Summary and Analysis of the First 17 Medical Inspections of California Prisons

SUMMARY AND ANALYSIS OF THE FIRST 17 MEDICAL INSPECTIONS OF CALIFORNIA PRISONS BUREAU OF AUDITS AND INVESTIGATIONS OFFICE OF THE INSPECTOR GENERAL DAVID R. SHAW INSPECTOR GENERAL STATE OF CALIFORNIA AUGUST 2010 Contents Executive Summary .................................................................................................................... 1 Introduction ................................................................................................................................. 4 OIG Medical Inspection Program ......................................................................................... 4 Objectives, Scope, and Methodology ................................................................................... 7 Results of the First 17 Medical Inspections .............................................................................. 10 Overall Scores and Medical Components ............................................................................ 11 Chronic Care ................................................................................................................. 16 Clinical Services ........................................................................................................... 18 Health Screening ........................................................................................................... 20 Specialty Services ......................................................................................................... 22 Urgent Services ............................................................................................................. 24 Emergency Services ...................................................................................................... 26 Prenatal Care/Childbirth/Post-Delivery ........................................................................ 28 Diagnostic Services ....................................................................................................... 30 Access to Health Care Information ............................................................................... 32 Outpatient Housing Unit ............................................................................................... 34 Internal Reviews ........................................................................................................... 36 Inmate Transfers ............................................................................................................ 38 Clinic Operations .......................................................................................................... 40 Preventive Services ....................................................................................................... 42 Pharmacy Services ........................................................................................................ 44 Other Services ............................................................................................................... 46 Inmate Hunger Strikes .................................................................................................. 48 Chemical Agent Contraindications ............................................................................... 50 Staffing Levels and Training ......................................................................................... 52 Nursing Policy .............................................................................................................. 56 General Medical Categories ................................................................................................ 58 Medication Management .............................................................................................. 62 Access to Providers and Services ................................................................................. 64 Continuity of Care ......................................................................................................... 67 Primary Care Provider Responsibilities ......................................................................... 69 Nurse Responsibilities .................................................................................................. 72 State of California • August 2010 Conclusion ................................................................................................................................ 74 Appendices ................................................................................................................................ 77 A: Component Definitions .................................................................................................. 79 B: Prisons’ Scores by Component ....................................................................................... 81 C: Component Questions and Scores ................................................................................... 82 D: Category Questions and Scores .................................................................................... 120 California Prison Health Care Receivership Corporation’s Response .................................... 142 Bureau of Audits and Investigations, Office of the Inspector General Executive Summary This report summarizes and analyzes the results of the Office of the Inspector General’s (OIG) first 17 medical inspections of adult prisons operated by the California Department of Corrections and Rehabilitation (CDCR). These first 17 medical inspections denote the halfway point of the Office of the Inspector General’s first cycle of prison medical inspections. Following completion of our inspection reports on all 33 prisons, we will issue a comprehensive report that covers the results of all 33 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 institution. In September 2008 we began our statewide inspections using teams of physicians, registered nurses, deputy inspectors general, and analysts. The inspection program uses “yes” and “no” answers to 166 questions 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. Compliance is measured in “yes” answers. Our inspections result in an overall weighted score for each institution. 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 define 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 17-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 reflect 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. State of California • August 2010 Page 1 Results in Brief The results of our first 17 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 two institutions exceeded the 75 percent minimum score for moderate adherence, and at 76 and 78 percent, those prisons barely achieved the minimum. Fifteen of the 17 prisons performed below the minimum score for moderate adherence; the average overall weighted score was 70 percent. Prisons’ scores ranged from 78 percent down to 62 percent. We reviewed the 17 prisons’ performance in these five general medical categories: medication management; access to medical providers and services; continuity of care; primary care provider responsibilities; and nurse responsibilities. In doing so, we noted two significant recurring problems. First: nearly all prisons were ineffective at ensuring that inmates receive their medications. Sixteen of the 17 institutions either failed to timely administer, provide, or deliver medications or failed to document that they had done so. The 17 prisons’ average score of 58 percent in medication management was significantly below the minimum score for moderate adherence. Numerous prisons were significantly 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 17 prisons was poor access to medical providers and services. Prisons were generally ineffective at ensuring that inmates are seen or provided 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. No prisons met the 75 percent minimum score for moderate adherence on access to providers and services, while seven prisons scored 60 percent or less. The average score, at 60 percent, was significantly less than the minimum score for moderate adherence. The 17 prisons fared better in continuity of care and primary care provider responsibilities; the average score was 74 percent in each of these categories, which is only one percentage point below the minimum score for moderate adherence. Moreover, in nurse responsibilities, Bureau of Audits and Investigations, Office of the Inspector General Page 2 the prisons scored 80 percent, five percentage points above the minimum score for moderate adherence. Other findings from our first 17 medical inspections follow. Prisons scored particularly poorly in four component areas: preventive services, inmate hunger strikes, access to health care information, and specialty services. The average score for preventive services was only 37 percent, and we found alarmingly low scores in tuberculosis treatment, which affects 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 46 percent. In providing necessary access to health care information on inmates, prisons scored a very poor 59 percent average, and none of the prisons updated inmate medical records by promptly filing new documents into those records. Prisons also scored a very poor 60 percent average in specialty services; we found prisons not granting inmates timely access and not providing prompt follow-up related to those services. Specialty services include services such as cardiology, oncology, and neurology. The prisons’ average score met the 75 percent minimum score for moderate adherence in 11 of the 20 component areas. Scores in five of those 11 components were 86 percent or higher. The 94 percent average score in staffing levels and training reflects 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 91 percent average score in chemical agent contraindications and the 90 percent average score in clinic operations are also noteworthy. On individual questions, the prisons achieved average scores of 86 percent or higher on 60 of the 166 questions in our medical inspection program. However, the prisons scored consistently poorly on 42 questions, averaging 60 percent or less, and in some cases substantially less. This 60 percent mark, the Receiver’s threshold for developing specific corrective action plans, indicates areas of prison medical care that require significant improvement. For example, 15 of the 17 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 29 percent. Conclusion We find 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 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. State of California • August 2010 Page 3 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 Office 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 first 17 medical inspections. Background In April 2001, inmates represented by the Prison Law Office filed 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. In addition, we agreed to inspect each state prison annually. 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. 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: • CDCR’s policies and procedures • relevant Court orders Bureau of Audits and Investigations, Office of the Inspector General Page 4 • guidelines developed by CDCR’s Quality Medical Assurance Team • guidelines and standards developed by the American Correctional Association and by the National Commission on Correctional Health Care • professional literature on correctional medical care and medical community standards of care • input from clinical experts, the Court, the Receiver’s office, CDCR, and the Prison Law Office Based on this research, we established an on-site inspection program that collects over 1,000 data elements from each prison using up to 166 questions that cover 20 essential components of medical care delivery. Our inspection teams consist of physicians, registered nurses, deputy inspectors general, and analysts. The inspection tool they use allows for a broadly scoped and consistent method 20 Components of the OIG’s of examining medical care at correctional institutions. Medical Inspections (in order of importance): For each of the 20 components of prison health care, we Chronic Care created questions with “yes” or “no” answers designed Clinical Services to gauge performance. We worked with clinical experts Health Screening to create a weighting system that factors in the relative Specialty Services importance of each component as well as considers the Urgent Services relative importance of questions within a component. Emergency Services This weighting ensures that components that pose Prenatal Care/Childbirth/Post- the greatest medical risk to the inmate-patient are Delivery given more weight than those that pose less risk.1 For Diagnostic Services example, we assigned a high number of possible points Access to Health Care Information to the chronic care component because inadequate Outpatient Housing Unit care of inmates with chronic conditions poses the most Internal Reviews significant risk of all the components. Conversely, Inmate Transfers we assigned proportionately fewer points to all other Clinic Operations components. Definitions of components are listed in Preventive Services Appendix A. Pharmacy Services Other Services The inspections identify instances of inadequate Inmate Hunger Strikes performance and noncompliance with CDCR medical Chemical Agent Contraindications policies and procedures, as well as medical community Staffing Levels and Training standards of care. However, we neither attempt to Nursing Policy identify the causes for noncompliance nor recommend remedies for specific instances of inadequacy. Our inspection tool is designed to present an objective and consistent assessment of medical care— to mirror back to the 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, 1 One question (Question 18.002) in the staffing levels and training component does not factor into the overall inspection score a prison receives. State of California • August 2010 Page 5 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 define 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 specific medical services. We then review the medical file for each inmate in our sample to determine if the medical care provided met established criteria. For these samples our inspection program assumes that if a prison’s medical staff does not document an event in an inmate’s unit health record, the event in question did not happen. If an inmate’s record does not show that the inmate received his medications on a specified date, for example, we assume that the inmate did not receive the medications. While it is possible that the inmate received his medications and the staff neglected to document the event, our program cannot assume that appropriate care was provided. Our program also reviews staffing level reports, medical appeals summaries, nursing policies and procedures, summaries of medical drills and emergencies, minutes from Quality Management Committee and Emergency Medical Response Review Committee meetings, the contents of inmate transfer envelopes, and assorted manual logs or tracking worksheets related to medical care delivery. Turning from the examination of documents to the examination of people and their actions, we observe the day-to-day medical operations at each prison. We conduct a live medical emergency drill and evaluate the adequacy of the responding staff’s actions. And finally, 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 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 itemize how the prison intends to remedy conditions that contributed to a score of 60 percent or lower on each question. Bureau of Audits and Investigations, Office of the Inspector General Page 6 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. We anticipate issuing our last report for the first cycle of 33 prison medical inspections by October 2010. Following this first cycle we will summarize and analyze the data for all 33 inspections and issue a comprehensive report. Objectives, Scope, and Methodology In September 2008, we began our statewide inspections. Sixteen months later, in January 2010, we issued our seventeenth inspection report. This report summarizes the results of those first 17 medical inspections—covering more than one-half of the state’s 33 prisons— and provides additional analysis of the data obtained from those inspections. The report includes data from inspections performed at 15 men’s prisons and two women’s prisons. The prisons are: • California State Prison, Sacramento (SAC) • California Medical Facility (CMF) • Richard J. Donovan Correctional Facility (RJD) • California State Prison, Centinela (CEN) • Deuel Vocational Institution (DVI) • Central California Women’s Facility (CCWF) • California Men’s Colony (CMC) • Sierra Conservation Center (SCC) • California State Prison, Los Angeles County (LAC) • Pleasant Valley State Prison (PVSP) • California Correctional Institution (CCI) • California Rehabilitation Center (CRC) • California Institution for Women (CIW) • Avenal State Prison (ASP) • High Desert State Prison (HDSP) • San Quentin State Prison (SQ) • California Conservation Center (CCC) In analyzing and summarizing the results of our first 17 medical inspections, our objective was State of California • August 2010 Page 7 to provide a practical interpretation of the data and an assessment of the quality of medical care provided to inmates.2 In doing so, we looked for significant 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 17-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 to relevant policies and procedures.3 Scores below 75 percent denote low adherence, while those above 85 percent reflect 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 reflects 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 two perspectives, and we cite the results of each perspective in separate sections of this report. Results by Medical Component – Our first perspective compares the weighted inspection scores of all 17 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 specific component areas, noting areas in which prisons scored particularly well or particularly poorly. In this first perspective, we present profiles of each of the 20 components. These profiles 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 significant improvement consistent with the Receiver’s requirement for corrective action plans. We also identify areas in which the prisons’ performances reflect high adherence to medical policies and procedures. We define areas requiring significant improvement as any area in which prisons earned an average score of 60 percent or less ― the Receiver’s threshold for corrective action. We define areas of high adherence as any area in which prisons earned an average score of 86 percent or more. 2 Each of the 17 inspection reports can be viewed at www.oig.ca.gov. 3 All average scores in this report are based on the arithmetic mean. We developed no median or modal averages. Bureau of Audits and Investigations, Office of the Inspector General Page 8 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 identified 100 questions that fit into five general categories of medical care. We sorted these questions into the general health care categories and analyzed the results. The five general medical categories, which offer a broader perspective on the experience of prison medical care, include: • Medication Management • Access to Providers and Services • Continuity of Care • Primary Care Provider Responsibilities • Nurse Responsibilities 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. Although we have reported the component-based results of all 17 inspections, including the results of all questions, we have not previously reported the results of this five-category analysis to the Court, the Receiver, or the Prison Law Office. Appendices – Because of the technical nature of our medical inspections and the significant volume of information in this report, we have included the following four appendices: • Appendix A: Contains the definitions of the components we use in our medical inspections program. • Appendix B: A synopsis of each institution’s scores by component. • Appendix C: Cites the text for each question in the 20 components and contains the 17 prisons’ scores for each question. • Appendix D: Cites the text for each question in the five medical categories and contains the 17 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 17 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 three of the 350 combined overall and component scores from our 17 medical inspections. In all three cases, the rounding favored the prisons because the rounded score moved the prisons from low adherence in a component to moderate adherence. In the first case, we rounded the 17 prisons’ average health screening score of 74.6 percent to 75 percent. In the second case, we rounded CRC’s score of 74.8 percent in outpatient housing unit to 75 percent. In the third case, we rounded SAC’s score of 74.5 percent in pharmacy services to 75 percent. State of California • August 2010 Page 9 Results of the First 17 Medical Inspections Only two prisons’ overall scores exceeded the 75 percent minimum score for moderate adherence, and at 76 and 78 percent, those prisons barely crested the minimum score for moderate adherence. Prisons’ overall scores ranged from 78 percent down to 62 percent, averaging 70 percent. These scores reveal that the Receiver and the prisons can improve compliance with CDCR’s medical policies and procedures and selected medical community standards. While overall scores varied by only 16 percentage points, there were differences of as much as 89 percentage points in the scores among institutions on individual components. Clearly, some prison staff understood and carried out relevant policies and procedures while others did not. The highest average component scores were 94 percent in staffing levels and training, 91 percent in chemical agent contraindications, and 90 percent in clinic operations. The prisons achieved high adherence on 60 of the 166 questions in our medical inspection program. The 17 prisons’ lowest average component scores were 37 percent in preventive services, 46 percent in inmate hunger strikes, 59 percent in access to health care information, and 60 percent in specialty services. The prisons scored 60 percent or less on 42 of the 166 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 42 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 five general medical categories that were recommended by our lead physician. From this broader perspective, we found significant problems in the categories of medication management and access to providers and services. The average score in medication management was only 58 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 60 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 74 percent down to 45 percent. In the remaining three categories only nurse responsibilities, with an average score of 80 percent, exceeded the 75 percent minimum score for moderate adherence. However, continuity of care and primary care provider responsibilities were close, with average scores of 74 percent. The following sections of this report summarize and analyze the 17 prisons’ overall scores, their scores in each of the 20 components, and their scores in each of the five general medical categories. Bureau of Audits and Investigations, Office of the Inspector General Page 10 Chart 1: OIG First Seventeen Medical Inspection Results, in Chronological Order of Report Date. 100% 95% TInostatitl uSticoonr eScore Average Score = 70% AMvienirmaguem S Mcoordee =ra 7te0 %Adherence = 75% 85% 78% 76% 75% 74% 74% 73% 73% 72% 72% 71% 70% 70% 68% 68% 65% 65% 65% 64% 62% 55% SAC CMF RJD CEN DVI CCWF CMC SCC LAC PVSP CCI CRC CIW ASP HDSP SQ CCC Nov. Jan. Feb. Feb. Mar. May May Jun. Jul. Aug. Sep. Oct. Nov. Nov. Dec. Dec. Jan. 2008 2009 2009 2009 2009 2009 2009 2009 2009 2009 2009 2009 2009 2009 2009 2009 2010 Overall Scores and Medical Components Only two prisons’ overall scores met the 75 percent minimum score for moderate adherence. As shown in Chart 1, the average score for the 17 prisons was 70 percent. The scores varied only 16 percentage points from highest to lowest. Only two prisons (CCWF and SCC) had scores that exceeded the 75 percent minimum score for moderate adherence with medical policies and procedures. CCWF’s score of 78 percent was the highest, while SCC’s score of 76 percent was a close second. The combined average score of these two highest-scoring prisons was 77 percent. Another nine institutions 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 six prisons had scores that ranged from 68 percent to 62 percent. Component Analysis Individual prisons’ component scores varied widely. We have summarized all 17 institutions’ scores for each of the 20 components on one table in Appendix B. State of California • August 2010 Page 11 There were wide variations in some prisons’ scores, while in other cases the variations were substantially narrower. For example: • The largest variation in an individual prison’s scores was 89 percentage points. This characteristic was shared by RJD and SAC. Each prison scored only 11 percentage points in inmate hunger strikes and yet each received 100 percent scores in other components. • The smallest variation in scores was the 41 percentage points achieved by CRC, which scored only 59 percent in specialty services and diagnostic services, yet received 100 percent in two other components. CRC tied with CEN for the third highest overall score of 74 percent. Sixteen of the 17 prisons scored 100 percent in at least one component, with CCWF’s and HDSP’s four 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 some 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. These scores ranged from a high of 94 percent in staffing levels and training down to 37 percent in preventive services, presenting a range of 57 percentage points. In five components, the average scores met the 86 percent minimum score for high adherence to medical policies and procedures. In addition to the 94 percent in staffing levels and training, the prisons achieved average scores of 91 percent in chemical agent contraindications, 90 percent in clinic operations, and 86 percent in inmate transfers and other services. The 94 percent average score in staffing levels and training reflects 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 six components had average scores of 75 percent to 85 percent, indicating that the prisons were performing moderately well. The six components were pharmacy services, urgent services, emergency services, outpatient housing unit, internal reviews, and health screening. Thus, a total of 11 of the 20 component average scores met or exceeded the 75 percent minimum score for moderate adherence. The average scores in the following four component areas indicate low adherence to medical policies and procedures and the need for improvement: • Preventive services (37 percent). The low average score in preventive services reflects CDCR’s systematic failure to effectively identify and schedule inmates who need cancer screenings and tuberculosis treatment. Bureau of Audits and Investigations, Office of the Inspector General Page 12 Chart 2: Average Score by Medical Component, Sorted by Order of Importance Chronic Care 64% Clinical Services 66% Health Screening 75% Specialty Services 60% Urgent Services 79% Emergency Services 77% Prenatal Care/Childbirth/Post-delivery 61% Diagnostic Services 69% Access to Health Care Information 59% Outpatient Housing Unit 77% Internal Reviews 76% Inmate Transfers 86% Clinic Operations 90% Preventive Services 37% Pharmacy Services 85% Other Services 86% Inmate Hunger Strikes 46% Chemical Agent Contraindications 91% Staffing Levels and Training 94% Nursing Policy 74% 25% 35% 45% 55% 65% 75% 85% 95% 100% • Inmate hunger strikes (46 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. • Access to health care information (59 percent). This low score shows the prisons are not effective in filing, storing, and retrieving medical records and medical information in a timely manner. • Specialty services (60 percent). The low average score reflects poorly on the prisons’ ability to schedule and follow up on outside specialty services in a timely manner. The variation in component scores among institutions indicates that the 17 prisons were not consistently executing CDCR’s medical policies and procedures, or complying with community medical standards. State of California • August 2010 Page 13 Table 1: Summary of High and Low Scores by Medical Component, Sorted by Order of Importance Variation Between Medical Component High Low Average High/Low Chronic Care 84 percent 45 percent 64 percent 39 percentage points Clinical Services 87 percent 47 percent 66 percent 40 percentage points Health Screening 87 percent 61 percent 75 percent 26 percentage points Specialty Services 74 percent 43 percent 60 percent 31 percentage points Urgent Services 89 percent 63 percent 79 percent 26 percentage points Emergency Services 90 percent 48 percent 77 percent 42 percentage points Prenatal Care/Childbirth/ 61 percent 61 percent 61 percent N/A Post-Delivery Diagnostic Services 87 percent 43 percent 69 percent 44 percentage points Access to Health Care 82 percent 20 percent 59 percent 62 percentage points Information Outpatient Housing Unit 86 percent 63 percent 77 percent 23 percentage points Internal Reviews 100 percent 60 percent 76 percent 40 percentage points Inmate Transfers 100 percent 43 percent 86 percent 57 percentage points Clinic Operations 100 percent 82 percent 90 percent 18 percentage points Preventive Services 82 percent 7 percent 37 percent 75 percentage points Pharmacy Services 100 percent 58 percent 85 percent 42 percentage points Other Services 100 percent 55 percent 86 percent 45 percentage points Inmate Hunger Strikes 100 percent 11 percent 46 percent 89 percentage points Chemical Agent 100 percent 65 percent 91 percent 35 percentage points Contraindications Staffing Levels and 100 percent 80 percent 94 percent 20 percentage points Training Nursing Policy 100 percent 36 percent 74 percent 64 percentage points 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 understood and carried out relevant medical policies and procedures while others did not. Beginning in the next section, we present profiles of each of the 20 components. In these profiles, 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 significant Bureau of Audits and Investigations, Office of the Inspector General Page 14 improvement as well as areas with scores that indicated high adherence to medical policies and procedures. We defined “areas requiring significant improvement” as areas of prison medical care in which prisons scored 60 percent or less. This is the Receiver’s threshold score for requiring formal corrective action plans. We defined “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 • August 2010 Page 15 Medical Component: Chronic Care Profile Page 1 of 2 Component Definition: The Chronic Care component examines how well the prison provided care and medications to inmates with specific chronic care conditions, which are those that affect (or have the potential to affect) an inmate’s functioning and long-term prognosis for more than six months. Our inspection tests anticoagulation therapy and the following chronic care conditions: asthma, diabetes, HIV (Human Immunodeficiency Virus), and hypertension. Results in Brief: Only three prisons scored at or above the 75 percent Key Statistics minimum score for moderate adherence. RJD, CCC, and HDSP • Component Average: ..... 