Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-4_94-cv-02307/USCOURTS-cand-4_94-cv-02307-11/pdf.json

Nature of Suit Code: 550
Nature of Suit: Prisoner - Civil Rights (U.S. defendant)
Cause of Action: 42:1983 Prisoner Civil Rights

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United States District Court

For the Northern District of California

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IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

JOHN ARMSTRONG, et al.,

Plaintiffs,

v.

ARNOLD SCHWARZENEGGER, et al.,

Defendants.

 /

No. C 94-2307 CW

ORDER

The Court Expert in this case presented to the Court six

statements drafted by the court representatives in Coleman v.

Schwarzenegger, 90-0520 (E.D. Cal.), Plata v. Schwarzenegger, 01-

1351 (N.D. Cal.), and Perez v. Tilton, 05-5241 (N.D. Cal.). The

statements, which are attached to this order, are presented for

review and approval. 

Good cause appearing, it is hereby ordered that the parties

shall file and serve by July 9, 2007 their positions on which if

any of these statements should be adopted in this case. Any

Case 4:94-cv-02307-CW Document 1133 Filed 06/26/07 Page 1 of 10
United States District Court

For the Northern District of California

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response to this order shall be filed in this case and served on

the Receiver in Plata. If the Receiver wishes to respond to the

parties' positions, he may do so by July 23, 2007. Thereafter, the

request for approval of the agreements will be taken under

submission. 

IT IS SO ORDERED.

Dated: 6/26/07 

CLAUDIA WILKEN

United States District Judge

cc: Robert Sillen

Case 4:94-cv-02307-CW Document 1133 Filed 06/26/07 Page 2 of 10
United States District Court

For the Northern District of California

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CIM-GACH

The Receiver and the Special Master have agreed that the

General Acute Care Hospital (GACH) license at the California

Institute for Men (CIM) should be suspended. The physical unit

will remain open and house 40-45 Mental Health Crisis Beds (MHCBs). 

Staffing levels will not change for mental health care. 

The Receiver and the Special Master are concerned that

defendants will not be allowed to operate MHCBs in unlicensed

facilities. A state court decision, Budd, et al. v. Cambra, et

al., Case No.319578, required the California Department of

Corrections and Rehabilitation (CDCR) to bring its correctional

treatment centers (CTCs) into compliance with state law licensing

requirements. Counsel for the parties may argue that Budd requires

defendants to provide inpatient health services to inmates

presently below an acute level of care in a licensed facility. 

 The Coleman Special Master has agreed to explore whether a CTC

license is necessary to operate a MHCB. If such a license is

necessary, the Special Master will seek an emergency order from the

Coleman Court to allow for the operation of the MHCBs at CIM, as

was done in the case of CMC.

On May 1, 2006, when faced with a MHCB crisis, the Coleman

Court ordered the establishment of 36 MHCBs in the former locked

observation unit (LOU) at California Men’s Colony (CMC). The LOU

at CMC had been closed and reopened as an outpatient housing unit,

in light of Budd. The Coleman Court stated that until further

notice and on a temporary emergency basis “defendants shall not

close any intermediate inpatient bed or mental health crisis bed on

the basis of state licensing requirements without approval of the

special master.” In its order, the Court stated that “it is

essential to provide immediately mental health crisis beds to

critically ill inmates in the CDCR...Under present circumstances,

state licensing requirements must temporarily give way to measures

necessary to remedy the Eighth Amendment violations that remained

unsolved in this action.” (See Coleman Order dated May 1, 2006,

document number 1800).

The purpose of the order was to provide, on an interim basis,

sufficient temporary MHCBs until the 50-bed MHCB projects at CMF

and CMC were completed. Allowing the license to remain for the

40-45 agreed upon MHCBs at CIM-GACH could possibly avoid

Budd-driven complications. 

