Using Muscle to Improve Health Care for Prisoners

SAN JOSE, Calif. — Last year, shortly after receiving extraordinary powers to overhaul the medical system in California’s prisons, Robert Sillen, armed with a stack of court papers, issued a blunt warning to cabinet officials at the governor’s office in Sacramento.

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Inside the Prison Hospital Ward

Enlarge This ImagePeter DaSilva for The New York Times

Robert Sillen, appointed as federal receiver for prisons, speaking to the Sacramento Press Club in July. More Photos »

“Every one of you is subject to being in contempt of court if you thwart my efforts or impede my progress,” said Mr. Sillen, a silver-haired former hospital administrator chosen to carry out the overhaul of the prison medical system as the result of a class-action suit brought by a prison advocacy group.

Backing up his warning, Mr. Sillen handed out copies of a federal court order that named him the health care receiver for the California prison system.

In a subsequent warning, Mr. Sillen threatened to “back up the Brink’s truck” to the state’s treasury, if need be, to finance better medical services for the state’s 173,000 inmates.

State figures show that court-ordered changes to California’s prison system, including those in Mr. Sillen’s health care domain, have cost more than $1.3 billion, and the meter is still running.

For decades, California officials have tried to bring order to the state’s prison system, which is the largest in the nation. There have been lawsuits, special legislative committees and a declaration of a state of emergency by Gov. Arnold Schwarzenegger, but never has one person attacked a problem, piece by piece, with such blunt force and disregard for political convention as Mr. Sillen has the prison system.

Mr. Sillen, whose $500,000 annual salary puts him among California’s highest paid public officials, said he had never visited a prison or thought much about the penal system until a recruiter called last year to persuade him to accept what the recruiter called a “mission impossible.”

Now he has the power to hire, fire, raise salaries, build facilities, waive laws, tap the state treasury and have jailed any bureaucrat who tries to thwart him.

“In my opinion, Robert Sillen is not going to be happy until he’s running the entire prison system,” said a state assemblyman, Todd Spitzer, an Orange County Republican and one of Mr. Sillen’s detractors. “He’s a man who has utter disdain for the legislature despite the fact that we’re the appropriate body for budgeting.”

Mr. Sillen asked the federal courts last month to take on the costly — and politically contentious — task of reducing California’s prison population, including the early release of some felons.

The appointment of Mr. Sillen as federal receiver in February 2006 resulted from a class-action lawsuit brought by the Prison Law Office, an advocacy group based at San Quentin. A federal court in the suit found an average of 65 preventable inmate deaths a year in the prison medical system, which the court ruled was tantamount to cruel and usual punishment.

The California prison medical system was the biggest state agency ever ordered to be taken over by a federal court. The takeover was the most aggressive of several federal interventions into dysfunctional prison operations in California in the past 12 years. The federal courts also involved themselves in the prison system’s mental health, dental care, access for disabled inmates and juvenile detention operations, and in the use of force by corrections officers.

Mr. Sillen, 64, had been the executive director of the Santa Clara County Valley Health and Hospital System. Since beginning his new duties in May 2006, he has attracted hundreds of new employees to the prison medical work force. The medical staff had been experiencing a 20 percent vacancy rate, but Mr. Sillen raised salaries, in some cases by as much as 64 percent. He has siphoned off so many clinicians from other public health agencies that some now face shortages.

Mr. Sillen’s critics say that he has an authoritarian streak that has led him to wrest more control than he was given in his appointment by the court. Most troubling to some of his opponents is Mr. Sillen’s acknowledgment that he has no idea how long the changes will take or what they will cost.

The Prison Law Office filed a complaint in federal court in June saying that Mr. Sillen’s plans have “no concrete details of how any of the goals or objectives are to be accomplished, no real timelines and no metrics.”

In an interview in his office in San Jose, Mr. Sillen dismissed the group’s assertions. “When people ask me how long and how much,” he said, “I have a stock answer: Long. Much.”

Mr. Sillen speaks in rapid-fire, thrust-and-parry sentences often punctuated with profanity. He said his confrontational approach and broad federal powers were essential in trying to turn around an agency that had repeatedly failed to comply with court-ordered changes.

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