“Systemic Failures Persist” in California Prison Mental Health Care, Judge Rules

California Security Housing Unit Cell

California Security Housing Unit Cell

California Governor Jerry Brown’s bid to end federal control over the state prison system’s mental health system was denied in federal court on Friday, April 5, in a sharply worded ruling by U.S. District Judge Lawrence K. Karlton. In the 68-page ruling, Judge Karlton determined that “systemic failures persist in the form of inadequate suicide prevention measures, excessive administrative segregation of the mentally ill, lack of timely access to adequate care, insufficient treatment space and access to beds, and unmet staffing needs.”

The ruling comes following months of campaigning and litigating by Governor Brown and the California Department of Corrections and Rehabilitation (CDCR) to end federal oversight of the California prison system. Friday’s ruling is the latest enforcement of the 1995 case Coleman v. Wilson, a federal class action suit filed against then-California Governor Pete Wilson, which resulted in  federal oversight over CDCR’s mental health and medical treatment that continues under the jurisdiction of Judge Karlton.

An additional federal class action lawsuit, Plata v. Schwarzenegger was merged with the Coleman lawsuit and in 2009, California was ordered to reduce it’s prison population to 137% capacity, as it was determined that Constitutionally acceptable medical and mental health delivery was hindered by the beyond-capacity prison population, which was deemed an 8th Amendment violation. California in turn appealed the order to reduce it’s prison population and in 2011, in Brown v. Plata, the US Supreme Court ordered California to reduce it’s prison population by 30,000 inmates. Governor Brown has an additional appeal of this order before U.S. District Judge Thelton E. Henderson.

Governor Jerry Brown has gone on the record to claim that California  has “one of the finest prison systems in the United States,” and no longer requires federal oversight. In a January 2013 press release, Governor Brown stated: “After decades of judicial intervention in our correctional system and the expenditure of billions of taxpayer dollars, the time has come to restore California’s rightful control of its prison system.” In February, CDCR announced the completion of a new mental health treatment building at the California Medical Facility, and declared that the facility “reinforces CDCR’s ongoing commitment to provide a constitutional level of mental health treatment in California’s prisons.”

Judge Karlton’s ruling, however, strongly rebukes these claims by Brown and CDCR, saying “based on defendants’ conduct to date, the court cannot rely on their averments of good faith as a basis for granting termination. There is overwhelming evidence in the record that much of defendants’ progress to date is due to the pressure of this and other litigation.”

A major factor in Judge Karlton’s ruling was the significant rate of suicides in the California prison system, which has previously been reported to be well above the national prison average.

“In summary, for over a decade a disproportionately high number of inmates have committed suicide in California’s prison system describable inadequacies in suicide prevention in the CDCR,” Judge Karlton writes,”Defendants have a constitutional obligation to take and adequately implement all reasonable steps to remedy those inadequacies. The evidence shows they have not yet done so. In addition, while defendants represent that they have fully implemented their suicide prevention program, they have not. An ongoing constitutional violation therefore remains.”

Judge Karlton cited the overuse of solitary confinement, particularly among individuals with severe mental health problems, as a continuing problem in the California prison system. The ruling states that such individuals “face substantial risk of serious harm, including exacerbation of mental illness and potential increase in suicide risk.”

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California Prison Conditions Driving Prisoners to Suicide

California Security Housing Unit Cell

California Security Housing Unit Cell

A court-appointed consultant, forensic psychiatrist Dr. Raymond Patterson, has reported that the California Department of Corrections and Rehabilitation (CDCR) has failed to effectively combat the large and escalating problem of suicides in the California prison system. According to reporting by KPCC, Patterson despondently asserted that his making any additional recommendations would be “a further waste of time and effort,” as recommendations over many years have gone unheeded.

The report comes as U.S. District Judge Lawrence Karlton is preparing a decision on whether or not California’s mental, mental health, and dental care must continue to be monitored by federal courts. In August 2012, then-CDCR Secretary Matthew Cate issued a plan to end federal oversight of California prison health care. “My goal is to end federal court oversight of medical, mental health and dental care by next year,” Cate said. Though Cate resigned in October, his enthusiasm for lifting federal court oversight has been championed by California Governor Jerry Brown. Brown has argued that California has made significant leaps in improving prison health care and addressing overcrowding.

