SPECIAL MASTER REPORT to JUDGE WANG 

Submitted May 28, 2021 

CENTER FOR LEGAL ADVOCACY, d/b/a 

DISABILITY LAW COLORADO, 

Plaintiff, 

v.

MICHELLE BARNES, 

in her official capacity as Executive Director of the Colorado Department 

of Human Services, and

JILL MARSHALL, 

in her official capacity as Chief Executive Officer of the Colorado Mental 

Health Institute at Pueblo, Defendants.

 

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May 28, 2021

Re: Civil Action No. 11-cv-02285-NYW 

The Honorable Judge Nina Wang

United States Magistrate Judge

District of Colorado

Alfred A. Arraj United States Courthouse

901 19th Street

Denver, CO 80294

Judge Wang, 

This report serves as our May 28, 2021 quarterly status report mandated by the Consent Decree 

that was filed March 15, 2019 pursuant to Case No. 1:11-cv-02285-NYW. As you know, the 

Consent Decree requires us to monitor progress and provide recommendations for improvement 

to the Colorado Department of Human Services (CDHS; hereafter the Department) as they 

attempt to improve competency-related services to criminal defendants with psychiatric illness. 

Specifically, the Consent Decree (p. 24) indicates, 

(i) As part of the duties, the Special Master shall provide the Court and the Parties with status 

reports every other month for the first six months, and then quarterly thereafter. The Special 

Master’s status report was submitted on January 28, 2019. Dkt. 146. The next report shall be 

submitted to the Court and the Parties on March 28, 2019, and then May 28, 2019, and then 

quarterly thereafter. Such reports shall address the Department’s compliance with the 

timeframe requirements of the Consent Decree concerning Competency Services and shall 

provide a detailed summary of information and recommendations the Special Master believes 

the Court and Parties should consider relating to the Department’s compliance with the 

Consent Decree timeframes concerning Competency Services. 

(ii) The Special Master’s report shall include, but is not limited to, reporting on the number of 

Pretrial Detainees ordered to receive Competency Services, an assessment of the 

Department’s operations, systems, and admissions practices and policies relating to the 

Department’s ability to comply with the Consent Decree timeframes, and guidance to the 

Department for improvement and increasing efficiencies in these areas. 

The Consent Decree that was filed March 15, 2019 prescribed a variety of steps the Department 

must take to improve the competency assessment and restoration system in Colorado, and to

comply with time frames and deadlines mandated in the Consent Decree. As you know, the 

Department initiated these steps and demonstrated meaningful progress. 

However, beginning in the spring of 2020—after significant progress, but well before attaining 

compliance with most metrics prescribed in the Consent Decree—the Department began to face

new and unforeseeable challenges prompted by the worldwide COVID-19 pandemic. Thus, this 

report, like the four prior quarterly reports, continues to address the pandemic’s impact on the 

functions prescribed in the Consent Decree, and the Department’s efforts to respond to the 

challenges COVID-19 has created. As you recall from prior reports, monitoring progress and 

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reporting data in this era has been complicated by the Department’s reasonable, continued 

invocation of Individual Special Circumstances (ISC) for the many pre-trial detainees whose 

movement has been constrained by COVID-19 precautions. Therefore, this report addresses the 

usual metrics of compliance and progress, but also acknowledges the large proportion of 

detainees designated ISC, because describing both are necessary to provide a full picture of the 

competency crisis in Colorado. 

Unfortunately, during this fifth quarter of the pandemic (i.e., the period since our prior quarterly 

report was submitted February 28, 2021) the situation for competence-involved pre-trial 

detainees has reached its worst point in the past two years. The precautions to avoid the spread 

of COVID-19 have further slowed admissions to the state psychiatric hospital, thereby increasing 

the wait-list for services, and the number of people waiting. So most key metrics reflect 

substantial delays in inpatient restoration services. We review these metrics, and provide other 

updates on the functions prescribed in the Consent Decree, throughout the following report. We 

have also attached our recent memo to the Colorado Department of Public Health & 

Environment (CDPH&E), which outlines our concerns for the extended pauses in admissions to 

the state hospital. 

 

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TABLE OF CONTENTS 

 

INTRODUCTION...........................................................................................................................5

ONGOING CAVEAT:............................................................................................................................10

KEY METRICS MUST ACKNOWLEDGE “INDIVIDUAL SPECIAL CIRCUMSTANCES” (ISC)..........................10

KEY METRICS FOR PROGRESS: ...................................................................................................12

COMPLIANCE WITH TIME FRAME REQUIREMENTS....................................................................12

KEY METRIC: COMPETENCE EVALUATION TIME FRAMES...................................................................13

KEY METRIC: TIME FRAMES FOR ADMISSION TO COMPETENCE RESTORATION.................................16

KEY METRIC: THE WAITLIST FOR COMPETENCE RESTORATION SERVICES ..........................................19

CONSENT DECREE SECTION VI UPDATES ...................................................................................21

ADMISSION OF PRETRIAL DETAINEES FOR INPATIENT COMPETENCY EVALUATIONS AND RESTORATION 

TREATMENT ......................................................................................................................................21

Wait Times for Inpatient Evaluation ..............................................................................................22

Wait Times for Inpatient Restoration.............................................................................................25

PERFORMANCE OF JAIL COMPETENCY EVALUATIONS........................................................................28

INTERIM JAIL MENTAL HEALTH TREATMENT......................................................................................30

RELEASE OF PRETRIAL DETAINEES FOR COMMUNITY-BASED RESTORATION TREATMENT ..................32

TRANSPORTATION OF PRETRIAL DETAINEES......................................................................................36

NOTIFICATION OF NON-COMPLIANCE WITH TIME FRAMES ...............................................................37

DECREE SECTION VII UPDATES ..................................................................................................41

CIVIL BED FREEZE...............................................................................................................................41

COMPREHENSIVE AND COHESIVE PLAN.............................................................................................42

INCREASE COMMUNITY RESTORATION SERVICES ..............................................................................43

CONCLUSION ............................................................................................................................47

APPENDIX A: MEMO TO CDPH&E..........................................................................................................48

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INTRODUCTION 

As you well know, the Consent Decree that was filed March 15, 2019 prescribed many steps the 

Department must take, and the timelines it must meet, to improve competency services in 

Colorado. The Department initiated these steps in ways that were faithful to the details and the

broader spirit of the Consent Decree. For simplicity, we summarize the overall spirit and 

provisions of the Consent Decree in three goals: 

a) Reducing the overall number of people on the waitlist for competence restoration 

services, 

b) Reducing the wait times for people on the waitlist, particularly people with the most 

acute psychiatric illness, and 

c) Reducing harm (by providing care) to people on the waitlist. 

Progress on the first goal was fairly steady—slightly fewer people were awaiting restoration 

services each month—until the COVID-19 pandemic began. Although there was a brief decrease

in the waitlist due to decreased arrests early in the pandemic, arrests resumed and the waitlist 

increased as competency services could not keep pace with arrests and court orders for 

competency services. Once COVID-19 spread to the state psychiatric hospital where inpatient 

restoration services occur (i.e., the Colorado Mental Health Institute in Pueblo; CMHIP), 

quarantine procedures slowed or stopped admissions, and list of people awaiting restoration 

services grew more dramatically.

