CCHCS Facts


WHAT IS CCHCS?

California Correctional Health Care Services provides medical, dental and mental health services to California’s incarcerated population at all 33 California Department of Corrections and Rehabilitation institutions statewide.

Our staff provides care for nearly 100,000 incarcerated individuals in California (see Population Reports for the latest numbers). Their efforts are tracked monthly on publicly available Health Care Services Dashboards that cover patient outcomes, access to care and utilization. These and more reports can be found on our Reports page.

Our mission is to facilitate the successful reintegration of individuals in our care back to their communities equipped with the tools to be drug-free, healthy, and employable members of society by providing education, treatment, rehabilitative, and restorative justice programs, all in a safe and humane environment.

Two CCHCS employees having a conversation.


FACTS AND FIGURES

Acuity of incarcerated patients for our 33 institutions (as of July 2023):

  • 17,079 high-medical acuity
  • 35,218 medium-medical acuity
  • 43,722 low-medical acuity
  • Total: 96,019 incarcerated patients

ProgramFiscal Year 23-24 Position AuthorityFiscal Year Budget Authority 23-24
Dental Services904.7172,255,000
Mental Health 3,202.5633,424,000
Division of Health Care Services (w/o CCJBH)331.867,402,000
Criminal Justice and Behavioral Health (CCJBH)3.01,081,000
Medical and Pharmaceuticals (CCHCS)13,675.63,155,682,000
Total18,117.64,029,844,000

Image of a Medical Assistant in a clinical setting consulting


SPECIALIZED HEALTH CARE BEDS

Reception Centers: Intake centers that evaluate newly arriving patients, identify appropriate resources, and expedite the transfer of high-risk patients to endorsed institutions.

Basic Institutions: Provide nursing and primary care provider services on a continuous basis and can provide urgent care onsite. Basic consultations are available, including general surgery and orthopedics.

Intermediate Institutions: Provide the same functions as Basic Institutions, but also includes Tertiary Care Consultations, including oncology, neurosurgery and interventional cardiology.

MHCB: Mental Health Crisis Beds

PIP: Psychiatric Inpatient Program

InstitutionTypeMedical BedsMHCBPIP BedsOther Specialties
ASPBasic28
CACBasic
CALBasic18
CCIBasic16
CCWFReception2612Skilled Nursing Facility
CENBasic13
CHCFIntermediate101280532Dialysis
CIMIntermediate4434
CIWIntermediate242945
CMCIntermediate373812
CMFIntermediate1195039617 hospice beds
CORBasic6824
CRCBasic10
CTFBasic17
CVSPBasic14
FSPIntermediate
HDSPBasic2010
ISPBasic14
KVSPBasic1012
LACIntermediate412
MCSPIntermediate28
NKSPReception610
PBSPBasic910
PVSPBasic96
RJDIntermediate1414Dialysis
SACIntermediate224
SATFBasic1820
SCCBasic10
SOLIntermediate69
SQIntermediate1040Dialysis
SVSPBasic1210246
VSPBasic20
WSPReception106Dialysis

Image of a health care provider working on a computer


DEFINITIONS

The following is a sampling of from the Health Care Department Operations Manual Definitions section. Please refer to that section for more definitions. The entire Health Care Department Operations Manual is available for review here.

Definitions

Advance Directive for Health Care: A written instrument which allows the patient to do either or both of the following: 1) state instructions for future health care decisions; and/or 2) appoint an agent with Power of Attorney for Health Care.

Bundling: When a patient has multiple pending appointments, setting appointments sequentially on the same day so that a patient need only be seen in one encounter for multiple purposes. Bundling helps increase clinic efficiency, meet mandated timeframes, and limit the need for custody escorts, lessening redundant work for custody and health care staff as well as making appointments more convenient for the patient.

California Department of Corrections and Rehabilitation Heart Healthy Diet: A meal plan restricted in sodium and fat while supplying adequate calories, fiber and all essential nutrients, provided by California Department of Corrections and Rehabilitation and approved by a Registered Dietitian,

California Department of Corrections and Rehabilitation Standardized Master Menu: A four week menu cycle based on the California Department of Corrections and Rehabilitation (CDCR) Heart Healthy Diet that is planned by the CDCR Department Food Administrator and approved by a Registered Dietitian.

