Medical Services Branch Clinical Practice Review and Credentialing Services 1

October 3, 2005: Federal Court establishes Receivership to oversee Prison Health Care February 14, 2006: Federal Court Appoints Receiver ◦To establish constitutionally adequate prison medical care as quickly as practicable and in a way which will be sustainable. 2 CCHCS Receivership

Court Orders Plata – Medical Services Coleman – Mental Health Program Perez – Dental Program 3

Plata - Federal Receiver’s Turnaround Plan of Action Goals 1. Ensure Timely Access to Care 2. Improve the Medical Program 3. Strengthen the Health Care Workforce 4. Implement Quality Assurance and Continuous Improvement 5. Establish Medical Support Infrastructure 6. Provide Health Care and Health Care-Related Facilities 4

Clinical Practice Review and Credentialing Services Section Provides support to the following committees: Credentials Committee (CC) Death Review Committee (DRC) Medical Peer Review Committee (MPRC) Clinical Practice Executive Committee (CPEC) Governing Body (GB) 5

Credentialing and Privileging Unit Administrative Support to CC. Credentials Committee Membership is Interdisciplinary: ◦Chiefs of each discipline for CCHCS  Medical  Mental Health  Dental 6

Credentialing and Privileging Unit Policy Statement The Credentials Committee (CC) and the Credentialing and Privileging Unit (CPU) serve to oversee all credentialing activities related to CCHCS health care providers on behalf of the Clinical Practices Executive Committee and the Governing Body. Mission: To assure only qualified, licensed practitioners who can demonstrate current clinical competence are: ◦Appointed to the health care staff organization and/or granted clinical privileges. ◦To protect patients from unethical or untrained practitioners. ◦To match desired services and skills with qualifications and competence of practitioners. 7

Credentialing and Privileging Unit Stakeholders ◦35 State Adult Institutions Average Annual Volume ◦Initial Credentialing: 1,940 ◦Recredentialing: 1,060 8

Death Review Committee (DRC) Peer Review Subcommittee (PRSC) Clinical Practice Executive Committee (CPEC) Governing Body (GB) Clinical Practice Review Committees 9

The Death Review Unit (DRU) provides administrative support to the Death Review Committee (DRC), including creating agendas for meetings and sending meeting material to participants as well as taking minutes at each meeting. The DRU is responsible for ensuring all referrals and notifications from the DRC are transmitted to the affected institutions and programs. The DRU distributes daily and weekly reports of deaths to designated stakeholders. Ad hoc reports are created and provided to; Office of Inspector General, Office of Internal Affairs, Receiver’s Office of Legal Affairs, Prison Law Office, and other stake holders upon request. 10 Death Review Unit Overview

Death Review Process: Each Death Review shall: Provide a thorough review of the patient’s electronic health record and any other relevant supporting documentation of the inmate death; Identify the degree of preventability of death as one of the following: not preventable, possibly preventable, or preventable; and Create a single Death Review Summary in each case, incorporating input from all involved clinical disciplines into one unitary report that sets forth all the Committee’s findings and any recommendations. 11

Death Review Program 2011 through 2014 Average Yearly Deaths:

◦Provides administrative support to the Medical Peer Review Committee (MPRC), Clinical Practice Executive Committee (CPEC), and Governing Body (GB) and ensures all committees adhere to current applicable policies and procedures, and provides daily, monthly, and quarterly reporting to designated stakeholders. ◦Organizes and completes outstanding action items/case referrals, provides follow-up and tracking of current cases. Cases are presented to committees and action items are received from the stakeholders. ◦Ensures all committee recommendations and actions are captured and disseminated appropriately to designated stakeholders including other committees, executive leadership, institution and headquarters staff, and external agencies. 13 Peer Review Unit Overview

Peer Review Committees Mission Statement The Peer Review Committees consist of the MPRC, CPEC, and the GB. On behalf of CCHCS, the committees shall reduce unnecessary morbidity and mortality within CDCR by using the peer review process to review the quality of the care delivered by licensed independent clinical providers. This process preserves the rights of the licensed independent clinical providers to a fair peer review process while ensuring safe, effective, timely, efficient, and equitable health care, for the CDCR patient-inmate population. 14

Clinical Practice Review Program ◦The MPRC provides a centralized and autonomous peer review process for medical health care practitioners in order to reduce unnecessary morbidity and mortality within the CDCR. ◦The CPEC enforces health care staff rules and policies, and ensures a standardized mechanism to determine when clinical privileges should be suspended, restricted, or revoked and when remedial measures are appropriate. - ◦The GB establishes standards and sets policies for Clinical Practice at CCHCS and takes action on recommendations from the CPEC consistent with peer review processes. 15

Medical Peer Review Referrals Medical Peer Review Referrals Potential medical clinical practice deficiencies are referred to PRC from any Referral Source including: ◦Safety Assessment ◦Institutional Health Care Leadership ◦Regional Health Care Leadership ◦Death Review Committee ◦Adverse/Sentinel Event Review Committee ◦Unit Health Record Clinical Appraisal ◦Office of Internal Affairs ◦Medical Peer Review Committee ◦Nursing Professional Practice Council ◦Mental Health Peer Review Committee ◦Headquarters Dental Peer Review Committee ◦Clinical Practice Executive Committee ◦Governing Body ◦Credentialing and Privileging Committee ◦Federal Receiver and designee(s) Referral must include appropriate Peer Review Referral Form with appropriate records and supporting documentation. 16

Peer Review Process Peer Review cases flow from the MPRC to CPEC, and on to the GB as warranted. CPEC may approve, reject, or modify MPRC findings; return the case to MPRC for further investigation; request credentialing alerts/bars on practitioner files; request a Clinical Practice Appraisal, monitoring, or mentorship; open a formal investigation to include a Pattern of Practice; and refer decisions for revocation of privileges to the GB. The GB acts exclusively in the interest of maintaining and enhancing the quality of patient care. The GB shall review all CPEC recommendations and may approve, reject, modify, or remand for changes or further investigation for any such recommendations. The flow of work, length of time, and level of review is dependent on the facts of each case. Cases that result in the revocation of privileges require the filing of a report with the appropriate licensing board. 17

Clinical Practice Review and Credentialing Services Section 18 CPRCSS CPUGBDRUMPRCCPEC