Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_01-cv-01351/USCOURTS-cand-3_01-cv-01351-394/pdf.json

Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 42:1983 Prisoner Civil Rights

---

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

MARCIANO PLATA, et al.,

Plaintiffs,

v.

EDMUND G. BROWN, et al.,

Defendants.

Case No. 01-cv-01351-JST 

ORDER DENYING PLAINTIFFS’

MOTION TO REVERSE 

DELEGATION OF THE CALIFORNIA 

CORRECTIONAL CENTER

Re: ECF No. 3046

Before the Court is Plaintiffs’ motion for an order reversing the Receiver’s delegation of 

the California Correctional Center (“CCC”). ECF No. 3046. The Court will deny the motion.

I. BACKGROUND

The California prison healthcare system was placed into receivership in 2005. Dkt. No. 

371. The process of transitioning control of that system back to the California Department of 

Corrections and Rehabilitation includes revocable delegations of authority by the Receiver. ECF 

No. 2841 at 5-7. These revocable delegations “provide an appropriate mechanism for allowing 

Defendants an opportunity to demonstrate their will, capacity, and leadership to maintain a 

constitutional system of care while, at the same time, ensuring that the Receiver can step in 

expeditiously to address any issues if Defendants fail.” Id. at 4. 

Delegation of an individual institution creates “a rebuttable presumption that care at the 

institution has reached a level of constitutional adequacy, subject to the completion of ongoing 

statewide or institution-specific initiatives to correct systemic deficiencies.” ECF No. 2857 at 1. 

“Prior to executing any delegation of authority, the Receiver shall meet and confer with the parties 

and consult with the court experts.” ECF No. 2841 at 6. After delegating an institution or 

systemwide process, the Receiver must evaluate, at least monthly, whether that delegation should 

Case 3:01-cv-01351-JST Document 3068 Filed 09/06/18 Page 1 of 6
2

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

be revoked. Id. “Prior to revoking any delegation of authority, the Receiver shall meet and confer 

with the parties and consult with the court experts.” Id. “Any party who disagrees with the 

Receiver’s decision to delegate or not delegate, or to revoke or not revoke a previous delegation, 

may challenge that decision by filing a motion before this Court. The moving party shall bear the 

burden of proof.” Id.

The Receiver delegated CCC on March 23, 2018. ECF No. 3047-2 at 2. Prior to 

delegation, the court experts reviewed the health records of fifty-five “medium to high-risk 

patients [at CCC] with chronic diseases and other serious medical conditions,” as well as five 

mortality reviews. ECF No. 3047-1 at 2-3. They “found care was adequate in 30 (55%) of 55 

applicable records.” Id. at 3. Their February 22, 2018 report concluded by observing:

Our review showed that newly arriving patients do not have timely 

access to a medical provider for their serious medical conditions and 

that patients with poorly controlled chronic diseases are not 

monitored in accordance with their disease control. Patients are 

often seen by multiple providers some of whom are unfamiliar with 

the patient. Physician assistants inappropriately managed poorly 

controlled diabetics, failing to change baseline medication regimens. 

This suggests that physician assistants are not being adequately 

supervised and may reflect lack of adequate physician staffing and 

leadership. In conclusion, our review showed harm, and ongoing 

risk of harm to patients with serious medical conditions.

Id. at 10.

The Receiver’s March 23, 2018 delegation assessment indicates that he considered 

“information from over 25 different sources,” including the court experts’ report, the Office of the 

Inspector General’s medical inspection report, tour reports by Plaintiffs’ counsel, and various 

internal reports and metrics. ECF No. 3047-3 at 2. He ultimately determined that “[t]he strong 

weight of evidence supports a conclusion that the management of CCC should be delegated to the 

State.” Id. at 3. The Receiver described several disagreements with the court experts’ assessment. 

