California DOC Medical Receiver's Initial On-The-Job Impression: "Conditions Disgraceful"

by John E. Dannenberg

In his first bi-monthly accounting to his boss (U.S. District Judge Thelton E. Henderson), California's Prison health-care Receiver ("CPR") Bob Sillen concluded that the California Department of Corrections and Rehabilitation's (CDCR) health-care situation was even worse than earlier reports indicated and that therefore "the remedies [needed] may be more dramatic, far-reaching and difficult to achieve than previously envisioned." The hard-hitting July 2006 33-page report is based upon Sillen's personal on-site visits and meetings with the parties' attorneys and dozens of state employees, including Governor Schwarzenegger (whose earlier flip comment of impending federal CDCR takeover, "Let them take it. It's no sweat off my back," still reverberates in the media). Sillen also met with state agency heads, CDCR executives, guards, health-care clinicians at five prisons, prisoner/patients, and union officials of all major bargaining units involved with CDCR. Additionally, Sillen dug into budget proposals, internal affairs investigations, policies and reports of the court's experts. He has set up offices at 1731 Technology Dr., Suite 700, San Jose, CA 95110 and hired a dozen key staff.

Addressing the "state of the State of California," he described CDCR medical services as "broken beyond repair." ... "Almost every necessary element of a working medical care system either does not exist, or functions in a state of abject disrepair...." He lamented that not only did prisoner/patients often not get care, but when they did, it was not adequate to meet Eighth Amendment standards. While Sillen reported that at his pilot program, San Quentin State Prison (SQ), he had commenced raising the level of medical care [Sillen announced his 17-point 90-day SQ emergency repair plan in June 2006], he reflected on larger systemic hurdles that must be crossed before meaningful reform of any sort could pervade. The two key impediments he identified were systemic long-term overcrowding and instability of leadership. He warned, "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."

Simply put, Sillen found the Court's characterization of CDCR ("trained incapacity") to be so endemic as to require looking at replacing the whole prison system with a streamlined receivership in order to obtain constitutional medical care. Sillen noted the impossibility of dealing with the California's gridlocked bureaucracy, whose agencies appeared dedicated to the perpetuation of the status quo by literally preventing proper management from ever taking place. This he observed in budgeting, contracting, labor administration, and even the state Legislature.

"Inmates are not the only prisoners in the CDCR," Sillen reflected, reporting that he found many staff employees desperate to do a good job but stopped by a "culture that dictates inappropriate rewards and punishments. ... Given the realities of the State system, however, the number of such individuals is far too insufficient at this time to enable the Office of the Receiver to achieve its mission." As a result, Sillen told the Court, "There will be no quick fixes." Nonetheless, Sillen counseled sternly against haphazard Band-Aid fixes to problems, and threatened to gain court orders to suspend rules, contracts and regulations that get in the way.

Sillen next called the current CDCR medical care program a "waste of taxpayer resources," opining that "a constitutional medical care system is entirely consistent with sound fiscal management." A prime example of waste he found was $2 million worth of gastroenterology (G.I.) imaging equipment delivered to San Quentin four years ago, idly stored because the space designated for its use could not support its weight. The ancillary fluoroscopy unit needed to make the imaging system complete was never even ordered. Another example was that after three years of trying to contract for in-prison dialysis services at Corcoran State Prison's hospital, CDCR still had no contract and was instead expensively transporting each patient to an outside facility, using two guards per prisoner. And the lack of centralized pharmacy procurement and distribution was wasting an estimated $80 million per year.

Funding for the Office of the Receiver was to come from the California Legislature in the form of a $250 million initial budget. But the Legislature trimmed this to $100 million, which will inexorably drive Sillen to ask the Court for authority to, in effect, raid the state treasury for CPR's needed funds.

Among initial successes, Sillen listed a soon-to-be-announced compensation schedule for gaining the high level of medical staff needed to carry out the Court's orders. Second, the CPR got CDCR to pay its past due bills to embittered private medical contractors, amounting to over $57 million and up to four years in arrears. Third, the CPR instituted development of health-care oriented policies to govern contract management.

The pharmacy fiasco was a case in point. The report closed with the status and expectations of the SQ 90-day pilot project. See: Plata v. Schwarzenegger, U.S.D.C. (N.D. Cal.), Case No. C01-1351-TEH, Receiver?s First Bi-Monthly Report (July 5, 2006).

Other source: Los Angeles Times.

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