Progress on the second goal was also clear—particularly for those defendants with most severe 

treatment needs—though delays remained for those with less acute needs. Initially, the 

Department was able to provide a prompt response to detainees found incompetent and 

identified as Tier 1 (i.e., acute need). But COVID-19 created new sources of delay, even for those 

with most urgent needs. 

Finally, progress towards the third goal—providing care for those waiting—has continued, even 

amid significant barriers. Amid restrictions on face-to-face contact with detainees, the

Department’s Forensic Support Team makes consistent efforts to monitor detainees with help 

from jail staff, and provide care while these detainees await hospitalization. 

As usual, this report details progress on these three primary goals, particularly the key metrics,

as well as other developments. However, like the past several quarters, our discussion begins by 

overviewing the ongoing effects of the global COVID-19 pandemic on the work outlined in the 

Consent Decree. It is simply impossible to describe the status of Colorado’s competency-service 

system without describing the effects of the COVID-19 pandemic. 

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Overview of Progress this Quarter amid the COVID-19 Pandemic: 

 

The Department has faced the most substantial pandemic-related challenges to date. 

As we explained in prior quarters, competency services are particularly vulnerable to the impact 

of the COVID-19 pandemic because they lie at the intersection of multiple systems—the courts, 

jails, and the Department—each of which has been attempting to minimize human contact to 

slow the spread of the COVID-19 virus. Although the Department has control over their own 

services, they have much less control over adjacent services (e.g., jails), so the Department must 

always adjust to the changing policies and strained resources in courts and jails. Furthermore, 

even the Department’s own services are shaped by other entities—particularly the Colorado 

Department of Public Health & Environment (CDPH&E)—that guide safety and quarantine 

procedures. These procedures, of course, often influence whether and when people can receive 

inpatient restoration services. So, an increasing challenge is identifying the domains that the 

Department can influence, whether directly or indirectly, to address the competency crisis. 

Following is a brief summary of procedural changes across competency services: 

Competency Evaluations: 

Many Colorado jails—particularly “outbreak jails” with known COVID-19 cases—were restricting

visits from external professionals, including the Department’s forensic evaluators. Indeed, for 

many months, most jails prohibited face-to-face meetings. The Department responded with 

creativity, arranging (and even providing the necessary technology) for videoconferencing. This 

mitigated delays in jail-based evaluations except in Denver, where the volume of referrals (and 

demands on staff and videoconferencing resources) were greatest. 

Fortunately, most evaluators have been vaccinated, jails have more recently been allowing more 

visits, and even the Denver jail began allowing greater opportunities for evaluation. With these 

recent developments—and persistent efforts from the Department’s Court Services—jail 

evaluation time frames have improved substantially. Indeed, virtually all jail-based evaluations 

are occurring on time (i.e., within the timeline prescribed by the Consent Decree) and there are 

virtually no detainees designated as Individual Special Circumstances (i.e., exceeding timelines 

for reasons beyond Departmental Control) while awaiting evaluations. Amid the tremendous 

difficulties in other competency-related services, the competence evaluations occurring in jails 

and communities are the “bright spot” where services occur punctually.

Inpatient Competency Restoration Services:

After evaluation, however, those detainees found incompetent to stand trial (IST) and ordered to 

inpatient restoration services have moved much more slowly into those inpatient services. 

CMHIP has used a cohort-based admissions procedure to create “safe zones” or quarantine 

strategies that greatly reduce the possibility of a newly-admitted individual infecting others. 

Nevertheless, as hospital infections increased over the past two quarters, admissions stopped 

from mid-November to mid-December 2020. This increased the number of people waiting from 

124 at the end of October 2020 to 189 at the end of December 2020. More recently, another 

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extended pause in admissions spanned early April to early May of 2021, such that now the 

number of people waiting has more than doubled, to roughly 300. Average wait times have also 

increased significantly, and the longest wait times have increased to more than 200 days. 

Similarly, the RISE programs had periods in which admissions were substantially delayed or even 

stopped entirely. Although admissions have recently resumed in all locations, we have been 

increasingly alarmed by the delays due to hospital infections and subsequent quarantine 

procedures. Although some aspects of outbreaks are beyond any control, other contributing 

factors (e.g., low vaccination rates among hospital staff) appear potentially malleable. As 

described later in this report, we are increasingly urging the Department, and those that guide 

their safety protocols (i.e., CDPH&E), to consider further efforts to employ COVID precautions 

that can also support admissions (see Appendix A for our letter to CDPH&E). 

Mental Health Services for those Awaiting Competency Restoration Services: 

With more detainees waiting, and waiting longer, for restoration services, Department efforts to 

provide care to those detainees becomes even more important. The Forensic Support Team 

(FST) and their Forensic Navigators—mandated by the Consent Decree to monitor defendants in 

jail awaiting competency restoration services—have worked diligently and creatively to carry out 

their duties. The same jail restrictions that prevented face-to-face visits from evaluators also 

prevented visits from the FST staff who would otherwise visit detainees. Thus, the FST (and even 

CMHIP staff) have worked with jail staff to arrange transfers to a private psychiatric hospital or to 

CMHIP for acutely ill individuals, and they use remote technology (primarily phone calls to jail 

staff) to monitor others. Although many pandemic-related barriers remain, we are pleased to 

report that the FST is able to resume face-to-face contacts in many jails, that they have been 

thoughtful in collaborating with jail-based mental health services, and that they have prioritized

the detainees who require greatest care.

Fines and “Individual Special Circumstances”: 

 

Recall that once certain Department functions were greatly altered or slowed by COVID-19, the 

Department began incurring fines (i.e., the Consent-Decree-mandated fines for exceeding 

prescribed time limits) to a greater degree than they had before these COVID-19-related delays. 

This quickly raised questions about how to best handle these fines. All parties (i.e., the 

Department, Disability Law Colorado, and Special Master) agreed conceptually that the 

Department should not be penalized for delays caused solely by COVID-19. Although the COVID19 pandemic is, conceptually, a broad “Departmental Special Circumstance” as defined in the 

Consent Decree, the Consent Decree precludes invoking Departmental Special Circumstances 

until June 2021.

1

 

1 See p. 33 of the Consent Decree.

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Absent the option to invoke Departmental Special Circumstances, or any other wide-scale 

agreement,2 the Department has been invoking ISC (“Individual Special Circumstance”) on every 

individual detainee whose progress has been slowed by the COVID-19 pandemic. This includes 

defendants who were found incompetent but could not be promptly transitioned to the hospital 

because of delays necessary for safety. Perhaps not surprisingly, the number of the competenceinvolved Pretrial Detainees awaiting competency restoration who are designated ISC has 

consistently exceeded the number who are not designated ISC. 

There remain several challenges to such wide-scale ISC. First, invoking ISC requires considerable 

work by OBH staff, particularly the leaders/administrators. Second, wide-scale ISC greatly 

complicates data management, reporting, and monitoring, as we explain later.

As we approach the second year of pandemic-related delays, the Department has proposed an 

alternate approach for handling fines. Rather than continue the labor-intensive process of 

designating ISC for every detainee whose movement has been slowed by pandemic-attributable 

delays, the Department has proposed a capped, lump-sum fine. The DLC has made a counterproposal, and at this point we are awaiting the Department’s response to this counter-proposal. 

