EXHIBIT 1 

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IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF COLORADO 

Civil Action No. 11-CV-02285-NYW 

CENTER FOR LEGAL ADVOCACY, d/b/a 

DISABILITY LAW COLORADO,

Plaintiff,

v.

REGGIE BICHA, 

in his official capacity as Executive Director 

of the Colorado Department of Human Services, and 

RONALD B. HALE, 

in his official capacity as Superintendent 

of the Colorado Mental Health Institute at Pueblo, 

Defendants.

DECLARATION OF JENNIFER L. PURRINGTON 

I, Jennifer L. Purrington, make the following declaration under penalty of perjury 

pursuant to 28 U.S.C. § 1746. 

1. I am an attorney for the Denver office of The Center for Legal Advocacy d/b/a Disability 

Law Colorado (“DLC”) and formerly known as The Legal Center for People with 

Disabilities and Older People. I have worked at DLC since August of 2012, and I was 

admitted to the Colorado State Bar in October of 2012 (Colorado Attorney Registration 

#44901). I have personal knowledge of, and am competent to testify concerning, the 

matters addressed in this declaration. 

2. The parties filed the operative Amended and Restated Settlement Agreement (the 

“Settlement Agreement”) with the Court on July 28, 2016. Dkt. 78-1. Under the 

Settlement Agreement, the Colorado Department of Human Services (the “Department”), 

which includes and oversees the Colorado Mental Health Institute at Pueblo (“CMHIP”), 

has been responsible for making monthly monitoring reports to DLC. The Department had 

similar reporting obligations under the parties’ prior settlement agreement in this action 

and first started reporting in August of 2012. Each report is due on the seventh day of each 

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month following the reporting month, or on the next business day if the seventh day of the 

month fell on a weekend or holiday. 

3. I have personally monitored and analyzed all monthly reports DLC has received from the 

Department since approximately the Fall of 2012. 

4. The Settlement Agreement specifies the following timeframes: 

a. The Department shall Offer Admission to Pretrial Detainees to the Hospital for 

Restorative Treatment or Inpatient Competency Evaluation no later than 28 days 

after the Pretrial Detainee is Ready for Admission, and shall maintain a Monthly 

Average of 24 days or less for both types of Offers of Admission. Compliance with 

this measure shall be calculated based on the number of Days Waiting for each 

Pretrial Detainee. 

b. The Department shall complete all Out-Patient Competency Evaluations of a 

Pretrial Detainee no later than 30 days after the Hospital’s receipt of a Court Order 

directing the evaluation and receipt of Collateral Materials. This timeframe 

requirement shall apply to the following counties: Boulder, Arapahoe, Douglas, 

Pueblo, Denver, Broomfield, Larimer, Weld, Adams, Jefferson, Alamos, El Paso, 

Fremont, Custer, Huerfano, Otero, Teller, Elbert and Crowley. Counties not 

specifically identified, are counties that use the “hold and wait” court ordered 

process. Counties utilizing the Hold and Wait Evaluation process will be offered a 

meeting date within 30 days of the Hospital’s receipt of the Court Order and 

Collateral Materials, and the evaluation will be completed within 30 days of the 

meeting. 

5. The monthly monitoring report includes several lists. 

a. Report A lists all pretrial detainees in Colorado state court actions for whom the 

court has found that the detainee is incompetent to proceed and must be transported 

to CMHIP or the Department’s facility in Arapahoe County for restorative 

treatment. The report details the detainee, his/her charges and case information, the 

date of the court order, when the Department received the order plus collateral 

materials, when the Department deems the detainee ready for admission, the 

Settlement Agreement’s deadline to admit the detainee, the date Defendants offer 

admission, the ultimate admission date, and the number of days waiting. 

b. Report B is the list of detainees whose competency to proceed has been raised and 

are awaiting evaluation by the Department at CMHIP or the Arapahoe County 

facility, termed “inpatient.” This information tracks the data inputs on Report A.

c. Report C is the list of detainees whose competency to proceed has been raised and 

are awaiting evaluation by the Department in the jail where the detainee is located, 

termed “outpatient.” The report details the detainee, his/her charges and case 

information, the date of the court order, when the Department received the order 

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plus collateral materials, when the Department deems the detainee ready for 

evaluation, the date the evaluator signs the report, and the number of days waiting. 

d. Report D is a list of Individual Special Circumstances, when they exist, as defined 

in the Settlement Agreement. 

6. I review the monthly reports and calculate from the data therein, whether Defendants are 

complying with the timeframes agreed to in the Settlement Agreement for inpatient 

restorations (using Report A), inpatient competency evaluations (using Report B), and 

outpatient evaluations (using Report C). 

