90.8% 76.9% 97.6% 75.9% 93.1% 100.0% 86.2% 100.0% 89.7% 79.3% Other Services 100.0% 94.0% 100.0% 100.0% 70.0% 57.1% 100.0% 100.0% 90.9% 94.0% 100.0% 100.0% 100.0% 55.0% 92.7% 83.3% 100.0% 70.0% Inmate Hunger Strikes 100.0% 100.0% 100.0% N/A N/A N/A 92.6% 100.0% 71.1% 78.9% 92.6% 31.6% 85.8% 58.9% 30.0% N/A N/A N/A Chemical Agent 100.0% 100.0% 100.0% 68.2% 100.0% 100.0% 100.0% 100.0% 100.0% 84.1% 100.0% 86.8% 90.6% 100.0% 100.0% N/A N/A 100.0% Contraindications Staffing Levels and 100.0% 100.0% 100.0% 100.0% 100.0% 85.0% 100.0% 95.0% 100.0% 100.0% 100.0% 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 85.0% Training Nursing Policy 80.0% 60.0% 92.9% 100.0% 77.1% 64.3% 100.0% 90.0% 78.6% 100.0% 60.0% 35.7% 100.0% 100.0% 85.7% 97.1% 87.1% 75.7% Overall Score 89.6% 84.8% 81.4% 87.6% 77.5% 69.6% 85.4% 80.0% 71.3% 79.1% 79.0% 72.4% 87.2% 76.2% 68.9% 84.6% 75.9% 74.3% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 49 Office of the Inspector General State of California APPENDIX B Institutions’ Scores by Component – Cycles 3, 2, and 1 Page 3 of 6 13 14 15 16 17 18 CTF CVSP DVI FSP HDSP ISP COMPONENT Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Chronic Care 81.7% 60.1% 56.2% 81.8% 77.7% 51.5% 88.9% 75.0% 73.5% 91.1% 82.9% 78.8% 79.9% 83.0% 45.0% 87.1% 69.2% 38.7% Clinical Services 90.4% 64.8% 59.2% 90.7% 80.8% 60.6% 84.2% 55.2% 72.8% 89.5% 82.1% 75.8% 91.1% 72.6% 51.1% 92.0% 82.1% 60.8% Health Screening 83.6% 74.9% 64.2% 79.1% 83.2% 75.9% 86.4% 80.4% 74.3% 85.3% 96.4% 88.8% 78.7% 80.0% 72.3% 78.9% 75.7% 82.3% Specialty Services 81.7% 59.7% 69.0% 88.7% 78.7% 86.1% 89.7% 82.1% 53.4% 97.5% 96.9% 80.1% 90.1% 75.1% 53.2% 83.0% 82.8% 82.4% Urgent Services 91.0% 82.2% 74.8% 87.1% 82.2% 77.9% 76.3% 63.6% 77.5% 87.3% 79.3% 87.6% 95.8% 80.5% 71.9% 76.4% 88.3% 70.2% Emergency Services 89.2% 58.3% 81.0% 86.0% 76.7% 73.1% 94.1% 57.4% 71.0% 96.9% 76.7% 83.6% 91.0% 85.8% 72.1% 84.7% 87.6% 73.2% Prenatal Care/Childbirth/ 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 N/A N/A N/A N/A Post-Delivery Diagnostic Services 91.3% 76.7% 71.5% 89.4% 84.8% 56.2% 90.4% 79.6% 73.7% 99.0% 84.8% 80.4% 87.7% 67.7% 42.9% 96.2% 79.6% 57.5% Access to Healthcare 76.5% 80.4% 77.5% 74.5% 85.3% 49.0% 76.5% 50.0% 58.8% 86.3% 90.2% 77.5% 76.5% 57.8% 58.8% 54.9% 39.2% 49.0% Information Outpatient Housing Unit 96.5% 96.0% 87.1% 91.7% 92.9% 99.0% 89.8% 100.0% 82.8% N/A N/A N/A N/A N/A N/A 96.3% 85.0% 89.8% Internal Reviews 87.5% 87.5% 93.0% 60.3% 66.8% 67.5% 95.7% 83.2% 93.3% 100.0% 100.0% 98.0% 85.5% 73.0% 62.5% 93.8% 76.8% 87.5% Inmate Transfers 95.3% 100.0% 67.9% 95.3% 68.2% 73.3% 95.3% 90.7% 78.9% 87.3% 90.7% 95.3% 86.0% 64.0% 100.0% 95.3% 74.0% 95.3% Clinic Operations 100.0% 91.8% 90.9% 100.0% 88.8% 90.9% 97.9% 100.0% 87.9% 97.9% 100.0% 93.9% 98.2% 96.1% 90.9% 95.5% 91.2% 97.0% Preventive Services 98.3% 63.0% 51.0% 100.0% 90.3% 48.3% 91.0% 54.0% 21.7% 96.0% 100.0% 56.7% 89.7% 72.0% 24.0% 89.7% 88.0% 33.7% Pharmacy Services 100.0% 79.3% 88.6% 100.0% 100.0% 82.8% 96.6% 100.0% 92.0% 100.0% 100.0% 100.0% 100.0% 95.5% 100.0% 96.6% 86.2% 82.8% Other Services 100.0% 83.3% 66.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 70.0% 100.0% 70.0% 72.7% 100.0% 83.3% 85.0% Inmate Hunger Strikes 63.2% 100.0% N/A N/A N/A N/A 100.0% N/A N/A 100.0% N/A N/A 100.0% 81.1% 44.2% N/A 84.2% N/A Chemical Agent N/A N/A 100.0% N/A N/A N/A 100.0% 100.0% 89.4% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 80.0% N/A 100.0% Contraindications Staffing Levels and 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 95.0% 100.0% Training Nursing Policy 100.0% 100.0% 100.0% 14.3% 80.0% 71.4% 100.0% 90.0% 35.7% 100.0% 100.0% 74.3% 100.0% 60.0% 88.6% 54.3% 90.0% 50.0% Overall Score 88.3% 74.5% 72.0% 85.5% 82.2% 69.4% 89.3% 75.4% 72.6% 93.4% 89.1% 83.2% 88.6% 77.8% 62.4% 86.2% 78.6% 68.3% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 50 Office of the Inspector General State of California APPENDIX B Institutions’ Scores by Component – Cycles 3, 2, and 1 Page 4 of 6 19 20 21 22 23 24 KVSP LAC MCSP NKSP PBSP PVSP COMPONENT Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Chronic Care 72.6% 71.4% 37.6% 91.6% 76.5% 70.1% 90.2% 72.0% 69.8% 76.5% 66.3% 58.9% 87.9% 77.5% 70.2% 83.2% 61.7% 56.9% Clinical Services 74.2% 72.4% 57.7% 78.2% 72.7% 65.5% 88.2% 72.3% 68.7% 85.1% 71.9% 64.0% 87.6% 76.5% 69.1% 78.6% 72.6% 46.7% Health Screening 85.5% 77.2% 75.4% 78.3% 83.9% 68.8% 77.1% 73.4% 81.0% 79.6% 89.1% 71.9% 87.9% 79.4% 85.1% 86.6% 73.0% 67.1% Specialty Services 87.2% 77.9% 61.7% 82.4% 85.4% 70.3% 84.1% 69.0% 75.8% 79.3% 81.5% 60.7% 85.1% 85.9% 96.2% 76.5% 76.2% 60.6% Urgent Services 80.5% 69.2% 61.0% 89.8% 69.7% 80.2% 84.2% 82.4% 74.6% 66.9% 70.5% 79.8% 79.8% 87.3% 92.3% 78.8% 59.0% 80.5% Emergency Services 72.1% 70.7% 71.9% 84.8% 72.4% 84.0% 100.0% 78.6% 64.0% 89.0% 82.1% 81.0% 97.2% 81.0% 81.0% 93.8% 96.9% 82.8% Prenatal Care/Childbirth/ 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 N/A N/A N/A N/A Post-Delivery Diagnostic Services 92.7% 80.0% 85.6% 91.2% 82.7% 54.0% 85.4% 84.6% 68.1% 90.8% 85.2% 67.9% 83.1% 77.9% 57.1% 90.2% 89.8% 64.6% Access to Healthcare 51.0% 62.7% 72.5% 61.8% 67.6% 72.5% 84.3% 100.0% 72.5% 44.1% 80.4% 72.5% 72.5% 100.0% 100.0% 77.5% 49.0% 62.7% Information Outpatient Housing Unit 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 N/A N/A N/A N/A Internal Reviews 60.0% 73.0% 68.8% 80.0% 63.3% 73.0% 92.5% 95.5% 82.5% 64.5% 87.5% 85.0% 88.8% 75.0% 68.8% 75.0% 67.5% 70.5% Inmate Transfers 92.6% 81.3% 100.0% 86.0% 85.3% 100.0% 95.3% 65.3% 68.4% 100.0% 86.0% 95.8% 100.0% 100.0% 92.9% 93.6% 81.3% 76.0% Clinic Operations 97.9% 87.3% 96.6% 92.4% 94.2% 90.0% 100.0% 87.3% 100.0% 100.0% 93.9% 90.0% 97.9% 94.8% 92.6% 95.5% 93.3% 92.7% Preventive Services 71.0% 93.8% 27.3% 84.0% 75.3% 20.0% 97.7% 72.3% 40.0% 85.3% 67.7% 55.0% 100.0% 98.3% 81.3% 96.0% 66.0% 27.3% Pharmacy Services 100.0% 96.6% 82.8% 100.0% 84.5% 100.0% 100.0% 93.1% 93.1% 100.0% 100.0% 93.1% 100.0% 100.0% 93.4% 96.6% 93.1% 72.4% Other Services 100.0% 82.4% 50.0% 70.0% 100.0% 100.0% 100.0% 70.0% 85.0% 100.0% 100.0% 50.0% 100.0% 85.0% 100.0% 83.3% 100.0% 70.0% Inmate Hunger Strikes 38.9% 66.3% 46.3% 87.4% 93.7% 42.1% N/A N/A 81.6% N/A N/A N/A N/A 65.8% 100.0% 78.4% 66.8% 36.8% Chemical Agent 82.4% 81.8% 60.0% 78.8% 78.8% 90.6% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 76.5% 48.2% 78.8% N/A 75.0% 66.3% Contraindications Staffing Levels and 100.0% 100.0% 95.0% 100.0% 95.0% 90.0% 100.0% 100.0% 100.0% 100.0% 100.0% 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 80.0% Training Nursing Policy 60.0% 90.0% 57.1% 80.0% 80.0% 57.1% 100.0% 100.0% 88.6% 80.0% 50.0% 71.4% 100.0% 50.0% 50.0% 100.0% 50.0% 100.0% Overall Score 77.6% 76.1% 64.0% 84.4% 78.4% 71.7% 90.4% 79.8% 74.5% 80.8% 79.3% 72.2% 88.6% 82.8% 81.0% 84.7% 73.3% 64.5% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 51 Office of the Inspector General State of California APPENDIX B Institutions’ Scores by Component – Cycles 3, 2, and 1 Page 5 of 6 25 26 27 28 29 30 RJD SAC SATF SCC SOL SQ COMPONENT Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Chronic Care 87.1% 66.9% 48.8% 76.2% 72.9% 62.7% 75.6% 74.6% 57.8% 93.2% 77.4% 75.0% 86.0% 64.8% 42.3% 82.2% 75.6% 64.6% Clinical Services 81.2% 60.7% 67.2% 86.3% 67.1% 67.0% 88.1% 73.7% 56.1% 91.3% 84.3% 71.1% 84.4% 70.5% 59.9% 89.9% 78.3% 46.6% Health Screening 92.2% 76.6% 68.0% 87.9% 83.4% 76.4% 84.2% 77.4% 72.7% 94.3% 87.9% 61.0% 90.5% 80.9% 76.9% 81.0% 90.6% 76.5% Specialty Services 80.3% 81.8% 62.3% 65.5% 62.8% 47.4% 61.5% 67.3% 61.5% 94.8% 84.2% 73.1% 80.0% 66.2% 65.6% 86.1% 83.4% 58.0% Urgent Services 78.6% 79.5% 73.2% 69.3% 61.5% 82.5% 81.0% 76.9% 75.2% 82.9% 89.3% 89.1% 85.1% 84.1% 70.4% 87.8% 66.9% 62.9% Emergency Services 100.0% 77.6% 89.7% 62.4% 82.2% 47.5% 97.6% 73.1% 69.6% 76.7% 100.0% 75.9% 96.9% 75.9% 82.4% 91.4% 58.3% 78.3% Prenatal Care/Childbirth/ 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 N/A N/A N/A N/A Post-Delivery Diagnostic Services 88.8% 79.4% 64.0% 77.9% 82.5% 68.1% 90.0% 67.9% 56.0% 97.1% 99.0% 85.7% 88.8% 66.9% 59.8% 90.0% 70.8% 69.4% Access to Healthcare 100.0% 43.1% 44.1% 82.4% 75.5% 39.2% 76.5% 70.6% 56.9% 96.1% 95.1% 82.4% 90.2% 98.0% 57.8% 100.0% 98.0% 53.9% Information Outpatient Housing Unit N/A N/A N/A 86.3% 98.2% 75.6% N/A N/A N/A 89.0% 98.5% 75.2% N/A N/A N/A 96.3% 100.0% 83.3% Internal Reviews 67.5% 62.2% 100.0% 70.0% 70.0% 70.4% 90.0% 63.0% 72.5% 100.0% 79.3% 60.4% 87.5% 83.0% 75.0% 98.0% 85.0% 68.8% Inmate Transfers 88.9% 74.5% 89.5% 100.0% 94.7% 75.3% 90.7% 100.0% 100.0% 100.0% 87.3% 95.3% 90.0% 81.3% 78.9% 100.0% 76.7% 100.0% Clinic Operations 100.0% 81.2% 94.9% 87.6% 93.9% 91.0% 97.9% 100.0% 98.5% 100.0% 95.5% 87.9% 100.0% 90.9% 83.9% 100.0% 95.5% 100.0% Preventive Services 77.3% 70.0% 24.0% 61.0% 76.0% 32.1% 96.0% 69.3% 36.0% 100.0% 96.0% 28.0% 92.0% 72.0% 58.0% 94.3% 70.0% 48.7% Pharmacy Services 100.0% 93.1% 93.3% 93.1% 90.3% 74.5% 100.0% 97.6% 90.0% 100.0% 86.2% 90.8% 100.0% 100.0% 89.0% 100.0% 93.1% 86.2% Other Services 100.0% 100.0% 100.0% 100.0% 85.0% 90.6% 100.0% 100.0% 100.0% 77.8% 100.0% 55.0% 100.0% 70.0% 75.0% 77.8% 100.0% 85.0% Inmate Hunger Strikes 86.3% 93.7% 10.5% 81.1% 60.0% 10.5% 80.0% 48.9% 78.9% N/A N/A N/A 54.2% N/A 87.9% 80.0% 83.2% 53.7% Chemical Agent 58.8% 100.0% 94.1% 94.7% 84.7% 100.0% 100.0% 94.1% 100.0% 100.0% 76.5% 100.0% 100.0% N/A 100.0% 94.1% 100.0% 89.4% Contraindications Staffing Levels and 100.0% 100.0% 100.0% 100.0% 100.0% 95.0% 100.0% 95.0% 100.0% 100.0% 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 95.0% Training Nursing Policy 100.0% 50.0% 88.6% 77.1% 50.0% 78.6% 100.0% 60.0% 71.4% 100.0% 50.0% 94.3% 100.0% 80.0% 71.4% 100.0% 90.0% 70.0% Overall Score 87.3% 73.0% 68.0% 79.2% 76.3% 65.2% 85.0% 75.7% 68.1% 93.0% 87.5% 76.1% 88.5% 76.7% 67.1% 90.4% 81.5% 68.2% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 52 Office of the Inspector General State of California APPENDIX B Institutions’ Scores by Component – Cycles 3, 2, and 1 Page 6 of 6 31 32 33 SVSP VSPW WSP Average Score COMPONENT Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Cycle 3 Cycle 2 Cycle 1 Chronic Care 79.5% 58.9% 57.1% 91.0% 81.7% 70.5% 75.7% 67.9% 51.7% 82.9% 72.0% 61.5% Clinical Services 86.9% 73.5% 61.1% 89.1% 