Four years ago at San Quentin, the 156-year-old prison where the state of California keeps some of its most dangerous criminals, doctors saw an inmate for high blood pressure, diabetes and renal failure. The inmate got two drugs that, according to court documents, made his kidney problems worse. His blood pressure climbed so high his eyes bled. Yet a year passed before prison medical staff referred the inmate to a kidney specialist at a local hospital. He never got to go—the records are unclear about why—and he died three months later.

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If only, as on the outside, there had been a database to alert prison doctors of drug interactions. If only there had been software to schedule appointments. If only there had been basic Internet access, e-mail and electronic data about patients, so that prison medical staff could share information.

That patient might have lived.

More than 170,000 inmates crowd California's 33 state prisons. That's about as many people as live in Tempe, Ariz., and it's more than double the number the prisons were built to hold. Inside those bars, one inmate dies every six to seven days because of "deplorable" medical care, according to U.S. District Court Judge Thelton Henderson. In 2001, 10 inmates at nine prisons, including San Quentin, accused the state of violating the Eighth Amendment with medicine that amounts to cruel and unusual punishment. In 2002, Henderson agreed with the inmates, pronouncing California's prison healthcare system unconstitutional.

The state settled the case, agreeing to fix the problems. But by mid-2005, after six days of hearings, Henderson concluded the state had made no progress. He seized control, appointing a receiver—a federal overseer—to hire new people, change processes and install basic information technology found even in small rural hospitals in the United States. The aim of the receivership (officially the California Prison Health Care Receivership) isn't to offer criminals state-of-the-art health care. It's to do no harm.

An "unconscionable degree of suffering and death is sure to continue if the system is not dramatically overhauled," he wrote, explaining his decision. The decision and other court material relay story after story of how inmates didn't get the right medications on time. Or they didn't see specialists when they should have. Or they were treated by incompetent doctors whose personnel records didn't document their failings. Or no one knew the inmate was sick because his medical record was wrong. Or lost.