More than 21 years ago, California prison inmate Jay Lee Gates, representing himself, filed a lawsuit in Sacramento federal court quarreling with the quality of his health care behind bars.

No one could have foreseen that this unremarkable civil rights action would morph into landmark litigation, marked by trial court decisions with national significance and precedent-setting opinions by appellate judges.

The Gates suit was taken over by prisoners' rights lawyers and converted to a class action on behalf of "all present and future inmates confined at the California Medical Facility" in Vacaville. It was eventually folded into a successor class action.

It and another successor class action have now come together in a historic trial before a three-judge panel in San Francisco. It is a critical event in the long and bitter struggle to bring treatment of sick inmates up to constitutional standards.

The non-jury trial convenes today to determine whether, as the classes contend, overcrowding is the primary cause of substandard medical and mental health care throughout the state's prison system.

The classes say too many prisoners are overwhelming doctors, nurses and technicians, stripping them of their ability to provide timely and effective care for the physically and mentally ill.

Prison officials are "just trying to keep the lid on the powder keg by holding it tighter and tighter," says Michael Bien, a lead attorney for the inmates.

The state adamantly denies overcrowding is the primary cause of poor health care.

The trial shapes up as a battle of the experts, with recognized authorities on prison operations and inmate health care espousing the parties' respective positions.

The judges have decreed the first phase shall conclude no later than Dec. 19.

The stakes are enormous.

The panel – appointed by the chief judge of the 9th U.S. Circuit Court of Appeals and made up of district judges Lawrence K. Karlton of Sacramento, Thelton E. Henderson of San Francisco and Circuit Judge Stephen R. Reinhardt of Los Angeles – must decide overcrowding is the main culprit if the trial is to move to a remedy phase sometime next year. The judges would then decide whether anything short of prisoner releases will cure the problem and, if not, how such a controversial solution should be carried out.

Inmates' attorneys will be asking for an order cutting California's core prison population from 160,000 to 110,000 – roughly 130 percent of design capacity, as opposed to the current 200 percent. The attorneys believe this can be done within two years.

A three-judge panel is an extraordinary step. It was formed under provisions of the federal Prison Litigation Reform Act of 1996, and over the strenuous objections of the state. In rejecting the state's appeal, the 9th Circuit said it has no jurisdiction. An appeal of the panel's ultimate decision goes directly to the U.S. Supreme Court.

In the years since Gates was filed, the state has fought trial court mandates of Karlton and Henderson, but has invested in capital improvements and additional health care professionals.

Aside from payments to the state's own lawyers and experts, the litigation has cost taxpayers millions of dollars in fees and expenses for inmates' attorneys and their experts, and millions more for court-appointed special masters, receivers, a mediator and their staffs.

Overcrowding has proved to be one of the hardest-fought battles of the war over reform.

Common areas such as classrooms, conference rooms, and meeting rooms have been converted to dormitory space, according to class counsel. They say their clients are double-celled in single cells, and the converted living spaces have insufficient toilets and showers and lack enough guards.

The conditions have "increased the hostility and potential for violence," leading to "harsher security measures," inmates' attorneys claim.

Further, they claim, work, education, recreation and rehabilitative programs are not expanded to accommodate the increased population, and plaintiffs are kept out of programs for which they are eligible.

Call The Bee's Denny Walsh, (916) 321-1189.