The court-appointed receiver overseeing California's prison health care system said Friday the state must keep its promise to spend more than $2 billion for new medical facilities before the federal courts can end an oversight role that has lasted six years.

California has committed to spending $750 million to upgrade existing medical facilities, building a new medical center and converting juvenile lockups. So far, only the new medical center in Stockton is being built.

Receiver J. Clark Kelso told The Associated Press that the state must begin all the upgrades before it should be allowed to retake control of a prison medical system once deemed so poor that it was found to have violated inmates' constitutional rights. They are his first public comments since a federal judge last week told officials to begin preparing for an end to the receivership...

The federal court-appointed receiver who oversees medical care in California's prison system said in a report Tuesday that the state still needs thousands of new prison hospital beds even as Gov. Jerry Brown proposes transferring responsibility for tens of thousands of convicts to local governments.

Even if Brown's proposal is approved, the state would need to build a $906 million, 1,722-bed medical center in Stockton, along with other facilities, because the most seriously ill inmates would remain in state custody, the report projects.

Poor treatment of physically and mentally ill inmates led the U.S. Supreme Court last month to uphold a federal court decision ordering California to reduce its prison population by about 33,000 inmates over the next two years...

The court-appointed receiver in charge of California prison medical care said a report criticizing the quality of inmate treatment is outdated and does not reflect recent improvements.

The state Office of the Inspector General reported last week that just nine of the 33 adult prisons met minimum health care standards, even after taxpayers spent billions of dollars to improve treatment.

In that report, the score for the California Institution for Men in Chino had surpassed standards, but first-round evaluations of the California Institution for Women in Chino and the California Rehabilitation Center in Norco found that those prisons had not met minimum adherence levels...

Amid California's budget crisis, the receiver put in charge of the prison health system by a federal judge has spent $82 million on blueprints for medical facilities that have been largely scrapped, more than $50,000 a month on an architectural consultant and millions hiring medical professionals — more per inmate than in many other states.

After four years of pouring money into the system, however, receiver J. Clark Kelso told legislators Wednesday that he didn't know when the federal oversight might stop and suggested early release of chronically sick inmates as one quick way to cut costs.

Exasperated lawmakers, who have to pay the bills but have little say in how the funds are spent, questioned whether federal control is making prison healthcare any better...

As noted in my op-ed in September, the receivership has made substantial progress in turning around prison medical care and controlling costs, and to finish the job, we need to spin off prison health care from the Department of Corrections and Rehabilitation so that health care can receive appropriate attention by a separate organization devoted to health care. The corrections department's mission is not health care; it is confinement.

Spinning off health care is only part of the solution to fixing our correctional system. Health care is not the only function that has been struggling. As of today, the "R" in CDCR exists in name only since rehabilitation programs have been decimated by budget cuts. The parole system has seen repeated failures, and even at its best, is woefully under-resourced. The juvenile program functions under the watchful eye of a state court judge.

The department has become impossible to manage given the huge scope of its operations, the unrelenting overcrowding, and the tension between day-to-day operational improvement and crisis management driven by periodic bad headlines. It is time to reorganize CDCR into smaller organizational pieces to improve focus on discrete functions and to strengthen transparency and accountability for operations...

Eighteen months ago, I promised to reduce prison medical costs by up to $500 million while improving the quality of care ("Prison health care reform can save money"; Viewpoints, March 16, 2009). Now that the 2009-10 fiscal year has ended, it is time for me to report on my promise.

We began the year anticipating our expenditures would be $2.146 billion. During the year, we implemented substantial changes to improve quality of care while simultaneously reducing unnecessary costs. The result? A reduction of $408 million in our expenditures. That is almost a 20 percent reduction and just over 80 percent of what I had forecast 18 months ago. My executive team and staff in the 33 institutions deserve the credit for this success...