Outspoken, Abrupt but Effective

If there is a job in healthcare that’s trickier than the one Bob Sillen is about to begin, it’s probably one he’s already had.

As a young public health officer for the federal government in the 1960s, Sillen’s task was to persuade syphilis patients in Harlem to reveal the names of their sexual partners -- then track the partners down in the streets and draw their blood.

“We were trying to break the chain of infection, and it was quite an adventure,” Sillen recalled in a recent interview. “My charming personality worked with some of the patients ... but not all of them.”

Forty years later, Sillen’s talents are about to be tested in a different, but no less daunting, arena: behind the bars of California’s prisons.

After a nationwide search, Sillen was chosen last week as a federal receiver charged with fixing the medical care crisis gripping the state’s 33 adult lockups. In a Feb. 14 order, U.S. District Judge Thelton Henderson announced Sillen’s appointment and gave him broad powers to raise healthcare for the state’s 168,000 inmates to “constitutionally adequate” standards.

Sillen, 63, will report directly to Henderson and have free rein to hire, fire, spend and generally bring order and quality to a $1.2-billion system that one medical expert has described as near anarchy. Sillen will take over April 17.

The stakes are high and the challenge huge. Last summer, inspectors testifying before Henderson said that at least one inmate died each week from medical neglect or incompetence.

Those who know Sillen say he’s a perfect match for the job, which will pay him $650,000 annually.

They say the man who currently runs Santa Clara County’s sprawling public hospital and health department is just obnoxious enough to blast through the barriers -- political, bureaucratic and economic -- blocking the path to success.

Most mean that as a compliment.

“There are some tough nuts to crack in that prison system, and Bob’s definitely got the nutcracker,” said Larry Gage, president of the National Assn. of Public Hospitals in Washington.

What Sillen also has, friends and colleagues say, is an innate drive to help those at the bottom of the heap.

The son of political lefties, as he called his parents, Sillen was raised in a small town outside New York City and was steeped from boyhood in the importance of “social justice” and “high value” work.

After receiving a bachelor’s degree in sociology, he contemplated a job in advertising before signing on with the U.S. Public Health Service. Before long, he was on the front lines of the battle against venereal disease, based in a clinic in Harlem.

In addition to interviewing syphilis patients, he was required to do fieldwork: on sidewalks, inside drug addicts’ apartments, wherever the potentially infected lurked. It was a time of intense urban unrest, and his clients were not always happy to see him.

“I loved it,” recalled Sillen, now a bespectacled, gray-haired, divorced father of two grown children. “I was saving the world.”

After receiving a master’s degree in public health from Yale University, Sillen joined the ranks of hospital administration -- first in New York, then as associate director at UC San Diego Medical Center, where he spent seven years.

In the late 1970s, an opening at Santa Clara County’s Valley Medical Center -- a struggling public hospital in Northern California -- caught his eye. He got the job, and a heaping plate of problems.

Beset by fiscal distress, the hospital also suffered from a bloated staff, anemic patient flow and political meddling. Sillen quickly established credibility by trimming a $6-million budget deficit to $500,000 in eight months.

Then he launched a turnaround that has made the medical center one of the most respected, and financially solvent, public hospitals in the country, industry experts said. While Sillen’s heart was in providing care for the poor and uninsured, his head drove him to create specialty units -- for burn victims and spinal cord injuries, for example -- that brought in paying patients, too.

In 1993, the county’s Board of Supervisors rewarded Sillen by expanding his domain to include the Public Health Department. He also oversaw drug and alcohol programs, mental health services and medical care in the jails and juvenile halls.

County Supervisor Liz Kniss, who has tangled with Sillen repeatedly over spending, said he succeeded by “cajoling and threatening and basically doing whatever it took to win support for his crusade to help the underserved.”

Though she admires his tenacity and zeal, Kniss did not always enjoy run-ins with Sillen: “I don’t think he thought he needed any oversight at all. I think Bob felt we [supervisors] were all sort of in the way.”

Others agreed that throughout his tenure, Sillen has displayed what might charitably be called an outspoken, abrupt style.

“Some bristle, but I appreciate his strong-willed nature and find it persuasive, because he’s so passionate about what he does,” said LaDoris Cordell, special counsel to the Stanford University president and a former judge who often watched Sillen in action. “With Bob, the mission is everything. He doesn’t play games.”

Others said Sillen’s aggressiveness is leavened by an oft-displayed wit. One year at the hospital’s Halloween party, he showed up dressed like a nun. Another time, when the county supervisors were discussing construction of a psychiatric facility, he told them he’d like a bed there himself.

That funny bone will no doubt come in handy as Sillen confronts the minefields scattered before him as prison healthcare czar. Potential obstacles include the Legislature, labor unions and the budget realities of California.

But Sillen considers the job his last hurrah, and one longtime acquaintance predicted that he would be fearless.

“Bob will do this job in a way to benefit inmates, not himself,” said Mark Collins, who led the search for a receiver by the headhunting firm Korn/Ferry International. “This is not a play for Bob to fluff his feathers, to get rich and retire.”

Sillen said he wasn’t looking for a new job but views the receivership as a perfect career capper.

“I’m not naive about the difficulties, and it’s a monster challenge,” he said. “But monster challenges can be overcome.”