United for No Injustice, Oppression or Neglect

Judge Henderson's Hearing - San Francisco
Cayenne Bird's - Notes

Henderson List - Newspapers & TV

Henderson Receivership - News Articles

June 2, 2005

Ladies and Gentlemen of the UNION: 

I have now sat through two days of testimony at Judge Thelton Henderson's trial in San Francisco and I am bringing you these notes of my observations at  2:30 am with court expected to begin at 8:30 am tomorrow morning.  Alexis has been attending with me but aside from Prison Law Office, there are no other groups or families present to witness what is truly unfolding to be a historical event. 

CDC's side of the courtroom is about half full and only the best reporters in California are present which means we really need to get out an alert that the most shocking murders by medical neglect ever described in US history are surfacing during this trial. 

The human drama of  what is happening here should be getting national network coverage as the doctors who have testified describe in detail deaths and inhumane conditions that equal any third world country. Not even CDC can argue with the medical facts and records and of course the most important detail of all - that scores of inmates per year are dying unnecessarily and that at least 64 more deaths are coming. 

There have been moments that the statements by the doctors describing the preventable deaths have almost brought me to tears of relief that people besides me sees the urgency and depth of the crisis in precisely the same way.  Dr. Piusis with twenty years experience as a  medical corrections physician  has written the only book in existence on the topic of proper medical management inside prisons and jails.  CDC cannot refute his claims with any degree of competence and it's an emotional sight to behold a healer taking them on with such moral indignation and competence that CDC looks like fools. 

He minces no words and true leadership ability drips out of every pore of Dr. Piusis as he had nothing good to say about the atrocities that he and another one of the medical specialists  Dr. Goldston has gleaned from medical records as they described case after case of what we have known for several years to be the truth - that people are being murdered in California's prisons by medical neglect in alarming numbers and most of it is flying under the radar of the media. 

It is taking awhile for the full impact of what is being said to be absorbed and even comprehended by all the media, so we need to do something about that since both doctors have exclaimed with anger and pain in their voices that they have never in their entire careers seen some of the worst cases of gross negligence, incompetence and what they describe "as a total lack of caring"  in the case histories they have presented. 

Yesterday,  Dr. Piusis compared conditions of California Prisons with those at Angola during its worst periods.  I am going to give you many of the facts from the testimony tomorrow when I return from court 

I cannot put in the newsletter the details of a wonderful turn of events today that means I cannot leave San Francisco tonight as I had planned to do.  The hearings are expected to last six days and I need to be here.  What has unfolded at this trial is of historic importance and I cannot drop the ball as the records I have kept for the past seven years and my personal insight into the processes are needed now.  I may need you so check your email and phone messages often. 

I need you all to be on stand by alert as anything can happen at this point, we are part of the proof that Plata has not been successfully implemented.  Your cases have been seen and last night the physician in charge of evaluating death reviews (Dr. Shurger in San Diego)  emailed the specialists another 23 cases - 20 of which were preventable deaths. 

This is in addition to 34 preventable deaths already identified not including those where the paperwork was withheld. 

OH MY GOD, it's even worse than I thought and there is no way to measure the number of deaths as the records are being reported as "lost"  or  never made - one of the most blatant statements of cover up is the absence of a death review policy.   Just as I have always stated, people have been dying and records of their care leading up to the death are being withheld as "incomplete" or "lost" - make no mistake, Judge Henderson is fully aware that missing records only add to the suspicious nature of these deaths. 

I can tell you without betraying confidences or compromising evidence that your letters and the summaries that you and I submitted were definitely personally read by Judge Henderson. CDC is unable to refute  the bottom line which is that  the number of dead bodies and morbidity that is clearly documented in their own medical records. 

Judge Henderson and the medical experts are  completely aware of the danger our loved ones are in and are moving rapidly here to institute emergency procedures. 

I want to clarify  that the injuries  the guards are causing to inmates, often by setting up other inmates to do their dirty work, comes under the medical category of  morbidity.  Both doctors are speaking of immeasurable instances of morbidity - suffering and injuries caused deliberately, accidentally or by medical neglect. Let me repeat IMMEASURABLE cases of morbidity have taken place and are expected in the future which heightens the crisis.  In other words the non-system is running so amok that nothing short of an emergency receivership is an option. 

In the past, my predictions have been very accurate so tonight I am going to go out on a limb and tell you what I feel is going to happen.  You, others and the medical experts have given Judge Henderson enough facts and finally enough dead bodies have proven that a crisis exists which CDC cannot deny.  Dead bodies are hard evidence.  It is no longer just a question of Constitutional Medical Care but a declared emergency to stop the deaths. 

Preventable "Morbidity"  is so great from cases of abuse, mismanagement and neglect that they can't even place an estimate on the extent that it exists, we know it is more the rule than the exception and our alerts have been heard, as well as cases from many other sources. 

The problem is truly exposed and backed with documented evidence. Your letters to Judge Henderson, along with your chronologies have been a part of bringing this to the fore. But there have been cases that equal the horrifying deaths that we in the UNION have experienced or know about  that never surfaced even to me or to the media. 

Undoubtedly, the cover up and continuing patterns which will result in more death and morbidity is also fully out in this courtroom. 

Judge Henderson and the experts are also now aware of the threat of an international pandemic manifesting itself within a few months according to the alerts the World Health Organization has been issuing for the past week or so.  Tuberculosis was discussed at great length today and it's a tremendous threat to the public safety.  When we had news of a case being confirmed at Pleasant Valley, that was correct.  It is possible that many more inmates were infected because the doctors didn't follow up so please spread the word that exposures may have happened there recently. 

We were also aware that Dr. Wu disappeared and although his name was not specifically mentioned, some of the worst abuses by a " physician at CSATF"  were described by expert testimony.  They stated he has been fired and if this testimony turns out to be Dr. Wu there is no doubt that slow torture and murder of Mark Grangetto who is down to 100 pounds will be even more apparent.  In other words, this testimony is evidence that will help our upcoming lawsuit.  Judge Henderson is fully aware of this case and I have been able to re-iterate the facts of the chronologies you gave to me. 

While failure to bring Plata requirements into conformity is the key reason for these hearings, everyone present is aware of the five lawsuits our UNION has managed to bring since September, with a sixth one in the works for Provencio. 

So there is no choice with the doctors estimating at least 64 more preventable deaths happening this year, and every year until this mess is cleaned up, other than  for emergency action to be taken. 

I have so much good news that I cannot deliver to you without violating ethics because our newsletter does circulate far beyond ourselves and our work has reached eyes and ears in the highest places.  We got their attention, Plate got their attention and physicians have verified that what we claimed is true. 

Nothing will ever be the same after Judge  Henderson takes action and believe me when I tell you he is taking action because he would be an accomplice in murder and maiming if he sees this proven and more potential  loss of life and does anything less. 

I believe  I have seen the glorious bright light at the end of the longest tunnel I ever traveled in my life.  I can see, feel, smell and taste medical  reform and major changes because now everyone is focused on the same goal - to stop the suffering and save the lives of the estimated 64 people who will die over the next year. 

I personally believe this a very, very low estimate. 

In my opinion, CDC has already lost and they can kiss a billion dollars in medical budgets goodbye.  I predict that a  temporary federal receiver given the right powers, which Judge Henderson can bestow,  will happen over the next few days. 


I will predict here that you  need not worry about the quality of the temporary federal receiver  because this is so important to Judge Henderson that I believe he will not fail to choose anyone but a capable person of courage that has nothing to do with the current regime.  The quality and accuracy of the medical specialists, especially their outspoken, forthright courage is a good indication that Judge Henderson recognizes what it's going  to take to do this job and at the top of the list is common sense and backbone. 

As you know, the intuitive side of my brain operates with 99% accuracy whenever the time comes to recognize that we are approaching another milestone.   For those who haven't been plugged into me for years, I make predictions only when it's important to do so for the purpose of preparedness. While it always risky for me to work ahead by doing this, I just cannot logically see any other result after the shocking testimony that has been given to support what we've been screaming about on a daily basis for the past seven years - that any sentence to prison is a potential death sentence. 

In my opinion, the boil is lanced, the ugly heads are out in full public view and the healing is about to begin with an emergency order which will happen within the next few days.  This is my prediction from all that I am hearing and seeing but you can place bets on it, that's how much I believe what I'm telling you. 

I have many facts from the testimony but I wanted to give you this summary and I apologize for it being a little repetitive but each fact is important here. Dead bodies stacking up and they've been stacking up mostly due to the media ban and complete lack of physician supervision (and in my opinion, real investigations of abuses by the guards), it's Orwellian, grisly, shocking and yet we've known about all of it while those in denial slumbered.  Those at the top of CDC are awake now, believe me they're awake and I cannot imagine how they can possibly defend any of it. 

I will do my best to hang because I realize that we must be there for Judge Henderson and for our cause as this it folks! 

Not a dress rehearsal but real life and major changes are unfolding now.  Bug the media, they're missing it except for the Chronicle, Mercury News and KTVU Channel 2.  The abuses alleged at Abu G are lightweight compared to these murders of US Citizens by their own government. 

You heard it here first, I predict we are going to get a federal emergency receiver and that major changes by courageous people will be forced on these monsters who have been torturing and murdering our sons and daughters in the name of justice. 

More facts tomorrow, tonight I wanted to share with you my opinions so that you can share some of my hope, relief and yes, JOY, that the light is shining brightly on the most evil, uncaring practices that the taxpayers didn't even know was happening. 

I am impressed with Judge Henderson and this is one good against evil tussle where the angels (that's us) are winning because truth has a way of coming out. 

I saw a glimpse of  heaven these past two days but I'm not going  to celebrate until we walk through the gates with the emergency federal receiver guarding the rear.  One thing I  know is that the benches in that courtroom have a strong resemblance to a church and I have had said a million prayers of thanks to all that has happened there the past two days. 

I believe that your letters to the editors should emphasize that in spite of a declared crisis that is costing the taxpayers millions in lawsuits, more of which are practically guaranteed with all these preventable deaths surfacing there is no plan for compassionate release.  Nobody is discussing this but I have discussed it, especially in view of the disease epidemics which the experts agree are in full bloom in the prison system and a pandemic expected within the next few months.  I have made our demand for compassionate release very clear, this was the first reaction that Oklahoma had to a similarly declared crisis.  There are cases described as "high risk" and there is no reason for the taxpayers to continue to spend millions in medical care and lawsuits for people who have one foot in the grave and another on a banana peel.  I was able to describe the deliberate indifference from every agency and individual in Eric's case as well as your cases and to describe quadriplegics, elderly, and Ed Rister a braindead inmate. I spent nearly an hour today relaying facts, opinions and naming the names of callous individuals who ignored your pleas for help for your loved one, my pleas on your behalf, telling our stories and their outcomes, often tragic. 

Good job UNION folks, pat yourself on the backs for your letters and chronologies and if you have a loved one in danger, I suggest you put HOPE into your heart and get this done because WE ARE HEARD. 

We want to recognize the Prison Law Office for putting up a brave and noble fight and do everything possible to support them at this time especially. 

A very tired but most joyous 

B. Cayenne Bird  Rightor1@yahoo.com
United for No Injustice, Oppression or Neglect

June 4, 2005

I am back in Sacramento with hundred pages of notes that need transcribing and work backed up on me, calls, emails. 

Nothing has changed, I believe this emergency federal receiver will be appointed and the witnesses on Thursday gave more testimony about the nuts and bolts of this reform - ITT Technology and hiring practices of nurses, physicians and positions mandated by  Plata which have never been filled. 

There is a $200,000 request for a medical director on the Governor's desk and by the end of the week, we should see an announcement that prison nurses will get raises. 

Phase II of the ITT Technology for tracking Pharmacy is about to launch and they are about to ask the legislature for money to go to Phase III.  It's ridiculous how long it takes to get the most simple things done. 

Judge Henderson kept saying "by the time you get that done, 18 more prisoners will have died." 

So the pressure is on and we must hope that dead bodies stacked up will please the 9th Circuit as a reason for the takeover if CDC appeals his decisions, which they will of course. 

At least one of the lawyers prosecuted the Dillard case, I wish you could have  seen how these arrogant dogs look with their ears laid back. 

They could not refute all the deaths.  For once, they were nearly speechless. 

Besides trying to catch up a bit here before the hearings resume on Tuesday (none set for Monday) and the trial projected to end by Wednesday, I am writing a 1200 word op-ed for publication. 

I have a call into Mike Wallace of 60 minutes who graciously covered the Dillard case for us if you recall.  So many of these atrocities happened at CSATF and Corcoran so this should be no surprise to anyone 

I will compile a factoid AFTER  I get my op-ed written here. 

some of our bills passed the legislature but I haven't had time to look at other news and won't until we get through the trial, however you may send me articles about what has happened. 

Judy called the San Diego Tribune to light a fire about the significance of this trial 

Nora contacted the Bakersfield Californian and faxed the last newsletter. 

Rob Bastian is drafting an article for the legal journal The Los Angeles Daily Journal so that all the judges and lawyers will see and know the extent of the crisis and why this is an emergency.  Rob writes for legal journals for no pay and this is an outstanding contribution to the cause!. 

some of the journalists on the UNION list are getting out the word to their affiliated media organizations about the atrocities that surfaced in Henderson's courtroom that people want to deny 

I was able to discuss during my one hour meeting with Judge Henderson how the media ban is a part of the problem and why so many of these deaths have records "lost." 

I was able to tell him in detail about Gene, the Fresno Bee news editor and he found it shocking that anyone would consider inmate deaths unimportant and business as usual!!!!!! 

One news editor told me yesterday that his views make him "an inhumane son-of-a-bitch" and Henderson thanked me for activating all of  you to for alerting both he and the media to your cases of preventable deaths and injurites. 

We are very much a part of what is going on in this case because of the lawsuits we inspired and the fact that some of our UNION people are still dying with no one coming to our assistance. 

You can imagine that in any hour I was able to point the finger and explain the callousness and uncaring attitudes of everyone who is pretending to do intervention. 

Henderson is very  proud of those of you who did a chronology and attached documents and I am already being consulted  on a number of malfunctions and tapped for solutions.  The format in which you are doing your description of your experiences is "very professional" he said and he knew every case in surprising detail. 

If you did not do a chronology,  your problem has no chance for remedy  until you get it done. What are  you waiting for? 

Good job at fighting for yourselves UNION folks!  Good job at helping to bring this around!  Judge Henderson saw UNION, UNION, UNION so much that he is hopeful in his late  years that you are really going to organize properly through recruiting others who are trained in just the same manner to do CAMPAIGNS. 

Even big judges need our support and involvement and that's what your chronologies and descriptive letters, our lawsuits have done to support this reform.  Major, major, major factors in this turn ov events. 

Alexis had the photo we took at the Lancaster rally of the little boy holding a sign that said "Every prisoner is somebody's child" and she showed it to everyone in the courtroom, put it in the faces of all the top CDC management and attorneys. 

I need to recognize Alexis and her husband without whose kind hospitality my trip would not have been possible.  I will gone Tuesday and Wednesday for the final days of the hearings.

June 5, 2005

I met another family at Henderson's hearings who still doesn't know why their son died at CSATF January 2004.  They cannot get his medical records, they were told he died of "Valley Fever" 

But this isn't closure.  I have sent the mother back to pull together some more data but I have her contact info if any of the journalists need it. 

