Appendix

Scope and Methodology

The Joint Legislative Audit Committee (Audit Committee) directed the California State Auditor to compare and contrast the timeliness of medical treatments provided to CDCR employees and inmates following work‑related injuries. Specifically, the Audit Committee requested that we review whether changes could be made to the workers’ compensation process to improve the timeliness of medical treatment provided to employees and inmates. The table lists the audit objectives that the Audit Committee approved and the methods we used to address them.

Audit Objectives and the Methods Used to Address Them
AUDIT OBJECTIVE		METHOD
1	Review and evaluate the laws, rules, and regulations significant to the audit objectives.	Identified and reviewed state laws, rules, and regulations for CDCR and SCIF that were applicable to workers’ compensation.
2	Determine CDCR’s policies and procedures for responding to and providing treatment for employee and inmate work‑related injuries, including any applicable standards for the timeliness of its response and the provision of treatment.	Obtained and reviewed CDCR’s policies and procedures for responding to and providing treatment following a work‑related injury. Interviewed return‑to‑work coordinators at three correctional facilities (selected in objective 3) to determine how those facilities implement the workers’ compensation process and adhere to CDCR’s policies. Reviewed SCIF’s and CalPIA’s procedures for processing workers’ compensation claims.
3	To the extent possible, review data on CDCR’s employee workers’ compensation claims and inmate work‑related injuries—including injuries to the lower back, neck, knee, shoulder, hand, wrist, ankle, and eye—to determine the following information: a. The number of days between the occurrence of the work‑related condition or injury and the date the recommended treatment was provided. b. The number of days between the date a medical treatment recommendation was made and the date the recommended treatment was provided, including the number of days between when a surgical intervention recommendation was made and the date that the surgical intervention was provided. c. The number of days between the first date that the employee or inmate received medical treatment and the date when the employee or inmate was released from care. d. The number of days between the first date that an employee or inmate received medical treatment and the date that the employee or inmate returned to work.	Obtained a list of accepted employee and inmate work‑related claims from SCIF’s Claims Adjusting and Reporting Engine for injuries incurred from January 2015 through June 2018. Judgmentally selected three of the 36 facilities to review (California Men’s Colony, California Rehabilitation Center, and California State Prison, Solano) based on an analysis of the number of work‑related claims per facility, number of working inmates, and other factors. Judgmentally selected 10 employee and 10 inmate accepted work‑related claims from each of the three facilities. Selected an additional six accepted work‑related claims for inmate employees of CalPIA. Selected claims from January 2015 through June 2018 for work‑related injuries including injuries to the lower back, neck, knee, shoulder, hand, wrist, ankle, and eye. For each of the selected work‑related claims, obtained and reviewed claim documentation from SCIF and the three facilities to document the dates and time frames listed in objectives 3a through 3d to determine if the facilities, SCIF, and CalPIA responded to and provided treatment following a work‑related injury within time requirements. Interviewed return‑to‑work coordinators at the facilities, and SCIF, as well as CalPIA staff to obtain their perspective on issues we identified related to these claims.
4	Compare and contrast the timeliness of medical treatment provided to CDCR employees and inmates and determine the reasons for any significant differences. Based on this review, identify any changes that could be made to improve the timeliness of medical treatment provided to CDCR employees and inmates.	Analyzed results from our review of case files from objective 3 to determine if any procedural differences affected the frequency and type of care provided to employees and inmates following a work‑related injury. Interviewed facility and SCIF staff to obtain their perspectives on factors contributing to the differences in timeliness of providing care to employees and inmates.
5	Review and assess any other issues that are significant to the audit.	We did not identify any additional issues that are significant to the audit.

Source: Analysis of Audit Committee’s audit request number 2018‑128 and information and documentation identified in the column titled Method.

Assessment of Data Reliability

In performing this audit, we relied on electronic data obtained from SCIF’S Claims Adjusting and Reporting Engine database. We also relied on electronic reports of inmate claims from two facilities we reviewed—California Men’s Colony and California Rehabilitation Center—to narrow our selection of inmate claims for testing. The U.S. Government Accountability Office, whose standards we are statutorily required to follow, requires us to assess the sufficiency and appropriateness of computer‑processed information that we use to support our findings, conclusions, and recommendations. To evaluate these data, we performed data‑set verification procedures and electronic testing of the key data elements and found the data used are sufficiently reliable for the purposes of selecting employee and inmate workers’ compensation claims for testing and to determine the total number of workers’ compensation claims for CDCR employees and inmates. Since we used the data only to select claims for testing, we needed to gain assurance that the population was complete. We verified completeness by obtaining haphazardly selected claim forms from each of the three facilities we reviewed and ensuring each claim could be found in the data we used to make our selection of cases for testing. We found the data used to make our testing selection were sufficiently complete. Additionally, we relied on data from CDCR’s COMPSTAT system to provide background information on the number of employees and inmates. However, because these data were used primarily for background or contextual information that does not materially affect findings, conclusions, or recommendations, we determined that a data reliability assessment was not necessary for this system.