United States District Court, N.D. California
ORDER GRANTING IN PART AND DENYING IN PART STATE
DEFENDANTS' MOTION FOR SUMMARY JUDGMENT; AND DENYING
PLAINTIFFS' MOTION FOR PARTIAL SUMMARY JUDGMENT DOCKET
NOS. 183, 181
M. CHEN, UNITED STATES DISTRICT JUDGE
in this case are (1) the successors in interest to decedent
Dat Thanh Luong (namely, his wife and minor son); (2) Mr.
Luong's wife, Ai Qiong Zhong; and (3) Mr. Luong's
minor son, W.L. Mr. Luong was diagnosed with schizophrenia
in or about 2001. See Haddad Decl., Ex. 2 (N. Luong
Depo. at 27-28). In January 2016, he was arrested and booked
into Alameda County's Santa Rita Jail. See
Prothero Decl., Ex. A (arrest report). In July 2016, a state
court ordered that Mr. Luong be committed to Napa State
Hospital (“NSH”) or “any other
Hospital” because he was mentally incompetent within
the meaning of California Penal Code § 1368. Defs.'
RJN, Ex. G (Order at 1). By September 2016, Mr. Luong still
had not been transferred to NSH or any other hospital, thus
prompting a state court to issue an order directing the
Director of the California Department of State Hospitals
(“DSH”) to transport Mr. Luong or to show cause
re contempt. See Defs.' RJN, Ex. H (order).
Despite the court orders, Mr. Luong was never transferred.
Pending the transfer that never came, he was killed in jail
in October 2016 after his cellmate strangled him.
juncture, the only defendants remaining in the case are the
State Defendants. They are as follows:
(2) Pam Ahlin (the Director of DSH during the relevant time);
(4) Dolly Matteucci (the Executive Director of NSH during the
(5) Patricia Tyler (the Medical Director at NSH during the
relevant time); and
(6) Cindy Black (the Clinical Administrator at NSH during the
pending before the Court are (1) the State Defendants'
motion for summary judgment or, in the alternative, summary
adjudication and (2) Plaintiffs' motion for partial
summary judgment. Having considered the parties' briefs
and accompanying submissions, as well as the oral argument of
counsel, the Court hereby GRANTS in part and
DENIES in part the State Defendants'
motion and DENIES Plaintiffs' motion.
FACTUAL & PROCEDURAL BACKGROUND
parties have submitted evidence in conjunction with their
motions. The evidence reflects as follows. Where there are
disputes of fact, they are so noted.
General Process re Incompetent-to-Stand-Trial
was created in 2012 to manage and operate the state
psychiatric hospital system.” Maynard Decl. ¶
It is “comprised of five state hospitals, four of which
serve IST defendants, ” including NSH. Maynard Decl.
¶ 12. In fiscal year 2016-17, DSH had an “average
daily census of 1, 524 IST defendants.” Maynard Decl.
state court commits an IST defendant to the care of DSH, it
does so at a hearing in which DSH is not a participant.
See Black ¶ 7. “When the court orders
that the defendant be committed to a State Department of
State Hospitals facility or other public or private treatment
facility, the court shall provide, ” inter
alia, a copy of the commitment order to DSH or other
facility prior to the admission of the defendant. Cal. Pen.
Code § 1370(a)(3). Pursuant to California Penal Code
§ 1370(a)(3), the “admission packet” for an
IST defendant also includes, e.g.,
“[c]ourt-ordered psychiatric examination or evaluation
reports” and “[m]edical records.”
Id. Prior to September 2016, “some counties
failed to include adequate medical records or any records at
all.” Black Decl. ¶ 9 (adding that this “was
a factor in DSH promulgating regulations [in September 2016]
requiring [that] full medical records be included in
the relevant period, NSH had an Admissions Suite that
received the commitment order and admission packet from the
county/court. See Black Decl. ¶ 8. Upon
receipt, the patient's name was placed on a wait list.