I am observing that deaths among blacks seem to be more prominent in the ones who have come to me which are different than the ones being reported in court. 

What this means is that they are only scratching the ice here on the number of suspicious deaths. 

I was able to tell Judge Henderson about the two frightened witnesses to Anthony Brown's murder and my dilemma not to put their lives in danger. 

"Judge Henderson these two people believe the guards will kill them if they testify in Anthony Brown's case but the FBI has already cleared these guards." 

"Cayenne" he replied.  "They will kill them." 

That part of me that is a patriot cried silently at his response.  I am hoping that I can achieve protection for inmate and health care workers who have witnessed these murders. 

There must be whistleblower protection for them too! 


Prison health system slammed 
U.S. judge may cite California officials for contempt 
- James Sterngold, Chronicle Staff Writer
Wednesday, May 11, 2005 

A federal district court judge issued on Tuesday the bleakest condemnation yet of California's failing prison health care system, saying it is allowing inmates to die through malfeasance and is in "such a blatant state of crisis" that he may soon appoint a receiver and hold corrections officials in contempt. 

The judge called a recent personal tour of San Quentin's medical facilities "horrifying," noted that a report by medical experts said inmates were suffering not just from incompetence but "cruelty" at the hands of some doctors, and he said that there was an 80 percent vacancy rate in the upper ranks of prison health care management. 

"It is beyond the court's understanding how the state of California could allow an institution to sink into such deplorable condition," wrote Judge Thelton Henderson, who is based in San Francisco. 

He added, "Defendants themselves have conceded that a significant number of prisoners have died as a direct result of this lack of care, and it is clear to the court that more are sure to suffer and die if the system is not immediately overhauled." 

Corrections officials admitted at a state Senate hearing last month that the state was abandoning any hope of operating the system properly on its own and said it was seeking outside help in a process that could take years. 

But the denunciation by Henderson was still humiliating for the state, made worse by the fact that it is just one of two such contempt motions corrections officials are facing because of their admitted failure to institute court-mandated reforms in the badly overtaxed prison system. 

Another federal district court will hold hearings shortly on whether corrections officials should be held in contempt for failing to deliver promised reforms in the parole system. In both cases, federal courts have found that the state was violating inmates' constitutional rights and ordered improvements that the state has repeatedly failed to deliver. 

"We are at a point of maximum futility in this case, where the state has publicly confessed its inability to grapple with the problem in any appreciable systemic manner for what is likely to be years to come," Judge Henderson wrote. 

He issued the order as part of the regular monitoring process of a previous settlement of a lawsuit, in which the state promised to meet a series of goals. 

The judge was saying, in effect, that the state no longer had any credibility in promising change. 

"The sad thing is he's not exaggerating," said Donald Specter, the director of the Prison Law Office, a prisoners advocacy group that filed the original lawsuit demanding health care improvements. "I believe now that a receiver is the prisoners' only hope of preventing more serious injury and deaths." 

State officials have previously agreed that the prison health care system is broken beyond repair, and a corrections official said Tuesday that the state might not fight the appointment of a receiver. 

"We don't necessarily disagree with him," J.P. Tremblay, a spokesman for the Youth and Adult Correctional Agency, said of the judge's observations. 

He added that a bill signed into law by Gov. Arnold Schwarzenegger on Tuesday was intended to help bring about some of the changes the judge called for. 

Standing in front of a 19th century gun tower at Folsom State Prison near Sacramento, Schwarzenegger called his prison reorganization plan a "great accomplishment" and a model of bipartisanship. 

The reorganization, which will take effect in July, will rename the state's prison system the Department of Corrections and Rehabilitation. It centralizes control of the state's far-flung prison system with the department secretary. 

It does not, however, directly address the repeated failures that the judge noted in his order, and it appears to do nothing to prevent the possibility of contempt citations. 

The state currently spends about $6.5 billion annually on its prison system, the largest in the country with nearly 165,000 inmates. Spending on prison health care has doubled in the past seven years to $1.1 billion, with the state spending two to three times as much per inmate as any other state. 

Yet even with that expense, which could rise even more rapidly under a receiver, the care has been deemed inadequate by every party involved. 

The governor's upbeat comments at the carefully staged bill signing stood in stark contrast to Henderson's highly detailed order. He called for a series of hearings that will begin on May 31. 

If the court were to appoint a receiver, the state could suggest candidates, but ultimately the choice would fall to the judge. The receiver, who would report to the court and not the state, would have broad powers to overcome any bureaucratic obstacles, and order changes in the prison health care system, no matter what it cost the state. 

Henderson did not just criticize corrections officials, he issued a blistering indictment of their failure to institute any of their promised reforms. 

He called a report by three medical experts on health care conditions at San Quentin, which was supposed to have been one of the first prisons to enjoy major improvements, "shocking." 

He summed up his position by writing, "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. 

"The prison medical delivery system is in such a blatant state of crisis that in recent days defendants have publicly conceded their inability to find and implement on their own solutions that will meet constitutional standards. The state's failure has created a vacuum of leadership and utter disarray in the management, supervision, and delivery of care in the Department of Corrections' medical system." 

He went on to rebuke the state for maintaining "an unconstitutional system fraught with medical neglect and malfeasance." 

Ever since the state agreed to the court-supervised plan for improving prison health care three years ago, the judge added, "the most notable characteristic of this case has been defendants' failure to achieve any substantial progress in bringing the medical care system even close to minimal constitutional standards." 

He noted that not a single one of the state's 32 prisons had yet come into compliance with the court orders despite three years of efforts. 

Chronicle staff writer Mark Martin contributed to this report.E-mail James Sterngold at  jsterngold@sfchronicle.com

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Murder by medical neglect

by Mary Charlotte White 

Protesters demonstrate at the gates of the Central California Women’s Facility, where a prisoner testified to legislators, “I could see that the whites of their eyes were as yellow as a caution sign; why couldn’t somebody else? … there was nothing I could do about it, but I know that something could be done.” 
Photo: Legal Services for Prisoners with Children 


An historic event is now taking place in a San Francisco courtroom. It is federal judge Thelton Henderson’s court, and he is considering emergency federal receivership or a takeover of health care in California’s prison system. Much of the medical neglect that even California Department of Corrections officials admit is rampant in California prisons is the result of callous disregard for prisoners who are trying to turn their lives around and for their families who are trying to assist in their rehabilitation.

For seven years a reform group has brought to the attention of the media and the public the atrocities occurring in California prisons. We call it ”murder by medical neglect,” for that is what it is – state sponsored neglect that is paid for by well meaning but unenlightened taxpayers. The group that has sought to educate the public and bring about badly needed reform is called U.N.I.O.N. (United for No Injustice, Oppression or Neglect). It was founded in 1998 by B. Cayenne Bird, a California journalist, and its members are dedicated to common-sense reform.

The following comments are a portion of B. Cayenne Bird’s eye-witness account of the courthouse proceedings: 

“I have now sat through two days of testimony at Judge Thelton Henderson’s trial in San Francisco and am bringing you these notes of my observations at 2:30 a.m. with court expected to begin at 8:30 tomorrow morning. Alexis has been attending with me, but aside from Prison Law Office, there are no other groups or families present to witness what is truly unfolding to be a historical event.

“CDC’s side of the courtroom is about half full, and only the best reporters in California are present, which means we really need to get out an alert that the most shocking murders by medical neglect ever described in U.S. history are surfacing during this trial.

“The human drama of what is happening here should be getting national network coverage as the doctors who have testified describe in detail deaths and inhumane conditions that equal any third world country. Yesterday, Dr. (Michael) Piusis compared conditions of California prisons with those at Angola during its worst periods. 

“There have been moments that I have been almost in tears listening to the doctors as they describe the crisis, knowing that finally others see the urgency and the depth in precisely the same way as we have. Both doctors exclaimed with anger and pain in their voices that they have never in their entire careers seen such cases of gross negligence and in their own words ‘a total lack of caring.’ 

“Dr. Piusis has 20 years experience as a medical corrections physician and has written the only book in existence on the topic of proper medical management inside prisons and jails. California Department of Corrections cannot refute his claims, and it is an emotional sight to behold a healer taking them on with such moral indignation and competence that CDC looks like fools.” 

“I need U.N.I.O.N. members to be on standby alert, as anything can happen at this point. We are part of the proof that Plata has not been successfully implemented. [In Plata v. Davis, settled as Plata v. Schwarzenegger, the largest ever prison class action lawsuit, prisoners alleged that California officials inflict cruel and unusual punishment by their deliberate indifference to serious medical needs. Judge Henderson, who oversees implementation of the 2002 settlement agreement, is holding the current hearings pursuant to an Order to Show Cause he issued last month, observing that California’s prison medical care system “is too far gone to be corrected by conventional means” and threatening to place the system in receivership and find the state in contempt of court.]

“Your cases have been seen, and last night the physician in charge of evaluating death reviews (Dr. Shurger in San Diego) emailed the specialists another 23 cases – 20 of which were preventable deaths. This is in addition to 34 preventable deaths already identified, not including those where the paperwork was withheld. (As you know, U.N.I.O.N. members believe this to be the tip of the iceberg and the preventable death estimates are too low – probably closer to two or three preventable deaths per facility per month rather than per year.) 

“It is even worse than I thought, and there is no way to measure the number of deaths, as the records are being reported as ‘lost’ or never made. One of the most blatant statements of cover-up is the absence of a death review policy. Just as we have been saying, people have been dying from otherwise preventable deaths and records of their care leading up to the death are being withheld from inmate families. Judge Henderson is aware that the missing records add to the suspicious nature of these deaths.

“I want to clarify that the injuries that the guards are causing to inmates, often by setting up other inmates to do their dirty work, comes under the medical category of morbidity. Both doctors are speaking of immeasurable instances of morbidity: suffering and injuries caused deliberately, accidentally or by medical neglect. Preventable morbidity is so great from cases of abuse, mismanagement and neglect that they can’t even place an estimate on the extent that it exists. We know it is more the rule than the exception. But there are horrifying cases even we did not know about.

“Almost too much for the media to comprehend, perhaps, is the cost in human and economic terms to the people who live outside the prison walls. Experts agree that disease epidemics are in full bloom within the prison system itself. Eventually prisoners will be released back into the community, often more ill than when they went in. We have known for some time that prisoners with hepatitis A, B, and C have been working in prison kitchens. We know of one instance of an inmate with TB who knew he had it and was punished by guards for responsibly refusing to work in the kitchen. Another case of TB at Pleasant Valley was confirmed. 

“In time, these illnesses, if left untreated, will spread into the outside world. Prison doctors are not testing and following up on TB, and sometimes weeks go by before anything is done. In the meantime, numerous inmates are exposed. Judge Henderson and the experts are also aware of the threat of an international pandemic manifesting itself with a few months according to the alerts by the World Health Organization.

“In view of the disease epidemics, which the experts agree are in full bloom in the prison system, and a pandemic expected within the next few months, it would seem reasonable for the state to consider compassionate release. We have a declared crisis with inmates who are at high risk in terms of their health who are unable to receive proper medical care. Conservatively, at least 64 more inmates will die from medical neglect this next year. This is costing the taxpayers millions in wrongful death lawsuits, and more are practically guaranteed. 

“At present we have guards beating quadriplegics, abusing the elderly or watching TV as they collect overtime pay for ‘standing guard’ over brain dead inmates. When Oklahoma had a similarly declared crisis, one of the first things they did was to institute compassionate release. There is no reason for taxpayers to continue to spend millions in medical care and lawsuit payouts for people who have one foot in the grave and another on a banana peel.” 

“While citizen efforts to work with California Department of Corrections in a cooperative spirit have failed, letter writing campaigns to editors and lawsuits are helping to bring this crisis out into the open where we can deal with it honestly. Until now, prisoner families have experienced contempt, denial and deceit from CDC officials and staff. 

“We would like to thank Prison Law Office for their work on Plata. The state’s failure to bring Plata requirements into conformity is the key reason for these hearings. Everyone at the hearing is also aware of the five lawsuits our U.N.I.O.N. has managed to bring since September, with a sixth one in the works for the Provencio family. [Daniel Provencio, 28, declared brain-dead after being shot in the head by a correctional officer, lingered in a coma under prison guard for 29 days before he died.] 

“We want an end to the torturing and death of our sons and daughters in the name of justice, and we want an end to the cover-ups and continuing patterns which will result in even more future deaths and morbidity.”

Contact U.N.I.O.N. at P.O. Box 340371, Sacramento CA 95834-0371, Rightor1@yahoo.com  or www.1union1.com .


Judge seeks oversight of prison health system

Reform bill signed
By Don Thompson and David Kravets
5:21 p.m. May 10, 2005

FOLSOM – A federal judge on Tuesday moved to place the state prison system's troubled health care operations into receivership, complicating a massive prison overhaul bill signed into law hours earlier by Gov. Arnold Schwarzenegger.

U.S. District Judge Thelton Henderson, ruling in a class-action lawsuit brought against the California Department of Corrections, said the state's 162,000 prisoners "are being subjected to an unconstitutional system fraught with medical neglect and malfeasance."

Poor care has been blamed for the deaths of more than two dozen inmates.

"Defendants themselves have conceded that a significant number of prisoners have died as a direct result of this lack of care, and it is clear to the court that more are sure to suffer and die if the system is not immediately overhauled," he said.

Henderson's ruling, in San Francisco, came after Schwarzenegger appeared at Folsom State Prison to sign into law the most sweeping overhaul in three decades of the nation's largest prison system.

Schwarzenegger's signature was expected. The Republican governor has been calling for major reforms to the $7 billion-a-year system since shortly after he took office in November 2003. He helped craft a bipartisan solution through months of negotiations with the Democrat-controlled Legislature.

"When I came into office, we faced some very serious problems with our correctional system, including out-of-control budgets, a failed internal discipline system and a disturbing lack of accountability," Schwarzenegger said. "And the more we looked at the problems, the more we realized that the first step that we must take is to reorganize the whole agency."

The law restructures the bureaucracy of the 32-prison system and concentrates power with his hand-picked corrections czar, Youth and Adult Corrections Secretary Roderick Hickman.

Schwarzenegger said attention must now turn to several reforms: improving the health care system targeted by the judge Tuesday; overhauling a youth corrections system experts described as draconian; and fixing a rehabilitation system so flawed that the majority of ex-convicts are soon back behind prison walls.

It's unclear what affect Henderson's ruling will have on the governor's overall reform plan, since it could take control of the health care system out of the state's hands.

Top prison officials have acknowledged they can't manage the inmate medical system. They said they are counting on consultants and the legislation the governor signed Tuesday to make improvements that should have begun more than a year ago.

Prison department spokesman Todd Slosek said it is "unknown at this time" whether the state would oppose a receiver.

"The department's interest all along was for ... constitutionally adequate health care to our inmates," he said.

The judge said he will appoint a receiver to force improvements unless the Department of Corrections convinces him otherwise. He will make his final decision following a July 11 hearing.

In a review of 193 prison deaths, Henderson said many of the medical records were lost and that 34 of them were "highly problematic, with multiple instances of incompetence, indifference, neglect and even cruelty by medical staff."

One inmate, Henderson said, was given medication for high blood pressure in 2002 and was not seen again by physicians until he was found dead.

In a separate ruling Tuesday, Henderson said he also might hold the corrections department in contempt of court for not abiding by a June 2002 agreement to improve health care.

