State Urged to Act on Prison Healthcare

California inmates will continue to die from neglect and incompetence unless the state immediately raises doctors’ salaries and takes other steps to recruit and retain prison medical workers, a report to a federal judge concluded Monday.

The report also suggested that leaders of the state’s foundering correctional healthcare system are incapable of reversing the “meltdown” and said Gov. Arnold Schwarzenegger must appoint a strike team to do the job.

Without such high-level attention -- along with a series of court orders mandating changes -- the state’s prison healthcare system “may simply collapse,” said the report by correctional expert John Hagar.

“It’s too late for business as usual,” Hagar warned.

His 33-page report sums up what inmates and their advocates have been saying for weeks: Conditions have worsened since U.S. District Judge Thelton Henderson, describing a system plagued by “an unconscionable degree of suffering and death,” decided to put prison medical care in the hands of a receiver.

Since that unusual June 30 decision, efforts to find someone qualified to run a $1.1-billion healthcare bureaucracy that serves 165,000 prisoners and employs 6,000 people have failed.

Recognizing the extraordinary challenges posed by the job, Henderson brought in a professional search firm, Korn/Ferry International, to find and recommend candidates, a process that will extend into next year.

To address problems in the interim, he appointed Hagar to identify the most urgent problems and suggest immediate measures to help save lives.

On Monday, Hagar said vacancies among medical staff had worsened in recent months, in part because as many as 60 doctors had left in disgust after the state began requiring that they undergo performance evaluations at UC San Diego Medical Center. The doctors contended the testing was unfair because it lacked objective standards with which to assess performance.

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, Hagar said. At Pleasant Valley State Prison, off Interstate 5 in Coalinga, there is one staff doctor for about 6,000 inmates.

During a series of hearings held by Henderson over the summer, experts cited inadequate staffing as one important cause of preventable deaths in California prisons, where an ill inmate dies once a week, on average.

“It’s just mind-boggling that the state knowingly operates a facility with 6,000 prisoners and one doctor,” said Donald Specter of the Prison Law Office, a nonprofit firm that sued the state over inmate medical care. “Prisoners are dying because they simply can’t get treatment for their illnesses.”

With many prisons located in remote locations, the Department of Corrections and Rehabilitation has for years struggled with recruiting and retaining qualified physicians and nurses.

To combat the staffing problem, Hagar said, the state must offer substantial salary increases, raising the pay of doctors to at least $150,000 annually. Though that falls below market rate for California physicians, state doctors receive a generous benefit and retirement package.

Hagar also recommends streamlining the hiring process for physicians and nurses, which now can take as long as six months because of regulations that slow the pace of security and credential checks, and require managers to give a list of staff physicians notification of every opening.

Calling the hiring procedure “completely broken,” Hagar recommends that candidates be assessed -- and either accepted or rejected -- within 10 days of submitting a written application.

“That’s terrific news,” said Gary Robinson, executive director of the Union of American Physicians and Dentists, which represents doctors at state prisons. “The way it is now, the department keeps applicants hanging for months. The good ones get tired of waiting and take another job.”

To retain doctors, Hagar recommends that the department create an orientation program to smooth their transition into prison medicine. He said newcomers should be closely supervised and mentored.

In a statement, Corrections Secretary Roderick Q. Hickman said Hagar was essentially recommending what department officials had sought to do months ago -- bring in outside experts to help them resolve the healthcare crisis.

“Had the legislators let us move forward last April with our plan to bring in outside consultants,” he said, officials “would have saved the taxpayers millions of dollars and accelerated the resolution of this long-standing departmental shortfall.”