7. Less than a year after the parties entered the Settlement Agreement, Defendants failed to 

meet the timeframes set forth in the Settlement Agreement for inpatient restorations and 

inpatient competency evaluations. As a result, on June 22, 2017, Defendants invoked 

Departmental Special Circumstances under the Settlement Agreement. A true and correct 

copy of the Notice of Invocation of Departmental Special Circumstances dated June 22, 

2017 that DLC received from the State is attached hereto as Exhibit A. In the June 22, 

2017 Notice of Invocation of Departmental Special Circumstances, Defendants claimed 

that they could not comply with the Settlement Agreement’s timeframes due to “an 

unanticipated spike in court-ordered referrals for inpatient competency evaluation and 

restoration treatment services.” 

8. On December 22, 2017—the day the Department’s six month suspension period was set to 

expire—the Department sent DLC another notice of invocation of Departmental Special 

Circumstances. A true and correct copy of the Notice of Invocation of Departmental 

Special Circumstances dated December 22, 2017 that DLC received from the State is 

attached hereto as Exhibit B. In that notice, the Department claimed Departmental Special 

Circumstances due to an “unabated” and “sustained increase” in court orders for evaluation 

and restoration as the reason why the Department remained unable to comply with the 

evaluation and restoration timeframes set forth in the Settlement Agreement. 

9. Defendants are out of compliance with the timeframes set forth in the Agreement. In his 

September 2017 report, the Independent Expert charged with overseeing Defendants’ 

compliance with the Settlement Agreement concluded that “currently the State is clearly 

failing to meet the deadlines contained in the Settlement Agreement.” A true and correct 

copy of the September 4, 2017 Report of Independent Expert, Joel A. Dvoskin, Ph.D., 

ABPP (Forensic) that Plaintiff received from the State is attached hereto as Exhibit C. 

10. Since June 2017, Defendants have failed to admit all pretrial detainees for restorative 

treatment with 28 days of their ready for admission date and failed to maintain a monthly 

average of 24 days. The monthly reports are now voluminous and exceed 100 pages each. 

Instead of attaching a year’s worth of these reports, I have attached a summary of those 

monthly reports in the below chart. I can provide the Court with a copy of all of these 

monthly reports (after redacting personal information) upon request. 

11. The below table summarizes the data in the monthly reports (Report A) that DLC received 

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from the State between June 2017 and May 2018 related to inpatient restoration. The first 

column is the number of detainees on that monthly report who had been waiting for 

inpatient restoration services in excess of 28 days, the Settlement Agreement’s limit. The 

next column is the average (mean) wait time of all detainees who were transported that 

month for inpatient restoration or otherwise exited the waiting list (because, for example, 

the prosecution dropped the charges and the detainee was released). The final column is 

the longest wait time of any pretrial detainee waiting for inpatient restoration services on 

that monthly report. 

Month 

Detainees on 

Wait List, 28+ 

Days 

Average 

Wait Time 

Longest Wait 

Time 

June 2017 3 23.93 29 

July 2017 19 28.12 45 

August 2017 87 37.35 56 

September 2017 104 47.26 68 

October 2017 120 58.17 88 

November 2017 144 66.46 87 

December 2017 170 67.14 129 

January 2018 177 72.84 129 

February 2018 193 74.51 114 

March 2018 221 90.24 133 

April 2018 213 87.34 136 

May 2018 206 93.98 142 

12. It is estimated that 25-30% of pretrial detainees listed in the Department’s reports are 

individuals being held in jail as a result of an arrest on a petty, misdemeanor, non-violent, 

or drug offense. Tragically, the length of their detention while waiting for an evaluation 

or treatment exceeds what jail sentence they likely would have received if they had pled 

guilty on the day they were arrested. Many of these pretrial detainees are seriously 

mentally ill and in danger of harming themselves or others, and are victimized by other 

detainees as they wait for a humane environment to be evaluated and treated. 

13. In 2015, Defendants did not comply with the timeframes in the parties’ previous settlement 

agreement for ten of twelve months. In 2016, Defendants were out of compliance for five 

out of twelve months. In 2017, Defendants were out of compliance for the last seven 

months of the year. It appears that Defendants will not come back into compliance until, 

at the earliest, July 2019. The result will be a five-year period in which Defendants have 

spent more time out of compliance than in compliance. 

14. Using another monthly report sent by Defendants, I created the following table, which 

shows the monthly totals of new inpatient evaluations and restorations between June 2016 

and May 2018. For “inpatient,” I included evaluations and restorations which occurred at 

CMHIP or CMHIP’s facility in Arapahoe County called RISE, which is how the parties 

have defined inpatient. 

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Fiscal Year In Patient Competency 

Evaluations 

In Patient Restorations 

June 2016 25 45 

July 2016 21 47 

August 2016 32 46 

September 2016 25 53 

October 2016 28 43 

November 2016 23 72 

December 2016 24 48 

January 2017 27 58 

February 2017 28 58 

March 2017 27 54 

April 2017 29 75 

May 2017 26 84 

June 2017 37 73 

July 2017 22 66 

August 2017 31 76 

September 2017 30 66 

October 2017 25 66 

November 2017 19 76 

December 2017 14 68 

January 2018 19 77 

February 2018 17 78 

March 2018 30 65 

April 2018 9 71 

15. I created the following table based on information Defendants provided to DLC in previous 

court filings and in our meetings during the last year. This table shows the number of 

referrals for in-patient evaluation and restoration for each fiscal year from 2005 through 

2017 and the percentage of change on an annual basis. 