64% performed the worst. Documentation at most of the 17 prisons • Top Two Average: ......... 83% indicated that inmates were not receiving their prescribed chronic • Range of Scores: .. 84%-45% care medications. Further, at all prisons there was inadequate • Variation: ...................... 39% documentation of inmates’ clinical histories. • Number of Prisons with: High Adherence ................ 0 Moderate Adherence ......... 3 Low Adherence ............... 14 Chart 3: Chronic Care Scores by Institution, Sorted Highest to Lowest Score 100% 95% Institution Score Chronic Care Average Score = 64% 85% 84% AMvineirmaguem S Mcoordee =ra 6te4 %Adherence = 75% 81% 75% 75% 74% 73% 70% 70% 67% 65% 65% 63% 62% 59% 57% 57% 55% 49% 46% 45% 45% 35% CMF CEN SCC DVI CCWF LAC CIW CRC SQ SAC CCI ASP CMC PVSP RJD CCC HDSP This component includes nine questions. Bureau of Audits and Investigations, Office of the Inspector General Page 16 Medical Component: Chronic Care Profile Page 2 of 2 Areas Requiring Significant Improvement Due to Scores of 60 Percent or Less Question Either the inmates’ medical files 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 31 percent. Fourteen of the 17 prisons had scores of 50 percent or less, and CMC, PVSP, and CIW received only 4 percent. Question The clinical histories in inmates’ medical files were consistently inadequate. The 03.235 average score was only 56 percent. Not one of the 17 prisons had a score that met the 75 percent minimum score for moderate adherence, and nine prisons scored 60 percent or below on this question. 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 58 percent, and seven prisons scored 52 percent or lower. SAC received only 4 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. State of California • August 2010 Page 17 Medical Component: Clinical Services Profile Page 1 of 2 Component Definition: 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. Results in Brief: Fifteen of the 17 prisons failed to ensure that inmates Key Statistics received their prescribed medications in a timely manner. Thirteen • Component Average: .... 66% prisons failed to meet the appointment dates set by the triage nurse • Top Two Average: ......... 84% for inmates’ visits with a primary care provider. As evidenced by their • Range of Scores: ...87%-47% overall clinical services scores, PVSP and SQ fared the worst in this • Variation: .......................40% component. • Number of Prisons with: High Adherence ................ 1 Moderate Adherence ......... 1 Low Adherence ............... 15 Chart 4: Clinical Services Scores by Institution, Sorted Highest to Lowest Score 100% 95% CInlinsitcitaul tSioenr vSicceosre Average Score = 66% 87% Average Score = 66% Minimum Moderate Adherence = 75% 85% 80% 75% 74% 74% 73% 71% 70% 67% 67% 66% 66% 65% 64% 62% 57% 55% 51% 47% 47% 45% 35% CMF CEN CMC CCWF DVI SCC CRC RJD SAC CCC LAC ASP CIW CCI HDSPPVSP SQ This component includes 14 questions. Areas Requiring Significant 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. Fifteen of the 17 prisons scored 55 percent or less, and the average score for this question was only 35 percent. PVSP received 11 percent and CRC scored just 10 percent. Bureau of Audits and Investigations, Office of the Inspector General Page 18 Medical Component: Clinical Services Profile Page 2 of 2 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 51 percent. RJD received 13 percent. Question Fourteen of the 17 prisons did not conduct timely follow-up appointments with 01.247 inmates when the initial sick call visits called for them. The average score for this question was only 53 percent. SCC received zero 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 53 percent. CRC and HDSP scored just 5 and 7 percent respectively. Question Most prisons failed to audit their clinic response bags daily or neglected to ensure 15.234 that the bags contained essential items. The average score for this question was only 59 percent. Four prisons received zero percent. Areas Achieving High Adherence with Scores of 86 Percent or More Question Nearly all of the prisons did well in developing strategies to address the problems 01.162 identified in the registered nurse’s face-to-face triage. The average score for this question was 94 percent. 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. Thirteen of the 17 prisons achieved scores of 86 percent or higher on this question, and the average score was 87 percent. See Appendix C-2 for detailed information on questions and scores for this component. State of California • August 2010 Page 19 Medical Component: Health Screening Profile Page 1 of 2 Component Definition: 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: More than half of the prisons inspected scored below • Component Average: ......75% the 75 percent minimum score for moderate adherence. Even though • Top Two Average: ...........86% prisons were regularly performing initial health screenings, we found • Range of Scores: ...87%-61% that they were not following up to ensure that inmates received • Variation: ...................... 26% required medications or treatment for medical conditions identified • Number of Prisons with: during those health screenings. High Adherence ................ 1 Moderate Adherence ......... 7 Low Adherence ................. 9 Chart 5: Health Screening Scores by Institution, Sorted Highest to Lowest Score 100% 95% HInesatlitthu tSiocnre Sencionrge Average Score = 75% Average Score = 75% Minimum Moderate Adherence = 75% 87% 84% 85% 81% 81% 78% 78% 77% 76% 74% 74% 75% 73% 72% 70% 69% 68% 67% 65% 61% 55% CMF CCWF ASP CCC CCI CEN SQ SAC DVI CRC CMC HDSP CIW LAC RJD PVSP SCC This component includes 19 questions. Some of these questions apply only to prisons with a reception center; other questions apply to prisons with general population inmates; still others apply to both. Bureau of Audits and Investigations, Office of the Inspector General Page 20 Medical Component: Health Screening Profile Page 2 of 2 Areas Requiring Significant Improvement Due to Scores of 60 Percent or Less Question The medical files contained no indication that the inmates who transferred from 02.128 other prisons were receiving existing medication orders by the calendar day following their arrival. The average score for this question was only 30 percent. Sixteen of the 17 prisons had scores of 50 percent or less, and DVI, PVSP, and CIW received zero percent. Question This question applies only to prisons with reception centers. Some reception centers 02.215 were not completing a portion of the History and Physical Examination form. The average score for this question was only 45 percent. RJD and HDSP received zero percent. Question If, during an assessment, a registered nurse referred the inmate to a clinician, the inmate 02.018 was not seen within the specified time frame. The average score for this question was only 47 percent. Thirteen of the 17 prisons had scores of 71 percent or less, and eight prisons scored below 50 percent. LAC received zero percent for the question. Areas Achieving High Adherence with Scores of 86 Percent or More 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 88 percent to 93 percent on each of these questions. 02.217 02.218 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 93 percent on this question. Seven 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 91 percent. Five prisons scored 100 percent. Question Within one calendar day of the inmate’s arrival, most prisons’ licensed health care 02.007 staff reviewed and signed the health care transfer information form. The average score for this question was 90 percent. Four prisons scored 100 percent. Question For inmates with positive tuberculin tests, most prisons completed a review of 02.015 symptoms and the infection control nurses reviewed the results. The average score for this question was 87 percent. Seven 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 86 percent. Nine prisons scored 100 percent. See Appendix C-3 for detailed information on questions and scores for this component. State of California • August 2010 Page 21 Medical Component: Specialty Services Profile Page 1 of 2 Component Definition: 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. Results in Brief: All 17 prisons performed poorly in providing inmates Key Statistics timely access to specialty services and prompt follow-up related to • Component Average: ......60% those services. The low scores associated with three specialty services • Top Two Average: ...........74% questions were so significant that they reduced the 17 prisons’ • Range of Scores: ...74%-43% average score in specialty services by 19 percentage points. Without • Variation: ...................... 31% the three questions, the 17 prisons’ average score would have been 79 • Number of Prisons with: percent instead of the 60 percent average score they received. High Adherence ................ 0 Moderate Adherence ......... 0 Low Adherence ............... 17 Chart 6: Specialty Services Scores by Institution, Sorted Highest to Lowest Score 100% 95% Institution Score Specialty Services Average Score = 60% 85% AMveinraimgeu Smc oMreo d=e 6r0a%te Adherence = 75% 75% 74% 73% 71% 70% 65% 63% 63% 62% 61% 60% 59% 58% 57% 55% 53% 53% 53% 47% 45% 43% 35% ASP SCC CCC LAC CMC CIW RJD PVSP CEN CRC SQ CCI DVI HDSPCCWF SAC CMF This component includes 9 questions. Areas Requiring Significant 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 specified time frames. The average score for this question was only 21 percent. CIW scored the highest with 38 percent, while CCWF and SQ scored zero percent. Bureau of Audits and Investigations, Office of the Inspector General Page 22 Medical Component: Specialty Services Profile Page 2 of 2 Question Fifteen prisons were not scheduling high-priority (urgent) specialty services within 07.261 14 days as required. For this question, the 17 prisons had an average score of only 29 percent. Nine prisons received 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 specified time frames following the specialty services consultation. The average score for this question was only 29 percent. HDSP’s score of zero percent was the lowest. Areas Achieving High Adherence with Scores of 86 Percent or More Question Sixteen of the 17 prisons’ physical therapists properly assessed inmates, documented 07.090 their treatment plans, and documented the treatment provided. The average score for this question was 98 percent. Question This question asks if the prisons’ specialty service providers provided timely 07.270 findings and recommendations, or if the prison’s registered nurse conducted timely follow-up with the provider to ascertain the findings and recommendations. The average score for this question was 92 percent. Fourteen of the 17 prisons scored at least 88 percent. See Appendix C-4 for detailed information on questions and scores for this component. State of California • August 2010 Page 23 Medical Component: Urgent Services Profile Page 1 of 2 Component Definition: The Urgent Services component addresses the care provided by the prison to inmates before and after they were sent to a community hospital. Results in Brief: On average, the 17 prisons performed relatively well Key Statistics in providing urgent services. Only four prisons did not meet the 75 • Component Average: ......79% percent minimum score for moderate adherence to policies and • Top Two Average: ...........89% procedures. However, upon inmates’ discharge from a community • Range of Scores: ...89%-63% hospital, few of the prisons administered or delivered all prescribed • Variation: ...................... 26% medications to the inmates within specified time frames. • Number of Prisons with: High Adherence ................ 2 Moderate Adherence ....... 11 Low Adherence ................. 4 Chart 7: Urgent Services Scores by Institution, Sorted Highest to Lowest Score 100% 95% Institution Score Average Score = 79% 89% 89% Minimum Moderate Adherence = 75% 85% 84% 84% 83% 83% 81% 81% 80% 80% 79% 78% 75% 75% 73% 72% 70% 65% 63% 55% CCWF SCC CCC CMC CCI SAC CRC PVSP CEN LAC CMF DVI CIW RJD HDSP ASP SQ This component includes eight questions. Two questions were not applicable at all prisons. Areas Requiring Significant Improvement Due to Scores of 60 Percent or Less Question Most prisons failed to administer or deliver all prescribed medications to inmates 21.281 in an appropriate time frame upon their discharge from a community hospital. The average score for this question was only 55 percent. PVSP, ASP, and SQ scored 13 percent or lower. Bureau of Audits and Investigations, Office of the Inspector General Page 24 Medical Component: Urgent Services Profile Page 2 of 2 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 21.279 managed 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. Fourteen prisons scored 100 percent. Question This question asks whether, upon the inmate’s discharge from the community 21.250 hospital, the inmate’s primary care provider gave orders for appropriate housing for the inmate. The average score for this question was 92 percent. Although RJD scored only 50 percent, nine prisons scored 100 percent. Question This question asks whether the clinical care rendered by the attending provider 21.276 was adequate and timely while the patient was in the triage and treatment area. The average score for this question was 87 percent, and CCWF, CMF, and SCC scored 100 percent. See Appendix C-5 for detailed information on questions and scores for this component. State of California • August 2010 Page 25 Medical Component: Emergency Services Profile Page 1 of 2 Component Definition: The Emergency Services component examines how well the prison responded to medical emergencies. Specifically, we focused on “man down” or “woman down” situations. Further, questions determine the adequacy of medical and staff response to a “man down” or “woman down” emergency drill. Results in Brief: Most prisons performed relatively well in providing Key Statistics emergency services, with 12 exceeding the 75 percent minimum • Component Average: ..... 77% score for moderate adherence to policies and procedures and four • Top Two Average: .......... 90% coming close. However, SAC performed very poorly with a score of • Range of Scores: ...90%-48% • Variation: ....................... 42% 48 percent. Further, half of the first responders in our emergency response drill failed to carry and use proper equipment and to • Number of Prisons with: properly perform cardiopulmonary resuscitation. In addition, most High Adherence ................ 3 prisons’ Emergency Medical Response Review Committees were Moderate Adherence ......... 9 slow in performing their duties. Low Adherence ................. 5 Chart 8: Emergency Services Scores by Institution, Sorted Highest to Lowest Score 100% 95% Institution Score 90% 90% Average Score = 77% 86% 85% 84% 83% MAvineirmaguem S cMoored e=r a7t7e% Adherence = 75% 80% 80% 78% 78% 78% 77% 76% 75% 73% 72% 72% 71% 65% 55% 48% 45% 35% RJD CCC CMC LAC PVSPCCWF CIW SQ ASP CCI CEN SCC CRC CMF HDSP DVI SAC 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 Significant Improvement Due to Scores of 60 Percent or Less Question The findings 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 24 percent, with nine prisons receiving zero percent. Bureau of Audits and Investigations, Office of the Inspector General Page 26 Medical Component: Emergency Services Profile Page 2 of 2 Question This question pertains to our emergency medical response drill, which we ran at 15.257 16 prisons.4 Eight responding officers failed to properly perform cardiopulmonary resuscitation. The average score for this question was only 47 percent. Question During the emergency medical response drill at eight prisons, the responding 15.255 officers 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 50 percent. Areas Achieving High Adherence with Scores of 86 Percent or More Question In the emergency medical response drill, all responding officers activated the 15.240 emergency response system. Every participating prison scored 100 percent on this question. Question In the emergency medical response drill, all emergency medical responders 15.285 continued basic life support activities. Every participating prison scored 100 percent on this question. Question For actual medical emergencies reviewed, the medical emergency responder was 08.183 notified without delay at each prison. The average score for this question was 99 percent. Question For actual medical emergencies reviewed, the first responder and the medical 08.186 emergency responder were certified in basic life support. The average score for this question was 94 percent. Question For actual medical emergencies reviewed, the medical emergency responder arrived 08.184 at the location of the medical emergency within five minutes of initial notification. The average score for this question was 91 percent. Question For actual medical emergencies reviewed, the medical emergency responder used 08.185 proper equipment and provided adequate medical care within the scope of his or her license. The average score for this question was 91 percent. Question In the emergency medical response drill, most prisons’ medical staff arrived on the 15.282 scene in five minutes or less. The average score for this question was 87 percent. See Appendix C-6 for detailed information on questions and scores for this component. 4 We did not complete the emergency response drill at Centinela State Prison due to special circumstances. State of California • August 2010 Page 27 Medical Component: Prenatal Care/Child Birth/Post-Delivery Profile Page 1 of 2 Component Definition: 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 was the only prison with female inmates who Key Statistics met our screening criteria for this component. CIW’s score was 61 • Component Average: ..... 61% percent, which is significantly below the 75 percent minimum score • Top Two Average: .......... N/A for moderate adherence to policies and procedures. The prison did not • Range of Scores: ........... N/A administer timely pregnancy tests to newly arrived inmates who were • Variation: .......................N/A reportedly pregnant, and there were inconsistencies in reported • Number of Prisons with: problems and risks when compared to prenatal tests and physical High Adherence ................ 0 examinations. Moderate Adherence ......... 0 Low Adherence ................. 1 Chart 9: Prenatal Care/Childbirth/Post Delivery Scores by Institution, Sorted Highest to Lowest Score 100% 95% Institution Score Minimum Moderate Adherence = 75% 85% 75% 65% 61% 55% No Prenatal/Childbirth/Post-Delivery cases at these prisons 45% CIW SAC CMF RJD CEN DVI CCWFCMC SCC LAC PVSP CCI CRC ASP HDSP SQ CCC This component includes nine questions. Areas Requiring Significant Improvement Due to Scores of 60 Percent or Less Question For newly arrived inmates, CIW did not routinely administer a pregnancy test within 09.066 three business days to positively identify the inmate’s pregnancy. The prison scored zero percent on this question. Bureau of Audits and Investigations, Office of the Inspector General Page 28 Medical Component: Prenatal Care/Child Birth/Post-Delivery Profile Page 2 of 2 Question The “Problems/Risks Identified” 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. CIW scored zero percent on this question. Question The prison did not always issue pregnant inmates a Form 7410 (Comprehensive 09.068 Accommodation Chrono) for a lower bunk and lower-tier housing when the inmate was housed in a multi-tiered housing unit. The prison scored only 43 percent on this question. Areas Achieving High Adherence with Scores of 86 Percent or More Question An obstetrician or an obstetric nurse practitioner examined newly arrived inmates 09.067 within seven business days of their arrival. CIW 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 prison scored 86 percent on this question. Question An obstetrician generally met with pregnant inmates according to applicable time 09.071 frames. CIW scored 86 percent on this question. Question Medical staff documented on Form 5703N the results of the inmate’s specified 09.223 prenatal screening tests. The prison scored 86 percent on this question. See Appendix C-7 for detailed information on questions and scores for this component. State of California • August 2010 Page 29 Medical Component: Diagnostic Services Profile Page 1 of 2 Component Definition: The Diagnostic Services component addresses the timeliness of radiology (x-ray) and laboratory services and whether the prison followed up on clinically significant results. Results in Brief: Only three prisons scored above the 75 percent Key Statistics minimum score for moderate adherence to policies and procedures. • Component Average: .... 69% HDSP performed the worst with a score of 43 percent. Of particular • Top Two Average: ......... 87% concern is that the primary care providers at most prisons failed to • Range of Scores: ...87%-43% give inmates timely notice of radiological results. Further, nearly all • Variation: ...................... 44% prisons’ primary care providers failed to give inmates timely notice of • Number of Prisons with: laboratory results. High Adherence ................ 2 Moderate Adherence ......... 1 Low Adherence ............... 14 Chart 10: Diagnostic Services Scores by Institution, Sorted Highest to Lowest Score 100% 95% Institution Score Diagnostic Services Average Score = 69% 87% 86% 85% 84% AMveinraimgeu Smc oMreo d=e 6r9a%te Adherence = 75% 75% 74% 74% 72% 71% 71% 70% 69% 68% 65% 65% 64% 60% 59% 55% 54% 45% 43% 35% ASP SCC CCWF CEN DVI CMF CCC CIW CMC SQ SAC PVSP RJD CCI CRC LAC HDSP This component includes seven questions. Areas Requiring Significant Improvement Due to Scores of 60 Percent or Less 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 notification form within two business days of the prison’s receiving the diagnostic report. The average score for this question was only 38 percent. Eleven of the 17 prisons had scores of 20 percent or less, and six of those 11 received zero percent. Bureau of Audits and Investigations, Office of the Inspector General Page 30 Medical Component: Diagnostic Services Profile Page 2 of 2 Question Sixteen of the 17 prisons scored poorly on primary care providers reviewing 06.202 the inmate’s diagnostic report for laboratory services and completing the inmate notification form within two business days of the prison’s receiving the report. The average score for this question was only 39 percent. Twelve of the 17 prisons had scores of 50 percent or less. LAC, HDSP, and SQ 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 93 percent. CEN and HDSP, with scores of 60 percent, were the only prisons not to achieve the 75 percent minimum score for moderate adherence. See Appendix C-8 for detailed information on questions and scores for this component. State of California • August 2010 Page 31 Medical Component: Access to Health Care Information Profile Page 1 of 2 Component Definition: The Access to Health Care Information component addresses the prison’s effectiveness in filing, storing, and retrieving medical records and medical-related information. Results in Brief: Only four prisons scored above the 75 percent Key Statistics minimum score for moderate adherence to policies and procedures. • Component Average: ..... 59% ASP’s score of 20 percent was the lowest, 19 percentage points below • Top Two Average: .......... 82% any other prison. None of the prisons kept inmates’ medical records • Range of Scores: ...82%-20% up to date by promptly filing loose documents. Further, most of the • Variation: ...................... 62% prisons failed to explain why certain requested medical records were • Number of Prisons with: not available for our inspection. High Adherence ................ 0 Moderate Adherence ......... 4 Low Adherence ............... 13 Chart 11: Access to Healthcare Information Scores by Institution, Sorted Highest to Lowest Score 100% 95% Institution Score Average Score = 59% 85% 82% 82% Minimum Moderate Adherence = 75% 78% 78% 75% 73% 65% 63% 59% 59% 59% 59% 55% 55% 54% 54% 45% 44% 39% 39% 35% 25% 20% 15% CEN SCC CRC CCC LAC PVSP CMF DVI CIW HDSP CCI CCWF SQ RJD SAC CMC ASP This component includes 6 questions. Bureau of Audits and Investigations, Office of the Inspector General Page 32 Medical Component: Access to Health Care Information Profile Page 2 of 2 Areas Requiring Significant Improvement Due to Scores of 60 Percent or Less Question Prisons’ medical records offices routinely failed to file all loose documents into 19.150 inmates’ unit health records within the specified time frame following medical services to the inmate. (CDCR policy requires the filing of all loose documents no later than the close of business each day. However, given the difficulty of complying with this requirement, we used a four-day criterion for this question.) All 17 prisons failed the question and received zero percent. Question The prisons were unable to account for all requested medical files. In requesting 19.243 such files, we stress to medical records personnel that if they cannot provide a requested file, they must explain why. However, 11 of the 17 prisons’ medical records staff failed to explain why files were missing. For this question, the 17 prisons had an average score of only 35 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, which scored zero percent, all prisons received 100 percent on this question. See Appendix C-9 for detailed information on questions and scores for this component. State of California • August 2010 Page 33 Medical Component: Outpatient Housing Unit Profile Page 1 of 2 Component Definition: 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 Key Statistics placement provided the inmate with adequate care and whether the • Component Average: ..... 