75.9% 65.7% 91.4% 81.0% 74.0% 86.4% 74.2% 65.4% Health Screening 88.3% 82.8% 83.7% 95.3% 95.2% 85.8% 87.5% 94.7% 86.3% 85.8% 82.1% 76.9% Specialty Services 73.9% 70.4% 71.0% 89.7% 92.0% 71.5% 81.7% 74.5% 70.5% 83.8% 79.1% 66.2% Urgent Services 92.0% 82.0% 83.8% 79.3% 79.7% 66.9% 94.1% 92.4% 85.2% 82.7% 78.1% 78.4% Emergency Services 100.0% 87.1% 82.8% 96.9% 78.8% 88.2% 96.9% 78.3% 72.8% 89.6% 79.4% 78.3% Prenatal Care/Childbirth/ N/A N/A N/A 94.0% 81.3% 80.8% N/A N/A N/A 93.8% 81.1% 71.1% Post-Delivery Diagnostic Services 83.7% 72.1% 77.1% 93.8% 76.9% 81.3% 89.0% 81.0% 89.2% 89.5% 78.6% 68.8% Access to Healthcare 96.1% 100.0% 88.2% 90.2% 39.2% 75.5% 76.5% 100.0% 75.5% 76.6% 75.2% 63.8% Information Outpatient Housing Unit N/A N/A N/A 89.4% 88.3% 88.5% N/A N/A N/A 92.8% 91.4% 81.1% Internal Reviews 87.5% 65.0% 72.5% 100.0% 85.7% 85.5% 82.5% 75.0% 87.5% 84.5% 76.8% 78.0% Inmate Transfers 100.0% 90.7% 85.3% 100.0% 100.0% 100.0% 100.0% 92.3% 88.9% 96.0% 87.3% 87.8% Clinic Operations 93.9% 90.9% 95.5% 100.0% 97.0% 100.0% 100.0% 97.9% 89.7% 97.3% 94.2% 92.2% Preventive Services 92.7% 96.7% 42.0% 91.5% 92.0% 81.4% 87.7% 92.0% 70.0% 90.4% 80.4% 43.9% Pharmacy Services 100.0% 100.0% 100.0% 100.0% 93.1% 86.2% 96.6% 93.1% 86.2% 98.0% 93.1% 87.5% Other Services 100.0% 83.3% 89.3% 100.0% 100.0% 100.0% 70.0% 100.0% 68.8% 95.6% 91.2% 84.2% Inmate Hunger Strikes 93.7% 52.6% 26.3% N/A N/A N/A 100.0% 100.0% N/A 83.5% 81.5% 57.0% Chemical Agent 89.4% 100.0% 100.0% 100.0% 73.5% 100.0% 100.0% 87.1% 94.1% 91.0% 91.5% 92.8% Contraindications Staffing Levels and 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 95.0% 100.0% 80.0% 99.8% 99.2% 95.9% Training Nursing Policy 50.0% 71.4% 100.0% 100.0% 50.0% 100.0% 85.7% 100.0% 100.0% 87.6% 75.9% 76.8% Overall Score 87.7% 78.0% 74.1% 92.6% 82.2% 80.0% 87.5% 84.3% 75.9% 87.0% 79.6% 71.9% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 53 Office of the Inspector General State of California APPENDIX C: Category Questions and Scores Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 54 Office of the Inspector General State of California APPENDIX C-16 C-1 Medication Management, Cycle 3 Page 1 of 4 Medication Management Category Definition: The Medication Management category determines if medications were properly administered and delivered to inmates as required by CDCR's policies. Reference Number ASP CAL CCC CCI CCWF CEN CIM CIW CMC CMF COR CRC CTF CVSP DVI FSP HDSP Sick Call Medication: Did the institution administer or deliver prescription medications (new orders) to the inmate within specified 01.124 timeframes? Score 97% 97% 82% 88% 100% 88% 100% 93% 83% 48% 93% 90% 88% 92% 78% 97% 88% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 5.8 5.8 4.9 5.3 6.0 5.3 6.0 5.6 5.0 2.9 5.6 5.4 5.3 5.5 4.7 5.8 5.3 If the inmate had an existing medication order upon arrival at the institution, did the inmate receive the medications within specified 02.128 timeframes, or did a physician document why the medications were not to be continued? Score 90% 84% 100% 100% 91% 100% 90% 93% 73% 45% 84% 91% 66% 66% 64% 80% 34% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 7.2 6.7 8.0 8.0 7.3 8.0 7.2 7.4 5.8 3.6 6.7 7.3 5.3 5.3 5.1 6.4 2.7 Did the inmate receive his or her prescribed chronic care medications during the most recent three-month period or did the institution follow 03.175 departmental policy if the inmate refused to pick up or show up for his or her medications? Score 91% 82% 61% 60% 96% 48% 68% 72% 79% 48% 74% 86% 86% 88% 76% 69% 56% Points Possible 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 Points Received 14.6 13.1 9.8 9.6 15.3 7.7 10.9 11.5 12.7 7.7 11.8 13.8 13.8 14.1 12.2 11.1 9.0 Do all appropriate forms in the transfer envelope identify all medications ordered by the physician; and, are the medications in the transfer 05.110 envelope? Score 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 Points Received 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 10.228 Inmates prescribed INH: Did the institution properly administer the medication to the inmate? Score 100% 100% 60% 60% 100% 80% 100% 60% 80% 20% 60% 100% 100% 100% 100% 80% 60% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 6.0 3.6 3.6 6.0 4.8 6.0 3.6 4.8 1.2 3.6 6.0 6.0 6.0 6.0 4.8 3.6 13.141 Does the institution properly maintain its emergency crash cart medications? Score 100% 100% 100% 85% 100% 100% 100% 100% 100% 65% 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 Points Received 2.0 2.0 2.0 1.7 2.0 2.0 2.0 2.0 2.0 1.3 2.0 2.0 2.0 2.0 2.0 2.0 2.0 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 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 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 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 13.252 Does the institution properly maintain medications in its after-hours medication supply(ies)? Score 0% 100% 100% 100% 100% 100% 85% 65% 100% 100% 0% 100% 100% 100% 50% 100% 100% Points Possible 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Points Received 0.0 2.0 2.0 2.0 2.0 2.0 1.7 1.3 2.0 2.0 0.0 2.0 2.0 2.0 1.0 2.0 2.0 6 The percentages of points earned for an individual question identified in individual inspection reports may differ slightly from the percentage identified above due to the differences in truncating and rounding numbers. Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 55 Office of the Inspector General State of California APPENDIX C-1 Medication Management, Cycle 3 Page 2 of 4 Medication Management Category Definition: The Medication Management category determines if medications were properly administered and delivered to inmates as required by CDCR's policies. Reference Number ISP KVSP LAC MCSP NKSP PBSP PVSP RJD SAC SATF SCC SOL SQ SVSP VSPW WSP Average Score 01.124 Sick Call Medication: Did the institution administer or deliver prescription medications (new orders) to the inmate within specified timeframes? Score 100% 83% 83% 95% 85% 97% 82% 63% 52% 90% 93% 62% 88% 95% 83% 97% 86% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 5.0 5.0 5.7 5.1 5.8 4.9 3.8 3.1 5.4 5.6 3.7 5.3 5.7 5.0 5.8 5.2 If the inmate had an existing medication order upon arrival at the institution, did the inmate receive the medications within specified timeframes, or 02.128 did a physician document why the medications were not to be continued? Score 80% 66% 69% 89% 73% 100% 88% 71% 64% 84% 100% 100% 64% 78% 86% 81% 80% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 6.4 5.3 5.5 7.1 5.8 8.0 7.0 5.7 5.1 6.7 8.0 8.0 5.1 6.2 6.9 6.5 6.4 Did the inmate receive his or her prescribed chronic care medications during the most recent three-month period or did the institution follow 03.175 departmental policy if the inmate refused to pick up or show up for his or her medications? Score 81% 60% 81% 88% 67% 91% 68% 76% 60% 52% 83% 84% 88% 52% 56% 64% 73% Points Possible 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 Points Received 13.0 9.6 13.0 14.1 10.7 14.6 10.9 12.2 9.6 8.3 13.2 13.4 14.1 8.3 9.0 10.2 11.6 Do all appropriate forms in the transfer envelope identify all medications ordered by the physician; and, are the medications in the transfer 05.110 envelope? Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 80% 100% 100% 100% 99% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 6.4 8.0 8.0 8.0 7.9 10.228 Inmates prescribed INH: Did the institution properly administer the medication to the inmate? Score 80% 80% 60% 100% 60% 100% 100% 40% 0% 80% 100% 80% 80% 80% 60% 80% 77% 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 3.6 6.0 3.6 6.0 6.0 2.4 0.0 4.8 6.0 4.8 4.8 4.8 3.6 4.8 4.6 13.141 Does the institution properly maintain its emergency crash cart medications? Score 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 50% 94% Points Possible 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Points Received 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 0.0 2.0 2.0 2.0 2.0 2.0 2.0 1.0 1.9 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 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 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 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 13.252 Does the institution properly maintain medications in its after-hours medication supply(ies)? Score 50% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 88% Points Possible 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Points Received 1.0 2.0 2.0 2.0 2.0 2.0 1.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 1.8 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 56 Office of the Inspector General State of California APPENDIX C-1 Medication Management, Cycle 3 Page 3 of 4 Medication Management Category Definition: The Medication Management category determines if medications were properly administered and delivered to inmates as required by CDCR's policies. Reference Number ASP CAL CCC CCI CCWF CEN CIM CIW CMC CMF COR CRC CTF CVSP DVI FSP HDSP 13.253 Does the institution conduct monthly inspections of its emergency cart and after-hours medication supply(ies)? Score 100% 100% 100% 100% 100% 100% 10% 100% 100% 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 1.0 1.0 1.0 1.0 1.0 1.0 0.1 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 Does medical staff in the facility clinic know which inmates are on modified program or confined to quarters (CTQ) and does staff have an 14.029 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% Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Points Received 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 Do medication nurses understand that the licensed staff member who prepares the medication must also administer it on the same day it is 14.131 prepared? Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 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 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 0.0 4.0 4.0 4.0 4.0 4.0 4.0 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 Points Received 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 Upon the inmate's discharge from a community hospital, did the institution administer or deliver all prescribed medications to the inmate 21.281 within specified timeframes? Score 100% 89% 90% 100% 100% 67% 100% 77% 84% 91% 100% 89% 100% 100% 93% 79% 93% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 7.0 6.2 6.3 7.0 7.0 4.7 7.0 5.4 5.9 6.4 7.0 6.2 7.0 7.0 6.5 5.5 6.5 Total Points Possible 77 77 73 77 69 69 77 77 77 69 77 77 77 77 77 69 77 Total Points Received 72.6 71.8 62.6 67.2 67.6 56.5 69.9 66.8 68.2 43.1 66.7 72.7 71.4 71.9 67.5 59.6 61.1 Total Score 94.3% 93.2% 85.8% 87.3% 98.0% 81.9% 90.8% 86.8% 88.6% 62.5% 86.6% 94.4% 92.7% 93.4% 87.7% 86.4% 79.4% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 57 Office of the Inspector General State of California APPENDIX C-1 Medication Management, Cycle 3 Page 4 of 4 Medication Management Category Definition: The Medication Management category determines if medications were properly administered and delivered to inmates as required by CDCR's policies. Reference Number ISP KVSP LAC MCSP NKSP PBSP PVSP RJD SAC SATF SCC SOL SQ SVSP VSPW WSP Average Score 13.253 Does the institution conduct monthly inspections of its emergency cart and after-hours medication supply(ies)? Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 97% Points Possible 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Points Received 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 Does medical staff in the facility clinic know which inmates are on modified program or confined to quarters (CTQ) and does staff have an 14.029 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 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 Do medication nurses understand that the licensed staff member who prepares the medication must also administer it on the same day it is 14.131 prepared? Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 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 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 3.9 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 Points Received 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 Upon the inmate's discharge from a community hospital, did the institution administer or deliver all prescribed medications to the inmate within 21.281 specified timeframes? Score 93% 80% 100% 100% 60% 100% 100% 67% 76% 100% 100% 70% 83% 100% 91% 100% 90% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 6.5 5.6 7.0 7.0 4.2 7.0 7.0 4.7 5.3 7.0 7.0 4.9 5.8 7.0 6.4 7.0 6.3 Total Points Possible 77 77 77 77 77 77 69 77 77 77 69 77 69 77 77 77 2481.0 Total Points Received 69.7 64.3 68.1 73.9 63.4 75.4 60.8 62.8 55.1 66.2 65.8 67.2 61.1 66.0 64.9 67.3 2169.2 Total Score 90.5% 83.5% 88.4% 96.0% 82.3% 97.9% 88.1% 81.6% 71.6% 86.0% 95.4% 87.3% 88.6% 85.7% 84.3% 87.4% 87.4% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 58 Office of the Inspector General State of California APPENDIX C-2 C-2 Access to Providers and Services, Cycle 3 Page 1 of 8 Access to Providers and Services 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. Reference Number ASP CAL CCC CCI CCWF CEN CIM CIW CMC CMF COR CRC CTF CVSP DVI FSP HDSP 01.025 Did the RN complete a face-to-face (FTF) visit within one (1) business day after the Form 7362 was reviewed? Score 97% 97% 100% 100% 100% 97% 92% 100% 100% 73% 91% 85% 97% 100% 84% 94% 100% Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 Points Received 9.7 9.7 10.0 10.0 10.0 9.7 9.2 10.0 10.0 7.3 9.1 8.5 9.7 10.0 8.4 9.4 10.0 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 01.027 during the FTF triage? Score 87% 83% 100% 79% 57% 90% 91% 83% 78% 75% 69% 88% 83% 80% 53% 91% 72% Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 Points Received 8.7 8.3 10.0 7.9 5.7 9.0 9.1 8.3 7.8 7.5 6.9 8.8 8.3 8.0 5.3 9.1 7.2 01.247 Sick Call Follow-up: If the provider ordered a follow-up sick call appointment, did it take place within the timeframe specified? Score 56% 100% 100% 88% 76% 84% 84% 54% 64% 72% 100% 76% 78% 90% 100% 76% Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 Points Received 2.8 5.0 5.0 4.4 3.8 4.2 4.2 2.7 3.2 3.6 5.0 3.8 3.9 4.5 5.0 3.8 Was a review of symptoms completed if the inmate's tuberculin test was positive, and were the results reviewed by the infection control 02.015 nurse or the public health nurse? Score 100% Points Possible 7 Points Received 7.0 02.016 Did the institution complete the initial health screening on the same day the inmate arrived at the institution? Score 90% 60% 100% 86% 100% 96% 93% 96% 100% 90% 90% 100% 96% 80% 90% 96% 96% Points Possible 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 Points Received 8.1 5.4 9.0 7.7 9.0 8.6 8.4 8.6 9.0 8.1 8.1 9.0 8.6 7.2 8.1 8.6 8.6 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 02.017 the date of arrival? Score 100% 91% 100% 34% 100% 78% 91% 95% 100% 100% 100% 100% 75% 81% 69% 95% 50% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 8.0 7.3 8.0 2.7 8.0 6.2 7.3 7.6 8.0 8.0 8.0 8.0 6.0 6.5 5.5 7.6 4.0 02.018 If, during the assessment, the RN referred the inmate to a clinician, was the inmate seen within the timeframe? Score 100% 60% 59% 80% 86% 88% 100% 53% 26% 90% 60% 71% 64% 61% 50% 100% Points Possible 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 Points Received 9.0 5.4 5.3 7.2 7.7 7.9 9.0 4.8 2.3 8.1 5.4 6.4 5.8 5.5 4.5 9.0 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 02.020 because of a previous positive TB test, was a review of signs and symptoms completed? Score 100% 95% 100% 88% 100% 85% 97% 100% 95% 80% 95% 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 6.0 5.7 6.0 5.3 6.0 5.1 5.8 6.0 5.7 4.8 5.7 6.0 6.0 6.0 6.0 6.0 6.0 Reception Center: Did the inmate receive a history and physical by a Nurse Practitioner, Physician Assistant, or a Physician and Surgeon 02.021 within the timeframe required by policy? Score 100% 100% 100% Points Possible 7 7 7 Points Received 7.0 7.0 7.0 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 59 Office of the Inspector General State of California APPENDIX C-2 Access to Providers and Services, Cycle 3 Page 2 of 8 Access to Providers and Services 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. Reference Number ISP KVSP LAC MCSP NKSP PBSP PVSP RJD SAC SATF SCC SOL SQ SVSP VSPW WSP Average 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 90% 89% 97% 88% 73% 100% 100% 93% 76% 100% 100% 96% 89% 93% 100% 100% 94% Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 Points Received 9.0 8.9 9.7 8.8 7.3 10.0 10.0 9.3 7.6 10.0 10.0 9.6 8.9 9.3 10.0 10.0 9.4 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 01.027 during the FTF triage? Score 86% 61% 60% 70% 76% 75% 69% 93% 71% 52% 88% 69% 73% 60% 67% 94% 76% Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 Points Received 8.6 6.1 6.0 7.0 7.6 7.5 6.9 9.3 7.1 5.2 8.8 6.9 7.3 6.0 6.7 9.4 7.6 01.247 Sick Call Follow-up: If the provider ordered a follow-up sick call appointment, did it take place within the timeframe specified? Score 84% 80% 54% 100% 78% 100% 66% 100% 86% 100% 100% 76% 100% 60% 80% 83% Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 Points Received 4.2 4.0 2.7 5.0 3.9 5.0 3.3 5.0 4.3 5.0 5.0 3.8 5.0 3.0 4.0 4.1 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 02.015 the public health nurse? Score 100% Points Possible 7 Points Received 7.0 02.016 Did the institution complete the initial health screening on the same day the inmate arrived at the institution? Score 90% 100% 90% 90% 97% 100% 90% 87% 100% 100% 100% 100% 90% 100% 96% 93% 93% Points Possible 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 Points Received 8.1 9.0 8.1 8.1 8.7 9.0 8.1 7.8 9.0 9.0 9.0 9.0 8.1 9.0 8.6 8.4 8.4 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 02.017 date of arrival? Score 29% 100% 100% 21% 100% 100% 100% 96% 100% 100% 100% 100% 100% 100% 100% 88% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 2.3 8.0 8.0 1.7 8.0 8.0 8.0 7.7 8.0 8.0 8.0 8.0 8.0 8.0 8.0 7.0 02.018 If, during the assessment, the RN referred the inmate to a clinician, was the inmate seen within the timeframe? Score 67% 64% 22% 26% 100% 67% 100% 76% 29% 100% 62% 69% 67% 100% 70% Points Possible 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 Points Received 6.0 5.8 2.0 2.3 9.0 6.0 9.0 6.8 2.6 9.0 5.6 6.2 6.0 9.0 6.3 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 02.020 a previous positive TB test, was a review of signs and symptoms completed? Score 100% 90% 100% 90% 97% 93% 70% 100% 95% 88% 100% 100% 97% 100% 95% 90% 95% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 5.4 6.0 5.4 5.8 5.6 4.2 6.0 5.7 5.3 6.0 6.0 5.8 6.0 5.7 5.4 5.7 Reception Center: Did the inmate receive a history and physical by a Nurse Practitioner, Physician Assistant, or a Physician and Surgeon within 02.021 the timeframe required by policy? Score 100% 100% 96% 99% Points Possible 7 7 7 7 Points Received 7.0 7.0 6.7 7.0 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 60 Office of the Inspector General State of California APPENDIX C-2 Access to Providers and Services, Cycle 3 Page 3 of 8 Access to Providers and Services 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. Reference Number ASP CAL CCC CCI CCWF CEN CIM CIW CMC CMF COR CRC CTF CVSP DVI FSP HDSP 03.076 Was the inmate's most recent chronic care visit within the timeframe required by policy? Score 68% 64% 74% 76% 92% 91% 80% 72% 44% 68% 84% 80% 68% 80% 88% 96% 64% Points Possible 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 Points Received 13.6 12.8 14.8 15.2 18.3 18.2 16.0 14.4 8.8 13.6 16.8 16.0 13.6 16.0 17.6 19.2 12.8 04.051 Did the primary care provider (PCP) evaluate the inmate within one (1) calendar day after placement? Score 100% 100% 80% 100% 100% 100% 92% 80% 88% 80% 80% 80% Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 Points Received 5.0 5.0 4.0 5.0 5.0 5.0 4.6 4.0 4.4 4.0 4.0 4.0 04.052 Did the RN complete an initial assessment of the inmate on the day of placement? Score 100% 100% 90% 100% 100% 100% 76% 100% 100% 100% 100% 90% Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 Points Received 5.0 5.0 4.5 5.0 5.0 5.0 3.8 5.0 5.0 5.0 5.0 4.5 While the inmate was placed in the OHU, did the PCP complete the Subjective, Objective, Assessment, Plan and Education (SOAPE) at a 04.053 minimum of every 14 days? Score 100% 90% 100% 100% 100% 100% 83% 60% 90% 100% 100% 90% Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 