Senators Make Recommendations at Department of Corrections Hearing

California should follow federal prison system regulations that have effectively lowered per-inmate spending in other states -- despite rising medical costs -- to help reduce the estimated $1 billion the state spends on prison health care, senators said Wednesday at an investigational hearing, the AP/San Diego Union-Tribune reports (Thompson, AP/San Diego Union-Tribune, 9/30).

At the hearing, led by Sens. Jackie Speier (D-San Mateo) and Gloria Romero (D-Los Angeles), senators discussed documents obtained by the Los Angeles Times showing that 20% of the state's 302 prison doctors have been convicted of a crime, have a history of cocaine or alcohol addiction or have had their privileges suspended at hospitals.

Earlier this month, a U.S. District judge approved an agreement between state officials and a law firm representing prison inmates that requires physicians working in each of the state's prison facilities by 2006 to complete a series of written and oral examinations to assess their medical knowledge. The order enforced a legal settlement in which the state promised to improve health care for prison inmates. The agreement comes after two reports released last month indicated that the Department of Corrections hired incompetent doctors, resulting in inadequate health care for some inmates.

Doctors who do not pass the exams will be retrained or banned from working with inmates. Department spokesperson Margot Bach said that it is not yet clear whether civil service rules would allow the department to fire doctors who are not found to be qualified or whether they must be moved to another job within the department.

The agreement also calls for the department to develop a plan to assess and train nurses and a proposal to improve doctor and nurse recruiting.

Under the order, department officials must compile a list of inmates with high-risk medical conditions and ensure that they receive care from qualified physicians. Independent doctors approved by the courts will then treat the high-risk patients until the prison system hires enough doctors to provide treatment (California Healthline, 9/29).

The joint government oversight committee and corrections review panel hearing is the prison's system's seventh in 18 months.

The senators "downplayed" suggestions by Gov. Arnold Schwarzenegger's (R) Corrections Independent Review Panel that the state privatize inmate health care but said that private and university experts should be recruited to recommend reforms.

Senators also said that recommendations by a prison review panel headed by former Gov. George Deukmejian (R) are not being reviewed quickly enough by the administration (AP/San Diego Union-Tribune, 9/30).

Speier said, "To put it very bluntly and very simply, the health care system at the California Department of Corrections is sick." She added, "The scratching of heads is no longer acceptable. It is time to realize what (the prisons') health care policies and practices are costing each and every Californian."

Romero said, "The sad fact is California has been growing its inmate population but has failed to provide adequate health care for those we lock away" (Warren, Los Angeles Times, 9/30). Romero said that inmates are less healthy than typical state residents and that many have diseases such as tuberculosis, AIDS and hepatitis that can spread easily. She also noted that some care for inmates must be provided in remote locations under security restrictions (AP/San Diego Union Tribune, 9/30).

Corrections officials "acknowledged that major problems remain with the network of clinics, hospitals, treatment centers and outside medical contractors," according to the Times. However, prison doctors cited "crucial differences" between the private sector and the prison system "that makes practicing medicine difficult at best," the Times reports.

Jacqueline Tulsky, a professor at the University of California-San Francisco School of Medicine who has studied prison health care, said, "No health care plan in this state has the severity of illnesses you find in the Department of Corrections."

Renee Kanan, the department chief of health care, said, "[H]istorically, our modus operandi has been very reactive. We've had plenty of fragmented exit strategies, but we've never had a comprehensive strategic plan." She noted that progress has been made in improving prison health care such as tighter screening and monitoring of physicians and the creation of an oversight committee to track costs.

Corrections Director Jeanne Woodford said, "We know we have many challenges in our efforts to provide quality health care. We want to fix what this committee has called a broken system ... and become known as a state that uses the best practices in all aspects of its health care system" (Los Angeles Times, 9/30).

KQED's "The California Report" on Thursday will include a segment on the prison health care system and the hearing (Margolis, "The California Report," KQED, 9/30). The complete segment will be available online in RealPlayer after the broadcast.