Gov. Is Ordered to Name Prison Healthcare Czar

Times Staff Writer

Fed up with a “business as usual” attitude among state prison officials, a federal judge Thursday ordered Gov. Arnold Schwarzenegger to take immediate action to resolve a healthcare crisis that kills an average of one California inmate each week.

If the judge’s mandates are not carried out, lawyers said, the governor could be ordered into court to face charges of contempt, a humiliating prospect for any political leader.

U.S. District Judge Thelton Henderson, in his strongly worded order, said he would not sit by while officials “twiddle their collective thumbs” as prisoners continue to suffer and die from medical neglect and incompetence.


Instead, he told the governor to personally appoint -- by next Thursday -- a top lieutenant to carry out a series of immediate fixes, including steps designed to stem the exodus of doctors and nurses caring for inmates behind bars.

Henderson “is putting the governor on notice that he had better get personally involved in this extreme emergency,” said lawyer Donald Specter of the Prison Law Office, which has sued the state over inmate medical care. “I don’t think the judge could be any more frustrated.”

Julie Soderlund, a spokeswoman for Schwarzenegger, said the governor “has been and remains committed to making the necessary reforms in our prison healthcare system.” She noted that Monday he appointed two new leaders of the medical division who have a combined six decades of experience in healthcare management.

One of them, Dr. Peter Farber-Szekrenyi, the new chief of healthcare services, will be the designated czar that the judge called for in his order and will work directly with the governor’s office on reforms, Soderlund said.

About the time Schwarzenegger was appointing the medical officials in Sacramento, Henderson, who sits on the federal bench in San Francisco, was holding a hearing with lawyers in the case. The veteran jurist said he was “taking the gloves off” because of what he perceived as a “no can do” attitude among those in charge of tackling the healthcare crisis.

The judge said it was unacceptable that preventable deaths continued in the 168,000-inmate system. He also told Schwarzenegger he should find money for emergency fixes “the same way you find the money to build a tent to smoke cigars” in the Capitol. The governor, a cigar lover, occasionally lights up in a tent outside his office because state law forbids smoking in public buildings.


The federal hearing was called to address a court expert’s report that said the $1.1-billion prison medical system was in “meltdown,” with doctors quitting in part because of a new requirement that they undergo a competency test they consider unfair.

As a result, several prisons now operate with a physician vacancy rate of 50% or higher -- not accounting for doctors who are incompetent and need to be replaced, the report said. At Pleasant Valley State Prison in Coalinga, there is one staff doctor for about 6,000 inmates.

In June, Henderson took an extraordinary step: deciding to put prison medical care in the hands of a federal receiver. But finding a person with the background and qualifications to manage the system has proved difficult, and the judge recently called in a professional search firm to recommend candidates, a process likely to extend into next year.

In the interim, Henderson appointed court expert John Hagar to identify the most urgent problems and suggest immediate measures to help save lives.

Thursday’s order directs the state to carry out Hagar’s recommendations. Chief among them is raising the salaries of doctors and nurses to help with recruitment and retention. Under the order, a prison physician’s pay will rise 10% to about $150,000 a year -- below market rate but attractive when coupled with the state’s generous benefits package.

Nurses will receive raises of 18%, while the pay of medical directors and clinical supervisors also will jump to encourage doctors to pursue important management jobs.


“This is a terrific step in the right direction and should make a major dent in stopping the loss of doctors from the system,” said Gary Robinson of the American Union of Physicians and Dentists, which represents about 600 medical providers in state prisons.

The order also mandates that the state streamline the hiring process for physicians and nurses. That process now takes months, because of regulations that slow the pace of security and credential checks.

In addition, the order requires managers to give a list of staff physicians notification of every opening. Many applicants get tired of waiting and accept other jobs, Robinson said.

Henderson wants all candidates to be assessed -- and either accepted or rejected -- within 10 days of submitting a written application.

While pledging the department’s intention to comply with the order, corrections officials said meeting that 10-day mandate would be challenging.

General Counsel Bruce Slavin said it often takes longer than that to conduct a thorough background check, conduct follow-up interviews and ensure that the provider is well-suited to working in a prison environment.


“But setting aside the difficulty of making good hiring decisions in 10 days, we intend to comply with the order,” he said.

Henderson’s order doesn’t mention the possibility of contempt charges, but lawyers said his language opens that door because it requires the governor to personally name someone who can be held accountable.