Medical Inspection Results Summary and Analysis of the First Cycle of Medical Inspections of Californias 33 Adult Prisons

MEDICAL INSPECTION RESULTS SUMMARY AND ANALYSIS OF THE FIRST CYCLE OF MEDICAL INSPECTIONS OF CALIFORNIA’S 33 ADULT PRISONS OFFICE OF THE INSPECTOR GENERAL STATE OF CALIFORNIA MAY 2011 Contents Executive Summary .................................................................................................................... 1 Introduction ................................................................................................................................. 5 OIG Medical Inspection Program ......................................................................................... 5 Objectives, Scope, and Methodology ................................................................................... 9 Results of the First Cycle of Medical Inspections .................................................................... 12 Overall Scores and Medical Components ............................................................................ 15 Chronic Care ................................................................................................................. 20 Clinical Services ........................................................................................................... 22 Health Screening ........................................................................................................... 24 Specialty Services ......................................................................................................... 28 Urgent Services ............................................................................................................. 30 Emergency Services ...................................................................................................... 32 Prenatal Care/Childbirth/Post-Delivery ........................................................................ 36 Diagnostic Services ....................................................................................................... 38 Access to Health Care Information ............................................................................... 40 Outpatient Housing Unit ............................................................................................... 42 Internal Reviews ........................................................................................................... 44 Inmate Transfers ............................................................................................................ 46 Clinic Operations .......................................................................................................... 48 Preventive Services ....................................................................................................... 50 Pharmacy Services ........................................................................................................ 52 Other Services ............................................................................................................... 54 Inmate Hunger Strikes .................................................................................................. 56 Chemical Agent Contraindications ............................................................................... 58 Staffi ng Levels and Training ......................................................................................... 60 Nursing Policy .............................................................................................................. 64 General Medical Categories ...................................................................................................... 66 Medication Management .............................................................................................. 70 Access to Providers and Services ................................................................................. 74 Primary Care Provider Responsibilities ........................................................................ 78 Continuity of Care .......................................................................................................... 82 Nurse Responsibilities .................................................................................................. 84 Conclusion ................................................................................................................................ 88 Appendices ................................................................................................................................ 90 Appendix Preface ................................................................................................................ 90 Appendix Table of Contents ............................................................................................... 91 A: Component Defi nitions .................................................................................................. 92 B: Prisonsʼ Scores by Component ....................................................................................... 93 C: Component Questions and Scores .................................................................................. 94 D: Category Questions and Scores .................................................................................... 140 California Prison Health Care Receivership Corporationʼs Response .................................... 164 Executive Summary This report summarizes and analyzes the results of the Offi ce of the Inspector General’s (OIG) medical inspections of the 33 adult prisons operated by the California Department of Corrections and Rehabilitation (CDCR). These 33 medical inspections denote the completion of the Offi ce of the Inspector General’s fi rst cycle of prison medical inspections. Background As the result of the federal court class action lawsuit known as Plata v. Schwarzenegger, medical care at California’s 33 prisons is the responsibility of a federal Receiver appointed by the United States District Court for the Northern District of California (Court). The Court appointed the Receiver in 2006 to raise the quality of medical care in California’s prisons to constitutional standards. At the Court’s and the Receiver’s request, the OIG developed a comprehensive inspection program to evaluate the quality of medical care at each prison. In September 2008, we began our statewide inspections using teams of physicians, registered nurses, deputy inspectors general, and analysts. For the fi rst cycle of medical inspections, the 166-question inspection program used “yes” and “no” answers to assess the prisons’ compliance with CDCR’s medical policies and procedures as well as with community standards in 20 key components of prison medical care. The questions are weighted based on their importance to the delivery of medical care to inmates. Compliance is measured in “yes” answers. Our inspections result in weighted component scores and an overall weighted score for each prison. All parties to the lawsuit agreed that the OIG should primarily measure prisons’ compliance with the aforementioned CDCR medical policies and procedures. However, the Court has yet to defi ne what level of compliance with those policies and procedures meets constitutional standards. Therefore, by agreement with the Court and the Receiver, our inspections do not conclude whether a prison has passed or failed an inspection. Instead, we report each prison’s percentage of compliance with CDCR medical policies and procedures and, in the absence of such policies and procedures, appropriate medical community standards. Unlike the individual inspection reports, this 33-prison report puts the prisons’ scores into a qualitative context. We do so by comparing the prisons’ average and individual scores to the Receiver’s scoring criteria for three levels of adherence to policies and procedures. Thus a 75 percent score is the minimum score for moderate adherence. Scores below 75 percent denote low adherence, while those above 85 percent refl ect high adherence. In providing a qualitative context to the percentage scores, it is not our intention to determine or imply the percentage score that meets a constitutional standard of medical care. That determination remains with the Court. This is our second report summarizing and analyzing the results of our prison medical inspections. Using the Receiver’s scoring criteria, we issued a report in August 2010 at the halfway point of the fi rst cycle of 33 prison medical inspections. That report, which covered the 17 prisons initially inspected, found that only two of the 17 prisons achieved overall scores State of California • May 2011 Page 1 that exceeded the Receiver’s minimum score for moderate adherence. The 17 prisons’ average overall score was 70 percent, and we found signifi cant problems with how the prisons managed inmates’ medications and how they provided inmates access to medical providers and services. Results in Brief The results of our fi rst 33 medical inspections demonstrate that the Receiver and CDCR can improve prisons’ compliance with CDCR medical policies and procedures and selected medical community standards in a number of areas. Only nine of the 33 prisons met or exceeded the 75 percent minimum score for moderate adherence, and no prison achieved high adherence. Twenty-four of the 33 prisons performed below the minimum score for moderate adherence, but 12 were close, with scores of 70 percent to 74 percent; the average overall weighted score was 72 percent. Prisons’ scores ranged from 83 percent for Folsom State Prison down to 62 percent for High Desert State Prison. Folsom State Prison is the only prison to achieve moderate or high adherence in the six most heavily weighted components of the inspection program. We also reviewed the 33 prisons’ performance in these fi ve general medical categories: medication management; access to medical providers and services; primary care provider responsibilities; continuity of care; and nurse responsibilities. In doing so, we noted two signifi cant recurring problems. First, nearly all prisons were ineffective at ensuring that inmates receive their medications. Thirty of the 33 prisons either failed to timely administer, provide, or deliver medications or failed to document that they had done so. The 33 prisons’ average score of 59 percent in medication management was signifi cantly below the minimum score for moderate adherence. Numerous prisons were signifi cantly noncompliant in the following medication management tasks: delivering sick call medications (new orders) to inmates; providing chronic care medications; providing medications to inmates within one day of arrival at the prison; delivering medications to inmates upon discharge from an outside hospital; and administering tuberculosis medications. Since failures in compliance with medication management policies can stem from a failure to provide medications or from a failure to document having provided medications, we do not know the extent to which either cause contributed to prisons’ poor performance in this area. However, our inspections found numerous instances in which the documentation suggests that inmates did not receive their medications, including Isoniazid, a medication that controls tuberculosis. We conclude, therefore, that the prisons are not merely failing to document that inmates received their medications; they are also failing to provide the medications to the inmates. Both types of failure denote noncompliance and poor performance. The second recurring problem among the 33 prisons was poor access to medical providers and services. Prisons were generally ineffective at ensuring that inmates are seen or provided Bureau of Audits, Offi ce of the Inspector General Page 2 services for routine, urgent, and emergency medical needs according to timelines set by CDCR policy. Effective prison medical care depends on inmates’ timely access to providers and services. Only six prisons met the 75 percent minimum score for moderate adherence on access to providers and services, while ten prisons scored 60 percent or less. The average score, at 66 percent, was substantially less than the minimum score for moderate adherence. More encouragingly, the 80 percent score in nurse responsibilities and the 76 percent score in continuity of care enabled both categories to exceed the minimum score for moderate adherence. However, by averaging 72 percent, primary care provider responsibilities fell below the minimum score for moderate adherence. Other fi ndings from our fi rst 33 medical inspections follow. Prisons scored particularly poorly in two component areas: preventive services and inmate hunger strikes. The average score for preventive services was only 44 percent, and we found alarmingly low scores in tuberculosis treatment, which can affect the health of inmates and staff alike. Prisons also performed quite poorly in monitoring inmates on hunger strikes lasting more than three days. Hunger strikes of this length, although few in number, require careful monitoring, yet the prisons scored only 57 percent. The prisons’ average score exceeded the 75 percent minimum score for moderate adherence in 12 of the 20 component areas. However, many of those 12 components are less heavily weighted. Health screening, urgent services, and emergency services were the only components of the six most heavily weighted components in which the prisons’ average score exceeded 75 percent. Moreover, 28 of the 33 prisons failed to achieve moderate adherence in both chronic care and clinical services, the two most heavily weighted components. Nevertheless, the 96 percent average score in staffi ng levels and training refl ects positively on the prisons’ efforts to provide around-the-clock physician and nursing services and to train nursing staff on face- to-face triage techniques in a prison setting. The 93 percent average score in chemical agent contraindications and the 92 percent average score in clinic operations are also noteworthy. The prisons had mixed results on individual questions. The prisons achieved average scores of 86 percent or higher on 69 of the 165 scored questions in our medical inspection program. However, the prisons scored consistently poorly on 36 questions, averaging 60 percent or less, and in some cases substantially less. This 60-percent mark, the Receiver’s threshold for developing specifi c corrective action plans, indicates areas of prison medical care that require signifi cant improvement. For example, 25 of the 33 prisons routinely failed to schedule appointments within two weeks for inmates with urgent needs for specialty services. The prisons’ average score on this question was 42 percent. Conclusion We fi nd that the wide variation among component scores within prisons, and the wide variation among prisons’ average component scores, suggest that the Receiver has not yet implemented State of California • May 2011 Page 3 a system that ensures that CDCR medical policies and procedures and medical community standards are followed across the prison system. The higher scores in some component areas and medical categories, however, demonstrate that system-wide improvement can be achieved. Bureau of Audits, Offi ce of the Inspector General Page 4 Introduction At the request of the federal Court and the Court-appointed Receiver, and authorized by California Penal Code section 6126, which assigns oversight of the California Department of Corrections and Rehabilitation (CDCR) to the Offi ce of the Inspector General (OIG), the OIG developed a comprehensive inspection program to evaluate the delivery of medical care at each of CDCR’s 33 adult prisons. This report summarizes and analyzes the results of the OIG’s initial medical inspections of those 33 prisons. This is our second report summarizing and analyzing the results of our prison medical inspections. In August 2010, we issued a report at the halfway point of the fi rst cycle of 33 prison medical inspections.1 That report covered the fi rst 17 prisons inspected. Background In April 2001, inmates represented by the Prison Law Offi ce fi led a federal court class action lawsuit, now known as Plata v. Schwarzenegger. The lawsuit alleged that the state provided inadequate medical care at California adult prisons in violation of inmates’ constitutional rights. In June 2002, the parties entered into a Stipulation for Injunctive Relief (stipulation), and the state agreed to implement comprehensive new medical care policies and procedures at all prisons. More than three years later, the United States District Court for the Northern District of California (Court) declared in October 2005 that California’s delivery system for prison medical care still did not meet constitutional standards. Characterizing the prison health care system as “broken beyond repair,” the Court ordered a receivership to raise medical care to constitutional standards. On February 14, 2006, the Court appointed a Receiver with orders to manage the state’s delivery of medical care and to develop a sustainable system that provides constitutionally adequate medical care to inmates. The Court will remove the Receiver and return control to CDCR once the system is stable and provides constitutionally adequate medical care. OIG Medical Inspection Program To monitor and evaluate the progress of their efforts to improve medical care delivery to inmates, the Court and the Receiver requested that the OIG establish an objective, clinically appropriate and metric-oriented medical inspection program. In response, the OIG developed an inspection program to test prisons’ compliance with CDCR medical policies and procedures and medical community standards. Our objective is to conduct consistently applied assessments of inmate medical care at all 33 California state prisons, and to present independent and comparable results. The inspection reports are intended to be used by the Court, the Receiver, CDCR, and the plaintiffs to assess the medical care that inmates receive at each state prison. 1 The 17-prison report and all inspection reports can be viewed at the Offi ce of the Inspector Generalʼs website at www.oig.ca.gov State of California • May 2011 Page 5 In 2007, we developed a medical inspection program to assess the medical care provided at California adult prisons. In devising the program, we obtained and reviewed the following: • 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 offi ce, CDCR, and the plaintiffs’ counsel (Prison Law Offi ce) Based on this research, we established an on-site inspection program to collect over 1,000 data elements from each prison using up to 166 questions covering 20 essential components of medical care delivery.2 Our inspection teams consist of physicians, 20 Components of the OIG’s registered nurses, deputy inspectors general, and analysts. The Medical Inspections inspection tool they use allows for a broadly scoped and consistent (in order of importance): method of examining medical care at correctional institutions. Chronic Care Clinical Services For each of the 20 components of prison health care, we created Health Screening questions with “yes” or “no” answers designed to gauge performance. Specialty Services We worked with clinical experts to create a weighting system that Urgent Services factors in the relative importance of each component as well as Emergency Services Prenatal Care/Childbirth/Post-Delivery considers the relative importance of questions within a component. Diagnostic Services This weighting ensures that components that pose the greatest medical Access to Health Care Information risk to the inmate-patient (and are thus more important) are given Outpatient Housing Unit 3 more weight than those that pose less risk. For example, we assigned Internal Reviews a high number of possible points to the chronic care component Inmate Transfers Clinic Operations because inadequate care of inmates with chronic conditions poses Preventive Services the most signifi cant risk of all the components. Accordingly, in Pharmacy Services cycle one, chronic care accounts for 16 percent of the total possible Other Services points in the medical inspection program. Clinical services, the Inmate Hunger Strikes second most heavily weighted component, accounts for 11 percent. Chemical Agent Contraindications Staffi ng Levels and Training In total, the six most heavily weighted components account for 56 Nursing Policy percent of the medical inspection program. Conversely, we assigned proportionately fewer points to components that pose less risk to the 2 For the second cycle of prison medical inspections currently underway, there are 152 questions. By prior agreement of all parties, we evaluated the medical inspection program following completion of the fi rst cycle of medical inspections. As a result, we made a limited number of changes. These changes include eliminating a medical emergency drill, adding some questions and dropping others, and changing the weighting of certain questions. 3 One question (Question 18.002) in the staffi ng levels and training component does not factor into the overall inspection score a prison receives. Bureau of Audits, Offi ce of the Inspector General Page 6 inmate-patient. For example, pharmacy services accounts for only three percent and chemical agent contraindications account for only two percent. Defi nitions of components are listed in Appendix A. The inspections identify instances of noncompliance with CDCR medical policies and procedures, as well as medical community standards of care. However, we neither attempt to identify the causes for noncompliance nor recommend remedies for specifi c instances of inadequacy. Further, we do not review for effi ciency and economy of operations. Our inspection tool is designed to present an objective and consistent assessment of medical care—to mirror back to the prisons the reality of their health care delivery system. Consequently, our inspection scores should be used by the prisons, CDCR, the Receiver, the plaintiffs’ counsel, and the Court to determine whether the constitutional level of medical care has been achieved and to identify areas that must be improved to meet the mandated level of care. All parties to the lawsuit agreed that the OIG should primarily measure prisons’ compliance with the aforementioned CDCR medical policies and procedures. However, the Court has yet to defi ne what level of compliance with those policies and procedures meets constitutional standards. Therefore, by agreement with the Court and the Receiver, our inspections do not conclude whether a prison has passed or failed an inspection. Instead, we merely report each prison’s percentage of compliance with CDCR medical policies and procedures and, in the absence of such policies and procedures, selected medical community standards. In performing the inspections, we identify random samples of inmates receiving or requiring specifi c medical services. We then review the medical fi le for each inmate in our sample to determine if the medical care provided met established criteria. For these samples our inspection program assumes that if 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 specifi ed 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 program also reviews staffi ng level reports, medical appeals summaries, nursing policies and procedures, summaries of medical drills and emergencies, minutes from Quality Management Committee and Emergency Medical Response Review Committee meetings, the contents of inmate transfer envelopes, and assorted manual logs or tracking worksheets related to medical care delivery. Turning from the examination of documents to the examination of people and their actions, we observe the day-to-day medical operations at each prison. For this fi rst cycle of medical inspections, we conducted a live medical emergency drill and evaluated the adequacy of the responding staff’s actions. And fi nally, we interview medical and custody staff about the delivery of medical care to inmates. For each prison, our published inspection reports present an overall percentage score as well as percentage scores for component areas. Although the Court has yet to determine the percentage State of California • May 2011 Page 7 score necessary for an institution to meet the constitutional standard, the Receiver currently applies the following scoring criteria to measure each prison’s adherence to medical policies and procedures: • More than 85 percent: High adherence • 75 to 85 percent: Moderate adherence • Less than 75 percent: Low adherence The Receiver requires that each prison develop a corrective action plan following an inspection. The corrective action plan must describe how the prison intends to remedy conditions that contributed to a score of 60 percent or lower on each question. Because the Plata litigation addresses only medical care, we do not assess the provision of dental care or mental health services in prisons. Nor do we assess the care provided in licensed hospitals or correctional treatment centers, which are subject to inspection and oversight by other regulatory agencies. Using the Receiver’s scoring criteria, we issued a report in August 2010 at the halfway point of the fi rst cycle of 33 prison medical inspections. That report, which covered the 17 prisons initially inspected, found that only two of the 17 prisons achieved overall scores that exceeded the Receiver’s minimum score for moderate adherence. The 17 prisons’ average overall score was 70 percent, and we found signifi cant problems with how the prisons managed inmates’ medications and how they provided inmates access to medical providers and services. Bureau of Audits, Offi ce of the Inspector General Page 8 Objectives, Scope, and Methodology In September 2008, we began the fi rst of our statewide medical inspections, and in October 2010 we completed the report on our thirty-third prison medical inspection. The thirty-third medical inspection denotes the end of the fi rst cycle of our prison medical inspection program. This report summarizes the results of that fi rst cycle of 33 medical inspections, and it provides additional analysis of the data obtained from those inspections. The report includes data from inspections performed at the state’s 30 men’s prisons and three women’s prisons. The prisons are listed below: First 17 Medical Inspections of Cycle 1 Final 16 Medical Inspections of Cycle 1 California State Prison, Sacramento (SAC) North Kern State Prison (NKSP) California Medical Facility (CMF) Folsom State Prison (FSP) R. J. Donovan Correctional Facility (RJD) Kern Valley State Prison (KVSP) California State Prison, Centinela (CEN) Valley State Prison for Women (VSPW) Deuel Vocational Institution (DVI) California State Prison, Solano (SOL) Central California Women’s Facility (CCWF) California Substance Abuse Treatment Facility and State Prison, Corcoran (SATF) California Men’s Colony (CMC) Ironwood State Prison (ISP) Sierra Conservation Center (SCC) Chuckawalla Valley State Prison (CVSP) California State Prison, Los Angeles County (LAC) California State Prison, Corcoran (COR) Pleasant Valley State Prison (PVSP) Calipatria State Prison (CAL) California Correctional Institution (CCI) Correctional Training Facility (CTF) California Rehabilitation Center (CRC) Mule Creek State Prison (MCSP) California Institution for Women (CIW) California Institution for Men (CIM) Avenal State Prison (ASP) Salinas Valley State Prison (SVSP) San Quentin State Prison (SQ) Pelican Bay State Prison (PBSP) High Desert State Prison (HDSP) Wasco State Prison (WSP) California Correctional Center (CCC) In analyzing and summarizing the results of our fi rst 33 medical inspections, our objective was to provide a practical interpretation of the data and an assessment of the quality of medical care provided to inmates. In doing so, we looked for signifi cant trends and variations in data, compliance problems common to or unique to prisons, and other data characteristics we believed noteworthy. Unlike the individual inspection reports, this 33-prison report puts the prisons’ scores into a qualitative context. We do so by comparing the prisons’ average and individual scores to the Receiver’s scoring criteria. Thus a 75 percent score is the minimum score for moderate adherence 4 to relevant policies and procedures. Scores below 75 percent denote low adherence, while those 4 All average scores in this report are based on the arithmetic mean. We developed no median or modal averages. State of California • May 2011 Page 9 above 85 percent refl ect high adherence. As discussed below, we have rounded all percentage scores in this report and the appendices to the nearest whole number. Therefore, when we apply rounding to the Receiver’s scoring criteria, this report refl ects adherence as follows: • 86 percent and higher: High adherence • 75-85 percent: Moderate adherence • 74 percent and lower: Low adherence In providing a qualitative context to the percentage scores, it is not our intention to determine or imply the percentage score that meets a constitutional standard of medical care. That determination remains with the Court. In addition to reviewing our inspection results by prison, we analyzed our data using the following two perspectives, and we cite the results of each perspective in separate sections of this report. Results by Medical Component – Our fi rst perspective compares the weighted inspection scores of all 33 prisons in each of the 20 component areas. This perspective provides a system- wide context, comparing health care delivery performances among prisons, and provides information about each prison’s performance in specifi c component areas, noting areas in which prisons scored particularly well or particularly poorly. In this fi rst perspective, we present profi les of each of the 20 components. These profi les summarize the prisons’ individual and average scores in each component of prison health care, including the average of the top two prisons’ scores and the variation from the highest score to the lowest score, expressed in percentage points. In addition, we identify areas requiring signifi cant improvement consistent with the Receiver’s requirement for corrective action plans. We also identify areas in which the prisons’ performances refl ect high adherence to medical policies and procedures. We defi ne areas requiring signifi cant improvement as any area in which prisons earned an average score of 60 percent or less — the Receiver’s threshold for corrective action. We defi ne areas of high adherence as any area in which prisons earned an average score of 86 percent or more. Results by General Medical Category – For our second perspective, we move from examining disparate components of prison health care to examining how these components function together to deliver health care at California’s 33 adult prisons. Working with our lead physician, we identifi ed 100 questions that fi t into fi ve general categories of medical care. We sorted these questions into the general health care categories and analyzed the results. The fi ve general medical categories, which offer a broader perspective on the experience of prison medical care, include: • Medication Management • Access to Providers and Services • Primary Care Provider Responsibilities • Continuity of Care • Nurse Responsibilities Bureau of Audits, Offi ce of the Inspector General Page 10 We analyze the data by prison, as well as by category, in order to help policy makers evaluate medical care delivery in this broader context. Appendices – Because of the technical nature of our medical inspections and the signifi cant volume of information in this report, we have included the following four appendices: • Appendix A: Contains the defi nitions of the components we use in our medical inspections program. • Appendix B: Contains a synopsis of each prison’s scores by component. • Appendix C: Cites the text for each question in the 20 components and contains the 33 prisons’ scores for each question. • Appendix D: Cites the text for each question in the fi ve medical categories and contains the 33 prisons’ scores for each question. Rounding – Throughout this report and the appendices, we have rounded all percentage scores to the nearest whole number. As discussed in the preface to the appendices of this report, our rounding has resulted in scores that differ slightly from those in the inspection reports for the 33 prisons. For example, the overall score in the inspection report for DVI is 72.6 percent; however, for this report we have rounded the score to 73 percent. The net effect of our rounding of scores is negligible, as shown by the fact that rounding affected the qualitative assessments of only 13 of the 654 combined overall and component scores from our 33 medical inspections. In all 13 cases, the rounding favored the prisons because in four cases the rounded score moved the prisons from low adherence to moderate adherence, and in nine cases the rounded score moved the prisons from moderate adherence to high adherence. In only one case did the rounding move a prison’s overall score. In that case, we rounded MCSP’s overall score from 74.5 percent to 75 percent, moving the qualitative score from low adherence to moderate compliance. State of California • May 2011 Page 11 Results of the First Cycle of Medical Inspections Nine of the 33 prisons’ overall scores met or exceeded the 75 percent minimum score for moderate adherence. Whereas our 17-prison summary report found that only two of the fi rst 17 prisons exceeded the 75 percent score for moderate adherence, seven of the last 16 prisons met or exceeded the 75 percent minimum score. Prisons’ overall scores ranged from 83 percent for FSP down to 62 percent for HDSP. FSP is the only prison to achieve moderate or high adherence in the six most heavily weighted components. The average score for the fi rst 17 inspections was 70 percent and the average score for the last 16 inspections was 74 percent, resulting in an overall average score of 72 percent for all 33 prisons. These scores reveal that the Receiver and the prisons can improve compliance with CDCR’s medical policies and procedures and selected medical community standards. Nearly all of the prisons failed to achieve moderate adherence in three of the six most heavily weighted components. For example, 28 of them failed to achieve moderate adherence in both chronic care and clinical services, the two most heavily weighted components. While overall scores varied by only 21 percentage points, there were differences of as much as 89 percentage points in the scores among institutions on individual components. Clearly, some prison staff members carried out relevant policies and procedures while others did not. The highest average component scores were 96 percent in staffi ng levels and training, 93 percent in chemical agent contraindications, and 92 percent in clinic operations. The prisons achieved high adherence on 69 of the 165 scored questions in our medical inspection program. The 33 prisons’ lowest average component scores were 44 percent in preventive services, 57 percent in inmate hunger strikes, 62 percent in chronic care, and 64 percent in access to health care information. The prisons scored 60 percent or less on 36 of the 165 scored questions in our medical inspection program. The Receiver can improve the prisons’ compliance with medical policies and procedures by continuing to focus prisons’ performance on these 36 questions. Turning from the in-depth examination of individual health care components, we examined how those components function together to deliver health care. We sorted the data from 100 questions into fi ve general medical categories that were recommended by our lead physician. From this broader perspective, we found signifi cant problems in the categories of medication management and access to providers and services. These are the same two categories we found problematic in our 17-prison summary report. The average score in medication management was only 59 percent, indicating that prisons were ineffective in getting medications to inmates in a timely manner or were failing to document their actions as required by policy. The average score for access to providers and services was only 66 percent. This low score indicates that the prisons were generally ineffective in ensuring that inmates are seen or provided services for routine, urgent, and emergency medical needs according to timelines set by CDCR policy. Access to providers and services scores ranged from 87 percent down to 45 percent. In the remaining three categories, nurse responsibilities and continuity of care, with scores of 80 Bureau of Audits, Offi ce of the Inspector General Page 12 percent and 76 percent, respectively, exceeded the 75 percent minimum score for moderate adherence. Further, primary care provider responsibilities was close, with an average score of 72 percent. The following sections of this report summarize and analyze the 33 prisons’ overall scores, their scores in each of the 20 components, and their scores in each of the fi ve general medical categories. State of California • May 2011 Page 13 Chart 1: Overall Scores for Each Prison, in Chronological Order of Report Date SAC Nov. 2008 65% CMF Jan. 2009 72% RJD Feb. 2009 68% CEN Feb. 2009 74% DVI Mar. 2009 73% CCWF May 