Coleman, et al v. Schwarzenegger, et al
Filing
4688
ORDER signed by Judge Lawrence K. Karlton on 7/11/2013 ORDERING that Plaintiffs' 4543 motion is GRANTED IN PART. Within seventy-five (75) days from the date of this order the Special Master shall report to the court on the adequacy of staffi ng levels at the Salinas Valley Psychiatric Program SVPP; and on whether the so-called cuff or orientation status, either as designed or as implemented, unduly interferes with or delays the provision of necessary care to class members at SVPP. Defen dants shall cooperate fully in providing the Special Master with all of the documents and facility access that he may require to meet this obligation. The Special Master shall complete one round of monitoring the adequacy of all inpatient programs and report to the court thereon not later than 3/31/2014. Except as expressly granted herein, plaintiffs' 4/11/2013 motion for orders concerning inpatient care is DENIED without prejudice. (Zignago, K.)
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UNITED STATES DISTRICT COURT
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EASTERN DISTRICT OF CALIFORNIA
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RALPH COLEMAN, et al.,
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Plaintiffs,
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No. 2:90-cv-0520 LKK JFM P
v.
ORDER
EDMUND G. BROWN, JR., et al.,
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Defendants.
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On April 11, 2013, plaintiffs filed a motion styled “Motion
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for Enforcement of Court Orders and Affirmative Relief Related to
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Inpatient Treatment.”
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(ECF No. 4629) the matter came on for evidentiary hearing on June
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19, 2013 on the issues raised in Section I(B)-(H) of plaintiffs’
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motion.1
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half days.
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filed in support of and in opposition to the motion, and the
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ECF No. 4543.
Pursuant to court order
The court heard testimony for a total of three and one
After consideration of that testimony, the papers
Section I(A) of plaintiffs’ motion concerns access to intermediate hospital
care for inmates on death row at San Quentin State Prison. Hearing on that
part of plaintiffs’ motion has been consolidated with hearing on issues raised
by two additional motions filed by plaintiffs. See Order filed May 24, 2013
(ECF No. 4632) at 2.
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arguments of counsel, for the reasons set forth in this order
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plaintiffs’ motion will be granted in part and denied in part.2
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Plaintiffs seek a number of orders relative to inpatient
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care provided to class members at programs operated by the
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California Department of State Hospitals (DSH), formerly known as
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the California Department of Mental Health (DMH).3
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orders relative to staffing levels and hiring; use of so-called
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cuff or orientation status for newly-admitted patients; provision
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of basic necessities including soap and clean and adequate
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blankets, clothing, and underwear; length of patient stays,
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discharges, and waitlists for inpatient care; access to DSH
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programs regardless of parole date; activation and closure of DSH
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units during the opening of and transition to the new CHCF
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facility in Stockton; and treatment provided at VPP.
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Proposed Order filed April 11, 2013 (ECF No. 4543-1).
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These include
See
Defendants’ oppose the motion on a number of grounds.
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Both parties have tendered objections to evidence offered by the other
party, and defendants have filed three motions in limine to exclude evidence
(ECF Nos. 4659, 4660, and 4661). The court denied all motions in limine at
the start of the hearing. Although not necessary to the court’s ruling on the
matters at bar, all objections not specifically sustained are deemed
overruled. Given the gravity of the evidence in this hearing, the defendants’
previous motion to terminate takes on the character of a condition in which
the defendants have simply divorced themselves from reality.
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With one exception, inpatient mental health care is provided to inmates in
the California Department of Corrections and Rehabilitation (CDCR) at programs
operated by the California Department of State Hospitals (DSH). The exception
is a new program for female inmates operated by CDCR at California Institution
for Women (CIW). In relevant part, DSH provides inpatient care to CDCR
inmates at the Salinas Valley Psychiatric Program (SVPP), the Vacaville
Psychiatric Program (VPP), Atascadero State Hospital (ASH), and Coalinga State
Hospital (CSH). In addition, on July 22, 2013, admissions for inpatient
mental health care will start at the new Correctional Health Care Facility
(CHCF), a CDCR facility that will contain, inter alia, additional DSH mental
health programs for California’s prison inmates. The DSH programs provide two
levels of hospital care. For male inmates, acute psychiatric care is provided
at VPP. Intermediate hospital care is provided at ASH, VPP, SVPP, and CSH.
Both acute and intermediate levels of hospital care will be provided at CHCF
for male inmates.
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First, defendants contend that the relief sought by plaintiffs,
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if granted, will “unnecessarily expand judicial oversight” in
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this action.
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Aff. Relief, filed May 9, 2013 (ECF No. 4592) at 12.
