|
|
| California point man |
| By Orange County Register |
| Published: 05/09/2007 |
Editor’s Note: With the attention California has been getting lately about its battered corrections system, we though this profile about Robert Sillen, the point man for a federal judge charged with updating California's prison medical care system, would provide interesting insight into what it takes to be a liaison between the corrections and judicial systems. It was originally published in California’s Orange County Register earlier this week.Robert Sillen is driven by two principles – quality health care and full access – and he doesn't mind trampling bureaucrats and legislators to achieve them. SACRAMENTO -- The way Robert Sillen tells it, he's been keen from the beginning on "equity and justice." A hard-left upbringing furnished those life-guiding principles, which led him after college to fight venereal disease in Harlem. Later, those principles pushed him to build a world-class public health system for the poor in Santa Clara County, Calif. These days, the 64-year-old, bureaucrat-battling street fighter from New York is focused on a different group of the dispossessed. For a year now, Sillen has been the point man for a federal judge in charge of bringing California's prison medical care system up to constitutional snuff. And in that year, Sillen has affirmed a reputation gained over a 42-year career as a master political infighter with a razor-sharp intellect and an ability to deliver the goods. Confident to the point of arrogance, Sillen's soaring self-assurance has led to mumbles in Capitol hearings that he's an egomaniac. But about one inmate a week was dying due to medical neglect at the time he was hired by U.S. District Judge Thelton Henderson as the prison medical care receiver, and Sillen said he hasn't spent much time worrying about what anybody thinks of him. "There's no room here for a wallflower," Sillen said recently in an interview from his seventh-floor office overlooking downtown San Jose. "This job by definition generates controversy. I generate controversy because I am candid and I tell it like it is, and people don't like that. "They operate a political business up there in Sacramento, and I don't have a problem with that. But I don't operate a political business. I operate an outfit that is going to straighten out the problems caused by operating a political business." The outfit he heads is the California Prison Receivership, set up through the federal courts as an independent, non-profit corporation to run the state prisons' medical care operation. In the receivership's first year, Sillen has exploded onto the statewide political stage with an impact that, with the exception of Gov. Arnold Schwarzenegger's, arguably exceeded any other official's in state government. He's threatened to seek contempt of court citations against anybody in state government who impedes him. He's forced the governor's top two prison health care appointees out of their jobs. He's told lawmakers and bureaucrats they're going to give him the money he wants to fix problems as he sees them or he'll send U.S. marshals to the state treasury to get it for him. Sillen also has served notice that prison medical reform will not come cheap. Legislative analysts have estimated that his capital outlay prescriptions will cost $3 billion over five years. He also has a $100 million discretionary fund at his disposal. His annual compensation package, meanwhile, is $650,000 – an "entry-level" wage, he says, for a man with his responsibilities. Tieless, coatless and sometimes with his shirttail hanging out, Sillen has told assorted legislative committees and agency boards and commissions that Henderson has his back and he will not be impeded. "I don't need their backing," Sillen said of the state's political establishment. "I cherish their backing if they're willing to give it. But I will get this job done with or without their backing." Robert Ross, the president and chief executive officer of The California Endowment, the statewide foundation that seeks to improve health care access for the poor, said the book on Sillen can be summed up in two concepts: high standards for everyone and accessibility for the poor. "He's what I call a straight, no-chaser kind of guy," Ross said. "He's going to give you unvarnished, no-sugar-coated feedback on what's going to have to happen in terms of achieving quality care and public health." Sillen's first year as receiver included some stumbles and shortcomings and a lot of strained feelings. Legislative Republicans, for their part, hold him up as a symbol of federal intrusion into state prerogatives, with no accountability to California voters. Assemblyman Todd Spitzer, R-Orange, noted that Sillen still hasn't produced a medical plan for the prisons, which was due last September. If Sillen couldn't get it done in a year with the power of the courts behind him, he should lighten up on everyone else, in Spitzer's estimation. "You would think he would come to the Legislature in trying to work with the Legislature and the courts in a partnership," Spitzer said. Sillen also has come under fire from the same inmates rights advocates who filed the class action lawsuit that got him his job. Rather than massive building projects, they'd like to see him pay more attention to prisoners' immediate health care needs. "I don't think he's focused enough on the crisis," said Steve Fama, an attorney with the San Rafael-based Prison Law Office. Born in New York City, Sillen was raised in Croton-on-Hudson in Westchester County by leftist parents whose influence shaped his politics to the present day. His mother, he said, was a union activist who got her two front teeth knocked out while helping labor