SAN FRANCISCO - California officials say the state has done enough to fix health care at its prisons and a federal court should dismiss a receiver who has ordered the state to spend $8 billion to build and renovate prison hospitals.
The hospital building plan - which the state has considered paying for with revenue bonds - is a "gold-plated," "utopian" luxury the state can't afford as it struggles to close a two-year $41.6 billion budget gap, Attorney General Jerry Brown said this week.
Brown on Wednesday filed a motion to have the receiver dismissed and replaced with a "special master," who would advise the court and the state on prison health care as control of the system is returned to the state.
In 2005, U.S. District Court for the Northern District of California in San Francisco found California's prison health care system was so bad that it amounted to cruel and unusual punishment prohibited by the 8th Amendment to the U.S. Constitution. The court appointed J. Clark Kelso as a receiver to fix and run the prison medical system.
"The question is, when is enough, enough?" Brown said at a press conference this week. "The state is facing a terrible fiscal crisis. Children are losing their education, the elderly are being deprived of medical care, and this prison receiver ... wants to spend wildly."
Under Kelso's orders, the state has increased health care spending to $2.2 billion, or $13,887 per prisoner, in the current fiscal year from $1.25 billion, or $7,601 per prisoner, in fiscal 2005-2006, according to the California Department of Finance. The spending increase doesn't include the $8 billion capital plan.
California prison health care spending has risen to three times federal prison health care spending of $4,413 per inmate in 2008-2009, Brown said. That's also more than twice as much as the $4,906 that the average Californian spent on health care in 2008, he said.
Brown, a Democrat who is expected to run for governor next year, and Gov. Arnold Schwarzenegger, a Republican whose term expires in 2011 and cannot run again, lambasted the special master and his spending plans.
Kelso, who was appointed by U.S. District Judge Thelton E. Henderson of San Francisco, has proposed the construction of seven new health care facilities with 10,000 new beds for acute and long-term needs. He also wants to renovate health care facilities at the state's 33 adult prisons.
"This is just another transparent attempt by a career politician to grab headlines," Kelso said in a prepared statement. "The attorney general should stop wasting taxpayers' money filing meritless motions, stop abusing his position to further his 2010 gubernatorial campaign, and start seeking a real solution to the inhumane and unconstitutional prison conditions."
Kelso said he believes the prison health system's operating budget is close to an adequate level, but that the system won't meet constitutional standards until it has improved facilities and a functioning system to monitor quality and preventable deaths.
Judge Henderson in October ordered Schwarzenegger and state Controller John Chiang to begin the improvements with an initial $250 million payment, but the 9th Circuit Court of Appeals issued an emergency stay. The appeals court will hear arguments on Feb. 12 on whether the judge exceeded his authority in ordering the payment.
Brown said the state has to provide health care that is "not deliberately indifferent" to the needs of inmates - not the best care in America. He and Schwarzenegger have seized on details of a 600-page draft construction proposal that included spaces for horticultural therapy, rooms for music and art therapy, basketball courts, and quiet rooms as proof that the receiver has exceeded his mandate.
"Over the last three years, my administration has worked with the courts and both receivers to improve health care in our prisons," Schwarzenegger said in a statement. "With an $8 billion price tag for a construction plan that includes yoga rooms and landscaped courtyards, it's clear that the receiver has lost site of his lawful charge to bring prison health care up to a constitutionally adequate level of care."
Brown's motion argued that the Prison Litigation Reform Act of 1995 prohibits judges from ordering the construction of state prison facilities and limits court-imposed remedies to the "least intrusive" necessary to provide adequate health care for prisoners.
Kelso, a professor at the University of the Pacific's McGeorge School of Law in Sacramento, said the state cannot use the 1995 statute to avoid the constitutional prohibition on cruel and unusual punishment.
"I understand that, given its current budget crisis, the state has a serious case of buyers remorse, but to suggest that the receivership has been out of control on this [spending] is just inaccurate," Kelso said in an interview. "This program was approved by and supported by the governor last year."
Neither Brown nor Department of Finance director Mike Genest, who works for Schwarzenegger, would say how much the state needs to spend on prison hospital construction, though they acknowledged some spending on facilities is still needed. The governor supported a bill last year that would have provided almost $7 billion of revenue bond-financed prison hospital construction.
"With the state facing the worst fiscal crisis in recent history, we are being forced to cut back even the highest-priority programs," Genest said. "We believe that it will be possible to continue bringing prison health care up to constitutional minimums even as we subject that budget to the same kind of cutbacks and discipline that we're imposing on all governmental services."
State Department of Corrections Secretary Matthew Cate said the increases in the prison health care operating budget the state has already been forced to undertake have cured the system's most pressing problems. He said the state has expanded clinics, provided more guards to accompany patients to specialty care outside of the prison health system, increased pay and staffing for doctors and nurses, fired incompetent doctors, and set up monitoring mechanisms to assure that the state provides adequate care.
"Receivership isn't supposed to last forever, and in our view, it's time to transition back to those who were elected" to run the state, Cate said in a press conference.
Brown was less diplomatic. "We've had billions of dollars of spending, and if the receiver can't bring [quality] up to what he considers the right standard, either he's incompetent or the standard is too high," he said.
The attorney general said the state has a constitutional right to manage its own prisons absent any evidence of cruel and unusual punishment. He said he's talked to two prison medical directors who told him they now deliver "very good" health care.
"Confronted with the consequences of their own mismanagement of the state's prison system, the governor and attorney general are desperate to deflect attention away from their conspicuous lack of stable leadership," Kelson said in his statement.
