Audit Finds Fundamental Flaws in State Mammogram Program

Jun 09, 2010
Anthony Matthews (Evans) – tel. (916) 319-2007, John Mann (Nava) – tel. (916) 718-7420

SACRAMENTO - The California State Auditor released an audit today of the state’s breast cancer screening program – or Every Woman Counts (EWC) – requested last year by Assemblymembers Noreen Evans (D-Santa Rosa) and Pedro Nava (D-Santa Barbara) in response to the Schwarzenegger Administration’s elimination of breast cancer screening to 100,000 low income women served by the program.

“The Auditor's report has uncovered what we long suspected--Every Woman Counts has been mismanaged by this administration at the cost of women's health,” said Evans.  “Judging from the Auditor's report, Every Woman Counts should be renamed ‘Every Contractor Counts.’  The administration continues to pay consultants for outreach and training for services that the state no longer provides, thereby wasting money that could be used to screen an additional 41,500 women for breast cancer.  The audit shows that reducing eligibility and cutting off services is not the solution; better management, more cooperation, and more transparency is.  I call upon the Governor to immediately reinstate eligibility for women aged 41-50 and to cooperate with the Legislature to make the changes necessary to restore the vital services provided by Every Woman Counts.”

“This audit shows that 41,500 more women could have been screened if reasonable steps had been taken. The EWC program has not been managed properly. The failure to include performance requirements in millions of dollars in contracts means no real way to determine if it has been well spent. Money saved could have been used to help women," said Assemblymember Pedro Nava, author of AB 359 signed by the Governor last year which increased access to digital mammography for women in California under the Every Women Counts program. “Changes must be made immediately so that the women who are eligible under the program’s original guidelines can get the necessary screening. The decision to cut-off screening for women under the age of 50 was not only shortsighted, but also a clear case of program inefficiency and mismanagement.”

Evans and Nava requested the audit in time for incorporation into the 2010-2011 Budget Act.  Since EWC has consistently faced financial shortfalls, the audit was requested to assess whether the program is operated efficiently by the Department of Public Health, making the most of the funding it has received. 

The California State Auditor found that EWC:

  1. Incorrectly claimed it could not redirect funds within the EWC program from other areas—such as outreach or training—to pay for more screening services and could have provided breast cancer screening to 41,500 women.
  2. Cannot determine how much its contractors spend on specific services that support the EWC program—hampering its ability to redirect funds towards mammograms or other screening activities that directly support women.
  3. Has not complied with state laws for more than 16 years that would allow the Legislature and the public to exercise oversight.
  4. Did not comply with state law enacted in 1994 requiring an annual report to the Legislature about the program - only one report was submitted in 1996.
  5. The Department of Public Health does not provide the Legislature with estimates of the number of women it expects to serve through the program in a fiscal year, even though it provides this information to the federal government to secure federal funds.

The Department of Public Health implemented two major eligibility changes to the EWC program that went into effect on January 1st of this year: they raised the minimum age for screening from 40 to 50 years; and froze all new enrollments for six months.

The Administration’s changes have disproportionately affected women from communities of color.  From 2003 to 2008, 68.7% of women receiving mammograms through EWC were Hispanic, 15% were Asian-Pacific-Islander, 9% were White, and 2.5% were African American.

This year, Evans and Nava introduced Assembly Bill 1640 aimed at reversing the Administration’s eligibility and enrollment requirements for breast cancer screenings covered under EWC. The measure recently passed the Assembly and now moves to the State Senate for consideration. 

Early detection of breast cancer is a key to surviving the disease.  When breast cancer is detected early, the 5-year relative survival rate is 98 percent.  In addition, studies show that breast cancer treatment costs can more than double if cancer goes undetected and spreads.  Costs for treatment can go from about $21,000 to over $52,000.

According to Susan G. Komen for the Cure, a sponsor of AB 1640, approximately 21,700 women in California will be diagnosed with breast cancer this year and more than 4,000 will lose their battle with the disease.

To read the audit, please go to: