Legal Corner: CDCR?s recievership background

Cassie Pierson, Staff Attorney, Legal Services for Prisoners with Children
In June 2005, U.S. District Court Judge Thelton Henderson ruled that the court would establish a Receivership to take control of the delivery of medical services to prisoners incarcerated by the California Department of Corrections and Rehabilitation (CDCR). On October 3, 2005, a written decision was issued detailing the court?s specific Findings of Fact and Conclusions of Law (Plata v. Schwarzenegger, No. C01-1351-THE, U.S. District Court, Northern District of California).
What led the court to take such a drastic step? It was not just the Plata lawsuit but years of neglect by the CDCR to deliver constitutionally mandated medical care to thousands of prisoners. Judge Henderson wrote: ?It is clear to the Court that this unconscionable degree of suffering and death is sure to continue if the system is not dramatically overhauled. Decades of neglecting medical care while vastly expanding the size of the prison system has led to a state of institutional paralysis. The Prison system is unable to function effectively and suffers a lack of will with respect to prisoner medical care.?
What were some of the findings that influenced the court? Here?s a partial list:
(1) An increase of over 500 percent since 1980 in the prisoner population coupled with the failure by the CDCR to reform its management structure, information technology, and health care services;
(2) A decentralized structure in the CDCR which allowed individual wardens to determine prison standards and operating procedures;
(3) Lack of qualified medical staff including administrators, doctors, and nurses;
(4) Data management (to manage appointments and track follow-up) is virtually non-existent;
(5) Lack of medical supervision—only 5 or 6 prisons have an adequate Chief Physician and only one-third of the prisons have an adequate Health Care Manager;
(6) Failure to engage in meaningful peer review;
(7) CDCR has failed to hire regional medical directors as ordered by the court;
(8) Prisoners do not have timely access to physicians nor are their requests for medical care properly assessed by a nurse;
(9) Interference by custodial staff with medical care; and,
(10) Extremely poor management of prison pharmacy operations.
In testimony, court expert Dr. Goldenson said that inadequate medical care was the result of not only incompetence, but also gross negligence. One example is the case of a prisoner who reported a two to three week history of chills and fever and although he repeatedly visited medical staff, he was sent back to his housing unit. The prisoner eventually received a diagnosis of endocarditis, a potentially fatal heart condition treatable with antibiotics, but did not receive any medication. The prisoner was seen in the prison emergency room and despite the objections of the nurse on duty who recognized the severity of the prisoner?s condition, the doctor tried to return the prisoner to his housing unit without treatment. The prisoner was sent to the prison?s Outpatient Housing Unit for observation rather than the community hospital emergency room and he died of cardiac arrest.
The receivership will remain in place until the State assumes its legal obligation to run the CDCR in a way that provides constitutionally adequate health care to all prisoners.