OIG
Chuckawalla Valley State Prison Medical Inspection Results Cycle 1
CHUCKAWALLA VALLEY STATE
PRISON
MEDICAL INSPECTION RESULTS
BUREAU OF AUDITS AND INVESTIGATIONS
OFFICE OF THE
INSPECTOR GENERAL
DAVID R. SHAW
INSPECTOR GENERAL
STATE OF CALIFORNIA
July 2010
Contents
Executive Summary ......................................................................................… 1
Introduction …................................................................................................… 3
Background …....................................................................................… 3
About the Institution …......................................................................… 4
Objectives, Scope, and Methodology ….............................................. 4
Medical Inspection Results ….......................................................................… 7
California Prison Health Care Receivership
Corporation's Response …............................................................................. 27
Executive Summary
An April 2001 class action lawsuit filed by inmates represented by the Prison Law Office alleged that
the state provided constitutionally inadequate medical care at California state prisons in violation of
inmates’ constitutional rights. And, in October 2005, the U.S. Northern District Court of California
declared that California’s delivery system for prison medical care was “broken beyond repair” and still
not meeting constitutional standards. As a result, the federal court imposed a receivership to raise the
delivery of medical care to constitutional standards. To evaluate and monitor the progress of medical
care delivery to inmates, the receiver requested, and the Office of the Inspector General (OIG) agreed,
to establish an objective, clinically appropriate, and metric-oriented medical program to annually
inspect the delivery of medical care at each state prison.
In March 2010, we inspected Chuckawalla Valley State Prison (CVSP). Our
Overall medical inspection encompassed 17 components of medical delivery and
Score comprised 138 questions. The questions are weighted based on their importance
69.4% to the delivery of medical care to inmates. CVSP received 69.4 percent of the
total weighted points possible.
The following summary table lists the components we inspected in order of importance (highest to
lowest), with the institution’s score and the definitions of each inspection component. The detailed
medical inspection results, with the questions for each component, begin on page 7 of this report.
While we are committed to helping each institution achieve a higher level of medical care, it is not our
intent to determine the percentage score needed by an institution to meet constitutional standards—that
is a legal matter for the federal court to determine.
Executive Summary Table
Component Weighted Score Definition
Chronic Care 51.5% Examines how well the prison provided care and medication to inmates with specific
chronic care conditions, which are those that affect (or have the potential to affect) an
inmate's functioning and long-term prognosis for more than six months. Our inspection tests
anticoagulation therapy and the following chronic care conditions: asthma, diabetes, HIV
(Human Immunodeficiency Virus), and hypertension.
Clinical Services 60.6% Evaluates the inmate's access to primary health care services and focuses on inmates who
recently received services from any of the prison's facility or administrative segregation unit
clinics. This component evaluates sick call processes (doctor or nurse line), medication
management, and nursing.
Health Screening 75.9% Focuses on the prison's process for screening new inmates upon arrival to the institution for
health care conditions that require treatment and monitoring, as well as ensuring inmates'
continuity of care.
Specialty Services 86.1% Focuses on the prison's process for approving, denying, and scheduling services that are
outside the specialties of the prison's medical staff. Common examples of these services
include physical therapy, oncology services, podiatry consultations, and neurology services.
Urgent Services 77.9% Addresses the care provided by the institution to inmates before and after they were sent to a
community hospital.
Emergency Services 73.1% Examines how well the prison responded to medical emergencies. Specifically, we focused
on "man down" or "woman down" situations. Further, questions determine the adequacy of
medical and staff response to a "man down" or "woman down" emergency drill.
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Office of the Inspector General State of California
Component Weighted Score Definition
Prenatal Care/Childbirth/ N/A Focuses on the prenatal and post-delivery medical care provided to pregnant inmates. Not
Post-delivery applicable at men's institutions.
Diagnostic Services 56.2% Addresses the timeliness of radiology (x-ray) and laboratory services and whether the prison
followed up on clinically significant results.
Access to Health Care 49.0% Addresses the prison's effectiveness in filing, storing, and retrieving medical records and
Information medical-related information.
Outpatient Housing Unit 99.0% Determines whether the prison followed department policies and procedures when placing
inmates in the outpatient housing unit. This component also evaluates whether the
placement provided the inmate with adequate care and whether the physician's plan
addressed the placement diagnosis.
Internal Reviews 67.5% Focuses on the frequency of meetings held by the prison's Quality Management Committee
(QMC) and Emergency Medical Response Review Committee (EMRRC) and whether key
staff attended the meetings, the number of medical appeals filed, and the prison's death
review process.
Inmate Transfers 73.3% Focuses on inmates pending transfer to determine whether the sending institution
documented medication and medical conditions to assist the receiving institution in
providing continuity of care.
Clinic Operations 90.9% Addresses the general operational aspects of the prison's facility clinics. Generally, the
questions in this component relate to the overall cleanliness of the clinics, privacy afforded
to inmates during nonemergency visits, use of priority ducats (slip of paper the inmate
carries for scheduled medical appointments), and availability of health care request forms.
Preventive Services 48.3% Focuses on inmate cancer screening, tuberculosis evaluation, and influenza immunizations.
Pharmacy Services 82.8% Addresses whether the prison'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 100.0% Examines additional areas that are not captured in the other components. The areas
evaluated in this component include the prison's provision of therapeutic diets, its handling
of inmates who display poor hygiene, and the availability of the current version of the
department's Inmate Medical Services Policies and Procedures.
Inmate Hunger Strikes N/A Examines medical staff's monitoring of inmates participating in hunger strikes lasting longer
than three days.
Chemical Agent N/A Addresses the prison's process of handling inmates who may be predisposed to an adverse
Contraindications outcome from calculated uses of force (cell extractions) involving Oleoresin Capsicum
(OC), which is commonly referred to as "pepper spray." For example, this might occur if the
inmate has asthma.
Staffing Levels and 100.0% Examines the prison's medical staffing levels and training provided.
