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Care of Avenal Inmates Blasted: Crowded Prison Gives Poor Health Coverage, State Medical Czar Says.

March 21, 2007

By E.J. Schultz, The Fresno Bee, Calif.

Mar. 21–Avenal State Prison is suffering a “complete breakdown in medical care coverage” that has led to three inmate deaths, according to a report issued Tuesday by the state’s prison medical czar.

Care is so poor at the prison that lab test results “only haphazardly find their way into medical charts” and often the wrong medications are ordered for inmates, said Robert Sillen, the federal court-appointed medical care receiver for the prison system.

The observations are made in a 92-page report Sillen submitted to U.S. District Judge Thelton Henderson.

The judge created the receivership as the result of a 2001 class-action lawsuit that found the medical care in California prisons violates constitutional protections forbidding cruel and unusual punishment. Sillen has been on the job for 11 months.

The Avenal findings occupy only a small section of the report, aimed at updating the judge on the progress Sillen is making on fixing medical care. The “crisis” at Avenal is used as an example of the dysfunction that exists throughout the 33-prison system.

The prison, built in 1987 in rural Kings County, was designed to hold 2,500 inmates.

But today, the prison is filled to triple its capacity with about 7,500 inmates, making it one of the most overstuffed prisons in the state. About 1,200 of the prisoners are older than 55, and many are in wheelchairs or have diabetes, Sillen said.

The three inmate deaths occurred in December 2006 and “involved inadequate care” and a “lack of physicians at the prison,” according to Sillen’s report. At the time, nurse practitioners and physician assistants lacked physician oversight because of staff turnover in recent years, the report states.

In one of the deaths, a 61-year-old convicted child molester with atherosclerotic coronary artery disease was found to be lethargic but not severe enough to be taken to the hospital, according to a report in The Sacramento Bee.

He later stopped breathing and was pronounced dead in his prison infirmary cell.

The situation worsened by January, leading to a complete breakdown in medical care, Sillen said in the report. In response, Sillen brought in teams of physicians from the University of California at San Francisco.

The doctors, once on site, began making a slew of referrals to outside specialists at University Medical Center in Fresno, Coalinga Regional Medical Center and other area clinics and hospitals.

Some of the referrals have drawn criticism from the California Correctional Peace Officers Association, which represents prison guards.

Ryan Sherman, a CCPOA spokesman, said union members have complained that some of the referrals were made for minor ailments.

Each time an inmate is taken to a hospital or clinic, they must be accompanied by at least two guards. So with so many referrals, guards have been forced to work a lot of overtime, Sherman said.

Rachael Kagan, a spokeswoman for Sillen, defended the “surge” of referrals, saying inmates had serious health problems — such as cancer, pneumonia and diabetes — that were long overlooked. The pace has slowed, she said, as the situation has stabilized and most of the UCSF physicians now consult with patients via videoconference.

But underlying problems persist — namely a shortage of qualified prison health-care workers.

Sillen has ordered the creation of 50 health-care positions for Avenal, including a chief physician and surgeon and 14 registered nurses.

However, the positions might be hard to fill because the state has long struggled to attract medical professionals to rural prisons.

Sillen hopes to fix the situation by boosting pay. In February, he ordered a new salary structure for prison physicians, costing the state an extra $5.9 million a year. A top-tier surgeon, for instance, will now make $200,004 annually, up from $168,360. Other medical staff also got raises.

The move is one example of the broad authority wielded by Sillen.

In other moves, he is working to replace the prison system’s medical services contracting system — now paper based — with an automated system. He also is moving forward with plans to build 5,000 medical beds statewide. Plans at Avenal include the construction of more clinic space.

Sillen on Tuesday appeared to gather even more power.

In a statement, Sillen’s office said he will manage “several of the system-wide” operations that transcend medical, mental health and dental care, including information technology and record-keeping.

Other lawsuits have found the state’s prison has failed to provide adequate mental health care and dental care, but the officials overseeing those cases have less authority than Sillen.

Kagan said the collaboration, led by Sillen, will save taxpayer money by streamlining operations.

Still, some Republican lawmakers, including Assembly Republican Leader Mike Villines of Clovis, have expressed concern that Sillen has almost unlimited access to the state treasury.

A recent report in The Sacramento Bee found that court-ordered fixes already have cost taxpayers more than $1 billion and are expected to cost nearly $8 billion in the next five years.

Villines has called for the Democratic-controlled Legislature to convene hearings on the matter, though it’s uncertain what the state could do because the prison cases are in federal courts.

Villines, in an interview Tuesday, said, “I have concern when I see Sillen expanding his role.”

The Legislature and Gov. Schwarzenegger are working on their own plan to reduce overcrowding at prisons, but a deal has been elusive as Republicans and Democrats have yet to find common ground on controversial issues such as sentencing reforms.

The reporter can be reached at eschultz@fresnobee.com or (916) 326-5541.

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Copyright (c) 2007, The Fresno Bee, Calif.

Distributed by McClatchy-Tribune Business News.

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