Generally, we strongly support this simplified lump-sum fine (versus the labor-intensive process 

of designating ISC in so many cases) and we are hopeful the parties can reach a satisfactory 

agreement. Once the parties have reached an agreement (or an impasse) we will notify the 

Court. 

Current Status and Foreseeable Future: 

 

The COVID-19 pandemic has caused increasing delays and challenges across each of the past 

several quarters. Last quarter, we speculated, “The only good news about these converging 

trends in the past quarter, it seems, is that they may have reached the ‘rock bottom.” We were 

clearly incorrect. Although CMHIP’s winter pause in admissions ended, and admissions had 

resumed, a second pause (April-May) has exacerbated the already-growing delays. We were 

optimistic that widespread vaccination would mitigate the pandemic effects, but vaccinations 

are not yet widespread among CMHIP staff (many of whom decline vaccines) or detainees. The 

hospital still cannot admit patients at anywhere near the pace that courts are ordering them for 

admission. Thus, delays have reached their worst point yet and—though there are reasons to 

anticipate improvement—the “backlog” in services (extended delays and waitlist) almost ensure 

any improvements will occur slowly.

As we look towards the next quarter, our prognosis is guarded. While we anticipate fewer 

 

2 As you recall, the Department initially proposed an agreement to DLC in which the Department would 

pay the fines that they estimated would have accrued absent COVID-19. However, DLC ultimately (around 

mid-June) declined this proposal from the Department, and the Department therefore proceeded to 

invoke Individual Special Circumstances for detainees who were delayed (i.e., for whom the Department

would accrue fines for missing timelines) due to COVID-19-related precautions or constraints. 

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pandemic-related cautions and complications in Colorado overall, the Department will continue 

certain precautions (e.g., quarantine-style admissions procedures at CMHIP) for the foreseeable 

future. The increases to the waitlist are tremendous: not just from increasing court orders for 

restoration, but from delays that increased during the pauses in admission (much like 

compounding interest on an unpaid debt). Thus, the waitlist will require many months to clear 

even if pandemic-related procedures could immediately end entirely. This increased waitlist will 

make it even more important for the Department to continue their strong progress in outpatient 

restoration, and continue pursuing new strategies such as diversion programs and strategies to 

reduce hospital lengths of stay.

As in every quarterly report, we review next the Department’s compliance with time frame 

requirements, because these are the primary focus of the Consent Decree (and the focus that 

the Consent Decree prescribes for our quarterly reports). We consider these time frames our 

“key metrics”—or primary markers of progress—that we review in each quarterly report. 

Obviously, many of these metrics have been directly influenced by the procedural changes 

necessary for public safety amid COVID-19. Likewise, many of these metrics require 

distinguishing those individuals designated ISC versus those who are not. 

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ONGOING CAVEAT: 

KEY METRICS MUST ACKNOWLEDGE “INDIVIDUAL SPECIAL CIRCUMSTANCES” (ISC) 

As you recall, the Department has—with good reason—invoked Individual Special Circumstances 

(ISC) for those many pretrial detainees whose progress through the competency system has 

been slowed by procedural changes due to COVID-19. As the pandemic has persisted, the 

number of individual detainees on ISC has often exceeded the number who are not on ISC. Per the 

Consent Decree, the Department does not pay daily fines for persons on ISC. Stated differently, 

the Department is not “out of compliance” if an individual is waiting but designated ISC, because 

“special circumstances” prevented compliance with timeframes. Therefore, once a detainee is 

designated ISC, that individual is not included in the metrics with which the Department has 

historically maintained compliance with the Consent Decree (e.g., waiting list, waiting times). 

So, quite reasonably, the Department does not include these ISC-designated individuals in their 

compliance metrics. But of course, excluding everyone on ISC from routine reporting would yield

figures that are grossly misleading with respect to the Department’s progress on goals, and with 

respect to the general state of competency services in Colorado (aside from compliance per se). 

For example, the waitlist (strictly defined) included 147 people at the end of April. But this figure 

does not include approximately 120 people designated ISC as they await restoration (for a grand 

total of more than 250 people waiting; a figure that reflects an all-time high). On the one hand, it 

is important not to penalize the Department for pandemic-related delays in services. On the 

other hand, it is important not to overlook those detainees whose services are delayed due to 

COVID-19 precautions (and therefore designated ISC) or to provide summary figures that omit a 

large number of detainees. 

Our approach to this dilemma has been to begin monitoring separately the individuals not on ISC 

and those designated ISC. We have asked the Department to present separate data on each 

group in their monthly reports, and (where possible) we present separate data on each group in 

this quarterly report. As you may recall from prior reports, this reporting (ISC vs non-ISC) has 

created new challenges for the Department and their data management systems. Providing 

precise details on each population is more challenging than it might seem. Following an 

agreement created with DLC in the spring of 2020, the Department places most pretrial 

detainees on ISC when they begin exceeding their maximum time frames (expect for a few cases 

in which COVID-19 is not the barrier for timely admission). Many pretrial detainees pass through 

a figurative “turnstile” at the end of their maximum time frame, moving from the narrowly 

defined waitlist into the ISC group. At some point, these individuals will be offered admission, 

and likely move back through the turnstile onto the traditional waitlist, before they are admitted 

to inpatient restoration services. These transitions (on and off of ISC) make data monitoring 

more complicated; simply reporting the number on ISC in a given month along with the number 

on the waitlist is misleading, in that a single person could have been in both categories. Thus, we 

are increasingly prioritizing point-in-time “snapshots” of data. 

We have met repeatedly with the Department regarding data requests to better clarify and 

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communicate the overall journey of persons awaiting inpatient restoration—whether placed on 

ISC at some stage or not, from start to finish. The Department continues refining their 

procedures for monitoring and reporting, and have promised a new approach for their next 

monthly report. We remain convinced that the data monitoring is generally improving, and we 

have appreciated the Department’s patience with our persistent data requests and questions. 

Thus, the figures we provide in this report reflect good-faith attempts to provide the most 

accurate data possible, albeit among a dynamic data management challenge. 

Finally, we note that these distinctions—those on ISC versus those who are not—may soon come 

to an end. As mentioned earlier, the Department has proposed a lump-sum fine payment for the 

next fiscal year. This would eliminate the labor-intensive process of managing ISC designations 

and reporting ISC data separately. This would return us to an era in which all parties are 

monitoring the full population of pretrial detainees without designating ISC (a designation 

relevant only to fines). Depending on further negotiations around this proposal, subsequent 

reports may need not address these ISC distinctions. But for the moment, these designations 

remain, and they shape the way we report data for the past quarter. 

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KEY METRICS FOR PROGRESS: 

COMPLIANCE WITH TIME FRAME REQUIREMENTS 

As prescribed in the Consent Decree, a primary focus of our quarterly reports must be the 

Department’s compliance with time frame requirements:

(i) As part of the duties, the Special Master shall provide the Court and the Parties with status 

reports ... Such reports shall address the Department’s compliance with the timeframe 

requirements of the Consent Decree concerning Competency Services and shall provide a 

detailed summary of information and recommendations the Special Master believes the Court 

and Parties should consider relating to the Department’s compliance with the Consent Decree 

timeframes concerning Competency Services. (Consent Decree p. 24)

(ii) The Special Master’s report shall include, but is not limited to, reporting on the number of 

Pretrial Detainees ordered to receive Competency Services, an assessment of the 

Department’s operations, systems, and admissions practices and policies relating to the 

Department’s ability to comply with the Consent Decree timeframes, and guidance to the 

Department for improvement and increasing efficiencies in these areas. 

