Healthcare in Prisons ‘Shocking’

A federal judge took a major step Tuesday toward seizing control of California’s prison healthcare system, concluding that state inmates are needlessly dying and state officials cannot stop it on their own.

U.S. District Judge Thelton Henderson of San Francisco said he may be compelled to appoint “an interim receiver” to manage the California Department of Corrections healthcare delivery system. He called on Gov. Arnold Schwarzenegger’s administration to appear for a July 11 hearing to present any arguments against such a plan.

“The problem of a highly dysfunctional, largely decrepit, overly bureaucratic and politically driven system, which these defendants have inherited from past administrations, is too far gone to be corrected by conventional methods,” Henderson wrote in a 19-page order.

The order comes three years after California prison officials settled a class action lawsuit over inmate care by agreeing to make ambitious improvements. Despite that agreement, Henderson concluded -- and state corrections officials acknowledged recently -- the prison healthcare system continues to put convicts’ lives in danger.

Federal law requires that states provide healthcare to prisoners, Henderson noted, adding that “when prisoners are dying due to the neglect or incompetence of doctors and other medical staff employed by the state ... there can be no doubt but that the Constitution is being violated.” The state proposes to spend $6.5 billion on the adult prison system in the coming year, including $1.09 billion on healthcare for its roughly 163,000 prisoners.

Henderson referred to a “shocking” report given to him in February detailing “widespread evidence of medical malpractice and neglect” in the prison system.

Court-appointed experts found that 34 of 193 prison deaths in recent years were “highly problematic.” The findings might have been worse except that records for several of the deceased inmates could not be found.

Their findings were discussed last month at a state Senate hearing. Instead of defending the operation, Corrections Undersecretary Kevin Carruth told lawmakers that nothing in the report was overstated. Carruth also said officials have all but abandoned hope of providing healthcare on their own and instead planned to contract with private managed-care companies.

State officials traditionally bristle at the prospect of federal court intervention. But on Tuesday, J.P. Tremblay, spokesman for the prison system, would not comment on whether a receiver might be the solution needed.

“We acknowledge that there are some issues that we need to deal with, and we are trying,” Tremblay said, adding that whether appointing a receiver would be the best approach is “the decision of the court.”

Prisoner rights attorneys have been suing the state alleging inadequate healthcare for years.

And even though the lawyers’ efforts have forced the state to improve aspects of medical care, problems have persisted.

Although a decision by Henderson to invoke his power to appoint a receiver would be unusual, a few judges have taken such steps. Henderson noted that heathcare in the Washington, D.C., jail system, for example, came under court oversight.

If he appoints a receiver, Henderson wrote, that person’s duties would be limited to healthcare; prison officials would retain power over nonmedical aspects of prison life. The judge said any receivership would end as soon as he concludes that the state is willing and able to maintain an adequate inmate healthcare system.

At the same time, a receiver could have broad authority. Attorney Donald Specter of the Prison Law Office near San Quentin State Prison, which brought the suit, said a receiver could force the state to raise the pay of prison nurses to help fill vacancies. A receiver also could fire incompetent doctors and nurses, something that is difficult given civil service protection.

“There is no other effective alternative,” said Specter, arguing for a receiver. “The state ... is utterly and completely incapable of taking the steps necessary.”

Henderson issued his order the same day that Schwarzenegger, appearing at Folsom State Prison east of Sacramento, signed legislation that is part of his plan to overhaul the Youth and Adult Correctional Agency and create a Department of Corrections and Rehabilitation.

Although critics have maligned the governor’s prison reorganization plan as a mere rearranging of titles and offices, Schwarzenegger said the move would give “our corrections system the structure to be more effective and accountable to the people.”

The change also would mean prisons would put greater emphasis on helping inmates succeed after release. Officials plan to identify programs that have reduced recidivism in other states and launch them in California.

In a statement, state Sen. Gloria Romero (D-Los Angeles), who has been holding prison oversight hearings, said she welcomed “Henderson’s call for a federal receiver to oversee inmate healthcare.” Romero said “drastic measures are necessary to address the broken healthcare system.”

In his order, Henderson said the “most notable characteristic of this case has been defendants’ failure to achieve any substantial progress in bringing the medical care system even close to minimal constitutional standards.”

Among the troubling aspects, the judge said, was an “emerging pattern of inadequate and seriously deficient physician quality.” The union representing the doctors has sued to block steps the administration says would improve the quality of its members and remove those who are incompetent.

Henderson took it upon himself to tour San Quentin State Prison in February and found it “horrifying.” In an examination room where 100 men a day are screened, the judge wrote, there was no way to ensure sanitary conditions because there was no sink. He also reported seeing a dentist examine numerous prisoners without washing his hands or changing gloves between patients.

While acknowledging that the administration has tried to make improvements, Henderson also said the state “fails to exhibit the force of will necessary to tackle the problem,” pointing out that prison officials say many of the changes cannot be undertaken without more funding.