2009 78% CMC May 2009 71% SCC Jun. 2009 76% Institution Score LAC Jul. 2009 72% Average Score = 72% Minimum Moderate Adherence = 75% PVSP Aug. 2009 65% CCI Sep. 2009 64% CRC Oct. 2009 74% CIW Nov. 2009 70% ASP Nov. 2009 70% HDSP Dec. 2009 62% SQ Dec. 2009 68% CCC Jan. 2010 73% NKSP Mar. 2010 72% KVSP Mar. 2010 64% FSP Mar. 2010 83% SOL Apr. 2010 67% SATF May 2010 68% VSPW May 2010 80% ISP Jun. 2010 68% CVSP Jul. 2010 69% COR Jul. 2010 69% CAL Jul. 2010 77% CTF Aug. 2010 72% MCSP Sep. 2010 75% SVSP Oct. 2010 74% CIM Oct. 2010 81% PBSP Nov. 2010 81% WSP Nov. 2010 76% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% Bureau of Audits, Offi ce of the Inspector General Page 14 Overall Scores and Medical Components Nine prisons’ overall scores met or exceeded the 75 percent minimum score for moderate adherence. As shown in Chart 1, the average score for the 33 prisons was 72 percent; this score is two percentage points higher than the 70 percent average score we reported in our 17-prison summary report. The scores varied 21 percentage points from highest to lowest. Of the nine prisons that met or exceeded the 75 percent minimum score for moderate adherence, FSP’s score of 83 percent was the highest, while CIM and PBSP tied for second- highest score with 81 percent. VSPW scored 80 percent. With the exception of a 57 percent score in preventive services, FSP had no component score lower than 70 percent. Further, FSP is the only prison to achieve moderate or high adherence in the six most heavily weighted components. Another 12 prisons had scores that ranged from 74 percent to 70 percent, which put them close to the 75 percent minimum score for moderate adherence. The remaining 12 prisons had scores that ranged from 69 percent to 62 percent. Component Analysis Nearly all of the prisons failed to achieve moderate adherence in three of the six most heavily weighted components. We have summarized all 33 institutions’ scores for each of the 20 components on one table in Appendix B. As shown in Appendix B, 28 of the 33 prisons failed to achieve moderate adherence in both chronic care and clinical services, the two most heavily weighted components in the medical inspection program, with a combined 27 percent of the total possible points in cycle one. The average score for chronic care was only 62 percent, and the score for clinical services was only 65 percent. The average score for specialty services, another of the six most heavily weighted components, was only 66 percent. The average of the scores in the six most heavily weighted components was only 71 percent, whereas the average of the scores in the remaining components was 77 percent. The six most heavily weighted components account for 56 percent of the possible points in the medical inspection program in cycle one. There were wide variations in some prisons’ component scores, while in other cases the variations were substantially narrower. For example: • The largest variation in an individual prison’s component scores was 89 percentage points. This characteristic was shared by RJD and SAC. Each prison scored only 11 percent in inmate hunger strikes and yet each received 100 percent scores in other components. • The smallest variation in component scores was the 34 percentage points achieved by VSPW, which scored only 66 percent in clinical services, yet received 100 percent in six other components. VSPW, which had the fourth highest overall score of 80 percent, could have had an even higher overall score if four of its lowest scores were not in the six most heavily weighted components. State of California • May 2011 Page 15 Thirty-two of the 33 prisons scored 100 percent in at least one component, with CAL’s seven 100 percent scores the most by any prison. CCI, with an overall score of 64, was the only prison not to achieve a 100 percent score in any component. However, even CCI did well in certain components. Notably, it scored 91 percent in clinic operations. There were wide variations in average scores by component. As a group, the prisons performed well in several components, marginally in other components, and poorly in several components. Chart 2 compares the average scores for medical components across all prisons. These scores ranged from a high of 96 percent in staffi ng levels and training down to 44 percent in preventive services, presenting a range of 52 percentage points. In fi ve components, the average scores met the 86 percent minimum score for high adherence to medical policies and procedures. In addition to the 96 percent in staffi ng levels and training, the prisons achieved average scores of 93 percent in chemical agent contraindications, 92 percent in clinic operations, 88 percent in inmate transfers, and 87 percent in pharmacy services. However, none of these components accounts for more than four percent of the total points possible in the medical inspection program in cycle one. The 96 percent average score in staffi ng levels and training refl ects positively on the prisons’ effort to ensure around-the-clock physician and nursing services, and to orient and train nursing staff on face-to-face triage techniques in a prison setting. Another seven components had average scores of 77 percent to 84 percent. The seven components were other services, outpatient housing unit, internal reviews, emergency services, urgent services, health screening, and nursing policy. Thus, a total of 12 of the 20 component average scores exceeded the 75 percent minimum score for moderate adherence. However, many of these 12 components are less heavily weighted components in the medical inspection program. Bureau of Audits, Offi ce of the Inspector General Page 16 Chart 2: Average Score by Medical Component, Sorted by Order of Importance Chronic Care 62% Average Clinical Services 65% Score Health Screening 77% Minimum Moderate Adherence = 75% Specialty Services 66% Urgent Services 78% Emergency Services 78% Prenatal/Childbirth/Post-delivery 71% Diagnostic Services 69% Access to Health Care Information 64% Outpatient Housing Unit 81% Internal Reviews 78% Inmate Transfers 88% Clinic Operations 92% Preventive Services 44% Pharmacy Services 87% Other Services 84% Inmate Hunger Strikes 57% Chemical Agent Contraindications 93% Staffing Levels and Training 96% Nursing Policy 77% 20% 30% 40% 50% 60% 70% 80% 90% 100% The average scores in the following two component areas indicate low adherence to medical policies and procedures and the need for improvement: • Preventive services (44 percent). The low average score in preventive services refl ects CDCR’s systematic failure to effectively identify and schedule inmates who need cancer screenings and tuberculosis treatment. • Inmate hunger strikes (57 percent). This low score shows that most of the prisons failed to effectively carry out CDCR’s policies and procedures for dealing with inmates on hunger strikes for more than three days. The wide variation in component scores among institutions indicates that the 33 prisons were not consistently executing CDCR’s medical policies and procedures, or complying with community medical standards. This inconsistency is further illustrated by Table 1, which shows the high and low scores that contributed to each component’s average score. Clearly, some prisons carried out relevant medical policies and procedures while others did not. State of California • May 2011 Page 17 Table 1: Summary of High and Low Scores by Medical Component, Sorted by Order of Importance Variation Between High Low Average Medical Component High/Low Percentage Percentage Percentage Percentage Points Chronic Care 84 45 64 39 Clinical Services 87 47 66 40 Health Screening 87 61 75 26 Specialty Services 74 43 60 31 Urgent Services 89 63 79 26 Emergency Services 90 48 77 42 Prenatal Care/ 61 61 61 N/A Childbirth/Post-Delivery Diagnostic Services 87 43 69 44 Access to Health Care 82 20 59 62 Information Outpatient Housing Unit 86 63 77 23 Internal Reviews 100 60 76 40 Inmate Transfers 100 43 86 57 Clinic Operations 100 82 90 18 Preventive Services 82 7 37 75 Pharmacy Services 100 58 85 42 Other Services 100 55 86 45 Inmate Hunger Strikes 100 11 46 89 Chemical Agent 100 65 91 35 Contraindications Staffi ng Levels and 100 80 94 20 Training Nursing Policy 100 36 74 64 Beginning in the next section, we present profi les of each of the 20 components. In these profi les, we summarize the prisons’ individual and average scores, including the average of the top two prisons’ scores and the variation from the top score to the lowest score, expressed in percentage points. The average of the top two scores is important because it shows that a higher level of performance by other prisons is possible. We also identify areas requiring signifi cant improvement as well as areas with scores that indicated high adherence to medical policies and procedures. We defi ned “areas requiring signifi cant improvement” as areas of prison medical care in which prisons scored 60 percent or less. This is the Receiver’s threshold score for Bureau of Audits, Offi ce of the Inspector General Page 18 requiring formal corrective action plans. We defi ned “areas achieving high adherence” as areas of prison medical care that met or exceeded the 86 percent minimum score for high adherence to medical policies and procedures. State of California • May 2011 Page 19 Medical Component: Chronic Care Profi le Page 1 of 2 Component Defi nition: The Chronic Care component examines how well the prison provided care and medications to inmates with specifi c 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 Key Statistics care conditions: asthma, diabetes, HIV (Human Immunodefi ciency Component Average: ....... 62% Virus), and hypertension. Top Two Average: ............ 83% Range of Scores: ..... 84%-38% Results in Brief: Only fi ve prisons scored at or above the 75 Variation: ........................ 46% percent minimum score for moderate adherence. KVSP, ISP, and SOL performed the worst. Documentation at most of the 33 prisons Number of Prisons with: High Adherence ..................... 0 indicated that inmates were not receiving their prescribed chronic Moderate Adherence .............. 5 care medications. Further, at nearly all prisons there was inadequate Low Adherence .................... 28 documentation of inmates’ clinical histories. This component includes nine questions. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less Question Either the inmates’ medical fi les did not indicate that they had received their 03.175 prescribed chronic care medications during the most recent three-month period, or the prison did not follow department policy when the inmate refused to pick up or show up for his or her prescribed medications. The average score for this question was only 34 percent. Twenty-four of the 33 prisons had scores of 50 percent or less, and seven prisons received eight percent or less. Question Prisons were not completing key components of two chronic care forms (Forms 03.077 7419 and 7392) that document vital signs and other important information about the inmate’s two most recent visits. The average score for this question was only 46 percent, and 22 prisons scored 54 percent or lower. SOL received zero percent. Question The clinical histories in inmates’ medical fi les were consistently inadequate. The 03.235 average score was only 54 percent. Only three of the 33 prisons had a score that met the 75 percent minimum score for moderate adherence, and 20 prisons scored 60 percent or below on this question. Question The inmates’ most recent chronic care visits were not within the time frames 03.076 required by the degree of control of the inmates’ conditions based on their prior visits. The average score for this question was only 58 percent. Areas Achieving High Adherence with Scores of 86 Percent or More None. See Appendix C-1 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 20 Medical Component: Chronic Care Profi le Page 2 of 2 Chart 3: Chronic Care Scores by Prison, Sorted Highest to Lowest Score CMF 84% CEN 81% FSP 79% CAL 75% SCC 75% DVI 74% CCWF 73% VSPW 71% PBSP 70% MCSP 70% CIW 70% LAC 70% CRC 67% SQ 65% SAC 63% CIM 62% CCI 62% NKSP 59% ASP 59% COR 58% SATF 58% SVSP 57% PVSP 57% CMC 57% CTF 56% WSP 52% CVSP 52% Institution Score Average Score = 62% RJD 49% Minimum Moderate Adherence = 75% CCC 46% HDSP 45% SOL 42% ISP 39% KVSP 38% 30% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 21 Medical Component: Clinical Services Profi le Page 1 of 2 Component Defi nition: The Clinical Services component evaluates the inmate’s access to primary health care services and focuses on inmates who recently received services from any of the prison’s facilities or administrative segregation unit clinics. This component evaluates sick call processes (doctor or nurse line), medication management, and nursing. Key Statistics Component Average: ....... 65% Results in Brief: Thirty-one of the 33 prisons failed to ensure that Top Two Average: ............ 84% inmates received their prescribed medications in a timely manner. Range of Scores: ......87%-47% Twenty-seven prisons failed to meet the appointment dates set by Variation: .........................40% the triage nurse for inmates’ visits with a primary care provider. As evidenced by their overall clinical services scores, PVSP and SQ Number of Prisons with: fared the worst in this component. High Adherence ..................... 1 Moderate Adherence .............. 2 Low Adherence .................... 30 This component includes 14 questions. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less Question Most prisons were not timely in the delivery of medications prescribed from 01.124 inmates’ sick call visits. Twenty-fi ve of the 33 prisons scored less than 50 percent, and the average score for this question was only 36 percent. CRC received ten percent and SATF scored just seven percent. Question Registered nurses’ objective notes at most prisons did not always include inmates’ 01.244 allergies, weight, current medication, and medication compliance. The average score for this question was only 47 percent. CRC and HDSP scored just fi ve and seven percent, respectively. Question Most of the prisons routinely failed to meet the appointment dates established by the 01.027 triage nurse for inmates’ visits with a primary care provider. The average score for this question was only 52 percent. RJD received 13 percent. Areas Achieving High Adherence with Scores of 86 Percent or More Question At most of the prisons, the registered nurses did well in reviewing all of the inmate’s 01.246 complaints on the Health Care Services Request Form. Twenty-six of the 33 prisons achieved scores of 86 percent or higher on this question, and the average score was 89 percent. Question Nearly all of the prisons did well in developing strategies to address the problems 01.162 identifi ed in the registered nurse’s face-to-face triage. The average score for this question was 88 percent. See Appendix C-2 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 22 Medical Component: Clinical Services Profi le Page 2 of 2 Chart 4: Clinical Services Scores by Prison, Sorted Highest to Lowest Score CMF 87% CEN 80% FSP 76% WSP 74% CIM 74% CMC 74% CCWF 74% DVI 73% SCC 71% CRC 70% PBSP 69% MCSP 69% COR 68% RJD 67% SAC 67% VSPW 66% CCC 66% LAC 66% ASP 64% NKSP 64% CIW 62% SVSP 61% CVSP 61% ISP 61% CAL 60% SOL 60% CTF 59% KVSP 58% CCI 57% Institution Score SATF 56% Minimum Moderate Adherence = 75% Average Score = 65% HDSP 51% SQ 47% PVSP 47% 30% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 23 Medical Component: Health Screening Profi le Page 1 of 3 Component Defi nition: The Health Screening component focuses on the prison’s process for screening new inmates upon arrival to the prison for health care conditions that require treatment and monitoring, as well as ensuring inmates’ continuity of care. Key Statistics Results in Brief: Twenty of the prisons inspected scored at or above Component Average: .........77% Top Two Average: ..............88% the 75 percent minimum score for moderate adherence. Even though Range of Scores: ......89%-61% prisons were regularly performing initial health screenings, we found Variation: ........................ 28% that they were not following up to ensure that inmates received required medications or treatment for medical conditions identifi ed Number of Prisons with: during those health screenings. High Adherence ..................... 5 Moderate Adherence ............ 15 This component includes 19 questions. Some of these questions Low Adherence .................... 13 apply only to prisons with a reception center; other questions apply to prisons with general population inmates; still others apply to both. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less Question The medical fi les contained no indication that the inmates who transferred from 02.128 other prisons or jails were receiving existing medication orders by the calendar day following their arrival. The average score for this question was only 33 percent. Twenty-eight of the 33 prisons had scores of 50 percent or less, and six prisons received zero percent. Question If, during an assessment, a registered nurse referred the inmate to a clinician, the 02.018 inmate was not seen within the specifi ed time frame. The average score for this question was only 53 percent. Twenty-three of the 32 prisons to which this question applied had scores of 74 percent or less, and 14 prisons scored below 50 percent. LAC and CTF received zero percent for the question. Question This question applies only to prisons with reception centers. Half of the reception 02.215 centers were not completing a portion of the History and Physical Examination form. The average score for this question was only 54 percent. VSPW scored only fi ve percent, and RJD and HDSP received zero percent. Bureau of Audits, Offi ce of the Inspector General Page 24 Medical Component: Health Screening Profi le Page 2 of 3 Chart 5: Health Screening Scores by Prison, Sorted Highest to Lowest Score FSP 89% CMF 87% WSP 86% CIM 86% VSPW 86% PBSP 85% SVSP 84% CCWF 84% ISP 82% MCSP 81% CCC 81% ASP 81% CAL 80% CCI 78% CEN 78% SOL 77% SQ 77% CVSP 76% SAC 76% KVSP 75% CRC 74% DVI 74% COR 73% SATF 73% CMC 73% NKSP 72% HDSP 72% CIW 70% Institution Score Average Score = 77% LAC 69% Minimum Moderate Adherence = 75% RJD 68% PVSP 67% CTF 64% SCC 61% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% State of California • May 2011 Page 25 Medical Component: Health Screening Profi le Page 3 of 3 Areas Achieving High Adherence with Scores of 86 Percent or More Question Nearly all of the prisons were completing the initial health screening on the same 02.016 day the inmate arrived at the prison. The prisons achieved an average score of 96 percent on this question. Twenty prisons scored 100 percent. Question Nursing staff adequately documented either the tuberculin test or a review of signs 02.020 and symptoms for inmates with a previous positive tuberculin test. The average score for this question was 93 percent. Fourteen prisons scored 100 percent. Question If “yes” was answered to any of the questions on the initial health screening forms, 02.017 most prisons’ registered nurses performed an assessment and disposition on the date of the inmate’s arrival. The average score for this question was 92 percent. Twenty- three prisons scored 100 percent. Question Within one calendar day of the inmate’s arrival, nearly all of the prisons’ licensed 02.007 health care staff reviewed and signed the health care transfer information form. The average score for this question was 91 percent. Eight prisons scored 100 percent. Questions These questions apply only to the prisons with reception centers. These prisons did 02.212 well in completing many sections of the History and Physical Examination Form 02.213 (Form 7206) upon the inmate’s arrival. These prisons received average scores 02.216 ranging from 87 percent to 90 percent on each of these questions. 02.217 02.218 Question Inmates needing medical accommodations received them upon arrival. The average 02.111 score for this question was 86 percent. Sixteen prisons scored 100 percent. See Appendix C-3 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 26 State of California • May 2011 Page 27 Medical Component: Specialty Services Profi le Page 1 of 2 Component Defi nition: The Specialty Services component 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 cardiology services, physical therapy, oncology services, podiatry consultations, and neurology services. Key Statistics Results in Brief: Most prisons performed poorly in providing inmates Component Average: .........66% timely access to specialty services and prompt follow-up related to Top Two Average: ..............91% those services. The low scores associated with three specialty services Range of Scores: ......96%-43% questions were so signifi cant that they reduced the 33 prisons’ Variation: ........................ 53% average score in specialty services by 16 percentage points. Without Number of Prisons with: the three questions, the 33 prisons’ average score would have been 82 High Adherence ..................... 2 percent instead of the 66 percent average score they received. Moderate Adherence ...............5 Low Adherence .................... 26 This component includes nine questions. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less Question Primary care providers were not seeing inmates between the date the physician 07.038 ordered the specialty service and the date the inmate received it, in accordance with specifi ed time frames. The average score for this question was only 32 percent. While CAL and PBSP scored 100 percent, two prisons scored zero percent. Question Primary care providers were not reviewing the consultant’s report and seeing the 07.043 inmate for a follow-up appointment within specifi ed time frames following the specialty services consultation. The average score for this question was only 39 percent. HDSP’s score of zero percent was the lowest. Question Twenty-fi ve prisons were not scheduling high-priority (urgent) specialty services 07.261 within 14 days as required. For this question, the 33 prisons had an average score of only 42 percent. Thirteen prisons received zero percent. Areas Achieving High Adherence with Scores of 86 Percent or More Question Thirty-two of the 33 prisons’ physical therapists properly assessed inmates, 07.090 documented their treatment plans, and documented the treatment provided. The average score for this question was 99 percent. Question Either the prisons’ specialty service providers provided timely fi ndings and 07.270 recommendations, or the prison’s registered nurse conducted timely follow-up with the provider to ascertain the fi ndings and recommendations. The average score for this question was 95 percent. Thirty of the 33 prisons scored at least 88 percent. See Appendix C-4 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 28 Medical Component: Specialty Services Profi le Page 2 of 2 Chart 6: Specialty Services Scores by Prison, Sorted Highest to Lowest Score PBSP 96% CVSP 86% CIM 83% ISP 82% FSP 80% MCSP 76% CAL 75% ASP 74% SCC 73% VSPW 72% WSP 71% SVSP 71% CCC 71% LAC 70% CTF 69% SOL 66% CIW 63% CMC 63% SATF 62% KVSP 62% RJD 62% NKSP 61% PVSP 61% CEN 60% CRC 59% SQ 58% Institution Score Average Score = 66% CCI 57% Minimum Moderate Adherence COR 55% HDSP 53% CCWF 53% DVI 53% SAC 47% CMF 43% 30% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 29 Medical Component: Urgent Services Profi le Page 1 of 2 Component Defi nition: The Urgent Services component addresses the care provided by the prison to inmates before and after they were sent to a community hospital. Key Statistics Results in Brief: On average, the 33 prisons performed relatively well Component Average: .........78% in providing urgent services. Only eight prisons did not meet the 75 Top Two Average: ..............91% percent minimum score for moderate adherence to policies and Range of Scores: ......92%-61% procedures. However, upon inmates’ discharge from a community Variation: ........................ 31% hospital, few of the prisons administered or delivered all prescribed Number of Prisons with: medications to the inmates within specifi ed time frames. High Adherence ..................... 5 Moderate Adherence ............ 20 Low Adherence ...................... 8 This component includes eight questions. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less Question Most prisons failed to administer or deliver all prescribed medications to inmates in an 21.281 appropriate time frame upon their discharge from a community hospital. The average score for this question was only 48 percent. Six prisons scored 13 percent or lower. Areas Achieving High Adherence with Scores of 86 Percent or More Question For patients sent to the triage and treatment area, if the primary care provider managed 21.279 the patient by telephone consultation alone, the provider’s decision not to come to the triage and treatment area was appropriate. The average score for this question was 99 percent. Twenty-eight prisons scored 100 percent. Question Upon the inmate’s discharge from the community hospital, the inmate’s primary care 21.250 provider gave orders for appropriate housing for the inmate. The average score for this question was 93 percent. Although RJD scored only 50 percent, fourteen prisons scored 100 percent. Question Upon the inmate’s discharge from the community hospital, the treatment and triage 21.248 area (TTA) registered nurse documented that he or she reviewed the inmate’s discharge plan and completed a face-to-face assessment of the inmate. The average score for this question was 87 percent, and fi ve prisons scored 100 percent. See Appendix C-5 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 30 Medical Component: Urgent Services Profi le Page 2 of 2 Chart 7: Urgent Services Scores by Prison, Sorted Highest to Lowest Score PBSP 92% SCC 89% CCWF 89% CAL 88% FSP 88% WSP 85% SVSP 84% CCC 84% CMC 84% CCI 83% SAC 83% CRC 81% PVSP 81% CIM 80% NKSP 80% LAC 80% CEN 80% CMF 79% CVSP 78% DVI 78% COR 76% MCSP 75% CTF 75% SATF 75% CIW 75% RJD 73% HDSP 72% Institution Score ISP 70% Average Score = 78% SOL 70% Minimum Moderate Adherence = 75% ASP 70% VSPW 67% SQ 63% KVSP 61% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% State of California • May 2011 Page 31 Medical Component: Emergency Services Profi le Page 1 of 3 Component Defi nition: The Emergency Services component examines how well the prison responded to medical emergencies. Specifi cally, 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. Key Statistics Component Average: ........ 78% Results in Brief: Most prisons performed relatively well in providing Top Two Average: ............. 90% emergency services, with 22 exceeding the 75 percent minimum Range of Scores: ......90%-48% score for moderate adherence to policies and procedures and nine Variation: ......................... 42% coming close. However, SAC performed very poorly with a score of 48 percent. Further, half of the fi rst responders in our emergency Number of Prisons with: response drill failed to carry and use proper equipment and to High Adherence ..................... 6 properly perform cardiopulmonary resuscitation. In addition, most Moderate Adherence ............ 16 prisons’ Emergency Medical Response Review Committees were Low Adherence .................... 11 slow in performing their duties. This component includes 19 total questions, eight of which focus on actual “man down” or “woman down” occurrences and 11 of which focus on an emergency response drill. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less Question The fi ndings of the prisons’ Emergency Medical Response Review Committee were 08.222 not always adequately documented and completed within 30 days of the emergency situation. The average score for this question was only 21 percent, with 16 prisons receiving zero percent. Question This question pertains to our emergency medical response drill. Thirteen responding 15.257 offi cers failed to properly perform cardiopulmonary resuscitation. The average score for this question was only 52 percent. Question During the emergency medical response drill at 14 prisons, the responding offi cers 15.255 failed to carry and use the proper equipment, such as a protective shield, a micro- mask, and protective gloves. The average score for this question was only 56 percent. Bureau of Audits, Offi ce of the Inspector General Page 32 Medical Component: Emergency Services Profi le Page 2 of 3 Chart 8: Emergency Services Scores by Prison, Sorted Highest to Lowest Score CIM 90% CCC 90% RJD 90% COR 88% VSPW 88% Institution Score CMC 86% Average Score = 78% CAL Minimum Moderate Adherence = 75% 85% FSP 84% LAC 84% SVSP 83% PVSP 83% SOL 82% PBSP 81% CTF 81% NKSP 81% CIW 80% CCWF 80% SQ 78% ASP 78% CCI 78% CEN 77% SCC 76% WSP 73% CVSP 73% ISP 73% CRC 73% KVSP 72% HDSP 72% CMF 72% DVI 71% SATF 70% MCSP 64% SAC 48% 30% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 33 Medical Component: Emergency Services Profi le Page 3 of 3 Areas Achieving High Adherence with Scores of 86 Percent or More Question In the emergency medical response drill, all responding offi cers activated the 15.240 emergency response system. Every participating prison scored 100 percent on this question. Question For actual medical emergencies reviewed, the medical emergency responder was notifi ed 08.183 without delay at each prison. The average score for this question was 99 percent. Question For actual medical emergencies reviewed, the fi rst responder and the medical 08.186 emergency responder at nearly all prisons were certifi ed in basic life support. The average score for this question was 95 percent. Question In the emergency medical response drill, most prisons’ medical staff arrived on the 15.282 scene in fi ve minutes or less. The average score for this question was 94 percent. Question For actual medical emergencies reviewed, the medical emergency responder at nearly 08.184 all prisons arrived at the location of the medical emergency within fi ve minutes of initial notifi cation. The average score for this question was 92 percent. Question In the emergency medical response drill, the responding offi cer at nearly all prisons 15.284 provided accurate information to responding medical staff. The average score for this question was 90 percent. Question In the emergency medical response drill, the emergency medical responders at nearly 15.283 all prisons arrived with the proper equipment. The average score for this question was 87 percent. Question In the emergency medical response drill, emergency medical responders at nearly all 15.285 prisons continued basic life support activities. The average score for this question was 87 percent. Question For actual medical emergencies reviewed, nearly all prisons provided adequate 8.187 preparation for the ambulance’s arrival, access to the inmate, and departure. The average score for this question was 87 percent. Question For actual medical emergencies reviewed, the medical emergency responder at nearly 8.185 all prisons used proper equipment and provided adequate medical care within the scope of his or her license. The average score for this question was 86 percent. See Appendix C-6 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 34 State of California • May 2011 Page 35 Medical Component: Prenatal Care/Child Birth/Post-Delivery Profi le Page 1 of 2 Component Defi nition: The Prenatal Care/Childbirth/Post-Delivery component focuses on the prenatal and post-delivery medical care provided to pregnant inmates. This component is not applicable at men’s prisons. Results in Brief: CIW and VSPW were the only prisons with female Key Statistics inmates who met our screening criteria for this component. CIW’s Component Average: ........ 71% Top Two Average: ............. 71% score of 61 percent was far below that of VSPW, which scored 81 Range of Scores: ..... 81%-61% percent and exceeded the 75 percent minimum score for moderate Variation: .........................20% adherence to policies and procedures. However, at both prisons there were inconsistencies in reported problems and risks when compared Number of Prisons with: to prenatal tests and physical examinations, and neither prison High Adherence ..................... 0 administered timely pregnancy tests to newly arrived inmates. Moderate Adherence .............. 1 Low Adherence ...................... 1 This component includes nine questions. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less Question The “Problems/Risks Identifi ed” section of the Briggs Form 5703N (Prenatal Flow 09.072 Record) did not corroborate the “Prenatal Screens” and the “Maternal Physical” examination sections of the form. Both prisons scored zero percent on this question. Question For newly arrived inmates, neither prison routinely administered a pregnancy test 09.066 within three business days to positively identify the inmate’s pregnancy. The average score for this question was 25 percent, and CIW scored zero percent. Areas Achieving High Adherence with Scores of 86 Percent or More Question An obstetrician or an obstetric nurse practitioner examined newly arrived inmates within 09.067 seven business days of their arrival. Both prisons scored 100 percent on this question. Question In nearly all cases, medical staff promptly ordered extra daily nutritional supplements 09.069 and food for pregnant inmates. The prisons averaged 93 percent on this question. Question An obstetrician generally met with pregnant inmates according to applicable time 09.071 frames. The prisons averaged 93 percent on this question. Question In nearly all cases, inmates received their six-week, post-delivery check-up on time. 09.074 The prisons averaged 90 percent on this question. Question Medical staff documented on Form 5703N the results of the inmate’s specifi ed 09.223 prenatal screening tests. The prisons averaged 86 percent on this question. Question In most cases, the inmate’s weight and blood pressure were documented at each clinic 09.224 visit. The prisons averaged 86 percent on this question. See Appendix C-7 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 36 Medical Component: Prenatal Care/Child Birth/Post-Delivery Profi le Page 2 of 2 Chart 9: Prenatal Care/Childbirth/Post Delivery Scores by Prison, Sorted Highest to Lowest Score VSPW 81% CIW 61% PBSP SVSP SCC CEN CIM CTF FSP CCC CRC WSP MCSP COR KVSP NKSP No Prenatal/Childbirth/Post-Delivery cases at these LAC institutions PVSP HDSP DVI CMF SOL SATF CCI Institution Score SQ Minimum Moderate Adherence = 75% Average Score = 71% CCWF CVSP ISP RJD CMC SAC CAL ASP 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 37 Medical Component: Diagnostic Services Profi le Page 1 of 2 Component Defi nition:The Diagnostic Services component addresses the timeliness of radiology (x-ray) and laboratory services and whether the prison followed up on clinically signifi cant results. Results in Brief: Only eight prisons scored above the 75 Key Statistics percent minimum score for moderate adherence to policies and Component Average: ....... 69% procedures. HDSP performed the worst with a score of 43 percent. Top Two Average: ............ 88% Range of Scores: ......89%-43% Of particular concern is that the primary care providers at most Variation: ........................ 46% prisons failed to give inmates timely notice of radiological results. Further, nearly all prisons’ primary care providers failed to give Number of Prisons with: inmates timely notice of laboratory results. High Adherence ..................... 4 Moderate Adherence .............. 4 This component includes seven questions. Low Adherence .................... 25 Areas Requiring Signifi cant Improvement Due to Scores of 60 PPercent or LLess Question Most prisons scored poorly on this question, which asks if the primary care provider 06.200 reviewed the inmate’s diagnostic report for radiological services and completed the inmate notifi cation form within two business days of the prison’s receiving the diagnostic report. The average score for this question was only 39 percent. Twenty of the 33 prisons had scores of 20 percent or less, and ten of those 20 received zero percent. Question Thirty of the 33 prisons scored poorly on primary care providers reviewing the 06.202 inmate’s diagnostic report for laboratory services and completing the inmate notifi cation form within two business days of the prison’s receiving the report. The average score for this question was only 42 percent. Twenty-one of the 33 prisons had scores of 50 percent or less. Four prisons received zero percent. Areas Achieving High Adherence with Scores of 86 Percent or More Question For radiology orders, most prisons received the diagnostic report within 14 days of 06.245 the radiological service provided. The average score for this question was 89 percent. However, fi ve prisons, with scores ranging from 20 percent to 60 percent, did not achieve the 75 percent minimum score for moderate adherence. See Appendix C-8 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 38 Medical Component: Diagnostic Services Profi le Page 2 of 2 Chart 10: Diagnostic Services Scores by Prison, Sorted Highest to Lowest Score WSP 89% ASP 87% KVSP 86% SCC 86% CCWF 84% VSPW 81% FSP 80% SVSP 77% DVI 74% CEN 74% CTF 72% CMF 72% CCC 71% CIW 71% CMC 70% SQ 69% CIM 68% MCSP 68% COR 68% NKSP 68% SAC 68% PVSP 65% RJD 64% SOL 60% CCI 60% CRC 59% CAL 58% ISP 58% Institution Score PBSP 57% Average Score = 69% Minimum Moderate Adherence = 75% CVSP 56% SATF 56% LAC 54% HDSP 43% 30% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 39 Medical Component: Access to Health Care Information Profi le Page 1 of 2 Component Defi nition: The Access to Health Care Information component addresses the prison’s effectiveness in fi ling, storing, and retrieving medical records and medical-related information. Key Statistics Results in Brief: Only eleven prisons scored above the 75 percent Component Average: ........ 