With more than 175,000 inmates at 33 adult facilities, California houses the largest state inmate population in a system that has teetered on the brink of disaster for several years.
The state is hoping to remediate many of the operational problems within the system with recently approved legislation, but according to a federal judge, the prison medical system is already in such disrepair that a federal receiver is needed to implement and manage improvements.
In 2006, Robert Sillen, the former executive director for the Santa Clara County Health and Hospital system, was appointed to head the improvements. Sillen, an outspoken critic of the politically entrenched prison system, says the job can only be done with the backing of the federal court, which has the power to dip into the state’s coffers for funding and waive state legislation.
“We are about to embark on $1 billion worth of construction,” he says. “We waived state laws so we could do the construction. I’m not going to rely on the state. I would take them 10 years, and it would cost twice as much.”
Sillen discussed the receivership and efforts to improve the medical system during a phone interview with Correctional News.
Q: Why did you take the receiver job?
A: I took the job for several reasons. First, it fits very well within my value system. I have dedicated my whole professional life to fighting for under-represented, downtrodden, poor and minority individuals who don’t necessarily have a fair shake in life. It had to do with healthcare, and that is my expertise and background.
Before improvements, inmates were treated in makeshift clinics at San Quentin that lacked medical supplies. Photo courtesy of California Prison Health Care Receivership Corp.
Third, I met Judge Henderson and became committed to him very early on as an individual and his approach to this. I would not have accepted this challenge had he not created a receivership. If the state approached me, I never would have done it in a million years. Judge Henderson’s willingness to stand behind me as a receiver convinced me that the job would be doable.
Q: Why would you refuse the job if it was offered by the state?
A: The state has no particular intention of doing the job or getting the job done. The state created the situation in the first place.
The politics of prison healthcare and prisons almost preclude any reasonable ability for California to do anything meaningful to turn that situation around. They had an ample opportunity for three or more years — after signing stipulated agreements — to bring healthcare up to constitutional levels. Not only did they not achieve their goals, they didn’t even lift a finger to try. The state never had the intention to do this, and that is why the system was taken away from the state and put into receivership. I never would attempt to do this for the state, which is a political operation.
Q: You toured San Quentin State Prison the second day you took office. Can you describe what you saw?
A: It was the first state prison that I had ever been to in my life, and I saw a sea of humanity milling around in a building that is more than 150 years old. I wondered how anybody could make anything out of the chaos. Everything was orderly, but it was very clear to me right off the bat that there are far too many people for the facility that exists there.
I had no idea the extent of overcrowding at the entire California prison system or at San Quentin at that time.
The California medical system was without a computer system that linked different facilities. Photo courtesy of California Prison Health Care Receivership Corp.
I saw physical facilities and living conditions that were horrid. There were spaces that were called clinics that were not clinics at all. There were double cells that were used as a medical care clinic. I saw those kinds of clinics with no hand-washing facilities. From a medical perspective, it was worse than third-world conditions.
There was an emergency room with chipped paint and no equipment. I asked a nurse if she was getting the supplies that she needed and she said they had not had have gauze or sutures for four months.
The California prison healthcare system was an abomination and it was found to be in violation of the constitution of the United States and cruel and unusual punishment, which is what brought me here.
Q: Your visit was in April 2006. Has the situation at San Quentin changed?
A: It has changed somewhat significantly. I made it clear to the warden, healthcare staff and everybody else that we are going to put San Quentin under the microscope for two reasons. First, we want to do what we can do for San Quentin, and second, we want to learn from our experience and analysis what some of the systemic statewide issues are. We have learned a lot, so far.
We started with a 90-day project in July 2006 that is still not complete because the bureaucracy of the state is paralyzed by its own rules, laws, regulations and lack of accountability among employees. Nothing is simple, there are no quick fixes, and this is going to take an immense amount of time.
Having said that, we put sufficient resources into San Quentin to make meaningful progress. We beefed up the staff and got rid of physicians who were not any good. We brought in additional nurses and implemented our own personnel offices.
We also initiated a $156 million building project there that is going to centralize all of the mental health, medical and dental programs into a new health center that will have 50 beds.
We are getting rid of those kinds of clinics that were spread around nooks and crannies in totally inappropriate places.
We’ve hired professional people to keep the place as clean as you can keep a 150-year-old building. We reviewed and have redone some of the medical records systems and lab reports because no lab reports were getting into the records. In fact, most of the medical records were totally incomplete.
I don’t want to give anybody the impression that we have cleaned up San Quentin to the point where we aim to be in two years from now, but we have come miles and miles further.
Q: What do you think an employee from a completely functional prison healthcare setting would say about the situation at San Quentin now?
