Sidebar: A look behind KPCC's prison medical series

KPCC's Julie Small talks to Steve Julian about what inspired her prison series, the findings and what to look forward to in the rest of the series. Small's series on prison medical care airs all this week on KPCC. The state's struggled to improve the medical care inside prisons for nearly a decade. Small has been reporting on that effort since a year after the receiver took over.

Small felt that the story had faded from sight and that there has been a lack of reporting on the prison medical system. Overcrowding, with the prison population cap, is a big risk for the state.

At the same time, there are huge deficits, as well as increased pressure to end the federal prison medical receivership before the job is done. The receiver's job is to bring medical care up to basic levels, not to provide "Cadillac care."

California has spent billions to improve prison medical care. That's gone to hike pay to attract better medical staff and to hire additional guards to get inmates to medical appointments.

These improvements have made a difference in the quality of inmate medical care. However, according to medical staff, improvements need to be made to the infrastructure.

The first federal receiver said that all of California's prison medical clinics need improvements, but so far only two have received them: San Quentin and Avenal.

Before, x-rays and test results would get stacked up. The stacks are much smaller now, and scanned and lab results are now computerized. However, no system is in place to create a single repository for inmate history –and that's important, because California has the largest prison system in the country.

Inmates are constantly being moved, and that's where a lot of the slip ups and delays happen.

Secretary of Corrections Matthew Cate said that prison medical care is good enough now – the state's spending a billion more a year on it now than it did a few years ago.

There are several measures for when medical care will be up to the standards being sought by the federal receiver. These include death analysis reviews, near death incidents and OIG medical reviews of protocols and procedures.

Judge Thelton Henderson will decide whether or not the California prison medical system has improved enough to end the federal receivership. He's going to weigh measurable results against the state's interests.

There's considerable risk that if the receivership ends before systemic changes, the system could return to the way it was before. This would leave the state at risk of facing another lawsuit.

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