He said the department has failed to achieve "any substantial progress in bringing the medical care system even close to minimal constitutional standards."

Tuesday's federal court decision is the latest instance in which the courts have sought to exert control over California's problem-plagued prison system.

Federal judges already are assuming oversight of pieces of what on July 1 will become the new Department of Corrections and Rehabilitation. The combined department will replace what now are the California Department of Corrections and the California Youth Authority.

Another judge has appointed a special master to help reform the youth authority, while a separate special master is being considered to oversee stalled parole reforms.

Schwarzenegger, driven by near-constant prison scandals, made reorganizing the system the vanguard of his larger plan to restructure state government.

"This is just the first step," said Hickman, who will have responsibility for the entire system.

On the Net:

Read the reorganization bill, SB737, and the parole bill, SB619: www.sen.ca.gov

California Youth and Adult Correctional Agency:  www.yaca.ca.gov

Associated Press writers Don Thompson in Folsom and David Kravets in San Francisco contributed to this report.


Judge seeks oversight of prison health system

Reform bill signed
By Don Thompson and David Kravets
5:21 p.m. May 10, 2005

FOLSOM – A federal judge on Tuesday moved to place the state prison system's troubled health care operations into receivership, complicating a massive prison overhaul bill signed into law hours earlier by Gov. Arnold Schwarzenegger.

U.S. District Judge Thelton Henderson, ruling in a class-action lawsuit brought against the California Department of Corrections, said the state's 162,000 prisoners "are being subjected to an unconstitutional system fraught with medical neglect and malfeasance."

Poor care has been blamed for the deaths of more than two dozen inmates.

"Defendants themselves have conceded that a significant number of prisoners have died as a direct result of this lack of care, and it is clear to the court that more are sure to suffer and die if the system is not immediately overhauled," he said.

Henderson's ruling, in San Francisco, came after Schwarzenegger appeared at Folsom State Prison to sign into law the most sweeping overhaul in three decades of the nation's largest prison system.

Schwarzenegger's signature was expected. The Republican governor has been calling for major reforms to the $7 billion-a-year system since shortly after he took office in November 2003. He helped craft a bipartisan solution through months of negotiations with the Democrat-controlled Legislature.

"When I came into office, we faced some very serious problems with our correctional system, including out-of-control budgets, a failed internal discipline system and a disturbing lack of accountability," Schwarzenegger said. "And the more we looked at the problems, the more we realized that the first step that we must take is to reorganize the whole agency."

The law restructures the bureaucracy of the 32-prison system and concentrates power with his hand-picked corrections czar, Youth and Adult Corrections Secretary Roderick Hickman.

Schwarzenegger said attention must now turn to several reforms: improving the health care system targeted by the judge Tuesday; overhauling a youth corrections system experts described as draconian; and fixing a rehabilitation system so flawed that the majority of ex-convicts are soon back behind prison walls.

It's unclear what affect Henderson's ruling will have on the governor's overall reform plan, since it could take control of the health care system out of the state's hands.

Top prison officials have acknowledged they can't manage the inmate medical system. They said they are counting on consultants and the legislation the governor signed Tuesday to make improvements that should have begun more than a year ago.

Prison department spokesman Todd Slosek said it is "unknown at this time" whether the state would oppose a receiver.

"The department's interest all along was for ... constitutionally adequate health care to our inmates," he said.

The judge said he will appoint a receiver to force improvements unless the Department of Corrections convinces him otherwise. He will make his final decision following a July 11 hearing.

In a review of 193 prison deaths, Henderson said many of the medical records were lost and that 34 of them were "highly problematic, with multiple instances of incompetence, indifference, neglect and even cruelty by medical staff."

One inmate, Henderson said, was given medication for high blood pressure in 2002 and was not seen again by physicians until he was found dead.

In a separate ruling Tuesday, Henderson said he also might hold the corrections department in contempt of court for not abiding by a June 2002 agreement to improve health care.

He said the department has failed to achieve "any substantial progress in bringing the medical care system even close to minimal constitutional standards."

Tuesday's federal court decision is the latest instance in which the courts have sought to exert control over California's problem-plagued prison system.

Federal judges already are assuming oversight of pieces of what on July 1 will become the new Department of Corrections and Rehabilitation. The combined department will replace what now are the California Department of Corrections and the California Youth Authority.

Another judge has appointed a special master to help reform the youth authority, while a separate special master is being considered to oversee stalled parole reforms.

Schwarzenegger, driven by near-constant prison scandals, made reorganizing the system the vanguard of his larger plan to restructure state government.

"This is just the first step," said Hickman, who will have responsibility for the entire system.

On the Net:

Read the reorganization bill, SB737, and the parole bill, SB619: www.sen.ca.gov

California Youth and Adult Correctional Agency:  www.yaca.ca.gov

Associated Press writers Don Thompson in Folsom and David Kravets in San Francisco contributed to this report.


Prison doctors' union sues to block higher standards 

By Don Thompson
3:03 p.m. May 2, 2005

SACRAMENTO – The union representing prison doctors sued the Department of Corrections to block higher standards for physicians, blaming appalling health care problems on an inferior prison system. 

The Oakland-based Union of American Physicians and Dentists said Monday its doctors are not responsible for the problems. The Department of Corrections wants doctors to be board certified in internal medicine or family practice, or pass a competency test. 

The plan follows a series of scathing reports on health care at state prisons. National experts reported last month that conditions are so poor that inmates are dying of neglect and maltreatment. 

The suit filed Friday in Sacramento County Superior Court said imposing new minimum qualification standards violates state law, which requires that any new qualifications must be approved by the State Personnel Board. The board now requires only that doctors and dentists be licensed in California. 

The department has twice tried to impose such standards under what the union alleged were flawed evaluation programs. The union said no correctional agency in the nation requires its doctors to prove their competency. 

The Department of Corrections is "arbitrarily, capriciously, and unilaterally imposing new minimum qualifications for prison doctors to divert attention from its own execrable management spanning two decades," the union said in a statement. "In a desperate last ditch effort to divert attention from its own colossal mismanagement, CDC is doing its best to blame prison doctors for its own failures." 

National experts last month reported cases of doctors who acted incompetently, prescribing the wrong treatment or ignoring complaints until it was too late. They and other experts have said doctors are sometimes unqualified to see the patients they treat, conditions are abysmal, and the medical system is severely understaffed. 

Youth and Adult Correctional Agency Undersecretary Kevin Carruth acknowledged last week that prison officials are unable to manage the medical system, and want to hire University of California consultants to design a plan to improve care in 18 months. 

The union criticized the plan to pay UC San Diego and UC San Francisco $14.7 million, when it says the state could be better served by implementing 28 reforms that the union has suggested. 

A Senate committee cut out the consultants' money last week, in anticipation that a federal judge will hold hearings and may appoint an overseer for the health care system. 

On the Net: 

California Youth and Adult Correctional Agency:  www.yaca.ca.gov

California Department of Corrections:  www.corr.ca.gov

Prison Law Office:  www.prisonlaw.com/


Posted on Thu, Apr. 14, 2005 

San Quentin 'decrepit'
By Mark Gladstone
Mercury News Sacramento Bureau

SACRAMENTO - California's landmark San Quentin Prison is a decrepit facility that poses a major public-health-care risk to thousands of inmates who are living in refugee-camp-like surroundings, a court-appointed panel of medical experts has found.

In a scathing report, obtained by the Mercury News, the experts said the prison is overseen by an indifferent staff that ignores a major federal court agreement to improve health care.

The inspectors examined 10 inmate deaths over the past three years and found that most were preventable. Before their deaths, three of the inmate-patients were treated by a single unidentified prison doctor, identified only as Dr. X, who at one point was placed on administrative leave.

The 53-page report is based on inspections earlier this year by two doctors and a nurse. In it, they told U.S. Judge Thelton Henderson that San Quentin is ``so old, antiquated, dirty, poorly staffed, poorly maintained with inadequate medical space and equipment and overcrowded'' that its entire mission needs to be re-evaluated.

In some of the strongest language ever used to describe a state-run facility, they also said that reviews of medical records at the Marin County lockup on the shore of San Francisco Bay ``demonstrate multiple instances of incompetence, indifference, cruelty and neglect.''

Longstanding concern

Corrections Director Jeanne Woodford, who was the longtime warden at San Quentin, was not available for comment. But Todd Slosek, a spokesman, acknowledged that concerns over health care are longstanding.

He said, ``The department has developed a remedial plan and is working with the court to ensure that the experts' concerns are addressed.'' And he noted the prison system is developing standards for physicians.

The reports on San Quentin and two other state prisons came to light on the eve of a Senate hearing set for today into the skyrocketing cost of prison health care. Costs have doubled to more than $1 billion annually over the past six years.

Sen. Gloria Romero, D-Los Angeles, chair of today's hearing, called the report ``damning.'' ``This has truly been a correctional agency that's neglected the most basic of inmate rights protected by the U.S. Constitution. It's shameful to realize that taxpayers are pouring $1 billion into a system'' that should pay for the most basic of health care needs.

Problems later

Not only are inmates constitutionally guaranteed adequate health care, but most inmates also wind up getting released and if they are sick they can pose a health risk to the general population. In addition, the state has been forced to pay out millions of dollars in settlements to inmates who have alleged they were mistreated in state institutions.

The inspections and report were ordered by Henderson who oversees compliance under a sweeping legal agreement known as the Plata settlement -- after Marciano Plata, one of nine plaintiffs in an April 2001 class-action lawsuit filed by inmates' rights activists. While the medical experts said there had been initial progress, they now found conditions ``disturbing'' in a cover letter dated April 9 and signed by Dr. Michael Puisis, an Illinois-based expert on correctional health care.

The legal settlement reached several years ago requires California's 32 prisons to provide adequate health care by 2008. The lawsuit charged that the prisons' poor medical care violated the Constitution's ban on cruel and unusual punishment.

But the experts found that overall compliance with the agreement was ``non-existent'' and that there was indifference to turning things around. In fact, they recommended that the mission of San Quentin, which receives new inmates, be re-evaluated.

Overhaul goal

The Schwarzenegger administration has been seeking to overhaul the way prisons are administered, centralizing control in Sacramento under Youth and Adult Corrections Secretary Roderick Hickman.

However, for the second time in the past month, an independent investigation has painted a grim picture of the way a state prison is managed. Last month, the Office of the Inspector General reported that the California Institution for Men in Chino was on the verge of chaos in the wake of the first slaying of a guard in 20 years.

Now, the medical panel is describing an equally disturbing situation at San Quentin.

``Some of the physical structures or arrangements for housing at San Quentin are so decrepit that it is degrading and dangerous to house human beings in them for extended periods of time,'' the report states.

``Yet, these arrangements have existed for so long that staff have become inured to the conditions and have become so accustomed to the degrading conditions that they are considered normal. Leadership has become so accepting of inability to change that an overwhelming attitude of resignation exists.''

Review of 10 deaths

Perhaps most important, the report reviewed 10 deaths. ``Each of these should have resulted in discipline; while these were referred to investigations, nothing had yet been done. Lack of timely discipline after the first death may have resulted in the continued mistakes and deaths.''

The experts also inspected California State Prison, Sacramento, and Salinas Valley State Prison. At Sacramento, they cited a lack of nursing supervision, and similarly they found a lack of nursing leadership at Salinas Valley. As a result of poor leadership there, the inspectors said, there is ``staff confusion and dissension.''

Besides Puisis, others involved with the report include Dr. Joe Goldenson of Berkeley and Madie Lamarre, a nurse from Atlanta, Ga.

Contact Mark Gladstone at  mgladstone@mercurynews.com  or (916) 325-4314. 

Posted on Fri, Apr. 15, 2005 

Prison's medical system assailed
By Mark Gladstone
Mercury News Sacramento Bureau

SACRAMENTO -- The inmate could neither eat nor drink and was dehydrated when he showed up at the San Quentin clinic shortly after 8 p.m. on Jan. 28. With a fever over 103 and a racing pulse, his vital signs indicated possible shock and a life-threatening emergency.

With prison medical records in disarray, the doctor on duty did not have a chart to check the inmate's history. The doctor failed to evaluate the inmate for dehydration and diagnosed bronchitis and the flu. He prescribed Tylenol, Benadryl, cough syrup, antibiotics and two other medications and told the inmate to come back in a week.

Heading back to his cell, the inmate collapsed, according to a report from three court-appointed medical experts obtained by the Mercury News. The physician, known only as ``Dr. X,'' gave him some fluids and sent him back to his housing unit. By the next afternoon, the felon was in shock and died about 30 hours after he was first seen by Dr. X.

In their report to U.S. District Court Judge Thelton Henderson, the medical experts cited 10 deaths at San Quentin. Most were preventable, they said, including three cases overseen by Dr. X.

These and other cases reflect a broken medical system that might require a partial takeover by the federal court, suggested Sen. Gloria Romero, D-Los Angeles, at a legislative oversight hearing on prison health care Thursday.

Department of Corrections officials acknowledged that the reports were ``damning.'' But in an apparent effort to stave off federal intervention, state authorities revealed for the first time that next year they expect to start contracting out for health care.

``This would be a different way of delivering health care,'' said Kevin Carruth, undersecretary of the Youth and Adult Correctional Agency, which oversees prisons. Asked his timeline, Carruth said, ``If we're lucky and things go well, a year plus.''

The plan is designed to help the state meet the terms of a settlement of a lawsuit by nine inmates in which the prison system has agreed to upgrade health care to its 165,000 inmates. The plan is still being shaped.

Carruth said he believes that in the long run the new scheme -- which would entail contractors in Sacramento overseeing subcontractors at different prisons -- would save money for the state, which now spends $1.1 billion a year on inmate health care.

``We've had a structure that has not historically placed health care priorities as high as other priorities,'' Carruth said. He noted that revamping the department -- set to take place in the next few months -- will help elevate health care priorities.

The notion of contracting out health services ran into immediate criticism from Sen. Mike Machado, D-Stockton. ``You guys are just hiding from the responsibility. You are putting the state at risk,'' he scolded Carruth. ``You are not being accountable to the taxpayers and yet you have the nerve to come to us and ask for money and say, `Trust us, we're going to come up with the performance standards.' ''

``You haven't given me the confidence to sit here and endorse the budget for your department,'' Machado declared to applause from the audience in a state Capitol hearing room.

Earlier, Machado tangled with Dr. Renee Kanan, corrections acting medical director, over whether she has the power to order washbasins in examination rooms. In their report, the experts determined that in some clinics at San Quentin doctors don't have access to hand-washing facilities.

``Do you have the authority to demand that wash sinks be placed in every examination room?'' Machado asked.

Kanan responded that she has required an alcohol-based material be made available for medical personnel to wash their hands with.

Machado interpreted this to mean that she doesn't have the clout to require the sinks. Later, a corrections spokesman said Kanan can order the washbasins but ``she can't do it alone.''

Kanan said the department is moving to address one of the broader criticisms raised by the investigators. In their report dated April 9, they said San Quentin does not conduct a review of each prisoner death. Kanan said she has now implemented death reviews, begun to look to hire physicians from overseas and retained a headhunter to find medical personnel for the prison system, which has many vacancies.

The report to Henderson said Dr. X ``exhibited extremely poor clinical judgment'' in three cases of extremely ill prisoners who needed to be seen in an acute hospital. ``His actions fall well below the accepted standard of care,'' the experts said. The physician was put on administrative leave after the inmate's death.