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Fiscal Year In Patient 

Competency 

Evaluations 

% Change In Patient 

Restorations 

% Change 

2005-06 115 - 167 - 

2006-07 144 25.2% 224 34.1% 

2007-08 184 27.8% 219 -2.2% 

2008-09 238 29.3% 170 -22.4% 

2009-10 275 15.5 212 24.7% 

2010-11 276 0.4% 213 0.5% 

2011-12 287 3.9% 268 25.8% 

2012-13 355 23.7% 274 2.2% 

2013-14 378 6.4% 342 24.8% 

2014-15 415 9.7% 462 35.1% 

2015-16 326 -21.4% 550 19.0% 

2016-17 327 0.3% 711 29.3% 

16. At DLC’s suggestion, the State sent letters to judges and attorneys involved in 15 cases 

since April 2018. In the letters, the State admits that it is holding pretrial detainees in jail 

for months whom it concedes would be better served in the community. Sadly, the effort 

has not been as successful as it could have been because the State has failed to partner with 

community mental health centers—for example, the letters fail to provide a judge any 

direction on what resources exist in the court’s community if the detainee were to be 

released. True and correct copies of these letters are attached hereto as Exhibit D. 

Signed: _____________________ Date: __6/13/18________ 

 Jennifer L. Purrington 

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EXHIBIT A 

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 Nancy VanDeMark, Ph.D., Director, Office of Behavioral Health

June 22, 2017 

Disability Law Colorado 

Attention: Mark Ivandick 

Attention: Jennifer Purrington 

455 Sherman Street #130 

Denver, CO 80203 

RE: Center for Legal Advocacy d/b/a The Legal Center for People with Disabilities and Older People v. 

Reggie Bicha, in his official capacity as Executive Director of the Colorado Department of Human Services 

and Ron Hale, in his official capacity as Superintendent of the Colorado Mental Health Institute at Pueblo, 

Case No. 11cv-02285-BNB (D. Col.)

SUBJECT: Notice of Invocation of Departmental Special Circumstances 

Dear Mr. Ivandick and Ms. Purrington: 

This correspondence serves as the Colorado Department of Human Services’ (CDHS) Notice of Invocation 

of Departmental Special Circumstances (DSC) in the above referenced case. DSC is being invoked pursuant 

to paragraph 6(c) of the Amended and Restated Settlement Agreement (Agreement). 

Basis for Invoking Departmental Special Circumstances 

CDHS may invoke DSC when “circumstances beyond the control of the Department impact the 

Department’s ability to comply with the timeframes” set forth in the Agreement. This could mean “an 

unanticipated spike in referrals, a national or statewide disaster impacting admissions decisions system 

wide,” or other “unique and often unforeseen” events. 

CDHS is in compliance with all timeframes set forth in the Agreement. However, circumstances beyond 

the control of the Department are expected to impact the Department’s ability to remain in compliance. 

Specifically, CDHS has experienced an unanticipated spike in court-ordered referrals for inpatient 

competency evaluation and restoration treatment services. Accordingly, CDHS is invoking DSC. 

On March 31, 2017, First Assistant Attorney General Tanja Wheeler and Assistant Attorney General 

Lauren Peach contacted Jennifer Purrington by telephone as a courtesy to let Disability Law Colorado 

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(DLC) know that the Colorado Mental Health Institute at Pueblo was under tremendous pressure related 

to the volume of court-ordered referrals for competency evaluation and restoration treatment services. 

At that time, CMHIP was closely reviewing the data and various pressure points to assess what was 

causing the potential problem. Ms. Purrington was informed that based on a cursory review of the daily 

data, it appeared the volume of orders for restoration treatment was outpacing orders for competency 

evaluations, potentially causing a backlog due to disparate length of stay related to each type of order. At 

the time, the data appeared to show a steady increase in orders, rather than a spike. 

On May 8, 2017, the parties and independent consultant, Dr. Joel Dvoskin, met for a quarterly meeting, as 

required by the Agreement. At that time, CMHIP again raised the issue of an increase in court ordered 

referrals for competency evaluation and restoration treatment services. Additionally, Dr. Patrick Fox 

reviewed data (presented in the chart included here as Attachment A) evidencing the same upward trend 

observed in March. 

Neither the upward trend in March or May was deemed sufficient by CDHS to warrant invoking DSC. 

However, between May and June 2017, CDHS has experienced an unanticipated spike in court ordered 

referrals, supporting invocation of DSC at this time. 

CDHS tracks the number of court ordered referrals in the regular course of business, in order to anticipate 

CMHIP’s future needs. This tracking informs decision-making regarding both regular and supplemental 

budget requests to the Joint Budget Committee and overall staffing allocations throughout CMHIP. In 

order to best plan for the future, CDHS projects growth as far as six fiscal years into the future. 

