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Brickbats And Bouquets For U.S Prison Healthcare In-Charge

The U.S federal receiver Robert Sillen, hired to improve healthcare for state prisoners has released an ambitious turnaround plan for his jurisdiction.

According to Sillen the 50-page plan "will eliminate the unconscionable human suffering" in prison and protect California communities from diseases carried by inmates cycling in and out.

Over time, Sillen says, taxpayers will get more for their dollar from a system that experts claim was so broken that it experienced an average of one inmate death per week, due to medical incompetence or neglect.

"Good care is less costly than bad care," quotes Sillen, who has predicted it will take as long as 20 years before the sprawling medical operation is fixed and handed back to the state.

U.S. District Judge Thelton Henderson appointed Sillen, 64, after Henderson concluded the state was incapable of fixing prison medical care on its own. He has been on the job a year and earns an annual salary and compensation package totaling $650,000.

Lawyers for inmates initially hailed his appointment as a prescription for a $1-billion-plus medical care system that they said was understaffed, riddled with incompetent doctors and plagued by an absence of standards and a shortage of basic supplies, such as bandages and hand soap. Yet time has dampened their initial enthusiasm. They now say their hope is tempered by frustration that Sillen has not moved faster on problems directly affecting inmate care.

Attorney Steve Fama of the nonprofit Prison Law Office, whose civil rights suit led to Sillen's appointment, said that a year ago he gave the receiver a list of seven prisons with the most severe medical crises. One was San Quentin, where Sillen established a pilot program for improving care. Another was Avenal, near Coalinga in the San Joaquin Valley, where three inmates died in December.

In response to the deaths, Sillen sent a team of doctors and created more t han 50 new medical positions at the severely overcrowded prison.

While Fama terms this terrific, he expresses his regret that Sillen had not moved faster, given his authority and his mission as defined by the judge.

Sillen also has taken his share of ire from the Legislature. Some lawmakers are chafing at his blunt style, while others are furious over the prospect of spending billions on inmate healthcare with no legislative control. In one episode, Sillen sparked substantial grumbling when he vowed to send U.S. marshals to the state treasury and seize whatever funds he needed to lift inmate care to constitutional standards.

"It's obvious the delivery of care needs to improve," said Assemblyman Todd Spitzer. "But he has made it clear he has no real interest in our branch of government, and we'd prefer to be treated as an active partner."

Yet some like Sen. Gloria Romero say they welcome the new sheriff in town.

"Some criticize him and say he's too arrogant, that he runs over us," Romero said. "I say: Get over it."

Whatever their thrust, the appraisals of others appear to have little effect on Sillen, who stirred plenty of anger during his years as chief of Santa Clara County's public health and hospital system. He stresses his job is not one for "a wallflower or someone lacking intestinal fortitude."

"It's the receiver's job to operate this system, and I suppose it's not surprising that there's a lot of resentment, especially by elected officials who are used to being able to control everybody they come in contact with," Sillen said.

As for complaints about the speed of improvements, Sillen defended his first-year record, saying the receivership is "exactly where we need to be."

"This cannot be done quickly," he said. "It's far too big, far too complex, so people are going to have to be patient."

He also warned of significant barriers to success, inclu ding the chaotic state of the corrections department, a "prison culture that devalues inmates," poor working conditions, punishing physical environments, resistance from "entrenched interests that do not want the change to occur" and overcrowding.


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