Coleman, et al v. Schwarzenegger, et al

Filing 4925

ORDER signed by Judge Lawrence K. Karlton on 11/12/13 DENYING 4868 Motion to Modify Findings in the 9/24/13 Report of the Special Master; ADOPTING IN FULL 4830 Report. The recommendations of the Special Master in 4830 Report are ADOPTED IN P ART. The CDCR and DHS defendants shall review and re-evaluate the use of Orientation and Cuff Status at SVPP to determine whether these policies as designed and implemented achieve the proper balance between legitimate security needs and access to n ecessary inpatient mental health care. This shall be carried out under the guidance of the Special Master and his staff, with participation and input from plaintiffs. The Special Master shall report to the court on the results of this review and re evaluation in the report to be filed on 3/31/14. Within 15 days from the date of this order, defendants shall inform the court in writing whether any there is any inmate-patient at SVPP on Cuff Status without the documentation required for such statu s, including reason for placement, intervention planned, and criteria for release. If there is any inmate-patient on Cuff Status without required documentation, defendants shall show cause in writing why this court should not issue an injunction pre venting defendants from placing or maintaining any inmate-patient at SVPP on Cuff Status without the required documentation. Defendants shall forthwith begin tracking all patient bed assignments at SVPP, and admit referred and accepted patients to SVPP as quickly as bed availability permits and in no event beyond 72 hours following bed assignment and 30 days from the date of the referral. Plaintiff's 4867 Motion for additional orders is DENIED WITHOUT PREJUDICE. (Meuleman, A)

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1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 EASTERN DISTRICT OF CALIFORNIA 10 11 RALPH COLEMAN, et al., 12 13 14 15 No. CIV. S-90-520 LKK/DAD (PC) Plaintiffs, v. ORDER EDMUND G. BROWN, JR., et al., Defendants. 16 17 Pursuant to court order, on September 24, 2013 the Special 18 Master filed a Report on the Salinas Valley Psychiatric Program 19 (SVPP) (Report) (ECF No. 4830). 20 findings concerning the delivery of mental health care to class 21 members at SVPP. 22 makes six recommendations for orders to address inadequacies 23 identified in the Report. 24 and a motion to strike or modify the Report (ECF No. 4868). 25 Plaintiffs have filed a response to the Report and a request for 26 additional recommendations and orders (ECF No. 4867). The Report contains numerous Based on those findings, the Special Master Defendants have filed objections to 27 28 1 Pursuant 1 to Fed. R. Civ. P. 53(f), the matters objected to are reviewed de 2 novo.1 3 A. 4 Defendants interpose two general objections to the Report Defendants’ General Objections 5 and a number of specific objections to the recommendations 6 contained therein. 7 July 11, 2013 order (ECF No. 4688) requiring the Special Master 8 to issue the report was improper because it “contravenes the 9 plain language” of restrictions contained in 18 U.S.C. § First, defendants contend that this court’s 10 3626(a)(1)(A) for prospective injunctive relief. 11 (ECF No. 4868) at 3. 12 court could not order the Special Master to report to the court 13 on care provided at SVPP, arguing (1) the Department of State 14 Hospitals (DSH) was not a party to this case at the time of the 15 original trial in 1995; (2) DSH care has “never been subject to 16 the Special Master’s supervisory powers” since the remedial phase 17 of this action began; (3) the court’s order “improperly imputed 18 liability to DSH for the constitutional violations found against 19 different Defendants in 1995;” and (4) the court did not, in its 20 July 2013 order, find that DSH was violating the Constitution in 21 its provision of hospital care to members of the plaintiff class. 22 Id. at 3. 23 contentions. See Order filed July 11, 2013 (ECF No. 4688) at 4-9; 24 Order filed September 5, 2013 (ECF No. 4784) at 2-5. 25 points bear repeating. 26 1 27 28 Defs. Objs. Defendants renew their contention that the The court already considered and rejected these A few All reports provided by the Special Master to the parties in accordance with the Order of Reference filed December 11, 1995 (Doc. No. 640) are reviewed under the standards set forth in that order. The Report at bar was filed directly with the court. 2 1 First, for the reasons explained in the court’s September 5, 2 2013 Order, the provisions of 18 U.S.C. § 3626(a)(1)(A) do not 3 apply to the court’s order directing the Special Master to 4 monitor inpatient mental health programs. 5 September 5, 2013 (ECF No. 4784) at 2-3. 6 Master is not “relief” within the meaning of that statute. 