Therefore, a primary focus of our review is the Department’s progress in meeting the time 

frames delineated in the Consent Decree. This includes both time frames for competence 

evaluation and for competence restoration. These will be the key metrics to gauge progress, so 

they are our starting point in the report, as well as a primary focus. Of course, performance in 

meeting these time frames depends greatly on enacting the other steps prescribed in the 

Consent Decree, so subsequent sections of the report review those steps in greater detail.

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KEY METRIC: COMPETENCE EVALUATION TIME FRAMES 

Again, many detainees are now designated by the Department as qualifying for Individual Special 

Circumstances (ISC) due to pandemic-related delays. We have requested that the Department 

report key metrics for both Pretrial Detainees on ISC and for those who are not. We report 

figures separately, beginning with those who are not on ISC. 

Waiting time (in days) for a competence evaluation among those not on ISC3

 

Nov 2020 

– Jan 2021 

Feb 

2021 

Mar 

2021 

Apr 

2021 

Ongoing Requirement 

Jail-based 

Competency 

Evaluations 

12.5 14.9 15.8 16.4 21 days

 

Inpatient 

Competency 

Evaluations 

 

10.9* 2.8* 3 N/A** 14 days

* = at least one defendant waited longer than the maximum time frame for the evaluation

**= this reflects that there were no admissions for inpatient evaluations in April

Court orders for jail-based competence evaluations had dropped to an all-time low during the 

Spring of 2020 (e.g., 56 people in April 2020), when the onset of the COVID-19 pandemic greatly 

decreased arrests. But arrests and orders for jail-based evaluations have resumed, and greatly 

increased, peaking at 159 in March of 2021 (a historic high). 

Fortunately, the Department’s Court Services unit has grown increasingly efficient and has for 

several months met all mandated time-frames for jail-based evaluations. Of course, this holds 

true only for those not on ISC; those delayed due to pandemic-related challenges are placed on 

ISC. The longer wait times for those on ISC awaiting evaluations are summarized below:

 

3 Information for both tables retrieved from the April 2021 Department’s Special Master Compliance Plan 

report, dated May 7, 2021, pp. 22-26. 

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Waiting time (in days) for a competence evaluation among those on ISC

 

Nov 2020 - 

Jan 2021 

Feb 

2021 

Mar 

2021 

Apr 

2021 

Ongoing 

Requirement 

Jail-based 

Competency 

Evaluations 

37.3* 47.5* 47.2* 30.3* 21 days

 

Inpatient 

Competency 

Evaluations 

81.7* 80.5* 71.4* 140* 14 days

* = defendants waited longer than the maximum time frame for the evaluation

As revealed in the ISC table above, those on ISC certainly wait longer than those not on ISC (after 

all, they are on ISC because of circumstances causing delays). Indeed, wait times for those on ISC

were sometimes double the maximum wait times the Consent Decree allows for jail-based 

evaluations. Fortunately, the wait times for jail-based evaluations have been decreasing among 

those on ISC. Moreover, the number of those awaiting evaluations on ISC has been decreasing, 

from 63 in January to 12 in April, 2021. More remarkably, the Department recently reported that 

there have been no detainees awaiting jail evaluations designated ISC in the past few weeks of 

May 2021. Thus, in this quarter, a substantial portion of pre-trial detainees who received 

evaluations in jail received them in compliance with established timelines. Another substantial 

portion—those designated ISC due to pandemic-related delays—received them much later. 

However, the latter group has been decreasing steadily, such that the Department reports in 

recent weeks all detainees ordered for a jail-based evaluation are evaluated in the established 

timeframe (i.e., 21 days). 

Regarding inpatient evaluations, the number of monthly referrals has varied greatly during the 

pandemic, and ranged from five to ten this quarter. Historically, although inpatient evaluations 

were completed well within mandated time frames, most were substantially delayed this quarter

due to COVID-19 precautions, including “cohort” admissions and a lengthy period in which 

CMHIP paused admissions altogether. Only six people this quarter were ultimately admitted for 

an inpatient evaluation at CMHIP. For the 8-9 detainees each month on ISC awaiting an inpatient 

evaluation, the wait times have increased from an average of 80 days in February to 140 days in 

April. In short, there are substantial delays for inpatient evaluations, for the same reasons there 

are substantial delays for inpatient restoration (described in later sections). 

This quarter in particular, we affirm the significant improvements among the Court Services unit 

as they have completed timely jail-based evaluations even amid COVID-19 challenges. However, 

it will be crucial to respond more rapidly to the few orders for inpatient evaluation. Indeed, 

those referred for inpatient evaluation are often referred this route because they appear to be 

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the most acutely ill, high-need detainees.

Orders for jail-based evaluations have increased steadily, not only exceeding pre-pandemic 

levels, but reaching an all-time high. Fortunately, pandemic-related barriers have decreased 

somewhat, making it more feasible for evaluators to enter jails, or at least continue evaluations 

via videoconference with fewer obstacles. The Department’s Court Services unit has continued 

to adapt and improve, such that they seem increasingly able to keep pace. Ultimately, jail-based 

evaluations this quarter were completed quite promptly for the slight majority not designated 

ISC, but completed more slowly for those that are ISC (usually those in jails with COVID-19 

outbreaks or protocols that make evaluations more difficult). Beyond the data reported for this 

quarter, very recent data (i.e., mid-May) suggests that the Court Services unit is now entirely in 

compliance with time frames for jail-based evaluations, with no detainees designated ISC as they 

await jail-based evaluations. For the few ordered to inpatient evaluation, however, the 

Department will need to find more creative ways to admit more promptly. Overall, we affirm this 

recent evidence of significant progress in jail-based evaluations, and are hopeful that next 

quarter’s data on jail-based evaluations will maintain the recently-reported perfect compliance. 

 

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KEY METRIC: TIME FRAMES FOR ADMISSION TO COMPETENCE RESTORATION 

Historical context: Historically, the Department often failed to provide prompt restoration

services; indeed, that was a primary reason for the litigation leading to the Consent Decree. In 

the months preceding the Triage system, defendants who were admitted for inpatient 

restoration treatment at CMHIP or RISE waited, on average, 71 days.4 Of course, this figure 

included all defendants referred for restoration, without distinction between those with more, 

versus less, acute needs. Since then, the Department launched on June 1, 2019 the Consent

Decree-mandated triage system,5 designed to prioritize the defendants with the most acute 

clinical needs (“Tier 1”) over those with less acute clinical needs (“Tier 2”). Currently, Tier 1 

defendants must receive services within 7 days of the competency hearing, whereas Tier 2 

defendants need not receive services for 35 days (per the January 2021 change in timeframe 

requirements). Upon initiating the Triage system, the Department achieved excellent adherence 

to the 7-day deadline for defendants designated as Tier 1. The wait times for Tier 2 defendants 

also improved, though they consistently exceeded the time frames prescribed in the Consent 

Decree. Still, despite persistent delays, wait times and the number on the waitlist were 

decreasing monthly. 

