Sillen is a mercurial but curmudgeonly man, prone to fits of anger when he doesn’t get his way, disdainful of compromise. At least in part, that’s why he was able to push broad changes on a reluctant correctional system. He aimed high, and while he didn’t always get his way, oftentimes he did. In the wake of last year’s AB 900, a bill that allocated billions of dollars in bond revenues to building new prison cells in California, ostensibly to alleviate an overcrowding crisis, Sillen publicly announced the new situation meant it would take ten years, and billions of dollars, for him to solve the prison healthcare problem Sure, some of AB 900’s money was to go into building medical and mental health care units, but much of it was to simply increase the size of an already enormous correctional system. Sillen feared his medical-improvement mandate would get lost in the shuffle – and so he made it abundantly clear, in a series of public speeches, that he had been empowered by the courts to be a pain in the butt to the powers that be for as long as was necessary to wring better health care out of the bureaucracy.

His position won him plaudits from reformers and denunciations from conservatives, who argued he was a typical big-spending, soft-on-crime liberal. 

Two weeks ago, out of the blue, the judge who hired him – Judge Thelton Henderson – fired him. Sillen had served his purpose, the judge wrote; now it was time for a man better able to forge alliances and to get things done through compromise to take over. In a stinging memo, Henderson wrote that ``The court has concluded that such work would best be accomplished by appointing a new receiver who brings a different set of strengths,''

Perhaps the new receiver will help to bring about better medical conditions for prisoners; Henderson’s progressive track record certainly suggests his action wasn’t intended to kill off reform. But I have my doubts as to whether the new receiver will maintain the wind under his sails. Sillen’s firing came during the same week in which California’s legislature effectively killed off the Governor’s proposal for a state-backed near-universal healthcare system. The reasoning? There wasn’t money in the state coffers to fund the program. If the state can't afford to provide healthcare for non-incarcerated individuals it seems mighty unlikely the medical needs of prisoners will fare much better. More likely, as California’s budget situation worsens, there will be tremendous political pressure to cut the cost, rather than raise the quality, of medical and mental health services inside prison. And that’s a shame… not just because shoddy care for prisoners represents a moral failing, but – at least as important – because prisons have long been incubators for nasty diseases such as hepatitis C and tuberculosis, as well as California-specific illnesses such as Valley Fever. Prison health care is a broader public safety issue as much as a moral issue. So too is prison mental health care. People who go into prison almost always eventually come back out of prison. When they do, we want them more, not less, functional.

I hope the incoming healthcare receiver will be able to convince the department and the general public that this is the case. I’m not, however, optimistic. Perhaps he’ll manage to increase the number of prison hospital beds, and continue Sillen’s move to pay prison doctors, nurses and counselors more competitive wages. I doubt, however, that Sillen’s more ambitious plans to comprehensively overhaul the delivery systems for prison medical care will now be realized.

Sasha Abramsky, author of American Furies: Crime, Punishment, and Vengeance in the Age of Mass Imprisonment, is a freelance journalist. His work has appeared in The Nation, Atlantic Monthly, New York magazine, the Village Voice, and Rolling Stone. In 2000 he was awarded a Soros Society, Crime, and Communities Media Fellowship, and he is currently a Senior Fellow at the New York City-based Demos Foundation. His other books are Hard Time Blues and Conned.