SACRAMENTO — The federal receiver assigned to fix healthcare in California prisons said Wednesday that the problems are far worse than he thought, with nearly every piece of the system either not working or in an "abject state of disrepair."
Receiver Bob Sillen said in a report that a federal judge probably will need to step in and suspend state laws, contracts and regulations that are hindering progress.
Sillen also launched a turnaround project at San Quentin, vowing to bring improved inmate care and a sense of hope to the prison's "clinical trenches" within 90 days.
Of all the state's 33 prisons, the decrepit lockup north of San Francisco has received the most attention, with experts finding widespread evidence of malpractice and neglect -- and proof that inmates suffered not just from incompetence but also from cruelty at the hands of some doctors.
Medical experts who reviewed 10 deaths at San Quentin in recent years found that most were preventable.
The prison, Sillen said, is an ideal laboratory to test possible remedies that could lift healthcare throughout the prison system to constitutional standards.
"If we can do it there," he said, "we can do it anywhere."
Sillen, who is paid $650,000 a year, began his open-ended term in April, and the report marked his first public assessment of the crisis -- as well as the first clues to his game plan.
The report is the first of a series he will produce for U.S. District Judge Thelton Henderson, who seized control of the state's $1.4-billion prison healthcare operation and put the receiver in charge.
Henderson, who presides over an ongoing lawsuit over inmate care, said he was compelled to act because an average of one state prisoner a week was dying through medical incompetence or neglect. The move marked the first time in the nation that a government operation the size of prison healthcare has been put under a federal receiver.
One legislator who has been critical of prison operations called Sillen's report "ominous" and evidence that he clearly "means business."
"There's a new sheriff in town," said state Sen. Gloria Romero (D-Los Angeles), "and it's the receiver."
Over the last two months, Sillen said in the report, he visited five prisons and met with dozens of doctors, union leaders, guards, wardens and inmates.
He also talked with Republican Gov. Arnold Schwarzenegger. Sillen said in an interview that the governor offered an open door and full support.
In addition, Sillen said he read thousands of pages of documents, including inmate medical charts, internal investigation papers, budgets and reports from experts hired by the courts.
His conclusion: "The problem is much worse and more complex than anyone originally thought."
From the pharmacies to medical records, supplies and training to chronic disease care and information technology, the system that serves more than 170,000 inmates is wasteful, dysfunctional, dangerous and will defy any quick fix, his report said.
Aside from harming inmates in violation of their constitutional rights, the system squanders taxpayer dollars, he said. In one case he cited, officials at San Quentin ordered expensive diagnostic imaging equipment four years ago but have yet to unpack it because it was too heavy for the exam room.
And according to an audit Sillen released, the prison pharmacies are bedeviled by problems with procurement, inventory control and distribution, all of which endanger inmates and waste money. In 2005, the audit said, California's prison drug costs were as much as $80 million higher than those for a comparably sized correctional system.
Exacerbating the problems, Sillen said, is severe overcrowding in the prisons, most of which are at twice their intended capacity, and management turmoil in the Department of Corrections and Rehabilitation. He noted that since his appointment, he has dealt with three corrections chiefs -- two of whom resigned their posts in frustration -- as well as continual turnover in the warden ranks.
Given the instability, demoralization and "ineffectiveness of the department in its custody and medical care responsibilities," Sillen said, he might ask the judge to strip healthcare from the department altogether and make it a separate operation.
Elaine Jennings, a department spokeswoman, declined to comment on Sillen's suggestion that healthcare might need to be removed from the corrections umbrella. But she said officials were "committed to working with the receiver to meet the goals he has laid out.
"Everyone concedes that there are problems, and we know the receiver has been sent in to make major changes," Jennings said. "We will help him accomplish that."