2024-114 California State Facilities—Medical and Mental Healthcare Staffing Contracts

Audit Scope and Objectives

The audit by the California State Auditor will provide independently developed and verified information related to the California Departments of Corrections and Rehabilitation (CDCR), the Department of Developmental Services (DDS), and the Department of State Hospitals (State Hospitals) use of medical and mental health care staffing contracts. Specifically, the audit will review Salinas Valley State Prison, Porterville Developmental Center, and Atascadero State Hospital. The audit’s scope will include, but not be limited to, the following activities:

1. Review and evaluate the laws, rules, and regulations significant to the audit objectives.
2. For the three selected facilities, evaluate budget and expenditure information for mental health care and medical workers for the past five fiscal years and perform the following:
   • Calculate the amount budgeted for positions, salaries, and total compensation for mental health care and medical workers, including the number of vacant positions, by classification. Identify how each department handled any funding budgeted for mental health care but not spent because of staff vacancies. 
   • Calculate the number of contract workers performing mental health care and medical work, including the amount paid to them, broken down by a dollar-per-hour-ratio, and determine which positions contract workers are replacing, by classification.
   • To the extent possible, identify whether contract workers are using classifications other than the classifications the three facilities would typically use to fill the vacant positions.
   • Assess notable trends in vacancy rates, staff recruitment, and hiring.
   • Compare the amount spent on mental health care and medical work performed by state employees and by contract workers, determine any scheduling differences, and identify the amount the State would save by using state employees instead of contract workers.
3. For the three selected facilities, evaluate information on the provision of mental health care and determine the following for the past five fiscal years:
   • The number of hours worked by state employees and by contract mental health care workers, categorized by classification.
   • The number of patients seen by state employees and by contract mental health care workers, categorized by classification.  
   • The length of service for full-time equivalent state employees and for contract mental health care workers.
   • The number of instances in which the departments did not meet staffing minimums for state employees.
4. For the three selected facilities for the last five fiscal years, determine the number of medical and mental health care worker contracts currently entered into and, for each contract, the contractor name, type of service provided, cost, and the contract duration. To the extent possible, determine the same information for any current and upcoming proposals for contract workers in the current and next budget year.
5. Evaluate the processes that CDCR, DDS, and State Hospitals use to determine the appropriateness of each medical and mental health care worker contract. Determine whether the departments ensure that contract workers possess appropriate licenses and certifications and whether the workers previously worked for the State and left as the result of an adverse action. 
6. Evaluate CDCR’s, DDS’s, and State Hospitals’ recruiting efforts, particularly for positions with high vacancy rates, and, to the extent possible, determine any differences between their strategies or approaches and those used by any outsourced staffing agencies recruiting for the same positions.
7. Review and assess any other issues that are significant to the audit.