7 id. 8 9 See Order filed Monitoring by a Special See Second, the monitoring ordered by this court in the July 11, 2013 order is necessary to a complete remedy in this action. In 10 1995, this court found the Governor of the State of California 11 and the California Department of Corrections and Rehabilitation 12 defendants in violation of their Eighth Amendment obligation to 13 provide seriously mentally ill inmates with ready access to 14 constitutionally adequate mental health care. 15 Wilson, 912 F.Supp. 1282 (E.D.Cal. 1995). 16 Department of Corrections and Rehabilitation (CDCR) defendants 17 are the custodians of the members of the plaintiff class and have 18 the primary legal responsibility for providing constitutionally 19 adequate mental health care to members of the plaintiff class.2 20 See In re Estevez, 165 Cal.App.4th 1445, 1463 (Cal. App. 5 Dist. 21 2008) (even where federal receiver appointed, “the state, and 22 through its appointed representative, the warden, cannot abdicate See Coleman v. The California 23 24 25 26 27 28 2 The plaintiff class consists of “all inmates with serious mental disorders who are now, or who will in the future, be confined within” the CDCR. July 23, 1999 Order & Stip. & Order Amending Plaintiff Class & Application of Remedy appended thereto at 2. All members of the plaintiff class are in the legal custody of the CDCR and, pursuant to state regulation, “remain under the jurisdiction” of CDCR when housed in Department of State Hospitals. 15 C.C.R. § 3369.1(c). 3 1 its constitutional responsibility to provide adequate medical 2 care, concomitant with which is the duty to assure said care is 3 not dispensed without any regard for the effect on the prison 4 system as a whole.”) 5 The remedial phase began with appointment of a Special 6 Master, who was tasked first with working with defendants to 7 develop a plan to remedy the “gross systemic failures in the 8 delivery of mental health care” and thereafter with monitoring 9 defendants’ implementation of that plan. Coleman v. Brown, ___ 10 F.Supp.2d ___, 2013 WL 1397335 (E.D.Cal. Apr. 5, 2013), slip op. 11 at 1. 12 developed over a decade of effort and most of its provisions were 13 given final approval by this court in 2006. 14 Revised Program Guide includes provisions governing delivery of 15 inpatient hospital care, and provides in relevant part: 16 18 19 20 21 The Program Guide, 2009 Revision, at 12-6-1 (footnote added). 23 24 See id. at 12.3 The California Department of Corrections and Rehabilitation (CDCR) is responsible for providing acute and intermediate inpatient care, in a timely manner, to those CDCR inmates clinically determined to be in need of such care. CDCR currently maintains a contract with the California Department of Mental Health (DMH) to provide acute and long-term intermediate inpatient mental health care to inmate-patients. 17 22 The remedial plan, known as the Revised Program Guide, was Delivery of constitutionally adequate inpatient mental health care to class members is a necessary part of complete 25 3 26 27 28 The version of the remedial plan under which defendants are currently operating is identified as the Mental Health Services Delivery System Program Guide, 2009 Revision. It will be referred to herein as the Revised Program Guide or the Program Guide; all citations will be to the 2009 Revision. 4 1 remediation of systemic Eighth Amendment violations in the 2 delivery of prison mental health care in California and full 3 compliance with defendants’ own remedial plan. 4 times in the remedial phase of this action CDCR has contracted 5 with DMH to provide most of the inpatient hospital care for class 6 members, and the Director of DMH has therefore been joined in 7 this action as a necessary party to the remedy.4 8 this court has previously explained, that contractual arrangement 9 does not relieve the CDCR defendants in this action of their At all relevant However, as 10 constitutional obligation to provide ready access to adequate 11 hospital care, which also runs to DMH and its successor the 12 Department of State Hospitals(DSH) as long as it maintains a 13 contract with that agency to provide inpatient care to members of 14 the plaintiff class. 15 4688) at 8 (citing West v. Atkins, 487 U.S. 42, 56 (1988). 16 See Order filed July 11, 2013 (ECF No. Finally, the court rejects defendants’ suggestion that a 17 separate finding of constitutional violations in the delivery of 18 inpatient care is required to support the monitoring ordered in 19 the July 11, 2013 order. 20 context of ongoing remediation of systemic Eighth Amendment 21 violations in the delivery of constitutionally adequate mental 22 health care to California’s seriously mentally ill prisoners 23 which has been monitored by a Special Master since 1995 and is 24 part of that remedial process. The July 11, 2013 order arose in the The order is also based on 25 4 26 27 28 The Department of State Hospitals (DSH) is the current name for the state agency that provides inpatient mental health hospital care for CDCR inmates and was referred to as DMH earlier in this remedial process. See Twenty-Fifth Round Monitoring Report filed January 18, 2013 (ECF No. 4298) at 33 n.11. 