Training
Nursing Policy 71.4% Determines whether the prison maintains written policies and procedures for the safe and
effective provision of quality nursing care. The questions in this component also determine
whether nursing staff review their duty statements and whether supervisors periodically
review the work of nurses to ensure they properly follow established nursing protocols.
Overall Score 69.4%
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Office of the Inspector General State of California
Introduction
Under the authority of California Penal Code section 6126, which assigns the Office of the Inspector
General (OIG) responsibility for oversight of the California Department of Corrections and
Rehabilitation, and at the request of the federal receiver, the OIG developed a comprehensive
inspection program to evaluate the delivery of medical care at each of the California Department of
Corrections and Rehabilitation’s 33 adult prisons.
In March 2010, we inspected Chuckawalla Valley State Prison (CVSP). Our medical inspection
encompassed 17 components of medical delivery and comprised 138 questions. To help readers
understand the medical risk associated with certain components of medical delivery—which pose a
greater risk to an inmate-patient—we developed a weighting system and assigned points to each
question. Consequently, we assigned more total points to more critical components, such as chronic
care, clinical services, and health screening. We assigned fewer total points to less critical components,
such as inmate hunger strikes, staffing levels and training, and chemical agent contraindications. (For a
detailed description of the weighting system, see Objectives, Scope, and Methodology on the next
page.)
Background
In April 2001, inmates represented by the Prison Law Office filed a class action lawsuit, known as
Plata v. Schwarzenegger. The lawsuit alleged that the state provided constitutionally inadequate
medical care at California state prisons in violation of inmates’ constitutional rights. In June 2002, the
parties entered into a Stipulation for Injunctive Relief, and the state agreed to implement over several
years comprehensive new medical care policies and procedures at all institutions.
Nevertheless, the U.S. Northern District Court of California declared in October 2005 that California’s
delivery system for prison medical care was “broken beyond repair” and still not meeting constitutional
standards. Thus, the federal court imposed a receivership to raise the delivery of medical care to
constitutional standards. In essence, the court ordered the receiver to manage the state’s delivery of
medical care and restructure day-to-day operations to develop and sustain a system that provides
constitutionally adequate medical care to inmates. The court stated that it would remove the receiver
and return control to the state once the system is stable and provides for constitutionally adequate
medical care.
To evaluate and monitor the progress of medical care delivery to inmates, the receiver requested that
the OIG establish an objective, clinically appropriate, and metric-oriented medical inspection program.
Toward that end, the Inspector General agreed to inspect each state prison annually. We are committed
to helping each institution achieve a higher level of medical care, but it is up to the federal court to
determine the percentage score necessary for an institution to meet constitutional standards.
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Office of the Inspector General State of California
About the Institution
The primary mission of Chuckawalla Valley State Prison (CVSP) is to provide long-term housing and
services for male felons classified as medium and low-medium custody inmates. CVSP was opened
December 1988 and encompasses 1,080 acres. As of May 26, 2010, the California Department of
Corrections and Rehabilitation reported that CVSP had custody over 3,525 male inmates, of which
3,258 are Level II inmates. CVSP operates six medical clinics where staff handle non-urgent requests
for medical services. CVSP also treats inmates needing urgent or emergency care in its triage and
treatment area (TTA). According to information provided by the institution, CVSP's vacancy rate
among licensed medical managers, primary care providers, supervisors, and rank and file nurses is
18.80 percent.
John W. Culton, M.D., M.P.H., serves as the prison's health care manager and Nazish Ali, M.D., serves
as the chief medical officer.
Objectives, Scope, and Methodology
In designing the medical inspection program, we reviewed the California Department of Corrections
and Rehabilitation’s policies and procedures, relevant court orders, guidelines developed by the
department’s Quality Medical Assurance Team, and guidance developed by the American Correctional
Association. We also reviewed professional literature on correctional medical care, consulted with
clinical experts, and met with stakeholders from the court, the receiver’s office, the department, and the
Prison Law Office to discuss the nature and scope of the inspection program. Based on input from these
stakeholders, we developed a medical inspection program that evaluates medical care delivery. Within
each of 20 components, we created “yes” or “no” questions designed to gauge performance.
To make the inspection results meaningful to both a medical expert and a lay reader, we worked with
clinical experts to create a weighting system that factors the relative importance of each component
compared to other components. Further, the program considers the relative importance of each question
within a component to the other questions in that component. This weighting ensures that more critical
components—such as those that pose the greatest medical risk to the inmate-patient—are given more
weight compared to those considered less serious. For example, we assign a high number of possible
points to the chronic care component because we consider this the most serious of all the components.
We assign proportionately fewer points to all other components.
Each inspection question is weighted and scored. The score is derived from the percentage of “yes”
answers for each question from all items sampled. We then multiply the percentage of “yes” answers
within a given question by the question’s weight to arrive at a score. The following example shows how
this scoring system works.
Example Question: Institution X
Answers Weighting Points
Yes No Yes + No Yes % Possible Received Score % N/A Unk
Is the clinical history adequate? 40 10 50 80% 20 16 80.0% 0 0
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Office of the Inspector General State of California
If the institution receives 40 “yes” answers and 10 “no” answers, the percentage of “yes” answers to
this question equals 80 percent. We calculate the number of points the institution would receive by
multiplying the “yes” percent of 80 by the number of possible points for this question, which is 20, to
arrive at 16 points.
To arrive at the total score, we add the points received for each question and then for each program
component. Finally, we calculate the institution’s overall score by dividing the sum of the points
received by the sum of the points possible. We do not include in the institution’s overall score the
weight for questions that are not applicable or, in some cases, where a lack of documentation would
result in numerous “no” answers for one deviation from policy (unknown). For instance, an institution
may not be able to provide documentation that its Emergency Medical Response Review Committee
met for a particular month. Therefore, when we evaluate whether meeting minutes document monthly
meetings for a particular month, the institution would receive a “no” answer for that question.
However, when we evaluate whether the meeting minutes document the warden’s attendance at the
meeting, the answer would be “unknown” so that the institution’s score is not penalized twice for the
same reason, not documenting the meeting.
To evaluate the institution’s delivery of medical care, we obtained various electronic data files
maintained by the institution for inmate medical scheduling and tracking, pharmacy, and census data.
