Report 2009-107.2 Recommendations and Responses in 2014-041

Report 2009-107.2: California Department of Corrections and Rehabilitation: Inmates Sentenced Under the Three Strikes Law and a Small Number of Inmates Receiving Specialty Health Care Represent Significant Costs

Department Number of Years Reported As Not Fully Implemented Total Recommendations to Department Not Implemented After One Year Not Implemented as of 2013-041 Response Not Implemented as of Most Recent Response
California Correctional Health Care Services 4 5 3 2 2
California Department of Corrections and Rehabilitation 4 6 5 4 4

Recommendation To: Corrections and Rehabilitation, Department of

To address the erroneous sentencing information and inappropriately assigned convictions in its data system, Corrections should create a schedule for regular checks of the accuracy of existing sentencing information, as well as the accuracy with which sentencing information has been assigned to convictions.

Response

The Case Records Administrator worked with SOMS to implement changes to the second striker credit earning formulas to address new statue rules. This is an ongoing maintenance activity that will be needed whenever statue or codes are revised to ensure the ongoing accuracy of sentencing information. This most recent example was completed in May 2014.

Additionally, each offender is received into CDCR with a Commitment (Legal documents such as Abstract of Judgment, Minute Order, and/or Felony Compliant) at the time they are admitted. The first check is completed by a Case Records Analyst to ensure the sentencing information is accurate for the conviction. Each offender will have regular checks at specific audit time frames, which include transfer audits, 60-day audits, and parole audits.

If a sentence is found to be inaccurate for a type of conviction, we continue to refer those cases to the presiding court/judge for clarification.

Recommendation To: Corrections and Rehabilitation, Department of

To better communicate to policy makers the annual cost of incarceration, and to provide a more accurate estimate of expenditures associated with changes in the large leave balances of custody staff—many of whom require relief coverage when they are absent—Corrections should provide a calculation of the annual increase or decrease in its liability for the leave balances of custody staff to better explain the cause of changes in expenditures to the relevant legislative policy and fiscal committees.

Response

Overall, leave liability for all "custody classifications", which we interpreted as BU6 staff, decreased by $64.7 million or 7.7% from June 30, 2013 to June 30, 2014. (detail by month attached via email)

Recommendation To: Corrections and Rehabilitation, Department of

To better communicate to policy makers the annual cost of incarceration, and to provide a more accurate estimate of expenditures associated with changes in the large leave balances of custody staff—many of whom require relief coverage when they are absent—Corrections should provide an estimate of the annual cost of leave balances likely to be paid for retiring custody staff to the relevant legislative policy and fiscal committees.

Response

CDCR's Budget Management Branch estimates from historical trends and current staff, FY 2014-15 projected separation payment (lump sum) to be approximately $90 million for custody positions, interpreted as BU6 staff. (details attached via email)

Recommendation To: Corrections and Rehabilitation, Department of

To address the erroneous sentencing information and inappropriately assigned convictions in its data system, Corrections should complete its cleanup of data that will be transferred into the new system, ensuring that this review includes a detailed evaluation of convictions that have been assigned outdated sentencing information as well as deleting erroneous sentencing information, before it begins using its new data system.

Response

As reported in October 2013, the EIS/SOMS Sentence Calculation module and SOMS statute table has been complete since August 2013. Efforts are continuing by the Division of Adult Institutions' (DAI) Case Records staff to work through data identified as needing review and to correct during conversion.

Recommendation To: Correctional Health Care Services, California

To determine whether the additional expansion of telemedicine is cost-effective within the California correctional system, Prison Health Care Services should identify and collect the data it needs to estimate the savings of additional telemedicine through an analysis of the cost of specialty care visits currently provided outside of the institution that could be replaced with telemedicine.

Response

CCHCS has implemented this recommendation to the extent possible. We are unable to assess further due to lack of staffing and data resources.

CCHCS has determined that Telemedicine appointments are billed at the same Medicare rates as in-person office visits and, therefore, do not reflect cost savings over traditional specialty service appointments. The primary goal of Telemedicine Services is to provide timely access to medically necessary care. In addition to increasing access to specialty care, CCHCS developed and implemented Primary Care Telemedicine in 2010. Primary Care Telemedicine utilizes civil-service CCHCS physicians to provide needed patient care to those remote locations that have had difficulty recruiting and/or retaining physicians and has improved access to primary care in mulitiple institutions statewide.

Telemedicine Services provide increased access to care, particularly in those remote locations where local medical facilities do not provide all the needed services to support the patient-inmate population. Expansion of Telemedicine Services shall primarily be based on efficacy and efficiency of patient care, as well as the needs of each individual institution, rather than cost effectiveness. Additionally, the use of telemedicine reduces transport of inmates into communities for healthcare through remote management, increasing public safety.

Recommendation To: Correctional Health Care Services, California

To determine whether the additional expansion of telemedicine is cost-effective within the California correctional system, Prison Health Care Services should further analyze the cost-effectiveness of telemedicine through a more robust estimate of savings, including considering factors such as the percent of telemedicine consultations that required subsequent in-person visits because the issue could not be addressed through telemedicine.

Response

CCHCS cannot fully implement this recommendation because the needed IT and personnel resources are not currently available to provide this level of in-depth data analysis.

Within Telemedicine Services' current resources, implementation of this recommendation would yield unreliable data. For example, the current system does not distinguish whether a follow-up encounter is scheduled in accordance with the patient's routine conservative plan of care or of the efficacy of a previous telemedicine encounter. Needed IT and personnel resources are not currently available to provide this level of in-depth analysis.

Rather than rely on retrospective data to determine efficacy of telemedicine encounters, Institutional utilization management teams follow a standardized process to approve referrals (Attachment 6) and determine appropriateness for telemedicine services before the consultations. Those referrals deemed not appropriate for telemedicine are routed for in-person office visits.

Current Status of Recommendations

All Recommendations in 2014-041