Contact Mark Gladstone at  mgladstone@mercurynews.com  or (916) 325-4314. 

Prison Clinics Called Dirty, Deadly

A report by court- appointed monitors says healthcare at San Quentin is so bad it is dangerous, sometimes fatal, to inmates.
By Jordan Rau
Times Staff Writer

April 14, 2005

SACRAMENTO — Despite a court order to improve medical care for inmates, San Quentin State Prison's health facilities and treatment practices are so harrowingly bad that many sick prisoners should not be taken there at all, independent examiners have concluded.

The court-appointed experts inspected the medical records of 10 inmates who died over the last few years in California's oldest and best known prison and concluded that in each case, the treatment "showed serious problems" and "most deaths were preventable."

Doctors and nurses misdiagnosed illnesses, gave patients the wrong medications, neglected them for months and even years or delayed sending them to emergency rooms until they were fatally ill, the experts discovered.

The examiners watched a dentist examine inmate after inmate while wearing the same pair of gloves. Records were in such disarray that doctors reported that they could not find medical files for at least 30% of the inmates they examined.

Based on visits to the prison earlier this year, the experts' April 8 report documented filthy clinics and patient housing. Dental examinations are done in a place without light or water; inmates are initially evaluated in a room without a sink for washing hands; nurses until recently used a broom closet as an examination room; and wheelchair-bound patients cannot roll into the hospital cells on their own because the doors are too narrow.

"We found a facility so old, antiquated, dirty, poorly staffed, poorly maintained, with inadequate medical space and equipment and overcrowded that it is our opinion that it is dangerous to house people there with certain medical conditions and also dangerous to use this facility as an intake facility," the experts wrote. 

The examiners found less dreadful but nonetheless extensive shortcomings with the medical care at Salinas Valley State Prison and the California State Prison at Sacramento, in Folsom. Although they found improvements, the visits uncovered some of the same management problems that plague San Quentin, including a lack of basic medical equipment, dirty facilities and a culture of indifference among some senior medical staff.

Taken together, the site reports raise major questions about California's compliance with the settlement of a lawsuit charging that inmate medical care was so poor it amounted to cruel and unusual punishment.

The case was settled in 2002 and is being overseen by U.S. District Judge Thelton Henderson in San Francisco, who appointed the monitors. 

Under the terms of the settlement, the state's prisons should already be making improvements, and must complete them by 2008.

Henderson, who last year threatened to appoint a receiver to take over the entire state Department of Corrections, discussed the reports Wednesday in Sacramento with the medical experts, state prisons commissioner Roderick Hickman and, separately, state Sen. Gloria Romero (D-Los Angeles), chairwoman of a Senate panel investigating state prisons.

Todd Slosek, a corrections spokesman, said department officials will be prepared to discuss the problems at a hearing Romero has set for today on the broader topic of prison healthcare costs.

"We're currently working with the courts to address the issues raised by the experts," he said, adding that the department has developed a remedial plan for the deficiencies found at San Quentin.

Romero said the reports make her question whether the prison system is capable of reforming itself. She noted that while $1 billion of the $7-billion annual prison budget is spent on healthcare, the reports suggest that much of this money is squandered.

"What these reports reflect is there has been a culture of negligence by the bureaucracies across the various administrations in terms of addressing the most basic healthcare needs of inmates," Romero said.

The monitors — who include doctors and nurses with experience in prison healthcare — raised the same concerns about the overcrowded San Quentin prison, which is supposed to house no more than 3,317 inmates but has a population hovering around 6,000. They noted the incredibly low expectations of the staff, who would refer to "the San Quentin way" and say that they were "making do with the hand we've been dealt" when discussing the prison's inferior clinics and equipment.

The experts also noted that the prison only emerged within the last decade from a previous federal order to improve medical care.

"The system of organizational structure within the [California Department of Corrections] that permitted this facility to deteriorate over the past 10 years to the state described in this report must be addressed as well," they wrote. "These problems have not occurred overnight."

Among the problems at San Quentin identified by the examiners:

•  Three patients who later died had been seen by the same doctor, who the experts said failed to properly treat patients with clear signs of extreme illness and did not refer them for emergency care "until their conditions had deteriorated to the point where their deaths were inevitable." The doctor, who was not named in the report, was placed on administrative leave after the third death.

•  One patient identified as having "extremely high blood pressure" was "basically neglected for over a year and a half" until he died.

•  Another patient who died from renal failure was not correctly diagnosed for "an extended period" and then was not given dialysis. He was, however, given medicines that were not safe for him.

•  A diabetic inmate with a foot problem was housed in the mental health unit because there were no empty beds in the medical unit. There, his shoes were taken away, as is customarily done with psychotic and suicidal patients, even though his bare foot was then made more vulnerable to damage. 

The experts found less serious but still inadequate conditions at Salinas. Their report said the Corrections Department had increased doctors' hours to reduce the backlog of untreated inmates.

Still, the experts concluded that high nurse and medical assistant turnover and vacancies undermined prompt examinations, with appointments often rescheduled and new patients not being referred to physicians.

"The fact that healthcare staff has difficulty obtaining basic medical supplies for clinic operations is completely unacceptable, and helps explain staff exasperation and frequent turnover," the experts wrote. 


Overseer may be needed for prison health care, experts say

By Don Thompson
5:09 p.m. April 14, 2005

SACRAMENTO – Health care conditions at California prisons are so bad a federal judge should consider appointing an overseer to manage the system before more inmates die of neglect or ill-treatment, experts and angry state lawmakers said Thursday.

Top prison administrators acknowledged they can't manage the prison medical system, but said outside consultants signed contracts this week to help. But even basic improvements are 18 months away, Youth and Adult Correctional Agency Undersecretary Kevin Carruth told a Senate hearing.

"Does it bother you in the next 18 months we're probably going to have even more deaths? Does it bother you?" asked Senate Majority Leader Gloria Romero, D-Los Angeles, who chaired the joint hearing of two prison oversight committees.

U.S. District Judge Thelton Henderson should hold the state in contempt or appoint a receiver to force the state to comply after court-appointed experts reported that inmates are dying for lack of basic care, said Don Spector of the Prison Law Office, an inmate rights law firm that was party to the settlement.

Romero said Henderson told her Wednesday he has a "dire concern over the ability and commitment of this prison bureaucracy to fix it." Henderson last year threatened to appoint a receiver to take over the entire state Department of Corrections, but has not done so.

"The reports are abominable, they are damning ... (portraying) a system so broken that is an actual threat to inmates, to the staff that work there, to the public," Romero said, noting experts' conclusion that "at least 30 inmates have died from preventable causes."

The deputy director who manages Corrections' Health Care Services Division, Dr. Renee Kanan, agreed a federal overseer should be considered, after acknowledging she can now only recommend improving even basic sanitary conditions that the experts found appalling and dangerous.

Sen. Mike Machado, D-Linden, was furious at the lack of progress in complying with a federal court order more than a year old.

"You guys are just hiding from the responsibility; you're putting the state at risk; you're not being responsible to the taxpayer," Machado told the officials.

Sen. John Campbell, R-Irvine, said, "The system needs to be changed, blown up, whatever it is, so we get a standard of care that is acceptable."

The experts said administrators at Marin County's antiquated San Quentin State Prison have had a year to comply with a court order to improve medical care, yet compliance was "nonexistent." Conditions there are so poor they said the number of inmates should be limited, an outpatient unit should be closed or used for nonmedical purposes, and new inmates should be processed at some other prison.

Things are better, and improving, at Salinas Valley State Prison and the California State Prison at Sacramento, in Folsom, yet still don't meet the progress expected after a year, the experts reported. The settlement requires that all 32 prisons provide adequate health care by 2008.

California's $1.1 billion inmate health care system is among the nation's worst, yet the state spends two or three times more per inmate as do other states, Romero said the experts told her Wednesday. The experts did not testify about their inspections, the first in their series of reports on the state's compliance.

Carruth said the reports are both "scathing" and "accurate."

"We are not appreciably better than we were 14 years ago," when the first in a series of suits challenged the state's inmate medical care, Carruth acknowledged. "It is not our area of expertise, frankly," which is why the state is seeking advice from the University of California medical system and the state Department of Managed Care.

"We are going to move as expeditiously as we possibly can, given the constraints we have to live under," Carruth said.

Kanan, who has directed the prison health care system for six months, said she had believed providing more and better doctors and nurses was the biggest problem.

But the experts' reports show even more basic reform is needed, she said. The experts found examining rooms with no sinks, employees who had to walk through sewage puddles or shower rooms to examine inmates, doctors who wore the same gloves and used the same tongue depressors to treat multiple inmates. Medical records were missing for at least 30 percent of inmates.

Inmates literally died of neglect or, worse, harmful medical treatment, said Spector, of the Prison Law Office.

"The medical care is so bad that more inmates are dying from medical neglect than are dying from violence," he said. "Being sent to prison is literally killing people."

On the Net:

California Youth and Adult Correctional Agency:  www.yaca.ca.gov

California Department of Corrections:  www.corr.ca.gov

Prison Law Office:  www.prisonlaw.com/

Business Wire

October 06, 2004 06:23 PM US Eastern Timezone 

Medical Board of California Obtains Suspension of Soledad Physician's License 

SACRAMENTO, Calif.--(BUSINESS WIRE)--Oct. 6, 2004--On October 4, 2004, Administrative Law Judge Jonathan Lew signed an order which prohibits Soledad physician Isaac A. Grillo, M.D. from practicing medicine; possessing, prescribing, dispensing, furnishing, administering, or otherwise distributing any controlled substance or any dangerous drug; and possessing or holding his physician wall and wallet certificates, any triplicates and regular prescription blanks, DEA order forms, and any DEA permits. Grillo has been ordered to appear at the Office of Administrative Hearings in Oakland on October 22, 2004 to show cause why the suspension of his license to practice medicine should not be extended. 

The Medical Board had filed an accusation against Grillo alleging unprofessional conduct through gross negligence and incompetence in that he failed to diagnose a cervical spinal injury of a prisoner at Soledad prison who had suffered a subluxation of C4-C5, resulting in quadriplegia. The board later adopted a stipulated settlement and disciplinary order, which imposed a public letter of reprimand with a condition precedent: successful completion of Phases I and II of the Physician Assessment and Clinical Education (PACE) program at the University of California at San Diego. 

In a September 8, 2004 communication to the board from the Director and Associate Director of the UCSD Pace Program, the board was informed that serious deficiencies were noted during Grillo's assessment by the PACE faculty/staff. The assessment report noted that at a multi-disciplinary staff meeting on September 1, 2004, the director and other participants "expressed grave reservations about whether Dr. Grillo should be practicing medicine" and that the "deficiencies documented during his two-day Phase-1 PACE Assessment, if applied in the real world of medical practice, would almost certainly have resulted in patient harm, and perhaps even death." The report also stated that Grillo's serious deficiencies of clinical knowledge and judgment extended beyond the limited scope of the PACE Program's five-day clinical education and that as a result, "may require additional training or monitoring either in residency, fellowship, or some other proctored environment." 

The mission of the Medical Board is to protect healthcare consumers through the proper licensing and regulation of physicians and surgeons and certain allied healthcare professions and through the vigorous, objective enforcement of the Medical Practice Act. 

If you have a question or complaint about the healthcare you are receiving, the board encourages you to visit its Web site at  www.caldocinfo.ca.gov , or for questions call the Consumer Information Line at 916-263-2382, or with complaints call 800-633-2322.


Relatives of Dead Inmate to Sue State
The man died after having a tooth pulled. Legislators hold a hearing on prison healthcare and criticize the system's quality.
By Jenifer Warren
Times Staff Writer

September 30, 2004

SACRAMENTO — The family of a California inmate who died after he had a tooth pulled said Wednesday that they were suing the state over his death, as two legislators held a Capitol hearing to investigate why prison healthcare remains poor but increasingly expensive.

Relatives of Anthony Shumake, 41, said they would file a wrongful-death lawsuit because a medical pathologist's report showed that he died of complications from the extraction.

The report from the San Joaquin County coroner's office showed that Shumake died June 28 after his airway was constricted by an abscess in his throat. In an interview, Dr. Robert Lawrence, a pathologist, said a "rip-roaring infection" had caused extensive swelling, reducing air flow.

"The airway was not sufficiently open to allow a free flow of oxygen," Lawrence said. "The lack of oxygen caused the heart to go into a fatal rhythm." 

Shumake's relatives said other inmates told them that they had tried to get medical help for Shumake in the days after the dental work, as his neck turned red and swollen and he complained of continuing pain. But those requests, they said, went unheeded at Solano State Prison in Vacaville until he fell into respiratory distress and an ambulance was finally called.

Prison officials would not comment on the case, saying that an internal investigation was underway.

"It's been very hard for our family to see a healthy young man have a tooth pulled and then wind up dead," said the Rev. Andre Shumake, the inmate's uncle and a neighborhood activist in the Bay Area city of Richmond. "Anthony was given a prison sentence, not a death sentence. These men may be inmates, but they're human beings."

The Shumake family traveled to Sacramento for a hearing that examined healthcare in the $6-billion California correctional system. Among the topics covered were reports from the California Medical Board, which licenses and disciplines doctors, that showed that one in five prison physicians had a blemished record or had been sued for malpractice.

That 20% rate is almost five times the figure statewide, the board said. Legislators called it unacceptable and indicative of a system in distress.

"To put it very bluntly and very simply, the healthcare system at the California Department of Corrections is sick," said state Sen. Jackie Speier (D-Hillsborough).

Sen. Gloria Romero (D-Los Angeles), co-chairwoman, with Speier, of the hearing, agreed. "The sad fact is California has been growing its inmate population but has failed to provide adequate healthcare for those we lock away," she said. 

Under questioning by the senators, corrections officials acknowledged that major problems remain with the network of clinics, hospitals, treatment centers and outside medical contractors that cares for the state's 164,000 inmates.

Dr. Renee Kanan, chief of healthcare for the system, said that "historically, our modus operandi has been very reactive. We've had plenty of fragmented exit strategies, but we've never had a comprehensive strategic plan."

But progress has been made, she said, since a class-action lawsuit, which was settled in 2002, alleged that California's prison healthcare amounted to cruel and unusual punishment.

The changes include tighter screening and monitoring of physicians and creation of an oversight committee to track healthcare costs, which have nearly doubled over the last five years and could hit $1 billion this year.

"We know we have many challenges in our efforts to provide quality healthcare," Corrections Director Jeanne Woodford testified. "We want to fix what this committee has called a broken system … and become known as a state that uses the best practices in all aspects of its healthcare system."

Speier and Romero, who have conducted hearings focused on problems in the prisons, did not appear to be patient. They said that the Department of Corrections had been sued over healthcare numerous times over the last two decades, and that it seemed as if only court-imposed mandates had forced change.

Speier asked why the federal government had been able to reduce its prison healthcare costs while the state's costs had soared — a question to which she received no clear answer.

"The scratching of heads is no longer acceptable," Speier said. "It is time to realize what [the prisons'] healthcare policies and practices are costing each and every Californian."

One major challenge facing prison doctors is the condition of patients. Inmates tend to be sicker than the population at large, often because of unhealthy habits and a lack of medical care earlier in life. One in five has a serious mental illness; one-third are infected with hepatitis C. The rate of HIV/AIDS in prison is five times higher than the national average.