77% physician’s plan addressed the placement diagnosis. • Top Two Average: ......... 85% • Range of Scores: ...86%-63% Results in Brief: Only ten prisons had outpatient housing units. • Variation: ...................... 23% Seven of them scored at or above the 75 percent minimum score for • Number of Prisons with: moderate adherence to policies and procedures. However, timeliness High Adherence ................ 1 of services was frequently a problem. For example, utilization Moderate Adherence ......... 6 management nurses did not assess inmates in a timely manner, and Low Adherence ................. 3 medical staff did not make their rounds with the required frequency when call buttons were not operational. Chart 12: Outpatient Housing Unit Scores by Institution, Sorted Highest to Lowest Score 100% 95% Institution Score Average Score = 77% Minimum Moderate Adherence = 75% 86% 85% 83% 83% 82% 76% 75% 75% 75% 73% 71% 65% 63% 55% No Outpatient Housing Units at these prisons 45% CMF SQ DVI CCC SAC SCC CRC CCI ASP CIW RJD CEN CCWFCMC LAC PVSPHDSP This component includes ten questions. Areas Requiring Significant Improvement Due to Scores of 60 Percent or Less Question Utilization management nurses did not assess inmates within one week of the 04.054 inmate’s placement in the outpatient housing unit and every 30 days thereafter. The average score for this question was only 6 percent. Eight of the ten prisons received zero percent. Bureau of Audits and Investigations, Office of the Inspector General Page 34 Medical Component: Outpatient Housing Unit Profile Page 2 of 2 Question This question asks if patient call buttons were operational or if medical staff 15.103 were making their rounds every 30 minutes. The average score was only 40 percent. Six of the ten 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 04.208 the patient’s clinical presentation. The average score for this question was 98 percent. Nine of the ten prisons scored 100 percent on this question. Question This question asks whether the primary care provider’s initial assessment (or 04.230 diagnosis) was appropriate for the findings in the initial evaluation. The average score for this question was 94 percent. Question With the exception of CRC, all prisons’ outpatient housing units used 15.225 disinfectant daily in common patient areas. The average score was 90 percent. Question This question asks whether the registered nurse completed an initial assessment 04.052 of the inmate on the day of placement. The average score for this question was 89 percent. See Appendix C-10 for detailed information on questions and scores for this component. State of California • August 2010 Page 35 Medical Component: Internal Reviews Profile Page 1 of 2 Component Definition: 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’ medical appeals and the prison’s use of inmate death reviews. Results in Brief: Six prisons performed very well. However, none of Key Statistics the other 11 scored at or above the 75 percent minimum score for • Component Average: .... 76% moderate adherence to policies and procedures. We found that most • Top Two Average: ......... 99% prisons were not conducting timely medical emergency response • Range of Scores: 100%-60% drills as required and that most prisons were not promptly • Variation: ...................... 40% processing inmates’ medical appeals. • Number of Prisons with: High Adherence ................ 6 Moderate Adherence ......... 0 Low Adherence ............... 11 Chart 13: Internal Reviews Scores by Institution, Sorted Highest to Lowest Score 100% 100% 98% Institution Score 95% Internal Reviews 95% 93% Average Score = 76% 91% AMvinerimaguem S cMoored =e r7a6te% Adherence = 75% 86% 85% 75% 73% 71% 70% 70% 69% 69% 66% 65% 63% 61% 60% 60% 55% RJD CCWF CIW DVI CRC CCC LAC PVSP CMC SAC CMF SQ ASP HDSP CEN SCC CCI This component includes eight questions. Areas Requiring Significant Improvement Due to Scores of 60 Percent or Less Question Most prisons’ medical facilities did not complete a medical emergency response 17.221 drill for each watch during the most recent quarter. The average score for this question was only 35 percent. Eleven of the 17 prisons had scores of zero percent. Bureau of Audits and Investigations, Office of the Inspector General Page 36 Medical Component: Internal Reviews Profile Page 2 of 2 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 47 percent. Nine of the 17 prisons scored zero percent. Areas Achieving High Adherence with Scores of 86 Percent or More Question This question asks whether the Quality Management Committee reported its findings 17.119 to the health care manager or to the chief medical officer following each of the last six meetings. The average score for this question was 96 percent, and 15 prisons had scores of 100 percent. Question Sixteen of the 17 prisons received 100 percent on this question, which asks whether 17.135 the last three Quality Management Committee meeting minutes reflect findings and strategies for improvement. The average score was 94 percent. However, HDSP received zero percent. Question Most prisons’ Quality Management Committee meeting minutes documented 17.118 monthly meetings for the last six months. The average score was 89 percent. See Appendix C-11 for detailed information on questions and scores for this component. State of California • August 2010 Page 37 Medical Component: Inmate Transfers Profile Page 1 of 2 Component Definition: 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 inmates • Component Average: ..... 86% to other prisons. Fifteen prisons met or exceeded the 75 percent • Top Two Average: ....... 100% minimum score for moderate adherence to policies and procedures. • Range of Scores: 100%-43% Eleven of these 15 prisons scored above the 86 percent minimum • Variation: ...................... 57% score for high adherence. However, CMF and CCI performed very • Number of Prisons with: poorly. High Adherence .............. 11 Moderate Adherence ......... 4 Low Adherence ................. 2 Chart 14: Inmate Transfers Scores by Institution, Sorted Highest to Lowest Score 100% 100% 100% 100% 100% 100% 100% 100% 95% 95% 94% 93% 90% 85% 80% 79% 76% 75% 75% 65% Institution Score 55% Average Score = 86% Minimum Moderate Adherence = 75% 50% 45% 43% CEN CCWF LAC CRC ASP HDSP SQ SCC CMC CCC RJD CIW DVI PVSP SAC CMF CCI This component includes five questions. Areas Requiring Significant Improvement Due to Scores of 60 Percent or Less None. Bureau of Audits and Investigations, Office of the Inspector General Page 38 Medical Component: Inmate Transfers Profile Page 2 of 2 Areas Achieving High Adherence with Scores of 86 Percent or More Question All 17 prisons received 100 percent on this question, which asks whether the 05.108 Receiving and Release office had the inmate’s unit health record and transfer envelope. Question Twelve prisons received 100 percent on this question, which asks whether the 05.110 inmate’s transfer envelope included all appropriate forms, identified all medications ordered by the physician, and contained the medications. The average score for this question was 91 percent. Question Fifteen 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 and CCI failed to do so. The average score for this question was 88 percent. See Appendix C-12 for detailed information on questions and scores for this component. State of California • August 2010 Page 39 Medical Component: Clinic Operations Profile Page 1 of 2 Component Definition: 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 Results in Brief: Prisons performed very well in clinic operations. The • Component Average: .... 90% 90 percent average score for this component is the third highest in the • Top Two Average: ......... 99% 20 component areas. All 17 prisons scored above the 75 percent • Range of Scores: 100%-82% minimum score for moderate adherence to policies and procedures, • Variation: ...................... 18% with 14 meeting or exceeding the 86 percent minimum score for high • Number of Prisons with: adherence. High Adherence .............. 14 Moderate Adherence ......... 3 Low Adherence ................. 0 Chart 15: Clinic Operations Scores by Institution, Sorted Highest to Lowest Score 100% 100% 98% 97% 95% 95% 94% 93% 91% 91% 91% 90% 88% 88% 86% 86% 85% 85% 83% 82% 75% Institution Score Average Score = 90% Minimum Moderate Adherence = 75% 65% SQ CIW CCC RJD ASP PVSP SAC HDSP CCI LAC DVI SCC CRCCCWFCMC CMF CEN This component includes ten questions. Areas Requiring Significant Improvement Due to Scores of 60 Percent or Less None. Bureau of Audits and Investigations, Office of the Inspector General Page 40 Medical Component: Clinic Operations Profile Page 2 of 2 Areas Achieving High Adherence with Scores of 86 Percent or More Questions These questions pertain to the inmate ducating (medical appointment) process. 14.032 The first question asks whether the prisons’ medical staff understood their prison’s 14.033 priority ducating process. All prisons scored 100 percent. The second question asks whether the prisons had adequate processes to ensure that inmates moved to new cells still received their medical ducats. The average score for this question was 97 percent. Questions These questions pertain to medication distribution policy and administration, and to 14.029 medication storage. Medical staff in the prisons’ clinics were aware of those inmates 14.131 on modified programs or confined to quarters, and they had an adequate process for 14.166 ensuring that 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 94 percent to 100 percent. Question The prisons were making the Form 7362 (Health Care Services Request Form) 14.023 available to inmates. The average score for this question was 98 percent. Fifteen 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 and CRC consistently failed to do so. The average score for this question was 89 percent. See Appendix C-13 for detailed information on questions and scores for this component. State of California • August 2010 Page 41 Medical Component: Preventive Services Profile Page 1 of 2 Component Definition: The Preventive Services component focuses on inmate cancer screening, tuberculosis evaluation, and influenza immunizations. Results in Brief: The 17 prisons had the lowest performance in this Key Statistics component, with the average score only 37 percent. With the • Component Average: ..... 37% exception of CRC, no prison scored higher than 60 percent. CCI • Top Two Average: .......... 71% had a score of 7 percent. We found very low scores in tuberculosis • Range of Scores: .... 82%-7% treatment. Tuberculosis is infectious and it jeopardizes the health of • Variation: ...................... 75% staff members and inmates alike. Three tuberculosis-related • Number of Prisons with: questions and two cancer screening questions disclosed consistently High Adherence ................ 0 poor performance by prisons. Moderate Adherence ......... 1 Low Adherence ............... 16 Chart 16: Preventive Services Scores by Institution, Sorted Highest to Lowest Score 100% 95% 85% 82% 75% 65% Institution Score 60% 59% Average Score = 37% 55% 53% Minimum Moderate Adherence = 75% 49% 45% 44% 37% 35% 33% 32% 28% 27% 25% 24% 24% 22% 20% 19% 15% 7% 5% 0% CRC ASP CCWFCMC SQ CMF CCC CIW SAC SCC PVSP RJD HDSP DVI LAC CEN CCI This component includes seven questions. However, two questions apply only to female prisons; and, one question applies only to male prisons. Bureau of Audits and Investigations, Office of the Inspector General Page 42 Medical Component: Preventive Services Profile Page 2 of 2 Areas Requiring Significant 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 27 percent. Four 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 9 percent, and 13 prisons received zero percent. Question Most of the 15 adult male prisons failed to administer a fecal occult blood test 10.085 (FOBT) to their inmates aged 51 or older within the past 12 months. This is an uncomplicated test that can be the first indicator of cancer. However, the prisons’ average score was only 31 percent. Eleven 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 10.229 and symptoms of tuberculosis within the previous 12 months. The average score for this question was only 39 percent. Although five prisons scored 100 percent, seven prisons received zero percent. Question For females age 41 to 64, the two women’s prisons did not consistently provide Pap 10.274 smears in compliance with policy. Pap smears can detect cervical cancer. CCWF scored 60 percent and CIW scored 50 percent, for an average score of 55 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 We did not test CCWF and CIW for compliance with this question because current CDCR policy requires the FOBT for male inmates only. State of California • August 2010 Page 43 Medical Component: Pharmacy Services Profile Page 1 of 2 Component Definition: 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. Results in Brief: Fourteen of the 17 prisons scored at or above the 75 Key Statistics percent minimum score for moderate adherence to policies and • Component Average: .... 85% procedures, and ten of those prisons scored at or exceeded the 86 • Top Two Average: ....... 100% percent minimum score for high adherence. CEN, however, lagged • Range of Scores: 100%-58% far behind the other prisons. Despite some good overall scores in • Variation: ...................... 42% pharmacy services, most prisons failed to properly maintain • Number of Prisons with: medications in their drug night lockers, and some did not maintain High Adherence .............. 10 required provider information. Moderate Adherence ......... 4 Low Adherence ................. 3 Chart 17: Pharmacy Services Scores by Institution, Sorted Highest to Lowest Score 100% 100% 100% 95% 95% 93% 92% 92% 92% 91% 91% 86% 85% 79% 79% 76% 75% 75% 72% 69% 65% 58% 55% Institution Score Average Score = 85% Minimum Moderate Adherence = 75% 45% LAC HDSP CIW RJD DVI CCWF ASP CMC SCC SQ CCI CRC CMF SAC PVSP CCC CEN This component includes eight questions. Bureau of Audits and Investigations, Office of the Inspector General Page 44 Medical Component: Pharmacy Services Profile Page 2 of 2 Areas Requiring Significant 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 44 percent. Eight of the 17 prisons scored zero percent. Question Some prisons did not maintain information to ensure that medications are prescribed 13.144 by licensed health care providers lawfully authorized to do so. The average score for this question was only 59 percent. Seven of the 17 prisons received zero percent. Areas Achieving High Adherence with Scores of 86 Percent or More Questions These are certification questions. The first question asks if the prison conspicuously 13.139 posted a valid permit in its pharmacies. The second question asks if the license of the 13.142 pharmacist in charge is current. All 17 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 17 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 had zero percent. See Appendix C-15 for detailed information on questions and scores for this component. State of California • August 2010 Page 45 Medical Component: Other Services Profile Page 1 of 2 Component Definition: 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. Results in Brief: Eleven of the 17 prisons scored well above the 75 Key Statistics percent minimum score for moderate adherence to policies and • Component Average: .... 86% procedures and another four prisons came close. Nine of the 11 • Top Two Average: ....... 100% exceeded the 86 percent minimum score for high adherence. • Range of Scores: ..100%-55% However, CIW’s and SCC’s performance was far below that of the • Variation: ...................... 45% other prisons. • Number of Prisons with: High Adherence ................ 9 Moderate Adherence ......... 2 Low Adherence ................. 6 Chart 18: Other Services Scores by Institution, Sorted Highest to Lowest Score 100% 100% 100% 100% 100% 100% 100% 100% 95% 91% 91% 85% 85% 85% 75% 73% 70% 70% 70% 65% 57% 55% 55% Institution Score Average Score = 86% Minimum Moderate Adherence = 75% 45% CMF RJD CEN DVI CCWF LAC CCC CMC SAC CCI SQ HDSPPVSP CRC ASP CIW SCC This component includes five questions. Areas Requiring Significant Improvement Due to Scores of 60 Percent or Less None. Bureau of Audits and Investigations, Office of the Inspector General Page 46 Medical Component: Other Services Profile Page 2 of 2 Areas Achieving High Adherence with Scores of 86 Percent or More Question All eight prisons that offered therapeutic diets properly provided them to inmates. 15.059 Each of the eight prisons scored 100 percent on this question. Question This question determines if the institutions properly responded to all active cases of 15.134 tuberculosis (TB) in the last six months. Only one case of active TB was identified in the 17 inspections. SAC properly responded to this active TB case resulting in a 100 percent score for this question. 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 99 percent. See Appendix C-16 for detailed information on questions and scores for this component. State of California • August 2010 Page 47 Medical Component: Inmate Hunger Strikes Profile Page 1 of 2 Component Definition: 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: .... 46% Hunger strikes of this length, although few in number, require careful • Top Two Average: ......... 86% monitoring, yet the prisons’ average score of 46 percent was the • Range of Scores: 100%-11% second lowest of all 20 component areas we inspected. Eleven of the • Variation: ...................... 89% 12 prisons that met our inspection criteria failed to score at or above • Number of Prisons with: the 75 percent minimum score for moderate adherence to policies and High Adherence ................ 1 procedures. SAC’s and RJD’s scores of 11 percent were the worst, 21 Moderate Adherence ......... 0 percentage points lower than that of any other prison. Low Adherence ............... 11 Chart 19: Inmate Hunger Strikes Scores by Institution, Sorted Highest to Lowest Score 100% 100% 95% Institution Score 85% Average Score = 46% Minimum Moderate Adherence = 75% 75% 71% 68% 65% 55% 54% 46% 45% 44% 42% 37% 35% 32% 32% 25% No inmate hunger strikes 15% lasting longer than three 11% 11% days occurred at these prisons. 5% 0% CCWFCMC CCC SQ CCI HDSP LAC PVSP CMF CEN SAC RJD DVI SCC CRC CIW ASP This component includes three questions. Areas Requiring Significant Improvement Due to Scores of 60 Percent or Less Question After the first 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 39 percent. Five prisons received zero percent. Bureau of Audits and Investigations, Office of the Inspector General Page 48 Medical Component: Inmate Hunger Strikes Profile Page 2 of 2 Question After the first 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 44 percent. Five prisons scored zero percent. Questions Registered nurses did not always: conduct timely face-to-face triages; document 11.097 the inmates’ reasons for the hunger strike; and, record the inmates’ weight, vital signs, and physical condition. The average score for this question was only 54 percent. PVSP, CCI, and CCC 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. State of California • August 2010 Page 49 Medical Component: Chemical Agent Contraindications Profile Page 1 of 2 Component Definition: 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 outcome from OC exposure might occur if the inmate has asthma. Results in Brief: Prisons generally performed well in this component. Key Statistics The 91 percent average score is the second highest achieved in the 20 • Component Average: .... 91% component areas. Fourteen prisons not only scored above the 75 • Top Two Average: ....... 100% percent minimum score for moderate adherence to policies and • Range of Scores: 100%-65% procedures, but they also exceeded the 86 percent minimum score for • Variation: ...................... 35% high adherence. However, PVSP, CCI, and CCWF scored far below • Number of Prisons with: the other prisons. These three prisons routinely failed to document High Adherence .............. 14 important procedures. Moderate Adherence ......... 0 Low Adherence ................. 3 Chart 20: Chemical Agent Contraindication Scores by Institution, Sorted Highest to Lowest Score 100% 100% 100% 100% 100% 100% 100% 100% 100% 95% 94% 91% 89% 89% 89% 87% 85% 75% 66% 66% 65% 65% Institution Score Average Score = 91% 55% Minimum Moderate Adherence = 75% SAC CMC SCC CRC CIW ASP HDSP CCC RJD LAC CEN DVI SQ CMF PVSP CCI CCWF This component includes two questions. Areas Requiring Significant Improvement Due to Scores of 60 Percent or Less None. Bureau of Audits and Investigations, Office of the Inspector General Page 50 Medical Component: Chemical Agent Contraindications Profile Page 2 of 2 Areas Achieving High Adherence with Scores of 86 Percent or More Question Prisons normally recorded how they decontaminated inmates and followed 12.064 decontamination policy. The average score for this question was 94 percent. Question The prisons generally 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 88 percent. See Appendix C-18 for detailed information on questions and scores for this component. State of California • August 2010 Page 51 Medical Component: Staffing Levels and Training Profile Page 1 of 4 Component Definition: The Staffing Levels and Training component examines the prison’s medical staffing levels and training provided. Results in Brief: The 94 percent average score for this component was Key Statistics the highest of all 20 component areas. All 17 prisons’ scores exceeded • Component Average: .... 94% the 75 percent minimum score for moderate adherence to policies and • Top Two Average: ....... 100% • Range of Scores: 100%-80% procedures, and the scores of 13 prisons exceeded the 86 percent • Variation: ...................... 20% minimum score for high adherence. Registered nurses and physicians were either on-site or available 24 hours per day, seven days a week. • Number of Prisons with: High Adherence .............. 13 Moderate Adherence ......... 4 Low Adherence ................. 0 Chart 21: Staffing Levels and Training Scores by Institution, Sorted Highest to Lowest Score 100% 100% 100% 100% 100% 100% 100% 100% 95% 95% 95% 95% 95% 90% 90% 85% 85% 85% 85% 80% 75% 65% SItnasfftiintug tLioenv eSlsc oarned Training Average Score = 94% AMveinraimgeu Smc oMreo d=e 9ra4t%e Adherence = 75% 55% RJD CEN CMC SCC ASP HDSP CCC SAC CMF DVI SQ LAC CCI CCWFCRC CIW PVSP This component includes five questions. However, one is for information only and is not scored. Areas Requiring Significant Improvement Due to Scores of 60 Percent or Less None. Bureau of Audits and Investigations, Office of the Inspector General Page 52 Medical Component: Staffing Levels and Training Profile Page 2 of 4 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 17 prisons scored 100 percent on this question. Question Every prison had a physician on site, a physician on call, or a medical officer of the 18.005 day available 24 hours a day, seven days a week, for the last 30 days. All 17 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 17 prisons scored 100 percent on this question. See Appendix C-19 for detailed information on questions and scores for this component. Note: In evaluating staffing levels and training, we collect information on staffing levels and vacancy rates at each prison. We collect this data for informational purposes only. We have summarized this information for all 17 prisons on the following pages. State of California • August 2010 Page 53 Medical Component: Staffing Levels and Training Profile Page 3 of 4 Data Not Included in Scoring: Results of Staffing and Vacancy Rate Analysis The 17 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 9 percent, and nine 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 difficulty of filling vacancies in rural, isolated prisons. Background During our prison medical inspections, the prisons provide us with data regarding their staffing levels and authorized position vacancy rates in the following four licensed medical classifications: management, primary care providers, supervisors, and rank and file nursing. We gather this information for the benefit of all interested parties; we do not, however, score prisons on their staffing levels and vacancy rates because we do not have objective criteria by which to evaluate compliance. Table 5 combines the data from the four medical classifications and summarizes each of the 17 prisons’ reported staffing levels and vacancy rates. Table 5 shows that the vacancy rates ranged from a low of zero percent at SAC to a high of 29 percent at PVSP. Six prisons had vacancy rates of 5 percent or less, and the other 11 had vacancy rates of 6 percent or more. Of this latter group, nine had double-digit vacancy rates. (While not shown on Table 5, the average vacancy rate of the 17 prisons was 9 percent.) PVSP and CCI, the prisons with the two highest vacancy rates, had among the lowest overall inspection scores, with 65 percent and 64 percent respectively. 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, with its 11 percent vacancy rate, had the second highest overall score (76 percent) of the 17 prisons. 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 5, some prisons relied extensively on private registries. Four prisons had 47 or more registry staff members. PVSP, with its 29 percent vacancy rate, had the most registry staff. Bureau of Audits and Investigations, Office of the Inspector General Page 54 Medical Component: Staffing Levels and Training Profile Page 4 of 4 Table 2: Staffing Levels and Vacancy Rates* Number of Total number Total number Total number Total number Vacancy staff hired Institution of filled of registry of vacancies: of positions: percentage: within last positions: staff: six months: PVSP 67.0 26.7 93.7 29% 14.0 67 CCI 87.0 17.7 104.7 17% 12.0 48 HDSP 80.3 10.7 91.0 12% 10.0 4 CEN 68.0 9.0 77.0 12% 5.0 9 CMC 183.0 23.8 206.8 12% 30.0 30 SCC 52.6 6.8 59.4 11% 1.0 18 CCC 58.8 7.5 66.3 11% 8.0 3 SQ 115.0 13.8 128.8 11% 12.0 38 CRC 68.6 8.0 76.6 10% 0 26 RJD 128.6 11.1 139.7 8% 39.0 2 ASP 109.0 7.0 116.0 6% 13.0 31 LAC 106.9 5.6 112.4 5% 12.0 20 DVI 109.5 5.0 114.5 4% 5.0 12 CIW 79.5 3.6 83.1 4% 5.5 32 CCWF 107.1 2.5 109.6 2% 9.0 47 CMF 229.0 5.0 234.0 2% 27.0 25 SAC 84.5 0 84.5 0% 11.0 49 * This table summarizes numbers previously published in the medical inspection reports for individual institutions. 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. CCI, with a vacancy rate second only to that of PVSP, is similarly situated. By way of contrast, SAC, with its zero percent vacancy rate, is located near a larger urban area. CMF, with the second lowest vacancy rate, is adjacent to both the Bay Area and the greater Sacramento area. State of California • August 2010 Page 55 Medical Component: Nursing Policy Profile Page 1 of 2 Component Definition: 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 review their duty statements and whether supervisors periodically review the work of nurses to ensure they properly follow established nursing protocols. Results in Brief: There was wide variation in the prisons’ scores, with Key Statistics nine prisons exceeding the 75 percent minimum score for moderate • Component Average: .... 74% adherence to policies and procedures. CCWF and PVSP performed • Top Two Average: ....... 100% very well. On the other hand, DVI and CMF performed the worst, • Range of Scores: 100%-36% scoring only 36 percent. • Variation: ...................... 64% • Number of Prisons with: High Adherence ................ 6 Moderate Adherence ......... 3 Low Adherence ................. 