5 1 significant and troubling evidence of serious deficiencies in the 2 delivery of inpatient care to class members. 3 September 5, 2013 (ECF No. 4784) at 4-5 (quoting Order filed July 4 11, 2013 (ECF No. 4688) at 10-11). Nothing further is required. 5 For the foregoing reasons and those set forth in this See Order filed 6 court’s July 11, 2013 and September 5, 2013 orders (ECF Nos. 4688 7 and 4784), defendants’ first general objection is overruled. 8 9 Defendants’ second general objection is that the Special Master’s recommendations “are not tethered to constitutional 10 standards.” 11 frivolous. 12 staffing levels; (2) the adequacy of treatment provided at SVPP, 13 particularly individualized and group therapy; (3) the impact of 14 so-called Orientation or Cuff Status on timely access to adequate 15 care; (4) delays in transfer to SVPP; and (5) timely provision of 16 basic necessities including clean clothing, bedding, and towels. 17 Report (ECF No. 4830) at 44-45. 18 in the fundamental requirement that defendants provide a “’system 19 of ready access to adequate [mental health care, ’” Coleman v. 20 Brown, ___ F.Supp.2d ___, 2013 WL 1397335, slip op. at 16 21 (quoting Hoptowit v. Ray, 682 F.2d 1237, 1253 (9th Cir. 1982)). 22 All but the last directly concern several of the components 23 required for such a system, components which have been repeatedly 24 identified by this court. See id.5 25 objection is overruled. 26 5 27 28 Defs. Objs. (ECF No. 4868) at 3. This objection is The Special Master’s recommendations focus on (1) The recommendations are grounded Defendants’ second general The last recommendation implicates the fundamental Eighth Amendment requirement that prison institutions provide inmates in their care with adequate clothing and sanitation, see Hoptowit, 682 F.2d at 1246, as well as the adequacy of conditions that 6 1 2 3 B. Defendants’ Specific Objections 1. Staffing/Programming The Special Master’s first recommendation is that SVPP be 4 directed to fill remaining staffing vacancies, giving priority to 5 filling psychiatry, psychology, and social work positions, and 6 consider modifying its planned staff-to-patient ratio of 1:35. 7 Report (ECF No. 4830) at 45. 8 directed to increase significantly the amount and quality of 9 individualized and group therapy provided.” Id. 10 11 12 13 14 15 16 17 18 19 20 interrelated: His second is that SVPP “be The two are the Special Master reports that [c]urrently, SVPP does not have the capacity or the resources to provide basic therapeutic and rehabilitative mental health support, services, and treatment to its inpatients in a coordinated, comprehensive, and individualized manner that is consistent with accepted standards for forensic and other hospital settings. The 1:35 clinical staffing ratio adopted by SVPP is inadequate for individual clinician caseloads as well as for admissions units and treatment teams. Clinician-to-patient staffing ratios in the field of inpatient psychiatric programs are more customarily 1:15 for admissions units, which conduct initial assessments and stabilization of newly arrived patients, and 1:25 for treatment units. 21 Report (ECF No. 4830) at 10. 22 acknowledge the need for improvement in some of the areas 23 identified by the monitor’s expert, as discussed below, but they 24 cited the shortage of staffing resources as a major obstacle to 25 implementing them.”) See also Report at 11 (“Staff often 26 27 28 directly impact the care of inmate-patients housed at SVPP. 7 1 Defendants raise a number of objections to these 2 recommendations and the findings on which they are based. 3 Defendants’ objections and the declaration in support thereof 4 contain little if any substantive disagreement with the findings 5 of the Special Master concerning staffing levels at SVPP during 6 the period monitored by the Special Master.6 7 an apparent acknowledgement that more staff is needed, defendants 8 represent that SVPP “is already undertaking dramatic measures to 9 recruit staff.” Defs. Objs. (ECF No. 4868) at 5. 10 Significantly, in Defendants assert that these efforts make a court order unnecessary. 