For fiscal year 2016-2017, CMHIP was projected to receive 318 orders for inpatient competency 

evaluations and 541 orders for inpatient restoration treatment services. These projections are based on 

the rate of court referrals reported so far in the current fiscal year. See Attachment A. 

In addition to reviewing data by fiscal year, CMHIP also projects the number of anticipated court-ordered 

referrals by month. During June 2016, CMHIP received 25 court-ordered referrals for competency 

evaluations (data is included here in Attachment B). These numbers informed the projections for the 

same month in 2017. CMHIP projected receiving 33 court ordered referrals for competency evaluations in 

June 2017. Similarly, CMHIP projected 53 referrals for inpatient restoration treatment in June 2017. See 

Attachment B. 

Based on these projections, CMHIP anticipated receiving 86 total court ordered referrals for inpatient 

competency evaluations and restoration treatment, in June 2017. On June 14, 2017 CMHIP recalculated 

its projections based on the number of orders received, and is now projected to receive 103 referrals in 

June 2017. See Attachment B. This number also reflects an increase in the projected referrals specifically 

attributable to orders for inpatient competency evaluations. In May 2017 CMHIP received 26 referrals for 

inpatient competency evaluations, but for June 2017, is now on pace to receive 41. See Attachment B. 

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Both the increase in projected combined inpatient referrals from 86 to 103, and the increase in inpatient 

competency referrals from 26 in May to a projected 41 in June, represent an unanticipated spike in 

referrals. 

A steady increase in the number of orders for inpatient restoration treatment is further exacerbating the 

pressure on CMHIP to meet the Agreement timeframes. Completing restoration treatment takes 

significantly longer than completing a competency evaluation. CMHIP received 450 court ordered 

referrals for inpatient restoration treatment in fiscal year 2015-2016; as of June 14, 2017, 487 orders have 

already been received. 

The bottom line is this: CMHIP has experienced an unanticipated spike in referrals for inpatient 

competency evaluation and restoration treatment services, at the same time that it is experiencing a 

decrease in the number of discharges, resulting in fewer beds available to meet the demand. 

Each of these factors is a circumstance beyond the Department’s control, and is the basis for CDHS’s 

invocation of Departmental Special Circumstances. 

Plan to Remedy Departmental Special Circumstances 

The Department has identified long and short-term options to keep pace with the referrals for inpatient 

competency evaluation and restoration treatment and the mechanisms available for funding these 

options. CDHS is continuously reviewing all options, including funding, and will approach the Joint Budget 

Committee in September or December if necessary. 

The most innovative of the near term options being explored includes contracts with private hospitals to 

complete restoration treatment for low risk patients or for the transfer of civil patients to increase 

inpatient capacity at both state mental health institutes, expansion of jail-based restoration treatment, 

and further streamlining competency evaluation processes at CMHIP. The Department has discussed the 

potential for contracts with four Colorado hospitals to enable the Department to rapidly expand capacity. 

The Department met with David Morris, CEO of Denver Springs Hospital, a 96-bed psychiatric hospital 

slated to open in August 2017, to explore the possibility of utilizing one of their inpatient units to meet 

the Department’s current need. The Department has also contacted the CEOs of Cedar Springs, 

Centennial Peaks, and Highlands Behavioral Health to explore the immediate use of available bed capacity 

at each of these facilities. CDHS is also considering approaching several other public and private hospitals 

regarding potential partnerships. 

The Department will also continue to work collaboratively with state Judicial to ensure that inpatient 

competency evaluation orders follow the current requirements of 16-8.5-105, C.R.S. This includes efforts 

such as educating individual courts, defense attorneys, and prosecutors on the new criteria for admission 

to CMHIP, for inpatient competency evaluations. CMHIP has seen an increase in the amount of pretrial 

detainees ordered for admission who have low level charges. When this happens, Court Services staff 

contact the clerk asking if the evaluation can take place in the community versus CMHIP, to ensure 

3 

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inpatient beds are being utilized for the most ill individuals and that services are being provided in the 

least restrictive setting. 

Additionally, in light of conversations between CDHS and State Judicial, ongoing training is provided to 

clerks and new judges regarding the statutory amendments; we have proposed to State Judicial that this 

topic be discussed again during the upcoming fall Judicial Conference. Related, State Judicial and CMHIP 

Court Services staff will be conducting joint training for clerks around the state, focusing in part on court 

orders for competency evaluations. 

Projected Timeframe for Resolution 

As stated in Paragraph 6(c), DSC commences on June 22, 2017, contemporaneously with the transmission 

of this Notice of Departmental Special Circumstances. As a result, the timeframe requirements of the 

Agreement are automatically suspended until December 22, 2017. However, CDHS may terminate DSC 

prior to that date, upon written notice to DLC of its intent to do the same. 

Thank you for your attention to this matter. CDHS looks forward to conferring with you and Dr. Dvoskin to 

review the reasons for invocation of DSC and resolve questions you may have about the circumstances 

that triggered this Notice. 

