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Lawmakers express frustration over excessive outlays for prison health

Inmate medical care is budgeted at $1.5 billion for this year. A federal overseer recommends early release of chronically ill inmates as a way to cut costs.

January 27, 2011|By Jack Dolan, Los Angeles Times
  • Inmates sit for dinner at the California State Prison in Lancaster. A federal overseer of the state's prison system has suggested freeing the sickest inmates as a way to cut costs.
Inmates sit for dinner at the California State Prison in Lancaster. A federal… (Gary Friedman / Los Angeles…)

Reporting from Sacramento — Amid California's budget crisis, the receiver put in charge of the prison health system by a federal judge has spent $82 million on blueprints for medical facilities that have been largely scrapped, more than $50,000 a month on an architectural consultant and millions hiring medical professionals — more per inmate than in many other states.

After four years of pouring money into the system, however, receiver J. Clark Kelso told legislators Wednesday that he didn't know when the federal oversight might stop and suggested early release of chronically sick inmates as one quick way to cut costs.

Exasperated lawmakers, who have to pay the bills but have little say in how the funds are spent, questioned whether federal control is making prison healthcare any better.

"That's a source of great frustration," said Assemblyman Roger Dickinson (D-Sacramento), chairman of the Assembly Committee on Accountability and Administrative Review, who called on Kelso to account for the spending, which is budgeted at about $1.5 billion for this year. "As we watch the numbers go up, we can't tell if we're any closer to hitting the mark."

California's prison health system fell into receivership in 2006 after a federal court ruled the state had not done enough to improve conditions since a 2000 court ruling found that care behind bars amounted to cruel and unusual punishment.

There were 48 "possibly preventable" deaths of patients in California's prison healthcare system in 2006, according to figures from Kelso's office. There were 43 such deaths in 2009. Asked how he measured progress, Kelso said the number of "likely preventable" deaths dropped from 18 in 2006 to 3 in 2009.

"Those are the ones where you look at the record and your jaw just drops at how bad the treatment was," Kelso said.

But as state leaders have struggled with historic budget deficits by making deep cuts in other services, they've had little choice but to write essentially blank checks for prison healthcare.

California prisons now employ one doctor for every 435 inmates, according to a report commissioned by former Gov. Arnold Schwarzenegger last year. By contrast, Texas prisons — which were once in receivership but have since emerged — employ one doctor for every 2,000 inmates.

Dickinson decried what he called "galactic" differences between staff levels in California and in other states.

Assemblywoman Alyson Huber (D-Eldorado Hills) said that the state now spends about $14,000 on healthcare per inmate each year, while many Californians have no health insurance.

"I'm not happy about the fact that our incarcerated inmates are getting better healthcare than people who aren't incarcerated," Huber said.

Lawmakers also expressed frustration about money spent on grand projects that did not materialize.

After $82 million was spent between 2007 and 2010 on blueprints, environmental reviews and other plans for seven new medical facilities capable of treating 10,000 inmates, Schwarzenegger abandoned that ambitious plan, instead settling on one new medical facility in Stockton with about 1,700 beds. Three former juvenile prisons will also be retrofitted as medical facilities.

While gearing up for the proposed building boom, the state paid at least seven different construction consultants a monthly rate that amounts to more than $240,000 per year, according to an Assembly committee review of invoices. One of those contractors, Washington State-based architectural consultant Robert Glass, was paid as much as $50,600 per month last year.

"He was working extraordinary hours trying to put together all of the input we were getting from healthcare professionals into a plan," Kelso said of Glass' contribution. "An extraordinary fellow."

Glass did not return a call requesting comment.

Kelso noted that the contract Glass and other consultants worked under had been signed by his predecessor as receiver and that he had since done away with most outside advisors. Kelso took over the office from the original receiver, Robert Sillen, in 2008.

One way to reduce costs quickly, Kelso told legislators, would be to allow him to release the sickest patients, who consume a disproportionate amount of medical care.

"You let me unload 1,500 inmates, and I'll give you a 30% drop in costs," Kelso said.

A bill that allows some parole for medical reasons was signed into law last year, but it applies only to "people who are literally hooked up to machines, in comas, that sort of thing" Kelso said, and won't do much to lower the state's overall bill.

jack.dolan@latimes.com

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