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Prison receivership audit: What’s the big deal?

By Josh Richman
Thursday, February 28th, 2008 at 3:11 pm in General.

The headlines make it sound like a scandal: “Audit finds prison receiver paid himself $52,000 a month,” “Spending by prison care overseer questioned,” “Audit pans prison receiver spending.” Even the milder ones — “Ex-prison healthcare receiver’s staff was well paid” — seem to imply shadyness.

But after taking a look at the Inspector General’s report on how the California Prison Health Care Receivership was spending its money, I’m still a little puzzled as to what the big deal is.

sillen.jpgWas receiver Robert Sillen well-paid? Damn straight he was, and that salary was set by the man who appointed him, Senior U.S. District Judge Thelton Henderson — not by Sillen himself. Sillen had run the massive Santa Clara Valley Health and Hospital System or its forerunner since 1979. He was tremendously well respected among his peers, and Henderson paid what it took to get the right guy for the job.

Were his staffers well-paid? Absolutely, compared to state bureaucrats and even elected officials. But those salaries, like Sillen’s, were directly comparable to what these people — many of them medical professionals with advanced degrees — would earn at equivalent positions in a large health-care system. Part of the reason the prison healthcare system had gone down the tubes in the first place was because it offered abyssmally low salaries and so couldn’t attract and retain enough workers and managers with adequate expertise.

Furthermore, despite today’s breathless headlines, all these salaries were approved by Henderson and were in the public record, widely known and fully reported from the get-go. Sillen in his first bi-monthly report to Henderson, back in July 2006, had estimated the receivership’s salaries would cost $4.6 million in FY 2006-07; the new OIG report finds salaries totaled about $4.89 million for a longer period, April 2006 through June 2007.

The report notes that executive staffers received cash-in-lieu payments to cover their healthcare expenses, and that staffers kept receiving such payments even after they were covered by the receivership’s employee benefit plan. Actually, what they continued to receive was the difference between the cash-in-lieu they had been getting and the value of the benefits for which they’d enrolled — exactly what their court-approved contracts called for, nothing more and nothing less. And even so, Henderson had stopped those payments well before Sillen’s departure and this report.

Some of the stories about the report make a big deal about travel expenses lacking receipts. From the report:

In our sample of lodging expenses, we found that the receivership had failed to require staff members to provide proper support before paying $10,500 in lodging expenses. Therefore, we could not determine whether the charges were appropriate. Similarly, in our limited review of 23 travel-related expenses, we found 11 instances of meal charges that exceeded the receivership’s policy limit or lacked the proper documentation. These expense claims totaled $1,800.

I’m all in favor of government officials keeping proper receipts for their spending, but we’re talking about around $12,000 here — hardly to blame for the state’s $16 billion deficit, I’d say. And don’t assume that spending was improper, either: the report clearly states the audit found no evidence of fraud.

Some stories noted this sentence from the OIG report: “For example, the receiver, Robert Sillen, claimed a February 2007 meal expense of $740 from a Sacramento steakhouse and provided no original receipt, business purpose, or listing of other business guests joining him at the meal.”

But I’m told this tab was for almost three dozen receivership staffers who dined midway through a two-day working retreat — hardly an exorbitant tab for that many people called away from their families for an overnight work engagement.

Honestly, as I read certain state officials’ quotes in today’s stories, I’m reminded that a receivership wouldn’t have been necessary in the first place if the state hadn’t failed so miserably at maintaining minimum standards of care in the prisons, or at correcting those errors once it had lost a massive lawsuit.

What strikes me most about this report and the articles it generates is the political expediency of its timing.

Sillen generally was known as a straight shooter unafraid to steamroll the state’s elected officials and entrenched bureaucracy and to spend whatever it took to bring the prison health-care system up to constitutional snuff — precisely his mandate from Henderson. This indubitably rubbed a lot of people in Sacramento the wrong way, and I must wonder what sort of communications — what sort of pressure — was brought to bear on Henderson in the weeks leading up to Sillen’s dismissal Jan. 23.

“While the current Receiver has successfully used his unique skills and bold, creative leadership style to investigate, confront, and break down many of the barriers that existed at the inception of the Receivership, the second phase of the Receivership demands a substantially different set of administrative skills and style of collaborative leadership,” Henderson wrote in his order axing Sillen.

Fair enough. But perhaps he also knew spending whatever it takes to improve prison health care was no longer palatable to the public in the face of the state’s staggering budget deficit. Or perhaps he just wanted to speed up the process; Henderson has said repeatedly he would like to retire, but not while this receivership is still in progress. We’ll probably never know the whole story.

kelso.jpgSillen’s replacement is J. Clark Kelso, a Sacramento law professor with a reputation as a “fixer” capable of cleaning up government messes quickly and efficiently; he was tapped to lead the state Insurance Department after Commissioner Chuck Quackenbush resigned amid scandal in 2000, and later was chosen as California’s Chief Information Officer in order to whip a dysfunctional state IT operation into shape.

I hear Kelso’s first act was to tell receivership staffers that instead of Sillen’s long view — a decade-long plan to build a culture of constitutionally adequate health care — the new goal would be to do it fast and cheap, and return control to the state within four years. Many of those staffers were subsequently pushed out the door.

This report gave Kelso an opportunity to explain the cuts and changes he has made already, and that’s fine. But while we’re discussing all of this information we already knew, we don’t seem to be hearing anything yet about what’s being done now and in coming months to improve prison health care.

Sillen had increased pay for prison doctors; overhauled the awful prison pharmacy system; completely renovated San Quentin’s emergency room as a pilot project for other prisons; and far more. Let’s hope Kelso has similar goals in mind — not just cutting office costs — because that’s what it’ll take to meet California’s legal and moral obligations in prison helath care. Let’s hope this report and the spin that’s being put on it aren’t a smokescreen for a u-turn away from real progress.

