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updated 5/23/2011 5:42:20 PM ET 2011-05-23T21:42:20

The Supreme Court on Monday narrowly endorsed reducing California's cramped prison population by more than 30,000 inmates to fix sometimes deadly problems in medical care, ruling that federal judges retain enormous power to oversee troubled state prisons.

The court's 5-4 decision means California may have to release tens of thousands of inmates or take other unprecedented steps to ease overcrowding in its prisons.

The reduction is "required by the Constitution" to correct longstanding violations of inmates' rights to adequate care for their mental and physical health, the court said. In 2009, the state's prisons averaged nearly a death a week that might have been prevented or delayed with better medical care.

The order mandates a prison population of no more than 110,000 inmates, still far above the 80,000 the system was designed to hold.

There were more than 143,000 inmates in California's 33 adult prisons as of May 11, so roughly 33,000 inmates will need to be transferred to other jurisdictions or released.

"The violations have persisted for years. They remain uncorrected," Justice Anthony Kennedy, a California native, wrote for the court. The lawsuit challenging the adequacy of mental health care was filed in 1990.

To emphasize the conditions, Kennedy took the unusual step of including photos of overcrowding, including cages where mentally ill inmates were held while they awaited a bed.

The court's four Democratic appointees joined with Kennedy in upholding a court order issued by three federal judges in California, all appointees of President Jimmy Carter.

Justice Antonin Scalia said in dissent that the court order is "perhaps the most radical injunction issued by a court in our nation's history" and that it did not comply with the Prison Litigation Reform Act, a 15-year-old law intended to limit the discretion of judges in lawsuits over prison conditions.

Scalia, reading his dissent aloud Monday, said it would require the release of "the staggering number of 46,000 convicted felons."

Scalia's number, cited in legal filings, comes from a period in which the prison population was even higher.

Justice Clarence Thomas joined Scalia's opinion, while Justice Samuel Alito wrote a separate dissent for himself and Chief Justice John Roberts.

Michael Bien, one of the lawyers representing inmates in the case, said, "The Supreme Court upheld an extraordinary remedy because conditions were so terrible."

Donald Specter, an attorney for the inmates, hailed the ruling.

"This landmark decision will not only help prevent prisoners from dying of malpractice and neglect but it will make the prisons safer for the staff, improve public safety and save the taxpayers billions of dollars," he said.

The ruling comes amid efforts in many states, accelerated by budget gaps, to send fewer people to prison in the first place. Proposals vary by state, but include ways to reduce sentences for lower-level offenders, direct some offenders to alternative sentencing programs and give judges more discretion in sentencing.

"There's a growing consensus that there are better ways to run criminal justice systems," said Michael Mushlin, an expert on prisoners' rights at Pace Law School in White Plains, N.Y.

Eighteen other states joined California in urging the justices to reject the population order as overreaching. They argued that it poses a threat to public safety. State attorneys general said they could face similar legal challenges.

Alito said he, too, feared that the decision, "like prior prisoner release orders, will lead to a grim roster of victims. I hope that I am wrong. In a few years, we will see."

Kennedy acknowledged the concern, but said the judges gave state officials flexibility in complying with the court order, including offering "early release only to those prisoners who pose the least risk of reoffending."

California Gov. Jerry Brown said he "will take all steps necessary to protect public safety."

The California dispute is the first high court case that reviewed a prisoner release order under the 1996 federal law, which also made it much harder for inmates to challenge prison conditions.

The state has protested a court order to cut the population to around 110,000 inmates within two years, but also has taken steps to meet, if not exceed, that target. Kennedy said the state also could ask the lower court for more time to reach the goal.

Earlier this year, Brown signed a bill that would reduce the prison population by about 40,000 inmates by transferring many low-level offenders to county jurisdiction. The state legislature has yet to authorize any money for the transfer.

A person appointed by federal judges now oversees prison medical operations, but the judges have said the key to improving health care is to reduce the number of inmates.

At the peak of the overcrowding, nearly 20,000 inmates were living in makeshift housing in gymnasiums and other common areas, often sleeping in bunks stacked three high. Another 10,000 inmates were in firefighting camps or private lockups within California.

In 2006, then-Gov. Arnold Schwarzenegger used his emergency powers to begin shipping inmates to private prisons in Arizona, Mississippi and Oklahoma. More than 10,000 California inmates are now housed in private prisons out of state.

Schwarzenegger also sought to reduce the inmate population by signing legislation that increased early release credits and made it more difficult to send ex-convicts back to prison for parole violations. Another law rewards county probation departments for keeping criminals out of state prisons.

One result of those changes is that the state has been able to do away with nearly two-thirds of its makeshift beds, although more than 7,000 inmates remain in temporary housing.

Copyright 2011 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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