The committee members conducted clinical audits at each institution and used their findings to identify deficiencies and ways to alleviate them. The most frequent type of audit currently used in the program examines compliance with standing orders regarding inmate-patient care. As the program developed, institution-specific audits examined an institution's policies and procedures. For instance, one such audit examined the use of emergency code call characteristics and response times. Another audit, the mortality review, involves examination of records of all inmates who have died to assess the appropriateness of medical treatment, whether institutional factors contributed to the death, and ways in which system performance could have been improved. Suicide and homicide deaths are also reviewed for inmate behavior patterns, mental health supervision, and emergency responses. A recent innovation has been the inclusion of an attorney in review committees. The attorney is able to provide an opinion on the legal appropriateness of the medical care and the legal defensibility of actions and make suggestions for improving the agency's defensive posture in the event of a lawsuit. The quality assurance program has proven its worth. It has provided a means of evaluating practice against standards, thereby improving the quality of inmate health care. It has promoted efficient use of resources by eliminating ineffective practices, and it has documented the quality of care given, providing a record in the event of legal action.