For example, he disagreed “that there was a material delay in accessing care” in some of the 

experts’ cited cases, and he observed that other “delays appear to be related to a backlog that 

developed at CCC in late 2017,” which “has been significantly reduced through telemedicine 

resources.” Id. at 4. The Receiver also disagreed with the experts’ determination that four 

patients with diabetes were not adequately treated, and he noted that “the dashboard indicates that 

Case 3:01-cv-01351-JST Document 3068 Filed 09/06/18 Page 2 of 6
3

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

89% of medium or high-risk patients who had 3 or more encounters with a PCP [primary care 

provider] over the last six months had no more than 2 different PCPs for those encounters.” Id. at 

5-6. As to the experts’ comments regarding physician assistants, the Receiver concluded:

That speculation is incorrect. Clear internal documentation shows 

that physician assistants at CCC are being appropriately supervised 

consistent with California law. ([Plaintiffs’ counsel’s] letter of 

February 23, 2018, also asserts that physician assistants were not 

being adequately supervised and that any such supervision occurred 

only very recently. This conclusion was based upon a 

misinterpretation of recent documentation. My review makes it 

clear that supervision has been appropriate for at least 18-24 

months.)

Id. at 6. 

In response to questions from Plaintiffs’ counsel, the Receiver issued a May 30, 2018 

addendum to his delegation assessment. ECF No. 3047-4. He explained that, while he did not 

address all of the individual cases described in the court experts’ report, “[i]mplicit in the failure to 

discuss those cases in detail was a determination that nothing in those cases, or considering them 

as a group, was an obstacle to delegation.” Id. at 2. As to supervision of physician assistants, the 

Receiver observed:

In response to the speculation expressed in the Court Experts’ report 

that mid-level providers at CCC were not being properly supervised, 

the assessment indicated that internal documentation showed that

mid-level providers were being supervised and monitored. Recent 

documentation regarding that supervision has already been provided 

to the parties. During 2017, the Chief P&S documented his 

supervision of mid-level providers by co-signing or reviewing 

individual charts within the electronic health record. Counsel will 

be providing that information to the parties confidentially. It shows 

846 instances of co-signature or review during 2017 for four midlevel providers.

Id. at 3. And the Receiver noted that, “[a]s of the end of May, it appears CCC is staffed by two 

telemedicine providers, two onsite mid-levels, and one registry provider. It currently has one 

provider vacancy.” Id. The Receiver concluded that neither staff vacancies nor having a chief 

physician and surgeon who works remotely prevented CCC from “performing very well with its 

population,” as reflected in “CCC’s dashboard show[ing] that it has excellent access to care scores 

across the board, excellent timeliness in the distribution of medications, and excellent population 

health measures in all categories.” Id.

Case 3:01-cv-01351-JST Document 3068 Filed 09/06/18 Page 3 of 6
4

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

Plaintiffs’ counsel asked the court experts “to state whether they stood by their opinion 

regarding care as stated in their February 22, 2018 Report in light of the information provided by 

the Receiver in his ‘Assessing Delegation’ and ‘Addendum’ documents.” ECF No. 3047 ¶ 6. The 

court experts responded on June 15, 2018, stating that they “stand by our opinion that there are 

systemic issues causing harm to CCC patients.” ECF No. 3047-5 at 2. They noted that:

The Receiver’s initial delegation assessment concluded that 

although problems with access to care were real at the time of our 

report, they had since been resolved. As improvements occurred 

after completion of our report we are unable to independently assess 

this information. We are concerned that CCC has not yet had the 

opportunity to demonstrate that timely access to a medical provider 

is sustained.

Id. They also explained their belief that “ineffective supervision of physician [assistants]” was 

“the primary reason for inadequate care described in the body of our report.” Id. at 3. They 

stated:

We have reviewed recent memoranda published in February 2018 

regarding physician assistant supervision, including a 2/16/18 

[memo] from the Chief Physician and Surgeon requesting that 

physician assistants self-select progress notes to be forwarded for 

review. This is not consistent with a 2/21/18 [memo] from the CCC 

Chief Executive Officer that indicates the Supervising Physician and 

Surgeon shall select cases for review. This raises questions about 

actual practice.

Id. They concluded by expressing their opinion that, “while some improvements may have 

occurred at CCC, our concerns about systemic issues related to care of chronic disease and 

hospitalized patients, as well as physician assistant supervision remain unchanged.” Id.

Plaintiffs now move for revocation of the Receiver’s delegation of CCC based on their 

contention that there has been “inadequate care provided by physician assistants who were 

ineffectively supervised and there has been insufficient time to assess whether recent changes have 

remedied the problems.” ECF No. 3046 at 9. Defendants oppose the motion, criticizing the court 

experts’ findings and methodology and noting that the current dashboard shows “that CCC is 

achieving the ‘high’ goal/ranking with respect to nearly all health care indicators, including 

scheduling and access to care, medication management, population health management, care 

management, grievance processing, and the availability of health information.” ECF No. 3057 at 

5, 19-22; see also id. at 23 (noting that 22 out of 27 dashboard scores are in the high range, and the 

Case 3:01-cv-01351-JST Document 3068 Filed 09/06/18 Page 4 of 6
5

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

same number of scores exceed the statewide average); ECF No. 3058-2 at 2 (April 2018 

dashboard). 

