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Prisons:3 6/7/07 2:57 PM Page 19 where we can stop the cycle [of violence]. Many of these people will be returning to society, and that affects us. The longer we think they are out of sight and out of mind, the less we address the problems, the longer it will take to repair the damage." To Upland the prisoners, shoved from sight and society's conscience, are human beings worthy of compassion. And the inmates have, in turn, shown compassion to her. Upland was pregnant with her daughter in the 1970s when she worked at San Quentin. Inmates there spent months saving and folding cigarette packages into tight squares to construct baby booties and a photo frame for a picture of her newborn baby. "They always knew that I cared," says Upland, who is still struck by the inmates' appreciation of her. he problems of care are not California's alone. They exist nationwide. By all accounts, many of the nation's prison systems are ill-equipped to manage care for the people they contain. Last year, the Delaware prison system was investigated for health rights abuses, as was New York's Department of Corrections. Upland wonders what it says about us as a society. She also wonders why more taxpayers aren't up in arms. "By neglecting prisoners and allowing their illnesses or injuries to go to urgent care or crisis management, the current system is costing taxpayers hundreds of thousands of dollars," she says. These same facts are born out by Receiver Robert Sillen's office. In Sillen's second bimonthly report to Judge Henderson, he details "extraordinary instances of waste of taxpayers' resources." An audit by the California state controller's office in August 2006 found evidence of gross mismanagement of prison healthcare services during the Schwarzenegger administration, including "a 300 percent increase in prison spending" since the governor took office with no evidence of improvement in medical care. Since Sillen founded the California Prison Health Care Receivership Corporation in 2006 and set up a website, cprinc.org, to provide information to the media and the public, he has visited 15 of the 33 adult prisons in the California prison system, with the intention of visiting them all. Among the actions Sillen has taken: Purchasing needed medical supplies and equipment; paying off more than $58 million in overdue bills; submitting plans for 5,000 new sub-acute and long-term care beds to accommodate inmate needs; raising nursing and other medical personnel salaries in order to retain and recruit good RNs and LVNs; calling for "nurse-driven" medical care; and phasing out the medical technical assistant classification. He has also audited the California prison system's pharmacy operations, confirming that the system is costing taxpayers $48 to 80 million more than equivalent systems elsewhere in the country and hiring an independent company to design a workable pharmacy distribution plan. Sillen says his first goal, however, is simple. "Right now we're focused on just stopping the killing," he says in a recent interview. "There are too many patients in the California prison system who are still dying." He sympathizes with many of the frustrations Upland and other prison nurses have with the system and agrees that access to medical care must be prioritized. "Many aspects of the prison culture need to change," Sillen says. "Our job is to empower nurses to do what they've been trained to do." So far, Sillen says he's made it clear to prison administrators and T M AY 2 0 0 7 correctional employees that they must cooperate with his concept of a nurse-driven system. Two years ago, he says, there was no nurse management in the system. He's trying to correct that by placing nursing professionals in leadership positions. Recently, he named administrative RN Betsy Chang Ha as his chief nurse executive. He is also trying to change a "totally hierarchical" culture that works against providing care. Sillen says he recognizes the struggles healthcare professionals are going through in the prisons. "In the past," he says. "Corrections dominated medical care. Now there are new tensions caused by organizational change." The receiver's primary job is to improve healthcare within the prisons to constitutional levels and then turn administration back to the state. That's going to be tricky, Sillen says, because the state will have to prove that they can maintain care at that level. Building the culture and capability to do so, says Sillen, will take a long time. One perpetual challenge is to retain qualified medical staff. Statistics on the receiver's website indicate that Upland is not alone in her desire to flee the system. Prior to Sillen's appearance, RNs had a 15 percent vacancy rate statewide, and a 51 percent vacancy rate in the San Francisco Bay Area. Sillen has attempted to stop the bleed of nursing talent by increasing RN salaries from 23 to 35 percent, and by raising new LVN salaries to competitive rates. Sillen also wants to hire 300 more RNs, and as many as 600 LVNs. Some of those LVNs will be former MTAs who are required to bid for either a correctional or LVN job by June. But Sillen says that most of the MTAs have already decided to bid on correctional jobs because of the higher pay and benefits package. The receiver's actions have not escaped criticism. After hiring the independent pharmaceutical company to develop a new pharmacy distribution plan, many were concerned that Sillen would privatize prison healthcare—a failed strategy in other states. But Sillen is adamant on this issue. "I have no desire to privatize," he says. "The company will design the system, only." According to Sillen, the newly-designed system will then be implemented by the state under his direction. Sillen has also met resistance from some prison administrators hoping to ignore his authority, but reassures healthcare workers like Upland who are struggling to stay in the system that they're "not going anywhere." Upland and other caregivers have been waiting a lifetime to see some of these measures take place. So far, she says she has seen no real changes. But she is acutely aware that the task will not be easy. The corrections mentality, says Upland, continues to permeate every aspect of care in the prison system. When Upland leaves DVI that first weekend of her return, walking into the parking lot past housing units under a dark sky, hearing the inmates calling back and forth to one another late into the night, she does not wonder whether she has changed a life on her shift that evening. She does not wonder if her interventions on behalf of inmates, or her assessment that a suicidal young man should be calmed first and given pills instead of being poked with a needle, matter. But she hopes it matters. She wants it to. I Erin FitzGerald is a freelance writer focusing on human rights and healthcare issues. She has just completed a documentary on family caregivers of the traumatically brain injured as part of her studies at the UC Berkeley Graduate School of Journalism. W W W. C A L N U R S E S . O R G REGISTERED NURSE 19