Case 4:94-cv-02307-CW Document 1133 Filed 06/26/07 Page 3 of 10
United States District Court

For the Northern District of California

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Contracts

Effective April 17, 2006 the Receiver assumed responsibility

for overseeing the State’s compliance with the Federal Court’s

mandate (1) that “all current outstanding, valid, and CDCR-approved

medical invoices” be paid within 60 days of March 30, 2006; and (2)

that under the direction of the Receiver, the CDCR and State

entities responsible for contracts develop and institute health

care-oriented policies and standards to govern the CDCR medical

contract management system considering both the need for timely

on-going care and the fiscal concerns of the State.

The Receiver has created a Contract Pilot Unit that includes

personnel from CDCR’s Office of Business Services, staff who now

report directly to the Office of the Receiver through the Plata

Support Division. In addition, selected personnel from the Health

Care Operations Support Section of the DCHCS, as well as personnel

from the Health Care Cost and Utilization Program have been added

to the Pilot, as have staff at four prisons (San Quentin State

Prison, Pelican Bay State Prison, California Medical Facility, and

the Central California Women’s Facility) and two Regional

Accounting Offices (North Coast and Corcoran). Upon successful

completion of the Pilot, the new streamlined contract procurement

and payment policies established by the Pilot will be adopted by

all CDCR facilities according to a time-phase schedule which has

not yet been determined.

These new policies are supported by a newly created,

computerized Health Care Document Management System (HCDMS) which

will manage all medical contracts, replacing the former paper based

system. The HCDMS has three primary components in that it:

• Assists CDCR staff by utilizing uniform contract templates for

the creation of contracts that do not permit deviation from

health care policies and standards.

• Stores all health care contracts in a database accessible to

all authorized users.

• Establishes an effective payment system designed to receive,

store and communicate invoices electronically. By

computerizing all contracts and invoices, the HCDMS eliminates

the time spent transferring paper copies throughout CDCR and

electronically prints invoices with their governing contracts

for faster information retrieval.

The Receiver will assume responsibility for direct oversight

of the contracting functions for medical, dental and mental health

programs. The Coleman Special Master and Perez Court appointed

experts will participate in the design and implementation of

periodic reports to monitor the status of contract management. The

Coleman Special Master and Perez Court appointed experts, along

with defendants’ mental health and dental administrators, will also

be involved in establishing standards (including proposed rates of

reimbursement for contract clinicians) for registry contracts

within their respective areas of concern.

Case 4:94-cv-02307-CW Document 1133 Filed 06/26/07 Page 4 of 10
United States District Court

For the Northern District of California

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Credentialing

Credentialing is the process of obtaining, verifying, and

assessing the qualifications of an applicant to provide patient

care, treatment, and services in a California Department of

Corrections and Rehabilitation (CDCR) medical facility. The

credentials review process is the basis for making appointments to

the clinical staff; it also provides information for granting

clinical privileges to licensed independent practitioners. The

purpose of verifying credential data is to ensure that the

individual requesting privileges is in fact the same individual

that is identified in the credentialing documents. In addition, it

is to ensure that the applicant has attained the credentials as

stated, that the credentials are current, and that there are no

challenges to any of the credentials.

Privileging is the process used to grant to a specific

practitioner the authorization to provide specific inmate-patient

care services. Privileging ensures that the individual is capable

of providing those services in accordance with the standard of care

of the Division of Correctional Health Care Services (DCHCS).

These processes are performed at time of appointment and at

least every two years to ensure the credentials remain current. 

Final approvals of credentialing/privileging are made by the chief

of either the medical, dental or mental health programs as

appropriate.

These functions are currently performed by the Division of

Correctional Health Care Services Pre-Employment Credential Unit

which consists of three positions. These positions are all

classified as Staff Services Analyst/Associate Governmental Program

Analyst. 

The Receiver will assume responsibility for the

credentialing/privileging functions for the medical, mental health,

and dental programs to include direct oversight of the

Pre-Employment Credential Unit.

The Coleman Special Master and the Perez Court experts will

consult with the defendants’ mental health and dental

administrators and will participate in, and have final approval of,

the establishment of credentialing/privileging standard within

their respective disciplines.

