Managers of California's beleaguered prison system received a double dose of bad news yesterday as a federal judge ordered them to pay tens of millions of dollars owed to doctors who treat inmates, and the state launched an audit of their agency.

Some of the doctors have not been paid in four years. Some of their contracts have lapsed. And some who deliver cardiology, radiology and a wide range of other services to prisoners are no longer responding when called. U.S. District Judge Thelton Henderson, who recently put the state prisons' healthcare system in the hands of a federal receiver, ordered that outstanding doctor bills --- which total more than $58 million --- be paid within two months.

Lax healthcare in California prisons is blamed for an average of 64 preventable deaths a year. In naming a federal receiver to take over this year, Henderson determined that corrections officials were incapable of solving the problem alone. Meanwhile, state Controller Steve Westly said his office will audit the department to determine why prison healthcare is so poor, despite a doubling of funding since 2000.

Dr. John Henry, a general surgeon in San Luis Obispo County, hasn't been paid since September. Henry said treating inmates at Avenal State Prison makes up about 40% of his caseload.

Until recently, he was performing about 20 surgeries a month on prisoners. But then the anesthesiologists at the local hospital stopped providing service to inmates because of nonpayment by the state. Now, Henry performs only emergencies, such as appendectomies, and even those "reluctantly."

"I won't tell you how much I'm owed, but it's a lot," Henry said. "Nobody wants to stop providing care, but this is ridiculous. We can't keep working for free."