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.
Was 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.
Sillen’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.