Dr. Jacqueline Tulsky, a professor at UC San Francisco Medical School who has studied prison healthcare, described the average California inmate as a 40-year-old male who is a high school dropout with alcohol addiction, a history of crack cocaine use and mild depression. His medical problems probably include hypertension, diabetes, elevated cholesterol levels and mild arthritis. Periodically, he needs treatment for injuries incurred on the prison yard.

"No healthcare plan in this state," Tulsky said, "has the severity of illnesses you find in the Department of Corrections." 

Several prison doctors cited other crucial differences, including a shabby infrastructure that makes practicing medicine difficult at best. Dr. Scott Anderson, who works at the California Medical Facility, a prison in Vacaville, said physicians sometimes lack essentials as basic as an examining table, soap and towels with which to dry their hands.

A severe shortage of nurses and medical technical assistants, who provide security as well as clinical help, also affects care, he said. And perhaps the greatest problem facing prison physicians is technological: the absence of computers to track inmate medical records, view X-rays and help with medical decisions.

Corrections officials agree that working conditions are not ideal. They said that plans to give each prison doctor competency testing should root out those unfit to practice.

Doctors who testified criticized the plan, warning that it could have the paradoxical effect of driving good doctors out of the system. Anderson said he considered his board certification in specialties such as rheumatology and geriatrics a sufficient validation of his skills.

"I certainly don't want to practice with doctors who are not competent," Anderson said. "But I'm troubled by the thought of going through testing that might be arbitrary, capricious … and may lead to a dark mark on our record that would follow us for life."


Posted on Wed, Sep. 29, 2004 

California should mimic federal prison health care, senators say


Associated Press

SACRAMENTO - Health care costs at California's prisons have nearly doubled in five years even as inmates die at the hands of unqualified doctors, senators said Wednesday at another hearing into the state's troubled corrections system.

In one case in February, a 72-year-old inmate starved to death in front of health care workers.

In June, a 41-year-old inmate died six days after having a wisdom tooth pulled, and after being shuttled more than two hours to medical care instead of being rushed to either of two closer hospitals.

"My nephew, Anthony Shumake, had a tooth pulled and now he is dead," the Rev. Andre Shumake told senators. Shumake "was given a prison sentence, not a death sentence. ... No one should have a tooth pulled and die in this day and age."

Shumake's fate shows the worst of the system that wastes millions of dollars a year but still brings poor results, said Sen. Jackie Speier, D-Daly City.

California should emulate the federal prison system, which has cut per-inmate spending amid rising medical costs, senators said during the hearing.

While they downplayed suggestions by Gov. Arnold Schwarzenegger's Corrections Independent Review Panel to privatize inmate health care in cooperation with the University of California, they said private and university experts should be recruited to recommend reforms.

Taxpayers will spend $1 billion this year to provide health services to the 164,000 inmates in the nation's largest state prison system, the fastest-growing component of the state's annual $6 billion corrections budget.

For all that money, inmates receive poor care often by doctors untrained for the positions they hold, according to a recent audit. Twenty percent of those physicians have malpractice or disciplinary problems.

Speier, who heads a government oversight committee, co-chaired Wednesday's hearing with Sen. Gloria Romero, D-Los Angeles, who leads a corrections review panel.

Their joint hearing is the seventh in 18 months on a system where management and spending is out of control, say auditors, national experts, Senate witnesses and a federal court monitor.

The administration, which says reforms are underway, recently settled the latest in a series of lawsuits over inmate health care. Recommendations by the prison review panel headed by former Gov. George Deukmejian are under review by the administration - though not quickly enough, the senators said.

It's a complicated problem, Romero said, because inmates are frequently in poor health, and diseases such as tuberculosis, AIDS and hepatitis can spread easily. Also, care must be provided in remote locations under extraordinary security restrictions. Inmates frequently are mentally ill or drug addicted, and strict sentencing laws are turning some prisons into "nursing homes" for geriatric patients.

California fights these problems with a "mind-blowing" lack of modern medical technology, including virtually nonexistent use of computers, the Internet, even cell phones and voice mail that can stall coordination and communication across the system, testified Dr. Jacqueline Tulsky of the University of California, San Francisco.

Still, the biggest problem is a prison medical staff that often is "barely licensable," Tulsky said. But several prison doctors denied the majority of physicians are unqualified, blaming problems instead on prison bureaucracy and a lack of equipment, nurses and medical technicians.

In July, a state audit found California prisons paid local hospitals as much as eight times more than Medicare would have paid for the same medical procedure, leading to an average 21 percent annual increase in health care costs the last five years.

"The (federal) Bureau of Prisons was in a position very similar to what the California system has seen" because of its rapid uncoordinated growth, testified Theodore Willich, vice president of a private federal health services contractor, Medical Development International. "It really just got out of control."

Senators said the state could cut costs as the federal government has, by paying only Medicare rates and providing care at prison infirmaries instead of outside hospitals. The state should have more centralized control over health care instead of having 32 decentralized prison "fiefdoms."

Schwarzenegger's administration says it's already doing more of that, leading to a projected $26 million cut in medical costs this year.


California Department of Corrections: http://www.cdc.state.ca.us


Scathing Report on Prison Doctors
A panel of experts ordered by court to review state system calls physician quality 'seriously deficient'
By Tim Reiterman
Times Staff Writer

August 11, 2004

SAN FRANCISCO — Incompetent doctors, including some with a history of substance abuse or mental health problems, have been hired by California's prison system and have contributed to serious deficiencies in healthcare for inmates, according to a federal court report released Tuesday.

At one facility, half of the eight doctors had prior criminal charges, loss of privileges at community hospitals or mental health problems, the panel said. At another, seven of 20 doctors had similar problems. 

"There appears to be an emerging pattern of inadequate and seriously deficient physician quality" in prisons, a panel of experts said in a letter to U.S. District Judge Thelton Henderson, who ordered the report as part of a civil rights suit alleging substandard medical care for inmates.

A panel of two doctors and a nurse practitioner conducted reviews of medical treatment at about half a dozen of the state's 32 prisons. They concluded in a July 16 letter to the judge that the department had hired many incompetent doctors with a history of problems, then failed to monitor them, putting inmates at serious risk of injury or death.

"The only requirement for hiring is a medical license," said the letter.

California Department of Corrections officials said they were formulating a plan that would improve prison medical services, the fastest-growing part of the $5.7-billion state prison budget. 

"There will be remedial training and greater clinical supervision … and a stricter adherence to department policies," said spokeswoman Margot Bach. "The department … takes the healthcare of inmates very seriously."

The panel concluded that many doctors were not trained to administer the treatments they were providing inmates, some with serious illnesses. The report did not name the prisons or the doctors. 

"An incompetent retired cardio-thoracic surgeon manages complex internal medicine patients and makes serious life-threatening mistakes on a continual basis," the report said.

The panel also cited the case of an obstetrician who was managing HIV patients and a neurosurgeon who was seeing patients with internal medicine problems, although he was not trained to read electrocardiograms used in internal medicine.

"It could be named the Keystone Docs," said state Sen. Jackie Speier (D-Hillsborough), who has scheduled hearings on the corrections healthcare system for next month. "If it was a want ad, it would say something like, 'Bad doctors apply here. No one turned away.' "

The prison healthcare budget for this fiscal year is $879 million. Officials say rising costs are a result of the growing and aging inmate population, as well as increased spending for prescription drugs, medical treatment and court-mandated services.

The Corrections Department agreed 2 1/2 years ago to settle a lawsuit brought by the Prison Law Office, a Marin County civil rights group, on behalf of the state's 163,000 inmates. That plan is projected to cost tens of millions of dollars a year, and, among other things, calls for putting nurses in prison clinics around the clock.

The findings by Henderson's medical panel surprised even Don Spector, executive director of the Prison Law Office. "It was worse than we thought," he said. "We always knew there were physicians who had no business practicing medicine, but we did not know it was this pervasive."

Henderson is expected to hold a conference on the panel's report and the state's remedial plans this month.

The report described a system in which individual prisons operated with great autonomy and little oversight. The corrections official in Sacramento with final word on hiring was not a doctor. Only one of the prisons reviewed had its chief physician and surgeon's position filled — and that doctor was an ophthalmologist who was training doctors in internal medicine.

At individual prisons, the report found, doctors with training deficiencies were hiring and overseeing the work of other prison physicians. "At one of the facilities reviewed, the vice chairman of the committee that oversees credentialing is an obstetrician who had lost his license for seven years for incompetence and alcoholism," said the report, adding that he oversees doctors practicing internal medicine although he has no experience in that area.

The union that represents about 600 prison doctors, dentists and psychologists blamed quality problems on cost cutting by the state, which has led to the hiring of contract physicians rather than civil service doctors.

"Contract doctors are most of the problem," said Dr. Robert Weinmann, president of the Union of American Physicians and Dentists. "We have a recalcitrant state system. They want to hire and fire locally at will with no benefits."

The panel and Spector of the Prison Law Office gave high marks to the new acting head of the state's prison healthcare services, Dr. Renee Kanan.

But, Spector added, "she is one person in a gigantic system with more bureaucratic hurdles than you can imagine."

Reports show poor medical care in state's prisons 
Incompetent doctors called systemwide problem 
- Mark Martin, Chronicle Sacramento Bureau
Wednesday, August 11, 2004 

Sacramento -- Half of the doctors working at one California prison have a criminal record or mental health problems or have lost the right to practice in a hospital. 

At another lockup, a neurosurgeon with no expertise in internal medicine misdiagnosed an inmate suffering from pneumonia in both lungs, prescribing anti-depression medicine that nearly killed him. 

And an obstetrician who lost his medical license for seven years helps determine whether problem physicians at one prison should remain on the job. 

Adding more bad news for a scandal-plagued state prison system, two reports released Tuesday depict a corrections system rife with unqualified doctors working in poor conditions. The reports were made public by a Marin County law office that sued the state over prison health care. They add to mounting evidence that California's troubled prisons run a medical operation with out-of-control costs that often fails to provide basic health care for 162,000 inmates. 

The reports come on the heels of the mysterious death of an inmate at a Vacaville prison who apparently died after having a tooth pulled. The death has the inmate's Richmond family and some lawmakers questioning whether health care providers at the prison made mistakes with deadly consequences. 

On Tuesday, state Sen. Jackie Speier, D-Hillsborough, called the reports' findings "shameful.'' 

"It's Keystone Docs,'' said Speier, who has become a frequent corrections critic and who is looking into the June 28 death of Solano State Prison inmate Anthony Shumake. 

The reports were commissioned by the Marin-based Prison Law Office, which represents inmates and in 2001 sued the state Department of Corrections over shoddy medical practices. The lawsuit was settled in 2002 after the department agreed to dramatically reshape its health care program. 

As part of the oversight of the settlement, three independent prison health experts -- Dr. Michael Puisis of Illinois, Dr. Joe Goldenson of San Francisco and Madie LaMarre, a nurse from Georgia -- this year reviewed medical procedures at several prisons and at department headquarters. Among the findings compiled in two reports: 

-- At one prison, an obstetrician sees HIV patients. At another, "an incompetent retired cardiothoracic surgeon manages complex internal medicine patients and makes serious life-threatening mistakes on a continual basis,'' according to the report. 

-- Doctors in one unit at Salinas Valley State Prison in Soledad (Monterey County) must conduct exams while inmates remain in their cells, meaning the only way to touch an inmate is through a 4-inch by 12-inch food port. Health clinics at Salinas Valley and Sacramento State Prison have no examination tables. 

-- At Sacramento State Prison, forms inmates file to request a visit with a doctor were found piled up on a desk and had not been reviewed in months. At some facilities, according to the report, there is no chief physician, and therefore "physicians monitor themselves.'' 

The reports' authors were unavailable for comment Tuesday, and many of the allegations in the reports did not include names of doctors, prison locations or other details. 

But corrections officials did not dispute the reports' findings, instead saying they are working on a response plan that will be presented later this month to U.S. District Court Judge Thelton Henderson, who is overseeing the implementation of the settlement. 

Margot Bach, a spokeswoman for the Department of Corrections, said plans are already being developed to improve supervision of doctors from department headquarters and ensure that doctors are only working with inmate maladies that they are qualified to diagnose. 

This is not the first indictment of the prison system's medical system. 

Composing about 20 percent of the Corrections Department's $6 billion annual budget, health care services have been blasted for being too expensive and, at times, deadly. Prisons typically employ several primary care doctors and contract with specialists for services. 

The state auditor reported in April that three-fourths of medical contracts doled out by the department were not competitively bid, and many prisons fail to review whether providers aren't over-billing the state. 

A lengthy review of the entire prison system commissioned by Gov. Arnold Schwarzenegger called for dismantling and rebuilding corrections' health care administration. 

And a largely confidential report conducted by a state prison watchdog agency reviewed by The Chronicle earlier this year suggested that three deaths at a Corcoran (Kings County) prison during the last two years could be attributed in part to medical negligence. 

Both prison officials and a representative of a union that represents about 600 state corrections doctors say the state faces some of its health care problems because of its inability to hire enough good doctors, leading to many vacancies and forcing some spots to go to physicians with checkered pasts. 

Corrections physicians typically earn about $134,000 a year -- a salary that isn't enough to lure many doctors to work inside prison walls, said Gary Robinson, executive director of the Union of American Physicians and Dentists. 

"Who wants to work inside a prison, most if which are located in the middle of the desert?'' Richardson said. 

Speier, who heads a Senate government oversight committee, said she has begun communicating with some of the state's largest health maintenance organizations in hopes of persuading them to loan executives to help provide advice to change the system without having to raise costs dramatically. 

"There is plenty of expertise in this state,'' she said. "Right now, we have a system with extraordinary costs, extraordinary liability and very poor care.'' 

E-mail Mark Martin at  markmartin@sfchronicle.com.

URL:  http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2004/08/11/BAG0G85QLF1.DTL


Posted on Sat, Jul. 03, 2004 

Legislator to investigate prison inmate's death

By Karl Fischer and Rebecca Rosen Lum

An aide for Assemblywoman Loni Hancock, D-Berkeley, said Friday her office intends to investigate the death of a prison inmate from Richmond who had a dental infection so severe that he could not swallow for days before officials sent him to an outside hospital.

A report from the ambulance that took 41-year-old Anthony Shumake from California State Prison Solano in Vacaville to a Manteca hospital on Monday stated that his neck "was swollen and red in color down to his clavicle ... patient was also spitting up gray sputum." Shumake died hours later at the hospital.

"The way it was handled raises some serious questions," said Hans Hemann, Hancock's chief of staff. "We'll be looking into it very thoroughly. It raises questions about the entire system as well as for this one family, who must be going through unbelievable anguish."

Prison officials said Friday state law forbade them from commenting about a prisoner's medical issues, adding that the facility's medical staff followed procedure after finding they could not properly care for Shumake.

But the death prompted mistrust and criticism from parts of Richmond's political establishment, led by the Rev. Andre Shumake, a prominent Iron Triangle activist and the prisoner's uncle.

Family members said prison officials have told them next to nothing since sending a telegram Tuesday morning informing them that Anthony Shumake had died and that the body would be cremated if they did not retrieve it.

"There has been tremendous negligence. Now it seems like they're trying to cover everything up," the Rev. Shumake said. "They didn't even have the decency to knock on the door."

