California Prison Healthcare Costs Soar Under Federal Receiver

Creating a balance between adequate healthcare for prisoners at a reasonable and affordable cost for taxpayers is at the heart of a debate being argued in legislative offices and behind prison walls in California.

The federal receiver appointed to overhaul the state’s prison healthcare says he has worked hard to reform a dysfunctional system that – at its worst in 2005 – claimed the life of one prisoner per week due to negligence, malfeasance or inadequate and substandard medical care. [See: PLN, March 2006, p.1].

State officials counter that the reforms have produced a “Cadillac” level of care that has caused medical costs to skyrocket, nearly doubling over the past decade. Statistics indicate, for example, that partly as a result of healthcare costs, California now spends more per year housing a state prisoner than it does to educate a child in public school.

When a federal district court assumed oversight of the state’s prison healthcare system and appointed a receiver in 2006 – initially Robert Sillen, who was replaced by J. Clark Kelso in 2008 – the court gave the receiver’s office the authority to hire medical staff and set their pay levels. [See: PLN, July 2008, p.30]. Immediately after being appointed, the receiver set out to bring medical care in California prisons up to constitutional standards.

To cure the prison system’s many problems, the receiver’s office, known as California Correctional Health Care Services, hired hundreds of employees to fill longtime vacancies, increased salaries and created new positions at higher pay rates. The number of medical, mental health and dental workers in state prisons increased from 5,100 in 2005 to 12,200 in 2011.

“The problem that we had is that the receiver was not accountable to anybody,” complained former state Senator George Runner. “So the receiver could just do or choose to spend whatever amount of money he thought was necessary to solve his problem, and unfortunately, now the state is stuck with that.”

Runner neglected to mention that it was the state’s decades-long failure to address problems related to deficient prison medical care, largely due to a lack of political will by the legislature in which he served, that led to the Plata and Coleman class-action lawsuits which in turn resulted in the appointment of the receiver and a federal court order to substantially reduce the state’s prison population. [See: PLN, July 2011, p.1].

California spent $1.1 billion in fiscal year 2003-04 to provide medical care to the state prison population, which peaked at around 160,000. Under California’s realignment initiative, which went into effect in 2011, the number of in-state prisoners has fallen to approximately 127,200. Yet the projected cost of prison healthcare in fiscal year 2013-14 was expected to top $2 billion – an 82.3% increase compared to a decade ago after adjusting for inflation.

In contrast, spending for each public school student in the state grew just 17.9% during the same time period.

“We incarcerate people in California at a rate higher than any other society in the world, including Russia and Iran,” noted Michael Bien, an attorney who represents prisoners in the still-pending Plata and Coleman cases. “One of the things we have to pay for is healthcare. Doctors and nurses only [work] in these places if you pay them.”


A survey of salaries for prison physicians found that only Texas has a base salary higher than California’s. An analysis of 2011 California payroll data by theAssociated Press indicated that of the top 100 highest-paid state employees outside the University of California system, 44 worked in state prisons.

The highest paid prison medical employees in 2013 included staff psychiatrist Rajababu Kurre, who earned $509,000; Hung V. Do, a chief physician and surgeon, who made $439,000; and physician and surgeon Dev Khatri, who received $431,000.

Since 2005, the average cost of prison healthcare in California has soared from $7,747 per prisoner annually to more than $18,000. Governor Jerry Brown has criticized Kelso’s efforts to improve medical care in the state’s prison system, calling it “Cadillac care.” Kelso countered that prisons only provide “minimally necessary medical care.” Of course, most prisoners would also likely dispute the notion that they receive Cadillac medical treatment; rather, it is more of a Chevy Cavalier level of care.

Kelso also pointed out that the state had failed to act in the wake of the expiration of a court order that increased prison healthcare workers’ salaries. At that point, the state was free to collectively bargain with the union representing the employees.

Joyce Hayhoe, a spokeswoman for the receiver’s office, added that contract medical service costs have dropped over the past several years and are now less than when the receiver was appointed. The state has reduced by half the cost of outside medical care at hospitals by having prison doctors provide more treatment, which also reduces transportation costs and the expense of having guards watch prisoners while they are hospitalized.

Although prison medical costs remain high, that is part of the cost of mass incarceration. When public officials enact laws and policies that put more people in prison for longer periods of time, higher costs – including medical expenses – are a predictable result.

Sources: Associated Press, www.montereycountyweekly.com, http://californiabudgetbites.org, www.sacbee.com

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