Sincerely, 

Dr. Nancy VanDeMark 

Director, Office of Behavioral Health 

cc: Dr. Joel Dvoskin, independent consultant 

Iris Eytan, Eytan Nielsen LLC 

 Ron Hale, Superintendent, CMHIP 

 Dr. Patrick Fox, Chief Medical Officer, CDHS 

 Anthony Gherardini, Deputy Executive Director of Operations, CDHS 

4 

Sincerely, 

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Attac

hment

A

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Attac

hment B

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EXHIBIT %

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 Robert Werthwein, Ph.D., Director, Office of Behavioral Health

December 22, 2017 

Disability Law Colorado 

Attention: Mark Ivandick 

Attention: Jennifer Purrington 

455 Sherman Street #130 

Denver, CO 80203 

RE: Center for Legal Advocacy d/b/a Disability Law Colorado v. Reggie Bicha, in his official capacity as 

Executive Director of the Colorado Department of Human Services and Ron Hale, in his official capacity as 

Superintendent of the Colorado Mental Health Institute at Pueblo, Case No. 11cv-02285-BNB (D. Col.)

SUBJECT: Notice of Invocation of Departmental Special Circumstances 

Dear Mr. Ivandick and Ms. Purrington: 

The Colorado Department of Human Services (the Department) hereby provides notice that it is invoking 

Departmental Special Circumstances (DSC) in the above referenced case. The Department has received 

your counsel’s correspondence dated December 22, 2017, alleging that the current term of DSC expires 

today and the Department is in breach of the Amended and Restated Settlement Agreement 

(Agreement). The Department respectfully disagrees. See Agreement at ¶ 6(c). 

The Department is invoking DSC pursuant to paragraph 6(a)(ii) of the Amended and Restated Settlement 

Agreement (Agreement). As agreed upon by the parties and stated in the Agreement, Departmental 

Special Circumstances means “circumstances beyond the control of the Department which impact the 

Department’s ability to comply with the timeframes set forth in [the Agreement]. This could mean an 

unanticipated spike in referrals, a national or statewide disaster impacting admissions decisions system 

wide. These examples are provided for illustration only. Departmental Special Circumstances is a flexible 

concept, due to the unique and often unforeseen nature of these events.” See Agreement at ¶ 6(a)(ii). 

Basis for Invoking Departmental Special Circumstances 

Currently, the volume of court orders for inpatient competency evaluation or restoration treatment is 

outpacing Department capacity at an unabating rate, which is a circumstance beyond the Department’s 

control. The Department is mobilizing a multi-faceted strategy to leverage more resources and engage a 

diverse group of stakeholders, and continues to admit pretrial detainees as capacity allows. However, the 

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Department cannot single-handedly curb the inflow of court orders. As such, and in accordance with the 

Agreement, the Department is invoking DSC. 

In May and June 2017, the Department experienced an unanticipated spike in the number of court orders 

for inpatient competency evaluation and restoration treatment services, at the same time that it 

experienced a decrease in the number of discharges. As soon as the Department identified the spike in 

court orders, in June 2017, the Department took steps to request the allocation of additional state 

resources through the emergency supplemental budget process to manage the unanticipated increase in 

court orders. At the time, the Department did not know that the increase in June represented a new 

normal in the number of court orders, as opposed to a temporary anomaly. 

Since then, the courts have continued to order pretrial detainees for inpatient restoration services at the 

same elevated level. Had the number of court orders for inpatient restoration services returned to the 

rate of growth seen prior to May 2017, the Department had sufficient resources to resume offering 

admission to pretrial detainees within the timeframes required by the Agreement. However, the rate of 

growth did not decline, and instead has remained at an elevated level. The unabated increase in 

restoration orders, which take significantly longer to complete than competency evaluations,1

 has 

reduced the number of beds available to accommodate new competency evaluation and restoration 

orders. Data reflecting the sustained increase in inpatient restoration orders is attached. See Attachment 

A – Competency and Restoration Referrals YTD. 

In summary, the sustained increase in the number of court orders for inpatient competency restoration 

treatment has outpaced the Department’s capacity and is beyond its control. The Department has 

conferred with Dr. Joel Dvoskin, the Independent Consultant on this case, concerning this invocation of 

DSC. Dr. Dvoskin agrees with the Department’s basis for invoking DSC. However, he is interested in 

working with DLC and the Department to explore further the plan to remedy DSC laid out below, to assess 

whether the plan is complete or if there are additional options that both the Department and DLC can 

pursue. 

Plan to Remedy Departmental Special Circumstances 

Over the past six months, the Department has worked diligently and creatively to devise and implement 

strategies to enable it to timely offer admission to pretrial detainees for competency evaluations and 

restoration treatment. In light of the sustained increase in the number of court orders for inpatient 

restoration treatment, the Department has identified multiple additional options, which together the 

Department believes will ultimately allow it to keep pace with the orders for inpatient competency 

restoration treatment. 

 

1

 The average length of stay for a pretrial detainee receiving restoration treatment at the Colorado Mental 

Health Institute at Pueblo (CMHIP) in FY2016-17 was 141.2 days (compared to 38.9 days for a competency 

evaluation). This results in fewer beds available to meet the demand caused by inpatient orders. 

