A BUREAUCRATIC HEALTH CARE SYSTEM THAT HAS TOTALLY BOGGED DOWN

It is killing people yet is beyond government power to fix

Saying "I can see myself appointing a receiver to stop 60-some people a year from dying," a judge indicated Tuesday that he's inclined to order a federal takeover of California's prison medical system. The remark by Senior U.S. District Judge Thelton Henderson came in response to expert testimony that poor health care is causing "probably one to two preventable deaths per site per year" at the state's 32 penal institutions.

The witness, nationally known correctional health care authority Dr. Michael Puisis, kicked off a series of hearings that will culminate in a decision by Henderson, who could give a receiver authority to fire and replace dangerous prison doctors. Puisis said he favored the move. He said it would permit reforms that now are stymied by union objections and bureaucratic red tape. He characterized such obstacles as "probably" the worst in the nation.

While Henderson said preventing inmate deaths was "basic," he also asked Puisis repeatedly whether placing the prison health care system under the court's control would make a difference. The system has been plagued by problems accumulated over the years, including many that have been acknowledged by Gov. Arnold Schwarzenegger's administration.

Puisis said a receiver would be an improvement because the state's own proposed changes were stuck in negotiations and litigation. Nothing the state has done so far has created a situation where "when Dr. X kills somebody, they can fire Dr. X," he said. He said 150 prison doctors are needed, and one-fourth to one-half of those currently working should be replaced.

Henderson appointed Puisis in 2002 to evaluate state compliance after Gov. Gray Davis' administration, in settling a lawsuit, signed an agreement to raise the quality of prison health care to constitutional standards. Acting on expert reports, personal observations and other evidence, including records of what Henderson called "highly problematic" inmate deaths, the judge last month ordered the state to show cause why it should not relinquish control of the $1.1 billion prison health care system to a court-appointed receiver. The hearings that opened Tuesday are expected to provide the bulk of the evidence on both sides. Top state prison health care administrators are scheduled to testify next week. Henderson has set a hearing timetable running through July 6 for written arguments. His final orders probably would follow within a few weeks.

A spokesman for the Youth and Adult Correctional Agency last month pledged the agency's cooperation with the court and pointed to an agencywide reorganization plan that will go into effect July 1. It will create a division of correctional health care services.

Asked about the reorganization plan on the witness stand Tuesday, Puisis said it "looks like more of the same ... a different configuration of the same kind of a structure." He said he was concerned that, under the plan, the system would be run by someone without budgeting authority. He said the acting deputy director in charge of health care services under the reorganization will still be "three layers" below the agency chief.

A recurring theme during Puisis' daylong testimony was that medical personnel have little say in running the health care system. Physician recruitment is made more difficult than it could be, he said, because doctors aren't allowed to make medical decisions without reporting to layers of custody personnel. He described one situation in which a warden directed inappropriate housing for a tuberculosis patient and another in which a purchasing agent insisted on receiving a small-business bid before approval of buying equipment that no small business was selling.

When Henderson asked how much could be achieved by using the $1.1 billion health care budget more efficiently, Puisis recommended shifting administrative funds into physician salaries. He also said the system was rife with waste on drug and hospital costs that could be reduced by providing better controls and earlier medical care. He said one inmate was hospitalized eight times, each for several days, because he repeatedly wasn't given needed medication for a diabetes-related problem.

During cross-examination, Paul Mello, an outside lawyer hired to defend the state, asked Puisis how a receiver would deal with health issues that are related to serious prison overcrowding. But Puisis said the "more important question" was: "Under what circumstances can those housed in overcrowded facilities get the best care?" He said, "A receiver could speed those decisions."

Source




Massachusetts madness: "A coalition of religious and community groups will launch a drive today to put universal healthcare on the 2006 state ballot, in a proposal that would raise the cigarette tax to buy coverage for more people and would require all but the smallest Massachusetts businesses to cover their workers. The Greater Boston Interfaith Organization argues that its approach would go further to reduce the ranks of the state's 500,000 uninsured than the alternatives under consideration on Beacon Hill that are backed by Governor Mitt Romney and Senate President Robert E. Travaglini. ... Romney and Travaglini want to make private insurance more affordable by allowing insurance companies to offer lower-cost policies with scaled-back benefits. Neither of their plans includes a tax increase or an ironclad employer mandate, an approach that the business community strongly opposes."

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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.

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