Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_90-cv-00520/USCOURTS-caed-2_90-cv-00520-1021/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 EASTERN DISTRICT OF CALIFORNIA 

RALPH COLEMAN, et al., 

Plaintiffs, 

v. 

GAVIN NEWSOM, et al., 

Defendants. 

No. 2:90-cv-0520 KJM DB P 

ORDER 

 

 On August 14, 2019, the court referred to the All Parties Workgroup a dispute over 

“interpretation of how and why medication non-compliant patients are scheduled for follow-up 

under the CCHCS [California Correctional Health Care Services]1 Medication Adherence 

Policy.” ECF No. 6242 at 11. On November 15, 2019, the parties filed a stipulation and 

proposed order seeking approval of a “Draft Proposed Psychiatrist Medication Adherence 

Clarifying Directives” (hereafter “proposed directives” or “directives”) as well as additional time 

to meet and confer over the process by which the Special Master will monitor compliance with 

this policy.” ECF No. 6393 at 2. At the third quarterly status conference of 2019, held on 

 1

 CCHCS was established by the Receiver in Plata v. Newsom, Case No. 01-1351 JST 

(N.D.Cal.), as part of accomplishing the Receiver’s remedial responsibilities in that action. 

Case 2:90-cv-00520-KJM-SCR Document 6467 Filed 02/18/20 Page 1 of 6
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December 13, 2019, the court directed the parties to supplement their stipulation with briefing on 

three questions: “(1) are the CDCR [California Department of Corrections and Rehabilitation] 

defendants developing their own quality management process for this policy; (2) how does this 

policy intersect with the Special Master’s general monitoring responsibilities; and (3) how, if at 

all, does the fact that the draft memo clarifies a policy of the Plata Receiver affect the monitoring 

issue presented by the parties’ request.” ECF No. 6441 at 7. 

 The parties have filed the required supplement. ECF No. 6434. In addition, the 

Special Master has informed the court that the purpose of the proposed directives is to clarify the 

steps that must be taken by a mental health prescriber, defined as “a psychiatrist or psychiatric 

nurse practitioner acting under the supervision of a psychiatrist,” when the prescriber receives 

email alerts automatically generated by the Electronic Health Record System (EHRS). ECF No. 

6393 at 5. The court recognizes that the data leading to generation of the specified email alerts 

will typically be generated by nurses, who are responsible for delivery of prescribed medication 

and who are supervised by the Plata Receiver. The Special Master has informed the court that 

the focus of monitoring compliance with these directives will be on whether the mental health 

prescribers, as defined in the directives, follow them appropriately 

 The court has reviewed both the stipulation and proposed order and the 

supplemental briefing in light of recent events. As the court discussed in its order after the 

evidentiary hearing it convened on the Golding Report, it has become clear that defendants have 

not adequately policed the boundaries between this action and the Plata case “to protect and 

advance the remedies required in this case.” ECF No. 6427 at 43. The court has also observed it 

appears that a coordination process implemented between the Coleman court and the Plata court 

“has strayed from its founding principles.” ECF No. 6441 at 2. With these considerations in 

mind, as explained below the parties’ stipulation will be approved in part. 

 The matter before the court originated with evidence reported by the court’s 

Neutral Expert with respect to the Golding Report. That evidence suggested “CDCR’s Timely 

Mental Health Referrals performance indicator is misleading because it does not reflect all 

patients who required medication non-compliance appointments and therefore overstates Program 

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Guide compliance.” ECF No. 6242 at 11. While the parties agreed that not all medication noncompliant patients were included in the performance indicator, id., as noted above they disputed 

“how and why medication non-compliant patients are scheduled for follow-up under the CCHCS 

Medication Adherence Procedure policy.” Id. 

 The CCHCS Medical Adherence Procedure policy is included in CCHCS’s 

“Inmate Medical Services Policies and Procedures” (IMSP&P) and is specifically referenced in 

the remedial plan for this action, which is titled the Mental Health Services Delivery System 

Program Guide (hereafter Program Guide).2 See ECF No. 6393 at 5 (citing Program Guide at 12-

3-12, 12-4-9, 12-4-12, 12-4-19, 12-6-15, 12-9-8, and 12-10-7).3 The IMSP&P has “been 

converted to the Health Care Department Operations Manual (HCDOM).” 

https://cchcs.ca.gov/imspp/. The HCDOM “outlines the delivery of medical and dental care 

provided to” inmate-patients in CDCR. https://cchcs.ca.gov/hcdom/. It is promulgated jointly by 

CDCR’s Division of Health Care Services (DHCS) and CCHCS, collectively referred to as 

“Health Care Services.” See HCDOM, Chapter 1, Article 1. 

 The Program Guide applicable in this case requires mental health staff to refer to 

the medication management provisions of the IMSP&P “regarding procedures for administration 

of medication, medication refusals, Directly Observed Therapy (DOT), and other aspects of 

medication administration.” ECF No. 5864-1 at 44; see also ECF No. 5864-1 at 58, 61, 67, 120, 

160 and 173. Thus, the provisions of the IMSP&P identified above are also part of the courtapproved remedy in this action. See ECF No. 6214 (approving 2018 Program Guide Revision). 

