Overhaul Sought in Inmates’ Medicine

The pharmacies in California prisons are so poorly run and dangerous to inmates’ health that they must be seized from the state and placed under private management, the federal receiver in charge of prison healthcare told a judge here Wednesday.

U.S. District Judge Thelton Henderson seemed more than ready to take such a step and welcomed a second proposal aired at a morning hearing -- that he double the pay of prison pharmacists and dramatically increase salaries for other prison healthcare employees.

“It is time for action, and action you will take,” Henderson told Robert Sillen, the receiver, after auditors described a chaotic pharmacy operation that has harmed inmates and squandered millions of taxpayer dollars.

On a related issue, Sillen said he is calling on Gov. Arnold Schwarzenegger and legislators to build hospitals for inmates, instead of the two new prisons the governor has proposed to ease severe overcrowding behind bars. Shifting incapacitated, terminally ill and other sick inmates to hospital beds would thin the incarcerated population, Sillen said in a letter outlining his proposal, and ensure that ailing prisoners get the care they are not getting now.

“Why spend the money twice?” said Sillen, who assumed his post in April. “The receivership plans to fill the need for medical facilities regardless” of whether the state decides to collaborate.

Sillen said he would discuss his hospital proposal for at least 1,200 beds at three facilities in the state next week with Schwarzenegger, Assembly Speaker Fabian Nunez (D-Los Angeles) and Senate leader Don Perata (D-Oakland).

Schwarzenegger’s communications director, Adam Mendelsohn, said the governor welcomed the chance to talk as the special session he called on corrections, scheduled for next month, approaches.

“The governor called the special session because there needs to be a serious dialogue about what changes need to occur in the prison system,” Mendelsohn said. “It’s the governor’s belief that we must address overcrowding, and there are a variety of alternatives ... which deserve discussion.”

As for Sillen’s proposal to hire a private firm to manage prison pharmacies, a lawyer for the state said the Schwarzenegger administration backs the idea. He said state officials would help Sillen expedite the contracting process, which normally takes from four to seven months.

At the hearing, auditors who studied the pharmacy operation presented their findings to Henderson, who appointed Sillen to run prison healthcare after concluding the state was incapable of fixing it.

Pharmacies were an early focus of the receivership, Sillen said, because medications are expensive and, if improperly dispensed, can be harmful to inmates.

In addition, four previous audits had highlighted serious problems -- and had been all but ignored by the state, Sillen said.

Overall, the auditors said they found a disorganized, poorly supervised system that put patients at great risk of medical error and wasted tens of millions of dollars.

Analyzing purchasing data from last year, for example, the auditors concluded that nearly a third of the medications the state bought for inmates were never recorded as dispensed or accounted for in any way -- a disparity they called shocking.

The team also found that California pays four times more for pharmaceuticals than two equivalent correctional systems: Texas’ system and the federal Bureau of Prisons. That means that California’s prison drug costs were as much as $80 million higher last year than costs at those systems.

Although hiring a private management team will cost money up front -- Sillen could not estimate how much -- he said it would save vast sums in the long run by improving inventory control and other deficiencies.

The same is true, he said, of the salary increases for the state’s 56 prison pharmacists, who now earn from $60,708 to $126,240 annually -- about half what they could earn in the private sector, Sillen said. The low pay is one reason the prisons are struggling with a 43% vacancy rate for pharmacists, Sillen said. To compensate for the vacancies, the state has relied heavily on private firms that supply contract pharmacists at higher rates -- and also collect a fee.

“The bottom line is that all clinical staff in the prisons are grossly underpaid,” Sillen said, “and we’re going to fix that.”

Attorneys representing state prisoners, whose class-action lawsuit over healthcare led to the receivership, applauded the plan.

“The state has 170,000 prisoners to care for, and they just have not been able to compete in the market for scarce healthcare providers,” said Donald Specter of the nonprofit Prison Law Office. “If the state is going to imprison that many people, it’s going to have pay very dearly to meet constitutional standards for healthcare.”

Sillen told Henderson he would return within one month with a proposed pharmacy management contract and an outline of salary increases.

The judge, noting that it boggled his mind that California incurred $80 million in unnecessary pharmaceutical costs last year, said he would “act as forcefully as the judicial branch can act” to remedy the problem.