Care Guide: A care guide supports the application of proven prevention, diagnosis, and treatment strategies, and the overall practice of evidence-based medicine improving patient care and outcomes by supporting the application of evidence-based medicine; developing recommendations conforming to current evidence in clinical science in the form of treatment guidelines; and providing assistance in clinical decision-making for California Correctional Health Care Services health care staff. A collection of CCHCS care guides can be found on our Clinical Resources Page.

Chronic Care: The ongoing care for a current health problem that impacts or has the potential to impact a patient’s functioning and long-term prognosis and has lasted, or is expected to last, for more than six months.

Correctional Clinic: A primary care clinic, pursuant to California Health and Safety Code Division 2, Chapter 1, Article 1 Section 1206(b), conducted, maintained, or operated by the State to provide health care to eligible patients of California Department of Corrections and Rehabilitation.

Correctional Treatment Center: A health facility operated by California Department of Corrections and Rehabilitation that provides inpatient health care services to patients who do not require a general acute care level of essential services and are in need of professionally supervised health care that cannot be provided on an outpatient basis.

Death Review: A type of review conducted by Nurse Consultant Program Review staff which assesses the quality and appropriateness of nursing care, nursing practice issues, best practices, and factors that may have significantly impacted the quality of patient care, thereby contributing to the death of a patient. The most recent annual death review can be found on our reports page.

Designated Reception Center Institution: An institution that receives persons newly committed to California Department of Corrections and Rehabilitation custody. CDCR Reception Centers include CCWF, NKSP, and WSP.

Do Not Resuscitate: A written order which directs that resuscitation efforts (i.e., intubation and assisted mechanical ventilation, cardiac compression, defibrillation, and administration of cardiotonic drugs) are not to be initiated in the event of cardiac and/or respiratory arrest.

Durable Medical Equipment: Equipment prescribed by a licensed provider to meet medical equipment needs of the patient that can withstand repeated use; is used to serve a medical purpose; is not normally useful to an individual in the absence of an illness, injury, functional impairment, or congenital anomaly; and is appropriate for use in or out of the institutional housing.

Gender Dysphoria: A Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which refers to discomfort or distress caused by a discrepancy between a person’s gender identity and that person’s assigned sex at birth.

Hospice: Services that are designed to provide palliative services to patients needing end-of-life care. Services are designed to alleviate the physical, emotional, social, and spiritual discomforts of an individual who is experiencing the last phases of life due to the existence of a terminal disease and to provide supportive care to the primary caregiver and the family. A skilled or unskilled person may provide care under a plan of care developed by a physician or interdisciplinary team under medical direction. Hospice services may be provided in all levels/areas of a specialized health care housing unit.

Latent Tuberculosis Infection: A tuberculosis (TB) infection that has not developed into disease. Persons with latent TB infection are at risk of developing TB disease throughout their lifetime, with immunocompromised patients at even higher risk.

Outpatient Housing Unit: A designated housing area within institutions designed to provide supportive services, including low-intensity nursing care, for patients who may require limited assistance with activities of daily living or short-term observations.

Palliative Care: Services that support a patient in managing his or her health care needs associated with a serious illness. Services are designed to provide comfort, relief from pain, support the patient, and to maintain or improve functioning and quality of life. Palliative care services can be provided at any stage of illness and at all levels of care within California Department of Corrections and Rehabilitation.

Peer Mentor Program: Inmate Peer Mentors provide structured peer preventions and evidence-based strategies to deliver patient education, support patient well-being, and modify patient behaviors within California Department of Corrections and Rehabilitation and following release.

Primary Care Provider: A physician, nurse practitioner, or physician assistant designated to have primary responsibility for the patient’s health care or, in the absence of a designation or if the designated physician is not reasonably available or declines to act as primary physician, a physician who undertakes the responsibility.

