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Letter From Receivership Corp California 2007

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Robert Sillen

Le :r from the Receiver, Vol. 2, Number 2
20 ~pril2007

:tings to all on the first anniversary of the Receivership!
~ta year it has been. I would like to share with you six significant accomplishments
together, we have made that will contribute greatly to the improvement of the prison
ical care system.

1. alarv crisis addressed


year ago,prison doctors, nurses, pharmacists and other medical staff were paid
tically depressed wages. The below-market salaries caused high vacancies, the use of
:nsive temporary agencies (costing taxpayers $90 million per year), often attracted
performers and added to the chaos and discontinuity of care. The state's own salary
eys confirmed that prison medical staff were underpaid, but the problem had
tined unaddressed.

It 1

zy, medical staff are paid competitive salaries, (costing $30 million per year when all


harmacy crisis addressed


year ago,the prison pharmacy system was out of control, wasting $46 to $80 million
lollars per year. Drugs went missing, there were no inventory or purchasing controls,
~versight,and an atmosphere ripe for medical errors. Despite numerous reviews and
ts over the past six years that found serious, wasteful and dangerous deficiencies in
xison pharmacy system, nothing had been done.


~ositionsare filled), and vacancies are starting to shrink. So far, we have hired more
500 Licensed Vocational Nurses (LVNs) and almost 300 Registered Nurses (RNs).
3k a waiver of state law by federal Judge Thelton E. Henderson to accomplish this
ntial change. We are not done. There are several classes that were not addressed last
that will be addressed this year. We will, on an ongoing basis, make sure that
ies are competitive in the marketplace and appropriate for recruitment and retention

To zy, national correctional pharmacy experts are managing the system and a turnaround
is ~denvay.Already, Maxor National Pharmacy Services C o p . has identified nearly
$5 1,000 in rebates that the state never collected. We are in the process of transferring
CO rol of the purchasing and procurement processes from the Department of General
Se ices (DGS) in order to achieve more cost effective and efficient results, which will
sa3 taxpayer money and ensure better service for our clinicians and patients.

1731 Technology Drive, Suite 700, San Jose, CA 95110
408.436.6800 Fax 408,453,3025 e-mail:

3. Nurse staffing restructured


On year ago, Medical Technical Assistants (h/lTAs) served as LVNs in the prison
me ical system, but their dual role as correctional officer (CO) and nurse caused
con usion in the workplace, divided loyalties and made it even more difficult to recruit
RN . This problem had been previously identified by court experts but not addressed.
LVNs are replacing MTAs at a savings to taxpayers of $39 million per year. The
is improving clarity of roles in the medical system. h4TAs may opt to help
slots or remain as LVNs. We wish the many high quality MTAs well in
and understand, but regret, that their underlying peace officer pay and
for most to stay in medical.

4. dontracting crisis under control


On year ago, specialty physicians and community hospitals that contract with state
pri ons had not been paid some $100 million for up to four years of work. As a result, the
sic est and most medically needy patients were no longer getting care.
all outstanding invoices have been paid and there is a four-prison pilot (at San
California Medical Facility, Pelican Bay State Prison, Central California
Facility) of a new automated contracting system that will replace CDCR's
inefficient and broken paper-based system that handles 2,600 contracts worth
annually. The new system will save time and money, make fewer mistakes
access to care. Our private and public sector partners deserve fair and
services they provide to our patients on behalf of the state.

5. $roken discipline svstem under repair


On year ago, medical staff worked without accountability. Efforts by supervisors to
dis ipline incompetent or uncaring clinicians were often turned back by the machine of
sta e bureaucracy. The Administrative Time Off (ATO) system had run amok, with at
lea t 40 health care staff, about half physicians, sitting home with full pay for weeks,
mo ths and years, at an enormous waste of tax dollars and an immeasurable impact on


To ay, there are zero medical staff on ATO. They all have been called back to work,
pe orming non-patient care duties, rather than being allowed to sit at home collecting
ful pay and benefits. Instead they are reporting to mailrooms, warehouses and filing
envork. We are working together with the physicians' union to develop new systems
discipline, accountability and performance. We are on our way to creating a
environment for staff.

6. Medical equipment and supplies delivered

ago, prison medical staff worked without the most basic medical supplies and
During my prison visits, I learned of a staggering unmet need - for sutures
cardiac monitors, gurneys, anatomical charts, white boards,
microscopes, training texts -- the list goes on and on.
~ o d a ythose
in the clinical trenches have felt some relief, with $5.6 million of medical
eq ipment and supplies ordered, and more on the way. Though there is still a long way to
go, working conditions and the ability to provide adequate care have improved with the
del'very of such items as stretchers, otoscopes, IV pumps, defibrillators, wheelchairs,
ph sician tables, exam lights, crash carts, transport vehicles, faxes, copiers, shredders and
o t h b hndamentals needed to operate medical offices and provide patient care.


n't do this alone. All the work of the Receivership is conducted under the watchful
Judge Henderson, to whom I report. The progress so far took long hours and lots
work by the members of my team, wardens, custody and medical leaders in the 33
CDCR health care, contracting, personnel and business staff and many others,
you. In particular, Warden Robert Ayers and the staff at San Quentin have
efforts and strides this year to improve the medical care delivered there.
is to be commended for their creativity, dedication and persistence in
through despite tremendous obstacles. Working together, all of us
around and deliver constitutionally adequate medical care to


Co ing up next, I am approaching Judge Henderson with requests to waive state law to
all w improvements in staffing, discipline, working conditions and to ensure that the
re edial actions of the Receivership happen in a timely manner. We also continue to
mo e forward with multiple initiatives to build 5,000 prison medical beds statewide;
rec it qualified, dedicated medical professionals; coordinate the efforts of the Plata
me ical, Coleman mental health and Perez dental cases; improve prisons' emergency
res onse; collaborate with custody to create new approaches to health care access; and
de elop the appropriate orientation and training, roles, responsibilities and working
for nurses, physicians and other clinicians and support staff who are essential
care and the proper functioning of a constitutional health care delivery


gratifying to see and hear that the Receivership already is making a difference. In
to 20 prisons so far there has been an outpouring of support and interest from staff,
of whom have been desperately waiting for this opportunity for change. I also
the positive feedback from the public, inmate patients and their families.
ever, it took decades for the system to devolve into the terrible shape it's in, and it
a long process digging it out. One of the key lessons of the past year is the internature of the problems - nearly every solution unearths new problems. There
of reasons, history and culture that keep so much of prison medical care


tra ped in its sub-standard state. There is a great and corresponding need for thorough,
tho ghtful approaches to create long-term systemic change. It is a job worth doing, and it
will save lives. Remember, all of our actions have one bottom line in mind: To create a
sys em where custody and health care stafftogether guarantee that access to care and
qu lily of medical services in California prisons meet constitutional standards.
forward to continuing to work with you to achieve that goal as we embark upon the
year of the Receivership. Thank you for your support and your efforts on behalf


Ro e Si len


Di tribution:
Ho orable Thelton E. Henderson
Ho orable Members, California Legislature
A1 State Department Heads
A1 Bargaining Units
A1 State Constitutional Officers

Honorable Governor, State of California
All Cabinet Secretaries
All Employees, CDCR
Inspector General
Legislative Analyst's Office