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California DOC Federal Health Care Receiver Replaced
Robert Sillen, the scrappy Receiver appointed by a U.S. District Court to fix California’s ailing prison healthcare system, was replaced on January 23, 2008 by J. Clark Kelso, former Chief Information Officer for Governor Arnold Schwarzenegger.
U.S. District Judge Thelton Henderson, who announced the change in a court order, felt that a new skill set was needed following Sillen’s sometimes abrasive strong-arm techniques that were necessary to deal with the prison system’s deeply entrenched bureaucracy. Judge Henderson opined that more contemporary and collaborative skills were appropriate to bring the already commenced changes to completion.
While Sillen had decades of experience as a healthcare administrator, Kelso, a law professor, has experience fixing Cali-fornia’s governmental information technology program. Sillen had quickly recognized the problems attending the state prison system’s abysmal healthcare – a lack of doctors, nurses, medical equipment, clinics and, most importantly, anyone who cared – and shook the California Dept. of Corrections and Rehabilitation (CDCR) to its foundation to force improvements. The situation when he was appointed Receiver included 66 preventable deaths per year plus countless thousands of cases of delayed or inadequate medical care. Pharmacy services were chaotic among CDCR’s 33 prisons; clinic sanitation prac-tices were shockingly deficient.
Sillen chose the aging San Quentin State Prison as his test case. He replaced all of the Medical Technical Assistants (guards who worked as medical aides) with registered nurses and licensed vocational nurses. He greatly increased the salaries for medical staff, which was necessary to achieve healthcare improvements through fuller staffing levels, and an-ticipated additional raises of 8-20% to fill all needed medical positions. He ordered a thorough cleaning and repainting of the prison’s “hospital” wing plus construction of a Triage Treatment Area. A new $160 million hospital facility was con-tracted to be built by 2009, replacing an existing condemned 124-year-old structure. Clinic space was created in each housing unit as well as in the reception area, where medical and dental screening of new arrivals is now performed.
Similar programs were instituted at many of California’s other prisons as Sillen visited each facility and designated Receiver’s representatives to monitor progress. However, as he continued to make improvements it became apparent that the CDCR’s intransigence to change was going to take more time than initially anticipated. Judge Henderson pressed Sil-len for a completion schedule, but he could only provide general estimates that stretched over ten years. Some state offi-cials complained to the court that Sillen was too roughshod to deal with and that the CDCR could ill afford to comply with his open-checkbook style of doing business – particularly given the state’s pending $16 billion budget shortfall.
With these criticisms in mind, Judge Henderson compromised by replacing Sillen with Kelso, a seasoned “fix-it” adminis-trator and member of Governor Schwarzenegger’s inner circle, and instructed him to finish the healthcare improvement process with a more firm schedule of completion.
Kelso is well respected in state government circles and may well have a smoother style than Sillen. But CDCR is an immense monolith, and if it took Sillen as Receiver to move the prison system as far as it already has, it remains an open question whether a less aggressive administrator will continue to make progress – thereby rendering the court’s desired completion schedule an elusive goal.
In November 2007, Sillen gave Judge Henderson an updated Plan of Action for Constitutional Prison Medical Care, which detailed a three-year project encompassing asthma care, new construction and new information technology programs. The 300-page Plan laid out metrics and timelines in which to measure progress on 22 major initiatives. These included a state-wide computer network within one year, new healthcare facilities in progress or completed at 21 prisons within two years, automation of pharmacies in all state prisons within three years, and new systems in place for medical and lab re-cords.
In addition to the proposed Plan of Action was a collaborative project with the University of California for clinical im-provements. But because Sillen discovered that “the situation [was] much worse than the court or the public ever imag-ined,” his anticipated completion date remained indefinite. Hoping for better, Judge Henderson ordered Kelso to rework Sillen’s Plan, aided by a Pro Bono Special Assistant, to make it “a more useful leadership document.”
Kelso has shown he is willing to exert his newly-appointed authority. He moved the Receiver’s office to Sacramento, so as to be closer to lawmakers and state agencies. In May 2008 he began an investigation into delayed medical treat-ment and the medical-related death of a California prisoner who had been transferred to a CCA-run prison in Mississippi.
However, Kelso’s efforts to get the state legislature to approve almost $7 billion in bond financing for 10,500 prison healthcare beds and medical services fell short; on May 27, 2008 the Senate failed to pass a bill to approve the financing.
If Kelso doesn’t have the same power of persuasion with the CDCR as did Sillen, his plan to fix the state’s prison healthcare system in “four to five years” may fade into bureaucratic obscurity.
Improving prison healthcare to meet Constitutional standards can be achieved by either increasing healthcare facili-ties and staff or by lowering the prison population. Judge Henderson is considering the latter option, too, as a member of a three-judge panel that is on the brink of taking over the rest of CDCR’s operations and imposing a prison population cap for medical and mental health care reasons. [See: PLN, March 2008, p.38].
Either way, hopefully Judge Henderson will steer the path to Constitutional medical care in California prisons with the firm resolve he has demonstrated over the past several decades. See: Plata v. Schwarzenegger, U.S.D.C. ND Cal., Case No. C01-1351-TEH (Order Appointing New Receiver, January 23, 2008).
Additional sources: Associated Press, Los Angeles Times, Reuters, California Prison Receivership Bulletin (November 16, 2007)
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Related legal case
Plata v. Schwarzenegger
|Cite||U.S.D.C. ND Cal., Case No. C01-1351-TEH|