11 Id. As noted above, the Special Master’s recommendation 12 concerning staffing levels is directly related to his 13 recommendation to increase the quantity and quality of 14 15 6 16 17 18 19 20 21 22 23 24 25 26 27 28 Defendants presently have a 1:35 staff to patient ratio for psychiatrists, psychologists, social workers, and rehabilitation therapists. See Report (ECF No. 4830) at 9. Defendants do not object to the Special Master’s finding that social workers’ caseloads average approximately 40 patients. See id. at 8. Defendants agree with the Special Master’s finding that there were 8 psychologists on staff at SVPP as of August 9, 2013; they do not address his finding that one was due to transfer to the Correctional Health Care Facility (CHCF) in October 2013. Defendants do object to the Special Master’s finding that as of August 22, 2013, there were five line psychiatrists and one chief psychiatrist, with contractors providing “some additional hours of coverage.” Report at [cit.] Defendants’ evidence, which consists of the declaration of Pam Ahlin, is insufficient to contravene the Special Master’s finding. Ms. Ahlin avers that on August 22, 2013 there were eight psychiatrists on staff “not including the second positions worked by 2 full-time psychiatrists.” It is unclear whether defendants are suggesting that there were eight psychiatrists, two of whom were working second positions, or something else. In any event, defendants’ evidence is insufficient to contradict the Special Master’s findings concerning the number of psychiatrists on staff at SVPP in August 2013. 8 1 individualized and group therapy at SVPP. 2 recommendation is based on several findings, including:  3 The latter “The amount of weekly group therapy per patient 4 was too limited for the intermediate level of 5 care, at only four to six hours per week on 6 average”;  7 8 “The quality of group treatment was inconsistent and ranged from very poor to excellent”;  9 10 “Psychologists appeared to have an overly-narrow role and to be underutilized”;  11 “Individualized therapy by psychologists and 12 social workers was not provided regularly and 13 occurred rarely for most patients, even when 14 prescribed by an IDTT,7 when clinically indicated, 15 or when requested by patients." 16 Id. at 4. 17 findings concerning the quantity and quality of therapy provided, 18 none of which contravene in any significant way the serious 19 inadequacies reported by the Special Master.8 Moreover, as with 20 7 21 22 23 24 25 26 27 28 Defendants interpose a number of objections to the IDTT stands for Interdisciplinary Treatment Team. See Report (ECF No. 4830) at 12. 8 Defendants first object that refusal to attend group therapy can be and is a basis for transfer of an inmate to SVPP which “explains, in part, the group therapy refusal rate of inmatepatients who have recently transferred to” SVPP. Defs. Objs. (ECF No. 4868) at 7. This objection is not responsive to the Special Master’s findings concerning the insufficient amount of therapy available at SVPP. Defendants next object that the Special Master’s comparison of therapy received by inmate-patients at SVPP with the minimum number of therapy hours required for the Enhanced Outpatient (EOP) level of care is “inaccurate and unfair.” Id. Defendants contend the Special Master should have “counted the number of group hours offered by [SVPP] and added to that number the hours 9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 of individual therapy, recreational and occupational therapy with a clinician, and work and educational programs offered to inmatepatients.” Id. Defendants also object that the Special Master does not explain how he arrived at the finding that weekly group therapy at SVPP is limited to an average of four to six hours per week, and they contend their evidence filed in opposition to plaintiffs’ motion concerning access to inpatient care “demonstrated provision of group therapy at a significantly higher rate.” Id. These objections are without merit. Defendants are correct that the “[t]en hours per week of scheduled structured therapeutic activities” required at the EOP level of care includes more than just group therapy. See Program Guide, 2009 Revision, at 12-4-9, 10. However, the Special Master’s Report includes findings about other therapy and programming provided at SVPP, including individual therapy and “solo treatment activity/solo programming”, which show that these other forms of therapy and programming do not materially increase the quantity or quality of programming offered to inmate-patients at SVPP. See Report (ECF No. 4830) at 18-22. Finally, the evidence cited by defendants about the amount of group therapy offered at SVPP is from March and April 2013, see Dec. Gaither (ECF No. 4602) at ¶¶19-20, while the Special Master’s report is based on findings from three visits between July 31 and August 22, 2013. Report at 2, 14-15. Defendants have presented no evidence of therapeutic program hours from July or August 2013 that calls into question the Special Master’s findings. Finally, defendants suggest that the Special Master should have based his recommendation on therapy hours offered, not hours received, because the Program Guide only requires that EOP inmate-patients be offered ten hours of therapy, not that they receive ten hours of therapy. Defs. Objs. (ECF No. 4868) at 7; see Program Guide at 12-4-8. Had defendants presented evidence to the