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argue that the court “has never found that DSH is providing
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inadequate care to class members.”
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“recent challenges with retaining psychiatrists” has affected the
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adequacy of care provided to inmates at SVPP and contend that VPP
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is adequately staffed.
Defs. Opp’n to Pls.’ Mot. for Enf. of Ct. Ord. &
Id.
Id. at 14, 17.
Defendants
Defendants dispute that
They contend that so-
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called cuff or orientation status for newly arriving patients is
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“reasonably related to legitimate penological interests” and that
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plaintiffs have not proved that the policy violates the Eighth
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Amendment.
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concerning soap and clothing are “inaccurate” and that
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plaintiffs’ contentions concerning length of stay, discharges,
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and management of waitlists are “unsupported and further orders
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will unnecessarily intrude into defendants’ operations.” Id. at
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22.
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improper discharges in anticipation of parole are “unfounded”,
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that they are properly managing the transition to Stockton, and
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that there is no basis for investigation of the programs at VPP.
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Id. at 24-25, 27.
Id. at 20. They contend that plaintiffs’ contentions
They contend that plaintiffs’ allegations concerning alleged
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The threshold question before the court is whether the
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Special Master should monitor and report to the court on issues
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related to the adequacy of inpatient care provided to members of
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the plaintiff class.
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to that question is yes.
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requested by plaintiffs should issue will be denied without
For the reasons set forth infra, the answer
The question of whether other orders
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prejudice pending monitoring and reporting by the Special Master.
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The relevant history of this action has been set forth in
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several recent court orders, including this court’s April 5, 2013
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order denying defendants’ January 7, 2013 motion to terminate
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this action, see Coleman v. Brown,
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1397335 (E.D.Cal. Apr. 5, 2013), and is repeated only briefly
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herein.
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their Eighth Amendment obligation to provide class members with
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access to adequate mental health care.
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F.Supp.2d
, 2013 WL
“In 1995, this court found defendants in violation of
Supp. 1282 (E.D. Cal. 1995).”
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Coleman v. Wilson, 912 F.
Id., slip op. at 1.4
The first remedial order in this action
directed defendants to work with the Special
Master and his staff to develop and implement
plans
to
remedy
the
Eighth
Amendment
violation. See Coleman, 912 F.Supp. at 1323–
24. [Footnote omitted.]
Over a decade of
effort led to development of the currently
operative remedial plan, known as the Revised
Program Guide. The Revised Program Guide
“represents
defendants’
considered
assessment, made in consultation with the
Special Master and his experts, and approved
by this court, of what is required to remedy
the Eighth Amendment violations identified in
this action and to meet their constitutional
obligation to deliver adequate mental health
care to seriously mentally ill inmates.”
February 28, 2013 Order (ECF No. 4361) at 3.
[Footnote omitted.] Over seven years ago,
this court ordered defendants to immediately
implement all undisputed provisions of the
Revised Program Guide.
[Footnote omitted.]
Id. at 5–6.
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Id. at 12.
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order,
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As the court explained in its February 28, 2013
the Special Master is tasked with monitoring
“defendants’ implementation of and compliance
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As the court noted in an order filed February 28, 2013, “[t]he Eighth
Amendment violations in this case predate 1994, when they were found by the
magistrate judge after a lengthy trial.” Order filed February 28, 2013 (ECF
No. 4361) at 3.
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with any remedial plan that this court may
order”, preparing and filing “with the court
periodic
reports
assessing
defendants’
compliance with such remedial plan as the
court may order”, and advising the court
“concerning any modification to the remedial
plan that is requested by a party or that
appears necessary to effectuate the purposes
of the remedial plan.”
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Order filed February 28, 2013 (ECF No. 4361) at 5 (quoting Order
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of Reference filed December 11, 1995 (Doc. No. 639) at 4-5).
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Defendants’ remedial plan, the Revised Program Guide, makes
specific provision for inpatient care.
At the start, the Revised
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Program Guide provides that CDCR’s Mental Health Services
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Delivery System (MHSDS) “provides a continuum of inpatient care
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from a contractual relationship with Department of Mental Health
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(DMH) for acute and intermediate and a short-term crisis
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inpatient program within CDCR institutions.”
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Program Guide at 12-1-1.
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provided via contract with the DMH is available for inmate-
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patients whose conditions cannot be successfully treated in the
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outpatient setting or in short-term MHCB [mental health crisis
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bed] placements.”
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2009 Revised
“Referral to inpatient programs
Id. at 12-1-9.
At Chapter 6, the Revised Program Guide covers inpatient
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care in greater detail.
