The receiver who once ran California's prison health care system promised three years ago that he would use his court-backed muscle to build a new medical facility in record time.
The pledge has come true with the opening of a $136 million, five-story hospital at San Quentin State Prison _ four months earlier than its ambitious schedule and $10 million under budget.
Yet the state-of-the-art facility already is a relic from a time when California had money and the federal receiver could act with impunity. Its aggressive advocate, receiver Robert Sillen, is gone, too.
Officials showed off the 50-bed hospital and its dental, medical and mental health outpatient clinics in an exclusive tour for The Associated Press last week, even before it was seen by top state officials. Parts of the facility are already in use and the rest are scheduled to open in January.
The old hospital was "like a Third World country," said nurse Elsa Monroe, standing beside a glass-walled isolation chamber filled with equipment including a negative pressure air decontaminator to stop the spread of infectious diseases. "I miss my mouse, though. We had a mouse that would come visiting from room to room."
A federal judge charged Sillen with swiftly transforming California's oldest prison in 2006 after national experts reported that the 5,000-inmate prison was so appallingly dirty and outdated that "San Quentin should be viewed as needing to start from the beginning."
Sillen did so with enthusiasm, using U.S. District Judge Thelton Henderson's authority to push aside state regulations and budgetary constraints and build the hospital in less than half the time officials said it would have taken the state bureaucracy.
Sillen also ordered construction of a $1.6 million emergency room, which was built in just eight months but now sits abandoned 2 1/2 years later, its duties transferred to the new hospital.
The judge fired Sillen, a blunt, prickly veteran health care executive, in January 2008, replacing him with J. Clark Kelso. Kelso has since been forced to sharply scale back his own ambitious plans for the nation's largest state prison system because of court challenges and a crashing economy that left California billions in debt.
At San Quentin's old hospital, some clinicians shared a converted shower stall as an office, or treated patients in cramped, makeshift examining rooms without equipment hookups, overhead lighting or sinks to wash their hands. Patient files were piled on gurneys and tables, in contrast with the new modern records room.
In the new hospital, 41-year-old Vine Merino of San Jose, serving a three-year sentence for probation violation, reclined in a spacious, brightly lit examining area. Nearby, inmates can sit in padded chairs watching a large flat screen TV while they wait for treatment.
"This is like a regular hospital to me, like a regular emergency room," Merino said as he was treated for an ear problem. "It doesn't feel like a prison. I wish I could spend all my time here."
Doctors now have computer work stations, digital X-ray machines and a modern medical library informally named for Sillen. A balcony nicknamed the Kelso Patio offers a lovely view of San Francisco Bay beyond the prison walls.
A staff auditorium is roofed with ancient timbers that officials believe came from a prison ship that anchored offshore in 1852 while convict labor built the prison. The modern facility incorporates the brick and wrought iron facade of an 1885 prison building, with a corner carved out to preserve the prison's historic dungeon, built in 1853.
Other planned prison medical facilities will not look like San Quentin, said Kelso, who has been stung by criticism from Attorney General Jerry Brown and others that the receivership is coddling inmates with "Cadillac care."
Of a planned $1.1 billion facility in Stockton, 50 miles south of the state capital, Kelso said, "We're not building marble hallways. It is going to be a correctional facility with a therapeutic mission." Kelso said of a planned $1.1 billion facility in Stockton, 50 miles south of the state capital.
The Stockton facility, with space for 1,734 mentally and physically ill inmates, is what's left of Kelso's original $8 billion plan to build seven new medical facilities to treat 10,000 ailing prisoners.
The revised plan he negotiated with the Department of Corrections and Rehabilitation, which relies on money already appropriated by the state Legislature, would add treatment beds at other prisons rather than build new hospitals.
Kelso said the facilities may incorporate prefabricated modular offices and examining rooms like the ones that were temporarily used at San Quentin.
"The state simply couldn't afford the prior vision," said Kelso, a law professor who worked for both Gov. Arnold Schwarzenegger, a Republican, and his Democratic predecessor.
Where the state once acquiesced to Sillen's demands, the administration now is fighting Kelso's original proposal and the existence of the receivership itself in a federal appeals court. Local opponents are also suing to stop the Stockton facility.
"The good part about Sillen was he was a bull in a china shop. That's also the bad part about him," said Don Specter, director of the Berkeley-based Prison Law Office that sued to force construction of new medical facilities. "We're really not sure whether in our lifetime we'll see the other hospitals built, absent some court intervention."