8 Chart 22: Nursing Policy Scores by Institution, Sorted Highest to Lowest Score 100% 100% 100% 95% 94% 94% Institution Score Nursing Policy 89% 89% Average Score = 74% 85% AMvienriamgeu mSc Moroed =e r7a4t%e Adherence = 75% 79% 79% 76% 75% 71% 70% 67% 65% 64% 57% 55% 50% 45% 36% 36% 35% CCWFPVSP SCC CCC RJD HDSP SAC CMC CRC CEN SQ ASP CIW LAC CCI CMF DVI This component includes three questions. Areas Requiring Significant 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 53 percent. Five prisons scored zero percent. Bureau of Audits and Investigations, Office of the Inspector General Page 56 Medical Component: Nursing Policy Profile Page 2 of 2 Areas Achieving High Adherence with Scores of 86 Percent or More Question All 17 prisons scored 100 percent on this question, which asks if the prison has 16.154 written nursing policies and procedures that adhere to CDCR’s guidelines. See Appendix C-20 for detailed information on questions and scores for this component. State of California • August 2010 Page 57 General Medical Categories After sorting the data from 100 key questions into five general medical categories recommended by our lead physician, we found significant problems in the categories of medication management and access to providers and services. The average score in medication management was only 58 percent 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 CMF, with a score of 84 percent, had a score that exceeded 69 percent. The average score for access to providers and services was only 60 percent. 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 74 percent down to 45 percent. In the remaining three categories, only nurse responsibilities, with an average score of 80 percent, exceeded the 75 percent minimum score for moderate adherence to policies and procedures. However, continuity of care and primary care provider responsibilities were close, with average scores of 74 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 inspection questions into the following five general categories of medical care: medication management, access to providers and services, continuity of care, primary care provider responsibilities, and nurse responsibilities. Of the inspection instrument’s 166 questions, we identified 100 that fit into the five categories. Table 3 describes each category, discloses the number of questions in that category, and provides an example question from the category. The five categories include 100 questions. In identifying the questions for the five categories, we determined that some questions were appropriate to more than one category. Therefore, we included such questions in all of the categories to which they applied. An example is the following question: • If the inmate had an existing medication order upon arrival at the institution, did the inmate receive the medications by the next calendar day, or did a physician explain why the medications were not to be continued?(Question 02.128) 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 five categories has a specific 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. Bureau of Audits and Investigations, Office of the Inspector General Page 58 Table 3: Description of Five General Medical Categories Medical Category Description Example Question Consists of 14 questions that Sick Call Medication: Did the determine if medications were institution administer or deliver Medication properly administered and delivered prescription medications (new Management to inmates as required by CDCR’s orders) to the inmate within specified policies. time frames? (Question 01.124) Consists of 35 questions that RN FTF Documentation: Did the evaluate whether inmates were RN complete the face-to-face triage Access to seen or provided services for within one business day after the Providers and routine, urgent, and emergency Form 7362 (Health Care Services Services medical needs within the time Request Form) was reviewed? frames specified by CDCR’s (Question 01.025) policies. Upon the inmate’s discharge from Consists of 19 questions that the community hospital, did the determine whether inmates triage and treatment area registered received care when moved within nurse document that he or she Continuity of Care a prison or from one prison to reviewed the inmate’s discharge another, or were received from an plan and completed a face-to- outside care provider after specialty face assessment of the inmate? services or hospitalization. (Question 21.248) Consists of 29 questions that determine whether primary care providers (physicians, nurse All Diagnostic Services: Did the Primary Care practitioners, and physician PCP adequately manage clinically Provider assistants) properly provided care significant test results? (Question Responsibilities to inmates and whether processes 06.263) related to providing clinical care are consistent with policy. Consists of 23 questions that Did documentation indicate that evaluate whether nurses properly the RN reviewed all of the inmate’s Nurse provided care to inmates and complaints listed on Form 7362 Responsibilities whether processes related (Health Care Services Request to providing nursing care are Form)? (Question 01.246) consistent with policy. 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 • August 2010 Page 59 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, staffing levels and training, and nursing policy are the only components without at least one question that fits into the five general categories. Table 4: Distribution of Medical Component Questions within the Medical Categories Access to Primary Care Medication Continuity Nurse Medical Component Providers and Provider Management of Care Responsibilities Services Responsibilities Chronic Care √ √ √ Clinical Services √ √ √ Health Screening √ √ √ √ √ Specialty Services √ √ Urgent Services √ √ √ √ √ Emergency Services √ √ Prenatal Care/ √ √ √ Childbirth/Post-delivery Diagnostic Services √ √ Outpatient Housing √ √ √ Unit Inmate Transfers √ √ √ Clinic Operations √ √ √ Preventive Services √ √ Pharmacy Services √ Inmate Hunger Strikes √ √ √ Bureau of Audits and Investigations, Office of the Inspector General Page 60 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 five general medical categories. The average scores for these categories range from a low of 58 percent in medication management to a high of 80 percent in nurse responsibilities. Our analysis clearly demonstrates that prisons’ performances in medication management and access to providers and services merit the Receiver’s attention, as the 17 prisons’ average scores of 58 percent and 60 percent, respectively, are far below the 75 percent minimum score for moderate adherence to policies and procedures. More encouragingly, in nurse responsibilities the prisons exceeded the minimum score for moderate adherence with an average score of 80 percent, while they were close to the minimum score for moderate adherence in the remaining two categories. In continuity of care and primary care provider responsibilities they averaged 74 percent. In the following sections, we provide a more in-depth analysis of the 17 prisons’ performances in each of the five medical categories. Chart 23: Scores by Category, Sorted Lowest to Highest Score. Medication Management 58% Access to Providers and Services 60% Continuity of Care 74% Primary Care Provider 74% Responsibilities Nurse Responsibilities 80% 40% 50% 60% 70% 80% 90% 100% State of California • August 2010 Page 61 Medical Category: Medication Management Page 1 of 2 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, five 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 17 prisons’ average score for medication management was only 58 percent. This is the lowest average score within any of the five general medical categories, and it clearly indicates that medication management is weak. Only CMF, with a score of 84 percent, scored higher than 69 percent. Particularly troubling is that eight of the prisons scored 55 percent or less. The prisons performed especially poorly in medication delivery. They had an average score of only 34 percent. Sixteen of the 17 prisons scored 53 percent or less, and ten of them scored from 32 percent down to 8 percent. CMF’s score of 84 percent was the only one to exceed the 75 percent minimum score for moderate adherence. The prisons’ very low scores in delivering Chart 24: Medication Management Scores by Institution, Sorted Highest to Lowest Score 100% 95% MInesdtiitcuattiioonn SMcaonraegement Average Score = 58% 85% 84% Average Score = 53% Minimum Moderate Adherence = 75% 75% 69% 68% 68% 67% 65% 64% 62% 61% 60% 55% 55% 55% 53% 51% 49% 45% 43% 42% 40% 35% 25% CMF CCI RJDCCWF SAC DVI LAC CRC CEN SCCHDSP CCC CMC ASP PVSP CIW SQ Bureau of Audits and Investigations, Office of the Inspector General Page 62 Medical Category: Medication Management Page 2 of 2 medications to inmates offset the 91 percent average score they achieved on the other nine, less heavily weighted questions in medication management. Compliance problems with medication delivery stem from one of two causes. The first 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 prisons’ administering of Isoniazid, a drug prescribed to treat latent or active tuberculosis, we found that in 73 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 file or completely blank, leaving the possibility that this was a documentation problem. However, for at least 44 percent of the cases, we found medication administration forms in the medical file 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 sick call medications (new orders) to inmates • Providing chronic care medications and following polices when inmates refuse their medications • Delivering medications to inmates within one day of arrival at the prison • Providing medications to inmates upon discharge from an outside hospital • Delivering tuberculosis medications to inmates and ensuring they take them These five areas pertain to the basic delivery of medications to inmates. As suggested by the poor 34 percent average score achieved by the 17 prisons, medication delivery is a significant health issue. See Appendix D-1 for detailed information on questions and scores for this category. State of California • August 2010 Page 63 Medical Category: Access to Providers and Services Page 1 of 3 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 17 prisons’ average score for access to providers and services was only 60 percent. This is the second lowest average score within the five general medical categories. With scores ranging from a high of 74 percent down to 45 percent, prisons are deficient in providing inmates timely access to the primary care providers and medical services they need. Only three prisons had scores of 70 percent or more, but none of them exceeded the 75 percent minimum score for moderate adherence to policies and procedures. HDSP, with a score of 45 percent, was the worst performer. Given the low scores shown in Chart 25, we further sorted and analyzed the access to providers and services data. Specifically, we categorized the questions into two types: those that related Chart 25: Access to Providers and Services Scores by Institution, Sorted Highest to Lowest Score. 100% 95% Institution Score Average Score = 60% Minimum Moderate Adherence = 75% 85% 75% 74% 72% 70% 69% 67% 66% 65% 65% 63% 62% 61% 60% 55% 54% 52% 52% 50% 47% 45% 45% CCWF CMC CRC ASP CCC SQ CIW CMF DVI SCC CEN SAC LAC PVSP CCI RJD HDSP Bureau of Audits and Investigations, Office of the Inspector General Page 64 Medical Category: Access to Providers and Services Page 2 of 3 or applied to a specific medical problem identified 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 by the degree of control of Medical problem-related the inmate’s condition based on his or her prior visit? (Question 03.076) Did the prison complete the initial health screening Screening and preventive- on the same day the inmate arrived at the prison? related (Question 02.016) The results of this analysis identified a significant weakness in the prisons’ administration of correctional health care. The average access to providers and services score for questions related to inmates with specific medical problems was only 57 percent. In contrast, the average access to providers and services score for screening and preventive-related procedures was 71 percent. In short, inmates with identified health problems had greater difficulty 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. Chart 26: Problem-related and Screening and Preventive-related Access to Providers and Services Scores by Institution, Sorted by Highest Problem-related Score to Lowest Problem-related Score 100% 95% 89% 87% 85% 85% 84% 81% 79% 75% 71% 72% 70% 70% 68% 67% 66% 66% 66% 65% 64% 64% 64% 65% 63% 63% 61% 59% 59% 57% 58% 55% 55% 51% 51% 48% 48% 45% Problem-related Access to Care Score 44% Average Problem-related Access to Care Score = 57% Screening and Preventive-related Access to Care Score 40% Average Screening and Preventive-related Access to Care Score = 71% 38% Minimum Moderate Adherence = 75% 35% CCWF CMC CCC CIW CRC ASP CMF CEN DVI SQ SCC PVSP CCI SAC LAC RJD HDSP State of California • August 2010 Page 65 Medical Category: Access to Providers and Services Page 3 of 3 With scores ranging from 71 percent down to 38 percent, all prisons failed to meet the 75 percent minimum score for moderate adherence in providing timely access to providers and services when inmates had identified medical problems. These identified 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 difficulty 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 proficient at processing inmates for routine screening and preventive-related appointments, but they are significantly less proficient in getting inmates who have identified medical problems seen by appropriate medical care providers. The failure to provide timely access to care for inmates with identified 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 and Investigations, Office of the Inspector General Page 66 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. Most prisons must improve the continuity of care they provide inmates to achieve moderate adherence to policies and procedures. As shown in Chart 27, the 17 prisons’ average score for continuity of care was 74 percent. While still below the 75 percent minimum score for moderate adherence, this score ties that of primary care provider responsibilities as the second highest average score in the five general medical categories. The 74 percent average score indicates that the prisons generally need to improve the continuity of their services if they are to achieve moderate adherence with medical policies and procedures. Seven prisons exceeded the 75 percent minimum score for moderate adherence. Prisons failed to achieve moderate adherence in the continuity of care category partly as the result of these problems: • Failing to transmit accurate health care information on transferring inmates who need specialty services. Chart 27: Continuity of Care Scores by Institution, Sorted Highest to Lowest Score 100% 95% Institution Score Continuity of Care Average Score = 74% Average Score = 74% Minimum Moderate Adherence = 75% 85% 84% 83% 83% 83% 80% 79% 78% 75% 74% 72% 72% 71% 70% 68% 68% 67% 67% 65% 64% 55% CRCCCWFCEN CCC SCC ASP LAC HDSPSAC CMC PVSP RJD CIW SQ CMF CCI DVI State of California • August 2010 Page 67 Medical Category: Continuity of Care Page 2 of 2 • 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 specified time frames for following up on specialty service consultations. See Appendix D-3 for detailed information on questions and scores for this category. Bureau of Audits and Investigations, Office of the Inspector General Page 68 Medical Category: Primary Care Provider Responsibilities Page 1 of 3 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 28, the 17 prisons’ average score for primary care provider Chart 28: Primary Care Provider Responsibilities Scores by Institution, Sorted Highest to Lowest Score 100% Institution Score 95% Average Score = 74% Minimum Moderate Adherence = 75% 85% 85% 84% 83% 81% 80% 79% 78% 77% 76% 76% 75% 74% 72% 71% 68% 66% 65% 55% 55% 54% 45% SCCCCWF CMF DVI CEN SQ CRC CIW LAC CCI PVSP ASP SAC CMC CCC HDSP RJD 6 In performing our inspections, judgment questions are answered by physician inspectors. When a physician inspector takes exception to the judgment of a primary care provider, the physician inspector consults with our lead physician before confirming the exception. State of California • August 2010 Page 69 Medical Category: Primary Care Provider Responsibilities Page 2 of 3 responsibilities was 74 percent. This score ties that of continuity of care as the second highest average score in the five general medical categories. The 74 percent average score does not meet the 75 percent minimum score for moderate adherence to policies and procedures. However, ten prisons’ scores met or exceeded the 75 percent minimum score for moderate adherence, with SCC’s 85 percent the highest score. HDSP’s score of 55 percent and RJD’s score of 54 percent stand 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. 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 29 and analyzed the results of the judgment questions exclusively. Judgment functioned far better than process. As shown in Chart 29, the 17 prisons’ average score on judgment questions was 77 percent, a score that by itself meets the 75 percent minimum score for moderate adherence. However, the prisons’ performance on the process questions reduced the category score three percentage points to the 74 percent score achieved Chart 29: Primary Care Provider Judgment Scores by Institution, Sorted Highest to Lowest Score 100% 95% 90% 88% 86% 86% 85% 85% 84% 84% 84% 80% 79% 79% 78% 78% 78% 75% 76% 75% 74% 72% 71% 69% 68% 66% 66% 66% 65% 64% 61% 59% 57% 58% 56% 55% 54% 45% Primary Care Provider Judgment Score Average Primary Care Provider Judgment Score = 77% 43% Primary Care Provider Process Score 39% Average Primary Care Provider Process Score = 63% 35% Minimum Moderate Adherence = 75% 35% CMF CCWF SQ CEN DVI SCC SAC LAC CCI CRC PVSP CIW ASP CMC CCC RJD HDSP Bureau of Audits and Investigations, Office of the Inspector General Page 70 Medical Category: Primary Care Provider Responsibilities Page 3 of 3 using both types of questions. The average score on the process questions was only 63 percent. The larger number and heavier weight of the judgment questions kept the category score from falling more than it did. On judgment questions, 12 prisons had scores that met or exceeded the 75 percent minimum score for moderate adherence. See Appendix D-4 for detailed information on questions and scores for this category. State of California • August 2010 Page 71 Medical Category: Nurse Responsibilities Page 1 of 2 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 in providing nursing care.7 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 17 prisons’ average score for nurse responsibilities was 80 percent. This average score is the highest average score within the five general medical categories and it is the only score to exceed the 75 percent minimum Chart 30: Nurse Responsibilities Scores by Institution, Sorted Highest to Lowest Score 100% 95% 94% Institution Score 91% 90% Average Score = 80% 88% 86% Minimum Moderate Adherence = 75% 85% 85% 84% 83% 82% 81% 78% 76% 75% 74% 72% 69% 67% 66% 65% 55% 45% CCWF CEN CRC CMC RJD SAC ASP SCC CCC LAC DVI CIW HDSP SQ CMF CCI PVSP 7 In performing our inspections, judgment questions are answered by registered nurse inspectors. When a registered nurse inspector takes exception to the judgment of a prison’s registered nurse, the nurse inspector consults with another registered nurse inspector or a physician inspector before confirming the exception. Bureau of Audits and Investigations, Office of the Inspector General Page 72 Medical Category: Nurse Responsibilities Page 2 of 2 score for moderate adherence. Twelve of the 17 prisons exceeded the 75 percent minimum score for moderate adherence, with five of them achieving high adherence scores of 86 percent or more. CCWF’s score of 94 percent was the highest. 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 negligible. The 17 prisons’ average score on the judgment questions was 80 percent, which is the same as the average score achieved using both types of questions. The average score for process questions was 81 percent, meaning that there was only a one percentage point gap between the average scores for the two types of questions. All three scores fall in the middle of the moderate adherence range. Therefore, we conclude that the impact of the nurse judgment questions was negligible. See Appendix D-5 for detailed information on questions and scores for this category. State of California • August 2010 Page 73 Conclusion The results of our first 17 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 two of the 17 prisons’ overall weighted scores exceeded 75 percent, the Receiver’s minimum score for moderate adherence to medical policies and procedures. At 76 and 78 percent, those scores barely achieved the minimum. • In the 20 component areas of our inspection program, prisons scored particularly poorly in preventive services. The average score was only 37 percent, and we found very low scores in tuberculosis treatment, which affects the health of inmates and staff alike. Further, as evidenced by the average score of 46 percent, the prisons performed quite poorly in monitoring inmates on hunger strikes lasting longer than three days. The prisons also scored poorly in providing access to health care information on inmates. The average score was only 59 percent, and none of the prisons kept inmates’ medical records updated with recently filed documents. Specialty services had an average score of only 60 percent. Within this component, we found consistent problems with granting inmates timely access to specialty services and in providing prompt follow-up related to those services. • Notwithstanding the problems cited above, the prisons performed well in several components. Their average scores were 86 percent or higher in five components, indicating high adherence with medical policies and procedures. The 94 percent score in staffing levels and training reflects 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 91 percent score in chemical agent contraindications and the 90 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 60 questions. However, the prisons scored consistently poorly on 42 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 significant improvement. • When sorting 100 of the questions into five general medical categories, we found recurring problems in how the prisons managed inmates’ medication. The average score in medication management was only 58 percent because the prisons scored only 34 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 60 percent. In contrast, nurse responsibilities had an average score of 80 percent, making it the only general medical category to exceed the 75 percent minimum score for moderate adherence. However, the continuity of care and primary care provider responsibilities categories, with average scores of 74 percent came close to the 75 percent minimum score for moderate adherence. We find that the wide variation among component scores within prisons, and the wide variation Bureau of Audits and Investigations, Office of the Inspector General Page 74 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 • August 2010 Page 75 This page intentionally left blank. Bureau of Audits and Investigations, Office of the Inspector General Page 76 APPENDIX PREFACE This report contains the following four appendices: Appendix A: The definitions of the 20 components we use in our medical inspection program. Appendix B: A synopsis of each prison’s scores on the 20 components in our medical inspection program. Appendix C: The text of each question in the 20 components and the 17 prisons’ scores for 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 17-prison average score for each question and each prison’s total score for each component. Appendix D: The text of each question in the five medical categories and the 17 prisons’ scores for 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 17-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 first reason is that the question does not apply to the institution. For example, seven of the 17 prisons did not have outpatient housing units. Therefore, the ten questions in the outpatient housing unit component would not apply to these seven 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 one of the 17 prisons had discovered an active case of tuberculosis in the six months preceding the inspection, only that prison 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. Further, totals may not sum due to this rounding. State of California • August 2010 Page 77 APPENDICES: Table of Contents Appendix A: Component Definitions .................................................................................. 79 Appendix B: Prisons’ Scores by Component ...................................................................... 81 Appendix C: Component Questions and Scores Appendix C-1: Chronic Care ........................................................................................ 82 Appendix C-2: Clinical Services .................................................................................. 84 Appendix C-3: Health Screening .................................................................................. 87 Appendix C-4: Specialty Services ................................................................................ 91 Appendix C-5: Urgent Services .................................................................................... 93 Appendix C-6: Emergency Services ............................................................................. 95 Appendix C-7: Prenatal Care ........................................................................................ 98 Appendix C-8: Diagnostic Services ............................................................................ 100 Appendix C-9: Access to Health Care Information .................................................... 102 Appendix C-10: Outpatient Housing Unit .................................................................. 104 Appendix C-11: Internal Reviews ............................................................................... 106 Appendix C-12: Inmate Transfers ............................................................................... 108 Appendix C-13: Clinic Operations ............................................................................. 109 Appendix C-14: Preventive Services .......................................................................... 111 Appendix C-15: Pharmacy Services ........................................................................... 113 Appendix C-16: Other Services .................................................................................. 115 Appendix C-17: Inmate Hunger Strikes ..................................................................... 116 Appendix C-18: Chemical Agent Contraindications .................................................. 117 Appendix C-19: Staffing Levels and Training ............................................................ 118 Appendix C-20: Nursing Policy .................................................................................. 119 Appendix D: Category Questions and Scores Appendix D-1: Medication Management ................................................................... 120 Appendix D-2: Access to Care .................................................................................... 123 Appendix D-3: Primary Care Provider Responsibilities ............................................. 129 Appendix D-4: Continuity of Care ............................................................................. 133 Appendix D-5: Registered Nurse Responsibilities ..................................................... 138 Bureau of Audits and Investigations, Office of the Inspector General Page 78 APPENDIX A: Component Definitions Chronic care: Examines how well the prison provided care and medication to inmates with specific chronic care conditions, which are those that affect (or have the potential to affect) an inmate’s functioning and long-term prognosis for more than six months. Our inspection tests anticoagulation therapy and the following chronic care conditions: asthma, diabetes, HIV (Human Immunodeficiency Virus), and hypertension. Clinical services: 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. Health screening: Focuses on the prison’s process for screening new inmates upon arrival to the institution for health care conditions that require treatment and monitoring, as well as ensuring inmates’ continuity of care. Specialty services: 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. Urgent services: Addresses the care provided by the institution to inmates before and after they were sent to a community hospital. Emergency services: Examines how well the prison responded to medical emergencies. Spe- cifically, we focused on “man down” or “woman down” situations. Further, questions deter- mine the adequacy of medical and staff response to a “man down” or “woman down” emer- gency drill. Prenatal care/childbirth/post-delivery: Focuses on the prenatal and post-delivery medical care provided to pregnant inmates. This component is not applicable at men’s institutions. Diagnostic services: Addresses the timeliness of radiology (x-ray) and laboratory services and whether the prison followed up on clinically significant results. Access to health care information: Addresses the prison’s effectiveness in filing, storing, and retrieving medical records and medical-related information. Outpatient housing unit: Determines whether the prison followed department policies and procedures when placing inmates in the outpatient housing unit.1 This component also evalu- ates whether the placement provided the inmate with adequate care and whether the physician’s plan addressed the placement diagnosis. 