Current realities: Wait times for inpatient restoration increased throughout 2020 and persist 

currently, due primarily to the pandemic and the procedures used to limit infection and spread 

of the COVID-19 virus. Like the previous quarter, this past quarter showed greater failures to 

meet the Tier 1 or Tier 2 time frames. These delays are reflected in the tables below. The non-ISC 

Tier 1 and Tier 2 figures regarding wait times show full or nearly-full compliance with the 

timelines for admission to restoration services. However, like last quarter, these figures continue 

to reflect increasing ISC designations more than they reflect decreasing wait times overall. In 

other words, detainees are placed onto the ISC list before maximum wait time frames are 

reached, and then removed from ISC shortly before admission. So these short wait times reflect 

more of a shuffling of detainees on and off the Consent Decree Waitlist rather than the actual 

time spent waiting for admission. For example, an individual might be placed on the Consent 

Decree Waitlist for 10 days, transferred to the ISC list for several weeks, and then transferred 

back to the Consent Decree Waitlist 3 days prior to admission. The official waitlist figure would 

reflect a 13 day wait for that individual, but of course the actual wait would be far longer. Again, 

such a procedure is proper with respect to the ISC designation (which is solely related to 

calculating fines), but we emphasize these details because the procedure might otherwise 

suggest briefer delays than detainees are actually experiencing. 

 

4 Average waiting period November 2018 - April 2019, as calculated from data provided by the 

Department (see p. 7 of their April monthly report filed May 7, 2019).

5 See Consent Decree paragraph 43.

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The first two rows of the summary table below show Tier 1 and Tier 2 wait times for persons not

on ISC. The third row documents the far-longer wait times for persons categorized as ISC. As 

detailed in a later table (p. 17), the number of persons awaiting inpatient restoration designated 

as ISC exceeds those who are not placed on ISC. In short, those awaiting restoration comprise 

two populations: one for which the Department has control (non-ISC), and one for which the 

Department faces barriers largely beyond their control (ISC). As the pandemic has worsened, 

most are in the ISC category—and they face increasing delays in access to restoration services. 

 

Average Wait Times for Inpatient Competence Restoration Services

6

 

 

Nov 2020 - 

Jan 2021 

Feb 

2021 

Mar 

2021 

Apr 

2021 

January 2021 

Requirement 

July 2021 

Requirement 

 

Tier 1 

(not ISC) 

0.3 0* 10.5* 7* 7 days 7 days

 

Tier 2 

(not ISC) 

 

9.9* 10.1* 12.3* 14.1* 35 days 28 days

Tiers 

1&2 (ISC) 

61.7** 78.6** 87.5** 69.4** n/a n/a

* = at least one defendant waited longer than maximum time frame for restoration services

** = most defendants waited longer than maximum time frame for restoration services

Although we are unable to distinguish outcomes for Tier 1 versus Tier 2 defendants on ISC, it is 

clear that wait times are increasing. Further, although most people waiting for inpatient 

restoration are on the ISC list (the non-ISC categories have represented a smaller proportion of 

people waiting), the non-ISC list has increased rapidly since mid-April. Recall that a person 

waiting for inpatient restoration is placed on “ISC” only if an open bed exists but the Department 

is unable to admit them due to COVID-19 restrictions. Once all beds are accounted for, a 

detainee cannot be categorized as ISC. Not surprisingly, the number waiting for competency 

restoration increased most dramatically after CMHIP was forced to halt all admissions in 

November and in April. Since April, the “non-ISC” number has jumped dramatically, as wait times 

and numbers of people waiting increased exponentially while the hospital was unable to admit. 

Scores of beds still remain unoccupied at CMHIP and the RISE programs due to restricted 

admissions protocols. Compared to this time in 2020, twice as many detainees are waiting for 

restoration services, and they are waiting twice as long; we attribute these delays largely to 

pauses in admission to CMHIP, which are largely attributable to COVID-19 outbreaks in the 

 

6 According to the April 2021 Department’s Special Master Compliance Plan report dated May 7, 2021, 

pp. 9-11. 

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hospital and related infection-control quarantine procedures.

As the pandemic continues to slow admissions to CMHIP and RISE—even pausing them entirely 

for several weeks on two separate occasions—the number of people awaiting restoration, and 

their wait times, increased steadily. Persons designated as ISC now wait for months before 

admission. We anticipate that once CMHIP is allowed to admit patients again, wait times will 

decrease. The Department will continue to implement other strategies to reduce time and 

numbers for those on the waitlist, but the obvious reality is that admissions must resume and 

continue without pause in order to decrease the time detainees spend on the waitlist. 

 

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KEY METRIC: THE WAITLIST FOR COMPETENCE RESTORATION SERVICES 

Historical context: One key metric for gauging the Department’s progress is the waitlist for 

competence restoration services. The Consent Decree aims not only to reduce wait times for 

defendants, but also to reduce the number of defendants waiting at all. In the months before

launch of the Triage system, the waitlist averaged around 150 to 180 defendants. By June 2020, 

the number on the waitlist was just below 100. The decrease clearly reflected Department 

efforts, and the Department projected that the waitlist would be minimal by December 2020. 

Current realities: However, the pandemic reversed this trend beginning in July 2020. 

Transportation, admissions, and discharges across most facilities slowed or even stopped. CMHIP 

was forced to stop nearly all admissions for much of November and December 2020 and 

between early-April through May. Meanwhile, orders for competency evaluations and 

restoration have resumed to the point that they now exceed pre-pandemic levels. This is the 

challenging context for waitlist data we present in this section. 

Again, we distinguish Pretrial Detainees not on ISC status from those placed on ISC. Only persons 

who are not on ISC technically remain on the formal waitlist (as defined in the Consent Decree, 

for purposes of calculating fines). However, a larger number of defendants have been placed on 

ISC and, practically speaking, continue to wait for services. 

 

Number of Defendants Waiting for Inpatient Restoration7

 

 March 2019 Jan 2021 Feb 2021 Mar 2021 Apr 2021 

Combined 157

Tier 1 (no ISC) N/A 0 0 7 5

Tier 2 (no ISC) N/A 131 103 128 147

Tiers 1&2 (ISC) N/A 196 175 160 160

+ Non-ISC numbers reflect the number of persons waiting for restoration services on the last day of the respective 

month. ISC numbers reflect the number of persons waiting for restoration at any point within that month. 

As mentioned previously, the number of people designated as ISC and awaiting inpatient 

restoration has remained high for each of the past three months. Because the ISC number 

reflects the total number of persons placed on ISC at any time during the month, the total 

number of people waiting at any point in time cannot be calculated perfectly from monthly 

 

7 According to the April 2021 Department’s Special Master Compliance Plan report dated May 7, 2021, 

pp. 9-11 as well as our calculations of compiled data from non-compliance reports provided at the end of 

each week. 