See Black Decl. ¶ 10; Prothero Decl. ¶
Like all state hospitals, NSH had, during the relevant time,
a wait list for admission. See Black Decl. ¶
11. There were wait lists because “[e]ach state
hospital has reached its maximum licensing, functional, or
statutory capacity.” Maynard Decl. ¶ 4; see
also Maynard Decl. ¶ 6 (testifying that
“[a]ll State Hospitals are licensed and regulated by
the California Department of Health” and “[e]ach
hospital has limitations on bed space and bed usage”;
NSH's “total number of beds is limited by its
license” and, “until June, 2016, [NSH] was
limited to 980 beds for patients whose placement was required
pursuant to the Penal Code”).
Admissions Suite had an Admissions Coordinator - at the
relevant time, Dana White, a registered nurse - who would
initially review the admission packet “looking for any
history of escape, violence, sex offender status, or specific
medical need, so that the IST defendant could be placed in
the proper hospital with the proper resources available when
he . . . arrived.” Prothero Decl. ¶ 3; see
also Haddad Decl., Ex. 14 (White Depo. at 27)
(testifying that, from 2005 to May 2019 (when she left NSH),
she was the only person at NSH who reviewed the admission
packets). After the Admissions Coordinator completed her
review, she would “release the packet to an analyst in
her office who checked the packet for completeness.”
Prothero Decl. ¶ 3; see also Black Decl. ¶
8; Haddad Decl., Ex. 13 (Black Depo. at 25) (testifying that
the packet was reviewed for completeness and accuracy by an
analyst and not medical staff); Haddad Decl., Ex. 14 (White
Depo. at 25) (testifying that analysts do not, e.g.,
have a nursing license). If information was missing, either
the Admissions Coordinator or an analyst would contact the
county, see Prothero Decl. ¶ 3, and
“facilitate the process of completing the packet with
the required documents.” Black Decl. ¶ 9. After
the admissions packet was complete, “the IST
defendant's status on the wait list was changed to
‘ready' to schedule admission.” Black Decl.
appears that, prior to the enactment of regulations in
September 2016, a defendant's place on the wait list was
- as a general matter - dependent on his commitment date.
See Prothero Decl. ¶ 5 (testifying that,
“[i]n 2016, because of concerns arising out of the
fairness of some counties in [NSH's] catchment area
having standing orders, the Admissions staff continued to
place all IST Defendants on the . . . wait list, once their
packet was complete, according to commitment
appears that, prior to September 2016, a defendant could be
immediately placed at a hospital - i.e., in spite of
the wait list - if the defendant had an acute psychiatric
need. See Haddad Decl., Ex. 13 (Black Depo. at 46).
Usually, NSH would be told by the county jail that the
defendant had such a need (although anyone could tell NSH,
including the defendant's attorney or any one concerned
about the defendant), and then the referral would be reviewed
by the Clinical Administrator (Ms. Black) and the Medical
Director (Dr. Tyler). See Black Decl. ¶¶
10, 12; see also Prothero Decl. ¶ 7.
“Based on the review of the available records and
discussion with staff treating the defendant, the Medical
Director [would] determine if the patient needed immediate
placement due to [his] psychiatric condition.” Black
Decl. ¶ 10.
is evidence that DSH/NSH did not have a practice of routinely
informing the state courts issuing commitment orders, medical
staff at the jails, the prosecution, or defense counsel that
a psychiatric acuity review could get an IST defendant
admitted on a priority basis. See, e.g., Haddad
Decl., Ex. 13 (Black Depo. at 54-55) (testifying that she
could not recall a specific instance of the above being told
“on a routine basis”); see also Haddad
Decl., Ex. 18 (Ahlin Depo. at 106) (testifying that she is
“not aware of a formal notification” to county
jail doctors or admissions that they can request psychiatric
acuity review); Haddad Decl., Ex. 19 (Tyler Depo. at 172)
(testifying that she has “never sent out a letter to
jail staff saying they can ask” for a psychiatric
acuity review for a patient); Blakely Decl. ¶ 7
(testifying that, while he was a public defender, he
“was never informed that the Department of Mental
Health or [DSH] allows for psychiatric acuity reviews upon
request, to provide an IST criminal Defendant with priority
admission to [NSH] based on the severity or acuity of his
addition, there is evidence that DSH/NSH did not have a
practice of automatically subjecting IST defendants to
psychiatric acuity reviews before they were placed on the
wait list - i.e., there was no attempt to
“triage.” See, e.g., Haddad Decl., Ex.