Points Received 4.0 3.6 4.0 4.0 4.0 4.0 3.3 2.4 3.6 4.0 4.0 3.6 06.049 Radiology order: Was the radiology service provided within the timeframe specified in the physician's order? Score 100% 76% 100% 100% 100% 100% 100% 80% 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 7.0 5.3 7.0 7.0 7.0 7.0 7.0 5.6 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 06.188 All laboratory orders: Was the specimen collected within the applicable timeframes of the physician's order? Score 90% 90% 100% 90% 90% 60% 88% 100% 100% 100% 100% 90% 80% 100% 100% 100% 90% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 5.4 5.4 6.0 5.4 5.4 3.6 5.3 6.0 6.0 6.0 6.0 5.4 4.8 6.0 6.0 6.0 5.4 07.035 Did the inmate receive the specialty service within specified timeframes? Score 100% 100% 100% 94% 100% 100% 100% 94% 100% 94% 100% 94% 82% 94% 100% 100% 100% Points Possible 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 Points Received 9.0 9.0 9.0 8.5 9.0 9.0 9.0 8.5 9.0 8.5 9.0 8.5 7.4 8.5 9.0 9.0 9.0 Did the PCP review the specialist's report and see the inmate for a follow-up appointment within specified timelines following completion of 07.043 the specialty service? Score 79% 100% 69% 67% 100% 88% 100% 86% 69% 31% 83% 64% 50% 92% 71% 94% 92% Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 Points Received 7.9 10.0 6.9 6.7 10.0 8.8 10.0 8.6 6.9 3.1 8.3 6.4 5.0 9.2 7.1 9.4 9.2 08.184 Did the medical emergency responder arrive at the location of the medical emergency within eight (8) minutes of initial notification? Score 100% 100% 80% 100% 100% 100% 100% 100% 100% 100% 100% 80% 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 6.0 6.0 4.8 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 4.8 6.0 6.0 6.0 6.0 6.0 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 61 Office of the Inspector General State of California APPENDIX C-2 Access to Providers and Services, Cycle 3 Page 4 of 8 Access to Providers and Services 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. Reference Number ISP KVSP LAC MCSP NKSP PBSP PVSP RJD SAC SATF SCC SOL SQ SVSP VSPW WSP Average Score 03.076 Was the inmate's most recent chronic care visit within the timeframe required by policy? Score 86% 64% 84% 80% 68% 96% 60% 72% 76% 64% 96% 68% 48% 84% 92% 60% 75% Points Possible 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 Points Received 17.1 12.8 16.8 16.0 13.6 19.2 12.0 14.4 15.2 12.8 19.2 13.6 9.6 16.8 18.4 12.0 15.1 04.051 Did the primary care provider (PCP) evaluate the inmate within one (1) calendar day after placement? Score 100% 100% 90% 90% 100% 92% Points Possible 5 5 5 5 5 5 Points Received 5.0 5.0 4.5 4.5 5.0 4.6 04.052 Did the RN complete an initial assessment of the inmate on the day of placement? Score 100% 100% 100% 100% 100% 97% Points Possible 5 5 5 5 5 5 Points Received 5.0 5.0 5.0 5.0 5.0 4.9 While the inmate was placed in the OHU, did the PCP complete the Subjective, Objective, Assessment, Plan and Education (SOAPE) at a minimum 04.053 of every 14 days? Score 90% 68% 90% 68% 100% 90% Points Possible 4 4 4 4 4 4 Points Received 3.6 2.7 3.6 2.7 4.0 3.6 06.049 Radiology order: Was the radiology service provided within the timeframe specified in the physician's order? Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 6.9 06.188 All laboratory orders: Was the specimen collected within the applicable timeframes of the physician's order? Score 100% 80% 100% 78% 100% 100% 100% 100% 90% 90% 100% 90% 80% 100% 78% 100% 93% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 4.8 6.0 4.7 6.0 6.0 6.0 6.0 5.4 5.4 6.0 5.4 4.8 6.0 4.7 6.0 5.6 07.035 Did the inmate receive the specialty service within specified timeframes? Score 100% 94% 100% 94% 94% 100% 88% 67% 82% 69% 100% 94% 88% 94% 100% 100% 95% Points Possible 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 Points Received 9.0 8.5 9.0 8.5 8.5 9.0 7.9 6.0 7.4 6.2 9.0 8.5 7.9 8.5 9.0 9.0 8.5 Did the PCP review the specialist's report and see the inmate for a follow-up appointment within specified timelines following completion of the 07.043 specialty service? Score 83% 62% 73% 93% 62% 50% 57% 77% 18% 60% 100% 77% 55% 87% 100% 79% 75% Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 Points Received 8.3 6.2 7.3 9.3 6.2 5.0 5.7 7.7 1.8 6.0 10.0 7.7 5.5 8.7 10.0 7.9 7.5 08.184 Did the medical emergency responder arrive at the location of the medical emergency within eight (8) minutes of initial notification? Score 100% 100% 100% 100% 100% 100% 100% 100% 40% 100% 100% 100% 100% 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 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 2.4 6.0 6.0 6.0 6.0 6.0 6.0 6.0 5.8 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 62 Office of the Inspector General State of California APPENDIX C-2 Access to Providers and Services, Cycle 3 Page 5 of 8 Access to Providers and Services 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. Reference Number ASP CAL CCC CCI CCWF CEN CIM CIW CMC CMF COR CRC CTF CVSP DVI FSP HDSP New arrival only: Did the inmate receive a pregnancy test within three (3) business days of arrival at the institution to positively identify her 09.066 pregnancy? Score 100% Points Possible 5 Points Received 5.0 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 09.067 institution? Score 100% 100% Points Possible 5 5 Points Received 5.0 5.0 09.071 Did the inmate visit with an OB physician according to the applicable timeframes? Score 100% 86% Points Possible 8 8 Points Received 8.0 6.9 09.074 Did the inmate receive her six-week check-up (post-delivery)? Score 60% Points Possible 7 Points Received 4.2 10.085 All inmates from the age of 51 through the age of 75: Did the inmate appropriately receive colorectal cancer screening? Score 100% 60% 80% 90% 100% 90% 80% 100% 90% 80% 90% 90% 90% 100% 70% 100% 100% Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 Points Received 5.0 3.0 4.0 4.5 5.0 4.5 4.0 5.0 4.5 4.0 4.5 4.5 4.5 5.0 3.5 5.0 5.0 10.086 All inmates age 65 and older: Did the inmate receive an influenza vaccination for the most recent influenza season? 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 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 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% 100% Points Possible 5 5 Points Received 5.0 5.0 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% 60% 100% 100% 100% 100% 100% 100% 90% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 4.2 7.0 7.0 7.0 7.0 7.0 7.0 6.3 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 100% 100% 100% 80% 60% 100% 60% 100% 100% 100% 100% 100% 100% 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 6.0 6.0 6.0 4.8 3.6 6.0 3.6 6.0 6.0 6.0 6.0 6.0 6.0 6.0 4.8 6.0 6.0 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 63 Office of the Inspector General State of California APPENDIX C-2 Access to Providers and Services, Cycle 3 Page 6 of 8 Access to Providers and Services 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. Reference Number ISP KVSP LAC MCSP NKSP PBSP PVSP RJD SAC SATF SCC SOL SQ SVSP VSPW WSP Average Score New arrival only: Did the inmate receive a pregnancy test within three (3) business days of arrival at the institution to positively identify her 09.066 pregnancy? Score 100% Points Possible 5 Points Received 5.0 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 5.0 5.0 09.071 Did the inmate visit with an OB physician according to the applicable timeframes? Score 100% 95% Points Possible 8 8 Points Received 8.0 7.6 09.074 Did the inmate receive her six-week check-up (post-delivery)? Score 100% 80% Points Possible 7 7 Points Received 7.0 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% 100% 100% 60% 100% 100% 100% 80% 100% 100% 90% 90% 80% 90% 50% 88% Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 Points Received 5.0 3.5 5.0 5.0 3.0 5.0 5.0 5.0 4.0 5.0 5.0 4.5 4.5 4.0 4.5 2.5 4.4 10.086 All inmates age 65 and older: Did the inmate receive an influenza vaccination for the most recent influenza season? Score 100% 100% 100% 100% 100% 100% 100% 90% 80% 100% 100% 100% 100% 100% 100% 100% 99% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 6.0 6.0 6.0 6.0 6.0 6.0 5.4 4.8 6.0 6.0 6.0 6.0 6.0 6.0 6.0 5.9 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 90% 97% Points Possible 5 5 Points Received 4.5 4.8 10.229 Annual TB Screening: Was the inmate appropriately screened for TB within the last year? Score 90% 100% 100% 90% 100% 100% 100% 80% 50% 100% 100% 90% 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 6.3 7.0 7.0 6.3 7.0 7.0 7.0 5.6 3.5 7.0 7.0 6.3 7.0 7.0 7.0 7.0 6.7 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 80% 0% 60% 100% 100% 100% 80% 80% 100% 100% 100% 100% 100% 100% 100% 100% 90% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 4.8 0.0 3.6 6.0 6.0 6.0 4.8 4.8 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 5.4 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 64 Office of the Inspector General State of California APPENDIX C-2 Access to Providers and Services, Cycle 3 Page 7 of 8 Access to Providers and Services 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. Reference Number ASP CAL CCC CCI CCWF CEN CIM CIW CMC CMF COR CRC CTF CVSP DVI FSP HDSP 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 100% 100% Points Possible 5 5 Points Received 5.0 5.0 11.097 Was the inmate offered initial baseline services for the hunger strike in accordance with policy requirements? Score 100% 60% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Possible 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 3.6 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 11.099 After the first 48 hours, did an RN or PCP complete daily assessments in accordance with policy requirements? Score 100% 40% 100% 100% 100% 33% 78% 100% 100% 100% 100% Points Possible 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 2.4 6.0 6.0 6.0 2.0 4.7 6.0 6.0 6.0 6.0 11.100 Was the hunger strike participant offered physician/primary care provider services as required by policy? Score 100% 60% 100% 100% 80% 100% 80% 0% 100% 100% 100% Points Possible 7 7 7 7 7 7 7 7 7 7 7 Points Received 7.0 4.2 7.0 7.0 5.6 7.0 5.6 0.0 7.0 7.0 7.0 Upon the inmate's discharge