Federal receiver issues prison health care plan
The federal receiver running California's prison health-care system issued his plan for the next two years Thursday, declaring that "an entirely new and different medical delivery system must be created - from the ground up." Robert Sillen issued a news release Thursday calling his plan "comprehensive, responsible and best of all, achievable ... Barring the success of efforts to derail it, the plan will result in a system that provides quality, timely, accessible and efficient care to California's thousands of inmate patients." In an overview filed Thursday with U.S. District Judge Thelton Henderson of San Francisco, Sillen, the former public health chief in Santa Clara County, said his plan is radically different from previous state efforts. Indeed, Sillen wrote, if the plan did not significantly differ "from the manner in which the state attempts to manage its prisons, it would not have a chance for success." Sillen had disclosed some of his ideas earlier. His plan envisions, among other things: Creating a system to measure progress in improving clinical care, complying with standards set by the courts, reviews of inmate deaths and patient satisfaction. Creating crisis-response teams of doctors, nurses and administrators to travel to prisons in medical crisis. Developing innovative ways to solve staffing needs at the state's most remote prisons, perhaps including a system of chartered airplanes to ferry doctors from San Francisco, Los Angeles and San Diego to work several days a week at the distant sites. Breaking the prison system into regions of three to five prisons each, with each region's medical care overseen by its own team of clinicians and administrators. Moving toward creating an electronic medical record for every inmate patient, with a computer system and Internet access so those records can be shared between prisons and departments. Launching a program to recruit, hire, train and retain medical staff. Tightening the California Department of Corrections and Rehabilitation's health care budgeting and accounting to ensure taxpayer dollars are being spent wisely; Developing teams to provide inmates with better escort, transportation and access to health care inside and outside the prisons. Assessing how many more medical beds are needed at all 33 prisons. Bill Maile, a spokesman for Gov. Arnold Schwarzenegger, said the governor "will swiftly implement the historic reforms just passed to help resolve the prison crisis" - a $7.8 billion plan he signed last week that includes adding 53,000 prison and county jail beds, and about $50 million for rehabilitation programs. "He supports an agenda to improve the prison health care system," Maile
added.
Receiver rips prison-reform obstructions
California's prison health care czar said in a report Tuesday that he has reached a "pivotal crossroad," with lawmakers failing to act and the state bureaucracy impeding his efforts to fix a system a federal judge found to be unconstitutionally bad. The third bimonthly report of Robert Sillen, director of the court-appointed California Prison Health Care Receivership, singled out the entire State Personnel Board as obstructing his reform plan. It also promised a construction program to create 10,000 hospital beds for physically and mentally ill inmate patients that will require billions in state funds to build and upward of 130 new employees to plan. Meanwhile, Sillen reported he is filling out his San Jose-based staff with professionals drawing substantial annual salaries. His $500,0000 -- more than twice Gov. Arnold Schwarzenegger's designated salary -- tops the list. The salaries do not include a benefit package that tacks on 30 percent. With progress running slower than expected -- Sillen's "plan of action" to fix the system is likely to run at least eight months late -- the receiver is threatening to seek court action to remove whatever obstacles he sees in his path. "The receiver will continue to work cooperatively and collaboratively with all stakeholders to the fullest degree possible," Sillen's report concluded. "However, maintaining the status quo is not an option. The mission ... will be accomplished, with or without cooperation. In this regard, the receiver anticipates seeking additional court orders whenever necessary to overcome the barriers imposed by those who attempt to obstruct the correction of unconstitutional conditions." U.S. District Court Judge Thelton Henderson placed the $1.5 billion prison health care system into receivership last year after finding it responsible for as many as 34 inmate deaths. Henderson appointed Sillen, the former director of the Santa Clara County medical system, to the receivership in February and gave him a virtual blank check on the state treasury and the power to suspend state laws and contracts to reshape the system. "At various levels of the organization, there have been those who have not been overly cooperative," Sillen said in an interview Tuesday. "And so we've dealt with that as we've gone along, and this is just to acknowledge that fact and