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Federal Court Compels Activation of California DOC Mental Health Crisis Beds; Approves New $111 Million Mental Care Hospital

by John E. Dannenberg

California?s 16-year-old prisoner mental health federal lawsuit (originally, Coleman v. Wilson) was given new and urgently needed life on May 2, 2006 when a frustrated U.S. District Judge (Emeritus) Lawrence K. Karlton ordered the California Department of Corrections and Rehabilitation (CDCR) to activate 125 intermediate inpatient mental health beds and 75 mental health crisis beds by May 30, 2006 to absorb the 123-bed long waiting list for prisoners in need of critical mental health care. The court further approved CDCR?s plan to commence building a $111 million mental health hospital within the confines of Salinas Valley State Prison (SVSP) which will house 200 maximum security patients. The court disapproved CDCR?s long-range plan for enhanced mental health care beds because CDCR?s own projection showed that plan would result in a shortfall of 1,000 needed beds by the year 2011; the court ordered an amended plan be submitted.

Of CDCR?s 172,000 prisoners, approximately 31,000 are known to be mentally ill. The majority are classified as CCCMS and can safely live in the general population while taking psychotropic medications. But severely mentally ill prisoners need ?crisis beds? in a mental hospital setting, with attending physicians and psychological technicians. The problem becomes more acute when these patients are violent or high security risk prisoners. At SVSP, a Level IV (maximum security) prison, the need for mental health care beds is grave. Of SVSP?s 5,000 total population, 1,309 are in outpatient care, versus a treatment capacity of 999. However, 187 have been diagnosed as ?intermediate care patients? in need of constant-care mental health professional treatment and isolated beds. SVSP?s capacity for these is only 64 beds, leaving the remaining patients at great risk of harming themselves or others.

On November 20, 2005, a 28-year-old mental patient named Joshua, who was in the Outpatient Housing Unit (OHU) (the prison?s infirmary) at San Quentin State Prison, banged his head on the wall for an hour while gouging out his eyes, with no intervention from guards. Attorney Michael Bien called the videotape of this event ?agonizing.? Outside hospital surgeons were later unable to save Joshua?s sight. And in April 2006, an acutely psychotic 60-year-old named Wayne, housed at Deuel Vocational Institute?s reception center, was placed in the OHU because there were no mental health crisis beds available. Although he was video-monitored and constantly guarded in a suicide-watch cell having no fixtures, and possessed only a smock, Wayne managed to hang himself. Mysteriously, the crucial videotape footage of his death ?disappeared,? according to court documents.

Judge Karlton, also at the end of his rope after 16 years, sternly ordered CDCR to take specific immediate steps to provide crisis beds for the 123 prisoners conceded to be on a ?waiting list.? First, he ordered that 36 former crisis beds at the California Men?s Colony state prison, previously diverted to other use because of state licensing standards for mental health care beds, be immediately reconverted back into crisis beds state regulations notwithstanding. Next, the court ordered that 36 crisis beds slated for decommissioning at the California Medical Facility prison?s P-2 Unit be kept on line as crisis beds ?until further order of the court.? The court then ordered CDCR to open 36 crisis beds at SVSP no later than May 30, 2006, to be used for Level IV prisoners. In addition to the above, the court ordered another 36 crisis beds created at SVSP on the same time schedule.

As to the 123 prisoners on the ?waiting list,? some of whom were housed at Atascadero State Hospital (run by the Department of Mental Health (DMH), and not CDCR), the court ordered that all be appropriately reclassified as to proper placement forthwith. Twenty-five were ordered to be immediately transferred to DMH?s new (and almost empty) Coalinga State Hospital, with 25 more to follow within 30 days. Additionally, the court ordered that within six months, DMH and CDCR must submit a plan to create 30 more Level IV crisis beds at Coalinga. And, noting the availability of crisis beds at Level IV Kern Valley State Prison and California State Prison (Sacramento), the court ordered all such beds activated by July 1, 2006. Finally, the court forbade CDCR or DMH from closing any such beds because of state licensing requirements, unless approved by the court?s special master.

Observing that the above orders went beyond CDCR and implicated DMH, the court issued an order to show cause as to why Steven Mayberg, Ph.D., Director of DMH, should not be joined as a defendant in the action. It is estimated that by 2011, it will take $500-600 million to build sufficient CDCR mental health facilities to comply with existing court orders. Readers should note that the mental health care issues covered here are separate from the recent dental health care settlement agreement as well as from the recent federal court seizure of CDCR?s health care system (PLN, March, 2006, p.1). See: Coleman v. Schwarzenegger, USDC, ED CA, Case No. CIV S-90-0520 LKK JFMP.

Other Source: Monterey Herald.

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Related legal case

Coleman v. Schwarzenegger