Prison officials and the San Joaquin Coroner's Office said Friday they would not release the cause of death for several weeks. Several inmates who knew Shumake told the family he died of heart failure.

Prison doctors did not find that Anthony Shumake needed emergency medical care, but did need care the facility could not provide, Department of Corrections Lt. Mary Neade said. So they called for a basic life-support ambulance to take Shumake on a two-hour ride to Doctors Hospital in Manteca, a facility with which the prison contracts.

"When an inmate is sick we try to treat him here. If the ... medical department feels he can't be treated here, we send them out to the hospital," Neade said. "If staff determines he needs immediate attention, they call 911 and he's treated at the nearest hospital."

The ambulance company did not return calls Friday. A hospital spokesman said the cause of death remained officially "undetermined" pending results of the coroner's autopsy and toxicology tests.

Shumake told the ambulance crew that he'd had a tooth pulled six days earlier and that his wound had become infected, according to the report. The swelling in his neck made it impossible for him to eat and difficult for him to breathe.

The private ambulance crew checked Shumake's vital signs three times during the trip and found no significant changes, the ambulance report shows.

It was the second prisoner death of the year at Solano, a medium-security prison housing about 6,000 prisoners, Neade said. In January a terminally ill prisoner died of natural causes at an area hospital.

Records show Shumake was serving a 12-year, eight-month sentence for convictions in 2000 of corporal injury to a spouse, stalking and drug possession, as well as a parole violation from a 1994 attempted robbery conviction.

Reach Karl Fischer at 510-262-2728 or  kfischer@cctimes.com . Reach Rebecca Rosen Lum at 510-262-2713 or  rrosenlum@cctimes.com


Inmates' Medical Tab Nears $1 Billion
Breast reduction surgery for a male prisoner is among the stories that outrage lawmakers.
By Evan Halper
Times Staff Writer

June 2, 2004

SACRAMENTO — As medical bills for the state prison system approach $1 billion a year, lawmakers Tuesday called into question the use of tax dollars for procedures such as a male inmate's breast reduction surgery and skin treatments at a Beverly Hills dermatologist. 

Paying millions to shuttle prisoners to hospitals hundreds of miles from where they are locked up also faced criticism. 

With inmate healthcare spending nearly double what it was in 1999, lawmakers are demanding immediate changes to bring costs into line.

"Even if it weren't a tight budget year, this would be something that is absolutely unacceptable," said Assemblywoman Wilma Chan (D-Alameda).

The attacks on prison spending came at a joint legislative hearing and followed a state audit released in April. The audit revealed that prison officials seek competitive bids for less than a quarter of the contracts they enter into with hospitals, and may be routinely paying claims for services never provided. 

The state prison system runs 32 facilities with 160,000 inmates, and healthcare accounts for a significant chunk of its $6-billion annual budget. 

Prison officials challenged some of the accusations made by lawmakers, but acknowledged that reforms were needed. "We are using the recommendations contained in the Bureau of State Audit report as a blueprint for change," said Jeanne Woodford, director of the Department of Corrections. 

Those recommendations include imposing rules to ensure that contracts are negotiated competitively and imposing uniform treatment standards spelling out what is appropriate and when. 

But Woodford warned that the department must abide by a number of court judgments requiring it to provide medical care that may seem excessive. 

"We are under court mandates affecting our services," she said. 

In many cases, officials say, they are unable to attract trained doctors and nurses to work in the prisons and are left no choice but to enter into costly contracts with distant hospitals.

Prison officials also pointed out that the system must tend to thousands of patients requiring special care, including those with AIDS and other diseases, elderly inmates, prisoners in need of transplants, and paraplegics and quadriplegics. 

Lawmakers, however, say the department can do better. 

"We need to protect the constitutional rights of the prisoners, but excuse me, as a taxpayer I have constitutional rights too, and these guys are getting care that I don't even get," said Assemblywoman Rebecca Cohn (D-Saratoga). 

Some legislators pointed out that at the same time prisons are entering into contracts with private healthcare providers with no discernible cost controls, many prisoners are unable to get the most basic treatment.

Sen. Jackie Speier (D-Hillsborough) said she was frustrated to learn — through a tip to the Legislature's government oversight hotline — that just last Thursday a prison inmate had received breast reduction surgery at the same time the department has had to eliminate efforts to curb tuberculosis. 

"I understand lots of inmates at this particular prison have undergone this procedure," Speier said. Prison officials say they do not authorize any surgery unless it is absolutely necessary; any treatment that is out of the ordinary must be approved by a team of physicians and headquarters.

"Certainly our policy is not to perform cosmetic surgery," said Renee Kanan, who oversees healthcare services for the department. "But there may be some mitigating factors in this particular case." 

Speier shot back: "I can't imagine the necessity for breast reduction surgery in a male inmate." 

Cohn demanded that the department tally up the cost for acne and other treatments provided to inmates by a Beverly Hills dermatologist. 

The department did not have the figures at the hearing, but Kanan said there are instances where such treatments are medically necessary. 

"There are severe cases of acne that are disfiguring," Kanan said. "There would be some circumstances where it would be appropriate medical treatment." 

Lawmakers also called on the department to find ways to provide care for inmates closer to the prisons. Sen. Gloria Romero (D-Los Angeles) estimates that the state is wasting millions of dollars by contracting with hospitals hundreds of miles away instead of taking advantage of facilities nearby or providing adequate care in their own clinics. 

In fiscal 2002-03, for example, the state spent more than $8.7 million transporting inmates to and from hospitals. 

Prison officials said they are working on ways to contain those and other costs — but cautioned lawmakers to be patient.

Woodford said the administration is talking to University of California officials about a plan "to partner with them to create a healthcare system that is more accountable and cost effective." 

Assemblyman Todd Spitzer (R-Orange), however, said the auditor's report came out two months ago, and the state Corrections Department should have a clear plan for moving forward by now. 

"This is what people hate about government."


Diseases Can't Be Locked In

June 1, 2004

Over recent months, legislators in Sacramento have taken Californians to some pretty grim places in hearings on the state's 32 prisons. No corridor of the $6-billion correctional system is likely to be darker than the one lawmakers plan to explore today. 

A joint Senate-Assembly committee will examine profound problems in the prisons' healthcare delivery system, including the tuberculosis and hepatitis C that inmates may carry back to their communities.

Although taxpayers pay nearly $1 billion a year to provide medical care to the state's 162,533 inmates, up from $600 million just three years ago, the extra money hasn't always bought better health. 

Consider the arrival of an inmate with infectious tuberculosis in December at Solano State Prison in Vacaville, west of Sacramento. Although Shasta County jail officials had accurately diagnosed and medicated him after he was arrested, he arrived at Vacaville with no TB medications, no TB culture results and no medical records, and infected up to 10 people, according to the California Conference of Local Health Officers, which monitors public health threats.

That does not mean TB runs rampant in the prisons, but it underscores the need to revive the prisons' own Public Health Service, a 40-person unit that had been tracking and treating infectious diseases until it was disbanded in October because of budget cuts.

The prisons also need to grapple better with an epidemic of hepatitis C, which is spread mostly through dirty drug needles and sexual contact. As of two years ago, top prison officials say, the disease had infected an incredible 1 in 3 state prison inmates. 

Currently, there is too little testing for and treatment of hepatitis C, and county health officials accuse prisons of fobbing off sick parolees on county health systems. 

Poor management goes beyond tracking and treating disease. State prison auditors have described a pattern of overpayment for medical services inside and outside prisons. In the last two years, only a quarter of prison contracts with medical providers were competitively bid, according to a report in April.

A related failure is the lack of a bulk purchasing system to drive down inmate prescription drug costs. California taxpayers pay 66% more to buy medications for inmates than the federal Department of Veterans Affairs does for drugs for former military personnel.

The Schwarzenegger administration has produced some good longer-term ideas. These include possibly turning over prison healthcare to the University of California or a managed-care provider.

First, however, legislators, prison officials and the administration should rein in uncontrolled costs, as well as find money to shore up detection and treatment in prisons. Diseases brought into prison or contracted there should be dealt with there.

Scathing report on prison health care still not out 
Agency suggests negligence in deaths at Corcoran facility 
Mark Martin, Chronicle Sacramento Bureau
Thursday, February 26, 2004 
©2004 San Francisco Chronicle

URL:  sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2004/02/26/MNG2P58ILF1.DTL

Sacramento -- The death last week of an 80-pound inmate at a prison in Corcoran who hadn't eaten in 40 days might not have surprised California corrections administrators. 

More than a year ago, a state prison watchdog agency issued a blistering confidential report on health services at the facility, suggesting three inmate deaths in the previous two years could be attributed in part to negligent medical treatment. 

Detailing conditions at the Substance Abuse Treatment Facility in Corcoran, the report chronicled a health department in disarray. The report, a copy of which was reviewed by The Chronicle, has not been publicly released by Gov. Arnold Schwarzenegger's administration. 

Problems ranged from lax oversight that has led to the wasting of millions of taxpayer dollars to full-time doctors who see only a handful of patients and continually sleep on the job, according to investigators with the Office of the Inspector General. 

Now an inmate is dead after apparently slowly starving himself to death, and prisoner advocates are wondering just what it will take to improve medical treatment at the Substance Abuse Treatment Facility in Corcoran. 

A Bay Area lawmaker who is leading the charge to reform California's troubled corrections system is demanding that Schwarzenegger publicly release the inspector general's report. 

"I'm becoming concerned that the administration is either dragging its feet or covering something up,'' said state Sen. Jackie Speier, D-Hillsborough, who has been asking for several inspector general reports for more than a month. "What are they hiding?'' 

A spokeswoman for Schwarzenegger said administration lawyers would likely release the reports to Speier -- and the public -- but were redacting names and other information that might be relevant to ongoing prison investigations. 

Meanwhile, corrections officials say they're still trying to determine exactly what happened to Khem Singh last week. Singh, 72, had been on and off hunger strikes since he was sent to prison in 2001. A Sikh priest who lived near Modesto, Singh was serving a lengthy sentence for lewd and lascivious conduct with a child under 14. 

Before dying, he had not eaten in 40 days, according to Patrick Hart, chief deputy district attorney for Kings County. Prison documents indicate he was removed from his cell Feb. 14 and taken to a local hospital, where he died two days later of heart and lung failure attributed to starvation. 

Corrections officials say Singh had been in and out of a medical clinic at the prison but was not there this month. 

"After 40 days, you would think he would have been in the hospital,'' said Kelly Santoro, public information director for the prison. 

Hart said his office has determined there was no criminal negligence by prison staff, but sources said Wednesday the inspector general's office had begun a probe this week. The office reports to the governor and conducts financial audits and investigations of prison issues. 

Prisoner advocates say death by starvation is something that shouldn't happen in modern prisons. 

"You don't just starve to death overnight,'' said Don Specter, executive director of the Prison Law Office. "This amount of inattention is inexcusable. '' 

State prisons do have policies to handle inmates on hunger strikes -- the policies were created after Specter's office won a 2002 class-action lawsuit alleging inhumane medical conditions in all state lock-ups. An internal review is determining whether prison medical staff correctly followed procedures, said Rosanne Campbell, deputy director of health care services for the Department of Corrections. 

It's not the first time health care at the facility has been investigated. 

Lesser known than its neighbor, Corcoran State Prison, the Substance Abuse Treatment Facility houses more than 6,200 inmates. 

Last January, investigators with the inspector general issued a report that concluded medical services there were inexcusably bad. A probe that lasted more than a year found full-time doctors paid more than $90,000 annually were only available to inmates 12 hours a week and full-time dentists spent most of their days outside the prison at private practices. Among the other findings: 

-- Three inmate deaths may have been caused in part by lax medical care. One inmate with a blood disorder was found lying prone in his cell in May 2001 and told a nurse "he couldn't go on,'' according to the report. The nurse told him to see a doctor the next day. He was later found vomiting blood and was pronounced dead soon after in the prison emergency room. 

-- One inmate in 2000 was diagnosed with tuberculosis, a highly contagious disease, but not isolated from the prison population for more than a year. Two guards and an inmate later tested positive for TB. 

-- Investigators witnessed pharmacy workers throwing away 30-pound garbage bags full of medication. They determined costly drugs were shipped to the prison for inmates who had been transferred or released in the same fiscal year that pharmacy spending at the prison exceeded the allotted budget by 211 percent, or more than $3 million. 

Corrections officials say they have a comprehensive plan to address each issue raised by the inspector general's report and review progress monthly. Included in the plan are establishing working hours for medical personnel and better tracking systems for medications. 

"A lot of it was oversight, and we're monitoring all of that,'' Campbell said. 

She said it would be "premature'' to say that the recent death at the facility shows that progress in improving medical care had been slow. 

"We're looking into it, and if we still see gaps (in care) we will address that,'' she said. 

But Speier said Singh's case may show yet another example of problems within corrections that never seem to be fixed. 

She and Sen. Gloria Romero, D-Los Angeles, held hearings in January highlighting a code of silence within prisons that prevents the system from policing rogue guards, a subject that came up in legislative hearings nearly a decade ago. And the state is in legal trouble for failing to change some procedures at Pelican Bay State Prison that were first described in a 1995 federal court decision. 

Speier and Romero are authoring legislation that would add funding to the inspector general's office and require that most of the office's reports be made public. She believes the public disclosure of reports would add pressure on corrections officials to make changes that benefit guards, inmates and taxpayers, who keep footing the bill for expensive litigation. 

Schwarzenegger, who first proposed eliminating the inspector general's office but has since changed his mind, has not offered an opinion yet on the legislation. 

Spokeswoman Terri Carbaugh said the governor generally does support beefing up the office and more public disclosure. The governor recently made public 20 previous inspector general reports, and Carbaugh said he planned to release more as soon as lawyers completed their review. 

Speier said she would place another call Wednesday to the governor's office to seek the other reports, including the study of medical care in Corcoran. 

"There are numerous examples of complete mismanagement in corrections, and this is precisely why we need more oversight, '' she said. 

E-mail Mark Martin at  markmartin@sfchronicle.com

Dying inmates seek release
PRISON: Those with terminal diseases apply for permission to die at home.

11:38 PM PST on Sunday, January 25, 2004


Lonnie Creech is dying. So is Helen Loheac. 

Both sit behind razor wire and iron bars at California prisons. Both are waiting for a compassionate release. 

Creech, 52, has lung cancer and has been given less than three months to live. Loheac, 81, has a chronic kidney ailment and goes to dialysis three times a week. 

Their chances of going home to die, though, are slim. 

Legislation passed in 1991 allows some sick inmates with fewer than six months to live and who are not threats to society to die at home. 

Last year, only 17 inmates out of 48 who applied won a compassionate release from the California Department of Corrections. 

Seven more applied to the Board of Prison Terms. One was denied and three more are being considered by the board. 

Last year, Vidilla Spragin of San Bernardino was granted her request and was released from the California Institution for Women in Chino. 

Spragin, who had killed her husband by setting him on fire, died last month from liver cancer. 

Creech was sentenced six years ago to 14 years for assaulting a Riverside police officer and making terrorist threats. He spends his days in the infirmary at the California Rehabilitation Center in Norco, said Lt. Tim Shirlock. 

"He qualifies for a compassionate release," said his sister, Vangel Creech, who lives in Murrieta. "He's in a very weakened condition." 