On reply, Plaintiffs do not address these asserted shortcomings in the experts’ findings or 

methodology. Instead, Plaintiffs ask the Court to “direct the experts to prepare and provide a 

written response, and, if necessary, hear testimony from them” to resolve the disputes over the 

experts’ findings and methodology. ECF No. 3064 at 2. Plaintiffs also emphasize that, in their 

view, “the adequacy of physician assistant supervision at CCC since February 2018” is the 

primary issue: “[T]he expert’s [sic] findings regarding current practices could substantially narrow 

the disputed issues underlying this motion. For example, if the experts opine physician assistants 

are now adequately supervised, the chief remaining dispute would be when, rather than whether, 

delegation was appropriate.” Id. at 3.

II. DISCUSSION

As the party moving to challenge a delegation decision by the Receiver, Plaintiffs bear the 

burden of proof. ECF No. 2841 at 6. In this case, they rely solely on the court experts’ opinions 

and, in particular, the experts’ conclusion that, as of February 22, 2018, supervision of physician 

assistants was inadequate and that, as of June 15, 2018, the experts “remain[ed] unconvinced . . . 

that adequate supervision is occurring.” ECF No. 3047-5 at 3. The court experts do not refute the 

Receiver’s notation in his addendum that the chief physician and surgeon “documented his 

supervision of mid-level providers by co-signing or reviewing individual charts” 846 times during 

2017, nor do Plaintiffs present any evidence disputing this factual representation. See ECF No. 

3047-4 at 3. Plaintiffs also do not present any evidence to counter the declarations submitted by 

Defendants that describe the level of supervision provided to both physician assistants and nurse 

practitioners at CCC – either to suggest factual disputes in what supervision is actually provided or 

to suggest that the described supervision is inadequate. See ECF No. 3059-4 (declaration of Dr. S. 

Aref, CCC’s chief executive officer); ECF No. 3059-6 (declaration of Dr. K. Ali, CCC’s chief 

physician and surgeon).

Plaintiffs suggest that the Court direct its experts to provide a written response to 

Defendants’ opposition and “to review and report on the adequacy of physician supervision at 

Case 3:01-cv-01351-JST Document 3068 Filed 09/06/18 Page 5 of 6
6

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

CCC since February 2018.” ECF No. 3064 at 4. While a party is free to make suggestions to the 

Court as to how to direct its experts, it cannot meet its burden on a contested motion by doing so. 

Plaintiffs could have performed their own investigations, or hired their own experts, to dispute the 

conclusions reached by Defendants’ experts and the facts presented in Defendants’ opposition and 

the Receiver’s delegation documents. Also, if they were able to do so, they could have rebutted 

Defendants’ criticisms on the merits. That they did not leaves this Court with no basis on which to 

reverse the Receiver’s delegation decision.

Defendants’ opposition also raises other questions that the Court does not reach, but that 

might become necessary to resolve if the parties have future disputes in which either party seeks to 

rely on the court experts’ conclusions. For example, Defendants challenge some of the experts’ 

factual findings, the validity of the experts’ sampling methodology to draw population-level 

inferences, and whether objective measures such as the Healthcare Effectiveness Data and 

Information Set (“HEDIS”) guidelines provide a better measure of the quality of care than 

subjective reviews. ECF No. 3057 at 6-10, 19-22. Other than suggesting that the Court direct the 

experts to prepare a response, Plaintiffs did not respond to these arguments. ECF No. 3064. The 

Court does not resolve any of these questions at this time because doing so is unnecessary to 

decide Plaintiffs’ motion. 

CONCLUSION

Plaintiffs’ motion to reverse the Receiver’s delegation of the California Correctional 

Center is denied.

IT IS SO ORDERED.

Dated: September 6, 2018

______________________________________

JON S. TIGAR

United States District Judge

Case 3:01-cv-01351-JST Document 3068 Filed 09/06/18 Page 6 of 6