| AVENAL -- For two days last December, inmate Melvin Fergerson sat slumped and naked in his prison infirmary cell, several people familiar with the case said. | Clinical personnel at Avenal State Prison checked in on the 61-year-old convicted child molester a couple of times and found him to be somewhat lethargic, but not so bad as to merit a trip to the hospital in nearby Coalinga. |
By the time medical personnel realized they had a serious problem, Fergerson had stopped breathing. Efforts to revive him failed, and he was pronounced dead in his cell.
According to the Kings County Coroner's Office, Fergerson's death resulted from atherosclerotic coronary artery disease. Federal prison medical care receiver Robert Sillen characterized the death as "horrific" and said it is under investigation by corrections officials to determine whether it was related to medical neglect.
"This was a totally unnecessary death," Sillen said.
Fergerson's death on Dec. 4 was one of three in two months at Avenal that triggered a massive response from Sillen's office. The deaths also prompted a cultural clash between medical providers and custody staff members at the prison, and they have helped turn Avenal into ground zero in the federal judiciary's oversight of California prisons.
In a Jan. 23 memo to the Department of Finance, the receiver's office describes Avenal as being in "a medical delivery crisis." In ordering dozens of new staff members to resolve it, the document might as well have been referring to problems in the entire state prison system, for which the courts, their appointed monitors, the Legislature and the Governor's Office all are searching for solutions at a potential cost of billions of dollars.
Sillen and Gov. Arnold Schwarzenegger agree that the state needs more prison hospitals for thousands of inmate patients.
Designed for 2,920 inmates when it opened in 1987, Avenal as of Feb. 21 housed 7,489 low-medium security prisoners, an overcrowding rate of 256 percent.
"If in fact the facilities were adequate when the place was constructed, they're totally inadequate at this point in time," Sillen said.
More than 1,000 inmates are serving life terms, helping to make Avenal's population one of the oldest and sickest in the state. It also has a mental health caseload of more than 1,000 inmates and hundreds more disabled prisoners.
Inmates' rights lawyers have won federal class-action lawsuits overseeing medical care, mental health treatment and disability access in the prisons, putting Avenal in the cross hairs of courts in Sacramento and San Francisco that are considering population caps and early-release orders.
"It's a huge problem," Prison Law Office attorney Steve Fama said of Avenal. His firm represented plaintiffs in the three class-action lawsuits.
After Fergerson's death, Sillen's office ordered the creation of 50 new clinical positions at Avenal. Last week, Sillen said he is planning to order the creation of 20 new custody positions at the infirmary -- to be funded through overtime payments -- to help handle the constant stream of inmate medical transports to outside hospitals.
Sillen visited Avenal on Feb. 1. In the ensuing weeks, a team of doctors from the University of California, San Francisco, swept into Avenal under his direction and began ordering dozens of inmates out of the prison for medical visits to local hospitals.
"It was a crisis situation, and we did take immediate steps to relieve it," receiver spokeswoman Rachael Kagan said.
Last week, the prison sent 33 inmates on medical transports; each required two- officer escorts.
At the Coalinga Regional Medical Center, an estimated 30 green-clad officers -- including some from nearby Pleasant Valley State Prison -- crowded the halls in one wing of the hospital, sitting around while clinicians examined inmate-patients.
Hospital Nursing Supervisor Lori Bryan called the situation "pretty normal."
"They're here to protect us, and we're here for patient care," Bryan said.
Avenal Warden Kathy Mendoza-Powers said that since Sillen's visit, out- of-prison inmate transports have jumped from about 10 a day to 30. She said the escorts have forced her to spend more on overtime to replace the officers who are out of the prison.
Still, Mendoza-Powers said, she supports Sillen's efforts to fix medical care at the prison.
"We want to see health care appropriate for inmates," Mendoza-Powers said. "If he can help, good."
Maggie Huddleston, the nursing director at the prison, said that medical care was "grinding down" at Avenal until Sillen showed up.
"He helped us get the resources we need to do a better job," Huddleston said.
In the housing units, some of the correctional officers expressed frustration with the receiver and his team. They said in interviews that inmates are asking for and receiving medical transports for minor maladies such as the flu, athlete's foot and constipation. Officers accused inmates of faking chest pains to get virtual day passes out of the prison. They also decried convicts' access to expensive medical equipment such as mobile CAT scans.
"Our members think the inmates are pretty much getting over on the medical staff and having fun with it," said Tim Grove, the California Correctional Peace Officers Association chapter vice president at Avenal.
Grove said that "everybody's for adequate health care for inmates," but that "some of (Sillen's) people are going over the top."
But in one triple-bunked gym at the prison, inmate James Vensel, 46, said the pre-Sillen state of medical affairs at Avenal nearly cost him his life.
Vensel, who is finishing a five-year term for petty theft with a prior offense, said it took him two months to see a doctor after he was transferred to Avenal last year, even though he complained about headaches and earaches and had a tumor cut out of his brain stem during a previous prison stay in 2000.
A magnetic resonance imaging test showed he had a new tumor the size of a baseball, Vensel said. It was removed in August.
"The doctor said if I didn't have the surgery, in two weeks I was going to die," Vensel said.
Just staying healthy on a day-to-day basis in the severely overcrowded prison is a problem, said inmate Richard Jump, 41.
"Somebody gets a cold and is coughing on one side of the unit, and two days later, it's all over the unit," said Jump, who is about halfway through a seven-year, eight-month term on a conviction for being a felon in possession of a gun.
Compounding the overcrowding problem, Jump said, are constant plumbing breakdowns that have reduced the number of working toilets for the 150 inmates in the gym from eight to five. Inmates said the water pressure gets so low at times that they have to keep buckets of water nearby to flush the toilets.
Correctional Officer O. Perez, a 10-year veteran, was one of two custody staff members watching the 150 inmates in the gym during a recent visit. She said the tripling of the medical transports forced prison officials to shut down exercise yards and send fuming inmates back into the gym, adding to what are already problematic safety conditions for staff members.
"It might not seem like a lot to take two officers out, but it is, especially when we need extra eyes and bodies," Perez said. "It takes away from our safety."
Sillen said he recognizes that the prison system has 4,000 officer vacancies. "I sympathize with that," he said, adding that the 20 new officer positions he's ordered for the prison should help alleviate the custody crunch at Avenal.
In the meantime, he said, the prison is going to have to make some adjustments.
"If the option is to leave a patient in the prison to die, that is not an option," Sillen said.
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