Special Master or to this court that they were in fact offering sufficient therapeutic programming at SVPP to meet therapeutic requirements for an ICF level of care (which presumably in most instances will over the course of a hospitalization, as the Special Master observes, exceed that required for EOP inmate-patients), this objection might merit further consideration. However, defendants represent that they have only begun to implement a program for tracking individual and group therapy hours, see Decl. of Ahlin at ¶ 16, and they have not presented any data from that tracking system concerning therapy hours offered. Absent such evidence, however, this objection is overruled. The Special Master found significant deficiencies in the quantity and quality of therapy offered to inmate-patients at SVPP. Defendants acknowledge that SVPP “is in the process of 10 1 staffing levels defendants also represent that SVPP “is in the 2 process of improving its group programming,” “acknowledge that 3 changes to group therapy can be and is” being made, and that they 4 have been developing and implementing a program for tracking 5 individual and group therapy hours. 6 at 7-8. Defs. Objs. (ECF No. 4868) 7 After de novo review, the court will adopt in full the 8 Special Master’s factual findings concerning staffing levels and 9 therapy provided at SVPP. However, in light of defendants’ 10 representations concerning their efforts to recruit and hire 11 staff and to improve the quantity and quality of therapy provided 12 to inmate-patients and SVPP and the fact that the Special Master 13 is continuing to monitor SVPP and other DSH inpatient programs 14 pursuant to the July 11, 2013 order, the court will not make 15 specific orders concerning staffing or therapy at this time. 16 Orders concerning staffing and the quantity and quality of 17 therapy will be deferred pending a further report and 18 recommendations from the Special Master. 19 20 2. Orientation Status/Cuff Status The Special Master recommends that SVPP “be directed to 21 reconsider and re-evaluate its use of Orientation Status to 22 automatically require patient cuffing whenever out-of-cell and 23 withhold mental health programming or treatment other than a 24 daily cell-front contact by a member of the interdisciplinary 25 improving its group programming.” Defs. Objs. (ECF No. 4868) at 7. Defendants have not presented any evidence that calls into question the Special Master’s findings concerning the inadequacies in individualized and group therapy at SVPP. Defendants’ objections are overruled. 26 27 28 11 1 treatment team.” 2 recommends that SVPP “be directed to eliminate the use of Cuff 3 Status to require automatic cuffing of patients when out-of-cell, 4 overriding of patients’ designations, and barring of patients’ 5 access to out-of-cell individual and group treatment.” 6 Defendants contend the Special Master has failed to adequately 7 weigh the safety and security needs that undergird use of 8 Orientation Status. 9 recommendation concerning Cuff Status as a motion to modify the 10 Special Master’s findings concerning Cuff Status; however, they 11 specifically request that the recommendation be rejected. 12 Objs. (ECF No. 4868) at 9-10. 13 Report (ECF No. 4830) at 45. He also Id. They characterize their objections to the Defs. As reported by the Special Master, both Orientation Status 14 and Cuff Status are part of a “status and staging paradigm” used 15 at SVPP to set housing and programming for inmate-patients. 16 Report (ECF No. 4830) at 23. 17 inmate-patients arriving at SVPP are placed on Orientation 18 Status, which means that they 19 20 21 22 23 24 25 26 27 The Special Master reports that all are housed in a single cell for up to 14 days, have only personal hygiene items for property, and must be cuffed at all times they are outside of their cells (i.e. they are effectively on Cuff Status) until they are cleared by an ICC [Institution Classification Committee] to program without such restrictions. Patients on Orientation Status are to be seen daily by an IDTT member at the patient’s cell front, but according to the SVPP Program Manual, they do not have additional programming. Report (ECF No. 4830) at 23. After inmate-patients are released from Orientation Status, they program through three Stages. 28 12 See 1 id. 2 of Orientation Status. 3 Program Manual requires that inmate-patients “’who engage in 4 aggressive/threatening behavior, assaultive behavior and indecent 5 exposure” be placed on Cuff Status. Id. (quoting SVPP Program 6 Manual, Section 6.12.) 7 Stage to which an inmate-patient has progressed and requires 8 handcuffs and escort by an MTA whenever an inmate it out of cell. 9 Id. Cuff Status is a “behavior-driven” return to the conditions Report (ECF No. 4830) at 25. The SVPP Cuff Status placement “overrides” the The Special Master describes in detail the procedures for 10 Cuff Status, as well as the documentation required for that 11 status. 