Medical Neglect Articles



Thomas D. Elias: Readers expose government waste
By Thomas D. Elias
February 3, 2009 - 1:02AM

Hey, Gov. Schwarzenegger, you say you want to root out big-time government waste to solve budget problems? Well, listen up. You'll be amazed at how much regular folks know about this and how they'll expose it with only the slightest encouragement.

Here's what happened when this column revealed a single type of wasteful government negligence: Dozens of readers responded with examples big-time squandered tax dollars.

J. Clark Kelso, the court-appointed chief of medical care in California prisons, estimated here last month that the prison system throws away at least $100 million a year because officials refused for decades to negotiate low rates with hospitals, as every insurance company does.

Readers followed with scores of tales of related waste, many of them accurate. This suggests legislators and the governor might get results if they'd only consult rank-and-file citizens in their alleged search for waste.

"I have nursed countless inmates and observed millions of dollars in excessive expenses," e-mailed an intensive care nurse at a non-prison hospital in Vacaville. "Of course, the physicians order every test in the book for the inmates...

"In many cases, the inmate is either temporarily or permanently incapacitated. I have seen brain dead inmates with two officers watching them around the clock; often on overtime..."

Dr. Terry Hill, chief medical officer for California Prison Health Care, confirmed the nurse's observations. "The rules of the California Department of Corrections and Rehabilitation require that where a prisoner is considered a risk to public safety (because of his crime), there be two guards at all times when the inmate is not in a prison facility," he said. "The rules are inflexible. I would confirm the nurse's statement."

When it comes to excessive blood tests and diagnostic scans, Hill also confirms waste. In this case, it's because convicts often sue doctors. "We have some physicians who have been sued by inmates 100 times or more," he reported. "Some of those complaints are valid; very many are very frivolous. One doctor got sued because he didn't give an inmate long underwear. So the doctors are very defensive."

A solid set of rules from the prison system could solve this problem by spelling out just what tests should be used in various circumstances. Do this, and prisoners would have to sue the state, leaving doctors to do their jobs less defensively and saving big bucks on tests.

Total cost of these forms of waste? There are no firm figures, but Hill estimates it's at least in the millions of dollars, perhaps tens of millions.

From Pam Hurt, head of Robinson Textiles, a Gardena-based firm that is America's second-largest provider of jail and prison uniforms and bedding, came this:

"The last time I checked the prices of the California Prison Industries Authority, it was charging $17.95 for one neon-green inmate coverall," she said. "I sell them for $12.90. With 170,000 inmates getting an average of two new coveralls a year, you do the math on the waste."

She's got the price comparison right. Robinson sells coveralls to many California county jails and to state prisons around the nation for far less than this state's prisons pay the state-run PIA, which gives inmate workers about $1 per day. State law makes prisons buy whatever they can use that's made by the PIA. But the code section says nothing about pricing.

"The point of our programs is training, not profit," says PIA spokesman Tom Collins. "We get inmates to interact in a professional manner with each other, their guards and their instructors. We provide training in skills they can use on the outside, things like underwater welding, carpentry and metal fabricating. We see about 25 percent less recidivism (repeat crime) from inmates who have worked in our industries than other inmates."

But Hurt says sewing uniforms and blue jeans is not a skill prisoners can use on the outside anymore. "All our sewing is done overseas and that's true of our leading competitors, too," she said.

Then there's the waste created by the sheer number of prisoners. "We don't need all these punitive laws like three strikes and you're out," said reader Ray Procunier, California director of corrections under Gov. Ronald Reagan. Procunier is now retired and living in Grass Valley. "When Reagan was governor, we cut the prison population by one-third and there was no increase in crime, not even a blip. I guarantee I could bring down today's prison population from 170,000 to 75,000 and not hurt a soul in the process."

If he's right, the state could save more than $4 billion in prison costs, at the current annual average cost of $47,000 per prisoner.

The common thread among reader comments was that even in a day of budget crisis, politicians don't ask constituents how the state could save money and avoid tax increases that no one really wants to pay. It turns out some of those people know more than any politico.

Thomas D. Elias writes on California politics and other issues. His column appears Tuesdays and Sundays. E-mail him at .

From the Los Angeles Times

Deadly medical lapses in prison
"Systemic failure" puts even those with asthma at risk, a report finds.
By Tim Reiterman
Los Angeles Times Staff Writer

Seagulls pass the east entrance of San Quentin prison, in Marin County, California. The report, which did not name the institutions or the inmates for privacy reasons, concluded that some sudden deaths involved failures by doctors and other staff to adequately evaluate "red flag" symptoms.

September 20, 2007

SAN FRANCISCO — -- As many as one in six deaths of California prison inmates last year might have been preventable, according to a study of medical care in 32 state lockups that will be used to help rebuild the troubled system.

One inmate, who reported extreme chest pains in the middle of the night, died of a heart ailment after waiting eight hours to see a doctor.

Another who complained for days of severe abdominal pain died of acute pancreatitis after medical staff did not believe his pleas were credible.

A third died after a two-year delay in diagnosis of his testicular cancer.

And an asthma patient died after failing to receive steroid medication for two days following transfer from a county jail.

The report, released Wednesday by the court-appointed receiver in charge of healthcare for the state's 173,000 prisoners, revealed a broad pattern of delays in diagnosis, poor inmate access to doctors and tests, botched handling of medical records, and failure of medical staff to recognize and treat dangerous conditions.

Officials said some lapses led to disciplinary actions against doctors and nurses.

There were 426 deaths in 2006, including 43 suicides, and the study examined 381 of them.

Eighteen deaths were found to be preventable, meaning better medical management or a better system of care would have prevented deaths. An additional 48 were found to be "possibly preventable," meaning better medical management of a system of care might have prevented death.

Of the deaths considered preventable, six were from asthma, which receiver Robert Sillen said he intended to make a priority for reforms.

"The leading cause of [preventable] death being asthma is unconscionable, and it is evidence of systemic problems and problems with individual clinical judgments," Sillen said in an interview. "Adults in 21st century California should not have asthma as a primary cause of death."

Sillen said the report, which concluded that problems such as human error, staffing shortages and poor medical records contributed to unnecessary deaths, provided additional evidence that the state's $1.5-billion-a-year medical care system needed to be rebuilt from the bottom up.

As part of a 2001 class-action suit that alleged substandard care of inmates, U.S. District Judge Thelton Henderson seized control of prison healthcare.

In 2006, he named Sillen, a former health official from Santa Clara County, to run the medical system and gave him a mandate to elevate treatment to constitutional standards.

The Bay Area-based Prison Law Office, which filed the suit on behalf of inmates, has been critical of the speed of Sillen's efforts to fix the system. But Steve Fama, one of the attorneys who filed the suit, commended the death report's timeliness and thoroughness.

"It is very important that was done not only to provide a baseline but also to identify factors that can be addressed to reduce the number of preventable deaths and the other lapses in care," he said. "Unfortunately at some prisons, the number of physicians available is nowhere near sufficient to meet the need for doctors' appointments."

Dr. Stuart Bussey, president of the Union of American Physicians and Dentists, which represents prison doctors, said: "We feel that the doctors in [the prisons] have been working in a battlefield situation. They do not have the tools to practice good medicine. The system needs work."

Seth Unger, press secretary of the California Department of Corrections and Rehabilitation, which operates the prisons, declined to comment on the report, saying that Sillen was now in charge of healthcare.

Although the receiver's office said it knew of no similar studies in other states, court-ordered studies before Sillen's appointment found significant proportions of preventable inmate deaths in California.

Sillen said his study provided a comprehensive and detailed analysis that would serve as a benchmark as he worked to reform the system.

The study by Dr. Kent Imai, who worked with Sillen at the Santa Clara Valley Medical Center, analyzed individual death reviews performed by the state's corrections agency.

The report, which did not name the institutions or the inmates for privacy reasons, concluded that some sudden deaths involved failures by doctors and other staff to adequately evaluate "red flag" symptoms such as chest pain, dizziness and passing out in patients with heart attack risk factors.

In an episode that the receiver's office said illustrated a difference between emergency medical access in prisons and in the outside world, an inmate with low blood pressure and an irregular heartbeat put in a written "sick call" request during the night but a nurse did not see the slip until eight hours later. Although a doctor then responded quickly and sent the inmate to a hospital, he died.

The study said one prisoner died from a perforated duodenal ulcer after doctors and nurses failed to adequately respond to the inmate's repeated complaint about severe stomach pain over five days.

But another patient who had recurring stomach pain, vomiting and a history of hernias died of a hernia condition after a five-week delay in a referral to a specialist -- one of the long-standing problems in the system.

One inmate complained of severe stomach pains nine times over three days, but the review found that medical staff did not believe him. He died of acute pancreatitis.

Rachel Kagan, a spokeswoman for the receiver, said that in the prison medical culture, the staff sometimes suspects inmates of faking illnesses. "We hear that a lot," she said. "But there should be clinical expertise to make that decision, rather than a bias."

The receiver's office identified one preventable death involving a 30-year-old inmate who had chronic pain in his testicles -- and officials said it highlighted multiple breakdowns that resulted in a two-year delay in his cancer diagnosis.

At one prison, a doctor ordered a magnetic resonance imaging test because antibiotics offered the inmate no relief, but the inmate was transferred to another prison before the MRI was performed.

At the second prison, another doctor prescribed antibiotics, which did not work, and ordered an MRI, which was performed. When the inmate was transferred to a third prison, some of his medical records did not follow him -- and by the time he was hospitalized, the cancer had spread through his body and he died.

Fixing the entire medical system, Sillen said, could take a decade or longer and cost huge sums of money.

But will the number of preventable deaths go down next year?

"I don't know," he said. "It might be foolishly optimistic to think we are going to have that kind of impact in our first 24 months."

Federal receiver issues prison health care plan 
By Josh Richman
San Jose Mercury News 
Article Launched:05/11/2007 01:37:09 AM PDT

The federal receiver running California's prison health-care system issued his plan for the next two years Thursday, declaring that "an entirely new and different medical delivery system must be created - from the ground up."

Robert Sillen issued a news release Thursday calling his plan "comprehensive, responsible and best of all, achievable ... Barring the success of efforts to derail it, the plan will result in a system that provides quality, timely, accessible and efficient care to California's thousands of inmate patients."

In an overview filed Thursday with U.S. District Judge Thelton Henderson of San Francisco, Sillen, the former public health chief in Santa Clara County, said his plan is radically different from previous state efforts. Indeed, Sillen wrote, if the plan did not significantly differ "from the manner in which the state attempts to manage its prisons, it would not have a chance for success."

Sillen had disclosed some of his ideas earlier. His plan envisions, among other things:

Creating a system to measure progress in improving clinical care, complying with standards set by the courts, reviews of inmate deaths and patient satisfaction.

Creating crisis-response teams of doctors, nurses and administrators to travel to prisons in medical crisis.

Developing innovative ways to solve staffing needs at the state's most remote prisons, perhaps including a system of chartered airplanes to ferry doctors from San Francisco, Los Angeles and San Diego to work several days a week at the distant sites.

Breaking the prison system into regions of three to five prisons each, with each region's medical care overseen by its own team of clinicians and administrators.

Moving toward creating an electronic medical record for every inmate patient, with a computer system and Internet access so those records can be shared between prisons and departments.

Launching a program to recruit, hire, train and retain medical staff.

Tightening the California Department of Corrections and Rehabilitation's health care budgeting and accounting to ensure taxpayer dollars are being spent wisely;

Developing teams to provide inmates with better escort, transportation and access to health care inside and outside the prisons.

Assessing how many more medical beds are needed at all 33 prisons.

Bill Maile, a spokesman for Gov. Arnold Schwarzenegger, said the governor "will swiftly implement the historic reforms just passed to help resolve the prison crisis" - a $7.8 billion plan he signed last week that includes adding 53,000 prison and county jail beds, and about $50 million for rehabilitation programs.

"He supports an agenda to improve the prison health care system," Maile added.

Receiver rips prison-reform obstructions
By Andy Furillo - Bee Capitol Bureau
Published 12:00 am PST Wednesday, December 6, 2006

California's prison health care czar said in a report Tuesday that he has reached a "pivotal crossroad," with lawmakers failing to act and the state bureaucracy impeding his efforts to fix a system a federal judge found to be unconstitutionally bad.

The third bimonthly report of Robert Sillen, director of the court-appointed California Prison Health Care Receivership, singled out the entire State Personnel Board as obstructing his reform plan. It also promised a construction program to create 10,000 hospital beds for physically and mentally ill inmate patients that will require billions in state funds to build and upward of 130 new employees to plan.

Meanwhile, Sillen reported he is filling out his San Jose-based staff with professionals drawing substantial annual salaries. His $500,0000 -- more than twice Gov. Arnold Schwarzenegger's designated salary -- tops the list. The salaries do not include a benefit package that tacks on 30 percent.

With progress running slower than expected -- Sillen's "plan of action" to fix the system is likely to run at least eight months late -- the receiver is threatening to seek court action to remove whatever obstacles he sees in his path.

"The receiver will continue to work cooperatively and collaboratively with all stakeholders to the fullest degree possible," Sillen's report concluded. "However, maintaining the status quo is not an option. The mission ... will be accomplished, with or without cooperation. In this regard, the receiver anticipates seeking additional court orders whenever necessary to overcome the barriers imposed by those who attempt to obstruct the correction of unconstitutional conditions."

U.S. District Court Judge Thelton Henderson placed the $1.5 billion prison health care system into receivership last year after finding it responsible for as many as 34 inmate deaths. Henderson appointed Sillen, the former director of the Santa Clara County medical system, to the receivership in February and gave him a virtual blank check on the state treasury and the power to suspend state laws and contracts to reshape the system.

"At various levels of the organization, there have been those who have not been overly cooperative," Sillen said in an interview Tuesday. "And so we've dealt with that as we've gone along, and this is just to acknowledge that fact and to say we've had our boots on the ground for seven months now and we won't be thwarted and we won't be impeded. So people either have to cooperate or be held accountable for not cooperating."

In characterizing his mission as having reached a crossroad, Sillen's report said the "overriding focus" of lawmakers over the past year -- seeking re-election -- resulted in "no progress" on the prison system's "gross overcrowding," where some 174,000 inmates are crammed into prisons designed for half that many.

He singled out the State Personnel Board as the state's leading bureaucratic impediment, for requiring pre-employment drug testing for incoming licensed vocational nurses. Sillen wants to hire them to replace the custody-oriented medical technical assistants in frontline prison health care delivery jobs.

The report called the drug-testing requirement "an apparent attempt to obstruct the MTA/LVN conversion."

Sillen said "there are foreboding signs of resistance and obstinance from major agencies such as the State Personnel Board as well as individuals within various agencies of state government." He said "it may be necessary" for him to "move for sanctions" with the court against the personnel board "or to move to add the SPB as a party defendant in this case."

State Personnel Board spokeswoman Sherry Evans said she can't comment on the report until the board reviews it.

Sillen said the conversion to LVNs will save the state $39 million. California Correctional Peace Officers Association spokesman Lance Corcoran disputed the figure.

"You will now need two people to do the job that one was accomplishing through the use of the MTAs," said Corcoran, whose union represents the prison system's 600 medical technical assistants.

Sillen called for the construction of as many as seven medical facilities at existing prison properties around the state to add as many as 10,000 hospital beds for inmates in need of medical or mental health care. The Legislative Analyst's Office put the cost of the medical care beds alone at $3 billion over three to five years.

Corrections Secretary Jim Tilton estimated in a report to the receiver that it will take a staff of 130 to plan, design and manage construction of the new facilities. Sillen said in an interview he expects the personnel to be requested in next year's state budget.

As for the receiver's staff salaries, Sillen's is more than twice the $206,500 designated for Schwarzenegger (who only takes a dollar of it every year). Others drawing significant salaries include communications director Rachael Kagan ($180,000), chief medical officer Terry Hill ($350,000), chief medical information officer Justin Graham ($275,000), chief financial officer Rich Wood ($275,000), chief information officer John Hummel ($275,000) and acting health care project officer Jayne Russell ($187,678).

Bold vow on inmate health
By Andy Furillo - Bee Capitol Bureau
Published 12:00 am PST Friday, November 17, 2006

California's prison health care czar used his first appearance in front of a governmental body Thursday to say there will be no fooling around when it comes to fixing what he termed a "horrid" system that is in "an utter state of disrepair."

Robert Sillen, the court-appointed prison health care receiver, said he's willing to back up the truck to raid the state treasury if need be, waive whatever civil service protections and state laws that get in his way and seek contempt-of-court citations against any state employee who tries to thwart his efforts to renovate California's $1.5 billion prison medical system.

"We're on our way," Sillen said, at the conclusion of his 1 1/2-hour testimony before the Little Hoover Commission. "We'll get medical care where medical care has to be, because I think we have the authority to do that over time. It's just a monstrous path to get there."

To illustrate the difficulties that Sillen said remain in his path, he recounted an inmate death that took place in August -- four months after he had been installed in his position by U.S. District Court Judge Thelton Henderson -- in which a quadriplegic inmate died of heat exhaustion after being transported in the middle of the summer from a Central Valley prison to another institution near the Mexican border.

The van had no medical personnel on board, and its air conditioning unit broke down during the course of an 11-hour trip -- made longer by six hours when the driver got lost, according to corrections spokeswoman Terry Thornton.

When the van arrived at the Centinela State Prison on Aug. 21 after driving from the Substance Abuse Treatment Facility in Kings County, the unidentified inmate had a body temperature of 109 degrees.

"That's the kind of thing I'm talking about," Sillen said. "There has to be a massive change of culture within the (California Department of Corrections and Rehabilitation) in general and with medical care. Inmate patients have to be viewed as patients in addition to being inmates.

"Not everybody in prison is a pedophile or murderer or a rapist."

Thornton said the inmate died Sept. 5 and that the case is under internal investigation.

Altogether, Sillen said, some 65 inmates die needlessly in the prison system every year.

"Those are inmates who perished because of either lack of access to care or, more horrifically, access to care," Sillen said.

Oscar Hidalgo, the prison system's communications director, echoed Sillen's testimony in saying that the problems in California's correctional health care are decades in the making and "will take time to correct."

"The department continues to work hand in hand with the receiver in order to remedy all the problems in the medical system," Hidalgo said.

Sillen told the state government watchdog commission during Thursday's hearing on prison management that he won't be shy in exercising his receiver's authority, especially when it comes to making sure he has enough money to get the job done.

"Something you must realize about money," he said, "is I do not need legislative appropriations to fund this. The power of the court includes calling the federal marshals, going to the controller or treasurer -- we've already worked out the arrangement -- and taking the money, seizing the money, through a writ of execution. And if we have to do that, we will."

Sillen has told the state that he and the special master overseeing mental health services need six new medical facilities. He told reporters Thursday he wants them located on prison property in San Luis Obispo, San Diego, Lancaster, Sacramento, Stockton and Whittier.

Hidalgo said the department will work with Sillen on the budget request during the next fiscal year. The Schwarzenegger administration proposed financing two prisons last year with lease revenue bonds, but later said it was willing to build medical facilities instead of big new lockups. Sillen said the bond funding sounded prudent to him.

"I'm going to do it in any case," he said of the six facilities. "If you want me to just reach into your general fund for a billion or a billion two, that's fine with me."

Sillen said he is prepared to seek court authority to circumvent civil service rules, the State Personnel Board and union contracts to get rid of incompetent doctors who administrators have failed to successfully fire.

"People are being reinstated who never should be practicing," Sillen told reporters after his testimony. "I won't have it."

Gary Robinson, executive director of the Union of American Physicians and Dentists, the union that represents prison doctors, said his members will appeal any attempt by Sillen to eliminate their employee rights.

"This is a kind of classic case that could end up before the U.S. Supreme Court," Robinson said.

Sillen said it is not just incompetent doctors he has in his sights.

"Anybody in state employ is under threat of contempt of court for thwarting my efforts, impeding my efforts, getting in the way, slowing it down," he told the commission.

Oct 18, 2006 1:03 pm US/Pacific

SF Judge Raises Prison Medical Personnel Salaries

(BCN) SAN FRANCISCO A lawyer for state prison inmates said Wednesday that an order by a federal judge in San Francisco raising salaries of prison medical staff is “a necessary first step” in improving care for prisoners.

