Probe of California’s prison-based mental health facilities ordered


SACRAMENTO — Citing evidence of doctor shortages, treatment delays and “denial of basic necessities, including clean underwear,” a federal judge on Thursday ordered an in-depth probe of conditions at prison-based mental health facilities run by the California Department of State Hospitals.

U.S. District Judge Lawrence K. Karlton has been overseeing mandated improvements of care for mentally ill prisoners throughout California, treatment that the courts 18 years ago deemed so substandard as to be unconstitutional.

The efforts largely have focused on state prisons. But in recent months psychiatrists and plaintiffs’ attorneys have complained of problems at the facilities at Salinas Valley and Vacaville state prisons. The facilities provide care to severely ill inmates under contract with the California Department of Corrections and Rehabilitation.


Last month, Karlton heard testimony on the question of whether to impose greater scrutiny.

Those pressing for oversight by a so-called special-master argued that at Salinas Valley, patients often waited weeks before receiving treatment. One inmate committed suicide last year as he was being assessed.

Attorneys for the Department of State Hospitals argued that the move would “unnecessarily expand judicial oversight.”

In his order, Karlton wrote: “The court finds there is a significant evidentiary basis for questioning the adequacy of critical aspects of inpatient care” at the prison facilities. The judge ordered the special master to complete a report on Salinas Valley within 75 days, and to conduct probes of the Vacaville psychiatric program and a new one slated to open this month in Stockton by March 2014.

The ruling applies primarily to the prison-based inpatient programs that currently house 761 patients. But the special master also is expected to explore conditions at three other state hospitals that admit mentally ill prisoners in order to stabilize them. There are 238 such patients currently being treated at Atascadero, Coalinga and Patton state hospitals.

In a statement, the Department of State Hospitals late Thursday said only that it was evaluating the court’s decision.


Michael Bien, who represented prisoners with severe mental illness in their class-action lawsuit, said Karlton’s order was very important. When prisoner advocates investigated complaints of inadequate care, Bien said, “we found things that were worse than we even expected.”

Long waits for available beds at the prison-based facilities have been endemic for years, but Bien said the care was always viewed as “such a level above the prisons that our people considered it lucky to get in there.”

To discover that care provided by the hospitals department also had been compromised by “budget cuts and mismanagement was quite troubling,” he said.

Among the key concerns: The 25-1 patient/doctor ratios once required by the department were changed to 35 to 1 shortly after the Justice Department lifted its oversight of four state mental hospitals (excluding the prison-based programs) early last year.

Psychiatrists at several facilities have said they carry caseloads exceeding 40 patients.

State mental health officials maintained throughout the proceedings that problems have been overblown.

They argued that the court “has never found that DSH is providing inadequate care” to prisoners, disputed that problems with retaining psychiatrists at Salinas Valley had affected the quality of care, and said the Vacaville program was properly staffed.

The delays caused by the orientation period for newly arriving patients was “reasonably related” to safety issues in the prisons, the officials added. And, they said, allegations that Salinas Valley patients had been denied soap and clean underwear were false.

While Karlton denied the requests by plaintiffs’ attorneys for direct orders to alter conditions, he was concerned enough to order the in-depth oversight.

Romney reported from San Francisco and St. John from Sacramento.