13 (Black Depo. at 48, 58) (testifying that “[w]e do
not do a triage for admission” - i.e., NSH
does “not triage patients to determine their
psychiatric acuity before putting them on the waiting
list”); Haddad Decl., Ex. 17 (Maynard Depo. at 63)
(testifying that “[t]here is not a standard that I am
aware of while I have been with DSH to triage and evaluate
every patient prior to placement on the wait list”).
However, there is some evidence indicating that the
Admissions Suite nurse of a state hospital would do a limited
kind of psychiatric acuity review at or about the time that
the admission packet was sent to the hospital. See,
e.g., Haddad Decl., Ex. 17 (Maynard Depo. at 39-40)
(testifying that, at the time of referral, “[t]he
patient referral information provided by the county is
reviewed by a nurse in each of the hospitals, or the patient
management unit, for specific placement issues which could be
related to psychiatric acuity” or other matters such as
“the type of offense” and “medical
conditions”); Haddad Decl., Ex. 14 (White Depo. at 39,
41) (testifying that “[w]e have medical records before
they go on the waiting list” such that, “if
anything sticks out in those medical records that call to us
to ask the jail for further information, we do call the
jail”; “sometimes, to me, I'll read something
and think: Wow, this person needs to get in a hospital
now” so “I'll ask the [Admissions] [S]uite to
make a phone call to the jail to see if they are suicidal
right now or if things have changed or how the person's
doing now, right that moment”). According to
Plaintiffs, it was feasible to do a more systematic
psychiatric acuity review for all IST defendants because
there is evidence that “it takes Dr. Tyler only about
an hour to do one on an ad hoc basis.” Pls.'
Opp'n at 8; see also Haddad Decl., Ex. 19 (Tyler
Depo. at 171-72) (stating that the time to do a psychiatric
acuity review “can vary, but I would say less than an
hour”; this includes reviewing available medical
State Defendants, however, note that “the numbers of
IST defendants that counties [have] referred to DSH . . .
have experienced tremendous growth over the last several
years. For example, the number of county IST referrals to DSH
systemwide increased from 1, 859 in Fiscal year (FY) 2013-14
to over 3, 400 in FY 2016-17.” Maynard Decl. ¶ 10.
Although DSH has been able “to increase admissions and
numbers of IST defendants served, ” Black Decl. ¶
11; see also Maynard Decl. ¶ 12 (testifying
that, in “the last four years, DSH has added 970 new
beds to its overall treatment system of state hospital beds
and Jail Based Competency (JBCT) Program
beds”), “the number of county referrals
continue to outpace the rate of admissions.” Maynard
Decl. ¶ 10; see also Maynard Decl. ¶ 13.
the above, it is not surprising that state courts often had
to issue orders to show cause (“OSCs”) because an
IST defendant had not been transferred to a hospital as
required by a court commitment order. When a state court
issues an OSC “for disobeying a court order of
commitment, it may be directed to the Director of DSH
[e.g., Ms. Ahlin] in [her] official capacity.”
Maynard Decl. ¶ 8. The OSC, however, “does not
[actually] go to the Director of DSH and instead [is] routed
directly to the DSH legal department for handling.”
Maynard Decl. ¶ 8; see also Carson Dec., Ex. A
(Ahlin Depo. at 42); Ahlin Decl. ¶ 4. “[I]n fiscal
year 2016, DSH received 1, 975 OSCs.” Maynard Decl.
Process Specific to Mr. Luong as an IST Defendant
January 26, 2016, Mr. Luong was arrested for assault after he
allegedly attacked a person with a mallet. See
Prothero Decl., Ex. A (arrest report). Mr. Luong was
eventually placed in custody in the Santa Rita Jail in
February 2016, medical staff at the jail assessed Mr. Luong
with schizophrenia and/or psychosis. See, e.g.,
Haddad Decl., Ex. 6 (PLF 617, 620). He was prescribed the
antipsychotic drug Risperdal. See Haddad Decl., Ex.