A: I think they would say it is a work in progress. One of the major problems is there are no computers for any kind of clinical purpose, let alone e-mails or anything else, within the entire California prison system. This is the 21st century in California, home to Silicon Valley, and everything is done manually. The state’s business practices are so outdated and outmoded, when it gets to prisons it’s worse, and when it gets to prison healthcare it is even worse because nobody cares about it.
We have a long way to go and I think some state prison systems would tell us the healthcare system is where they were at 20 years ago. Texas, for instance, went through this process around 1978. I spent four days looking at the Texas medical system and I would take their system tomorrow. But, it took decades to get there, and it is going to take decades for us to get there.
Q: Did you learn anything from the Texas system?
A: I learned a lot of things. First, it was good to see that it can be accomplished. They have achieved the light at the end of the tunnel. When you walk into a Texas prison it is a totally different environment than a California prison. Essentially, they are clean and a lot of the construction that has occurred during the last 15 years was for the purpose of medical care.
Built in 1885, the former medical building at San Quentin is one of the oldest buildings at the prison. Photo by Matthew Crawford
It was designed as a unified system. It is clearly a viable medical care system that has measurable objectives. We can’t measure anything in California because there is no data in our system. We are just back in the caves.
Q: You have made some pretty strong statements about the state. How would you characterize your relationship with state officials and the corrections system?
A: It varies depending on what the issue is. The receivership takes me out of the whole political process, so we ultimately are not dependent on the state for resources.
We try as much as possible to cooperate with the state, but we are going to get our job done and we are not going to allow the state to thwart our efforts. Everybody from the governor down is under the threat of contempt of court if they impede my progress.
We had some initial issues with the control agencies — centralized services that seem to run everything in the state, such as the Department of General Services — but we have straightened most of that out because they don’t want to be held in contempt of court.
The governor’s office has been helpful and has not gotten in our way. The Legislature — because it is made up of all sorts of individuals who only report to their constituents back home — is somewhat of a different problem. Most of the anti-receivership rhetoric that one hears in California mostly comes from individual members of the Legislature. They resent that fact that the federal court can go directly into their general fund and take the state’s money without legislative appropriation.
I have to remind them that had they not gone so far as to violate the Constitution they wouldn’t have me to contend with. It’s the legislators and the governors from the past 25 years that created this situation. It’s a little tense at times, but it sort of doesn’t matter.
Q: There is also the political theory that some politicians want receivership so the blame can be taken off their plate in 10 years if there are still problems with the system.
A: I believe that is probably true. Politics is a funny thing — today matters, nobody cares about tomorrow. There are some political advantages for people to be able to say in the future, “Gee, it didn’t work out. Don’t blame us, blame the federal court.”
Overcrowding forced prison officials to house 300 inmates in a gym at San Quentin. Photo by Matthew Crawford
I understand the politics. People don’t get elected by having a platform that says, “Let’s take care of pedophiles, rapist and murders.” The fact of the matter is, that is not everybody who is in the prison system. There are 173,000 inmates in the California prison system — that in itself is shameful — and half of them are nonviolent offenders.
The whole criminal justice system in California needs revamping. There needs to be sentencing and parole reform, and somebody needs to do something about the number of people who are going to state prison. It is an utterly dysfunctional, broken system.
Q: Would it benefit the state if the entire prison system went under receivership?
A: I think it would benefit the state if the Legislature and governor did what needs to be done, which is reform. It is not a lack of intellect that prevents them from doing it, it is a lack of political will.
The politics of this prison stuff is going to change rapidly. A legislative analyst said spending for the state department of corrections over the next two years is going to be greater than educational spending. That is sinful and the people of California are going to recognize that. Most people understand that the prison system and the criminal justice system are a bit out of control.
Q: Are there any simple steps the state could have taken to avoid the situation it is in now?
A: At this point nothing is simple and there are no quick fixes.
Had the state government add-ressed the problem in a meaningful fashion between 2002 and 2005 when they agreed to certain remedial actions — which wouldn’t have been simple — things might be different. They didn’t do anything, which I’m sure is for political reasons.
Q: Earlier you mentioned the enormity of the job at hand. How are you holding up? Do you think you will see it through the decades of work?
A: Here’s the way it works: I’ll be here as long as Judge Henderson is here because that is the essential relationship that has to exist.
If Judge Henderson is not here, then I have to make a decision at that point. I’m not going to work with somebody who isn’t going to make sure that we have the ability to get this job done. I can’t do it on my own; I need the court to back me up and make sure that I can get accomplished what needs to get accomplished. If I don’t have that, there is no point in me being here because I won’t be able to do it.
Q: So, if Henderson leaves his position and a new judge with a totally different philosophy is appointed, that could derail the whole project?
A: It could certainly derail me and I would suggest that, of course, it could derail the whole thing.