By Don Thompson | KFF Health News
SACRAMENTO — A federal judge has found top California prison officials in civil contempt for failing to hire enough mental health professionals to adequately treat tens of thousands of incarcerated people with serious mental disorders.
Chief U.S. District Judge Kimberly Mueller on Tuesday ordered the state to pay $112 million in fines at a time when the state is trying to close a multibillion-dollar budget deficit. The fines have been accumulating since April 2023, after Mueller said she was fed up with the state prison system’s inadequate staffing despite years of court orders demanding that the state address the issue.
“The sanctions imposed here are necessary to sharpen that focus and magnify defendants’ sense of urgency to finally achieve a lasting remedy for chronic mental health understaffing in the state’s prison system,” Mueller said in her order in the long-running class-action lawsuit.
The ongoing harm “caused by these high vacancy rates is as clear today as it was thirty years ago and the harm persists despite multiple court orders requiring defendants to reduce those rates,” she added.
Mueller ordered the state to pay the fines within 30 days and said they “will be used exclusively for steps necessary to come into compliance with the court’s staffing orders.” She ordered California to keep paying additional fines for each month the state remains in violation of court orders.
The ruling was unwelcome news for Gov. Gavin Newsom, who is struggling with a budget deficit that’s forcing reductions in numerous state programs.
The contempt finding “is deeply flawed, and it does not reflect reality,” said Diana Crofts-Pelayo, a Newsom spokesperson. “Amid a nationwide shortage of mental health therapists, the administration has led massive and unprecedented efforts to expand care and recruit and retain mental health care professionals.”
California Department of Corrections and Rehabilitation spokesperson Terri Hardy said the state will appeal Mueller’s order. Prisoners “often have greater access to mental health care in custody than what presently exists for people outside” because of the state’s “extraordinary steps to expand access to mental health care,” Hardy said.
Mueller’s contempt finding comes as Newsom, a Democrat, has prioritized improving mental health treatment statewide, partly to combat California’s seemingly intractable homelessness crisis. His administration has argued that Mueller is setting impossible standards for improving treatment for about 34,000 imprisoned people with serious mental illnesses — more than a third of California’s prison population.
Attorneys representing prisoners with mental illness vehemently disagree.
“It’s very unfortunate that the state officials have allowed this situation to get so bad and to stay so bad for so long,” said Ernest Galvan, one of the prisoners’ attorneys in the long-running litigation. “And I hope that this order, which the judge reserved as an absolute last resort, refocuses officials’ attention where it needs to be: bringing lifesaving care into the prisons, where it’s urgently needed.”
As part of her tentative contempt ruling in March, Mueller ordered Newsom personally, along with five of his top state officials, to read testimony by prison mental health employees describing the ongoing problem during a trial last fall.
The other five were the directors of his departments of Corrections and Rehabilitation, State Hospitals, and Finance; the corrections department’s undersecretary for health care services; and the deputy director in charge of its statewide mental health program.
Mueller limited her formal contempt finding to Corrections Secretary Jeff Macomber and two aides, Undersecretary Diana Toche and Deputy Director Amar Mehta.
“Fundamentally, the overall record reflects defendants are following a ‘business as usual’ approach to hiring, recruitment and retention that does very little if anything to transform the bureaucracy within which the hiring practices are carried out,” Mueller wrote.
Mueller had ordered state officials to calculate each month what they owe in fines for each unfilled position exceeding a 10% vacancy rate among required prison mental health professionals. The fines are calculated based on the maximum annual salary for each job, including some that approach or exceed $300,000.
The 10% vacancy limit dates to a court order by Mueller’s predecessor more than 20 years ago, in 2002, in the class-action case filed in 1990 over poor treatment of prisoners with mental disorders.
The $112 million in pending fines for understaffing is one of three sets of fines Mueller imposed.
She imposed $1,000-a-day fines in 2017 for a backlog in sending imprisoned people to state mental health facilities. But that money, which now tops $4.2 million, has never been collected, and Mueller postponed a planned hearing on the fines after prisoners’ attorneys said the state was making improvements.
In April 2023, Mueller also began assessing $1,000-a-day fines for the state’s failure to implement court-ordered suicide prevention measures. A court-appointed expert said his latest inspection of prisons showed the state was still not in full compliance.
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.