64% minimum score for moderate adherence to policies and procedures. Top Two Average: ............. 94% ASP’s score of 20 percent was the lowest, 17 percentage points Range of Scores: ....100%-20% below any other prison. Only two prisons kept inmates’ medical Variation: ........................ 80% records up to date by promptly fi ling loose documents, and most did not promptly fi le blood pressure logs in inmates’ unit health records. Number of Prisons with: Further, many prisons failed to explain why certain requested medical High Adherence ..................... 2 records were not available for our inspection. Moderate Adherence .............. 9 Low Adherence .................... 22 This component includes six questions. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less Question Prisons’ medical records offi ces routinely failed to fi le all loose documents into inmates’ 19.150 unit health records within the specifi ed time frame following medical services to the inmate. (CDCR policy requires the fi ling of all loose documents no later than the close of business each day. However, given the diffi culty of complying with this requirement, we used a four-day criterion for this question.) Thirty-one of the 33 prisons failed the question and received zero percent. The average score for this question was only six percent. Question Twenty-two of the 33 prisons did not promptly fi le blood pressure logs in inmates’ 19.272 unit health records. The average score for this question was only 48 percent. Question Many prisons were unable to account for all requested medical fi les. In requesting 19.243 such fi les, we stress to medical records personnel that if they cannot provide a requested fi le, they must explain why. However, 15 of the 33 prisons’ medical records staff failed to explain why fi les were missing. For this question, the 33 prisons had an average score of only 55 percent. Areas Achieving High Adherence with Scores of 86 Percent or More Question Medical records staff performed very well in making unit health records available 19.169 to clinic staff for inmates ducated for medical appointments the next day. With the exception of ASP and SOL, all prisons received 100 percent on this question. The average score was 95 percent. Question Notwithstanding the slowness with which they did so, nearly all prisons properly fi led 19.266 inmates’ medical information. The average score for this question was 88 percent. Question At all but four prisons, the OIG’s registered nurse and physician inspectors were 19.271 able to locate all relevant documentation of health care provided to inmates. The average score for this question was 87 percent. See Appendix C-9 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 40 Medical Component: Access to Health Care Information Profi le Page 2 of 2 Chart 11: Access to Healthcare Information Scores by Prison, Sorted Highest to Lowest Score PBSP 100% SVSP 88% SCC 82% CEN 82% CIM 78% CTF 78% FSP 78% CCC 78% CRC 78% WSP 76% VSPW 76% MCSP 73% COR 73% KVSP 73% NKSP 73% LAC 73% PVSP 63% HDSP 59% CIW 59% DVI 59% CMF 59% SOL 58% SATF 57% CCI 55% SQ 54% CCWF 54% CVSP 49% ISP 49% RJD 44% Institution Score Average Score = 64% CMC 39% Minimum Moderate Adherence = 75% SAC 39% CAL 37% ASP 20% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 41 Medical Component: Outpatient Housing Unit Profi le Page 1 of 2 Component Defi nition: The Outpatient Housing Unit component determines whether the prison followed CDCR policies and procedures when placing inmates in the outpatient housing unit, a facility that provides outpatient health services to inmates and assists them with the activities of daily living. This component also evaluates whether the outpatient housing unit placement provided the inmate with adequate care and whether the Key Statistics physician’s plan addressed the placement diagnosis. Component Average: ........ 81% Top Two Average: ............ 96% Results in Brief: Only 17 prisons had outpatient housing units. Range of Scores: ......99%-62% Thirteen of them scored at or above the 75 percent minimum score for Variation: ........................ 37% moderate adherence to policies and procedures. However, timeliness Number of Prisons with: of services was frequently a problem. For example, utilization High Adherence ..................... 7 management nurses did not assess inmates in a timely manner, and Moderate Adherence .............. 6 medical staff members did not make their rounds with the required Low Adherence ...................... 4 frequency when call buttons were not operational. This component includes ten questions. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less Question Utilization management nurses at nearly all of the 17 prisons did not assess inmates 04.054 within one week of the inmate’s placement in the outpatient housing unit and every 30 days thereafter. The average score for this question was only 21 percent. Ten of the 17 prisons received zero percent. Question In the absence of operational call buttons for inmate-patients, medical staff members at 15.103 many prisons were not making their rounds every 30 minutes. The average score was only 59 percent. Seven of the 17 prisons had scores of zero percent. Areas Achieving High Adherence with Scores of 86 Percent or More Question The level of care available in the outpatient housing unit was appropriate to the patient’s 04.208 clinical presentation. The average score for this question was 98 percent. Fifteen of the 17 prisons scored 100 percent on this question. Question The primary care provider’s initial assessment (or diagnosis) was appropriate for the 04.230 fi ndings in the initial evaluation. The average score for this question was 96 percent. Question The registered nurse completed an initial assessment of the inmate on the day of 04.052 placement. The average score for this question was 94 percent. Question With the exception of CRC and COR, all prisons’ outpatient housing units used 15.225 disinfectant daily in common patient areas. The average score was 88 percent. Question At all prisons but CIW, the primary care provider evaluated the inmate within one 04.051 calendar day of placement. The average score for this question was 88 percent. Question At each prison, the primary care provider’s treatment plan adequately addressed the initial 04.056 assessment. The average score for this question was 87 percent. See Appendix C-10 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 42 Medical Component: Outpatient Housing Unit Profi le Page 2 of 2 Chart 12: Outpatient Housing Unit Scores by Prison, Sorted Highest to Lowest Score CVSP 99% CIM 93% CAL 93% ISP 90% VSPW 89% CTF 87% CMF 86% SQ 83% DVI 83% CCC 82% SAC 76% CRC 75% SCC 75% CCI 73% ASP 71% CIW 63% COR 62% WSP PBSP SVSP MCSP SATF SOL FSP KVSP No Outpatient Housing Units at these institutions NKSP HDSP PVSP LAC Institution Score CMC Average Score = 81% Minimum Moderate Adherence = 75% CCWF CEN RJD 40% 50% 60% 70% 80% 90% 100 State of California • May 2011 Page 43 Medical Component: Internal Reviews Profi le Page 1 of 2 Component Defi nition: The Internal Reviews component focuses on the activities of the prison’s Quality Management Committee (QMC) and its Emergency Medical Response Review Committee (EMRRC). The component also evaluates the timeliness of inmates’ Key Statistics medical appeals and the prison’s use of inmate death reviews. Component Average: ....... 78% Top Two Average: ............ 99% Results in Brief: Twelve prisons performed very well. However, Range of Scores: ... 100%-60% 17 failed to score at or above the 75 percent minimum score for Variation: ........................ 40% moderate adherence to policies and procedures. We found that most prisons were not conducting timely medical emergency Number of Prisons with: response drills as required and that most prisons were not promptly High Adherence ................... 12 processing inmates’ medical appeals. Moderate Adherence .............. 4 Low Adherence .................... 17 This component includes eight questions. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less Question Most prisons’ medical facilities did not complete a medical emergency response drill 17.221 for each watch during the most recent quarter. The average score for this question was only 27 percent. Twenty-four of the 33 prisons had scores of zero percent. Question Most of the prisons did not promptly process inmates’ medical appeals during the 17.174 most recent 12 months. The average score for this question was only 48 percent. Seventeen of the 33 prisons scored zero percent. Areas Achieving High Adherence with Scores of 86 Percent or More Question The Quality Management Committee reported its fi ndings to the health care manager 17.119 or to the chief medical offi cer following each of the last six meetings. The average score for this question was 98 percent, and 31 prisons had scores of 100 percent. Question Thirty-two of the 33 prisons received 100 percent on this question, which asks whether 17.135 the last three Quality Management Committee meeting minutes refl ect fi ndings and strategies for improvement. The average score for this question was 97 percent. However, HDSP received zero percent. Question Most prisons’ Quality Management Committee meeting minutes documented monthly 17.118 meetings for the last six months. The average score was 94 percent. Question Most prisons’ Emergency Medical Response Review Committee meeting minutes 17.132 documented monthly meetings for the last six months. The average score for this question was 89 percent. See Appendix C-11 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 44 Medical Component: Internal Reviews Profi le Page 2 of 2 Chart 13: Internal Reviews Scores by Prison, Sorted Highest to Lowest Score RJD 100% FSP 98% CCWF 98% CIM 96% CIW 95% CTF 93% DVI 93% CRC 91% WSP 88% ISP 88% VSPW 86% CCC 86% NKSP 85% MCSP 83% CAL 75% SOL 75% SVSP 73% SATF 73% LAC 73% PVSP 71% CMC 70% SAC 70% PBSP 69% KVSP 69% SQ 69% Institution Score CMF 69% Minimum Moderate Adherence = 75% CVSP 68% Average Score = 78% COR 66% ASP 66% HDSP 63% CEN 61% CCI 60% SCC 60% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% State of California • May 2011 Page 45 Medical Component: Inmate Transfers Profi le Page 1 of 2 Component Defi nition: The Inmate Transfers component focuses on inmates pending transfer to determine whether the sending prison documented medication and medical conditions to assist the receiving prison in providing continuity of care. Key Statistics Results in Brief: Most prisons performed well in transferring Component Average: ....... 88% inmates to other prisons. Twenty-eight prisons met or exceeded the Top Two Average: .......... 100% Range of Scores: ... 100%-43% 75 percent minimum score for moderate adherence to policies and Variation: ........................ 57% procedures. Twenty-two of these 28 prisons scored above the 86 percent minimum score for high adherence. However, CMF and CCI Number of Prisons with: performed very poorly. High Adherence ................... 22 Moderate Adherence .............. 6 This component includes fi ve questions. Low Adherence ...................... 5 Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less None. Areas Achieving High Adherence with Scores of 86 Percent or More Question All 33 prisons received 100 percent on this question, which asks whether the 05.108 Receiving and Release offi ce had the inmate’s unit health record and transfer envelope. Question Thirty prisons’ Health Records Departments maintained a copy of the inmate’s Form 05.172 7371 (Health Care Transfer Information) and Form 7231A (Outpatient Medication Administration Record) when the inmate transferred. SAC, CCI, and CVSP failed to do so. The average score for this question was 91 percent. Question Twenty-three prisons received 100 percent on this question, which asks whether the 05.110 inmate’s transfer envelope included all appropriate forms, identifi ed all medications ordered by the physician, and contained the medications. The average score for this question was 90 percent. See Appendix C-12 for detailed information on questions and scores for this component Bureau of Audits, Offi ce of the Inspector General Page 46 Medical Component: Inmate Transfers Profi le Page 2 of 2 Chart 14: Inmate Transfers Scores by Prison, Sorted Highest to Lowest Score CAL 100% VSPW 100% SATF 100% Institution Score KVSP 100% Minimum Moderate Adherence = 75% SQ Average Score = 88% 100% HDSP 100% ASP 100% CRC 100% LAC 100% CCWF 100% CEN 100% NKSP 96% ISP 95% FSP 95% SCC 95% CMC 94% PBSP 93% CIM 93% CCC 93% RJD 90% WSP 89% COR 87% SVSP 85% CIW 80% SOL 79% DVI 79% PVSP 76% SAC 75% CVSP 73% MCSP 68% CTF 68% CMF 50% CCI 43% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 47 Medical Component: Clinic Operations Profi le Page 1 of 2 Component Defi nition: The Clinic Operations component addresses the general operational aspects of the prison’s 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 (slip of paper the inmate carries for scheduled medical appointments), and availability of health care request forms. Key Statistics Component Average: ....... 92% Top Two Average: .......... 100% Results in Brief: Prisons performed very well in clinic operations. The Range of Scores: ... 100%-82% 92 percent average score for this component is the third highest in the Variation: ........................ 18% 20 component areas. All 33 prisons scored above the 75 percent mini- mum score for moderate adherence to policies and procedures, with 29 Number of Prisons with: meeting or exceeding the 86 percent minimum score for high adherence. High Adherence ................... 29 Moderate Adherence .............. 4 This component includes ten questions. Low Adherence ...................... 0 Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less None. Areas Achieving High Adherence with Scores of 86 Percent or More Questions These questions pertain to medication distribution policy and administration, and to 14.029 medication storage. Medical staff in the prisons’ clinics was aware of those inmates on 14.131 modifi ed programs or confi ned to quarters and had an adequate process for ensuring that 14.166 those inmates received their medications. Medication nurses understood that medications were to be administered by the same licensed staff member who prepared it and on the same day. Medications stored in the clinic refrigerator were stored in a sealed container if food was present in the refrigerator. The average scores for these three questions ranged from 95 percent to 100 percent. Questions These questions pertain to the inmate ducating (medical appointment) process. Most 14.032 prisons’ medical personnel understood their prison’s priority ducating process, and they 14.033 scored an average of 97 percent on the question (Question 14.032). Further, the prisons had adequate processes to ensure that inmates moved to new cells still received their medical ducats; the average score for this question (Question 14.033) was 98 percent. Question The prisons were generally making the Form 7362 (Health Care Services Request Form) 14.023 available to inmates. The average score for this question was 94 percent. Twenty-seven prisons scored 100 percent on this question. Question The prisons generally made areas available to ensure inmates’ privacy during the 14.164 registered nurses’ face-to-face assessments and doctors’ examinations for non- emergencies. Only CMF, CRC, and SOL consistently failed to do so. The average score for this question was 91 percent. Question The prisons generally had processes to identify, review, and address urgent appointments if a 14.160 doctor’s line was canceled. The average score for this question was 86 percent. See Appendix C-13 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 48 Medical Component: Clinic Operations Profi le Page 2 of 2 Chart 15: Clinic Operations Scores by Prison, Sorted Highest to Lowest Score MCSP 100% CAL 100% VSPW 100% SQ 100% SATF 99% CIW 98% ISP 97% KVSP Institution Score 97% CCC Minimum Moderate Adherence = 75% 97% Average Score = 92% SVSP 96% CIM 95% RJD 95% FSP 94% ASP 94% PBSP 93% PVSP 93% CTF 91% CVSP 91% HDSP 91% CCI 91% SAC 91% WSP 90% COR 90% NKSP 90% LAC 90% SCC 88% DVI 88% CRC 86% CCWF 86% CMC 85% SOL 84% CMF 83% CEN 82% 60% 65% 70% 75% 80% 85% 90% 95% 100% State of California • May 2011 Page 49 Medical Component: Preventive Services Profi le Page 1 of 2 Component Defi nition: The Preventive Services component focuses on inmate cancer screening, tuberculosis evaluation, and infl uenza immunizations. Key Statistics Results in Brief: The 33 prisons had the lowest performance in this Component Average: ........ 44% Top Two Average: ............. 82% component, with the average score only 44 percent. Only three Range of Scores: ....... 82%-7% prisons scored above the 75 percent benchmark for moderate adher- Variation: ........................ 75% ence to policies and procedures. CCI had a score of seven percent. We found very low scores in tuberculosis treatment. Tuberculosis is Number of Prisons with: infectious and it jeopardizes the health of staff members and inmates High Adherence ..................... 0 alike. Three tuberculosis-related questions and one cancer screening Moderate Adherence .............. 3 question disclosed consistently poor performance by prisons. Low Adherence .................... 30 This component includes seven questions. However, two questions applly onlly to ffemalle priisons, andd one question applies only to male prisons. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less Questions Nearly all prisons failed to properly administer the Isoniazid (INH) medication 10.228 prescribed to inmates. Inmates prescribed INH are being treated for active or latent 10.232 tuberculosis infection. The average score for this question (Question 10.228) was only 29 percent. Eight prisons scored zero percent. The second question (Question 10.232) asks whether the prison monitored inmates monthly while they were on the medication. For this question, the average score was only 19 percent, and 20 prisons received zero percent. Question Most of the 30 adult male prisons failed to administer a fecal occult blood test (FOBT) 10.085 to their inmates aged 51 or older within the past 12 months. This is an uncomplicated test that can be the fi rst indicator of cancer. However, the prisons’ average score was only 41 percent. Fifteen of the prisons had scores of 30 percent or less. LAC, CCC, and PVSP scored zero percent.5 Question Most prisons did not evaluate inmates with latent tuberculosis infection for signs and 10.229 symptoms of tuberculosis within the previous 12 months. The average score for this question was only 50 percent. Although eleven prisons scored 100 percent, ten prisons received zero percent. Areas Achieving High Adherence with Scores of 86 Percent or More None. See Appendix C-14 for detailed information on questions and scores for this component.5 5 We did not test CCWF, CIW, or VSPW because CDCR policy at the time required the FOBT for male inmates only. Bureau of Audits, Offi ce of the Inspector General Page 50 Medical Component: Preventive Services Profi le Page 2 of 2 Chart 16: Preventive Services Scores by Prison, Sorted Highest to Lowest Score CRC 82% PBSP 81% VSPW 81% CIM 71% WSP 70% ASP 60% CCWF 59% SOL 58% FSP 57% NKSP 55% CMC 53% CTF 51% SQ 49% CAL 48% CVSP 48% CMF 44% SVSP 42% MCSP 40% CCC 37% SATF 36% ISP 34% CIW 33% SAC 32% Institution Score Average Score = 44% COR 30% Minimum Moderate Adherence = 75% SCC 28% KVSP 27% PVSP 27% HDSP 24% RJD 24% DVI 22% LAC 20% CEN 19% CCI 7% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 51 Medical Component: Pharmacy Services Profi le Page 1 of 2 Component Defi nition: The Pharmacy Services component 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. This component also addresses whether the pharmacy has an effective process for screening medication orders for potential adverse reactions/interactions. Key Statistics Component Average: ....... 87% Results in Brief: Thirty of the 33 prisons scored at or above the Top Two Average: .......... 100% 75 percent minimum score for moderate adherence to policies and Range of Scores: ... 100%-58% procedures, and 23 of those prisons scored at or exceeded the 86 Variation: ........................ 42% percent minimum score for high adherence. CEN, however, lagged far behind the other prisons. Despite some good overall scores Number of Prisons with: in pharmacy services, most prisons failed to properly maintain High Adherence ................... 23 Moderate Adherence .............. 7 medications in their after-hours medication supplies. Low Adherence ...................... 3 This component includes eight questions. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less Question Most prisons did not properly maintain medications in their after-hours medication 13.252 supplies. The average score for this question was only 39 percent. Seventeen of the 33 prisons scored zero percent. Areas Achieving High Adherence with Scores of 86 Percent or More Questions These are certifi cation questions. All prisons conspicuously posted a valid permit 13.139 in their pharmacies, and the license of the pharmacist in charge was current. All 33 13.142 prisons scored 100 percent on each of these questions. Question The prisons’ pharmacists in charge had an effective process for screening new 13.145 medication orders for potential adverse reactions. All 33 prisons had scores of 100 percent on this question. Question Nearly all of the pharmacists in charge monitored the quantity of medications on 13.148 hand, and their pharmacies conducted an annual inventory. The average score for this question was 94 percent. However, CEN and WSP had zero percent. See Appendix C-15 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 52 Medical Component: Pharmacy Services Profi le Page 2 of 2 Chart 17: Pharmacy Services Scores by Prison, Sorted Highest to Lowest Score SVSP 100% FSP 100% HDSP 100% LAC 100% CAL 97% CIM Institution Score 96% Average Score = 87% CIW 95% Minimum Moderate Adherence = 75% PBSP 93% MCSP 93% NKSP 93% RJD 93% ASP 92% CCWF 92% DVI 92% SCC 91% CMC 91% SATF 90% CTF 89% SOL 89% WSP 86% COR 86% VSPW 86% SQ 86% CVSP 83% ISP 83% KVSP 83% CRC 79% CCI 79% CMF 76% SAC 75% PVSP 72% CCC 69% CEN 58% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 53 Medical Component: Other Services Profi le Page 1 of 2 Component Defi nition: The Other Services component 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 CDCR’s Inmate Medical Services Policies and Procedures. Key Statistics Results in Brief: Twenty-two of the 33 prisons scored at or above Component Average: ....... 84% Top Two Average: .......... 100% the 75 percent minimum score for moderate adherence to policies Range of Scores: .....100%-50% and procedures and another fi ve prisons came close. Seventeen of Variation: ........................ 50% the 22 exceeded the 86 percent minimum score for high adherence. However, the performance of four prisons was far below that of the Number of Prisons with: others. High Adherence ................... 17 Moderate Adherence .............. 5 This component includes fi ve questions. Low Adherence .................... 11 Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less Question Two of the three prisons that had active cases of tuberculosis (TB) in the last six 15.134 months failed to follow all required procedures for responding upon discovering the case. CTF and WSP received zero percent, while SAC scored 100 percent. The average score for this question was only 33 percent. Areas Achieving High Adherence with Scores of 86 Percent or More Question Custody staff understood CDCR’s policies and procedures for identifying and 20.092 evaluating inmates displaying inappropriate hygiene management. The average score for this question was 98 percent. Question Fourteen of the 16 prisons that offered therapeutic diets properly provided them to 15.059 inmates. Thirteen of the 14 prisons scored 100 percent on this question. See Appendix C-16 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 54 Medical Component: Other Services Profi le Page 2 of 2 Chart 18: Other Services Scores by Prison, Sorted Highest to Lowest Score PBSP 100% CIM 100% CAL 100% CVSP 100% VSPW 100% SATF 100% CCC 100% LAC 100% CCWF 100% DVI 100% CEN 100% RJD 100% CMF 100% COR 93% CMC 91% SAC 91% SVSP 89% MCSP 85% ISP 85% SQ 85% CCI 85% SOL 75% HDSP 73% FSP 70% ASP 70% CRC 70% PVSP 70% WSP 69% CTF 67% Institution Score Minimum Moderate Adherence = 75% CIW 57% Average Score = 84% SCC 55% KVSP 50% NKSP 50% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 55 Medical Component: Inmate Hunger Strikes Profi le Page 1 of 2 Component Defi nition: The Inmate Hunger Strikes component examines medical staff members’ monitoring of inmates participating in hunger strikes lasting more than three days. Results in Brief: The prisons performed especially poorly in Key Statistics monitoring inmates on hunger strikes lasting more than three days. Component Average: ....... 57% Hunger strikes of this length, although few in number, require careful Top Two Average: .......... 100% monitoring, yet the prisons’ average score of 57 percent was the Range of Scores: ... 100%-11% second lowest of all 20 component areas we inspected. Fourteen Variation: ........................ 89% of the 21 prisons that met our inspection criteria failed to score at or above the 75 percent minimum score for moderate adherence to Number of Prisons with: policies and procedures. SAC’s and RJD’s scores of 11 percent were High Adherence ..................... 5 Moderate Adherence .............. 2 the worst, 15 percentage points lower than that of any other prison. Low Adherence .................... 14 This component includes three questions. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less Question After the fi rst 72 hours, physicians did not always perform a physical examination 11.100 and order a metabolic panel and a urinalysis of the inmate. The average score for this question was only 48 percent. Six prisons scored zero percent. Question After the fi rst 48 hours, the nurses or the primary care providers did not always 11.099 complete daily assessments documenting the inmates’ weight, physical condition, emotional condition, vital signs and hydration status. The average score for this question was only 50 percent. Six prisons received zero percent. Areas Achieving High Adherence with Scores of 86 Percent or More None. See Appendix C-17 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 56 Medical Component: Inmate Hunger Strikes Profi le Page 2 of 2 Chart 19: Inmate Hunger Strikes Scores by Prison, Sorted Highest to Lowest Score PBSP 100% CIM 100% CAL 100% CCWF 100% SOL 88% MCSP 82% SATF 79% CMC 71% CCC 68% SQ 54% KVSP 46% CCI 46% HDSP 44% LAC 42% PVSP 37% CEN 32% CMF 32% COR 30% SVSP 26% Institution Score Average Score = 57% RJD 11% Minimum Moderate Adherence = 75% SAC 11% WSP CTF CVSP ISP VSPW FSP No inmate hunger strikes lasting longer than three days occurred at these institutions NKSP ASP CIW CRC SCC DVI 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 57 Medical Component: Chemical Agent Contraindications Profi le Page 1 of 2 Component Defi nition: The Chemical Agent Contraindications component addresses the prison’s process for handling inmates who may be predisposed to an adverse outcome from calculated uses of force (cell extractions) involving Oleoresin Capsicum (OC), commonly referred to as “pepper spray.” For example, an adverse Key Statistics Component Average: ....... 93% outcome from OC exposure might occur if the inmate has asthma. Top Two Average: .......... 100% Range of Scores: ... 100%-60% Results in Brief: Prisons generally performed well in this component. Variation: ........................ 40% The 93 percent average score is the second highest achieved in the 20 component areas. Twenty-seven prisons exceeded the 86 percent Number of Prisons with: minimum score for high adherence. However, four prisons scored High Adherence ................... 27 far below the other prisons, largely because they routinely failed to Moderate Adherence .............. 1 document important procedures. Low Adherence ...................... 4 This component includes two questions. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less None. Areas Achieving High Adherence with Scores of 86 Percent or More Question Prisons nearly always recorded how they decontaminated inmates and followed 12.064 decontamination policy. The average score for this question was 96 percent. Question The prisons routinely consulted with a registered nurse or a primary care provider 12.062 before a calculated, non-emergency use of OC spray. The average score for this question was 91 percent. See Appendix C-18 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 58 Medical Component: Chemical Agent Contraindications Profi le Page 2 of 2 Chart 20: Chemical Agent Contraindication Scores by Prison, Sorted Highest to Lowest Score CIM 100% SVSP 100% Institution Score MCSP Average Score = 93% 100% CTF Minimum Moderate Adherence = 75% 100% CAL 100% COR 100% ISP 100% VSPW 100% SATF 100% SOL 100% FSP 100% NKSP 100% CCC 100% HDSP 100% ASP 100% CIW 100% CRC 100% SCC 100% CMC 100% SAC 100% WSP 94% RJD 94% LAC 91% SQ 89% DVI 89% CEN 89% CMF 87% PBSP 79% CCI 66% PVSP 66% CCWF 65% KVSP 60% No Chemical Agent Contraindication information available at this institution CVSP 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% State of California • May 2011 Page 59 Medical Component: Staffi ng Levels and Training Profi le Page 1 of 4 Component Defi nition: The Staffi ng Levels and Training component Key Statistics examines the prison’s medical staffi ng levels and training provided. Component Average: ....... 96% Top Two Average: .......... 100% Results in Brief: The 96 percent average score for this component Range of Scores: ... 100%-80% was the highest of all 20 component areas. All 33 prisons’ scores Variation: ........................ 20% exceeded the 75 percent minimum score for moderate adherence to policies and procedures, and the scores of 28 prisons exceeded the Number of Prisons with: 86 percent minimum score for high adherence. Registered nurses and High Adherence ................... 28 Moderate Adherence .............. 5 physicians were either on-site or available 24 hours per day, seven Low Adherence ...................... 0 days a week. This component includes fi ve questions. However, one is for information only and is not scored. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less None. Areas Achieving High Adherence with Scores of 86 Percent or More Question All prisons had a registered nurse available on site 24 hours per day, seven days a 18.004 week, for emergency care. All 33 prisons scored 100 percent on this question. Question Every prison had a physician on site, a physician on call, or a medical offi cer of the 18.005 day available 24 hours a day, seven days a week, for the last 30 days. All 33 prisons received 100 percent for this question. Question Each prison’s orientation program for all newly hired nursing staff included a module 18.006 for sick call protocols that require face-to-face triage. All 33 prisons scored 100 percent on this question. See Appendix C-19 for detailed information on questions and scores for this component. Note: In evaluating staffi ng levels and training, we collect information on staffi ng levels and vacancy rates at each prison. We collect this data for informational purposes only. We have summarized this information for all 33 prisons on the following pages. Bureau of Audits, Offi ce of the Inspector General Page 60 Medical Component: Staffi ng Levels and Training Profi le Page 2 of 4 Chart 21: Staffi ng Levels and Training Scores by Prison, Sorted Highest to Lowest Score PBSP 100% CIM 100% SVSP 100% MCSP 100% CTF 100% Institution Score CAL Average Score = 96% 100% Minimum Moderate Adherence = 75% COR 100% CVSP 100% ISP 100% VSPW 100% SATF 100% SOL 100% FSP 100% CCC 100% HDSP 100% ASP 100% SCC 100% CMC 100% CEN 100% RJD 100% KVSP 95% NKSP 95% SQ 95% DVI 95% CMF 95% SAC 95% CCI 90% LAC 90% CIW 85% CRC 85% CCWF 85% WSP 80% PVSP 80% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 61 Medical Component: Staffi ng Levels and Training Profi le Page 3 of 4 Data Not Included in Scoring: Results of Staffi ng and Vacancy Rate Analysis The 33 prisons’ vacancy rates for authorized positions ranged from a low of zero percent at SAC to a high of 29 percent at PVSP. The average vacancy rate was eight percent, and 16 prisons had double-digit vacancy rates. We could not directly correlate vacancy rates with medical inspection scores. Some prisons relied extensively on private registries to address their vacancy problems. PVSP, with its 29 percent vacancy rate, had the most registry staff members: 67. Vacancies may partially be the result of prison location. Prison medical staff members frequently commented on the diffi culty of fi lling vacancies in rural, isolated prisons. Background During our prison medical inspections, the prisons provide us with data regarding their staffi ng levels and authorized position vacancy rates in the following four medical classifi cations: management, primary care providers, nursing supervisors, and nursing staff. We gather this information for the benefi t of all interested parties; we do not, however, score prisons on their staffi ng levels and vacancy rates because we do not have objective criteria by which to evaluate compliance. Table 2 combines the data from the four medical classifi cations and summarizes each of the 33 prisons’ reported staffi ng levels and vacancy rates. The table shows that the vacancy rates ranged from a low of zero percent at SAC to a high of 29 percent at PVSP. Twelve prisons had vacancy rates of fi ve percent or less, and the other 21 had vacancy rates of six percent or more. Of this latter group, 16 had double-digit vacancy rates. (While not shown on Table 2, the average vacancy rate for authorized positions at the 33 prisons was eight percent.) PVSP and CVSP, the prisons with the two highest vacancy rates, had overall inspection scores of 65 percent and 69 percent respectively, placing them in the bottom third of all prisons. While these facts imply a correlation between vacancy rates and inspection scores, we cannot make such a correlation. This is because SAC had a zero percent vacancy rate, but its inspection score of 65 percent tied that of PVSP. On the other hand, SCC and WSP, with their 11 percent vacancy rates, were among only nine prisons to achieve overall scores that met the 75 percent benchmark for moderate adherence to medical policies and procedures. When staff vacancies occur, prisons may have to pay overtime, work salaried staff members for longer hours, or hire temporary staff from private registries. As shown in Table 2, some prisons relied extensively on private registries. Six prisons had 47 or more registry staff members. PVSP, with its 29 percent vacancy rate, had the most registry staff. Bureau of Audits, Offi ce of the Inspector General Page 62 Medical Component: Staffi ng Levels and Training Profi le Page 4 of 4 Table 2: Staffi ng Levels and Vacancy Rates* Number of staff Total number of Total number of Total number of Vacancy Total number of Institution hired within last fi lled positions: vacancies: positions: percentage: registry staff: six months: PVSP 67.0 26.7 93.7 29% 14.0 67.0 CVSP 54.0 12.5 66.5 19% 10.0 9.0 CCI 87.0 17.7 104.7 17% 12.0 48.0 NKSP 93.0 15.5 108.5 14% 6.0 0.0 CTF 96.0 14.8 110.8 13% 19.0 50.0 HDSP 80.3 10.7 91.0 12% 10.0 4.0 CEN 68.0 9.0 77.0 12% 5.0 9.0 CMC 183.0 23.8 206.8 12% 30.0 30.0 VSPW 83.0 10.8 93.8 12% 5.0 0.0 WSP 101.5 13.1 114.6 11% 18.0 45.0 SCC 52.6 6.8 59.4 11% 1.0 18.0 CCC 58.8 7.5 66.3 11% 8.0 3.0 SQ 115.0 13.8 128.8 11% 12.0 38.0 KVSP 77.0 8.7 85.7 10% 4.0 27.0 CRC 68.6 8.0 76.6 10% 0.0 26.0 SATF 101.8 10.8 112.6 10% 10.0 3.0 ISP 69.0 7.2 76.2 9% 12.0 16.0 COR 182.4 17.7 200.2 9% 17.0 51.0 RJD 128.6 11.1 139.7 8% 39.0 2.0 SOL 83.8 6.1 89.9 7% 9.0 14.0 ASP 109.0 7.0 116.0 6% 13.0 31.0 SVSP 88.4 5.0 93.3 5% 9.0 37.0 LAC 106.9 5.6 112.4 5% 12.0 20.0 CAL 72.9 3.5 76.4 5% 10.2 10.0 MCSP 82.0 3.6 85.6 4% 4.0 4.0 PBSP 93.6 4.0 97.6 4% 4.0 1.4 DVI 109.5 5.0 114.5 4% 5.0 12.0 CIW 79.5 3.6 83.1 4% 5.5 32.0 CIM 208.9 6.0 214.9 3% 24.0 44.0 CCWF 107.1 2.5 109.6 2% 9.0 47.0 CMF 229.0 5.0 234.0 2% 27.0 25.0 FSP 59.8 1.0 60.8 2% 5.0 0.6 SAC 84.5 0.0 84.5 0% 11.0 49.0 * This table summarizes numbers previously published in the medical inspection reports for individual prisons. The numbers have been rounded and may differ slightly from prior reported numbers. Further, totals and percentages may not calculate due to rounding. The data previously published in the inspection reports were provided by the prisons and have not been audited. Vacancies may be partially the result of prison location. PVSP, for example, is located in a rural, remote setting. CVSP and CCI, with vacancy rates that were second and third highest behind PVSP, are similarly situated. By way of contrast, SAC, with its zero percent vacancy rate, is located near a larger urban area. FSP, which tied CMF for the second lowest vacancy rate, is next door to SAC. CMF is adjacent to both the Bay Area and the Sacramento urban area. State of California • May 2011 Page 63 Medical Component: Nursing Policy Profi le Page 1 of 2 Component Defi nition: The Nursing Policy component 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 members review their duty statements and whether supervisors periodically review the work of nurses to Key Statistics ensure they properly follow established nursing protocols. Component Average: ....... 