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Prisons:3 6/7/07 2:57 PM Page 14 role as corrections officers and LVNs. The MTA role is one that Upland understands well, both from her years working in corrections and because she extensively researched the position as part of her work with the California Nurses Association Statewide Correctional Advocacy Group. "You can't have a caregiver and a jailer in the same body," concludes Upland. "It doesn't work. The entire prison system favors punishment and incarceration. But as a nurse you are legally and morally bound to deliver care. But if the correctional system says, no, this guy is going into solitary, or this guy is going to be transported here or there, and he can't take that pill or get that shot right now, corrections rules." More often than not, says Upland, medical mismanagement prevents the inmate from ever receiving the medication. The role of the MTA was so controversial and such a primary source of the prison medical system's problems that one of receiver Robert Sillen's first actions was to eliminate the position. The classification is to be phased out by June of this year. Personnel serving as MTAs will be allowed to bid for jobs as either correctional officers or LVNs. If the MTA chooses to become an LVN, the person would no longer be allowed to act in a correctional capacity. According to Sillen, their sole focus would be patient care. If they choose to bid for a job as a correctional officer, their role would be limited to correctional tasks. Sillen declared that he wanted to replace the old system with a "nurse-driven" prison healthcare system. Upland says the anger and resentment spawned throughout the system by the receiver's decision to phase out the MTA classification and his emphasis on hiring more RN administrators, RNs, and LVNs is reaching a fever pitch as the June deadline approaches. Upland points out that there are good MTAs and bad ones, just as there are good correctional officers and bad correctional officers. The problem, she says, is not the individuals as much as it is the system whose mission is punishment rather than rehabilitation; a system that encourages personnel to act outside their scope of practice or ignore and neglect patient need out of an allegiance to a correctional view of medical care. riving her suv through downtown Tracy, Upland passes lumber yards, a masonry supply center, single-story motels, and family-style restaurants. Outside of town, she is in heartland California. Farms stretch on all sides, and beyond, vast highways lead diesel trucks someplace else. Out past an industrial yard, past a rusted tilting trailer, and a row of abandoned cars, Upland turns into the long driveway leading to the prison. As she approaches DVI, the oldness of the place evokes images from a black and white newsreel. It is not imposing, nor powerful. Instead it is somehow forlorn, a dismal sorting house in the middle of forgotten tracts of land. Next to the staff parking lot, 50 feet in front of the inmates' housing units, the remnants of discarded plastic bags flutter on the tips of barbed wire topping a chain-link fence. Beyond the wire, pigeons, gulls, and crows stand sentry atop buildings between which echo the voices of men who shout back and forth to one another. "They do that all the time," says Upland as she gets out of her car, listening. "Hey, do you believe that?" A man shouts across the half-kept grass to the next building. It is impossible to hear the reply. There are fragments of disembodied conversation. "Legal bills," a voice says before it drifts into silence. "They're trying to get me out of here quick," says another. It is chatter offered up to a cloud-filled sky, falling on deaf fields and dairy cows. Occasionally there are shouts, rhythmic murmurs, wild sounds – like wolves howling into nothingness. As Upland arrives for her shift, so do countless others. A uniformed officer stands next to his automobile, pausing to strap a holster around his waist. Other officers carry backpacks and ice chests. Upland gets out of her car with her fanny pack and the bottled water she always carries so she can avoid the DVI tap water that, she says, "comes out the color of bourbon." She walks toward central check D MEDICAL TIME BOMB TICKING A TIMELINE OF THE CALIFORNIA DEPARTMENT OF CORRECTIONS UNDER RECEIVERSHIP February 2006: Judge Hen- 2001: The Prison Law Office in the Plata case. The settle- that he will place the prison files the lawsuit Plata vs. Davis ment requires that the depart- healthcare system under the derson names Robert Sillen, (later Plata vs. Schwarzenegger) ment of corrections completely control of a court-appointed previously Santa Clara Valley against the state of California. overhaul its medical care poli- receiver. The receiver will have Health and Hospital System The lawsuit alleges gross negli- cies and procedures. It also jurisdiction over the California director, as the federal receiver million more Robert Sillen, gence and neglect of inmate requires the state to invest sig- Department of Corrections and in charge of reforming the than equiva- left, with healthcare and charges the Cal- nificant resources into the pris- Rehabilitation (CDCR) and is state's prison health system. lent prison Controller ifornia Department of Correc- ons to ensure access to care, empowered to take all neces- He is required to file bimonthly systems Steve Westly tions and Rehabilitation (CDCR) and demands constitutional sary actions to deliver quality reports to Henderson regard- elsewhere. with violation of the Eighth levels of care for inmates. care to inmates. Henderson ing his progress. Amendment barring cruel and June 2005: For three years calls the prison healthcare sys- June 2006: Sillen audits July 2006: Sillen issues first report to Judge Hender- unusual punishment. U.S. Dis- the state of California fails to tem "broken beyond repair" the California prison pharma- son. In it he says, "Inmates trict Court Judge Thelton Hen- comply with the Plata settle- and finds that, on average, an cy system, calling the current aren't the only prisoners – derson oversees the case. ment requiring inmates to inmate in one of California's system "chaotic" and "rife with everyone working in the cor- receive constitutional stan- prisons needlessly dies every medical error." The audit finds rections setting is a prisoner to expert witness testimony, a set- dards of care. In response, six to seven days due to grossly that prison pharmacies cost state policies...that make it vir- tlement agreement is reached Judge Henderson announces deficient medical care. California taxpayers $46 to 80 tually impossible to accom- 2002: After months of 14 REGISTERED NURSE W W W. C A L N U R S E S . O R G M AY 2 0 0 7