from the community hospital, did the inmate receive a follow-up appointment with his or her Primary Care 21.249 Provider (PCP) within five (5) calendar days of discharge? Score 100% 79% 88% 100% 96% 81% 100% 95% 95% 100% 95% 88% 96% 96% 84% 96% 95% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 8.0 6.3 7.0 8.0 7.7 6.5 8.0 7.6 7.6 8.0 7.6 7.0 7.7 7.7 6.7 7.7 7.6 Total Points Possible 161 180 161 180 182 161 194 191 166 180 180 161 180 161 178 166 166 Total Points Received 147.2 156.2 144.3 148.5 170.2 148.1 181.9 170.3 137.9 146.1 158.7 143.3 148.2 144.5 156.6 157.5 147.9 Total Score 91.4% 86.8% 89.6% 82.5% 93.5% 92.0% 93.8% 89.2% 83.1% 81.2% 88.2% 89.0% 82.3% 89.8% 88.0% 94.9% 89.1% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 65 Office of the Inspector General State of California APPENDIX C-2 Access to Providers and Services, Cycle 3 Page 8 of 8 Access to Providers and Services 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. Reference Number ISP KVSP LAC MCSP NKSP PBSP PVSP RJD SAC SATF SCC SOL SQ SVSP VSPW WSP Average Score 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 100% 100% Points Possible 5 5 Points Received 5.0 5.0 11.097 Was the inmate offered initial baseline services for the hunger strike in accordance with policy requirements? Score 80% 80% 100% 100% 80% 100% 100% 80% 100% 100% 94% Points Possible 6 6 6 6 6 6 6 6 6 6 6 Points Received 4.8 4.8 6.0 6.0 4.8 6.0 6.0 4.8 6.0 6.0 5.7 11.099 After the first 48 hours, did an RN or PCP complete daily assessments in accordance with policy requirements? Score 20% 80% 60% 80% 60% 60% 33% 80% 80% 100% 76% Points Possible 6 6 6 6 6 6 6 6 6 6 6 Points Received 1.2 4.8 3.6 4.8 3.6 3.6 2.0 4.8 4.8 6.0 4.6 11.100 Was the hunger strike participant offered physician/primary care provider services as required by policy? Score 20% 100% 76% 80% 100% 80% 33% 80% 100% 100% 80% Points Possible 7 7 7 7 7 7 7 7 7 7 7 Points Received 1.4 7.0 5.3 5.6 7.0 5.6 2.3 5.6 7.0 7.0 5.6 Upon the inmate's discharge from the community hospital, did the inmate receive a follow-up appointment with his or her Primary Care Provider 21.249 (PCP) within five (5) calendar days of discharge? Score 100% 86% 100% 100% 64% 23% 90% 91% 78% 60% 100% 86% 84% 95% 96% 86% 89% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 8.0 6.9 8.0 8.0 5.1 1.8 7.2 7.3 6.2 4.8 8.0 6.9 6.7 7.6 7.7 6.9 7.1 Total Points Possible 161 166 166 138 154 142 166 173 180 166 161 166 172 166 191 164 5580 Total Points Received 141.3 123.3 140.8 118.8 125.0 127.1 137.7 151.0 141.0 131.8 158.1 138.3 138.5 150.7 180.8 147.2 4858.8 Total Score 87.8% 74.3% 84.8% 86.1% 81.2% 89.5% 83.0% 87.3% 78.3% 79.4% 98.2% 83.3% 80.5% 90.8% 94.7% 89.8% 87.1% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 66 Office of the Inspector General State of California APPENDIX C-3 C-3 Primary Care Provider Responsibilities, Cycle 3 Page 1 of 6 Primary Care Provider Responsibilities 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. Reference Number ASP CAL CCC CCI CCWF CEN CIM CIW CMC CMF COR CRC CTF CVSP DVI FSP HDSP Reception Center: Is the history of present illness section of the provider's intake history and physical examination complete and appropriate to the chief 02.211 complaint(s), if any? Score 100% 85% 70% Points Possible 2 2 2 Points Received 2.0 1.7 1.4 02.212 Reception Center: Is the past medical history complete? Score 100% 90% 80% Points Possible 2 2 2 Points Received 2.0 1.8 1.6 02.213 Reception Center: Is the family and social history complete? Score 100% 100% 100% Points Possible 1 1 1 Points Received 1.0 1.0 1.0 02.215 Reception Center: Is the review of systems complete? Score 100% 80% 100% Points Possible 2 2 2 Points Received 2.0 1.6 2.0 02.216 Reception Center: Is the physical examination complete and appropriate to the history and review of systems? Score 100% 90% 100% Points Possible 2 2 2 Points Received 2.0 1.8 2.0 02.217 Reception Center: Is the assessment appropriate to the history and physical examination? Score 90% 77% 100% Points Possible 3 3 3 Points Received 2.7 2.3 3.0 02.218 Reception Center: Is the plan appropriate to the assessment? Score 100% 100% 100% Points Possible 4 4 4 Points Received 4.0 4.0 4.0 02.219 Reception Center: Has required intake testing been completed? Score 60% 50% 100% Points Possible 3 3 3 Points Received 1.8 1.5 3.0 03.082 Did the institution document that it provided the inmate with health care education? Score 100% 100% 100% 100% 97% 100% 100% 100% 97% 100% 88% 100% 100% 100% 100% 97% 100% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 6.0 6.0 6.0 5.8 6.0 6.0 6.0 5.8 6.0 5.3 6.0 6.0 6.0 6.0 5.8 6.0 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 67 Office of the Inspector General State of California APPENDIX C-3 Primary Care Provider Responsibilities, Cycle 3 Page 2 of 6 Primary Care Provider Responsibilities 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. Reference Number ISP KVSP LAC MCSP NKSP PBSP PVSP RJD SAC SATF SCC SOL SQ SVSP VSPW WSP Average Score 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), 02.211 if any? Score 85% 100% 90% 88% Points Possible 2 2 2 2 Points Received 1.7 2.0 1.8 1.8 02.212 Reception Center: Is the past medical history complete? Score 85% 100% 80% 89% Points Possible 2 2 2 2 Points Received 1.7 2.0 1.6 1.8 02.213 Reception Center: Is the family and social history complete? Score 100% 80% 100% 97% Points Possible 1 1 1 1 Points Received 1.0 0.8 1.0 1.0 02.215 Reception Center: Is the review of systems complete? Score 85% 80% 100% 91% Points Possible 2 2 2 2 Points Received 1.7 1.6 2.0 1.8 02.216 Reception Center: Is the physical examination complete and appropriate to the history and review of systems? Score 95% 100% 100% 98% Points Possible 2 2 2 2 Points Received 1.9 2.0 2.0 2.0 02.217 Reception Center: Is the assessment appropriate to the history and physical examination? Score 83% 100% 90% 90% Points Possible 3 3 3 3 Points Received 2.5 3.0 2.7 2.7 02.218 Reception Center: Is the plan appropriate to the assessment? Score 88% 100% 95% 97% Points Possible 4 4 4 4 Points Received 3.5 4.0 3.8 3.9 02.219 Reception Center: Has required intake testing been completed? Score 100% 100% 100% 40% 79% Points Possible 3 3 3 3 3 Points Received 3.0 3.0 3.0 1.2 2.4 03.082 Did the institution document that it provided the inmate with health care education? Score 95% 100% 100% 92% 97% 100% 100% 100% 100% 97% 100% 100% 92% 83% 97% 97% 98% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 5.7 6.0 6.0 5.5 5.8 6.0 6.0 6.0 6.0 5.8 6.0 6.0 5.5 5.0 5.8 5.8 5.9 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 68 Office of the Inspector General State of California APPENDIX C-3 Primary Care Provider Responsibilities, Cycle 3 Page 3 of 6 Primary Care Provider Responsibilities 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. Reference Number ASP CAL CCC CCI CCWF CEN CIM CIW CMC CMF COR CRC CTF CVSP DVI FSP HDSP 03.235 Is the clinical history adequate? Score 68% 80% 69% 84% 88% 79% 84% 60% 68% 92% 88% 68% 64% 60% 88% 88% 76% Points Possible 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 Points Received 12.2 14.4 12.5 15.1 15.8 14.3 15.1 10.8 12.2 16.6 15.8 12.2 11.5 10.8 15.8 15.8 13.7 03.236 Is the focused clinical examination adequate? Score 91% 85% 68% 86% 90% 57% 95% 88% 62% 81% 100% 68% 85% 86% 86% 100% 91% Points Possible 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 Points Received 14.5 13.6 10.9 13.7 14.4 9.1 15.2 14.0 9.9 13.0 16.0 10.9 13.6 13.7 13.8 16.0 14.5 03.237 Is the assessment adequate? Score 67% 69% 68% 83% 96% 91% 86% 73% 73% 100% 78% 82% 95% 89% 92% 87% 91% Points Possible 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 Points Received 12.0 12.5 12.3 14.9 17.2 16.4 15.5 13.1 13.1 18.0 14.1 14.7 17.1 16.1 16.5 15.7 16.3 03.238 Is the plan adequate? Score 95% 82% 94% 82% 83% 59% 100% 86% 78% 100% 87% 73% 79% 74% 87% 100% 80% Points Possible 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 Points Received 20.0 17.2 19.8 17.2 17.5 12.3 21.0 18.0 16.3 21.0 18.3 15.3 16.6 15.5 18.3 21.0 16.8 03.262 Is the inmate's Problem List complete and filed accurately in the inmate's Unit Health Record (UHR)? Score 96% 100% 100% 93% 100% 84% 84% 100% 93% 44% 100% 84% 100% 93% 100% 100% 100% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 7.7 8.0 8.0 7.4 8.0 6.7 6.7 8.0 7.4 3.5 8.0 6.7 8.0 7.4 8.0 8.0 8.0 04.056 Did the PCP's plan adequately address the patient's medical needs? Score 89% 100% 100% 100% 100% 80% 100% 100% 100% 100% 100% 100% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 6.2 7.0 7.0 7.0 7.0 5.6 7.0 7.0 7.0 7.0 7.0 7.0 04.112 Was the PCP's initial evaluation adequate for the problem(s) requiring OHU placement? Score 80% 100% 70% 100% 90% 80% 76% 70% 23% 90% 80% 100% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 5.6 7.0 4.9 7.0 6.3 5.6 5.3 4.9 1.6 6.3 5.6 7.0 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% 100% 100% 100% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 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% 100% 100% 77% 100% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 5.4 7.0 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 69 Office of the Inspector General State of California APPENDIX C-3 Primary Care Provider Responsibilities, Cycle 3 Page 4 of 6 Primary Care Provider Responsibilities 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. Reference Number ISP KVSP LAC MCSP NKSP PBSP PVSP RJD SAC SATF SCC SOL SQ SVSP VSPW WSP Average Score 03.235 Is the clinical history adequate? Score 86% 72% 96% 96% 64% 79% 92% 100% 72% 88% 92% 84% 76% 80% 100% 64% 80% Points Possible 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 Points Received 15.4 13.0 17.3 17.3 11.5 14.3 16.6 18.0 13.0 15.8 16.5 15.1 13.7 14.4 18.0 11.5 14.4 03.236 Is the focused clinical examination adequate? Score 100% 65% 100% 91% 64% 80% 80% 81% 81% 80% 91% 100% 85% 96% 100% 69% 84% Points Possible 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 Points Received 16.0 10.4 16.0 14.5 10.2 12.8 12.8 13.0 13.0 12.8 14.6 16.0 13.6 15.3 16.0 11.1 13.5 03.237 Is the assessment adequate? Score 75% 80% 96% 100% 94% 88% 83% 92% 84% 87% 100% 83% 92% 80% 96% 88% 86% Points