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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UNITED STATES DISTRICT COURT
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EASTERN DISTRICT OF CALIFORNIA
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RALPH COLEMAN, et al.,
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No. CIV. S-90-520 LKK/DAD (PC)
Plaintiffs,
v.
ORDER
EDMUND G. BROWN, JR., et al.,
Defendants.
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Pursuant to court order, on September 24, 2013 the Special
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Master filed a Report on the Salinas Valley Psychiatric Program
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(SVPP) (Report) (ECF No. 4830).
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findings concerning the delivery of mental health care to class
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members at SVPP.
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makes six recommendations for orders to address inadequacies
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identified in the Report.
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and a motion to strike or modify the Report (ECF No. 4868).
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Plaintiffs have filed a response to the Report and a request for
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additional recommendations and orders (ECF No. 4867).
The Report contains numerous
Based on those findings, the Special Master
Defendants have filed objections to
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Pursuant
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to Fed. R. Civ. P. 53(f), the matters objected to are reviewed de
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novo.1
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A.
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Defendants interpose two general objections to the Report
Defendants’ General Objections
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and a number of specific objections to the recommendations
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contained therein.
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July 11, 2013 order (ECF No. 4688) requiring the Special Master
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to issue the report was improper because it “contravenes the
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plain language” of restrictions contained in 18 U.S.C. §
First, defendants contend that this court’s
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3626(a)(1)(A) for prospective injunctive relief.
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(ECF No. 4868) at 3.
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court could not order the Special Master to report to the court
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on care provided at SVPP, arguing (1) the Department of State
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Hospitals (DSH) was not a party to this case at the time of the
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original trial in 1995; (2) DSH care has “never been subject to
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the Special Master’s supervisory powers” since the remedial phase
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of this action began; (3) the court’s order “improperly imputed
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liability to DSH for the constitutional violations found against
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different Defendants in 1995;” and (4) the court did not, in its
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July 2013 order, find that DSH was violating the Constitution in
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its provision of hospital care to members of the plaintiff class.
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Id. at 3.
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contentions. See Order filed July 11, 2013 (ECF No. 4688) at 4-9;
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Order filed September 5, 2013 (ECF No. 4784) at 2-5.
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points bear repeating.
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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.
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First, for the reasons explained in the court’s September 5,
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2013 Order, the provisions of 18 U.S.C. § 3626(a)(1)(A) do not
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apply to the court’s order directing the Special Master to
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monitor inpatient mental health programs.
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September 5, 2013 (ECF No. 4784) at 2-3.
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Master is not “relief” within the meaning of that statute.
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id.
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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
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1995, this court found the Governor of the State of California
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and the California Department of Corrections and Rehabilitation
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defendants in violation of their Eighth Amendment obligation to
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provide seriously mentally ill inmates with ready access to
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constitutionally adequate mental health care.
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Wilson, 912 F.Supp. 1282 (E.D.Cal. 1995).
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Department of Corrections and Rehabilitation (CDCR) defendants
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are the custodians of the members of the plaintiff class and have
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the primary legal responsibility for providing constitutionally
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adequate mental health care to members of the plaintiff class.2
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See In re Estevez, 165 Cal.App.4th 1445, 1463 (Cal. App. 5 Dist.
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2008) (even where federal receiver appointed, “the state, and
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through its appointed representative, the warden, cannot abdicate
See Coleman v.
The California
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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).
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its constitutional responsibility to provide adequate medical
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care, concomitant with which is the duty to assure said care is
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not dispensed without any regard for the effect on the prison
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system as a whole.”)
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The remedial phase began with appointment of a Special
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Master, who was tasked first with working with defendants to
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develop a plan to remedy the “gross systemic failures in the
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delivery of mental health care” and thereafter with monitoring
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defendants’ implementation of that plan.
Coleman v. Brown, ___
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F.Supp.2d ___, 2013 WL 1397335 (E.D.Cal. Apr. 5, 2013), slip op.
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at 1.
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developed over a decade of effort and most of its provisions were
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given final approval by this court in 2006.
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Revised Program Guide includes provisions governing delivery of
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inpatient hospital care, and provides in relevant part:
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The
Program Guide, 2009 Revision, at 12-6-1 (footnote added).
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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.
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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
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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.
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remediation of systemic Eighth Amendment violations in the
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delivery of prison mental health care in California and full
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compliance with defendants’ own remedial plan.
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times in the remedial phase of this action CDCR has contracted
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with DMH to provide most of the inpatient hospital care for class
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members, and the Director of DMH has therefore been joined in
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this action as a necessary party to the remedy.4
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this court has previously explained, that contractual arrangement
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does not relieve the CDCR defendants in this action of their
At all relevant
However, as
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constitutional obligation to provide ready access to adequate
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hospital care, which also runs to DMH and its successor the
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Department of State Hospitals(DSH) as long as it maintains a
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contract with that agency to provide inpatient care to members of
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the plaintiff class.