to say we've had our boots on the ground for seven months now and we won't be thwarted and we won't be impeded. So people either have to cooperate or be held accountable for not cooperating." In characterizing his mission as having reached a crossroad, Sillen's report said the "overriding focus" of lawmakers over the past year -- seeking re-election -- resulted in "no progress" on the prison system's "gross overcrowding," where some 174,000 inmates are crammed into prisons designed for half that many. He singled out the State Personnel Board as the state's leading bureaucratic impediment, for requiring pre-employment drug testing for incoming licensed vocational nurses. Sillen wants to hire them to replace the custody-oriented medical technical assistants in frontline prison health care delivery jobs. The report called the drug-testing requirement "an apparent attempt to obstruct the MTA/LVN conversion." Sillen said "there are foreboding signs of resistance and obstinance from major agencies such as the State Personnel Board as well as individuals within various agencies of state government." He said "it may be necessary" for him to "move for sanctions" with the court against the personnel board "or to move to add the SPB as a party defendant in this case." State Personnel Board spokeswoman Sherry Evans said she can't comment on the report until the board reviews it. Sillen said the conversion to LVNs will save the state $39 million. California Correctional Peace Officers Association spokesman Lance Corcoran disputed the figure. "You will now need two people to do the job that one was accomplishing through the use of the MTAs," said Corcoran, whose union represents the prison system's 600 medical technical assistants. Sillen called for the construction of as many as seven medical facilities at existing prison properties around the state to add as many as 10,000 hospital beds for inmates in need of medical or mental health care. The Legislative Analyst's Office put the cost of the medical care beds alone at $3 billion over three to five years. Corrections Secretary Jim Tilton estimated in a report to the receiver that it will take a staff of 130 to plan, design and manage construction of the new facilities. Sillen said in an interview he expects the personnel to be requested in next year's state budget. As for the receiver's staff salaries, Sillen's is more than twice the $206,500 designated for Schwarzenegger (who only takes a dollar of it every year). Others drawing significant salaries include communications director Rachael Kagan ($180,000), chief medical officer Terry Hill ($350,000), chief medical information officer Justin Graham ($275,000), chief financial officer Rich Wood ($275,000), chief information officer John Hummel ($275,000) and acting health care project officer Jayne Russell ($187,678).
Bold vow on inmate health
California's prison health care czar used his first appearance in front of a governmental body Thursday to say there will be no fooling around when it comes to fixing what he termed a "horrid" system that is in "an utter state of disrepair." Robert Sillen, the court-appointed prison health care receiver, said he's willing to back up the truck to raid the state treasury if need be, waive whatever civil service protections and state laws that get in his way and seek contempt-of-court citations against any state employee who tries to thwart his efforts to renovate California's $1.5 billion prison medical system. "We're on our way," Sillen said, at the conclusion of his 1 1/2-hour testimony before the Little Hoover Commission. "We'll get medical care where medical care has to be, because I think we have the authority to do that over time. It's just a monstrous path to get there." To illustrate the difficulties that Sillen said remain in his path, he recounted an inmate death that took place in August -- four months after he had been installed in his position by U.S. District Court Judge Thelton Henderson -- in which a quadriplegic inmate died of heat exhaustion after being transported in the middle of the summer from a Central Valley prison to another institution near the Mexican border. The van had no medical personnel on board, and its air conditioning unit broke down during the course of an 11-hour trip -- made longer by six hours when the driver got lost, according to corrections spokeswoman Terry Thornton. When the van arrived at the Centinela State Prison on Aug. 21 after driving from the Substance Abuse Treatment Facility in Kings County, the unidentified inmate had a body temperature of 109 degrees. "That's the kind of thing I'm talking about," Sillen said. "There has to be a massive change of culture within the (California Department of Corrections and Rehabilitation) in general and with medical care. Inmate patients have to be viewed as patients in addition to being inmates. "Not everybody in prison is a pedophile or murderer or a rapist." Thornton said the inmate died Sept. 5 and that the case is under internal investigation. Altogether, Sillen said, some 65 inmates die needlessly in the prison system