This matter is before the court on the Special Master's Report and Recommendations on His Expert's Report on Suicides Completed in the California Department of Corrections and Rehabilitation in Calendar Year 2007 filed December 24, 2009 (hereafter December 24, 2009 Report and Recommendations). Therein, the special master recommends orders based on recommendations contained in the Report on Suicides Completed In the California Department of Corrections and Rehabilitation in Calendar Year 2007, filed September 17, 2009, (hereafter the 2007 Suicide Report). Defendants interpose several objections to the special master's report and recommendations. Plaintiffs have filed an opposition to defendants' objections, and defendants have filed a reply in support thereof.
The special master recommends the following orders:
1. Defendants shall specifically identify inmates' known and/or suspected medical problems and medications within these inmates' mental health treatment plans, rather than merely allude to them by reference to other records.
2. CDCR and DMH shall communicate and collaborate with each other to ensure that the highest level of care provided by DMH to CDCR inmates is given to any inmate who has been determined to need it.
3. Defendants shall accord priority to access to inpatient care for CDCR inmates at DMH facilities, particularly for Level III and Level IV inmates. This involves requiring clinical staff to properly assess suicide risk factors for inmates experiencing changes in mental health functioning, particularly on placement in administrative segregation or other single-cell housing. A vital component of this process is appropriate crisis-level service in treatment settings such as MHCBs, or limited treatment within OHUs, until transfers to DMH facilities can be achieved. DMH must be held accountable for its decisions on admissions or rejections and cannot be permitted to avoid transparency behind a pretext of patient "confidentiality."
4. Defendants shall fully and timely implement the suicide prevention and review processes that are already in place, at both the institutional and department levels, and shall give this priority. This includes incorporation of revised policy and procedural guidelines and court orders into these processes. It also entails the identification of deficiencies at the facility and systemic levels, appropriate follow-up of corrective action plans, and submission of documentation to the Coleman special master on the outcomes of investigations of staff misconduct, negligence, and error. This process must include not only training but supervision and appropriate supervisory action regarding staff performance.
December 24, 2009 Report and Recommendations at 2. The recommended orders are based on several findings in the 2007 Suicide Report, including:
* The CDCR inmate suicide rate in 2007 continued "CDCR's pattern of exceeding the national prison suicide rate."
* The 2007 CDCR inmate suicide rate was "higher by 1.5 percent than the CDCR average annual suicide rate per 100,000 inmates for the preceding nine years."
* "In 82 percent of the suicide cases in 2007, there was at least some degree of inadequacy in assessment, treatment, or intervention, for the highest rate of inadequacy in these areas in the past several years."
* In 79 percent of cases, deadlines in completion and submission of required documentation of suicides were missed, and some reporting was not completed at all by the time the 2007 Suicide Report was filed.
* Although three suicides were completed in Department of Mental Health (DMH) facilities, DMH refused to provide complete documentation of quality improvement and other action plans to the special master.
2007 Suicide Report at 1-2.
At the outset, the court notes that the recommended orders are almost identical to the four recommendations contained in the 2007 Suicide Report, which was filed on September 17, 2009. Id. at 18-19. On October 1, 2009, defendants filed a motion to modify that report. Defendants did not object to the substance of any of the recommendations. Defendants did, however, object to the request by plaintiffs, made in opposition to the motion, that those recommendations be made orders of this court; defendants contended then only that none of the recommendations meets the criteria for injunctive relief set forth in 18 U.S.C. § 3626. See Defendants' Reply Brief, filed November 6, 2009, at 11. By order filed November 23, 2009, defendants' motion was denied. Plaintiffs' request that the recommendations in the 2007 Suicide Report be made orders of this court was also denied, without prejudice, based on the court's determination that requests for such orders should come, if at all, from the special master. Order filed November 23, 2009, at 14. On December 24, 2009, the special master filed ...