Figure 1
Medical Treatment for Work‑Related Injuries for CDCR Employees and Inmates Follow Similar Processes but Are Administered Separately and Under Different Criteria
Figure 1 is a flowchart showing the medical treatment processes for work-related injuries when workers’ compensation claims are submitted by CDCR employees and inmates. Medical treatment for CDCR employees and inmates follow similar processes but are administered separately and under different criteria.
Employees
The left side of the flowchart shows the process for employees: For employee injuries resulting in a claim, the employer first authorizes treatment up to $10,000 for the employee to receive initial medical care from a workers’ compensation physician while SCIF determines whether CDCR is liable for the claim. If SCIF determines that CDCR is liable then it accepts the claim. For accepted claims, SCIF reviews any treatments proposed by the employee’s workers’ compensation physician against established medical standards through its authorization process, which determines if the treatment is medically necessary. The flowchart shows the process for a prospective treatment request in which SCIF authorizes the treatment before it is provided. A separate process for retrospective requests allows SCIF to approve treatments after it is provided. However, a majority of the requests we reviewed were prospective. If SCIF determines the treatment is medically necessary, the workers’ compensation physician provides the treatment. For employees, certain medical providers can bypass the review for specific procedures. If the injured employee needs further treatment, the same review process is followed, beginning with SCIF reviewing treatments proposed by the workers’ compensation physician.
The flowchart identifies that the following steps must be completed within time requirements, which vary under different circumstances:
- Employer authorization of treatment up to $10,000
- SCIF liability decision
- SCIF review of proposed treatment
Inmates
The right side of the flowchart shows the process for inmates: For inmate injuries resulting in a claim, the facility medical provider provides initial medical care. SCIF determines whether CDCR is liable for the claim. However, SCIF’s liability decision does not affect the provision of care while the inmate is incarcerated. For proposed treatments that are high-cost, high-risk, exceptional, and complex, the facility’s head physician reviews the proposed treatment for medical necessity and if approved, the facility medical provider provides the treatment. If further treatment is needed while the inmate is still in custody, the same process is used beginning with the facility medical provider proposing further treatment. If the inmate is released from custody and needs further treatment, the inmate would follow the same process as employees seeking treatment from a SCIF workers’ compensation provider.
The flowchart identifies that the following steps must be completed within time requirements, which vary under different circumstances:
- Initial medical care by facility medical provider
- SCIF liability decision
- Facility head physician review of proposed treatment if the treatment is for “high-cost, high-risk, exceptional, and complex cases.”
Figure 2
Employees Receive Comparable Medical Care Faster With Passport Providers
Figure 2 is a flowchart showing that CDCR employees receive comparable medical treatment faster from passport providers. The left side of the flowchart shows the process for obtaining medical treatments requiring authorization. The right side of the flowchart shows the process for obtaining medical care for preauthorized treatment through passport providers. Each side begins with the same first two steps: the employee suffers a work-related injury, and sees a workers’ compensation physician following the injury. For treatments requiring authorization the process shows four additional steps: the workers’ compensation physician request treatments, SCIF reviews the treatment request, approves treatment request, and then the physician provides the treatment. The average number of days from treatment recommendation to treatment provided for claims reviewed was 21 days. For preauthorized treatment through passport providers, the flowchart shows two additional steps: the passport provider orders the treatment and provides the treatment. The average number of days from treatment recommendation to treatment provided for passport providers was 9 days.
Figure 3
Employees’ Injuries Resulted in Longer Recovery Times Than Inmates’ Injuries
Figure 3 is a chart showing that CDCR employees’ injuries resulted in longer recovery times than inmates’ injuries. Specifically, Figure 3 shows the number of months it took 30 CDCR employees and 36 inmate workers with injuries between January 2015 and June 2018 to be released from care after their first medical exam. The chart categorizes the months into three categories of time: injured workers who were released from care in one month or less; those in one to six months; and those that were more than six months. The figure shows the following results: ten employees (33 percent) and 22 inmates (66 percent) were released from care in one month or less. Nine employees (30 percent) and eight inmates (22 percent) were released from care in one to six months. Eleven employees (37 percent) and six inmates (17 percent) were released from care after more than six months. The chart also shows the median number of days that employees were released from care was 82 days, whereas the median number of days that inmates were released from care was 12 days. Also, the Figure notes that one injured employee and two injured inmates had not been released from care as of March 31, 2019.
Figure 4
Employees Were Generally Off Work Longer Than Inmates Following Work‑Related Injuries
Figure 4 is a chart showing that CDCR employees were generally off work longer than inmates following work-related injuries. Specifically, Figure 4 shows the number of days it took 30 CDCR employees and 36 inmate workers with injuries between January 2015 and June 2018 to return to work after their first medical exam. The chart categorizes the number of days into four categories of time: injured workers who returned to work the same or next day after the first medical exam; those in two to ten days; those in 11 to 150 days; and those that were more than 150 days. The figure shows the following results: seven employees (25 percent) and 12 inmates (33 percent) returned the same or next day after the first medical exam. Seven employees (25 percent) and 11 inmates (33 percent) returned in two to 10 days. Seven employees (25 percent) and nine inmates (25 percent) returned in 11 to 150 days, and seven employees (25 percent) and four inmates (11 percent) returned in more than 150 days after the first medical exam. The chart also shows that the median number of days employees returned to work was 14 days after the first medical exam, whereas the median number of days for inmates to return to work was 6 days. Also, the Figure notes that two of the 30 employees reviewed are excluded from the results because they took disability retirement rather than returning to work.
Figure 5
Five Employees Whose Cases Took More Than 150 Days to Resolve Often Shifted Between Full, Modified, and Off Work
Figure 5 is horizontal bar graph showing five employees whose cases took more than 150 days to resolve after their first medical exam, and whose work statuses often shifted between not medically cleared for work, medically cleared for modified duty but not working, and medically cleared for full duty. Five horizontal bars represent each of the five employees. The horizontal bars show three colors that represent the time spent on the three work statuses. The red color on each horizontal bar shows the time that the employee was not medically cleared to work. The yellow color on each horizontal bar shows the time the employee was medically cleared for modified duty but was not working. The blue color on each horizontal bar shows the time the employee was medically cleared for full duty. The figure highlights the fourth employee, whose horizontal bar specifies the number of days the employee spent in each status during the more than 150 days it took for the employee to return to work after the first medical exam. Employee 4’s horizontal bar first shows a red portion of 38 days (not medically cleared to work); followed by a blue portion of 41 days (medically cleared for full duty); followed by a red portion of 49 days (not medically cleared to work); followed by a yellow portion of 128 days (medically cleared for modified duty but not working; followed by a red portion of 33 days (not medically cleared to work); followed by a yellow portion of 54 days (medically cleared for modified duty but not working; followed by a blue portion (return to fully duty. The figure also notes that employees were not able to work while cleared for modified duty in any of these five cases because the employees could not perform their job duties with medical restrictions.
Figure 6
Although Cleared for Modified Duty, Many Employees Spent Most of This Time Not Working Because Facilities Could Not Accommodate Work Restrictions
Figure 6 is a pie chart showing that although cleared for modified duty, many employees spent most of this time not working because facilities could not accommodate work restrictions. Specifically, the pie chart shows the total number of weeks that CDCR employees we reviewed spent in three categories: not medically cleared to work, medically cleared for modified duty and working; and medically cleared for modified duty but not working. Specifically, the pie chart shows that 18 employees spent a total of 257 weeks medically cleared for modified duty but not working; five employees spent a total of 30 weeks medically cleared for modified duty and working; and 15 employees spent a total of 170 weeks not medically cleared to work.