Sentence questioned 

Creech's brother Dub, a retired Riverside police officer, said he never thought Lonnie would receive more than two years in prison for his crime. 

He was convicted of pushing a gun at a police officer after his in-laws reported he was suicidal and had a gun in the same Riverside apartment as his wife and child. 

Vangel Creech said her brother pushed the gun away after an officer shoved it in his eye. 

"He's been dealt a bad deck of cards," said Dub Creech. "He's a great guy. We just want him to spend his last days outside of that rat hole and just spend his last days with his family." 

Creech is a former auto mechanic with three children. His health has suffered all his life, said Vangel Creech. 

His right foot was severed in a car accident and in 1992 he had a heart attack, she said. 

In July he was diagnosed with small cell lung cancer and a tumor in his stomach, according to Sarv M. Grover, California Rehabilitation Center Chief Medical Officer. 

A compassionate release request with the California Department of Corrections was denied in September by then-director Edward Alameida. Two weeks ago, a second request was denied by acting director Richard Rimmer. Spokeswoman Terry Thornton said the decision was based on Creech's criminal history and current medical condition. 

"He is still ambulatory," Thornton said. 

Creech's family plans to appeal the decision to the Youth and Adult Correctional Agency and legislators. 

Recently, the Riverside County District Attorney's Office, which prosecuted Creech, wrote a letter to the corrections department stating it would not be opposed to his release, as long as he wears an electronic monitoring device and is not allowed access to drugs and alcohol, said Deputy District Attorney Robert Spira. Former Youth and Adult Corrections Agency secretary Robert Presley also wrote a letter on Creech's behalf. 

Even if the CDC had recommended that he be released, the sentencing judge would have had the final say, said Thornton. 

Being terminally ill is unfortunate, but not necessarily a reason to be released from prison, said Jim Benson, vice chairman of the Santa Ana-based Citizens Against Violent Crimes. Each case should be reviewed individually and one must make sure a sick inmate wouldn't be able to commit another crime, he said. 

Benson said he is, however, open to making provisions so that family members can visit with terminally ill inmates more often. "I would favor some flexibility," he said. "What we are concerned about is protecting citizens." 

Time short 

Helen Loheac, an 81-year-old woman who is serving a 25-years-to-life sentence at the California Institution for Women for conspiracy to commit murder, is also waiting to hear if she will receive a compassionate release. 

Loheac has a chronic kidney ailment and is shackled by correctional officers every other day to go to dialysis. The Board of Prison Terms is reviewing her case, said spokesman Bill Sessa. 

"Her time is very short," said Daisy Benson, an inmate at CIW. "(It) just makes me crazy, this old doll sitting here waiting for handouts." 

At the time of her conviction, Loheac was 69 years old and living in Shasta County in Northern California. 

Her son, who was in jail, said he was sending a friend to her house to pick up some items. Meanwhile, an informant had reported to police that the son had accepted his offer to kill the only witness to the son's crime.

When an undercover officer, posing as the friend, came to the house Loheac gave him some money, a photograph and the pink slip to the son's car. Loheac was then convicted of conspiracy for a murder that never happened.

Inmates like Loheac and Creech who are terminally ill are no longer a threat to society and should be released, said Cynthia Chandler, co-director of the Oakland-based Justice NOW, which assists women in prison. 

Often, ill inmates don't even realize they are behind bars and up to $80,000 per year can be spent treating them, she said. 

"The only people you are punishing are family and friends," Chandler said. 

Reach Stefanie Frith at (909) 893-2114 or s frith@pe.com

Online at:  http://www.pe.com/localnews/inland/stories/PE_News_Local_comp26.a1452.html


Rotting in Jail
by John Seeley 

L.A. County jails have become incubators for an ugly drug-resistant skin disease, venting it into state prisons and out into the community as inmates with still-active sores bring the infection home to family and friends. Though down somewhat from its July-September peak caseload, incidence of drug-resistant “staph” (Methicillin-resistant staphylococcus aureus or MRSA) is still running at twice last year’s level. Eradication in the jails is nowhere on the horizon and counter-measures recommended over a year ago have not all yet been implemented.

One strain of MRSA has been a chronic problem in hospitals, where it usually attacks the elderly or immune-compromised; the so-called “community-based” strain thrives in crowded quarters where people of any age share clothing or equipment (sports teams) or are simply in frequent physical contact (day care centers). Jails, where these factors are often coupled with limited access to showers, provide an ideal hothouse for its spread. 

At the onset, MRSA infection might be mistaken for an intense insect bite reaction, but the inflammation expands in size, continues to ooze, and can spread from one part of the body to another. On the scalp – less visible and less well-washed – infection often proliferates. If not properly treated, serious complications can follow, including blood infection (bacteremia) and inflammation of the heart membrane or bone marrow. There have even been a few fatalities at Texas prisons, according to a report in Morbidity and Mortality, published by the Center for Disease Control. 

Though some inmates say the problem goes back to 2000 or earlier, growing complaints at the Wayside (North L.A. County) facility in late 2001 took officials of the L.A. County Sheriff’s Department (which administers all county correctional facilities) on a sidetrack: an assault on spiders suspected to be coming in with clothes and bedding. Despite fumigations of the laundry facility, no spiders were captured dead or alive. By April 2002, bacterial cultures from skin complaints were showing a high MRSA incidence, and in June, Sheriff’s medical personnel notified the County Health Department of mushrooming infection rates. A joint task force of the two agencies started meeting regularly in summer 2002 and – after consulting California’s Department of Health Services, the U.S. Center for Disease Control, and veterans of an outbreak in Georgia’s prison system – developed an action plan to roll the bug back. 

Strategies included heightened skin infection screening on intake, better monitoring (with more culturing of suspicious lesions), and improved inmate education and videos on spotting symptoms and preventive measures (frequent hand-washing and showers, not sharing clothing or soap). More frequent and disinfecting laundering was urged and, of course, prompt medical attention to suspicious wounds, which would be treated by a better-trained health staff. Finally, based on input from the Center for Disease Control, anti-bacterial liquid soap was to be provided periodically. 

By the end of last year, 921 cases had been confirmed, with 57 inmates hospitalized, 10 of them with invasive complications. So this February, L.A. County chief medical officer Thomas Garthwaite began reporting monthly (or more) to a perturbed Board of Supervisors. While the caseload climbed, averaging almost 130 per month during the first half of the year, Garthwaite’s reports chronicled task force countermeasures implemented at a leisurely pace. In March, jail medics were being encouraged to do more wound cultures; in April, a cost estimate of the liquid soap was expected and “logistical barriers” to increasing linen changes were noted. A lack of trained jail personnel meant inmates must go to County-USC to get wounds drained. July cases spiked to 216; August’s and September’s hovered around 200. 

November’s number, 155 cases, was an encouraging turn downward. But it’s too early to call it a trend. Random interviews of inmates released from Twin Towers don’t show that there’s much familiarity with the term “staph” or recollection of seeing any videos. The anti-bacterial soap is slated to start in January, says Capt. Rod Penner, who oversees medical services for LASD. Why so late? “We couldn’t introduce it until other parts of the program were functioning well, because we wouldn’t know if reductions were due to that or other improvements,” explains Dr. Elizabeth Bancroft of the Health Department.

Control measures may be working, but the jails are still exporting cases which may come back to haunt them. Sergio Frutis of Pomona, fresh out after three weeks behind county bars, isn’t sure he’s heard of staph and says he saw no video when he came in. “Does this look like it?” Frutis asks, displaying a bump on his breastbone about as big and bright as a glowing cigar end. It keeps oozing into his T-shirt; he says. He put some lotion on, saw a nurse, received no pills, and requested a medical appointment. The next day, he was in court and got released, never having seen a doctor. Now he has no idea what he has or where to go for treatment.

© 2003 Southland Publishing, All Rights Reserved
Designed and Developed by R7 Media. 


Chowchilla inmates sue over medical service 
By Lisa Aleman-Padilla
The Fresno Bee
Published 12/19/03 05:20:31

Seven inmates at Central California Women's Facility in Chowchilla have sued prison medical staff members, alleging malpractice, negligence and unprofessional conduct.
The lawsuits, received this week in Madera County Superior Court, demand the firing of Dr. Augustine Mekkam, the prison's chief physician and surgeon. The inmates also seek more oversight of California's prison employees, especially medical staff.

"We need some kind of watchdog board to oversee these doctors so that there doesn't have to be all this litigation," said Michelle Kinser, one of the plaintiffs, in a statement issued by Justice Now, an Oakland-based human rights organization that works with women in prison.

Kinser, a San Jose native, began suffering extreme weight loss, tremors and pain in and around her pelvis and bladder nearly two years ago. Though she was diagnosed with a possible bladder mass, Kinser said, Mekkam canceled two referrals to a surgeon and an oncologist.

She said Mekkam told her she was suffering from a mental disorder and was imagining symptoms despite a history of multiple carcinomas, or cancerous growths, including bladder cancer that required chemotherapy in 1995.

Mekkam did not return The Bee's phone calls.

Other defendants named in the lawsuits, which were written by the inmates, include physicians Loraine Goodwin, Ernest Reeves, Jagdev Singh, Sampeth Suryadevara, Kuldip Behniwal, a urologist in private practice, and several nurses.

Some of the plaintiffs allege they were denied referrals to specialists and were removed from the prison's chronic care program, though they were clearly ill. "These cases make a powerful statement, exposing medical neglect that is tantamount to torture," said Cynthia Chandler, co-director of Justice Now. "Taxpayers need to know how their money is being misused."

The Chowchilla prison, which opened in October 1990, houses more than 3,000 female inmates and employs more than 900 workers. Russ Heimerich, spokesman for California Department of Corrections, said the agency is frequently sued for medical neglect by inmates, but almost always prevails in court.

He said all the state's inmates receive the medical care they need. "We are both morally and legally obligated to provide necessary medical care to inmates, and we do so."

Alice do Valle, spokeswoman for Justice Now, said the lawsuits are not the first legal remedy the women sought.

Several of the plaintiffs had filed earlier complaints with the California Medical Board, but were told that prison doctors do not fall within the board's jurisdiction, she said.

"What I want to know is whose jurisdiction these doctors fall under and who is supposed to be overseeing their practice," said Loraine Stallings, another plaintiff, in the Justice Now statement.

Stallings, who was diagnosed with a tumor in her left ear, is suing prison doctors for attributing her symptoms of constant ear pain, infections, headaches and hearing loss to excessive wax buildup. She said she now faces surgery that doctors say will cause facial drooping, complete loss of hearing in her left ear and damage to the taste buds on the left side of her mouth.

The five remaining lawsuits alleging similar complaints were filed by inmates Eleanor Guiterrez, Michelle Joe, Wilma Kilpatrick, Cynthia Escobar and Bonnie Stum.

The reporter can be reached at  lapadilla@fresnobee.com  or 675-6805.

December 2003


For the reporters reading this: My good friend who is in prison sends me many details about the almost unbelievable conditions inside our prisons and jails. These are things he does not make up but witnesses personally with his own eyes. I have never known him to lie.

He was recently taken to the old men's central jail in downtown L.A. to await a resentencing. He was there for a period of one month and while there he told me about something that was happening to a cellmate.

The young man had been there for several months awaiting trial. While there he had picked up a foot disease. My friend described it as quite nasty with lots of peeling skin. I asked him, "Is it athlete's foot?" He said, "If it is I've never seen anything like it before." He said besides the flaking and peeling of the skin, which was quite deep, the area surrounding the skin was blackened. This should have been healthy tissue but was not. This was a white kid and the dark skin was not part of his natural color. It was clearly connected to some kind of infection or fungus or something.

I got the address of Merrick Bobb from the Internet and asked the boy to write directly to him as we felt that at least this person knew enough about the failures of the present system to keep an open mind and listen to his plight. I have not followed up on it further.

The inmate was very concerned as the condition was only getting worse and jail staff appeared not to want to be bothered. When he went to the clinic for help he was given Vasoline. Of course, that was ineffective. The prisoner then bought a tube of cream at canteen (at an inflated price) which only had about 10% of the type of medicine he believed he needed to cure the  problem. He needed something stronger but was denied anything else from the clinic. In spite of the worsening condition, the clinic continued to recommend Vasoline.

Adding to the situation was the fact that the men's showers were not draining well. When the men showered, the water backed up two to three inches around the men's ankles. My friend thought this alone could be helping in he spread of the disesase and he was afraid to take a shower even though he had some shower sandals.

Inmates there were afraid to file a grievance. You know the old story. Nearly every complaint is ignored. For inmates who persist and continue to file complaints there is guard retaliation.  Retaliation is as certain as night follows day. How do you get a handle on something where the truth is throttled?

For people who think this is no big deal, consider the fact that these diseases are easily spread. Some men are not held long at the old jail and are soon released back to the communities they came from. They carry with them whatever illnesses or conditions they picked up in jail. It is a case ALWAYS of being sicker than before you went in and I continue to believe that this sort of 
thing is a danger to the public health and safety.


What a timely article when inmates in our state prisons are dying daily due to medical neglect!  I am a member of the U.N.I.O.N.(United for No Injustice, Oppression or Neglect) fighting for "Murder by Medical Neglect" to stop. 

The UNION was started by a very insightful woman, Cayenne Bird, who loyally attends sessions and hearings in Sacramento often as the only voice for prisoners. We join her at rallies and protests to speak out on neglect and abuse that plague inmates at every prison in California.  I have called several prison wardens begging for intervention for a dying inmate.  I have handed out hundreds of flyers and information on how to help and to educate the public to the abuse.  I send newsletters to inmates addressing the work the UNION is doing to get medical attention and psychological help for mentally ill inmates. 

Cayenne Bird has been influential in helping families initiate lawsuits to get somebody's attention so that the issues will be addressed.  I am appalled that men are lying on the cement dying while guards stand by watching and do nothing.  It sickens me to know that more than one prisoner has pulled his own teeth to relieve the pain.  Worse that an inmate died after having a tooth pulled by a prison dentist due to lack of proper dental care. 

Mentally ill inmates are sprayed with pepper spray for acting out their illnesses.  Lack of medications for diabetes, high blood pressure, mental illnesses and various other medical issues leave men and women inmates plagued with problems and often death is the result.  Too many inmates are dying at too young an age due to lack of proper medical help. 

The UNION under the leadership of Cayenne Bird has campaigned steadily, rallied, protested, sat through long sessions and hearings in Sacramento and initiated lawsuits to make changes in our deplorable system called prison. CDC continues to ignore our pleas for help. 

There are many prison groups out there, emailing back and forth.  We need numbers to make an impact.  We need more voices.  We have an organizer who is educated and experienced in leadership, organization and action.  Cayenne Bird is a publisher, editor, writer, educator and has organized many rallies and protests without incident, however we need more voices to get the word out to the public, the media, and our representatives. 

Cayenne attended Judge Henderson's hearings in Sacramento to listen to the reports of the professionals who spoke on the deplorable conditions in prison and medical as well as physical neglect and abuse.  She spoke out as often as possible on our findings over the past few years and her predictions of death and suffering have come true. 

It is good to see in print the things we have been dealing with for several years.  The tears of mothers, wives and other family members will not be dried until more and more unite for no injustice, oppression or neglect. 

Once again thank you for the great article. 

Shirley Wetherwax, Voting taxpayer Active U.N.I.O.N. member

 this is the law on prisoner medical care. It isn't that we need so many new laws.  There needs to be enforcement of the ones that we already have in place!

