Handling of Mentally Ill in Prisons Assailed : Corrections: Inmates were denied medication and locked in solitary confinement, class-action lawsuit alleges. Some improvements have been made, state officials say.

When the new psychiatrist arrived at the California State Prison, Solano, in 1990, he was concerned about the sloppy procedures used to medicate mentally ill convicts.

Dr. George Maloof found that inmates routinely received two-week supplies of drugs to control such symptoms as inner voices. The inmates, he learned, frequently traded their medicines on the prison black market or were coerced out of their drugs by other convicts. Maloof, the sole mental health professional at the 4,000-inmate prison, also found that no therapy or monitoring accompanied the medication.

But in an attempt to deal with that situation, Maloof created another problem. The psychiatrist instituted a policy of refusing to prescribe drugs to disturbed prisoners. With the backing of the warden, Maloof withheld psychiatric medication for two years, no matter how ill the inmate. Convicts so disturbed that they could not function were locked in solitary confinement or transferred.

Maloof’s no-medication policy was revealed during a civil rights lawsuit trial in federal court here that presented an unsettling litany of alleged abuses and neglect of mentally ill and retarded inmates in the California prison system. The director of corrections testified that there are problems in caring for such inmates, although he insisted that prison officials are taking steps to correct them.

As a witness in the trial, Maloof defended his policy of withholding psychiatric medication. “I found giving it sparsely was more problematic . . . than just not giving it at all,” he said in court.

Maloof testified that he transferred to the state Parole Division in protest when a new warden countermanded his medication policy at State Prison, Solano--part of a large complex of penal institutions at Vacaville.

The lawsuit is the largest class-action case ever brought against California’s prison system. It was filed by the small but effective nonprofit Prison Law Office on behalf of an estimated 28,000 mentally ill inmates and 2,300 retarded convicts.

The plaintiffs accuse corrections department officials of widespread neglect and mistreatment, charging them with using the state’s penitentiaries to warehouse mentally ill and retarded people. Throughout the system, the suit says, officials routinely fail to provide proper medication and treatment and instead lock disturbed inmates in solitary confinement and shoot them with stun guns.

The suit also accuses prison officials of being “deliberately indifferent” to mentally ill inmates and with causing them to become more disturbed and more dangerous before they are released into the community.

“There was no coordinated system to identify those inmates,” testified Dr. Jean Dansereau, a psychiatrist at Wasco State Prison Reception Center in Kern County, where new inmates are processed. “We had just fiascoes where they’ve been taken out of their cells, shipped around the state of California (to other prisons), brought back to the reception center psychotic, readmitted, rehospitalized at tremendous cost to the taxpayer.”

The plaintiffs also charge that the state Department of Corrections has no programs for retarded inmates, nor any system to identify such prisoners--who are easy prey for other convicts. The suit asks the court to establish a “protected environment,” with separate housing and training programs for these convicts.

The suit could have a huge and expensive impact on the state prison system if Federal Magistrate Judge John F. Moulds, who heard closing arguments last month, finds merit to the allegations and agrees with a study that found that 25% of the state’s 114,000 convicts are in urgent need of treatment for mental illness. Moulds has given no indication when he will rule.

The plaintiffs maintain that about 2,000 mentally ill inmates “desperately need hospitalization,” while there are only 735 psychiatric hospital beds in the prison system. There are treatment programs available for only about 10% of the more than 20,000 inmates who need non-hospital therapy, the suit said.

The plaintiffs are seeking more mental health professionals assigned to prisons, a screening process to identify disturbed inmates upon admission, establishment of a suicide prevention program, a prohibition against using electric stun guns on mentally disturbed prisoners, and treatment programs for disturbed inmates rather than placing them in solitary confinement.

In an interview with The Times, corrections Director James Gomez acknowledged that the method of identifying mentally disturbed inmates needs to be standardized, that medication monitoring is inadequate and that there is no identification system or special programs for retarded convicts.

