Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_90-cv-00520/USCOURTS-caed-2_90-cv-00520-535/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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IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

RALPH COLEMAN, et al.,

Plaintiffs, No. 2:90-cv-0520 LKK JFM P

vs.

EDMUND G. BROWN, JR., et al.,

Defendants. ORDER

 /

On July 2, 2012, the Special Master filed his Twenty-Fourth Round Monitoring

Report. The report contains one recommendation, as follows:

[T]he special master recommends that the Coleman court enter an

order requiring defendants to review and assess their existing

quality assurance process, and to develop an improved quality

improvement process by which it can address issues with the

quality of the care that is delivered, as described above. The

quality improvement process should be developed from the

standpoint of it being the beginning of a transition by CDCR into

self-monitoring by its own DCHCS. It should include, but not be

limited to, the development of a process for improved document

production for institutional paper reviews, so that the provided

information is clear, consistent, responsive to the special master’s

document request, and useful for the assessment of institutional

levels of compliance. The defendants’ review and assessment of

their existing quality assurance process, and the development of an

improved quality improvement process, should be carried out

under the guidance of the special master and his staff, with

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participation and input of the Coleman plaintiffs, during the sixmonth period following the entry of such order.

Twenty-Fourth Round Monitoring Report, filed July 2, 2012, at 66-67. On July 12, 2012,

defendants filed objections to the recommendation. Plaintiffs filed a response to defendants’

objections on July 20, 2012, and on August 3, 2012, defendants filed a reply to plaintiffs’

response.

Defendants raise three objections to the Special Master’s recommendation. First,

they contend their “current quality assurance process is constitutionally adequate, and an order

directing Defendants to revise a presumptively constitutional process is not needed.” 

Defendants’ Objections, filed July 12, 2012, at 1. Second, they contend that the order “is

unnecessary and could be counterproductive” because of steps the Receiver in Plata v. Brown,

No. 01-1351 TEH (N.D.Cal.) is taking to implement a “comprehensive remodeling and revision

of CDCR’s health care quality assurance process, of which mental health’s quality assurance

process is a subset.” Id. at 2. Third, defendants state their willingness to work with the special

master to “improve the quality assurance process without a court order.” Id.

Pursuant to paragraph C of this court’s December 11, 1995 order of reference,

which outlines the duties and powers of the Special Master in this action, this court will not

entertain any objection to the Special Master’s report “unless an identical objection was

previously submitted to the special master in the form of a specific written objection . . . .” 

Order of Reference, filed December 11, 1995, at 8. With their response to defendants’

objections, plaintiffs have filed a copy of the written “comments and objections” submitted by

defendants to the Special Master after the parties received his draft Twenty-Fourth Round

Monitoring Report. Ex. A to Declaration of Laura Boysen-Aragon, filed July 20, 2012, at 1. 

The “comments and objections” contain no objection to issuance of the recommended order. 

Instead, defendants offered comments, as follows:

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I. Recommendation Concerning the Division of Correctional

Health Care Services’ Quality Assurance Process. 

 The Report recommends that the Court issue an order

instructing Defendants to “review and assess their existing quality

assurance process, and to develop an improved quality

improvement process by which it can develop and address issue

within the quality of care that is delivered. . .” and that this process

should be implemented under the guidance of the Special Master

and with the participation of the Coleman plaintiffs over a period

of six months. (Report pp. 62-63.) While Defendants believe that

their current quality assurance process is constitutional, they are

willing to evaluate and improve their system for providing care in

cooperation with the Special Master.

 Currently, the Receiver in Plata v. Brown is implementing a

comprehensive remodeling and revision of CDCR’s health care

quality assurance process, of which mental health’s quality

assurance process is a subset. These revisions reflect the

Receiver’s and the State’s goal of integrating all three health care

disciplines–medical, mental health, and dental–under one

administrative system. In his Nineteenth Tri-Annual Report, the

Receiver states that his process is in the “final” stage of

development. (Nineteenth Triannual Report, Dkt. 4145-1 p.16.) 

Defendants therefore invite the Special Master to review the

revised quality assurance process in coordination with the CDCR

and the Receiver. This coordination will allow the quality

assurance process to be evaluated without duplicating planned

revisions or creating conflicted systems.

Id. at 1-2. In a footnote, defendants added that they “do not waive any legal rights or limitations

under the Prison Litigation Reform Act by inviting the Special Master to review and assess their

quality assurance process in coordination with the Plata Receiver.” Id. at 2 n.1. 

Nothing in the foregoing constitutes an objection to issuance of the order

recommended by the Special Master.1 Indeed, the comments suggest acquiescence in the

recommended order. The principal purpose of the requirement that the parties tender an

identical objection to the special master prior to raising it with the court is to give the Special

Master an opportunity to address all objections before a final report is filed. Considerations of

1

The “comments and objections” tendered to the Special Master contains three sections. 

Section I, which is set forth in its entirety above, nowhere contains any reference to an objection. 

In contrast, Section II is identified as “Overall Objections to Report” and Section III is identified

as “Comments and Objections Regarding Specific Institutions and Inmates.” Id. at 2.