Donald Specter, an attorney with the Marin County-based Prison Law Office, said the order by U.S. District Judge Thelton Henderson will aid in “making some progress and fixing the problem.”

Henderson is presiding over a case in which he concluded last year that medical care for the state’s more than 166,000 prisoners was so abysmal that it was necessary for the court to take over supervision of the prison health care system.

The order issued by Henderson on Tuesday allows the system’s receiver, Robert Sillen, to raise the salaries of various medical personnel from 5 to 64 percent without following the normal procedures of the state Department of Personnel Administration and collective bargaining.

Sillen, formerly chief of Santa Clara County’s health and hospital system, was appointed by Henderson earlier this year to take charge of the troubled health care system.

The order giving Sillen the authority to raise salaries was requested by Sillen and was not opposed by the California Department of Corrections and Rehabilitation. 

Sillen said on Tuesday, “We cannot move forward to improve prison medical care without qualified, adequately compensated staff in sufficient numbers.”

The receiver said, “Years of neglect by the state have produced an underpaid medical workforce, which not surprisingly has resulted in high vacancy rates, inadequate care and over-reliance on high-priced temporary agencies.”

Henderson wrote in his ruling that the salary increases were needed to address the high vacancy rates for prison medical staff and bring health care up to constitutional standards.

Last year, the judge concluded that “on average, an inmate in one of California’s prisons needlessly dies every six to seven days due to constitutional deficiencies” in prison health care.

Rachel Kagan, a spokeswoman for Sillen, said the raises—costing about $24 million in the first year if all positions are filled—will cost less than the $90 million per year now spent on temporary employees to fill vacancies.

Cruel and unusual prison health care
By Robert Sillen - Special To The Bee
Published 12:00 am PDT Sunday, October 8, 2006

To reach one of San Quentin's medical clinics, you must walk past a row of 20 maximum-security cells with inmates confined behind fine crosshatched wire, barely visible. The floor is strewn with trash, puddles of water and worse from the runoff of inmate showers from the tiers above. Soap and hair drip off the guardrails of the walkways, leaving a slippery mess to dance around as you approach the clinic, which is shoehorned into a converted cell. A mildewed shower curtain hangs in front of the clinic's entrance to keep the water from spraying directly into the medical area.

I have run hospitals, clinics and public health facilities for the past 40 years, and medical care in California prisons is unlike anything I've ever seen. Inhumane is the nice term for the conditions. From a clinical standpoint, it is almost unrecognizable -- an exam room without a sink, a 53-bed medical unit with just one vital sign machine and an emergency room with broken defibrillators are just three glimpses at the bleak picture. The environment for patients, medical providers and custody staff is degrading, unsanitary and unsafe. The resulting patient health outcomes tell a gruesome story. Needless deaths occur weekly in our prisons, either from lack of access to care, or worse, from access to it.

Inmates are serving time and receiving court-appointed punishment for their deeds. But no one is sentenced by a judge to medical neglect or incompetence, or to die from unaddressed kidney disease or uncontrolled diabetes. No judge has mandated a pharmacy system out of control, creating danger to patients and wasting tens of millions of dollars of taxpayer money.

The stories of individuals suffering in California's prisons go on and on. Unfortunately, the outrage they generate has not been sufficient to move the state's leadership to clean up its prison health care system, so a federal court has been forced to intervene. As Receiver, I represent U.S. District Court Judge Thelton E. Henderson's commitment to rectify these atrocious conditions. The court has found that what California provides today violates the Eighth Amendment of the U.S. Constitution, which forbids cruel and unusual punishment. Spelling out the need for a Receivership a year ago, Henderson wrote:

The Court has given defendants (the State) every reasonable opportunity to bring its prison medical system up to constitutional standards, and it is beyond reasonable dispute that the State has failed. Indeed, it is an uncontested fact that, on average, an inmate in one of California's prisons needlessly dies every six to seven days due to constitutional deficiencies in the CDCR's medical delivery system. ... It is clear to the Court that this unconscionable degree of suffering and death is sure to continue if the system is not dramatically overhauled.

How do you begin to repair a system that is broken at every level? There are no easy answers or quick fixes, but the work can and will be done. It may take five to seven years to get the system up to constitutional muster, and an equal or greater amount of time until it can be reliably turned back over to the state, without fear of an immediate back slide. So far, the Receivership has embarked upon a two-track approach.

On one track, we have begun to deliver immediate relief in the clinical trenches where medical care is provided to nearly 175,000 California inmates. My team and I are visiting all 33 prisons in the state, meeting with inmate patients, medical and custody staff, wardens and physician leaders to get a feel for the realities they face every day. The working conditions are jaw dropping. In some places nurses work in closets. In others they have no keys to the hospital-bed cells, and must stand helplessly at the windows watching patients suffer while they wait for a correctional officer -- who may not arrive for hours due to chronic understaffing -- to bring the key. It is common to find medical areas filthy and ill-equipped, if equipped at all.

At the end of each visit, we ask the staff to prepare a list of critically needed medical supplies and equipment, which is immediately reviewed. Essential items, such as cardiac monitors and gurneys, sutures and gauze for the emergency room, are delivered as soon as possible. Our approach at San Quentin is more in-depth, with a special four-month project focused on improving medical care there. What we learn at San Quentin will be invaluable as we uncover systemic, bureaucratic and cultural barriers to adequate health care, which apply to one degree or another at each prison.

On track two, we are addressing systemic problems that have been ignored by the state for years and which must be solved to achieve meaningful change. For example, the way that prisons contract with local physician specialists to provide care to inmate patients in the areas of cardiology, oncology, optometry, podiatry, neurology, surgery and others was so dysfunctional that many of these physicians were not being paid for their work. In some cases, the bills -- totaling more than $58 million -- were four years overdue. Not surprisingly, many specialists had stopped accepting inmate patients. Under direction of the Receivership, supported by California Department of Corrections and Rehabilitation personnel, all of these providers have now been paid, and we are working on a new contracting system to avoid this type of mess in the future. What it boils down to is access to care for the sickest inmates, who suffer from advanced diabetes, heart disease, cancer, HIV/AIDS, Hepatitis C and other life-threatening conditions.

Uncompetitive salaries for clinical and support personnel is another instance of such neglect by the state that the Receivership is tackling.

Clearly, we cannot construct a constitutionally adequate medical care system without qualified, dedicated staff. Unfortunately, until now the state has paid prison clinical staff drastically depressed wages that are so far below market standards they have resulted in staggering vacancy rates, heavy reliance on costly temporary agencies and the hiring of many below-par clinicians willing to work for less. I have asked Judge Henderson to rectify this by waiving state law, in the absence of the state's willingness to act, to allow the Receiver to raise prison medical staff salaries, retroactive to Sept. 1 -- at a $24 million price tag in the first year. There is a lot of catching up to do. It's going to take more than money to recruit and retain the people we need, but it is an important first step, without which all attempts at remedial action will be fruitless.

Don't get me wrong. I have encountered many CDCR employees, medical providers and correctional personnel who desperately want to do a good job. There are many capable prison medical staff who have been toiling away in virtual anonymity and abject frustration, trying their best to care for their patients in impossible circumstances. They will be rewarded -- first with more appropriate compensation and, over time, better working conditions and a real clinical environment in which to practice medicine.

The obstacles run deep -- into the culture of prisons, which historically, and self-admittedly, have not seen themselves as places that deliver adequate health care. But that is already starting to change. Across the state, I have found wardens open to working toward fixing the problems. That improvement also translates into safer environments for correctional officers, clinical staff and surrounding communities in which these prisons are located.

The greater impediment, however, lies in state government itself. Remember, the CDCR does not set public policy, it carries out the decisions of the Legislature and the governor. As I reported to Judge Henderson in July, inmates aren't the only prisoners in the CDCR. The department's custody and medical staff are imprisoned by a state bureaucracy that is virtually paralyzed by its own rules, regulations, policies and procedures. Add to that the political component of pursuing prison reform, and you have the formula for the present crisis -- created and tolerated by both the executive and legislative branches. Every governor, every Legislature since Jerry Brown's administration is culpable.

Fortunately, the Receivership is not part of state government and, therefore, is not as grossly hampered by bureaucratic and political barriers. That is why, after state leaders failed to take action during the recent special session on the prison crisis, the Receivership is able to move forward with plans to build 5,000 new medical beds for inmates who require care. Those beds will become a reality in the next three to five years, at a necessary cost of hundreds of millions of dollars. These costs could have been substantially avoided had the state been doing its job. In the next six months, my team will find 500 medical beds to meet the most urgent needs dictated by patients' conditions as well as the dictates of prudent use of taxpayer money.

Today's political climate does not reward policy makers for doing the right thing for prison reform. Whoever got elected or re-elected on a platform of improving prison conditions? Yet, policies that swell our prison population are easily put into place -- resulting in a 73 percent increase since 1990. The revolving door of parole makes matters that much worse. In California, two-thirds of those released return to prison within three years. More than half of them are sent back for "technical" parole violations alone -- not the commission of a new crime -- a rate much higher than other large states. Multiple federal court interventions -- on medical care, mental health, dental, use of excessive force -- lay bare a system in crisis. But the state continues to do virtually nothing about it.

Prison overcrowding lurks at the root of many of these problems. Wardens and health care managers cannot operate safe, adequate programs when their institutions are filled to twice the intended capacity. At San Quentin, for instance, more than 5,200 inmates are crowded into an outdated prison built for fewer than 3,000.

There, my team is redesigning medical care, including building new facilities and staffing them appropriately. These centers will be designed to serve a maximum estimated number of patients. When that limit is reached, the institution will stop accepting inmates, rather than diminish the adequacy of care provided. Establishing capacity for patient care is essential, as we have seen the prison system continue to balloon beyond any reasonable expectations of what's manageable.

It is imperative that the Legislature and Gov. Arnold Schwarzenegger move quickly to confront the overcrowding problem and its destructive effect on every aspect of our prison system -- from internal security and public safety, to rehabilitation and medical care, to efficient and effective use of taxpayer resources.

About the writer:
Robert Sillen is the former Executive Director of the Santa Clara County Health and Hospital System, where he served in leadership positions for 27 years.

As an Inmate Dies, Why Not Save a Million Dollars?

New America Media, Commentary, Dwight E. Abbott, Sep 01, 2006

EDITOR’S NOTE: Today’s prison medical system is dysfunctional, costly and wasteful, says the writer, a longtime prison inmate. Dwight Abbott, who is currently locked up in Salinas Valley State Prison, offers a practical solution to the problem. Abbott is the author of, "I Cried, You Didn't Listen," first published in 1991 to expose the widespread abuse of incarcerated children. It has just been reprinted by AK Press, and is available at and

SALINAS VALLEY STATE PRISON -- When an inmate’s health begins to deteriorate and he accepts that death is near, the prisoner rarely seeks anything more than to end life upon this Earth with dignity and some creature comforts. Instead, he’s given, as it always has been, meager care and is most often treated no differently from inmates with minor complaints.

Among a number of problems detrimental to a chronically ill prisoner’s existence in a “general population” setting, is the fact that they’re among often rebellious inmates, gangbangers and troublemakers, who create a constantly violent and stressful environment. 

There are the bullies who are under the misconception that they get respect by picking on handicapped inmates, many of whom are confined to wheelchairs. Then there are the guards whose sole focus is, understandably, “security.” They’re not trained to care for the growing geriatric population, nor do they have time to pick and choose as they quell daily physical confrontations among the young and healthy prisoners, in which handicapped inmates are often caught in the middle.

There are many inmates with lung diseases such as emphysema, laboring to inhale life-preserving oxygen and are often forced to share that air with clouds of pepper spray. 

“I was sitting outside in my wheelchair,” one inmate exclaims. “there was a fight nearby and several guards began to pepper spray the combatants. I lost consciousness and woke up in the hospital; that pepper spray damn near killed me.”

“If we complain we are taken to C.T.C. (medical facility) and put into an empty cell,” a 76-year-old man shared with me.

“All we got there is a blank wall to stare at, as if we are being punished for having the nerve to ask for decent care. After 87 days, I had to sign out against medical advice to get back into general population.”

By so refusing treatment, the above inmate has cleared the way for medical personnel to absolve themselves of negligence should there later be “complications.”

I’m a criminal; I’ve been one since I was a teenager. For this rebellious behavior, my punishment has been to exist nearly my entire life incarcerated, beginning in 1957. Through this time I’ve suffered unbelievable punishment with little complaint. I’m the first to admit I’m not a nice person and that I don’t deserve to be free. Yet, as bad as I am, I’ve never stood and watched another human being suffer, without reaching out and attempting to help -- even those who have been my enemies.

There’s a way to do the right thing here for everyone, and it can have a twofold effect as it will also create the alleged “much needed additional beds to deal with overcrowding.”

Instead of building “two prisons,” as Gov. Arnold Schwarzenegger, along with a representative of the powerful guards union, CCPOA, would have you believe is “the only way to resolve the immediate crisis,” why not build two prison hospitals? One would be for the chronically ill, the seriously handicapped and the frail elderly inmates, where they would be compassionately cared for as all human beings deserve, no matter their faults in life.

The second prison hospital would be for the thousands of mentally ill inmates currently assigned to nearly every state prison in California. In this hospital they would get the long-term care and treatment they require and deserve, without being taken advantage of by predators on the prison yards.

At long last, the California Department of Corrections could perform its lawful duty to care for those who have difficulty caring for themselves. The taxpayers, finally, would get what they’ve been paying for all along but not receiving, and save tens of millions of dollars in the process. All of this by simply centralizing habitually ill inmates, voiding the need to rush them out to public hospitals each time a medical crisis arises.

To appreciate this proposal, consider the current cost of each in-town “doctor’s appointment” scheduled every day, throughout all of California’s prisons, for dozens of inmates who must then be transported by armed prison guards. Also, there are the hundreds of inmates each year, mostly elderly and chronically ill, who periodically suffer life-threatening medical emergencies that often require admission into a public hospital. With so much taxpayer money to go around, prison guards “bid,” using their “seniority,” for emergency medical transport duty. For each guard, often three per inmate being transported, so-called overtime pay amounts to nearly $1,000 for each 16-hour period.

The California Department of Corrections currently owes in taxpayer money approximately $56 million that has not yet been paid to hospitals, air and ground ambulance services and doctors utilized to treat inmates who had life-threatening medical emergencies. This is but a fraction of what has been paid out in recent years, but there are hospitals that haven’t been paid that refuse to admit sick prisoners. 

In addition, take into consideration that each and every time an inmate is taken from prison and escorted into town, citizens are placed at risk. Many prisoners are dangerous; they range from the extremely desperate and most violent of all criminals, to the pathetic, non-violent, recently-made-desperate drug user serving a life sentence under California’s Three Strikes Law.

Right now we have the opportunity to reform a dysfunctional and costly medical system that has long ripped off taxpayers and unnecessarily taken the lives of more than 1,040 inmates in the past 20 years. Fix it now or fix it later -- I suppose that will depend on how much money we choose to continue flushing down the proverbial toilet.

Prison-hospital plan gains backing
Court-appointed receiver welcomes support from several corners of Capitol.
By Andy Furillo -- Bee Capitol Bureau
Published 12:01 am PDT Saturday, August 5, 2006

A push by the state's prison health czar to convert two proposed prisons into hospital-like facilities for mentally ill and chronically sick inmates is gaining traction in both the Governor's Office and with one of the Legislature's two top leaders.

With a special legislative session on prisons set to start on Monday, Gov. Arnold Schwarzenegger has expressed conceptual support for the medical care conversion plan, according to a spokeswoman, while state Senate President Pro Tem Don Perata says he flat-out supports the idea.

The positive reception came as welcome news to Robert Sillen, the receiver appointed by U.S. District Judge Thelton Henderson to fix the long-documented deficiencies in California's 33 prisons. It was Sillen who first proposed turning the prisons -- requested by Schwarzenegger -- into health care facilities.

"I'm very pleased with that," Sillen said, following a meeting with Schwarzenegger on Thursday in the governor's office, about the growing support for the conversion plan. "In terms of trying to attempt to solve the problems of both overcrowding and the medical care and mental health problems, I think it's well worthy of serious consideration."

Sillen outlined his call for the prison-hospital conversion in a July 24 letter to Schwarzenegger, Perata, D-Oakland, and Assembly Speaker Fabian Núñez, D-Los Angeles. It came in response to the governor's special session request for two new prisons as part of what evolved into a $6 billion capital outlay plan -- almost entirely funded by $5.8 billion in lease revenue bonds -- to ease correctional overcrowding in California.

Margita Thompson, the spokeswoman for the Republican governor, said Schwarzenegger at Thursday's meeting did not express favor toward "any particular policy." He did, however, voice "general agreement" with Sillen's proposal that the two prisons be set aside solely for health care.

"It was more of a stage-setting conversation, as opposed to specific operation outcomes that were agreed to," Thompson said of the meeting attended by Schwarzenegger, Senate Republican leader Dick Ackerman of Irvine and Assembly Republican leader George Plescia of La Jolla, as well as Sillen, staff members for Democratic leaders Perata and Núñez and Special Master J. Michael Keating, who is overseeing mental health care in the prison system.

"Right now, the governor is willing to listen to people's ideas," Thompson added. "But the fundamental issue is how to deal with the overcrowding issue, and as the governor has said, there is agreement on the goal. So now is a fair time to have a discussion on the means."

Perata, at a press conference of his own on Thursday, gave an unqualified endorsement of the Sillen plan.

"Makes sense to me," Perata said. "I don't know why you have to have the same kind of prison apparatus and structure to take care of somebody who is in an iron lung as opposed to some young buck who's 22 years old. That's his (Sillen's) job … to figure out how to make this thing work, and I'm more than prepared to have him do that."

Núñez has taken no position on what, if any, prison or correctional medical facilities should or shouldn't be built, spokesman Richard Stapler said.

In his letter, Sillen said that the prison system's medical shortcomings -- including some 34 deaths that Henderson last year classified as "highly problematic, with multiple instances of incompetence, indifference, neglect and even cruelty by medical staff" -- are all but a necessary result of overcrowding.

Sillen said in the letter that the state can't "build its way" out of the overcrowding crisis. It can, however, make smarter use of prison construction money by putting it into the medical facilities for "acute care, long-term care/skilled nursing care, chronic care, care for the seriously mentally ill, crisis care for the mentally ill, hospice and palliative care, 'home' care and assisted living care," he said.

"I can assure you that this is the approach the receivership will have to take in any case in the very near future and would involve, most likely, taxpayer dollars similar to that being proposed for the special session," Sillen wrote. "I would suggest that the money be spent only once, rather than twice, in the described 'smart' manner."

In an interview, Sillen said the bed space freed up by the transfer of an estimated 10,000 sick inmates to the two medical care facilities would help soothe the health crisis plaguing the main-line prisons.

"We would drain that number of people out from around the state into these facilities and centralize staff," Sillen said. "Rather than trying to do various things at 33 separate prisons, we can really develop a health care system … and do it more efficiently and less expensively than otherwise."

The Sillen plan is not receiving universal acclaim, however.

Inmate rights activist Dan Macallair, executive director of the Center for Juvenile and Criminal Justice, characterized the hospital plan as "a good concept," but one that "is playing into what is a manufactured crisis."

Macallair said he suspects the prison hospitals would still be prisons and that "we don't need any new prisons."

"My prediction would be that if they turn these into two (medical care) facilities, (the Schwarzenegger administration) is going to turn around and argue for two new prisons as well," Macallair said. "This will turn out to be an add-on. That's my concern."

About the writer:
The Bee's Andy Furillo can be reached at (916) 321-1141 or .

Posted on Wed, Aug. 02, 2006 

Audit finds wasteful spending in California prison health system

Associated Press

SACRAMENTO - A urologist charged California's prison system $2,036 an hour to treat inmates. An orthopedic surgeon billed the state for 30 hours' work - for a single day.

The examples are contained in an audit released Wednesday that found rampant waste in how California's prison health care system spends money on outside doctors, nurses and laboratories.

The lax spending practices have cost California taxpayers millions, according to the audit by the state controller's office. Prison health care spending soared from $153 million in 2001 to $821 million this year - an increase of $668 million, or 437 percent.

"Waste, abuse and management deficiencies are rampant" in contracted health care services, state Controller Steve Westly said during a news conference.

