CALIFORNIA'S MOST SOCIALIZED MEDICINE SYSTEM IS A DISASTER

A federal judge took the first formal step Tuesday toward placing the California prison health care system in receivership, saying it has killed "a significant number of prisoners" and is sure to kill more without drastic intervention. Senior U.S. District Judge Thelton Henderson issued an order to show cause why the state should not relinquish control of the system to a court-appointed receiver who could be granted the power to direct policy, staff and spending. Henderson said he'll also consider holding Gov. Arnold Schwarzenegger and members of his corrections team in contempt of court for reneging on reforms promised by the current administration and that of former Gov. Gray Davis. Prompting Henderson to act, he said, were recent admissions made in his San Francisco courtroom by people representing the Department of Corrections that even stop-gap reforms may be impossible, and "unconstitutional conditions will remain until an outside entity is hired to take over."

"The problem of a highly dysfunctional, largely decrepit, overly bureaucratic and politically driven prison system, which these defendants have inherited from past administrations, is too far gone to be corrected by conventional methods," Henderson said. Besides the state's admissions in court, Henderson cited reports by panels of court-appointed experts and a personal visit to San Quentin State Prison in February. The judge said he found "horrifying" conditions, including a main examining room lacking "any means of sanitation - there was no sink and no alcohol gel."

He observed that a dentist "neither washed his hands nor changed his gloves after treating patients into whose mouths he had placed his hands" - a problem that could be fixed, the judge said, without "a budget change proposal, a strategic plan or the hiring of new personnel." Henderson described other conditions related to serious overcrowding at an institution that was designed for 3,317 prisoners but currently houses about 6,000. Some prisoners live in corridors "where they are subjected to having feces and urine flung at them from above, and where water continually seeps from the walls and collects in pools on the floor," the judge said.

Under both Schwarzenegger and Davis the state has signed a series of legal agreements to improve inmate care. But Henderson, who has been meeting monthly with lawyers on both sides of a suit filed in 2001 by the nonprofit Prison Law Office, said the state failed to follow through on the agreements. He said the state submitted a document last month referring to prison medical care as a "broken system" with "fundamental barriers" to improvement, including "budget, personnel, contracts, procurement, information systems, physical plant and space issues."

Henderson set a series of court hearings on the receivership and contempt issues, starting May 31, at which he'll take testimony from court experts and state representatives. He also set a timetable running through July 6 for written arguments. His final orders probably would follow within a few weeks. The Governor's Office referred reporters to the Youth and Adult Correctional Agency, where assistant secretary J.P. Tremblay said, "We do intend to work cooperatively with the court to provide the treatment that's required." Tremblay acknowledged that reforms have been hindered by "some overly bureaucratic systems." ....

Nevertheless, one key lawmaker called Henderson's proposed takeover "an appropriate course of action." "What we have seen is that the Department of Corrections has consistently demonstrated its inability to deliver health care," said Sen. Michael Machado, D-Linden, a member of the Senate budget subcommittee on corrections.....

Henderson said that although the state plans to contract out prison health care management services, that process is expected to take at least 18 months, and there's no estimate on how long it will take to improve the standard of medical care. "In the meantime," he said, "prisoners continue to unnecessarily die, suffer and go unattended." Henderson said the experts advised him that although San Quentin may be in the worst physical condition among the 32 state prisons, "it is paralleled by a number of other prisons in terms of physician and nurse vacancies, incompetent medical staff, lack of supervision and all other aspects of medical care delivery."

The judge said one group of experts attempted to review 193 death records throughout the prison system. Some prisons were unable to locate records. Those records that could be found revealed 34 "highly problematic" deaths, "with multiple instances of incompetence, indifference, neglect and even cruelty by medical staff," Henderson said

More here




ANOTHER KILLER DOCTOR LOOSE IN AN AUSTRALIAN PUBLIC HOSPITAL?

Western Australia's senior health bureaucrat has moved to reassure surgical patients of their safety following revelations that 48 patients of one surgeon died during a 30-month period. The deaths came to light upon the release yesterday of an audit of almost 900 hospital deaths in WA between January 2002 and June 2004. Participation in the peer-review audit was voluntary and some surgeons with high death rates declined to take part, including the surgeon found to be involved in the 48 deaths. The audit results come ahead of three separate inquiries in Queensland into the scandal involving Jayant Patel, who has been linked to 20 deaths at Bundaberg Base Hospital. Dr Patel, dubbed 'Dr Death' by colleagues, fled Australia at Easter and is believed to be in India.

Neale Fong, acting director-general of the WA Department of Health, said today processes were in place to protect the safety of surgical patients. Care should be taken in interpreting death rate data because the unnamed surgeon highlighted in the review might handle only extremely ill or high-risk patients, Dr Fong said. "He may well be our best surgeon in WA, who gets all the hard cases and when everyone can't do anything they send (patients) to him and unfortunately there is a high mortality rate," he told ABC radio. "If there was a WA surgeon having that many deaths and it was due to something people were concerned about, we have other mechanisms in place that would identify that surgeon very quickly - much, much before he got to death number 48." Every public and private hospital in WA automatically reviewed deaths, and suspicious cases were referred to the coroner, he said. "There are lots of other ways we can identify rogue surgeons," he said. "I'm quite confident and assured that we have the processes in place - this (audit) just adds another whole dimension to it."

Dr Fong, whose department funded the WA Audit of Surgical Mortality, praised the high rate of participation from surgeons intent on improving work practices and saving lives. He said 96 per cent of doctors had completed at least one or more audit forms, while others working in high-risk cardiothoracic or neurosurgery already participated in separate review processes when deaths occurred. Dr Fong foreshadowed mandatory participation in the audit in the future, with the Royal Australasian College of Surgeons planning to extend it to all other states and into New Zealand.

In Queensland, three inquiries are pending over Dr Patel: one into the state of the health system, another into Dr Patel's appointment and supervision, and a Crime and Misconduct Commission inquiry into Queensland Health's complaints process.

Source

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************