Federal receiver downsizes turnaround plan for prison medical care

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California Prison Health Care Services

The federal receiver spent $135 million on a new San Quentin Health Facility, and $18 million to expand medical space at Avenal - but California's other 31 prison medical facilities still lack improvements.

Nearly a decade ago, one state prison inmate a week died because medical care inside prisons was so poor. A federal judge decided to stop that – so for the last few years a court-appointed receiver has been working to improve the quality of prison medical care in California.

It’s taken billions of dollars to do it.

California spent eight times more on prison medicine last year than it did when inmates sued to get better care.

Fewer inmates dying

Prison officials, doctors and inmates interviewed for this series agree care is better today.

But, "it doesn’t matter. You can still kill people if you don’t have the right system in place," said federal receiver Clark Kelso when he unveiled a recent review of inmate deaths.

A smaller percentage of inmates died in California prisons in recent years, but Kelso found a greater number of them might have lived with better care.

Kelso says prisons still struggle to schedule and track inmate medical appointments – and to keep paper medical records up to date.

"I think the problems really we’re dealing with are truly systemic ones," he says. "It’s not we’ve got bad clinicians. It’s that they’re working in a Third World environment."

California's budget deficit poses problems for upgrades

A couple years ago Kelso intended to spend $8 billion to improve that “Third World environment.”

He wanted seven new prison hospitals that would include 10,000 beds for inmates with chronic or serious medical problems.

Lawmakers pointed to California’s budget deficit – and said no.

Kelso had to delay or drop parts of his plan to fix prison medical care.

That worries Ron Shansky. The prison medical care expert visited some of the prisons two years ago and found breakdowns in the medical system.

"The system now has high standards and is attracting high quality clinicians," Shansky says. "However, high quality clinicians are not going to tolerate for a long time and without any hope a system that inhibits their ability to provide the standard of care that they feel is appropriate."

Shansky says the medical staff hopes the court will keep the receiver in place.

"I think the receivership exiting any time in the immediate future would have disastrous morale consequences," Shansky says.

Kelso expects to spend a couple more years on the job. But he’s returned some control of care to the Department of Corrections – and replaced his staff with Corrections employees.

Among those let go is Joe McGrath. The former chief deputy of Corrections says prison care isn't cured. "No. And is it completed to the extent that I would feel like it’s going to operate effectively from now on?" McGrath says. "I don’t think so yet. I think the systems aren’t up to where they need to be."

Hiring freeze prevents expansion of 'doctor's cops'

McGrath should know. He created a special squad of 2,400 correctional officers he calls “doctor's cops” because they work on behalf of prison medical teams to escort inmates to medical appointments. He did that because back in 2006 inmates missed those appointments about half of the time.

McGrath wanted to hire 350 more doctor's cops, but Kelso froze hiring. Kelso said he did that for "budgetary reasons."

McGrath says there's no question prison medical care's improved. But has it improved enough to satisfy the federal judge who took it over from California?

"Does it meet the constitutional minimum at this point?" McGrath asks. "That’s a decision the court’s going to have to make."

Federal judge Thelton Henderson is handling the prison medical case. He declined to be interviewed for this series. But at a University of San Francisco speech a couple years ago, Henderson said judges must balance inmate rights with the state’s right to manage prisons.

Governor Arnold Schwarzenegger insists California shouldn’t have to agree to a prison medical care overhaul it can’t afford. This year he pushed to cut the budget in half.

"The bulk of the cuts – $811 million – comes from making our prison medical system more efficient," Schwarzenegger said.

If the legislature enacts the cuts, California will spend about the same on inmate care as it did before the receiver took over.

Big upgrades to medical records, clinic expansions planned

But lawmakers have set aside $800 million over the next few years to finish putting inmate medical records on computer. They’ve also shifted $2 billion to build a prison hospital and turn three juvenile justice centers into clinics.

Kelso says that’ll boost the medical staff’s morale.

"People will see then on a daily basis that it’s not as crowded, the facilities are better," Kelso says. "I can work and feel like I’m working as a professional in this environment."

Kelso thinks his scaled-back plan may suffice because there soon might be fewer inmates to treat.

Last year, a panel of three federal judges ordered California to reduce its prison population by 40,000 inmates.

They say fewer inmates will lead to better prison medical care.

This fall, the U.S. Supreme Court will decide if the order is legal.

Measuring results - Office of Inspector General's Medical Reviews

A summary of medical reviews of 17 prisons released Thursday found that only two met minimal health care standards.

Inmate deaths

• From 2006-2008 the overall inmate death rate decreased from 249 per 100,000 inmates to 216.

• The number of deaths medical reviewers deemed “likely preventable” deaths dropped from 18 in 2006 to 5 in 2008.

• The rate of “possibly preventable” deaths jumped over that same time period from 48 to 61.

• Part of the reason may be that the receiver's office raised the threshold for a death to be deemed "non–preventable."

Money

• California spent $1.5 billion on inmate medical care in FY 2005-2006

• California spent $2.5 billion on prison medical care in FY 2008-2009

• The Legislative Analyst's Office says that's an average annual increase of 27 percent. But California will spend $1.5 billion on inmate medical care in FY 09-10.

• Per inmate CDCR spent $6,000 in FY-05-06 – the year the receivership was established.

• CDCR spent $16,000 per inmate in FY 08-09.

Staffing

• 2,400 access to health care correctional officers hired

• 85 clinicians dismissed or fired for incompetence

• 50 percent of all prison doctors board certified; all new doctors must be board certified

• Lowered physician and nursing vacancy rates at most prisons

Facilities

• San Quentin Health Facility constructed

• Avenal Health Care Administrative building, Yard clinic and Ad Seg clinic constructed.

• Legislature allocated $2.3 billion in June, 2010 for construction of:

– New acute care facility in Stockton with beds for 1,700 inmates with chronic or serious conditions

– Renovation of 3 juvenile justice facilities into subacute care facilities.

– Enhancements at 9 prisons.

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