He said the rise in overall costs is too great to be explained by normal increases in health care services. Westly said he will ask the state attorney general to consider bringing criminal charges against the unnamed doctors and others whose actions are detailed in the audit. He also will seek compensation.

An attorney general's spokesman said the office will review the audit.

Westly, who unsuccessfully sought the Democratic nomination for governor in the June primary, said the audit found what he characterized as gross mismanagement.

"We've got to put a stop to it," he said.

California's prison health care system already operates under the authority of a receiver who was appointed by a federal court. It is one of several parts of the state corrections department in which reforms are being dictated by agents assigned by federal or state judges.

Westly said he ordered the audit in April after Robert Sillen, the receiver who controls the prison health care system, reported that the Department of Corrections and Rehabilitation was $58 million behind in paying for contracted medical services.

Some providers - including the urologist and surgeon - took advantage of the department's poor negotiations for services and lax oversight of billing and payments, the audit states. The corrections department paid the orthopedic surgeon, for example, nearly $1.5 million in one year.

Sillen said the audit reinforces his view that the state could save money in the long run by hiring more of its own doctors, pharmacists and nurses instead of contracting for services. He said that within weeks he plans to order substantial salary increases for medical professionals so their wages will be competitive with those working for private companies.

Corrections spokesman Oscar Hidalgo said he couldn't comment on the audit's specific allegations of over-billing. But he said prison health care reform is included in Gov. Arnold Schwarzenegger's budget and in a $6 billion prison building plan the governor is asking state lawmakers to approve when they return next week from their summer recess.

"The department has been working with the receiver to fix some of the problems that exist and have existed for decades," Hidalgo said.

The audit is the latest critical review of prison health care spending. The prison system's inspector general and the Bureau of State Audits also have found overspending, mismanagement and abuse by outside contractors.

Westly said his audit shows the department has failed to improve.

In one case, the department overpaid a contractor nearly $500,000 over 10 months. The laboratory provided false test results for inmates suspected of having hepatitis C, but the department paid for retests and renewed the lab's contract for another three years.

The health care system has been plagued by neglect and malpractice for years. The poor conditions led to a 2001 lawsuit filed on behalf of inmates, which in turn led to the appointment of the federal overseer.



U.S. judge tells state to hire prison mental health staff 
- James Sterngold, Chronicle Staff Writer
Tuesday, August 1, 2006 

In a further sign of how the deepening state prison crisis is going to affect taxpayers, a federal District Court judge has ordered that the state promptly hire more than 550 new mental health care staff to improve inadequate treatment for inmates. 

Under Gov. Arnold Schwarzenegger, an array of severe problems in the prisons has worsened. California's prison population has soared to nearly double the capacity, and the result has been a near collapse in many rehabilitation programs and services, and a special master to the courts noted that the prison suicide rate is soaring because of poor mental health treatment. 

The federal courts now are exerting control over such areas as health care, parole and mental health care, and the remedies are likely to cost many billions of dollars. 

Under pressure from U.S. District Judge Lawrence Karlton, the governor agreed to hire more than 200 mental health care workers earlier this year, and to build new facilities at a cost of more than $600 million. Under the new order issued late Friday, Karlton ordered the state to hire an additional 552 staff. These range from certified psychiatrists and therapists to nurses and clerks. The new hires are likely to cost the state more than $30 million a year. 

The order could have repercussions throughout the state. First, the corrections department already is struggling with a roughly 30 percent vacancy rate among prison mental health care staff, said Michael Bien, the attorney who represents the inmates who filed the original class action suit against the state for inadequate mental health treatment. 

With the need to fill those vacancies, and then hire more than 750 more staff, the state is likely to have to raise, perhaps sharply, what it pays, Bien said, to actually fill the positions. 

If the state does that, it is likely to drive wages in the mental health care field broadly higher, which means other state departments, such as the Department of Mental Health, are likely to have to increase their wages to attract staff as well. The result is that this massive prison hiring could send the salaries of mental health care workers soaring, all at taxpayer expense. 

Bien called the judge's order "a tremendous step, a real victory," because it will end what has been the Schwarzenegger administration's extremely slow response to the crisis. Bien added that if the state fails to hire the new staff quickly then he will seek to have the federal court order that the prisons start releasing inmates they cannot care for.

In the court documents, the special master who reports to Judge Karlton notes that the suicide rate in the solitary confinement sections of the prisons is increasing, suggesting they are due to inadequate monitoring and treatment of mentally ill inmates. 

Elaine Jennings, a spokeswoman for the prisons department, said the state intends to comply with the order, but that "there's no quick solution," and it is not clear how long it will take to fill the new slots. 

Schwarzenegger has called a special session of the Legislature to address the prison crisis, but it already appears that the needs of the prisons and costs are soaring out of control. 

The governor earlier outlined a $3.6 billion plan that included new prison construction and new programs, but the plan, even if it were implemented, could take many years. 

E-mail James Sterngold at

Posted on Thu, Jul. 13, 2006 

AP Interview: Receiver wants new hospitals for California prisons

Associated Press

SACRAMENTO - The federal receiver in charge of California's inmate health care system said Thursday that the two prisons Gov. Arnold Schwarzenegger wants to build should be used instead as hospitals for inmates.

The proposal was among a wide range of initiatives outlined by Robert Sillen in his first in-depth interview since he was given broad authority to reform the inmate health care system, which has been plagued for years by poor treatment and neglect.

"Why spend that money twice?" Sillen told The Associated Press during an interview in his capital office. "It would seem to me the smart way to go about this is to get the double benefit for the dollar, because it has the same bottom-line impact on the overpopulation problem."

His comments also mark the first time Sillen has inserted himself into the political debate over the larger question of improving conditions in the nation's largest prison system.

A separate federal watchdog with oversight of inmate abuse issues, employee discipline and eliminating the so-called code of silence among prison guards has been deeply critical of the Schwarzenegger administration, saying it has backtracked on mandated reform efforts.

Schwarzenegger has called a special session of the Legislature later this summer to address prison reform and favors building new prisons as one part of the solution. A system designed for 100,000 inmates now holds about 172,000.

The price tag for a new prison is generally thought to be about $500 million.

Sillen has virtually unlimited power to demand reforms to the health care system since a federal judge gave him control in April. U.S. District Court Judge Thelton Henderson told Sillen to draft a reform plan within seven months of assuming his office, although Sillen said he might need more time.

Sillen said he will present his proposal for the prison hospitals as a recommendation to Schwarzenegger. However, he said he will require that California build more prison hospitals regardless, so the state might as well authorize the beds now to get a double benefit - relieving crowding by taking ill prisoners out of existing prisons while also improving inmate health care.

"We still have people dying every week in that system - needlessly - and we need to stop that," Sillen said.

Sillen said he believes at least 1,200 additional prison hospital beds are needed to help bring care to adequate levels. His staff had been considering three 400-bed hospitals scattered around the state to handle patients from California's 33 adult prisons.

A Schwarzenegger spokeswoman said Sillen's announcement underscores the importance of the special session, expected to start when the Legislature returns from its summer recess Aug. 7.

"It is a positive sign in recognition of the governor's leadership in this area that the receiver is actively engaging in the special session so that we can jointly solve the problem," spokeswoman Margita Thompson said.

In addition to his proposal for the hospitals, Sillen said that within weeks he will order pay raises for thousands of prison health workers. In some cases, he will double their salaries and make them some of the highest-paid state employees.

He is demanding that California hire many more medical providers and is ordering more supplies and temporary medical facilities to be housed in trailers on prison grounds around the state.

Sillen said he won't be deterred by the price tag for reforms.

"Astronomical is in the eye of the beholder," Sillen said.

But he said the $100 million allocated by lawmakers for reform this year is insufficient and even the $250 million Schwarzenegger had proposed might not be enough to cover improvements just in the first 12 months.

Improving medical care eventually will require changing state laws, rules and regulations to eliminate bureaucracy, he said. He blamed the current system for a long list of troubles, including an inability to fire bad doctors and preventing basic medical supplies such rubber gloves and gauze from being ordered.

Sillen, who previously headed Santa Clara County's public health system, made it clear that he is now in charge of prison health care and will act on his own or through the federal judge if Schwarzenegger, state lawmakers or prison employee unions get in the way of reforms or don't act quickly enough.

He acknowledged that reforms will lead to dramatic upfront costs, but said California taxpayers ultimately will see savings because inmates will be treated before they require expensive hospitalizations. The state also will be able to stop paying for expensive outside medical services that it now uses because it can't hire or retain enough of its own doctors and nurses.

REPORT: Prison health care worse than thought 

By Josh Richman, STAFF WRITER
Inside Bay Area 

California's prison medical care morass is "much worse and more complex than anyone originally thought" and might eventually require removing health care from prison officials' authority permanently, according to a court-appointed receiver's first report.

"Almost every necessary element of a working medical care system either does not exist, or functions in a state of abject disrepair, including but not limited to the following: medical records, pharmacy, information technology, peer review, training, chronic disease care and speciality services," Robert Sillen wrote Wednesday to U.S. District Judge Thelton Henderson of San Francisco.

Download and read the prison medical system receiver's report.
[.pdf file, right-click and save to your computer] 

For example, a recent audit found the prison pharmacy system is a logistical train wreck with too few pharmacists; poor inventory tracking; erratic purchasing practices; and so on. The state's 2005 prison pharmacy costs were about $46 million to $80 million more than comparable programs, even after adjusting for pricing and population.

Sillen wrote he has seen many cases in which inmates either received grossly inadequate care or couldn't get care at all, yet he also has met many workers "who desperately want to do a good job.

"The medical care crisis in California's prisons was not created by the men and women who toil in the CDCR (California Department of Corrections and Rehabilitation) trenches," he wrote. "They are prisoners to a culture that dictates inappropriate rewards and punishments, and a system of operation groaning under the burden of the numerous statutes, rules, regulations, policies and procedures imposed upon them."

The problems reach beyond CDCR and into entities overseeing it: the governor's office, the Legislature, and the departments of Finance, General Services and Personnel Administration. Meaningful reform must involve them too, he wrote.

"(T)here will be no quick fixes," Sillen wrote. "If a quick fix was available, the court would not have appointed a receiver."

Henderson last summer found the state — even since the 2002 settlement of a class-action lawsuit — hadn't brought prison health care up to constitutional muster, and so he ordered it into receivership.

In February he named Sillen, formerly the Santa Clara Valley Health & Hospital System's executive director, to take over; Sillen began in April and must report to Henderson every 60 days.

The first report's release Wednesday coincided with the launch of a 90-day project to improve medical equipment, supplies, staffing and clinic conditions in San Quentin State Prison — not a long-term fix, but day-to-day headway for inmates and staff overseen by Sillen's on-site team. Sillen said it'll be a test case for future, systemwide reforms.

Sillen so far has visited five prisons and held dozens of meetings with inmates, prison doctors, union officials, Gov. Arnold Schwarzenegger and many others, he wrote. 

His task's difficulty is exacerbated by overcrowding, as most prisons hold twice as many inmates as intended, and by leadership turnover, he wrote: he has worked with three permanent or acting CDCR secretaries so far, and individual facilities' wardens come and go frequently.

"Given this state of affairs, and the poor reputation that the CDCR has earned as an employer, raising the medical system to constitutional standards may require removing it from the umbrella of CDCR," he wrote.

The state's prison medical reform earmark was cut from a proposed $250 million to $100 million in the final 2006-07 budget, Sillen noted. His staffers will meet with state officials on this, he wrote, and then he'll report back on whether Henderson should consider ordering the state to grant more money and leeway.

Lousy pay makes recruiting and retaining qualified workers hard, so CDCR contracts out many services at more cost to taxpayers, Sillen wrote, adding he expects to finalize a salary-boost plan in the next 60 days.

CDCR and other agencies aren't staffed and trained to implement state competitive-bidding policies, so "the CDCR process for negotiating, processing, renewing and payment of medical contracts collapsed," he wrote, adding he has taken over the process and is starting to make progress.

Sillen noted a few specific instances of absurd waste. For example, San Quentin ordered gastroenterology diagnostic imaging equipment four years ago and got it two years ago, but it's still in storage because the floor of the room in which it was to be installed can't bear its weight.

Also, the state for three years has failed to award a contract for in-house kidney dialysis care, so many inmates still are taken outside prison walls for costlier care and CDCR now must dispose of 16,000 outdated syringes it bought in 2001.

Contact Josh Richman at .

Posted on Sun, Jul. 09, 2006 

Health care system is in critical condition

Mercury News Editorial

California's 171,000 inmates are in prison to be punished, not abused. At a minimum, they deserve humane medical treatment when sick or injured.

That's clearly not what they get in the state's 33 prisons.

Bob Sillen, the new court-appointed receiver of the state's prison medical care system, made a whirlwind tour of the facilities and found them in even worse shape than he had anticipated. The former head of the Santa Clara County health and hospital system, well known for not mincing words, uses terms like ``Third World,'' ``disgraceful'' and ``Abu Ghurayb and Gitmo times 33'' to describe what he saw.

At San Quentin, Sillen discovered that nurses in the urgent care center had no access to 4-by-4 gauze bandages for four months and had no idea if they would be delivered. A new X-ray machine was sitting boxed up at the clinic two years after it was delivered. Overflow housing forced 330 prisoners at the clinic into ``degrading, unsanitary'' conditions for both the inmates and their health care providers.

U.S. District Judge Thelton Henderson named Sillen to take over the state's prison medical system after finding that California officials were violating the terms of a settlement of a class-action lawsuit filed by prisoners in 2001. Inmates have been reportedly dying at the rate of one a month due to medical incompetence.

With the court-ordered power to bring the state's prison health care system up to minimal standards, Sillen should first determine whether state agencies have the capacity to fix the system or whether an entirely separate, new system should be created. In making that decision, Sillen should bear in mind that despite his free hand to change the $1.2 billion medical care part of the system, he must ultimately build a prison medical care structure that the state can afford under anticipated future budget constraints.

One place to begin is the prison pharmacy system.

At Sillen's request, the Texas-based Maxor National Pharmacy Services did an audit of the manner in which California dispenses prescription drugs to prisoners. Maxor found that the drug cost per inmate per day in California ($2.29) is five times higher than in Texas ($0.56) and more than twice as high as the federal prison system ($0.93). Maxor estimates that enacting relatively simple cost efficiencies, the state could save between $46 million and $80 million a year.

Maxor also found the pharmacy information system ``unsatisfactory from a patient-safety standpoint,'' saying the prison system lacked sufficient monitoring to detect potentially dangerous overdosing or underdosing of inmates. Maxor discovered that the record-keeping process is so unreliable that it is virtually impossible to ``provide a meaningful audit'' of how drugs are dispensed.

That's unacceptable, both in terms of patient safety and efficient use of taxpayer dollars.

California doesn't need to build the Taj Mahal of prison health care systems. But it does need to take major steps to guarantee that its system meets constitutional standards by providing the most basic health care coverage for inmates as cheaply as possible.

That challenge is immense. Sillen himself says he's never seen a political ``onion'' with so many layers. But to anyone who thinks he might not up to the challenge, he replies, ``Oh, yeah? Watch.'' His first target? A 90-day blitz to fix the disaster at San Quentin. Let the reforms begin.


Stern warning on health care in state prisons 
Receiver threatens to seize government funds to fix crisis 
- Mark Martin, Chronicle Sacramento Bureau
Thursday, July 6, 2006 

(07-06) 04:00 PDT Sacramento -- The federal official appointed to revamp medical care inside California prisons blamed an inept state bureaucracy, the governor and lawmakers for the prison crisis and suggested he would send federal marshals to Sacramento to seize money if legislators and Gov. Arnold Schwarzenegger don't provide sufficient funding to improve care for the state's 171,000 inmates. 

In a report released Wednesday, Robert Sillen declared that the medical system, which previously had been criticized by federal court officials as so depraved that inmates were needlessly dying, was in worse shape than first described and that his remedies would have to be more dramatic and far-reaching than previously envisioned. 

The report by Sillen, who was appointed this year by U.S. District Court Judge Thelton Henderson and has substantial power to make changes, was described as "ominous" by one state senator for its implication that Sillen might demand major changes to state government. 

In depicting a dysfunctional system, Sillen noted that overly bureaucratic procedures mean incompetent doctors can't be fired, efforts to save money are hampered by lengthy contracting processes and the state has wasted millions of dollars buying unneeded medicine while declining to pay for computer systems that would fix the problem. 

And in a wide-ranging interview, Sillen said he will likely spend far more money than Schwarzenegger and the Legislature allocated for prison health care fixes this year, that he expects his job to take five to 10 years, and that politicians will have to reduce overcrowding in the state's lockups before regaining control of the health care system. 

"There's no way we're going to get to constitutional medical care standards with the current overcrowding,'' he said. "If the state wants its system back, it will eventually have to address that.''

Gov. Arnold Schwarzenegger called last week for a special legislative session to address the state's jam-packed prisons, setting up an election-year debate in Sacramento over thorny crime-and-punishment issues such as building more prisons and changing other prison policies. 

In calling for the session, Schwarzenegger argued that severe overcrowding could lead to a federal takeover of the system and the early release of thousands of inmates. Sillen said health care delivery in prisons is being hampered by overcrowding but that it is "way premature" for him to contemplate drastic measures that confront major political opposition like early release. 

He was more willing to take on lawmakers and the governor on other matters however, previewing what could be a clash between branches of government. 

He noted that the Schwarzenegger administration agreed earlier this year to set aside $250 million for the fiscal year that began this month to make health care fixes. That amount was changed to $100 million by a legislative budget committee -- a total that did not sit well with Sillen. 

"We will spend far in excess of $100 million,'' he said, adding that "if the state isn't going to provide the money, we will go to the judge and ask for a court order, and we will send federal marshals to Sacramento to get the money.'' 

A spokesman for the Schwarzenegger administration said the administration is "committed to working with the receiver and the Legislature,'' and that the budget enacted last week has a hefty reserve that can handle more expenses. A June letter to Sillen from the administration noted that the Legislature's budget conference committee had reduced the allocation. 

A spokesman for Assemblyman John Laird, D-Santa Cruz, who was chairman of the conference committee, did not return phone calls. The Legislature is on a summer break. 

Sillen was hired in February by Henderson, who stripped control of the prison medical system from Schwarzenegger last year. The system is plagued by such poor facilities and low numbers of doctors, nurses and other health care professionals that Henderson called it depraved. The judge has presided over a lawsuit brought by law firms representing inmates and arguing that prisoners' rights to medical care were being denied by the state. 

Sillen's report accuses both the executive and legislative branches of government for creating and then ignoring the prison health care crisis. 

He also suggested that bureaucracy has hampered reform, noting that an effort begun three years ago to save money by providing dialysis in prisons -- instead of driving inmates to area hospitals -- has still not been implemented because of hang-ups in the contracting process. Personnel rules make it difficult to ever fire an employee, he also said. 

"The way the state does business is a major obstacle,'' Sillen said. 

He suggested in an interview that he will make suggestions to Schwarzenegger for reforms in other agencies. He also referred to Schwarzenegger's earlier attempt to remake state government, the California Performance Review, which was largely a failure. 

"We're not necessarily going to blow up boxes, but there are better ways to build the mousetrap and we will do that,'' he said. 

The report also blasts pharmacy operations in state prisons, noting that a recent audit found that the state spent as much as $80 million annually more than other comparable prison operations because it failed to use discounted rates from manufacturers and often bought large amounts of medicine it did not need. Requests by corrections officials to buy new computer systems to help solve the problem have been turned down under former Gov. Gray Davis and Schwarzenegger. 

Sillen has called a hearing on pharmacy operations for later this month and said he will likely require the state to hire a private firm to manage its pharmacies. 

The report Wednesday also details a project to upgrade medical services at San Quentin State Prison as a pilot project. While calling the infamous Marin County prison "too troubled, too decrepit and too overcrowded for fixing,'' Sillen outlined a plan, beginning this week, to hire more doctors, upgrade health care facilities and change procedures at San Quentin within 90 days. 

State Sen. Gloria Romero, D-Los Angeles, who has advocated for changes in the prison system, called the report ominous in its implication that the receiver has found much broader problems throughout state government. 

The report describes "a web of incompetence in a department that has simply chosen to ignore its problems,'' she said. 

