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The U.S. Supreme Court hears arguments today in a case that pits California's right to run its prisons against prisoners' constitutional right to minimally basic medical care. At issue is a federal court order from a specially created three-judge panel. That order requires California to do whatever it needs to do to bring down the state's prison population by some 46,000 inmates.

NPR legal affairs correspondent Nina Totenberg has the story.

NINA TOTENBERG: Undisputed facts demonstrate a horrific scene in California's prisons. A system designed to house 80,000 prisoners now houses more than twice that many. Prisoners are not only doubled and tripled up in six-by-nine cells built for one; they are stacked in bunks in areas meant to be used for recreation, for vocational training, even for clinic space.

Mr. WAYNE SCOTT (Former Director of Corrections, Texas): The California state prison system is the worst overcrowded system that I have seen in my experience.

TOTENBERG: Wayne Scott served for nearly 30 years in the Texas prison system, rising to be the state's director of corrections under then-Governor George W. Bush.

Mr. SCOTT: I guess what shocked me - if that's the right word - the most was taking over recreation space, classroom space, day room space, and converting all of that space into living areas for offenders.

TOTENBERG: Texas, notes Scott, was also under court order to relieve overcrowded conditions in the 1980s. But, he adds, Texas never had conditions close to those in California. Scott describes California's prison overcrowding as more than a threat to the health and safety of the prisoners, but also as a threat to the prison guards and staff.

Scott was one of four top prison officials from highly populated states who testified in the two cases before the Supreme Court today. One case, filed in 1990, charged that prisoners with acute mental conditions, like schizophrenia, were not receiving basic mental health care. A second case, filed in 2001, made the same claim for the prisoners' physical care.

Lawyers for the prisoners contend that one prisoner dies every eight days for lack of medical care - 112 in the last two years alone.

The examples are stark. The former head of the California prison system, for instance, described how a prisoner was beaten in the middle of a crowded gymnasium that had been converted into a bunkroom. But because the gym was so crowded, prison officials didn't even know about the injury, much less provide emergency aid, until hours after the prisoner was dead.

On the mental health side, the examples too are, in the words of one observer, Dickensian, with suicides averaging one a week, and the number of preventable suicides rising dramatically.

The Supreme Court has long held that prisoners are, in essence, wards of the state, and that since they're not free to find and consult a doctor, the state is required to provide them basic, minimal medical care while they're in prison.

California admits that the conditions in its prisons violate the Constitution's ban on cruel and unusual punishment. Over the last two decades, the state has convened some two dozen blue-ribbon panels to study the prison crisis, and each has concluded that to provide basic health services the system must reduce overcrowding. The problem is that the state legislature has not been willing to change the state's uniquely punitive laws or to spend the money to reduce overcrowding.

Governor Arnold Schwarzenegger's repeated requests that the legislature enact prison population reduction measures have fallen on deaf ears. And when the federal courts stepped in to order such reductions, he was not surprised.

Governor ARNOLD SCHWARZENEGGER (Republican, California): I don't blame the courts for stepping in to try to solve the overcrowding crisis that we have, because the fact of the matter is, for decades the state of California hasn't really taken it seriously. It hasn't really done something about it.

TOTENBERG: The state nonetheless has appealed the lower court order, which would require the state to reduce the prison population from its current 200 percent of capacity to 137 percent, and to do it in two years.

The lower court said it was giving the state maximum flexibility to reach that goal. The state could build more prisons, it could send prisoners to other states, put them in private prisons. The state could change its uniquely severe parole system, under which even a minor technical infraction results in sending the offender back to prison. It could release low-risk nonviolent offenders; that presumably would involve letting go some low-level offenders, from shoplifters to burglars, sentenced to long prison terms under the state's three strikes law.

The choice of which measures to use, and how to combine them, was up to the state, but it had to reduce overcrowding by 46,000 prisoners in two years.

California, however, contends that the lower court exceeded its authority and did not give sufficient weight to public safety concerns. Lawyer Carter Phillips, representing the state, will tell the Supreme Court today that the lower court's assertion of flexibility for the state is illusory.

Mr. CARTER PHILLIPS (Attorney): Well, that's willful blindness. The only way to bring yourself into compliance is by releasing tens of thousands of prisoners.

TOTENBERG: The state, he says, has not been afforded a reasonable enough time to comply with the court's orders.

Mr. PHILLIPS: I think the fundamental question is, do you essentially just throw your hands up or do you allow an orderly process? And if they can't succeed, then you say, OK, fine, the final remedy is available.

TOTENBERG: But lawyers for the prisoners reply that enough is enough. The mental health case has gone on for 20 years, with the first court order issued 15 years ago and more than 70 other major court orders since then.

Paul Clement, who served as solicitor general in the George W. Bush administration, represents some of the prisoners.

Mr. PAUL CLEMENT (Former Solicitor General): How much more time do they really need? They've had 15 years since the finding of a constitutional violation. You know, we're not talking about abstract constitutional issues here. As the courts have found, people are dying unnecessarily in the California prison system as we speak.

TOTENBERG: Neither the courts nor Congress have been friendly to prison reform litigation. Indeed, Congress enacted a federal law in 1996 to limit such litigation to extreme cases. Clement contends that California's prison overcrowding presents just the kind of case Congress had in mind for court intervention.

Mr. CLEMENT: California - you can't emphasize this enough - is a complete outlier. This is not a case where California has the same problem that everybody else does and it's just a little bit worse. California really has a problem that's different in both kind and degree. Why is that? Because they are incarcerating people who are not incarcerated in other states.

TOTENBERG: Clement says these exceptional circumstances justify federal court intervention in what would otherwise be state business.

Mr. CLEMENT: This is like the proverbial ax behind the glass - you know, break glass only in case of emergency. But it's one thing to say don't use this unless it's an emergency. It's another thing to take the ax away entirely. And that's really what the state's asking to be done here.

TOTENBERG: But Carter Phillips, representing the state, contends that the lower court order poses a grave threat to public safety.

Mr. PHILLIPS: I guarantee you to a moral certainty as we sit here today that if you release 30,000 inmates, I don't care how carefully you do it, more than a few of them will commit a violent act, and that will be on somebody's head.

TOTENBERG: A decision in the case is expected by the spring or summer.

Nina Totenberg, NPR News, Washington.

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