We used these electronic data files only to identify random samples of inmates receiving or requiring
specific medical services. We then reviewed the medical file for each inmate in our sample. We did not
rely on the medical care information contained in these electronic data files.
Our inspection program assumes that if a prison's medical staff does not document an event in an
inmate's unit health record, the event in question did not happen. If an inmate's record does not show
that the inmate received his medications on a specified date, for example, we assume that the inmate
did not receive the medications. While it is possible that the inmate received his medications and the
staff neglected to document the event, our program cannot assume that appropriate care was provided.
Our medical inspection at CVSP encompassed 17 of the 20 components of medical delivery. Three of
the components were not applicable during the period inspected. In total, we reviewed 184 inmate
medical files, which are referred to as unit health records. In addition, we reviewed staffing level
reports, medical appeals summaries, nursing policies and procedures, summaries of medical drills and
emergencies, minutes from Quality Management Committee and Emergency Medical Response
Review Committee hearings, contents of inmate transfer envelopes, and assorted manual logs or
tracking worksheets related to medical care delivery. We also conducted a live medical emergency drill
and evaluated the adequacy of the responding staff’s actions. Finally, we interviewed medical and
custody staff members about the delivery of medical care to inmates, and we observed day-to-day
medical delivery at the institution.
We do not test the care provided in the licensed hospitals or correctional treatment centers because they
are subject to inspections and oversight by other regulatory agencies.
Consistent with our agreement with the receiver, our report only addresses the conditions found related
to the medical care criteria. We do not discuss the causes of noncompliance, nor do we make specific
recommendations in this report. However, if we learn of an inmate-patient who needs immediate care,
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Office of the Inspector General State of California
we notify the health care manager and request a status report. Moreover, if we learn of significant
departures from community standards, we may report such departures to the institution’s health care
manager or the receiver’s office. Because these matters involve confidential medical information
protected by state and federal privacy laws, specific details related to these cases are not included in our
report.
For ease of reference, following is a table of abbreviations used in the remainder of this report.
Abbreviations used in this report
AED Automatic External Defibrillator
BLS Basic Life Support
CMO Chief Medical Officer
CTC Correctional Treatment Center
CTQ Confined to Quarters
EMRRC Emergency Medical Response Review Committee
FTF Face-to-Face
GACH General Acute Care Hospital
HCM Health Care Manager
INH Isoniazid (antituberculous medication)
LVN Licensed Vocational Nurse
MOD Medical Officer of the Day
OB Obstetrician
OC Oleoresin Capsicum (pepper spray)
OHU Outpatient Housing Unit
OIG Office of the Inspector General
PCP Primary Care Provider
QMC Quality Management Committee
RN Registered Nurse
SOAPE Subjective, Objective, Assessment, Plan, Education
SRN Supervising Registered Nurse
TB Tuberculosis
TTA Triage and Treatment Area
UHR Unit Health Record
UM Utilization Management
Bureau of Audits and Investigations Page 6
Office of the Inspector General State of California
OFFICE OF THE INSPECTOR GENERAL CHUCKAWALLA VALLEY STATE PRISON
Overall Score:
MEDICAL INSPECTION RESULTS
69.4%
03/01/2010 – 03/04/2010
Answers Weighting Points Questions Not Answered
Component Page Yes No Yes + No Yes % Points Possible Points Received Score % Not Applicable Unknown
Chronic Care 8 109 108 217 50.2% 133 68.5 51.5% 0 8
Clinical Services 9 198 131 329 60.2% 95 57.6 60.6% 47 11
Health Screening 11 79 13 92 85.9% 59 44.8 75.9% 87 1
Specialty Services 12 74 14 88 84.1% 71 61.1 86.1% 56 0
Urgent Services 13 117 30 147 79.6% 52 40.5 77.9% 46 7
Emergency Services 14 15 2 17 88.2% 52 38.0 73.1% 0 1
Diagnostic Services 16 36 24 60 60.0% 52 29.2 56.2% 4 1
Access to Health Care Information 17 4 4 8 50.0% 51 25.0 49.0% 0 0
Outpatient Housing Unit 18 69 1 70 98.6% 48 47.5 99.0% 12 0
Internal Reviews 19 27 5 32 84.4% 40 27.0 67.5% 1 0
Inmate Transfers 20 11 5 16 68.8% 30 22.0 73.3% 9 0
Clinic Operations 21 25 2 27 92.6% 33 30.0 90.9% 0 0
Preventive Services 22 21 14 35 60.0% 30 14.5 48.3% 0 0
Pharmacy Services 23 5 6 11 45.5% 29 24.0 82.8% 0 0
Other Services 24 7 0 7 100.0% 10 10.0 100.0% 2 0
Staffing Levels and Training 25 8 0 8 100.0% 16 16.0 100.0% 1 0
Nursing Policy 26 10 5 15 66.7% 14 10.0 71.4% 0 0
Totals 815 364 1179 69.1% 815 565.7 69.4% 265 29
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Office of the Inspector General State of California
Answers Weighting Points
Reference
Chronic Care
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
03.076 Was the inmate's most recent chronic care visit within the time frame 12 13 25 48.0% 10 4.8 48.0% 0 0
required by the degree of control of the inmate's condition based on his or
her prior visit?
03.077 Were key elements on Forms 7419 (Chronic Care Follow-Up Visit) and 10 15 25 40.0% 10 4.0 40.0% 0 0
7392 (Primary Care Flow Sheet) filled out completely for the inmate's two
most recent visits?
03.082 Did the institution document that it provided the inmate with health care 21 4 25 84.0% 12 10.1 84.0% 0 0
education?
03.175 Did the inmate receive his or her prescribed chronic care medications during 5 20 25 20.0% 18 3.6 20.0% 0 0
the most recent three-month period or did the institution follow
departmental policy if the inmate refused to pick up or show up for his or
her medications?