Case 4:94-cv-02307-CW Document 1133 Filed 06/26/07 Page 5 of 10
United States District Court

For the Northern District of California

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Hiring

The Receiver has established the Plata Support Division to

provide administrative support for the reform initiatives he has

established. The Personnel Services and Staff Development Section

have implemented new recruiting and hiring programs to improve the

retention of medical staff (including creating new or revising

current job classifications, implementing salary increases for

specified classifications, designing new hiring and on-boarding

processes, establishing training programs for institution personnel

staff and for new supervisors, and improving the credentialing

process of medical staff). This section has assumed full

responsibility for all human resources-related functions for the

Plata classifications, removing those functions from the CDCR’s

Support Services Division.

The Plata Workforce Development Section is working to recruit

and hire additional medical professionals to fill the many

vacancies that exist throughout California’s prison system. To

ensure that proactive steps are taken on a daily basis to fill

medical professions vacancies in an expeditious manner, a pilot for

“one-day hiring” was rolled out February 22, 2007. 

The Receiver will assume responsibility for hiring of medical

personnel only. However, Plata Support Division staff will provide

consultation to the Coleman Special Master and Perez Court experts,

as well as to defendants’ mental health and dental administrators,

on recruitment and hiring practices.

The Receiver will consider assuming responsibility for hiring

dental and mental health personnel only after:

• The Plata hiring programs are fully implemented and the future

workload has been assessed.

Case 4:94-cv-02307-CW Document 1133 Filed 06/26/07 Page 6 of 10
United States District Court

For the Northern District of California

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IT

The objective of the Receiver’s long term IT program is to

construct and support the California Correction Health Care

Information System based on the importance of “correct data at the

point of care.” The core design is based on an Electronic Medical

Record (EMR) for each inmate/patient. The EMR will be paperless,

medical information gathered in one location for physicians and

clinicians to access, at various locations, and thereby enable them

to make informed and safe medical decisions. All data obtained

will be patient centric to allow for an “Information at the Point

of Care” system.

To support the establishment of an EMR, a foundation will be

formed. It will contain four components: 1) technical

infrastructure, 2) clinical infrastructure, 3) data infrastructure,

and 4) operational infrastructure. The technical infrastructure

will provide a high-speed connection to a network of multiple

sites. The clinical infrastructure will provide a repository of

standardized data through verifiable data processes and compile

medical data across all compliant data sources into a unified

database that can be used to generate information valuable for

patient care and healthcare management. The data infrastructure

will implement a secure clinical web-based portal tool that allows

clinical staff appropriate access to verified and standardized

patient data at the point of care or clinical work areas (i.e.

university hospitals, local specialty care centers). The

operational infrastructure will provide clinical informatics with a

near zero fault tolerance system to support various operations

(i.e. Maxor Pharmaceuticals).

Upon this foundation, the EMR will be supported by uniform

clinical data provided by two types of clinical information

systems: 1) clinical business systems and 2) clinical systems. 

The Clinical Business System will sustain such areas as access

tracking, scheduling, correctional interface, clinical resource

scheduling, clinical contracting, credentialing, and CME (define

acronym) verification. The clinical systems will sustain such

areas as laboratory, radiology, pharmacy, clinical department

workflow, telemedicine, digital imaging, dental systems and mental

health systems.

Based on these systems the EMR will facilitate:

• a clinical data warehouse

• views on data - patient, clinician, administrator

portals and reports

• integrated patient care at the a regional level

• clinical/case management and outcome reporting

• chronic disease registries 

• enterprise wide/common scheduling

• supported clinical decisions

• cost effective and timely patient-centered care

Case 4:94-cv-02307-CW Document 1133 Filed 06/26/07 Page 7 of 10
United States District Court

For the Northern District of California

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• telemedicine delivery

The Receiver will assume responsibility for implementation of

the long term IT program to include the medical, dental and mental

health programs. The Coleman Special Master, the Perez Court

experts, and defendants’ mental health and dental administrators

will be kept informed of the progress of this long range project

and will provide necessary input concerning mental health and

dental clinical data needs.