According to reporting by the Los Angeles Times, the March 13 report by Patterson and five other experts reviewed 15 of 32 suicides in 2012. The report notes that prisoners housed in segregation units, Administrative Segregation Units and Security Housing Units, have a 33 times higher chance of suicide. According to Amnesty International, between 2006 and 2010, there was an average of 34 suicides in the California prison system a year, with 42 percent occurring in segregation units.

According to the LA Times reporting, “13 of the 15 deaths showed some form of inadequate assessment, treatment or intervention.” Three of the 15 prisoners had already undergone rigor mortis, meaning hours had gone by from the time of their death to the time they were found. Further, the California prison suicide rate of nearly 24 per 100,000 exceeds the national state prison average of 16 per 100,000.

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Suicide in Solitary: The Life and Death of Armando Cruz (Part 2)

California State Prison, Sacramento

On December 26, 2008, Armando Cruz was admitted to Mercy Hospital of Folsom following an attempted self-castration. He had “wrapped strips of sheets/shirts around base of scrotum and has been tightening them over the past three days because ‘I am on a mission,’” according to a Clinical Report by a physician who examined him.

Cruz would go on to say that he did it “to prove he was tougher then the voices.”

Housed alone in the PSU, he would participate in few groups.  However, no disciplinary issues are noted in his documentation. On February 5, 2009, his custody was reduced from Max to Close Custody. His SHU term was suspended and he was allowed to participate in EOP Programming, which included more social interaction.

He would remain disciplinary free throughout much of 2009.

He was transferred back to Salinas Valley State Prison, being placed back in the Department of Mental Health, on September 29, 2009.  The goal was to make him competent to stand trial for the January 18, 2008 incident in which he bit an officer. Within a month, on October 16, he would be cited for possession of dangerous contraband.

Two months later, he would participate in his first, and only, parole board hearing. The parole board noted that “Cruz has not been released from Discretionary Program Status (DPS) due to his erratic behavior and therefore, has not participated in any group activities.” The board also indicated that Cruz had spent some time before the board emphasizing that he wished to stay away from the El Cajon Dukes, a gang he had claimed he was a member of since his arrest, a claim his mother disputes.

On February 2, 2010, the board would deny parole for seven years, telling him he needed to stay disciplinary free and that he had not yet taken full responsibility for his actions.

Cruz would remain at Close Custody security until December 2010.

His mother believes that quietly, Cruz was agonizing over his February parole denial. “He thought that he would serve 8 years and come home,” she says.

He would have a cellmate for most of 2010, and remained relatively discipline free. In May 2010, he was transferred to Vacaville, at the California Medical Facility.

On July 27, 2010, a Department of Mental Health/Vacaville Psychiatric Program Discharge Summary indicated that he remained incompetent to stand trial. Quoting a court ordered psychological evaluation, the Discharge Summary reads “it was noted he has made some improvement since his last evaluation in that he is now aware of the charges against him whereas previously he was not…he is still experiencing psychotic and manic symptoms which interfere with his ability to be an effective participant in his own defense.”

Further, the report indicates that the nature of Cruz’s diagnosis of schizophrenia “often leads the patient to misinterpret reality and engage in behavior which may be dangerous to him or others. It is therefore recommended that the patient be transferred to a facility that can continue to provide further mental healthcare within a safe environment.”

The Discharge Summary cites a visit by family—his mother and his sister.  He was reportedly “overjoyed on account of that” and indicated his desire to be “placed at a facility which could be closer to his family.” This would be the last contact visit. The last time that Cruz was able to hug and kiss his family.

At this time, Cruz was diagnosed with Schizoaffective Disorder, bipolar type. He also was noted to have hypothyroidism.

He would be discharged back to Salinas Valley State Prison, and then was sent back to CSP, Sacramento in the EOP program.  The assault charge against him would be dropped in favor of administrative measures.

