A federal judge said Thursday that he would seize control of prison healthcare from the state and place it under a receiver, declaring that "extreme measures" were needed to fix a system that kills one inmate each week through medical incompetence or neglect.
U.S. District Judge Thelton Henderson said that despite repeated warnings from his court and the "good intentions" of some state officials, the Department of Corrections continues to allow sick prisoners to die "for no acceptable reason." The judge said he would soon issue a written order outlining details of the receivership and begin discussing potential receivers with lawyers in the case.
Attorneys on both sides called the decision historic, saying they believed it marks the first time in the nation that a government operation the size of California's prison medical care system is to be placed under a federal receiver.
In 1995 the District of Columbia's jails were assigned to a receiver for five years. That system has 1,700 inmates. The California Department of Corrections' healthcare network serves more than 163,000 prisoners, employs 6,000 workers and has an annual budget of $1.1 billion.
Henderson, in a quietly passionate 25-minute speech from the bench, said "horrifying details" presented in a series of hearings he convened over the last month had filled him with a sense of urgency.
He said he believed "nothing short of a receiver" could halt the deaths and other harm inflicted on California convicts who fall ill.
The judge said he was especially alarmed by the "uncontested statistic," provided by a court-appointed expert, "that a prisoner needlessly dies an average of roughly once a week."
Henderson said that anyone "would have to be shocked, as I certainly was," by that fact.
By putting the system in receivership, Henderson effectively shifts power for all decisions related to inmate care -- from how many nurses should work a given shift to when a cancer patient receives treatment at a community hospital -- to the federal court.
The receiver, who will report directly to the judge, will be empowered to order fixes now delayed or thwarted by Civil Service rules, collective bargaining agreements and bureaucratic red tape, lawyers said.
Attorneys said they could not speculate how long the receivership might last or what it would cost. Henderson said it would certainly be a "multiyear effort."
Bruce Slavin, who as general counsel for the Youth and Adult Correctional Agency is the top lawyer for the state's $7-billion correctional system, said "it will not be cheap." But he expressed hope that under a receiver, there would be better management of healthcare spending.
Margita Thompson, spokeswoman for Gov. Arnold Schwarzenegger, said the administration would cooperate with a receiver.
"We look forward to working with the receiver to create a sustainable healthcare system," she said.
Adult prisons are not the only piece of California's correctional system receiving outside oversight. The California Youth Authority, which houses about 3,000 of the state's most troubled juvenile offenders, is under the supervision of a special master, who monitors compliance with court-ordered improvements in inmate medical care, mental healthcare, education and other areas.
State Sen. Gloria Romero (D-Los Angeles), chairwoman of an oversight committee on corrections, attended the hearing and applauded the judge's decision.
"This is the right thing to do, the only thing to do," Romero said.
"We invest $1.1 billion in this [healthcare] system every year," she added, "and it's incredible to me that we don't get better results."
An attorney for the inmate plaintiffs, who claimed in a 2001 class-action lawsuit that prison healthcare amounted to unconstitutionally cruel and unusual punishment, called Henderson's ruling "everything we asked for" and a beacon of hope for his clients.
"As the judge said ... the magnitude of the suffering could not be ignored," said Donald Specter, director of the Prison Law Office, a nonprofit firm taking the lead role in the case.
Corrections officials did not oppose appointing a receiver, though they described it in legal briefs as "a highly intrusive remedy" that should be a last resort. Slavin said Thursday that the department had recently made progress in firing incompetent doctors, hiring nurses and addressing other woes.
"The question of fixing healthcare is not one of whether but when," he said. "The administration has always been committed to getting it fixed. This [receivership] speeds it up."
Henderson's ruling was based on testimony from court-appointed experts who have been inspecting prison medical facilities as part of the lawsuit.
The case was settled in 2002, when the state agreed to overhaul inmate healthcare and phase in improvements by 2008.
Among the changes mandated by the settlement were the creation of a triage system to identify the sickest inmates and ensure they did not wait long to see a doctor and a program allowing prisoners with chronic conditions to be more carefully monitored.
The experts found few signs of progress and provided the court with chilling examples illustrating filthy conditions, ill-trained and neglectful doctors and a pattern of preventable deaths that one expert called "macabre" and unlike anything he had ever seen before.
The expert, correctional healthcare authority Dr. Michael Puisis, said medical treatment amounted to "almost anarchy" at some prisons, where disorganized or missing patient records mean that "medical providers are reduced to guessing or repeating tests and treatment already done."
Puisis, editor of a textbook on medical care in prisons, said inmates needing diagnostic tests faced extreme delays that imperiled their lives. Such delays could be caused by transportation snafus, scheduling errors, prison emergencies and a variety of other circumstances.
In one instance, a patient at Pleasant Valley State Prison near Bakersfield who needed a colonoscopy waited nearly a year and then could not undergo the test because his "mass was so large, the scope could not be passed through," according to a written summary of Puisis' testimony.
He also cited the case of an inmate at Salinas Valley State Prison who had suffered a neck injury in a fight and could not move his legs. After sticking needles in his legs, "the doctor said the patient was faking and moved his head from side to side."
The inmate is now paralyzed, and it is unclear whether the paralysis resulted from the fight or the doctor's inappropriate actions, according to a summary of Puisis' testimony in a legal brief.
In appointing a receiver, Henderson acknowledged that he was taking "perhaps the most extreme measure available" to him.
But, he added, "this court has tried to use lesser measures, and all agree that those lesser measures have failed."
A receiver still must be selected -- someone with a blend of financial, correctional and medical experience suitable for the massive job.
The judge underscored this point by remarking that the perfect candidate would be someone who has operated Kaiser Permanente and "also has an MBA from Stanford or Cal and is a former warden."
Specter has asked the judge to name a temporary receiver while a search is made for a permanent one. State officials oppose an interim receiver, saying the right person can be hired within a few months.
Henderson said he is inclined to appoint a temporary receiver, because lives are at stake.