E-mail Mark Martin at

Posted on Thu, Jun. 08, 2006 

Federal judges pledge cooperation in California inmate care cases

Associated Press

SACRAMENTO - Two federal judges pledged extraordinary cooperation Thursday in seeking quick reforms to the way California's prison system manages its inmate health care and mental health programs.

The U.S. District Court judges, Judge Thelton Henderson of San Francisco and Judge Lawrence Karlton of Sacramento, will meet quarterly to ensure reforms advance swiftly and smoothly. They also said a federally appointed receiver who is charged with overseeing prison health care will meet monthly with a special master who is monitoring prisoners' mental health treatment.

The judges said they might involve a third judge, U.S. District Court Judge Jeffrey White of San Francisco, who is overseeing a settlement pending next month of a third class-action inmate lawsuit - this one over dental care.

"It's a cautionary note to the administration and the Legislature that the courts are going to be a force" in prison reforms, said state Sen. Majority Leader Gloria Romero, D-Los Angeles, who attended Thursday's 30-minute hearing in Sacramento. "This really does say, in a sense, 'Don't block us.'"

The eventual reform recommendations could cost the state hundreds of millions - even billions - of dollars.

Gov. Arnold Schwarzenegger already has asked lawmakers to approve $364 million for improved inmate health care and warned that is likely to be only a down payment on the coming reforms. That money would be spread between the current fiscal year and the one that begins July 1.

The health care receiver, appointed in April, is the result of a lawsuit filed against the state in 2001 by an inmate advocacy group, the San Francisco-based Prison Law Office. The state's prison health care system has been widely denounced as inhumane, leading to an average of one death a week from medical neglect.

The separate settlement of a class-action lawsuit on behalf of more than 26,000 mentally ill inmates has been in place nearly 11 years, but inmate attorney Michael Bien told the judges he still faces "roadblocks and bureaucratic hurdles" in reforms.

"The need is urgent, and we are at a time of crisis in corrections," Bien said.

Karlton and Henderson said they decided to cooperate because their appointments of twin overseers had sowed bureaucratic confusion, unexpectedly slowing the very reforms they had hoped to speed up.

"We're in a new world now," Karlton said. "This is the first receiver, to my knowledge, that has ever been appointed in a prison case."

Dr. Peter Farber-Szekrenyi, who directs the state's Division of Correctional Health Care Services and is Schwarzenegger's top official overseeing inmate health care reform, welcomed the cooperation.

"A federal judge can basically make the state move faster than normal processes ... which from a patient care standard (are) not acceptable," Farber-Szekrenyi said after the hearing.

Henderson said there are at least 32 areas in which the health and mental health cases overlap. Common issues include medication, medical records, a lack of medical staff, competition for scarce beds and delays in getting advanced care, Bien said.,0,358576.story?coll=la-headlines-california

Prison Health Chief Set
A U.S. judge picks a Santa Clara County official to take over inmate care in a move shifting power from the state to the federal level.
By Jenifer Warren
Times Staff Writer

February 12, 2006

SACRAMENTO — Ending a nationwide search, a federal judge has picked the top health official in Santa Clara County to take charge of California's deeply troubled prison healthcare system, sources familiar with the selection process said Saturday.

Bob Sillen, 63, is expected to be formally appointed as a federal receiver on Tuesday by U.S. District Judge Thelton Henderson. The San Francisco judge decided to act after concluding last July that "extreme measures" were needed to fix a system that kills one inmate each week through medical incompetence or neglect.

The move effectively shifts power from state to federal authorities for all decisions related to inmate care — including medical staffing, treatment standards and contracts with outside hospitals. 

Legal scholars said the appointment marks the first time a government operation of this size has been placed under a federal receiver.

This week, the sources said, Henderson will issue an order detailing the extraordinary powers Sillen will have in managing the system, which provides healthcare for 168,000 inmates and employs 6,000 people in 33 prisons. 

Details of Henderson's order remain closely guarded. The sources spoke to The Times on condition of anonymity because they were not authorized to discuss it. 

A spokesman for the state Department of Corrections and Rehabilitation, Todd Slosek, said officials "look forward to working with whomever the judge picks to help us manage healthcare in our prisons."

Sillen was out of town and could not be reached Saturday. On Friday, he abruptly announced his resignation as director of the Santa Clara Valley Health and Hospital System, a multifaceted medical and mental-health care empire that has 6,200 employees and a $1.4-billion budget.

Although he declined to reveal his plans, Sillen told the San Jose Mercury News that his new job would be announced this week and would involve "a major turnaround effort" related to healthcare in the nonprofit sector.

Healthcare providers who have worked with Sillen described him in interviews as hard-nosed, blunt, extremely competent and a lifelong crusader for quality healthcare for the poor. 

They said he arrived in 1979 to head a hospital — Santa Clara Valley Medical Center — that was beset by fiscal distress, low staff morale and other problems and turned it into one of the most respected healthcare institutions in the state.

"He is one of the most progressive, innovative and aggressive public health administrators I've known," said Rhonda McClinton Brown, executive director of a coalition of community clinics in Santa Clara County. "He has really pushed the envelope of public hospital care with Valley Medical Center."

McClinton Brown predicted that in his new job as czar of state prison healthcare, Sillen will "rip it apart and clean it up and put it back together again."

Though McClinton Brown called him adept at dealing with public officials, others have described Sillen as controversial, and pushy in his determination to provide quality medical care to the poor and uninsured.

In a 1994 interview with the San Jose Business Journal, Sillen described himself as "a pragmatist with a heavy ideological overlay." 

"Some people think I'm absolutely a pain in the ass," he said in another 1994 interview, with the Mercury News. "But that's OK. God forbid one goes through life … not doing anything meaningful enough for anyone to care about. That'd be terrible."

Sillen was raised in New York and graduated from the University of Denver in 1965. He went to work for the U.S. Public Health Service and sought to stem the spread of sexually transmitted diseases while based in a Harlem clinic, according to Who's Who Among Human Services Professionals and past profiles in the San Jose Business Journal.

He later obtained a master's degree in public health at Yale University and became a hospital administrator. Through the 1970s, he held top positions at the University of California Medical Center in San Diego.

Since 1993, he has overseen a network in Santa Clara County that includes a hospital, a string of community clinics, the public health department, and also mental-health and drug-abuse programs.

Sillen also has joint responsibility, with corrections officials, for healthcare inside Santa Clara County jails and juvenile facilities. A grand jury report in April concluded that the county provided high-quality care for its adult inmates, but that the cost of care was high compared with what was spent on medical benefits for a comparable number of county employees.

In Santa Clara, Sillen earned an annual salary of $244,129, making him the county's top-paid public official. As receiver, he is expected to be paid considerably more during a tenure that would last several years.

Henderson, the federal judge, announced his decision to name a receiver last summer, after a series of hearings during which court-appointed experts decried healthcare conditions in prison medical facilities. They testified as part of a lawsuit challenging the quality of inmate healthcare.

The case was settled in 2002, when the state agreed to overhaul inmate healthcare and phase in improvements by 2008. But the experts found few signs of progress, testifying that filthy conditions, ill-trained and neglectful doctors and a dearth of staff added up to a pattern of preventable deaths that one witness said was unlike anything he had ever seen.

To help him find a qualified receiver, Henderson hired an international search firm, Korn/Ferry International Inc., which developed a list of candidates. Henderson picked Sillen from four finalists with a range of experience in the public and private sectors.

The California receivership, experts say, is unprecedented in its scale. In 1995 the District of Columbia's jails were assigned to a receiver for five years, but that system had only 1,700 inmates. The state prisons hold nearly 100 times that number.

In Texas, a lawsuit in the 1970s led a federal judge to appoint a special master as a monitor, but a receiver's powers are far greater, involving the day-to-day management of the system, rather than oversight.

Adult prisons are not the only piece of California's correctional system under court supervision. The state's juvenile facilities, home to about 3,000 of its most troubled juvenile offenders, are under the supervision of a special master, who monitors compliance with court-ordered improvements in inmate medical care, mental-health care, education and other areas.

Editorial: Prison health 'shambles'
Judge struggles to fix a $1 billion system

Published 2:15 am PST Saturday, December 10, 2005

When Arnold Schwarzenegger was sworn in as governor in November 2003, California seemed on the cusp of reform of its broken prison system. The governor brought in new leadership. The federal courts put on pressure to bring prisons up to constitutional standards. The Legislature in 2003 enacted key reforms.
The result was supposed to be a decline in prison population to mid-1990s levels, an increase in parolees under improved supervision and increased levels of parole success.

None of this has occurred.

But nothing symbolizes the failure of the prison system more than the horrid state of its medical care. The prison health care budget is more than $1 billion, yet it is so poorly managed, writes U.S. District Court Judge Thelton Henderson, that it is "tantamount to throwing good (taxpayer) money after bad." Medical records for this 167,000-inmate system are either in a "shambles or nonexistent," making "even mediocre medical care impossible."

Henderson has concluded that California's prison medical system is so broken, its leadership so lacking (characterized by a "can't do" attitude) and its custody culture so devaluing of human life that only drastic action can bring about change. At a Dec. 1 hearing, Henderson noted a "remarkable symptom" of dysfunctional leadership: Neither Department of Corrections and Rehabilitation Secretary Roderick Hickman nor Undersecretary Jeanne Woodford were even aware of the arguments being made on their behalf in court.

Henderson could cite the state for contempt for its failure to act, but believes such action has no "realistic likelihood of proving effective." He believes it would simply "extend the future life span of the current dysfunctional system" given the state's "self-professed inability to cope with the magnitude and complexity of this crisis." Contempt, he concludes, "simply is not an appropriate remedy in the current circumstances." That sounds right.

Henderson also could simply order the closing of some prisons or the release of some prisoners. That action can still be reserved for the future.

He chose the less drastic route of receivership, where the court itself takes control of the delivery of medical services to all California state prisoners. This is the right thing to do - really the only thing left to do that has any hope of forcing real change. The court will do a national search for a receiver, an official who will direct the reforms and report to Henderson. Clearly, the first priority has to be hiring competent medical staff and creating a working medical records system.

An undersecretary in the corrections department admitted in court testimony that medical care is not a priority or "core competency" in California's prison system. At this stage, reasonable people might wonder just what, if anything, is a priority or core competency in California's prison system.

Old and sick behind bars

Photo Gallery

Sunday, November 27, 2005

FOR A GRIM GLIMPSE of the future of California's correctional system, you need go no further than the California Medical Facility, a few blocks off Interstate 80 in Vacaville. 

That's what we did a few weeks ago when we visited the prison, the only one in California dedicated to providing medical care to inmates. 

What we saw pointed to the outcome of a "get tough on crime" policy that began decades ago, and has resulted in the continuing incarceration of thousands of ailing and aging inmates, most of whom present little or no threat to public safety. 

In mid-September, the Vacaville facility opened the first licensed elderly care unit in a California prison. It offers an even higher level of care than a regular nursing home to inmates who can no longer care for themselves. It is home to 17 inmates ranging in age from 43 to 82. Half suffer from dementia. Some are paralyzed from strokes. Name a common debilitating disease -- from insulin-dependent diabetes to Parkinson's disease -- and you're likely to find it there. 

On the day we visited, three inmates lay on beds in the "day room" of the elderly care unit. They seemed barely conscious. Sixty-one-year-old Richard Carreiro was the only one who seemed aware of his surroundings, as he sat in a wheelchair watching a rerun of the television show "Cops." He has been battling drug problems since he was 12, and has been in and out of jail almost as long. Rather than being incarcerated, he says he should be getting drug treatment. But the last time he was in a prison drug-treatment program was in the 1960s. 

Originally from Fresno, Carreiro was sentenced to 18 years for second-degree robbery, which was reduced to nine years for good behavior. With a little over a year of his sentence to complete, he was arrested for possession of less than a gram of heroin while still in prison. Under California's three-strikes law, he received a 43-years-to-life sentence. He won't be eligible for parole until 2022. 

For even sicker inmates, the prison runs a hospice for patients who are not expected to live more than six months. It's an urgently needed service. In 2002, the last year for which figures are available, 327 inmates died from natural causes. That's the highest number in the history of the correctional system. 

The hospice -- a large central room with smaller perimeter rooms where the dying inmates are cared for -- had, at first glance, the mundane feel of a middle-school classroom. A poster of the Rev. Martin Luther King Jr.'s "I Have a Dream" speech graced a wall. A fish tank added to the air of normality. 

But these touches couldn't conceal the aura of death's encroachment. In one hospice room, Henry Callahan, 42, who suffers from AIDS, degenerative hips and a range of other health problems, was "on vigil," which means that doctors believed he had 72 hours or less to live. Yet he still dreamed that that despite six failed attempts to get parole, his next appearance before the parole board would bring freedom. 

So far, he has served 23 years of a 7-years-to-life sentence for a kidnapping in Los Angeles connected to a drug deal. "I didn't hurt anybody," he told us. "It was just a mistake. They told me if I stayed discipline-free they'd let me go. I'm hoping that they'll let me go this time." 

As the 163,000 prison population continues to grow and age, it's likely that every prison in California will have to open hospices and licensed nursing facilities -- unless the system is reformed so that the oldest, sickest and most harmless inmates are released. 

It must be done, if only to spare California taxpayers the exorbitant cost of caring for very sick inmates behind prison walls. The state already spends $1.1 billion on a malfunctioning prison health system. All aging inmates will need extras, such as eyeglasses and hearing aids, in addition to the growing numbers who will need treatment for chronic or terminal diseases. As the nonpartisan Legislative Analyst pointed out in a 2003 report, "Many elderly inmates will ultimately require constant bed care and intensive medical supervision." 

Inmates over the age of 50 already make up 10 percent of California's prison population. The number of inmates over age 60 doubled from 1,781 in 1998 to 3,358 in 2004. That number is expected to jump to 30,200 by 2022. By some estimates, the costs of caring for these elderly inmates is two to three times the cost of younger ones -- upward of $70,000 each a year. 

This ballooning investment in older inmates is especially misguided because the payoff in terms of public safety is minimal. Few people over 55 commit crimes. A U.S. Department of Justice study showed that only 1.4 percent of inmates 55 and older released from prison ever return there. 

The state could start by releasing eligible inmates over 55 who were convicted of nonviolent crimes, regardless of their health status. According to the Legislative Analyst, such a move would save the state at least $9 million now, and more later on, "without jeopardizing public safety." It would also help relieve widespread overcrowding in our prisons. For example, the Vacaville facility was built to house 2,315 men, but now houses a thousand more. 

The state should also consider granting "compassionate release" to feeble or dying inmates who have already served the fixed portions of their sentence, and are eligible for parole. Continuing to incarcerate them, even in model programs like those at Vacaville, amounts to unnecessarily cruel punishment and disregards the spiraling costs being inflicted on California taxpayers. 


(4) Hospice: The hospice at the California Medical Facility for terminally ill inmates is the by-product of a correctional system that keeps many inmates locked up long after they are a danger to society — and, in some cases, long after they are eligible for parole. Men qualify for the hospice when they have fewer than six months to live. Here Katrina Davis, center, a nurse assistant, and Aluana Laulea, left, an inmate trained as pastoral-care worker, tend to dying inmates, including Richard Moody, 49, who suffers from cirrhosis of the liver. 
(5) Immobilized: Richard Moody is an example of an inmate being incarcerated at huge expense to taxpayers. He was sentenced to 15 years to life for murdering a man during a botched drug deal. He says he killed his victim in self-defense. He has now been imprisoned for 19 years, four years after becoming eligible for parole. 

Over the years, he took a range of courses to prepare himself for life on the outside, including qualifying as a mechanic and a machinist. Family members in Los Angeles are adding a room to their house for him to spend his last days, yet both his applications for parole and for "compassionate release have been denied. I think I have paid my debt to society, he says. 

(6) Inmate support: A pastoral-care worker reads a hand-painted card sent to Bernard Whalen by fellow inmates. God bless you, Bernard, reads one message in the card. I'll see you soon again in the kingdom of God. 

(7) Guarded care: Inmates must be escorted to medical appointments, which is just one of the many reasons providing health care in prison is so expensive. 

(8) Consulting through bars: Medical director Dr. Nadim Khoury sometimes has to consult with patients through barred doors in the prison hospital, yet he says he feels safer here than in the emergency room at Highland Hospital in Oakland, where he worked previously. “At Highland we didn’t know who was the victim and who was the criminal,” he said. Beyond that, he says, the inmates at Vacaville “are not interested in hurting us. They’re smart enough to know that we’re here to help them.” 

/ Photographs by Paul Chinn

Fast action sought for prison health care 
Emergency steps needed to avoid deaths, expert says 
- James Sterngold, Chronicle Staff Writer
Tuesday, November 15, 2005 

A court-appointed prisons expert said Monday that because of soaring vacancy rates for doctors, nurses and supervisors, the California prison health care system is "disintegrating" and requires emergency intervention by both the federal court and the governor. 

The report calls for immediate steps to raise salaries significantly as a recruitment tool, by more than 15 percent in many cases throughout the prison system. The most pointed proposal is that the governor be ordered to appoint, within five days, personal representatives to oversee the required changes. 

That proposal, if accepted by the judge, could ensure high-level oversight for the first time in the crisis, and also make Gov. Arnold Schwarzenegger personally accountable if the system, which provides health care for 165,000 inmates, deteriorates further. 

Federal district court Judge Thelton Henderson has issued a stream of harshly worded orders over the past year on the abysmal state of health care in the state prisons. Because of the state's failure to improve conditions, Henderson has ordered that a court-appointed receiver seize control of the vast system, under which, he has said, there are as many as 64 preventable deaths of inmates a year. 

The new report, by John Hagar, a prisons expert appointed by Henderson last month, is even more specific in citing failed leadership by officials at the California Department of Corrections and Rehabilitation, and it sounds an even more urgent alarm that the prison health care system is in danger of collapsing because of the state's failed policies. 

"State officials have no coherent or realistic plan to implement correction actions," Hagar wrote in the 33-page report. 

He added, "Given the steady loss of necessary clinical personnel, it has become apparent that without orders from the court, the (department's) health care system may simply collapse." 

Bruce Slavin, the corrections department's general counsel, said that he could not dispute "the gist" of the report and that the state intends to comply with the proposals if the judge orders the report implemented. 

Julie Soderland, a spokesman for the governor, said that Schwarzenegger was aware of the report and was "already working on some key appointments." 

She added that the governor will meet any deadlines imposed by the court. 

In his report, Hagar said, for instance, that vacancy rates among health care officials at the state prison headquarters is now about 80 percent, suggesting an almost complete loss of leadership and no apparent effort to rebuild it. 

The vacancy rate for doctors alone has doubled since the summer, the report said, to about 30 percent, but it is much higher at some prisons, particularly for primary care physicians. The vacancy rate for some nursing supervisors is more than 50 percent. The vacancy rate for chief physicians is 65 percent. 

The report suggests that some proposals by the corrections department for improvement were either impractical or ignored by the department itself. 

For instance, senior state officials proposed trying to hire doctors displaced by Hurricane Katrina, the report said. Some experts said that even if large numbers of such doctors could be located and if it could be determined they did not intend to return to their homes, the process of getting them certified in California could take months. 

The state also proposed transferring sick inmates to prisons that have adequate centers to care for them, but it had taken no such steps, the report said. 

The report expressed particular impatience with the state's director of the Division of Health Care Services, Dr. Renee Kanan. 

Critical to filling the vacancies, Hagar said, are studies of physician and nurse salary levels at comparable institutions so that the prisons can determine what they should pay to attract qualified professionals. Kanan had said for some time that her office was preparing comparisons of physician salaries, the report said, but then last month Kanan admitted that the study had never begun and that it would not be ready until next summer. 

The report describes the department's hiring procedure as "completely broken, creating an ineffectual, bureaucratic, time-consuming, and wasteful quagmire." 

Donald Specter, the director of the Prison Law Office, a public interest group that has represented inmates, said he is glad the report included practical steps and strict deadlines, in particular that it calls for Schwarzenegger to take direct responsibility for making the needed improvements. 

The prison system has about 165,000 inmates and spends $1.1 billion a year on health care. 

Henderson will now consider Hagar's report. He has indicated previously that he wants to take urgent action because of the number of inmates at risk of suffering injury or death because of poor medical care. 