This was sent to me by one of the attorneys who read the newsletter taken from their legal resource Westlaw

B. Cayenne Bird

FYI: Government Code section 845.6 (prisoner's right to have medical care summoned when the prisoner has an immediate need for such care).

Government Code section 845.6 states: "Neither a public entity nor a public employee is liable for injury proximately caused by the failure of the employee to furnish or obtain medical care for a prisoner in his custody; but, except [in circumstances not relevant in this case], a public employee, and the public entity where the employee is acting within the scope of his employment, is liable if the employee knows or has reason to know that the prisoner is in need of immediate medical care and he fails to take reasonable action to summon such medical care. Nothing in this section exonerates a public employee who is lawfully engaged in the practice of one of the healing arts under any law of this state from liability for injury proximately caused by malpractice or exonerates the public entity from its obligation to pay any judgment, compromise, or settlement that it is required to pay under subdivision (d) of Section 844.6." 

See also Keel v. County of Los Angeles
displayTruncatedTitle("Not Reported in Cal.Rptr.2d, 2001 WL 1589172", "http://statcont.westlaw.com") Not Reported in Cal.Rptr.2d, 2001 WL 1589172

displayTruncatedTitle("Cal.App. 2 Dist.,2001.", "http://statcont.westlaw.com") Cal.App. 2 Dist.,2001 (The general basis of plaintiff's complaint is that (1) while he was incarcerated in the county's jail facility, the defendant deputy sheriff committed assault and battery on him and negligently and intentionally inflicted emotional distress on him; (2) the other defendants were negligent in the medical care they gave him and negligent in their supervision of medical personnel and the deputy sheriff, and they negligently inflicted emotional distress on plaintiff; and (3) plaintiff's statutory rights were violated. The alleged bases of such statutory rights are Civil Code section. 43 (right of protection from bodily restraint and harm), Civil Code section 52.1 (right to be free from interference with civil rights), and Government Code section 845.6 (prisoner's right to have medical care summoned when the prisoner has an immediate need for such care)

Keeping this law in mind here are some excerpts from Dr. Piusis' and Dr. Goldson's testimony

Dr. Michael Puisis is an Osteopath and is Board certified in Internal Medicine.  He has served for 20 years in Correctional medicine including the Cook County Jail in Chicago.  He authored the “Textbook of Correctional Medicine” which is the only book on this topic.

He has served as a court expert in 20 cases.

For this study commissioned by the Court he inspected medical records after death, conducted interviews with staff, physically inspected hospital discharge data, morbidity/harm  injuries that fell short of death.  His reports revealed to CDC administrators things they were not aware of including Dr.Rene  Kanan.  There were no means to hire good doctors or fire bad doctors which resulted in very bad care.

Prisons were not giving him details of deaths.

"Deaths of prisoner is a non-event to CDC"

"Cancer is ignored and untreated"

"The sickest patients are locked away"

Investigations take so long against doctors that more people die before they are completed and can be fired"

"Even Kevin Carruth has stated 'Medical care is not one of CDC's competencies'"

To many nursing staff vacancies - 80% at some facilites  wages are 20% to 40% below market rate.  A study was done but DPA rejected it and the vacancies still exist, no improvement."

Conditions compare to Angola.  CDC cannot comply with Plata.

CDC never ID'd any prisons that have come into compliance.  Salinas Valley (SVSP) was supposed to be done by 2003 and are still not in compliance

The state's failure is causing harm to prisoners - there are a number of deaths and at least two to three more per facility can be expected until we find remedy.  A total of at least 64 per year.

The physicians don't review diabetes, there are inmate patients who need to be protected because the threat to them is immediate.

The physicians should be able to self review to learn what needs to be done to correct.  Death reviews are not done regularly.  They are behind on death reviews with a HUGE backlog and have agreed that an emergency in this area exists.  Out of 193  death records reviewed only a small portion had a death rewview.  State has no standard policy on death reviews.

Mother institutions outside of California and hospitals have a death review within a week or two while all the information that contributed toward the death is fresh, this way they can take action and immediately identify problems, engage in  corrective peer review, take personnel actions.

My site visits found that death reviews done by CDC is not done adequately, the information is deficient, some do not even report why the prisoner died.  Others had a very brief description or info was reported "lost."

There were particular cases that caused concern, 34 were preventable deaths, 65 had insufficent information,.  Info should be available on more than one day only.

In my entire 20 years in correctional medicine I would expect one such death for years.  But  here I am seeing one to two deaths per site with circumstances  that I as a correctional physician would almost never see elsewhere. 

I see mistreatment of diabetes

Fluid and Intravenous insulin not given

Prisoners are not taken to a hospital

In one case the Chief Physician didn't know the cause of death which was ABSURD.  He had no excuse, didn't make it official, prime  example of indifference, incompetence, callousness. 

Some facilities do not perform credentialing to study a physician's malpractice history, substance abuse, criminal record and other important info.  Credentialing determines qualifications and gives privileges for their area of ability. 

This is now sometimes done at the local CDC level, not at the central office by bad physicians voting on credentials of other bad physicians.  A high number of physicians have training that makes them not qualified for their jobs.

Some Chief Physicians trained 40 YEARS AGO with obscure abilities.  It varies site by site but some sites have 50% poor quality, no aggregate credentialing.  Board Certified yes but IN WHAT.  I estimate at least 15% to 20% are poor quality physicians.  The good doctors are getting dragged along with the bad ones.

The Doctor's union should go for peer revew - they are in charge - but don't do it.  The doctor's Union does not stand up for quality.  They need to be told that the doctors should be able to self organize.  A temporary emergency receiver can address credentialing and emergency procedure, how to jumpstart this process.

Credentialing is crucial for preventative harm, not that complicated.  CDC has hired a firm to write the policy for them, it's probably a physician's union issue for hiring, firing, legal opinions around credentialing. 

There is no mechanism to identify incompetent physicians, let alone remove them.  When I made complaints against physicians some have been removed but regarding others there has not been much response, even in unspecified morbidity cases.

Physicians aren't even asking the basic questions!

Cleaning the clinics, having tables, appropriate equiment, basic supplies, staffing issues, Infrastructure wastes millions on pharmacy, hospital referrals.  it isn't that hard to identify and correct these problems but CDC doesn't have the desire to do that, there is no will do it.

It's not just the money that potential physicians look at - they ask "What would I have to deal with - the physician UNION prohibits doctors from signing in and out.  Some are working a few hours to get State benefits then leaving to another job while getting full time pay." 

1.  Compensation

2.  Support in what they need to do are both factors.

Some physicians are 76 years old and had their training at least 50 years  ago.  They need to be retired.

Some inmates know they are going to die but they are told that they are faking.  Some are finally seen after several weeks.  One doctor told an inmate do not come to see me with a list of diagnoses and had the prisoner escorted out of the clinic.  This resulted in a crisis.

High blood pressure turning into renal failure is happening.

Most doctors do not know how to treat complex problems.  They are not following chronic illnesses.  There is no medical records technology.

At least 15% of the prisoners need to be followed.  There is tension between custody and medical care, instances where an MTA yelled at a doctor.

I tried to call on a Friday regarding a medical matter.  I got no phones, just machines, you can get through.

These are the prisons I've reviewed so far



CSATF Corcoran

San Quentin

Mule Creek

Salinas Valley

Pleasant Valley

Valley State Prison

California Institute for Men at Chino

High Desert

Morbidity is harm such as lost limbs, untreated high blood pressure going into renal failure, other types of diseases and injuries that fall just short of death.  Sometimes these high risk patients go to a hospital and then are returned to the facility.  There is a need to follow these patients because the facility does not usually follow instructions.  This can lead to death.

A federal receiver could direct the Department of Corrections Director, which is necessary and to supervise the physicians   They have no supervision now.

Regional directors are temporary, not permanently hired.  The Plata mandated management positions are vacant.  Regional directors are still Chief Medical Officers at the various institutions so they cannot also be doing duties as both.  There is a need for increased supervision of the staff without doing full -time jobs.  There is an absence of leadership, all you need is a license to be a Chief physician, it is a low salaried and disagreeable job that attract people who would rather not work.

There is a need for CDC to hire competent physicians.  The State needs to hire 150 physicians this does not include, there are 25-50% physician vacancies, and many of those need to retire, there are just not enough doctors.

Pleasant Valley built for 3600 actually has 6000 inmates and is overcrowding.  The CMO is a temp. 

(There is a new mental health facility mentioned in my notes here)

Custody always wins out over the medical doctors and staff. 

Approvals are made by a bureaucratic system which doesn't know what "qualified is" - the criteria is set by DP 

Physicians do not have an organized inmate records system.  They measure unfiled paperwork in some facilities in feet.

The records are evidence of physicians orders, exams, lab work, hospital summary results and a medical chronology. 

Two facilities had no medical supervisor for three years - staff makes up the rules as they go along.

Records are lost or incomplete and at best only 0 to 20% of the time do inmates have any record, there is a failure to have lab records.

There needs to be devised a method for recordkeeping.  Once it set up, order it to be followed or the person is in contempt, that’s how important this is….

Sometimes, when there is insufficient staff, the medical administrator needs to be a leader.  You need autonomy in order the supervisor to be effective and the staff to do the work.

The record is not available for every death.  The peer review is bogus or not done at all.  There is not an appropriate relationship between custody and medical – custody should respect the medical staff. 

One warden wrote a memo on how TB patients were to be housed.  The warden had no business doing that!!!!!

Ordering supplies goes through the chain of command.  If it more than $2000 it must include three bids every time.  You must send it out to bid

Dr.Rene Kanan, Deputy Director of CDC Health Care Services has to go through a series of staff members, decisions are being made around her.  Mr. Duffy undercut her Director of health care services education, communication, reorganization concerns.  Now medical staff has less of a voice.  There are two filters of custody people for decisions.  There is l.l billions dollars of health care business.

A medical person cannot make budgetary decisions.  The new reorganized lines of authority are unclear, and there are barriers.  It’s all good ideas rather than abilities to complete anything.

Morbidity and mortality numbers affect issues in a timely manner.  What the federal receiver should do first is hire qualified physicians, make sure records can be accessed more quickly, hiring and firing powers.

The receiver should be given these powers for two years from now, and this job must be done with vigor.

What could be done in two years?

Leadership Regional Directors– 50% to 60% of physicians  hired 

Put a dent in Medical Records retrievable

Revamp purchasing

Improve santitation, acquire basic equipment, 

There should be two to three more physicians per facility possible after the first two years.

We would see savings  in  years two to three.

The Registry staff brought in to help ease shortages are costing 33% more than if the positions had been filled in the first place.  You could give people raises and still save money with that much difference.

Pharmacies, poor inventory and excessive amounts of waste.  Poor business management as far as hospitalizations, not following discharge diagnoses, inmates should not go into diabetic shock.

Eight inmates required hospitalization as a result of not getting their medications.  This was preventable.

CDC does not do the review to see what could be prevented   Custody doesn’t understand any of it.

Physicians are not accountable because they are not supervised


Testimony notes by Dr. Golson, San Francisco County Jail, primary care and mental health care. Worked on the Madrid vs. Gomez case for a decade. 

This is bigger than Constitution medicine, the dying must be the first consideration.

Sept  2004 there was a court order to hire regional medical directors, to hire registered nursing directors.  But did they do it? 

One inmate at Corcoran was made to change his shoes in an emergency, he had difficulty walking as he had meningitis, which was the cause of death.

I find this disturbing as he was confused, disoriented and very sick  yet the me medical staff refused him a wheelchair.  This was an emergency that they ignored which resulted in death.

And in spite of the notes in the medical record that he was confused and unable to walk, the guards forced him to go back to change his shoes before he was taken to the hospital.

This case was concerning.  Office of Internal Affairs did an investigation, this was a preventable death, the patient was mismanaged and then there was cover up

I consider this reckless and gross negligent

Internal Affairs did find other wrongful death cases.  A 48 yr old patient at San Quentin was brought to their Treatment, Triage Area (TTA) with low blood pressure and a fast pulse.  The doctor said that it was bronchitis.  It was clear he needed help.  Custody brought him back to the Emergency Room, they sent him back to his cell a second time before the emergency was ever acknowledged.  He died when he finally reached the hospital.

The cases described were basic infections allowed to go untreated and unattended 

Dr.Shurger in San Diego did 23 death reviews.  There was a total lack of caring, more than a lack of judgment  Out of 23 more death reviews turned in to me last night, 20 were preventable. 

Pleasant Valley had a case of TB.  With physicians TB’s importance as a public health issue ranks as #1, #2, and #3 – that’s how important it is – in the 90’s there was a TB epidemic back East which was spread by prison guards.

He had an xray, tested TB positive and was housed in the infirmary area in Dec 2002 to Jan 2003 

The procedure is to xray them every year once diagnosed.  Then isolate that person until cause of infiltration is found.  In 2004 there was a strange finding that had no follow up.  In fact thee the record says repeat xray – rule out TB – it was three weeks until the physician responded, people could have been exposed.

There is a general level of incompetence, total incompetence, a lac of caring, gross negligence.  I have never seen it this bad.

There is is no process for death reviews, and the ones that take place are extremely superficial.

The death review process is way behind to cover up.

In Dr. Shurger’s report of 23 deaths, 20 errors contributed to the death of the patient. 

 There is a risk to inmates of significant morbidity and mortality, they are dying and deteriorating.

It is getting worse.  Lives are shortened because there is no medical care.

I have seen prisoners lying in their own feces

Some had no iron – not just low iron – but NO iron in their blood

Total dehydration, neglected

These conditions took a long time to develop and amount to criminal negligence

Sandra Dubichek  YACA Dept of Human Resources  testified that it takes normally takes a year for all the processes of hiring

Jeff Baldo testified about the inadequacies of ITT Technology and the roadblocks to reform

These are my notes thus far and I would like our journalists to know that the  most dynamic testimony was given in days one and two by the physicians who minced no words.

Whether or not transcripts can be ordered in this manner I do not know but this is what I was able to capture

I left out many of the horror stories already told by other reporters such as the inmate who was told he was faking and then had pins stuck into him, and MOVED which paralyzed him for life if he wasn’t already paralyzed.

I don’t see any errors in Mark Gladstone’s accounting of the hearing nor in Jim Sterngold’s, so here you have much more detail.

This is a landmark case, the request for a federal receiver to be appointed in an emergency was a surprise and the media needs to be alerted as to the seriousness of what has surfaced.

There aren’t any photos yet but the atrocities that were described and those I have documented at our own website are horrifying enough.

I believe they are just scratching the surface and that many more deaths are going to surface.

I can only hope, in the name of God, that ALL the media starts tracking inmate deaths and at least announcing them so that the reform team can clean up this bloody mess.

Lives are at stake and at least 64 per year were estimated to die of preventable deaths but with the amount of cover up and corruption, this appears to be a gross under-estimate in my opinion.

We as  families seem to know a great deal more of the details of the extent of this crisis but I must say that the indignation and grief of the physicians is something I will confirm, they were both exactly right on with their facts.

I never met either of them before the trial.  As far as the families and inmates are concerned, they need to do detailed chronologies and get them into the Court and to the National Prison Commission as the physicians both stated that all inmates are in danger.

B. Cayenne Bird
P.O. Box 340371
Sacramento, Ca. 95833

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