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FAQ's
The Receiver has a new website at www.cphcs.ca.gov and as of 7/4/2008 the cprinc.org
website will no longer be updated with new content. Please, update your bookmarks and visit the new website for current
information concerning the Receiver's activities.
The effort to remediate California's prison medical care system is complex and multi-dimensional and must be flexible to
respond as crises erupt and new information comes to light. Because of that, activities and time frames often must be adjusted.
The Frequently Asked Questions and answers listed here reflect the most current accurate information. We will continue to update
both the questions and answers over time, so please check back regularly.
What is CPR's Mission?
The mission of the California Prison Health Care Receivership Corp. is to raise to constitutional standards the level of medical
care delivered to adult inmate patients incarcerated in California prisons. Acting on the authority of the federal court, CPR will
make the structural, clinical, budgetary and organizational changes necessary to create a safe and secure clinical environment in
which custody and medical staff together can guarantee that quality of and access to care in California's adult prisons is
constitutionally adequate. Once achieved, CPR will work to transition the prison medical care system back to the State for future
maintenance at constitutional levels.
Who oversees the Receiver's activities?
The Receiver reports directly to federal Judge Thelton E. Henderson, of the U.S. District Court for Northern California.
Judge Henderson presides over the Plata v. Schwarzenegger case in which medical care in California's adult prisons was found to
be unconstitutional. After the State failed to make court-ordered corrections, Henderson put the system into Receivership.
The Receiver may request that the Judge issue court orders or waive state laws in order to remediate the problems in the prison
medical care system effectively and create a new, constitutional structure for medical care delivery. These powers are spelled out in the
February 14 2006 Order Appointing the Receiver, which is available on this web site in the Court Materials section.
How long will the Receivership last?
There is no predetermined timeframe for the Receivership. There is also no model, as this Receivership is unprecedented in size and scope
nationwide. The Receiver's job will be complete when medical care in California state prisons reaches constitutional standards, and the State
is equipped to resume control and maintain that level of care. It may take five to 10 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 back slide.
How can I get up to date information about the Receivership?
The Receiver is required to submit regular progress reports to Judge Henderson every quarter. These are public documents
that are available on this web site (in the Court Materials section), as well as
directly through the U.S. District Court for Northern California. Visit the Receiver's web site often to read those court
reports and other public information, such as press releases and updates on various projects.
What areas of prison operations are now under the Receiver's jurisdiction?
The Receiver is the executive manager of medical care in California state prisons. That means that everyone who works for the
CDCR Division of Correctional Health Care Services (medical) including the physicians, nurses and other medical staff at the
headquarters and institution level, now work for the Receiver. The Secretary of CDCR no longer has jurisdiction over medical care
services in the state's 33 adult prisons.
What areas of prison operations are not under the Receiver's jurisdiction?
The Receiver's mandate does not extend to mental health, dental, substance abuse and treatment or juvenile health in
California prisons.
What is the relationship between the federal oversight of medical, mental health and dental services?
U.S. District Court Judge Thelton E. Henderson appointed J. Clark Kelso as Receiver to direct operations and oversee improvements
in prison medical services in the federal court case Plata v. Schwarzenegger.
Mental health services are the subject of a separate federal class action law suit (Coleman v. Schwarzenegger). In that case,
U.S. District Court Judge Lawrence Karlton has appointed a Special Master to oversee remedial efforts.
Dental services are the subject of another federal class action law suit (Perez v. Tilton), which is presided over by U.S. District Court Judge Jeffrey White.
The three judges issued an order in January 2007 (available in the Court Materials section of this web site) instructing
the representatives of the three cases (the Receiver in Plata, the Special Master in Coleman and the Court
Representative in Perez) to coordinate their remedial activities through formal monthly meetings. The purpose of the
coordination is to ensure that the three efforts would be complimentary and each would be well informed of the other's actions,
thus reducing unnecessary duplication and waste of taxpayer money.
Since then, U.S. District Court Judge Claudia Wilken, who presides over another federal class action law suit
(Armstrong v. Schwarzenegger) also has joined the coordination efforts. This case addresses the rights of disabled inmates
under the Americans with Disabilities Act (ADA).
Though they remain separate cases, there are many issues which apply to medical, mental health, disabled and dental services as part of an
overall health care system. The participants have agreed that the Receiver will take the lead in managing the remedial activity for
many areas that the cases have in common, such as pharmacy, medical records, information technology and health services contracting.
In these areas, the Coleman Special Master and the Perez and Armstrong Court Representatives will continue to provide expertise
related to their respective fields. The four Judges meet quarterly to facilitate the coordination of the remedial processes for
prison medical, mental health, disabled and dental care.
Which prisons has the Receiver visited?