It begins:
“The California Department
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of Corrections and Rehabilitation (CDCR) is responsible for
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providing acute and intermediate inpatient care, in a timely
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manner, to those CDCR inmates clinically determined to be in need
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of such care.
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California Department of Mental Health (DMH) to provide acute and
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long-term intermediate inpatient mental health care to inmate-
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patients.”
CDCR currently maintains a contract with the
Id. at 12-6-1.
Chapter 6 contains admission and
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discharge criteria for both acute and intermediate hospital care,
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as well as referral, admission, discharge, and transfer
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procedures.
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provides:
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Under the heading Utilization Management, Chapter 6
1.
CDCR reserves the right to inspect,
monitor, and perform utilization reviews
prospectively,
concurrently,
or
retrospectively regarding the courses of
treatment or inpatient care provided to
CDCR’s inmate-patient. Such reviews shall be
undertaken to determine whether the course of
treatment or services was prior authorized,
medically
necessary
and
performed
in
accordance with CDCR rules and guidelines.
DMH agrees to make available, upon request by
CDCR, for purposes of utilization review, an
individual patient’s medical record and any
committee reviews and recommendations related
to a CDCR patient.
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2.
DMH
acknowledges
and
agrees
that
concurrent
utilization
management
review
shall not operate to prevent or delay the
delivery of emergency treatment.
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3.
DMH acknowledges that the care of a
patient at DMH shall be reviewed by CDCR
Utilization
Management
(UM)
nurses
or
designated party and by a Joint CDCR/DMH
Review Process.
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4.
CDCR UM nurses or designated party will
gather data and review cases of CDCR inmatepatients in DMH programs. CDCR UM nurses or
designated party will report their findings
and make recommendations to the CDCR Health
Care Manager and CDCR Chief Psychiatrist or
their designee(s).
CDCR and DMH managers
will meet monthly to review the data.
Each
DMH program also will have a joint CDCR/DMH
UM process that will review individual cases.
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If there is a disagreement about discharge,
the UM nurse will review the patient’s record
and forward a recommendation to the Joint
CDCR/DMH UM Review Process.
If there
continues
to
be
disagreement,
the
recommendation will be conveyed to the CCAT
[(Coordinated Clinical Assessment Team)].
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12-6-12.
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The inpatient programs are included in defendants’ plan to
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remedy the Eighth Amendment violation in this case.5
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defendants’ implementation of and compliance with that part of
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defendants’ remedial plan, reporting to the court on defendants’
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compliance, and advising the court concerning any required
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modifications are all plainly within the Special Master’s duties
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under the Order of Reference.
Monitoring
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Defendants’ assertion that the court has never found that
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DSH provides inadequate care to class members misses the mark.
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In 1995, when the court found the Eighth Amendment violations
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defendants are now tasked with remedying, the following
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California officials were defendants in this action:
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Governor, the Secretary of the Youth and Corrections Agency, the
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Director of the California Department of Corrections (CDC), the
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Assistant Deputy Director for Health Care Services for CDC, and
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the Chief of Psychiatric Services for CDC.
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912 F.Supp. at 1293.
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failing to provide constitutionally adequate mental health care
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and ordered them to remedy the Eighth Amendment violations
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through preparation and implementation of remedial plans.
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remedial process has been ongoing since late 1995.
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the
Coleman v. Wilson,
The court found those defendants were
The
During the remedial phase the court has ordered the joinder
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of two additional state officials, the Director of the Department
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of Mental Health (now the Department of State Hospitals) and the
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Director of the Department of Finance, as defendants based on
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findings that the “‘just, orderly and effective’ resolution” of
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Defendants do not contend, nor could they do so successfully, that access to
inpatient mental health care is not required by the Eighth Amendment for this
class of plaintiffs.
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this action required their joinder.
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2006 (ECF No. 1855) at 2 and Order filed July 28, 2006 (ECF No.
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1922) at 3.
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then DMH was based on a finding that
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In relevant part, the joinder of the Director of
DMH plays a critical role in creating
sustainable
and
effective
solutions
for
inpatient
care
within
the
California
Department of Corrections and Rehabilitation
(CDCR). . . .[and] for multiple reasons, DMH
is failing to address specific court-ordered
remedies.
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See Order filed June 28,
Order filed June 28, 2006 (ECF No. 1855) at 2.
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As noted above, the remedial plan developed by defendants
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and approved by the court provides for inpatient mental health
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care as part of the continuum of mental health care to be
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provided to seriously mentally ill inmates.
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established principles of Eighth Amendment jurisprudence, under
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the express language of the remedial plan the CDCR is
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“responsible for providing acute and intermediate inpatient care,
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in a timely manner, to those CDCR inmates clinically determined
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to be in need of such care.”
