Judge Names Receiver to Fix Prison Health System

Convinced that state officials cannot solve the healthcare crisis gripping their prisons, a judge on Tuesday transferred control of California’s $1.2-billion inmate medical care system to a federal receiver.

In a sweeping order, U.S. District Judge Thelton Henderson granted the receiver extraordinary powers to do whatever he deems necessary to raise prison healthcare to a “constitutionally adequate standard.”

Under the order, receiver Bob Sillen will have the power to set budgets; hire, fire and discipline staff; make and break contracts; write and discard policies; and decide how to spend every dollar used to care for 168,000 inmates in 33 prisons.

If a state law, regulation or contract -- including labor agreements -- blocks his way, Sillen may simply ask Henderson to waive it, the order said.

Legal scholars said the appointment marks the first time such a vast correctional operation has been placed under a federal receiver. Dental care, mental health services and substance abuse programs would be the only services not under Sillen’s control.

In appointing a receiver who will report directly to him, Henderson simultaneously suspended state Corrections Secretary Roderick Q. Hickman’s authority over healthcare. But the judge said he expected Sillen to work closely with state officials, and Hickman pledged his support.

Henderson seized control of the system as a result of a 2001 class-action suit over prison healthcare. Sillen, who has been the top health official in Santa Clara County for 26 years, was picked from among four finalists identified during a nationwide search. He will take over April 17.

In an interview, Sillen said he viewed the job as “a mission and a cause,” noting that Californians should be “ashamed that this level of care -- or non-care -- is being rendered in our prisons.”

Sillen, 63, said he was hopeful that the turnaround would be accomplished with “significant state cooperation.

“But either way,” he said, “the job will get done. We will not be stonewalled by bureaucracy, vested interests, politics or other obstacles.”

The judge did not set a time limit for the receivership, saying that it would end once he and Sillen were satisfied state officials had “the will, capacity and leadership” to run a constitutionally adequate healthcare system on their own. Sillen said he believed substantial progress would be made within five years, but predicted that completing the job could take longer.

Lawyers for prisoners who filed the class-action suit praised the selection of Sillen. But they cautioned that the challenge before him is enormous.

“Mr. Sillen appears to have the toughness and smarts to get this job done, and his career so far shows a strong commitment to care,” said attorney Steve Fama of the nonprofit Prison Law Office. “But the scope and depth of the problem he faces can’t be overstated, and he can’t do it alone.”

Gov. Arnold Schwarzenegger pledged his help, saying in a statement that he was “committed to working cooperatively” with the receiver.

State Sen. Gloria Romero (D-Los Angeles), who chairs a committee on the correctional system, said she telephoned Sillen on Tuesday to wish him good luck.

“I’ve heard nothing but the strongest accolades about his character, integrity and ability to cut through red tape and make things happen,” Romero said. “This is a new captain for this Titanic, and one who I think will make a noticeable difference.”

Romero added that Sillen told her to be prepared to allocate more money for inmate healthcare. The senator said legislators would have to increase the scrutiny they give to spending on the rest of the correctional system, including the governor’s proposed bonds for new prisons and jails.

Although the class-action suit was settled in 2002, when the state agreed to overhaul inmate healthcare and phase in improvements, court-appointed inspectors told Henderson last summer that they saw few signs of progress in a system that on average kills one inmate -- through neglect or malpractice -- each week.

Rather, one expert told the judge that prison medical facilities were in near “anarchy,” causing a pattern of preventable deaths that he called “macabre.”

After a series of hearings featuring such testimony, Henderson concluded last June that the system was in crisis.

Acknowledging that a federal takeover was an “extreme measure,” he said it was essential to stop the “unconscionable degree of suffering and death” behind bars.

Initially, Henderson considered hiring a commercial company specializing in turnaround efforts. Ultimately, however, he hired the search firm Korn/Ferry International to find experienced healthcare administrators.

The manager of that search, Mark Collins, said finding executives with the right combination of experience -- and passion -- for the job was challenging, especially because this sort of receivership is an anomaly.

“There are plenty of examples around the country of people who went in and took over a [housing] agency, or a school district, but there is nothing on this scale, and nothing that has substantially involved corrections,” Collins said Tuesday.

Sillen, he said, possessed an ideal blend of healthcare management experience, political savvy and “dedication to helping the underserved.”

“At the end of the day, I think that’s what really struck the judge -- that Bob truly wanted to help a population that, for some people, is a tough population to care deeply about,” Collins said.

As director of the Santa Clara Valley Health and Hospital System, Sillen has run a multifaceted medical and mental healthcare system with 6,200 employees and a $1.4-billion budget. He supervises the county’s public hospital and health department, medical care inside jails and juvenile halls, drug and alcohol programs and mental health services.

In his order, the judge spelled out the range of powers Sillen will have and ordered Sillen to report to the court bimonthly. Those reports must include an accounting of expenditures and an update on problems and successes.

The judge also ordered the state to establish an operating fund with the court and make an opening deposit of $750,000 within 30 days. Sillen will make monthly requests for withdrawals.

Anyone who interferes with Sillen’s work or attempts to thwart him would be subject to contempt charges, the judge warned. He has not yet specified Sillen’s salary, but experts have said it will probably exceed $500,000 annually.

Inmate medical care is not the only piece of California’s $8.2-billion corrections system under some form of court monitoring. Others include the youth prisons, the mental healthcare system, the parole revocation process, and Pelican Bay State Prison on the North Coast. Federal judges also are monitoring the state’s compliance with orders regarding the rights of disabled inmates.