Possible 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 Points Received 13.5 14.4 17.3 18.0 16.9 15.8 15.0 16.6 15.2 15.7 18.0 14.9 16.6 14.4 17.3 15.9 15.5 03.238 Is the plan adequate? Score 88% 90% 100% 79% 84% 92% 96% 90% 76% 76% 92% 86% 92% 82% 88% 81% 86% Points Possible 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 Points Received 18.4 18.9 21.0 16.6 17.7 19.3 20.1 18.9 16.0 16.0 19.3 18.0 19.3 17.3 18.5 17.0 18.0 03.262 Is the inmate's Problem List complete and filed accurately in the inmate's Unit Health Record (UHR)? Score 95% 28% 96% 100% 76% 71% 100% 93% 80% 100% 100% 93% 96% 100% 100% 100% 91% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 7.6 2.2 7.7 8.0 6.1 5.7 8.0 7.4 6.4 8.0 8.0 7.4 7.7 8.0 8.0 8.0 7.3 04.056 Did the PCP's plan adequately address the patient's medical needs? Score 100% 67% 100% 100% 100% 96% Points Possible 7 7 7 7 7 7 Points Received 7.0 4.7 7.0 7.0 7.0 6.7 04.112 Was the PCP's initial evaluation adequate for the problem(s) requiring OHU placement? Score 80% 100% 90% 100% 70% 82% Points Possible 7 7 7 7 7 7 Points Received 5.6 7.0 6.3 7.0 4.9 5.8 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% Points Possible 7 7 7 7 7 7 Points Received 7.0 7.0 7.0 7.0 7.0 7.0 04.230 Was the PCP's initial assessment (or diagnoses) appropriate for the findings in the initial evaluation? Score 100% 100% 90% 100% 100% 98% Points Possible 7 7 7 7 7 7 Points Received 7.0 7.0 6.3 7.0 7.0 6.9 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 70 Office of the Inspector General State of California APPENDIX C-3 Primary Care Provider Responsibilities, Cycle 3 Page 5 of 6 Primary Care Provider Responsibilities 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. Reference Number ASP CAL CCC CCI CCWF CEN CIM CIW CMC CMF COR CRC CTF CVSP DVI FSP HDSP 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 Score 71% 59% 80% 59% 69% 71% 80% 69% 71% 73% 59% 83% 73% 53% 90% 93% 67% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 5.0 4.1 5.6 4.1 4.8 5.0 5.6 4.8 5.0 5.1 4.1 5.8 5.1 3.7 6.3 6.5 4.7 06.263 All diagnostic services: At the next clinic visit following the report of a clinically significant abnormal diagnostic test, was the result adequately managed? Score 92% 67% 100% 88% 100% 100% 100% 100% 100% 100% 82% 90% 100% 88% 70% 100% 100% Points Possible 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 Points Received 11.0 8.0 12.0 10.5 12.0 12.0 12.0 12.0 12.0 12.0 9.8 10.8 12.0 10.5 8.4 12.0 12.0 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 5.0 5.0 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 09.072 physical examination? Score 100% 100% Points Possible 7 7 Points Received 7.0 7.0 09.223 Were the results of the inmate's specified prenatal screening tests documented on the prenatal flow record? Score 100% 58% Points Possible 5 5 Points Received 5.0 2.9 11.100 Was the hunger strike participant offered physician/primary care provider services as required by policy? Score 100% 60% 100% 100% 80% 100% 80% 0% 100% 100% 100% Points Possible 7 7 7 7 7 7 7 7 7 7 7 Points Received 7.0 4.2 7.0 7.0 5.6 7.0 5.6 0.0 7.0 7.0 7.0 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 95% 100% 100% 100% 100% 100% 100% 100% 88% 95% 100% 95% 100% 95% 100% 100% 100% Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Points Received 3.8 4.0 4.0 4.0 4.0 4.0 4.0 4.0 3.5 3.8 4.0 3.8 4.0 3.8 4.0 4.0 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 86% 81% 90% 56% 71% 90% 76% 88% 72% 79% 79% 83% 94% 76% 68% 95% 92% Points Possible 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 Points Received 16.3 15.4 17.1 10.7 13.4 17.1 14.5 16.8 13.7 15.0 15.0 15.8 17.9 14.5 13.0 18.1 17.4 Total Points Possible 157 164 157 164 165 136 183 174 136 164 164 157 164 157 183 136 136 Total Points Received 134.3 138.2 134.1 135.8 147.4 109.9 165.6 147.6 104.5 147.3 141.9 124.6 139.1 127.0 163.1 129.9 120.4 Total Score 85.5% 84.3% 85.4% 82.8% 89.3% 80.8% 90.5% 84.8% 76.8% 89.8% 86.5% 79.4% 84.8% 80.9% 89.1% 95.5% 88.5% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 71 Office of the Inspector General State of California APPENDIX C-3 Primary Care Provider Responsibilities, Cycle 3 Page 6 of 6 Primary Care Provider Responsibilities Category Definition: Assesses how well Reference Number ISP KVSP LAC MCSP NKSP PBSP PVSP RJD SAC SATF SCC SOL SQ SVSP VSPW WSP Average Score 06.191 All diagnostic services: Score 71% 93% 79% 73% 61% 80% 57% 100% 67% 54% 79% 86% 73% 69% 73% 59% 72% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 5.0 6.5 5.5 5.1 4.3 5.6 4.0 7.0 4.7 3.8 5.5 6.0 5.1 4.8 5.1 4.1 5.1 06.263 All diagnostic services: At the next clinic visit following the report of a clinically significant abnormal diagnostic test, was the result adequately managed? Score 100% 100% 92% 93% 100% 62% 100% 93% 75% 100% 100% 100% 100% 100% 100% 100% 94% Points Possible 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 Points Received 12.0 12.0 11.0 11.1 12.0 7.4 12.0 11.1 9.0 12.0 12.0 12.0 12.0 12.0 12.0 12.0 11.2 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 5.0 5.0 Is the problems/risks 09.072 identified section of the Score 83% 94% Points Possible 7 7 Points Received 5.8 6.6 09.223 Were the results of the inmate's specified prenatal screening tests documented on the prenatal flow record? Score 66% 75% Points Possible 5 5 Points Received 3.3 3.7 11.100 Was the hunger strike participant offered physician/primary care provider services as required by policy? Score 20% 100% 76% 80% 100% 80% 33% 80% 100% 100% 80% Points Possible 7 7 7 7 7 7 7 7 7 7 7 Points Received 1.4 7.0 5.3 5.6 7.0 5.6 2.3 5.6 7.0 7.0 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% 100% 95% 93% 95% 100% 100% 95% 100% 100% 100% 95% 93% 100% 100% 100% 98% Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Points Received 4.0 4.0 3.8 3.7 3.8 4.0 4.0 3.8 4.0 4.0 4.0 3.8 3.7 4.0 4.0 4.0 3.9 21.276 While the patient was in the TTA, did the provider render adequate and timely clinical care and adequately document that care? Score 56% 72% 82% 65% 58% 82% 67% 74% 43% 67% 69% 94% 100% 93% 75% 100% 78% Points Possible 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 Points Received 10.6 13.6 15.6 12.4 11.1 15.5 12.7 14.0 8.1 12.7 13.1 17.8 19.0 17.7 14.3 19.0 14.8 Total Points Possible 157 136 136 129 148 129 136 155 164 136 157 136 167 136 174 155 5048 Total Points Received 134.8 102.4 128.2 112.2 116.4 106.4 116.5 139.8 128.1 112.2 143.6 119.3 152.8 119.9 159.0 131.5 4333.8 Total Score 85.9% 75.3% 94.3% 87.0% 78.6% 82.5% 85.7% 90.2% 78.1% 82.5% 91.5% 87.7% 91.5% 88.2% 91.4% 84.8% 85.9% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 72 Office of the Inspector General State of California APPENDIX C-4 C-4 Continuity of Care, Cycle 3 Page 1 of 4 Continuity of Care 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. Reference Number ASP CAL CCC CCI CCWF CEN CIM CIW CMC CMF COR CRC CTF CVSP DVI FSP HDSP Non-reception center: Does the health care transfer information form indicate that it was reviewed and signed by licensed health care staff within one (1) calendar day 02.007 of the inmate's arrival at the institution? Score 100% 66% 100% 90% 96% 76% 90% 90% 100% 80% 96% 100% 94% 96% 80% 100% 96% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 7.0 4.6 7.0 6.3 6.7 5.3 6.3 6.3 7.0 5.6 6.7 7.0 6.6 6.7 5.6 7.0 6.7 Non-reception center: If the inmate was scheduled for a specialty appointment at the sending institution, did the receiving institution schedule the appointment within 02.014 30 days of the original appointment date? Score 100% 50% Points Possible 7 7 Points Received 7.0 3.5 02.111 Non-reception center: Did the inmate receive medical accommodations upon arrival, if applicable? Score 100% 100% 100% 100% 100% 100% 100% 50% 67% 100% Points Possible 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 6.0 6.0 6.0 6.0 6.0 6.0 3.0 4.0 6.0 If the inmate had an existing medication order upon arrival at the institution, did the inmate receive the medications within specified timeframes, or did a 02.128 physician document why the medications were not to be continued? Score 90% 84% 100% 100% 91% 100% 90% 93% 73% 45% 84% 91% 66% 66% 64% 80% 34% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 7.2 6.7 8.0 8.0 7.3 8.0 7.2 7.4 5.8 3.6 6.7 7.3 5.3 5.3 5.1 6.4 2.7 04.051 Did the primary care provider (PCP) evaluate the inmate within one (1) calendar day after placement? Score 100% 100% 80% 100% 100% 100% 92% 80% 88% 80% 80% 80% Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 Points Received 5.0 5.0 4.0 5.0 5.0 5.0 4.6 4.0 4.4 4.0 4.0 4.0 04.052 Did the RN complete an initial assessment of the inmate on the day of placement? Score 100% 100% 90% 100% 100% 100% 76% 100% 100% 100% 100% 90% Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 Points Received 5.0 5.0 4.5 5.0 5.0 5.0 3.8 5.0 5.0 5.0 5.0 4.5 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 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 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 Points Possible Points Received 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% 100% 100% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 73 Office of the Inspector General State of California APPENDIX C-4 Continuity of Care, Cycle 3 Page 2 of 4 Continuity of Care 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. Reference Number ISP KVSP LAC MCSP NKSP PBSP PVSP RJD SAC SATF SCC SOL SQ SVSP VSPW WSP Average Score Non-reception center: Does the health care transfer information form indicate that it was reviewed and signed by licensed health care staff within one (1) calendar day 02.007 of the inmate's arrival at the institution? Score 100% 96% 84% 100% 50% 100% 94% 96% 96% 100% 100% 100% 96% 90% 90% 70% 91% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 7.0 6.7 5.9 7.0 3.5 7.0 6.6 6.7 6.7 7.0 7.0 7.0 6.7 6.3 6.3 4.9 6.4 Non-reception center: If the inmate was scheduled for a specialty appointment at the sending institution, did the receiving institution schedule the appointment within 02.014 30 days of the original appointment date? Score 67% 72% Points Possible 7 7 Points Received 4.7 5.1 02.111 Non-reception center: Did the inmate receive medical accommodations upon arrival, if applicable? Score 100% 100% 0% 100% 75% 100% 50% 100% 67% 100% 85% Points Possible 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 6.0 0.0 6.0 4.5 6.0 3.0 6.0 4.0 6.0 5.1 If the inmate had an existing medication order upon arrival at the institution, did the inmate receive the medications within specified timeframes, or did a physician 02.128 document why the medications were not to be continued? Score 80% 66% 69% 89% 73% 100% 88% 71% 64% 84% 100% 100% 64% 78% 86% 81% 80% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 6.4 5.3 5.5 7.1 5.8 8.0 7.0 5.7 5.1 6.7 8.0 8.0 5.1 6.2 6.9 6.5 6.4 04.051 Did the primary care provider (PCP) evaluate the inmate within one (1) calendar day after placement? Score 100% 100% 90% 90% 100% 92% Points Possible 5 5 5 5 5 5 Points Received 5.0 5.0 4.5 4.5 5.0 4.6 04.052 Did the RN complete an initial assessment of the inmate on the day of placement? Score 100% 100% 100% 100% 100% 97% Points Possible 5 5 5 5 5 5 Points Received 5.0 5.0 5.0 5.0 5.0 4.9 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 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 7.0 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% 100% 100% 100% Points Possible 8 8 8 8 Points Received 8.0 8.0 8.0 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% 100% 100% 100% 100% 100% 100% 80% 100% 100% 100% 99% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 6.4 8.0 8.0 8.0 7.9 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 74 Office of the Inspector General State of California APPENDIX C-4 Continuity of Care, Cycle 3 Page 3 of 4 Continuity of Care 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. Reference Number ASP CAL CCC CCI CCWF CEN CIM CIW CMC CMF COR CRC CTF CVSP DVI FSP HDSP 05.171 Did an RN accurately complete all applicable sections of Form 7371 (Health Care Transfer Information) based on the inmate's UHR? Score 100% 100% 100% 80% 80% 100% 80% 100% 100% 100% 100% 80% 80% 80% 60% 40% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 7.0 7.0 7.0 5.6 5.6 7.0 5.6 7.0 7.0 7.0 7.0 5.6 5.6 5.6 4.2 2.8 Did the Health Records Department maintain a copy of the inmate's Form 7371 (Health Care Transfer Information) and Form 7231A (Outpatient Medication 05.172 Administration Record) when the inmate transferred? Score 80% 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 Points Received 6.4 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 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 79% 100% 69% 67% 100% 88% 100% 86% 69% 31% 83% 64% 50% 92% 71% 94% 92% Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 Points Received 7.9 10.0 6.9 6.7 10.0 8.8 10.0 8.6 6.9 3.1 8.3 6.4 5.0 9.2 7.1 9.4 9.2 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 07.270 and recommendations? Score 100% 100% 100% 100% 100% 88% 100% 100% 100% 100% 100% 100% 100% 93% 100% 100% 100% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 6.0 6.0 6.0 6.0 5.3 6.0 6.0 6.0 6.0 6.0 6.0 6.0 5.6 6.0 6.0 6.0 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 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 Upon the inmate's discharge from the community hospital, did the Triage and Treatment Area (TTA) Registered Nurse document that he or she reviewed the inmate's 21.248 discharge plan and complete a Face-to-Face assessment of the inmate? Score 100% 83% 100% 100% 97% 97% 100% 100% 95% 90% 100% 100% 97% 97% 100% 100% 100% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 5.0 6.0 6.0 5.8 5.8 6.0 6.0 5.7 5.4 6.0 6.0 5.8 5.8 6.0 6.0 6.0 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 21.249 five (5) calendar days of discharge? Score 100% 79% 88% 100% 96% 81% 100% 95% 95% 100% 95% 88% 96% 96% 84% 96% 95% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 8.0 6.3 7.0 8.0 7.7 6.5 8.0 7.6 7.6 8.0 7.6 7.0 7.7 7.7 6.7 7.7 7.6 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 95% 100% 100% 100% 100% 100% 100% 100% 88% 95% 100% 95% 100% 95% 100% 100% 100% Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Points Received 3.8 4.0 4.0 4.0 4.0 4.0 4.0 4.0 3.5 3.8 4.0 3.8 4.0 3.8 4.0 4.0 4.0 Upon the inmate's discharge from a community hospital, did the institution administer or deliver all prescribed medications to the inmate within specified 21.281 timeframes? Score 100% 89% 90% 100% 100% 67% 100% 77% 84% 91% 100% 89% 100% 100% 93% 79% 93% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 7.0 6.2 6.3 7.0 7.0 4.7 7.0 5.4 5.9 6.4 7.0 6.2 7.0 7.0 6.5 5.5 6.5 Total Points Possible 106 106 100 100 95 82 106 113 96 76 106 106 106 100 100 82 90 Total Points Received 101.3 98.8 93.7 94.6 92.1 74.4 103.1 104.8 88.4 60.3 98.3 97.1 95.0 92.7 88.1 75.2 78.5 Total Score 95.6% 93.2% 93.7% 94.6% 96.9% 90.7% 97.3% 92.7% 92.1% 79.3% 92.7% 91.6% 89.6% 92.7% 88.1% 91.7% 87.2% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 75 Office of the Inspector General State of California APPENDIX C-4 Continuity of Care, Cycle 3 Page 4 of 4 Continuity of Care 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. Reference Number ISP KVSP LAC MCSP NKSP PBSP PVSP RJD SAC SATF SCC SOL SQ SVSP VSPW WSP Average Score 05.171 Did an RN accurately complete all applicable sections of Form 7371 (Health Care Transfer Information) based on the inmate's UHR? Score 80% 60% 40% 80% 100% 100% 80% 40% 100% 60% 100% 80% 100% 100% 100% 100% 84% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 5.6 4.2 2.8 5.6 7.0 7.0 5.6 2.8 7.0 4.2 7.0 5.6 7.0 7.0 7.0 7.0 5.9 Did the Health Records Department maintain a copy of the inmate's Form 7371 (Health Care Transfer Information) and Form 7231A (Outpatient Medication 05.172 Administration Record) when the inmate transferred? Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 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 83% 62% 73% 93% 62% 50% 57% 77% 18% 60% 100% 77% 55% 87% 100% 79% 75% Points Possible 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 Points Received 8.3 6.2 7.3 9.3 6.2 5.0 5.7 7.7 1.8 6.0 10.0 7.7 5.5 8.7 10.0 7.9 7.5 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 07.270 and recommendations? Score 93% 100% 100% 100% 88% 100% 100% 100% 92% 93% 100% 100% 100% 100% 93% 100% 98% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 5.6 6.0 6.0 6.0 5.3 6.0 6.0 6.0 5.5 5.6 6.0 6.0 6.0 6.0 5.6 6.0 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% 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 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 Upon the inmate's discharge from the community hospital, did the Triage and Treatment Area (TTA) Registered Nurse document that he or she reviewed the inmate's 21.248 discharge plan and complete a Face-to-Face assessment of the inmate? Score 97% 100% 92% 100% 95% 93% 100% 100% 100% 95% 100% 100% 97% 100% 100% 100% 98% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 5.8 6.0 5.5 6.0 5.7 5.6 6.0 6.0 6.0 5.7 6.0 6.0 5.8 6.0 6.0 6.0 5.9 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 (5) 21.249 calendar days of discharge? Score 100% 86% 100% 100% 64% 23% 90% 91% 78% 60% 100% 86% 84% 95% 96% 86% 89% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 8.0 6.9 8.0 8.0 5.1 1.8 7.2 7.3 6.2 4.8 8.0 6.9 6.7 7.6 7.7 6.9 7.1 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% 95% 93% 95% 100% 100% 95% 100% 100% 100% 95% 93% 100% 100% 100% 98% Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Points Received 4.0 4.0 3.8 3.7 3.8 4.0 4.0 3.8 4.0 4.0 4.0 3.8 3.7 4.0 4.0 4.0 3.9 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 93% 80% 100% 100% 60% 100% 100% 67% 76% 100% 100% 70% 83% 100% 91% 100% 90% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 6.5 5.6 7.0 7.0 4.2 7.0 7.0 4.7 5.3 7.0 7.0 4.9 5.8 7.0 6.4 7.0 6.3 Total Points Possible 106 98 96 90 90 96 88 104 108 96 98 103 98 90 106 90 3227 Total Points Received 100.2 85.9 84.8 86.7 73.6 78.4 80.1 90.2 92.6 84.0 94.5 92.0 84.8 85.8 102.9 83.2 2936.1 Total Score 94.5% 87.7% 88.3% 96.3% 81.8% 81.7% 91.0% 86.7% 85.7% 87.5% 96.4% 89.3% 86.5% 95.3% 97.1% 92.4% 91.0% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 76 Office of the Inspector General State of California APPENDIX C-5 C-5 Nurse Responsibilities, Cycle 3 Page 1 of 4 Nurse Responsibilities 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. Reference Number ASP CAL CCC CCI CCWF CEN CIM CIW CMC CMF COR CRC CTF CVSP DVI FSP HDSP 01.024 RN FTF Documentation: Did the inmate's request for health care get reviewed the same day it was received? Score 100% 97% 100% 100% 100% 93% 88% 100% 98% 93% 85% 100% 92% 100% 95% 92% 97% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 5.8 6.0 6.0 6.0 5.6 5.3 6.0 5.9 5.6 5.1 6.0 5.5 6.0 5.7 5.5 5.8 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 100% 100% 100% 93% 100% 100% 100% 87% 88% 80% 95% 85% 95% 97% 75% 75% 90% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 6.0 6.0 5.6 6.0 6.0 6.0 5.2 5.3 4.8 5.7 5.1 5.7 5.8 4.5 4.5 5.4 RN FTF Documentation: For the clinically significant complaints, did the RN's assessment provide appropriate conclusions based on subjective and objective 01.158 data? Score 92% 78% 88% 86% 96% 82% 76% 94% 88% 80% 92% 50% 82% 100% 100% 98% 74% Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 Points Received 4.6 3.9 4.4 4.3 4.8 4.1 3.8 4.7 4.4 4.0 4.6 2.5 4.1 5.0 5.0 4.9 3.7 RN FTF Documentation: Did the RN's objective note include vital signs, a focused physical examination, and did it adequately address the clinically significant 01.159 problems noted in the subjective note? Score 100% 88% 96% 76% 96% 94% 88% 76% 78% 66% 86% 76% 86% 90% 70% 82% 86% Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 Points Received 5.0 4.4 4.8 3.8 4.8 4.7 4.4 3.8 3.9 3.3 4.3 3.8 4.3 4.5 3.5 4.1 4.3 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 100% 97% 100% 100% 100% 100% 100% 100% 98% 93% 100% 90% 100% 100% 95% 97% 97% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 5.8 6.0 6.0 6.0 6.0 6.0 6.0 5.9 5.6 6.0 5.4 6.0 6.0 5.7 5.8 5.8 01.163 RN FTF Documentation: Did the RN's education/instruction adequately address the clinically significant problems identified during the FTF triage? Score 100% 100% 100% 93% 100% 100% 100% 100% 95% 98% 98% 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 Points Received 4.0 4.0 4.0 