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6-1.6
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contract the provision of that care to DSH.
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responsibility for providing constitutionally adequate care
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remains with CDCR, and it also runs to DSH by virtue of the
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contract it has with CDCR.
Consistent with
2009 Revised Program Guide, at 12-
At all relevant times to date, CDCR has delegated by
Id.7
The
Cf. West v. Atkins, 487 U.S. at 56
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Established principles of Eighth Amendment jurisprudence impose on the State
“a constitutional duty to provide adequate medical treatment to those in its
custody….” West v. Atkins, 487 U.S. 42, 56 (1988). The CDCR is the custodian
of all members of the plaintiff class. See Coleman v. Wilson, 912 F.Supp. at
1293 (quoting original class certification order).
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CDCR has decided to assume full responsibility for the provision of
inpatient mental health care to female inmates in the new unit at CIW.
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(state’s constitutional obligation to provide adequate medical
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care runs to those the state delegates the function and who
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assume the duties by contract).
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proceedings the duty to provide constitutionally adequate mental
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health care is a remedial duty as well as an affirmative one;
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having been found in violation of the Eighth Amendment, the
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defendants must remedy that violation and demonstrate to this
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court they have done so.
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DSH “plays a critical role” in that remedy as it applies to
At this stage of these
By reason of its contract with CDCR,
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inpatient mental health care.
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No. 1855) at 2.
12
See Order filed June 28, 2006 (ECF
As discussed above, development and implementation of a
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remedial plan and compliance with said plan is proceeding under
14
the supervision of a Special Master.
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relevant orders exempts DSH or the inpatient programs it operates
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under contract with CDCR for members of the plaintiff class from
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this supervision.
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part of the remedial plan and therefore subject to the same
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monitoring and reporting requirements as all other aspects of the
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remedial plan.
Nothing in any of the
To the contrary, the inpatient programs are
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The extended remedial phase of this action has required
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wide-ranging and extensive efforts by the Special Master and his
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team of experts and monitors.
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the Special Master has for almost a decade been required to
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devote considerable attention and resources to seemingly
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insurmountable problems in identification and referral of inmates
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to inpatient care and woefully insufficient numbers of inpatient
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beds available for inmates in need of such care.
With respect to inpatient care,
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See Coleman v.
, 2013 WL 1397335, slip op. at 17-18.8
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Brown,
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While the Special Master finally reported “substantial
3
improvement in access to inpatient care” in 2012, id. at 17, the
4
fact that the unacceptable bed shortages and attendant waitlists
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for inpatient care (which at one time neared 1,000 inmates) have
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within the last year been reduced does not, by itself,
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demonstrate that the inpatient care being provided to members of
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the plaintiff class is adequate.9
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F.Supp.2d
Plaintiffs have presented significant and troubling evidence
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of, inter alia, severe staffing shortages, apparently redundant
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custodial policies that delay the start of necessary inpatient
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care and may in fact cause additional harm to class members
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transferred for such care, denial of basic necessities including
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clean underwear, failure to follow established timelines for
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Nor were the intractable problems with referral to inpatient care the only
remedial issues that required the Special Master’s time and attention over
this period of time. In addition to his regular semi-annual monitoring and
reporting requirements, the Special Master has been required to focus
considerable time and effort on, inter alia, addressing significant clinical
staffing shortages; an increasing rate of inmate suicide, particularly in
administrative segregation units; ongoing construction projects, and
development and implementation of a sustainable quality improvement process.
In addition, severe overcrowding in the California prison system, which has
not yet been adequately remedied, has impacted and impeded all remedial
efforts in this action. See, e.g., Opinion and Order filed August 4, 2009
(ECF No. 3641) at 34-36.
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Indeed, measuring compliance by excluding the first 30 days on the waiting
list appears to at least suggest a lack of prompt care. The Revised Program
Guide provides that patients accepted for intermediate care must be
transferred “[w]ithin 30 days of referral. . . .” 2009 Revised Program Guide
at 12-1-16 (emphasis added). Evidence before the court suggests that
defendants may not view time on a wait list for intermediate inpatient care as
violating the remedial plan, or the Eighth Amendment, unless that time exceeds
30 days. Evidence also suggests that the calculation of the 30 day period is
being improperly adjusted so that it starts at some after referral by a CDCR
clinician and, consequently, additional delays attend the start of necessary
inpatient care. While the court does not presently make any findings
concerning the timeliness of transfers to inpatient care, it requests the
Special Master to address that question in his next full monitoring report.
