The federal receiver assigned to fix healthcare in California prisons said Wednesday that the problems are far worse than he thought, with nearly every piece of the system either not working or in an "abject state of disrepair."
Receiver Bob Sillen said in a report that a federal judge probably will need to step in and suspend state laws, contracts and regulations that are hindering progress.
Sillen also launched a turnaround project at San Quentin, vowing to bring improved inmate care and a sense of hope to the prison's "clinical trenches" within 90 days.
Of all the state's 33 prisons, the decrepit lockup north of San Francisco has received the most attention, with experts finding widespread evidence of malpractice and neglect -- and proof that inmates suffered not just from incompetence but also from cruelty at the hands of some doctors.
Medical experts who reviewed 10 deaths at San Quentin in recent years found that most were preventable.
The prison, Sillen said, is an ideal laboratory to test possible remedies that could lift healthcare throughout the prison system to constitutional standards.
"If we can do it there," he said, "we can do it anywhere."
Sillen, who is paid $650,000 a year, began his open-ended term in April, and the report marked his first public assessment of the crisis -- as well as the first clues to his game plan.
The report is the first of a series he will produce for U.S. District Judge Thelton Henderson, who seized control of the state's $1.4-billion prison healthcare operation and put the receiver in charge.
Henderson, who presides over an ongoing lawsuit over inmate care, said he was compelled to act because an average of one state prisoner a week was dying through medical incompetence or neglect. The move marked the first time in the nation that a government operation the size of prison healthcare has been put under a federal receiver.
One legislator who has been critical of prison operations called Sillen's report "ominous" and evidence that he clearly "means business."
"There's a new sheriff in town," said state Sen. Gloria Romero (D-Los Angeles), "and it's the receiver."
Over the last two months, Sillen said in the report, he visited five prisons and met with dozens of doctors, union leaders, guards, wardens and inmates.
He also talked with Republican Gov. Arnold Schwarzenegger. Sillen said in an interview that the governor offered an open door and full support.
In addition, Sillen said he read thousands of pages of documents, including inmate medical charts, internal investigation papers, budgets and reports from experts hired by the courts.
His conclusion: "The problem is much worse and more complex than anyone originally thought."
From the pharmacies to medical records, supplies and training to chronic disease care and information technology, the system that serves more than 170,000 inmates is wasteful, dysfunctional, dangerous and will defy any quick fix, his report said.
Aside from harming inmates in violation of their constitutional rights, the system squanders taxpayer dollars, he said. In one case he cited, officials at San Quentin ordered expensive diagnostic imaging equipment four years ago but have yet to unpack it because it was too heavy for the exam room.
And according to an audit Sillen released, the prison pharmacies are bedeviled by problems with procurement, inventory control and distribution, all of which endanger inmates and waste money. In 2005, the audit said, California's prison drug costs were as much as $80 million higher than those for a comparably sized correctional system.
Exacerbating the problems, Sillen said, is severe overcrowding in the prisons, most of which are at twice their intended capacity, and management turmoil in the Department of Corrections and Rehabilitation. He noted that since his appointment, he has dealt with three corrections chiefs -- two of whom resigned their posts in frustration -- as well as continual turnover in the warden ranks.
Given the instability, demoralization and "ineffectiveness of the department in its custody and medical care responsibilities," Sillen said, he might ask the judge to strip healthcare from the department altogether and make it a separate operation.
Elaine Jennings, a department spokeswoman, declined to comment on Sillen's suggestion that healthcare might need to be removed from the corrections umbrella. But she said officials were "committed to working with the receiver to meet the goals he has laid out.
"Everyone concedes that there are problems, and we know the receiver has been sent in to make major changes," Jennings said. "We will help him accomplish that."
Sillen said that of all the roadblocks to improvement he had spotted so far, one stood out: the web of labor contracts, laws, regulations and procedures that govern hiring, budgetary and countless other decisions made in prisons. Such regulations, he said, make it nearly impossible to do anything in a timely manner, from hiring a nurse to obtaining a new supply of bandages.
They also waste money. In 2003, for instance, a prison in Corcoran decided to contract for in-prison dialysis treatment to avoid the expense of sending inmates into the community for care. But because of rules that caused delays in the contracting process and other hitches, nothing happened.
Now, officials must figure out how to dispose of 16,000 syringes that were purchased for the in-prison dialysis but have become outdated, Sillen said.
To combat such roadblocks, the receiver said he would probably ask the judge to suspend rules, contracts and regulations that get in the way. Some are within the corrections agency, but many involve the hiring and contracting authority of other state departments, such as finance and general services.
"There's always someone in some other agency who impinges on something you're trying to get done," Sillen said in the interview, describing his incredulity at the bureaucratic logjams he has encountered. "It's an outrageous way to try to conduct business."
At San Quentin, Sillen's team will focus on 17 areas of medical care, including medical records, staffing, equipment and patient complaints.
Though acknowledging that he would not be able to cure all that ails San Quentin in just three months, Sillen promised to quickly improve care and breathe new life into a culture of low expectations.
Another early priority, Sillen said, will be the raising of salaries for doctors and nurses, which have lagged far below market, creating severe shortages. That in turn has led to a heavy reliance on contract providers, who are paid an hourly rate far in excess of what state employees earn.
As a result, the cost of contract healthcare has increased from $153 million in 2000-01, to $821 million in 2005-06.
At the Prison Law Office, the nonprofit firm that sued the state over the quality of inmate care, attorney Steve Fama mostly applauded the receiver's goals but said he hoped the focus on San Quentin wouldn't delay help for inmates elsewhere.