For six years, a federal receiver has been in charge of fixing California’s broken-down prison medical system.
The receiver says he can finish the job soon, but he needs state lawmakers to pay the full $2.5 billion they promised for medical facilities. The state has already spent a billion dollars on improvements. Lawmakers now say they don’t need to spend any more. The receiver worries that the improvements in prison medical care could slip away.
At Deuel Vocational Institution in Tracy, the medical facility doesn’t meet earthquake standards. It will when a seismic retrofit is done – but the 60-year-old building won’t have more room for the medical staff. They work in cramped offices off a narrow corridor.
Correctional officers shout out “Escort” warning when they bring in an inmate considered dangerous to staff or other prisoners.
Inmates wait in holding cages outside exam rooms that aren’t big enough for all the medical staff.
“We don’t have enough room for the docs and nurses at the same time,” says Dr. Michael Kim, the chief medical executive who oversees inmate medical care. Kim says the cramped space forces him to assign nurses to run after-hour clinics to keep up. He says that’s just not efficient.
“There’s only limited things that a nurse can do based on their scope of practice and if doc’s not there, it makes it very hard to care for the patient,” Kim says.
Kim says that mean follow-up visits, which adds to the backlog and the expense. Rebecca Potts, who oversees prison nurses, says new medical practices have improved care but the outdated facility makes the improvement hard to sustain.
“A facility built in 1953 just is not able to support the technology of today…Our telemedicine room is probably a good example,” Kim said.
Deuel Vocational uses high-tech conferencing to consult with outside specialists. It cuts the cost of transporting inmates and it speeds up diagnosis. But the consults are done in a converted shower that doubles as an administrative office.
“We could use just a little more space in there!” Potts laughs.
Federal receiver Clark Kelso wants to give all of California’s 33 prisons “a little more space.” He says most of the medical staffers still work in clinics converted from offices, cells or broom closets. And what about the thousands of inmates who’ll stay in prison well into the their 70s or 80s? Kelso says California doesn’t have enough medical beds for geriatric aging inmates.
“The facilities just have been in a state of constant disrepair,” says Kelso. “Insufficient monies have been allocated for basic maintenance and they’ve been burdened by a good 10 to 12 years of very serious overcrowding that have put a strain on the facilities.”
The federal receiver has asked the state for $750 million for improvements at all prisons. Lawmakers approved the money five years ago as part of a prison construction bill but they won’t release it.
Corrections Secretary Matthew Cate defends that choice.
“The governor’s view is, ‘Let’s see how much we can get out of existing resources’” Cate says.
In October, the governor’s “realignment” plan began re-routing some low-level felons into county jails to comply with a federal court order to cut the prison population. It’s now down by more than 14,000 inmates. With fewer inmates in prison, Gov. Jerry Brown wants to hold off on more prison construction.
Cate says the governor is right, “because he’s done a brave thing on realignment — and I think he wants to not only get out of the receivership but not spend as much money on prisons. And if we build too many, we’ll spend too much.”
But receiver Clark Kelso says even if realignment gets the prison population down to the goal of 111,000 inmates, the job of fixing prison medical care won’t be done.
Of state lawmakers refusal to release funds Kelso says, “I think it’s just a desire not to spend any money, to spend as little as possible on prisons and hope that realignment solves everything. And I think it’s just difficult at times to convince people, you have to say it about a thousand times: ‘No! Realignment doesn’t address this problem!'"
The federal judge who appointed the receiver wants to end federal oversight of prison medical care. Receiver Clark Kelso had a five-year plan to do that, but he says construction fallen two years behind.