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transfer of patients to inpatient care, and perhaps premature
2
discharges of patients from inpatient care, all of which call
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into question the adequacy of the inpatient care that is being
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provided to the plaintiff class.10
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evidence tendered by plaintiffs and they contest the inferences
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plaintiffs would have the court draw from other evidence.
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Defendants dispute some of the
After hearing and considering all of the evidence tendered
8
by both parties at the evidentiary hearing, the court finds there
9
is a significant evidentiary basis for questioning the adequacy
10
of critical aspects of inpatient care currently provided to
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members of the plaintiff class.
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not already have the authority, and the duty, to monitor the
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adequacy of inpatient care provided to class members, the
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evidence tendered by plaintiffs would suggest the necessity that
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he do so.
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Even if the Special Master did
For these reasons, the court will, by this order, make
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express what should be clear from the prior orders discussed
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above.
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to monitor all programs for the provision of inpatient mental
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health care to the plaintiff class.
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the issues tendered by plaintiffs, the Special Master will be
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directed to forthwith commence monitoring all such programs11, and
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to report to the court on their adequacy and whether any
First, the Special Master has the authority and the duty
Second, given the urgency of
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The evidence also demonstrated a continuing inability of defendants to
identify and remedy on their own, without court supervision, critical staffing
shortages and other impediments to constitutionally adequate mental health
care.
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In addition to the existing DSH programs at SVPP, VPP, ASH, and CSH, this
order includes the new programs opening at CHCF in Stockton and the new
program run by CDCR for female inmates at CIW.
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modifications to defendants’ remedial plan are required to ensure
2
that members of the plaintiff class are receiving adequate
3
inpatient mental health care.
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Recognizing the enormity of the task before the Special
5
Master, but also the urgency of the issues at hand the court will
6
direct the Special Master to report first on the adequacy of
7
staffing levels at SVPP, and on whether the so-called cuff or
8
orientation status, either as designed or as implemented, unduly
9
interferes with or delays the provision of necessary care to
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class members.
11
from the date of this order.12
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discretion, include in said report any other matters which he
13
determines require urgent attention by the court.
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expects defendants to cooperate fully in providing the Special
15
Master with all of the documents and facility access that he may
16
require to meet this obligation.
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That report will be due seventy-five (75) days
The Special Master may, in his
The court
Not later than the end of that period, the Special Master
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shall commence additional monitoring of the
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inpatient programs and shall file a report on the results of such
20
monitoring not later than March 31, 2014.13
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the Special Master may require additional staff to meet the
22
obligations of this order, he shall follow the procedures used in
adequacy of all
To the extent that
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The court had originally intended a much shorter date for the initial
report. The Special Master has requested this later date, given the
complexity of the problem.
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The Special Master may, as appropriate, schedule monitoring and reporting so
that he may focus his attention on areas that may require more immediate
attention or action by the court. The court expects all parties to cooperate
fully with the Special Master in this effort and to work expeditiously and
efficiently under his guidance to remedy any deficiencies identified during
such monitoring.
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this action to date for seeking appointment of such additional
2
staff.
3
As noted above, plaintiffs also request additional specific
4
orders from this court.
5
some of the evidence tendered by plaintiffs, they contest the
6
inferences plaintiffs would have the court draw from other pieces
7
of evidence, and they defend as grounded in a legitimate
8
penological foundation the so-called cuff or orientation status
9
challenged by plaintiffs.
As also discussed, defendants dispute
To date, the court has generally
10
relied on the Special Master’s monitoring, reporting and
11
recommendations before entering specific remedial orders and the
12
court finds it prudent to continue that practice with respect to
13
the issues at bar.
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additional orders beyond investigation and monitoring by the
15
Special Master will be denied at this time.
For that reason, plaintiffs’ request for
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In accordance with the above, IT IS HEREBY ORDERED that:
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1.
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19
Plaintiffs’ April 11, 2013 motion (ECF No. 4543) is
granted in part.
2.
Within seventy-five (75) days from the date of this
20
order the Special Master shall report to the court on the
21
adequacy of staffing levels at the Salinas Valley Psychiatric
22
Program SVPP; and on whether the so-called cuff or orientation
23
status, either as designed or as implemented, unduly interferes
24
with or delays the provision of necessary care to class members
25
at SVPP.
26
Special Master with all of the documents and facility access that
27
he may require to meet this obligation.
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3.
Defendants shall cooperate fully in providing the
The Special Master shall complete one round of
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1
monitoring the adequacy of all inpatient programs and report to
2
the court thereon not later than March 31, 2014.
3
4.
Except as expressly granted herein, plaintiffs’ April
4
11, 2013 motion for orders concerning inpatient care is denied
5
without prejudice.
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DATED: July 11, 2013.
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