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both judicial economy and fairness inform this requirement. The court is aided immeasurably by

the Special Master’s monitoring reports and by his consideration of all objections tendered to his

draft reports and recommendations. Defendants did not raise with the Special Master their

objection that the recommended order should not be issued. For that reason, their objections to

its issuance will not be entertained by this court.2 

The Special Master’s Twenty-Fourth Round Monitoring Report and the findings

and recommendation contained therein will be adopted in full. At this late stage in this case, the

court wants to emphasize in particular its complete concurrence with the Special Master’s

finding that “[a]n important goal of the remedial phase of this case is, . . ., for CDCR itself to

assume the mantle of ultimate responsibility for diagnosing of its own problems, i.e. conduct its

own ‘qualitative analysis,’ and create a quality improvement process that it can use to achieve

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Defendants’ “Overall Objections” to the draft Twenty-Fourth Round Monitoring Report

were as follows: “Defendants renew all past objections to the scope, length, and timeliness of

the monitoring report. Defendants specifically object to: (1) areas of monitoring and reporting

that overlap with the Plata Receiver’s oversight of staffing and hiring issues, medication

management, medical record-keeping, and use of information technology, to the extent that the

Special Master’s monitoring is duplicative; and (2) the lack of clear benchmarks and qualitative

analysis designed to assist Defendants in achieving program guide requirements. Defendants

also object to the Report’s criticism of the quality of document production of the institutions on

paper review as there was no substantive reporting of those institutions.” Ex. A to BoysenAragon Declaration of Laura Boysen-Aragon, at 1. The Special Master responded to these

objections in detail. See Twenty-Fourth Round Monitoring Report, at 15-19 (addressing

defendants’ objection to the “scope” of the monitoring report in light of the orders that govern

the Special Master’s duties in this action and in light of ongoing coordination efforts with, in

particular, the receiver in Plata v. Brown, No. 01-1351 TEH (N.D.Cal.)); 22-24 (addressing

defendants’ objections to the criticism of the quality of document production of institutions on

paper review and alleged “lack of clear benchmarks and qualitative analysis designed to assist

defendants in achieving program guide requirements”); 24-27 (addressing defendants’ objection

to the length of the monitoring report); and 28-30 (addressing defendants’ objection to the

timeliness of the monitoring report). Defendants have not renewed any of these objections

before this court in response to the Twenty-Fourth Round Monitoring Report. 

The Special Master’s time is a resource that going forward need not be spent on

objections that have been raised and, as evidenced by defendants’ decision not to tender them to

this court, he has resolved. While the parties are required to raise before the Special Master any

objection they intend to raise here, the Special Master is not required to respond to any

objections that are frivolous or repetitive of objections that were previously resolved or

withdrawn. 

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and maintain compliance, and move on to eventual removal from federal court oversight.” 

Twenty-Fourth Round Monitoring Report at 65 (emphasis added). 

The Special Master’s role in guiding the remedial process has been invaluable. 

Most recently, that guidance, together with the cooperation of the parties and diligent efforts by

defendants, has led to significant breakthroughs in what previously seemed intractable problems

with access to inpatient mental health care. The court expects and anticipates the same level of

focus and diligence to be brought to the tasks that remain in the remedial phase of this litigation.3

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

1. The Special Master’s Twenty-Fourth Round Monitoring Report and the

findings and recommendation contained therein are adopted in full; and

2. Defendants shall review and assess their existing quality assurance process,

and shall develop an improved quality improvement process by which they can address issues

with the quality of the care that is delivered, as described in the Special Master’s Twenty-Fourth

Round Monitoring Report. The quality improvement process shall be developed from the

standpoint of it being the beginning of a transition by CDCR into self-monitoring by its own

DCHCS. It shall include, but not be limited to, the development of a process for improved

document production for institutional paper reviews, so that the provided information is clear,

3

In his Twenty-Second and Twenty-Third Round Monitoring Reports, the Special Master

identified “seven general goals” for the defendants. Defendants have made substantial progress

on one of those goals with the recent elimination of the inpatient wait list. The first goal

identified in each report pertains to suicide prevention. See Twenty-Third Round Monitoring

Report, filed December 1, 2011, at 74; Twenty-Second Round Monitoring Report, filed March 9,

2011, at 461-2. There were 346 suicides among CDCR inmates in the years from 2000 through

2010. See Report on Suicides Completed in the California Department of Corrections and

Rehabilitation in Calendar Year 2010, filed November 9, 2011, at 5. The Special Master has

informed the court that there were 33 suicides in 2011 and there have been 24 suicides to date in

2012. The total of 403 suicides in that period represents an average of approximately 1 suicide

every 11.5 days. The other goals identified by the Special Master include review of and

compliance with orders and standards applicable to administrative segregation, completion of

construction of mental health beds and treatment space, full implementation of defendants’

mental health staffing plan, and refinement and full implementation of MHTS.net. Meeting each

of these goals is critically important. 

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consistent, responsive to the Special Master’s document request, and useful for the assessment of

institutional levels of compliance. The defendants’ review and assessment of their existing

quality assurance process, and the development of an improved quality improvement process,

shall be carried out under the guidance of the Special Master and his staff, with participation and

input of the Coleman plaintiffs, during the six-month period following the entry of this order. 

DATED: August 30, 2012.

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