every year. "Those are inmates who perished because of either lack of access to care or, more horrifically, access to care," Sillen said. Oscar Hidalgo, the prison system's communications director, echoed Sillen's testimony in saying that the problems in California's correctional health care are decades in the making and "will take time to correct." "The department continues to work hand in hand with the receiver in order to remedy all the problems in the medical system," Hidalgo said. Sillen told the state government watchdog commission during Thursday's hearing on prison management that he won't be shy in exercising his receiver's authority, especially when it comes to making sure he has enough money to get the job done. "Something you must realize about money," he said, "is I do not need legislative appropriations to fund this. The power of the court includes calling the federal marshals, going to the controller or treasurer -- we've already worked out the arrangement -- and taking the money, seizing the money, through a writ of execution. And if we have to do that, we will." Sillen has told the state that he and the special master overseeing mental health services need six new medical facilities. He told reporters Thursday he wants them located on prison property in San Luis Obispo, San Diego, Lancaster, Sacramento, Stockton and Whittier. Hidalgo said the department will work with Sillen on the budget request during the next fiscal year. The Schwarzenegger administration proposed financing two prisons last year with lease revenue bonds, but later said it was willing to build medical facilities instead of big new lockups. Sillen said the bond funding sounded prudent to him. "I'm going to do it in any case," he said of the six facilities. "If you want me to just reach into your general fund for a billion or a billion two, that's fine with me." Sillen said he is prepared to seek court authority to circumvent civil service rules, the State Personnel Board and union contracts to get rid of incompetent doctors who administrators have failed to successfully fire. "People are being reinstated who never should be practicing," Sillen told reporters after his testimony. "I won't have it." Gary Robinson, executive director of the Union of American Physicians and Dentists, the union that represents prison doctors, said his members will appeal any attempt by Sillen to eliminate their employee rights. "This is a kind of classic case that could end up before the U.S. Supreme Court," Robinson said. Sillen said it is not just incompetent doctors he has in his sights. "Anybody in state employ is under threat of contempt of court for thwarting my efforts, impeding my efforts, getting in the way, slowing it down," he told the commission.
http://cbs5.com/health/local_story_291160618.html Oct 18, 2006 1:03 pm US/Pacific SF Judge Raises Prison Medical Personnel Salaries (BCN) SAN FRANCISCO A lawyer for state prison inmates said Wednesday that an order by a federal judge in San Francisco raising salaries of prison medical staff is “a necessary first step” in improving care for prisoners. Donald Specter, an attorney with the Marin County-based Prison Law Office, said the order by U.S. District Judge Thelton Henderson will aid in “making some progress and fixing the problem.” Henderson is presiding over a case in which he concluded last year that medical care for the state’s more than 166,000 prisoners was so abysmal that it was necessary for the court to take over supervision of the prison health care system. The order issued by Henderson on Tuesday allows the system’s receiver, Robert Sillen, to raise the salaries of various medical personnel from 5 to 64 percent without following the normal procedures of the state Department of Personnel Administration and collective bargaining. Sillen, formerly chief of Santa Clara County’s health and hospital system, was appointed by Henderson earlier this year to take charge of the troubled health care system. The order giving Sillen the authority to raise salaries was requested by Sillen and was not opposed by the California Department of Corrections and Rehabilitation. Sillen said on Tuesday, “We cannot move forward to improve prison medical care without qualified, adequately compensated staff in sufficient numbers.” The receiver said, “Years of neglect by the state have produced an underpaid medical workforce, which not surprisingly has resulted in high vacancy rates, inadequate care and over-reliance on high-priced temporary agencies.” Henderson wrote in his ruling that the salary increases were needed to address the high vacancy rates for prison medical staff and bring health care up to constitutional standards. Last year, the judge concluded that “on average, an inmate in one of California’s prisons needlessly dies every six to seven days due to constitutional deficiencies” in prison health care. Rachel Kagan, a spokeswoman for Sillen, said the raises—costing about $24 million in the first year if all positions are filled—will cost less than the $90 million per year now spent on temporary employees to fill vacancies.
