Prison medical reform plan is released

Times Staff Writers

The federal receiver hired to improve healthcare for state prisoners released an ambitious turnaround plan Thursday, prompting some critics to warn of exorbitant costs and others to lament the sluggish pace of reform.

The 50-page plan “will eliminate the unconscionable human suffering” in prison and protect California communities from diseases carried by inmates cycling in and out, receiver Robert Sillen said in filing the document with the federal court here.

Over time, he said, taxpayers will get more for their dollar from a system that experts said was so broken that it experienced an average of one inmate death per week as a result of medical incompetence or neglect.


“Good care is less costly than bad care,” said Sillen, who has predicted it will take as long as 20 years before the sprawling medical operation is fixed and handed back to the state.

Sillen, 64, was appointed by U.S. District Judge Thelton Henderson after Henderson concluded the state was incapable of fixing prison medical care on its own. He has been on the job a year and earns an annual salary and compensation package totaling $650,000.

Lawyers for inmates initially hailed his appointment as a prescription for a $1-billion-plus medical care system that they said was understaffed, riddled with incompetent doctors and plagued by an absence of standards and a shortage of basic supplies, such as bandages and hand soap.

Now, however, they say their hope is tempered by frustration that Sillen has not moved faster on problems directly affecting inmate care.

Attorney Steve Fama of the nonprofit Prison Law Office, whose civil rights suit led to Sillen’s appointment, said that a year ago he gave the receiver a list of seven prisons with the most severe medical crises. One was San Quentin, where Sillen established a pilot program for improving care. Another was Avenal, near Coalinga in the San Joaquin Valley, where three inmates died in December.

In response to the deaths, Sillen sent a team of doctors and created more than 50 new medical positions at the severely overcrowded prison.


“That action is terrific,” Fama said. “I just wish it had been done months before that, given his authority and his mission as defined by the judge.”

Sillen also has taken his lumps in the Legislature. Some lawmakers are chafing at his blunt style, while others are furious over the prospect of spending billions on inmate healthcare with no legislative control.

In one episode, Sillen sparked substantial grumbling when he vowed to send U.S. marshals to the state treasury and seize whatever funds he needed to lift inmate care to constitutional standards.

“It’s obvious the delivery of care needs to improve,” said Assemblyman Todd Spitzer (R-Orange). “But he has made it clear he has no real interest in our branch of government, and we’d prefer to be treated as an active partner.”

But Sen. Gloria Romero (D-Los Angeles) said she welcomed “the new sheriff in town.”

“Some criticize him and say he’s too arrogant, that he runs over us,” Romero said. “I say: Get over it.”

Whatever their thrust, the appraisals of others appear to have little effect on Sillen, who stirred plenty of anger during his years as chief of Santa Clara County’s public health and hospital system. He said his job is not one for “a wallflower or someone lacking intestinal fortitude.”


“It’s the receiver’s job to operate this system, and I suppose it’s not surprising that there’s a lot of resentment, especially by elected officials who are used to being able to control everybody they come in contact with,” Sillen said.

As for complaints about the speed of improvements, Sillen defended his first-year record, saying the receivership is “exactly where we need to be.”

“This cannot be done quickly,” he said. “It’s far too big, far too complex, so people are going to have to be patient.”

He also warned of significant barriers to success, including the chaotic state of the corrections department, a “prison culture that devalues inmates,” poor working conditions, punishing physical environments, resistance from “entrenched interests that do not want the change to occur” and overcrowding.

Despite such obstacles, Sillen expressed confidence that his new action plan would help him build a standardized, quality system focused on reducing preventable deaths and improving access to care for roughly 172,000 state prisoners.

The plan spells out a broad range of changes, including the creation of SWAT teams to respond to medical crises, specialized care for elderly inmates, the use of medical scorecards for each prison and an initiative on pain management.


It also includes some unique incentives designed to attack one of the system’s biggest problems: the recruitment and retention of doctors. To lure talented physicians, Sillen wants to pay off their medical school loans and deploy an “air force” of chartered planes to fly urban practitioners to remote prisons several days a week.

That approach follows Sillen’s move in the last year to increase salaries for doctors and other healthcare workers, an effort to boost hiring and reduce the state’s reliance on expensive contractors.

Gary Robinson, executive director of the Union of American Physicians and Dentists, said Sillen increased salaries for 300 primary care physicians at the prisons from about $157,000 to $180,000 to $200,000. The boost, he said, was enough to retain many doctors but not enough to attract many new ones.

“There still is a 40% vacancy rate,” Robinson said. “You cannot provide good care when 40% of the physicians’ positions are not filled.”

Sillen’s plan did not include a cost estimate, but he has made it clear in public comments that he will spend whatever is necessary to raise care to the constitutional standard ordered by the court.

Legislative analysts estimate that his proposals will cost more than $3 billion over the next five years. This year, he has spent about $53 million of a $100-million discretionary fund. The prison-building and reform package signed by Gov. Arnold Schwarzenegger last week includes $1.1 billion to create 8,000 medical beds throughout the system.


Sen. Mike Machado (D-Linden), chairman of a budget subcommittee over corrections, warned taxpayers to brace for a high price tag.

“He is essentially putting in a medical system for a city of 180,000 spread between Oregon and the Mexican border, the Bay Area and the high desert,” Machado said. “And so there are some big challenges there.”

Assembly Republican leader Mike Villines said it was irresponsible of Sillen to omit a cost estimate from his plan.

“This comes from someone who is unaccountable,” Villines said, “and you would literally have to print money to keep up with the cost of what he wants to do.”



Federal receiver’s plan for change

Highlights of a plan released Thursday by the court-appointed receiver responsible for fixing California’s troubled prison healthcare system:


* Chartered planes to transport urban doctors to remote prisons several days a week.

* Intensified program to recruit, hire, train and retain essential medical staff, including state payment of medical school loans.

* Electronic patient records.

* Improved long-term care for aging and disabled inmates.

* Public health office to reduce risk of communicable diseases posed by inmates leaving prison.

* “SWAT teams” of medical staff deployed to prisons in event of medical crises or unusual inmate deaths.

* Expedited hiring of clinical staff.

* Increased use of technology such as video-conferencing.


Source: Report of receiver Robert Sillen

Los Angeles Times