Death rate of inmates down 29%

The death rate of California prisoners has dropped 29% since the beginning of 2006, when inmate healthcare was seized from state control, according to a report Monday by a court-appointed overseer.

J. Clark Kelso, the receiver for inmate medical care, said the drop is an indication that his office is succeeding in reducing the number of preventable deaths in state prisons due to inadequate access to care, poor treatment and other factors.

But a prison expert and a lawyer for inmates said the causes of the decline are not totally clear.

In a report to U.S. District Court Judge Thelton Henderson, who is presiding over an inmate lawsuit, Kelso said the number of deaths fell from 73 per 100,000 inmates in the first quarter of 2006, when the receivership took over prison healthcare, to 51 deaths per 100,000 inmates in the second quarter of 2008.

Donald Specter, director of the Prison Law Office, which represents inmates in the case that spawned the receivership, said the “figures don’t say too much” because there is no breakdown of which deaths are related to medical care as opposed to other causes.

“I don’t know how useful a measure that is of anything,” said Specter, who says the state needs to do much more, including reducing overcrowding, to improve medical care. “It could be the age of the population. I just don’t know.”

The total number of inmate deaths declined from 428 in 2006 to 397 last year, Kelso said.

So far, 186 inmates have died in custody this year.

Kelso said his office will complete a survey in November of how many of last year’s deaths could clearly have been prevented, and it probably will be “a very small number.” In 2006, about 15% of deaths might have been prevented, the receiver’s office said.

In an interview, Kelso said that in reviewing death reports for inmates, his staff found that many died needlessly as a result of not just one mistake but multiple negative factors, including missed diagnoses, errors or general lack of care. But he said that has changed as his office has filled vacancies for doctors and nurses and replaced doctors with poor performance records.

“Doctors and nurses have to usually miss three or four or five times” before an inmate dies, Kelso said. “What we are seeing is that increasingly, they are not missing as often, and that’s because we have more people, more eyes, more competent clinicians that are catching things.”

Since mid-2005, shortly before the receiver’s office was established, 65 prison doctors have been fired or left the system, and 33 are practicing on a restricted basis pending completion of an investigation. The receivership hired 172 doctors, nearly half the number it is authorized to have, between Aug. 1, 2007, and July 31, along with hundreds of nurses.

Joan Petersilia, a criminologist who studies prisons at UC Irvine, said she believes a number of factors might be at work, not all of them connected to the receiver’s staff. She said the state had been more frequently segregating gang members and other disruptive prisoners from the rest of the inmate population, which could bring down the number of deaths related to violence.

Prisoners with mental illnesses are also getting their medications more regularly and more often are being isolated from other inmates, she said.

“The inmates sometimes tell me that they feel safer now because they do notice that gang members are being extracted,” she said. “That may have something to do with it. It’s hard to know what to make of it, but for me, any good sign is a good sign because we see so many trends going in the opposite direction.”

The number of lockdowns -- in which inmates are confined to their cells almost exclusively -- could also be contributing to the decrease in deaths, because it tends to reduce violence among inmates. The state has increased lockdowns in the last two years, Petersilia said.

In his report to Henderson, Kelso said the reduction might be seized upon by state officials “who allowed horrific prison conditions to fester” as evidence that his office is no longer needed, and that his efforts to obtain $8 billion for construction of medical facilities might now be derided as unnecessary.

“Nothing could be further from the truth,” Kelso wrote, saying the reduction in deaths demonstrates only “preliminary results, not that the work is complete.”

--

michael.rothfeld@latimes.com