E-mail James Sterngold at,2232,REDD_17533_4239624,00.html

Study: California Prisoners Dying of Bad Healthcare
By Jenifer Warren
Times Staff Writer

3:13 PM PST, November 14, 2005

SACRAMENTO — California prisoners will continue to die from neglect and incompetence unless the state immediately raises doctors' salaries and takes other steps to recruit and retain medical workers, a report to a federal judge concluded today.

The report also called leaders of the state's floundering correctional healthcare system incapable of making needed reforms 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.

The report sums up what inmates and their advocates have been saying for weeks — that conditions have worsened since U.S. District Judge Thelton Henderson said he would put prison medical care in the hands of a receiver because of "an unconscionable degree of suffering and death."

Since that June 30 decision, efforts to find someone up to the challenge of running a $1.1-billion healthcare bureaucracy that serves 165,000 prisoners and employs 6,000 people have faltered.

Recognizing the extraordinary challenges of the job, Henderson has brought in a professional search firm, Korn Ferry International, and appointed Hagar to recommend interim measures to save lives.

Those recommendations are contained in today's report. Along with offering substantial salary increases to lure doctors and nurses into the sprawling correctional system, they include streamlining the application process for physicians and nurses, which can take as long as six months.

Vacancies on the medical staff are among the toughest problems in a state where a doctor shortage is a problem for society at large and many prisons are in far-flung, undesirable locations. At Pleasant Valley State Prison, off Interstate 5 near Coalinga, there is one doctor for almost 6,000 inmates.

At a series of hearings held by Henderson over the summer, experts testified that inadequate staffing was one important cause of the startling rate of preventable deaths in California prisons, where an ill inmate dies at an average rate of one per week.

"These recommendations represent the first concrete action we've seen that will prevent prisoners from dying," said Donald Specter of the Prison Law Office, which sued the state over inmate medical care. "It's just criminal that the state has allowed these conditions to not only continue, but to get worse."

The union representing doctors who work behind bars in California also expressed support for Hagar's report, along with the hope for an improvement in working conditions for physicians.

"This is a good start," said Gary Robinson, executive director of the Union of American Physicians and Dentists. "The healthcare leadership of the department has been completely incompetent, so maybe this will take us in a new direction."

Posted on Tue, Oct. 04, 2005 

Judge assails death rate, health care in prisons
By Mark Gladstone
Mercury News Sacramento Bureau

SACRAMENTO - For more than three years, California's prison officials have disregarded an agreement to scrutinize scores of prison deaths and allowed the backlog to reach more than 300 fatalities, including many due to ``neglect and cruelty,'' a federal judge said on Monday.

In his 53-page finding, U.S. District Judge Thelton Henderson reiterated that an inmate dies needlessly in state prison every six or seven days because of longstanding failures of the system. Last spring, he said, the pace quickened to almost one per day.

Henderson described an ``unconscionable degree of suffering and death'' behind the walls of the state's 33 lockups as he formally outlined his reasons for taking over prison health care. His written conclusions were released three months after the judge first announced his rare action.

Henderson said the state-run prison health care system reflects ``a textbook example'' of how ``political institutions sometimes fail to muster the will to protect a disenfranchised, stigmatized and unpopular subgroup of the population.'' And while the judge acknowledged some progress, he labeled it ``piecemeal.''

Moving forward

Roderick Hickman, secretary of the Department of Corrections and Rehabilitation, said his agency will ``continue to work with the court to expedite the appointment of a receiver so we can move forward with our efforts to reform the health care system'' and ``change the culture that has led to the current situation.''

Henderson spent the summer grappling with whether to name an interim receiver. Several sources who spoke on condition of anonymity said one potential candidate was a corporate turnaround firm. Now, Henderson plans to take additional time to launch a nationwide search for a permanent administrator with the help of a respected prison legal expert. John Hagar, the court-appointed special master at Pelican Bay State Prison, also has been asked to coordinate more immediate improvements, such as the hiring of new physicians and nurses. At some institutions, the vacancy rate for nurses is as high as 70 percent.

``What he's doing is being very careful to make sure he picks the best person in the country and I think that's appropriate,'' said Don Specter, an attorney with the Prison Law Office. The Marin County inmates rights group filed a class-action lawsuit in April 2001 on behalf of Marciano Plata and eight other inmate plaintiffs.

Under an agreement, the state was required to take a number of steps to improve health care. Instead, Henderson said, the state shirked its duty.

``This failure of political will, combined with a massive escalation in the rate of incarceration over the past few decades, has led to a serious and chronic abnegation of state responsibility for basic medical needs of prisoners,'' he said.

Widespread problems

Henderson paints a grim picture of poorly equipped and unsanitary medical facilities, medical records in shambles and waste of taxpayer funds. At San Quentin, he noted, pharmaceutical drugs are thrown away due to mismanagement.

He also cited interference from guards in the $1 billion-a-year health care system: ``Too frequently medical care decisions are pre-empted by custodial staff who have been given improper managerial responsibility over medical decision making.'' A spokesman for the prison guard union could not be reached for comment.

He emphasized that some physicians are dedicated and care about doing a good job. Gary Robinson, executive director of the Union of American Physicians and Dentists that represents prison physicians, welcomed Hagar's appointment and asserted ``health care management in corrections is incompetent.''

Contact Mark Gladstone at  or (916) 325-4314.

Judge seeks oversight of prison health system

Reform bill signed
By Don Thompson and David Kravets
5:21 p.m. May 10, 2005

FOLSOM – A federal judge on Tuesday moved to place the state prison system's troubled health care operations into receivership, complicating a massive prison overhaul bill signed into law hours earlier by Gov. Arnold Schwarzenegger.

U.S. District Judge Thelton Henderson, ruling in a class-action lawsuit brought against the California Department of Corrections, said the state's 162,000 prisoners "are being subjected to an unconstitutional system fraught with medical neglect and malfeasance."

Poor care has been blamed for the deaths of more than two dozen inmates.

"Defendants themselves have conceded that a significant number of prisoners have died as a direct result of this lack of care, and it is clear to the court that more are sure to suffer and die if the system is not immediately overhauled," he said.

Henderson's ruling, in San Francisco, came after Schwarzenegger appeared at Folsom State Prison to sign into law the most sweeping overhaul in three decades of the nation's largest prison system.

Schwarzenegger's signature was expected. The Republican governor has been calling for major reforms to the $7 billion-a-year system since shortly after he took office in November 2003. He helped craft a bipartisan solution through months of negotiations with the Democrat-controlled Legislature.

"When I came into office, we faced some very serious problems with our correctional system, including out-of-control budgets, a failed internal discipline system and a disturbing lack of accountability," Schwarzenegger said. "And the more we looked at the problems, the more we realized that the first step that we must take is to reorganize the whole agency."

The law restructures the bureaucracy of the 32-prison system and concentrates power with his hand-picked corrections czar, Youth and Adult Corrections Secretary Roderick Hickman.

Schwarzenegger said attention must now turn to several reforms: improving the health care system targeted by the judge Tuesday; overhauling a youth corrections system experts described as draconian; and fixing a rehabilitation system so flawed that the majority of ex-convicts are soon back behind prison walls.

It's unclear what affect Henderson's ruling will have on the governor's overall reform plan, since it could take control of the health care system out of the state's hands.

Top prison officials have acknowledged they can't manage the inmate medical system. They said they are counting on consultants and the legislation the governor signed Tuesday to make improvements that should have begun more than a year ago.

Prison department spokesman Todd Slosek said it is "unknown at this time" whether the state would oppose a receiver.

"The department's interest all along was for ... constitutionally adequate health care to our inmates," he said.

The judge said he will appoint a receiver to force improvements unless the Department of Corrections convinces him otherwise. He will make his final decision following a July 11 hearing.

In a review of 193 prison deaths, Henderson said many of the medical records were lost and that 34 of them were "highly problematic, with multiple instances of incompetence, indifference, neglect and even cruelty by medical staff."

One inmate, Henderson said, was given medication for high blood pressure in 2002 and was not seen again by physicians until he was found dead.

In a separate ruling Tuesday, Henderson said he also might hold the corrections department in contempt of court for not abiding by a June 2002 agreement to improve health care.

He said the department has failed to achieve "any substantial progress in bringing the medical care system even close to minimal constitutional standards."

Tuesday's federal court decision is the latest instance in which the courts have sought to exert control over California's problem-plagued prison system.

Federal judges already are assuming oversight of pieces of what on July 1 will become the new Department of Corrections and Rehabilitation. The combined department will replace what now are the California Department of Corrections and the California Youth Authority.

Another judge has appointed a special master to help reform the youth authority, while a separate special master is being considered to oversee stalled parole reforms.

Schwarzenegger, driven by near-constant prison scandals, made reorganizing the system the vanguard of his larger plan to restructure state government.

"This is just the first step," said Hickman, who will have responsibility for the entire system.

On the Net:

Read the reorganization bill, SB737, and the parole bill, SB619:

California Youth and Adult Correctional Agency:

Associated Press writers Don Thompson in Folsom and David Kravets in San Francisco contributed to this report.

Judge seeks oversight of prison health system

Reform bill signed
By Don Thompson and David Kravets
5:21 p.m. May 10, 2005

FOLSOM – A federal judge on Tuesday moved to place the state prison system's troubled health care operations into receivership, complicating a massive prison overhaul bill signed into law hours earlier by Gov. Arnold Schwarzenegger.

U.S. District Judge Thelton Henderson, ruling in a class-action lawsuit brought against the California Department of Corrections, said the state's 162,000 prisoners "are being subjected to an unconstitutional system fraught with medical neglect and malfeasance."

Poor care has been blamed for the deaths of more than two dozen inmates.

"Defendants themselves have conceded that a significant number of prisoners have died as a direct result of this lack of care, and it is clear to the court that more are sure to suffer and die if the system is not immediately overhauled," he said.

Henderson's ruling, in San Francisco, came after Schwarzenegger appeared at Folsom State Prison to sign into law the most sweeping overhaul in three decades of the nation's largest prison system.

Schwarzenegger's signature was expected. The Republican governor has been calling for major reforms to the $7 billion-a-year system since shortly after he took office in November 2003. He helped craft a bipartisan solution through months of negotiations with the Democrat-controlled Legislature.

"When I came into office, we faced some very serious problems with our correctional system, including out-of-control budgets, a failed internal discipline system and a disturbing lack of accountability," Schwarzenegger said. "And the more we looked at the problems, the more we realized that the first step that we must take is to reorganize the whole agency."

The law restructures the bureaucracy of the 32-prison system and concentrates power with his hand-picked corrections czar, Youth and Adult Corrections Secretary Roderick Hickman.

Schwarzenegger said attention must now turn to several reforms: improving the health care system targeted by the judge Tuesday; overhauling a youth corrections system experts described as draconian; and fixing a rehabilitation system so flawed that the majority of ex-convicts are soon back behind prison walls.

It's unclear what affect Henderson's ruling will have on the governor's overall reform plan, since it could take control of the health care system out of the state's hands.

Top prison officials have acknowledged they can't manage the inmate medical system. They said they are counting on consultants and the legislation the governor signed Tuesday to make improvements that should have begun more than a year ago.

Prison department spokesman Todd Slosek said it is "unknown at this time" whether the state would oppose a receiver.

"The department's interest all along was for ... constitutionally adequate health care to our inmates," he said.

The judge said he will appoint a receiver to force improvements unless the Department of Corrections convinces him otherwise. He will make his final decision following a July 11 hearing.

In a review of 193 prison deaths, Henderson said many of the medical records were lost and that 34 of them were "highly problematic, with multiple instances of incompetence, indifference, neglect and even cruelty by medical staff."

One inmate, Henderson said, was given medication for high blood pressure in 2002 and was not seen again by physicians until he was found dead.

In a separate ruling Tuesday, Henderson said he also might hold the corrections department in contempt of court for not abiding by a June 2002 agreement to improve health care.

He said the department has failed to achieve "any substantial progress in bringing the medical care system even close to minimal constitutional standards."

Tuesday's federal court decision is the latest instance in which the courts have sought to exert control over California's problem-plagued prison system.

Federal judges already are assuming oversight of pieces of what on July 1 will become the new Department of Corrections and Rehabilitation. The combined department will replace what now are the California Department of Corrections and the California Youth Authority.

Another judge has appointed a special master to help reform the youth authority, while a separate special master is being considered to oversee stalled parole reforms.

Schwarzenegger, driven by near-constant prison scandals, made reorganizing the system the vanguard of his larger plan to restructure state government.

"This is just the first step," said Hickman, who will have responsibility for the entire system.

On the Net:

Read the reorganization bill, SB737, and the parole bill, SB619:

California Youth and Adult Correctional Agency:

Associated Press writers Don Thompson in Folsom and David Kravets in San Francisco contributed to this report.

Prison doctors' union sues to block higher standards 

By Don Thompson
3:03 p.m. May 2, 2005

SACRAMENTO – The union representing prison doctors sued the Department of Corrections to block higher standards for physicians, blaming appalling health care problems on an inferior prison system. 

The Oakland-based Union of American Physicians and Dentists said Monday its doctors are not responsible for the problems. The Department of Corrections wants doctors to be board certified in internal medicine or family practice, or pass a competency test. 

The plan follows a series of scathing reports on health care at state prisons. National experts reported last month that conditions are so poor that inmates are dying of neglect and maltreatment. 

The suit filed Friday in Sacramento County Superior Court said imposing new minimum qualification standards violates state law, which requires that any new qualifications must be approved by the State Personnel Board. The board now requires only that doctors and dentists be licensed in California. 

The department has twice tried to impose such standards under what the union alleged were flawed evaluation programs. The union said no correctional agency in the nation requires its doctors to prove their competency. 

The Department of Corrections is "arbitrarily, capriciously, and unilaterally imposing new minimum qualifications for prison doctors to divert attention from its own execrable management spanning two decades," the union said in a statement. "In a desperate last ditch effort to divert attention from its own colossal mismanagement, CDC is doing its best to blame prison doctors for its own failures." 

National experts last month reported cases of doctors who acted incompetently, prescribing the wrong treatment or ignoring complaints until it was too late. They and other experts have said doctors are sometimes unqualified to see the patients they treat, conditions are abysmal, and the medical system is severely understaffed. 

Youth and Adult Correctional Agency Undersecretary Kevin Carruth acknowledged last week that prison officials are unable to manage the medical system, and want to hire University of California consultants to design a plan to improve care in 18 months. 

The union criticized the plan to pay UC San Diego and UC San Francisco $14.7 million, when it says the state could be better served by implementing 28 reforms that the union has suggested. 

A Senate committee cut out the consultants' money last week, in anticipation that a federal judge will hold hearings and may appoint an overseer for the health care system. 

On the Net: 

California Youth and Adult Correctional Agency:

California Department of Corrections:

Prison Law Office:

Posted on Thu, Apr. 14, 2005 

San Quentin 'decrepit'
By Mark Gladstone
Mercury News Sacramento Bureau

SACRAMENTO - California's landmark San Quentin Prison is a decrepit facility that poses a major public-health-care risk to thousands of inmates who are living in refugee-camp-like surroundings, a court-appointed panel of medical experts has found.

In a scathing report, obtained by the Mercury News, the experts said the prison is overseen by an indifferent staff that ignores a major federal court agreement to improve health care.

The inspectors examined 10 inmate deaths over the past three years and found that most were preventable. Before their deaths, three of the inmate-patients were treated by a single unidentified prison doctor, identified only as Dr. X, who at one point was placed on administrative leave.

The 53-page report is based on inspections earlier this year by two doctors and a nurse. In it, they told U.S. Judge Thelton Henderson that San Quentin is ``so old, antiquated, dirty, poorly staffed, poorly maintained with inadequate medical space and equipment and overcrowded'' that its entire mission needs to be re-evaluated.

In some of the strongest language ever used to describe a state-run facility, they also said that reviews of medical records at the Marin County lockup on the shore of San Francisco Bay ``demonstrate multiple instances of incompetence, indifference, cruelty and neglect.''

Longstanding concern

Corrections Director Jeanne Woodford, who was the longtime warden at San Quentin, was not available for comment. But Todd Slosek, a spokesman, acknowledged that concerns over health care are longstanding.

He said, ``The department has developed a remedial plan and is working with the court to ensure that the experts' concerns are addressed.'' And he noted the prison system is developing standards for physicians.

The reports on San Quentin and two other state prisons came to light on the eve of a Senate hearing set for today into the skyrocketing cost of prison health care. Costs have doubled to more than $1 billion annually over the past six years.

Sen. Gloria Romero, D-Los Angeles, chair of today's hearing, called the report ``damning.'' ``This has truly been a correctional agency that's neglected the most basic of inmate rights protected by the U.S. Constitution. It's shameful to realize that taxpayers are pouring $1 billion into a system'' that should pay for the most basic of health care needs.

Problems later

Not only are inmates constitutionally guaranteed adequate health care, but most inmates also wind up getting released and if they are sick they can pose a health risk to the general population. In addition, the state has been forced to pay out millions of dollars in settlements to inmates who have alleged they were mistreated in state institutions.

The inspections and report were ordered by Henderson who oversees compliance under a sweeping legal agreement known as the Plata settlement -- after Marciano Plata, one of nine plaintiffs in an April 2001 class-action lawsuit filed by inmates' rights activists. While the medical experts said there had been initial progress, they now found conditions ``disturbing'' in a cover letter dated April 9 and signed by Dr. Michael Puisis, an Illinois-based expert on correctional health care.

The legal settlement reached several years ago requires California's 32 prisons to provide adequate health care by 2008. The lawsuit charged that the prisons' poor medical care violated the Constitution's ban on cruel and unusual punishment.

But the experts found that overall compliance with the agreement was ``non-existent'' and that there was indifference to turning things around. In fact, they recommended that the mission of San Quentin, which receives new inmates, be re-evaluated.

Overhaul goal

The Schwarzenegger administration has been seeking to overhaul the way prisons are administered, centralizing control in Sacramento under Youth and Adult Corrections Secretary Roderick Hickman.

However, for the second time in the past month, an independent investigation has painted a grim picture of the way a state prison is managed. Last month, the Office of the Inspector General reported that the California Institution for Men in Chino was on the verge of chaos in the wake of the first slaying of a guard in 20 years.

Now, the medical panel is describing an equally disturbing situation at San Quentin.

``Some of the physical structures or arrangements for housing at San Quentin are so decrepit that it is degrading and dangerous to house human beings in them for extended periods of time,'' the report states.

``Yet, these arrangements have existed for so long that staff have become inured to the conditions and have become so accustomed to the degrading conditions that they are considered normal. Leadership has become so accepting of inability to change that an overwhelming attitude of resignation exists.''

Review of 10 deaths

Perhaps most important, the report reviewed 10 deaths. ``Each of these should have resulted in discipline; while these were referred to investigations, nothing had yet been done. Lack of timely discipline after the first death may have resulted in the continued mistakes and deaths.''

The experts also inspected California State Prison, Sacramento, and Salinas Valley State Prison. At Sacramento, they cited a lack of nursing supervision, and similarly they found a lack of nursing leadership at Salinas Valley. As a result of poor leadership there, the inspectors said, there is ``staff confusion and dissension.''

Besides Puisis, others involved with the report include Dr. Joe Goldenson of Berkeley and Madie Lamarre, a nurse from Atlanta, Ga.

Contact Mark Gladstone at  or (916) 325-4314. 

Posted on Fri, Apr. 15, 2005 

Prison's medical system assailed
By Mark Gladstone
Mercury News Sacramento Bureau

SACRAMENTO -- The inmate could neither eat nor drink and was dehydrated when he showed up at the San Quentin clinic shortly after 8 p.m. on Jan. 28. With a fever over 103 and a racing pulse, his vital signs indicated possible shock and a life-threatening emergency.

With prison medical records in disarray, the doctor on duty did not have a chart to check the inmate's history. The doctor failed to evaluate the inmate for dehydration and diagnosed bronchitis and the flu. He prescribed Tylenol, Benadryl, cough syrup, antibiotics and two other medications and told the inmate to come back in a week.

Heading back to his cell, the inmate collapsed, according to a report from three court-appointed medical experts obtained by the Mercury News. The physician, known only as ``Dr. X,'' gave him some fluids and sent him back to his housing unit. By the next afternoon, the felon was in shock and died about 30 hours after he was first seen by Dr. X.

In their report to U.S. District Court Judge Thelton Henderson, the medical experts cited 10 deaths at San Quentin. Most were preventable, they said, including three cases overseen by Dr. X.