77% Top Two Average: .......... 100% Results in Brief: There was wide variation in the prisons’ scores, Range of Scores: ... 100%-36% with 14 prisons exceeding the 85 percent minimum score for high Variation: ........................ 64% adherence to policies and procedures. Seven prisons scored 100 percent. On the other hand, 16 prisons failed to meet the 75 percent Number of Prisons with: High Adherence ................... 14 minimum score for moderate adherence. DVI and CMF performed Moderate Adherence .............. 3 the worst, scoring only 36 percent. Low Adherence .................... 16 This component includes three questions. Areas Requiring Signifi cant Improvement Due to Scores of 60 Percent or Less Question Many of the prisons’ supervising registered nurses did not conduct periodic reviews 16.254 of nursing staff performance. The average score for this question was only 58 percent. Ten prisons scored zero percent. Areas Achieving High Adherence with Scores of 86 Percent or More Question With the exception of certain ISP policies and procedures, all prisons had written 16.154 nursing policies and procedures that adhere to CDCR’s guidelines. The average score for this question was 99 percent. See Appendix C-20 for detailed information on questions and scores for this component. Bureau of Audits, Offi ce of the Inspector General Page 64 Medical Component: Nursing Policy Profi le Page 2 of 2 Chart 22: Nursing Policy Scores by Prison, Sorted Highest to Lowest Score WSP 100% SVSP 100% CTF 100% CAL 100% VSPW 100% PVSP 100% CCWF 100% CCC 94% SCC 94% CIM 93% MCSP 89% HDSP 89% RJD 89% COR 86% CMC 79% SAC 79% CRC 76% FSP 74% CVSP 71% SATF 71% SOL 71% NKSP 71% CEN 71% SQ 70% ASP 67% CIW 64% KVSP 57% LAC 57% PBSP 50% Institution Score ISP 50% Minimum Moderate Adherence = 75% CCI 50% Average Score = 77% DVI 36% CMF 36% 30% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 65 General Medical Categories As we did in our 17-prison summary report, we sorted the data from 100 key questions into fi ve general medical categories recommended by our lead physician. In this 33-prison summary report, we found the same signifi cant problems in the categories of medication management and access to providers and services. The average score in medication management was only 59 percent, an increase of one percentage point over the 17-prison score. The medication management score was low because prisons were ineffective in delivering medications to inmates in a timely manner or were failing to document inmates’ receipt of medications as required by policy. This problem occurred in the distribution or administration of medications to newly arrived inmates, to inmates returning from outside hospitalization, to resident inmates requiring routine care, and to resident inmates in need of chronic care medications and tuberculosis medications. Only three prisons had scores that exceeded the 75 percent minimum score for moderate adherence to medical policies and procedures. The average score for access to providers and services was only 66 percent, an increase of six percentage points over the 17-prison score. This low score indicates that the prisons were generally ineffective 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. Access to providers and services scores ranged from 87 percent down to 45 percent. In the remaining three categories, nurse responsibilities and continuity of care exceeded the 75 percent minimum score for moderate adherence to policies and procedures. Nurse responsibilities had the same 80 percent score achieved in the 17-prison summary report. Continuity of care’s score of 76 percent was two percentage points higher than the score from the 17-prison review. However, in primary care provider responsibilities the score fell from 74 percent to 72 percent. Background While our inspections and their resultant reports show prisons’ scores in 20 components of medical care delivery, the inspection instrument’s questions can be sorted and viewed from various perspectives. One perspective recommended by our lead physician was to sort our in- spection questions into the following fi ve general categories of medical care: medication man- agement, access to providers and services, continuity of care, primary care provider responsi- bilities, and nurse responsibilities. Of the inspection instrument’s 165 questions, we identifi ed 100 that fi t into the fi ve categories. Table 3 describes each category, discloses the number of questions in that category, and pro- vides an example question from the category. The fi ve categories include 100 questions. In identifying the questions for the fi ve categories, we determined that some questions were ap- propriate to more than one category. Therefore, we included such questions in all of the catego- ries to which they applied. An example is the following question: If the inmate had an existing medication order upon arrival at the institution, did the inmate receive the medications by the next calendar day, or did a physician explain why the medications were not to be continued?(Question 02.128) Bureau of Audits, Offi ce of the Inspector General Page 66 The above question applies to the medication management category because it involves the prisons’ 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 prisons. Accordingly, while each of the fi ve categories has a specifi c set of questions, individual questions like the one above sometimes appear in multiple categories. See Appendix D for the questions we assigned to each category. Table 3: Description of Five General Medical Categories Medical Category Description Example Question Sick Call medication: Did the Consists of 14 questions that determine if institution administer or deliver Medication medications were properly administered and prescription medications (new orders) Management delivered to inmates as required by CDCR’s to the inmate within specifi ed time policies. frames? (Question 01.124) RN FTF Documentation: Did the RN Consists of 35 questions that evaluate whether in- Access to complete the face-to-face triage within mates were seen or provided services for routine, Providers and one business day after the Form 7362 urgent, and emergency medical needs within the Services (Health Care Services Request Form) time frames specifi ed by CDCR’s policies. was reviewed? (Question 01.025) Consists of 29 questions that determine whether Primary Care All Diagnostic Services: Did the primary care providers (physicians, nurse practitio- Provider PCP adequately manage clinically ners, and physician assistants) properly provided Responsibilities signifi cant test results? (Question care to inmates and whether processes related to and Processes 06.263) providing clinical care are consistent with policy. Upon the inmate’s discharge from Consists of 19 questions that determine whether the community hospital, did the triage inmates received care when moved within a prison and treatment area registered nurse Continuity of Care or from one prison to another, or were received document that he or she reviewed from an outside care provider after specialty the inmate’s discharge plan and services or hospitalization. completed a face-to-face assessment of the inmate? (Question 21.248) Did documentation indicate that Consists of 23 questions that evaluate whether the RN reviewed all of the inmate’s Nurse nurses properly provided care to inmates and complaints listed on Form 7362 Responsibilities whether processes related to providing nursing (Health Care Services Request care are consistent with policy. Form)? (Question 01.246) We excluded other questions from categories because we determined that including them could inappropriately impact scores. For example, Question 14.106 asks: “Does clinical staff wash their hands (either with soap or hand sanitizer) or change gloves between patients?” This question pertains to the hygienic practices of all staff and does not differentiate primary care providers from nurses. Therefore, we cannot fairly score primary care providers’ State of California • May 2011 Page 67 performance on this question when the hygienic practices of nurses cannot be separated, and vice versa. Accordingly, we excluded this question and others with similar predicaments from categories for which the questions skew the categories’ scores. As shown by the checked boxes in Table 4 below, we extract questions from 14 of the 20 component areas to allow the reader to evaluate performance from this additional perspective. Access to health care information, internal reviews, other services, chemical agent contraindications, staffi ng levels and training, and nursing policy are the only components without at least one question that fi ts into the fi ve general categories. Table 4: Distribution of Medical Component Questions within the Medical Categories Access to Primary Care Medication Continuity Nurse Medical Component Providers Provider Management of Care Responsibilities and 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 √ √ √ Bureau of Audits, Offi ce of the Inspector General Page 68 Category Analysis There is low adherence to policies and procedures in the medication management and access to providers and services categories. Chart 23 summarizes the results of our sorting the questions from the 20 component areas into the fi ve general medical categories. The average scores for these categories range from a low of 59 percent in medication management to a high of 80 percent in nurse responsibilities. This range of scores is consistent with the range of scores from the 17-prison summary report. In that report, medication management also scored lowest at 58 percent, while nurse responsibilities were highest with the same 80 percent score. Our analysis clearly demonstrates that prisons’ performances in medication management and access to providers and services merit the Receiver’s continuing attention, as the 33 prisons’ average scores of 59 percent and 66 percent, respectively, are far below the 75 percent minimum score for moderate adherence to policies and procedures. More encouragingly, in addition to nurse responsibilities’ 80 percent score, continuity of care’s 76 percent score enabled both categories to exceed the minimum score for moderate adherence. However, by averaging 72 percent, primary care provider responsibilities fell below the minimum score for moderate adherence. In the following sections, we provide a more in-depth analysis of the 33 prisons’ performances in each of the fi ve medical categories. Chart 23: Scores by Category, Sorted Lowest to Highest Score Medication Management 59% Access to Providers and 66% Services Primary Care Provider 72% Responsibilities Continuity of Care 76% Nurse Responsibilities 80% 40% 50% 60% 70% 80% 90% 100% Average Score Minimum Moderate Adherence = 75% State of California • May 2011 Page 69 Medical Category: Medication Management Page 1 of 3 The medication management category evaluates the timely delivery of medications to inmates and certain elements of medication administration. These elements include the availability of medications, maintenance of medications, and the screening of new medications for potential adverse reactions. To develop our analysis, we used 14 questions from the following medical care components: chronic care, clinical services, health screening, urgent services, inmate transfers, clinic operations, preventive services, and pharmacy services. Of the 14 questions, fi ve pertain to medication delivery and nine pertain to medication administration. However, the medication delivery questions are more important, and therefore they are more heavily weighted. Prisons are ineffective at ensuring that inmates receive their medications. As shown in Charts 23 and 24, the 33 prisons’ average score for medication management was only 59 percent, one percentage point higher than that reported in our 17-prison summary report. This is the lowest average score within any of the fi ve general medical categories, and it clearly indicates that medication management is weak. Only three prisons had scores that exceeded the 75 percent score for moderate adherence to medical policies and procedures. Particularly troubling is that 18 of the prisons scored 57 percent or less. The prisons performed especially poorly in medication delivery. They had an average score of only 35 percent, which is one percentage point higher than the score reported for medication delivery in our 17-prison summary report. Thirty of the 33 prisons scored 53 percent or less, and 17 of them scored from 32 percent down to eight percent. CMF and PBSP, with scores of 83 percent, were the only prisons to exceed the 75 percent minimum score for moderate adherence. The prisons’ very low scores in delivering medications to inmates offset the 90 percent average score they achieved on the other nine, less heavily weighted questions in medication management. Bureau of Audits, Offi ce of the Inspector General Page 70 Medical Category: Medication Management Page 2 of 3 Chart 24: Medication Management Scores by Prison, Sorted Highest to Lowest PBSP 84% CMF 84% SVSP 77% FSP 71% CCI 69% CCWF 68% RJD 68% SAC 67% CAL 66% MCSP 64% DVI 64% CTF 62% LAC 62% CRC 61% CEN 60% VSPW 57% WSP 56% CVSP 56% NKSP 56% CIM 55% SOL 55% HDSP 55% SCC 55% COR 54% CCC 53% CMC 51% ASP 49% Institution Score ISP 47% Minimum Moderate Adherence = 75% SATF 44% Average Score = 59% PVSP 43% CIW 42% KVSP 41% SQ 40% 20% 30% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 71 Medical Category: Medication Management Page 3 of 3 Compliance problems with medication delivery stem from one of two causes. The fi rst is failure to administer, provide, or deliver medications in a timely manner. The second is the medical staff’s failure to document their actions after they provided or delivered medications. We do not know the extent to which either cause contributed to the low score in medication delivery. However, records we inspected indicate that this noncompliance is not simply a documentation problem, but rather a problem of inmates not receiving their medications. For example, in reviewing the 33 prisons’ administering of Isoniazid, a drug prescribed to treat latent or active tuberculosis, we found that in 71 percent of the cases, the institutions did not properly administer the medication. We reviewed the underlying documentation to determine if this was a documentation problem or if the inmates in fact did not receive the Isoniazid. We found that in many cases, the medication administration record was either completely missing from the fi le or completely blank, leaving the possibility that this was a documentation problem. However, for at least 51 percent of the cases, we found medication administration forms in the medical fi le that indicated some medications had been given to the inmate, but sections of the same forms were blank where ordered doses of Isoniazid should have been recorded as administered. This documentation suggests that the missing dose was not given to the inmate. We conclude, therefore, that the prisons are not merely failing to document that inmates received their medications; they are also failing to get the medications to the inmates. Regardless, both types of failure denote noncompliance and poor performance. Numerous prisons performed inadequately in the following areas: • Delivering tuberculosis medications to inmates and ensuring they take them • Delivering medications to inmates within one day of arrival at the prison • Providing chronic care medications and following policies when inmates refuse their medications • Delivering sick call medications (new orders) to inmates • Providing medications to inmates upon discharge from an outside hospital These fi ve areas pertain to the basic delivery of medications to inmates. As suggested by the poor 35 percent average score achieved by the 33 prisons, medication delivery is a signifi cant health issue. See Appendix D-1 for detailed information on questions and scores for this category. Bureau of Audits, Offi ce of the Inspector General Page 72 State of California • May 2011 Page 73 Medical Category: Access to Providers and Services Page 1 of 4 The access to providers and services category 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. Effective prison medical care depends on inmates’ access to providers and services; a key indicator of access is timeliness. To develop our analysis, we used 35 access to providers and services-related questions 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. Access to providers and services is poor. As shown in Chart 25, the 33 prisons’ average score for access to providers and services was only 66 percent. While this score is six percentage points higher than the access to providers and services score reported in our 17-prison summary report, it is still the second lowest average score within the fi ve general medical categories. With scores ranging from a high of 87 percent down to 45 percent, prisons are generally defi cient in providing inmates timely access to the primary care providers and medical services they need. Only six prisons met or exceeded the 75 percent minimum score for moderate adherence to medical policies and procedures. HDSP, with a score of 45 percent, was the worst performer. Bureau of Audits, Offi ce of the Inspector General Page 74 Medical Category: Access to Providers and Services Page 2 of 4 Chart 25: Access to Providers and Services Scores by Prison, Sorted Highest to Lowest CIM 87% FSP 86% VSPW 85% PBSP 80% CAL 79% WSP 75% CCWF 74% CVSP 73% CMC 72% CRC 70% NKSP 69% ASP 69% MCSP 67% CCC 67% CTF 66% ISP 66% SOL 66% SQ 66% CIW 65% CMF 63% DVI 62% SVSP 61% SCC 61% COR 60% CEN 60% KVSP 58% SATF 56% SAC 54% Institution Score PVSP 52% Average Score = 65% LAC 52% Minimum Moderate Adherence = 75% CCI 50% RJD 47% HDSP 45% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% State of California • May 2011 Page 75 Medical Category: Access to Providers and Services Page 3 of 4 Given the low scores shown in Chart 25, we further sorted and analyzed the access to providers and services data. Specifi cally, we categorized the questions into two types: those that related or applied to a specifi c medical problem identifi ed for an inmate, and those that related or applied to various screening and preventive health processes. The following are examples of each type of question: Was the inmate’s most recent chronic care visit within the time frame required Medical problem-related by the degree of control of the inmate’s condition based on his or her prior visit? (Question 03.076) Did the prison complete the initial health screening on the same day the inmate Screening and preventive-related arrived at the prison? (Question 02.016) The results of this analysis identifi ed a signifi cant weakness in the prisons’ administration of correctional health care. The average access to providers and services score for questions related to inmates with specifi c medical problems was only 62 percent. In contrast, the average access to providers and services score for screening and preventive-related procedures was 75 percent. (We noted a similar gap in the scores for the fi rst 17 prisons we inspected: 57 percent for questions related to inmates with specifi c medical problems, and 71 percent for questions related to screening and preventive-related procedures.) In short, inmates with identifi ed health problems had greater diffi culty gaining access to the providers and services for which they had a demonstrable need. Chart 26 shows each prison’s comparative scores for the two types of access to providers and services. With scores ranging from 87 percent down to 38 percent, only four prisons exceeded the 75 percent minimum score for moderate adherence in providing timely access to providers and services when inmates had identifi ed medical problems. These identifi ed medical problems included chronic diseases as well as other conditions that require specialty care or medical treatment at outside hospitals. Moreover, inmates often did not have timely access to a physician or a specialist for the health care management or follow-up required by CDCR policy. The lowest-scoring prisons in problem-related access to providers and services had particular diffi culty in getting inmates with medical issues seen by a primary care provider in an appropriate time frame for both interim and follow-up appointments for specialty services. Overall, the prisons are relatively profi cient at processing inmates for routine screening and preventive-related appointments, but they are less profi cient in getting inmates who have identifi ed medical problems seen by appropriate medical care providers. The failure to provide timely access to care for inmates with identifi ed medical problems clearly increases risks to the inmates’ health. See Appendix D-2 for detailed information on questions and scores for this category. Bureau of Audits, Offi ce of the Inspector General Page 76 Medical Category: Access to Providers and Services Page 4 of 4 Chart 26: Access to Providers and Services Scores by Prison, Sorted Highest to Lowest CIM 87% 87% FSP Screening and Preventive-related 82% 98% Access to Care Score VSPW 96% Average Screening Score = 75% 81% CAL Problem-related Access to Care 80% 79% Score PBSP 94% Average Problem Related Score = 75% CVSP 62% 75% 73% Minimum Moderate Adherence = CCWF 75% 81% 71% WSP 91% 69% CMC 85% 68% CCC 70% 67% CIW 64% 66% NKSP 76% 66% MCSP 78% 65% ASP 84% 64% ISP 71% 64% CRC 89% 64% SOL 71% 64% CMF 65% 63% CEN 57% 61% CTF 84% 60% SVSP 66% 59% SQ 87% 59% COR 65% 59% DVI 70% 59% SCC 72% 58% KVSP 73% 53% PVSP 55% 51% CCI 44% 51% SATF 78% 50% LAC 63% 48% SAC 79% 48% RJD 66% 40% HDSP 66% 38% 30% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 77 Medical Category: Primary Care Provider Responsibilities Page 1 of 4 The primary care provider responsibilities category 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. To develop our analysis, we used 29 questions from the following medical care components: chronic care, health screening, urgent services, prenatal care/childbirth/post-delivery, diagnostic services, outpatient housing unit, and inmate hunger strikes. The 29 questions are of two types: judgment questions and process questions. Judgment questions evaluate how well the primary care provider applied his or her medical knowledge, skills, and abilities in providing medical care.6 Process questions assess the primary care provider’s compliance with established protocols for providing services and maintaining records. Of the 29 questions, 21 are judgment questions, and eight are process questions. Some prisons’ primary care providers must improve their performance to achieve moderate adherence. As shown in Chart 27, the 33 prisons’ average score for primary care provider responsibilities was 72 percent, which is two percentage points lower than the 74 percent score we reported in our 17-prison summary report . The 72 percent score is the third lowest average score in the fi ve general medical categories, and it does not meet the 75 percent minimum score for moderate adherence to policies and procedures. Only 15 prisons’ scores met or exceeded the 75 percent minimum score for moderate adherence, with SCC and CAL tying for the highest score at 85 percent. KVSP’s score of 51 percent stands out as exceptionally low. The lower-performing prisons’ scores are driven largely by poor performance in response to questions in the chronic care component, which represents 61 percent of the total point value for primary care provider responsibilities. 6 In performing our inspections, judgement questions are answered by physician inspectors. When a physician inspector takes exception to the judgement of a primary care provider, the physician inspector consults with our lead physician before confi rming the exception. Bureau of Audits, Offi ce of the Inspector General Page 78 Medical Category: Primary Care Provider Responsibilities Page 2 of 4 Chart 27: Primary Care Provider Responsibilities Scores by Prison, Sorted Highest to Lowest CAL 85% SCC 85% FSP 84% CCWF 84% CMF 83% VSPW 81% DVI 81% CEN 80% SQ 79% CIM 78% CRC 78% CIW 77% CCI 76% LAC 76% PBSP 75% PVSP 74% MCSP 73% SATF 72% NKSP 72% ASP 72% SAC 71% WSP 70% CVSP 69% CTF 68% CMC 68% CCC 66% SVSP 65% Institution Score Average Score = 72% COR 63% Minimum Moderate Adherence = 75% ISP 61% SOL 56% HDSP 55% RJD 54% KVSP 51% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 79 Medical Category: Primary Care Provider Responsibilities Page 3 of 4 Chart 28: Primary Care Provider Responsibilities Scores by Prison, Sorted Highest to Lowest CMF 59% 90% SQ 54% 86% CCWF 79% 86% CAL 81% 86% CEN 66% 85% DVI 66% 84% SCC 88% 84% FSP 88% 83% VSPW 84% 80% SAC 39% 79% SATF 50% 79% CCI 68% 78% CIM 75% 78% LAC 71% 78% CRC 80% 78% PVSP 66% 76% CIW 84% 75% WSP 57% 74% ASP 64% 74% PBSP 80% 74% MCSP 74% 73% NKSP 66% 73% CMC 57% 72% CVSP 54% 72% CTF 51% 71% CCC 56% 69% SVSP 54% 69% COR 49% 66% 61% ISP 62% RJD 35% Process Scores by Institution 61% Judgment Scores by Institution SOL 43% 60% Average Judgment Score = 75% HDSP 43% Minimum Moderate Adherence = 75% 58% Average Process Score = 63% KVSP 29% 58% 20% 30% 40% 50% 60% 70% 80% 90% 100% Bureau of Audits, Offi ce of the Inspector General Page 80 Medical Category: Primary Care Provider Responsibilities Page 4 of 4 Impact of Primary Care Provider Judgment To determine if the primary care provider judgment questions were more problematic for the prisons than the process questions, we eliminated the process questions for the data sort shown in Chart 28 and analyzed the results of the judgment questions exclusively. Judgment functioned far better than process. As shown in Chart 28, the 33 prisons’ average score on judgment questions was 75 percent, a score that by itself meets the minimum score for moderate adherence. However, the prisons’ performance on the process questions reduced the category score three percentage points to the 72 percent score achieved using both types of questions. The average score on the process questions was only 63 percent, or 12 percentage points less. (These scores are consistent with the trend we fi rst noted in our 17-prison summary report. In that report, the average score on judgment questions was 77 percent, and the average score on the process questions was 63 percent, or 14 percentage points less.) The larger number and heavier weight of the judgment questions kept the category score from falling more than it did. On judgment questions, 17 prisons had scores that met or exceeded the 75 percent minimum score for moderate adherence. See Appendix D-3 for detailed information on questions and scores for this category. State of California • May 2011 Page 81 Medical Category: Continuity of Care Page 1 of 2 The continuity of care category 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. To develop our analysis, we used 19 questions from the following medical care components: health screening, specialty services, urgent services, outpatient housing unit, inmate transfers, and clinic operations. Some prisons must improve the continuity of care they provide inmates to achieve moderate adherence to policies and procedures. As shown in Chart 29, the 33 prisons’ average score for continuity of care was 76 percent. This score exceeds the 75 percent minimum score for moderate adherence, and it is the second highest average score in the fi ve general medical categories. The 76 percent average score indicates that the prisons generally provided continuity of medical services to the inmate-patients in their care. However, while 20 prisons met or exceeded the 75 percent minimum score for moderate adherence, the remaining 13 did not. Those prisons that failed to achieve moderate adherence in the continuity of care category did so partly as the result of these problems: • Failing to transmit accurate health care information on transferring inmates who need specialty services. • Failing to document the delivery of medications to arriving inmates or document within one calendar day the reasons that arriving inmates’ medications were discontinued. • Failing to meet specifi ed time frames for following up on specialty service consultations. See Appendix D-4 for detailed information on questions and scores for this category. Bureau of Audits, Offi ce of the Inspector General Page 82 Medical Category: Continuity of Care Page 2 of 2 Chart 29: Continuity of Care Scores by Prison, Sorted Lowest to Highest PBSP 91% FSP 87% CIM Institution Score 85% Average Acore = 76% SVSP 85% Minimum Moderate Adherence = 75% CRC 84% CAL 83% CCC 83% CCWF 83% CEN 83% SCC 80% SATF 79% ASP 79% WSP 78% ISP 78% LAC 78% CVSP 76% SOL 76% KVSP 76% VSPW 75% NKSP 75% COR 74% HDSP 74% MCSP 72% CMC 72% SAC 72% PVSP 71% RJD 70% SQ 68% CIW 68% CCI 67% CMF 67% CTF 64% DVI 64% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% State of California • May 2011 Page 83 Medical Category: Nurse Responsibilities Page 1 of 4 The nurse responsibilities category 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. To develop our analysis, we used 23 questions 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. The 23 questions are of two types: judgment questions and process questions. Judgment questions evaluate how well the nurse applied his or her medical knowledge, skills, and abilities 7 in providing nursing care. Process questions assess the nurse’s compliance with established guidelines for providing services and maintaining records. Seven of the 23 questions are judgment questions, and 16 are process questions. Prisons’ nurses performed relatively well. As shown in Chart 30, the 33 prisons’ average score for nurse responsibilities was 80 percent. This is the same score the nurse responsibilities category earned in our 17-prison summary report. The 80 percent average score is the highest average score within the fi ve general medical categories, and it exceeds the 75 percent minimum score for moderate adherence. Twenty-three of the 33 prisons exceeded the 75 percent minimum score for moderate adherence, with seven of them achieving high adherence scores of 86 percent or more. CCWF’s score of 94 percent was the highest. 7 In performing our inspections, judgement questions are answered by registered nurse inspectors. When a registered nurse inspector takes exception to the judgement of a prisonʼs registered nurse, the nurse inspector consults with another registered nurse inspector or a physician inspector before confi rming the exception. Bureau of Audits, Offi ce of the Inspector General Page 84 Medical Category: Nurse Responsibilities Page 2 of 4 Chart 30: Nurse Responsibilities Scores by Prison, Sorted Highest to Lowest CCWF 94% CEN 91% CRC 90% PBSP 89% FSP 89% CMC 88% Institution Score RJD Minimum Moderate Adherence = 75% 86% Average Score = 80% WSP 85% CIM 85% SAC 85% KVSP 84% ASP 84% COR 83% SCC 83% ISP 82% CCC 82% CAL 81% SATF 81% LAC 81% NKSP 80% DVI 78% VSPW 77% CIW 76% SOL 74% HDSP 74% SVSP 73% CTF 73% CVSP 73% SQ 72% MCSP 71% CMF 69% CCI 67% PVSP 66% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 85 Medical Category: Nurse Responsibilities Page 3 of 4 Impact of Nurse Judgment To determine if the nurse judgment questions were more problematic for the prisons than the process questions, we analyzed the results of the judgment questions exclusively. The impact of judgment questions was substantial. As shown in Chart 31, the 33 prisons’ average score on the judgment questions was 75 percent, which is fi ve percentage points lower than the average score achieved using both types of questions. The average score for process questions was 83 percent, meaning that there was an eight percentage point gap between the average scores for the two types of questions. While all three scores fall in the moderate adherence range, it is apparent that the 33 prisons’ nurses performed better on process questions than on judgment questions. This observation contrasts with the one we made in our 17-prison summary report. In that report, we concluded that one type of question had no more impact than the other. Our conclusion was based on the fact that for the fi rst 17 prisons inspected, the nurse judgment average score of 80 percent was the same as the overall nurse responsibilities score, and that the process question average score of 81 percent was nearly the same. However, for the last 16 prisons inspected there was a signifi cant drop in the scores on judgment questions and an increase in the scores on process questions. The average judgment score for the last 16 prisons was 70 percent, far below the 86 percent the same prisons achieved on the process questions. Therefore, for all 33 prisons we conclude that the impact of the nurse judgment questions was substantial. See Appendix D-5 for detailed information on questions and scores for this category. Bureau of Audits, Offi ce of the Inspector General Page 86 Medical Category: Nurse Responsibilities Page 4 of 4 Chart 31: Impact of Nurse Judgement Scores by Prison, Sorted Highest to Lowest CCWF 93% 96% CEN 88% Process Scores by Institution 96% RJD Judgment Scores by Institution 83% 91% Average Judgment Score = 75% SCC Minimum Moderate Adherence = 75% 80% 90% PBSP Average Process Score = 83% 89% 87% FSP 91% 86% CRC 91% 86% CMC 90% 86% SAC 85% 85% LAC 80% 82% COR 85% 80% WSP 89% 79% CCC 84% 79% CCI 61% 79% CMF 63% 78% CIM 90% 76% ASP 91% 75% CIW 76% 75% NKSP 83% 74% SOL 74% 74% KVSP 91% 72% CTF 75% 69% DVI 84% 69% HDSP 77% 69% SVSP 76% 67% CAL 90% 67% PVSP 65% 66% ISP 92% 65% SQ 79% 63% SATF 93% 62% MCSP 76% 61% VSPW 91% 55% CVSP 92% 46% 20% 30% 40% 50% 60% 70% 80% 90% 100% State of California • May 2011 Page 87 Conclusion The results of our fi rst 33 medical inspections demonstrate that the Receiver and CDCR can improve prisons’ compliance with CDCR medical policies and procedures and medical community standards in a number of areas. In particular, we note the following results: • Only nine of the 33 prisons’ overall weighted scores met or exceeded 75 percent, the Receiver’s minimum score for moderate adherence to medical policies and procedures. The highest score was FSP’s 83 percent, and FSP is the only prison to achieve moderate or high adherence in all six of the most heavily weighted components of the medical inspection program. • Nearly all of the prisons failed to achieve moderate adherence in three of the six most heavily weighted components. The average score for chronic care, the most heavily weighted component, was only 62 percent. Failure to ensure inmates received their chronic care medications and inadequate documentation of inmates’ clinical histories were recurring problems. Clinical services, the second most heavily weighted component, had an average score of only 65 percent. Within this component, we found consistent problems with getting inmates their prescribed medications and in primary care providers’ seeing inmates by the appointment dates set by triage nurses. The average score for specialty services, another heavily weighted component, was only 66 percent. We found poor performance in providing inmates timely access to specialty services and prompt follow-up related to those services. • In other component areas of our inspection program, prisons scored particularly poorly in preventive services. The average score was only 44 percent, and we found very low scores in tuberculosis treatment, which can affect the health of inmates and staff alike. Further, as evidenced by the average score of 57 percent, the prisons performed quite poorly in monitoring inmates on hunger strikes lasting longer than three days. In access to health care information the average score was only 64 percent, and only two of the prisons kept inmates’ medical records updated with recently fi led documents. • Notwithstanding the problems cited above, the prisons performed well in several components. Their average scores were more than 86 percent in fi ve components, indicating high adherence with medical policies and procedures. The 96 percent score in staffi ng levels and training refl ects positively on the prisons’ efforts to provide around-the-clock physician and nursing services, and to orient and train nurses on face- to-face triage techniques in a prison setting. The 93 percent score in chemical agent contraindications and the 92 percent score in clinic operations are also noteworthy. • In the 20 components of health care that we examined, prisons achieved an average score of 86 percent or higher on 69 of the 165 scored questions. However, the prisons scored consistently poorly on 36 questions, averaging 60 percent or less, and in some cases substantially less. This 60 percent mark, the Receiver’s threshold for a formal corrective action plan, indicates areas of prison medical care that require signifi cant improvement. • When sorting 100 of the questions into fi ve general medical categories, we found recurring problems in how the prisons managed inmates’ medication. The average score in Bureau of Audits, Offi ce of the Inspector General Page 88 medication management was only 59 percent because the prisons scored only 35 percent on questions related to medication delivery. Inmates’ access to providers and services was also of concern, with timeliness of access the main problem. The average score for this category was only 66 percent. In contrast, nurse responsibilities had an average score of 80 percent and continuity of care had an average score of 76 percent, making them the only general medical categories to exceed the 75 percent minimum score for moderate adherence. Primary care provider responsibilities, with an average score of 72 percent, came close to the 75 percent minimum score for moderate adherence. However, the 63 percent score on process questions offset the 75 percent score on judgement questions, which by itself met the Receiver’s minimum score for moderate adherence. We fi nd that the wide variation among component scores within prisons, and the wide variation among prisons’ average component scores, suggest that the Receiver has not yet implemented a system that ensures that CDCR policies and procedures and selected medical community standards are consistently followed throughout the prison system. The higher scores in some component areas and medical categories, however, demonstrate that system-wide improvement can be achieved. State of California • May 2011 Page 89 Appendix Preface This report contains the following four appendices: APPENDIX A: This appendix contains the defi nitions of the 20 components we use in our medical inspection program. APPENDIX B: This appendix is a synopsis of each prison’s scores on the 20 components in our medical inspection program. APPENDIX C: This appendix contains the 33 prisons’ scores for each question in the 20 components and cites the text of each question. In addition, for each question the appendix discloses the possible points for the question and the points received for the question. It also shows the 33-prison average score for each question and each prison’s total score for each component. APPENDIX D: This appendix contains the 33 prisons’ scores for each question in the fi ve medical categories and cites the text of each question. In addition, for each question the appendix discloses the possible points for the question and the points received for the question. It also shows the 33-prison average score for each question and each prison’s total score for each medical category. Blank scores in Appendices C and D: The reader may occasionally encounter blank spaces in Appendix C and Appendix D. The spaces are blank for two possible reasons. The fi rst reason is that the question does not apply to the institution. For example, 16 of the 33 prisons did not have outpatient housing units. Therefore, the ten questions in the outpatient housing unit component would not apply to these 16 prisons. The second reason is that the question does not apply to any sample items selected for inspection. For example, Question 15.134 asks, “Did the institution properly respond to all active cases of TB discovered in the last six months?” Because only three of the 33 prisons had discovered an active case of tuberculosis in the six months preceding the inspection, only those prisons received a score for Question 15.134. When questions do not apply to a prison, we exclude them from our scoring calculations. Rounding in Appendices B, C, and D: We have rounded the percentage scores in Appendices B, C, and D to the nearest whole number. In Appendices C and D, the points received for each question are displayed to the nearest tenth of a point. However, our computer-based scoring system carries the points received calculation to multiple decimal points before calculating the percentage score. Accordingly, we have included the percentage score each prison earned on each of the applicable questions from its inspection report. As a result, the reader may notice slightly different percentage scores among prisons for questions with the same possible points and the same points received. In addition, totals may not sum due to this rounding. Bureau of Audits, Offi ce of the Inspector General Page 90 Appendices: Table of Contents Appendix A: Component Defi nitions ........................................................................................ 