12 Id. Defendants contend that the Special Master has not 13 adequately considered the safety and security concerns in 14 recommending that the use of Orientation Status and Cuff Status 15 be reviewed and re-evaluated. This objection is without merit. 16 The Special Master recommends review and re-evaluation of the use 17 of Orientation Status and Cuff Status in light of the impact 18 placement in these statuses has on hospitalized inmate-patients’ 19 access to necessary mental health care. 20 4830) at 5. 21 See Report (ECF No. Orientation Status and Cuff Status require the same 22 restricted housing conditions and extremely limited programming 23 for inmate-patients placed in either status. 24 delays the start of all but the most basic level of mental health 25 treatment for up to fourteen days for inmate-patients in need of 26 hospital care, many of whom have already waited more than thirty 27 days for necessary inpatient hospital care. 28 interrupts for behavioral reasons all but the most basic mental 13 Orientation Status Cuff Status 1 health treatment. 2 these policies is not a recommendation for a particular outcome. 3 It is a recommendation, entirely appropriate on this record, that 4 defendants review these policies to assess whether the proper 5 balance between security considerations and necessary inpatient 6 mental health care has been achieved. 7 the record, and good cause appearing, this court will adopt in 8 full the Special Master’s recommendation concerning review and 9 re-evaluation of the use of Orientation Status and Cuff Status. A recommendation to review and re-evaluate After de novo review of 10 In view of the fact that CDCR is the custodian of all members of 11 the plaintiff class and ultimately responsible for the delivery 12 of constitutionally adequate mental health care to them, and in 13 view of defendants’ continuing objection concerning the role of 14 DSH in the remedial phase of this action, the order to review and 15 re-evaluate these policies will be directed to both the CDCR and 16 the DSH defendants. 17 evaluation will take place under the supervision of the Special 18 Master and his experts. Given all the above, the review and re- 19 Defendants seek modification of the Special Master’s 20 findings concerning a lack of adequate documentation for eleven 21 inmates placed on cuff status because they contend “the Special 22 Master failed to give [SVPP] adequate credit for the 23 documentation that was present for these eleven inmates.” 24 Objs. (ECF No. 4868) at 10. 25 this assertion is scant. 26 ¶ 31. 27 the Special Master’s recommendations, defendants acknowledge the 28 need for improvement. Defs. Defendants’ evidentiary support for See Decl. of Ahlin (ECF No. 4830-1) at Moreover, as with most of the other findings underlying See Defs. Objs. (ECF No. 4868) at 10. 14 1 The motion to modify the Special Master’s findings concerning the 2 adequacy of documentation for inmate-patients on Cuff Status will 3 be denied. 4 The Special Master reports that 5 [m]ultiple patients were found to be on Cuff Status without any documented rationale, intervention and/or release criteria, leaving patients with very limited mental health programming for long periods of time. Patients on Cuff Status for longer than ten days were not referred to a psychologist supervisor for the development of a behavior plan, as required by SVPP policy. 6 7 8 9 10 11 Report (ECF No. 4830) at 5. 12 on Cuff Status interrupts the provision of necessary mental 13 health care. 14 16 17 18 19 20 21 22 24 As the Special Master finds, [b]y placing a patient on Cuff Status without documenting the reason for the placement, the intervention planned, and the criteria for release from Cuff Status, and by failing to develop a required behavior plan, SVPP in effect places the patient at risk of needless deprivation of treatment and isolation in his cell – the very antithesis of a therapeutic environment for a seriously mentally ill person. . . . The ability of a patient on Cuff Status to access treatment is also severely limited, despite the fact that he was transferred to an inpatient program because he needs more treatment than he was receiving at the sending institution. 15 23 As the Report makes clear, placement Id. at 30. While the security considerations at issue cannot be 25 gainsaid, neither can the risk to members of the plaintiff class 26 from inappropriate placement and retention on Cuff Status be 27 underestimated. Defendants represent that they are correcting 28 15 1 the problems with documentation, have recently trained staff, and 2 have developed and implement a “cuff status monitoring tool.” 3 Defs. Objs. (ECF No. 4868) at 10. 4 defendants will be directed to report to the court within fifteen 5 days whether there is any inmate-patient at SVPP on Cuff Status 6 without the required documentation. 