03.235 Is the clinical history adequate? 9 14 23 39.1% 18 7.0 39.1% 0 2
03.236 Is the focused clinical examination adequate? 20 5 25 80.0% 19 15.2 80.0% 0 0
03.237 Is the assessment adequate? 12 9 21 57.1% 19 10.9 57.1% 0 4
03.238 Is the plan adequate and consistent with the degree of control based on the 13 10 23 56.5% 19 10.7 56.5% 0 2
chronic care program intervention and follow up requirements?
03.262 Is the inmate's Problem List complete and filed accurately in the inmate's 7 18 25 28.0% 8 2.2 28.0% 0 0
unit health record (UHR)?
Components Subtotals: 109 108 217 50.2% 133 68.5 51.5% 0 8
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Office of the Inspector General State of California
Answers Weighting Points
Reference
Clinical Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
01.024 RN FTF Documentation: Did the inmate's request for health care get 28 2 30 93.3% 4 3.7 93.3% 0 0
reviewed the same day it was received?
01.025 RN FTF Documentation: Did the RN complete the face-to-face (FTF) triage 29 1 30 96.7% 6 5.8 96.7% 0 0
within one (1) business day after the Form 7362 was reviewed?
01.246 Did documentation indicate that the RN reviewed all of the inmate's 24 6 30 80.0% 5 4.0 80.0% 0 0
complaints listed on Form 7362 (Health Care Services Request Form)?
01.157 RN FTF Documentation: Did the RN's subjective note address the nature 15 15 30 50.0% 7 3.5 50.0% 0 0
and history of the inmates primary complaint?
01.159 RN FTF Documentation: Did the RN's objective note include vital signs and 14 16 30 46.7% 6 2.8 46.7% 0 0
a focused physical examination, and did it adequately address the problems
noted in the subjective note?
01.244 RN FTF Documentation: Did the RN's objective note include allergies, 8 22 30 26.7% 3 0.8 26.7% 0 0
weight, current medication, and where appropriate, medication compliance?
01.158 RN FTF Documentation: Did the RN's assessment provide conclusions 18 11 29 62.1% 6 3.7 62.1% 0 1
based on subjective and objective data, were the conclusions formulated as
patient problems, and did it contain applicable nursing diagnoses?
01.162 RN FTF Documentation: Did the RN's plan include an adequate strategy to 23 7 30 76.7% 7 5.4 76.7% 0 0
address the problems identified during the FTF triage?
01.163 RN FTF Documentation: Did the RN's education/instruction adequately 13 17 30 43.3% 5 2.2 43.3% 0 0
address the problems identified during the FTF triage?
01.027 If the RN determined a referral to a primary care physician (PCP) was 12 9 21 57.1% 8 4.6 57.1% 9 0
necessary, was the inmate seen within the timelines specified by the RN
during the FTF triage?
01.247 Sick Call Follow-up: If the provider ordered a follow-up sick call 1 0 1 100.0% 7 7.0 100.0% 29 0
appointment, did it take place within the time frame specified?
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Office of the Inspector General State of California
Answers Weighting Points
Reference
Clinical Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
01.124 Sick Call Medication: Did the institution administer or deliver prescription 7 19 26 26.9% 6 1.6 26.9% 4 0
medications (new orders) to the inmate within specified time frames?
15.234 Are clinic response bags audited daily and do they contain essential items? 1 1 2 50.0% 5 2.5 50.0% 0 0
21.278 For inmates seen in the TTA, was there adequate prior management of pre- 5 5 10 50.0% 20 10.0 50.0% 5 10
existing medical conditions related to the reason for the TTA visit?
Components Subtotals: 198 131 329 60.2% 95 57.6 60.6% 47 11
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Office of the Inspector General State of California
Answers Weighting Points
Reference
Health Screening
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
02.016 Did the institution complete the initial health screening on the same day the 19 1 20 95.0% 9 8.6 95.0% 0 0
inmate arrived at the institution?
02.017 If yes was answered to any of the questions on the initial health screening 8 0 8 100.0% 8 8.0 100.0% 12 0
form(s), did the RN provide an assessment and disposition on the date of
arrival?
02.018 If, during the assessment, the RN referred the inmate to a clinician, was the 6 5 11 54.5% 8 4.4 54.5% 9 0
inmate seen within the time frame?
02.020 Did the LVN/RN adequately document the tuberculin test or a review of 17 3 20 85.0% 6 5.1 85.0% 0 0
signs and symptoms if the inmate had a previous positive tuberculin test?
02.015 Was a review of symptoms completed if the inmate's tuberculin test was 0 0 0 0.0% 0 0.0 0.0% 20 0
positive, and were the results reviewed by the infection control nurse?
02.128 If the inmate had an existing medication order upon arrival at the institution, 6 2 8 75.0% 8 6.0 75.0% 12 0
did the inmate receive the medications by the next calendar day, or did a
physician explain why the medications were not to be continued?
02.007 Non-reception center: Does the health care transfer information form 19 1 20 95.0% 7 6.7 95.0% 0 0
indicate that it was reviewed and signed by licensed health care staff within
one calendar day of the inmate's arrival at the institution?
02.014 Non-reception center: If the inmate was scheduled for a specialty 0 1 1 0.0% 7 0.0 0.0% 18 1
appointment at the sending institution, did the receiving institution schedule
the appointment within 30 days of the original appointment date?
02.111 Non-reception center: Did the inmate receive medical accommodations 4 0 4 100.0% 6 6.0 100.0% 16 0
upon arrival, if applicable?
Components Subtotals: 79 13 92 85.9% 59 44.8 75.9% 87 1
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Office of the Inspector General State of California
Answers Weighting Points
Reference
Specialty Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
07.037 Did the institution approve or deny the PCP's request for specialty services 17 5 22 77.3% 8 6.2 77.3% 0 0
within the specified time frames?
07.038 Did the PCP see the inmate between the date the PCP ordered the service 3 1 4 75.0% 8 6.0 75.0% 18 0
and the date the inmate received it, in accordance with specified time
frames?
07.035 Did the inmate receive the specialty service within specified time frames? 15 2 17 88.2% 9 7.9 88.2% 5 0
07.090 Physical therapy services: Did the physical therapist assess the inmate and 2 0 2 100.0% 8 8.0 100.0% 20 0
document the treatment plan and treatment provided to the inmate?