1 An outpatient housing unit (OHU) is a facility that provides outpatient health services to inmates and assists them with the activities of daily living. State of California • August 2010 Page 79 APPENDIX A: Component Definitions Internal reviews: 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’ medical appeals and the prison’s use of inmate death reviews. Inmate transfers: Focuses on inmates pending transfer to determine whether the sending institution documented medication and medical conditions to assist the receiving institution in providing continuity of care. Clinic operations: Addresses the general operational aspects of the prison’s facility clinics. Gen- erally, 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. Preventive services: Focuses on inmate cancer screening, tuberculosis evaluation, and influ- enza immunizations. Pharmacy services: Addresses whether the prison’s pharmacy complies with various op- erational 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 screen- ing medication orders for potential adverse reactions/interactions. Other services: Examines additional areas that are not captured in the other components. The areas evaluated in this component include the prison’s provision of therapeutic diets, its han- dling of inmates who display poor hygiene, and the availability of the current version of the department’s Inmate Medical Services Policies and Procedures. Inmate hunger strikes: Examines medical staff’s monitoring of inmates participating in hun- ger strikes lasting more than three days. Chemical agent contraindications: 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 example, this might occur if the inmate has asthma. Staffing levels and training: Examines the prison’s medical staffing levels and training provided. Nursing policy: 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 periodi- cally review the work of nurses to ensure they properly follow established nursing protocols. Bureau of Audits and Investigations, Office of the Inspector General Page 80 APPENDIX B: Prisons’ Scores by Component State of California • August 2010 Page 81 TNENOPMOC YB SEROCS ’SNOSIRP egarevA egnaR PSDH ICC PSVP CAS DJR QS WIC PSA CMC CAL FMC IVD CCC CRC NEC CCS FWCC tnenopmoC lacideM erocS %93 %46 %54 %26 %75 %36 %94 %56 %07 %95 %75 %07 %48 %47 %64 %76 %18 %57 %37 eraC cinorhC %04 %66 %15 %75 %74 %76 %76 %74 %26 %46 %47 %66 %78 %37 %66 %07 %08 %17 %47 secivreS lacinilC %62 %57 %27 %87 %76 %67 %86 %77 %07 %18 %37 %96 %78 %47 %18 %47 %87 %16 %48 gnineercS htlaeH %13 %06 %35 %75 %16 %74 %26 %85 %36 %47 %36 %07 %34 %35 %17 %95 %06 %37 %35 secivreS ytlaicepS %62 %97 %27 %38 %18 %38 %37 %36 %57 %07 %48 %08 %97 %87 %48 %18 %08 %98 %98 secivreS tnegrU %24 %77 %27 %87 %38 %84 %09 %87 %08 %87 %68 %48 %27 %17 %09 %37 %77 %67 %08 secivreS ycnegremE /htribdlihC/latanerP A/N %16 A/N A/N A/N A/N A/N A/N %16 A/N A/N A/N A/N A/N A/N A/N A/N A/N A/N eraC yreviled-tsoP %44 %96 %34 %06 %56 %86 %46 %96 %17 %78 %07 %45 %27 %47 %17 %95 %47 %68 %48 secivreS citsongaiD htlaeH ot sseccA %26 %95 %95 %55 %36 %93 %44 %45 %95 %02 %93 %37 %95 %95 %87 %87 %28 %28 %45 noitamrofnI eraC gnisuoH tneitaptuO %32 %77 A/N %37 A/N %67 A/N %38 %36 %17 A/N A/N %68 %38 %28 %57 A/N %57 A/N tinU %04 %67 %36 %06 %17 %07 %001 %96 %59 %66 %07 %37 %96 %39 %68 %19 %16 %06 %89 sweiveR lanretnI %75 %68 %001 %34 %67 %57 %09 %001 %08 %001 %49 %001 %05 %97 %39 %001 %001 %59 %001 srefsnarT etamnI %81 %09 %19 %19 %39 %19 %59 %001 %89 %49 %58 %09 %38 %88 %79 %68 %28 %88 %68 snoitarepO cinilC %57 %73 %42 %7 %72 %23 %42 %94 %33 %06 %35 %02 %44 %22 %73 %28 %91 %82 %95 secivreS evitneverP %24 %58 %001 %97 %27 %57 %39 %68 %59 %29 %19 %001 %67 %29 %96 %97 %85 %19 %29 secivreS ycamrahP %54 %68 %37 %58 %07 %19 %001 %58 %75 %07 %19 %001 %001 %001 %001 %07 %001 %55 %001 secivreS rehtO regnuH etamnI %98 %64 %44 %64 %73 %11 %11 %45 A/N A/N %17 %24 %23 A/N %86 A/N %23 A/N %001 sekirtS tnegA lacimehC %53 %19 %001 %66 %66 %001 %49 %98 %001 %001 %001 %19 %78 %98 %001 %001 %98 %001 %56 snoitacidniartnoC dna sleveL gnfifatS %02 %49 %001 %09 %08 %59 %001 %59 %58 %001 %001 %09 %59 %59 %001 %58 %001 %001 %58 gniniarT %46 %47 %98 %05 %001 %97 %98 %07 %46 %76 %97 %75 %63 %63 %49 %67 %17 %49 %001 yciloP gnisruN %61 %07 %26 %46 %56 %56 %86 %86 %07 %07 %17 %27 %27 %37 %37 %47 %47 %67 %87 egarevA lanoitutitsnI ecnerehda wol ecnerehda etaredom ecnerehda hgih Bureau of Audits and Investigations, Office of the Inspector General Page 82 eraC cinorhC :SNOITSEUQ TNENOPMOC noitidnoc s’etamni eht fo lortnoc fo eerged eht yb deriuqer emarf emit eht nihtiw tisiv erac cinorhc tnecer tsom s’etamni eht saW 670.30 ?tisiv roirp reh ro sih no desab rof yletelpmoc tuo dellfi )teehS wolF eraC yramirP( 2937 dna )tisiV pU-wolloF eraC cinorhC( 9147 smroF no stnemele yek ereW 770.30 ?stisiv tnecer tsom owt s’etamni eht ?noitacude erac htlaeh htiw etamni eht dedivorp ti taht tnemucod noitutitsni eht diD 280.30 eht did ro doirep htnom-eerht tnecer tsom eht gnirud snoitacidem erac cinorhc debircserp reh ro sih eviecer etamni eht diD 571.30 ?snoitacidem reh ro sih rof pu wohs ro pu kcip ot desufer etamni eht fi ycilop latnemtraped wollof noitutitsni ?etauqeda yrotsih lacinilc eht sI 532.30 ?etauqeda noitanimaxe lacinilc desucof eht sI 632.30 ?etauqeda tnemssessa eht sI 732.30 pu wollof dna noitnevretni margorp erac cinorhc eht no desab lortnoc fo eerged eht htiw tnetsisnoc dna etauqeda nalp eht sI 832.30 ?stnemeriuqer ?)RHU( drocer htlaeh tinu s’etamni eht ni yletarucca delfi dna etelpmoc tsiL melborP s’etamni eht sI 262.30 APPENDIX C-1: Component Questions and Scores - Chronic Care eraC cinorhC :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 071 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 stnioP elbissoP 670.30 1.321 6.5 4.8 4.4 2.7 5.7 6.9 8.6 2.7 4.6 6 6.7 9 6.5 5.9 8.4 7.8 8.8 stnioP devieceR %27 %65 %48 %44 %27 %57 %69 %86 %27 %46 %06 %67 %09 %65 %59 %84 %78 %88 erocS 071 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 stnioP elbissoP 770.30 7.89 8.2 2.7 8.2 6 2.7 6 2.5 4.2 6.7 5.8 2.5 5.8 8.7 4.7 6.4 1.9 4.0 stnioP devieceR %85 %82 %27 %82 %06 %27 %06 %25 %42 %67 %58 %25 %58 %87 %47 %64 %19 %4 erocS APPENDIX C-1 State of California • August 2010 Page 83 deunitnoc ,eraC cinorhC :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 402 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 stnioP elbissoP 280.30 8.831 2.6 4.1 1.9 3.5 6.01 5.11 6.9 2.7 5.11 8.01 8.5 21 6 9 2.6 9.8 7.7 stnioP devieceR %86 %25 %21 %67 %44 %88 %69 %08 %06 %69 %09 %84 %001 %05 %57 %25 %47 %46 erocS 603 81 81 81 81 81 81 81 81 81 81 81 81 81 81 81 81 81 stnioP elbissoP 571.30 6.49 1.3 4.1 4.1 3.3 8.0 6.3 6.8 8.0 3.5 6.5 8.0 2.7 6.11 9.9 9 9.31 3.8 stnioP devieceR %13 %71 %8 %8 %81 %4 %02 %84 %4 %92 %13 %4 %04 %56 %55 %05 %77 %64 erocS 603 81 81 81 81 81 81 81 81 81 81 81 81 81 81 81 81 81 stnioP elbissoP 532.30 8.071 9.7 2.21 8.5 6.8 2.21 8.5 8.01 9.7 5.11 7.11 6.8 6.21 21 6.21 5.6 3.31 8.01 stnioP devieceR %65 %44 %86 %23 %84 %86 %23 %06 %44 %46 %56 %84 %07 %76 %07 %63 %47 %06 erocS 323 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 stnioP elbissoP 632.30 9.042 4.11 4.41 1.9 9.21 2.51 7.31 4.41 7.31 8.51 1.71 2.21 3.31 7.31 2.51 4.41 2.81 2.61 stnioP devieceR %57 %06 %67 %84 %86 %08 %27 %67 %27 %38 %09 %46 %07 %27 %08 %67 %69 %58 erocS 323 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 stnioP elbissoP 732.30 6.832 9 4.71 2.11 5.31 4.61 4.61 4.8 21 3.41 61 7.31 61 6.61 91 6.7 2.71 9.31 stnioP devieceR %47 %74 %29 %95 %17 %68 %68 %44 %36 %57 %48 %27 %48 %88 %001 %04 %19 %37 erocS 323 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 stnioP elbissoP 832.30 1.752 01 4.71 9.01 41 3.61 2.61 6.31 8.61 2.81 9.61 6.51 9.71 7.71 71 5.9 1.81 11 stnioP devieceR %08 %35 %29 %75 %47 %68 %58 %17 %88 %69 %98 %28 %49 %39 %09 %05 %59 %85 erocS 631 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 262.30 7.39 8.4 1.6 1.5 8 4.6 4.6 8.4 7.7 6.2 2.7 7.6 8.0 7.6 8 2.2 8.3 4.6 stnioP devieceR %96 %06 %67 %46 %001 %08 %08 %06 %69 %23 %09 %48 %01 %38 %001 %82 %84 %08 erocS 1622 331 331 331 331 331 331 331 331 331 331 331 331 331 331 331 331 331 stnioP elbissoP latoT 2.6541 8.06 9.58 8.95 8.87 6.29 2.98 2.28 7.57 2.39 8.99 2.67 3.79 7.79 6.701 9.46 1.111 4.38 stnioP devieceR latoT %46 %64 %56 %54 %95 %07 %76 %26 %75 %07 %57 %75 %37 %47 %18 %94 %48 %36 erocS latoT Bureau of Audits and Investigations, Office of the Inspector General Page 84 ?deviecer saw ti yad emas eht deweiver teg erac htlaeh rof tseuqer s’etamni eht diD :noitatnemucoD FTF NR 420.10 saw 2637 mroF eht retfa yad ssenisub )1( eno nihtiw egairt )FTF( ecaf-ot-ecaf eht etelpmoc NR eht diD :noitatnemucoD FTF NR 520.10 ?deweiver senilemit eht nihtiw nees etamni eht saw ,yrassecen saw )PCP( redivorp erac yramirp a ot larrefer a denimreted NR eht fI 720.10 egairt FTF eht gnirud NR eht yb defiiceps defiiceps nihtiw etamni eht ot )sredro wen( snoitacidem noitpircserp reviled ro retsinimda noitutitsni eht diD :noitacideM llaC kciS 421.10 ?semarf emit ?tnialpmoc yramirp s’etamni eht fo yrotsih dna erutan eht sserdda eton evitcejbus s’NR eht diD :noitatnemucoD FTF NR 751.10 eht erew ,atad evitcejbo dna evitcejbus no desab snoisulcnoc edivorp tnemssessa s’NR eht diD :noitatnemucoD FTF NR 851.10 ?sesongaid gnisrun elbacilppa niatnoc ti did dna ,smelborp tneitap sa detalumrof snoisulcnoc ti did dna ,noitanimaxe lacisyhp desucof a dna sngis lativ edulcni eton evitcejbo s’NR eht diD :noitatnemucoD FTF NR 951.10 ?eton evitcejbus eht ni deton smelborp eht sserdda yletauqeda FTF eht gnirud defiitnedi smelborp eht sserdda ot ygetarts etauqeda na edulcni nalp s’NR eht diD :noitatnemucoD FTF NR 261.10 ?egairt ?egairt FTF eht gnirud defiitnedi smelborp eht sserdda yletauqeda noitcurtsni/noitacude s’NR eht diD :noitatnemucoD FTF NR 361.10 ,etairporppa erehw dna ,noitacidem tnerruc ,thgiew ,seigrella edulcni eton evitcejbo s’NR eht diD :noitatnemucoD FTF NR 442.10 ?ecnailpmoc noitacidem secivreS eraC htlaeH( 2637 mroF no detsil stnialpmoc s’etamni eht fo lla deweiver NR eht taht etacidni noitatnemucod diD 642.10 ?)mroF tseuqeR ?defiiceps emarf emit eht nihtiw ecalp ekat ti did ,tnemtnioppa llac kcis pu-wollof a deredro redivorp eht fI :pu-wolloF llaC kciS 742.10 ?smeti laitnesse niatnoc yeht od dna yliad detidua sgab esnopser cinilc erA 432.51 rof nosaer eht ot detaler snoitidnoc lacidem gnitsixe-erp fo tnemeganam roirp etauqeda ereht saw ,ATT eht ni nees setamni roF 872.12 ?tisiv ATT eht APPENDIX C-2: Component Questions and Scores - Clinical Services secivreS lacinilC :SNOITSEUQ TNENOPMOC APPENDIX C-2 State of California • August 2010 Page 85 secivreS lacinilC :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 420.10 8.84 2.3 5.0 6.1 5.3 2.3 8.1 7.3 5.3 1.3 2.1 6.3 1.2 3 5.3 7.3 8.3 8.3 stnioP devieceR %27 %08 %11 %04 %98 %08 %54 %29 %78 %77 %03 %09 %25 %67 %78 %39 %69 %69 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 520.10 7.86 5 1.2 4.2 5.1 1.4 8.4 6.3 2 5 9.3 7.4 3.5 3.5 6.4 8.4 5 6.4 stnioP devieceR %76 %48 %43 %04 %62 %86 %08 %06 %33 %38 %56 %87 %88 %88 %67 %08 %48 %67 erocS 631 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 720.10 6.96 6.3 4.4 1.2 2.4 6.5 3.4 2 8.3 8.2 6 6 5.4 3.6 4 1 6.6 4.2 stnioP devieceR %15 %64 %65 %72 %25 %17 %45 %52 %74 %53 %57 %57 %65 %97 %05 %31 %28 %92 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 421.10 7.53 9.0 3.1 6.2 8.1 7.1 6.0 5.2 7.0 2 8.0 7.1 1.3 2 6.4 3.3 8.4 3.1 stnioP devieceR %53 %41 %22 %44 %03 %82 %01 %14 %11 %33 %31 %82 %25 %33 %77 %55 %08 %22 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 751.10 5.58 5.5 2.2 4 5.4 8.3 2.3 5.4 5.3 1.4 6.5 5.6 4.6 8.5 7 8.5 7.6 4.6 stnioP devieceR %27 %97 %23 %75 %56 %45 %54 %46 %05 %95 %08 %39 %29 %38 %001 %38 %69 %29 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 851.10 87 5.3 6.1 6.3 4.4 8.4 4.5 1.4 2 4.5 7.5 5 8.5 5.5 4.5 8.4 3.5 7.5 stnioP devieceR %67 %85 %72 %16 %47 %97 %09 %86 %33 %09 %59 %38 %69 %19 %98 %97 %88 %69 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 951.10 6.37 7.4 3 3 5.3 6.4 4.5 1.4 2.3 3.3 8.4 4.4 3.5 4 4.5 8.4 6.4 5.5 stnioP devieceR %27 %97 %05 %05 %95 %67 %09 %86 %35 %55 %08 %37 %88 %76 %09 %08 %77 %19 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 261.10 211 3.6 7 7 6.6 7.6 7 4.6 4.4 7 6.6 8.6 7.6 7.6 8.6 7 6.6 4.6 stnioP devieceR %49 %09 %001 %001 %49 %69 %001 %29 %36 %001 %59 %89 %69 %69 %79 %001 %49 %29 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 361.10 86 2.3 2.3 2.3 1.4 5.3 8.4 4 8.2 3.4 5.4 3.4 8.4 5.3 7.4 5.4 7.4 9.3 stnioP devieceR %08 %36 %46 %46 %28 %17 %59 %08 %75 %68 %09 %58 %69 %07 %39 %09 %49 %77 erocS 68 egap no deunitnoc Bureau of Audits and Investigations, Office of the Inspector General Page 86 egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 15 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 stnioP elbissoP 442.10 9.62 4.1 5.0 2.0 9.1 4.0 2.0 8.0 1 1 5.1 4.2 4.2 4.2 8.2 4.2 8.2 8.2 stnioP devieceR %35 %74 %81 %7 %56 %21 %5 %82 %33 %53 %05 %08 %08 %97 %39 %08 %49 %29 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 642.10 7.37 5.4 5.4 3.4 8.3 4 8.4 2.3 3.3 3.4 5 4.4 8.4 8.4 5.4 3.4 6.4 6.4 stnioP devieceR %78 %09 %19 %78 %77 %08 %59 %46 %76 %68 %001 %88 %69 %69 %09 %78 %29 %29 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 742.10 4.36 7.4 5.3 5.3 4.4 9.3 1.6 4 5.2 4.1 0 7.4 7.4 2.4 7 6.1 4.5 8.1 stnioP devieceR %35 %76 %05 %05 %36 %65 %88 %75 %63 %02 %0 %76 %76 %06 %001 %22 %87 %52 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 432.51 05 5 5.2 5.2 5 5 5 5.2 5 5.2 5 0 5.2 0 0 5.2 5 0 stnioP devieceR %95 %001 %05 %05 %001 %001 %001 %05 %001 %05 %001 %0 %05 %0 %0 %05 %001 %0 erocS 043 02 02 02 02 02 02 02 02 02 02 02 02 02 02 02 02 02 stnioP elbissoP 872.12 1.312 1.11 8 2.8 21 3.7 3.31 1.9 7.6 61 9.61 3.61 21 7.51 61 3.31 7.61 5.41 stnioP devieceR %36 %65 %04 %14 %06 %63 %76 %64 %33 %08 %58 %18 %06 %97 %08 %76 %38 %37 erocS 5161 59 59 59 59 59 59 59 59 59 59 59 59 59 59 59 59 59 stnioP elbissoP latoT 8.6601 6.26 3.44 5.84 2.16 6.85 7.66 5.45 4.44 2.26 5.76 4.07 4.07 2.96 1.67 9.36 7.28 6.36 stnioP devieceR latoT %66 %66 %74 %15 %46 %26 %07 %75 %74 %66 %17 %47 %47 %37 %08 %76 %78 %76 erocS latoT APPENDIX C-2 deunitnoc ,secivreS lacinilC :SEROCS TNENOPMOC APPENDIX C-3: Component Questions and Scores - Health Screening State of California • August 2010 Page 87 gnineercS htlaeH :SNOITSEUQ TNENOPMOC desnecil yb dengis dna deweiver saw ti taht etacidni mrof noitamrofni refsnart erac htlaeh eht seoD :retnec noitpecer-noN 700.20 ?noitutitsni eht ta lavirra s’etamni eht fo yad radnelac eno nihtiw ffats erac htlaeh gniviecer eht did ,noitutitsni gnidnes eht ta tnemtnioppa ytlaiceps a rof deludehcs saw etamni eht fI :retnec noitpecer-noN 410.20 ?etad tnemtnioppa lanigiro eht fo syad 03 nihtiw tnemtnioppa eht eludehcs noitutitsni eht yb deweiver stluser eht erew dna ,evitisop saw tset nilucrebut s’etamni eht fi detelpmoc smotpmys fo weiver a saW 510.20 ?esrun lortnoc noitcefni ?noitutitsni eht ta devirra etamni eht yad emas eht no gnineercs htlaeh laitini eht etelpmoc noitutitsni eht diD 610.20 dna tnemssessa na edivorp NR eht did ,)s(mrof gnineercs htlaeh laitini eht no snoitseuq eht fo yna ot derewsna saw sey fI 710.20 ?lavirra fo etad eht no noitisopsid ?emarf emit eht nihtiw nees etamni eht saw ,naicinilc a ot etamni eht derrefer NR eht ,tnemssessa eht gnirud ,fI 810.20 suoiverp a dah etamni eht fi smotpmys dna sngis fo weiver a ro tset nilucrebut eht tnemucod yletauqeda NR/NVL eht diD 020.20 ?tset nilucrebut evitisop a ro ,tnatsissA naicisyhP ,renoititcarP esruN a yb lacisyhp dna yrotsih etelpmoc a eviecer etamni eht diD :retnec noitpeceR 120.20 ?lavirra fo syad radnelac 41 nihtiw noegruS dna naicisyhP etamni eht refer PCP eht did ,teid laiceps a deriuqer etamni eht detacidni )PCP( redivorp erac yramirp eht fI :retnec noitpeceR 220.20 ?naiciteid deretsiger a ot ?elbacilppa fi ,lavirra nopu snoitadommocca lacidem eviecer etamni eht diD :retnec noitpecer-noN 111.20 txen eht yb snoitacidem eht eviecer etamni eht did ,noitutitsni eht ta lavirra nopu redro noitacidem gnitsixe na dah etamni eht fI 821.20 ?deunitnoc eb ot ton erew snoitacidem eht yhw nialpxe naicisyhp a did ro ,yad radnelac lacisyhP dna yrotsiH( 6027 mroF fo noitces ”ssenllI tneserP fo yrotsiH“ eht sI :lacisyhp dna yrotsih retnec noitpeceR 112.20 ?yna fi ,)s(tnialpmoc feihc eht ot etairporppa dna etelpmoc )noitanimaxE dna yrotsiH( 6027 mroF fo snoitces ”yrotsiH lacideM tsaP“ dna ”yrotsiH tsaP“ eht erA :lacisyhp dna yrotsih retnec noitpeceR 212.20 ?etelpmoc )noitanimaxE lacisyhP lacisyhP dna yrotsiH( 6027 mroF fo noitces ”yrotsiH laicoS dna ylimaF“ eht sI :lacisyhp dna yrotsih retnec noitpeceR 312.20 ?etelpmoc )noitanimaxE 88 egap no deunitnoc APPENDIX C-3 Bureau of Audits and Investigations, Office of the Inspector General Page 88 deunitnoc ,gnineercS htlaeH :SNOITSEUQ TNENOPMOC )noitanimaxE lacisyhP dna yrotsiH( 6027 mroF fo noitces ”smetsyS weiveR“ eht sI :lacisyhp dna yrotsih retnec noitpeceR 512.20 ?etelpmoc )noitanimaxE lacisyhP dna yrotsiH( 6027 mroF fo noitces ”noitanimaxE lacisyhP“ eht sI :lacisyhp dna yrotsih retnec noitpeceR 612.20 ?smetsys fo weiver dna yrotsih eht ot etairporppa dna etelpmoc )noitanimaxE lacisyhP dna yrotsiH( 6027 mroF fo noitces ”noisserpmI/sisongaiD“ eht sI :lacisyhp dna yrotsih retnec noitpeceR 712.20 ?noitanimaxe lacisyhp dna yrotsih eht ot etairporppa )noitanimaxE lacisyhP dna yrotsiH( 6027 mroF fo noitces ”noitcA fo nalP“ eht sI :lacisyhp dna yrotsih retnec noitpeceR 812.20 ?mrof eht fo noitces ”noisserpmI/sisongaiD“ eht ot etairporppa ?deredro neeb gnitset ekatni deriuqer saH :lacisyhp dna yrotsih retnec noitpeceR 912.20 gnineercS htlaeH :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 89 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 700.20 5.88 7 7 6 6.6 7 6.6 6.6 1.6 3.5 6 3.6 5.4 5.6 7 stnioP devieceR %09 %001 %001 %58 %59 %001 %59 %59 %88 %57 %58 %09 %46 %39 %001 erocS 24 7 7 7 7 7 7 stnioP elbissoP 410.20 53 7 7 7 7 0 7 stnioP devieceR %38 %001 %001 %001 %001 %0 %001 erocS 77 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 510.20 1.76 7 7 7 3.2 7 8.5 3.5 7.4 7 7 7 stnioP devieceR %78 %001 %001 %001 %33 %001 %38 %57 %76 %001 %001 %001 erocS 351 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 stnioP elbissoP 610.20 1.241 7.7 1.8 4.8 1.8 6.8 6.8 9.6 9.5 1.8 9 9 9 9 9 7.8 9 9 stnioP devieceR %39 %58 %09 %39 %09 %59 %59 %77 %56 %09 %001 %001 %001 %001 %001 %79 %001 %001 erocS 821 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 710.20 011 8 8 8 9.6 8 8 6.5 7.3 3.2 8 8 8 5.7 6.7 4.4 8 stnioP devieceR %68 %001 %001 %001 %78 %001 %001 %07 %64 %92 %001 %001 %001 %39 %49 %65 %001 erocS State of California • August 2010 Page 89 09 egap no deunitnoc APPENDIX C-3 deunitnoc ,gnineercS htlaeH :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 821 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 810.20 1.06 2.3 9.4 3.1 4.4 9.0 7.2 7.5 0 3.2 8 9.6 4 8.4 1 8 2 stnioP devieceR %74 %04 %16 %71 %55 %11 %33 %17 %0 %92 %001 %68 %05 %06 %31 %001 %52 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 020.20 39 6 8.5 8.5 1.5 4.5 6 8.4 1.5 6 7.5 1.5 6 6 4.5 2.5 2.4 4.5 stnioP devieceR %19 %001 %69 %79 %58 %09 %001 %08 %58 %001 %59 %58 %001 %001 %09 %78 %07 %09 erocS 04 5 5 5 5 5 5 5 5 stnioP elbissoP 120.20 7.72 8.4 5 2 5 5.2 8.2 8.2 8.2 stnioP devieceR %96 %59 %001 %04 %001 %05 %55 %55 %65 erocS 4 4 stnioP elbissoP 220.20 0 0 stnioP devieceR %0 %0 erocS 87 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 111.20 5.46 6 3 6 6 5.4 6 6 5.4 6 2 5.4 6 4 stnioP devieceR %38 %001 %05 %001 %001 %57 %001 %001 %57 %001 %33 %57 %001 %76 erocS 631 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 821.20 14 3.1 9.1 8.2 4.2 0 8.1 4.3 0 3.3 2 1 4.3 0 4 4 7 7.2 stnioP devieceR %03 %71 %42 %53 %03 %0 %32 %34 %0 %24 %52 %31 %34 %0 %05 %05 %88 %33 erocS 41 2 2 2 2 2 2 2 stnioP elbissoP 112.20 7.01 2.1 6.1 8.1 8.0 2 8.1 5.1 stnioP devieceR %67 %06 %28 %98 %04 %001 %29 %57 erocS 41 2 2 2 2 2 2 2 stnioP elbissoP 212.20 3.21 8.1 8.1 2 7.1 2 2.1 8.1 stnioP devieceR %88 %09 %09 %001 %58 %001 %06 %88 erocS 41 2 2 2 2 2 2 2 stnioP elbissoP 312.20 6.21 6.1 5.1 2 5.1 2 2 2 stnioP devieceR %09 %08 %57 %001 %57 %001 %001 %001 erocS APPENDIX C-3 Bureau of Audits and Investigations, Office of the Inspector General Page 90 deunitnoc ,gnineercS htlaeH :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 21 2 2 2 2 2 2 stnioP elbissoP 512.20 4.5 0 4.0 6.1 4.1 2 0 stnioP devieceR %54 %0 %02 %08 %07 %001 %0 erocS 41 2 2 2 2 2 2 2 stnioP elbissoP 612.20 3.21 2.1 7.1 2 2 2 9.1 5.1 stnioP devieceR %88 %06 %58 %001 %001 %001 %59 %57 erocS 41 2 2 2 2 2 2 2 stnioP elbissoP 712.20 4.21 1.1 8.1 2 2 8.1 9.1 8.1 stnioP devieceR %98 %65 %98 %001 %001 %09 %59 %88 erocS 41 2 2 2 2 2 2 2 stnioP elbissoP 812.20 31 3.1 2 2 2 2 7.1 2 stnioP devieceR %39 %76 %001 %001 %001 %001 %58 %001 erocS 23 4 4 4 4 4 4 4 4 stnioP elbissoP 912.20 4.42 4.3 8.0 4 6.3 8.3 4 2 8.2 stnioP devieceR %67 %58 %02 %001 %09 %59 %001 %05 %07 erocS 4111 66 06 28 95 45 95 98 25 28 35 66 76 96 95 68 25 95 stnioP elbissoP latoT 6.138 2.35 9.54 3.95 6.74 7.73 8.34 7.96 9.43 4.65 4.23 3.84 5.65 3.15 9.54 5.85 1.54 1.54 stnioP devieceR latoT %57 %18 %77 %27 %18 %07 %47 %87 %76 %96 %16 %37 %48 %47 %87 %86 %78 %67 erocS latoT State of California • August 2010 Page 91 secivreS ytlaicepS :SNOITSEUQ TNENOPMOC ?semarf emit defiiceps nihtiw ecivres ytlaiceps eht eviecer etamni eht diD 530.70 ?semarf emit defiiceps eht nihtiw secivres ytlaiceps rof tseuqer s’PCP eht yned ro evorppa noitutitsni eht diD 730.70 ecnadrocca ni ,ti deviecer etamni eht etad eht dna ecivres eht deredro PCP eht etad eht neewteb etamni eht ees PCP eht diD 830.70 ?semarf emit defiiceps htiw secivres ytlaiceps eht retfa tnemtnioppa pu-wollof a rof etamni eht ees dna troper s’tnatlusnoc eht weiver PCP eht diD 340.70 ?semarf emit defiiceps nihtiw noitatlusnoc tnemtaert dna nalp tnemtaert eht tnemucod dna etamni eht ssessa tsipareht lacisyhp eht diD :secivres ypareht lacisyhP 090.70 ?etamni eht ot dedivorp ?secivres ytlaiceps fo lained eht rof nosaer eht fo noitatnemucod etauqeda ereht saW 952.70 ?tnemeriuqer ”ytissecen lacidem“ eht htiw tnetsisnoc secivres ytlaiceps rof tseuqer s’PCP eht fo lained s’noitutitsni eht saW 062.70 ?syad 41 nihtiw secivres ytlaiceps )tnegru( ytiroirp-hgih gniludehcs noitutitsni eht sI 162.70 eht dellac ehs ro eh taht tnemucod NR na did ro snoitadnemmocer dna sgnidnfi ylemit edivorp redivorp ytlaiceps eht diD 072.70 ?snoitadnemmocer dna sgnidnfi eht niatrecsa ot redivorp ytlaiceps secivreS ytlaicepS :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 351 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 stnioP elbissoP 530.70 59 9.7 8.5 2.4 9.6 9.7 6.2 7.3 2.6 8.5 9.6 3.5 5.8 3.5 3.5 3.5 2.3 2.4 stnioP devieceR %26 %88 %56 %74 %77 %88 %92 %14 %96 %56 %77 %95 %49 %95 %95 %95 %53 %74 erocS 631 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 730.70 6.001 5.6 3.7 6.7 8.5 3.6 4 2.6 9.6 3.7 1.5 3.7 6.5 4.4 1.5 8 6.3 6.3 stnioP devieceR %47 %28 %19 %69 %37 %97 %05 %77 %68 %19 %46 %19 %07 %55 %46 %001 %64 %64 erocS 631 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 830.70 2.82 4.4 0 5.0 7.2 3 5.0 4.2 7.0 3.2 9.2 8.1 0 7.0 2.1 2 5.2 6.0 stnioP devieceR %12 %65 %0 %7 %33 %83 %7 %92 %8 %92 %63 %32 %0 %9 %51 %52 %13 %8 erocS APPENDIX C-4: Component Questions and Scores - Specialty Services 29 egap no deunitnoc Bureau of Audits and Investigations, Office of the Inspector General Page 92 egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 351 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 stnioP elbissoP 340.70 2.44 8.3 1.2 0 5.6 1.2 4.3 2.4 2.3 2.3 3.2 1.1 6.1 7.0 7.3 7.1 6.2 2 stnioP devieceR %92 %24 %32 %0 %37 %32 %83 %74 %63 %63 %52 %31 %81 %8 %14 %91 %92 %22 erocS 631 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 090.70 3.331 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 3.5 8 stnioP devieceR %89 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %76 %001 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 952.70 55 1 3 2 5 5.2 4 3 3 8.3 5 2 7.1 3 4 5 4 3 stnioP devieceR %56 %02 %06 %04 %001 %05 %08 %06 %06 %57 %001 %04 %33 %06 %08 %001 %08 %06 erocS 351 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 stnioP elbissoP 062.70 8.921 6.3 9 4.5 2.7 9 9 2.7 9 9 2.7 9 6 8.6 9 9 4.5 9 stnioP devieceR %58 %04 %001 %06 %08 %001 %001 %08 %001 %001 %08 %001 %76 %57 %001 %001 %06 %001 erocS 351 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 stnioP elbissoP 162.70 54 9 0 5.4 5.4 0 5.4 0 0 5.4 9 5.4 0 5.4 0 0 0 0 stnioP devieceR %92 %001 %0 %05 %05 %0 %05 %0 %0 %05 %001 %05 %0 %05 %0 %0 %0 %0 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 072.70 8.39 6 6 6.5 6 6 6 6 6 6 6.5 6 6 6.4 6 3.5 5.3 2.3 stnioP devieceR %29 %001 %001 %49 %001 %001 %001 %001 %001 %001 %49 %001 %001 %77 %001 %88 %95 %35 erocS 7021 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 stnioP elbissoP latoT 8.427 2.05 2.14 8.73 6.25 8.44 24 7.04 34 9.94 9.15 54 4.73 9.73 3.24 2.44 2.03 7.33 stnioP devieceR latoT %06 %17 %85 %35 %47 %36 %95 %75 %16 %07 %37 %36 %35 %35 %06 %26 %34 %74 erocS latoT APPENDIX C-4 deunitnoc ,secivreS ytlaicepS :SEROCS TNENOPMOC State of California • August 2010 Page 93 secivreS tnegrU :SNOITSEUQ TNENOPMOC tnemucod esrun deretsiger )ATT( aera tnemtaert dna egairt eht did ,latipsoh ytinummoc eht morf egrahcsid s’etamni eht nopU 842.12 ?etamni eht fo tnemssessa ecaf-ot-ecaf a detelpmoc dna nalp egrahcsid s’etamni eht deweiver ehs ro eh taht reh ro sih htiw tnemtnioppa pu-wollof a eviecer etamni eht did ,latipsoh ytinummoc eht morf egrahcsid s’etamni eht nopU 942.12 ?egrahcsid fo syad radnelac evfi nihtiw )PCP( redivorp erac yramirp rof sredro edivorp )PCP( redivorP eraC yramirP s’etamni eht did ,latipsoh ytinummoc eht morf egrahcsid s’etamni eht nopU 052.12 ?etamni eht rof gnisuoh etairporppa na ni desuoh saw etamni eht fi enevretni esruN deretsigeR eht did ,latipsoh ytinummoc eht morf egrahcsid s’etamni eht nopU 152.12 ?sredro gnisuoh )PCP( s’redivorp erac yramirp eht no desab erac gnisrun rof etairporppani saw taht aera ?etauqeda ATT eht ni dedivorp erac lacinilc eht fo noitatnemucod eht saW 572.12 ?ylemit dna etauqeda redivorp gnidnetta eht yb deredner erac lacinilc eht saw ,ATT eht ni saw tneitap eht elihW 672.12 ?etairporppa ATT eht ot emoc ot ton noisiced s’redivorp eht saw ,enola noitatlusnoc enohpelet yb deganam stneitap roF 972.12 ot snoitacidem debircserp lla reviled ro retsinimda noitutitsni eht did ,latipsoh ytinummoc a morf egrahcsid s’etamni eht nopU 182.12 ?semarf emit defiiceps nihtiw etamni eht secivreS tnegrU :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 842.12 8.79 2.6 6.3 2.2 4.6 9.5 7 4.6 2.6 7.6 7 9.5 4.6 2.6 3.5 6.4 3.6 5.5 stnioP devieceR %28 %88 %25 %23 %29 %48 %001 %29 %88 %69 %001 %48 %29 %88 %57 %56 %09 %97 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 942.12 3.37 8.5 4.3 4.3 6.3 9.3 9.5 3.3 1.4 8.2 4.6 1.6 6.3 5.4 6.4 7.1 6 2.4 stnioP devieceR %26 %28 %84 %84 %25 %65 %48 %84 %85 %04 %29 %88 %25 %46 %56 %42 %58 %06 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 052.12 901 7 5 7 7 7.6 7.6 7 7.6 7 7 7 7 7.6 7 5.3 6.5 1.5 stnioP devieceR %29 %001 %27 %001 %001 %69 %69 %001 %69 %001 %001 %001 %001 %69 %001 %05 %08 %37 erocS APPENDIX C-5: Component Questions and Scores - Urgent Services 49 egap no deunitnoc Bureau of Audits and Investigations, Office of the Inspector General Page 94 egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 24 7 7 7 7 7 7 stnioP elbissoP 152.12 82 7 7 0 7 0 7 stnioP devieceR %76 %001 %001 %0 %001 %0 %001 erocS 071 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 stnioP elbissoP 572.12 1.331 8.8 8.6 6.9 4.6 4.6 6 6.7 8 8.8 8 6.7 4.8 2.9 2.7 3.8 5.9 5.6 stnioP devieceR %87 %88 %86 %69 %46 %46 %06 %67 %08 %88 %08 %67 %48 %29 %27 %38 %59 %56 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 672.12 3.301 7.4 5.5 4.4 5.4 7.5 8.5 7.6 7.6 1.6 7 4.6 7 4.6 3.6 7.6 7 4.6 stnioP devieceR %78 %76 %97 %36 %46 %18 %38 %59 %69 %78 %001 %19 %001 %29 %19 %59 %001 %19 erocS 021 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 