Judge's sudden change of receivers worrisome

last updated: January 28, 2008 01:58:44 AM

California's prison medical system is so broken that a federal judge took the drastic step of placing it in federal receivership. Judge Thelton Henderson appointed a receiver who began work in April 2006. The job was to reverse "entrenched paralysis and dysfunction and bring the delivery of health care in California prisons up to constitutional standards." Now, after 20 months, Henderson has abruptly changed receivers and called for a new "Plan of Action" for the prison health system.

The judge believes the first phase of receivership required a "bold, creative leadership style" to "investigate, confront and break down" barriers. Robert Sillen, who had run hospitals, clinics and public health facilities for 40 years, filled that role.

He brought on new staff, new equipment and a new cadre of medical leaders. Morale in the prison medical system vastly improved.

But, the judge now believes, the next phase requires a "collaborative leadership" style, working more closely with "all stakeholders, including state officials." The new receiver, J. Clark Kelso, is a bureaucratic insider with no background in health care who has made a career of rescuing scandal-ridden state agencies and then stepping aside.

Does this mark a return to business as usual? Sillen's 300-page Plan of Action included 22 initiatives and timelines for what could be achieved within six months, 12 months, 24 months and 36 months. But Sillen also has said, "It may take five to seven years to get the system up to constitutional muster, and an equal or greater amount of time until it can be reliably turned back over to the state, without fear of an immediate backslide." Kelso has said he expects to draft a new plan that will return the prison medical system to the state within four years.

What kind of medical system does the judge expect Kelso to return to the state within four years? We hope Henderson's abrupt action doesn't signal a new "get in and out as fast as possible" philosophy. This is no time to give up on a real transformation of California's broken prison medical system.

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