Inventory Maintenance and Delivery

The Bureau of Equipment (BOE) maintains an inventory of medical supplies and pharmaceuticals that it distributes to the Advanced Life Support (ALS) cost centers for use in emergency vehicles by EMS personnel. BOE is responsible for purchasing, managing, and accounting for an estimated $1,200,000 annually in such inventories.

Twenty-one ALS cost centers send orders for specific quantities of medical supplies and pharmaceuticals to BOE. (Controlled substances are not included under this system. They are tracked separately and are distributed by San Francisco General Hospital). BOE then delivers the order to the requesting location. Each of the 21 cost centers has a set of four lockers containing medical supplies and pharmaceuticals, for a total of 84 lockers.

A four-locker set is located in each fire station where an ambulance is based. The lockers are not locked and EMS personnel remove items as needed to restock emergency vehicles. There is no system for tracking such removals of items. According to the BOE, supplies are generally replenished by each apparatus at its base location. However, they may be replenished at any ALS cost center.

Enhancing Internal Controls

The BOE is in the process of implementing a new computerized inventory management system that will allow it to track distributions of medical supplies and pharmaceuticals. BOE further reports that it is working on a plan to standardize the lockers among the cost centers.

As part of these efforts, we recommend that the lockers be locked and the keys controlled by management within the individual fire station. The keys should always be available to EMS personnel but should be accessible only through management, or a representative designated by management. Further, the BOE should implement sign-out sheets for the removal of medical supplies and pharmaceuticals from the lockers.

The Resource Manager for the BOE Procurement/Distribution Center notes that prior to the merger with DPH, the system for the purchase and distribution of BLS medical supplies for the Fire Department included seven lockers for which sign-out sheets were used. A periodic matching of sign-out sheets and restock forms was effective in monitoring whether any inventory was unaccounted for. We also note that similar sign-out sheets are currently used to monitor supplies and usage of controlled substances.

We recommend that sign-out sheets be implemented for the existing 84 lockers and that such sheets require dual signatures when medical supplies and pharmaceuticals are removed from the lockers in the fire station. The sign-out sheets should provide sufficient detail with regard to which unit and crew is removing inventory. The sign-out sheets should be periodically compared to the restock orders. Quantities of unaccounted-for inventory, if any, should be reported to the management of each individual fire station. This, combined with the new inventory management system, would allow the Department to identify irregularities in usage of such medical supplies and pharmaceuticals and would reduce the risk of loss by enhancing internal control.

Conclusions

The Bureau of Equipment (BOE) Procurement/Distribution Center procures and distributes an inventory of medical supplies and pharmaceuticals (excluding controlled substances) to the Department"s fire stations for use by EMS personnel. BOE is responsible for purchasing, managing, and accounting for approximately $1,200,000 annually in such inventory.

At the fire stations, such supplies are stored in unlocked lockers and are not tracked when they are removed. There is a risk of loss due to theft or misuse because medical supplies and pharmaceuticals are not tracked as they are removed from the lockers. While we have no evidence that such losses have occurred, the existing internal controls are inadequate to prevent such losses.

The Department should lock the lockers and implement sign-out sheets to be completed by EMS personnel when they remove supplies from the lockers. BOE should also use its proposed inventory management system to identify irregularities in the use of medical supplies and pharmaceuticals by fire stations.

Increased monitoring of medical supplies and pharmaceuticals would improve internal controls and therefore reduce the risk of loss due to theft or misuse.

Recommendations

The Fire Department should:

4.6.1 Lock supply lockers that contain medical supplies and pharmaceuticals. Keys should always be available in case supplies are needed. However, they should be accessible only through fire station management, or a representative designated by management.

4.6.2 Implement sign-out sheets, similar to those used by the Department for controlled substances, for the removal of medical supplies and pharmaceuticals from the fire station supply lockers. Such sign-out sheets should require two signatures for the removal of supplies and should provide sufficient detail with regard to the unit and crew removing the inventory.

4.6.3 Begin monitoring the usage of medical supplies and pharmaceuticals, through the recommended sign-out sheets and through the pending computerized inventory management system. Irregularities should be reported to management and appropriately researched and addressed.

Costs and Benefits

There would be no cost to implement these recommendations.

The Bureau of Equipment manages approximately $1,200,000 annually in inventory. The risk of loss due to theft or misuse would be decreased by strengthening internal controls.