972.12 7.811 8 8 8 8 8 8 8 8 8 8 8 8 7.6 8 8 stnioP devieceR %99 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %38 %001 %001 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 182.12 2.65 3 4.0 8.2 6.0 6.2 8.2 4 8.0 3.2 9.2 8.3 3.5 7.4 7.4 5.3 6 6 stnioP devieceR %55 %05 %7 %74 %01 %44 %74 %76 %31 %83 %84 %46 %88 %97 %97 %85 %001 %001 erocS 019 25 25 25 25 25 25 25 95 25 25 44 95 95 25 95 15 95 stnioP elbissoP latoT 3.917 5.34 7.23 4.73 5.63 2.93 2.24 34 5.74 7.14 3.64 8.63 8.25 7.54 7.14 2.34 4.04 7.84 stnioP devieceR latoT %97 %48 %36 %27 %07 %57 %18 %38 %18 %08 %98 %48 %98 %87 %08 %37 %97 %38 erocS latoT APPENDIX C-5 deunitnoc ,secivreS tnegrU :SEROCS TNENOPMOC State of California • August 2010 Page 95 secivreS ycnegremE :SNOITSEUQ TNENOPMOC ?yaled tuohtiw ycnegreme lacidem eht fo defiiton rednopser ycnegreme lacidem eht saW 381.80 laitini fo setunim )5( evfi nihtiw ycnegreme lacidem eht fo noitacol eht ta evirra rednopser ycnegreme lacidem eht diD 481.80 ?noitacfiiton erac lacidem etauqeda saw dna ycnegreme eht sserdda ot tnempiuqe reporp esu rednopser ycnegreme lacidem eht diD 581.80 ?esnecil reh ro sih fo epocs eht nihtiw dedivorp efil cisab rednopser ycnegreme lacidem eht dna )ffats erac htlaeh desnecil ro recfifo ecaep fi( rednopser tsrfi eht htob ereW 681.80 ?tnedicni eht fo emit eht ta defiitrec )SLB( troppus ?erutraped dna ,etamni eht ot ssecca ,lavirra s’ecnalubma eht rof noitaraperp etauqeda edivorp noitutitsni eht diD 781.80 dna noitatnemucod eht yb detroppus )CRRE( eettimmoC weiveR esnopseR ycnegremE s’noitutitsni eht fo sgnidnfi eht ereW 222.80 ?syad 03 nihtiw detelpmoc ?gnivirra ffats lacidem ot roirp )SLB( troppus efil cisab etauqeda edivorp rednopser tsrfi eht diD 142.80 desnecil a yb defiitnedi saw noitidnoc gninetaerht-efil a retfa yaled yrassecennu tuohtiw 119 llac ffats erac htlaeh desnecil diD 242.80 ?recfifo ecaep ro redivorp erac htlaeh eht gnidivorp yb metsys esnopser ycnegreme eht etavitca recfifo gnidnopser eht diD :llirD esnopseR lacideM ycnegremE 042.51 ?yaled tuohtiw dna yletaidemmi ,seitrap tnaveler eht ot noitamrofni tnenitrep -orcim ro dleihs evitcetorp( tnempiuqe reporp eht esu dna yrrac recfifo gnidnopser eht diD :llirD esnopseR lacideM ycnegremE 552.51 ?tnemtraped eht yb deriuqer )sevolg ,ksam rof tneitap eht no tnemssessa na mrofrep ylreporp recfifo gnidnopser eht diD :llirD esnopseR lacideM ycnegremE 652.51 ?ssenevisnopser ?RPC mrofrep ylreporp recfifo gnidnopser eht diD :llirD esnopseR lacideM ycnegremE 752.51 ?yaled yrassecennu tuohtiw RPC nigeb recfifo gnidnopser eht diD :llirD esnopseR lacideM ycnegremE 852.51 ?ssel ro setunim evfi ni enecs no evirra ffats lacidem diD :llirD esnopseR lacideM ycnegremE 282.51 -evlav-gab ,gab RE( tnempiuqe reporp htiw evirra srednopser lacidem ycnegreme eht diD :llirD esnopseR lacideM ycnegremE 382.51 ?)DEA ,ksam ?ffats lacidem gnidnopser ot noitamrofni etarucca edivorp recfifo gnidnopser eht diD :llirD esnopseR lacideM ycnegremE 482.51 ?troppus efil cisab eunitnoc srednopser lacidem ycnegreme diD :llirD esnopseR lacideM ycnegremE 582.51 fo lavirra eht litnu tneitap eht gnitropsnart tuohtiw RPC htiw eunitnoc ffats lacidem diD :llirD esnopseR lacideM ycnegremE gniwollof noitseuq siht detanimile eW :etoN ?defiitsuj noisiced siht saw ,detropsnart saw tneitap eht fI ?lennosrep ecnalubma 682.51 .srewsna tnetsisnocni rof laitnetop eht ot eud noitcepsni tsrfi eht ?yaled yrassecennu tuohtiw dellac 119 saW :llirD esnopseR lacideM ycnegremE 782.51 APPENDIX C-6: Component Questions and Scores - Emergency Services Bureau of Audits and Investigations, Office of the Inspector General Page 96 secivreS ycnegremE :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 08 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 381.80 97 5 5 5 5 4 5 5 5 5 5 5 5 5 5 5 5 stnioP devieceR %99 %001 %001 %001 %001 %08 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 46 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 481.80 1.85 4 2.3 4 4 4 2 3 4 4 4 7.2 4 4 2.3 4 4 stnioP devieceR %19 %001 %08 %001 %001 %001 %05 %57 %001 %001 %001 %76 %001 %001 %08 %001 %001 erocS 211 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 581.80 3.201 7 7 3.5 3.5 7 7 7 7 7 6.5 7 6.5 7 7 7 5.3 stnioP devieceR %19 %001 %001 %57 %57 %001 %001 %001 %001 %001 %08 %001 %08 %001 %001 %001 %05 erocS 46 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 681.80 06 0 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP devieceR %49 %0 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 46 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 781.80 35 4 4 7.2 0 4.2 7.2 4 4 4 4 2.3 4 4 4 4 2 stnioP devieceR %38 %001 %001 %76 %0 %06 %76 %001 %001 %001 %001 %08 %001 %001 %001 %001 %05 erocS 211 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 222.80 4.72 7 0 8.1 5.3 8.1 0 0 0 0 0 8.2 0 0 7 0 5.3 stnioP devieceR %42 %001 %0 %52 %05 %52 %0 %0 %0 %0 %0 %04 %0 %0 %001 %0 %05 erocS 69 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 142.80 8.47 6 6.3 6 6 4 6 6 6 3 6 6 6 3 8.4 4.2 0 stnioP devieceR %87 %001 %06 %001 %001 %76 %001 %001 %001 %05 %001 %001 %001 %05 %08 %04 %0 erocS 69 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 242.80 1.08 6 6.3 6 5.4 6.3 5.4 6 5.4 6 6 8.4 6.3 6 6 6 3 stnioP devieceR %38 %001 %06 %001 %57 %06 %57 %001 %57 %001 %001 %08 %06 %001 %001 %001 %05 erocS 23 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 042.51 23 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS APPENDIX C-6 State of California • August 2010 Page 97 egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 61 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 stnioP elbissoP 552.51 8 1 1 0 1 0 1 0 1 1 0 1 0 0 1 0 0 stnioP devieceR %05 %001 %001 %0 %001 %0 %001 %0 %001 %001 %0 %001 %0 %0 %001 %0 %0 erocS 61 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 stnioP elbissoP 652.51 21 1 1 1 1 1 1 1 1 1 0 1 0 1 1 0 0 stnioP devieceR %57 %001 %001 %001 %001 %001 %001 %001 %001 %001 %0 %001 %0 %001 %001 %0 %0 erocS 03 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 752.51 41 0 2 0 0 0 2 2 2 2 2 0 0 0 2 0 stnioP devieceR %74 %0 %001 %0 %0 %0 %001 %001 %001 %001 %001 %0 %0 %0 %001 %0 erocS 23 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 852.51 22 2 2 0 2 2 0 2 2 2 0 2 2 2 2 0 0 stnioP devieceR %96 %001 %001 %0 %001 %001 %0 %001 %001 %001 %0 %001 %001 %001 %001 %0 %0 erocS 03 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 282.51 62 2 2 0 2 2 2 2 2 2 2 2 2 2 2 0 stnioP devieceR %78 %001 %001 %0 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %0 erocS 51 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 stnioP elbissoP 382.51 21 1 1 1 1 1 0 1 1 1 1 1 0 1 1 0 stnioP devieceR %08 %001 %001 %001 %001 %001 %0 %001 %001 %001 %001 %001 %0 %001 %001 %0 erocS 51 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 stnioP elbissoP 482.51 21 1 1 0 1 1 1 1 1 1 1 1 1 1 0 0 stnioP devieceR %08 %001 %001 %0 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %0 %0 erocS 51 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 stnioP elbissoP 582.51 51 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 1 1 stnioP elbissoP 682.51 0 0 stnioP devieceR %0 %0 erocS 03 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 782.51 22 2 2 2 2 2 2 2 0 2 2 2 2 0 0 0 stnioP devieceR %37 %001 %001 %001 %001 %001 %001 %001 %0 %001 %001 %001 %001 %0 %0 %0 erocS 029 85 85 85 85 51 65 85 85 35 85 85 85 85 34 85 65 95 stnioP elbissoP latoT 7.907 25 4.54 8.14 3.54 21 8.04 2.54 84 5.44 44 6.94 5.64 2.14 33 25 4.04 82 stnioP devieceR latoT %77 %09 %87 %27 %87 %08 %37 %87 %38 %48 %67 %68 %08 %17 %77 %09 %27 %84 erocS latoT APPENDIX C-6 deunitnoc ,secivreS ycnegremE :SEROCS TNENOPMOC Bureau of Audits and Investigations, Office of the Inspector General Page 98 yrevileD-tsoP/htribdlihC/eraC latanerP :SNOITSEUQ TNENOPMOC ylevitisop ot noitutitsni eht ta lavirra fo syad ssenisub )3( eerht nihtiw tset ycnangerp a eviecer etamni eht diD :ylno lavirra weN 660.90 ?ycnangerp reh yfitnedi lavirra reh fo syad ssenisub )7( neves nihtiw renoititcarp esrun BO ro naicisyhp BO na yb nees etamni eht saW :ylno lavirra weN 760.90 ?noitutitsni eht ta gnisuoh reit-rewol dna knub rewol a rof )onorhC noitadommoccA evisneherpmoC( 0147 mroF a deussi etamni tnangerp eht saW 860.90 ?tinu gnisuoh dereit-itlum a ni desuoh fi ?etamni eht rof doof dna stnemelppus lanoitirtun yliad artxe redro yltpmorp ffats lacidem diD 960.90 ?semarf emit elbacilppa eht ot gnidrocca naicisyhp BO na htiw tisiv etamni eht diD 170.90 ”sneercS latanerP“ eht etaroborroc )droceR wolF latanerP( N3075 mroF sggirB eht fo noitces ”defiitnedI sksiR/smelborP“ eht diD 270.90 ?snoitces noitanimaxe ”lacisyhP lanretaM“ eht dna ?)yreviled-tsop( pu-kcehc keew-xis reh eviecer etamni eht diD 470.90 ?N3075 mroF no detnemucod stset gnineercs latanerp defiiceps s’etamni eht fo stluser eht ereW 322.90 ?tisiv cinilc hcae ta detnemucod erusserp doolb dna thgiew s’etamni eht saW 422.90 yrevileD-tsoP/htribdlihC/eraC latanerP :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 5 5 stnioP elbissoP 660.90 0 0 stnioP devieceR %0 %0 erocS 5 5 stnioP elbissoP 760.90 5 5 stnioP devieceR %001 %001 erocS 5 5 stnioP elbissoP 860.90 1.2 1.2 stnioP devieceR %34 %34 erocS APPENDIX C-7: Component Questions and Scores - Prenatal Care APPENDIX C-7 State of California • August 2010 Page 99 deunitnoc ,yrevileD-tsoP/htribdlihC/eraC latanerP :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 5 5 stnioP elbissoP 960.90 3.4 3.4 stnioP devieceR %68 %68 erocS 8 8 stnioP elbissoP 170.90 9.6 9.6 stnioP devieceR %68 %68 erocS 7 7 stnioP elbissoP 270.90 0 0 stnioP devieceR %0 %0 erocS 7 7 stnioP elbissoP 470.90 6.5 6.5 stnioP devieceR %08 %08 erocS 5 5 stnioP elbissoP 322.90 3.4 3.4 stnioP devieceR %68 %68 erocS 6 6 stnioP elbissoP 422.90 3.4 3.4 stnioP devieceR %17 %17 erocS 35 35 stnioP elbissoP latoT 5.23 5.23 stnioP devieceR latoT %16 %16 erocS latoT Bureau of Audits and Investigations, Office of the Inspector General Page 100 secivreS citsongaiD :SNOITSEUQ TNENOPMOC ?redro s’naicisyhp eht ni defiiceps emarf emit eht nihtiw dedivorp ecivres ygoloidar eht saW :redro ygoloidaR 940.60 ?redro s’naicisyhp eht fo semarf emit elbacilppa eht nihtiw detcelloc nemiceps eht saW :sredro yrotarobal llA 881.60 yranilpicsidretnI( 0327 mroF no stluser tset citsongaid tnacfiingis yllacinilc eht tnemucod PCP eht diD :secivres citsongaid llA 191.60 ?)setoN ssergorP nihtiw etamni eht ot eciton nettirw etaitini dna troper citsongaid eht weiver )PCP( redivorp erac yramirp eht diD :redro ygoloidaR 002.60 ?stroper citsongaid eht deviecer noitutitsni eht etad eht fo syad ssenisub )2( owt ssenisub )2( owt nihtiw etamni eht ot eciton nettirw etaitini dna stroper citsongaid eht weiver PCP eht diD :sredro yrotarobal llA 202.60 ?stroper citsongaid eht deviecer noitutitsni eht etad eht fo syad ?syad 41 nihtiw noitutitsni eht yb deviecer troper citsongaid eht saW :redro ygoloidaR 542.60 ?stluser tset tnacfiingis yllacinilc eganam yletauqeda PCP eht diD :secivres citsongaid llA 362.60 secivreS citsongaiD :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 940.60 4.29 2.4 7 2.4 2.4 7 0 6.5 6.5 7 7 6.5 7 4.1 7 7 6.5 7 stnioP devieceR %87 %06 %001 %06 %06 %001 %0 %08 %08 %001 %001 %08 %001 %02 %001 %001 %08 %001 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 881.60 8.37 2.4 6 8.1 2.4 3 4.5 4.2 2.4 4.5 6 8.4 2.4 8.4 6.3 3 4.5 4.5 stnioP devieceR %27 %07 %001 %03 %07 %05 %09 %04 %07 %09 %001 %08 %07 %08 %06 %05 %09 %09 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 191.60 2.38 1.5 2.6 3.4 1.6 8.4 5.4 7.4 1.5 1 9.3 9.4 6.5 3.5 1.6 1.4 1.6 4.5 stnioP devieceR %07 %37 %98 %26 %78 %96 %46 %76 %37 %41 %65 %07 %08 %57 %88 %85 %78 %87 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 002.60 8.44 2.4 0 4.1 6.5 4.1 4.1 0 0 0 7 4.1 7 7 7 0 4.1 0 stnioP devieceR %83 %06 %0 %02 %08 %02 %02 %0 %0 %0 %001 %02 %001 %001 %001 %0 %02 %0 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 202.60 2.64 1.2 0 0 7 2.4 8.2 7.0 7.0 0 9.4 5.3 8.2 2.4 5.3 2.4 5.3 1.2 stnioP devieceR %93 %03 %0 %0 %001 %06 %04 %01 %01 %0 %07 %05 %04 %06 %05 %06 %05 %03 erocS APPENDIX C-8: Component Questions and Scores - Diagnostic Services APPENDIX C-8 State of California • August 2010 Page 101 deunitnoc ,secivreS citsongaiD :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 631 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 542.60 4.621 8 8 8.4 8 8 8 8 8 8 8 8 8 8 8.4 8 4.6 4.6 stnioP devieceR %39 %001 %001 %06 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %06 %001 %08 %08 erocS 071 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 stnioP elbissoP 362.60 7.141 9 9.8 8.5 01 3.8 3.8 01 01 7.6 8.7 2.8 9 7.7 7.6 7 2.9 1.9 stnioP devieceR %38 %09 %98 %85 %001 %38 %38 %001 %001 %76 %87 %28 %09 %77 %76 %07 %29 %19 erocS 488 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 stnioP elbissoP latoT 3.806 8.63 1.63 3.22 1.54 7.63 4.03 4.13 6.33 1.82 6.44 4.63 6.34 3.83 7.83 3.33 5.73 4.53 stnioP devieceR latoT %96 %17 %96 %34 %78 %17 %95 %06 %56 %45 %68 %07 %48 %47 %47 %46 %27 %86 erocS latoT Bureau of Audits and Investigations, Office of the Inspector General Page 102 noitamrofnI eraC htlaeH ot sseccA :SNOITSEUQ TNENOPMOC ?gnilfi esool sti htiw tnerruc ecfifo sdrocer lacidem eht sI 051.91 lacidem rof detacud setamni eht rof ffats cinilc ot elbaliava )RHU( sdrocer htlaeh tinu ekam ffats sdrocer lacidem diD 961.91 ?yad txen eht stnemtnioppa ?selfi RHU detseuqer s’GIO eht rof tnuocca ot elba noitutitsni eht saW 342.91 ?noitamrofni lacidem ’setamni elfi ylreporp noitutitsni eht seoD 662.91 etacol ot elba srotcepsni DM dna NR s’GIO eht erew ,noitcepsni s’GIO eht fo trap sa )RHU( sdrocer htlaeh tinu gniweiver elihW 172.91 ?setamni ot dedivorp erac htlaeh fo noitatnemucod tnaveler lla ?)RHU( sdrocer htlaeh tinu ni sgol erusserp doolb elfi yltpmorp noitutitsni eht seoD 272.91 noitamrofnI eraC htlaeH ot sseccA :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 351 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 stnioP elbissoP 051.91 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 stnioP devieceR %0 %0 %0 %0 %0 %0 %0 %0 %0 %0 %0 %0 %0 %0 %0 %0 %0 %0 erocS 552 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 51 stnioP elbissoP 961.91 042 51 51 51 0 51 51 51 51 51 51 51 51 51 51 51 51 51 stnioP devieceR %49 %001 %001 %001 %0 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 402 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 stnioP elbissoP 342.91 27 21 0 0 0 0 21 0 21 21 21 0 0 0 21 0 0 0 stnioP devieceR %53 %001 %0 %0 %0 %0 %001 %0 %001 %001 %001 %0 %0 %0 %001 %0 %0 %0 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 662.91 07 5 5 5 0 5 5 5 0 5 5 5 5 5 5 5 5 0 stnioP devieceR %28 %001 %001 %001 %0 %001 %001 %001 %0 %001 %001 %001 %001 %001 %001 %001 %001 %0 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 172.91 86 5 5 5 5 5 5 3 5 5 5 0 5 5 5 0 5 0 stnioP devieceR %08 %001 %001 %001 %001 %001 %001 %06 %001 %001 %001 %0 %001 %001 %001 %0 %001 %0 erocS APPENDIX C-9: Component Questions and Scores - Access to Health Care Information APPENDIX C-9 State of California • August 2010 Page 103 deunitnoc ,noitamrofnI eraC htlaeH ot sseccA :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 272.91 5.75 5.2 5.2 5 5 5 5.2 5 0 0 5 0 5.2 5 5 5.2 5 5 stnioP devieceR %86 %05 %05 %001 %001 %001 %05 %001 %0 %0 %001 %0 %05 %001 %001 %05 %001 %001 erocS 768 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 stnioP elbissoP latoT 5.705 5.93 5.72 03 01 03 5.93 82 23 73 24 02 5.72 03 24 5.22 03 02 stnioP devieceR latoT %95 %87 %45 %95 %02 %95 %87 %55 %36 %37 %28 %93 %45 %95 %28 %44 %95 %93 erocS latoT Bureau of Audits and Investigations, Office of the Inspector General Page 104 tinU gnisuoH tneitaptuO :SNOITSEUQ TNENOPMOC ?tnemecalp retfa yad radnelac eno nihtiw etamni eht etaulave )PCP( redivorp erac yramirp eht diD 150.40 ?tnemecalp fo yad eht no etamni eht fo tnemssessa laitini na etelpmoc NR eht diD 250.40 noitacudE dna nalP ,tnemssessA ,evitcejbO ,evitcejbuS eht etelpmoc PCP eht did ,UHO eht ni decalp saw etamni eht elihW 350.40 ?syad 41 yreve fo muminim a ta )EPAOS( syad 03 yreve dna tnemecalp s’etamni eht fo keew eno nihtiw etamni eht ssessa esrun )MU( tnemeganam noitazilitu eht diD 450.40 ?retfaereht ?tnemssessa laitini eht sserdda yletauqeda nalp s’PCP eht diD 650.40 ?tnemecalp UHO gniriuqer )s(melborp eht rof etauqeda noitaulave laitini s’PCP eht saW 211.40 ?noitatneserp lacinilc s’tneitap eht ot etairporppa UHO eht ni elbaliava erac fo level eht saW 802.40 ?noitaulave laitini eht ni sgnidnfi eht rof etairporppa )sesongaid ro( tnemssessa laitini s’PCP eht saW 032.40 ?setunim 03 yreve sdnuor ekam ffats lacidem seod ro lanoitarepo snottub llac tneitap era ,)UHO( tinu gnisuoh tneitaptuo eht nI 301.51 ?saera tneitap nommoc ni yliad tnatcefnisid esu UHO eht seoD 522.51 tinU gnisuoH tneitaptuO :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 05 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 150.40 24 4 4 4 5.3 5 4 5 4 4 5.4 stnioP devieceR %48 %08 %08 %08 %07 %001 %08 %001 %08 %08 %09 erocS 05 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 250.40 5.44 5.4 5 4 5.4 5 3 5 4 5 5.4 stnioP devieceR %98 %09 %001 %08 %09 %001 %06 %001 %08 %001 %09 erocS 04 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 350.40 6.82 2 4 3 4 4 3.1 2 4 1.3 2.1 stnioP devieceR %27 %05 %001 %57 %001 %001 %33 %05 %001 %87 %03 erocS 04 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 450.40 4.2 0 0 0 0 0 2 0 0 4.0 0 stnioP devieceR %6 %0 %0 %0 %0 %0 %05 %0 %0 %11 %0 erocS APPENDIX C-10: Component Questions and Scores - Outpatient Housing Unit APPENDIX C-10 State of California • August 2010 Page 105 deunitnoc ,tinU gnisuoH tneitaptuO :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 05 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 650.40 9.04 5 5 1.3 9.1 4.4 4.4 8.3 8.3 5.4 5 stnioP devieceR %28 %001 %001 %36 %83 %98 %88 %57 %57 %09 %001 erocS 05 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 211.40 63 4 5 2 5.1 5.3 5.3 9.3 4 5.4 1.4 stnioP devieceR %27 %08 %001 %04 %03 %07 %07 %87 %08 %09 %28 erocS 09 9 9 9 9 9 9 9 9 9 9 stnioP elbissoP 802.40 88 9 9 9 7 9 9 9 9 9 9 stnioP devieceR %89 %001 %001 %001 %87 %001 %001 %001 %001 %001 %001 erocS 05 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 032.40 74 5 5 1.3 5 5 5 4.4 5 5.4 5 stnioP devieceR %49 %001 %001 %36 %001 %001 %001 %98 %001 %09 %001 erocS 03 3 3 3 3 3 3 3 3 3 3 stnioP elbissoP 301.51 21 3 0 3 0 0 0 0 3 3 0 stnioP devieceR %04 %001 %0 %001 %0 %0 %0 %0 %001 %001 %0 erocS 03 3 3 3 3 3 3 3 3 3 3 stnioP elbissoP 522.51 72 3 3 3 3 0 3 3 3 3 3 stnioP devieceR %09 %001 %001 %001 %001 %0 %001 %001 %001 %001 %001 erocS 084 84 84 84 84 84 84 84 84 84 84 stnioP elbissoP latoT 5.863 5.93 04 2.43 4.03 9.53 2.53 1.63 8.93 1.14 3.63 stnioP devieceR latoT %77 %28 %38 %17 %36 %57 %37 %57 %38 %68 %67 erocS latoT Bureau of Audits and Investigations, Office of the Inspector General Page 106 sweiveR lanretnI :SNOITSEUQ TNENOPMOC ?shtnom )6( xis tsal eht rof sgniteem ylhtnom tnemucod setunim gniteem )CMQ( eettimmoC tnemeganaM ytilauQ eht oD 811.71 ?sgniteem )6( xis tsal eht fo hcae OMC/MCH eht ot sgnidnfi sti troper )CMQ( eettimmoC tnemeganaM ytilauQ eht diD 911.71 )6( xis tsal eht rof sgniteem ylhtnom tnemucod setunim gniteem )CRRE( eettimmoC weiveR esnopseR ycnegremE eht oD 231.71 ?shtnom ?tnemevorpmi rof seigetarts dna sgnidnfi tcefler setunim gniteem )CMQ( eettimmoC tnemeganaM ytilauQ eerht tsal eht diD 531.71 ?ssecorp weiver htaed eht etelpmoc noitutitsni eht did ,delpmas htaed hcae roF 631.71 )s’eengised reh ro sih ro( s’nedraw eht tnemucod setunim gniteem )CRRE( eettimmoC weiveR esnopseR ycnegremE eht oD 831.71 ?ecnadnetta ?shtnom 21 tnecer tsom eht gnirud slaeppa lacidem etamni ssecorp yltpmorp noitutitsni eht diD 471.71 lacidem hcae morf noitapicitrap edulcni dna hctaw hcae rof llird esnopser ycnegreme lacidem a etelpmoc noitutitsni eht diD 122.71 ?retrauq lluf tnecer tsom eht gnirud ytilicaf sweiveR lanretnI :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 811.71 67 5 5 5 5 5 5 2.4 5 5 7.1 5 5 2.4 7.1 5 2.4 5 stnioP devieceR %98 %001 %001 %001 %001 %001 %001 %38 %001 %001 %33 %001 %001 %38 %33 %001 %38 %001 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 911.71 7.18 5 5 5 5 5 5 5 5 5 5 5 5 5 5.2 5 2.4 5 stnioP devieceR %69 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %05 %001 %38 %001 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 231.71 1.17 5 5 5 2.4 3.3 2.4 5.2 5 2.4 5.2 2.4 2.4 2.4 2.4 5 2.4 2.4 stnioP devieceR %48 %001 %001 %001 %38 %76 %38 %05 %001 %38 %05 %38 %38 %38 %38 %001 %38 %38 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 531.71 08 5 5 0 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP devieceR %49 %001 %001 %0 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS APPENDIX C-11: Component Questions and Scores - Internal Reviews APPENDIX C-11 State of California • August 2010 Page 107 deunitnoc ,sweiveR lanretnI :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 08 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 631.71 66 5 5 5 3 4 4 4 5 0 4 5 5 3 5 5 4 stnioP devieceR %38 %001 %001 %001 %06 %08 %08 %08 %001 %0 %08 %001 %001 %06 %001 %001 %08 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 831.71 2.86 2.4 5.2 5 4 5 3 3.3 2.4 5 5 5 5 4 3 5 0 5 stnioP devieceR %08 %38 %05 %001 %08 %001 %06 %76 %38 %001 %001 %001 %001 %08 %06 %001 %0 %001 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 471.71 04 5 0 0 0 5 5 0 0 0 5 0 5 5 0 5 5 0 stnioP devieceR %74 %001 %0 %0 %0 %001 %001 %0 %0 %0 %001 %0 %001 %001 %0 %001 %001 %0 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 122.71 03 0 0 0 0 5 5 0 0 0 0 0 5 5 5 5 0 0 stnioP devieceR %53 %0 %0 %0 %0 %001 %001 %0 %0 %0 %0 %0 %001 %001 %001 %001 %0 %0 erocS 576 04 04 04 04 53 04 04 04 04 04 04 04 04 04 04 04 04 stnioP elbissoP latoT 7.215 2.43 5.72 52 2.62 3.33 2.63 42 2.82 2.92 2.42 2.82 2.93 3.73 3.42 04 5.72 2.82 stnioP devieceR latoT %67 %68 %96 %36 %66 %59 %19 %06 %17 %37 %06 %07 %89 %39 %16 %001 %96 %07 erocS latoT Bureau of Audits and Investigations, Office of the Inspector General Page 108 srefsnarT etamnI :SNOITSEUQ TNENOPMOC ?epolevne refsnart dna RHU s’etamni eht evah esaeleR dna gnivieceR diD 801.50 refsnarT eraC htlaeH( 1737 mroF no deton secivres eht erew ,secivres ytlaiceps gnimocpu yna rof deludehcs saw etamni eht fI 901.50 ?)noitamrofnI eht ni snoitacidem eht era dna ,naicisyhp eht yb deredro snoitacidem lla yfitnedi epolevne refsnart eht ni smrof etairporppa lla oD 011.50 ?epolevne refsnart s’etamni eht no desab )noitamrofnI refsnarT eraC htlaeH( 1737 mroF fo snoitces elbacilppa lla etelpmoc yletarucca NR na diD 171.50 ?RHU mroF dna )noitamrofnI refsnarT eraC htlaeH( 1737 mroF s’etamni eht fo ypoc a niatniam tnemtrapeD sdroceR htlaeH eht diD 271.50 ?derrefsnart etamni eht nehw )droceR noitartsinimdA noitacideM tneitaptuO( A1327 srefsnarT etamnI :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 801.50 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 08 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 901.50 25 8 8 8 0 8 0 8 4 0 8 stnioP devieceR %56 %001 %001 %001 %0 %001 %0 %001 %05 %0 %001 erocS 021 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 011.50 6.901 8 8 2.3 8 8 4.6 8 8 8 8 8 8 8 4 8 stnioP devieceR %19 %001 %001 %04 %001 %001 %08 %001 %001 %001 %001 %001 %001 %001 %05 %001 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 171.50 7.09 2.4 7 7 7 2.4 7 4.1 4.1 7 6.5 3.5 7 7 7 7 0 6.5 stnioP devieceR %67 %06 %001 %001 %001 %06 %001 %02 %02 %001 %08 %57 %001 %001 %001 %001 %0 %08 erocS 631 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 271.50 021 8 8 8 8 8 8 0 8 8 8 8 8 8 8 8 8 0 stnioP devieceR %88 %001 %001 %001 %001 %001 %001 %0 %001 %001 %001 %001 %001 %001 %001 %001 %001 %0 erocS 475 83 22 03 22 83 83 83 03 03 03 03 83 83 83 83 83 83 stnioP elbissoP latoT 3.194 2.53 22 03 22 4.03 83 4.61 8.22 03 6.82 3.82 83 03 83 43 91 6.82 stnioP devieceR latoT %68 %39 %001 %001 %001 %08 %001 %34 %67 %001 %59 %49 %001 %97 %001 %09 %05 %57 erocS latoT APPENDIX C-12: Component Questions and Scores - Inmate Transfers State of California • August 2010 Page 109 snoitarepO cinilC :SNOITSEUQ TNENOPMOC ?setamni ot elbaliava )mroF tseuqeR secivreS eraC htlaeH( 2637 mroF eht ekam noitutitsni eht seoD 320.41 ffats seod dna )QTC( sretrauq ot denfinoc ro margorp defiidom no era setamni hcihw wonk cinilc ytilicaf eht ni ffats lacidem seoD 920.41 ?noitacidem rieht eviecer setamni esoht erusne ot ssecorp etauqeda na evah ?ssecorp tacud ytiroirp s’noitutitsni eht dnatsrednu ffats lacidem seoD 230.41 ?stacud lacidem rieht eviecer llits llec wen a ot devom era ohw setamni erusne ot ssecorp etauqeda na evah noitutitsni eht seoD 330.41 ?stneitap neewteb sevolg egnahc ro )rezitinas dnah ro paos htiw rehtie( sdnah rieht hsaw ffats lacinilc seoD 601.41 dna ti seraperp ohw rebmem ffats desnecil emas eht yb deretsinimda eb ot si noitacidem taht dnatsrednu sesrun noitacidem oD 131.41 ?yad emas eht no ?delecnac si enil s’rotcod a fi stnemtnioppa tnegru sserdda dna ,weiver ,yfitnedi ot ssecorp a evah noitutitsni eht seoD 061.41 ?seicnegreme-non rof snoitanimaxe ’srotcod dna stnemssessa ecaf-ot-ecaf NR gnirud ycavirp erusne ot elbaliava saera erA 461.41 ?yliad tnatcefnisid a htiw denaelc tnempiuqe dna ,sriahc moor gnitiaw ,sroofl cinilc eht erA 561.41 ?rotaregirfer cinilc eht ni tneserp saw doof fi reniatnoc delaes a ni derots noitacidem eht saW 661.41 snoitarepO cinilC :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 320.41 9.66 4 4 4 4 4 4 6.3 3.3 4 4 4 4 4 4 4 4 4 stnioP devieceR %89 %001 %001 %001 %001 %001 %001 %98 %38 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 46 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 920.41 26 4 4 2 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP devieceR %79 %001 %001 %05 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 43 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 230.41 43 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 330.41 66 4 4 4 2 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP devieceR %79 %001 %001 %001 %05 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS APPENDIX C-13: Component Questions and Scores - Clinic Operations 011 egap no deunitnoc Bureau of Audits and Investigations, Office of the Inspector General Page 110 egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 601.41 85 3 4 3 4 4 3 4 3 4 4 3 4 4 2 3 4 2 stnioP devieceR %58 %57 %001 %57 %001 %001 %57 %001 %57 %001 %001 %57 %001 %001 %05 %57 %001 %05 erocS 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 131.41 46 4 4 4 4 4 4 4 4 4 4 4 4 4 0 4 4 4 stnioP devieceR %49 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %0 %001 %001 %001 erocS 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 061.41 05 4 4 4 4 4 4 4 4 2 0 0 0 2 4 4 2 4 stnioP devieceR %47 %001 %001 %001 %001 %001 %001 %001 %001 %05 %0 %0 %0 %05 %001 %001 %05 %001 erocS 15 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 stnioP elbissoP 461.41 2.54 3 3 3 3 3 5.1 3.2 3 3 3 3 3 3 3 3 0 4.2 stnioP devieceR %98 %001 %001 %001 %001 %001 %05 %57 %001 %001 %001 %001 %001 %001 %001 %001 %0 %08 erocS 43 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 561.41 2.32 2 2 2 2 3.1 0 0 3.1 7.0 2 2 3.1 0 2 3.1 3.1 2 stnioP devieceR %86 %001 %001 %001 %001 %76 %0 %0 %76 %33 %001 %001 %76 %0 %001 %76 %76 %001 erocS 43 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 661.41 43 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 755 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 33 92 stnioP elbissoP latoT 3.305 23 33 03 13 3.23 5.82 9.92 6.03 7.92 92 82 3.82 92 72 3.13 3.72 4.62 stnioP devieceR latoT %09 %79 %001 %19 %49 %89 %68 %19 %39 %09 %88 %58 %68 %88 %28 %59 %38 %19 erocS latoT APPENDIX C-13 deunitnoc ,snoitarepO cinilC :SEROCS TNENOPMOC State of California • August 2010 Page 111 secivreS evitneverP :SNOITSEUQ TNENOPMOC eht saw ro shtnom 21 suoiverp eht nihtiw )TBOF( tset doolb tlucco lacef a eviecer etamni eht diD :redlo ro 15 ega setamni elaM 580.01 ?detnemucod lasufer s’etamni s’etamni eht saw ro shtnom 21 suoiverp eht nihtiw noitaniccav azneuflni na eviecer etamni eht diD :redlo ro 66 ega setamni llA 680.01 ?detnemucod lasufer ?shtnom 42 suoiverp eht nihtiw margommam a eviecer etamni eht diD :redlo ro 14 ega setamni elameF 780.01 ?etamni eht ot noitacidem eht retsinimda ylreporp noitutitsni eht diD :HNI debircserp setamnI 822.01 ?shtnom 21 suoiverp eht nihtiw BT fo smotpmys dna sngis rof detaulave etamni eht saW :43 edoc BT htiw setamnI 922.01 eht no saw ehs ro eh shtnom eerht tnecer tsom eht rof ylhtnom etamni eht rotinom noitutitsni eht diD :HNI debircserp setamnI 232.01 ?noitacidem ?ycilop htiw ecnailpmoc ni raems paP a eviecer etamni eht diD :46 ot 14 ega setamni elameF 472.01 secivreS evitneverP :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 57 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 580.01 32 0 1 1 5.1 5.3 1 0 0 1 5.4 5.0 5.1 5.1 5.3 5.2 stnioP devieceR %13 %0 %02 %02 %03 %07 %02 %0 %0 %02 %09 %01 %03 %03 %07 %05 erocS 69 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 680.01 9.96 6 4.5 6.3 6 4.5 3.3 0 0 8.4 6 6 1.5 6 3 5.4 8.4 stnioP devieceR %37 %001 %09 %06 %001 %09 %65 %0 %0 %08 %001 %001 %68 %001 %05 %57 %08 erocS 01 5 5 stnioP elbissoP 780.01 5.6 5.3 3 stnioP devieceR %56 %07 %06 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 822.01 6.72 4.2 2.1 2.1 4.2 0 8.4 2.1 2.1 2.1 0 2.1 4.2 0 0 2.1 8.4 4.2 stnioP devieceR %72 %04 %02 %02 %04 %0 %08 %02 %02 %02 %0 %02 %04 %0 %0 %02 %08 %04 erocS APPENDIX C-14: Component Questions and Scores - Preventive Services 211 egap no deunitnoc Bureau of Audits and Investigations, Office of the Inspector General Page 112 egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 922.01 2.64 4.1 7 4.1 7 0 7 0 7 0 4.1 2.4 7 0 0 0 0 8.2 stnioP devieceR %93 %02 %001 %02 %001 %0 %001 %0 %001 %0 %02 %06 %001 %0 %0 %0 %0 %04 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 232.01 6.9 2.1 0 0 2.1 0 6 0 0 0 0 0 0 0 2.1 0 0 0 stnioP devieceR %9 %02 %0 %0 %02 %0 %001 %0 %0 %0 %0 %0 %0 %0 %02 %0 %0 %0 erocS 01 5 5 stnioP elbissoP 472.01 5.5 5.2 3 stnioP devieceR %55 %05 %06 erocS 415 03 03 03 03 53 03 03 03 03 03 03 53 03 03 03 03 42 stnioP elbissoP latoT 3.881 11 6.41 2.7 1.81 4.11 6.42 2.2 2.8 6 4.8 9.51 5.02 5.6 7.5 2.7 1.31 7.7 stnioP devieceR latoT %73 %73 %94 %42 %06 %33 %28 %7 %72 %02 %82 %35 %95 %22 %91 %42 %44 %23 erocS latoT APPENDIX C-14 deunitnoc ,secivreS evitneverP :SEROCS TNENOPMOC State of California • August 2010 Page 113 secivreS ycamrahP :SNOITSEUQ TNENOPMOC ?seicamrahp sti ni timrep dilav a tsop ylsuoucipsnoc noitutitsni eht seoD 931.31 ?snoitacidem trac hsarc ycnegreme sti niatniam ylreporp noitutitsni eht seoD 141.31 ?tnerruc esnecil s’egrahc ni tsicamrahp eht sI 241.31 yllufwal sredivorp erac-htlaeh desnecil yb debircserp era snoitacidem taht erusne ot noitamrofni evah noitutitsni eht seoD 441.31 ?os od ot dezirohtua ?snoitcaer esrevda laitnetop rof sredro noitacidem wen gnineercs rof ssecorp evitceffe na evah egrahc ni tsicamrahp eht seoD 541.31 yrotnevni launna na tcudnoc ycamrahp eht seod dna ,dnah no snoitacidem fo ytitnauq eht rotinom egrahc ni tsicamrahp eht seoD 841.31 ?dnah no snoitacidem fo ytitnauq eht sehctam metsys eht ni snoitacidem fo ytitnauq eht taht erusne ot ?)sei(ylppus noitacidem sruoh-retfa sti ni snoitacidem niatniam ylreporp noitutitsni eht seoD 252.31 ?)sei(ylppus noitacidem sruoh-retfa dna trac ycnegreme sti fo snoitcepsni ylhtnom tcudnoc noitutitsni eht seoD 352.31 secivreS ycamrahP :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 43 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 931.31 43 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 43 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 141.31 6.82 1 0 2 0 2 2 2 2 2 2 2 2 2 2 2 2 6.1 stnioP devieceR %48 %05 %0 %001 %0 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %08 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 241.31 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 441.31 06 0 6 6 6 6 0 0 0 6 6 6 6 6 0 6 0 0 stnioP devieceR %95 %0 %001 %001 %001 %001 %0 %0 %0 %001 %001 %001 %001 %001 %0 %001 %0 %0 erocS APPENDIX C-15: Component Questions and Scores - Pharmacy Services 411 egap no deunitnoc Bureau of Audits and Investigations, Office of the Inspector General Page 114 egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 541.31 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 841.31 46 4 4 4 4 4 4 4 4 4 4 4 4 4 0 4 4 4 stnioP devieceR %49 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %0 %001 %001 %001 erocS 43 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 252.31 51 0 0 2 2 3.1 2 2 0 2 0 0 0 0 0 7.0 1 2 stnioP devieceR %44 %0 %0 %001 %001 %76 %001 %001 %0 %001 %0 %0 %0 %0 %0 %33 %05 %001 erocS 71 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 stnioP elbissoP 352.31 2.21 1 1 1 7.0 3.0 1 1 1 1 3.0 3.0 7.0 7.0 8.0 4.0 1 0 stnioP devieceR %27 %001 %001 %001 %76 %52 %001 %001 %001 %001 %33 %33 %76 %76 %57 %04 %001 %0 erocS 394 92 92 92 92 92 92 92 92 92 92 92 92 92 92 92 92 92 stnioP elbissoP latoT 8.714 02 52 92 7.62 6.72 32 32 12 92 3.62 3.62 7.62 7.62 8.61 1.72 22 6.12 stnioP devieceR latoT %58 %96 %68 %001 %29 %59 %97 %97 %27 %001 %19 %19 %29 %29 %85 %39 %67 %57 erocS latoT APPENDIX C-15 deunitnoc ,secivreS ycamrahP :SEROCS TNENOPMOC State of California • August 2010 Page 115 secivreS rehtO :SNOITSEUQ TNENOPMOC era ohw setamni gnirrefsnart rof serudecorp s’tnemtraped eht wollof ffats seod ,steid cituepareht reffo ton seod noitutitsni eht fI 850.51 ?teid cituepareht a eriuqer ot denimreted ?setamni ot steid cituepareht edivorp ylreporp noitutitsni eht diD 950.51 ?shtnom xis tsal eht ni derevocsid BT fo sesac evitca lla ot dnopser ylreporp noitutitsni eht diD 431.51 ?yrarbil wal s’noitutitsni eht ni elbaliava serudecorP dna seiciloP secivreS htlaeH RCDC eht fo noisrev tnerruc tsom eht sI 562.51 gnitaulave dna gniyfitnedi rof serudecorp dna seicilop s’tnemtraped eht dnatsrednu ffats ydotsuc diD :noitnevretnI eneigyH 290.02 ?tnemeganam eneigyh etairporppani gniyalpsid setamni secivreS rehtO :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 42 3 3 3 3 3 3 3 3 stnioP elbissoP 850.51 51 3 3 3 0 3 0 0 3 stnioP devieceR %36 %001 %001 %001 %0 %001 %0 %0 %001 erocS 23 4 4 4 4 4 4 4 4 stnioP elbissoP 950.51 23 4 4 4 4 4 4 4 4 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 5 5 stnioP elbissoP 431.51 5 5 stnioP devieceR %001 %001 erocS 15 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 stnioP elbissoP 562.51 63 3 5.1 0 0 0 3 5.1 3 3 5.1 3 3 3 3 3 3 5.1 stnioP devieceR %17 %001 %05 %0 %0 %0 %001 %05 %001 %001 %05 %001 %001 %001 %001 %001 %001 %05 erocS 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 290.02 76 4 4 4 4 4 4 4 4 4 4 3 4 4 4 4 4 4 stnioP devieceR %99 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %57 %001 %001 %001 %001 %001 %001 erocS 081 01 01 11 01 7 01 01 01 11 01 11 11 11 01 11 11 61 stnioP elbissoP latoT 551 01 5.8 8 7 4 7 5.8 7 11 5.5 01 11 11 01 11 11 5.41 stnioP devieceR latoT %68 %001 %58 %37 %07 %75 %07 %58 %07 %001 %55 %19 %001 %001 %001 %001 %001 %19 erocS latoT APPENDIX C-16: Component Questions and Scores - Other Sevices Bureau of Audits and Investigations, Office of the Inspector General Page 116 sekirtS regnuH etamnI :SNOITSEUQ TNENOPMOC tnemucod dna B-821 mroF eht fo tpiecer fo syad ssenisub )2( owt nihtiw etamni eht fo egairt ecaf-ot-ecaf a tcudnoc NR eht diD 790.11 ?noitidnoc lacisyhp dna ,sngis lativ ,thgiew tnerruc ,thgiew dedrocer tnecer tsom ,ekirts regnuh eht rof snosaer s’etamni eht ,noitidnoc lacisyhp ,thgiew s’etamni eht gnitnemucod stnemssessa yliad etelpmoc PCP ro NR na did ,sruoh 84 tsrfi eht retfA 990.11 ?sutats noitardyh dna ,sngis lativ ,noitidnoc lanoitome eht fo sisylaniru a dna lenap cilobatem a redro dna noitanimaxe lacisyhp a mrofrep naicisyhp a did ,sruoh 27 tsrfi eht retfA 001.11 ?etamni sekirtS regnuH etamnI :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 27 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 790.11 1.93 0 8.4 8.4 0 0 5.1 6 6 6 2 6 2 stnioP devieceR %45 %0 %08 %08 %0 %0 %52 %001 %001 %001 %33 %001 %33 erocS 27 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 990.11 8.72 6 2.1 6.3 4 0 3 4 6 0 0 0 0 stnioP devieceR %93 %001 %02 %06 %76 %0 %05 %76 %001 %0 %0 %0 %0 erocS 48 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 001.11 9.63 7 2.4 0 7.4 7 5.3 5.3 7 0 0 0 0 stnioP devieceR %44 %001 %06 %0 %76 %001 %05 %05 %001 %0 %0 %0 %0 erocS 822 91 91 91 91 91 91 91 91 91 91 91 91 stnioP elbissoP latoT 8.301 31 2.01 4.8 7.8 7 8 5.31 91 6 2 6 2 stnioP devieceR latoT %64 %86 %45 %44 %64 %73 %24 %17 %001 %23 %11 %23 %11 erocS latoT APPENDIX C-17: Component Questions and Scores - Inmate Hunger Strikes State of California • August 2010 Page 117 snoitacidniartnoC tnegA lacimehC :SNOITSEUQ TNENOPMOC ?CO fo esu detaluclac a erofeb )PCP( redivorp erac yramirp ro NR na htiw detlusnoc ti taht tnemucod noitutitsni eht diD 260.21 ?ycilop noitanimatnoced eht wollof ti did dna etamni eht detanimatnoced ti woh drocer noitutitsni eht diD 460.21 snoitacidniartnoC tnegA lacimehC :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 711 9 9 9 9 9 9 9 9 9 9 9 9 9 stnioP elbissoP 260.21 4.301 9 2.7 9 9 9 9 9 3 2.7 2.7 9 8.6 9 stnioP devieceR %88 %001 %08 %001 %001 %001 %001 %001 %33 %08 %08 %001 %57 %001 erocS 631 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 460.21 821 8 8 8 8 8 8 3.5 3.5 4.6 8 8 8 8 8 7 8 8 stnioP devieceR %49 %001 %001 %001 %001 %001 %001 %76 %76 %08 %001 %001 %001 %001 %001 %88 %001 %001 erocS 352 71 71 71 71 8 8 8 8 71 71 71 71 71 71 71 71 71 stnioP elbissoP latoT 4.132 71 2.51 71 71 8 8 3.5 3.5 4.51 71 71 11 2.51 2.51 61 8.41 71 stnioP devieceR latoT %19 %001 %98 %001 %001 %001 %001 %66 %66 %19 %001 %001 %56 %98 %98 %49 %78 %001 erocS latoT APPENDIX C-18: Component Questions and Scores - Chemical Agent Contraindications Bureau of Audits and Investigations, Office of the Inspector General Page 118 gniniarT dna sleveL gnfifatS :SNOITSEUQ TNENOPMOC ?gniniart deriuqer dnetta yeht did dna snoitacfiitrec rieht htiw tnerruc ffats erac htlaeh desnecil erA 100.81 gnitrats ffats erac htlaeh fo rebmun eht ,segatnecrep ycnacav egareva s’noitutitsni eht etaluclaC :ylno sesoprup noitamrofnI siht rotcaf ton od eW :etoN .yrtsiger eht morf derih ffats erac htlaeh fo rebmun eht dna ,tisiv GIO eht fo shtnom )6( xis nihtiw 200.81 .gniniart dna slevel gnfifats rof erocs s’noitutitsni eht otni noitseuq ?erac ycnegreme rof ,keew a syad neves ,yad a sruoh 42 etis no elbaliava )NR( esrun deretsiger a evah noitutitsni eht diD 400.81 eht rof ,keew a syad neves ,yad a sruoh 42 elbaliava DOM na ro ,llac no naicisyhp a ,etis no naicisyhp a evah noitutitsni eht diD 500.81 ?syad 03 tsal eriuqer taht slocotorp llac kcis rof eludom a edulcni ffats gnisrun derih ylwen lla rof margorp noitatneiro s’noitutitsni eht seoD 600.81 ?egairt ecaf-ot-ecaf gniniarT dna sleveL gnfifatS :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 100.81 2.15 4 2.3 4 4 6.1 6.1 4.2 8.0 4.2 4 4 6.1 2.3 4 4 2.3 2.3 stnioP devieceR %57 %001 %08 %001 %001 %04 %04 %06 %02 %06 %001 %001 %04 %08 %001 %001 %08 %08 erocS stnioP elbissoP 200.81 stnioP devieceR erocS 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 400.81 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 500.81 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 600.81 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 272 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 61 stnioP elbissoP latoT 2.552 61 2.51 61 61 6.31 6.31 4.41 8.21 4.41 61 61 6.31 2.51 61 61 2.51 2.51 stnioP devieceR latoT %49 %001 %59 %001 %001 %58 %58 %09 %08 %09 %001 %001 %58 %59 %001 %001 %59 %59 erocS latoT APPENDIX C-19: Component Questions and Scores - Staffing Levels and Training State of California • August 2010 Page 119 yciloP gnisruN :SNOITSEUQ TNENOPMOC ?senilediug s’tnemtraped eht ot erehda taht serudecorp dna seicilop gnisrun nettirw evah noitutitsni eht seoD 451.61 ?stnemetats ytud rieht weiver ffats gnisrun taht erusne noitutitsni eht seoD 132.61 ?ffats gnisrun fo sweiver cidoirep tcudnoc )NRS( esrun deretsiger gnisivrepus s’noitutitsni eht seoD 452.61 yciloP gnisruN :SEROCS TNENOPMOC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 451.61 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 132.61 45 5 4 5 2 4 4 2 5 3 5 2 5 0 1 5 0 2 stnioP devieceR %46 %001 %08 %001 %04 %08 %08 %04 %001 %06 %001 %04 %001 %0 %02 %001 %0 %04 erocS 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 452.61 63 2.3 8.0 4.2 4.2 0 6.1 0 4 0 2.3 4 4 0 4 4.2 0 4 stnioP devieceR %35 %08 %02 %06 %06 %0 %04 %0 %001 %0 %08 %001 %001 %0 %001 %06 %0 %001 erocS 832 41 41 41 41 41 41 41 41 41 41 41 41 41 41 41 41 41 stnioP elbissoP latoT 571 2.31 8.9 4.21 4.9 9 6.01 7 41 8 2.31 11 41 5 01 4.21 5 11 stnioP devieceR latoT %47 %49 %07 %98 %76 %46 %67 %05 %001 %75 %49 %97 %001 %63 %17 %98 %63 %97 erocS latoT APPENDIX C-20: Component Questions and Scores - Nursing Policy Bureau of Audits and Investigations, Office of the Inspector General Page 120 tnemeganaM noitacideM :SNOITSEUQ YROGETAC defiiceps nihtiw etamni eht ot )sredro wen( snoitacidem noitpircserp reviled ro retsinimda noitutitsni eht diD :noitacideM llaC kciS 421.10 ?semarf emit txen eht yb snoitacidem eht eviecer etamni eht did ,noitutitsni eht ta lavirra nopu redro noitacidem gnitsixe na dah etamni eht fI 821.20 ?deunitnoc eb ot ton erew snoitacidem eht yhw nialpxe naicisyhp a did ro ,yad radnelac eht did ro doirep htnom-eerht tnecer tsom eht gnirud snoitacidem erac cinorhc debircserp reh ro sih eviecer etamni eht diD 571.30 ?snoitacidem reh ro sih rof pu wohs ro pu kcip ot desufer etamni eht fi ycilop latnemtraped wollof noitutitsni ni snoitacidem eht era dna ,naicisyhp eht yb deredro snoitacidem lla yfitnedi epolevne refsnart eht ni smrof etairporppa lla oD 011.50 ?epolevne refsnart eht ?etamni eht ot noitacidem eht retsinimda ylreporp noitutitsni eht diD :HNI debircserp setamnI 822.01 ?snoitacidem trac hsarc ycnegreme sti niatniam ylreporp noitutitsni eht seoD 141.31 ?snoitcaer esrevda laitnetop rof sredro noitacidem wen gnineercs rof ssecorp evitceffe na evah egrahc ni tsicamrahp eht seoD 541.31 launna na tcudnoc ycamrahp eht seod dna ,dnah no snoitacidem fo ytitnauq eht rotinom egrahc ni tsicamrahp eht seoD 841.31 ?dnah no snoitacidem fo ytitnauq eht sehctam metsys eht ni snoitacidem fo ytitnauq eht taht erusne ot yrotnevni ?)sei(ylppus noitacidem sruoh-retfa sti ni snoitacidem niatniam ylreporp noitutitsni eht seoD 252.31 ?)sei(ylppus noitacidem sruoh-retfa dna trac ycnegreme sti fo snoitcepsni ylhtnom tcudnoc noitutitsni eht seoD 352.31 seod dna )QTC( sretrauq ot denfinoc ro margorp defiidom no era setamni hcihw wonk cinilc ytilicaf eht ni ffats lacidem seoD 920.41 ?noitacidem rieht eviecer setamni esoht erusne ot ssecorp etauqeda na evah ffats dna ti seraperp ohw rebmem ffats desnecil emas eht yb deretsinimda eb ot si noitacidem taht dnatsrednu sesrun noitacidem oD 131.41 ?yad emas eht no ?rotaregirfer cinilc eht ni tneserp saw doof fi reniatnoc delaes a ni derots noitacidem eht saW 661.41 eht ot snoitacidem debircserp lla reviled ro retsinimda noitutitsni eht did ,latipsoh ytinummoc a morf egrahcsid s’etamni eht nopU 182.12 ?semarf emit defiiceps nihtiw etamni tnemeganaM noitacideM :SEROCS YROGETAC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 421.10 7.53 9.0 3.1 6.2 8.1 7.1 6.0 5.2 7.0 2 8.0 7.1 1.3 2 6.4 3.3 8.4 3.1 stnioP devieceR %53 %41 %22 %44 %03 %82 %01 %14 %11 %33 %31 %82 %25 %33 %77 %55 %08 %22 erocS APPENDIX D-1: Category Questions and Scores - Medication Management State of California • August 2010 Page 121 egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 631 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 821.20 14 3.1 9.1 8.2 4.2 0 8.1 4.3 0 3.3 2 1 4.3 0 4 4 7 7.2 stnioP devieceR %03 %71 %42 %53 %03 %0 %32 %34 %0 %24 %52 %31 %34 %0 %05 %05 %88 %33 erocS 603 81 81 81 81 81 81 81 81 81 81 81 81 81 81 81 81 81 stnioP elbissoP 571.30 6.49 1.3 4.1 4.1 3.3 8.0 6.3 6.8 8.0 3.5 6.5 8.0 2.7 6.11 9.9 9 9.31 3.8 stnioP devieceR %13 %71 %8 %8 %81 %4 %02 %84 %4 %92 %13 %4 %04 %56 %55 %05 %77 %64 erocS 021 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 011.50 6.901 8 8 2.3 8 8 4.6 8 8 8 8 8 8 8 4 8 stnioP devieceR %19 %001 %001 %04 %001 %001 %08 %001 %001 %001 %001 %001 %001 %001 %05 %001 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 822.01 6.72 4.2 2.1 2.1 4.2 0 8.4 2.1 2.1 2.1 0 2.1 4.2 0 0 2.1 8.4 4.2 stnioP devieceR %72 %04 %02 %02 %04 %0 %08 %02 %02 %02 %0 %02 %04 %0 %0 %02 %08 %04 erocS 43 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 141.31 6.82 1 0 2 0 2 2 2 2 2 2 2 2 2 2 2 2 6.1 stnioP devieceR %48 %05 %0 %001 %0 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %08 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 541.31 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 841.31 46 4 4 4 4 4 4 4 4 4 4 4 4 4 0 4 4 4 stnioP devieceR %49 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %0 %001 %001 %001 erocS 43 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 252.31 51 0 0 2 2 3.1 2 2 0 2 0 0 0 0 0 7.0 1 2 stnioP devieceR %44 %0 %0 %001 %001 %76 %001 %001 %0 %001 %0 %0 %0 %0 %0 %33 %05 %001 erocS 71 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 stnioP elbissoP 352.31 2.21 1 1 1 7.0 3.0 1 1 1 1 3.0 3.0 7.0 7.0 8.0 4.0 1 0 stnioP devieceR %27 %001 %001 %001 %76 %52 %001 %001 %001 %001 %33 %33 %76 %76 %57 %04 %001 %0 erocS 46 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 920.41 26 4 4 2 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP devieceR %79 %001 %001 %05 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS APPENDIX D-1 deunitnoc ,tnemeganaM noitacideM :SEROCS YROGETAC 221 egap no deunitnoc Bureau of Audits and Investigations, Office of the Inspector General Page 122 egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 131.41 46 4 4 4 4 4 4 4 4 4 4 4 4 4 0 4 4 4 stnioP devieceR %49 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %0 %001 %001 %001 erocS 43 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 661.41 43 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 182.12 2.65 3 4.0 8.2 6.0 6.2 8.2 4 8.0 3.2 9.2 8.3 3.5 7.4 7.4 5.3 6 6 stnioP devieceR %55 %05 %7 %74 %01 %44 %74 %76 %31 %83 %84 %46 %88 %97 %97 %85 %001 %001 erocS 6031 87 07 87 07 87 87 87 87 87 87 87 87 87 87 87 87 47 stnioP elbissoP latoT 5.367 7.14 2.82 8.24 2.43 9.23 6.74 7.35 9.33 1.84 6.24 8.93 1.35 05 74 1.35 5.56 3.94 stnioP devieceR latoT %85 %35 %04 %55 %94 %24 %16 %96 %34 %26 %55 %15 %86 %46 %06 %86 %48 %76 erocS latoT APPENDIX D-1 deunitnoc ,tnemeganaM noitacideM :SEROCS YROGETAC State of California • August 2010 Page 123 eraC ot sseccA :SNOITSEUQ YROGETAC 2637 mroF eht retfa yad ssenisub )1( eno nihtiw egairt )FTF( ecaf-ot-ecaf eht etelpmoc NR eht diD :noitatnemucoD FTF NR 520.10 ?deweiver saw senilemit eht nihtiw nees etamni eht saw ,yrassecen saw )PCP( redivorp erac yramirp a ot larrefer a denimreted NR eht fI 720.10 ?egairt FTF eht gnirud NR eht yb defiiceps ?defiiceps emarf emit eht nihtiw ecalp ekat ti did ,tnemtnioppa llac kcis pu-wollof a deredro redivorp eht fI :pu-wolloF llaC kciS 742.10 noitcefni eht yb deweiver stluser eht erew dna ,evitisop saw tset nilucrebut s’etamni eht fi detelpmoc smotpmys fo weiver a saW 510.20 ?esrun lortnoc ?noitutitsni eht ta devirra etamni eht yad emas eht no gnineercs htlaeh laitini eht etelpmoc noitutitsni eht diD 610.20 dna tnemssessa na edivorp NR eht did ,)s(mrof gnineercs htlaeh laitini eht no snoitseuq eht fo yna ot derewsna saw sey fI 710.20 ?lavirra fo etad eht no noitisopsid ?emarf emit eht nihtiw nees etamni eht saw ,naicinilc a ot etamni eht derrefer NR eht ,tnemssessa eht gnirud ,fI 810.20 suoiverp a dah etamni eht fi smotpmys dna sngis fo weiver a ro tset nilucrebut eht tnemucod yletauqeda NR/NVL eht diD 020.20 ?tset nilucrebut evitisop a ro ,tnatsissA naicisyhP ,renoititcarP esruN a yb lacisyhp dna yrotsih etelpmoc a eviecer etamni eht diD :retnec noitpeceR 120.20 ?lavirra fo syad radnelac 41 nihtiw noegruS dna naicisyhP noitidnoc s’etamni eht fo lortnoc fo eerged eht yb deriuqer emarf emit eht nihtiw tisiv erac cinorhc tnecer tsom s’etamni eht saW 670.30 ?tisiv roirp reh ro sih no desab ?tnemecalp retfa yad radnelac eno nihtiw etamni eht etaulave )PCP( redivorp erac yramirp eht diD 150.40 ?tnemecalp fo yad eht no etamni eht fo tnemssessa laitini na etelpmoc NR eht diD 250.40 noitacudE dna nalP ,tnemssessA ,evitcejbO ,evitcejbuS eht etelpmoc PCP eht did ,UHO eht ni decalp saw etamni eht elihW 350.40 ?syad 41 yreve fo muminim a ta )EPAOS( ?redro s’naicisyhp eht ni defiiceps emarf emit eht nihtiw dedivorp ecivres ygoloidar eht saW :redro ygoloidaR 940.60 ?redro s’naicisyhp eht fo semarf emit elbacilppa eht nihtiw detcelloc nemiceps eht saW :sredro yrotarobal llA 881.60 ?semarf emit defiiceps nihtiw ecivres ytlaiceps eht eviecer etamni eht diD 530.70 ecnadrocca ni ,ti deviecer etamni eht etad eht dna ecivres eht deredro PCP eht etad eht neewteb etamni eht ees PCP eht diD 830.70 ?semarf emit defiiceps htiw secivres ytlaiceps eht retfa tnemtnioppa pu-wollof a rof etamni eht ees dna troper s’tnatlusnoc eht weiver PCP eht diD 340.70 ?semarf emit defiiceps nihtiw noitatlusnoc APPENDIX D-2: Category Questions and Scores - Access to Care 421 egap no deunitnoc Bureau of Audits and Investigations, Office of the Inspector General Page 124 laitini fo setunim )5( evfi nihtiw ycnegreme lacidem eht fo noitacol eht ta evirra rednopser ycnegreme lacidem eht diD 481.80 ?noitacfiiton ylevitisop ot noitutitsni eht ta lavirra fo syad ssenisub )3( eerht nihtiw tset ycnangerp a eviecer etamni eht diD :ylno lavirra weN 660.90 ?ycnangerp reh yfitnedi lavirra reh fo syad ssenisub )7( neves nihtiw renoititcarp esrun BO ro naicisyhp BO na yb nees etamni eht saW :ylno lavirra weN 760.90 ?noitutitsni eht ta ?semarf emit elbacilppa eht ot gnidrocca naicisyhp BO na htiw tisiv etamni eht diD 170.90 ?)yreviled-tsop( pu-kcehc keew-xis reh eviecer etamni eht diD 470.90 eht saw ro shtnom 21 suoiverp eht nihtiw )TBOF( tset doolb tlucco lacef a eviecer etamni eht diD :redlo ro 15 ega setamni elaM 580.01 ?detnemucod lasufer s’etamni s’etamni eht saw ro shtnom 21 suoiverp eht nihtiw noitaniccav azneuflni na eviecer etamni eht diD :redlo ro 66 ega setamni 680.01 ?detnemucod lasufer ?shtnom 42 suoiverp eht nihtiw margommam a eviecer etamni eht diD :redlo ro 14 ega setamni elameF 780.01 ?shtnom 21 suoiverp eht nihtiw BT fo smotpmys dna sngis rof detaulave etamni eht saW :43 edoc BT htiw setamnI 922.01 eht no saw ehs ro eh shtnom eerht tnecer tsom eht rof ylhtnom etamni eht rotinom noitutitsni eht diD :HNI debircserp setamnI 232.01 ?noitacidem ?ycilop htiw ecnailpmoc ni raems paP a eviecer etamni eht diD :46 ot 14 ega setamni elameF 472.01 tnemucod dna B-821 mroF eht fo tpiecer fo syad ssenisub )2( owt nihtiw etamni eht fo egairt ecaf-ot-ecaf a tcudnoc NR eht diD 790.11 ?noitidnoc lacisyhp dna ,sngis lativ ,thgiew tnerruc ,thgiew dedrocer tnecer tsom ,ekirts regnuh eht rof snosaer s’etamni eht ,noitidnoc lacisyhp ,thgiew s’etamni eht gnitnemucod stnemssessa yliad etelpmoc PCP ro NR na did ,sruoh 84 tsrfi eht retfA 990.11 ?sutats noitardyh dna ,sngis lativ ,noitidnoc lanoitome eht fo sisylaniru a dna lenap cilobatem a redro dna noitanimaxe lacisyhp a mrofrep naicisyhp a did ,sruoh 27 tsrfi eht retfA 001.11 ?etamni ?yaled yrassecennu tuohtiw RPC nigeb recfifo gnidnopser eht diD :llirD esnopseR lacideM ycnegremE 852.51 ?ssel ro setunim evfi ni enecs no evirra ffats lacidem diD :llirD esnopseR lacideM ycnegremE 282.51 reh ro sih htiw tnemtnioppa pu-wollof a eviecer etamni eht did ,latipsoh ytinummoc eht morf egrahcsid s’etamni eht nopU 942.12 ?egrahcsid fo syad radnelac evfi nihtiw )PCP( redivorp erac yramirp APPENDIX D-2 deunitnoc ,eraC ot sseccA :SNOITSEUQ YROGETAC State of California • August 2010 Page 125 eraC ot sseccA :SEROCS YROGETAC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 520.10 7.86 5 1.2 4.2 5.1 1.4 8.4 6.3 2 5 9.3 7.4 3.5 3.5 6.4 8.4 5 6.4 stnioP devieceR %76 %48 %43 %04 %62 %86 %08 %06 %33 %38 %56 %87 %88 %88 %67 %08 %48 %67 erocS 631 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 720.10 6.96 6.3 4.4 1.2 2.4 6.5 3.4 2 8.3 8.2 6 6 5.4 3.6 4 1 6.6 4.2 stnioP devieceR %15 %64 %65 %72 %25 %17 %45 %52 %74 %53 %57 %57 %65 %97 %05 %31 %28 %92 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 742.10 4.36 7.4 5.3 5.3 4.4 9.3 1.6 4 5.2 4.1 0 7.4 7.4 2.4 7 6.1 4.5 8.1 stnioP devieceR %35 %76 %05 %05 %36 %65 %88 %75 %63 %02 %0 %76 %76 %06 %001 %22 %87 %52 erocS 77 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 510.20 1.76 7 7 7 3.2 7 8.5 3.5 7.4 7 7 7 stnioP devieceR %78 %001 %001 %001 %33 %001 %38 %57 %76 %001 %001 %001 erocS 351 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 stnioP elbissoP 610.20 1.241 7.7 1.8 4.8 1.8 6.8 6.8 9.6 9.5 1.8 9 9 9 9 9 7.8 9 9 stnioP devieceR %39 %58 %09 %39 %09 %59 %59 %77 %56 %09 %001 %001 %001 %001 %001 %79 %001 %001 erocS 821 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 710.20 011 8 8 8 9.6 8 8 6.5 7.3 3.2 8 8 8 5.7 6.7 4.4 8 stnioP devieceR %68 %001 %001 %001 %78 %001 %001 %07 %64 %92 %001 %001 %001 %39 %49 %65 %001 erocS 821 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 810.20 1.06 2.3 9.4 3.1 4.4 9.0 7.2 7.5 0 3.2 8 9.6 4 8.4 1 8 2 stnioP devieceR %74 %04 %16 %71 %55 %11 %33 %17 %0 %92 %001 %68 %05 %06 %31 %001 %52 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 020.20 39 6 8.5 8.5 1.5 4.5 6 8.4 1.5 6 7.5 1.5 6 6 4.5 2.5 2.4 4.5 stnioP devieceR %19 %001 %69 %79 %58 %09 %001 %08 %58 %001 %59 %58 %001 %001 %09 %78 %07 %09 erocS 04 5 5 5 5 5 5 5 5 stnioP elbissoP 120.20 7.72 8.4 5 2 5 5.2 8.2 8.2 8.2 stnioP devieceR %96 %59 %001 %04 %001 %05 %55 %55 %65 erocS APPENDIX D-2 621 egap no deunitnoc APPENDIX D-2 Bureau of Audits and Investigations, Office of the Inspector General Page 126 deunitnoc ,eraC ot sseccA :SEROCS YROGETAC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 071 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 stnioP elbissoP 670.30 1.321 6.5 4.8 4.4 2.7 5.7 6.9 8.6 2.7 4.6 6 6.7 9 6.5 5.9 8.4 7.8 8.8 stnioP devieceR %27 %65 %48 %44 %27 %57 %69 %86 %27 %46 %06 %67 %09 %65 %59 %84 %78 %88 erocS 05 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 150.40 24 4 4 4 5.3 5 4 5 4 4 5.4 stnioP devieceR %48 %08 %08 %08 %07 %001 %08 %001 %08 %08 %09 erocS 05 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 250.40 5.44 5.4 5 4 5.4 5 3 5 4 5 5.4 stnioP devieceR %98 %09 %001 %08 %09 %001 %06 %001 %08 %001 %09 erocS 04 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 350.40 6.82 2 4 3 4 4 3.1 2 4 1.3 2.1 stnioP devieceR %27 %05 %001 %57 %001 %001 %33 %05 %001 %87 %03 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 940.60 4.29 2.4 7 2.4 2.4 7 0 6.5 6.5 7 7 6.5 7 4.1 7 7 6.5 7 stnioP devieceR %87 %06 %001 %06 %06 %001 %0 %08 %08 %001 %001 %08 %001 %02 %001 %001 %08 %001 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 881.60 8.37 2.4 6 8.1 2.4 3 4.5 4.2 2.4 4.5 6 8.4 2.4 8.4 6.3 3 4.5 4.5 stnioP devieceR %27 %07 %001 %03 %07 %05 %09 %04 %07 %09 %001 %08 %07 %08 %06 %05 %09 %09 erocS 351 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 stnioP elbissoP 530.70 59 9.7 8.5 2.4 9.6 9.7 6.2 7.3 2.6 8.5 9.6 3.5 5.8 3.5 3.5 3.5 2.3 2.4 stnioP devieceR %26 %88 %56 %74 %77 %88 %92 %14 %96 %56 %77 %95 %49 %95 %95 %95 %53 %74 erocS 631 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 830.70 2.82 4.4 0 5.0 7.2 3 5.0 4.2 7.0 3.2 9.2 8.1 0 7.0 2.1 2 5.2 6.0 stnioP devieceR %12 %65 %0 %7 %33 %83 %7 %92 %8 %92 %63 %32 %0 %9 %51 %52 %13 %8 erocS 351 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 stnioP elbissoP 340.70 2.44 8.3 1.2 0 5.6 1.2 4.3 2.4 2.3 2.3 3.2 1.1 6.1 7.0 7.3 7.1 6.2 2 stnioP devieceR %92 %24 %32 %0 %37 %32 %83 %74 %63 %63 %52 %31 %81 %8 %14 %91 %92 %22 erocS 46 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 481.80 1.85 4 2.3 4 4 4 2 3 4 4 4 7.2 4 4 2.3 4 4 stnioP devieceR %19 %001 %08 %001 %001 %001 %05 %57 %001 %001 %001 %76 %001 %001 %08 %001 %001 erocS APPENDIX D-2 State of California • August 2010 Page 127 deunitnoc ,eraC ot sseccA :SEROCS YROGETAC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 5 5 stnioP elbissoP 660.90 0 0 stnioP devieceR %0 %0 erocS 5 5 stnioP elbissoP 760.90 5 5 stnioP devieceR %001 %001 erocS 8 8 stnioP elbissoP 170.90 9.6 9.6 stnioP devieceR %68 %68 erocS 7 7 stnioP elbissoP 470.90 6.5 6.5 stnioP devieceR %08 %08 erocS 57 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 580.01 32 0 1 1 5.1 5.3 1 0 0 1 5.4 5.0 5.1 5.1 5.3 5.2 stnioP devieceR %13 %0 %02 %02 %03 %07 %02 %0 %0 %02 %09 %01 %03 %03 %07 %05 erocS 69 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 680.01 9.96 6 4.5 6.3 6 4.5 3.3 0 0 8.4 6 6 1.5 6 3 5.4 8.4 stnioP devieceR %37 %001 %09 %06 %001 %09 %65 %0 %0 %08 %001 %001 %68 %001 %05 %57 %08 erocS 01 5 5 stnioP elbissoP 780.01 5.6 5.3 3 stnioP devieceR %56 %07 %06 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 922.01 2.64 4.1 7 4.1 7 0 7 0 7 0 4.1 2.4 7 0 0 0 0 8.2 stnioP devieceR %93 %02 %001 %02 %001 %0 %001 %0 %001 %0 %02 %06 %001 %0 %0 %0 %0 %04 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 232.01 6.9 2.1 0 0 2.1 0 6 0 0 0 0 0 0 0 2.1 0 0 0 stnioP devieceR %9 %02 %0 %0 %02 %0 %001 %0 %0 %0 %0 %0 %0 %0 %02 %0 %0 %0 erocS 01 5 5 stnioP elbissoP 472.01 5.5 5.2 3 stnioP devieceR %55 %05 %06 erocS 821 egap no deunitnoc Bureau of Audits and Investigations, Office of the Inspector General Page 128 egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 27 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 790.11 1.93 0 8.4 8.4 0 0 5.1 6 6 6 2 6 2 stnioP devieceR %45 %0 %08 %08 %0 %0 %52 %001 %001 %001 %33 %001 %33 erocS 27 