6 (PLF 627).
March 7, 2016, the state court in the criminal proceeding
related to the assault appointed an alienist (Victoria
Campagna) pursuant to California Penal Code § 1368 to
assess Mr. Luong's competency. See Defs.'
RJN, Ex. A (order).
thereafter, medical staff at the Santa Rita Jail made note
that Mr. Luong was refusing to take his medication. See,
e.g., Haddad Decl., Ex. 6 (PLF 629-31). Risperdal
continued to be prescribed. See, e.g., Haddad Decl.,
Ex. 6 (PLF 634, 636, 638).
April 5, 2016, Dr. Campagna (the court-appointed alienist)
opined that Mr. Luong was competent to stand trial. This was
based on, inter alia, an interview with Mr. Luong on
the preceding day. See Prothero Decl., Ex. A
April 6, 2016, the state court appointed another alienist
(Martin Blinder) to assess Mr. Luong's competency.
See Defs.' RJN, Ex. C (order).
7, 2016, Dr. Blinder (the court-appointed alienist) opined
that Mr. Luong was not competent to stand trial. This was
based, inter alia, on an interview with Mr. Luong on
May 3, 2016. See Prothero Decl., Ex. A (Blinder
to late May 2016, Mr. Luong's condition began to
deteriorate, with medical records indicating, e.g.,
that he had been refusing to eat and drink and that he was
delusional. See, e.g., Haddad Decl., Ex. 6 (PLF 639,
1, 2016, medical staff at the Santa Rita Jail noted that Mr.
Luong refused to take his anti-psychotic medication and
determined that Mr. Luong's condition had deteriorated to
the point where he was a danger to self and had a grave
disability, thus prompting a detention for evaluation and
treatment at the John George Psychiatric Pavilion pursuant to
California Welfare & Institutions Code §
5150. See Haddad Decl., Ex. 6 (PLF
2, 2016, the state court appointed another alienist (David
Echeandia) to assess Mr. Luong's competency. See
Defs.' RJN, Ex. E (order).
about June 10, 2016, Mr. Luong returned to the jail from the
John George Psychiatric Pavilion. See Haddad Decl.,
Ex. 6 (PLF 649); see also Haddad Decl., Ex. 7
(hospital records from the John George Psychiatric Pavilion).
in late June 2016 and continuing into July 2016, Mr. Luong
began to refuse to take his anti-psychotic medication again.
See, e.g., Haddad Decl., Ex. 6 (PLF 656, 660).
5, 2016, Dr. Echeandia (the court-appointed alienist) opined
that Mr. Luong was not competent to stand trial. This was
based, inter alia, on an interview on July 1, 2016.
See Prothero Decl., Ex. A (Echeandia report).
8, 2016, the state court found Mr. Luong mentally incompetent
within the meaning of § 1368. The court ordered Mr.
Luong to be referred to the Conditional Release Program (also
known as “CONREP”) for an examination and a
recommendation for placement pursuant to California Penal
Code § 1370. See Defs.' RJN, Ex. F (order).
CONREP is a program overseen/administered by DHS.
See Cal. Wel. & Inst. Code § 4360(a)
(providing that DSH “shall provide mental health
treatment and supervision in the community for judicially
committed persons” and that “[t]he program
established and administered by [DSH] under this chapter to
provide these services shall be known as the Forensic
Conditional Release Program [or CONREP]”).
about July 29, 2016, Alameda County, with whom DSH had
contracted to provide CONREP services, see Id.
