Auditor’s report says California health departments “high risk”

A report from the State Auditor Elaine Howell released last month found several troubling issues in various health departments throughout the state. The California Department of Corrections & Rehabilitation (CDCR), the Department of Health Care Services (DHS) and the California Department of Public Health (DPH) were all identified as high-risk agencies because of various inadequacies in delivering health care services. 


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In the California inmate health care system, the auditor’s findings showed that medical care is inadequate at many prisons and that medications were prescribed inappropriately, among other findings. 

The auditor’s report points to continued inadequacies in providing patient care to inmates despite the CDCR being relieved of the responsibility of providing medical care to inmates more than 10 years ago. The provision of medical care, according to the report, continues to worsen for some institutions.

“Moreover, according to the Office of the Inspector General, quality of care has declined in six institutions since its 2017 evaluation,” the report read. “Thus, CDCR has not made the significant improvements in the provision of inmate medical care necessary to remove it as a high-risk agency.”

A federal court in 2005 found that CDCR’s medical care to inmates violated the U.S. Constitution’s prohibition of cruel and unusual punishment, according to the report, and the Federal Receiver was appointed to oversee the provision of medical care in California’s prison system. A subsequent report in 2007 from the state auditor designated CDCR a high-risk agency due to a faulty management structure. Several vacancies in the department’s management put the entire CDCR management structure at risk, showing there was no “succession plan” for the future CDCR management. 

With the lack of leadership and effective management in the department found in the auditor’s initial findings from 2005, inmates languished and suffered under the substandard medical care afforded to them.One doctor employed by CDCR accused an inmate of faking symptoms, which the report said may have caused that inmate to become paralyzed. The Office of the Attorney General identified one prison where opioids were prescribed unnecessarily, and poor care was provided for diabetic patients. The CDCR, according to the report, is still deemed a high-risk agency because of its substandard medical care provided to inmates.

“Our 2018 high risk update found that CDCR had made some progress in reducing the number of vacancies, but did not have a program in place to ensure the availability and quality of future leaders,” the report read.

The Department of Health Services, similarly, was deemed a high-risk agency because of improper Medi-Cal payments to beneficiaries who weren’t actually eligible for Medi-Cal. Insufficient guidance from DHS to local programs also resulted in millions of unspent dollars that were supposed to be used on improving mental health services throughout the state, according to the auditor’s report. 

A lack of oversight of the use of Mental Health Services Act (MHSA) dollars resulted in $230 million not being spent by local mental health improvement programs. The department still hasn’t completely implemented regulations that would more effectively guide local agencies on the expenditure of MHSA money — money that could go towards carrying out important mental health programs in communities all over the state. 

DHS also allowed $1 billion of improper payments to go out to ineligible or potentially ineligible Med-Cal beneficiaries, according to a U.S. Health & Human Services Office report issued in February 2018 cited in the state auditor’s report. Faulty eligibility criteria set by the state and caseworker mistakes contributed to the improper expenditures, the auditor’s report said.

“Health Care Services continues to struggle to address discrepancies in its Medi-Cal eligibility system that may result in ongoing costs to the state,” the report read. “Because it did not resolve these discrepancies, Health Care Services paid at least $4 billion in questionable Medi-Cal payments from 2014 through 2017.”

Calls to the state auditor’s office for further questions did not go through, as the state auditor’s press office voicemail box was full as of Thursday morning.