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4688) at 8 (citing West v. Atkins, 487 U.S. 42, 56 (1988).
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See Order filed July 11, 2013 (ECF No.
Finally, the court rejects defendants’ suggestion that a
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separate finding of constitutional violations in the delivery of
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inpatient care is required to support the monitoring ordered in
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the July 11, 2013 order.
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context of ongoing remediation of systemic Eighth Amendment
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violations in the delivery of constitutionally adequate mental
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health care to California’s seriously mentally ill prisoners
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which has been monitored by a Special Master since 1995 and is
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part of that remedial process.
The July 11, 2013 order arose in the
The order is also based on
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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.
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significant and troubling evidence of serious deficiencies in the
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delivery of inpatient care to class members.
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September 5, 2013 (ECF No. 4784) at 4-5 (quoting Order filed July
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11, 2013 (ECF No. 4688) at 10-11). Nothing further is required.
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For the foregoing reasons and those set forth in this
See Order filed
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court’s July 11, 2013 and September 5, 2013 orders (ECF Nos. 4688
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and 4784), defendants’ first general objection is overruled.
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Defendants’ second general objection is that the Special
Master’s recommendations “are not tethered to constitutional
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standards.”
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frivolous.
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staffing levels; (2) the adequacy of treatment provided at SVPP,
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particularly individualized and group therapy; (3) the impact of
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so-called Orientation or Cuff Status on timely access to adequate
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care; (4) delays in transfer to SVPP; and (5) timely provision of
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basic necessities including clean clothing, bedding, and towels.
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Report (ECF No. 4830) at 44-45.
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in the fundamental requirement that defendants provide a “’system
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of ready access to adequate [mental health care, ’” Coleman v.
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Brown, ___ F.Supp.2d ___, 2013 WL 1397335, slip op. at 16
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(quoting Hoptowit v. Ray, 682 F.2d 1237, 1253 (9th Cir. 1982)).
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All but the last directly concern several of the components
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required for such a system, components which have been repeatedly
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identified by this court. See id.5
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objection is overruled.
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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
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B. Defendants’ Specific Objections
1.
Staffing/Programming
The Special Master’s first recommendation is that SVPP be
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directed to fill remaining staffing vacancies, giving priority to
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filling psychiatry, psychology, and social work positions, and
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consider modifying its planned staff-to-patient ratio of 1:35.
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Report (ECF No. 4830) at 45.
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directed to increase significantly the amount and quality of
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individualized and group therapy provided.” Id.
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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.
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Report (ECF No. 4830) at 10.
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acknowledge the need for improvement in some of the areas
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identified by the monitor’s expert, as discussed below, but they
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cited the shortage of staffing resources as a major obstacle to
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implementing them.”)
See also Report at 11 (“Staff often
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directly impact the care of inmate-patients housed at SVPP.
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Defendants raise a number of objections to these
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recommendations and the findings on which they are based.
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Defendants’ objections and the declaration in support thereof
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contain little if any substantive disagreement with the findings
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of the Special Master concerning staffing levels at SVPP during
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the period monitored by the Special Master.6
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an apparent acknowledgement that more staff is needed, defendants
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represent that SVPP “is already undertaking dramatic measures to
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recruit staff.” Defs. Objs. (ECF No. 4868) at 5.
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Significantly, in
Defendants
assert that these efforts make a court order unnecessary.
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Id.
As noted above, the Special Master’s recommendation
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concerning staffing levels is directly related to his
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recommendation to increase the quantity and quality of
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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.
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individualized and group therapy at SVPP.
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recommendation is based on several findings, including:
3
The latter
“The amount of weekly group therapy per patient
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was too limited for the intermediate level of
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care, at only four to six hours per week on
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average”;
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“The quality of group treatment was inconsistent
and ranged from very poor to excellent”;
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“Psychologists appeared to have an overly-narrow
role and to be underutilized”;
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“Individualized therapy by psychologists and
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social workers was not provided regularly and
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occurred rarely for most patients, even when
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prescribed by an IDTT,7 when clinically indicated,
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or when requested by patients."
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Id. at 4.
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findings concerning the quantity and quality of therapy provided,
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none of which contravene in any significant way the serious
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inadequacies reported by the Special Master.8 Moreover, as with
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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
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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
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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.
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Orders concerning staffing and the quantity and quality of
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therapy will be deferred pending a further report and
18
recommendations from the Special Master.
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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
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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.
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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
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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.
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Report (ECF No. 4830) at 5.
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on Cuff Status interrupts the provision of necessary mental
13
health care.
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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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