Court Weighing Takeover of Mental Health Care in California Prisons

A federal judge overseeing a settlement meant to improve psychiatric care in California state prisons is poised to do the one thing she’s tried hardest to avoid: wrest control of prison mental health from the California Department of Corrections and Rehabilitation.

“The court has done every single thing within its authority to allow defendants to achieve compliance while still exercising a great degree of discretion and autonomy,” District Judge Kimberly J. Mueller wrote in a July 12, 2024, order. “The court concludes the only way to achieve full compliance in this action is for the court to appoint its own receiver.”

A court-appointed federal receiver could hire staff, implement improvements and spend the state’s money to fulfill the court’s numerous outstanding orders.

The move comes two months after Mueller held the department in civil contempt for ongoing staffing shortages, delays in treatment and insufficient suicide prevention efforts. The judge imposed a $112 million fine and directed the state to spend those funds to carry out measures she’d previously ordered. The 9th Circuit Court of Appeals will hear the state’s appeal of the order, but denied a stay of the payment. The fines are due on Friday.

In her July 12 order, Mueller wrote that instead of signaling a willingness to achieve compliance, the state sought “further delays” and “repeatedly asserted positions the court has found are not supported by the record.”

A 34-year-old court saga

In 1990, Ralph Coleman, a former Sacramento resident serving a sentence of life without parole, sued CDCR alleging its repeated failure to diagnose and treat his mental illness violated the Eighth Amendment’s ban on cruel and unusual punishment.

The suit eventually became a class action, and in 1994, a federal court found that incarcerated people with serious mental disorders in California prisons went years without diagnosis or care.

“Untold thousands of mentally ill inmates have gone undiscovered, undiagnosed and untreated while at the same time being subjected to conditions that aggravate their illnesses,” Judge John F. Moulds wrote.

Moulds identified chronic staff shortages and the lack of any system for screening for mental illness among the incarcerated as two key shortcomings.

The following year, U.S. District Judge Lawrence Karlton ruled CDCR was failing to provide adequate mental health care to the incarcerated and placed psychiatric care in the prisons under the supervision of a special master.

For nearly three decades, the special master has monitored prison psychiatric care, issued reports and made recommendations. But unlike a receiver, the special master lacks the power to implement or pay for improvements in care.

The Coleman attorneys have argued those limits on the special master’s authority have stymied reforms, pointing to CDCR’s inability to achieve agreed-upon staffing ratios and suicide prevention protocols.

High suicide rates

In 2013, CDCR’s suicide prevention expert Raymond Patterson quit after a decade with the department to protest what he called the indifference of prison officials. In court filings, Patterson said his recommendations went “unheeded, year after year” and that continuing to make them would be “a further waste of time and effort.”

Later that year the parties in the Coleman case agreed on 33 measures to improve suicide prevention.

Last month, more than a decade later, CDCR attorneys acknowledged in court papers that just 14 of the measures are complete. However they argued that current suicide prevention protocols are “more robust, thorough and extensive” than they were when the court first ruled that such care was inadequate.

Michael Bien, the attorney who filed Coleman’s original case in 1990, disputes the state’s claim. “The (suicide) rates are up beyond where they’ve ever been before,” he said in an interview.

In court filings arguing for appointing a receiver to oversee psychiatric care, Bien said the CDCR’s own data shows the prison suicide rate is tied directly to its high number of staff vacancies.

“Defendants’ most recent annual report on suicides in CDCR concedes that inadequate mental health staffing plays a significant role in the unusually and unacceptably high suicide rate among people incarcerated in CDCR institutions,” Bien wrote.

CDCR’s most recent report on suicide prevention found that from 2003 through 2022, its prisons averaged 30 suicides per year. The rate of suicide in CDCR during 2023 was 32.2 suicide deaths per 100,000 incarcerated individuals. In 2021, the rate was 15.5 suicide deaths per 100,000; it rose to 21.6 in 2022.

The U.S. Bureau of Justice Statistics estimates the suicide rate among state prison inmates nationally was 27 per 100,000 in 2019, the most recent data available.

Who should be tasked with bringing prisons into compliance?

In a joint filing Aug. 1, attorneys for both prison officials and inmates proposed that the court consider appointing Clark Kelso, the federal receiver in another long-running case about substandard prison medical care, Plata v. Newsom. Federal court investigators in that case, first filed in 2001, found that one person a week was dying in state prison from inadequate access to medical care.

In 2008, a federal judge appointed Kelso, a law professor at the University of the Pacific’s McGeorge School of Law, as a receiver empowered to impose sweeping reforms across CDCR’s health care system. The two sides in the Coleman case have said in court filings they agree that during Kelso’s tenure access to and the quality of prison medical care have improved.

The attorneys noted Kelso has been able to return authority over medical care to 26 of the state’s 33 prisons and is on track to bring all of the facilities into compliance with court orders.

Kelso has told the two sides he “does not rule out” taking on the additional role of receiver for prison psychiatric care, pending discussions with the special master in the case. Those discussions are reportedly taking place this week.