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California Turns a Corner in Effort To Regain Prison Health Care Oversight

California’s prison population is getting smaller, according to a Public Policy Institute of California report, and that could be a step in the right direction for retaking control of its prison health care system.

The state lost its prison health care oversight responsibilities in the mid-2000s — shortly before a federal court ordered California to reduce prison overcrowding.

But now, “the state is finally under the court ordered population cap, which is a big part of getting back control of health care and mental health care in state prisons,” said PPIC report co-author Brandon Martin.


In response to a lawsuit filed by the Prison Law Office, U.S. District Judge Thelton Henderson first called for the California prison health care system to be placed in federal control in late June 2005. Citing conditions of “outright depravity,” Henderson ordered a federal receiver to rectify the system.

California officially ceded control in 2006 and has been battling to take it back since. But it can’t do so until passing muster with the court-appointed receiver.

The first receiver — Bob Sillen, then-director of the Santa Clara Valley Health and Hospital System — was named in February 2006. By 2008, Sillen was replaced by J. Clark Kelso, who had been the state’s chief information technology officer since 2002. Kelso is still in the receiver position.

In 2009, after ruling that overcrowding was the main cause of substandard prison medical care, a federal three-judge panel ordered the state to reduce its prison population. Prompted by that order, California in 2011 rolled out a prison realignment plan that changed where inmates convicted of lower-level crimes were sent.

Mixed Results

Experts predicted the realignment plan would cut costs and reduce incarceration rates.

But it hasn’t all worked out. In particular, costs have increased — in part because of the state’s efforts to improve health care.

According to PPIC, correctional spending in fiscal year 2015-2016 is budgeted at $10.07 billion, up from $9.6 billion in FY 2010-2011. “Higher outlays for inmate medical and mental health care contribute to rising corrections spending,” the report noted.

But, Martin said, those costs could be offset by some of the realignment plan’s successes, in particular by reducing the inmate population to a manageable level.

According to PPIC, about 18,000 individuals who previously would have been in prison or jail have been released since the reforms were implemented in October 2011.

“The prisons were so overcrowded that you couldn’t really provide services,” Martin said. “Hopefully, now that the population has come down, we’re able to provide the correct medical care, we’re able to provide the correct mental health care,” and prisons might not experience the same financial “stresses or strain” as before.

A Long Time in the Making

California faced setbacks as recently as August, when an Office of the Inspector General report found that medical services at the California Correctional Center were “inadequate.”

But the state has been putting in place reforms to prepare for the transition of control, said Diana Toche, undersecretary of health care at the California Department of Corrections and Rehabilitation.

For example, CDCR has been implementing the receiver’s “turn-around plan.” There’s just one final component waiting to be implemented: a new electronic health record system. It’s scheduled to launch at the end of October, Toche said.

The other “main initiative” is the receiver’s quality management model, Toche said. Under the initiative, there will be quality checks “at headquarters, at the regional level and institutional level,” according to Toche.

She said the plan will help prison staff members “assess what they’re doing, see where they’re doing well and not doing so well, and be able to self-correct. This would lead to sustainability of the system in the end when the receiver leaves.”

Toche said she was unsure how much the changes cost, and the Department of Finance did not respond to requests for an interview.

Is the End in Sight?

In 2012, Henderson, the judge who ordered the receivership, signaled that “the end was near,” Toche said. CDCR in its plan to meet federal requirements predicted an end by 2013.

Two years later, conditions are seemingly better. PPIC in its report said California appears “to be close to meeting the conditions for ending receivership.”

But how close really is California to regaining control?

The federal receiver so far has returned oversight of just one facility: Folsom State Prison. There are 33 facilities to go, including the California Health Care Facility in Stockton, which was created expressly to care for inmates, Toche said.

The California inspector general has given medical care a passing grade — required before the receiver will consider returning control — at three other facilities:

  • The California Rehabilitation Center at Norco, which passed in July;
  • Chuckawalla Valley State Prison, which passed in September; and
  • The Correctional Training Facility in Soledad, which passed in June.

Regaining control has been a slow process, Toche said, noting that CDCR initially had to wait for the state inspector general to complete three cycles of audits for the prisons. The state’s Health Care Facility Improvement Project, a major construction effort to build new inmate care facilities, also took time.

“It takes a while to change the direction of a ship here,” Toche said.

She said it’s “a little too early” to predict when the receivership might end. But when it does, stakeholders expect to be prepared.

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