92 Appendix B: Prisonsʼ Scores by Component ............................................................................ 93 Appendix C: Component Questions and Scores Appendix C-1: Chronic Care .............................................................................................. 94 Appendix C-2: Clinical Services ........................................................................................ 96 Appendix C-3: Health Screening ...................................................................................... 100 Appendix C-4: Specialty Services .................................................................................... 104 Appendix C-5: Urgent Services ........................................................................................ 106 Appendix C-6: Emergency Services ................................................................................. 108 Appendix C-7: Prenatal Care ............................................................................................ 112 Appendix C-8: Diagnostic Services .................................................................................. 114 Appendix C-9: Access to Health Care Information ......................................................... 116 Appendix C-10: Outpatient Housing Unit ........................................................................ 118 Appendix C-11: Internal Reviews ..................................................................................... 120 Appendix C-12: Inmate Transfers ..................................................................................... 122 Appendix C-13: Clinic Operations ................................................................................... 124 Appendix C-14: Preventive Services ................................................................................ 126 Appendix C-15: Pharmacy Services ................................................................................. 128 Appendix C-16: Other Services ........................................................................................ 130 Appendix C-17: Inmate Hunger Strikes ........................................................................... 132 Appendix C-18: Chemical Agent Contraindications ........................................................ 134 Appendix C-19: Staffi ng Levels and Training .................................................................. 136 Appendix C-20: Nursing Policy ........................................................................................ 138 Appendix D: Category Questions and Scores Appendix D-1: Medication Management ......................................................................... 140 Appendix D-2: Access to Providers and Services ............................................................. 144 Appendix D-3: Primary Care Provider Responsibilities ................................................... 150 Appendix D-4: Continuity of Care ................................................................................... 156 Appendix D-5: Nurse Responsibilities ............................................................................. 160 State of California • May 2011 Page 91 Appendix A: Component Defi nitions Chronic Care: Examines how well the Diagnostic Services: Addresses the tuberculosis evaluation, and infl uenza prison provided care and medication to timeliness of radiology (x-ray) and immunizations. inmates with specifi c chronic care con- laboratory services and whether the Pharmacy Services: Addresses ditions, which are those that affect (or prison followed up on clinically whether the prison’s pharmacy have the potential to affect) an inmate’s signifi cant results. complies with various operational functioning and long-term prognosis for Access to Health Care Information: policies, such as conducting periodic more than six months. Our inspection Addresses the prison’s effectiveness inventory counts, maintaining the tests the following chronic care condi- in fi ling, storing, and retrieving currency of medications in its crash tions: asthma, anti-coagulation therapy, medical records and medical-related carts and after-hours medication diabetes, HIV (Human Immunodefi - information. supplies, and having valid permits. ciency Virus), and hypertension. In addition, this component also Outpatient Housing Unit: Determines Clinical Services: Evaluates the in- addresses whether the pharmacy has whether the prison followed mate’s access to primary health care an effective process for screening department policies and procedures services and focuses on inmates who medication orders for potential when placing inmates in the outpatient recently received services from any of adverse reactions/interactions. housing unit.8This component also the prison’s facilities or administrative evaluates whether the placement Other Services: Examines additional segregation unit clinics. This com- provided the inmate with adequate areas that are not captured in the other ponent evaluates sick call processes care and whether the physician’s plan components. The areas evaluated in this (doctor or nurse line), medication addressed the placement diagnosis. component include the prison’s provi- management, and nursing. sion of therapeutic diets, its handling of Internal Reviews: Focuses on the Health Screening: Focuses on the inmates who display poor hygiene, and frequency of meetings held by prison’s process for screening new the availability of the current version of the prison’s Quality Management inmates upon arrival to the institution the department’s Inmate Medical Ser- Committee and Emergency Medical for health care conditions that require vices Policies and Procedures. Response Review Committee and treatment and monitoring, as well as whether key staff attended the meetings. Inmate Hunger Strikes: Examines ensuring inmates’ continuity of care. This component also evaluates the medical staff’s monitoring of inmates Specialty Services: Focuses on timeliness of the prison’s responses to participating in hunger strikes lasting the prison’s process for approving, inmates’ medical appeals fi led, and the more than three days. denying, and scheduling services prison’s death review process. Chemical Agent Contraindications: that are outside the specialties of Inmate Transfers: Focuses on inmates Addresses the prison’s process the prison’s medical staff. Common pending transfer to determine whether for handling inmates who may be examples of these services include the sending institution documented predisposed to an adverse outcome cardiology services, physical medication and medical conditions to from calculated uses of force (cell therapy, oncology services, podiatry assist the receiving institution in pro- extractions) involving Oleoresin consultations, and neurology services. viding continuity of care. Capsicum (OC), which is commonly Urgent Services: Addresses the care referred to as “pepper spray.” For Clinic Operations: Addresses the gen- provided by the institution to inmates example, this might occur if the eral operational aspects of the prison’s before and after they were sent to a inmate has asthma. facility clinics. Generally, the questions community hospital. in this component relate to the cleanli- Staffi ng Levels and Training: Emergency Services: Examines ness of the clinics, privacy afforded to Examines the prison’s medical staffi ng how well the prison responded to inmates during non-emergency visits, levels and training provided. medical emergencies. Specifi cally, we use of priority ducats (slips of paper Nursing Policy: Determines whether focused on “man down” or “woman the inmates carries for scheduled medi- the prison maintains written policies down” situations. Further, questions cal appointments), and availability of and procedures for the safe and determine the adequacy of medical health care request forms. effective provision of quality nursing and staff response to a “man down” or Preventive Services: Focuses care. The questions in this component “woman down” emergency drill. on inmate cancer screening, also determine whether nursing staff Prenatal Care/Childbirth/Post- review their duty statements and delivery: Focuses on the prenatal and 8 An outpatient housing unit (OHU) whether supervisors periodically post-delivery medical care provided is a facility that provides outpatient review the work of nurses to ensure to pregnant inmates. Not applicable at health services to inmates and assists they properly follow established men’s institutions. them with the activities of daily living. nursing protocols. Bureau of Audits, Offi ce of the Inspector General Page 92 State of California • May 2011 Page 93 gnitropeR PSKNFMC IVD CCCPSVSCRC NECPSCMPSW CCS LAC FWCCWPSVPSBP MIC PSF tnenopmoC %95 %48 %47 %64 %75 %76 %18 %07 %25 %57 %57 %37 %17 %07 %26 %97 eraC cinorhC %46 %78 %37 %66 %16 %07 %08 %96 %47 %17 %06 %47 %66 %96 %47 %67 secivreS lacinilC %27 %78 %47 %18 %48 %47 %87 %18 %68 %16 %08 %48 %68 %58 %68 %98 gnineercS htlaeH %16 %34 %35 %17 %17 %95 %06 %67 %17 %37 %57 %35 %27 %69 %38 %08 secivreS ytlaicepS %08 %97 %87 %48 %48 %18 %08 %57 %58 %98 %88 %98 %76 %29 %08 %88 secivreS tnegrU ycnegremE %18 %27 %17 %09 %38 %37 %77 %46 %37 %67 %58 %08 %88 %18 %09 %48 secivreS /htribdlihC/latanerP A/N A/N A/N A/N A/N A/N A/N A/N A/N A/N A/N A/N %18 A/N A/N A/N eraC yreviled-tsoP %86 %27 %47 %17 %77 %95 %47 %86 %98 %68 %85 %48 %18 %75 %86 %08secivreS citsongaiD htlaeH ot sseccA %37 %95 %95 %87 %88 %87 %28 %37 %67 %28 %73 %45 %67 %001 %87 %87 noitamrofnI eraC gnisuoH tneitaptuO A/N %68 %38 %28 A/N %57 A/N A/N A/N %57 %39 A/N %98 A/N %39 A/N tinU %58 %96 %39 %68 %37 %19 %16 %38 %88 %06 %57 %89 %68 %96 %69 %89 sweiveR lanretnI %69 %05 %97 %39 %58 %001%001 %86 %98 %59 %001%001%001 %39 %39 %59 srefsnarT etamnI %09 %38 %88 %79 %69 %68 %28 %001 %09 %88 %001 %68 %001 %39 %59 %49 snoitarepO cinilC evitneverP %55 %44 %22 %73 %24 %28 %91 %04 %07 %82 %84 %95 %18 %18 %17 %75 secivreS %39 %67 %29 %96 %001 %97 %85 %39 %68 %19 %79 %29 %68 %39 %6 9%001secivreS ycamrahP %05%001%001%001 %98 %07 %001 %58 %96 %55 %001%001%001%001%001 %07 secivreS rehtO regnuH etamnI A/N %23 A/N %86 %62 A/N %23 %28 A/N A/N %001%001 A/N %001%001 A/N sekirtS tnegA lacimehC %001%78 %98 %001%001%001 %98 %001 %49 %001%001 %56 %001 %97 %001%001 snoitacidniartnoC dna sleveL gn fifatS %59 %59 %59 %001%001 %58 %001%001 %08 %001%001 %58 %001%001%001%001 gniniarT %17 %63 %63 %49 %001 %67 %17 %98 %001 %49 %001%001%001 %05 %39 %47 yciloP gnisruN %27 %27 %37 %37 %47 %47 %47 %57 %67 %67 %77 %87 %08 %18 %18 %38 erocS llarevO %05 %86 %87 %36 %47 %14 %18 %06 %84 %27 %36 %74 %43 %05 %83 %34 egnaR lanoitutitsnI APPENDIX B: Prisons’ Scores By Component egarevA egnaR PSDHPSVK ICC PSVP CAS LOS DJR FTAS QS PSI ROCPSVC WIC PSA CMC CAL FTC erocS %64 %26 %54 %83 %26 %75 %36 %24 %94 %85 %56 %93 %85 %25 %07 %95 %75 %07 %65 %04 %56 %15 %85 %75 %74 %76 %06 %76 %65 %74 %16 %86 %16 %26 %46 %47 %66 %95 %82 %77 %27 %57 %87 %76 %67 %77 %86 %37 %77 %28 %37 %67 %07 %18 %37 %96 %46 %35 %66 %35 %26 %75 %16 %74 %66 %26 %26 %85 %28 %55 %68 %36 %47 %36 %07 %96 %13 %87 %27 %16 %38 %18 %38 %07 %37 %57 %36 %07 %67 %87 %57 %07 %48 %08 %57 %24 %87 %27 %27 %87 %38 %84 %28 %09 %07 %87 %37 %88 %37 %08 %87 %68 %48 %18 %02 %17 A/N A/N A/N A/N A/N A/N A/N A/N A/N A/N A/N A/N %16 A/N A/N A/N A/N %64 %96 %34 %68 %06 %56 %86 %06 %46 %65 %96 %85 %86 %65 %17 %78 %07 %45 %27 %08 %46 %95 %37 %55 %36 %93 %85 %44 %75 %45 %94 %37 %94 %95 %02 %93 %37 %87 %73 %18 A/N A/N %37 A/N %67 A/N A/N A/N %38 %09 %26 %99 %36 %17 A/N A/N %78 %04 %87 %36 %96 %06 %17 %07 %57 %001 %37 %96 %88 %66 %86 %59 %66 %07 %37 %39 %75 %88 %001%001 %34 %67 %57 %97 %09 %001%001 %59 %78 %37 %08 %001 %49 %001 %86 %81 %29 %19 %79 %19 %39 %19 %48 %59 %99 %001 %79 %09 %19 %89 %49 %58 %09 %19 %57 %44 %42 %72 %7 %72 %23 %85 %42 %63 %94 %43 %03 %84 %33 %06 %35 %02 %15 %24 %78 %001 %38 %97 %27 %57 %98 %39 %09 %68 %38 %68 %38 %59 %29 %19 %001 %98 %05 %48 %37 %05 %58 %07 %19 %57 %001%001 %58 %58 %39 %001 %75 %07 %19 %001 %76 %98 %75 %44 %64 %64 %73 %11 %88 %11 %97 %45 A/N %03 A/N A/N A/N %17 %24 A/N %04 %39 %001 %06 %66 %66 %001%001 %49 %001 %98 %001%001 A/N %001%001%001 %19 %001 %02 %69 %001 %59 %09 %08 %59 %001%001%001 %59 %001%001%001 %58 %001%001 %09 %001 %46 %77 %98 %75 %05 %001 %97 %17 %98 %17 %07 %05 %68 %17 %46 %76 %97 %75 %001 %12 %27 %26 %46 %46 %56 %56 %76 %86 %86 %86 %86 %96 %96 %07 %07 %17 %27 %27 %25 %67 %37 %48 %37 %98 %85 %98 %46 %35 %66 %07 %25 %76 %08 %16 %08 %94 ecnerehdA hgiH ecnerehdA etaredoM ecnerehdA woL APPENDIX C-1:Chronic Care ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: Examines how well the prison provided care and medication to inmates with specifi c 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 Immunodefi ciency Virus), and hypertension. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number Was the inmate’s most recent chronic care visit within the time frame required by the degree of control of the inmate’s condition based 03.076 on his or her prior visit? (10 points possible) Score 88% 87% 48% 95% 56% 90% 76% 60% 64% 72% 68% 96% 75% 72% 44% Points Received 8.8 8.7 4.8 9.5 5.6 9 7.6 6 6.4 7.2 6.8 9.6 7.5 7.2 4.4 Were key elements on Forms 7419 (Chronic Care Follow-Up Visit) and 7392 (Primary Care Flow Sheet) fi lled out completely for the 03.077 inmate’s two most recent visits? (10 points possible) Score 4% 91% 46% 74% 78% 85% 52% 85% 76% 24% 52% 60% 72% 60% 28% Points Received 0.4 9.1 4.6 7.4 7.8 8.5 5.2 8.5 7.6 2.4 5.2 6 7.2 6 2.8 03.082 Did the institution document that it provided the inmate with health care education? (12 points possible) Score 64% 74% 52% 75% 50% 100% 48% 90% 96% 60% 80% 96% 88% 44% 76% Points Received 7.7 8.9 6.2 9 6 12 5.8 10.8 11.5 7.2 9.6 11.5 10.6 5.3 9.1 Did the inmate receive his or her prescribed chronic care medications during the most recent three-month period or did the institution 03.175 follow departmental policy if the inmate refused to pick up or show up for his or her medications? (18 points possible) Score 46% 77% 50% 55% 65% 40% 4% 31% 29% 4% 48% 20% 4% 18% 8% Points Received 8.3 13.9 9 9.9 11.6 7.2 0.8 5.6 5.3 0.8 8.6 3.6 0.8 3.3 1.4 03.235 Is the clinical history adequate? (18 points possible) Score 60% 74% 36% 70% 67% 70% 48% 65% 64% 44% 60% 32% 68% 48% 32% Points Received 10.8 13.3 6.5 12.6 12 12.6 8.6 11.7 11.5 7.9 10.8 5.8 12.2 8.6 5.8 03.236 Is the focused clinical examination adequate? (19 points possible) Score 85% 96% 76% 80% 72% 70% 64% 90% 83% 72% 76% 72% 80% 68% 48% Points Received 16.2 18.2 14.4 15.2 13.7 13.3 12.2 17.1 15.8 13.7 14.4 13.7 15.2 12.9 9.1 03.237 Is the assessment adequate? (19 points possible) Score 73% 91% 40% 100% 88% 84% 72% 84% 75% 63% 44% 86% 86% 71% 59% Points Received 13.9 17.2 7.6 19 16.6 16 13.7 16 14.3 12 8.4 16.4 16.4 13.5 11.2 Is the plan adequate and consistent with the degree of control based on the chronic care program intervention and follow up requirements? 03.238 (19 points possible) Score 58% 95% 50% 90% 93% 94% 82% 89% 96% 88% 71% 85% 86% 74% 57% Points Received 11 18.1 9.5 17 17.7 17.9 15.6 16.9 18.2 16.8 13.6 16.2 16.3 14 10.9 03.262 Is the inmate’s Problem List complete and fi led accurately in the inmate’s unit health record (UHR)? (8 points possible) Score 80% 48% 28% 100% 83% 10% 84% 90% 32% 96% 60% 80% 80% 100% 64% Points Received 6.4 3.8 2.2 8 6.7 0.8 6.7 7.2 2.6 7.7 4.8 6.4 6.4 8 5.1 Total Points Received 83.4 111.1 64.9 107.6 97.7 97.3 76.2 99.8 93.2 75.7 82.2 89.2 92.6 78.8 59.8 Total Points Possible 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 Total Score 63% 84% 49% 81% 74% 73% 57% 75% 70% 57% 62% 67% 70% 59% 45% Bureau of Audits, Offi ce of the Inspector General Page 94 APPENDIX C-1:Chronic Care _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 84% 56% 60% 52% 76% 24% 24% 72% 15% 48% 42% 46% 32% 28% 48% 70% 13% 35% 58% 8.4 5.6 6 5.2 7.6 2.4 2.4 7.2 1.5 4.8 4.2 4.6 3.2 2.8 4.8 7 1.3 3.5 191.6 72% 28% 32% 8% 84% 0% 40% 52% 10% 40% 24% 54% 16% 52% 28% 25% 50% 16% 46% 7.2 2.8 3.2 0.8 8.4 0 4 5.2 1 4 2.4 5.4 1.6 5.2 2.8 2.5 5 1.6 151.8 12% 52% 68% 28% 88% 28% 68% 88% 86% 84% 68% 83% 48% 88% 72% 88% 92% 68% 70% 1.4 6.2 8.2 3.4 10.6 3.4 8.2 10.6 10.3 10.1 8.2 10 5.8 10.6 8.6 10.5 11 8.2 276.5 8% 17% 24% 16% 57% 21% 5% 32% 0% 20% 52% 63% 72% 72% 42% 25% 75% 22% 34% 1.4 3.1 4.3 2.9 10.2 3.8 0.8 5.8 0 3.6 9.4 11.3 13 13 7.5 4.5 13.5 3.9 202.1 68% 44% 58% 13% 80% 32% 72% 84% 29% 39% 48% 71% 48% 52% 32% 58% 83% 36% 54% 12.2 7.9 10.5 2.3 14.4 5.8 13 15.1 5.1 7 8.6 12.8 8.6 9.4 5.8 10.5 15 6.5 321.2 76% 60% 68% 71% 92% 64% 76% 80% 62% 80% 60% 78% 56% 84% 64% 64% 88% 62% 73% 14.4 11.4 13 13.5 17.5 12.2 14.4 15.2 11.8 15.2 11.4 14.9 10.6 16 12.1 12.1 16.6 11.8 459.2 92% 47% 68% 42% 84% 55% 96% 78% 21% 57% 58% 80% 48% 76% 74% 74% 71% 77% 70% 17.4 9 13 8 16 10.5 18.2 14.9 4 10.9 11.1 15.2 9 14.4 14 14 13.5 14.5 439.8 92% 53% 65% 53% 67% 55% 72% 64% 57% 57% 71% 94% 79% 71% 70% 68% 50% 67% 73% 17.4 10 12.4 10.1 12.7 10.4 13.7 12.1 10.9 10.7 13.5 17.9 15 13.5 13.3 13 9.5 12.7 458.5 76% 60% 96% 48% 92% 96% 28% 96% 86% 28% 96% 96% 100% 100% 88% 96% 100% 76% 76% 6.1 4.8 7.7 3.8 7.4 7.7 2.2 7.7 6.9 2.2 7.7 7.7 8 8 7 7.7 8 6.1 199.5 85.9 60.8 78.3 50 104.8 56.2 76.9 93.8 51.5 68.5 76.5 99.8 74.8 92.9 75.9 81.8 93.4 68.8 2700.1 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 4389 65% 46% 59% 38% 79% 42% 58% 71% 39% 52% 58% 75% 56% 70% 57% 62% 70% 52% 62% State of California • May 2011 Page 95 APPENDIX C-2:Clinical Services ______________________________________________________________________________________________________________________ Page 1 of 4 Component Defi nition: Evaluates the inmate’s access to primary health care services and focuses on inmates who recently received services from any of the prison’s facilities or administrative segregation unit clinics. This component evaluates sick call processes (doctor or nurse line), medication management, and nursing. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 01.024 RN FTF Documentation: Did the inmate’s request for health care get reviewed the same day it was received? (4 points possible) Score 96% 96% 93% 87% 76% 52% 90% 30% 77% 87% 92% 45% 80% 89% 40% Points Received 3.8 3.8 3.7 3.5 3 2.1 3.6 1.2 3.1 3.5 3.7 1.8 3.2 3.5 1.6 RN FTF Documentation: Did the RN complete the face-to-face (FTF) triage within one (1) business day after the Form 7362 was reviewed? 01.025 (6 points possible) Score 76% 84% 80% 76% 88% 88% 78% 65% 83% 33% 60% 80% 68% 26% 40% Points Received 4.6 5 4.8 4.6 5.3 5.3 4.7 3.9 5 2 3.6 4.8 4.1 1.5 2.4 If the RN determined a referral to a primary care provider (PCP) was necessary, was the inmate seen within the timelines specifi ed by the 01.027 RN during the FTF triage? (8 points possible) Score 29% 82% 13% 50% 79% 56% 75% 75% 35% 47% 25% 54% 71% 52% 27% Points Received 2.4 6.6 1 4 6.3 4.5 6 6 2.8 3.8 2 4.3 5.6 4.2 2.1 Sick Call Medication: Did the institution administer or deliver prescription medications (new orders) to the inmate within specifi ed time 01.124 frames? (6 points possible) Score 22% 80% 55% 77% 33% 52% 28% 13% 33% 11% 41% 10% 28% 30% 44% Points Received 1.3 4.8 3.3 4.6 2 3.1 1.7 0.8 2 0.7 2.5 0.6 1.7 1.8 2.6 01.157 RN FTF Documentation: Did the RN’s subjective note address the nature and history of the inmate’s primary complaint? (7 points possible) Score 92% 96% 83% 100% 83% 92% 93% 80% 59% 50% 64% 45% 54% 65% 57% Points Received 6.4 6.7 5.8 7 5.8 6.4 6.5 5.6 4.1 3.5 4.5 3.2 3.8 4.5 4 RN FTF Documentation: Did the RN’s assessment provide conclusions based on subjective and objective data, were the conclusions 01.158 formulated as patient problems, and did it contain applicable nursing diagnoses? (6 points possible) Score 96% 88% 79% 89% 91% 96% 83% 95% 90% 33% 68% 90% 79% 74% 61% Points Received 5.7 5.3 4.8 5.4 5.5 5.8 5 5.7 5.4 2 4.1 5.4 4.8 4.4 3.6 RN FTF Documentation: Did the RN’s objective note include vital signs and a focused physical examination, and did it adequately address 01.159 the problems noted in the subjective note? (6 points possible) Score 91% 77% 80% 90% 67% 88% 73% 80% 55% 53% 68% 90% 76% 59% 50% Points Received 5.5 4.6 4.8 5.4 4 5.3 4.4 4.8 3.3 3.2 4.1 5.4 4.6 3.5 3 RN FTF Documentation: Did the RN’s plan include an adequate strategy to address the problems identifi ed during the FTF triage? 01.162 (7 points possible) Score 92% 94% 100% 97% 96% 96% 98% 95% 100% 63% 92% 100% 96% 94% 100% Points Received 6.4 6.6 7 6.8 6.7 6.7 6.8 6.6 7 4.4 6.4 7 6.7 6.6 7 RN FTF Documentation: Did the RN’s education/instruction adequately address the problems identifi ed during the FTF triage? 01.163 (5 points possible) Score 77% 94% 90% 93% 70% 96% 85% 90% 86% 57% 80% 95% 71% 82% 64% Points Received 3.9 4.7 4.5 4.7 3.5 4.8 4.3 4.5 4.3 2.8 4 4.8 3.5 4.1 3.2 RN FTF Documentation: Did the RN’s objective note include allergies, weight, current medication, and where appropriate, medication 01.244 compliance? (3 points possible) Score 92% 94% 80% 93% 79% 80% 80% 50% 35% 33% 28% 5% 12% 65% 7% Points Received 2.8 2.8 2.4 2.8 2.4 2.4 2.4 1.5 1 1 0.8 0.2 0.4 1.9 0.2 Did documentation indicate that the RN reviewed all of the inmate’s complaints listed on Form 7362 (Health Care Services Request Form)? 01.246 (5 points possible) Score 92% 92% 87% 90% 96% 96% 88% 100% 86% 67% 64% 95% 80% 77% 93% Points Received 4.6 4.6 4.3 4.5 4.8 4.8 4.4 5 4.3 3.3 3.2 4.8 4 3.8 4.6 Bureau of Audits, Offi ce of the Inspector General Page 96 APPENDIX C-2: Clinical Services _____________________________________________________________________________________________________________________ Page 2 of 4 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 11% 80% 48% 29% 63% 60% 56% 44% 97% 93% 46% 53% 71% 82% 50% 83% 58% 80% 68% 0.5 3.2 1.9 1.1 2.5 2.4 2.2 1.8 3.9 3.7 1.8 2.1 2.9 3.3 2 3.3 2.3 3.2 89.2 34% 84% 44% 57% 80% 64% 40% 60% 70% 97% 71% 70% 71% 68% 70% 79% 98% 71% 68% 2.1 5 2.6 3.4 4.8 3.8 2.4 3.6 4.2 5.8 4.3 4.2 4.3 4.1 4.2 4.8 5.9 4.3 135.4 56% 46% 40% 25% 61% 48% 46% 77% 64% 57% 52% 53% 63% 55% 46% 57% 75% 38% 52% 4.4 3.6 3.2 2 4.9 3.8 3.7 6.2 5.1 4.6 4.2 4.2 5.1 4.4 3.7 4.6 6 3 138.3 22% 14% 65% 18% 57% 48% 7% 48% 17% 27% 27% 46% 20% 30% 73% 12% 68% 37% 36% 1.3 0.9 3.9 1.1 3.4 2.9 0.4 2.9 1 1.6 1.6 2.8 1.2 1.8 4.4 0.7 4.1 2.2 71.7 32% 79% 40% 46% 57% 54% 55% 40% 37% 50% 60% 46% 56% 39% 44% 62% 76% 68% 62% 2.2 5.5 2.8 3.2 4 3.8 3.9 2.8 2.6 3.5 4.2 3.2 3.9 2.7 3.1 4.3 5.3 4.7 143.5 27% 58% 72% 80% 93% 75% 58% 58% 73% 62% 80% 76% 56% 78% 52% 76% 64% 97% 74% 1.6 3.5 4.3 4.8 5.6 4.5 3.5 3.5 4.4 3.7 4.8 4.6 3.4 4.7 3.1 4.6 3.9 5.8 147.2 50% 79% 84% 63% 53% 63% 53% 56% 44% 47% 71% 35% 68% 39% 56% 62% 87% 65% 66% 3 4.7 5 3.8 3.2 3.8 3.2 3.4 2.7 2.8 4.2 2.1 4.1 2.3 3.3 3.7 5.2 3.9 130.3 100% 90% 92% 97% 100% 87% 73% 77% 60% 77% 80% 77% 68% 96% 71% 73% 96% 81% 88% 7 6.3 6.4 6.8 7 6.1 5.1 5.4 4.2 5.4 5.6 5.4 4.7 6.7 5 5.1 6.7 5.6 203.2 64% 63% 96% 89% 97% 57% 69% 83% 76% 43% 91% 60% 64% 83% 78% 81% 98% 90% 79% 3.2 3.2 4.8 4.4 4.8 2.8 3.5 4.1 3.8 2.2 4.6 3 3.2 4.1 3.9 4 4.9 4.5 130.6 18% 47% 80% 23% 40% 33% 43% 24% 56% 27% 44% 12% 44% 30% 48% 29% 53% 71% 47% 0.5 1.4 2.4 0.7 1.2 1 1.3 0.7 1.7 0.8 1.3 0.3 1.3 0.9 1.4 0.9 1.6 2.1 46.5 91% 90% 80% 100% 97% 88% 90% 88% 86% 80% 91% 89% 85% 100% 87% 91% 98% 94% 89% 4.5 4.5 4 5 4.8 4.4 4.5 4.4 4.3 4 4.6 4.4 4.3 5 4.3 4.5 4.9 4.7 146.1 State of California • May 2011 Page 97 APPENDIX C-2:Clinical Services ______________________________________________________________________________________________________________________ Page 3 of 4 Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number Sick Call Follow-up: If the provider ordered a follow-up sick call appointment, did it take place within the time frame specifi ed? 01.247 (7 points possible) Score 25% 78% 22% 100% 60% 67% 67% 0% 20% 36% 57% 88% 56% 63% 50% Points Received 1.8 5.4 1.6 7 4.2 4.7 4.7 0 1.4 2.5 4 6.1 3.9 4.4 3.5 15.234 Are clinic response bags audited daily and do they contain essential items? (5 points possible) Score 0% 100% 50% 0% 0% 50% 0% 100% 50% 100% 50% 100% 100% 100% 50% Points Received 0 5 2.5 0 0 2.5 0 5 2.5 5 2.5 5 5 5 2.5 For inmates seen in the TTA, was there adequate prior management of pre-existing medical conditions related to the reason for the TTA 21.278 visit? (20 points possible) Score 73% 83% 67% 80% 79% 60% 81% 85% 80% 33% 46% 67% 36% 60% 41% Points Received 14.5 16.7 13.3 16 15.7 12 16.3 16.9 16 6.7 9.1 13.3 7.3 12 8.2 Total Points Received 63.6 82.7 63.9 76.1 69.2 70.4 70.4 67.5 62.2 44.4 54.5 66.7 58.6 61.2 48.5 Total Points Possible 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 Total Score 67% 87% 67% 80% 73% 74% 74% 71% 66% 47% 57% 70% 62% 64% 51% Bureau of Audits, Offi ce of the Inspector General Page 98 APPENDIX C-2: Clinical Services _____________________________________________________________________________________________________________________ Page 4 of 4 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 50% 67% 100% 50% 100% 38% 55% 75% 83% 100% 67% 100% 40% 100% 50% 100% 60% 63% 3.5 4.7 7 3.5 7 2.6 3.8 5.3 5.8 7 4.7 7 2.8 7 3.5 7 4.2 141.6 50% 100% 50% 33% 100% 100% 100% 100% 100% 50% 100% 0% 100% 100% 100% 100% 0% 100% 68% 2.5 5 2.5 1.7 5 5 5 5 5 2.5 5 0 5 5 5 5 0 5 111.7 40% 56% 50% 67% 69% 50% 54% 67% 46% 50% 68% 69% 50% 67% 56% 89% 50% 86% 62% 8 11.1 10 13.3 13.8 10 10.8 13.3 9.1 10 13.7 13.8 10 13.3 11.1 17.8 10 17.1 410.2 44.3 62.6 60.8 54.8 72 56.9 53.3 62.4 57.8 57.6 64.6 57.1 56.2 65.3 58 70.3 60.8 70.3 2045 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 88 95 3128 47% 66% 64% 58% 76% 60% 56% 66% 61% 61% 68% 60% 59% 69% 61% 74% 69% 74% 65% State of California • May 2011 Page 99 APPENDIX C-3: Health Screening ______________________________________________________________________________________________________________________ Page 1 of 4 Component Defi nition: 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. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number Non-reception center: Does the health care transfer information form indicate that it was reviewed and signed by licensed health care staff 02.007 within one calendar day of the inmate’s arrival at the institution? (7 points possible) Score 100% 93% 64% 90% 85% 75% 88% 95% 95% 100% 95% 85% Points Received 7 6.5 4.5 6.3 6 5.3 6.1 6.6 6.6 7 6.6 6 Non-reception center: If the inmate was scheduled for a specialty appointment at the sending institution, did the receiving institution 02.014 schedule the appointment within 30 days of the original appointment date? (7 points possible) Score 100% 0% 100% 100% 100% Points Received 7 0 7 7 7 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? (7 points possible) Score 100% 100% 100% 67% 75% 83% 100% 33% 100% Points Received 7 7 7 4.7 5.3 5.8 7 2.3 7 02.016 Did the institution complete the initial health screening on the same day the inmate arrived at the institution? (9 points possible) Score 100% 100% 97% 100% 100% 100% 100% 100% 90% 65% 77% 95% 95% 90% 93% Points Received 9 9 8.7 9 9 9 9 9 8.1 5.9 6.9 8.6 8.6 8.1 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 02.017 the date of arrival? (8 points possible) Score 100% 56% 94% 93% 100% 100% 100% 29% 46% 70% 100% 100% 87% 100% 100% Points Received 8 4.4 7.6 7.5 8 8 8 2.3 3.7 5.6 8 8 6.9 8 8 02.018 If, during the assessment, the RN referred the inmate to a clinician, was the inmate seen within the time frame? (8 points possible) Score 25% 100% 13% 60% 50% 86% 100% 29% 0% 71% 33% 11% 55% 17% Points Received 2 8 1 4.8 4 6.9 8 2.3 0 5.7 2.7 0.9 4.4 1.3 Did the LVN/RN adequately document the tuberculin test or a review of signs and symptoms if the inmate had a previous positive tuberculin 02.020 test? (6 points possible) Score 90% 70% 87% 90% 100% 100% 85% 95% 100% 85% 80% 100% 90% 85% 97% Points Received 5.4 4.2 5.2 5.4 6 6 5.1 5.7 6 5.1 4.8 6 5.4 5.1 5.8 Reception center: Did the inmate receive a complete history and physical by a Nurse Practitioner, Physician Assistant, or a Physician and 02.021 Surgeon within 14 calendar days of arrival? (5 points possible) Score 56% 55% 55% 50% 100% 40% 100% Points Received 2.8 2.8 2.8 2.5 5 2 5 Reception center: If the primary care provider (PCP) indicated the inmate required a special diet, did the PCP refer the inmate to a registered 02.022 dietician? (4 points possible) Score 0% Points Received 0 02.111 Non-reception center: Did the inmate receive medical accommodations upon arrival, if applicable? (6 points possible) Score 67% 100% 75% 33% 100% 75% 100% 100% 75% 100% 100% Points Received 4 6 4.5 2 6 4.5 6 6 4.5 6 6 If the inmate had an existing medication order upon arrival at the institution, did the inmate receive the medications by the next calendar day, 02.128 or did a physician explain why the medications were not to be continued? (8 points possible) Score 33% 88% 50% 50% 0% 43% 13% 25% 42% 0% 43% 23% 0% 30% 35% Points Received 2.7 7 4 4 0 3.4 1 2 3.3 0 3.4 1.8 0 2.4 2.8 Reception center history and physical: Is the “History of Present Illness” section of Form 7206 (History and Physical Examination) complete 02.211 and appropriate to the chief complaint(s), if any? (2 points possible) Score 75% 92% 100% 40% 89% 82% 60% Points Received 1.5 1.8 2 0.8 1.8 1.6 1.2 Bureau of Audits, Offi ce of the Inspector General Page 100 APPENDIX C-3: Health Screening _____________________________________________________________________________________________________________________ Page 2 of 4 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 100% 100% 100% 94% 100% 95% 100% 95% 90% 100% 75% 84% 95% 90% 85% 91% 7 7 7 6.6 7 6.7 7 6.7 6.3 7 5.3 5.9 6.6 6.3 6 172.9 100% 50% 0% 0% 100% 100% 68% 7 3.5 0 0 7 7 52.5 100% 100% 0% 100% 100% 0% 100% 100% 100% 100% 100% 100% 84% 7 7 0 7 7 0 7 7 7 7 7 7 123.1 90% 85% 100% 100% 100% 100% 100% 100% 100% 95% 100% 100% 100% 95% 100% 100% 95% 100% 96% 8.1 7.7 9 9 9 9 9 9 9 8.6 9 9 9 8.6 9 9 8.6 9 284.9 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 96% 75% 100% 92% 8 8 8 8 8 8 8 8 8 8 8 8 8 8 7.6 6 8 235.6 61% 40% 100% 18% 100% 85% 6% 100% 57% 55% 38% 78% 0% 40% 36% 74% 60% 100% 53% 4.9 3.2 8 1.5 8 6.8 0.5 8 4.6 4.4 3 6.2 0 3.2 2.9 5.9 4.8 8 135.9 96% 100% 100% 100% 100% 95% 100% 100% 100% 85% 95% 90% 100% 85% 85% 90% 100% 100% 93% 5.8 6 6 6 6 5.7 6 6 6 5.1 5.7 5.4 6 5.1 5.1 5.4 6 6 184.5 95% 100% 65% 75% 90% 74% 4.8 5 3.3 3.8 4.5 44.3 0% 0 50% 100% 100% 50% 100% 100% 100% 100% 50% 100% 100% 100% 100% 86% 3 6 6 3 6 6 6 6 3 6 6 6 6 124.5 24% 17% 0% 0% 60% 36% 20% 33% 40% 75% 11% 0% 14% 50% 86% 46% 83% 25% 33% 1.9 1.3 0 0 4.8 2.9 1.6 2.7 3.2 6 0.9 0 1.1 4 6.9 3.6 6.7 2 87.4 43% 85% 60% 86% 74% 0.9 1.7 1.2 1.7 16.2 State of California • May 2011 Page 101 APPENDIX C-3: Health Screening ______________________________________________________________________________________________________________________ Page 3 of 4 Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number Reception center history and physical: Are the “Past History” and “Past Medical History” sections of Form 7206 (History and Physical 02.212 Examination) complete? (2 points possible) Score 88% 60% 100% 85% 100% 90% 90% Points Received 1.8 1.2 2 1.7 2 1.8 1.8 Reception center history and physical: Is the “Family and Social History” section of Form 7206 (History and Physical Examination) 02.213 complete? (2 points possible) Score 100% 100% 100% 75% 100% 75% 80% Points Received 2 2 2 1.5 2 1.5 1.6 Reception center history and physical: Is the “Review Systems” section of Form 7206 (History and Physical Examination) complete? 