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Problems with California’s New Medical Prison

With construction costs of $840 million and a capacity to provide care to almost 3,000 patients, California’s new medical prison near Stockton is the largest and most expensive in the nation. Unfortunately, that expense has not resulted in a smooth-running operation; instead, waste and mismanagement have occurred as prisoners’ basic needs were neglected.

Nurses at the facility said they were unable to get latex gloves that fit them or adult diapers that do not leak. Prisoners complained of a lack of towels and soap. Prisoners’ rights advocates noted some prisoners had been left in broken wheelchairs or in soiled clothes. Disabled prisoners were left on toilets for hours.

Two issues were at the core of these problems: understaffing and a split administration. Both had their origins in the litigation which led a federal court to declare California’s prison system unconstitutional due to inadequate medical care. The prison in Stockton was built as a direct result of that ruling. [See: PLN, June 2013, p.54; July 2011, p.1].

A federal district court appointed J. Clark Kelso as the Receiver to oversee medical care in California prisons, and as often happens when federal courts exercise authority over state agencies, the prison system’s administrators resented the intrusion on their “territory.” Consequently, the level of cooperation with Kelso was very low.

Kelso wanted a medical officer in charge of prison medical care. The corrections department agreed, but then brought in a warden, Ronald J. Rackley, who boasted he knew nothing about medical treatment and had never even been admitted to a hospital. When Kelso brought in Jackie Clark, an RN with an MBA, to run the medical side, it created a parallel chain of command.

A lack of cooperation and communication caused some of the problems. For example, nurses were placing towels that were contaminated with blood or urine in plastic biohazard bags so they would be sterilized. Somehow, on their way to the laundry, which is located at another facility, they were thrown in the trash. Thus the prison had to order 38,000 towels and washcloths in the space of a few months – five times the normal amount.

Rackley blamed Clark’s nurses for throwing out the towels. He also blamed the nurses for handing out too much soap, creating a shortage. His solution was to order extra soap and have prisoners search the trash for towels.

Additionally, both the security and nursing staff experienced problems caused by understaffing. In December 2013, the lack of adequate staff almost resulted in the facility losing its operating licenses, as there weren’t enough employees to unlock doors, take patients to showers or help disabled prisoners move around. Prisoners were told to provide assistance to other prisoners. One wheelchair-bound prisoner informed an advocate that it was his job to push around another prisoner who also was in a wheelchair.

Things came to a head in January 2014, when prisoner John Earl Cartwright, a stroke victim, died of a heart attack. He had repeatedly pressed his bedside call button and cried out for help. Other nearby prisoners had also taken up the cry. Nonetheless, by the time a nurse arrived 30 minutes later, he was dead. This resulted in nurses receiving training on the operation of the bedside call system, which contains different buttons for a variety of needs.

“Why on earth in six to nine months you haven’t figured out a hospital call button system.... And if you don’t know how it was working, you didn’t ask?” Kelso wondered.

Kelso suspended new admissions to the prison until he felt it was ready to receive more prisoner patients. Rackley responded to the inability to care for the existing patients by hiring workers for a 1,133-bed addition to the facility, expanding it from an initial 1,800 beds.

The California Health Care Facility (CHCF) in Stockton reopened in July 2014 with an increased capacity and almost 2,500 employees, after Kelso announced that most of the issues plaguing the prison had been corrected.

Critics remained concerned. “There are still substantial improvements that need to be made,” said Don Specter, director of the nonprofit Prison Law Office in Berkeley. His firm, among others, litigated the class-action lawsuit against the state over inadequate prison medical care that resulted in federal oversight.

A week after reopening, the California Association of Psychiatric Technicians (CAPT) union reported that CHCF employees were being pressured into falsifying suicide-watch records due to understaffing. “These welfare checks were put in there because of the extremely high suicide rate we have in California,” Specter said. “It could mean the difference between life and death.”

A union protest in late August 2014 drew attention to poor working conditions and understaffing at the prison. “[W]e can’t help those in need if the Receiver won’t give us the staff we need to help them,” said CAPT Corrections Chapter President Jennifer Are.

Governor Jerry Brown appointed Brian Duffy as the new warden of CHCF in April 2015 and Jennifer Barretto as Chief Deputy Warden. In January 2016, Barretto was named acting Warden at the medical prison, and currently remains in that position.

While conditions at CHCF have reportedly improved, problems with medical care persist at other California prisons. In April 2016, the state’s Inspector General found the Wasco State Prison was providing substandard care – it had failed four of 15 benchmarks, and had problems with record-keeping and the provision of medical treatment. Previously, the Inspector General had reported that four other prisons – in Chowchilla, Delano, Susanville and Vacaville – were not providing adequate medical care.

These shortcomings are despite the federal Receivership, a substantial reduction in the state’s prison population over the past five years, and doubling the prison system’s healthcare budget to almost $1.7 billion annually.


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