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As the state prepares to resume control of inmate medical care, it must find ways to reduce costs that are triple the national average, the nonpartisan Legislative Analyst's Office said Thursday.
The federal receivership that has been in place since 2006 has greatly improved the medical care of state prison inmates but also has caused costs to soar, according to the report. California spends $16,000 per inmate for health care services, compared to an average of $5,000 in other states.
The analysis was released less than two weeks before the state and attorneys representing inmates must report to a federal judge with recommendations on when the receivership should end and whether it should maintain some oversight role.
The Legislature should create an independent board to monitor prison medical care to make sure conditions do not deteriorate once the state retakes control, the report said. It also recommends that the state experiment with contracting for medical services to cut costs.
The state should rely more on telemedicine so physicians in urban medical facilities can treat inmates without physically traveling to remote prisons. The analysis also found that the receivership has not been consistent in using management safeguards that are designed to hold down medical spending.
The receivership already is following many of the recommendations outlined in the report, said Nancy Kincaid, spokeswoman for the receiver's office.
The receivership began emphasizing telemedicine a year ago, Kincaid said. She acknowledged that while medical staff in some prisons follow the receivership's uniform policy for controlling medical costs, those in other prisons must do a better job.
The receiver, J. Clark Kelso, uses private contractors when they are cheaper, she said, but is limited by a prohibition in the state constitution on using a contractor if a state employee can do the job.
She disputed the report's comparisons with costs in other states, contending that many others don't count their administrative, information technology or contract costs in their accounting.
"Eighty cents of every dollar is spent on inmate direct care. Everything he's done is done with an eye to increasing efficiency ... and saving taxpayers' money wherever he can," Kincaid said.
The legislative analyst called a recent 7 percent decline in inmate health care costs "encouraging," but said the proposed prison medical budget for the fiscal year beginning July 1 is still 42 percent higher than it was before the receivership began.
Ending the receivership could save money in the "low tens of millions of dollars annually," the analysis estimated, because the state could consolidate what currently are two duplicate bureaucracies overseeing the prison medical system -- one for the court-appointed receiver and the other for the California Department of Corrections and Rehabilitation.