§ 4360(b) (providing that DSH “may provide
directly, or through contract with private providers or
counties, for these services”), recommended to the
state court (via a letter) that the court place Mr. Luong at
NSH and that the court authorize the use of involuntary
medication. See Prothero Decl., Ex. 1 (CONREP
22, 2016, the state court ordered Mr. Luong to be committed
to NSH “or any other Hospital” pursuant to §
1370. Defs.' RJN, Ex. G (Order at 1). The
court also ordered that “the treatment facility may
administer antipsychotic medication to [Mr. Luong]
involuntarily when and as prescribed by a treating
physician.” Defs.' RJN, Ex. G (Order at 2). (The
local jail did not have the authority to administer
medication involuntarily. See Hayward Rpt. at 6
(noting that “the Alameda County jail had no statutory
authorization to involuntarily treat Mr. Luong even after the
court had issued an involuntary medication order”).)
Finally, the court ordered that, “within ninety (90)
days of this commitment and thereafter at no less than six
months intervals, the Executive Director of the Hospital or
facility where [Mr. Luong] is housed shall make a written
report to this Court . . . concerning [his] progress toward
recover of . . . mental competence.” Defs.' RJN,
Ex. G (Order at 1).
July 2016, medical staff at the Santa Rita Jail described Mr.
Luong as “catatonic, ” Haddad Decl., Ex. 6 (PLF
664, 666), noted that he was refusing to take his medication,
and indicated that he would be detained again for a §
5150 evaluation at the John George Psychiatric Pavilion.
See Haddad Decl., Ex. 6 (PLF 666, 668) (indicating
that Mr. Luong had been “decompensating since clinician
last saw him on 7/7/16”).
about August 3, 2016, Mr. Luong was returned to the jail from
the John George Psychiatric Pavilion. See Haddad
Decl., Ex. 6 (PLF 669-70).
August 22, 2016 - approximately a month after the state court
issued the order placing Mr. Luong at NSH - Alameda County
transmitted the commitment order and admission packet for Mr.
Luong to NSH. See Prothero Decl. ¶ 10;
see also Haddad Decl., Ex. 14 (White Depo. at 24)
(testifying that, although the commitment order issued in
late July 2016, it took time for NSH to approve Mr. Luong for
admission because it took time for the court to generate the
admission packet and send it to NSH). “The [admission]
packet was reviewed and completed on August 26, 2016.”
Prothero Decl. ¶ 10. Because no beds for IST defendants
were available at that time, “Mr. Luong was placed on
the waiting list according to his date of
[c]ommitment.” Prothero Decl. ¶ 12.
Luong's admission packet included (1) three psychological
and psychiatric reports regarding competency to stand trial
(as ordered by the state court); (2) a letter from CONREP
regarding placement (as ordered by the state court); and (3)
medical records. More specifically, these documents indicated
• Psychological report by Dr. Campagna, dated April
5, 2016. Dr. Campagna opined that, “at the present
time, Mr. Luong is competent to stand trial.” Prothero
Decl., Ex. A (Campagna Rpt. at 1) (emphasis omitted). She
noted, however, that, according to Mr. Luong's sister, he
“functions well when he takes his medication” but
not when he does not take his medication, and “[t]his
is what appears to have happened in this instance.”
Prothero Decl., Ex. A (Campagna Rpt. at 2). She recommended
that, when Mr. Luong “is released to the community, . .
. he be ordered to investigate the appropriateness of a
long-lasting injectable psychiatric medication to treat his
schizophrenia, and if his physicians feel this is an option
for him, that he be court-ordered to avail himself of this
treatment.” Prothero Decl., Ex. A (Campagna Rpt. at 2)
• Psychiatric report of Dr. Blinder, dated May 7,
2016. Dr. Blinder opined that Mr. Luong has
“[i]ntermittent psychosis, etiology to be
determined.” Prothero Decl., Ex. A (Blinder Rpt. at 3).
He also opined that Mr. Luong was not competent to stand
trial: “I find this gentleman's commerce with
reality impaired sufficient[ly] to negate any likelihood of
rational participation in forthcoming legal
proceedings.” Prothero Decl., Ex. A (Blinder Rpt. at
3). Dr. Blinder added that Mr. Luong was “currently
receiving appropriate medications which, though thus far not
curative, have doubtless brought him closer to remission,
” and “it is entirely possible that several
months hence he may be psychiatrically equal to his day in
court. . . . [¶] [S]o long as he continues to take his
medication he constitutes little danger to self or
others.” Prothero Decl., Ex. A (Blinder Rpt. at 3).