These and other cases reflect a broken medical system that might require a partial takeover by the federal court, suggested Sen. Gloria Romero, D-Los Angeles, at a legislative oversight hearing on prison health care Thursday.

Department of Corrections officials acknowledged that the reports were ``damning.'' But in an apparent effort to stave off federal intervention, state authorities revealed for the first time that next year they expect to start contracting out for health care.

``This would be a different way of delivering health care,'' said Kevin Carruth, undersecretary of the Youth and Adult Correctional Agency, which oversees prisons. Asked his timeline, Carruth said, ``If we're lucky and things go well, a year plus.''

The plan is designed to help the state meet the terms of a settlement of a lawsuit by nine inmates in which the prison system has agreed to upgrade health care to its 165,000 inmates. The plan is still being shaped.

Carruth said he believes that in the long run the new scheme -- which would entail contractors in Sacramento overseeing subcontractors at different prisons -- would save money for the state, which now spends $1.1 billion a year on inmate health care.

``We've had a structure that has not historically placed health care priorities as high as other priorities,'' Carruth said. He noted that revamping the department -- set to take place in the next few months -- will help elevate health care priorities.

The notion of contracting out health services ran into immediate criticism from Sen. Mike Machado, D-Stockton. ``You guys are just hiding from the responsibility. You are putting the state at risk,'' he scolded Carruth. ``You are not being accountable to the taxpayers and yet you have the nerve to come to us and ask for money and say, `Trust us, we're going to come up with the performance standards.' ''

``You haven't given me the confidence to sit here and endorse the budget for your department,'' Machado declared to applause from the audience in a state Capitol hearing room.

Earlier, Machado tangled with Dr. Renee Kanan, corrections acting medical director, over whether she has the power to order washbasins in examination rooms. In their report, the experts determined that in some clinics at San Quentin doctors don't have access to hand-washing facilities.

``Do you have the authority to demand that wash sinks be placed in every examination room?'' Machado asked.

Kanan responded that she has required an alcohol-based material be made available for medical personnel to wash their hands with.

Machado interpreted this to mean that she doesn't have the clout to require the sinks. Later, a corrections spokesman said Kanan can order the washbasins but ``she can't do it alone.''

Kanan said the department is moving to address one of the broader criticisms raised by the investigators. In their report dated April 9, they said San Quentin does not conduct a review of each prisoner death. Kanan said she has now implemented death reviews, begun to look to hire physicians from overseas and retained a headhunter to find medical personnel for the prison system, which has many vacancies.

The report to Henderson said Dr. X ``exhibited extremely poor clinical judgment'' in three cases of extremely ill prisoners who needed to be seen in an acute hospital. ``His actions fall well below the accepted standard of care,'' the experts said. The physician was put on administrative leave after the inmate's death.

Contact Mark Gladstone at  or (916) 325-4314. 

Prison Clinics Called Dirty, Deadly

A report by court- appointed monitors says healthcare at San Quentin is so bad it is dangerous, sometimes fatal, to inmates.
By Jordan Rau
Times Staff Writer

April 14, 2005

SACRAMENTO — Despite a court order to improve medical care for inmates, San Quentin State Prison's health facilities and treatment practices are so harrowingly bad that many sick prisoners should not be taken there at all, independent examiners have concluded.

The court-appointed experts inspected the medical records of 10 inmates who died over the last few years in California's oldest and best known prison and concluded that in each case, the treatment "showed serious problems" and "most deaths were preventable."

Doctors and nurses misdiagnosed illnesses, gave patients the wrong medications, neglected them for months and even years or delayed sending them to emergency rooms until they were fatally ill, the experts discovered.

The examiners watched a dentist examine inmate after inmate while wearing the same pair of gloves. Records were in such disarray that doctors reported that they could not find medical files for at least 30% of the inmates they examined.

Based on visits to the prison earlier this year, the experts' April 8 report documented filthy clinics and patient housing. Dental examinations are done in a place without light or water; inmates are initially evaluated in a room without a sink for washing hands; nurses until recently used a broom closet as an examination room; and wheelchair-bound patients cannot roll into the hospital cells on their own because the doors are too narrow.

"We found a facility so old, antiquated, dirty, poorly staffed, poorly maintained, with inadequate medical space and equipment and overcrowded that it is our opinion that it is dangerous to house people there with certain medical conditions and also dangerous to use this facility as an intake facility," the experts wrote. 

The examiners found less dreadful but nonetheless extensive shortcomings with the medical care at Salinas Valley State Prison and the California State Prison at Sacramento, in Folsom. Although they found improvements, the visits uncovered some of the same management problems that plague San Quentin, including a lack of basic medical equipment, dirty facilities and a culture of indifference among some senior medical staff.

Taken together, the site reports raise major questions about California's compliance with the settlement of a lawsuit charging that inmate medical care was so poor it amounted to cruel and unusual punishment.

The case was settled in 2002 and is being overseen by U.S. District Judge Thelton Henderson in San Francisco, who appointed the monitors. 

Under the terms of the settlement, the state's prisons should already be making improvements, and must complete them by 2008.

Henderson, who last year threatened to appoint a receiver to take over the entire state Department of Corrections, discussed the reports Wednesday in Sacramento with the medical experts, state prisons commissioner Roderick Hickman and, separately, state Sen. Gloria Romero (D-Los Angeles), chairwoman of a Senate panel investigating state prisons.

Todd Slosek, a corrections spokesman, said department officials will be prepared to discuss the problems at a hearing Romero has set for today on the broader topic of prison healthcare costs.

"We're currently working with the courts to address the issues raised by the experts," he said, adding that the department has developed a remedial plan for the deficiencies found at San Quentin.

Romero said the reports make her question whether the prison system is capable of reforming itself. She noted that while $1 billion of the $7-billion annual prison budget is spent on healthcare, the reports suggest that much of this money is squandered.

"What these reports reflect is there has been a culture of negligence by the bureaucracies across the various administrations in terms of addressing the most basic healthcare needs of inmates," Romero said.

The monitors — who include doctors and nurses with experience in prison healthcare — raised the same concerns about the overcrowded San Quentin prison, which is supposed to house no more than 3,317 inmates but has a population hovering around 6,000. They noted the incredibly low expectations of the staff, who would refer to "the San Quentin way" and say that they were "making do with the hand we've been dealt" when discussing the prison's inferior clinics and equipment.

The experts also noted that the prison only emerged within the last decade from a previous federal order to improve medical care.

"The system of organizational structure within the [California Department of Corrections] that permitted this facility to deteriorate over the past 10 years to the state described in this report must be addressed as well," they wrote. "These problems have not occurred overnight."

Among the problems at San Quentin identified by the examiners:

•  Three patients who later died had been seen by the same doctor, who the experts said failed to properly treat patients with clear signs of extreme illness and did not refer them for emergency care "until their conditions had deteriorated to the point where their deaths were inevitable." The doctor, who was not named in the report, was placed on administrative leave after the third death.

•  One patient identified as having "extremely high blood pressure" was "basically neglected for over a year and a half" until he died.

•  Another patient who died from renal failure was not correctly diagnosed for "an extended period" and then was not given dialysis. He was, however, given medicines that were not safe for him.

•  A diabetic inmate with a foot problem was housed in the mental health unit because there were no empty beds in the medical unit. There, his shoes were taken away, as is customarily done with psychotic and suicidal patients, even though his bare foot was then made more vulnerable to damage. 

The experts found less serious but still inadequate conditions at Salinas. Their report said the Corrections Department had increased doctors' hours to reduce the backlog of untreated inmates.

Still, the experts concluded that high nurse and medical assistant turnover and vacancies undermined prompt examinations, with appointments often rescheduled and new patients not being referred to physicians.

"The fact that healthcare staff has difficulty obtaining basic medical supplies for clinic operations is completely unacceptable, and helps explain staff exasperation and frequent turnover," the experts wrote.

Overseer may be needed for prison health care, experts say

By Don Thompson
5:09 p.m. April 14, 2005

SACRAMENTO – Health care conditions at California prisons are so bad a federal judge should consider appointing an overseer to manage the system before more inmates die of neglect or ill-treatment, experts and angry state lawmakers said Thursday.

Top prison administrators acknowledged they can't manage the prison medical system, but said outside consultants signed contracts this week to help. But even basic improvements are 18 months away, Youth and Adult Correctional Agency Undersecretary Kevin Carruth told a Senate hearing.

"Does it bother you in the next 18 months we're probably going to have even more deaths? Does it bother you?" asked Senate Majority Leader Gloria Romero, D-Los Angeles, who chaired the joint hearing of two prison oversight committees.

U.S. District Judge Thelton Henderson should hold the state in contempt or appoint a receiver to force the state to comply after court-appointed experts reported that inmates are dying for lack of basic care, said Don Spector of the Prison Law Office, an inmate rights law firm that was party to the settlement.

Romero said Henderson told her Wednesday he has a "dire concern over the ability and commitment of this prison bureaucracy to fix it." Henderson last year threatened to appoint a receiver to take over the entire state Department of Corrections, but has not done so.

"The reports are abominable, they are damning ... (portraying) a system so broken that is an actual threat to inmates, to the staff that work there, to the public," Romero said, noting experts' conclusion that "at least 30 inmates have died from preventable causes."

The deputy director who manages Corrections' Health Care Services Division, Dr. Renee Kanan, agreed a federal overseer should be considered, after acknowledging she can now only recommend improving even basic sanitary conditions that the experts found appalling and dangerous.

Sen. Mike Machado, D-Linden, was furious at the lack of progress in complying with a federal court order more than a year old.

"You guys are just hiding from the responsibility; you're putting the state at risk; you're not being responsible to the taxpayer," Machado told the officials.

Sen. John Campbell, R-Irvine, said, "The system needs to be changed, blown up, whatever it is, so we get a standard of care that is acceptable."

The experts said administrators at Marin County's antiquated San Quentin State Prison have had a year to comply with a court order to improve medical care, yet compliance was "nonexistent." Conditions there are so poor they said the number of inmates should be limited, an outpatient unit should be closed or used for nonmedical purposes, and new inmates should be processed at some other prison.

Things are better, and improving, at Salinas Valley State Prison and the California State Prison at Sacramento, in Folsom, yet still don't meet the progress expected after a year, the experts reported. The settlement requires that all 32 prisons provide adequate health care by 2008.

California's $1.1 billion inmate health care system is among the nation's worst, yet the state spends two or three times more per inmate as do other states, Romero said the experts told her Wednesday. The experts did not testify about their inspections, the first in their series of reports on the state's compliance.

Carruth said the reports are both "scathing" and "accurate."

"We are not appreciably better than we were 14 years ago," when the first in a series of suits challenged the state's inmate medical care, Carruth acknowledged. "It is not our area of expertise, frankly," which is why the state is seeking advice from the University of California medical system and the state Department of Managed Care.

"We are going to move as expeditiously as we possibly can, given the constraints we have to live under," Carruth said.

Kanan, who has directed the prison health care system for six months, said she had believed providing more and better doctors and nurses was the biggest problem.

But the experts' reports show even more basic reform is needed, she said. The experts found examining rooms with no sinks, employees who had to walk through sewage puddles or shower rooms to examine inmates, doctors who wore the same gloves and used the same tongue depressors to treat multiple inmates. Medical records were missing for at least 30 percent of inmates.

Inmates literally died of neglect or, worse, harmful medical treatment, said Spector, of the Prison Law Office.

"The medical care is so bad that more inmates are dying from medical neglect than are dying from violence," he said. "Being sent to prison is literally killing people."

On the Net:

California Youth and Adult Correctional Agency:

California Department of Corrections:

Prison Law Office:

Business Wire

October 06, 2004 06:23 PM US Eastern Timezone 

Medical Board of California Obtains Suspension of Soledad Physician's License 

SACRAMENTO, Calif.--(BUSINESS WIRE)--Oct. 6, 2004--On October 4, 2004, Administrative Law Judge Jonathan Lew signed an order which prohibits Soledad physician Isaac A. Grillo, M.D. from practicing medicine; possessing, prescribing, dispensing, furnishing, administering, or otherwise distributing any controlled substance or any dangerous drug; and possessing or holding his physician wall and wallet certificates, any triplicates and regular prescription blanks, DEA order forms, and any DEA permits. Grillo has been ordered to appear at the Office of Administrative Hearings in Oakland on October 22, 2004 to show cause why the suspension of his license to practice medicine should not be extended. 

The Medical Board had filed an accusation against Grillo alleging unprofessional conduct through gross negligence and incompetence in that he failed to diagnose a cervical spinal injury of a prisoner at Soledad prison who had suffered a subluxation of C4-C5, resulting in quadriplegia. The board later adopted a stipulated settlement and disciplinary order, which imposed a public letter of reprimand with a condition precedent: successful completion of Phases I and II of the Physician Assessment and Clinical Education (PACE) program at the University of California at San Diego. 

In a September 8, 2004 communication to the board from the Director and Associate Director of the UCSD Pace Program, the board was informed that serious deficiencies were noted during Grillo's assessment by the PACE faculty/staff. The assessment report noted that at a multi-disciplinary staff meeting on September 1, 2004, the director and other participants "expressed grave reservations about whether Dr. Grillo should be practicing medicine" and that the "deficiencies documented during his two-day Phase-1 PACE Assessment, if applied in the real world of medical practice, would almost certainly have resulted in patient harm, and perhaps even death." The report also stated that Grillo's serious deficiencies of clinical knowledge and judgment extended beyond the limited scope of the PACE Program's five-day clinical education and that as a result, "may require additional training or monitoring either in residency, fellowship, or some other proctored environment." 

The mission of the Medical Board is to protect healthcare consumers through the proper licensing and regulation of physicians and surgeons and certain allied healthcare professions and through the vigorous, objective enforcement of the Medical Practice Act. 

If you have a question or complaint about the healthcare you are receiving, the board encourages you to visit its Web site at , or for questions call the Consumer Information Line at 916-263-2382, or with complaints call 800-633-2322.,1,1974389.story

Relatives of Dead Inmate to Sue State
The man died after having a tooth pulled. Legislators hold a hearing on prison healthcare and criticize the system's quality.
By Jenifer Warren
Times Staff Writer

September 30, 2004

SACRAMENTO — The family of a California inmate who died after he had a tooth pulled said Wednesday that they were suing the state over his death, as two legislators held a Capitol hearing to investigate why prison healthcare remains poor but increasingly expensive.

Relatives of Anthony Shumake, 41, said they would file a wrongful-death lawsuit because a medical pathologist's report showed that he died of complications from the extraction.

The report from the San Joaquin County coroner's office showed that Shumake died June 28 after his airway was constricted by an abscess in his throat. In an interview, Dr. Robert Lawrence, a pathologist, said a "rip-roaring infection" had caused extensive swelling, reducing air flow.

"The airway was not sufficiently open to allow a free flow of oxygen," Lawrence said. "The lack of oxygen caused the heart to go into a fatal rhythm." 

Shumake's relatives said other inmates told them that they had tried to get medical help for Shumake in the days after the dental work, as his neck turned red and swollen and he complained of continuing pain. But those requests, they said, went unheeded at Solano State Prison in Vacaville until he fell into respiratory distress and an ambulance was finally called.

Prison officials would not comment on the case, saying that an internal investigation was underway.

"It's been very hard for our family to see a healthy young man have a tooth pulled and then wind up dead," said the Rev. Andre Shumake, the inmate's uncle and a neighborhood activist in the Bay Area city of Richmond. "Anthony was given a prison sentence, not a death sentence. These men may be inmates, but they're human beings."

The Shumake family traveled to Sacramento for a hearing that examined healthcare in the $6-billion California correctional system. Among the topics covered were reports from the California Medical Board, which licenses and disciplines doctors, that showed that one in five prison physicians had a blemished record or had been sued for malpractice.

That 20% rate is almost five times the figure statewide, the board said. Legislators called it unacceptable and indicative of a system in distress.

"To put it very bluntly and very simply, the healthcare system at the California Department of Corrections is sick," said state Sen. Jackie Speier (D-Hillsborough).

Sen. Gloria Romero (D-Los Angeles), co-chairwoman, with Speier, of the hearing, agreed. "The sad fact is California has been growing its inmate population but has failed to provide adequate healthcare for those we lock away," she said. 

Under questioning by the senators, corrections officials acknowledged that major problems remain with the network of clinics, hospitals, treatment centers and outside medical contractors that cares for the state's 164,000 inmates.

Dr. Renee Kanan, chief of healthcare for the system, said that "historically, our modus operandi has been very reactive. We've had plenty of fragmented exit strategies, but we've never had a comprehensive strategic plan."

But progress has been made, she said, since a class-action lawsuit, which was settled in 2002, alleged that California's prison healthcare amounted to cruel and unusual punishment.

The changes include tighter screening and monitoring of physicians and creation of an oversight committee to track healthcare costs, which have nearly doubled over the last five years and could hit $1 billion this year.

"We know we have many challenges in our efforts to provide quality healthcare," Corrections Director Jeanne Woodford testified. "We want to fix what this committee has called a broken system … and become known as a state that uses the best practices in all aspects of its healthcare system."

Speier and Romero, who have conducted hearings focused on problems in the prisons, did not appear to be patient. They said that the Department of Corrections had been sued over healthcare numerous times over the last two decades, and that it seemed as if only court-imposed mandates had forced change.

Speier asked why the federal government had been able to reduce its prison healthcare costs while the state's costs had soared — a question to which she received no clear answer.

"The scratching of heads is no longer acceptable," Speier said. "It is time to realize what [the prisons'] healthcare policies and practices are costing each and every Californian."

One major challenge facing prison doctors is the condition of patients. Inmates tend to be sicker than the population at large, often because of unhealthy habits and a lack of medical care earlier in life. One in five has a serious mental illness; one-third are infected with hepatitis C. The rate of HIV/AIDS in prison is five times higher than the national average.

Dr. Jacqueline Tulsky, a professor at UC San Francisco Medical School who has studied prison healthcare, described the average California inmate as a 40-year-old male who is a high school dropout with alcohol addiction, a history of crack cocaine use and mild depression. His medical problems probably include hypertension, diabetes, elevated cholesterol levels and mild arthritis. Periodically, he needs treatment for injuries incurred on the prison yard.

"No healthcare plan in this state," Tulsky said, "has the severity of illnesses you find in the Department of Corrections." 

Several prison doctors cited other crucial differences, including a shabby infrastructure that makes practicing medicine difficult at best. Dr. Scott Anderson, who works at the California Medical Facility, a prison in Vacaville, said physicians sometimes lack essentials as basic as an examining table, soap and towels with which to dry their hands.

A severe shortage of nurses and medical technical assistants, who provide security as well as clinical help, also affects care, he said. And perhaps the greatest problem facing prison physicians is technological: the absence of computers to track inmate medical records, view X-rays and help with medical decisions.

Corrections officials agree that working conditions are not ideal. They said that plans to give each prison doctor competency testing should root out those unfit to practice.

Doctors who testified criticized the plan, warning that it could have the paradoxical effect of driving good doctors out of the system. Anderson said he considered his board certification in specialties such as rheumatology and geriatrics a sufficient validation of his skills.

"I certainly don't want to practice with doctors who are not competent," Anderson said. "But I'm troubled by the thought of going through testing that might be arbitrary, capricious … and may lead to a dark mark on our record that would follow us for life."

Posted on Wed, Sep. 29, 2004 

California should mimic federal prison health care, senators say


Associated Press

SACRAMENTO - Health care costs at California's prisons have nearly doubled in five years even as inmates die at the hands of unqualified doctors, senators said Wednesday at another hearing into the state's troubled corrections system.

In one case in February, a 72-year-old inmate starved to death in front of health care workers.

In June, a 41-year-old inmate died six days after having a wisdom tooth pulled, and after being shuttled more than two hours to medical care instead of being rushed to either of two closer hospitals.

"My nephew, Anthony Shumake, had a tooth pulled and now he is dead," the Rev. Andre Shumake told senators. Shumake "was given a prison sentence, not a death sentence. ... No one should have a tooth pulled and die in this day and age."

Shumake's fate shows the worst of the system that wastes millions of dollars a year but still brings poor results, said Sen. Jackie Speier, D-Daly City.

California should emulate the federal prison system, which has cut per-inmate spending amid rising medical costs, senators said during the hearing.