Telemedicine is a critical component of the Receiver’s plan to

bring the California Prison Health Care system to a constitutional

standard. The Receiver has determined that the current

Telemedicine program managed by the Division of Correctional Health

Care Services (DCHCS) has been mismanaged resulting in lack of

utilization and understaffing. The Receiver will assume

responsibility for the telemedicine program serving the medical,

dental and mental health programs to include direct oversight of

the office of telemedicine services comprised of eight personnel (4

RNs, 2 SSAs, 1 HRT II, and 1 TCA II). The Coleman Special Master

will consult with defendants’ mental health administrators to

assist in establishing clinical guidelines for the mental health

component of the telemedicine program. 

The Receiver will assume responsibility to support the current

Mental Health Tracking System until it can be integrated into the

long term IT program. 

The Perez Court experts will meet with the Receiver’s IT staff

to determine:

• Whether the “intermediate” dental IT system ordered by Judge

White can be implemented within the prescribed time

constraints?

• If it cannot be implemented as directed, whether the Court

experts should seek a modification of the court order to

integrate the dental IT system within the infrastructure and

timeline of the long term IT program?

Case 4:94-cv-02307-CW Document 1133 Filed 06/26/07 Page 8 of 10
United States District Court

For the Northern District of California

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28 9

Pharmacy

In late 2006 the Office of the Receiver entered into an

agreement with Maxor National Pharmacy Services Corporation (Maxor)

to provide pharmacy management consulting services. That contract

was effective January 1, 2007. On March 30, 2007 the Receiver’s

request for an order nunc pro tunc to waive state law applicable to

this agreement was granted by the Court. 

Maxor has developed a “road map” designed to restructure and

manage a constitutionally adequate pharmacy services delivery

system. The primary objective of the road map is to produce

sustainable, patient-centered, outcome-driven processes, with the

ultimate goal of creating a CDCR-managed and operated “best

practice” pharmacy system within three years. 

The road map consists of the following interior goals for pharmacy

operations that will serve medical, dental and mental health

delivery systems: 

• Develop meaningful and effective centralized

oversight, control and monitoring of the pharmacy

services program.

• Implement and enforce clinical pharmacy management

processes including formulary controls, Pharmacy and

Therapeutics (P&T) committee, disease management

guidelines, and the establishment of a program of

regular institutional operational audits.

• Establish a comprehensive program to review, audit

and monitor pharmaceutical contracting and

procurement processes to ensure cost efficiency in

pharmaceutical purchases.

• Develop a meaningful pharmacy human resource program

that effectively manages staffing, compensation, job

descriptions, competency, performance, assessment,

discipline, training, and use of the workforce

including temporary employees and non-pharmacist

staff.

• Redesign and standardize overall institution level

pharmacy drug distribution operations for inpatient

and outpatient needs. Design, construct and operate

a centralized pharmacy facility.

• Design and implement a uniform pharmacy information

management system needed to successfully operate and

maintain the CDCR pharmacy operation in a safe,

effective and cost efficient way, based on a

thorough understanding of a redesigned work process.

• Develop a process to assure that CDCR pharmacy meets

accreditation standards of the designated healthcare

review body (NCCHC or ACA) and assist in obtaining

accredited status.

The Receiver through Maxor will assume oversight of pharmacy

operations serving medical, dental and mental health programs. 

Case 4:94-cv-02307-CW Document 1133 Filed 06/26/07 Page 9 of 10
United States District Court

For the Northern District of California

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Coleman and Perez Court appointed experts will consult with

defendants' mental health and dental administrators and participate

in the P&T committee in development of formularies within their

respective areas of concern. Maxor will provide periodic reports

to the Receiver, the Coleman Special Master and the Perez Court

appointed experts concerning road map compliance. 

Case 4:94-cv-02307-CW Document 1133 Filed 06/26/07 Page 10 of 10