• Psychological report of Dr. Echeandia, dated July
5, 2016. Notably, Dr. Echeandia stated that, during his
interview with Mr. Luong, Mr. Luong's “mental state
appeared to deteriorate more and more” and
“[t]oward the end of the interview, [he] decompensated
to an acute psychotic state.” Prothero Decl., Ex. A
(Echeandia Rpt. at 3). Dr. Echeandia also took note that
medical records “revealed that [Mr. Luong] had been
treated with antipsychotic drugs for psychotic symptoms . . .
over a period spanning the past 15 years or so. Other medical
records provided diagnoses of Schizophrenia, Paranoid Type
and/or Psychotic Disorder NOS, and described treatment with
antipsychotic medications, as well as several psychiatric
hospitalizations, the most recent in 2015. During his current
incarceration, he was also transported to John George
[Psychiatric Pavilion] for psychiatric reasons.”
Prothero Decl., Ex. A (Echeandia Rpt. at 5). Dr. Echeandia
opined that Mr. Luong was not competent to stand trial and
that “treatment with antipsychotic medications both
medically appropriate and necessary to restore [his] mental
competence, given the evidence of his acutely psychotic
behavior during the interview.” Prothero Decl., Ex. A
(Echeandia Rpt. at 5). Dr. Echeandia stated that, based on
the assault that resulted in Mr. Luong's arrest, he was
“inclined to believe that Mr. Luong may continue to
represent a danger to others unless adequate treatment in the
form of more effective psychiatric medication and therapy is
provided.” Prothero Decl., Ex. A (Echeandia Rpt. at 6).
• CONREP letter, dated July 19, 2016. CONREP
stated that it was evaluating Mr. Luong for placement as
ordered by the state court. CONREP noted that Mr. Luong has a
serious mental illness, Schizophrenia”; that, pursuant
to California Welfare & Institutions Code § 5150, he
had been detained for evaluation and treatment at John George
Psychiatric Pavilion (“JGPP”) in October 2015
(i.e., a few months before his arrest in January
2016); and that he had been hospitalized for nine days at
JGPP in June 2016 (i.e., several months after his
arrest). Prothero Decl., Ex. A (CONREP Letter at 1). (CONREP
did not mention the second hospitalization at JGPP in late
July/early August 2016 because that hospitalization took
place after the date of the CONREP letter.) CONREP also
stated that it appeared Mr. Luong “generally does well
when he takes his anti-psychotic medications” but that
he “was not taking his medications at the time of the
alleged offenses”; that he “is currently refusing
to take” an anti-psychotic drug prescribed at the jail;
and that, without “consistent treatment to keep his
psychotic symptoms under control, ” he “is at
high risk for deterioration.” Prothero Decl., Ex. A
(CONREP Letter at 1). CONREP recommended to the state court
that it place Mr. Luong at NSH and that it authorize the use
of involuntarily medication.
• Medical records. The medical records
consisted of two pages. The first page was a “Medical
Information Transfer Form” from the Alameda County
Sheriff's Office. It indicated that Mr. Luong had a
“mental disorder” for which he was being
prescribed, inter alia, Risperdal (which is an
antipsychotic drug) as of August 2016. Prothero Decl., Ex. A
(Medical Information Transfer Form). The second page was a
form from the Santa Rita Jail indicating that a skin test for
tuberculosis had been applied to Mr. Luong in February 2016.
See Prothero Decl., Ex. A (PPD Skin Test). Alameda
County did not transfer the full medical records from the
Santa Rita Jail, nor did it transfer the medical records from
Mr. Luong's two hospitalizations at the John George
Psychiatric Pavilion (i.e., while he was in custody
in June and late July/early August 2016). See
Defs.' Mot. at 11.
August 2016, medical staff at the Santa Rita Jail noted that
Mr. Luong was once again not compliant with his medication.
See Haddad Decl., Ex. 6 (PLF 678).