07.043 Did the PCP review the consultant's report and see the inmate for a follow- 9 5 14 64.3% 9 5.8 64.3% 8 0
up appointment after the specialty services consultation within specified
time frames?
07.260 Was the institution's denial of the PCP's request for specialty services 4 1 5 80.0% 9 7.2 80.0% 0 0
consistent with the "medical necessity" requirement?
07.259 Was there adequate documentation of the reason for the denial of specialty 5 0 5 100.0% 5 5.0 100.0% 0 0
services?
07.270 Did the specialty provider provide timely findings and recommendations or 17 0 17 100.0% 6 6.0 100.0% 5 0
did an RN document that he or she called the specialty provider to ascertain
the findings and recommendations?
07.261 Is the institution scheduling high-priority (urgent) specialty services within 2 0 2 100.0% 9 9.0 100.0% 0 0
14 days?
Components Subtotals: 74 14 88 84.1% 71 61.1 86.1% 56 0
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Office of the Inspector General State of California
Answers Weighting Points
Reference
Urgent Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
21.248 Upon the inmate's discharge from the community hospital, did the triage 24 1 25 96.0% 7 6.7 96.0% 0 0
and treatment area (TTA) registered nurse document that he or she reviewed
the inmate's discharge plan and completed a face-to-face assessment of the
inmate?
21.250 Upon the inmate's discharge from the community hospital, did the inmate's 23 2 25 92.0% 7 6.4 92.0% 0 0
Primary Care Provider (PCP) provide orders for appropriate housing for the
inmate?
21.251 Upon the inmate's discharge from the community hospital, did the 0 0 0 0.0% 0 0.0 0.0% 25 0
Registered Nurse intervene if the inmate was housed in an area that was
inappropriate for nursing care based on the primary care provider's (PCP)
housing orders?
21.249 Upon the inmate's discharge from the community hospital, did the inmate 18 7 25 72.0% 7 5.0 72.0% 0 0
receive a follow-up appointment with his or her primary care provider
(PCP) within five calendar days of discharge?
21.281 Upon the inmate's discharge from a community hospital, did the institution 4 8 12 33.3% 6 2.0 33.3% 12 1
administer or deliver all prescribed medications to the inmate within
specified time frames?
21.275 Was the documentation of the clinical care provided in the TTA adequate? 16 9 25 64.0% 10 6.4 64.0% 0 0
21.276 While the patient was in the TTA, was the clinical care rendered by the 18 3 21 85.7% 7 6.0 85.7% 0 4
attending provider adequate and timely?
21.279 For patients managed by telephone consultation alone, was the provider's 14 0 14 100.0% 8 8.0 100.0% 9 2
decision not to come to the TTA appropriate?
Components Subtotals: 117 30 147 79.6% 52 40.5 77.9% 46 7
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Office of the Inspector General State of California
Answers Weighting Points
Reference
Emergency Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
08.183 Was the medical emergency responder notified of the medical emergency 1 0 1 100.0% 5 5.0 100.0% 0 0
without delay?
08.241 Did the first responder provide adequate basic life support (BLS) prior to 1 0 1 100.0% 6 6.0 100.0% 0 0
medical staff arriving?
08.184 Did the medical emergency responder arrive at the location of the medical 1 0 1 100.0% 4 4.0 100.0% 0 0
emergency within five (5) minutes of initial notification?
08.185 Did the medical emergency responder use proper equipment to address the 0 1 1 0.0% 7 0.0 0.0% 0 0
emergency and was adequate medical care provided within the scope of his
or her license?
08.242 Did licensed health care staff call 911 without unnecessary delay after a life- 0 0 0 0.0% 0 0.0 0.0% 0 1
threatening condition was identified by a licensed health care provider or
peace officer?
08.187 Did the institution provide adequate preparation for the ambulance's arrival, 1 0 1 100.0% 4 4.0 100.0% 0 0
access to the inmate, and departure?
08.186 Were both the first responder (if peace officer or licensed health care staff) 1 0 1 100.0% 4 4.0 100.0% 0 0
and the medical emergency responder basic life support (BLS) certified at
the time of the incident?
08.222 Were the findings of the institution's Emergency Medical Response Review 0 1 1 0.0% 7 0.0 0.0% 0 0
Committee (EMRRC) supported by the documentation and completed
within 30 days?
15.240 Emergency Medical Response Drill: Did the responding officer activate the 1 0 1 100.0% 2 2.0 100.0% 0 0
emergency response system by providing the pertinent information to the
relevant parties, immediately and without delay?
15.255 Emergency Medical Response Drill: Did the responding officer carry and 1 0 1 100.0% 1 1.0 100.0% 0 0
use the proper equipment (protective shield or micro-mask, gloves) required
by the department?
Bureau of Audits and Investigations Page 14
Office of the Inspector General State of California
Answers Weighting Points
Reference
Emergency Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
15.256 Emergency Medical Response Drill: Did the responding officer properly 1 0 1 100.0% 1 1.0 100.0% 0 0
perform an assessment on the patient for responsiveness?
15.257 Emergency Medical Response Drill: Did the responding officer properly 1 0 1 100.0% 2 2.0 100.0% 0 0
perform CPR?
15.258 Emergency Medical Response Drill: Did the responding officer begin CPR 1 0 1 100.0% 2 2.0 100.0% 0 0
without unnecessary delay?
15.282 Emergency Medical Response Drill: Did medical staff arrive on scene in 1 0 1 100.0% 2 2.0 100.0% 0 0
five minutes or less?
15.283 Emergency Medical Response Drill: Did the emergency medical responders 1 0 1 100.0% 1 1.0 100.0% 0 0
arrive with proper equipment (ER bag, bag-valve-mask, AED)?
15.284 Emergency Medical Response Drill: Did the responding officer provide 1 0 1 100.0% 1 1.0 100.0% 0 0
accurate information to responding medical staff?