02.215 (2 points possible) Score 0% 100% 70% 80% 20% 0% Points Received 0 2 1.4 1.6 0.4 0 Reception center history and physical: Is the “Physical Examination” section of Form 7206 (History and Physical Examination) complete and 02.216 appropriate to the history and review of systems? (2 points possible) Score 75% 95% 100% 100% 100% 85% 60% Points Received 1.5 1.9 2 2 2 1.7 1.2 Reception center history and physical: Is the “Diagnosis/Impression” section of Form 7206 (History and Physical Examination) appropriate 02.217 to the history and physical examination? (2 points possible) Score 88% 95% 90% 100% 100% 89% 56% Points Received 1.8 1.9 1.8 2 2 1.8 1.1 Reception center history and physical: Is the “Plan of Action” section of Form 7206 (History and Physical Examination) appropriate to the 02.218 “Diagnosis/Impression” section of the form? (2 points possible) Score 100% 85% 100% 100% 100% 100% 67% Points Received 2 1.7 2 2 2 2 1.3 02.219 Reception center history and physical: Has required intake testing been ordered? (4 points possible) Score 70% 50% 100% 95% 90% 100% 20% Points Received 2.8 2 4 3.8 3.6 4 0.8 Total Points Received 45.1 45.1 58.5 45.9 51.3 56.5 48.3 32.4 56.4 34.9 69.7 43.8 37.7 47.6 59.3 Total Points Possible 59 52 86 59 69 67 66 53 82 52 89 59 54 59 82 Total Score 76% 87% 68% 78% 74% 84% 73% 61% 69% 67% 78% 74% 70% 81% 72% Bureau of Audits, Offi ce of the Inspector General Page 102 APPENDIX C-3: Health Screening _____________________________________________________________________________________________________________________ Page 4 of 4 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 80% 90% 100% 95% 89% 1.6 1.8 2 1.9 19.6 65% 90% 75% 100% 87% 1.3 1.8 1.5 2 19.2 80% 5% 90% 95% 54% 1.6 0.1 1.8 1.9 10.8 90% 95% 95% 80% 89% 1.8 1.9 1.9 1.6 19.5 68% 100% 94% 95% 89% 1.4 2 1.9 1.9 19.6 78% 95% 85% 80% 90% 1.6 1.9 1.7 1.6 19.8 85% 85% 100% 75% 84% 80% 3.4 3.4 4 3 3.4 38.2 45.9 53.2 49.6 44.5 52.4 45.4 37.8 59.2 54.3 44.8 42.9 41.6 42.4 47.8 38.5 76.6 45.1 53.5 1608 60 66 69 59 59 59 52 69 66 59 59 52 66 59 46 89 53 62 2092 77% 81% 72% 75% 89% 77% 73% 86% 82% 76% 73% 80% 64% 81% 84% 86% 85% 86% 77% State of California • May 2011 Page 103 APPENDIX C-4: Specialty Services ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: 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 cardiology services, physical therapy, oncology services, podiatry consultations, and neurology services. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 07.035 Did the inmate receive the specialty service within specifi ed time frames? (9 points possible) Score 47% 35% 59% 59% 59% 94% 59% 77% 65% 69% 41% 29% 88% 77% 47% Points Received 4.2 3.2 5.3 5.3 5.3 8.5 5.3 6.9 5.8 6.2 3.7 2.6 7.9 6.9 4.2 07.037 Did the institution approve or deny the PCP’s request for specialty services within the specifi ed time frames? (8 points possible) Score 46% 46% 100% 64% 55% 70% 91% 64% 91% 86% 77% 50% 79% 73% 96% Points Received 3.6 3.6 8 5.1 4.4 5.6 7.3 5.1 7.3 6.9 6.2 4 6.3 5.8 7.6 Did the PCP see the inmate between the date the PCP ordered the service and the date the inmate received it, in accordance with specifi ed 07.038 time frames? (8 points possible) Score 8% 31% 25% 15% 9% 0% 23% 36% 29% 8% 29% 7% 38% 33% 7% Points Received 0.6 2.5 2 1.2 0.7 0 1.8 2.9 2.3 0.7 2.4 0.5 3 2.7 0.5 Did the PCP review the consultant’s report and see the inmate for a follow-up appointment after the specialty services consultation within 07.043 specifi ed time frames? (9 points possible) Score 22% 29% 19% 41% 8% 18% 13% 25% 36% 36% 47% 38% 23% 73% 0% Points Received 2 2.6 1.7 3.7 0.7 1.6 1.1 2.3 3.2 3.2 4.2 3.4 2.1 6.5 0 Physical therapy services: Did the physical therapist assess the inmate and document the treatment plan and treatment provided to the 07.090 inmate? (8 points possible) Score 100% 67% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 8 5.3 8 8 8 8 8 8 8 8 8 8 8 8 8 07.259 Was there adequate documentation of the reason for the denial of specialty services? (5 points possible) Score 60% 80% 100% 80% 60% 33% 40% 100% 75% 60% 60% 80% 50% 100% 40% Points Received 3 4 5 4 3 1.7 2 5 3.8 3 3 4 2.5 5 2 Was the institution’s denial of the PCP’s request for specialty services consistent with the “medical necessity” requirement? 07.260 (9 points possible) Score 100% 60% 100% 100% 75% 67% 100% 80% 100% 100% 80% 100% 100% 80% 60% Points Received 9 5.4 9 9 6.8 6 9 7.2 9 9 7.2 9 9 7.2 5.4 07.261 Is the institution scheduling high-priority (urgent) specialty services within 14 days? (9 points possible) Score 0% 0% 0% 0% 50% 0% 50% 100% 50% 0% 0% 50% 0% 50% 50% Points Received 0 0 0 0 4.5 0 4.5 9 4.5 0 0 4.5 0 4.5 4.5 Did the specialty provider provide timely fi ndings and recommendations or did an RN document that he or she called the specialty provider 07.270 to ascertain the fi ndings and recommendations? (6 points possible) Score 53% 59% 88% 100% 77% 100% 100% 94% 100% 100% 100% 100% 100% 100% 94% Points Received 3.2 3.5 5.3 6 4.6 6 6 5.6 6 6 6 6 6 6 5.6 Total Points Received 33.7 30.2 44.2 42.3 37.9 37.4 45 51.9 49.9 43 40.7 42 44.8 52.6 37.8 Total Points Possible 71 71 71 71 71 71 71 71 71 71 71 71 71 71 71 Total Score 47% 43% 62% 60% 53% 53% 63% 73% 70% 61% 57% 59% 63% 74% 53% Bureau of Audits, Offi ce of the Inspector General Page 104 APPENDIX C-4: Specialty Services _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 65% 88% 65% 82% 100% 41% 56% 100% 94% 88% 71% 88% 59% 93% 77% 94% 94% 77% 71% 5.8 7.9 5.8 7.4 9 3.7 5.1 9 8.5 7.9 6.4 7.9 5.3 8.4 6.9 8.5 8.5 6.9 210.2 91% 82% 77% 82% 96% 86% 95% 59% 73% 77% 41% 43% 46% 68% 65% 96% 96% 68% 73% 7.3 6.5 6.2 6.5 7.6 6.9 7.6 4.7 5.8 6.2 3.3 3.4 3.6 5.5 5.2 7.6 7.6 5.5 193.8 0% 56% 17% 20% 67% 22% 17% 25% 33% 75% 25% 100% 50% 67% 100% 32% 0 4.4 1.3 1.6 5.3 1.8 1.3 2 2.7 6 2 8 4 5.3 8 77.5 23% 42% 31% 25% 73% 80% 60% 25% 62% 64% 27% 43% 14% 27% 54% 64% 80% 50% 39% 2.1 3.8 2.8 2.3 6.6 7.2 5.4 2.3 5.5 5.8 2.5 3.9 1.3 2.5 4.8 5.7 7.2 4.5 114.5 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99% 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 261.3 60% 20% 80% 60% 0% 80% 33% 60% 80% 100% 20% 80% 100% 100% 67% 100% 100% 60% 67% 3 1 4 3 0 4 1.7 3 4 5 1 4 5 5 3.3 5 5 3 111 100% 40% 100% 100% 60% 100% 100% 75% 100% 80% 60% 80% 80% 100% 67% 80% 100% 67% 85% 9 3.6 9 9 5.4 9 9 6.8 9 7.2 5.4 7.2 7.2 9 6 7.2 9 6 251.2 0% 100% 0% 0% 100% 0% 0% 100% 100% 100% 50% 50% 100% 50% 50% 50% 100% 50% 42% 0 9 0 0 9 0 0 9 9 9 4.5 4.5 9 4.5 4.5 4.5 9 4.5 126 100% 100% 100% 100% 100% 100% 94% 100% 100% 100% 100% 100% 93% 94% 100% 100% 100% 100% 95% 6 6 6 6 6 6 5.6 6 6 6 6 6 5.6 5.6 6 6 6 6 188.6 41.2 50.2 43.1 43.8 56.9 46.6 43.7 50.8 58.5 61.1 39.1 52.9 49 53.8 44.7 52.5 68.3 44.4 1534 71 71 71 71 71 71 71 71 71 71 71 71 71 71 63 63 71 63 2319 58% 71% 61% 62% 80% 66% 62% 72% 82% 86% 55% 75% 69% 76% 71% 83% 96% 71% 66% State of California • May 2011 Page 105 APPENDIX C-5: Urgent Services ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: Addresses the care provided by the institution to inmates before and after they were sent to a community hospital. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number Upon the inmate’s discharge from the community hospital, did the triage and treatment area (TTA) registered nurse document that he or she 21.248 reviewed the inmate’s discharge plan and completed a face-to-face assessment of the inmate? (7 points possible) Score 79% 90% 65% 75% 88% 92% 84% 100% 96% 88% 92% 100% 84% 92% 32% Points Received 5.5 6.3 4.6 5.3 6.2 6.4 5.9 7 6.7 6.2 6.4 7 5.9 6.4 2.2 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 fi ve calendar days of discharge? (7 points possible) Score 60% 85% 24% 65% 64% 52% 88% 92% 40% 58% 48% 84% 56% 52% 48% Points Received 4.2 6 1.7 4.6 4.5 3.6 6.1 6.4 2.8 4.1 3.3 5.9 3.9 3.6 3.4 Upon the inmate’s discharge from the community hospital, did the inmate’s Primary Care Provider (PCP) provide orders for appropriate 21.250 housing for the inmate? (7 points possible) Score 73% 80% 50% 100% 96% 100% 100% 100% 100% 96% 100% 96% 96% 100% 100% Points Received 5.1 5.6 3.5 7 6.7 7 7 7 7 6.7 7 6.7 6.7 7 7 Upon the inmate’s discharge from the community hospital, did the Registered Nurse intervene if the inmate was housed in an area that was 21.251 inappropriate for nursing care based on the primary care provider’s (PCP) housing orders? (7 points possible) Score 100% 0% 100% 0% 100% 100% Points Received 7 0 7 0 7 7 21.275 Was the documentation of the clinical care provided in the TTA adequate? (10 points possible) Score 65% 95% 83% 72% 92% 84% 76% 80% 88% 80% 76% 60% 64% 64% 96% Points Received 6.5 9.5 8.3 7.2 9.2 8.4 7.6 8 8.8 8 7.6 6 6.4 6.4 9.6 21.276 While the patient was in the TTA, was the clinical care rendered by the attending provider adequate and timely? (7 points possible) Score 91% 100% 95% 91% 92% 100% 91% 100% 87% 96% 95% 83% 81% 64% 63% Points Received 6.4 7 6.7 6.3 6.4 7 6.4 7 6.1 6.7 6.7 5.8 5.7 4.5 4.4 21.279 For patients managed by telephone consultation alone, was the provider’s decision not to come to the TTA appropriate? (8 points possible) Score 100% 100% 83% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 8 8 6.7 8 8 8 8 8 8 8 8 8 8 Upon the inmate’s discharge from a community hospital, did the institution administer or deliver all prescribed medications to the inmate 21.281 within specifi ed time frames? (6 points possible) Score 100% 100% 58% 79% 79% 88% 64% 48% 38% 13% 67% 47% 44% 10% 47% Points Received 6 6 3.5 4.7 4.7 5.3 3.8 2.9 2.3 0.8 4 2.8 2.6 0.6 2.8 Total Points Received 48.7 40.4 43.2 41.7 45.7 52.8 36.8 46.3 41.7 47.5 43 42.2 39.2 36.5 37.4 Total Points Possible 59 51 59 52 59 59 44 52 52 59 52 52 52 52 52 Total Score 83% 79% 73% 80% 78% 89% 84% 89% 80% 81% 83% 81% 75% 70% 72% Bureau of Audits, Offi ce of the Inspector General Page 106 APPENDIX C-5: Urgent Services _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 52% 88% 100% 72% 92% 88% 92% 100% 92% 96% 96% 96% 88% 96% 100% 96% 96% 88% 87% 3.6 6.2 7 5 6.4 6.2 6.4 7 6.4 6.7 6.7 6.7 6.2 6.7 7 6.7 6.7 6.2 201.8 48% 82% 63% 57% 100% 40% 56% 68% 24% 72% 72% 80% 71% 42% 80% 76% 84% 78% 64% 3.4 5.8 4.4 4 7 2.8 3.9 4.8 1.7 5 5 5.6 5 2.9 5.6 5.3 5.9 5.5 147.7 72% 100% 88% 100% 100% 92% 91% 92% 92% 92% 100% 100% 92% 96% 100% 96% 96% 96% 93% 5 7 6.1 7 7 6.4 6.4 6.4 6.4 6.4 7 7 6.4 6.7 7 6.7 6.7 6.7 215.3 100% 0% 63% 7 0 35 68% 88% 76% 40% 80% 75% 79% 60% 80% 64% 68% 88% 68% 68% 68% 75% 92% 80% 76% 6.8 8.8 7.6 4 8 7.5 7.9 6 8 6.4 6.8 8.8 6.8 6.8 6.8 7.5 9.2 8 249.2 79% 67% 87% 62% 76% 67% 82% 62% 75% 86% 68% 92% 77% 67% 77% 74% 79% 92% 82% 5.5 4.7 6.1 4.3 5.3 4.7 5.7 4.3 5.3 6 4.8 6.4 5.4 4.7 5.4 5.2 5.5 6.4 188.8 100% 100% 100% 92% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99% 8 8 8 7.4 8 8 8 8 8 8 8 8 8 8 8 8 8 238.1 7% 50% 39% 0% 50% 17% 13% 50% 11% 33% 50% 57% 18% 50% 64% 33% 100% 59% 48% 0.4 3 2.3 0 3 1 0.8 3 0.7 2 3 3.4 1.1 3 3.8 2 6 3.5 94.8 32.7 43.5 41.5 31.7 51.7 36.6 39.1 39.5 36.5 40.5 33.3 45.9 38.9 38.8 43.6 41.4 48 44.3 1370.6 52 52 52 52 59 52 52 59 52 52 44 52 52 52 52 52 52 52 1748 63% 84% 80% 61% 88% 70% 75% 67% 70% 78% 76% 88% 75% 75% 84% 80% 92% 85% 78% State of California • May 2011 Page 107 APPENDIX C-6: Emergency Services ______________________________________________________________________________________________________________________ Page 1 of 4 Component Defi nition: Examines how well the prison responded to medical emergencies. Specifi cally, 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. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 08.183 Was the medical emergency responder notifi ed of the medical emergency without delay? (5 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 80% 100% 100% Points Received 5 5 5 5 5 5 5 5 5 5 5 4 5 5 Did the medical emergency responder arrive at the location of the medical emergency within fi ve (5) minutes of initial notifi cation? 08.184 (4 points possible) Score 100% 100% 80% 100% 100% 67% 100% 100% 100% 75% 50% 100% 100% 100% Points Received 4 4 3.2 4 4 2.7 4 4 4 3 2 4 4 4 Did the medical emergency responder use proper equipment to address the emergency and was adequate medical care provided within the 08.185 scope of his or her license? (7 points possible) Score 50% 100% 100% 100% 80% 100% 80% 100% 100% 100% 100% 100% 75% 75% Points Received 3.5 7 7 7 5.6 7 5.6 7 7 7 7 7 5.3 5.3 Were both the fi rst responder (if peace offi cer or licensed health care staff) and the medical emergency responder basic life support (BLS) 08.186 certifi ed at the time of the incident? (4 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 4 08.187 Did the institution provide adequate preparation for the ambulance’s arrival, access to the inmate, and departure? (4 points possible) Score 50% 100% 100% 100% 100% 80% 100% 100% 100% 100% 67% 60% 0% 67% Points Received 2 4 4 4 4 3.2 4 4 4 4 2.7 2.4 0 2.7 Were the fi ndings of the institution’s Emergency Medical Response Review Committee (EMRRC) supported by the documentation and 08.222 completed within 30 days? (7 points possible) Score 50% 0% 100% 0% 0% 40% 0% 0% 0% 0% 0% 25% 50% 25% Points Received 3.5 0 7 0 0 2.8 0 0 0 0 0 1.8 3.5 1.8 08.241 Did the fi rst responder provide adequate basic life support (BLS) prior to medical staff arriving? (6 points possible) Score 0% 40% 80% 50% 100% 100% 100% 50% 100% 100% 100% 67% 100% 100% Points Received 0 2.4 4.8 3 6 6 6 3 6 6 6 4 6 6 Did licensed health care staff call 911 without unnecessary delay after a life-threatening condition was identifi ed by a licensed health care 08.242 provider or peace offi cer? (6 points possible) Score 50% 100% 100% 100% 60% 80% 100% 100% 75% 100% 75% 60% 75% 100% Points Received 3 6 6 6 3.6 4.8 6 6 4.5 6 4.5 3.6 4.5 6 Emergency Medical Response Drill: Did the responding offi cer activate the emergency response system by providing the pertinent 15.240 information to the relevant parties, immediately and without delay? (2 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Emergency Medical Response Drill: Did the responding offi cer carry and use the proper equipment (protective shield or micro-mask, 15.255 gloves) required by the department? (1 point possible) Score 0% 0% 100% 0% 0% 100% 0% 100% 100% 0% 100% 0% 100% 0% Points Received 0 0 1 0 0 1 0 1 1 0 1 0 1 0 Emergency Medical Response Drill: Did the responding offi cer properly perform an assessment on the patient for responsiveness? 15.256 (1 point possible) Score 0% 0% 100% 100% 0% 100% 0% 100% 100% 100% 100% 100% 100% 100% Points Received 0 0 1 1 0 1 0 1 1 1 1 1 1 1 15.257 Emergency Medical Response Drill: Did the responding offi cer properly perform CPR? (2 points possible) Score 0% 100% 0% 0% 0% 100% 100% 100% 100% 100% 0% 0% 0% Points Received 0 2 0 0 0 2 2 2 2 2 0 0 0 Bureau of Audits, Offi ce of the Inspector General Page 108 APPENDIX C-6: Emergency Services _____________________________________________________________________________________________________________________ Page 2 of 4 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 100% 100% 100% 80% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99% 5 5 5 4 5 5 5 5 5 5 5 5 5 5 5 5 5 5 158 80% 100% 100% 80% 100% 100% 100% 100% 75% 100% 100% 75% 100% 67% 100% 100% 100% 80% 92% 3.2 4 4 3.2 4 4 4 4 3 4 4 3 4 2.7 4 4 4 3.2 117.2 100% 100% 67% 60% 100% 100% 60% 80% 100% 0% 100% 100% 100% 40% 100% 100% 100% 80% 86% 7 7 4.7 4.2 7 7 4.2 5.6 7 0 7 7 7 2.8 7 7 7 5.6 192.4 100% 0% 100% 100% 100% 100% 80% 100% 100% 100% 75% 100% 100% 100% 100% 100% 100% 100% 95% 4 0 4 4 4 4 3.2 4 4 4 3 4 4 4 4 4 4 4 122.2 100% 100% 50% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 75% 100% 100% 80% 87% 4 4 2 4 2 4 4 4 4 4 4 4 4 4 3 4 4 3.2 111.2 0% 100% 33% 0% 50% 40% 20% 40% 0% 0% 20% 25% 0% 0% 0% 25% 0% 20% 21% 0 7 2.3 0 3.5 2.8 1.4 2.8 0 0 1.4 1.8 0 0 0 1.8 0 1.4 46.6 60% 100% 100% 80% 50% 100% 50% 100% 100% 100% 100% 100% 80% 100% 100% 100% 100% 84% 3.6 6 6 4.8 3 6 3 6 6 6 6 6 4.8 6 6 6 6 156.4 60% 100% 67% 80% 100% 100% 80% 100% 0% 100% 75% 100% 60% 100% 100% 67% 80% 82% 3.6 6 4 4.8 6 6 4.8 6 0 6 4.5 6 3.6 6 6 4 4.8 152.6 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 64 100% 100% 100% 100% 0% 0% 0% 100% 100% 100% 100% 100% 0% 100% 0% 100% 100% 0% 56% 1 1 1 1 0 0 0 1 1 1 1 1 0 1 0 1 1 0 18 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 81% 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 25 100% 0% 100% 0% 100% 0% 100% 100% 100% 100% 0% 100% 0% 0% 52% 2 0 2 0 2 0 2 2 2 2 0 2 0 0 28 State of California • May 2011 Page 109 APPENDIX C-6: Emergency Services ______________________________________________________________________________________________________________________ Page 3 of 4 Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 15.258 Emergency Medical Response Drill: Did the responding offi cer begin CPR without unnecessary delay? (2 points possible) Score 0% 0% 100% 100% 100% 100% 0% 100% 100% 100% 0% 100% 100% 0% Points Received 0 0 2 2 2 2 0 2 2 2 0 2 2 0 15.282 Emergency Medical Response Drill: Did medical staff arrive on scene in fi ve minutes or less? (2 points possible) Score 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% Points Received 0 2 2 2 2 2 2 2 2 2 2 2 0 Emergency Medical Response Drill: Did the emergency medical responders arrive with proper equipment (ER bag, bag-valve-mask, AED)? 15.283 (1 point possible) Score 0% 100% 100% 0% 100% 100% 100% 100% 100% 0% 100% 100% 100% Points Received 0 1 1 0 1 1 1 1 1 0 1 1 1 15.284 Emergency Medical Response Drill: Did the responding offi cer provide accurate information to responding medical staff? (1 point possible) Score 0% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% Points Received 0 0 1 1 1 1 1 1 1 1 1 1 0 15.285 Emergency Medical Response Drill: Did emergency medical responders continue basic life support? (1 point possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 1 1 1 1 1 1 1 1 1 1 1 1 1 Emergency Medical Response Drill: Did medical staff continue with CPR without transporting the patient until the arrival of ambulance 15.286 personnel? If the patient was transported, was this decision justifi ed? (1 point possible) Score 0% Points Received 0 15.287 Emergency Medical Response Drill: Was 911 called without unnecessary delay? (2 points possible) Score 0% 0% 0% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% Points Received 0 0 0 2 2 2 2 0 2 2 2 2 2 Total Points Received 28 40.4 52 33 41.2 46.5 49.6 44 44.5 48 45.2 40.8 12 45.3 41.8 Total Points Possible 59 56 58 43 58 58 58 58 53 58 58 56 15 58 58 Total Score 48% 72% 90% 77% 71% 80% 86% 76% 84% 83% 78% 73% 80% 78% 72% Bureau of Audits, Offi ce of the Inspector General Page 110 APPENDIX C-6: Emergency Services _____________________________________________________________________________________________________________________ Page 4 of 4 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 0% 76% 2 2 2 2 2 0 2 2 2 2 2 2 2 2 0 44 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 94% 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 58 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 87% 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 27 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 90% 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 28 100% 100% 100% 100% 100% 100% 0% 0% 100% 100% 100% 100% 0% 0% 100% 100% 100% 87% 1 1 1 1 1 1 0 0 1 1 1 1 0 0 1 1 1 26 0% 0 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 0% 100% 100% 100% 100% 79% 2 2 2 2 2 2 0 2 2 2 2 0 2 2 2 2 46 45.4 52 47 41 48.5 47.8 37.6 49.4 41 38 49.4 44.3 47 33.9 48 48.8 47 42.2 1420.6 58 58 58 57 58 58 54 56 56 52 56 52 58 53 58 54 58 58 1816 78% 90% 81% 72% 84% 82% 70% 88% 73% 73% 88% 85% 81% 64% 83% 90% 81% 73% 78% State of California • May 2011 Page 111 APPENDIX C-7: Prenatal Care/Childbirth/Post-Delivery ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: Focuses on the prenatal and post-delivery medical care provided to pregnant inmates. This component is not applicable at men’s institutions. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 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? (5 points possible) Score 0% Points Received 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? (5 points possible) Score 100% Points Received 5 Was the pregnant inmate issued a Form 7410 (Comprehensive Accommodation Chrono) for a lower bunk and lower-tier housing if housed 09.068 in a multi-tiered housing unit? (5 points possible) Score 43% Points Received 2.1 09.069 Did medical staff promptly order extra daily nutritional supplements and food for the inmate? (5 points possible) Score 86% Points Received 4.3 09.071 Did the inmate visit with an OB physician according to the applicable time frames? (8 points possible) Score 86% Points Received 6.9 Did the “Problems/Risks Identifi ed” section of the Briggs Form 5703N (Prenatal Flow Record) corroborate the “Prenatal Screens” and the 09.072 “Maternal Physical” examination sections? (7 points possible) Score 0% Points Received 0 09.074 Did the inmate receive her six-week check-up (post-delivery)? (7 points possible) Score 80% Points Received 5.6 09.223 Were the results of the inmate’s specifi ed prenatal screening tests documented on Form 5703N? (5 points possible) Score 86% Points Received 4.3 09.224 Was the inmate’s weight and blood pressure documented at each clinic visit? (6 points possible) Score 71% Points Received 4.3 Total Points Received 32.5 Total Points Possible 53 Total Score 61% Bureau of Audits, Offi ce of the Inspector General Page 112 APPENDIX C-7: Prenatal Care/Childbirth/Post-Delivery _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 50% 25% 2.5 2.5 100% 100% 5 10 100% 71% 5 7.1 100% 93% 5 9.3 100% 93% 8 14.9 0% 0% 0 0 100% 90% 7 12.6 86% 86% 4.3 8.6 100% 86% 6 10.3 42.8 75.3 53 106 81% 71% State of California • May 2011 Page 113 APPENDIX C-8: Diagnostic Services ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: Addresses the timeliness of radiology (x-ray) and laboratory services and whether the prison followed up on clinically signifi cant results. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 06.049 Radiology order: Was the radiology service provided within the time frame specifi ed in the physician’s order? (7 points possible) Score 100% 80% 100% 100% 20% 100% 80% 100% 100% 80% 80% 0% 100% 60% 60% Points Received 7 5.6 7 7 1.4 7 5.6 7 7 5.6 5.6 0 7 4.2 4.2 06.188 All laboratory orders: Was the specimen collected within the applicable time frames of the physician’s order? (6 points possible) Score 90% 90% 50% 60% 80% 70% 80% 100% 90% 70% 40% 90% 50% 70% 30% Points Received 5.4 5.4 3 3.6 4.8 4.2 4.8 6 5.4 4.2 2.4 5.4 3 4.2 1.8 All diagnostic services: Did the PCP document the clinically signifi cant diagnostic test results on Form 7230 (Interdisciplinary Progress 06.191 Notes)? (7 points possible) Score 78% 87% 58% 88% 75% 80% 70% 56% 14% 73% 67% 64% 69% 87% 62% Points Received 5.4 6.1 4.1 6.1 5.3 5.6 4.9 3.9 1 5.1 4.7 4.5 4.8 6.1 4.3 Radiology order: Did the primary care provider (PCP) review the diagnostic report and initiate written notice to the inmate within two (2) 06.200 business days of the date the institution received the diagnostic reports? (7 points possible) Score 0% 20% 0% 100% 100% 100% 20% 100% 0% 0% 0% 20% 20% 80% 20% Points Received 0 1.4 0 7 7 7 1.4 7 0 0 0 1.4 1.4 5.6 1.4 All laboratory orders: Did the PCP review the diagnostic reports and initiate written notice to the inmate within two (2) business days of the 06.202 date the institution received the diagnostic reports? (7 points possible) Score 30% 50% 60% 50% 60% 40% 50% 70% 0% 10% 10% 40% 60% 100% 0% Points Received 2.1 3.5 4.2 3.5 4.2 2.8 3.5 4.9 0 0.7 0.7 2.8 4.2 7 0 06.245 Radiology order: Was the diagnostic report received by the institution within 14 days? (8 points possible) Score 80% 80% 100% 60% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 60% Points Received 6.4 6.4 8 4.8 8 8 8 8 8 8 8 8 8 8 4.8 06.263 All diagnostic services: Did the PCP adequately manage clinically signifi cant test results? (10 points possible) Score 91% 92% 70% 67% 77% 90% 82% 78% 67% 100% 100% 83% 83% 100% 58% Points Received 9.1 9.2 7 6.7 7.7 9 8.2 7.8 6.7 10 10 8.3 8.3 10 5.8 Total Points Received 35.4 37.5 33.3 38.7 38.3 43.6 36.4 44.6 28.1 33.6 31.4 30.4 36.7 45.1 22.3 Total Points Possible 52 52 52 52 52 52 52 52 52 52 52 52 52 52 52 Total Score 68% 72% 64% 74% 74% 84% 70% 86% 54% 65% 60% 59% 71% 87% 43% Bureau of Audits, Offi ce of the Inspector General Page 114 APPENDIX C-8: Diagnostic Services _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 100% 60% 100% 100% 100% 100% 40% 80% 60% 40% 100% 80% 100% 100% 100% 100% 60% 100% 81% 7 4.2 7 7 7 7 2.8 5.6 4.2 2.8 7 5.6 7 7 7 7 4.2 7 187.6 100% 70% 100% 90% 70% 90% 20% 90% 60% 70% 80% 70% 83% 70% 70% 70% 80% 80% 73% 6 4.2 6 5.4 4.2 5.4 1.2 5.4 3.6 4.2 4.8 4.2 5 4.2 4.2 4.2 4.8 4.8 145.4 89% 73% 73% 90% 92% 64% 43% 100% 39% 64% 42% 71% 23% 46% 60% 67% 60% 78% 67% 6.2 5.1 5.1 6.3 6.5 4.5 3 7 2.7 4.5 2.9 5 1.6 3.2 4.2 4.7 4.2 5.4 154 0% 60% 0% 100% 20% 0% 100% 60% 0% 0% 20% 20% 60% 100% 60% 20% 20% 80% 39% 0 4.2 0 7 1.4 0 7 4.2 0 0 1.4 1.4 4.2 7 4.2 1.4 1.4 5.6 91 0% 30% 60% 70% 100% 10% 0% 30% 40% 70% 30% 30% 20% 70% 60% 10% 30% 80% 42% 0 2.1 4.2 4.9 7 0.7 0 2.1 2.8 4.9 2.1 2.1 1.4 4.9 4.2 0.7 2.1 5.6 95.9 100% 100% 50% 80% 100% 100% 100% 100% 100% 80% 100% 20% 100% 20% 100% 100% 100% 100% 89% 8 8 4 6.4 8 8 8 8 8 6.4 8 1.6 8 1.6 8 8 8 8 234.4 89% 90% 90% 75% 77% 55% 71% 100% 86% 64% 90% 100% 100% 75% 83% 92% 50% 100% 83% 8.9 9 9 7.5 7.7 5.5 7.1 10 8.6 6.4 9 10 10 7.5 8.3 9.2 5 10 272.5 36.1 36.8 35.3 44.5 41.8 31.1 29.1 42.3 29.9 29.2 35.2 29.9 37.2 35.4 40.1 35.2 29.7 46.4 1180.6 52 52 52 52 52 52 52 52 52 52 52 52 52 52 52 52 52 52 1716 69% 71% 68% 86% 80% 60% 56% 81% 58% 56% 68% 58% 72% 68% 77% 68% 57% 89% 69% State of California • May 2011 Page 115 APPENDIX C-9: Access to Health Care Information ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: Addresses the prison’s effectiveness in fi ling, storing, and retreiving medical records and medical-related information. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 19.150 Is the medical records offi ce current with its loose fi ling? (9 points possible) Score 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% Points Received 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Did medical records staff make unit health records (UHR) available to clinic staff for the inmates ducated for medical appointments the next 19.169 day? (15 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% Points Received 15 15 15 15 15 15 15 15 15 15 15 15 15 0 15 19.243 Was the institution able to account for the OIG’s requested UHR fi les? (12 points possible) Score 0% 0% 0% 100% 0% 0% 0% 100% 100% 100% 0% 100% 0% 0% 0% Points Received 0 0 0 12 0 0 0 12 12 12 0 12 0 0 0 19.266 Does the institution properly fi le inmates’ medical information? (5 points possible) Score 0% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 0% 100% Points Received 0 5 5 5 5 5 5 5 5 0 5 5 5 0 5 While reviewing unit health records (UHR) as part of the OIG’s inspection, were the OIGs RN and MD inspectors able to locate all relevant 19.271 documentation of health care provided to inmates? (5 points possible) Score 0% 100% 0% 100% 100% 100% 0% 100% 100% 100% 60% 100% 100% 100% 100% Points Received 0 5 0 5 5 5 0 5 5 5 3 5 5 5 5 19.272 Does the institution promptly fi le blood pressure logs in unit health records (UHR)? (5 points possible) Score 100% 100% 50% 100% 100% 50% 0% 100% 0% 0% 100% 50% 100% 100% 100% Points Received 5 5 2.5 5 5 2.5 0 5 0 0 5 2.5 5 5 5 Total Points Received 20 30 22.5 42 30 27.5 20 42 37 32 28 39.5 30 10 30 Total Points Possible 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 Total Score 39% 59% 44% 82% 59% 54% 39% 82% 73% 63% 55% 78% 59% 20% 59% Bureau of Audits, Offi ce of the Inspector General Page 116 APPENDIX C-9: Access to Health Care Information _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 100% 0% 100% 0% 6% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0 9 0 18 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 95% 15 15 15 15 15 7.5 15 15 15 15 15 15 15 15 15 15 15 15 472.5 0% 100% 100% 100% 100% 100% 0% 100% 0% 0% 100% 0% 100% 100% 100% 100% 100% 100% 55% 0 12 12 12 12 12 0 12 0 0 12 0 12 12 12 12 12 12 216 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 88% 5 5 5 5 5 5 5 5 5 5 5 0 5 5 5 5 5 5 145 100% 100% 100% 100% 100% 100% 80% 80% 100% 100% 100% 80% 100% 100% 80% 100% 100% 80% 87% 5 5 5 5 5 5 4 4 5 5 5 4 5 5 4 5 5 4 143 50% 50% 0% 0% 50% 0% 100% 50% 0% 0% 0% 0% 50% 0% 0% 50% 100% 50% 48% 2.5 2.5 0 0 2.5 0 5 2.5 0 0 0 0 2.5 0 0 2.5 5 2.5 80 27.5 39.5 37 37 39.5 29.5 29 38.5 25 25 37 19 39.5 37 45 39.5 51 38.5 1074.5 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 1683 54% 78% 73% 73% 78% 58% 57% 76% 49% 49% 73% 37% 78% 73% 88% 78% 100% 76% 64% State of California • May 2011 Page 117 APPENDIX C-10: Outpatient Housing Unit ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: 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. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 04.051 Did the primary care provider (PCP) evaluate the inmate within one calendar day after placement? (5 points possible) Score 90% 80% 80% 100% 80% 100% 70% 80% Points Received 4.5 4 4 5 4 5 3.5 4 04.052 Did the RN complete an initial assessment of the inmate on the day of placement? (5 points possible) Score 90% 100% 80% 100% 60% 100% 90% 80% Points Received 4.5 5 4 5 3 5 4.5 4 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? (4 points possible) Score 30% 78% 100% 50% 33% 100% 100% 75% Points Received 1.2 3.1 4 2 1.3 4 4 3 Did the utilization management (UM) nurse assess the inmate within one week of the inmate’s placement and every 30 days thereafter? 04.054 (4 points possible) Score 0% 11% 0% 0% 50% 0% 0% 0% Points Received 0 0.4 0 0 2 0 0 0 04.056 Did the PCP’s plan adequately address the initial assessment? (5 points possible) Score 100% 90% 75% 75% 88% 89% 38% 63% Points Received 5 4.5 3.8 3.8 4.4 4.4 1.9 3.1 04.112 Was the PCP’s initial evaluation adequate for the problem(s) requiring OHU placement? (5 points possible) Score 82% 90% 80% 78% 70% 70% 30% 40% Points Received 4.1 4.5 4 3.9 3.5 3.5 1.5 2 04.208 Was the level of care available in the OHU appropriate to the patient’s clinical presentation? (9 points possible) Score 100% 100% 100% 100% 100% 100% 78% 100% Points Received 9 9 9 9 9 9 7 9 04.230 Was the PCP’s initial assessment (or diagnoses) appropriate for the fi ndings in the initial evaluation? (5 points possible) Score 100% 90% 100% 89% 100% 100% 100% 63% Points Received 5 4.5 5 4.4 5 5 5 3.1 In the outpatient housing unit (OHU), are patient call buttons operational or does medical staff make rounds every 30 minutes? 15.103 (3 points possible) Score 0% 100% 100% 0% 0% 0% 0% 100% Points Received 0 3 3 0 0 0 0 3 15.225 Does the OHU use disinfectant daily in common patient areas? (3 points possible) Score 100% 100% 100% 100% 100% 0% 100% 100% Points Received 3 3 3 3 3 0 3 3 Total Points Received 36.3 41.1 39.8 36.1 35.2 35.9 30.4 34.2 Total Points Possible 48 48 48 48 48 48 48 48 Total Score 76% 86% 83% 75% 73% 75% 63% 71% Bureau of Audits, Offi ce of the Inspector General Page 118 APPENDIX C-10: Outpatient Housing Unit _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 80% 80% 100% 100% 90% 75% 90% 100% 100% 88% 4 4 5 5 4.5 3.8 4.5 5 5 74.8 100% 90% 100% 100% 100% 100% 100% 100% 100% 94% 5 4.5 5 5 5 5 5 5 5 79.5 100% 50% 100% 100% 100% 0% 100% 100% 100% 77% 4 2 4 4 4 0 4 4 4 52.6 0% 0% 0% 25% 100% 0% 100% 33% 33% 21% 0 0 0 1 4 0 4 1.3 1.3 14 100% 100% 100% 100% 100% 75% 89% 90% 100% 87% 5 5 5 5 5 3.8 4.4 4.5 5 73.6 100% 80% 70% 63% 100% 0% 80% 100% 89% 72% 5 4 3.5 3.1 5 0 4 5 4.4 61 100% 100% 100% 100% 100% 100% 90% 100% 100% 98% 9 9 9 9 9 9 8.1 9 9 150.1 100% 100% 100% 100% 100% 100% 89% 100% 100% 96% 5 5 5 5 5 5 4.4 5 5 81.4 0% 100% 100% 100% 100% 100% 100% 0% 100% 59% 0 3 3 3 3 3 3 0 3 30 100% 100% 100% 100% 100% 0% 100% 100% 100% 88% 3 3 3 3 3 0 3 3 3 45 40 39.5 42.5 43.1 47.5 29.6 44.4 41.8 44.7 662.1 48 48 48 48 48 48 48 48 48 816 83% 82% 89% 90% 99% 62% 93% 87% 93% 81% State of California • May 2011 Page 119 APPENDIX C-11: Internal Reviews ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: Focuses on the activities of the prison’s Quality Management Committee (QMC) and its Emergency Medical Response Review Committee (EMRRC). The component also evaluates the timelines of inmates’ medical appeals and the prison’s use of inmate death reviews. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 17.118 Do the Quality Management Committee (QMC) meeting minutes document monthly meetings for the last six (6) months? (5 points possible) Score 100% 83% 100% 33% 83% 100% 100% 33% 100% 100% 83% 100% 100% 100% 100% Points Received 5 4.2 5 1.7 4.2 5 5 1.7 5 5 4.2 5 5 5 5 17.119 Did the Quality Management Committee (QMC) report its fi ndings to the HCM/CMO each of the last six (6) meetings? (5 points possible) Score 100% 83% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 5 4.2 5 2.5 5 5 5 5 5 5 5 5 5 5 5 Do the Emergency Medical Response Review Committee (EMRRC) meeting minutes document monthly meetings for the last 17.132 six (6) months? (5 points possible) Score 83% 83% 100% 83% 83% 83% 83% 50% 83% 100% 50% 83% 67% 83% 100% Points Received 4.2 4.2 5 4.2 4.2 4.2 4.2 2.5 4.2 5 2.5 4.2 3.3 4.2 5 Did the last three Quality Management Committee (QMC) meeting minutes refl ect fi ndings and strategies for improvement? 17.135 (5 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% Points Received 5 5 5 5 5 5 5 5 5 5 5 5 5 5 0 17.136 For each death sampled, did the institution complete the death review process? (5 points possible) Score 80% 100% 100% 60% 100% 100% 80% 0% 100% 80% 80% 80% 60% 100% Points Received 4 5 5 3 5 5 4 0 5 4 4 4 3 5 Do the Emergency Medical Response Review Committee (EMRRC) meeting minutes document the warden’s (or his or her designee’s) 17.138 attendance? (5 points possible) Score 100% 0% 100% 60% 80% 100% 100% 100% 100% 83% 67% 60% 100% 80% 100% Points Received 5 0 5 3 4 5 5 5 5 4.2 3.3 3 5 4 5 17.174 Did the institution promptly process inmate medical appeals during the most recent 12 months? (5 points possible) Score 0% 100% 100% 0% 100% 100% 0% 100% 0% 0% 0% 100% 100% 0% 0% Points Received 0 5 5 0 5 5 0 5 0 0 0 5 5 0 0 Did the institution complete a medical emergency response drill for each watch and include participation from each medical facility during 17.221 the most recent full quarter? (5 points possible) Score 0% 0% 100% 100% 100% 100% 0% 0% 0% 0% 0% 100% 100% 0% 0% Points Received 0 0 5 5 5 5 0 0 0 0 0 5 5 0 0 Total Points Received 28.2 27.5 40 24.3 37.3 39.2 28.2 24.2 29.2 28.2 24 36.2 33.3 26.2 25 Total Points Possible 40 40 40 40 40 40 40 40 40 40 40 40 35 40 40 Total Score 70% 69% 100% 61% 93% 98% 70% 60% 73% 71% 60% 91% 95% 66% 63% Bureau of Audits, Offi ce of the Inspector General Page 120 APPENDIX C-11: Internal Reviews _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 100% 100% 100% 83% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 94% 5 5 5 4.2 5 5 5 5 5 5 5 5 5 5 5 5 5 5 155.2 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 161.7 100% 100% 100% 67% 100% 100% 100% 100% 100% 83% 67% 100% 100% 100% 100% 100% 100% 100% 89% 5 5 5 3.3 5 5 5 5 5 4.2 3.3 5 5 5 5 5 5 5 146.9 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 97% 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 160 100% 100% 80% 100% 100% 100% 80% 100% 100% 75% 60% 100% 60% 60% 80% 100% 100% 100% 85% 5 5 4 5 5 5 4 5 5 3.8 3 5 3 3 4 5 5 5 135.8 50% 83% 100% 100% 83% 100% 100% 83% 100% 80% 100% 100% 83% 100% 100% 67% 50% 100% 85% 2.5 4.2 5 5 4.2 5 5 4.2 5 4 5 5 4.2 5 5 3.3 2.5 5 140.6 0% 100% 100% 0% 100% 0% 0% 100% 100% 0% 0% 0% 100% 100% 0% 100% 0% 100% 48% 0 5 5 0 5 0 0 5 5 0 0 0 5 5 0 5 0 5 80 0% 0% 0% 0% 100% 0% 0% 0% 0% 0% 0% 0% 100% 0% 0% 100% 0% 0% 27% 0 0 0 0 5 0 0 0 0 0 0 0 5 0 0 5 0 0 45 27.5 34.2 34 27.5 39.2 30 29 34.2 35 27 26.3 30 37.2 33 29 38.3 27.5 35 1024.9 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 40 1315 69% 86% 85% 69% 98% 75% 73% 86% 88% 68% 66% 75% 93% 83% 73% 96% 69% 88% 78% State of California • May 2011 Page 121 APPENDIX C-12: Inmate Transfers ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: 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. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 05.108 Did Receiving and Release have the inmate’s UHR and transfer envelope? (7 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 If the inmate was scheduled for any upcoming specialty services, were the services noted on Form 7371 (Health Care Transfer 05.109 Information)? (8 points possible) Score 100% 0% 50% 100% 0% 100% 0% 100% 100% Points Received 8 0 4 8 0 8 0 8 8 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? (8 points possible) Score 100% 50% 100% 100% 100% 100% 100% 100% 100% 80% 100% 100% 40% 100% Points Received 8 4 8 8 8 8 8 8 8 6.4 8 8 3.2 8 Did an RN accurately complete all applicable sections of Form 7371 (Health Care Transfer Information) based on the inmate’s UHR? 05.171 (7 points possible) Score 80% 0% 100% 100% 100% 100% 75% 80% 100% 20% 20% 100% 60% 100% 100% Points Received 5.6 0 7 7 7 7 5.3 5.6 7 1.4 1.4 7 4.2 7 7 Did the Health Records Department maintain a copy of the inmate’s Form 7371 (Health Care Transfer Information) and Form 7231A 05.172 (Outpatient Medication Administration Record) when the inmate transferred? (8 points possible) Score 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% Points Received 0 8 8 8 8 8 8 8 8 8 0 8 8 8 8 Total Points Received 28.6 19 34 38 30 38 28.3 28.6 30 22.8 16.4 38 30.4 22 30 Total Points Possible 38 38 38 38 38 38 30 30 30 30 38 38 38 22 30 Total Score 75% 50% 90% 100% 79% 100% 94% 95% 100% 76% 43% 100% 80% 100% 100% Bureau of Audits, Offi ce of the Inspector General Page 122 APPENDIX C-12: Inmate Transfers _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 231 100% 100% 100% 0% 0% 0% 100% 100% 100% 64% 8 8 8 0 0 0 8 8 8 92 100% 80% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 50% 100% 75% 67% 100% 90% 8 6.4 8 8 8 8 8 8 8 4 8 8 4 8 6 5.3 8 223.3 100% 60% 100% 100% 80% 100% 100% 100% 80% 100% 100% 100% 40% 100% 20% 100% 100% 40% 80% 7 4.2 7 7 5.6 7 7 7 5.6 7 7 7 2.8 7 1.4 7 7 2.8 185.9 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 91% 8 8 8 8 8 8 8 8 8 0 8 8 8 8 8 8 8 8 240 22 35.2 36.4 38 28.6 30 30 30 28.6 22 26 30 25.8 26 32.4 28 35.3 33.8 972.2 22 38 38 38 30 38 30 30 30 30 30 30 38 38 38 30 38 38 1118 100% 93% 96% 100% 95% 79% 100% 100% 95% 73% 87% 100% 68% 68% 85% 93% 93% 89% 88% State of California • May 2011 Page 123 APPENDIX C-13: Clinic Operations ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: Addresses the general operational aspects of the prison’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 inmate carries for scheduled medical appointments), and availability of health care request forms. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 14.023 Does the institution make the Form 7362 (Health Care Services Request Form) available to inmates? (4 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 83% 89% 100% 100% 100% 100% Points Received 4 4 4 4 4 4 4 4 4 3.3 3.6 4 4 4 4 Does medical staff in the facility clinic know which inmates are on modifi ed program or confi ned to quarters (CTQ) and does staff have an 14.029 adequate process to ensure those inmates receive their medication? (4 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 2 14.032 Does medical staff understand the institution’s priority ducat process? (2 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Does the institution have an adequate process to ensure inmates who are moved to a new cell still receive their medical ducats? 14.033 (4 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 2 4 14.106 Does clinical staff wash their hands (either with soap or hand sanitizer) or change gloves between patients? (4 points possible) Score 50% 100% 75% 50% 100% 100% 75% 100% 100% 75% 100% 75% 100% 100% 75% Points Received 2 4 3 2 4 4 3 4 4 3 4 3 4 4 3 Do medication nurses understand that medication is to be administered by the same licensed staff member who prepares it and on the 14.131 same day? (4 points possible) Score 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 4 4 4 0 4 4 4 4 4 4 4 4 4 4 4 Does the institution have a process to identify, review, and address urgent appointments if a doctor’s line is canceled? 14.160 (4 points possible) Score 100% 50% 100% 100% 50% 0% 0% 0% 50% 100% 100% 100% 100% 100% 100% Points Received 4 2 4 4 2 0 0 0 2 4 4 4 4 4 4 Are areas available to ensure privacy during RN face-to-face assessments and doctors’ examinations for non-emergencies? 14.164 (3 points possible) Score 80% 0% 100% 100% 100% 100% 100% 100% 100% 100% 75% 50% 100% 100% 100% Points Received 2.4 0 3 3 3 3 3 3 3 3 2.3 1.5 3 3 3 14.165 Are the clinic fl oors, waiting room chairs, and equipment cleaned with a disinfectant daily? (2 points possible) Score 100% 67% 67% 100% 0% 67% 100% 100% 33% 67% 0% 0% 67% 100% 100% Points Received 2 1.3 1.3 2 0 1.3 2 2 0.7 1.3 0 0 1.3 2 2 14.166 Was the medication stored in a sealed container if food was present in the clinic refrigerator? (2 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Total Points Received 26.4 27.3 31.3 27 29 28.3 28 29 29.7 30.6 29.9 28.5 32.3 31 30 Total Points Possible 29 33 33 33 33 33 33 33 33 33 33 33 33 33 33 Total Score 91% 83% 95% 82% 88% 86% 85% 88% 90% 93% 91% 86% 98% 94% 91% Bureau of Audits, Offi ce of the Inspector General Page 124 APPENDIX C-13: Clinic Operations _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 100% 100% 100% 100% 100% 67% 100% 100% 100% 100% 67% 100% 100% 100% 63% 100% 100% 40% 94% 4 4 4 4 4 2.7 4 4 4 4 2.7 4 4 4 2.5 4 4 1.6 124.4 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 50% 100% 100% 100% 100% 100% 95% 4 4 4 4 4 4 4 4 2 4 4 2 4 4 4 4 4 118 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 100% 100% 50% 100% 97% 2 2 2 2 2 2 2 2 2 1 2 2 2 2 1 2 60 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 130 100% 75% 75% 100% 50% 50% 100% 100% 75% 100% 75% 100% 75% 100% 100% 100% 75% 75% 85% 4 3 3 4 2 2 4 4 3 4 3 4 3 4 4 4 3 3 112 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 97% 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 128 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 86% 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 114 100% 100% 67% 100% 100% 33% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 91% 3 3 2 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 90.2 100% 100% 33% 50% 100% 100% 75% 100% 100% 100% 67% 100% 100% 100% 100% 67% 33% 100% 75% 2 2 0.7 1 2 2 1.5 2 2 2 1.3 2 2 2 2 1.3 0.7 2 49.7 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 66 33 32 29.7 28 31 27.7 32.5 33 32 30 28 33 30 33 31.5 31.3 28.7 29.6 992.3 33 33 33 29 33 33 33 33 33 33 31 33 33 33 33 33 31 33 1077 100% 97% 90% 97% 94% 84% 99% 100% 97% 91% 90% 100% 91% 100% 96% 95% 93% 90% 92% State of California • May 2011 Page 125 APPENDIX C-14: Preventive Services ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: Focuses on inmate cancer screening, tuberculosis evaluation, and infl uenza immunizations. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number Male inmates age 51 or older: Did the inmate receive a fecal occult blood test (FOBT) within the previous 12 months or was the inmate’s 10.085 refusal documented? (5 points possible) Score 50% 70% 30% 30% 10% 90% 20% 0% 0% 20% 70% 30% 20% Points Received 2.5 3.5 1.5 1.5 0.5 4.5 1 0 0 1 3.5 1.5 1 All inmates age 66 or older: Did the inmate receive an infl uenza vaccination within the previous 12 months or was the inmate’s refusal 10.086 documented? (6 points possible) Score 80% 75% 50% 100% 86% 100% 100% 80% 0% 0% 56% 90% 100% 60% Points Received 4.8 4.5 3 6 5.1 6 6 4.8 0 0 3.3 5.4 6 3.6 10.087 Female inmates age 41 or older: Did the inmate receive a mammogram within the previous 24 months? (5 points possible) Score 60% 70% Points Received 3 3.5 10.228 Inmates prescribed INH: Did the institution properly administer the medication to the inmate? (6 points possible) Score 40% 80% 20% 0% 0% 40% 20% 0% 20% 20% 20% 80% 0% 40% 20% Points Received 2.4 4.8 1.2 0 0 2.4 1.2 0 1.2 1.2 1.2 4.8 0 2.4 1.2 10.229 Inmates with TB code 34: Was the inmate evaluated for signs and symptoms of TB within the previous 12 months? (7 points possible) Score 40% 0% 0% 0% 0% 100% 60% 20% 0% 100% 0% 100% 0% 100% 20% Points Received 2.8 0 0 0 0 7 4.2 1.4 0 7 0 7 0 7 1.4 Inmates prescribed INH: Did the institution monitor the inmate monthly for the most recent three months he or she was on the medication? 10.232 (6 points possible) Score 0% 0% 0% 20% 0% 0% 0% 0% 0% 0% 0% 100% 0% 20% 0% Points Received 0 0 0 1.2 0 0 0 0 0 0 0 6 0 1.2 0 10.274 Female inmates age 41 to 64: Did the inmate receive a Pap smear in compliance with policy? (5 points possible) Score 60% 50% Points Received 3 2.5 Total Points Received 7.7 13.1 7.2 5.7 6.5 20.5 15.9 8.4 6 8.2 2.2 24.6 11.4 18.1 7.2 Total Points Possible 24 30 30 30 30 35 30 30 30 30 30 30 35 30 30 Total Score 32% 44% 24% 19% 22% 59% 53% 28% 20% 27% 7% 82% 33% 60% 24% Bureau of Audits, Offi ce of the Inspector General Page 126 APPENDIX C-14: Preventive Services _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 20% 0% 50% 60% 80% 40% 40% 10% 70% 50% 10% 30% 40% 60% 20% 100% 100% 41% 1 0 2.5 3 4 2 2 0.5 3.5 2.5 0.5 1.5 2 3 1 5 5 61 90% 100% 100% 20% 100% 80% 100% 100% 100% 100% 30% 100% 100% 50% 80% 100% 90% 50% 77% 5.4 6 6 1.2 6 4.8 6 6 6 6 1.8 6 6 3 4.8 6 5.4 3 147.9 90% 73% 4.5 11 20% 40% 40% 20% 0% 20% 0% 0% 40% 60% 20% 20% 60% 0% 60% 20% 100% 40% 29% 1.2 2.4 2.4 1.2 0 1.2 0 0 2.4 3.6 1.2 1.2 3.6 0 3.6 1.2 6 2.4 57.6 100% 20% 80% 40% 100% 100% 40% 100% 0% 20% 0% 80% 60% 100% 0% 100% 80% 100% 50% 7 1.4 5.6 2.8 7 7 2.8 7 0 1.4 0 5.6 4.2 7 0 7 5.6 7 116.2 0% 20% 0% 0% 0% 40% 0% 100% 20% 0% 60% 20% 0% 0% 20% 100% 40% 60% 19% 0 1.2 0 0 0 2.4 0 6 1.2 0 3.6 1.2 0 0 1.2 6 2.4 3.6 37.2 100% 70% 5 10.5 14.6 11 16.5 8.2 17 17.4 10.8 28.5 10.1 14.5 9.1 14.5 15.3 12 12.6 21.2 24.4 21 441.4 30 30 30 30 30 30 30 35 30 30 30 30 30 30 30 30 30 30 999 49% 37% 55% 27% 57% 58% 36% 81% 34% 48% 30% 48% 51% 40% 42% 71% 81% 70% 44% State of California • May 2011 Page 127 APPENDIX C-15: Pharmacy Services ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: 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 addresses whether the pharmacy has an effective process for screening medication orders for potential adverse reactions/interactions. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 13.139 Does the institution conspicuously post a valid permit in its pharmacies? (2 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 13.141 Does the institution properly maintain its emergency crash cart medications? (2 points possible) Score 80% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% Points Received 1.6 2 2 2 2 2 2 2 2 2 2 2 2 0 2 13.142 Is the Pharmacist in Charge’s license current? (5 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 Does the institution have information to ensure that medications are prescribed by licensed health-care providers lawfully authorized to do 13.144 so? (6 points possible) Score 0% 0% 100% 0% 100% 100% 100% 100% 100% 0% 0% 0% 100% 100% 100% Points Received 0 0 6 0 6 6 6 6 6 0 0 0 6 6 6 Does the pharmacist in charge have an effective process for screening new medication orders for potential adverse reactions? 13.145 (7 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Does the pharmacist in charge monitor the quantity of medications on hand, and does the pharmacy conduct an annual inventory to ensure 13.148 that the quantity of medications in the system matches the quantity of medications on hand? (4 points possible) Score 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 4 4 4 0 4 4 4 4 4 4 4 4 4 4 4 13.252 Does the institution properly maintain medications in its after-hours medication supply(ies)? (2 points possible) Score 100% 50% 33% 0% 0% 0% 0% 0% 100% 0% 100% 100% 67% 100% 100% Points Received 2 1 0.7 0 0 0 0 0 2 0 2 2 1.3 2 2 13.253 Does the institution conduct monthly inspections of its emergency cart and after-hours medication supply(ies)? (1 point possible) Score 0% 100% 40% 75% 67% 67% 33% 33% 100% 100% 100% 100% 25% 67% 100% Points Received 0 1 0.4 0.8 0.7 0.7 0.3 0.3 1 1 1 1 0.3 0.7 1 Total Points Received 21.6 22 27.1 16.8 26.7 26.7 26.3 26.3 29 21 23 23 27.6 26.7 29 Total Points Possible 29 29 29 29 29 29 29 29 29 29 29 29 29 29 29 Total Score 75% 76% 93% 58% 92% 92% 91% 91% 100% 72% 79% 79% 95% 92% 100% Bureau of Audits, Offi ce of the Inspector General Page 128 APPENDIX C-15: Pharmacy Services _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 66 0% 50% 100% 0% 100% 38% 67% 0% 0% 0% 0% 100% 33% 0% 100% 100% 54% 100% 67% 0 1 2 0 2 0.8 1.3 0 0 0 0 2 0.7 0 2 2 1.1 2 44.5 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 165 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 79% 6 0 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 156 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 231 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 94% 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 0 124 0% 0% 0% 0% 100% 0% 0% 0% 0% 0% 0% 50% 0% 100% 100% 40% 50% 100% 39% 0 0 0 0 2 0 0 0 0 0 0 1 0 2 2 0.8 1 2 25.8 100% 100% 100% 0% 100% 100% 75% 100% 0% 0% 100% 100% 100% 100% 100% 100% 100% 100% 76% 1 1 1 0 1 1 0.8 1 0 0 1 1 1 1 1 1 1 1 25 25 20 27 24 29 25.8 26.1 25 24 24 25 28 25.7 27 29 27.8 27.1 25 837.3 29 29 29 29 29 29 29 29 29 29 29 29 29 29 29 29 29 29 957 86% 69% 93% 83% 100% 89% 90% 86% 83% 83% 86% 97% 89% 93% 100% 96% 93% 86% 87% State of California • May 2011 Page 129 APPENDIX C-16: Other Services ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: 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. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number If the institution does not offer therapeutic diets, does staff know the department’s procedures for transferring inmates who are determined 15.058 to require a therapeutic diet? (3 points possible) Score 100% 0% 0% 100% 0% 100% Points Received 3 0 0 3 0 3 15.059 Did the institution properly provide therapeutic diets to inmates? (4 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% Points Received 4 4 4 4 4 4 4 4 15.134 Did the institution properly respond to all active cases of TB discovered in the last six months? (5 points possible) Score 100% Points Received 5 Is the most current version of the CDCR Health Services Policies and Procedures available in the institution’s law library? 15.265 (3 points possible) Score 50% 100% 100% 100% 100% 100% 100% 50% 100% 100% 50% 100% 0% 0% 0% Points Received 1.5 3 3 3 3 3 3 1.5 3 3 1.5 3 0 0 0 Hygiene Intervention: Did custody staff understand the department’s policies and procedures for identifying and evaluating inmates 20.092 displaying inappropriate hygiene management? (4 points possible) Score 100% 100% 100% 100% 100% 100% 75% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 4 4 4 4 4 4 3 4 4 4 4 4 4 4 4 Total Points Received 14.5 11 11 10 11 11 10 5.5 11 7 8.5 7 4 7 8 Total Points Possible 16 11 11 10 11 11 11 10 11 10 10 10 7 10 11 Total Score 91% 100% 100% 100% 100% 100% 91% 55% 100% 70% 85% 70% 57% 70% 73% Bureau of Audits, Offi ce of the Inspector General Page 130 APPENDIX C-16: Other Services _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 82% 3 3 3 3 3 3 3 3 3 3 3 42 0% 0% 100% 80% 100% 100% 100% 100% 86% 0 0 4 3.2 4 4 4 4 55.2 0% 0% 33% 0 0 5 50% 100% 50% 50% 0% 50% 100% 100% 50% 100% 100% 100% 100% 50% 50% 100% 100% 100% 73% 1.5 3 1.5 1.5 0 1.5 3 3 1.5 3 3 3 3 1.5 1.5 3 3 3 72 100% 100% 100% 100% 100% 75% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% 4 4 4 4 4 3 4 4 4 4 4 4 4 4 4 4 4 4 130 8.5 10 5.5 5.5 7 7.5 11 10 8.5 10 10.2 10 10 8.5 12.5 11 11 11 304.2 10 10 11 11 10 10 11 10 10 10 11 10 15 10 14 11 11 16 361 85% 100% 50% 50% 70% 75% 100% 100% 85% 100% 93% 100% 67% 85% 89% 100% 100% 69% 84% State of California • May 2011 Page 131 APPENDIX C-17: Inmate Hunger Strikes ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: Examines medical staff’s monitoring of inmates participating in hunger strikes lasting more than three days. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number Did the RN conduct a face-to-face triage of the inmate within two (2) business days of receipt of the Form 128-B and document the inmate’s 11.097 reasons for the hunger strike, most recent recorded weight, current weight, vital signs, and physical condition? (6 points possible) Score 33% 100% 33% 100% 100% 100% 25% 0% 0% 80% Points Received 2 6 2 6 6 6 1.5 0 0 4.8 After the fi rst 48 hours, did an RN or PCP complete daily assessments documenting the inmate’s weight, physical condition, emotional 11.099 condition, vital signs, and hydration status? (6 points possible) Score 0% 0% 0% 0% 100% 67% 50% 0% 67% 60% Points Received 0 0 0 0 6 4 3 0 4 3.6 After the fi rst 72 hours, did a physician perform a physical examination and order a metabolic panel and a urinalysis of the inmate? 11.100 (7 points possible) Score 0% 0% 0% 0% 100% 50% 50% 100% 67% 0% Points Received 0 0 0 0 7 3.5 3.5 7 4.7 0 Total Points Received 2 6 2 6 19 13.5 8 7 8.7 8.4 Total Points Possible 19 19 19 19 19 19 19 19 19 19 Total Score 11% 32% 11% 32% 100% 71% 42% 37% 46% 44% Bureau of Audits, Offi ce of the Inspector General Page 132 APPENDIX C-17: Inmate Hunger Strikes _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 80% 0% 100% 100% 100% 75% 100% 100% 20% 100% 100% 69% 4.8 0 6 6 6 4.5 6 6 1.2 6 6 86.8 20% 100% 0% 100% 80% 20% 100% 100% 40% 100% 50% 1.2 6 0 6 4.8 1.2 6 6 2.4 6 60.2 60% 100% 40% 67% 60% 0% 100% 50% 20% 100% 48% 4.2 7 2.8 4.7 4.2 0 7 3.5 1.4 7 67.5 10.2 13 8.8 16.7 15 5.7 19 15.5 5 19 6 214.5 19 19 19 19 19 19 19 19 19 19 6 386 54% 68% 46% 88% 79% 30% 100% 82% 26% 100% 100% 57% State of California • May 2011 Page 133 APPENDIX C-18: Chemical Agent Contraindications ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: Addresses the prison’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 Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number Did the institution document that it consulted with an RN or primary care provider (PCP) before a calculated use of OC? 12.062 (9 points possible) Score 100% 75% 100% 80% 80% 33% 100% 100% 100% 100% 100% Points Received 9 6.8 9 7.2 7.2 3 9 9 9 9 9 12.064 Did the institution record how it decontaminated the inmate and did it follow the decontamination policy? (8 points possible) Score 100% 100% 88% 100% 100% 100% 100% 100% 80% 67% 67% 100% 100% 100% 100% Points Received 8 8 7 8 8 8 8 8 6.4 5.3 5.3 8 8 8 8 Total Points Received 17 14.8 16 15.2 15.2 11 17 17 15.4 5.3 5.3 8 8 17 17 Total Points Possible 17 17 17 17 17 17 17 17 17 8 8 8 8 17 17 Total Score 100% 87% 94% 89% 89% 65% 100% 100% 91% 66% 66% 100% 100% 100% 100% Bureau of Audits, Offi ce of the Inspector General Page 134 APPENDIX C-18: Chemical Agent Contraindications _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 80% 100% 100% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 60% 100% 91% 7.2 9 9 4.5 9 9 9 9 9 9 9 9 9 9 9 5.4 9 230.3 100% 100% 100% 71% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 88% 96% 8 8 8 5.7 8 8 8 8 8 8 8 8 8 8 8 8 7 244.7 15.2 17 17 10.2 17 17 17 17 17 17 17 17 17 17 17 13.4 16 475 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 508 89% 100% 100% 60% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 79% 94% 93% State of California • May 2011 Page 135 APPENDIX C-19: Staffi ng Levels and Training ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: Examines the prison’s medical staffi ng levels and training provided. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 18.001 Are licensed health care staff current with their certifi cations and did they attend required training? (4 points possible) Score 80% 80% 100% 100% 80% 40% 100% 100% 60% 20% 60% 40% 40% 100% 100% Points Received 3.2 3.2 4 4 3.2 1.6 4 4 2.4 0.8 2.4 1.6 1.6 4 4 Did the institution have a registered nurse (RN) available on site 24 hours a day, seven days a week, for emergency care? 18.004 (4 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Did the institution have a physician on site, a physician on call, or an MOD available 24 hours a day, seven days a week, for the last 30 18.005 days? (4 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Does the institution’s orientation program for all newly hired nursing staff include a module for sick call protocols that require face-to-face 18.006 triage? (4 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Total Points Received 15.2 15.2 16 16 15.2 13.6 16 16 14.4 12.8 14.4 13.6 13.6 16 16 Total Points Possible 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 Total Score 95% 95% 100% 100% 95% 85% 100% 100% 90% 80% 90% 85% 85% 100% 100% Bureau of Audits, Offi ce of the Inspector General Page 136 APPENDIX C-19: Staffi ng Levels and Training _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 80% 100% 80% 80% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 20% 84% 3.2 4 3.2 3.2 4 4 4 4 4 4 4 4 4 4 4 4 4 0.8 110.4 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 132 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 132 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 132 15.2 16 15.2 15.2 16 16 16 16 16 16 16 16 16 16 16 16 16 12.8 506.4 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 528 95% 100% 95% 95% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 80% 96% State of California • May 2011 Page 137 APPENDIX C-20: Nursing Policy ______________________________________________________________________________________________________________________ Page 1 of 2 Component Defi nition: 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. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 16.154 Does the institution have written nursing policies and procedures that adhere to the department’s guidelines? (5 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 16.231 Does the institution ensure that nursing staff review their duty statements? (5 points possible) Score 40% 0% 100% 20% 0% 100% 40% 100% 60% 100% 40% 80% 80% 40% 100% Points Received 2 0 5 1 0 5 2 5 3 5 2 4 4 2 5 16.254 Does the institution’s supervising registered nurse (SRN) conduct periodic reviews of nursing staff? (4 points possible) Score 100% 0% 60% 100% 0% 100% 100% 80% 0% 100% 0% 40% 0% 60% 60% Points Received 4 0 2.4 4 0 4 4 3.2 0 4 0 1.6 0 2.4 2.4 Total Points Received 11 5 12.4 10 5 14 11 13.2 8 14 7 10.6 9 9.4 12.4 Total Points Possible 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 Total Score 79% 36% 89% 71% 36% 100% 79% 94% 57% 100% 50% 76% 64% 67% 89% Bureau of Audits, Offi ce of the Inspector General Page 138 APPENDIX C-20: Nursing Policy _____________________________________________________________________________________________________________________ Page 2 of 2 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 100% 100% 100% 100% 100% 100% 100% 100% 60% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99% 5 5 5 5 5 5 5 5 3 5 5 5 5 5 5 5 5 5 163 80% 100% 100% 60% 60% 100% 20% 100% 0% 100% 60% 100% 100% 100% 100% 80% 40% 100% 70% 4 5 5 3 3 5 1 5 0 5 3 5 5 5 5 4 2 5 115 20% 80% 0% 0% 60% 0% 100% 100% 100% 0% 100% 100% 100% 60% 100% 100% 0% 100% 58% 0.8 3.2 0 0 2.4 0 4 4 4 0 4 4 4 2.4 4 4 0 4 76.8 9.8 13.2 10 8 10.4 10 10 14 7 10 12 14 14 12.4 14 13 7 14 354.8 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 462 70% 94% 71% 57% 74% 71% 71% 100% 50% 71% 86% 100% 100% 89% 100% 93% 50% 100% 77% State of California • May 2011 Page 139 APPENDIX D-1: Medication Management ______________________________________________________________________________________________________________________ Page 1 of 4 Category Defi nition: Evaluates the timely delivery of medications to inmates and certain elements of medication administration. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number Sick Call Medication: Did the institution administer or deliver prescription medications (new orders) to the inmate within specifi ed time 01.124 frames? (6 points possible) Score 22% 80% 55% 77% 33% 52% 28% 13% 33% 11% 41% 10% 28% 30% 44% Points Received 1.3 4.8 3.3 4.6 2 3.1 1.7 0.8 2 0.7 2.5 0.6 1.7 1.8 2.6 If the inmate had an existing medication order upon arrival at the institution, did the inmate receive the medications by the next calendar 02.128 day, or did a physician explain why the medications were not to be continued? (8 points possible) Score 33% 88% 50% 50% 0% 43% 13% 25% 42% 0% 43% 23% 0% 30% 35% Points Received 2.7 7 4 4 0 3.4 1 2 3.3 0 3.4 1.8 0 2.4 2.8 Did the inmate receive his or her prescribed chronic care medications during the most recent three-month period or did the institution 03.175 follow departmental policy if the inmate refused to pick up or show up for his or her medications? (18 points possible) Score 46% 77% 50% 55% 65% 40% 4% 31% 29% 4% 48% 20% 4% 18% 8% Points Received 8.3 13.9 9 9.9 11.6 7.2 0.8 5.6 5.3 0.8 8.6 3.6 0.8 3.3 1.4 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? (9 points possible) Score 100% 50% 100% 100% 100% 100% 100% 100% 100% 80% 100% 100% 40% 100% Points Received 8 4 8 8 8 8 8 8 8 6.4 8 8 3.2 8 10.228 Inmates prescribed INH: Did the institution properly administer the medication to the inmate? (8 points possible) Score 40% 80% 20% 0% 0% 40% 20% 0% 20% 20% 20% 80% 0% 40% 20% Points Received 2.4 4.8 1.2 0 0 2.4 1.2 0 1.2 1.2 1.2 4.8 0 2.4 1.2 13.141 Does the institution properly maintain its emergency crash cart medications? (2 points possible) Score 80% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% Points Received 1.6 2 2 2 2 2 2 2 2 2 2 2 2 0 2 Does the pharmacist in charge have an effective process for screening new medication orders for potential adverse reactions? 13.145 (7 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 Does the pharmacist in charge monitor the quantity of medications on hand, and does the pharmacy conduct an annual inventory to ensure 13.148 that the quantity of medications in the system matches the quantity of medications on hand? (4 points possible) Score 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 4 4 4 0 4 4 4 4 4 4 4 4 4 4 4 13.252 Does the institution properly maintain medications in its after-hours medication supply(ies)? (2 points possible) Score 100% 50% 33% 0% 0% 0% 0% 0% 100% 0% 100% 100% 67% 100% 100% Points Received 2 1 0.7 0 0 0 0 0 2 0 2 2 1.3 2 2 13.253 Does the institution conduct monthly inspections of its emergency cart and after-hours medication supply(ies)? (9 points possible) Score 0% 100% 40% 75% 67% 67% 33% 33% 100% 100% 100% 100% 25% 67% 100% Points Received 0 1 0.4 0.8 0.7 0.7 0.3 0.3 1 1 1 1 0.3 0.7 1 Does medical staff in the facility clinic know which inmates are on modifi ed program or confi ned to quarters (CTQ) and does staff have an 14.029 adequate process to ensure those inmates receive their medication? (4 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 2 Do medication nurses understand that medication is to be administered by the same licensed staff member who prepares it and on the 14.131 same day? (4 points possible) Score 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 4 4 4 0 4 4 4 4 4 4 4 4 4 4 4 Bureau of Audits, Offi ce of the Inspector General Page 140 APPENDIX D-1: Medication Management _____________________________________________________________________________________________________________________ Page 2 of 4 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 22% 14% 65% 18% 57% 48% 7% 48% 17% 27% 27% 46% 20% 30% 73% 12% 68% 37% 36% 1.3 0.9 3.9 1.1 3.4 2.9 0.4 2.9 1 1.6 1.6 2.8 1.2 1.8 4.4 0.7 4.1 2.2 71.7 24% 17% 0% 0% 60% 36% 20% 33% 40% 75% 11% 0% 14% 50% 86% 46% 83% 25% 33% 1.9 1.3 0 0 4.8 2.9 1.6 2.7 3.2 6 0.9 0 1.1 4 6.9 3.6 6.7 2 87.4 8% 17% 24% 16% 57% 21% 5% 32% 0% 20% 52% 63% 72% 72% 42% 25% 75% 22% 34% 1.4 3.1 4.3 2.9 10.2 3.8 0.8 5.8 0 3.6 9.4 11.3 13 13 7.5 4.5 13.5 3.9 202.1 100% 80% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 50% 100% 75% 67% 100% 90% 8 6.4 8 8 8 8 8 8 8 4 8 8 4 8 6 5.3 8 223.3 20% 40% 40% 20% 0% 20% 0% 0% 40% 60% 20% 20% 60% 0% 60% 20% 100% 40% 29% 1.2 2.4 2.4 1.2 0 1.2 0 0 2.4 3.6 1.2 1.2 3.6 0 3.6 1.2 6 2.4 57.6 0% 50% 100% 0% 100% 38% 67% 0% 0% 0% 0% 100% 33% 0% 100% 100% 54% 100% 67% 0 1 2 0 2 0.8 1.3 0 0 0 0 2 0.7 0 2 2 1.1 2 44.5 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 231 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 94% 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 0 124 0% 0% 0% 0% 100% 0% 0% 0% 0% 0% 0% 50% 0% 100% 100% 40% 50% 100% 39% 0 0 0 0 2 0 0 0 0 0 0 1 0 2 2 0.8 1 2 25.8 100% 100% 100% 0% 100% 100% 75% 100% 0% 0% 100% 100% 100% 100% 100% 100% 100% 100% 76% 1 1 1 0 1 1 0.8 1 0 0 1 1 1 1 1 1 1 1 25 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 50% 100% 100% 100% 100% 100% 95% 4 4 4 4 4 4 4 4 2 4 4 2 4 4 4 4 4 118 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 97% 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 128 State of California • May 2011 Page 141 APPENDIX D-1: Medication Management ______________________________________________________________________________________________________________________ Page 3 of 4 Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 14.166 Was the medication stored in a sealed container if food was present in the clinic refrigerator? (2 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Upon the inmate’s discharge from a community hospital, did the institution administer or deliver all prescribed medications to the inmate 21.281 within specifi ed time frames? (6 points possible) Score 100% 100% 58% 79% 79% 88% 64% 48% 38% 13% 67% 47% 44% 10% 47% Points Received 6 6 3.5 4.7 4.7 5.3 3.8 2.9 2.3 0.8 4 2.8 2.6 0.6 2.8 Total Points Received 49.3 65.5 53.1 47 50 53.1 39.8 42.6 48.1 33.9 53.7 47.6 32.9 34.2 42.8 Total Points Possible 74 78 78 78 78 78 78 78 78 78 78 78 78 70 78 Total Score 67% 84% 68% 60% 64% 68% 51% 55% 62% 43% 69% 61% 42% 49% 55% Bureau of Audits, Offi ce of the Inspector General Page 142 APPENDIX D-1: Medication Management _____________________________________________________________________________________________________________________ Page 4 of 4 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 66 7% 50% 39% 0% 50% 17% 13% 50% 11% 33% 50% 57% 18% 50% 64% 33% 100% 59% 48% 0.4 3 2.3 0 3 1 0.8 3 0.7 2 3 3.4 1.1 3 3.8 2 6 3.5 94.8 28.2 41.7 43.3 30.2 55.4 42.6 34.7 44.4 36.3 43.8 42.1 51.7 48.7 49.8 60.2 42.8 65.7 44 1499.2 70 78 78 74 78 78 78 78 78 78 78 78 78 78 78 78 78 78 2550 40% 53% 56% 41% 71% 55% 44% 57% 47% 56% 54% 66% 62% 64% 77% 55% 84% 56% 59% State of California • May 2011 Page 143 APPENDIX D-2: Access to Providers and Services ______________________________________________________________________________________________________________________ Page 1 of 6 Category Defi nition: Assesses the prisons’ effectiveness in ensuring that inmates are seen by primary care providers or provided services for routine, urgent, and emergency medical needs according to timelines set by CDCR policy. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number RN FTF Documentation: Did the RN complete the face-to-face (FTF) triage within one (1) business day after the Form 7362 was reviewed? 01.025 (6 points possible) Score 76% 84% 80% 76% 88% 88% 78% 65% 83% 33% 60% 80% 68% 26% 40% Points Received 4.6 5 4.8 4.6 5.3 5.3 4.7 3.9 5 2 3.6 4.8 4.1 1.5 2.4 If the RN determined a referral to a primary care physician (PCP) was necessary, was the inmate seen within the timelines specifi ed by the 01.027 RN during the FTF triage? (8 points possible) Score 29% 82% 13% 50% 79% 56% 75% 75% 35% 47% 25% 54% 71% 52% 27% Points Received 2.4 6.6 1 4 6.3 4.5 6 6 2.8 3.8 2 4.3 5.6 4.2 2.1 Sick Call Follow-up: If the provider ordered a follow-up sick call appointment, did it take place within the time frame specifi ed? 01.247 (7 points possible) Score 25% 78% 22% 100% 60% 67% 67% 0% 20% 36% 57% 88% 56% 63% 50% Points Received 1.8 5.4 1.6 7 4.2 4.7 4.7 0 1.4 2.5 4 6.1 3.9 4.4 3.5 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? (7 points possible) Score 100% 100% 100% 67% 75% 83% 100% 33% 100% Points Received 7 7 7 4.7 5.3 5.8 7 2.3 7 02.016 Did the institution complete the initial health screening on the same day the inmate arrived at the institution? (9 points possible) Score 100% 100% 97% 100% 100% 100% 100% 100% 90% 65% 77% 95% 95% 90% 93% Points Received 9 9 8.7 9 9 9 9 9 8.1 5.9 6.9 8.6 8.6 8.1 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 02.017 the date of arrival? (8 points possible) Score 100% 56% 94% 93% 100% 100% 100% 29% 46% 70% 100% 100% 87% 100% 100% Points Received 8 4.4 7.6 7.5 8 8 8 2.3 3.7 5.6 8 8 6.9 8 8 02.018 If, during the assessment, the RN referred the inmate to a clinician, was the inmate seen within the time frame? (8 points possible) Score 25% 100% 13% 60% 50% 86% 100% 29% 0% 71% 33% 11% 55% 17% Points Received 2 8 1 4.8 4 6.9 8 2.3 0 5.7 2.7 0.9 4.4 1.3 Did the LVN/RN adequately document the tuberculin test or a review of signs and symptoms if the inmate had a previous positive 02.020 tuberculin test? (6 points possible) Score 90% 70% 87% 90% 100% 100% 85% 95% 100% 85% 80% 100% 90% 85% 97% Points Received 5.4 4.2 5.2 5.4 6 6 5.1 5.7 6 5.1 4.8 6 5.4 5.1 5.8 Reception center: Did the inmate receive a complete history and physical by a Nurse Practitioner, Physician Assistant, or a Physician and 02.021 Surgeon within 14 calendar days of arrival? (5 points possible) Score 56% 55% 55% 50% 100% 40% 100% Points Received 2.8 2.8 2.8 2.5 5 2 5 Was the inmate’s most recent chronic care visit within the time frame required by the degree of control of the inmate’s condition based on 03.076 his or her prior visit? (10 points possible) Score 88% 87% 48% 95% 56% 90% 76% 60% 64% 72% 68% 96% 75% 72% 44% Points Received 8.8 8.7 4.8 9.5 5.6 9 7.6 6 6.4 7.2 6.8 9.6 7.5 7.2 4.4 04.051 Did the primary care provider (PCP) evaluate the inmate within one calendar day after placement? (5 points possible) Score 90% 80% 80% 100% 80% 100% 70% 80% Points Received 4.5 4 4 5 4 5 3.5 4 04.052 Did the RN complete an initial assessment of the inmate on the day of placement? (5 points possible) Score 90% 100% 80% 100% 60% 100% 90% 80% Points Received 4.5 5 4 5 3 5 4.5 4 Bureau of Audits, Offi ce of the Inspector General Page 144 APPENDIX D-2: Access to Providers and Services _____________________________________________________________________________________________________________________ Page 2 of 6 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 34% 84% 44% 57% 80% 64% 40% 60% 70% 97% 71% 70% 71% 68% 70% 79% 98% 71% 68% 2.1 5 2.6 3.4 4.8 3.8 2.4 3.6 4.2 5.8 4.3 4.2 4.3 4.1 4.2 4.8 5.9 4.3 135.4 56% 46% 40% 25% 61% 48% 46% 77% 64% 57% 52% 53% 63% 55% 46% 57% 75% 38% 52% 4.4 3.6 3.2 2 4.9 3.8 3.7 6.2 5.1 4.6 4.2 4.2 5.1 4.4 3.7 4.6 6 3 138.3 50% 67% 100% 50% 100% 38% 55% 75% 83% 100% 67% 100% 40% 100% 50% 100% 60% 63% 3.5 4.7 7 3.5 7 2.6 3.8 5.3 5.8 7 4.7 7 2.8 7 3.5 7 4.2 141.6 100% 100% 0% 100% 100% 0% 100% 100% 100% 100% 100% 100% 84% 7 7 0 7 7 0 7 7 7 7 7 7 123.1 90% 85% 100% 100% 100% 100% 100% 100% 100% 95% 100% 100% 100% 95% 100% 100% 95% 100% 96% 8.1 7.7 9 9 9 9 9 9 9 8.6 9 9 9 8.6 9 9 8.6 9 284.9 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 96% 75% 100% 92% 8 8 8 8 8 8 8 8 8 8 8 8 8 8 7.6 6 8 235.6 61% 40% 100% 18% 100% 85% 6% 100% 57% 55% 38% 78% 0% 40% 36% 74% 60% 100% 53% 4.9 3.2 8 1.5 8 6.8 0.5 8 4.6 4.4 3 6.2 0 3.2 2.9 5.9 4.8 8 135.9 96% 100% 100% 100% 100% 95% 100% 100% 100% 85% 95% 90% 100% 85% 85% 90% 100% 100% 93% 5.8 6 6 6 6 5.7 6 6 6 5.1 5.7 5.4 6 5.1 5.1 5.4 6 6 184.5 95% 100% 65% 75% 90% 74% 4.8 5 3.3 3.8 4.5 44.3 84% 56% 60% 52% 76% 24% 24% 72% 15% 48% 42% 46% 32% 28% 48% 70% 13% 35% 58% 8.4 5.6 6 5.2 7.6 2.4 2.4 7.2 1.5 4.8 4.2 4.6 3.2 2.8 4.8 7 1.3 3.5 191.6 80% 80% 100% 100% 90% 75% 90% 100% 100% 88% 4 4 5 5 4.5 3.8 4.5 5 5 74.8 100% 90% 100% 100% 100% 100% 100% 100% 100% 94% 5 4.5 5 5 5 5 5 5 5 79.5 State of California • May 2011 Page 145 APPENDIX D-2: Access to Providers and Services ______________________________________________________________________________________________________________________ Page 3 of 6 Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 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? (4 points possible) Score 30% 78% 100% 50% 33% 100% 100% 75% Points Received 1.2 3.1 4 2 1.3 4 4 3 06.049 Radiology order: Was the radiology service provided within the time frame specifi ed in the physician’s order? (7 points possible) Score 100% 80% 100% 100% 20% 100% 80% 100% 100% 80% 80% 0% 100% 60% 60% Points Received 7 5.6 7 7 1.4 7 5.6 7 7 5.6 5.6 0 7 4.2 4.2 06.188 All laboratory orders: Was the specimen collected within the applicable time frames of the physician’s order? (6 points possible) Score 90% 90% 50% 60% 80% 70% 80% 100% 90% 70% 40% 90% 50% 70% 30% Points Received 5.4 5.4 3 3.6 4.8 4.2 4.8 6 5.4 4.2 2.4 5.4 3 4.2 1.8 07.035 Did the inmate receive the specialty service within specifi ed time frames? (9 points possible) Score 47% 35% 59% 59% 59% 94% 59% 77% 65% 69% 41% 29% 88% 77% 47% Points Received 4.2 3.2 5.3 5.3 5.3 8.5 5.3 6.9 5.8 6.2 3.7 2.6 7.9 6.9 4.2 Did the PCP see the inmate between the date the PCP ordered the service and the date the inmate received it, in accordance with specifi ed 07.038 time frames? (8 points possible) Score 8% 31% 25% 15% 9% 0% 23% 36% 29% 8% 29% 7% 38% 33% 7% Points Received 0.6 2.5 2 1.2 0.7 0 1.8 2.9 2.3 0.7 2.4 0.5 3 2.7 0.5 Did the PCP review the consultant’s report and see the inmate for a follow-up appointment after the specialty services consultation within 07.043 specifi ed time frames? (9 points possible) Score 22% 29% 19% 41% 8% 18% 13% 25% 36% 36% 47% 38% 23% 73% 0% Points Received 2 2.6 1.7 3.7 0.7 1.6 1.1 2.3 3.2 3.2 4.2 3.4 2.1 6.5 0 Did the medical emergency responder arrive at the location of the medical emergency within fi ve (5) minutes of initial notifi cation? 08.184 (4 points possible) Score 100% 100% 80% 100% 100% 67% 100% 100% 100% 75% 50% 100% 100% 100% Points Received 4 4 3.2 4 4 2.7 4 4 4 3 2 4 4 4 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? (5 points possible) Score 0% Points Received 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? (5 points possible) Score 100% Points Received 5 09.071 Did the inmate visit with an OB physician according to the applicable time frames? (8 points possible) Score 86% Points Received 6.9 09.074 Did the inmate receive her six-week check-up (post-delivery)? (7 points possible) Score 80% Points Received 5.6 Male inmates age 51 or older: Did the inmate receive a fecal occult blood test (FOBT) within the previous 12 months or was the inmate’s 10.085 refusal documented? (5 points possible) Score 50% 70% 30% 30% 10% 90% 20% 0% 0% 20% 70% 30% 20% Points Received 2.5 3.5 1.5 1.5 0.5 4.5 1 0 0 1 3.5 1.5 1 All inmates age 66 or older: Did the inmate receive an infl uenza vaccination within the previous 12 months or was the inmate’s refusal 10.086 documented? (6 points possible) Score 80% 75% 50% 100% 86% 100% 100% 80% 0% 0% 56% 90% 100% 60% Points Received 4.8 4.5 3 6 5.1 6 6 4.8 0 0 3.3 5.4 6 3.6 Bureau of Audits, Offi ce of the Inspector General Page 146 APPENDIX D-2: Access to Providers and Services _____________________________________________________________________________________________________________________ Page 4 of 6 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 100% 50% 100% 100% 100% 0% 100% 100% 100% 77% 4 2 4 4 4 0 4 4 4 52.6 100% 60% 100% 100% 100% 100% 40% 80% 60% 40% 100% 80% 100% 100% 100% 100% 60% 100% 81% 7 4.2 7 7 7 7 2.8 5.6 4.2 2.8 7 5.6 7 7 7 7 4.2 7 187.6 100% 70% 100% 90% 70% 90% 20% 90% 60% 70% 80% 70% 83% 70% 70% 70% 80% 80% 73% 6 4.2 6 5.4 4.2 5.4 1.2 5.4 3.6 4.2 4.8 4.2 5 4.2 4.2 4.2 4.8 4.8 145.4 65% 88% 65% 82% 100% 41% 56% 100% 94% 88% 71% 88% 59% 93% 77% 94% 94% 77% 71% 5.8 7.9 5.8 7.4 9 3.7 5.1 9 8.5 7.9 6.4 7.9 5.3 8.4 6.9 8.5 8.5 6.9 210.2 0% 56% 17% 20% 67% 22% 17% 25% 33% 75% 25% 100% 50% 67% 100% 32% 0 4.4 1.3 1.6 5.3 1.8 1.3 2 2.7 6 2 8 4 5.3 8 77.5 23% 42% 31% 25% 73% 80% 60% 25% 62% 64% 27% 43% 14% 27% 54% 64% 80% 50% 39% 2.1 3.8 2.8 2.3 6.6 7.2 5.4 2.3 5.5 5.8 2.5 3.9 1.3 2.5 4.8 5.7 7.2 4.5 114.5 80% 100% 100% 80% 100% 100% 100% 100% 75% 100% 100% 75% 100% 67% 100% 100% 100% 80% 92% 3.2 4 4 3.2 4 4 4 4 3 4 4 3 4 2.7 4 4 4 3.2 117.2 50% 25% 2.5 2.5 100% 100% 5 10 100% 93% 8 14.9 100% 90% 7 12.6 20% 0% 50% 60% 80% 40% 40% 10% 70% 50% 10% 30% 40% 60% 20% 100% 100% 41% 1 0 2.5 3 4 2 2 0.5 3.5 2.5 0.5 1.5 2 3 1 5 5 61 90% 100% 100% 20% 100% 80% 100% 100% 100% 100% 30% 100% 100% 50% 80% 100% 90% 50% 77% 5.4 6 6 1.2 6 4.8 6 6 6 6 1.8 6 6 3 4.8 6 5.4 3 147.9 State of California • May 2011 Page 147 APPENDIX D-2: Access to Providers and Services ______________________________________________________________________________________________________________________ Page 5 of 6 Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 10.087 Female inmates age 41 or older: Did the inmate receive a mammogram within the previous 24 months? (5 points possible) Score 60% 70% Points Received 3 3.5 10.229 Inmates with TB code 34: Was the inmate evaluated for signs and symptoms of TB within the previous 12 months? (7 points possible) Score 40% 0% 0% 0% 0% 100% 60% 20% 0% 100% 0% 100% 0% 100% 20% Points Received 2.8 0 0 0 0 7 4.2 1.4 0 7 0 7 0 7 1.4 Inmates prescribed INH: Did the institution monitor the inmate montley for the most recent three months he or she was on the medication? 