While they downplayed suggestions by Gov. Arnold Schwarzenegger's Corrections Independent Review Panel to privatize inmate health care in cooperation with the University of California, they said private and university experts should be recruited to recommend reforms.

Taxpayers will spend $1 billion this year to provide health services to the 164,000 inmates in the nation's largest state prison system, the fastest-growing component of the state's annual $6 billion corrections budget.

For all that money, inmates receive poor care often by doctors untrained for the positions they hold, according to a recent audit. Twenty percent of those physicians have malpractice or disciplinary problems.

Speier, who heads a government oversight committee, co-chaired Wednesday's hearing with Sen. Gloria Romero, D-Los Angeles, who leads a corrections review panel.

Their joint hearing is the seventh in 18 months on a system where management and spending is out of control, say auditors, national experts, Senate witnesses and a federal court monitor.

The administration, which says reforms are underway, recently settled the latest in a series of lawsuits over inmate health care. Recommendations by the prison review panel headed by former Gov. George Deukmejian are under review by the administration - though not quickly enough, the senators said.

It's a complicated problem, Romero said, because inmates are frequently in poor health, and diseases such as tuberculosis, AIDS and hepatitis can spread easily. Also, care must be provided in remote locations under extraordinary security restrictions. Inmates frequently are mentally ill or drug addicted, and strict sentencing laws are turning some prisons into "nursing homes" for geriatric patients.

California fights these problems with a "mind-blowing" lack of modern medical technology, including virtually nonexistent use of computers, the Internet, even cell phones and voice mail that can stall coordination and communication across the system, testified Dr. Jacqueline Tulsky of the University of California, San Francisco.

Still, the biggest problem is a prison medical staff that often is "barely licensable," Tulsky said. But several prison doctors denied the majority of physicians are unqualified, blaming problems instead on prison bureaucracy and a lack of equipment, nurses and medical technicians.

In July, a state audit found California prisons paid local hospitals as much as eight times more than Medicare would have paid for the same medical procedure, leading to an average 21 percent annual increase in health care costs the last five years.

"The (federal) Bureau of Prisons was in a position very similar to what the California system has seen" because of its rapid uncoordinated growth, testified Theodore Willich, vice president of a private federal health services contractor, Medical Development International. "It really just got out of control."

Senators said the state could cut costs as the federal government has, by paying only Medicare rates and providing care at prison infirmaries instead of outside hospitals. The state should have more centralized control over health care instead of having 32 decentralized prison "fiefdoms."

Schwarzenegger's administration says it's already doing more of that, leading to a projected $26 million cut in medical costs this year.


California Department of Corrections:,1,3721958.story?coll=la-news-state

Scathing Report on Prison Doctors
A panel of experts ordered by court to review state system calls physician quality 'seriously deficient'
By Tim Reiterman
Times Staff Writer

August 11, 2004

SAN FRANCISCO — Incompetent doctors, including some with a history of substance abuse or mental health problems, have been hired by California's prison system and have contributed to serious deficiencies in healthcare for inmates, according to a federal court report released Tuesday.

At one facility, half of the eight doctors had prior criminal charges, loss of privileges at community hospitals or mental health problems, the panel said. At another, seven of 20 doctors had similar problems. 

"There appears to be an emerging pattern of inadequate and seriously deficient physician quality" in prisons, a panel of experts said in a letter to U.S. District Judge Thelton Henderson, who ordered the report as part of a civil rights suit alleging substandard medical care for inmates.

A panel of two doctors and a nurse practitioner conducted reviews of medical treatment at about half a dozen of the state's 32 prisons. They concluded in a July 16 letter to the judge that the department had hired many incompetent doctors with a history of problems, then failed to monitor them, putting inmates at serious risk of injury or death.

"The only requirement for hiring is a medical license," said the letter.

California Department of Corrections officials said they were formulating a plan that would improve prison medical services, the fastest-growing part of the $5.7-billion state prison budget. 

"There will be remedial training and greater clinical supervision … and a stricter adherence to department policies," said spokeswoman Margot Bach. "The department … takes the healthcare of inmates very seriously."

The panel concluded that many doctors were not trained to administer the treatments they were providing inmates, some with serious illnesses. The report did not name the prisons or the doctors. 

"An incompetent retired cardio-thoracic surgeon manages complex internal medicine patients and makes serious life-threatening mistakes on a continual basis," the report said.

The panel also cited the case of an obstetrician who was managing HIV patients and a neurosurgeon who was seeing patients with internal medicine problems, although he was not trained to read electrocardiograms used in internal medicine.

"It could be named the Keystone Docs," said state Sen. Jackie Speier (D-Hillsborough), who has scheduled hearings on the corrections healthcare system for next month. "If it was a want ad, it would say something like, 'Bad doctors apply here. No one turned away.' "

The prison healthcare budget for this fiscal year is $879 million. Officials say rising costs are a result of the growing and aging inmate population, as well as increased spending for prescription drugs, medical treatment and court-mandated services.

The Corrections Department agreed 2 1/2 years ago to settle a lawsuit brought by the Prison Law Office, a Marin County civil rights group, on behalf of the state's 163,000 inmates. That plan is projected to cost tens of millions of dollars a year, and, among other things, calls for putting nurses in prison clinics around the clock.

The findings by Henderson's medical panel surprised even Don Spector, executive director of the Prison Law Office. "It was worse than we thought," he said. "We always knew there were physicians who had no business practicing medicine, but we did not know it was this pervasive."

Henderson is expected to hold a conference on the panel's report and the state's remedial plans this month.

The report described a system in which individual prisons operated with great autonomy and little oversight. The corrections official in Sacramento with final word on hiring was not a doctor. Only one of the prisons reviewed had its chief physician and surgeon's position filled — and that doctor was an ophthalmologist who was training doctors in internal medicine.

At individual prisons, the report found, doctors with training deficiencies were hiring and overseeing the work of other prison physicians. "At one of the facilities reviewed, the vice chairman of the committee that oversees credentialing is an obstetrician who had lost his license for seven years for incompetence and alcoholism," said the report, adding that he oversees doctors practicing internal medicine although he has no experience in that area.

The union that represents about 600 prison doctors, dentists and psychologists blamed quality problems on cost cutting by the state, which has led to the hiring of contract physicians rather than civil service doctors.

"Contract doctors are most of the problem," said Dr. Robert Weinmann, president of the Union of American Physicians and Dentists. "We have a recalcitrant state system. They want to hire and fire locally at will with no benefits."

The panel and Spector of the Prison Law Office gave high marks to the new acting head of the state's prison healthcare services, Dr. Renee Kanan.

But, Spector added, "she is one person in a gigantic system with more bureaucratic hurdles than you can imagine."

Reports show poor medical care in state's prisons 
Incompetent doctors called systemwide problem 
- Mark Martin, Chronicle Sacramento Bureau
Wednesday, August 11, 2004 

Sacramento -- Half of the doctors working at one California prison have a criminal record or mental health problems or have lost the right to practice in a hospital. 

At another lockup, a neurosurgeon with no expertise in internal medicine misdiagnosed an inmate suffering from pneumonia in both lungs, prescribing anti-depression medicine that nearly killed him. 

And an obstetrician who lost his medical license for seven years helps determine whether problem physicians at one prison should remain on the job. 

Adding more bad news for a scandal-plagued state prison system, two reports released Tuesday depict a corrections system rife with unqualified doctors working in poor conditions. The reports were made public by a Marin County law office that sued the state over prison health care. They add to mounting evidence that California's troubled prisons run a medical operation with out-of-control costs that often fails to provide basic health care for 162,000 inmates. 

The reports come on the heels of the mysterious death of an inmate at a Vacaville prison who apparently died after having a tooth pulled. The death has the inmate's Richmond family and some lawmakers questioning whether health care providers at the prison made mistakes with deadly consequences. 

On Tuesday, state Sen. Jackie Speier, D-Hillsborough, called the reports' findings "shameful.'' 

"It's Keystone Docs,'' said Speier, who has become a frequent corrections critic and who is looking into the June 28 death of Solano State Prison inmate Anthony Shumake. 

The reports were commissioned by the Marin-based Prison Law Office, which represents inmates and in 2001 sued the state Department of Corrections over shoddy medical practices. The lawsuit was settled in 2002 after the department agreed to dramatically reshape its health care program. 

As part of the oversight of the settlement, three independent prison health experts -- Dr. Michael Puisis of Illinois, Dr. Joe Goldenson of San Francisco and Madie LaMarre, a nurse from Georgia -- this year reviewed medical procedures at several prisons and at department headquarters. Among the findings compiled in two reports: 

-- At one prison, an obstetrician sees HIV patients. At another, "an incompetent retired cardiothoracic surgeon manages complex internal medicine patients and makes serious life-threatening mistakes on a continual basis,'' according to the report. 

-- Doctors in one unit at Salinas Valley State Prison in Soledad (Monterey County) must conduct exams while inmates remain in their cells, meaning the only way to touch an inmate is through a 4-inch by 12-inch food port. Health clinics at Salinas Valley and Sacramento State Prison have no examination tables. 

-- At Sacramento State Prison, forms inmates file to request a visit with a doctor were found piled up on a desk and had not been reviewed in months. At some facilities, according to the report, there is no chief physician, and therefore "physicians monitor themselves.'' 

The reports' authors were unavailable for comment Tuesday, and many of the allegations in the reports did not include names of doctors, prison locations or other details. 

But corrections officials did not dispute the reports' findings, instead saying they are working on a response plan that will be presented later this month to U.S. District Court Judge Thelton Henderson, who is overseeing the implementation of the settlement. 

Margot Bach, a spokeswoman for the Department of Corrections, said plans are already being developed to improve supervision of doctors from department headquarters and ensure that doctors are only working with inmate maladies that they are qualified to diagnose. 

This is not the first indictment of the prison system's medical system. 

Composing about 20 percent of the Corrections Department's $6 billion annual budget, health care services have been blasted for being too expensive and, at times, deadly. Prisons typically employ several primary care doctors and contract with specialists for services. 

The state auditor reported in April that three-fourths of medical contracts doled out by the department were not competitively bid, and many prisons fail to review whether providers aren't over-billing the state. 

A lengthy review of the entire prison system commissioned by Gov. Arnold Schwarzenegger called for dismantling and rebuilding corrections' health care administration. 

And a largely confidential report conducted by a state prison watchdog agency reviewed by The Chronicle earlier this year suggested that three deaths at a Corcoran (Kings County) prison during the last two years could be attributed in part to medical negligence. 

Both prison officials and a representative of a union that represents about 600 state corrections doctors say the state faces some of its health care problems because of its inability to hire enough good doctors, leading to many vacancies and forcing some spots to go to physicians with checkered pasts. 

Corrections physicians typically earn about $134,000 a year -- a salary that isn't enough to lure many doctors to work inside prison walls, said Gary Robinson, executive director of the Union of American Physicians and Dentists. 

"Who wants to work inside a prison, most if which are located in the middle of the desert?'' Richardson said. 

Speier, who heads a Senate government oversight committee, said she has begun communicating with some of the state's largest health maintenance organizations in hopes of persuading them to loan executives to help provide advice to change the system without having to raise costs dramatically. 

"There is plenty of expertise in this state,'' she said. "Right now, we have a system with extraordinary costs, extraordinary liability and very poor care.'' 

E-mail Mark Martin at


Posted on Sat, Jul. 03, 2004 

Legislator to investigate prison inmate's death

By Karl Fischer and Rebecca Rosen Lum

An aide for Assemblywoman Loni Hancock, D-Berkeley, said Friday her office intends to investigate the death of a prison inmate from Richmond who had a dental infection so severe that he could not swallow for days before officials sent him to an outside hospital.

A report from the ambulance that took 41-year-old Anthony Shumake from California State Prison Solano in Vacaville to a Manteca hospital on Monday stated that his neck "was swollen and red in color down to his clavicle ... patient was also spitting up gray sputum." Shumake died hours later at the hospital.

"The way it was handled raises some serious questions," said Hans Hemann, Hancock's chief of staff. "We'll be looking into it very thoroughly. It raises questions about the entire system as well as for this one family, who must be going through unbelievable anguish."

Prison officials said Friday state law forbade them from commenting about a prisoner's medical issues, adding that the facility's medical staff followed procedure after finding they could not properly care for Shumake.

But the death prompted mistrust and criticism from parts of Richmond's political establishment, led by the Rev. Andre Shumake, a prominent Iron Triangle activist and the prisoner's uncle.

Family members said prison officials have told them next to nothing since sending a telegram Tuesday morning informing them that Anthony Shumake had died and that the body would be cremated if they did not retrieve it.

"There has been tremendous negligence. Now it seems like they're trying to cover everything up," the Rev. Shumake said. "They didn't even have the decency to knock on the door."

Prison officials and the San Joaquin Coroner's Office said Friday they would not release the cause of death for several weeks. Several inmates who knew Shumake told the family he died of heart failure.

Prison doctors did not find that Anthony Shumake needed emergency medical care, but did need care the facility could not provide, Department of Corrections Lt. Mary Neade said. So they called for a basic life-support ambulance to take Shumake on a two-hour ride to Doctors Hospital in Manteca, a facility with which the prison contracts.

"When an inmate is sick we try to treat him here. If the ... medical department feels he can't be treated here, we send them out to the hospital," Neade said. "If staff determines he needs immediate attention, they call 911 and he's treated at the nearest hospital."

The ambulance company did not return calls Friday. A hospital spokesman said the cause of death remained officially "undetermined" pending results of the coroner's autopsy and toxicology tests.

Shumake told the ambulance crew that he'd had a tooth pulled six days earlier and that his wound had become infected, according to the report. The swelling in his neck made it impossible for him to eat and difficult for him to breathe.

The private ambulance crew checked Shumake's vital signs three times during the trip and found no significant changes, the ambulance report shows.

It was the second prisoner death of the year at Solano, a medium-security prison housing about 6,000 prisoners, Neade said. In January a terminally ill prisoner died of natural causes at an area hospital.

Records show Shumake was serving a 12-year, eight-month sentence for convictions in 2000 of corporal injury to a spouse, stalking and drug possession, as well as a parole violation from a 1994 attempted robbery conviction.

Reach Karl Fischer at 510-262-2728 or . Reach Rebecca Rosen Lum at 510-262-2713 or,1,5039466.story

Inmates' Medical Tab Nears $1 Billion
Breast reduction surgery for a male prisoner is among the stories that outrage lawmakers.
By Evan Halper
Times Staff Writer

June 2, 2004

SACRAMENTO — As medical bills for the state prison system approach $1 billion a year, lawmakers Tuesday called into question the use of tax dollars for procedures such as a male inmate's breast reduction surgery and skin treatments at a Beverly Hills dermatologist. 

Paying millions to shuttle prisoners to hospitals hundreds of miles from where they are locked up also faced criticism. 

With inmate healthcare spending nearly double what it was in 1999, lawmakers are demanding immediate changes to bring costs into line.

"Even if it weren't a tight budget year, this would be something that is absolutely unacceptable," said Assemblywoman Wilma Chan (D-Alameda).

The attacks on prison spending came at a joint legislative hearing and followed a state audit released in April. The audit revealed that prison officials seek competitive bids for less than a quarter of the contracts they enter into with hospitals, and may be routinely paying claims for services never provided. 

The state prison system runs 32 facilities with 160,000 inmates, and healthcare accounts for a significant chunk of its $6-billion annual budget. 

Prison officials challenged some of the accusations made by lawmakers, but acknowledged that reforms were needed. "We are using the recommendations contained in the Bureau of State Audit report as a blueprint for change," said Jeanne Woodford, director of the Department of Corrections. 

Those recommendations include imposing rules to ensure that contracts are negotiated competitively and imposing uniform treatment standards spelling out what is appropriate and when. 

But Woodford warned that the department must abide by a number of court judgments requiring it to provide medical care that may seem excessive. 

"We are under court mandates affecting our services," she said. 

In many cases, officials say, they are unable to attract trained doctors and nurses to work in the prisons and are left no choice but to enter into costly contracts with distant hospitals.

Prison officials also pointed out that the system must tend to thousands of patients requiring special care, including those with AIDS and other diseases, elderly inmates, prisoners in need of transplants, and paraplegics and quadriplegics. 

Lawmakers, however, say the department can do better. 

"We need to protect the constitutional rights of the prisoners, but excuse me, as a taxpayer I have constitutional rights too, and these guys are getting care that I don't even get," said Assemblywoman Rebecca Cohn (D-Saratoga). 

Some legislators pointed out that at the same time prisons are entering into contracts with private healthcare providers with no discernible cost controls, many prisoners are unable to get the most basic treatment.

Sen. Jackie Speier (D-Hillsborough) said she was frustrated to learn — through a tip to the Legislature's government oversight hotline — that just last Thursday a prison inmate had received breast reduction surgery at the same time the department has had to eliminate efforts to curb tuberculosis. 

"I understand lots of inmates at this particular prison have undergone this procedure," Speier said. Prison officials say they do not authorize any surgery unless it is absolutely necessary; any treatment that is out of the ordinary must be approved by a team of physicians and headquarters.

"Certainly our policy is not to perform cosmetic surgery," said Renee Kanan, who oversees healthcare services for the department. "But there may be some mitigating factors in this particular case." 

Speier shot back: "I can't imagine the necessity for breast reduction surgery in a male inmate." 

Cohn demanded that the department tally up the cost for acne and other treatments provided to inmates by a Beverly Hills dermatologist. 

The department did not have the figures at the hearing, but Kanan said there are instances where such treatments are medically necessary. 

"There are severe cases of acne that are disfiguring," Kanan said. "There would be some circumstances where it would be appropriate medical treatment." 

Lawmakers also called on the department to find ways to provide care for inmates closer to the prisons. Sen. Gloria Romero (D-Los Angeles) estimates that the state is wasting millions of dollars by contracting with hospitals hundreds of miles away instead of taking advantage of facilities nearby or providing adequate care in their own clinics. 

In fiscal 2002-03, for example, the state spent more than $8.7 million transporting inmates to and from hospitals. 

Prison officials said they are working on ways to contain those and other costs — but cautioned lawmakers to be patient.

Woodford said the administration is talking to University of California officials about a plan "to partner with them to create a healthcare system that is more accountable and cost effective." 

Assemblyman Todd Spitzer (R-Orange), however, said the auditor's report came out two months ago, and the state Corrections Department should have a clear plan for moving forward by now. 

"This is what people hate about government.",1,3864675.story

Diseases Can't Be Locked In

June 1, 2004

Over recent months, legislators in Sacramento have taken Californians to some pretty grim places in hearings on the state's 32 prisons. No corridor of the $6-billion correctional system is likely to be darker than the one lawmakers plan to explore today. 

A joint Senate-Assembly committee will examine profound problems in the prisons' healthcare delivery system, including the tuberculosis and hepatitis C that inmates may carry back to their communities.

Although taxpayers pay nearly $1 billion a year to provide medical care to the state's 162,533 inmates, up from $600 million just three years ago, the extra money hasn't always bought better health. 

Consider the arrival of an inmate with infectious tuberculosis in December at Solano State Prison in Vacaville, west of Sacramento. Although Shasta County jail officials had accurately diagnosed and medicated him after he was arrested, he arrived at Vacaville with no TB medications, no TB culture results and no medical records, and infected up to 10 people, according to the California Conference of Local Health Officers, which monitors public health threats.

That does not mean TB runs rampant in the prisons, but it underscores the need to revive the prisons' own Public Health Service, a 40-person unit that had been tracking and treating infectious diseases until it was disbanded in October because of budget cuts.

The prisons also need to grapple better with an epidemic of hepatitis C, which is spread mostly through dirty drug needles and sexual contact. As of two years ago, top prison officials say, the disease had infected an incredible 1 in 3 state prison inmates. 

Currently, there is too little testing for and treatment of hepatitis C, and county health officials accuse prisons of fobbing off sick parolees on county health systems. 

Poor management goes beyond tracking and treating disease. State prison auditors have described a pattern of overpayment for medical services inside and outside prisons. In the last two years, only a quarter of prison contracts with medical providers were competitively bid, according to a report in April.

A related failure is the lack of a bulk purchasing system to drive down inmate prescription drug costs. California taxpayers pay 66% more to buy medications for inmates than the federal Department of Veterans Affairs does for drugs for former military personnel.

