This matter is before the court on a report and recommendations from the special master concerning defendants' November 24, 2010 court-ordered plan to "reduce or eliminate the wait lists for inpatient [mental health] care and, in the interim, to better serve the treatment needs of Coleman class members placed on such lists." Plaintiffs have responded to the report and recommendations, and defendants have filed objections .
In March 2010, following completion of the second assessment of unmet needs for inpatient care for class members conducted in this action*fn1 , the court held a status conferenceto hear from defendants concerning the steps they have taken and are taking to ensure that the referral and transfer of inmates to higher levels of care is proceeding in a way that will avoid the need for any future special assessments of unmet need and will ensure that those who required inpatient care are referred and admitted in a timely manner. Order, filed January 27, 2010, at 7. Following the status conference, the court issued a written order with two provisions, both relevant to the matter at bar, as follows:
1. The special master shall monitor defendants' implementation of their policies and practices regarding referral and transfer of Coleman class members for inpatient care. This monitoring shall include, as necessary, collection, review and analysis of relevant data. If at any point during monitoring it becomes apparent to the special master that the sustainability of defendants' inpatient referral process is jeopardized by deficiencies uncovered during monitoring, he shall take all steps necessary to ensure that defendants correct such deficiencies. The special master shall report to the court on defendants' identification and referral process by the end of the year, either in his regular monitoring report or in a special report.
2. Within ninety days, under the guidance of the special master defendants shall work together to develop a plan to reduce or eliminate the wait lists for inpatient care and, in the interim, to better serve the treatment needs of Coleman class members placed on such lists. The special master shall consult with plaintiffs as appropriate during this process. The plan shall be filed with the court within one hundred twenty days from the date of this order.
Order filed March 31, 2010, at 3-4.
After receiving an extension of time, on November 24, 2010, defendants filed their Plan Re: Intermediate Care Facility and Acute Inpatient Waitlists (hereafter plan). The plan contains five elements: an Extended Enhanced Outpatient Program Care Plan (EECP); enhanced Utilization Management strategies involving conducting prospective, concurrent and retrospective reviews to "optimize inpatient care"; increased used of the Health Care Placement Oversight Program (HC-POP); activation of a new inmate patient information system called SharePoint; and the construction projects, both short and long-term, identified in defendants' previously filed bed plans.
On February 25, 2011, plaintiffs filed objections to the plan and on March 18, 2011, defendants filed a response to plaintiff's objections. By order filed April 28, 2011, defendants' plan was referred to the special master for a report and recommendations in light of plaintiffs' objections and defendants' response thereto.
The special master makes four recommendations, as follows:
1. That defendants' Plan Re: Intermediate Care Facility and Acute Inpatient Wait List be approved. All parts of the plan should be implemented immediately with the condition that no inmates who are accepted and placed in the EECP shall be removed from the wait list.
2. That the special master should be ordered to monitor and conduct a review of the EECP, including but not limited to staffing. The special master should be ordered to report to the court either in his regular monitoring report or in a special report, whether inmates transferred to the EECP should be removed from the wait list.
3. The Court should set this matter for an evidentiary hearing for defendants to show cause why the 50 beds at Coalinga State Hospital designated for Coleman class members, as well as any other vacant beds at the facility, cannot be filled with high-custody CDCR inmates.
4. The defendants should be ordered to conduct a further assessment to determine whether there are unmet needs for inpatient care among the plaintiff class. The assessment should be modeled after MHARP which was conducted in 2009, and only at the original twelve identified male institutions and two female institutions and under the guidance of the special master. As part of this process, the special master should also be directed to monitor the continued implementation and sustainability of defendants' policies and practices regarding referral and transfer of Coleman class members for inpatient care. The special master should be ordered to report to the court on defendants' identification and referral process either in his regular monitoring report or in a special report.Report at 54.
In response to the first two recommendations, defendants have withdrawn the EECP from their plan. Defendants contend this moots the last sentence of the first recommendation and all of the second recommendation. It is unclear whether defendants are abandoning the EECP altogether or, instead, whether it will continue but they are no longer relying on it to meet their obligations under this court's March 31, 2010 order. Good cause appearing, defendants will be directed to inform the court in writing within ten days whether the EECP will continue.*fn2
Defendants object to the special master's recommendation that the court conduct an evidentiary hearing concerning the use of vacant beds at Coalinga State Hospital (Coalinga) for Coleman class members on the wait list for inpatient care. The special master's recommendation is based on his finding that "the inaccessibility to DMH facilities is a primary cause of inmates lingering on the wait list" and that "[t]he only way to achieve any meaningful reduction of the wait list is by placing these inmates into inpatient beds." Report at 44. He reports that the California Department of Mental Health (DMH) had 183 beds available at Coalinga as of June 8, 2011, id., that in April 2011 there were a total of 84 low-custody beds available at Atascadero State Hospital (ASH) and in the inpatient ...