California to Start Regaining Control of Prison Healthcare

Court’s overseer says 1st steps will include handing over authority to the state to staff and equip new facilities. He says full state control could occur in 2 years.

Seven years after federal courts took control of California’s prison healthcare system, citing care so poor that inmates were dying needlessly, they will start the long process Friday of turning operations back over to the state.

J. Clark Kelso, the court-appointed overseer, said he could foresee a full resumption of state control in about two years. He will begin Friday with a test: handing over authority to staff and equip new care facilities, including a $1-billion project in Stockton, and the sensitive job of making sure inmates get to doctors, clinics and hospitals.

The early moves will tell whether the state has “the will and capacity to maintain improvement.”

“You’re never going to find out unless you take your hands off the wheel and turn the car over,” Kelso said Wednesday. “I’m not getting out of the car entirely. I’m going to sit over in the passenger seat, and I’m only letting them do a portion of it. They’re not ready to get on the highway yet.”

Kelso and Gov. Jerry Brown‘s administration, which declined to comment, reached agreement earlier this week on the transfer of select administrative functions. For now, Kelso will retain control over the delivery of medical care to inmates.

California lost its authority after U.S. District Judge Thelton Henderson declared in June 2005 that “extreme measures” were needed to fix a care network that killed one inmate each week through incompetence or neglect. Henderson said that despite repeated warnings from his court, sick prisoners continued to die “for no acceptable reason.”

The state had two such deaths last year, a level Kelso said is within reason: “There are limits to how perfect medicine can be.”

Attorneys for inmates who filed the lawsuit that led to Henderson’s decision called this week’s agreement “an appropriate starting point.” But they expressed concern about the state’s ability to run the entire prison healthcare system.

Regaining full control would allow California’s Department of Corrections and Rehabilitation to determine how much money is allocated to prison medical facilities and staff — decisions now made by Kelso.

Donald Specter, lead attorney for the nonprofit Prison Law Office, expressed concern that the progress made by Kelso’s office could unravel at a time when the Brown administration has warned that prison-system spending cuts could be on the horizon.

“It is not at all clear that the department has the ability to manage such a large and complicated operation that is essential, literally, for the lives and well-being of the people in its custody,” Specter said.

Though he avoided any discussion of a deadline, Kelso already is beginning to reduce his staff. He said that if all goes well, California could be back in control of prison medical care in less than two years.

“The judge wants to do this on the basis of demonstrated performance: ‘What you need to do is assess, evaluate and report to the court,’ ” Kelso said.

“Having said that, as a practical matter … two years sounds about right, and I think it could be less than that,” Kelso said. “It depends on … so many things.”

California during the summer sought immediate restoration of control, arguing that a falling prison population and the construction of a large medical prison at Stockton showed the state was ready to maintain adequate medical healthcare. Henderson’s refusal noted that California has “not always cooperated with … the receiver’s efforts.”

Kelso’s office is negotiating with the state over how to measure the quality of inmate care once responsibility is returned to Sacramento, and what shape the healthcare administration will take.

Kelso said he would prefer that medical services be delivered by a separate entity, not by the Department of Corrections and Rehabilitation, “but that’s not where the state wants to go right now.”

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