 The overarching task of the court’s Special Master is to “work with defendants and 

experts to be selected by the special master . . . to develop a remedial plan that effectively 

addresses the constitutional violations set forth in this court’s September 13, 1995 order.” ECF 

 2

 The Program Guide sets out the system for the delivery of mental health care to seriously 

mentally ill inmates incarcerated in CDCR institutions. See ECF No. 5864-1 at 3. It is also the 

plan for that part of this action which requires defendants to remedy Eighth Amendment 

violations in the delivery of mental health care to these inmates. See, e.g., ECF No. 5610 at 1 n.1. 

3

 The 2018 Program Guide is found at ECF No. 5864-1. The pages cited by the parties in 

the proposed clarification are found at ECF No. 5864-1 at 44, 58, 61, 67, 120, 160 and 173. 

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No. 640 at 3, 4. The Special Master is also required to monitor implementation of all remedies, 

which must be approved by the court. See ECF No. 640 at 4. “[D]evelopment of a quality 

assurance program” is one of the remedies required in this action. Coleman v. Wilson, 912 

F.Supp. 1282, 1308 (E.D.Cal. 1995). In other words, to perform his job, the Special Master must 

work closely with defendants as defendants plan and implement quality management systems for 

the delivery of mental health care. 

 With the foregoing in mind, the court turns to the specific stipulation presented by 

the parties. The Draft Proposed Psychiatric Medication Adherence Clarifying Directives attached 

as Exhibit A to the Joint Report and Stipulation filed November 15, 2019 represents the 

agreement of the parties and the Special Master regarding proper interpretation of the relevant 

medication management provisions of the IMSP&P as incorporated into the Program Guide. This 

interpretation will be approved by this order. The parties also represent that the Plata Receiver 

has received the proposed directives and it is likely the directives will need to be incorporated 

into the HCDOM at a subsequent stage of these proceedings. ECF No. 6434 at 3. The court 

accepts these representations. 

 The parties also request approval of their stipulated agreement “to continue to 

meet and confer in the Workgroup process to discuss a process to monitor compliance with the 

medication adherence policy, and to file a joint report, within sixty days from the date of the order 

approving [the] stipulation, that sets forth the agreement for monitoring, if completed, or a 

description of the progress made towards finalizing the monitoring process.” ECF No. 6393 at 2. 

The supplemental briefing of the parties makes clear that the monitoring contemplated by their 

agreement will be accomplished with the use of computer-generated performance reports, and 

that proper implementation and monitoring of the proposed directives require both “technical 

changes to the electronic health record system” (EHRS) and development of “performance report 

indicators.” ECF No. 6434 at 2. Defendants propose to develop the performance report 

indicators and implementation plan internally first, and then present those to the Special Master 

and plaintiffs’ counsel for input. Id. 

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The tasks necessary to proper monitoring of the proposed directives, namely, the 

technical changes to the EHRS and development of performance report indicators for monitoring 

compliance with the proposed directives, is occurring in the larger context of remediation of 

defendants’ data management and reporting systems following the conclusion of the evidentiary 

proceedings on the Golding Report. The court’s December 23, 2019 order confirmed that the 

Special Master is authorized “to hire his own data expert or otherwise make arrangements to 

ensure he has the necessary expertise at his disposal.” ECF No. 6435 at 2-3. That order includes 

specific direction concerning the Special Master’s access to defendants’ business rules, mental 

health care data, and discussions concerning possible “use of the CCHCS Quality Management 

Section to manage CDCR Mental Health data.” Id. at 3. While the December 23, 2019 order was 

issued after the November 15, 2019 stipulation was submitted to the court for review and 

approval, the provisions and general spirit of the December 23, 2019 order must apply to all 

aspects of development of defendants’ mental health quality management processes going 

forward. Those provisions clarify long-standing practices that must not be abandoned, 

particularly at this point in time. To that end, the Special Master must supervise development of 

the performance indicators and the monitoring plan, with plaintiffs’ involvement subject to his 

direction. 

In accordance with the above, IT IS HEREBY ORDERED that: 

1. The Draft Proposed Psychiatric Medication Adherence Clarifying Directives

appended as Exhibit A to the Joint Stipulation of the Parties filed November 

15, 2019, ECF No. 6393, is approved for incorporation into the Program 

Guide, either directly or by reference as an addendum to the Medication 

Management provisions of the HCDOM referred to in the Program Guide; the 

court expects this incorporation will take place prior to submission of the 2021 

Program Guide and that the manner of incorporation will be clear in that 

document. 

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2. The Special Master shall supervise full implementation and monitoring of the 

Psychiatric Medication Adherence Clarifying Directives, consistent with his 

duties under the Order of Reference, ECF No. 640. 

DATED: February 14, 2020. 

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