7 patient, defendants shall show cause in writing why this court 8 should not issue an injunction preventing defendants from placing 9 or maintaining any inmate-patient at SVPP on Cuff Status without 10 Good cause appearing, If there is any such inmate- the required documentation. 11 3. 12 Transfer Timelines The Special Master recommends that SVPP “be directed to 13 begin tracking all patient bed assignments, and admit referred 14 and accepted patients as quickly as bed availability permits so 15 that beds are utilized to the fullest extent possible, and in no 16 event beyond 72 hours following bed assignment and 30 days from 17 the date of the referral.” 18 Defendants contend this recommendation is based on an inaccurate 19 analysis of the wait list and an unreasonable interpretation of 20 Program Guide requirements for transfer to inpatient care.9 21 9 22 23 24 25 26 27 28 Report (ECF No. 4830) at 46. Defendants also contend that “strict compliance with transfer timelines is not the measure of whether SVPP is constitutionally compliant; defendants argue that the key question is whether transfer waiting periods expose inmates to significant risks of harm” and “[t]he Special Master’s report fails to describe a single example in which an inmate-patient was exposed to an excessive risk of harm because his admission to the SVPP was not completed immediately.” Defs. Objs. (ECF No. 4868) at 12. The court reminds defendants, once again, that the Program Guides are the remedial plan for this action and represent defendants’ determination of what is required to meet their constitutional obligations to the plaintiff class. Moreover, the Special Master reminds the court that the thirty-day timeframe in the Program 16 1 The Special Master’s recommendation is based on findings 2 that (1) in a four month period between March 1, 2013 and June 3 30, 2013, twenty-seven percent of inmate-patients accepted for 4 treatment at SVPP were transferred after the end of the thirty 5 day period; (2) during that same four month period more than half 6 of the transfers completed within the thirty day period occurred 7 in the last five days of that period; and (3) SVPP does not track 8 bed assignments, which makes compliance with the seventy-two hour 9 timeframe for transport “difficult, if not impossible.” 10 Defendants object to the percentages as reported by the 11 Special Master. 12 from the time DSH decides to accept the inmate-patient, not from 13 the date the patient is referred by CDCR. 14 argument on language in the Program Guide that provides that some 15 inmate-patients may be placed on a waitlist after “acceptance.” 16 In defendants’ view, the thirty day period runs The Program Guide is clear. Defendants base their All inmate-patients accepted 17 for treatment at SVPP, which is an intermediate care facility 18 (ICF), must be transferred within thirty days of referral. 19 Program Guide, 2009 Revision, at 12-1-16. 20 “the date the completed referral packet is received by DMH by Referral is defined as 21 22 23 24 25 26 27 28 Guide “was negotiated during a time when inpatient beds for CDCR inmates were slowly becoming less scarce, and there was need for a timeframe within which CDCR could conceivably comply under the circumstances at that time.” Report (ECF No. 4830) at 32. He suggests, correctly, that in light of the dramatic increase in availability of inpatient beds and known vacant hospital beds, “[t]oday, transfers need not take anywhere close to 30 days to complete, and in no instance should they take more than 30 days.” Id. Defendants are reminded that their constitutional obligation is to provide “ready” access to adequate mental health care. See Hoptowit v. Ray, 682 F.2d 1237, 1253 (9th Cir. 1982) abrogated on other grounds by Sandin v. Conner, 515 U.S. 472 (1995). 17 1 facsimile or overnight mail.” Referral must be completed within 2 five or ten working days from when an interdisciplinary treatment 3 team (IDTT) identifies an inmate-patient for referral to 4 inpatient care. 5 the date on which an inmate-patient “is placed into the LOC and 6 program to which s/he was referred.” 7 Program Guide also requires that transport of inmate-patients to 8 the ICF “must be completed within 72 hours of bed assignment.” 9 Id. at 12-1-16. Id. at 12-1-15, 12-1-16. Transfer is defined as Id. at 12-1-15. The Under the Program Guide, all inmate-patients 10 accepted by DSH for treatment at SVPP must arrive at SVPP within 11 thirty days of the date the referral packet arrives at DSH from 12 CDCR.10 Within that thirty day period all of the following must 13 occur: (1) the decision whether to accept an inmate-patient, 14 which be made within three working days of DSH receipt of the 15 referral, 16 accepted inmate-patient; and (3) transport of the accepted 17 inmate-patient, which must occur within seventy-two hours of bed 18 assignment, see id. at 12-6-11. None of these operates to extend 19 the thirty day period, nor does the language cited by defendants 20 change the controlling timeframe. 