15.285 Emergency Medical Response Drill: Did emergency medical responders 1 0 1 100.0% 1 1.0 100.0% 0 0
continue basic life support?
15.287 Emergency Medical Response Drill: Was 911 called without unnecessary 1 0 1 100.0% 2 2.0 100.0% 0 0
delay?
Components Subtotals: 15 2 17 88.2% 52 38.0 73.1% 0 1
Bureau of Audits and Investigations Page 15
Office of the Inspector General State of California
Answers Weighting Points
Reference
Diagnostic Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
06.049 Radiology order: Was the radiology service provided within the time frame 2 3 5 40.0% 7 2.8 40.0% 0 0
specified in the physician's order?
06.245 Radiology order: Was the diagnostic report received by the institution 4 1 5 80.0% 8 6.4 80.0% 0 0
within 14 days?
06.200 Radiology order: Did the primary care provider (PCP) review the diagnostic 0 5 5 0.0% 7 0.0 0.0% 0 0
report and initiate written notice to the inmate within two (2) business days
of the date the institution received the diagnostic reports?
06.188 All laboratory orders: Was the specimen collected within the applicable time 7 3 10 70.0% 6 4.2 70.0% 0 0
frames of the physician's order?
06.191 All diagnostic services: Did the PCP document the clinically significant 9 5 14 64.3% 7 4.5 64.3% 1 0
diagnostic test results on Form 7230 (Interdisciplinary Progress Notes)?
06.263 All diagnostic services: Did the PCP adequately manage clinically 7 4 11 63.6% 10 6.4 63.6% 3 1
significant test results?
06.202 All laboratory orders: Did the PCP review the diagnostic reports and initiate 7 3 10 70.0% 7 4.9 70.0% 0 0
written notice to the inmate within two (2) business days of the date the
institution received the diagnostic reports?
Components Subtotals: 36 24 60 60.0% 52 29.2 56.2% 4 1
Bureau of Audits and Investigations Page 16
Office of the Inspector General State of California
Answers Weighting Points
Reference
Access to Health Care Information
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
19.150 Is the medical records office current with its loose filing? 0 1 1 0.0% 9 0.0 0.0% 0 0
19.169 Did medical records staff make unit health records (UHR) available to clinic 2 0 2 100.0% 15 15.0 100.0% 0 0
staff for the inmates ducated for medical appointments the next day?
19.243 Was the institution able to account for the OIG's requested UHR files? 0 1 1 0.0% 12 0.0 0.0% 0 0
19.266 Does the institution properly file inmates' medical information? 1 0 1 100.0% 5 5.0 100.0% 0 0
19.271 While reviewing unit health records (UHR) as part of the OIG's inspection, 1 0 1 100.0% 5 5.0 100.0% 0 0
were the OIG's RN and MD inspectors able to locate all relevant
documentation of health care provided to inmates?
19.272 Does the institution promptly file blood pressure logs in unit health records 0 2 2 0.0% 5 0.0 0.0% 0 0
(UHR)?
Components Subtotals: 4 4 8 50.0% 51 25.0 49.0% 0 0
Bureau of Audits and Investigations Page 17
Office of the Inspector General State of California
Answers Weighting Points
Reference
Outpatient Housing Unit
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
04.052 Did the RN complete an initial assessment of the inmate on the day of 10 0 10 100.0% 5 5.0 100.0% 0 0
placement?
04.051 Did the primary care provider (PCP) evaluate the inmate within one 9 1 10 90.0% 5 4.5 90.0% 0 0
calendar day after placement?
04.053 While the inmate was placed in the OHU, did the PCP complete the 4 0 4 100.0% 4 4.0 100.0% 6 0
Subjective, Objective, Assessment, Plan and Education (SOAPE) at a
minimum of every 14 days?
04.054 Did the utilization management (UM) nurse assess the inmate within one 4 0 4 100.0% 4 4.0 100.0% 6 0
week of the inmate's placement and every 30 days thereafter?
04.112 Was the PCP's initial evaluation adequate for the problem(s) requiring OHU 10 0 10 100.0% 5 5.0 100.0% 0 0
placement?
04.230 Was the PCP's initial assessment (or diagnoses) appropriate for the findings 10 0 10 100.0% 5 5.0 100.0% 0 0
in the initial evaluation?
04.056 Did the PCP's plan adequately address the initial assessment? 10 0 10 100.0% 5 5.0 100.0% 0 0
04.208 Was the level of care available in the OHU appropriate to the patient's 10 0 10 100.0% 9 9.0 100.0% 0 0
clinical presentation?
15.103 In the outpatient housing unit (OHU), are patient call buttons operational or 1 0 1 100.0% 3 3.0 100.0% 0 0
does medical staff make rounds every 30 minutes?
15.225 Does the OHU use disinfectant daily in common patient areas? 1 0 1 100.0% 3 3.0 100.0% 0 0
Components Subtotals: 69 1 70 98.6% 48 47.5 99.0% 12 0
Bureau of Audits and Investigations Page 18
Office of the Inspector General State of California
Answers Weighting Points
Reference
Internal Reviews
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
17.221 Did the institution complete a medical emergency response drill for each 0 1 1 0.0% 5 0.0 0.0% 0 0
watch and include participation from each medical facility during the most
recent full quarter?
17.174 Did the institution promptly process inmate medical appeals during the most 0 1 1 0.0% 5 0.0 0.0% 0 0
recent 12 months?
17.136 For each death sampled, did the institution complete the death review 3 1 4 75.0% 5 3.8 75.0% 0 0
process?
17.132 Do the Emergency Medical Response Review Committee (EMRRC) 5 1 6 83.3% 5 4.2 83.3% 0 0
meeting minutes document monthly meetings for the last six (6) months?
17.138 Do the Emergency Medical Response Review Committee (EMRRC) 4 1 5 80.0% 5 4.0 80.0% 1 0
meeting minutes document the warden's (or his or her designee's)
attendance?
17.118 Do the Quality Management Committee (QMC) meeting minutes document 6 0 6 100.0% 5 5.0 100.0% 0 0
monthly meetings for the last six (6) months?