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compliance report data. After accounting for the number of people removed from the ISC list in 

April, we estimate that at the end of April 2021, approximately 268 detainees were awaiting 

competency restoration services. This reflects an all-time high. The majority of those waiting 

have been placed on ISC at some stage, indicating that barriers beyond the Department’s control 

(the pandemic) prevent them from promptly accessing inpatient restoration services at CMHIP. 

Similar to our concerns about the length of time detainees spend on the waitlist, we see no 

appreciable improvement in the number of detainees on the waitlist until admissions can 

resume. As of the writing of this report, more than 100 beds remain unoccupied at CMHIP and 

the various jail-based competency restoration programs due to infection control protocols. Once 

admissions resume, and these beds can be filled, we anticipate that the waitlist number will 

decrease sharply within several weeks. Then, however, decreases will occur more slowly as they 

will depend on bed turnover (i.e., which depends on those in the hospital attaining competence 

and being discharged from the hospital). 

Fortunately, as we review the documented updates on each person on ISC awaiting restoration 

weekly, we see clearly that CMHIP is prioritizing admission for persons who are either Tier 1 or 

who have shown acute decompensation after being classified as Tier 2. We affirm the 

Department’s efforts in prioritizing for admission those detainees who are most acutely ill and 

most urgently in need of services. 

Given the substantial delays caused by pauses in admissions at CMHIP, we have increasingly 

urged the Department and CMHIP to consider greater flexibility in their quarantine and 

infection-control procedures. CMHIP, in turn, has conveyed that they essentially have no 

flexibility because they are bound by the directives of another agency: the Colorado Department 

of Public Health & Environment (CDPH&E). CMHIP leadership routinely asks CDPH&E for greater 

options in quarantine strategies, and CDPH&E reportedly declines, or allows only very limited

and stringent options. All parties recognize the importance of adequate COVID-19 infection 

control and public safety procedures, but we also grow increasingly concerned about the public 

health problems of detainees with psychiatric illness becoming more symptomatic in jail as they 

await hospital services. Therefore, we (Special Masters) submitted a memo to CDPH&E asking 

them to consider greater flexibility in safety procedures at CMHIP to balance the competing 

public safety crises we face. See Appendix A for this memo.

Unfortunately, the number of people waiting in jails for restoration services has hit historic highs 

due to delays and barriers attributable to the pandemic. Although inpatient capacity has 

increased, few individuals were admitted within the time frames identified in the Consent 

Decree because of pandemic-related impediments to transportation, admission, and discharge. 

Pauses in admissions to CMHIP have been particularly disastrous for the waitlist. Without 

admissions resuming, and continuing steadily, the waitlist will inevitably increase. Fortunately, 

the number of Tier 1 (i.e., acutely ill) persons waiting for restoration services is much smaller 

than the number of Tier 2 individuals waiting, their wait times are shorter, and the Department 

continues to prioritize those Tier 1 persons for admission. 

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CONSENT DECREE SECTION VI UPDATES 

ADMISSION OF PRETRIAL DETAINEES8 FOR INPATIENT COMPETENCY EVALUATIONS 

AND RESTORATION TREATMENT 

33. (a) Admission of Pretrial Detainees for Inpatient Competency Evaluations and Restoration 

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

Restoration Treatment or Inpatient Competency Evaluations pursuant to the attached table (Table 1). 

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

Pretrial Detainee. 

The Consent Decree prescribes the following time frames for admitting defendants to inpatient 

competence restoration and for performing competence evaluations.

9

 Admission time frames 

shorten every six months, with a recent reduction in January 2021, and the next in July 2021. 

 

 

Deadlines 

Tier 1: Maximum 

Time to Offer 

Admission for 

Inpatient 

Restoration 

Tier 2: Maximum 

Time to Offer 

Admission for 

Inpatient 

Restoration 

Maximum Time to 

Offer Admission for 

Inpatient 

Competency 

Evaluations 

Maximum time to 

Complete Jail 

Competency 

Evaluations 

June 1, 2019 7 days 56 days 21 days 28 days

January 1, 2020 7 days 49 days 21 days 28 days

July 1, 2020 7 days 42 days 14 days 21 days

January 1, 2021 7 days 35 days 14 days 21 days

July 1, 2021 7 days 28 days 14 days 21 days

As summarized earlier, the Department has generally attained, or come close to, formal 

compliance with all evaluation timeframes for the past several months. But this applies only to 

those detainees not designated ISC; the many detainees designated as ISC tend to wait beyond 

the prescribed time frames.

 

8 “Pretrial Detainee” means a person who is being held in the custody of a County Jail and whom a court 

has ordered to undergo competence-related services (i.e., competence evaluation or restoration 

treatment). Persons serving a sentence in the Department of Corrections and juveniles are excluded from 

this Consent Decree.

9 Fine amounts are tied to delays beyond each of the time frames listed. However, these fines are not 

applied for pretrial detainees designated ISC. 

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Wait Times for Inpatient Evaluation 

Inpatient evaluations are fairly rare, compared to the typical practice of jail-based evaluations. 

Judges typically order an inpatient evaluation only when the defendant appears obviously ill and 

in need of urgent admission (rather than waiting for an evaluation to determine whether they 

must be admitted for restoration). The Department was generally successful in timely admission 

for inpatient competence evaluations before the COVID-19 era, but significantly exceeded 

timeframes during many of the months thereafter. As detailed below, the number of pretrial 

detainees not on ISC admitted for an inpatient competence evaluation have been quite low, and 

yet they often still wait well beyond mandated time frames. 

 

Recent Wait Times for Inpatient Evaluation for Persons not on ISC10 

 

Month Number “admitted or 

ended” for inpatient 

evaluation11 

Average days waited 

prior to admission to 

CMHIP or RISE 

 

People who waited more 

than 14 days 

Apr 2021 2 (1 admitted)12 0** 0

Mar 2021 6 (1 admitted) 3 0

Feb 2021 6 (4 admitted) 2.8* 1

Nov 2020 – Jan 2021

average

 

8.7 10.9* 8

March 2019 total 18 16.4 1

* = at least one defendant waited longer than maximum time frame for inpatient evaluation services

**= This 0 does not indicate the one person admitted actually waited zero days. Rather, that person was originally 

designated ISC, but then was designated non-ISC once admitted.

 

10 According to the April 2021 Department’s Special Master Compliance Plan report for January, dated 

May 7, 2021, pp. 16-17.

11 This column reflects the number of pretrial detainees admitted to either CMHIP or RISE for an inpatient 

competency evaluation, bonded out, or had their cases dismissed. Recently, this figure has featured very 

few actually “admitted” and far more orders that were “ended” for other reasons. 

12 Actual admission figures according to the April 2021 Department’s Special Master Compliance Plan 

report for January, dated May 7, 2021, p. 19

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As mentioned previously, the Department is now separating data for Pretrial Detainees who are 

on ISC versus those who are not. Thus, the wait times for those who are on ISC is below: 

 

Recent Wait Times for Inpatient Evaluation for Persons on ISC13 

 

Month Number “removed 

from ISC list for 

inpatient 

evaluation”14 

Average days waited 

prior to admission to 

CMHIP or RISE 

 

People who waited more 

than 14 days15 

Apr 2021 1 140* Not reported

Mar 2021 7 71.4* Not reported

Feb 2021 2 80.5* Not reported

Nov 2020 – Jan 2021

average

 

5.3 81.7* Not reported

March 2019 total 18 16.4 1

* = at least one defendant waited longer than max time frame for inpatient evaluation services

Generally, the past quarter featured increases in referrals for inpatient competence evaluations, 

but far fewer actual admissions for those evaluations. This almost certainly occurred because

CMHIP was forced to pause admissions and discharges due to a significant COVID-19 outbreak. 