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  • Morris1

    Thank you very much for this report. I knew this was a hatchet job as soon as I read the first stories. Mr. Sillen was the right person for the job. He made more progress in a year than the state did in 12 years. Please keep digging and expose the States motive here to all. THEY DON’T WANT TO REFORM THE PRISON SYSTEM. Mr. Kelso has not uttered one word and nothing has been done by the State other than argue about who got paid what. WE WANT THE PRISON MEDICAL FIXED. Stop stalling and get it done. This was never going to be a cheap and easy fix.

  • marge bosetti

    Has this article been sent to the mercury news? It seems like they should print this entire article to clear up the misinformation their article contained.

    Thank you.

  • Madhatter

    I agree with Morris1 for the most part. Mr. Sillen DID get the ball rolling, albeit not as fast as some of us would have wished.

    For those of us who have loved ones incarcerated in California that have medical issues, it will never be fast enough to please us.

    I am willing to give Mr. Kelso a chance to prove that he can FIX the system faster, but not if he is going to do a “quick fix” to make it “appear” to be fixed when in truth it is a cover up.

    WE WANT IT FIXED – BUT WE WANT IT FIXED RIGHT!!!!!

  • http://www.1union1.com Stephanie

    Sillen did fire the MTA’s, a hybrid guard-like job that covered up evidence in the lawsuits so that no one could be brought to justice for state murder by medical neglect. He was unresponsive to individual complaints and thought of the prisoners as “products” instead of people. When he hired $200,000 a year p.r. people instead of patient advocates to prevent more deaths, that was the handwriting on the wall. For what he was paid, progress was very slow and hundreds more people died on his watch. The dead bodies are the bottom line. The people posting here do not handle prisoner medical complaints so they have no idea how responsive he was or not.

    The lawsuits coming to court this year will keep the kettle boiling on medical neglect, be sure to support them all because reform can only happen at the polls, via lawsuits or initiative campaigns which cost a ton of money to keep in progress.

  • http://www.1union1.com Stephanie

    He also hired on his staff, people who were kicked out because of their role in the rampant mismanagement, yes, the very same people. None of them worked on prisoner medical complaints either, of course not!

  • prisondoc

    I’m not sure where you get your information, but I am a physician at a CA prison and I have personally received emails from the medical management in the Receiver’s office asking me to address concerns from letters written to them by prisoners or their families. And we have addressed them. The system still has lots of problems buy there are people within the system who believe prisoners are people with rights. And there are a lot more of us since the receiver took over.

  • John Vidovich

    The reporting of the audit was done in a manner to purposely imply bad actions and character. The health care system in the prisons were in a crisis and either Sillen was successful at fixing it or he wasn’t. Clearly he was not servient to any of the politicians who lobbied the Federal Judge to remove him. Sillen is at fault for underestimating the power of the politicians. The governer and the leadership lobbied the Federal Judge to remove him.

    What I do not understand is how the press could dump on Sillen? I think it is all about his salary and their predjudice against his compensation. Why else would the press turn a blind eye to an obvious take over by the state of the court ordered reform of a horrible medical system that was killing people and was used to steal tax payer monies. I guess in the reporters eyes they would rather see the stealing and murdering of inmates by the medical system than to see a competent leader make $600,000 a year fixing the system. Here is a case of the legislative leaders, the governer, the judiciary and the press all failing the people. Bob you need to respond and get out some information to correct this wrong. We are all waiting. Please tell us the other side of the story. It is truly important to all of us that you respond. Hurry.

  • http://www.1union1.com Stephanie

    Prisondoc

    He may have done that at San Quentin but what did he to follow up to make sure you handled the problem? People died on Sillen’s watch and he was too casual about preventable death situations. He viewed the prisoners as “products” not as people, he did some good in some areas but the death toll didn’t decline. Dead bodies don’t lie. The media was kept fully informed on many of the cases every step of the process as families looked desperately for help and found little or none.

  • Morris1

    Thank you prisondoc for your post. It is good to hear from people on the inside. I believe that this task is huge and for the short amount of time Mr. Sillen was in the trenches he did what needed to be done. I am sure some still died, the reasons are unclear and never published. But he was on the way to reforms that will take the bettter part of a decade in my opinion. I also heard from several that sent emails and made calls to the receivers office. They got help. One was dealing with recurring cancer, another with a foot broken in several places. I am sure there were lapses, but mostly I heard good things from those who were desperately trying to get treatment previously. All I know is that we have heard not one word from the new Receiver Kelso and the 3 Judge Panel is silent. Mr. Sillens salary is just a way to create smoke and mirrors and deflect from continuing the reforms.

  • Morris1

    John, Excellent post. Couldn’t have said it better.

  • http://www.1union1.com Stephanie

    the reasons are very clear to those actually handling these serious life and death complaints. Sillen was good at making noise but the lawsuit filings by the families of prisoners and the death toll had already established the problem. He was callous and I doubt if Morris 1 saw any serious complaints or knows anything about this process. Dead bodies don’t lie, hundreds died on Sillen’s watch

  • http://www.1union1.com Stephanie

    The HIPPA laws make it difficult for the media to report, plus CDC covers everything up and if the families don’t do protests at the Capitol in large numbers, no one even knows that a prisoner died. Our side drops the ball all the time, so we can’t expect advocates to want to fight for people who don’t notify the media of deaths, disease outbreaks, riots and who don’t post often enough in these forums about what is really going on. There are some who think they know, but they’re just blowing air. The hundreds of deaths were not sudden deaths with no family members trying to get help. Know what you’re talking about before you post.