21 overruled. 22 in full. 23 see id. at 12-6-10; (2) bed assignment for the The Special Master’s recommendation will be adopted 4. 24 Defendants’ objections are Laundry The Special Master’s final recommendation is that SVPP 25 “resolve any and all remaining issues with, and obstacles to, 26 providing patients with the full complement of clean clothing, 27 10 28 In fact, the Program Guide defines “’Referral’ to DMH” as “the date the completed referral packet is received by DMH by facsimile or overnight mail.” 18 1 towels, and bed coverings, and make these provisions available to 2 patients on a timely basis according to established schedules.” 3 Report (ECF No. 4830) at 46. 4 concerning laundry is unnecessary because SVPP “has formed a 5 laundry committee that inventories laundry and is responsible for 6 resolving any laundry issues that arise.” 7 is unclear when this committee was formed, but it may be that the 8 existence of the committee will operate to fulfill the Special 9 Master’s final recommendation without a further order by this 10 Defendants contend an order Defs. Objs. at 13. It court. 11 C. 12 Plaintiffs seek a further report from the Special Master Plaintiffs’ Motion 13 within sixty days and a series of other specific orders. 14 the matters for which plaintiffs seek remedial orders, use of 15 force and issuance of rules violation reports, are the subject of 16 ongoing proceedings before this court. 17 not included recommendations concerning these or the other two 18 issues highlighted by plaintiffs. 19 resolution of plaintiffs’ pending motion concerning use of force 20 and disciplinary proceedings (ECF No. 4638), as well as further 21 monitoring by the Special Master, is necessary before the court 22 considers issuance of further specific orders in this area. 23 Plaintiffs’ motion will be denied without prejudice. Two of The Special Master has The court finds that 24 D. 25 The court does, by this order, direct specific action by Standards for Injunctive Relief 26 defendants. 27 are in aid of the remedy required by this court’s 1995 order. 28 the extent that the requirements of 18 U.S.C. § 3626(a)(1) may In this court’s view, the orders contained herein 19 To 1 apply, this court finds that the orders contained herein are 2 narrowly drawn, extend no further than necessary to correct the 3 Eighth Amendment violation in the delivery of mental health care 4 to members of the plaintiff class, and are the least intrusive 5 means to that end. See 18 U.S.C. § 3626(a)(1)(A). 6 In accordance with the above, IT IS HEREBY ORDERED that: 7 1. Defendants’ October 14, 2013 motion to modify findings 8 in the September 24, 2013 Report of the Special Master on the 9 Salinas Valley Psychiatric Program (ECF No. 4868) is denied. 10 2. The findings in the September 24, 2013 Report of the 11 Special Master on the Salinas Valley Psychiatric Program (SVPP) 12 (ECF No. 4830) are adopted in full. 13 14 15 3. The recommendations of the Special Master in said Report are adopted in part. 4. The CDCR and DHS defendants shall review and re-evaluate 16 the use of Orientation and Cuff Status at SVPP to determine 17 whether these policies as designed and implemented achieve the 18 proper balance between legitimate security needs and access to 19 necessary inpatient mental health care. 20 out under the guidance of the Special Master and his staff, with 21 participation and input from plaintiffs. 22 shall report to the court on the results of this review and re- 23 evaluation in the report to be filed on March 31, 2014. 24 5. This shall be carried The Special Master Within fifteen days from the date of this order 25 defendants shall inform the court in writing whether any there is 26 any inmate-patient at SVPP on Cuff Status without the 27 documentation required for such status, including reason for 28 placement, intervention planned, and criteria for release. 20 If 1 there is any inmate-patient on Cuff Status without required 2 documentation, defendants shall show cause in writing why this 3 court should not issue an injunction preventing defendants from 4 placing or maintaining any inmate-patient at SVPP on Cuff Status 5 without the required documentation. 6 6. Defendants shall forthwith begin tracking all patient 7 bed assignments at SVPP, and admit referred and accepted patients 8 to SVPP as quickly as bed availability permits and in no event 9 beyond seventy-two hours following bed assignment and thirty days 10 11 12 from the date of the referral. 7. Plaintiffs’ October 14, 2013 motion for additional orders (ECF No. 4867) is denied without prejudice. 13 IT IS SO ORDERED. 14 DATED: November 12, 2013. 15 16 17 18 19 20 21 22 23 24 25 26 27 28 21

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