legend John L. Lewis organize mine workers in West Virginia. His father, a college professor and writer, refused to testify before the House Un-American Activities Committee when it was investigating communist influence in academia and other areas. His parents' ideology, he said, "shaped me in terms of my value system, and my value system has driven my professional decisions so that I've always been an advocate for equity and justice," a framework that he is applying to the prisons with no apology. "There are tens of thousands of people in state prison who didn't have a chance from the get-go because of their surroundings or economic status or their race or whatever," Sillen said. As for their medical care, "the issue is that their constitutional rights have been violated. That, per se, is wrong." Sillen said he got into the health care business as a matter of "happenstance." After he graduated from the University of Denver in 1965, a friend tipped him off to an opening at the U.S. Public Health Service in New York City, where he worked as a field epidemiologist investigating venereal disease in the neighborhoods of Harlem, East New York and Brownsville. He eventually moved into management, got a master's degree in public health from Yale in 1972 and headed that year to California, where he became assistant director at the University of California, San Diego's University Hospital. Sillen moved to San Jose in 1979, taking over as executive director of the Santa Clara Valley Medical Center. In 1993, his responsibilities expanded to cover the county's entire public health and hospital system. In San Jose, Sillen spearheaded a 26-year effort to maintain Santa Clara County's public health system at a time when lower-income people were pouring in due to lack of insurance coverage, while at the same time the state was paring back reimbursements to local facilities. "Given all that, he was able to do a substantial retooling of the system, rebuilding investment in facilities, outpatient services and primary care," said Larry Gage, president of the National Association of Public Hospitals and Health Systems in Washington, D.C. "I think Bob did a great job." A variety of current and former South Bay officials credited Sillen for fighting the county administrative office to push through construction of two massive new towers at the county hospital to bring it into compliance with earthquake standards, and for getting them finished on time and on budget. They said that he led drives to make Valley Medical home to newly created trauma, burn, spinal cord and neonatal units, that he maintained the hospital as the sole Santa Clara County outfit caring for Medi-Cal patients, and that he insisted that the county maintain access for undocumented children. "What drives Bob is his all-consuming passion for access and quality health care," said Pete Kutras, the Santa Clara County executive officer, Sillen's former boss. "You can turn him upside down and shake him and look for all kinds of different reasons, but that's what drives him." Sillen ran the public hospital so effectively and efficiently, former Supervisor Rod Diridon said, that even people of means prefer it to the private hospitals – allowing it to maintain one of the lowest percentages of taxpayer subsidies in the state. "I don't think there's a challenge in the medical community that would be too tough for Bob Sillen," Diridon said. The political backing of the Santa Clara County Board of Supervisors helped Sillen get what he wanted. Listening to community meetings packed with Sillen supporters, the board usually supported him when he took on the county bureaucracy. "He was a master of bureaucratic infighting," said San Jose State political science professor Terry Christensen. "He was great at defending the interests of Valley Medical and people it serves and taking no prisoners." His success did not come without alienating a few folks in the county's health care hierarchy. "His philosophy is, 'It's my way or the highway,"' said Gary Allen, chief executive officer of The Health Trust in San Jose. "He was in such a position of power (in Santa Clara County), he got away with saying screw you and the horse you rode in on. I'm not sure that works in a bigger environment." In his new job, Sillen said, he is confronted by an "impossible" political environment. Nobody holding elected state office, he said, got there by representing his despised constituency, allowing prison medical care to sink into constitutional unacceptability, which he vows to correct. While Schwarzenegger last week signed a plan to add 53,000 beds to the prison system to ease overcrowding, the package did not address directly the health care crisis Sillen is tackling. To get a fix, he said, "the politics have to change, or be ignored, and the judge has created that opportunity by taking this thing into receivership of not having to play the stereotypical political game." With the only vote he needs – Henderson's – already sewn up, Sillen doesn't spend time lobbying elected state officials. In fact, he blames them for allowing the bottom to drop out of prison medical care. Now, he said, "it's my job to get it back," a task that he said will take at least five years to finish. When he's done, Sillen said the state will have "a cost-effective system" free from judicial control. Inmates will be healthier and the system's overall costs will come down. Sillen predicted the final product "will be a hallmark of good government," because "we're going to clean up not just the way CDCR performs, but the way state government performs. |
MARKETPLACE search vendors | advanced search
IN CASE YOU MISSED IT
|
Comments:
No comments have been posted for this article.
Login to let us know what you think