According to court-appointed medical experts, California Central Women’s Facility (CCWF) is not delivering adequate medical care to female inmates. CCWF is one of three women’s facilities in the state
The experts toured CCWF last July to conduct observations and interviews with medical staff and inmates. They inspected facilities, clinics, medical bed space, medical records and various housing units.
The facility’s records show care was sporadic and “providers did not address all the patients’ medical conditions.”
The report found some women were prematurely discharged from medical beds, or sent back to housing units without their health problems addressed.
The report “found significant problems related to timeliness and quality of care in several systems.” Most of the problems were attributable to overcrowding, insufficient health care staffing and inadequate medical bed space.
Many older women with a higher need of medical care were transferred to CCWF despite difficulties in the health care delivery system.
“With respect to medical intake, the process is fragmented and does not result in the timely identification and treatment of serious medical conditions,” the report said, adding there is no standardization to laboratory tests ordered for newly arriving inmates; instead, nurses independently order laboratory tests without a physician’s order.
“Providers do not write medication orders but sign the sending jail facility’s medication profile without designating the duration of the medication order,” the report said. “…the initial history and physical examination is not performed timely and providers do not adequately document history and physical findings.”
In one case, the examiners documented a 55-year-old woman who arrived at CCWF last June. Her medical history included several serious medical problems including HIV/AIDS and hepatitis C, problems with her blood levels, seizures and mental health issues. She had a hysterectomy in 1999. It took more than a week after her arrival for a physical examination to be completed. Medical providers did not perform a comprehensive medical history, although the patient told medical staff about her extensive health issues.
In another case, a 33-year-old woman also arrived in June at CCWF from the Los Angeles County Jail. Her medical history included HIV and a chronic infection, asthma and mental health issues. Upon her arrival, the reception nurse did not address a pending medical appointment even though it was noted on the jail transfer form. Her history and physical examination also were not performed within seven days of arrival. A week later, a doctor saw her and performed a brief HIV history. The doctor reordered HIV medications for two months and ordered a chest X-ray and laboratory tests, but did not include an HIV viral load or urinalysis. The following month another doctor saw her and determined that the HIV and hepatitis C infection were in control, even though there were no laboratory tests.
The doctor determined that she had a boil and ordered skin cream for seven days. The next day, a nurse practitioner performed a history and physical examination, noting the boil was about 2.5 by 2 centimeters. The nurse practitioner’s clinical description differed significantly from the physician’s description and referred the inmate to the trauma unit for consideration of incision and drainage of the boil.
The report noted CCWF medical staff’s inability to downsize its doctors’ referral backlog, exacerbated by problems with the system’s new electronic medical records system.
The nursing and pharmacy staff told examiners that an inability to scan records in a timely manner limited the ability to timely and continually dispense medication to inmates. Staff reported that the new system is too labor intensive. “Staff reported that MedSATS is more labor intensive than previous systems.”
The examiners noted that staffing in the medical records department was reduced from 15 to six. At the same time, the inmate population increased, which overloaded the staff’s ability to scan medical records on a timely basis, hindering doctors from evaluating the inmates’ needs.
The report concluded that “We are impressed with CCWF health care leadership and believe that with adequate health care staffing, medical bed space, improved medical and nursing evaluations, and support from CCHCS (California Correctional Health Care Services), improvement at CCWF will likely follow.”
