San Francisco Chronicle - April 15, 2005
James Sterngold, jsterngold@sfchronicle.com.

One witness after another at a state Senate hearing offered scathing testimony on deplorable health care facilities, incompetent doctors, deaths of inmates due to medical negligence, and bureaucratic red tape. State officials acknowledged that, in spite of the fact that California spends two and three times as much per inmate on health care as other states, there are Third World conditions at some prisons.

"We are in a crisis," said Donald Specter, director of the Prison Law Office, a prison advocacy group that won a court-ordered settlement three years ago requiring major improvements in the health care system. "We are in a state of emergency and people are dying."

Specter said that at a meeting Wednesday, the federal district court judge overseeing his settlement, Thelton Henderson, had discussed appointing a receiver to seize control of the system as perhaps the only way of preventing inmates' constitutional rights from being violated by poor health care.

"They are so deep in the hole, they cannot dig themselves out," Specter said.

Some state officials made no attempt to defend the system.

"Nothing in there was overstated," G. Kevin Carruth, undersecretary of the Youth and Adult Correctional Agency, admitted in an interview after the hearing. "We have a health care system that either through neglect or poor care puts people's lives in danger. We know we have a very serious problem."

He disclosed during the hearing that the state has just this week signed a contract with a private company that will design a new contracting system and solicit bids from managed care providers. It is hoped, Carruth said, that the state will hand over health care at the state's 32 prisons to outside managed care providers within about 18 months. That would mark a major turnaround in policy.

Carruth acknowledged in the interview, however, that the state has no clear idea of how much the new system would cost or even if private health care providers would be willing to take on the system, which has roughly 165, 000 inmates in institutions spread the length of the state, many in remote locations.

Carruth said that the prospect of the court appointing a receiver is real, and he expressed disappointment that 14 years of concerted state efforts have failed to build a reliable prison health care system. California has doubled spending on prison health care over the past seven years, to about $1.1 billion annually.

"The system is so completely broken that I wonder if it is worth even trying to repair," said state Sen. Gloria Romero, D-Los Angeles, who chaired the committee hearing. She said she was coming around to the view that only a court-appointed receiver, who would have enormous power to hire and fire and order changes in the system, could begin to provide the minimal level of care required.

Romero told Carruth during his testimony that it seems the state simply does not know how to run a competent health care system in the prisons on its own.

"Correct," he replied.

State Sen. Mike Machado, D-Linden (San Joaquin County), angrily fired off questions and tartly reprimanded state prison officials, demanding to know, for instance, why they have not even fixed such basic problems as installing wash basins in medical examination rooms, an apparently widespread problem.

Renee Kanan, head of health care in the corrections department, said she does not have the authority to just order the basins, and that she had no clear explanation why so many rooms are not properly outfitted.

Machado continued to grill the officials on why they had not asked for more money or more authority in previous years if the system was in such dire shape, and he dismissed Carruth's proposal to bring in managed health care companies as a dodge.

He said state officials are "hiding from their responsibility" by not working harder on fixing things themselves.

Romero said she feared that Carruth's proposals are merely a means of pushing the problem off until a new set of lawmakers sit in the statehouse, and she openly doubted that the private companies could be in place within 18 months.

Specter said he felt the health care problem simply does not have the urgency required within the corrections department.

"I don't think it's possible to stop the bleeding without a receiver taking over," he said in an interview. "Enough is enough already."

Among the problems cited were extraordinarily high vacancy rates in key jobs, of as much as 20 percent and higher in positions like nurses, doctors and social workers. Also, the prison salaries are as much as 30 and 40 percent lower than private sector jobs, making it difficult to recruit qualified personnel.

A report to the federal court last month on San Quentin prison said that, in part because it is holding twice as many inmates as it was designed for, the health care facilities there "pose a risk of imminent harm and death to patients."

Another report on San Quentin is particularly disturbing, the doctors who compiled it said.

"We found overall compliance with the Stipulated Order and subsequent Court Orders was nonexistent," it said.

The report added, "We found a facility so old, antiquated, dirty, poorly staffed, poorly maintained, with inadequate medical space and equipment and overcrowded that it is our opinion that it is dangerous to house people there with certain medical conditions and is also dangerous to use this facility as an intake facility."

Many rooms are filthy, medical records "are in disarray," there is no privacy for patients during examinations and patients infected with HIV are not tracked. One room used for examinations can be reached only by walking through a men's shower, according to the report.

"These conditions are deplorable and have no resemblance to a medical setting whatsoever," the report said. It added that, of 10 inmate deaths in the prison's health care system that were reviewed, most were preventable. California's prisons

Number of prisons: 32

Number of inmates: 165,000

Amount spent on prison health care annually: $1.1 billion

What's next: The state hopes to hand over health care to managed care providers within about 18 months.

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