Daniel Weintraub: Prison health care crisis points to larger problem
Few Californians probably give much thought to the quality of health care in our state prisons. But a court-ordered takeover of the prison medical system now under way could have far-reaching implications for all of government, because the man who has been put in charge of the effort has already concluded that the system cannot be fixed within the laws, rules and regulations that are in place today. And Robert Sillen, the former director of the Santa Clara Valley Health and Hospital System, who has taken over this thankless task, says the obstacles he has encountered within the prison system probably apply equally in every other corner of government, where the rights of customers, unlike those of prison inmates, are not protected by the U.S. Constitution. Taking a phrase from the man who appointed him, Federal Judge Thelton Henderson, Sillen calls the problem "trained incapacity" -- meaning that perverse incentives for individuals within the system create a condition in which the institution itself can no longer function. It is a self-induced paralysis. "In the name of transparency, in the name of protecting the taxpayers, a lot of harm is done and taxpayer money is wasted," Sillen told me in an interview. "The bureaucracy is just phenomenal at the state level." The problems begin with a framework in which every person has a job to do but few understand how their job fits into any overall mission. And so, in the zeal to perform specific tasks, nobody is looking at the big picture. Every contract, every purchase, every job description change has to go through so many layers and obtain so many approvals that doing nothing often is easier. "Everybody has a little box, but nobody has bottom line responsibility to make sure the overall job gets done," Sillen says. "They're only responsible for making sure their little piece of it gets done. There are too many bases that have to be touched. Too many rules, regulations and laws inhibit employees' ability to perform in a way that gets the mission accomplished." One example: The state, he says, had a $58 million backlog of payments to private health care providers, including doctors, hospitals and ambulance companies, some of whom had not been paid in up to four years. But nobody within state government had an incentive to make sure those bills got paid, at least nobody with the power to make it happen. "All of the sudden, a lot of them stopped providing services," he says. "They wouldn't accept referrals. The providers said, 'Sorry, nobody's paying us. We keep working and nobody is paying us. So we're stopping.' "There is no logical, rational reason why that should have occurred. There are all sorts of reasons given. The state is out of money, which is never true. Or we don't have this piece of paper signed. Or somebody else didn't do their job. Nobody kept in mind that the patients are not going to get the care." But if in that case the state inadvertently faced a shortage of contracted services, at other times it has overused the practice, paying more for private health care providers who were needed because of an acute shortage of in-house personnel. He said the state tries to save money by holding down salaries of nurses, doctors and lab technicians but ends up paying far more to buy those services in a pinch. "It's this false economy," he says. "The state does not want to see the number of employees grow. So rather than have employees, they do all this contracting, which costs them probably two to three times more than it would to fill the positions. … Everything is geared to not spending money. And at the same time an enormous amount of money is spent, I'd say wastefully." The numbers: The total annual cost for contract health care in the prisons has increased from $153 million in 2001 to about $821 million today. But hiring good people is only half the challenge, Sillen says. Firing bad ones is even more difficult. "There are physicians who, at least within the health services division, have been found to be deficient, to use a kind word -- incompetent would be the more correct word," he says. "But because of the state's investigative process, civil service rules, the personnel board, many of these physicians have been out on paid leave for up to two or three years. It's nuts." This inability to effectively discipline underachievers or get rid of bad apples has led to a situation in which managers simply give up in frustration, Sillen wrote in a report to the court earlier this month. To make matters worse, the lack of qualifications, training and, in some cases, competence of certain employees has created what he calls a "culture of incompetence and nonperformance which, unfortunately, is more rewarded than not within state employment." Sillen, thanks to the court order creating his job, has more power than
even the governor to cut through the problems he has encountered. He hopes
to demonstrate what can be done by overhauling the health care system at
San Quentin Prison. In my next column, I will take a look at what he has
in mind.
About the writer:
Guards union cozy in politicos' pocket
San Gabriel Valley Tribune
And considering the campaign largess bestowed on them from the state's most powerful public employees union, it's a place they no doubt would like to keep. Still, the charges leveled by prison reform Special Master John Hagar that the governor's administration has been backsliding on prison reforms and, worse, doing favors for the prison guards union to get campaign support indicate that the prison guards have found a new friend in high places. Hagar says Schwarzenegger's chief of staff, Susan Kennedy, a former Gov. Gray Davis aide, is chiefly to blame for opening the governor's office door to the influence of the California Correctional Peace Officers Association. These are disturbing charges, made all the more so by the fact that Hagar is no ill-informed troublemaker. He was appointed by U.S. District Judge Thelton Henderson to oversee prison reform. His concerns are supported by the resignations of two prison officials who said their efforts at reform were thwarted by the cozy new relationship between the governor and the prison guards union. It's an understatement to say these allegations reflect poorly on the "people's" governor - who campaigned on reforming "business as usual" state politics. Still, the situation has to be considered in the larger context of historic influence-peddling in Sacramento. For two years, Schwarzenegger tried to fight the prison guards, but found that even trying to find a compromise with the union was like trying to make a deal with the devil. That in no way absolves the governor from responsibility. But that responsibility is shared by generations of lawmakers who succumbed to the power, money or persuasive tactics of the CCPOA. Hagar has asked for a full investigation of the governor's work on prison reforms and his relationship with the union. Henderson should grant it but insist that this investigation look even deeper into the CCPOA's connections and influence over the entire state political structure. Undoubtedly, that would provide much richer - and disturbing - revelations
about how Sacramento works on both sides of the aisle, for the benefit
of special interests, and not the public interest.