But, he insisted, “we’re not deliberately indifferent. Although we have some deficiencies in the system, we spend over $80 million a year in psychiatric services.”

Gomez also challenged the plaintiffs’ estimate of the number of mentally ill inmates, contending that the number is closer to 9,000 than 28,000.

Tip Kindel, chief spokesman for the state prisons, takes a tougher line than Gomez in responding to accusations in the suit.

“The initial lawsuit is crap,” snorted Kindel. “This is nothing more than a way to collect a bunch of legal fees. The department is not wantonly indifferent. You can’t be wantonly indifferent and spend $80 million on this issue.”

Over the last decade, the Prison Law Office has put together an impressive litigation record in forcing improvements in prison conditions.

The firm, headed by attorney Donald Specter, is near San Quentin Prison. Although Specter’s resources are modest, his suits--as is the case in the mental health litigation--are sometimes joined by commercial firms in the Bay Area, which receive court-mandated fees.

All but two of California’s prisons could be affected by the suit. (San Quentin and the California Medical Facility at Vacaville are under court orders to make mental health care reforms as a result of Prison Law Office litigation.)

A court-mandated reform of the treatment of mentally ill and retarded inmates throughout the prison system could cost $50 million at a time when the state is financially strapped, Gomez said.

“I think if you compare what (prisoners) are getting to what they’re getting in the community, you’d find (prisoners) are doing pretty good,” Gomez said.

But the plaintiffs contend that the price of reform is simply the bill due from public policies that reduced the population of state mental institutions but failed to provide funds for local mental health care.

“This has led to a striking rise in the number of persons with serious mental disorders who live on the streets and shelters,” the suit said. “Because of their mental illness, these persons are more likely to be subject to arrest and conviction when not properly treated or supervised.

“Tougher sentencing laws make it more difficult for mentally ill offenders to avoid a state prison sentence,” the suit continued. “The net result has been the transfer of a large number of persons with complex and acute mental illness . . . to state prison.”

Fifty-one witnesses testified for the plaintiffs and defense in the trial that lasted 39 court days.

The most graphic testimony came from beleaguered prison psychiatrists and inmates who described the treatment of mental illness behind penitentiary walls as reminiscent at times of 19th-Century madhouses.

Dansereau, who has served as a psychiatrist at Wasco State Prison since December, 1991, testified in March that, while there have been dramatic improvements in mental health care, the 4,500-inmate penitentiary is “wholly inadequate and well below any standard of care that I’ve seen anywhere.”

Dansereau told of a grossly psychotic and uncooperative inmate who was kept in solitary confinement because prison officials had established no policy for seeking court permission to administer involuntarily medication.

“So he sits in administrative segregation (solitary confinement), smearing feces on the walls, stopping up toilets, being assaultive toward guards, refusing to come out of his cell to take a shower,” Dansereau testified. “And that’s been going on for a month now.”

Wasco State Prison, which opened in 1991, is a reception center used to house prisoners temporarily while they are evaluated, primarily as escape risks, and assigned to other penitentiaries.

Dansereau described inmates pouring into Wasco by the busload, many of them in need of psychiatric medication but without medical records that specify the proper medicines or dosages.

“It was completely disjointed,” Dansereau said. “We had a waiting list of over 400 inmates waiting to be seen by a psychiatrist. Despite all our attempts to get the Department of Corrections to help in this matter . . . we had no help whatsoever.

“We had people who were grossly psychotic (becoming worse) because we had inadequate staff to be able to treat them. And every day we got a new bus from L.A. or from another county.”

Dansereau said February, 1992, was a particularly trying period: “Oh, it was horrible. . . . It escalated to the point where inmates were cutting their wrists just to be able to receive medication. . . . Some inmates were waiting for months to get their medication.”

When psychiatric medication is cut off, Dansereau testified, mentally ill prisoners can become psychotic and dangerous: “They endanger themselves and they also endanger correctional staff.”

Many inmates do receive medication, acknowledge the plaintiffs, but get little or no other psychiatric treatment and continue to behave strangely and sometimes violently.