September 7, 2016 - after receiving notice from the public
defender that Mr. Luong was still at Santa Rita Jail and had
not been transferred to NSH - the state court issued an order
to Ms. Ahlin, the Director of DSH, instructing her to comply
with the order to transport Mr. Luong or to show cause why
she should not be held in contempt. A hearing was set for
September 12, 2016. See Defs.' RJN, Ex. H
appears that a hearing was held on September 12, 2016, as
reflected by a state court minute order. The minute order
indicates that, at the hearing, a September 20, 2016,
progress report was canceled. See Defs.' RJN,
Ex. I (order).
about October 7, 2016, the Santa Rita Jail staff assigned
Aref Popal to be Mr. Luong's cellmate. See SAC
October 11, 2016, NSH's Admissions Suite “was
notified that a bed would become available for the next IST
Defendant on the wait list, ” which was Mr. Luong.
Prothero Decl. ¶ 13.
Admissions Suite called the Santa Rita Jail to arrange for
Mr. Luong's transport and was subsequently told that Mr.
Luong had died. See Prothero Decl. ¶¶
13-14. Mr. Luong had been killed by his cellmate on the same
date. See Haddad Decl., Ex. 4 (autopsy report for
Mr. Luong) (indicating death from
to Plaintiffs, at least twelve inmates have died awaiting
transfer to a state hospital. See Pls.'
Opp'n at 11-12. Plaintiffs also maintain that multiple
inmates have waited for as long as 100-300 days for transfer
to a state hospital. See Pls.' Opp'n at 12;
Haddad Decl., Ex. 32 (Plaintiffs' chart on “Longest
Waits on Direct Admission Wait List”). But see
Defs.' Opp'n at 22-23 (asserting that there were
reasons for these wait times).
have provided expert evidence in support of their opposition
to the State Defendants' summary judgment motion. There
are four experts in total:
(1) Dr. Terry Kupers. The expert report from Dr. Kupers was
technically submitted in a different case, Stiavetti v.
Ahlin, No. RG15779731 (Alameda Superior Court). However,
Plaintiffs indicate that they will be using Dr. Kupers as an
expert in their case as well. In his report, Dr. Kupers
states, inter alia, as follows.
a. “Adequate competency restoration treatment can only
occur in a setting conducive to mental health
treatment.” Kupers Rpt. at 31.
b. “Jail is not a setting conducive to mental health
treatment nor to competency restoration treatment, absent
major alterations in milieu, staffing, and programming. Jail
crowding, the threat of violence, the culture of punishment
that permeates the facilities, and the relative inadequacy of
programs and treatments have a very detrimental effect on the
mental status of incompetent prisoners, and on the ability to
participate effectively in competency restoration.”
Kupers Rpt. at 31-32.
c. “Jails are violent places. Prisoners with serious
mental illness are disproportionately victims of violence, or
lose control of their temper and get involved in
altercations.” Kupers Rpt. at 32.
d. “[S]ixty days is far too long for incompetent
individuals to remain in harmful jail conditions with limited
mental health treatment.” Kupers Rpt. at 33.
(2) Dr. Bruce Gage. The expert report from Dr. Gage was also
technically submitted in a different case, Stiavetti v.
Ahlin, No. RG15779731 (Alameda Superior Court). However,
as above, Plaintiffs indicate that they will be using Dr.
Gage as an expert in their case as well. In his report, Dr.
Gage states, inter alia, as follows.
a. DSH has an “unwieldy admissions process that
demand[s] excessive information from the counties and other
local entities.” Gate Rpt. at 1.
b. The process is “not currently causing delay in
DSH” but “only because DSH capacity to treat this
population is so limited that the delays caused by lack of
capacity mask the inefficiencies of the admission
process.” Gage Rpt. at 1.
c. “Once placement is determined, two weeks gives ample
time to conduct medical and short-term risk assessment,
communicate with the jails for clarification of packet
information, identify the appropriate facility, provide the
information to the receiving facility, and arrange
transportation. To accomplish this most efficiently, central
control of the admissions process is ...