17.119 Did the Quality Management Committee (QMC) report its findings to the 6 0 6 100.0% 5 5.0 100.0% 0 0
HCM/CMO each of the last six (6) meetings?
17.135 Did the last three Quality Management Committee (QMC) meeting minutes 3 0 3 100.0% 5 5.0 100.0% 0 0
reflect findings and strategies for improvement?
Components Subtotals: 27 5 32 84.4% 40 27.0 67.5% 1 0
Bureau of Audits and Investigations Page 19
Office of the Inspector General State of California
Answers Weighting Points
Reference
Inmate Transfers
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
05.108 Did Receiving and Release have the inmate's UHR and transfer envelope? 5 0 5 100.0% 7 7.0 100.0% 0 0
05.109 If the inmate was scheduled for any upcoming specialty services, were the 0 0 0 0.0% 0 0.0 0.0% 5 0
services noted on Form 7371 (Health Care Transfer Information)?
05.110 Do all appropriate forms in the transfer envelope identify all medications 1 0 1 100.0% 8 8.0 100.0% 4 0
ordered by the physician, and are the medications in the transfer envelope?
05.171 Did an RN accurately complete all applicable sections of Form 7371 5 0 5 100.0% 7 7.0 100.0% 0 0
(Health Care Transfer Information) based on the inmate's UHR?
05.172 Did the Health Records Department maintain a copy of the inmate's Form 0 5 5 0.0% 8 0.0 0.0% 0 0
7371 (Health Care Transfer Information) and Form 7231A (Outpatient
Medication Administration Record) when the inmate transferred?
Components Subtotals: 11 5 16 68.8% 30 22.0 73.3% 9 0
Bureau of Audits and Investigations Page 20
Office of the Inspector General State of California
Answers Weighting Points
Reference
Clinic Operations
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
14.023 Does the institution make the Form 7362 (Health Care Services Request 5 0 5 100.0% 4 4.0 100.0% 0 0
Form) available to inmates?
14.164 Are areas available to ensure privacy during RN face-to-face assessments 3 0 3 100.0% 3 3.0 100.0% 0 0
and doctors' examinations for non-emergencies?
14.166 Was the medication stored in a sealed container if food was present in the 2 0 2 100.0% 2 2.0 100.0% 0 0
clinic refrigerator?
14.131 Do medication nurses understand that medication is to be administered by 2 0 2 100.0% 4 4.0 100.0% 0 0
the same licensed staff member who prepares it and on the same day?
14.106 Does clinical staff wash their hands (either with soap or hand sanitizer) or 4 0 4 100.0% 4 4.0 100.0% 0 0
change gloves between patients?
14.033 Does the institution have an adequate process to ensure inmates who are 2 0 2 100.0% 4 4.0 100.0% 0 0
moved to a new cell still receive their medical ducats?
14.032 Does medical staff understand the institution's priority ducat process? 1 1 2 50.0% 2 1.0 50.0% 0 0
14.160 Does the institution have a process to identify, review, and address urgent 2 0 2 100.0% 4 4.0 100.0% 0 0
appointments if a doctor's line is canceled?
14.029 Does medical staff in the facility clinic know which inmates are on modified 1 1 2 50.0% 4 2.0 50.0% 0 0
program or confined to quarters (CTQ) and does staff have an adequate
process to ensure those inmates receive their medication?
14.165 Are the clinic floors, waiting room chairs, and equipment cleaned with a 3 0 3 100.0% 2 2.0 100.0% 0 0
disinfectant daily?
Components Subtotals: 25 2 27 92.6% 33 30.0 90.9% 0 0
Bureau of Audits and Investigations Page 21
Office of the Inspector General State of California
Answers Weighting Points
Reference
Preventive Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
10.228 Inmates prescribed INH: Did the institution properly administer the 3 2 5 60.0% 6 3.6 60.0% 0 0
medication to the inmate?
10.232 Inmates prescribed INH: Did the institution monitor the inmate monthly for 0 5 5 0.0% 6 0.0 0.0% 0 0
the most recent three months he or she was on the medication?
10.229 Inmates with TB code 34: Was the inmate evaluated for signs and symptoms 1 4 5 20.0% 7 1.4 20.0% 0 0
of TB within the previous 12 months?
10.086 All inmates age 66 or older: Did the inmate receive an influenza vaccination 10 0 10 100.0% 6 6.0 100.0% 0 0
within the previous 12 months or was the inmate's refusal documented?
10.085 Male inmates age 51 or older: Did the inmate receive a fecal occult blood 7 3 10 70.0% 5 3.5 70.0% 0 0
test (FOBT) within the previous 12 months or was the inmate's refusal
documented?
Components Subtotals: 21 14 35 60.0% 30 14.5 48.3% 0 0
Bureau of Audits and Investigations Page 22
Office of the Inspector General State of California
Answers Weighting Points
Reference
Pharmacy Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
13.139 Does the institution conspicuously post a valid permit in its pharmacies? 1 0 1 100.0% 2 2.0 100.0% 0 0
13.141 Does the institution properly maintain its emergency crash cart 0 2 2 0.0% 2 0.0 0.0% 0 0
medications?
13.252 Does the institution properly maintain medications in its after-hours 0 1 1 0.0% 2 0.0 0.0% 0 0
medication supply(ies)?
13.253 Does the institution conduct monthly inspections of its emergency cart and 0 3 3 0.0% 1 0.0 0.0% 0 0
after-hours medication supply(ies)?
13.142 Is the Pharmacist in Charge's license current? 1 0 1 100.0% 5 5.0 100.0% 0 0
13.144 Does the institution have information to ensure that medications are 1 0 1 100.0% 6 6.0 100.0% 0 0
prescribed by licensed health-care providers lawfully authorized to do so?
13.145 Does the pharmacist in charge have an effective process for screening new 1 0 1 100.0% 7 7.0 100.0% 0 0
medication orders for potential adverse reactions?
13.148 Does the pharmacist in charge monitor the quantity of medications on hand, 1 0 1 100.0% 4 4.0 100.0% 0 0
and does the pharmacy conduct an annual inventory to ensure that the
quantity of medications in the system matches the quantity of medications
on hand?