3.7 4.0 4.0 4.0 4.0 3.8 3.9 3.9 4.0 4.0 4.0 4.0 4.0 3.9 01.244 RN FTF Documentation: Did the RN's objective note include allergies, weight, current medication, and where appropriate, medication compliance? Score 93% 83% 93% 80% 97% 87% 87% 97% 70% 73% 83% 97% 90% 100% 90% 93% 67% Points Possible 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 Points Received 2.8 2.5 2.8 2.4 2.9 2.6 2.6 2.9 2.1 2.2 2.5 2.9 2.7 3.0 2.7 2.8 2.0 01.246 Did documentation indicate that the RN reviewed all of the inmate's clinically significant complaints listed on Form 7362 (Health Care Services Request Form)? Score 100% 100% 100% 100% 100% 100% 95% 100% 100% 98% 98% 100% 98% 100% 100% 100% 98% Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Points Received 4.0 4.0 4.0 4.0 4.0 4.0 3.8 4.0 4.0 3.9 3.9 4.0 3.9 4.0 4.0 4.0 3.9 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 02.015 health nurse? Score 100% Points Possible 7 Points Received 7.0 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 77 Office of the Inspector General State of California APPENDIX C-5 Nurse Responsibilities, Cycle 3 Page 2 of 4 Nurse Responsibilities 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. Reference Number ISP KVSP LAC MCSP NKSP PBSP PVSP RJD SAC SATF SCC SOL SQ SVSP VSPW WSP Average Score 01.024 RN FTF Documentation: Did the inmate's request for health care get reviewed the same day it was received? Score 100% 88% 100% 100% 97% 55% 100% 100% 100% 100% 100% 97% 100% 100% 100% 97% 96% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 5.3 6.0 6.0 5.8 3.3 6.0 6.0 6.0 6.0 6.0 5.8 6.0 6.0 6.0 5.8 5.8 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 97% 83% 77% 97% 83% 95% 73% 70% 100% 93% 90% 88% 77% 97% 92% 100% 90% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 5.8 5.0 4.6 5.8 5.0 5.7 4.4 4.2 6.0 5.6 5.4 5.3 4.6 5.8 5.5 6.0 5.4 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 84% 92% 74% 92% 84% 84% 66% 86% 80% 80% 80% 68% 72% 84% 100% 98% 84% Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 Points Received 4.2 4.6 3.7 4.6 4.2 4.2 3.3 4.3 4.0 4.0 4.0 3.4 3.6 4.2 5.0 4.9 4.2 RN FTF Documentation: Did the RN's objective note include vital signs, a focused physical examination, and did it adequately address the clinically significant problems noted 01.159 in the subjective note? Score 90% 72% 72% 92% 76% 100% 64% 66% 92% 96% 90% 88% 82% 84% 88% 92% 84% Points Possible 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 Points Received 4.5 3.6 3.6 4.6 3.8 5.0 3.2 3.3 4.6 4.8 4.5 4.4 4.1 4.2 4.4 4.6 4.2 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 100% 95% 95% 100% 93% 100% 93% 90% 92% 98% 100% 100% 95% 100% 100% 100% 98% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 5.7 5.7 6.0 5.6 6.0 5.6 5.4 5.5 5.9 6.0 6.0 5.7 6.0 6.0 6.0 5.9 01.163 RN FTF Documentation: Did the RN's education/instruction adequately address the clinically significant problems identified during the FTF triage? Score 100% 98% 98% 100% 100% 100% 90% 98% 95% 100% 100% 95% 98% 100% 100% 100% 98% Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Points Received 4.0 3.9 3.9 4.0 4.0 4.0 3.6 3.9 3.8 4.0 4.0 3.8 3.9 4.0 4.0 4.0 3.9 01.244 RN FTF Documentation: Did the RN's objective note include allergies, weight, current medication, and where appropriate, medication compliance? Score 87% 73% 90% 97% 90% 90% 53% 90% 87% 73% 100% 83% 93% 77% 83% 93% 86% Points Possible 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 Points Received 2.6 2.2 2.7 2.9 2.7 2.7 1.6 2.7 2.6 2.2 3.0 2.5 2.8 2.3 2.5 2.8 2.6 01.246 Did documentation indicate that the RN reviewed all of the inmate's clinically significant complaints listed on Form 7362 (Health Care Services Request Form)? Score 90% 98% 98% 100% 93% 100% 93% 100% 95% 95% 100% 95% 98% 100% 95% 98% 98% Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Points Received 3.6 3.9 3.9 4.0 3.7 4.0 3.7 4.0 3.8 3.8 4.0 3.8 3.9 4.0 3.8 3.9 3.9 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 02.015 nurse? Score 0% Points Possible 7 Points Received 0.0 Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 78 Office of the Inspector General State of California APPENDIX C-5 Nurse Responsibilities, Cycle 3 Page 3 of 4 Nurse Responsibilities 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. Reference Number ASP CAL CCC CCI CCWF CEN CIM CIW CMC CMF COR CRC CTF CVSP DVI FSP HDSP 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 02.020 TB test, was a review of signs and symptoms completed? Score 100% 95% 100% 88% 100% 85% 97% 100% 95% 80% 95% 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 6.0 5.7 6.0 5.3 6.0 5.1 5.8 6.0 5.7 4.8 5.7 6.0 6.0 6.0 6.0 6.0 6.0 05.109 If the inmate was scheduled for any upcoming specialty services, were the services noted on Form 7371 (Health Care Transfer Information)? Score Points Possible Points Received 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% 100% 100% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 05.171 Did an RN accurately complete all applicable sections of Form 7371 (Health Care Transfer Information) based on the inmate's UHR? Score 100% 100% 100% 80% 80% 100% 80% 100% 100% 100% 100% 80% 80% 80% 60% 40% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 7.0 7.0 7.0 5.6 5.6 7.0 5.6 7.0 7.0 7.0 7.0 5.6 5.6 5.6 4.2 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 100% 20% 60% 80% 100% 80% 100% 60% 100% 60% 40% 100% 100% 80% 80% 80% 80% Points Possible 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 Points Received 9.0 1.8 5.4 7.2 9.0 7.2 9.0 5.4 9.0 5.4 3.6 9.0 9.0 7.2 7.2 7.2 7.2 09.224 Was the inmate's weight and blood pressure documented at each clinic visit? Score 100% 100% Points Possible 6 6 Points Received 6.0 6.0 11.097 Was the inmate offered initial baseline services for the hunger strike in accordance with policy requirements? Score 100% 60% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Possible 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 3.6 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 6.0 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% 0% 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 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 0.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 Upon the inmate's discharge from the community hospital, did the Triage and Treatment Area (TTA) Registered Nurse document that he or she reviewed the 21.248 inmate's discharge plan and complete a Face-to-Face assessment of the inmate? 100% 83% 100% 100% 97% 97% 100% 100% 95% 90% 100% 100% 97% 97% 100% 100% 100% 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6.0 5.0 6.0 6.0 5.8 5.8 6.0 6.0 5.7 5.4 6.0 6.0 5.8 5.8 6.0 6.0 6.0 Total Points Possible 87 93 87 93 85 85 100 93 93 78 93 87 93 87 93 85 93 Total Points Received 86.4 81.2 82.4 78.2 82.9 78.3 94.6 86.6 88.7 62.9 84.3 81.7 86.6 81.4 83.4 76.6 78.8 Total Score 99.3% 87.3% 94.7% 84.1% 97.5% 92.1% 94.6% 93.1% 95.4% 80.6% 90.6% 93.9% 93.1% 93.6% 89.7% 90.1% 84.7% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 79 Office of the Inspector General State of California APPENDIX C-5 Nurse Responsibilities, Cycle 3 Page 4 of 4 Nurse Responsibilities 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. Reference Number ISP KVSP LAC MCSP NKSP PBSP PVSP RJD SAC SATF SCC SOL SQ SVSP VSPW WSP Average Score 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, 02.020 was a review of signs and symptoms completed? Score 100% 90% 100% 90% 97% 93% 70% 100% 95% 88% 100% 100% 97% 100% 95% 90% 95% Points Possible 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 Points Received 6.0 5.4 6.0 5.4 5.8 5.6 4.2 6.0 5.7 5.3 6.0 6.0 5.8 6.0 5.7 5.4 5.7 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% 100% 100% 100% Points Possible 8 8 8 8 Points Received 8.0 8.0 8.0 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% 100% 100% 100% 100% 100% 100% 80% 100% 100% 100% 99% Points Possible 8 8 8 8 8 8 8 8 8 8 8 8 8 8 Points Received 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 6.4 8.0 8.0 8.0 7.9 05.171 Did an RN accurately complete all applicable sections of Form 7371 (Health Care Transfer Information) based on the inmate's UHR? Score 80% 60% 40% 80% 100% 100% 80% 40% 100% 60% 100% 80% 100% 100% 100% 100% 84% Points Possible 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Points Received 5.6 4.2 2.8 5.6 7.0 7.0 5.6 2.8 7.0 4.2 7.0 5.6 7.0 7.0 7.0 7.0 5.9 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 76% 20% 80% 100% 80% 100% 60% 100% 0% 100% 100% 100% 100% 100% 80% 80% 79% Points Possible 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 Points Received 6.8 1.8 7.2 9.0 7.2 9.0 5.4 9.0 0.0 9.0 9.0 9.0 9.0 9.0 7.2 7.2 7.1 09.224 Was the inmate's weight and blood pressure documented at each clinic visit? Score 100% 100% Points Possible 6 6 Points Received 6.0 6.0 11.097 Was the inmate offered initial baseline services for the hunger strike in accordance with policy requirements? Score 80% 80% 100% 100% 80% 100% 100% 80% 100% 100% 94% Points Possible 6 6 6 6 6 6 6 6 6 6 6 Points Received 4.8 4.8 6.0 6.0 4.8 6.0 6.0 4.8 6.0 6.0 5.7 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% 97% Points Possible 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Points Received 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 4.0 3.9 Upon the inmate's discharge from the community hospital, did the Triage and Treatment Area (TTA) Registered Nurse document that he or she reviewed the inmate's discharge 21.248 plan and complete a Face-to-Face assessment of the inmate? 97% 100% 92% 100% 95% 93% 100% 100% 100% 95% 100% 100% 97% 100% 100% 100% 98% 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 5.8 6.0 5.5 6.0 5.7 5.6 6.0 6.0 6.0 5.7 6.0 6.0 5.8 6.0 6.0 6.0 5.9 Total Points Possible 87 101 93 87 87 87 85 101 101 93 79 93 77 93 93 93 2975 Total Points Received 75.2 84.4 80.4 77.6 80.5 82.1 70.6 91.3 87.8 86.5 76.9 86.0 71.0 90.5 89.1 89.6 2714.5 Total Score 86.4% 83.6% 86.5% 89.2% 92.5% 94.4% 83.1% 90.4% 86.9% 93.0% 97.3% 92.5% 92.2% 97.3% 95.8% 96.3% 91.2% Comparative Summary and Analysis of the First, Second, and Third Medical Inspection Cycles of California’s 33 Adult Institutions Page 80 Office of the Inspector General State of California