Primary Care Team: An interdisciplinary team that organizes and coordinates services, resources, and programs to ensure consistent delivery of appropriate, timely, and patient-centered, evidence-based care to a designated patient panel.

Quality Management: A planned, strategic, system-wide approach to defining, evaluating, and improving organizational performance, thereby continually enhancing the quality and value of patient care and services provided and the likelihood of desired outcomes.

Six Sigma: A measurement-based, data-driven, systematic approach to process improvement and problem solving through the application of tools and techniques with the purpose of minimizing unnecessary variation in processes and eliminating defects.

Skilled Nursing Facility: A health facility or a distinct part of a hospital which provides continuous skilled nursing care and supportive care to patients whose primary need is for skilled nursing care on an extended basis. It provides 24-hour inpatient care and at a minimum includes physician, skilled nursing, dietary, and pharmaceutical services as well as an activity program.

Specialized Health Care Housing: A distinct housing unit located within a facility or institution operated by California Department of Corrections and Rehabilitation that provides health care services 24 hours a day to patients who are in need of professionally supervised health care. Specialized Health Care Housing units may, or may not be licensed and/or accredited. Specialized Health Care Housing units include the following levels of care: Outpatient Housing Unit, Correctional Treatment Center, Mental Health Crisis Bed, Psychiatric Inpatient Program, Skilled Nursing Facility, Hospice, Acute Care Facility (Mental Health), and Intermediate Care Facility (Mental Health).

Specialized Medical Bed: An institutional Correctional Treatment Center, Outpatient Housing Unit, Skilled Nursing Facility, or Specialized Outpatient bed.

Specialized Outpatient: A high medical risk outpatient who has long-term care needs with the potential for clinical deterioration, decompensation, morbidity, or mortality.

Telemedicine Services: Through the Telemedicine Program, California Correctional Health Care Services coordinates with private health care entities to provide specialty care services using audio-visual technologies to California patients in California Department of Corrections and Rehabilitation institutions. The Telemedicine Program links health care providers and patients with high-definition cameras, electronic medical instruments, and voice to enhance physicians’ abilities to diagnose and connect with patients remotely.

Transgender: Describing or relating to a person whose gender identity is different from the person’s sex assigned at birth.

Tuberculin Skin Test: The Mantoux Tuberculin Skin Test is a method of determining whether a person is infected with Mycobacterium tuberculosis.

Tuberculosis Disease: A disease caused by Mycobacterium tuberculosis or other bacteria in the Mycobacterium tuberculosis complex. Tuberculosis (TB) is a treatable infectious disease that usually affects the lungs and airway but may also affect other parts of the body. People with TB disease of the lungs or airway may be infectious to others until they have received their initial phase of treatment with TB medications. People with TB disease in other parts of the body but not in the lungs are not infectious to others.

Whole Person Care: A model or approach which recognizes the best way to improve health outcomes is to coordinate the full spectrum of patient needs – including medical, behavioral, socioeconomic, and beyond.


ABOUT THE RECEIVERSHIP

The Receivership was established by U.S. District Court Judge Thelton E. Henderson as the result of a 2001 class-action lawsuit (Plata v. Newsom) against the State of California over the quality of medical care in the state’s prisons. The court found that the medical care was a violation of the Eighth Amendment of the U.S. Constitution, which forbids cruel and unusual punishment of the incarcerated.

The State entered into a stipulation in 2002, agreeing to remedies that would bring prison medical care in line with constitutional standards. However, the State failed to comply with the court’s direction, and in June 2005, Judge Henderson established a Receivership for prison medical care. The Receiver reports to the federal court, not the Governor. Mental health and dental care are overseen by CDCR and are not under the Receivership’s authority.

Under this arrangement, improvements have been made to medical care at institutions across the state with the goal of improving the standard of patient care in accordance with the court’s decisions. As of February 2023, medical operations at 20 institutions have been delegated back to the authority of the CDCR Secretary.