Clearly, these delays leave detainees waiting longer for inpatient evaluations, with the most 

recent individual admitted having waited 140 days (far longer than wait times before the 

pandemic, or even during earlier months of the pandemic).

 

13 According to the April 2021 Department’s Special Master Compliance Plan report, dated May 7, 2021, 

pp. 16-17.

14 This figure reflects those “removed from the list for inpatient competency evaluations” per April 2021 

Department’s Special Master Compliance Plan report, dated May 7, 2021, p. 17. While this figure includes 

actual admissions, it appears that recently, most of these individuals are “removed from the list” for 

reasons other than actual admission. We are working with the Department to better understand the 

outcomes for the large majority of this group, given their account of only one inpatient competency 

evaluation this month. 

15 The Department has not provided this data. 

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We also continue to monitor the clinical appropriateness of those court-ordered admissions. 

That is, we track how many of the defendants ordered for inpatient evaluation actually met the 

strict criteria for involuntary hospitalization (C.R.S. § 27-65-105).

16 The Department reported that 

during the past 3 months, five of the six admission for inpatient evaluation did indeed meet the 

strict “27-65” criteria for involuntary hospitalization.

17 This 83% rate of evaluation admissions 

that met criteria for involuntary admission is generally a good (albeit crude) metric for the 

appropriateness of inpatient evaluation. That is, almost all of the six individuals admitted for 

inpatient evaluation required urgent hospitalization. The concern, of course, is that some of 

those urgently needing hospitalization waited weeks or months to receive it. This is precisely the 

problem the Consent Decree was designed to address, but pandemic-related complications have 

undermined progress.

Generally, the past quarter featured somewhat fewer referrals for inpatient competence 

evaluations, and far fewer admissions for those evaluations. Wait times are especially long for 

persons on ISC status, peaking at 140 days in April. The same pandemic-related delays that 

interfere with hospital admissions for restoration have also interfered with hospital admissions 

for inpatient evaluation. These have caused a regression after meaningful progress in prepandemic quarters. 

 

16 C.R.S. § 27-65-105: (1) Emergency procedure may be invoked under either one of the following two 

conditions:

(a)(I) When any person appears to have a mental health disorder and, as a result of such mental health 

disorder, appears to be an imminent danger to others or to himself or herself or appears to be gravely 

disabled, then an intervening professional, as specified in subsection (1)(a)(II) of this section, upon 

probable cause and with such assistance as may be required, may take the person into custody, or cause 

the person to be taken into custody, and placed in a facility designated or approved by the executive 

director for a seventy-two-hour treatment and evaluation...

(b) Upon an affidavit sworn to or affirmed before a judge that relates sufficient facts to establish that a 

person appears to have a mental health disorder and, as a result of the mental health disorder, appears 

to be an imminent danger to others or to himself or herself or appears to be gravely disabled, the court 

may order the person described in the affidavit to be taken into custody and placed in a facility 

designated or approved by the executive director for a seventy-two-hour treatment and evaluation. 

17 From the CDHS Monthly Compliance Plan Report dated February 8, 2021, p. 21.

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Wait Times for Inpatient Restoration 

Regarding wait times for inpatient restoration at CMHIP, the Consent Decree established a twotier triage system that prioritizes defendants with the most urgent clinical needs (Tier 1) with an 

admission deadline of 7 days. The maximum timeframe for those with less urgent needs (Tier 2) 

decreased to 35 days as of January 1, 2021. It will decrease to 28 days on July 1, 2021. 

As in previous sections, we separate data for persons not on ISC status versus those persons on 

ISC. 

 

Recent Wait Times for Inpatient Restoration for Persons not on ISC list 18 

Month Number “admitted or 

ended” for inpatient 

restoration 

Average days waited 

before “admitted or 

ended” on inpatient 

restoration order 

People who waited more 

than the max days for 

admission to CMHIP 

inpatient restoration 

 

Tier 1 Tier 2 Tier 1 Tier 2 Tier 1 Tier 2

Apr 2021 3 53 5.7 14.1 1 51

Mar 2021 15 55 11.9 12.3 11 30

Feb 2021 12 65 2.5 10.1 2 0

Previous Quarter 

Monthly Average

(Nov 20 – Jan 21)

11 51 1.8 9.9 0 2

March 19

(before tier 

distinctions)

44 58.2 31

Again, the above table data includes only that minority of pretrial detainees not on ISC, a small 

subset of the total population awaiting inpatient restoration services. Wait times appear to be 

reasonable, but these figures represent only the amount of time spent on the waitlist – not the 

time spent on ISC (which is substantial, as reflected in the next table). There is some overlap in 

the detainees represented in the two tables. Further, recall that wait times are ended at 

 

18 According to the April 2021 Department’s Special Master Compliance Plan report, dated May 7, 2021, 

2021, pp. 9-11 and corrected data provided via email from OBH dated May 27, 2021. 

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admission to CMHIP or RISE, or when ended for other reasons (i.e., a case is dismissed or the 

court changes an order for inpatient restoration to an order for outpatient restoration when onbond in the community). For example, among 56 “admitted or ended” in April 2021, only 3

defendants were actually admitted to an inpatient facility. The others were either dismissed, 

vacated, or placed on bond.19 Actual admissions to CMHIP remained nearly paused, and may 

remain slow until pandemic-related admission protocols change. 

The following table describes persons on ISC status: 

 

Recent Wait Times for Inpatient Restoration for Persons on ISC list20 

Month Number of people waiting for 

admission to inpatient 

restoration (Tiers 1&2) 

Average days waited before “admitted or 

ended” 

Apr 2021 160 69.4

Mar 2021 160 87.5

Feb 2021 176 78.6

Previous Quarter 

Monthly Average

(Nov 20 – Jan 21)

175 60.4

Recall that the Department began placing many defendants on the ISC list in Summer 2020 as a 

result of delays caused by the pandemic. Overall, the number of people waiting on ISC has risen 

from a quarterly average of 40 (May – July 2020) to 160 at the end of April 2021. Wait times for 

those on ISC have also increased, from 46 days to a current average of 69 days. These large 

numbers coincide with the pause admissions at CMHIP and RISE in November-December 2020 

and in April-May 2021. The numbers also increased as a result of the record number of orders 

for competency evaluation and restoration in March and April of 2021. 

 

19 To be clear, these latter outcomes are often good outcomes. In many cases, they reflect FST efforts to 

arrange robust outpatient services for detainees whom may not need intensive inpatient services. This 

tends to decrease wait times, and preserve inpatient resources, for the detainees who need them most. 

But we emphasize this distinction to make it clear that the Department’s “admitted or ended” 

designation has recently included far more “ended” than “admitted.” 

20 According to the April 2021 Department’s Special Master Compliance Plan report, dated May 7, 2021, 

pp. 9-11.