The Receiver visits an average of two prisons per month. To date those include:
- CSP San Quentin
- Central California Women's Facility, Chowchilla
- Valley State Prison for Women, Chowchilla
- California Institution for Men, Chino
- California Institution for Women, Corona
- California Medical Facility, Vacaville
- CSP Solano, Vacaville
- Salinas Valley State Prison, Soledad
- Correctional Training Facility, Soledad
- CSP, Corcoran
- SATF, Corcoran
- Calipatria State Prison
- Centinela State Prison
- Pleasant Valley State Prison
- Avenal State Prison
- Sierra Conservation Center
- Deuel Vocational Institute
- California Men's Colony
- CSP Sacramento
- Folsom State Prison
- Chuckawala Valley State Prison
- Ironwood State Prison
- High Desert State Prison
- California Correctional Center
- R.J. Donovan Correctional Facility
- Mule Creek State Prison
- California Rehabilitation Center
- Kern Valley State Prison
- North Kern State Prison
- Wasco State Prison
- California Correctional Institution, Tehachapi
- California State Prison, Los Angeles County
The Receiver is committed to visiting all 33 adult prisons in California.
What has the Receiver done so far?
Year One
Here are six significant accomplishments from the first year of the Receivership (April 2006 to April 2007) that will contribute greatly to the improvement of the prison medical care system.
- Salary crisis addressed
In April 2006, prison doctors, nurses, pharmacists and other medical staff were paid drastically depressed wages.
The below-market salaries caused high vacancies, the use of expensive temporary agencies (costing taxpayers $90 million per year),
often attracted poor performers and added to the chaos and discontinuity of care. The state's own salary surveys confirmed that
prison medical staff were underpaid, but the problem had remained unaddressed.
In April 2007, medical staff are paid competitive salaries, (costing $30 million per year when all the positions are filled),
and vacancies are starting to shrink. So far, we have hired more than 500 Licensed Vocational Nurses (LVNs) and almost 300
Registered Nurses (RNs). It took a waiver of state law by federal Judge Thelton E. Henderson to accomplish this essential change.
We are not done. There are several classes that were not addressed last year that will be addressed this year. We will, on an
ongoing basis, make sure that salaries are competitive in the marketplace and appropriate for recruitment and retention of quality
staff.
(For more information, see September 12 and
October 17 2006, and
February 23 2007 press releases in
Press section and Receiver's Motion for a Waiver of State Law in the Court Materials section of this web
site.)
- Pharmacy crisis addressed
In April 2006, the prison pharmacy system was out of control, wasting $46 to $80 million tax dollars per year. Drugs were
unaccounted for, there were no inventory or purchasing controls, lax oversight, and an atmosphere ripe for medical errors. Despite
numerous reviews and audits over the past six years that found serious, wasteful and dangerous deficiencies in the prison pharmacy
system, nothing had been done.
In April 2007, national correctional pharmacy experts are managing the system and a turnaround is underway. Already,
Maxor National Pharmacy Services Corp. has identified nearly $500,000 in rebates that the state never collected. We are in the
process of transferring control of the purchasing and procurement processes from the Department of General Services (DGS) in order
to achieve more cost effective and efficient results, which will save taxpayer money and ensure better service for our clinicians
and patients.
(The audit by Maxor National Pharmacy Services, and their regular updates to the Receiver are available on this web site in the
Projects section.)
- Nurse staffing restructured
In April 2006, Medical Technical Assistants (MTAs) served primarily as LVNs in the prison medical system, but their dual role as
correctional officer (CO) and nurse caused confusion in the workplace, divided loyalties and made it even more difficult to recruit
RNs. This problem had been previously identified by court experts but not addressed.
In April 2007, LVNs are replacing MTAs at a savings to taxpayers of $39 million per year. The new staffing is improving clarity
of roles in the medical system. MTAs may opt to help fill vacant CO slots or remain as LVNs. We wish the many high quality MTAs well
in their new careers and understand, but regret, that their underlying peace officer status, pay and benefits make it impossible for
most to stay in medical.
- Contracting crisis under control
In April 2006, specialty physicians and community hospitals that contract with state prisons had not been paid some
$100 million for up to four years of work. As a result, the sickest and most medically needy patients were no longer getting care.
In April 2007, all outstanding invoices have been paid and there is a four-prison pilot (at San Quentin, California
Medical Facility, Pelican Bay State Prison, Central California Women's Facility) of a new automated contracting system that will
replace CDCR's unwieldy, inefficient and broken paper-based system that handles 2,600 contracts worth $433 million annually. The
new system will save time and money, make fewer mistakes and provide better access to care. Our private and public sector partners
deserve fair and timely payment for services they provide to our patients on behalf of the state.
- Broken discipline system under repair
In April 2006, medical staff worked without accountability. Efforts by supervisors to discipline incompetent or uncaring
clinicians were often turned back by the machine of state bureaucracy. The Administrative Time Off (ATO) system had run amok, with
at least 40 health care staff, about half physicians, sitting home with full pay for weeks, months and years, at an enormous waste
of tax dollars and an immeasurable impact on morale.