RECEIVERSHIP TIMELINE

  • August 29, 2001: Plata v. Davis class-action lawsuit filed alleging prison medical care neglect.
  • June 13, 2002: State enters into a stipulation with the plaintiffs promising to improve prison medical care.
  • October 3, 2005: Federal court finds that medical care does not meet constitutional standards, and establishes a receivership to oversee prison medical care.
  • February 14, 2006: Federal court appoints Robert Sillen as the first Receiver.
  • 2007 to 2009: The Receiver established custody health care access units at each institution to ensure patients were able to access medical care in every medical clinic within each institution.
  • January 23, 2008: Federal court appoints J. Clark Kelso who replaces Robert Sillen as Receiver.
  • June 16, 2008: Receiver’s “Turnaround Plan of Action” is approved by the federal court.
  • August 13, 2008: Receiver and state officials go to court over funding for construction projects.
  • June 3, 2010: Governor signs AB 552 (Solorio) which funds construction of integrated bed plan negotiated between the Receiver and the Administration.
  • September 5, 2012: Federal Court issues order setting forth a plan to transition oversight of medical care from the Receiver back to the Secretary.
  • October 2012: Responsibility for Health Care Access Unit and Activation Unit is delegated back to the Secretary under a revocable delegation of authority signed by the Receiver and CDCR. A total of 3,320.6 authorized positions were delegated back to the CDCR.
  • July 2013: The California Health Care Facility (Stockton) is opened to provide medical and mental health services to inmates needing the most intensive medical and mental health care.
  • March 10, 2015: Federal court issues an order providing a plan for the receiver to delegate oversight of the medical program back to the Secretary, with the Receiver ultimately to assume a monitoring function.
  • July 2015: Complete Care Model, based on the industry standard known as the Patient-Centered Health Home, becomes the foundation for CCHCS health care services delivery.
  • October 31, 2017: The statewide implementation of the Electronic Health Records System is completed.
  • December 3, 2018: The statewide implementation of the Electronic Dental Records System is completed.
  • July 2019: The Health Care Department Operations Manual (HCDOM) is published to include all medical and dental policies and procedures and mirrors the format of the CDCR Department Operations Manual. Additionally, comprehensive regulations for medical care under Title 15 were filed with the Secretary of State and became effective statewide
  • September 2019: CCHCS begins providing regular patient education videos for the population through DRP-TV on a Wellness channel. The content is available at all CDCR institutions for viewing in cells as well as public spaces.
  • January 2020: The Integrated Substance Use Disorder Treatment program is implemented statewide across 34 CDCR institutions. The program launched with five core program elements, including substance use disorder screening, medication assisted treatment, cognitive behavioral interventions, supportive housing, and enhanced pre-release planning and transition services aimed at strengthening care coordination upon release.
  • March 2020: Gov. Gavin Newsom issues a proclamation beginning California’s COVID-19 State of Emergency.
  • July 2020: Dr. Joseph Bick is named Director of Health Care Services for CCHCS
  • October 29, 2021: Federal court issues an order modifying the March 10, 2015 transition plan 
  • April 2022: A report showing the impacts of the Integrated Substance Use Disorder Treatment Program titled Transforming Substance Use Disorder Treatment in California’s Prison System (2019-2021) is published.
  • October 2022: Wasco State Prison becomes the 20th of the state’s 33 institutions to have its medical care delegated back to CDCR.
  • February 2023: Gov. Gavin Newsom issues a proclamation ending California’s COVID-19 State of Emergency.
  • August 2023: Ironwood State Prison becomes the 21st of the state’s 33 institutions to have its medical care delegated back to CDCR.

DELEGATED INSTITUTIONS

The Receiver has delegated oversight of the medical program at 21 of 33 institutions back to the Secretary as of August 2023.

  • 2015: FSP
  • 2016: CTF, CVSP, CCI, PBSP, CEN, SCC, CIM, ASP
  • 2017: SQ, CIW, KVSP, CAC, PVSP, CAL
  • 2018: CCC, CMC, VSP, COR
  • 2022: WSP
  • 2023: ISP

UPDATES

This page is updated twice annually in January and July. This page was last updated July 2023.