A STATE-RUN HEALTH BUREAUCRACY FINALLY COLLAPSES

A federal judge, saying he was acting urgently to stop the needless deaths of inmates because of medical malfeasance, ordered Thursday that a receiver take control of California's prison health care system and correct what he called deplorable conditions. Experts said the order by U.S. District Judge Thelton Henderson of San Francisco was unprecedented in its scope given that the prison system provides health care to roughly 164,000 inmates at an annual cost of $1.1 billion. The order also was an embarrassing blow for the administration of Gov. Arnold Schwarzenegger, which has promised to deliver major medical reforms for nearly two years but, Henderson said, has utterly failed.

The prison medical system offered "at times outright depravity, and I intentionally call it that," said Henderson. He also said the need for action was so dire that he might appoint a temporary receiver in just weeks to at least begin to limit the harm to inmates from the poor medical care before a permanent receiver is put in place.

Inmate families and those who have long fought for change in the prisons were ebullient. "It's certainly everything we asked for," said Donald Specter, head of the Prison Law Office, the prisoner rights group that filed the suit on which the judge was acting. Henderson said he would begin the process of selecting a receiver and defining his or her powers in consultation with state officials and the inmates' lawyers. The decision followed weeks of testimony from medical experts that Henderson described as horrifying in its depiction of barbaric medical conditions in some prisons, resulting in as many as 64 preventable deaths of inmates a year and injury to countless others.

The state's attorneys have never even bothered to fight those characterizations or the need for federal intervention in spite of their damning reflection on prison managers. "This is humiliating," said James Jacobs, a law professor at New York University and an expert on court intervention in prison management. "What's extreme here is, it's like the judge is saying to the state, 'I'm totally giving up on you -- you are unwilling or unable to do this on your own.' " Indeed, top prisons officials for months have admitted the department was incapable of administering the system, a massive and complex medical program stretching the length of the state, often in remote locations.

The state's lawyers have focused principally on trying to limit the power of the receiver. "Nobody can do this by themselves," said Bruce Slavin, the prison system's general counsel. "A receiver can help us do what we want to do faster. " The unions representing prison health workers, who have been at war with the prisons department, in part over who was responsible for conditions in the prisons, said they were thrilled at the judge's decision. The unions had jointly filed a brief in favor of the appointment of a receiver. "All the unions are more than willing to work with the receiver," said Gary Robinson, the executive director of the Union of American Physicians and Dentists. "We think the department is incapable of the reforms that are necessary. The judge's position is absolutely correct. The management has been incompetent."

Michael Jacobson, the director of the Vera Institute of Justice and the former head of New York City's jails, said the receiver should begin a process of deep changes reaching into all levels of management and the culture inside the prisons. "Nothing is going to happen for some years," he said. "This has to be a catalyst for longer-term structural changes. The potential implications of this are just so humongous." Henderson said appointing a receiver was a last resort but was a result of the Schwarzenegger administration's refusal to comply with his orders to improve the appalling quality of prison medical care.

A federal injunction has been in place for three years requiring phased-in medical improvements at each state prison, but the Corrections Department has met none of the goals. In one case described by court-appointed experts, an inmate's spine was injured in a fight. A prison doctor refused to believe the inmate's claim that he couldn't move, and the doctor wrenched the inmate's head and neck during the examination, aggravating his paralysis.

In a case at San Quentin in January, an inmate reported to the infirmary seeking emergency treatment with signs of shock. A doctor already under investigation for two previous suspicious deaths prescribed antibiotics for what he said was bronchitis. When the inmate collapsed on the way back to his cell, the guards brought him back. The doctor ordered that the inmate be given intravenous fluids, but when the staff could not find a vein, the inmate was simply returned to his cell. The inmate died the next day from a serious lung ailment.

He indicated that the receiver was likely to have the ability, at the least, to fire incompetent doctors and hire quickly to fill the more than 150 positions that have been vacant for years and to order construction to improve conditions in the state's 33 prisons. "This is no panacea," said Jacobs. "It's a staggeringly large job."

Henderson was clear that the process is likely to be long and arduous because of the depth of the problems. In spite of condemning incompetent doctors described in earlier testimony, Henderson went out of his way to praise the rank-and-file prison health workers while excoriating prison managers. "It's also become apparent that the state has no effective management structure to offer health care," Henderson said. He added later in his comments from the bench, "My decision to establish a receivership is just a start."

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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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