10.232 (6 points possible) Score 0% 0% 0% 20% 0% 0% 0% 0% 0% 0% 0% 100% 0% 20% 0% Points Received 0 0 0 1.2 0 0 0 0 0 0 0 6 0 1.2 0 10.274 Female inmates age 41 to 64: Did the inmate receive a Pap smear in compliance with policy? (5 points possible) Score 60% 50% Points Received 3 2.5 Did the RN conduct a face-to-face triage of the inmate within two (2) business days of receipt of the Form 128-B and document the inmate’s 11.097 reasons for the hunger strike, most recent recorded weight, current weight, vital signs, and physical condition? (6 points possible) Score 33% 100% 33% 100% 100% 100% 25% 0% 0% 80% Points Received 2 6 2 6 6 6 1.5 0 0 4.8 After the fi rst 48 hours, did an RN or PCP complete daily assessments documenting the inmate’s weight, physical condition, emotional 11.099 condition, vital signs, and hydration status? (6 points possible) Score 0% 0% 0% 0% 100% 67% 50% 0% 67% 60% Points Received 0 0 0 0 6 4 3 0 4 3.6 After the fi rst 72 hours, did a physician perform a physical examination and order a metabolic panel and a urinalysis of the inmate? 11.100 (7 points possible) Score 0% 0% 0% 0% 100% 50% 50% 100% 67% 0% Points Received 0 0 0 0 7 3.5 3.5 7 4.7 0 15.258 Emergency Medical Response Drill: Did the responding offi cer begin CPR without unnecessary delay? (2 points possible) Score 0% 0% 100% 100% 100% 100% 0% 100% 100% 100% 0% 100% 100% 0% Points Received 0 0 2 2 2 2 0 2 2 2 0 2 2 0 15.282 Emergency Medical Response Drill: Did the medical staff arrive on scene in fi ve minutes or less? (2 points possible) Score 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% Points Received 0 2 2 2 2 2 2 2 2 2 2 2 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 fi ve calendar days of discharge? (7 points possible) Score 60% 85% 24% 65% 64% 52% 88% 92% 40% 58% 48% 84% 56% 52% 48% Points Received 4.2 6 1.7 4.6 4.5 3.6 6.1 6.4 2.8 4.1 3.3 5.9 3.9 3.6 3.4 Total Points Received 93.9 109 80.4 92.9 102.1 129.6 119.3 98.9 88.2 82.8 91.7 112.9 115.8 105.7 73.4 Total Points Possible 174 173 171 155 166 176 166 161 169 159 185 161 177 154 164 Total Score 54% 63% 47% 60% 62% 74% 72% 61% 52% 52% 50% 70% 65% 69% 45% Bureau of Audits, Offi ce of the Inspector General Page 148 APPENDIX D-2: Access to Providers and Services _____________________________________________________________________________________________________________________ Page 6 of 6 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 90% 73% 4.5 11 100% 20% 80% 40% 100% 100% 40% 100% 0% 20% 0% 80% 60% 100% 0% 100% 80% 100% 50% 7 1.4 5.6 2.8 7 7 2.8 7 0 1.4 0 5.6 4.2 7 0 7 5.6 7 116.2 0% 20% 0% 0% 0% 40% 0% 100% 20% 0% 60% 20% 0% 0% 20% 100% 40% 60% 19% 0 1.2 0 0 0 2.4 0 6 1.2 0 3.6 1.2 0 0 1.2 6 2.4 3.6 37.2 100% 70% 5 10.5 80% 0% 100% 100% 100% 75% 100% 100% 20% 100% 100% 69% 4.8 0 6 6 6 4.5 6 6 1.2 6 6 86.8 20% 100% 0% 100% 80% 20% 100% 100% 40% 100% 50% 1.2 6 0 6 4.8 1.2 6 6 2.4 6 60.2 60% 100% 40% 67% 60% 0% 100% 50% 20% 100% 48% 4.2 7 2.8 4.7 4.2 0 7 3.5 1.4 7 67.5 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 0% 76% 2 2 2 2 2 0 2 2 2 2 2 2 2 2 0 44 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 94% 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 58 48% 82% 63% 57% 100% 40% 56% 68% 24% 72% 72% 80% 71% 42% 80% 76% 84% 78% 64% 3.4 5.8 4.4 4 7 2.8 3.9 4.8 1.7 5 5 5.6 5 2.9 5.6 5.3 5.9 5.5 147.7 117.1 121.2 104.2 96.3 126.4 108.9 87.3 165.7 106.1 112.4 108.2 136.6 106.7 105.7 91.7 151.8 116.6 103 3562.5 177 180 152 166 147 166 157 196 161 154 180 173 161 157 151 175 146 137 5447 66% 67% 69% 58% 86% 66% 56% 85% 66% 73% 60% 79% 66% 67% 61% 87% 80% 75% 66% State of California • May 2011 Page 149 APPENDIX D-3: Primary Care Provider Responsibilities ______________________________________________________________________________________________________________________ Page 1 of 6 Category Defi nition: Assesses how well the prisons’ physicians, nurse practitioners, and physician assistants perform their duties and whether processes related to providing clinical care are consistent with policy. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number Reception center: If the primary care provider (PCP) indicated the inmate required a special diet, did the PCP refer the inmate to a registered 02.022 dietician? (4 points possible) Score 0% Points Received 0 Reception center history and physical: Is the “History of Present Illness” section of Form 7206 (History and Physical Examination) complete 02.211 and appropriate to the chief complaint(s), if any? (2 points possible) Score 75% 92% 100% 40% 89% 82% 60% Points Received 1.5 1.8 2 0.8 1.8 1.6 1.2 Reception center history and physical: Are the “Past History” and “Past Medical History” sections of Form 7206 (History and Physical 02.212 Examination) complete? (2 points possible) Score 88% 60% 100% 85% 100% 90% 90% Points Received 1.8 1.2 2 1.7 2 1.8 1.8 Reception center history and physical: Is the “Family and Social History” section of Form 7206 (History and Physical Examination) 02.213 complete? (2 points possible) Score 100% 100% 100% 75% 100% 75% 80% Points Received 2 2 2 1.5 2 1.5 1.6 Reception center history and physical: Is the “Review Systems” section of Form 7206 (History and Physical Examination) complete? 02.215 (2 points possible) Score 0% 100% 70% 80% 20% 0% Points Received 0 2 1.4 1.6 0.4 0 Reception center history and physical: Is the “Physical Examination” section of Form 7206 (History and Physical Examination) complete 02.216 and appropriate to the history and review of systems? (2 points possible) Score 75% 95% 100% 100% 100% 85% 60% Points Received 1.5 1.9 2 2 2 1.7 1.2 Reception center history and physical: Is the “Diagnosis/Impression” section of Form 7206 (History and Physical Examination) appropriate 02.217 to the history and physical examination? (2 points possible) Score 88% 95% 90% 100% 100% 89% 56% Points Received 1.8 1.9 1.8 2 2 1.8 1.1 Reception center history and physical: Is the “Plan of Action” section of Form 7206 (History and Physical Examination) appropriate to the 02.218 “Diagnosis/Impression” section of the form? (2 points possible) Score 100% 85% 100% 100% 100% 100% 67% Points Received 2 1.7 2 2 2 2 1.3 02.219 Reception center history and physical: Has required intake testing been ordered? (4 points possible) Score 70% 50% 100% 95% 90% 100% 20% Points Received 2.8 2 4 3.8 3.6 4 0.8 Were key elements on Forms 7419 (Chronic Care Follow-Up Visit) and 7392 (Primary Care Flow Sheet) fi lled out completely for the inmate’s 03.077 two most recent visits? (10 points possible) Score 4% 91% 46% 74% 78% 85% 52% 85% 76% 24% 52% 60% 72% 60% 28% Points Received 0.4 9.1 4.6 7.4 7.8 8.5 5.2 8.5 7.6 2.4 5.2 6 7.2 6 2.8 03.082 Did the institution document that it provided the inmate with health care education? (12 points possible) Score 64% 74% 52% 75% 50% 100% 48% 90% 96% 60% 80% 96% 88% 44% 76% Points Received 7.7 8.9 6.2 9 6 12 5.8 10.8 11.5 7.2 9.6 11.5 10.6 5.3 9.1 03.235 Is the clinical history adequate? (18 points possible) Score 60% 74% 36% 70% 67% 70% 48% 65% 64% 44% 60% 32% 68% 48% 32% Points Received 10.8 13.3 6.5 12.6 12 12.6 8.6 11.7 11.5 7.9 10.8 5.8 12.2 8.6 5.8 Bureau of Audits, Offi ce of the Inspector General Page 150 APPENDIX D-3: Primary Care Provider Responsibilities _____________________________________________________________________________________________________________________ Page 2 of 6 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 0% 0 43% 85% 60% 86% 74% 0.9 1.7 1.2 1.7 16.2 80% 90% 100% 95% 89% 1.6 1.8 2 1.9 19.6 65% 90% 75% 100% 87% 1.3 1.8 1.5 2 19.2 80% 5% 90% 95% 54% 1.6 0.1 1.8 1.9 10.8 90% 95% 95% 80% 89% 1.8 1.9 1.9 1.6 19.5 68% 100% 94% 95% 89% 1.4 2 1.9 1.9 19.6 78% 95% 85% 80% 90% 1.6 1.9 1.7 1.6 19.8 85% 85% 100% 75% 84% 80% 3.4 3.4 4 3 3.4 38.2 72% 28% 32% 8% 84% 0% 40% 52% 10% 40% 24% 54% 16% 52% 28% 25% 50% 16% 46% 7.2 2.8 3.2 0.8 8.4 0 4 5.2 1 4 2.4 5.4 1.6 5.2 2.8 2.5 5 1.6 151.8 12% 52% 68% 28% 88% 28% 68% 88% 86% 84% 68% 83% 48% 88% 72% 88% 92% 68% 70% 1.4 6.2 8.2 3.4 10.6 3.4 8.2 10.6 10.3 10.1 8.2 10 5.8 10.6 8.6 10.5 11 8.2 276.5 68% 44% 58% 13% 80% 32% 72% 84% 29% 39% 48% 71% 48% 52% 32% 58% 83% 36% 54% 12.2 7.9 10.5 2.3 14.4 5.8 13 15.1 5.1 7 8.6 12.8 8.6 9.4 5.8 10.5 15 6.5 321.2 State of California • May 2011 Page 151 APPENDIX D-3: Primary Care Provider Responsibilities ______________________________________________________________________________________________________________________ Page 3 of 6 Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 03.236 Is the focused clinical examination adequate? (19 points possible) Score 85% 96% 76% 80% 72% 70% 64% 90% 83% 72% 76% 72% 80% 68% 48% Points Received 16.2 18.2 14.4 15.2 13.7 13.3 12.2 17.1 15.8 13.7 14.4 13.7 15.2 12.9 9.1 03.237 Is the assessment adequate? (19 points possible) Score 73% 91% 40% 100% 88% 84% 72% 84% 75% 63% 44% 86% 86% 71% 59% Points Received 13.9 17.2 7.6 19 16.6 16 13.7 16 14.3 12 8.4 16.4 16.4 13.5 11.2 Is the plan adequate and consistent with the degree of control based on the chronic care program intervention and follow up requirements? 03.238 (19 points possible) Score 58% 95% 50% 90% 93% 94% 82% 89% 96% 88% 71% 85% 86% 74% 57% Points Received 11 18.1 9.5 17 17.7 17.9 15.6 16.9 18.2 16.8 13.6 16.2 16.3 14 10.9 03.262 Is the inmate’s Problem List complete and fi led accurately in the inmate’s unit health record (UHR)? (8 points possible) Score 80% 48% 28% 100% 83% 10% 84% 90% 32% 96% 60% 80% 80% 100% 64% Points Received 6.4 3.8 2.2 8 6.7 0.8 6.7 7.2 2.6 7.7 4.8 6.4 6.4 8 5.1 04.056 Did the PCP’s plan adequately address the initial assessment? (5 points possible) Score 100% 90% 75% 75% 88% 89% 38% 63% Points Received 5 4.5 3.8 3.8 4.4 4.4 1.9 3.1 04.112 Was the PCP’s initial evaluation adequate for the problem(s) requiring OHU placement? (5 points possible) Score 82% 90% 80% 78% 70% 70% 30% 40% Points Received 4.1 4.5 4 3.9 3.5 3.5 1.5 2 04.208 Was the level of care available in the OHU appropriate to the patient’s clinical presentation? (9 points possible) Score 100% 100% 100% 100% 100% 100% 78% 100% Points Received 9 9 9 9 9 9 7 9 04.230 Was the PCP’s initial assessment (or diagnoses) appropriate for the fi ndings in the initial evaluation? (5 points possible) Score 100% 90% 100% 89% 100% 100% 100% 63% Points Received 5 4.5 5 4.4 5 5 5 3.1 All diagnostic services: Did the PCP document the clinically signifi cant diagnostic test results on Form 7230 (Interdisciplinary Progress 06.191 Notes)? (7 points possible) Score 78% 87% 58% 88% 75% 80% 70% 56% 14% 73% 67% 64% 69% 87% 62% Points Received 5.4 6.1 4.1 6.1 5.3 5.6 4.9 3.9 1 5.1 4.7 4.5 4.8 6.1 4.3 06.263 All diagnostic services: Did the PCP adequately manage clinically signifi cant test results? (10 points possible) Score 91% 92% 70% 67% 77% 90% 82% 78% 67% 100% 100% 83% 83% 100% 58% Points Received 9.1 9.2 7 6.7 7.7 9 8.2 7.8 6.7 10 10 8.3 8.3 10 5.8 09.069 Did medical staff promptly order extra daily nutritional supplements and food for the inmate? (5 points possible) Score 86% Points Received 4.3 Did the “Problems/Risks Identifi ed” section of the Briggs Form 5703N (Prenatal Flow Record) corroborate the “Prenatal Screens” and the 09.072 “Maternal Physical” examination sections? (7 points possible) Score 0% Points Received 0 09.223 Were the results of the inmate’s specifi ed prenatal screening tests documented on Form 5703N? (5 points possible) Score 86% Points Received 4.3 After the fi rst 72 hours, did a physician perform a physical examination and order a metabolic panel and a urinalysis of the inmate? 11.100 (7 points possible) Score 0% 0% 0% 0% 100% 50% 50% 100% 67% 0% Points Received 0 0 0 0 7 3.5 3.5 7 4.7 0 Bureau of Audits, Offi ce of the Inspector General Page 152 APPENDIX D-3: Primary Care Provider Responsibilities _____________________________________________________________________________________________________________________ Page 4 of 6 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 76% 60% 68% 71% 92% 64% 76% 80% 62% 80% 60% 78% 56% 84% 64% 64% 88% 62% 73% 14.4 11.4 13 13.5 17.5 12.2 14.4 15.2 11.8 15.2 11.4 14.9 10.6 16 12.1 12.1 16.6 11.8 459.2 92% 47% 68% 42% 84% 55% 96% 78% 21% 57% 58% 80% 48% 76% 74% 74% 71% 77% 70% 17.4 9 13 8 16 10.5 18.2 14.9 4 10.9 11.1 15.2 9 14.4 14 14 13.5 14.5 439.8 92% 53% 65% 53% 67% 55% 72% 64% 57% 57% 71% 94% 79% 71% 70% 68% 50% 67% 73% 17.4 10 12.4 10.1 12.7 10.4 13.7 12.1 10.9 10.7 13.5 17.9 15 13.5 13.3 13 9.5 12.7 458.5 76% 60% 96% 48% 92% 96% 28% 96% 86% 28% 96% 96% 100% 100% 88% 96% 100% 76% 76% 6.1 4.8 7.7 3.8 7.4 7.7 2.2 7.7 6.9 2.2 7.7 7.7 8 8 7 7.7 8 6.1 199.5 100% 100% 100% 100% 100% 75% 89% 90% 100% 87% 5 5 5 5 5 3.8 4.4 4.5 5 73.6 100% 80% 70% 63% 100% 0% 80% 100% 89% 72% 5 4 3.5 3.1 5 0 4 5 4.4 61 100% 100% 100% 100% 100% 100% 90% 100% 100% 98% 9 9 9 9 9 9 8.1 9 9 150.1 100% 100% 100% 100% 100% 100% 89% 100% 100% 96% 5 5 5 5 5 5 4.4 5 5 81.4 89% 73% 73% 90% 92% 64% 43% 100% 39% 64% 42% 71% 23% 46% 60% 67% 60% 78% 67% 6.2 5.1 5.1 6.3 6.5 4.5 3 7 2.7 4.5 2.9 5 1.6 3.2 4.2 4.7 4.2 5.4 154 89% 90% 90% 75% 77% 55% 71% 100% 86% 64% 90% 100% 100% 75% 83% 92% 50% 100% 83% 8.9 9 9 7.5 7.7 5.5 7.1 10 8.6 6.4 9 10 10 7.5 8.3 9.2 5 10 272.5 100% 93% 5 9.3 0% 0% 0 0 86% 86% 4.3 8.6 60% 100% 40% 67% 60% 0% 100% 50% 20% 100% 48% 4.2 7 2.8 4.7 4.2 0 7 3.5 1.4 7 67.5 State of California • May 2011 Page 153 APPENDIX D-3: Primary Care Provider Responsibilities ______________________________________________________________________________________________________________________ Page 5 of 6 Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number Upon the inmate’s discharge from the community hospital, did the inmate’s Primary Care Provider (PCP) provide orders for appropriate 21.250 housing for the inmate? (7 points possible) Score 73% 80% 50% 100% 96% 100% 100% 100% 100% 96% 100% 96% 96% 100% 100% Points Received 5.1 5.6 3.5 7 6.7 7 7 7 7 6.7 7 6.7 6.7 7 7 21.276 While the patient was in the TTA, was the clinical care rendered by the attending provider adequate and timely? (7 points possible) Score 91% 100% 95% 91% 92% 100% 91% 100% 87% 96% 95% 83% 81% 64% 63% Points Received 6.4 7 6.7 6.3 6.4 7 6.4 7 6.1 6.7 6.7 5.8 5.7 4.5 4.4 21.279 For patients managed by telephone consultation alone, was the provider’s decision not to come to the TTA appropriate? (8 points possible) Score 100% 100% 83% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 8 8 6.7 8 8 8 8 8 8 8 8 8 8 Total Points Received 123.4 138.9 93.6 121 150.9 140.5 97.8 142.9 129 111.2 146.8 131.2 156.6 121.1 92.5 Total Points Possible 175 167 173 151 186 167 143 168 169 151 193 168 203 168 169 Total Score 71% 83% 54% 80% 81% 84% 68% 85% 76% 74% 76% 78% 77% 72% 55% Bureau of Audits, Offi ce of the Inspector General Page 154 APPENDIX D-3: Primary Care Provider Responsibilities _____________________________________________________________________________________________________________________ Page 6 of 6 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 72% 100% 88% 100% 100% 92% 91% 92% 92% 92% 100% 100% 92% 96% 100% 96% 96% 96% 93% 5 7 6.1 7 7 6.4 6.4 6.4 6.4 6.4 7 7 6.4 6.7 7 6.7 6.7 6.7 215.3 79% 67% 87% 62% 76% 67% 82% 62% 75% 86% 68% 92% 77% 67% 77% 74% 79% 92% 82% 5.5 4.7 6.1 4.3 5.3 4.7 5.7 4.3 5.3 6 4.8 6.4 5.4 4.7 5.4 5.2 5.5 6.4 188.8 100% 100% 100% 92% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99% 8 8 8 7.4 8 8 8 8 8 8 8 8 8 8 8 8 8 238.1 141.3 115.9 115.9 77.2 121.5 83.8 108.1 163.5 103.1 115.4 104.4 148.2 113.5 110.7 97.9 149.5 108 113.9 3989.2 179 175 162 151 144 151 151 203 168 168 167 175 168 151 151 193 144 162 5514 79% 66% 72% 51% 84% 56% 72% 81% 61% 69% 63% 85% 68% 73% 65% 78% 75% 70% 72% State of California • May 2011 Page 155 APPENDIX D-4: Continuity of Care ______________________________________________________________________________________________________________________ Page 1 of 4 Category Defi nition: Evaluates whether or not inmates continue to receive prescribed medical care when they move within a prison, move between prisons, or return to prison from receiving specialty services or from being hospitalized. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number Non-reception center: Does the health care transfer information form indicate that it was reviewed and signed by licensed health care staff 02.007 within one calendar day of the inmate’s arrival at the institution? (7 points possible) Score 100% 93% 64% 90% 85% 75% 88% 95% 95% 100% 95% 85% Points Received 7 6.5 4.5 6.3 6 5.3 6.1 6.6 6.6 7 6.6 6 Non-reception center: If the inmate was scheduled for a specialty appointment at the sending institution, did the receiving institution 02.014 schedule the appointment within 30 days of the original appointment date? (7 points possible) Score 100% 0% 100% 100% 100% Points Received 7 0 7 7 7 02.111 Non-reception center: Did the inmate receive medical accommodations upon arrival, if applicable? (6 points possible) Score 67% 100% 75% 33% 100% 75% 100% 100% 75% 100% 100% Points Received 4 6 4.5 2 6 4.5 6 6 4.5 6 6 If the inmate had an existing medication order upon arrival at the institution, did the inmate receive the medications by the next calendar 02.128 day, or did a physician explain why the medications were not to be continued? (8 points possible) Score 33% 88% 50% 50% 0% 43% 13% 25% 42% 0% 43% 23% 0% 30% 35% Points Received 2.7 7 4 4 0 3.4 1 2 3.3 0 3.4 1.8 0 2.4 2.8 04.051 Did the primary care provider (PCP) evaluate the inmate within one calendar day after placement? (5 points possible) Score 90% 80% 80% 100% 80% 100% 70% 80% Points Received 4.5 4 4 5 4 5 3.5 4 04.052 Did the RN complete an initial assessment of the inmate on the day of placement? (5 points possible) Score 90% 100% 80% 100% 60% 100% 90% 80% Points Received 4.5 5 4 5 3 5 4.5 4 05.108 Did Receiving and Release have the inmate’s UHR and transfer envelope? (7 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 If the inmate was scheduled for any upcoming specialty services, were the services noted on Form 7371 (Health Care Transfer 05.109 Information)? (8 points possible) Score 100% 0% 50% 100% 0% 100% 0% 100% 100% Points Received 8 0 4 8 0 8 0 8 8 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? (8 points possible) Score 100% 50% 100% 100% 100% 100% 100% 100% 100% 80% 100% 100% 40% 100% Points Received 8 4 8 8 8 8 8 8 8 6.4 8 8 3.2 8 Did an RN accurately complete all applicable sections of Form 7371 (Health Care Transfer Information) based on the inmate’s UHR? 05.171 (7 points possible) Score 80% 0% 100% 100% 100% 100% 75% 80% 100% 20% 20% 100% 60% 100% 100% Points Received 5.6 0 7 7 7 7 5.3 5.6 7 1.4 1.4 7 4.2 7 7 Did the Health Records Department maintain a copy of the inmate’s Form 7371 (Health Care Transfer Information) and Form 7231A 05.172 (Outpatient Medication Administration Record) when the inmate transferred? (8 points possible) Score 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% Points Received 0 8 8 8 8 8 8 8 8 8 0 8 8 8 8 Did the PCP review the consultant’s report and see the inmate for a follow-up appointment after the specialty services consultation within 07.043 specifi ed time frames? (9 points possible) Score 22% 29% 19% 41% 8% 18% 13% 25% 36% 36% 47% 38% 23% 73% 0% Points Received 2 2.6 1.7 3.7 0.7 1.6 1.1 2.3 3.2 3.2 4.2 3.4 2.1 6.5 0 Bureau of Audits, Offi ce of the Inspector General Page 156 APPENDIX D-4: Continuity of Care _____________________________________________________________________________________________________________________ Page 2 of 4 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 100% 100% 100% 94% 100% 95% 100% 95% 90% 100% 75% 84% 95% 90% 85% 91% 7 7 7 6.6 7 6.7 7 6.7 6.3 7 5.3 5.9 6.6 6.3 6 172.9 100% 50% 0% 0% 100% 100% 68% 7 3.5 0 0 7 7 52.5 50% 100% 100% 50% 100% 100% 100% 100% 50% 100% 100% 100% 100% 86% 3 6 6 3 6 6 6 6 3 6 6 6 6 124.5 24% 17% 0% 0% 60% 36% 20% 33% 40% 75% 11% 0% 14% 50% 86% 46% 83% 25% 33% 1.9 1.3 0 0 4.8 2.9 1.6 2.7 3.2 6 0.9 0 1.1 4 6.9 3.6 6.7 2 87.4 80% 80% 100% 100% 90% 75% 90% 100% 100% 88% 4 4 5 5 4.5 3.8 4.5 5 5 74.8 100% 90% 100% 100% 100% 100% 100% 100% 100% 94% 5 4.5 5 5 5 5 5 5 5 79.5 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 231 100% 100% 100% 0% 0% 0% 100% 100% 100% 64% 8 8 8 0 0 0 8 8 8 92 100% 80% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 50% 100% 75% 67% 100% 90% 8 6.4 8 8 8 8 8 8 8 4 8 8 4 8 6 5.3 8 223.3 100% 60% 100% 100% 80% 100% 100% 100% 80% 100% 100% 100% 40% 100% 20% 100% 100% 40% 80% 7 4.2 7 7 5.6 7 7 7 5.6 7 7 7 2.8 7 1.4 7 7 2.8 185.9 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 91% 8 8 8 8 8 8 8 8 8 0 8 8 8 8 8 8 8 8 240 23% 42% 31% 25% 73% 80% 60% 25% 62% 64% 27% 43% 14% 27% 54% 64% 80% 50% 39% 2.1 3.8 2.8 2.3 6.6 7.2 5.4 2.3 5.5 5.8 2.5 3.9 1.3 2.5 4.8 5.7 7.2 4.5 114.5 State of California • May 2011 Page 157 APPENDIX D-4: Continuity of Care ______________________________________________________________________________________________________________________ Page 3 of 4 Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number Did the specialty provider provide timely fi ndings and recommendations or did an RN document that he or she called the specialty provider 07.270 to ascertain the fi ndings and recommendations? (6 points possible) Score 53% 59% 88% 100% 77% 100% 100% 94% 100% 100% 100% 100% 100% 100% 94% Points Received 3.2 3.5 5.3 6 4.6 6 6 5.6 6 6 6 6 6 6 5.6 Does the institution have an adequate process to ensure inmates who are moved to a new cell still receive their medical ducats? 14.033 (4 points possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 100% Points Received 4 4 4 4 4 4 4 4 4 4 4 4 4 2 4 Upon the inmate’s discharge from the community hospital, did the triage and treatment area (TTA) registered nurse document that he or she 21.248 reviewed the inmate’s discharge plan and completed a face-to-face assessment of the inmate? (7 points possible) Score 79% 90% 65% 75% 88% 92% 84% 100% 96% 88% 92% 100% 84% 92% 32% Points Received 5.5 6.3 4.6 5.3 6.2 6.4 5.9 7 6.7 6.2 6.4 7 5.9 6.4 2.2 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 fi ve calendar days of discharge? (7 points possible) Score 60% 85% 24% 65% 64% 52% 88% 92% 40% 58% 48% 84% 56% 52% 48% Points Received 4.2 6 1.7 4.6 4.5 3.6 6.1 6.4 2.8 4.1 3.3 5.9 3.9 3.6 3.4 Upon the inmate’s discharge from the community hospital, did the inmate’s Primary Care Provider (PCP) provide orders for appropriate 21.250 housing for the inmate? (7 points possible) Score 73% 80% 50% 100% 96% 100% 100% 100% 100% 96% 100% 96% 96% 100% 100% Points Received 5.1 5.6 3.5 7 6.7 7 7 7 7 6.7 7 6.7 6.7 7 7 Upon the inmate’s discharge from the community hospital, did the registered nurse intervene if the inmate was housed in an area that was 21.251 inappropriate for nursing care based on the primary care provider’s (PCP) housing orders? (7 points possible) Score 100% 0% 100% 0% 100% 100% Points Received 7 0 7 0 7 7 Upon the inmate’s discharge from a community hospital, did the institution administer or deliver all prescribed medications to the inmate 21.281 within specifi ed time frames? (6 points possible) Score 100% 100% 58% 79% 79% 88% 64% 48% 38% 13% 67% 47% 44% 10% 47% Points Received 6 6 3.5 4.7 4.7 5.3 3.8 2.9 2.3 0.8 4 2.8 2.6 0.6 2.8 Total Points Received 88.3 81.5 78.3 92.6 69.4 82.3 75.2 81.1 75.9 73.4 81.3 97.1 69.6 84.1 76.8 Total Points Possible 122 122 112 112 109 99 104 101 97 104 122 115 102 106 104 Total Score 72% 67% 70% 83% 64% 83% 72% 80% 78% 71% 67% 84% 68% 79% 74% Bureau of Audits, Offi ce of the Inspector General Page 158 APPENDIX D-4: Continuity of Care _____________________________________________________________________________________________________________________ Page 4 of 4 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 100% 100% 100% 100% 100% 100% 94% 100% 100% 100% 100% 100% 93% 94% 100% 100% 100% 100% 95% 6 6 6 6 6 6 5.6 6 6 6 6 6 5.6 5.6 6 6 6 6 188.6 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 130 52% 88% 100% 72% 92% 88% 92% 100% 92% 96% 96% 96% 88% 96% 100% 96% 96% 88% 87% 3.6 6.2 7 5 6.4 6.2 6.4 7 6.4 6.7 6.7 6.7 6.2 6.7 7 6.7 6.7 6.2 201.8 48% 82% 63% 57% 100% 40% 56% 68% 24% 72% 72% 80% 71% 42% 80% 76% 84% 78% 64% 3.4 5.8 4.4 4 7 2.8 3.9 4.8 1.7 5 5 5.6 5 2.9 5.6 5.3 5.9 5.5 147.7 72% 100% 88% 100% 100% 92% 91% 92% 92% 92% 100% 100% 92% 96% 100% 96% 96% 96% 93% 5 7 6.1 7 7 6.4 6.4 6.4 6.4 6.4 7 7 6.4 6.7 7 6.7 6.7 6.7 215.3 100% 0% 63% 7 0 35 7% 50% 39% 0% 50% 17% 13% 50% 11% 33% 50% 57% 18% 50% 64% 33% 100% 59% 48% 0.4 3 2.3 0 3 1 0.8 3 0.7 2 3 3.4 1.1 3 3.8 2 6 3.5 94.8 67.4 100.8 69 79.3 90 79.5 76.8 76.2 89 86.1 79.2 89.1 77.8 80.3 84.1 97.3 90.5 72.2 2691.5 99 122 92 105 104 105 97 101 114 114 107 107 122 112 99 114 99 92 3536 68% 83% 75% 76% 87% 76% 79% 75% 78% 76% 74% 83% 64% 72% 85% 85% 91% 78% 76% State of California • May 2011 Page 159 APPENDIX D-5: Nurse Responsibilities ______________________________________________________________________________________________________________________ Page 1 of 4 Category Defi nition: Evaluates how well the prisons’ registered nurses and licensed vocational nurses perform their duties and whether processes related to providing nursing care are consistent with policy. Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 01.024 RN FTF Documentation: Did the inmate’s request for health care get reviewed the same day it was received? (4 points possible) Score 96% 96% 93% 87% 76% 52% 90% 30% 77% 87% 92% 45% 80% 89% 40% Points Received 3.8 3.8 3.7 3.5 3 2.1 3.6 1.2 3.1 3.5 3.7 1.8 3.2 3.5 1.6 01.157 RN FTF Documentation: Did the RN’s subjective note address the nature and history of the inmates primary complaint? (7 points possible) Score 92% 96% 83% 100% 83% 92% 93% 80% 59% 50% 64% 45% 54% 65% 57% Points Received 6.4 6.7 5.8 7 5.8 6.4 6.5 5.6 4.1 3.5 4.5 3.2 3.8 4.5 4 RN FTF Documentation: Did the RN’s assessment provide conclusions based on subjective and objective data, were the conclusions 01.158 formulated as patient problems, and did it contain applicable nursing diagnoses? (6 points possible) Score 96% 88% 79% 89% 91% 96% 83% 95% 90% 33% 68% 90% 79% 74% 61% Points Received 5.7 5.3 4.8 5.4 5.5 5.8 5 5.7 5.4 2 4.1 5.4 4.8 4.4 3.6 RN FTF Documentation: Did the RN’s objective note include vital signs and a focused physical examination, and did it adequately address 01.159 the problems noted in the subjective note? (6 points possible) Score 91% 77% 80% 90% 67% 88% 73% 80% 55% 53% 68% 90% 76% 59% 50% Points Received 5.5 4.6 4.8 5.4 4 5.3 4.4 4.8 3.3 3.2 4.1 5.4 4.6 3.5 3 RN FTF Documentation: Did the RN’s plan include an adequate strategy to address the problems identifi ed during the FTF triage? 01.162 (7 points possible) Score 92% 94% 100% 97% 96% 96% 98% 95% 100% 63% 92% 100% 96% 94% 100% Points Received 6.4 6.6 7 6.8 6.7 6.7 6.8 6.6 7 4.4 6.4 7 6.7 6.6 7 RN FTF Documentation: Did the RN’s education/instruction adequately address the problems identifi ed during the FTF triage? 01.163 (5 points possible) Score 77% 94% 90% 93% 70% 96% 85% 90% 86% 57% 80% 95% 71% 82% 64% Points Received 3.9 4.7 4.5 4.7 3.5 4.8 4.3 4.5 4.3 2.8 4 4.8 3.5 4.1 3.2 RN FTF Documentation: Did the RN’s objective note include allergies, weight, current medication, and where appropriate, medication 01.244 compliance? (3 points possible) Score 92% 94% 80% 93% 79% 80% 80% 50% 35% 33% 28% 5% 12% 65% 7% Points Received 2.8 2.8 2.4 2.8 2.4 2.4 2.4 1.5 1 1 0.8 0.2 0.4 1.9 0.2 Did documentation indicate that the RN reviewed all of the inmate’s complaints listed on Form 7362 (Health Care Services Request Form)? 01.246 (5 points possible) Score 92% 92% 87% 90% 96% 96% 88% 100% 86% 67% 64% 95% 80% 77% 93% Points Received 4.6 4.6 4.3 4.5 4.8 4.8 4.4 5 4.3 3.3 3.2 4.8 4 3.8 4.6 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? (7 points possible) Score 100% 100% 100% 67% 75% 83% 100% 33% 100% Points Received 7 7 7 4.7 5.3 5.8 7 2.3 7 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? (8 points possible) Score 100% 56% 94% 93% 100% 100% 100% 29% 46% 70% 100% 100% 87% 100% 100% Points Received 8 4.4 7.6 7.5 8 8 8 2.3 3.7 5.6 8 8 6.9 8 8 Did the LVN/RN adequately document the tuberculin test or a review of signs and symptoms if the inmate had a previous positive tuberculin 02.020 test? (6 points possible) Score 90% 70% 87% 90% 100% 100% 85% 95% 100% 85% 80% 100% 90% 85% 97% Points Received 5.4 4.2 5.2 5.4 6 6 5.1 5.7 6 5.1 4.8 6 5.4 5.1 5.8 If the inmate was scheduled for any upcoming specialty services, were the services noted on Form 7371 (Health Care Transfer 05.109 Information)? (8 points possible) Score 100% 0% 50% 100% 0% 100% 0% 100% 100% Points Received 8 0 4 8 0 8 0 8 8 Bureau of Audits, Offi ce of the Inspector General Page 160 APPENDIX D-5: Nurse Responsibilities _____________________________________________________________________________________________________________________ Page 2 of 4 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 11% 80% 48% 29% 63% 60% 56% 44% 97% 93% 46% 53% 71% 82% 50% 83% 58% 80% 68% 0.5 3.2 1.9 1.1 2.5 2.4 2.2 1.8 3.9 3.7 1.8 2.1 2.9 3.3 2 3.3 2.3 3.2 89.2 32% 79% 40% 46% 57% 54% 55% 40% 37% 50% 60% 46% 56% 39% 44% 62% 76% 68% 62% 2.2 5.5 2.8 3.2 4 3.8 3.9 2.8 2.6 3.5 4.2 3.2 3.9 2.7 3.1 4.3 5.3 4.7 143.5 27% 58% 72% 80% 93% 75% 58% 58% 73% 62% 80% 76% 56% 78% 52% 76% 64% 97% 74% 1.6 3.5 4.3 4.8 5.6 4.5 3.5 3.5 4.4 3.7 4.8 4.6 3.4 4.7 3.1 4.6 3.9 5.8 147.2 50% 79% 84% 63% 53% 63% 53% 56% 44% 47% 71% 35% 68% 39% 56% 62% 87% 65% 66% 3 4.7 5 3.8 3.2 3.8 3.2 3.4 2.7 2.8 4.2 2.1 4.1 2.3 3.3 3.7 5.2 3.9 130.3 100% 90% 92% 97% 100% 87% 73% 77% 60% 77% 80% 77% 68% 96% 71% 73% 96% 81% 88% 7 6.3 6.4 6.8 7 6.1 5.1 5.4 4.2 5.4 5.6 5.4 4.7 6.7 5 5.1 6.7 5.6 203.2 64% 63% 96% 89% 97% 57% 69% 83% 76% 43% 91% 60% 64% 83% 78% 81% 98% 90% 79% 3.2 3.2 4.8 4.4 4.8 2.8 3.5 4.1 3.8 2.2 4.6 3 3.2 4.1 3.9 4 4.9 4.5 130.6 18% 47% 80% 23% 40% 33% 43% 24% 56% 27% 44% 12% 44% 30% 48% 29% 53% 71% 47% 0.5 1.4 2.4 0.7 1.2 1 1.3 0.7 1.7 0.8 1.3 0.3 1.3 0.9 1.4 0.9 1.6 2.1 46.5 91% 90% 80% 100% 97% 88% 90% 88% 86% 80% 91% 89% 85% 100% 87% 91% 98% 94% 89% 4.5 4.5 4 5 4.8 4.4 4.5 4.4 4.3 4 4.6 4.4 4.3 5 4.3 4.5 4.9 4.7 146.1 100% 100% 0% 100% 100% 0% 100% 100% 100% 100% 100% 100% 84% 7 7 0 7 7 0 7 7 7 7 7 7 123.1 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 96% 75% 100% 92% 8 8 8 8 8 8 8 8 8 8 8 8 8 8 7.6 6 8 235.6 96% 100% 100% 100% 100% 95% 100% 100% 100% 85% 95% 90% 100% 85% 85% 90% 100% 100% 93% 5.8 6 6 6 6 5.7 6 6 6 5.1 5.7 5.4 6 5.1 5.1 5.4 6 6 184.5 100% 100% 100% 0% 0% 0% 100% 100% 100% 64% 8 8 8 0 0 0 8 8 8 92 State of California • May 2011 Page 161 APPENDIX D-5: Nurse Responsibilities ______________________________________________________________________________________________________________________ Page 3 of 4 Ref SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP Number 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? (8 points possible) Score 100% 50% 100% 100% 100% 100% 100% 100% 100% 80% 100% 100% 40% 100% Points Received 8 4 8 8 8 8 8 8 8 6.4 8 8 3.2 8 05.171 Did an RN complete all applicable sections of Form 7371 (Health Care Transfer Information) based on the inmate’s UHR? (7 points possible) Score 80% 0% 100% 100% 100% 100% 75% 80% 100% 20% 20% 100% 60% 100% 100% Points Received 5.6 0 7 7 7 7 5.3 5.6 7 1.4 1.4 7 4.2 7 7 Did the medical emergency responder use proper equipment to address the emergency and was adequate medical care provided within the 08.185 scope of his or her license? (7 points possible) Score 50% 100% 100% 100% 80% 100% 80% 100% 100% 100% 100% 100% 75% 75% Points Received 3.5 7 7 7 5.6 7 5.6 7 7 7 7 7 5.3 5.3 09.224 Was the inmate’s weight and blood pressure documented at each clinic visit? (6 points possible) Score 71% Points Received 4.3 Did the RN conduct a face-to-face triage of the inmate within two (2) business days of receipt of the Form 128-B and document the inmate’s 11.097 reasons for the hunger strike, most recent recorded weight, current weight, vital signs, and physical condition? (6 points possible) Score 33% 100% 33% 100% 100% 100% 25% 0% 0% 80% Points Received 2 6 2 6 6 6 1.5 0 0 4.8 Do medication nurses understand that medication is to be administered by the same licensed staff member who prepares it and on the 14.131 same day? (4 points possible) Score 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 4 4 4 0 4 4 4 4 4 4 4 4 4 4 4 15.282 Emergency Medical Response Drill: Did medical staff arrive on scene in fi ve mintues or less? (2 points possible) Score 0% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% Points Received 0 2 2 2 2 2 2 2 2 2 2 2 0 Emergency Medical Response Drill: Did the emergency medical responders arrive with proper equipment (ER bag, bag-valve-mask, AED)? 15.283 (1 point possible) Score 0% 100% 100% 0% 100% 100% 100% 100% 100% 0% 100% 100% 100% Points Received 0 1 1 0 1 1 1 1 1 0 1 1 1 15.285 Emergency Medical Response Drill: Did emergency medical responders continue basic life support? (1 point possible) Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Points Received 1 1 1 1 1 1 1 1 1 1 1 1 1 Upon the inmate’s discharge from the community hospital, did the triage and treatment area (TTA) registered nurse document that he or 21.248 she reviewed the inmate’s discharge plan and completed a face-to-face assessment of the inmate? (7 points possible) Score 79% 90% 65% 75% 88% 92% 84% 100% 96% 88% 92% 100% 84% 92% 32% Points Received 5.5 6.3 4.6 5.3 6.2 6.4 5.9 7 6.7 6.2 6.4 7 5.9 6.4 2.2 Upon the inmate’s discharge from the community hospital, did the registered nurse intervene if the inmate was housed in an area that was 21.251 inappropriate for nursing care based on the primary care provider’s (PCP) housing orders? (7 points possible) Score 100% 0% 100% 0% 100% 100% Points Received 7 0 7 0 7 7 Total Points Received 104.1 79 104.7 94.3 90.5 114.4 94.6 84.3 83.4 70.4 76.7 97.6 76.9 72.1 74.3 Total Points Possible 122 115 122 104 116 122 107 101 103 107 115 109 101 86 100 Total Score 85% 69% 86% 91% 78% 94% 88% 83% 81% 66% 67% 90% 76% 84% 74% Bureau of Audits, Offi ce of the Inspector General Page 162 APPENDIX D-5: Nurse Responsibilities _____________________________________________________________________________________________________________________ Page 4 of 4 Average SQ CCC NKSP KVSP FSP SOL SATF VSPW ISP CVSP COR CAL CTF MCSP SVSP CIM PBSP WSP Score 100% 80% 100% 100% 100% 100% 100% 100% 100% 50% 100% 100% 50% 100% 75% 67% 100% 90% 8 6.4 8 8 8 8 8 8 8 4 8 8 4 8 6 5.3 8 223.3 100% 60% 100% 100% 80% 100% 100% 100% 80% 100% 100% 100% 40% 100% 20% 100% 100% 40% 80% 7 4.2 7 7 5.6 7 7 7 5.6 7 7 7 2.8 7 1.4 7 7 2.8 185.9 100% 100% 67% 60% 100% 100% 60% 80% 100% 0% 100% 100% 100% 40% 100% 100% 100% 80% 86% 7 7 4.7 4.2 7 7 4.2 5.6 7 0 7 7 7 2.8 7 7 7 5.6 192.4 100% 86% 6 10.3 80% 0% 100% 100% 100% 75% 100% 100% 20% 100% 100% 69% 4.8 0 6 6 6 4.5 6 6 1.2 6 6 86.8 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 97% 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 128 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 94% 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 58 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 87% 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 27 100% 100% 100% 100% 100% 100% 0% 0% 100% 100% 100% 100% 0% 0% 100% 100% 100% 87% 1 1 1 1 1 1 0 0 1 1 1 1 0 0 1 1 1 26 52% 88% 100% 72% 92% 88% 92% 100% 92% 96% 96% 96% 88% 96% 100% 96% 96% 88% 87% 3.6 6.2 7 5 6.4 6.2 6.4 7 6.4 6.7 6.7 6.7 6.2 6.7 7 6.7 6.7 6.2 201.8 100% 0% 63% 7 0 35 65.7 94.7 86.7 96 96.1 84.7 80.8 87.7 82.6 68.9 89 81.2 79.8 76.3 78.8 91.1 101.8 87.1 2846.3 91 115 109 114 108 115 100 114 101 94 107 100 109 108 108 107 115 102 3547 72% 82% 80% 84% 89% 74% 81% 77% 82% 73% 83% 81% 73% 71% 73% 85% 89% 85% 80% State of California • May 2011 Page 163 California Prison Health Care Receivership Corporation’s Response Bureau of Audits, Offi ce of the Inspector General Page 164 California Prison Health Care Receivership Corporation’s Response (page 1 of 1) State of California • May 2011 Page 165 MEDICAL INSPECTION RESULTS SUMMARY AND ANALYSIS OF THE FIRST CYCLE OF MEDICAL INSPECTIONS OF CALIFORNIA’S 33 ADULT PRISONS OFFICE OF THE INSPECTOR GENERAL Bruce Monfross INSPECTOR GENERAL (A) Nancy Faszer DEPUTY INSPECTOR GENERAL, IN-CHARGE STATE OF CALIFORNIA MAY 2011 WWW.OIG.CA.GOV