On September 27, he was admitted to the Mental Health Crisis Unit due to having bruising on his neck.  According to a Mental Health Interdisciplinary Progress Note, “He reports (vaguely) a psychotic episode in which he was feeling tremendous pain in his neck and put his hands around his neck to stop the pain, causing bruising.”

In October, he was again admitted to the Mental Health Crisis Unit for “self-abuse by choking himself out.” It was noted that he has “chronic thoughts of impending doom and an internal feeling of senselessness…which he explains as a perception that everything in the world is dull and boring.”

While there, two psychologists evaluated him by request of the Mental Health Crisis Bed Interdisciplinary Treatment Team. Cruz was noted to have a fourth grade reading ability and indicated that a neurological examination might be necessary to determine if Cruz’s frequent self-asphyxiation has caused any brain injury. His attention was found to be in the “Profound Impairment” range. His memory, language, and executive functioning were also noted to be impaired.

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Suicide in Solitary: The Life and Death of Armando Cruz (Part 1)

0010557353-01-1.jpg_20110926

On September 20, 2011, at 10:55 pm in the Psychiatric Services Unit of California State Prison, Sacramento, a guard was completing his rounds checking on patients in the unit. Locked in solitary confinement, but allowed 10 hours of recreation a week as well as some group activities, prisoners held in these units have been diagnosed with a litany of severe mental health problems. In cell number 104, Armando Cruz, 28, was found facing “toward the opposite side of the door window…[a] rope from his neck to the ceiling…his tongue protruding.” His face was purple and there was no pulse. At 11:35 pm, he was pronounced dead.

On a dozen Post-It notes he scribbled his final words, telling his family he loved them. His final message was “REMEMBER ME!”

 The death of Armando Cruz was the culmination of years suffering from hallucinations, engaging in self-harm and escalating problems. It also exemplifies what can and does happen to people with severe mental health problems when they are locked into the prison system.

Entering the California prison system on February 25, 2003 following three years of legal wrangling, he would spend at least four years in solitary confinement units, including the final year of his life. Housed alone, his hallucinations and delusions would fester as he ruminated in cells no larger than a bathroom to the point where, in the final months of his life, he invented a family that lived with him. For a vulnerable young man with a fear of “being alone in a cell,” the protracted isolation amounted to psychological torture. Ultimately, he became one of 33 California prisoners who would commit suicide in 2011.

In order to understand Armando Cruz’s death, it is important to understand the tumultuous life that he led.

Troubled Youth

Armando Emmanuel Cruz, Jr. was born on April 23, 1983 to Armando and Yolanda Cruz in Fontana, California. He was a relatively quiet child who enjoyed playing sports, participated in karate, and was well liked by his peers. He was a decent student in elementary school.

Says his mother, Yolanda, of her son, “What I want the broken system to know and the State of California is, that Armando…was a sensitive son who worried about the less fortunate and the injustices in our world.

Things began to change when he entered adolescence. When he was thirteen, he began to use marijuana and methamphetamine and engaged in inhalant abuse (“huffing”). He began experimenting with cocaine and LSD and also began to drink alcohol, which he reportedly did to the point of losing consciousness.

In August 1997 at the age of 14, he was arrested for possessing marijuana at school. The following month he was arrested for burglary. He had stolen several thousand dollars worth of tools.

In 1998, he began to exhibit early psychotic symptoms, yelling at his mother that he was feeling forgetful, that he “felt out of place” and that he was “losing his language.”

In January 1998, according to legal documents, he was examined at County Mental Health and diagnosed as suffering from Inhalant Dependency. Two months later,”[Cruz] had a juvenile forensic evaluation and was diagnosed as suffering from a psychotic disorder, probably a hallucinogen induced psychosis, and also suffering from Borderline Intellectual Functioning.”

Though he was placed in various diversionary programs to keep him out of juvenile detention facilities, his problems continued to escalate.

Friends commented that they felt that the various psychiatric drug combinations Cruz was on “made him slower,” “made him seem more dazed” and that “it felt like Cruz was getting farther away.”

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