In April 2007, there are zero medical staff on ATO. They all have been called back to work, performing non-patient care duties,
rather than being allowed to sit at home collecting full pay and benefits. Instead they are reporting to mailrooms, warehouses and
filing paperwork. We are working together with the physicians' union to develop new systems for doctors' discipline, accountability
and performance. We are on our way to creating a real-world medical environment for staff.
- Medical equipment and supplies delivered
In April 2006, prison medical staff worked without the most basic medical supplies and equipment. During visits to 20 prisons,
I learned of a staggering unmet need - for sutures and gauze, cardiac monitors, gurneys, anatomical charts, white boards,
sphygmomamometers, microscopes, training texts -- the list goes on and on.
In April 2007, those in the clinical trenches have felt some relief, with $5.6 million of medical equipment and supplies ordered,
and more on the way. Though there is still a long way to go, working conditions and the ability to provide adequate care have
improved with the delivery of such items as stretchers, otoscopes, IV pumps, defibrillators, wheelchairs, physician tables, exam
lights, crash carts, transport vehicles, faxes, copiers, shredders and other fundamentals needed to operate medical offices and
provide patient care.
Year Two
Since April 2007
What is next?
In addition to continuing the efforts described above, the Receiver's priorities for the next 36 months are spelled out in the Plan of Action. They include:
- Construction of up to 5,000 medical and 5,000 mental health beds statewide
- We have hired a construction program manager to coordinate the process, begun project planning and secured initial funding from the Legislature.
- We have commissioned a prison survey to tell us what kinds of beds are needed, the results of which are posted on this web site in the Resources section. (Chronic and Long-term Care in California Prisons: Needs Assessment.)
- We have visited potential sites for the new construction, including:
R.J. Donovan Correctional Facility at Rock Mountain;
California Men's Colony in San Luis Obispo;
Deuel Vocational Institution in Tracy;
California State Prison,
Sacramento and Folsom State Prison;
California Institution for Men in Chino;
California State Prison, Los Angeles County, at Lancaster;
San Quentin State Prison;
California Medical Facility and California State Prison, Solano in Vacaville,
Ventura Youth Correctional Facility in Camarillo and
the vacant Nelles Youth Correctional Facility in Whittier.
- Launch of an asthma initiative
- We will launch an asthma initiative to provide clinical protocols, case management and training to improve the care given to inmates with asthma. Asthma was CDCR’s leading cause of preventable death in 2006.
- Creation of space
- We are conducting assessments of clinical and support space needs at individual institutions.
- Interdisciplinary teams made up of custody, medical, mental health and dental experts will evaluate approximately eight to 12 prisons per year.
- This project begins with the addition of space at Avenal State Prison.
- Recruitment of qualified, dedicated medical professionals
- We are making strides in hiring nurses and soon will launch a major recruitment and marketing effort to attract physicians and other clinicians into the prisons.
- Continuation of the San Quentin project
- We are adding to and maintaining improvements to medical care, including building new medical facilities and staffing them appropriately.
(For more information, visit the San Quentin Project section of this web site.)
- Expansion of access to care
- We are collaborating with custody leadership to create new approaches to health care access.
- Health Care Access Units are currently piloting at San Quentin. The next pilots are slated for California Medical Facility and California State Prison, Sacramento. This program assigns correctional officers to medical escort and transport duties, improving access to care.
- Improvement in working conditions
- We will develop the appropriate orientation and training, roles, responsibilities and working conditions for nurses, physicians and other clinicians and support staff who are essential to quality patient care and the proper functioning of a constitutional health care delivery system.
- An orientation and preceptor program for new nursing staff is under development.
What does the future hold?
The Receiver submits to Judge Henderson on Nov 15 2007 a revised plan of action for the next three years of activities to
improve the state prison medical care system.
Over time, the Receiver will address specific areas of medical care, such as geriatrics, chronic illness, pain management,
women's health, emergency, communicable disease and long-term care needs.
The Receiver also will improve the medical complaints and appeals process for inmate patients to ensure timely clinical
review and response.
Will the Receiver address individual staff or inmate patient problems?
The Receivership was created to direct and support change and to provide leadership to solve the systemic problems of the
State of California's prison medical care system. Information about staff and patient issues within that system can be valuable
in expanding CPR's understanding of the situation and help in setting priorities for systemic change. Generally, the Receiver
will not intervene in individual staff disputes. All patient correspondence is carefully reviewed and responded to.
Some patient-care issues brought to the Receiver's attention may prompt clinical investigation and action. These are handled
on a case by case basis. All information provided to us is considered in implementing systemic improvements.
Inmate Patients and their families may contact the Receiver about specific medical issues by writing:
J. Clark Kelso, Receiver
c/o California Department of Corrections and Rehabilitation
Controlled Correspondence Unit
P.O. Box 4038
Sacramento, CA 95812-4038
Due to the high volume of correspondence, we do not accept complaints about medical care over the phone or via email.
How can I contact the Receiver?
All other correspondence may be sent to:
J. Clark Kelso, Receiver
California Prison Health Care Receivership
P.O. Box 4038
Sacramento, CA 95812-4038
receiver@cprinc.org
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