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Resource Development and Legislative Proposals 

During the 2017 legislative session, the Department introduced a bill to increase the availability of 

outpatient restoration services. The proposal designated the Office of Behavioral Health as the state 

entity responsible for the oversight of restoration education and coordination of clinical services to 

restore defendants to competency in the community. By designating a specific state entity for oversight of 

community restoration and providing funding to deliver restoration services, the Department believed 

that the courts would order a greater number of individuals to receive outpatient restoration, instead of 

inpatient competency restoration, as is currently the practice. Although the bill passed, the General 

Assembly struck the funding to provide outpatient competency restoration services. In late September 

2017, the Department submitted an emergency supplemental to the Joint Budget Committee (JBC), 

requesting additional funding in part to address challenges meeting the Agreement timeframes. 

Consequently, the JBC approved $479,711 in FY2017-18 and $1,177,767 annually, so that the Department 

could begin providing outpatient competency restoration services sooner. The Department is currently 

procuring a vendor to provide statewide outpatient competency restoration services, and anticipates that 

the system will be operational by May 2018. Until then, the Department is contracting with vendors 

through single case agreements to provide outpatient competency restoration services on a case-by-case 

basis, and has set aside some of the FY2017-18 appropriation to accomplish this. 

Additionally, as a result of the FY2017-18 Figure Setting in March 2017, CMHIP received $0.9 million as of 

July 1, 2017 and $1.2 million ongoing, to move adolescent patients at CMHIP from their current unit to 

the Sol Vista building, which is better designed to meet their needs (the Circle Program formerly occupied 

the Sol Vista building). Because of the move, the hospital’s forensic capacity will be increased by an 

additional 20 beds. The Department expects that the additional 20 beds will be available for use by March 

2018. 

The Department also requested emergency supplemental funds in September 2017. The approved funds 

are documented in the JBC’s Interim Supplemental Budget Requests FY 2017-18 for the Department of 

Human Services (Office of Behavioral Health). Those funds include, in relevant part, the following: 

● Expansion of CMHIP Forensic Unit: The FY2017-18 Long Bill includes $5.4 million in 

capital construction funding to add 24 beds in the CMHIP high security forensic 

facility (designated as the L2 unit). These beds are designed to serve patients with 

high acuity and security needs, and are anticipated to become operational in 

FY2020-21. 

● Law Enforcement Assisted Diversion (LEAD) pilot programs: The FY2017-18 Long Bill 

includes $2.6 million to support four LEAD pilot programs. LEAD is an evidencebased pre-booking diversion program that offers low-level drug offenders case 

management and other supportive services as an alternative to jail and prosecution. 

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Program participants are assessed and then receive ongoing case management 

services, are connected with existing resources in the community (e.g., legal 

advocacy, job training or placement, housing assistance, counseling). 

● Mental Health Services for Juvenile and Adult Offenders: The FY2017-18 Long Bill 

includes an increase of $2.4 million to allow community mental health center staff 

in every region to provide case management and treatment services, wrap-around 

services, and medications (that are not covered by Medicaid) for juvenile and adult 

offenders who have mental health problems. 

● Senate Bill 17-019 (Behavioral Health Medication for Persons in the Criminal Justice 

System): This act seeks to improve medication consistency for individuals in the 

criminal justice system by authorizing the establishment of a medication formulary, 

cooperative purchasing of medication, and the sharing of patient-specific mental 

health care and treatment information. 

● Senate Bill 17-021 (Assistance to Persons with Mental Illness in the Criminal Justice 

System): The act establishes a housing program for persons with a behavioral or 

mental health disorder transitioning from the criminal justice system. The FY2017-

18 Long Bill includes $15.3 million for supportive housing initiatives, including $4.0 

million to support the development of housing units with intensive support services 

(called permanent supportive housing) for behavioral health consumers, including 

those exiting or at risk of entering hospitals or state mental health institutes, and 

$11.3 million for other permanent supportive housing and rapid rehousing 

initiatives. 

● Senate Bill 17-207 (Strengthen Behavioral Health Crisis Response System): Effective 

May 1, 2018, this act eliminates the use of the criminal justice system to hold 

individuals who are experiencing a mental health crisis. The act also makes a 

number of changes to enhance the State's coordinated behavioral health crisis 

response system, including the addition of $7.1 million for FY2017-18 to: 

o support local partnerships between law enforcement and behavioral health 

agencies; 

o to improve regional coordination for the provision of 24-7 crisis services; and 

o to expand behavioral health crisis response system services in rural areas. 

In September 2017, the Legislature also approved $1.9 million in FY2017-18 to expand jail-based 

competency evaluation and restoration services in the RISE (Restoring Individuals Safely and Effectively) 

program by an additional 28 beds. Funding for the initial four beds became available immediately, and 

funding for the remaining 24 beds will be available in January 2018. The initial four beds have been 

operational since late October 2017, and the remaining 24 beds are expected to be operational by March 

2018, to allow time for required renovations to the space within the facility. The Department is 

continually evaluating whether it will be necessary to make additional requests for supplemental funding 

in January 2018. 

Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 19 of 85
5 

On November 1, 2017, the Governor released the State’s FY2018-19 Budget. The budget contains a 

request from the Department for new funding, which includes the following: 

● $7.4 million and 3.3 FTE to create an additional 62-bed jail-based competency evaluation and 

restoration program; 

● $1.1 million and 11 FTE for additional psychologists (8) and administrative support (3) at 

CMHIP to conduct competency evaluations; 

● $3.4 million and 3 FTE to allow the Department to enter into contracts, which the Department 

believes is the first of their kind nationally, with private/non-profit hospitals within the 

Denver metro area. This appropriation will enable the Department to pay for 10 non-state 

hospital beds to further expand the state’s inpatient bed capacity; and 

● $11.8 million to complete Phase IIa of the Department’s Facility Modernization Plan for the 

Colorado Mental Health Institute at Fort Logan. This funding will enable the Department to 

complete the design phase for replacement of the existing facility. The Site Master Plan and 

Facility Program Plan call for an increase in the facility’s bed capacity from 94 beds to 244 

beds. The Department will use the additional 150 beds to serve both civil and forensic 

patients. Once Phase IIa is completed, the next phase (Phase III) of the project will be facility 

construction. The date of completion of the project is contingent on funding of Phases IIa and 

Phase III. 

The Department is also proposing several legislative changes as part of the solution. For instance, the 

Department has received a number of court orders for inpatient competency restoration for pretrial 

detainees who do not require a hospital level of care. The Department has drafted proposed bills that 

would require the courts to order restoration in the most appropriate setting, similar to HB16-1410. The 

Department is also proposing statutory language that would limit when the court may order inpatient 

competency restoration for pretrial detainees who are not eligible for release from custody. Finally, the 

Department has also proposed a statutorily created pilot program that would enable a specific number of 

jails to petition the probate court for authority to administer involuntary medications. 

Partnerships and Collaboration 

Department representatives participate on the Commission for Criminal and Juvenile Justice’s (CCJJ) 

Mental Health/Point of Contact Through Jail Release Task Force (the Task Force). Task Force members 

also include representatives from the State Public Defender’s Office, the Colorado District Attorneys’ 

Council, Sheriffs, the Department of Probation, the Department of Parole, the Colorado Jail Association, 

and others. The Task Force was instrumental in crafting SB17-207, involving pre-arrest jail deflection, 

which ultimately became law. The CCJJ recently approved the second area of focus for the Task Force; 

specifically, expansion and enhancement of the use of pre-filing and arraignment jail diversion. Through 

participation on the Task Force, the Department strongly supports and advocates for the allocation of 

Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 20 of 85
6 

resources to provide for pre-arrest and pre-arraignment jail diversion, as these upstream interventions 

reduce incarceration rates for persons with mental health disorders, which in turn reduces the number of 

competency to proceed evaluation orders. In addition, the Department suggested that the JBC request a 

multi-systemic interim committee or task force representing each branch of government to make 

systemic improvements in anticipation of the forecasted rate of referrals. 

The Department also continues to work collaboratively with the State Court Administrator’s Office within 

State Judicial to ensure that inpatient competency evaluation orders comply with § 16-8.5-105, C.R.S. This 

includes efforts such as educating individual courts, defense attorneys, and prosecutors on the current 

criteria for inpatient competency evaluations. The Department’s Court Services staff also contact clerks to 

request that evaluations be ordered to occur outpatient, in cases where pretrial detainees with low-level 

charges have been ordered inpatient. Because the Department has seen an increase in these type of 

orders, these requests help ensure that inpatient beds are utilized for the most ill pretrial detainees and 

that services are being provided in the most appropriate setting. 

County sheriffs have compounded issues arising from the overall demand on the Department’s inpatient 

system. Despite court orders requiring transport within 72-hours after a pretrial detainee is ready to 

return to the jail, county sheriffs routinely delay in transporting pretrial detainees. In some cases, the 

delays are longer than a week, and delays in discharge result in under-utilization of inpatient beds. CMHIP 

staff continues to work with sheriffs’ offices to address this issue. 

Additionally, the lack of adequate treatment in jails across the state is a significant contributor to the 

decompensation of pretrial detainees. This decompensation can trigger an order for a competency 

evaluation, which could be avoided if the pretrial detainee were receiving adequate treatment in the jail. 

Pretrial detainees who are found incompetent to proceed because they decompensate in jail then add to 

the number of inpatient restoration treatment orders. Pretrial detainees also decompensate upon return 

to the jail after being restored to competency by CMHIP, due to the same lack of adequate mental health 

treatment in the jail. Department staff are working with the Task Force to explore ways to improve the 

adequacy of mental health care provided in the state’s jails, with the goal of reducing the number of 

competency evaluation orders and subsequent competency restoration orders that are necessary. 