Components Subtotals: 5 6 11 45.5% 29 24.0 82.8% 0 0
Bureau of Audits and Investigations Page 23
Office of the Inspector General State of California
Answers Weighting Points
Reference
Other Services
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
15.059 Did the institution properly provide therapeutic diets to inmates? 0 0 0 0.0% 0 0.0 0.0% 1 0
15.058 If the institution does not offer therapeutic diets, does staff know the 1 0 1 100.0% 3 3.0 100.0% 0 0
department's procedures for transferring inmates who are determined to
require a therapeutic diet?
15.134 Did the institution properly respond to all active cases of TB discovered in 0 0 0 0.0% 0 0.0 0.0% 1 0
the last six months?
15.265 Is the most current version of the CDCR Health Services Policies and 2 0 2 100.0% 3 3.0 100.0% 0 0
Procedures available in the institution's law library?
20.092 Hygiene Intervention: Did custody staff understand the department's 4 0 4 100.0% 4 4.0 100.0% 0 0
policies and procedures for identifying and evaluating inmates displaying
inappropriate hygiene management?
Components Subtotals: 7 0 7 100.0% 10 10.0 100.0% 2 0
Bureau of Audits and Investigations Page 24
Office of the Inspector General State of California
Answers Weighting Points
Reference
Staffing Levels and Training
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
18.002 Information purposes only: Calculate the institution's average vacancy 0 0 0 0.0% 0 0.0 0.0% 1 0
percentages, the number of health care staff starting within six (6) months of
the OIG visit, and the number of health care staff hired from the registry.
The institution provided vacancy statistics within four licensed medical
staffing groups: (1) management; (2) primary care providers; (3)
supervision; and (4) rank and file nursing.
Total number of filled positions: 54
Total number of vacancies: 12.5
Total number of positions: 66.5
Vacancy percentage: 18.8%
Number of staff hired within last six months: 10
Total number of registry staff: 9
18.004 Did the institution have a registered nurse (RN) available on site 24 hours a 1 0 1 100.0% 4 4.0 100.0% 0 0
day, seven days a week, for emergency care?
18.005 Did the institution have a physician on site, a physician on call, or an MOD 1 0 1 100.0% 4 4.0 100.0% 0 0
available 24 hours a day, seven days a week, for the last 30 days?
18.006 Does the institution's orientation program for all newly hired nursing staff 1 0 1 100.0% 4 4.0 100.0% 0 0
include a module for sick call protocols that require face-to-face triage?
18.001 Are licensed health care staff current with their certifications and did they 5 0 5 100.0% 4 4.0 100.0% 0 0
attend required training?
Components Subtotals: 8 0 8 100.0% 16 16.0 100.0% 1 0
Bureau of Audits and Investigations Page 25
Office of the Inspector General State of California
Answers Weighting Points
Reference
Nursing Policy
Number Yes No Yes + No Yes % Possible Received Score % N/A Unk
16.231 Does the institution ensure that nursing staff review their duty statements? 5 0 5 100.0% 5 5.0 100.0% 0 0
16.154 Does the institution have written nursing policies and procedures that 5 0 5 100.0% 5 5.0 100.0% 0 0
adhere to the department's guidelines?
16.254 Does the institution's supervising registered nurse (SRN) conduct periodic 0 5 5 0.0% 4 0.0 0.0% 0 0
reviews of nursing staff?
Components Subtotals: 10 5 15 66.7% 14 10.0 71.4% 0 0
Bureau of Audits and Investigations Page 26
Office of the Inspector General State of California
California Prison Health Care
Receivership Corporation's
Response
Bureau of Audits and Investigations Page 27
Office of the Inspector General State of California
STATE OF CALIFORNIA J. Clark Kelso, Receiver
PRISON HEALTH CARE SERVICES
June 14,2010
David R. Shaw, Inspector General
Office ofthe Inspector General
P.O. Box 348780
Sacramento, CA 95834-8780
Dear Mr. Shaw,
The purpose of this letter is to inform you that the Office ofthe Receiver has reviewed the draft
report of the Office of the Inspector General's (OIG) Medical Inspection Results (MIR) for the
March, 2010 inspection of Chuckawalla Valley State Prison (CYSP). At this time, we would
like to acknowledge that CYSP accepts all OIG findings that were rated 60% or less. CYSP
will formulate corrective action plans for each of the deficiencies noted that are not being
addressed by statewide initiatives or other resources designed to achieve a constitutional level
of health care.
Thank you for preparing the report. Your efforts have advanced our mutual objective of
ensuring transparency and accountability in the California Prison Health Care Services
operations. Should you have any questions or concerns, please contact Olga Durette, Health
Program Manager II, Program Compliance Section at (916) 322-7669.
Sincerely,
i~~~
Policy and Risk Management Services
California Prison Health Care Services
cc: 1. Clark Kelso, Receiver
Elaine Bush, ChiefDeputy, Office ofthe Receiver
Dwight W. Winslow, M.D., ChiefPhysician Executive, Medical Services
Karen Rea, Statewide ChiefNurse Executive
Brenda Epperly-Ellis, Director, Allied Health Services
Starr Babcock, Special Assistant to the Court
Mary Jo Bruns, Southern Regional Administrator
Steven Ritter, D.O., Southern Regional Medical Executive
Susan Scott, SouthernRegional ChiefNurse Executive
John Culton, M.D., Health Care Manager, (CYSP)
Nazish Ali, MD., ChiefMedical Officer, (CYSP)
Steve Fama, Attorney, Prison Law Office
Nancy Faszer, Deputy Inspector General In-Charge
P.O. Box 4038 • Sacramento, CA 95812-4038
David R. Shaw, Inspector General
June 14,2010
Page 2
Bernie Fernandez, Deputy Inspector General Senior
Rob Hughes, Deputy Inspector General
Sueann Gawel, Deputy Inspector General
Johnny Hui, ChiefofInternal Audit, CPHCS
Olga Durette, Health Program Manager II, Program Compliance Section