Prison break

Despite unconstitutional conditions in California’s correctional system, the state balks at funding improvements

This tiny examination room is supposed to serve the medical needs of thousands of prisoners in San Quentin State Prison, one reason why the state has been ordered to construct a new medical facility at Folsom State Prison.

This tiny examination room is supposed to serve the medical needs of thousands of prisoners in San Quentin State Prison, one reason why the state has been ordered to construct a new medical facility at Folsom State Prison.

Courtesy Of Federal Receiver

Plans for a 1,500-bed facility in Folsom for California’s sick and mentally ill prison inmates are proceeding, even as funds for the project remain in lockdown amid a court battle and state budget cuts.

Lawyers for the attorney general’s office will head to appeals court next month to ask a judge to block the federal receiver in charge of California prison health care, J. Clark Kelso, from collecting $250 million of approximately $8 billion needed for upgrades and expansion of existing prison health-care facilities.

In 2006, a three-judge panel in a separate overcrowding case ordered the receiver’s office to bring the California Department of Corrections and Rehabilitation’s inmate health-care services to constitutional levels after it found the existing system “broken beyond repair.” According to court documents, an inmate died unnecessarily every six to seven days “due to constitutional deficiencies in the CDCR’s medical delivery system.”

Kelso says in order to meet the standard set by the court, he needs money from the state to construct seven new facilities that would provide a total of 10,000 medical and mental-health beds.

“We need to consolidate the prisoners who have the most serious mental-health needs into these facilities over the next 10 years,” Kelso told SN&R. “With consolidation, you can provide much more cost-effective treatment.”

Roughly half of the beds at the Folsom facility would serve inmates with mental-health issues. The other half would provide medical care for chronically ill, incapacitated and elderly inmates.

Currently, most sick inmates are treated at on-site infirmaries in prisons designed to hold about half their current population of nearly 170,000. California Medical Facility can accommodate a few hundred long-term-care patients. The receiver’s office estimates the need is in the thousands.

For now, there are no plans to scrap the Folsom project or any of the other six projects in the works around the state. Groundbreaking on a similar facility in Stockton, slated to begin in February, however, has been pushed back.

A spokesman for the receiver’s office, Richard Stapler, told SN&R the same could hold true in Folsom, where groundbreaking was to begin this summer.

“The reality is it will slow down the actual construction of the facilities a little bit,” said Stapler. “We still have adequate funding to continue through the [California Environmental Quality Act] process. There is plenty of other work to be done at this point. We’re just going to see how the case progresses through the courts.”

Christine Gasparac, spokeswoman for the attorney general’s office, said the state of California is in no position to finance the receiver’s plans, nor does the federal government have the right to force it to do so.

“The scope of the receiver’s plans, coupled with the state’s financial crisis, makes clear that the receiver’s construction projects are wildly inappropriate, and the court lacks the authority to order their construction,” said Gasparac.

Kelso said he has been forthcoming with the public and all government agencies concerning details of the proposed facilities, and welcomes criticism and suggestions.

“This is not something I’ve kept secret,” he said. “I invite the A.G. to conduct more detailed analysis. I’d be delighted to hear [Attorney General Jerry Brown’s] views on some of the specifics.”

However, according to Dr. Corey Weinstein, a board member of the prison-reform group California Prison Focus and an observer of prison conditions since 1970, new prison facilities are not the answer to the health-care crisis in California’s prisons.

Weinstein acknowledged improvements made in pharmacies, filing systems and numbers of qualified staff since the receiver has taken over, but said the prisons continue to operate like “clean slums,” meaning that despite the improvements, overcrowded conditions still lead to the spread of disease.

Stapler agreed that overcrowding leads to health problems both inside the prisons and when prisoners return to the general population.

“You get a situation where you have enough people crowded into a facility and you have communicable diseases like tuberculosis—inmates are not properly treated, and then they are released into the community,” he said. “You have a public-health crisis not just in the institution, but for California’s population at large.”

Stapler noted additional problems that persist around the state, including inmates in California State Prison, Corcoran, who currently wait seven weeks to see a doctor, and a lack of appropriate accommodations for prisoners with disabilities. Finding bottom bunks for wheelchair-bound prisoners and appropriate housing for those who are visually impaired is a challenge in the state’s overburdened facilities, he said.

Stapler described one elderly female prison inmate whose physician had prescribed barriers for her bed to prevent her from rolling out.

“She’s been waiting nine months,” said Stapler. “The human reality of it is the longer it takes for us to construct these facilities, the longer it takes to relieve the suffering of the inmates.”

According to Weinstein, no amount of upgrades will substitute for putting the brakes on prison expansion. Eventually new facilities will become just as crowded, he argues, and the public-health issues the receiver is attempting to resolve with updated facilities will return.

“It’s not about whether you have good technical medical care,” said Weinstein. “It’s about decent housing, decent plumbing.”

The receiver’s office projects the prison population would outgrow the new facilities in 15 to 20 years.

In the opening brief filed in the appeals-court case, the attorney general’s office argues the receiver has overstepped his bounds in ordering money for new prison-facilities construction, stating, “The Prison Litigation Reform Act absolutely bars district courts from ordering a state to fund the construction of prisons against its will.”

A response filed by the receiver says the state was onboard with the project until last summer.

Gasparac disagrees.

“The A.G.’s office has not changed its position,” she said. “As required by court order, the governor and CDCR initially cooperated with the receiver as he began to develop his construction plans.”

Part of the dispute, she says, is over the method of financing the plans.

“When the receiver attempted to seize $8 billion from the state’s general fund, the state opposed the receiver’s construction plans. In short, there is a big difference between the state agreeing to fund the construction program through legislatively authorized means and the court unilaterally ordering it to fund such construction.”

Assembly Bill 900, passed in May 2007, approved $1.14 billion in bond funds for construction of new medical, mental and dental facilities, but a problem with the bill’s language has made this money inaccessible.

The receiver is now seeking $250 million allocated for prison infrastructure improvements in a separate section of the bill. The state argues the receiver should use the original $1.14 billion allocation first.

Gasparac also alleges the receiver’s office has decided not to seek this type of financing because, by law, it would have to comply with state contracting rules.

Kelso told SN&R the receiver’s office is indeed seeking some leeway to fast-track the project. They do not seek to waive any part of the CEQA process, Kelso said.

Closing arguments in the federal district court overcrowding case are scheduled for February 4, and a ruling is expected this spring. If the three-judge panel decides to release 52,000 inmates, that case will likely move to a higher court.

The funds the receiver seeks will remain in limbo for the duration of the appeals case, set to begin mid-February in the 9th U.S. Circuit Court of Appeals.

What does this mean for the health of California’s 170,000 inmates?

“It stays as bad as it is,” said Weinstein, “which is so bad that it violates the constitution. That’s really bad. It’s not malpractice. It’s deliberate indifference. And that’s going to remain the same.”