Ultimately, while the Department is part of the system responsible for ensuring that individuals receive 

timely competency evaluations and restoration services, all three branches of government and nongovernment stakeholders such as DLC, must work collaboratively to address the systemic issues 

underlying the mental health crisis. The Department is committed to continuing its work and welcomes 

strengthened and strategic collaboration across stakeholder groups. 

Projected Timeframe for Resolution 

Pursuant to Paragraph 6(c) of the Agreement, DSC commences on December 22, 2017, 

contemporaneously with the transmission of this Notice of Departmental Special Circumstances. As a 

result, the timeframe requirements of the Agreement are automatically suspended through June 22, 

Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 21 of 85
7 

2018. See Agreement at ¶ 6(c). As the plan to remedy DSC moves forward, the Department will 

continually assess the timeframe for resolution. The Department will update DLC as more information 

becomes available, in addition to providing the regular updates agreed upon by the parties concerning the 

multi-faceted strategies outlined above. 

The Department has complied with the Agreement in good faith and will continue to do so. The 

Department looks forward to conferring with you and Dr. Dvoskin to review the reasons for invocation of 

DSC, to resolve questions you may have about the circumstances that triggered this Notice, and to explore 

any additional suggestions you may have concerning options to remedy the circumstances forming the 

basis for DSC. Thank you for your attention to this matter. 

Sincerely, 

Dr. Robert Werthwein 

Director, Office of Behavioral Health 

cc: Dr. Joel Dvoskin, Independent Consultant 

Iris Eytan, Eytan Nielsen LLC 

 Dr. Patrick Fox, Chief Medical Officer, CDHS 

 Anthony Gherardini, Deputy Executive Director of Operations, CDHS 

Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 22 of 85
EXHIBIT &

Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 23 of 85
Joel A. Dvoskin, Ph.D., ABPP (Forensic) 

Phone: 520-577-3051 

Cell: 520-906-0366 

E-Mail: joelthed@aol.com

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EXHIBIT '

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Colorado Mental Health Institute at Pueblo, 1600 West 24th Street, Pueblo, CO 81003 P 719.546.4000 F 719.546.4484

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Robert Werthwein, PhD, Director, OBH

Jill Marshall, Chief Executive Officer, CMHIP

Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 53 of 85
Colorado Mental Health Institute at Pueblo, 1600 West 24th Street, Pueblo, CO 81003 P 719.546.4000 F 719.546.4484

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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 56 of 85
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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 57 of 85
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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 58 of 85
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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 59 of 85
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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 60 of 85
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www.colorado.gov/cdhs

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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 61 of 85
Colorado Mental Health Institute at Pueblo, 1600 West 24th Street, Pueblo, CO 81003 P 719.546.4000 F 719.546.4484

www.colorado.gov/cdhs

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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 62 of 85
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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 63 of 85
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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 65 of 85
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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 66 of 85
Colorado Mental Health Institute at Pueblo, 1600 West 24th Street, Pueblo, CO 81003 P 719.546.4000 F 719.546.4484

www.colorado.gov/cdhs

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Colorado Mental Health Institute at Pueblo, 1600 West 24th Street, Pueblo, CO 81003 P 719.546.4000 F 719.546.4484

www.colorado.gov/cdhs

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Jill Marshall, Chief Executive Officer, CMHIP

Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 68 of 85
Colorado Mental Health Institute at Pueblo, 1600 West 24th Street, Pueblo, CO 81003 P 719.546.4000 F 719.546.4484

www.colorado.gov/cdhs

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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 69 of 85
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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 71 of 85
Colorado Mental Health Institute at Pueblo, 1600 West 24th Street, Pueblo, CO 81003 P 719.546.4000 F 719.546.4484

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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 72 of 85
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www.colorado.gov/cdhs

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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 73 of 85
Colorado Mental Health Institute at Pueblo, 1600 West 24th Street, Pueblo, CO 81003 P 719.546.4000 F 719.546.4484

www.colorado.gov/cdhs

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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 74 of 85
Colorado Mental Health Institute at Pueblo, 1600 West 24th Street, Pueblo, CO 81003 P 719.546.4000 F 719.546.4484

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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 75 of 85
Colorado Mental Health Institute at Pueblo, 1600 West 24th Street, Pueblo, CO 81003 P 719.546.4000 F 719.546.4484

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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 76 of 85
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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 77 of 85
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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 78 of 85
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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 79 of 85
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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 80 of 85
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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 81 of 85
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Jill Marshall, Chief Executive Officer, CMHIP

Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 83 of 85
Colorado Mental Health Institute at Pueblo, 1600 West 24th Street, Pueblo, CO 81003 P 719.546.4000 F 719.546.4484

www.colorado.gov/cdhs

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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 84 of 85
Colorado Mental Health Institute at Pueblo, 1600 West 24th Street, Pueblo, CO 81003 P 719.546.4000 F 719.546.4484

www.colorado.gov/cdhs

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Case 1:11-cv-02285-NYW Document 82-1 Filed 06/13/18 USDC Colorado Page 85 of 85