From the Los Angeles Times State Prisons' Special Master Won't Be a Slave to System
July 16, 2006 SAN FRANCISCO — Ask John Hagar about the state of the state's prisons and he gets right to the point. California's correctional system is in crisis, he says, and the governor's election-year ambitions are bedeviling efforts to fix it. Last week, Hagar laid out his case at an extraordinary hearing in a San Francisco courtroom. As stunned onlookers stifled gasps, Hagar, a special master overseeing prison reforms for a federal judge, fired a barrage of accusations at Gov. Arnold Schwarzenegger and his innermost circle, alleging perjury, the trading of favors, politically motivated intimidation and more. As Hagar sees it, Schwarzenegger's bid for reelection has prompted his aides to improperly snuggle up to the prison guards union, a deep-pocket powerhouse in California politics. To sweeten relations, Hagar asserts, Schwarzenegger is granting the union clout over key decisions — and at least temporarily shelving his agenda of prison reform. Hagar's blunt charges at the hearing — and in a written report released last month — have vaulted the compact man with the gray crew cut into a rare moment of public visibility. Typically, special masters labor in near anonymity. Appointed by judges as watchdogs in lawsuit settlements, they mediate disputes, monitor progress and periodically report on their findings for the court. Their only official power comes through judicial orders sometimes arising from their work. In California, special masters have seldom reached the high-profile status that Los Angeles native Hagar, 59, achieved last week. State Sen. Jackie Speier, who attended the hearing, said that in accusing Schwarzenegger of giving the union undue influence, Hagar demonstrated "more guts than any public official in California." Speier, a longtime critic of the prison system and the union of guards who police it, also said that political fallout from Hagar's report — coupled with other problems plaguing the prisons — is creating a huge liability for the Republican governor. "I think it will be every bit as big as the energy crisis was for Gray Davis," said Speier, a Democrat from Hillsborough. One of Hagar's biggest admirers is the man who named him special master in the case in 1997, U.S. District Judge Thelton Henderson. Henderson called Hagar a person of "great commitment and principle," and "a bulldog very good at dealing with tough people who are used to controlling their own turf." The judge added that although comments from the governor's office suggest a belief that Hagar "is full of it," the special master has never been one to shortchange facts to sell an argument: "Anyone who has worked with John as I have," Henderson said, "will tell you that he is not one to shoot from the hip or the lip." Not everyone is so kind. Schwarzenegger Chief of Staff Susan Kennedy and Cabinet Secretary Fred Aguiar, the two aides Hagar singled out for his fiercest attack, have released sworn declarations disputing some of his primary allegations. Both denied, for example, Hagar's charge that they consulted with union officials about the proposed appointment of a prison labor official the union disliked. The candidate was ultimately rejected, and the episode was cited by Hagar as one reason former Corrections Secretary Jeanne Woodford, who favored the candidate, quit in frustration, believing her authority was being undermined by politics. Schwarzenegger spokesman Adam Mendelsohn said that statement and others in the special master's report were "absolutely false" and based on "undisclosed sources and rumors." Mendelsohn said Kennedy, who also works part time as a campaign consultant for the governor, had reached out to the union — and other groups — because Schwarzenegger believes he must consult all "stakeholders" to make progress. Leaders of the guards union, the California Correctional Peace Officers' Assn., were Hagar's other main target. He said the union had never played a major role in any significant prison reform and told its top officials they bear some blame for the escalating problems of the 171,000-inmate system. Union lobbyist Lance Corcoran said Hagar's "cloak and dagger" depiction of back-room deal-making between his group and the governor was "laughable." "Unfortunately, I think Mr. Hagar has become very caught up in his belief that the CCPOA is to blame for all the ills in the Department of Corrections," Corcoran said. "I think he spoke too much and displayed a bias that is not healthy for the process." In an interview midway through a visit to San Quentin last week, Hagar said he is unmoved by all the hue and cry. A veteran lawyer, he has represented inmates and local governments in suits over prison conditions for 25 years — and he has taken on powerful interests before. In the late 1980s, he filed a lawsuit against Los Angeles County — and every one of its 101 Superior Court judges — to compel action to relieve jail overcrowding. The judges, before whom he frequently was required to appear, called the action part of a campaign that was "perverse and insupportable." But Hagar saw it as the best course of action for his clients. Such controversial moments aside, Hagar has mostly forged a reputation as a meticulous collector of evidence, fair and dogged in his work to guide prison improvements. He spent three years in Alaska as a court-appointed mediator between the state and attorneys for inmates, and ultimately brought to a close a case on prison conditions that had languished unresolved for 18 years. The assistant attorney general representing Alaska in that case, John Bodick, recalled Hagar as "outstanding, with a balanced, pragmatic approach reflecting the needs of prisoners as well as those of the state." Hagar is a UCLA graduate who in off-hours likes to paint, hike and write — he published a novel, "A Politically Correct Murder," six years ago. After college, he went into the insurance business, rising to vice president of Prudential Insurance. He eventually went into private practice after earning a law degree in night classes at Southwestern Law School, and years later he became a consulting attorney for the ACLU of Southern California. He spent much of the 1980s and 1990s litigating cases on overcrowding and other conditions in jails and prisons. Hagar said he was drawn to prison work because it focuses on "very basic human rights, like the adequacy of shelter, physical protection, medical care. To me, that was more relevant in the world than analyzing insurance contract litigation." Hagar said he hopes Henderson will allow him to hold investigative hearings this fall. Then, he said, he will present testimony from his sources and call Kennedy and other gubernatorial aides to the stand. "I'd really like to be done with this case, with this work, but I'm
not going to stand by and allow the accomplishments of the past few years
to just float away," he said. "As long as Judge Henderson is concerned
about problems in corrections, I'm here to stay."
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