In California's dysfunctional prison system, costs defy containment, inmate care is shoddy and guards wield enormous political clout. Along the way, people die needlessly on the inside, while the state spends millions of dollars to guard comatose patients who cannot move, let alone escape.

Citing "incompetence and outright depravity in the rendering of medical care," US District Court Judge Thelton Henderson said he had no choice but to strip the Schwarzenegger administration of management of the $1.1 billion-a-year prison medical system and turn it over to an outside administrator.

The San Francisco judge estimated that an inmate dies every six or seven days due to medical negligence or malpractice. He described a bureaucracy engulfed in institutional inertia, unable to fix the problem.

In April, the San Jose Mercury News detailed one of the cases. An inmate who could neither eat nor drink and was dehydrated arrived at the San Quentin clinic shortly after 8 p.m. With a fever over 103 and a racing pulse, his vital signs indicated possible shock and a life-threatening emergency.

The prison doctor on duty did not have a chart to check the inmate's history. The doctor failed to evaluate for dehydration and diagnosed bronchitis and the flu. He prescribed Tylenol, Benadryl, cough syrup, antibiotics and two other medications and told the inmate to come back in a week.

The inmate collapsed on the way back to his cell, according to a report from three court-appointed medical experts obtained by the Mercury News. The physician, known only as "Dr. X," gave him some fluids and sent him back to his housing unit. By the next afternoon, the man was in shock and died -- about 30 hours after he was first seen by Dr. X.

Litany of Healthcare Woes

The litany of healthcare woes shows the rocky road the Schwarzenegger administration faces in trying to overhaul a dysfunctional prison system where costs defy containment, inmate care is shoddy and guards wield enormous political clout. Along the way, people die needlessly on the inside, while the state spends millions of dollars to guard comatose patients who cannot move, let alone escape.

Henderson said he would move within the next few weeks to name a temporary administrator who could hire qualified physicians and then launch a search for a permanent manager to crack down on mistreatment. He wryly said his challenge is to find someone who administered a major medical system like Johns Hopkins, received an MBA from Stanford in medical management and served as a prison warden.

Attorneys for the nonprofit Prison Law Office, which brought the action that resulted in Henderson's landmark decision, indicated they would support one of three court-appointed experts as the interim administrator.

'Bold and Uncharted Adventure'

State officials conceded inmates receive shoddy care and said they have no plans to appeal the ruling. Instead, they expect to cooperate with Henderson, who now will have the final say in health care in prisons.

"I have said all along that if something is broken it needs to be fixed," Corrections Secretary Roderick Hickman said in a statement. "The taxpayers of this state can't afford to keep paying for repeated lawsuits that result from the same kinds of problems such as inadequate healthcare, poor mental health treatment and insufficient staffing."

Attorneys for the state and inmates described the decision as historic and said they were unaware of such a sweeping action undertaken in any other prison healthcare system. Henderson hailed it as a "bold and uncharted adventure" that could last several years.

At 71 and already on part-time status, the bearded and bespectacled Henderson said he would like "to retire and go fishing" but he feels an obligation to provide humane treatment to the state's 16,000 inmates.

Who Has the Ultimate Say?

The decision is expected to shake up the sprawling prison system -- which effective Friday is changing its name to the Department of Corrections and Rehabilitation as part of a massive reorganization. For one of the first times, someone with an independent set of eyes and broad power will be examining prison practices and that could affect the closed culture of the state's 33 prisons.

For the past 18 months, the Schwarzenegger administration has faced mounting problems in the prison system and has been at loggerheads with the guard union. The union represents some medical personnel, too.

Another key issue has been who has the ultimate say when an inmate is ill -- the security staff or medical personnel. If the new health care administrator fails to give as much leeway to guards, it could lessen the power officers have inside institutions.

Thursday's hearing was set to hear final arguments in the latest episode of a class action lawsuit filed in 2001 by nine plaintiffs, including inmate Marciano Plata. The state previously had entered into a broad legal agreement intended to improve healthcare.

Trail of Broken Promises

Sitting in front of a US flag in the quiet courtroom with about 40 spectators, Henderson calmly described a trail of mostly broken promises made by the state prison authorities dating back 25 years.

In the Plata case, Henderson said, over the past four years he's tried to encourage the state "to fix what the state admits is a broken system."

After viewing the historic ruling from the jury box, Sen. Gloria Romero, D-Los Angeles, told reporters she expects the new receiver to find more problems.

"It's the tip of a very big iceberg," Romero said.