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 990.11 8.72 6 2.1 6.3 4 0 3 4 6 0 0 0 0 stnioP devieceR %93 %001 %02 %06 %76 %0 %05 %76 %001 %0 %0 %0 %0 erocS 48 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 001.11 9.63 7 2.4 0 7.4 7 5.3 5.3 7 0 0 0 0 stnioP devieceR %44 %001 %06 %0 %76 %001 %05 %05 %001 %0 %0 %0 %0 erocS 23 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 852.51 22 2 2 0 2 2 0 2 2 2 0 2 2 2 2 0 0 stnioP devieceR %96 %001 %001 %0 %001 %001 %0 %001 %001 %001 %0 %001 %001 %001 %001 %0 %0 erocS 03 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 282.51 62 2 2 0 2 2 2 2 2 2 2 2 2 2 2 0 stnioP devieceR %78 %001 %001 %0 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %0 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 942.12 3.37 8.5 4.3 4.3 6.3 9.3 9.5 3.3 1.4 8.2 4.6 1.6 6.3 5.4 6.4 7.1 6 2.4 stnioP devieceR %26 %28 %84 %84 %25 %65 %48 %84 %85 %04 %29 %88 %25 %46 %56 %42 %58 %06 erocS 8682 081 771 461 451 771 161 581 951 961 161 661 671 661 551 171 371 471 stnioP elbissoP latoT 9.4371 2.121 1.711 4.37 7.501 8.511 9.211 7.19 8.28 2.88 9.89 3.911 6.921 1.201 9.29 4.08 901 9.39 stnioP devieceR latoT %06 %76 %66 %54 %96 %56 %07 %05 %25 %25 %16 %27 %47 %26 %06 %74 %36 %45 erocS latoT APPENDIX D-2 deunitnoc ,eraC ot sseccA :SEROCS YROGETAC State of California • August 2010 Page 129 eraC fo ytiunitnoC :SNOITSEUQ YROGETAC htlaeh desnecil yb dengis dna deweiver saw ti taht etacidni mrof noitamrofni refsnart erac htlaeh eht seoD :retnec noitpecer-noN 700.20 ?noitutitsni eht ta lavirra s’etamni eht fo yad radnelac eno nihtiw ffats erac gniviecer eht did ,noitutitsni gnidnes eht ta tnemtnioppa ytlaiceps a rof deludehcs saw etamni eht fI :retnec noitpecer-noN 410.20 ?etad tnemtnioppa lanigiro eht fo syad 03 nihtiw tnemtnioppa eht eludehcs noitutitsni ?elbacilppa fi ,lavirra nopu snoitadommocca lacidem eviecer etamni eht diD :retnec noitpecer-noN 111.20 txen eht yb snoitacidem eht eviecer etamni eht did ,noitutitsni eht ta lavirra nopu redro noitacidem gnitsixe na dah etamni eht fI 821.20 ?deunitnoc eb ot ton erew snoitacidem eht yhw nialpxe naicisyhp a did ro ,yad radnelac ?tnemecalp retfa yad radnelac eno nihtiw etamni eht etaulave )PCP( redivorp erac yramirp eht diD 150.40 ?tnemecalp fo yad eht no etamni eht fo tnemssessa laitini na etelpmoc NR eht diD 250.40 ?epolevne refsnart dna RHU s’etamni eht evah esaeleR dna gnivieceR diD 801.50 refsnarT eraC htlaeH( 1737 mroF no deton secivres eht erew ,secivres ytlaiceps gnimocpu yna rof deludehcs saw etamni eht fI 901.50 ?)noitamrofnI ni snoitacidem eht era dna ,naicisyhp eht yb deredro snoitacidem lla yfitnedi epolevne refsnart eht ni smrof etairporppa lla oD 011.50 ?epolevne refsnart eht s’etamni eht no desab )noitamrofnI refsnarT eraC htlaeH( 1737 mroF fo snoitces elbacilppa lla etelpmoc yletarucca NR na diD 171.50 ?RHU mroF dna )noitamrofnI refsnarT eraC htlaeH( 1737 mroF s’etamni eht fo ypoc a niatniam tnemtrapeD sdroceR htlaeH eht diD 271.50 ?derrefsnart etamni eht nehw )droceR noitartsinimdA noitacideM tneitaptuO( A1327 secivres ytlaiceps eht retfa tnemtnioppa pu-wollof a rof etamni eht ees dna troper s’tnatlusnoc eht weiver PCP eht diD 340.70 ?semarf emit defiiceps nihtiw noitatlusnoc eht dellac ehs ro eh taht tnemucod NR na did ro snoitadnemmocer dna sgnidnfi ylemit edivorp redivorp ytlaiceps eht diD 072.70 ?snoitadnemmocer dna sgnidnfi eht niatrecsa ot redivorp ytlaiceps lacidem rieht eviecer llits llec wen a ot devom era ohw setamni erusne ot ssecorp etauqeda na evah noitutitsni eht seoD 330.41 ?stacud tnemucod esrun deretsiger )ATT( aera tnemtaert dna egairt eht did ,latipsoh ytinummoc eht morf egrahcsid s’etamni eht nopU 842.12 ?etamni eht fo tnemssessa ecaf-ot-ecaf a detelpmoc dna nalp egrahcsid s’etamni eht deweiver ehs ro eh taht reh ro sih htiw tnemtnioppa pu-wollof a eviecer etamni eht did ,latipsoh ytinummoc eht morf egrahcsid s’etamni eht nopU 942.12 ?egrahcsid fo syad radnelac evfi nihtiw )PCP( redivorp erac yramirp rof sredro edivorp )PCP( redivorP eraC yramirP s’etamni eht did ,latipsoh ytinummoc eht morf egrahcsid s’etamni eht nopU 052.12 ?etamni eht rof gnisuoh etairporppa APPENDIX D-3: Category Questions and Scores - Continuity of Care 031 egap no deunitnoc Bureau of Audits and Investigations, Office of the Inspector General Page 130 na ni desuoh saw etamni eht fi enevretni esrun deretsiger eht did ,latipsoh ytinummoc eht morf egrahcsid s’etamni eht nopU 152.12 ?sredro gnisuoh )PCP( s’redivorp erac yramirp eht no desab erac gnisrun rof etairporppani saw taht aera eht ot snoitacidem debircserp lla reviled ro retsinimda noitutitsni eht did ,latipsoh ytinummoc a morf egrahcsid s’etamni eht nopU 182.12 ?semarf emit defiiceps nihtiw etamni eraC fo ytiunitnoC :SEROCS YROGETAC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 89 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 700.20 5.88 7 7 6 6.6 7 6.6 6.6 1.6 3.5 6 3.6 5.4 5.6 7 stnioP devieceR %09 %001 %001 %58 %59 %001 %59 %59 %88 %57 %58 %09 %46 %39 %001 erocS 24 7 7 7 7 7 7 stnioP elbissoP 410.20 53 7 7 7 7 0 7 stnioP devieceR %38 %001 %001 %001 %001 %0 %001 erocS 87 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 111.20 5.46 6 3 6 6 5.4 6 6 5.4 6 2 5.4 6 4 stnioP devieceR %38 %001 %05 %001 %001 %57 %001 %001 %57 %001 %33 %57 %001 %76 erocS 631 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 821.20 14 3.1 9.1 8.2 4.2 0 8.1 4.3 0 3.3 2 1 4.3 0 4 4 7 7.2 stnioP devieceR %03 %71 %42 %53 %03 %0 %32 %34 %0 %24 %52 %31 %34 %0 %05 %05 %88 %33 erocS 05 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 150.40 24 4 4 4 5.3 5 4 5 4 4 5.4 stnioP devieceR %48 %08 %08 %08 %07 %001 %08 %001 %08 %08 %09 erocS 05 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 250.40 5.44 5.4 5 4 5.4 5 3 5 4 5 5.4 stnioP devieceR %98 %09 %001 %08 %09 %001 %06 %001 %08 %001 %09 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 801.50 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS APPENDIX D-3 deunitnoc ,eraC fo ytiunitnoC :SNOITSEUQ YROGETAC State of California • August 2010 Page 131 egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 08 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 901.50 25 8 8 8 0 8 0 8 4 0 8 stnioP devieceR %56 %001 %001 %001 %0 %001 %0 %001 %05 %0 %001 erocS 021 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 011.50 6.901 8 8 2.3 8 8 4.6 8 8 8 8 8 8 8 4 8 stnioP devieceR %19 %001 %001 %04 %001 %001 %08 %001 %001 %001 %001 %001 %001 %001 %05 %001 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 171.50 7.09 2.4 7 7 7 2.4 7 4.1 4.1 7 6.5 3.5 7 7 7 7 0 6.5 stnioP devieceR %67 %06 %001 %001 %001 %06 %001 %02 %02 %001 %08 %57 %001 %001 %001 %001 %0 %08 erocS 631 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 271.50 021 8 8 8 8 8 8 0 8 8 8 8 8 8 8 8 8 0 stnioP devieceR %88 %001 %001 %001 %001 %001 %001 %0 %001 %001 %001 %001 %001 %001 %001 %001 %001 %0 erocS 351 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 stnioP elbissoP 340.70 2.44 8.3 1.2 0 5.6 1.2 4.3 2.4 2.3 2.3 3.2 1.1 6.1 7.0 7.3 7.1 6.2 2 stnioP devieceR %92 %24 %32 %0 %37 %32 %83 %74 %63 %63 %52 %31 %81 %8 %14 %91 %92 %22 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 072.70 8.39 6 6 6.5 6 6 6 6 6 6 6.5 6 6 6.4 6 3.5 5.3 2.3 stnioP devieceR %29 %001 %001 %49 %001 %001 %001 %001 %001 %001 %49 %001 %001 %77 %001 %88 %95 %35 erocS 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 330.41 66 4 4 4 2 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP devieceR %79 %001 %001 %001 %05 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 842.12 8.79 2.6 6.3 2.2 4.6 9.5 7 4.6 2.6 7.6 7 9.5 4.6 2.6 3.5 6.4 3.6 5.5 stnioP devieceR %28 %88 %25 %23 %29 %48 %001 %29 %88 %69 %001 %48 %29 %88 %57 %56 %09 %97 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 942.12 3.37 8.5 4.3 4.3 6.3 9.3 9.5 3.3 1.4 8.2 4.6 1.6 6.3 5.4 6.4 7.1 6 2.4 stnioP devieceR %26 %28 %84 %84 %25 %65 %48 %84 %85 %04 %29 %88 %25 %46 %56 %42 %58 %06 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 052.12 901 7 5 7 7 7.6 7.6 7 7.6 7 7 7 7 7.6 7 5.3 6.5 1.5 stnioP devieceR %29 %001 %27 %001 %001 %69 %69 %001 %69 %001 %001 %001 %001 %69 %001 %05 %08 %37 erocS APPENDIX D-3 deunitnoc ,eraC fo ytiunitnoC :SEROCS YROGETAC 231 egap no deunitnoc Bureau of Audits and Investigations, Office of the Inspector General Page 132 deunitnoc ,eraC fo ytiunitnoC :SEROCS YROGETAC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 24 7 7 7 7 7 7 stnioP elbissoP 152.12 82 7 7 0 7 0 7 stnioP devieceR %76 %001 %001 %0 %001 %0 %001 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 182.12 2.65 3 4.0 8.2 6.0 6.2 8.2 4 8.0 3.2 9.2 8.3 3.5 7.4 7.4 5.3 6 6 stnioP devieceR %55 %05 %7 %74 %01 %44 %74 %76 %31 %83 %84 %46 %88 %97 %97 %85 %001 %001 erocS 2581 221 99 401 601 201 511 221 401 79 101 401 99 901 211 211 221 221 stnioP elbissoP latoT 1.5731 8.001 4.76 8.67 1.48 6.96 1.79 3.18 4.37 9.57 1.18 2.57 3.28 4.96 6.29 3.87 5.18 3.88 stnioP devieceR latoT %47 %38 %86 %47 %97 %86 %48 %76 %17 %87 %08 %27 %38 %46 %38 %07 %76 %27 erocS latoT APPENDIX D-3 State of California • August 2010 Page 133 seitilibisnopseR redivorP eraC yramirP :SNOITSEUQ YROGETAC ot etamni eht refer PCP eht did ,teid laiceps a deriuqer etamni eht detacidni )PCP( redivorp erac yramirp eht fI :retnec noitpeceR 220.20 ?naiciteid deretsiger a lacisyhP dna yrotsiH( 6027 mroF fo noitces ”ssenllI tneserP fo yrotsiH“ eht sI :lacisyhp dna yrotsih retnec noitpeceR 112.20 ?yna fi ,)s(tnialpmoc feihc eht ot etairporppa dna etelpmoc )noitanimaxE dna yrotsiH( 6027 mroF fo snoitces ”yrotsiH lacideM tsaP“ dna ”yrotsiH tsaP“ eht erA :lacisyhp dna yrotsih retnec noitpeceR 212.20 ?etelpmoc )noitanimaxE lacisyhP lacisyhP dna yrotsiH( 6027 mroF fo noitces ”yrotsiH laicoS dna ylimaF“ eht sI :lacisyhp dna yrotsih retnec noitpeceR 312.20 ?etelpmoc )noitanimaxE )noitanimaxE lacisyhP dna yrotsiH( 6027 mroF fo noitces ”smetsyS weiveR“ eht sI :lacisyhp dna yrotsih retnec noitpeceR 512.20 ?etelpmoc )noitanimaxE lacisyhP dna yrotsiH( 6027 mroF fo noitces ”noitanimaxE lacisyhP“ eht sI :lacisyhp dna yrotsih retnec noitpeceR 612.20 ?smetsys fo weiver dna yrotsih eht ot etairporppa dna etelpmoc )noitanimaxE lacisyhP dna yrotsiH( 6027 mroF fo noitces ”noisserpmI/sisongaiD“ eht sI :lacisyhp dna yrotsih retnec noitpeceR 712.20 ?noitanimaxe lacisyhp dna yrotsih eht ot etairporppa )noitanimaxE lacisyhP dna yrotsiH( 6027 mroF fo noitces ”noitcA fo nalP“ eht sI :lacisyhp dna yrotsih retnec noitpeceR 812.20 ?mrof eht fo noitces ”noisserpmI/sisongaiD“ eht ot etairporppa ?deredro neeb gnitset ekatni deriuqer saH :lacisyhp dna yrotsih retnec noitpeceR 912.20 rof yletelpmoc tuo dellfi )teehS wolF eraC yramirP( 2937 dna )tisiV pU-wolloF eraC cinorhC( 9147 smroF no stnemele yek ereW 770.30 ?stisiv tnecer tsom owt s’etamni eht ?noitacude erac htlaeh htiw etamni eht dedivorp ti taht tnemucod noitutitsni eht diD 280.30 ?etauqeda yrotsih lacinilc eht sI 532.30 ?etauqeda noitanimaxe lacinilc desucof eht sI 632.30 ?etauqeda tnemssessa eht sI 732.30 pu wollof dna noitnevretni margorp erac cinorhc eht no desab lortnoc fo eerged eht htiw tnetsisnoc dna etauqeda nalp eht sI 832.30 ?stnemeriuqer ?)RHU( drocer htlaeh tinu s’etamni eht ni yletarucca delfi dna etelpmoc tsiL melborP s’etamni eht sI 262.30 ?tnemssessa laitini eht sserdda yletauqeda nalp s’PCP eht diD 650.40 ?tnemecalp UHO gniriuqer )s(melborp eht rof etauqeda noitaulave laitini s’PCP eht saW 211.40 APPENDIX D-4: Category Questions and Scores - Primary Care Provider Responsibilities 431 egap no deunitnoc APPENDIX D-4 Bureau of Audits and Investigations, Office of the Inspector General Page 134 deunitnoc ,seitilibisnopseR redivorP eraC yramirP :SNOITSEUQ YROGETAC ?noitatneserp lacinilc s’tneitap eht ot etairporppa UHO eht ni elbaliava erac fo level eht saW 802.40 ?noitaulave laitini eht ni sgnidnfi eht rof etairporppa )sesongaid ro( tnemssessa laitini s’PCP eht saW 032.40 yranilpicsidretnI( 0327 mroF no stluser tset citsongaid tnacfiingis yllacinilc eht tnemucod PCP eht diD :secivres citsongaid llA 191.60 ?)setoN ssergorP ?stluser tset tnacfiingis yllacinilc eganam yletauqeda PCP eht diD :secivres citsongaid llA 362.60 ?etamni eht rof doof dna stnemelppus lanoitirtun yliad artxe redro yltpmorp ffats lacidem diD 960.90 latanerP“ eht etaroborroc )droceR wolF latanerP( N3075 mroF sggirB eht fo noitces ”defiitnedI sksiR/smelborP“ eht diD 270.90 ?snoitces noitanimaxe ”lacisyhP lanretaM“ eht dna ”sneercS ?N3075 mroF no detnemucod stset gnineercs latanerp defiiceps s’etamni eht fo stluser eht ereW 322.90 eht fo sisylaniru a dna lenap cilobatem a redro dna noitanimaxe lacisyhp a mrofrep naicisyhp a did ,sruoh 27 tsrfi eht retfA 001.11 ?etamni rof sredro edivorp )PCP( redivorP eraC yramirP s’etamni eht did ,latipsoh ytinummoc eht morf egrahcsid s’etamni eht nopU 052.12 ?etamni eht rof gnisuoh etairporppa ?ylemit dna etauqeda redivorp gnidnetta eht yb deredner erac lacinilc eht saw ,ATT eht ni saw tneitap eht elihW 672.12 ?etairporppa ATT eht ot emoc ot ton noisiced s’redivorp eht saw ,enola noitatlusnoc enohpelet yb deganam stneitap roF 972.12 seitilibisnopseR redivorP eraC yramirP :SEROCS YROGETAC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 4 4 stnioP elbissoP 220.20 0 0 stnioP devieceR %0 %0 erocS 41 2 2 2 2 2 2 2 stnioP elbissoP 112.20 7.01 2.1 6.1 8.1 8.0 2 8.1 5.1 stnioP devieceR %67 %06 %28 %98 %04 %001 %29 %57 erocS 41 2 2 2 2 2 2 2 stnioP elbissoP 212.20 3.21 8.1 8.1 2 7.1 2 2.1 8.1 stnioP devieceR %88 %09 %09 %001 %58 %001 %06 %88 erocS State of California • August 2010 Page 135 egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 41 2 2 2 2 2 2 2 stnioP elbissoP 312.20 6.21 6.1 5.1 2 5.1 2 2 2 stnioP devieceR %09 %08 %57 %001 %57 %001 %001 %001 erocS 21 2 2 2 2 2 2 stnioP elbissoP 512.20 4.5 0 4.0 6.1 4.1 2 0 stnioP devieceR %54 %0 %02 %08 %07 %001 %0 erocS 41 2 2 2 2 2 2 2 stnioP elbissoP 612.20 3.21 2.1 7.1 2 2 2 9.1 5.1 stnioP devieceR %88 %06 %58 %001 %001 %001 %59 %57 erocS 41 2 2 2 2 2 2 2 stnioP elbissoP 712.20 4.21 1.1 8.1 2 2 8.1 9.1 8.1 stnioP devieceR %98 %65 %98 %001 %001 %09 %59 %88 erocS 41 2 2 2 2 2 2 2 stnioP elbissoP 812.20 31 3.1 2 2 2 2 7.1 2 stnioP devieceR %39 %76 %001 %001 %001 %001 %58 %001 erocS 23 4 4 4 4 4 4 4 4 stnioP elbissoP 912.20 4.42 4.3 8.0 4 6.3 8.3 4 2 8.2 stnioP devieceR %67 %58 %02 %001 %09 %59 %001 %05 %07 erocS 071 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 stnioP elbissoP 770.30 7.89 8.2 2.7 8.2 6 2.7 6 2.5 4.2 6.7 5.8 2.5 5.8 8.7 4.7 6.4 1.9 4.0 stnioP devieceR %85 %82 %27 %82 %06 %27 %06 %25 %42 %67 %58 %25 %58 %87 %47 %64 %19 %4 erocS 402 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 stnioP elbissoP 280.30 8.831 2.6 4.1 1.9 3.5 6.01 5.11 6.9 2.7 5.11 8.01 8.5 21 6 9 2.6 9.8 7.7 stnioP devieceR %86 %25 %21 %67 %44 %88 %69 %08 %06 %69 %09 %84 %001 %05 %57 %25 %47 %46 erocS 603 81 81 81 81 81 81 81 81 81 81 81 81 81 81 81 81 81 stnioP elbissoP 532.30 8.071 9.7 2.21 8.5 6.8 2.21 8.5 8.01 9.7 5.11 7.11 6.8 6.21 21 6.21 5.6 3.31 8.01 stnioP devieceR %65 %44 %86 %23 %84 %86 %23 %06 %44 %46 %56 %84 %07 %76 %07 %63 %47 %06 erocS 323 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 stnioP elbissoP 632.30 9.042 4.11 4.41 1.9 9.21 2.51 7.31 4.41 7.31 8.51 1.71 2.21 3.31 7.31 2.51 4.41 2.81 2.61 stnioP devieceR %57 %06 %67 %84 %86 %08 %27 %67 %27 %38 %09 %46 %07 %27 %08 %67 %69 %58 erocS APPENDIX D-4 deunitnoc ,seitilibisnopseR redivorP eraC yramirP :SEROCS YROGETAC 631 egap no deunitnoc Bureau of Audits and Investigations, Office of the Inspector General Page 136 deunitnoc ,seitilibisnopseR redivorP eraC yramirP :SEROCS YROGETAC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 323 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 stnioP elbissoP 732.30 6.832 9 4.71 2.11 5.31 4.61 4.61 4.8 21 3.41 61 7.31 61 6.61 91 6.7 2.71 9.31 stnioP devieceR %47 %74 %29 %95 %17 %68 %68 %44 %36 %57 %48 %27 %48 %88 %001 %04 %19 %37 erocS 323 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 91 stnioP elbissoP 832.30 1.752 01 4.71 9.01 41 3.61 2.61 6.31 8.61 2.81 9.61 6.51 9.71 7.71 71 5.9 1.81 11 stnioP devieceR %08 %35 %29 %75 %47 %68 %58 %17 %88 %69 %98 %28 %49 %39 %09 %05 %59 %85 erocS 631 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 262.30 7.39 8.4 1.6 1.5 8 4.6 4.6 8.4 7.7 6.2 2.7 7.6 8.0 7.6 8 2.2 8.3 4.6 stnioP devieceR %96 %06 %67 %46 %001 %08 %08 %06 %69 %23 %09 %48 %01 %38 %001 %82 %84 %08 erocS 05 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 650.40 9.04 5 5 1.3 9.1 4.4 4.4 8.3 8.3 5.4 5 stnioP devieceR %28 %001 %001 %36 %83 %98 %88 %57 %57 %09 %001 erocS 05 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 211.40 63 4 5 2 5.1 5.3 5.3 9.3 4 5.4 1.4 stnioP devieceR %27 %08 %001 %04 %03 %07 %07 %87 %08 %09 %28 erocS 09 9 9 9 9 9 9 9 9 9 9 stnioP elbissoP 802.40 88 9 9 9 7 9 9 9 9 9 9 stnioP devieceR %89 %001 %001 %001 %87 %001 %001 %001 %001 %001 %001 erocS 05 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 032.40 74 5 5 1.3 5 5 5 4.4 5 5.4 5 stnioP devieceR %49 %001 %001 %36 %001 %001 %001 %98 %001 %09 %001 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 191.60 2.38 1.5 2.6 3.4 1.6 8.4 5.4 7.4 1.5 1 9.3 9.4 6.5 3.5 1.6 1.4 1.6 4.5 stnioP devieceR %07 %37 %98 %26 %78 %96 %46 %76 %37 %41 %65 %07 %08 %57 %88 %85 %78 %87 erocS 071 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 stnioP elbissoP 362.60 7.141 9 9.8 8.5 01 3.8 3.8 01 01 7.6 8.7 2.8 9 7.7 7.6 7 2.9 1.9 stnioP devieceR %38 %09 %98 %85 %001 %38 %38 %001 %001 %76 %87 %28 %09 %77 %76 %07 %29 %19 erocS 5 5 stnioP elbissoP 960.90 3.4 3.4 stnioP devieceR %68 %68 erocS APPENDIX D-4 State of California • August 2010 Page 137 deunitnoc ,seitilibisnopseR redivorP eraC yramirP :SEROCS YROGETAC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 7 7 stnioP elbissoP 270.90 0 0 stnioP devieceR %0 %0 erocS 5 5 stnioP elbissoP 322.90 3.4 3.4 stnioP devieceR %68 %68 erocS 48 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 001.11 9.63 7 2.4 0 7.4 7 5.3 5.3 7 0 0 0 0 stnioP devieceR %44 %001 %06 %0 %76 %001 %05 %05 %001 %0 %0 %0 %0 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 052.12 901 7 5 7 7 7.6 7.6 7 7.6 7 7 7 7 7.6 7 5.3 6.5 1.5 stnioP devieceR %29 %001 %27 %001 %001 %69 %69 %001 %69 %001 %001 %001 %001 %69 %001 %05 %08 %37 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 672.12 3.301 7.4 5.5 4.4 5.4 7.5 8.5 7.6 7.6 1.6 7 4.6 7 4.6 3.6 7.6 7 4.6 stnioP devieceR %78 %76 %97 %36 %46 %18 %38 %59 %69 %78 %001 %19 %001 %29 %19 %59 %001 %19 erocS 021 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 972.12 7.811 8 8 8 8 8 8 8 8 8 8 8 8 7.6 8 8 stnioP devieceR %99 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %38 %001 %001 erocS 5092 571 971 961 861 302 861 391 151 961 861 341 761 681 151 371 761 571 stnioP elbissoP latoT 5512 9.511 3.141 5.29 1.121 6.651 2.131 8.641 2.111 921 341 8.79 5.041 9.051 121 7.39 931 5.321 stnioP devieceR latoT %47 %66 %97 %55 %27 %77 %87 %67 %47 %67 %58 %86 %48 %18 %08 %45 %38 %17 erocS latoT APPENDIX D-4 Bureau of Audits and Investigations, Office of the Inspector General Page 138 seitilibisnopseR esruN :SNOITSEUQ YROGETAC ?deviecer saw ti yad emas eht deweiver teg erac htlaeh rof tseuqer s’etamni eht diD :noitatnemucoD FTF NR 420.10 ?tnialpmoc yramirp s’etamni eht fo yrotsih dna erutan eht sserdda eton evitcejbus s’NR eht diD :noitatnemucoD FTF NR 751.10 eht erew ,atad evitcejbo dna evitcejbus no desab snoisulcnoc edivorp tnemssessa s’NR eht diD :noitatnemucoD FTF NR 851.10 ?sesongaid gnisrun elbacilppa niatnoc ti did dna ,smelborp tneitap sa detalumrof snoisulcnoc ti did dna ,noitanimaxe lacisyhp desucof a dna sngis lativ edulcni eton evitcejbo s’NR eht diD :noitatnemucoD FTF NR 951.10 ?eton evitcejbus eht ni deton smelborp eht sserdda yletauqeda FTF eht gnirud defiitnedi smelborp eht sserdda ot ygetarts etauqeda na edulcni nalp s’NR eht diD :noitatnemucoD FTF NR 261.10 ?egairt ?egairt FTF eht gnirud defiitnedi smelborp eht sserdda yletauqeda noitcurtsni/noitacude s’NR eht diD :noitatnemucoD FTF NR 361.10 ,etairporppa erehw dna ,noitacidem tnerruc ,thgiew ,seigrella edulcni eton evitcejbo s’NR eht diD :noitatnemucoD FTF NR 442.10 ?ecnailpmoc noitacidem secivreS eraC htlaeH( 2637 mroF no detsil stnialpmoc s’etamni eht fo lla deweiver NR eht taht etacidni noitatnemucod diD 642.10 ?)mroF tseuqeR noitcefni eht yb deweiver stluser eht erew dna ,evitisop saw tset nilucrebut s’etamni eht fi detelpmoc smotpmys fo weiver a saW 510.20 ?esrun lortnoc dna tnemssessa na edivorp NR eht did ,)s(mrof gnineercs htlaeh laitini eht no snoitseuq eht fo yna ot derewsna saw sey fI 710.20 ?lavirra fo etad eht no noitisopsid suoiverp a dah etamni eht fi smotpmys dna sngis fo weiver a ro tset nilucrebut eht tnemucod yletauqeda NR/NVL eht diD 020.20 ?tset nilucrebut evitisop refsnarT eraC htlaeH( 1737 mroF no deton secivres eht erew ,secivres ytlaiceps gnimocpu yna rof deludehcs saw etamni eht fI 901.50 ?)noitamrofnI ni snoitacidem eht era dna ,naicisyhp eht yb deredro snoitacidem lla yfitnedi epolevne refsnart eht ni smrof etairporppa lla oD 011.50 ?epolevne refsnart eht s’etamni eht no desab )noitamrofnI refsnarT eraC htlaeH( 1737 mroF fo snoitces elbacilppa lla etelpmoc yletarucca NR na diD 171.50 ?RHU erac lacidem etauqeda saw dna ycnegreme eht sserdda ot tnempiuqe reporp esu rednopser ycnegreme lacidem eht diD 581.80 ?esnecil reh ro sih fo epocs eht nihtiw dedivorp ?tisiv cinilc hcae ta detnemucod erusserp doolb dna thgiew s’etamni eht saW 422.90 APPENDIX D-5: Category Questions and Scores - Nurse Responsibilities State of California • August 2010 Page 139 tnemucod dna B-821 mroF eht fo tpiecer fo syad ssenisub )2( owt nihtiw etamni eht fo egairt ecaf-ot-ecaf a tcudnoc NR eht diD 790.11 ?noitidnoc lacisyhp dna ,sngis lativ ,thgiew tnerruc ,thgiew dedrocer tnecer tsom ,ekirts regnuh eht rof snosaer s’etamni eht dna ti seraperp ohw rebmem ffats desnecil emas eht yb deretsinimda eb ot si noitacidem taht dnatsrednu sesrun noitacidem oD 131.41 ?yad emas eht no ?ssel ro setunim evfi ni enecs no evirra ffats lacidem diD :llirD esnopseR lacideM ycnegremE 282.51 -evlav-gab ,gab RE( tnempiuqe reporp htiw evirra srednopser lacidem ycnegreme eht diD :llirD esnopseR lacideM ycnegremE 382.51 ?)DEA ,ksam ?troppus efil cisab eunitnoc srednopser lacidem ycnegreme diD :llirD esnopseR lacideM ycnegremE 582.51 tnemucod esrun deretsiger )ATT( aera tnemtaert dna egairt eht did ,latipsoh ytinummoc eht morf egrahcsid s’etamni eht nopU 842.12 ?etamni eht fo tnemssessa ecaf-ot-ecaf a detelpmoc dna nalp egrahcsid s’etamni eht deweiver ehs ro eh taht na ni desuoh saw etamni eht fi enevretni esrun deretsiger eht did ,latipsoh ytinummoc eht morf egrahcsid s’etamni eht nopU 152.12 ?sredro gnisuoh )PCP( s’redivorp erac yramirp eht no desab erac gnisrun rof etairporppani saw taht aera seitilibisnopseR esruN :SEROCS YROGETAC egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 420.10 8.84 2.3 5.0 6.1 5.3 2.3 8.1 7.3 5.3 1.3 2.1 6.3 1.2 3 5.3 7.3 8.3 8.3 stnioP devieceR %27 %08 %11 %04 %98 %08 %54 %29 %78 %77 %03 %09 %25 %67 %78 %39 %69 %69 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 751.10 5.58 5.5 2.2 4 5.4 8.3 2.3 5.4 5.3 1.4 6.5 5.6 4.6 8.5 7 8.5 7.6 4.6 stnioP devieceR %27 %97 %23 %75 %56 %45 %54 %46 %05 %95 %08 %39 %29 %38 %001 %38 %69 %29 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 851.10 87 5.3 6.1 6.3 4.4 8.4 4.5 1.4 2 4.5 7.5 5 8.5 5.5 4.5 8.4 3.5 7.5 stnioP devieceR %67 %85 %72 %16 %47 %97 %09 %86 %33 %09 %59 %38 %69 %19 %98 %97 %88 %69 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 951.10 6.37 7.4 3 3 5.3 6.4 4.5 1.4 2.3 3.3 8.4 4.4 3.5 4 4.5 8.4 6.4 5.5 stnioP devieceR %27 %97 %05 %05 %95 %67 %09 %86 %35 %55 %08 %37 %88 %76 %09 %08 %77 %19 erocS APPENDIX D-5 deunitnoc ,seitilibisnopseR esruN :SNOITSEUQ YROGETAC 041 egap no deunitnoc Bureau of Audits and Investigations, Office of the Inspector General Page 140 egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 261.10 211 3.6 7 7 6.6 7.6 7 4.6 4.4 7 6.6 8.6 7.6 7.6 8.6 7 6.6 4.6 stnioP devieceR %49 %09 %001 %001 %49 %69 %001 %29 %36 %001 %59 %89 %69 %69 %79 %001 %49 %29 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 361.10 86 2.3 2.3 2.3 1.4 5.3 8.4 4 8.2 3.4 5.4 3.4 8.4 5.3 7.4 5.4 7.4 9.3 stnioP devieceR %08 %36 %46 %46 %28 %17 %59 %08 %75 %68 %09 %58 %69 %07 %39 %09 %49 %77 erocS 15 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 stnioP elbissoP 442.10 9.62 4.1 5.0 2.0 9.1 4.0 2.0 8.0 1 1 5.1 4.2 4.2 4.2 8.2 4.2 8.2 8.2 stnioP devieceR %35 %74 %81 %7 %56 %21 %5 %82 %33 %53 %05 %08 %08 %97 %39 %08 %49 %29 erocS 58 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 stnioP elbissoP 642.10 7.37 5.4 5.4 3.4 8.3 4 8.4 2.3 3.3 3.4 5 4.4 8.4 8.4 5.4 3.4 6.4 6.4 stnioP devieceR %78 %09 %19 %78 %77 %08 %59 %46 %76 %68 %001 %88 %69 %69 %09 %78 %29 %29 erocS 77 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 510.20 1.76 7 7 7 3.2 7 8.5 3.5 7.4 7 7 7 stnioP devieceR %78 %001 %001 %001 %33 %001 %38 %57 %76 %001 %001 %001 erocS 821 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 710.20 011 8 8 8 9.6 8 8 6.5 7.3 3.2 8 8 8 5.7 6.7 4.4 8 stnioP devieceR %68 %001 %001 %001 %78 %001 %001 %07 %64 %92 %001 %001 %001 %39 %49 %65 %001 erocS 201 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 020.20 39 6 8.5 8.5 1.5 4.5 6 8.4 1.5 6 7.5 1.5 6 6 4.5 2.5 2.4 4.5 stnioP devieceR %19 %001 %69 %79 %58 %09 %001 %08 %58 %001 %59 %58 %001 %001 %09 %78 %07 %09 erocS 08 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 901.50 25 8 8 8 0 8 0 8 4 0 8 stnioP devieceR %56 %001 %001 %001 %0 %001 %0 %001 %05 %0 %001 erocS 021 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 stnioP elbissoP 011.50 6.901 8 8 2.3 8 8 4.6 8 8 8 8 8 8 8 4 8 stnioP devieceR %19 %001 %001 %04 %001 %001 %08 %001 %001 %001 %001 %001 %001 %001 %05 %001 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 171.50 7.09 2.4 7 7 7 2.4 7 4.1 4.1 7 6.5 3.5 7 7 7 7 0 6.5 stnioP devieceR %67 %06 %001 %001 %001 %06 %001 %02 %02 %001 %08 %57 %001 %001 %001 %001 %0 %08 erocS APPENDIX D-5 deunitnoc ,seitilibisnopseR esruN :SEROCS YROGETAC State of California • August 2010 Page 141 egarevA feR CCC QS PSDH PSA WIC CRC ICC PSVP CAL CCS CMC FWCC IVD NEC DJR FMC CAS erocS rebmuN 211 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 581.80 3.201 7 7 3.5 3.5 7 7 7 7 7 6.5 7 6.5 7 7 7 5.3 stnioP devieceR %19 %001 %001 %57 %57 %001 %001 %001 %001 %001 %08 %001 %08 %001 %001 %001 %05 erocS 6 6 stnioP elbissoP 422.90 3.4 3.4 stnioP devieceR %27 %17 erocS 27 6 6 6 6 6 6 6 6 6 6 6 6 stnioP elbissoP 790.11 1.93 0 8.4 8.4 0 0 5.1 6 6 6 2 6 2 stnioP devieceR %45 %0 %08 %08 %0 %0 %52 %001 %001 %001 %33 %001 %33 erocS 86 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 stnioP elbissoP 131.41 46 4 4 4 4 4 4 4 4 4 4 4 4 4 0 4 4 4 stnioP devieceR %49 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %0 %001 %001 %001 erocS 03 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 stnioP elbissoP 282.51 62 2 2 0 2 2 2 2 2 2 2 2 2 2 2 0 stnioP devieceR %78 %001 %001 %0 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %0 erocS 51 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 stnioP elbissoP 382.51 21 1 1 1 1 1 0 1 1 1 1 1 0 1 1 0 stnioP devieceR %08 %001 %001 %001 %001 %001 %0 %001 %001 %001 %001 %001 %0 %001 %001 %0 erocS 51 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 stnioP elbissoP 582.51 51 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 stnioP devieceR %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 %001 erocS 911 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 stnioP elbissoP 842.12 8.79 2.6 6.3 2.2 4.6 9.5 7 4.6 2.6 7.6 7 9.5 4.6 2.6 3.5 6.4 3.6 5.5 stnioP devieceR %28 %88 %25 %23 %29 %48 %001 %29 %88 %69 %001 %48 %29 %88 %57 %56 %09 %97 erocS 24 7 7 7 7 7 7 stnioP elbissoP 152.12 82 7 7 0 7 0 7 stnioP devieceR %76 %001 %001 %0 %001 %0 %001 erocS 6381 511 19 001 68 101 901 511 701 301 101 701 221 611 401 221 511 221 stnioP elbissoP latoT 4.7741 7.49 7.56 47 1.27 9.67 6.79 7.67 4.07 4.38 3.48 6.49 4.411 5.09 3.49 7.401 97 1.401 stnioP devieceR latoT %08 %28 %27 %47 %48 %67 %09 %76 %66 %18 %38 %88 %49 %87 %19 %68 %96 %58 erocS latoT APPENDIX D-5 deunitnoc ,seitilibisnopseR esruN :SEROCS YROGETAC California Prison Health Care Receivership Corporation’s Response Bureau of Audits and Investigations, Office of the Inspector General Page 142 California Prison Health Care Receivership Corporation’s Response (page 1 of 1) State of California • August 2010 Page 143 SPESCPEIACILAL R REEPPOORTR T INMATE CELL PHONE USE ENDANGERS PRISON SECURITY AND PUBLIC SAFETY SUMMARY AND ANALYSIS OF T HE FIRST 17 MEDICAL INSPECTIONS OF CALIFORNIA PRISONS OFFICE OF THE INSPECTOR GENERAL OFFICE OF THE INSPECTDOAVIRD R G. SHEAWN ERAL INSPECTOR GENERAL STATE OF CALIFORNIA David R. ShaMwAY 2009 INSPECTOR GENERAL   Je rry Twomey CHIEF ASSISTANT INSPECTOR GENERAL Nancy Faszer DEPUTY INSPECTOR GENERAL, IN-CHARGE STATE OF CALIFORNIA AUGUST 2010 WWW.OIG.CA.GOV