The Schwarzenegger administration has produced some good longer-term ideas. These include possibly turning over prison healthcare to the University of California or a managed-care provider.

First, however, legislators, prison officials and the administration should rein in uncontrolled costs, as well as find money to shore up detection and treatment in prisons. Diseases brought into prison or contracted there should be dealt with there.

Scathing report on prison health care still not out 
Agency suggests negligence in deaths at Corcoran facility 
Mark Martin, Chronicle Sacramento Bureau
Thursday, February 26, 2004 
©2004 San Francisco Chronicle


Sacramento -- The death last week of an 80-pound inmate at a prison in Corcoran who hadn't eaten in 40 days might not have surprised California corrections administrators. 

More than a year ago, a state prison watchdog agency issued a blistering confidential report on health services at the facility, suggesting three inmate deaths in the previous two years could be attributed in part to negligent medical treatment. 

Detailing conditions at the Substance Abuse Treatment Facility in Corcoran, the report chronicled a health department in disarray. The report, a copy of which was reviewed by The Chronicle, has not been publicly released by Gov. Arnold Schwarzenegger's administration. 

Problems ranged from lax oversight that has led to the wasting of millions of taxpayer dollars to full-time doctors who see only a handful of patients and continually sleep on the job, according to investigators with the Office of the Inspector General. 

Now an inmate is dead after apparently slowly starving himself to death, and prisoner advocates are wondering just what it will take to improve medical treatment at the Substance Abuse Treatment Facility in Corcoran. 

A Bay Area lawmaker who is leading the charge to reform California's troubled corrections system is demanding that Schwarzenegger publicly release the inspector general's report. 

"I'm becoming concerned that the administration is either dragging its feet or covering something up,'' said state Sen. Jackie Speier, D-Hillsborough, who has been asking for several inspector general reports for more than a month. "What are they hiding?'' 

A spokeswoman for Schwarzenegger said administration lawyers would likely release the reports to Speier -- and the public -- but were redacting names and other information that might be relevant to ongoing prison investigations. 

Meanwhile, corrections officials say they're still trying to determine exactly what happened to Khem Singh last week. Singh, 72, had been on and off hunger strikes since he was sent to prison in 2001. A Sikh priest who lived near Modesto, Singh was serving a lengthy sentence for lewd and lascivious conduct with a child under 14. 

Before dying, he had not eaten in 40 days, according to Patrick Hart, chief deputy district attorney for Kings County. Prison documents indicate he was removed from his cell Feb. 14 and taken to a local hospital, where he died two days later of heart and lung failure attributed to starvation. 

Corrections officials say Singh had been in and out of a medical clinic at the prison but was not there this month. 

"After 40 days, you would think he would have been in the hospital,'' said Kelly Santoro, public information director for the prison. 

Hart said his office has determined there was no criminal negligence by prison staff, but sources said Wednesday the inspector general's office had begun a probe this week. The office reports to the governor and conducts financial audits and investigations of prison issues. 

Prisoner advocates say death by starvation is something that shouldn't happen in modern prisons. 

"You don't just starve to death overnight,'' said Don Specter, executive director of the Prison Law Office. "This amount of inattention is inexcusable. '' 

State prisons do have policies to handle inmates on hunger strikes -- the policies were created after Specter's office won a 2002 class-action lawsuit alleging inhumane medical conditions in all state lock-ups. An internal review is determining whether prison medical staff correctly followed procedures, said Rosanne Campbell, deputy director of health care services for the Department of Corrections. 

It's not the first time health care at the facility has been investigated. 

Lesser known than its neighbor, Corcoran State Prison, the Substance Abuse Treatment Facility houses more than 6,200 inmates. 

Last January, investigators with the inspector general issued a report that concluded medical services there were inexcusably bad. A probe that lasted more than a year found full-time doctors paid more than $90,000 annually were only available to inmates 12 hours a week and full-time dentists spent most of their days outside the prison at private practices. Among the other findings: 

-- Three inmate deaths may have been caused in part by lax medical care. One inmate with a blood disorder was found lying prone in his cell in May 2001 and told a nurse "he couldn't go on,'' according to the report. The nurse told him to see a doctor the next day. He was later found vomiting blood and was pronounced dead soon after in the prison emergency room. 

-- One inmate in 2000 was diagnosed with tuberculosis, a highly contagious disease, but not isolated from the prison population for more than a year. Two guards and an inmate later tested positive for TB. 

-- Investigators witnessed pharmacy workers throwing away 30-pound garbage bags full of medication. They determined costly drugs were shipped to the prison for inmates who had been transferred or released in the same fiscal year that pharmacy spending at the prison exceeded the allotted budget by 211 percent, or more than $3 million. 

Corrections officials say they have a comprehensive plan to address each issue raised by the inspector general's report and review progress monthly. Included in the plan are establishing working hours for medical personnel and better tracking systems for medications. 

"A lot of it was oversight, and we're monitoring all of that,'' Campbell said. 

She said it would be "premature'' to say that the recent death at the facility shows that progress in improving medical care had been slow. 

"We're looking into it, and if we still see gaps (in care) we will address that,'' she said. 

But Speier said Singh's case may show yet another example of problems within corrections that never seem to be fixed. 

She and Sen. Gloria Romero, D-Los Angeles, held hearings in January highlighting a code of silence within prisons that prevents the system from policing rogue guards, a subject that came up in legislative hearings nearly a decade ago. And the state is in legal trouble for failing to change some procedures at Pelican Bay State Prison that were first described in a 1995 federal court decision. 

Speier and Romero are authoring legislation that would add funding to the inspector general's office and require that most of the office's reports be made public. She believes the public disclosure of reports would add pressure on corrections officials to make changes that benefit guards, inmates and taxpayers, who keep footing the bill for expensive litigation. 

Schwarzenegger, who first proposed eliminating the inspector general's office but has since changed his mind, has not offered an opinion yet on the legislation. 

Spokeswoman Terri Carbaugh said the governor generally does support beefing up the office and more public disclosure. The governor recently made public 20 previous inspector general reports, and Carbaugh said he planned to release more as soon as lawyers completed their review. 

Speier said she would place another call Wednesday to the governor's office to seek the other reports, including the study of medical care in Corcoran. 

"There are numerous examples of complete mismanagement in corrections, and this is precisely why we need more oversight, '' she said. 

E-mail Mark Martin at

Dying inmates seek release
PRISON: Those with terminal diseases apply for permission to die at home.

11:38 PM PST on Sunday, January 25, 2004


Lonnie Creech is dying. So is Helen Loheac.

Both sit behind razor wire and iron bars at California prisons. Both are waiting for a compassionate release. 

Creech, 52, has lung cancer and has been given less than three months to live. Loheac, 81, has a chronic kidney ailment and goes to dialysis three times a week. 

Their chances of going home to die, though, are slim. 

Legislation passed in 1991 allows some sick inmates with fewer than six months to live and who are not threats to society to die at home. 

Last year, only 17 inmates out of 48 who applied won a compassionate release from the California Department of Corrections. 

Seven more applied to the Board of Prison Terms. One was denied and three more are being considered by the board. 

Last year, Vidilla Spragin of San Bernardino was granted her request and was released from the California Institution for Women in Chino. 

Spragin, who had killed her husband by setting him on fire, died last month from liver cancer. 

Creech was sentenced six years ago to 14 years for assaulting a Riverside police officer and making terrorist threats. He spends his days in the infirmary at the California Rehabilitation Center in Norco, said Lt. Tim Shirlock. 

"He qualifies for a compassionate release," said his sister, Vangel Creech, who lives in Murrieta. "He's in a very weakened condition." 

Sentence questioned 

Creech's brother Dub, a retired Riverside police officer, said he never thought Lonnie would receive more than two years in prison for his crime. 

He was convicted of pushing a gun at a police officer after his in-laws reported he was suicidal and had a gun in the same Riverside apartment as his wife and child. 

Vangel Creech said her brother pushed the gun away after an officer shoved it in his eye. 

"He's been dealt a bad deck of cards," said Dub Creech. "He's a great guy. We just want him to spend his last days outside of that rat hole and just spend his last days with his family." 

Creech is a former auto mechanic with three children. His health has suffered all his life, said Vangel Creech. 

His right foot was severed in a car accident and in 1992 he had a heart attack, she said. 

In July he was diagnosed with small cell lung cancer and a tumor in his stomach, according to Sarv M. Grover, California Rehabilitation Center Chief Medical Officer. 

A compassionate release request with the California Department of Corrections was denied in September by then-director Edward Alameida. Two weeks ago, a second request was denied by acting director Richard Rimmer. Spokeswoman Terry Thornton said the decision was based on Creech's criminal history and current medical condition. 

"He is still ambulatory," Thornton said. 

Creech's family plans to appeal the decision to the Youth and Adult Correctional Agency and legislators. 

Recently, the Riverside County District Attorney's Office, which prosecuted Creech, wrote a letter to the corrections department stating it would not be opposed to his release, as long as he wears an electronic monitoring device and is not allowed access to drugs and alcohol, said Deputy District Attorney Robert Spira. Former Youth and Adult Corrections Agency secretary Robert Presley also wrote a letter on Creech's behalf. 

Even if the CDC had recommended that he be released, the sentencing judge would have had the final say, said Thornton. 

Being terminally ill is unfortunate, but not necessarily a reason to be released from prison, said Jim Benson, vice chairman of the Santa Ana-based Citizens Against Violent Crimes. Each case should be reviewed individually and one must make sure a sick inmate wouldn't be able to commit another crime, he said. 

Benson said he is, however, open to making provisions so that family members can visit with terminally ill inmates more often. "I would favor some flexibility," he said. "What we are concerned about is protecting citizens." 

Time short 

Helen Loheac, an 81-year-old woman who is serving a 25-years-to-life sentence at the California Institution for Women for conspiracy to commit murder, is also waiting to hear if she will receive a compassionate release. 

Loheac has a chronic kidney ailment and is shackled by correctional officers every other day to go to dialysis. The Board of Prison Terms is reviewing her case, said spokesman Bill Sessa. 

"Her time is very short," said Daisy Benson, an inmate at CIW. "(It) just makes me crazy, this old doll sitting here waiting for handouts." 

At the time of her conviction, Loheac was 69 years old and living in Shasta County in Northern California. 

Her son, who was in jail, said he was sending a friend to her house to pick up some items. Meanwhile, an informant had reported to police that the son had accepted his offer to kill the only witness to the son's crime.

When an undercover officer, posing as the friend, came to the house Loheac gave him some money, a photograph and the pink slip to the son's car. Loheac was then convicted of conspiracy for a murder that never happened.

Inmates like Loheac and Creech who are terminally ill are no longer a threat to society and should be released, said Cynthia Chandler, co-director of the Oakland-based Justice NOW, which assists women in prison. 

Often, ill inmates don't even realize they are behind bars and up to $80,000 per year can be spent treating them, she said. 

"The only people you are punishing are family and friends," Chandler said. 

Reach Stefanie Frith at (909) 893-2114 or s

Online at:

Rotting in Jail
by John Seeley 

L.A. County jails have become incubators for an ugly drug-resistant skin disease, venting it into state prisons and out into the community as inmates with still-active sores bring the infection home to family and friends. Though down somewhat from its July-September peak caseload, incidence of drug-resistant “staph” (Methicillin-resistant staphylococcus aureus or MRSA) is still running at twice last year’s level. Eradication in the jails is nowhere on the horizon and counter-measures recommended over a year ago have not all yet been implemented.

One strain of MRSA has been a chronic problem in hospitals, where it usually attacks the elderly or immune-compromised; the so-called “community-based” strain thrives in crowded quarters where people of any age share clothing or equipment (sports teams) or are simply in frequent physical contact (day care centers). Jails, where these factors are often coupled with limited access to showers, provide an ideal hothouse for its spread. 

At the onset, MRSA infection might be mistaken for an intense insect bite reaction, but the inflammation expands in size, continues to ooze, and can spread from one part of the body to another. On the scalp – less visible and less well-washed – infection often proliferates. If not properly treated, serious complications can follow, including blood infection (bacteremia) and inflammation of the heart membrane or bone marrow. There have even been a few fatalities at Texas prisons, according to a report in Morbidity and Mortality, published by the Center for Disease Control. 

Though some inmates say the problem goes back to 2000 or earlier, growing complaints at the Wayside (North L.A. County) facility in late 2001 took officials of the L.A. County Sheriff’s Department (which administers all county correctional facilities) on a sidetrack: an assault on spiders suspected to be coming in with clothes and bedding. Despite fumigations of the laundry facility, no spiders were captured dead or alive. By April 2002, bacterial cultures from skin complaints were showing a high MRSA incidence, and in June, Sheriff’s medical personnel notified the County Health Department of mushrooming infection rates. A joint task force of the two agencies started meeting regularly in summer 2002 and – after consulting California’s Department of Health Services, the U.S. Center for Disease Control, and veterans of an outbreak in Georgia’s prison system – developed an action plan to roll the bug back. 

Strategies included heightened skin infection screening on intake, better monitoring (with more culturing of suspicious lesions), and improved inmate education and videos on spotting symptoms and preventive measures (frequent hand-washing and showers, not sharing clothing or soap). More frequent and disinfecting laundering was urged and, of course, prompt medical attention to suspicious wounds, which would be treated by a better-trained health staff. Finally, based on input from the Center for Disease Control, anti-bacterial liquid soap was to be provided periodically. 

By the end of last year, 921 cases had been confirmed, with 57 inmates hospitalized, 10 of them with invasive complications. So this February, L.A. County chief medical officer Thomas Garthwaite began reporting monthly (or more) to a perturbed Board of Supervisors. While the caseload climbed, averaging almost 130 per month during the first half of the year, Garthwaite’s reports chronicled task force countermeasures implemented at a leisurely pace. In March, jail medics were being encouraged to do more wound cultures; in April, a cost estimate of the liquid soap was expected and “logistical barriers” to increasing linen changes were noted. A lack of trained jail personnel meant inmates must go to County-USC to get wounds drained. July cases spiked to 216; August’s and September’s hovered around 200.

November’s number, 155 cases, was an encouraging turn downward. But it’s too early to call it a trend. Random interviews of inmates released from Twin Towers don’t show that there’s much familiarity with the term “staph” or recollection of seeing any videos. The anti-bacterial soap is slated to start in January, says Capt. Rod Penner, who oversees medical services for LASD. Why so late? “We couldn’t introduce it until other parts of the program were functioning well, because we wouldn’t know if reductions were due to that or other improvements,” explains Dr. Elizabeth Bancroft of the Health Department.

Control measures may be working, but the jails are still exporting cases which may come back to haunt them. Sergio Frutis of Pomona, fresh out after three weeks behind county bars, isn’t sure he’s heard of staph and says he saw no video when he came in. “Does this look like it?” Frutis asks, displaying a bump on his breastbone about as big and bright as a glowing cigar end. It keeps oozing into his T-shirt; he says. He put some lotion on, saw a nurse, received no pills, and requested a medical appointment. The next day, he was in court and got released, never having seen a doctor. Now he has no idea what he has or where to go for treatment.

© 2003 Southland Publishing, All Rights Reserved
Designed and Developed by R7 Media.

Chowchilla inmates sue over medical service 
By Lisa Aleman-Padilla
The Fresno Bee
Published 12/19/03 05:20:31

Seven inmates at Central California Women's Facility in Chowchilla have sued prison medical staff members, alleging malpractice, negligence and unprofessional conduct.
The lawsuits, received this week in Madera County Superior Court, demand the firing of Dr. Augustine Mekkam, the prison's chief physician and surgeon. The inmates also seek more oversight of California's prison employees, especially medical staff.

"We need some kind of watchdog board to oversee these doctors so that there doesn't have to be all this litigation," said Michelle Kinser, one of the plaintiffs, in a statement issued by Justice Now, an Oakland-based human rights organization that works with women in prison.

Kinser, a San Jose native, began suffering extreme weight loss, tremors and pain in and around her pelvis and bladder nearly two years ago. Though she was diagnosed with a possible bladder mass, Kinser said, Mekkam canceled two referrals to a surgeon and an oncologist.

She said Mekkam told her she was suffering from a mental disorder and was imagining symptoms despite a history of multiple carcinomas, or cancerous growths, including bladder cancer that required chemotherapy in 1995.

Mekkam did not return The Bee's phone calls.

Other defendants named in the lawsuits, which were written by the inmates, include physicians Loraine Goodwin, Ernest Reeves, Jagdev Singh, Sampeth Suryadevara, Kuldip Behniwal, a urologist in private practice, and several nurses.

Some of the plaintiffs allege they were denied referrals to specialists and were removed from the prison's chronic care program, though they were clearly ill. "These cases make a powerful statement, exposing medical neglect that is tantamount to torture," said Cynthia Chandler, co-director of Justice Now. "Taxpayers need to know how their money is being misused."

The Chowchilla prison, which opened in October 1990, houses more than 3,000 female inmates and employs more than 900 workers. Russ Heimerich, spokesman for California Department of Corrections, said the agency is frequently sued for medical neglect by inmates, but almost always prevails in court.

He said all the state's inmates receive the medical care they need. "We are both morally and legally obligated to provide necessary medical care to inmates, and we do so."

Alice do Valle, spokeswoman for Justice Now, said the lawsuits are not the first legal remedy the women sought.

Several of the plaintiffs had filed earlier complaints with the California Medical Board, but were told that prison doctors do not fall within the board's jurisdiction, she said.

"What I want to know is whose jurisdiction these doctors fall under and who is supposed to be overseeing their practice," said Loraine Stallings, another plaintiff, in the Justice Now statement.

Stallings, who was diagnosed with a tumor in her left ear, is suing prison doctors for attributing her symptoms of constant ear pain, infections, headaches and hearing loss to excessive wax buildup. She said she now faces surgery that doctors say will cause facial drooping, complete loss of hearing in her left ear and damage to the taste buds on the left side of her mouth.

The five remaining lawsuits alleging similar complaints were filed by inmates Eleanor Guiterrez, Michelle Joe, Wilma Kilpatrick, Cynthia Escobar and Bonnie Stum.

The reporter can be reached at  or 675-6805.

December 2003


For the reporters reading this: My good friend who is in prison sends me many details about the almost unbelievable conditions inside our prisons and jails. These are things he does not make up but witnesses personally with his own eyes. I have never known him to lie.

He was recently taken to the old men's central jail in downtown L.A. to await a resentencing. He was there for a period of one month and while there he told me about something that was happening to a cellmate.

The young man had been there for several months awaiting trial. While there he had picked up a foot disease. My friend described it as quite nasty with lots of peeling skin. I asked him, "Is it athlete's foot?" He said, "If it is I've never seen anything like it before." He said besides the flaking and peeling of the skin, which was quite deep, the area surrounding the skin was blackened. This should have been healthy tissue but was not. This was a white kid and the dark skin was not part of his natural color. It was clearly connected to some kind of infection or fungus or something.

I got the address of Merrick Bobb from the Internet and asked the boy to write directly to him as we felt that at least this person knew enough about the failures of the present system to keep an open mind and listen to his plight. I have not followed up on it further.

The inmate was very concerned as the condition was only getting worse and jail staff appeared not to want to be bothered. When he went to the clinic for help he was given Vasoline. Of course, that was ineffective. The prisoner then bought a tube of cream at canteen (at an inflated price) which only had about 10% of the type of medicine he believed he needed to cure the  problem. He needed something stronger but was denied anything else from the clinic. In spite of the worsening condition, the clinic continued to recommend Vasoline.

Adding to the situation was the fact that the men's showers were not draining well. When the men showered, the water backed up two to three inches around the men's ankles. My friend thought this alone could be helping in he spread of the disesase and he was afraid to take a shower even though he had some shower sandals.

Inmates there were afraid to file a grievance. You know the old story. Nearly every complaint is ignored. For inmates who persist and continue to file complaints there is guard retaliation.  Retaliation is as certain as night follows day. How do you get a handle on something where the truth is throttled?

For people who think this is no big deal, consider the fact that these diseases are easily spread. Some men are not held long at the old jail and are soon released back to the communities they came from. They carry with them whatever illnesses or conditions they picked up in jail. It is a case ALWAYS of being sicker than before you went in and I continue to believe that this sort of 
thing is a danger to the public health and safety.



 Murder by Medical Neglect

 Three Strikes Legal - Index