California Medical Facility

One of the chief beneficiaries of the receiver’s reforms was the California Medical Facility (CMF) in Vacaville, just outside the state capital of Sacramento. California had ailing prisoners in each of its 33 state facilities, including two other prison hospitals. But a disproportionate number—the population hovered around 2,500 men—were sent to CMF. The prison, which resembled a large high school with long and impersonal corridors, had been built in 1955 to serve male prisoners. Like most California prisons, its physical plant was outdated, ill-suited for modern medicine and designed for a considerably smaller population.

Before the receiver took over, care at CMF had been substandard. When internist Dr. Joseph Bick arrived in 1992, he was the only board-certified doctor among the 15-20 staff physicians. “This place was just a mess,” he recalls. “The physical plant was totally inadequate.  People were seeing patients at cell fronts or converted cells that didn’t have sinks.”  Prisoners’ paper health records were stacked in towering piles on every surface in what was called the clinic.

But in one respect, CMF was fortunate. In 1988, a court consent decree (Gates vs. Deukmejian) mandated improvements at CMF to delivery of mental healthcare as well as treatment of HIV/AIDS patients. Bick’s background was in HIV/AIDS, and in 1993 he became director of all the prison’s HIV treatment programs (he was one of two chief medical officers in the prison). In that capacity, he oversaw the creation of a hospice unit for dying AIDS patients, designed a scheduling system for medical appointments, installed a computer database, and expedited reports of lab results. In 2005, Bick spearheaded construction of a modern clinic with up-to-date equipment, and individual offices for medical exams (windows allowed corrections officers to monitor doctor safety). For all its frustrations, Bick found his job rewarding. He says:

I felt every single day like I was making a difference, even the days that were dreadful… I’ve not yet had a day where I haven’t rolled out of bed and said, I want to get there.  And it’s not because it’s easy, or that every day is successful. 


Dr. Joseph Bick

With the creation of the Receiver’s Office in 2006, matters improved even further. Old and incompetent staff were fired or left. Kelso hired Nate Elam as CEO. A statewide IT system gathered all prisoners’ medical records in one database, and money was available for facility upgrades. Among other improvements, Dr. Bick oversaw construction of a modern clinic with up-to-date equipment, and individual offices for medical exams (windows allowed corrections officers to monitor doctor safety).  The hospice got a facelift. CMF also had an assisted living facility (or outpatient housing unit) for incapacitated inmates. There were nurses 24 hours a day, and meals served on the ward. Inmates had help with all activities of daily living, from dressing to bathing or eating.

None of this came cheap, either at CMF or system-wide. By 2008, prison healthcare costs were closing in on $2 billion, in a state with a deficit of $16 billion. In late 2008, Receiver Kelso began to scrutinize spending. “Doctors were referring anybody with a toothache out to a hospital,” he says only half in jest. “We needed to start doing things to reduce costs.”