Cruel and unusual prison health care
I have run hospitals, clinics and public health facilities for the past 40 years, and medical care in California prisons is unlike anything I've ever seen. Inhumane is the nice term for the conditions. From a clinical standpoint, it is almost unrecognizable -- an exam room without a sink, a 53-bed medical unit with just one vital sign machine and an emergency room with broken defibrillators are just three glimpses at the bleak picture. The environment for patients, medical providers and custody staff is degrading, unsanitary and unsafe. The resulting patient health outcomes tell a gruesome story. Needless deaths occur weekly in our prisons, either from lack of access to care, or worse, from access to it. Inmates are serving time and receiving court-appointed punishment for their deeds. But no one is sentenced by a judge to medical neglect or incompetence, or to die from unaddressed kidney disease or uncontrolled diabetes. No judge has mandated a pharmacy system out of control, creating danger to patients and wasting tens of millions of dollars of taxpayer money. The stories of individuals suffering in California's prisons go on and on. Unfortunately, the outrage they generate has not been sufficient to move the state's leadership to clean up its prison health care system, so a federal court has been forced to intervene. As Receiver, I represent U.S. District Court Judge Thelton E. Henderson's commitment to rectify these atrocious conditions. The court has found that what California provides today violates the Eighth Amendment of the U.S. Constitution, which forbids cruel and unusual punishment. Spelling out the need for a Receivership a year ago, Henderson wrote: The Court has given defendants (the State) every reasonable opportunity to bring its prison medical system up to constitutional standards, and it is beyond reasonable dispute that the State has failed. Indeed, it is an uncontested fact that, on average, an inmate in one of California's prisons needlessly dies every six to seven days due to constitutional deficiencies in the CDCR's medical delivery system. ... It is clear to the Court that this unconscionable degree of suffering and death is sure to continue if the system is not dramatically overhauled. How do you begin to repair a system that is broken at every level? There are no easy answers or quick fixes, but the work can and will be done. It may take five to seven years to get the system up to constitutional muster, and an equal or greater amount of time until it can be reliably turned back over to the state, without fear of an immediate back slide. So far, the Receivership has embarked upon a two-track approach. On one track, we have begun to deliver immediate relief in the clinical trenches where medical care is provided to nearly 175,000 California inmates. My team and I are visiting all 33 prisons in the state, meeting with inmate patients, medical and custody staff, wardens and physician leaders to get a feel for the realities they face every day. The working conditions are jaw dropping. In some places nurses work in closets. In others they have no keys to the hospital-bed cells, and must stand helplessly at the windows watching patients suffer while they wait for a correctional officer -- who may not arrive for hours due to chronic understaffing -- to bring the key. It is common to find medical areas filthy and ill-equipped, if equipped at all. At the end of each visit, we ask the staff to prepare a list of critically needed medical supplies and equipment, which is immediately reviewed. Essential items, such as cardiac monitors and gurneys, sutures and gauze for the emergency room, are delivered as soon as possible. Our approach at San Quentin is more in-depth, with a special four-month project focused on improving medical care there. What we learn at San Quentin will be invaluable as we uncover systemic, bureaucratic and cultural barriers to adequate health care, which apply to one degree or another at each prison. On track two, we are addressing systemic problems that have been ignored by the state for years and which must be solved to achieve meaningful change. For example, the way that prisons contract with local physician specialists to provide care to inmate patients in the areas of cardiology, oncology, optometry, podiatry, neurology, surgery and others was so dysfunctional that many of these physicians were not being paid for their work. In some cases, the bills -- totaling more than $58 million -- were four years overdue. Not surprisingly, many specialists had stopped accepting inmate patients. Under direction of the Receivership, supported by California Department of Corrections and Rehabilitation personnel, all of these providers have now been paid, and we are working on a new contracting system to avoid this type of mess in the future. What it boils down to is access to care for the sickest inmates, who suffer from advanced diabetes, heart disease, cancer, HIV/AIDS, Hepatitis C and other life-threatening conditions. Uncompetitive salaries for clinical and support personnel is another ins |