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From brain surgery to Band-Aid

By Josh Richman
Friday, January 25th, 2008 at 10:19 am in Arnold Schwarzenegger, Assembly, California State Senate, General, Sacramento.

Senior U.S. District Judge Thelton Henderson of San Francisco on Wednesday sacked Bob Sillen, the man he’d put in charge of reforming the unconstituionally inadequate California prison healthcare system, and replaced him with law professor and serial “government clean-up guy” Clark Kelso. (Read Henderson’s order here.)

The Sacramento Bee had this to say about it today:

California’s prison medical system is so broken that a federal judge took the drastic step of placing it in federal receivership. Judge Thelton Henderson appointed a receiver who began work mid-April 2006. The job was to reverse “entrenched paralysis and dysfunction and bring the delivery of health care in California prisons up to constitutional standards.”

Now, after 20 months, Henderson has abruptly changed receivers and called for a new “Plan of Action” for the prison health system.

The judge believes the first phase of receivership required a “bold, creative leadership style” to “investigate, confront and break down” barriers. Robert Sillen, who had run hospitals, clinics and public health facilities for 40 years, filled that role. He brought on new staff, new equipment and a new cadre of medical leaders. Morale in the prison medical system vastly improved.

But, the judge now believes, the next phase requires a “collaborative leadership” style, working more closely with “all stakeholders, including state officials.” The new receiver, J. Clark Kelso, is a bureaucratic insider with no background in health care who has made a career of rescuing scandal-ridden state agencies and then stepping aside. Does this mark a return to business as usual?

Sillen’s 300-page Plan of Action included 22 initiatives and timelines for what could be achieved within six months, 12 months, 24 months and 36 months. But Sillen also has said, “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.” Kelso has said he expects to draft a new plan that will return the prison medical system to the state within four years. What kind of medical system does the judge expect Kelso to return to the state within four years?

We hope Judge Henderson’s abrupt action doesn’t signal a new “get-in-and-out-as-fast-as-possible” philosophy. This is no time to give up on a real transformation of California’s broken prison medical system.

I share this concern. It seems like we’re going from brain surgery and six months of intesnive rehabilitation to a splash of Bactine and a Band-Aid, from a true cure to “treat-and-street” — with the decision made not by doctors, but by lawyers.

Moreover, having written about the receivership in the past, I have to wonder what kind of political pressures were brought to bear on Henderson — from the governor? the Legislature? — to oust Sillen, who was making the most of his mandate to clean up the system with or without the state’s cooperation. (Remember, it was the state’s utter failure to address the problem that led to the creation of a receivership in the first place.)

No offense to Kelso, but this just doesn’t seem to bode well.

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  • Fred Brewer

    Having actually seen the CDCR medical system from the inside, and having years of experience in the community and military medical systems, I’m tired of seeing articles written by the clueless. While it is very true there are problems in the system, there are similar and even worse problems in the community medical system. The sad part of this is that law-abiding, tax payers have no Judge Henderson to champion their cause. What we get is the Governator to gut the worker’s comp system to prevent workers from receiving necessary medical care and HMO’s that can’t be sued when they deny a claim. Millions of tax payers can’t afford insurance or can’t get it because of “preexisting conditions” which would not prevent any inmate from being covered.
    Where Sillen went wrong in his approach was to avoid addressing the two biggest obstacles to quality medical care in the prison system, incompetent managers and inmate abuse. CDCR has always been ripe with incompetent management which has been allowed to make boneheaded policies and decisions and practice favoritism without consequences. Even worse was the failure to address abuse of the medical system by the most manipulative and abusive population in the world. Instead of addressing it, Sillen facilitated the abuse by firing most of the Dr’s and bringing in new ones who were no better but at a much higher cost. The new Dr’s knew Sillen would fire them if they didn’t give the inmates whatever they wanted and medications shot up over 100%. Any inmate who wants narcotics now needs only go to the MD and ask!