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So, while the first table shows significant compliance with Consent Decree time frames, the 

overall population of persons waiting for inpatient restoration also includes persons on ISC—and 

the ISC population is not only substantially larger than the former population, but is also 

experiencing significant delays. In short, the actual number of people waiting in jail for inpatient 

restoration services continued to climb, with most persons placed on ISC status. We do not 

anticipate a change in this trajectory unless robust admissions resume at CMHIP. 

As mentioned previously, we attribute most of these increasing delays and waitlist numbers to 

the extended pauses in admission at CMHIP, mostly required by CDPH&E. Please see the memo 

to CDPH&E in Appendix A outlining our concern and recommendations regarding this issue. 

The numbers of people ordered to inpatient restoration have grown over the past several 

months, and their average time to admission far exceeds Consent Decree time frames. Both the 

number of people waiting for restoration services—and the time they spend waiting—have 

increased substantially this past quarter. Extended pauses in admissions to CMHIP and the jailbased restoration settings are largely responsible for these increases, though March and April of 

2021 also saw record numbers of orders for both evaluations and restorations, which increases 

the demand on an already-slowed system. 

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PERFORMANCE OF JAIL COMPETENCY EVALUATIONS 

33. (b) Performance of Jail Competency Evaluations. The Department shall complete all Jail 

Competency Evaluations of a Pretrial Detainee pursuant to the attached table (Table 1), after the 

Department’s receipt of a Court Order directing the evaluation and receipt of Collateral Materials. 

This timeframe requirement shall apply to the following counties: Adams, Alamosa, Arapahoe, 

Boulder, Broomfield, Crowley, Custer, Denver, Douglas, El Paso, Elbert, Fremont, Huerfano, 

Jefferson, Larimer, Mesa, Otero, Pueblo, Teller, and Weld. 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 Department’s receipt of the 

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

meeting. Beginning January 1, 2020, counties utilizing the Hold and Wait Evaluation process will be 

offered a meeting date within 30 days of the Department’s receipt of the Court Order and Collateral 

Materials, and the evaluation will be completed within 14 days of the meeting. 

The mandated time limit for jail-based evaluation decreased from 28 days to 21 days on July 21, 

2020, per the Consent Decree. 

Historical context: Recall that timely competence evaluation was a relative strength of the 

Department until around November 2019, when performance deteriorated substantially. Many 

jail-based evaluations then exceeded the 28-day time frame—reaching a peak of delays in 

January 2020 (46%)—as we have described in prior reports. Even through much of Spring 2020, 

roughly 30% of jail-based evaluations exceeded the 28-day time frame, peaking again at 39% in 

May of 2020. 

During the summer of 2020, referrals for jail-based evaluations began to increase towards typical 

levels, setting the stage for what could have been a severe backlog. To their credit, however, the 

Department continued to make steady improvements to Court Services over the past year. The 

new Court Services Director, Amanda Edwards, overhauled case assignment procedures and 

other administrative steps in ways that increase efficiency. The Department has hired new 

evaluators and contractors, increasing compensation for both. The new workforce was, in our 

view, sufficient to complete incoming jail-based evaluations and even reduce the backlog under 

routine circumstances. Of course, the COVID-19 pandemic has posed a new and unexpected 

challenge to timely evaluations. 

Current realities: As Court Services improved, far fewer pretrial detainees waited in jail for 

evaluations beyond the required timeline (less than 10% in the Fall of 2020), and for the past 

two quarters delays were limited to those designated ISC. Of course, jail-based evaluations this 

quarter have remained greatly constrained by the pandemic. The perfect compliance in the past 

two quarters does not include individuals designated ISC, of course. The vast majority of those 

on ISC have been waiting longer than the required 21 days for their evaluations. The average 

wait time for this group increased for most of the past two quarters, from 34 days in November 

to 47 days in March, then decreasing to 30 in April. However, very recent developments suggest 

greater improvements. 

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First, in our view, the greatest factor in the many ISC designations for jail-based evaluations was

the Denver County Jail. Although other “outbreak” jails that still prohibited all visits, Denver is 

the largest (i.e., the site with more competency-involved defendants than any other) and the 

most challenging. For months, Denver Jail allowed only one evaluation per day, ensuring the 

backlog continued. Ultimately, the Department continued efforts to persuade the jail to change 

policy, and/or identify alternate creative solutions, until they were successful. Denver Jail 

eventually allowed for more evaluations, and the delays decreased. 

Second, perhaps due largely to the changes at the Denver Jail, the past several weeks (data 

more recent than the February – April data covered in this report) reveal virtually no detainees 

designated ISC as they await evaluations in jail. Furthermore, the Department reports that they 

have very recently been accomplishing all evaluations within the designated time frames. That is, 

there are no detainees designated ISC and waiting longer than allowed. The Department’s 

progress on jail-based evaluations is particularly remarkable given the rate at which court orders 

for evaluation have been increasing steadily, and peaked this quarter at historic highs (i.e., up to 

159 defendants referred in March).

Current Status and Foreseeable Future: The Department’s Court Services unit may well be able to 

maintain their very recent progress (i.e., compliance with time frames, even without ISC 

designations), even amid increasing orders for evaluation. The concern, of course, is that each 

aspect of the competency system is interconnected; their improved progress on jail-based 

evaluations will inevitably lead to more defendants referred for restoration services and further 

strain on inpatient admissions. 

Amid increasing challenges due to the pandemic, the Department’s Court Services unit has 

generally improved and pursued creative solutions to pandemic-related barriers to evaluations. 

Though many detainees were at times designated ISC and waited longer than timelines allow, 

services appear to be improving, largely because barriers in the large Denver Jail have been 

resolved. Indeed, recent weeks have witnessed timely evaluations and no ISC designations. Thus, 

we anticipate this quarter will feature timely responses even to the increasing court orders for 

jail-based evaluations.

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INTERIM JAIL MENTAL HEALTH TREATMENT21  

34. Interim Jail Mental Health Treatment. If the court does not release the Pretrial Detainee to 

Community-Based Restoration Treatment and the Pretrial Detainee is awaiting receipt of Inpatient 

Restoration Treatment, the Department shall work with the County Jails to develop a program to 

assist in the provision of coordinated services for individuals in accordance with C.R.S. §§ 27-60-105 

et seq. to screen, treat, assess, and monitor for triage purposes Pretrial Detainees in the least 

restrictive setting possible. This paragraph does not toll or otherwise modify the Department’s 

obligation to Offer Admission to the Pretrial Detainees for Inpatient Restoration Treatment. Interim 

Jail Mental Health Treatment shall not replace or be used as a substitute for Inpatient Restoration 

Treatment but does not preclude the Department from providing Restoration Treatment. A member of 

the Forensic Support Team shall report to the Court Liaison every 10 days concerning the clinical 

status and progress towards competency of the Pretrial Detainee. 

Historical context: As detailed in prior reports, the Department is required to partner with county 

jails to develop a program of coordinated services for incarcerated individuals involved in 

competency matters. The Department utilizes Jail-Based Behavioral Services (JBBS) as a hub for 

coordinating these subcontracted services across Colorado. These providers are tasked with 

providing adequate mental health services to inmates involved in competency matters until their 

transfer to competency restoration services. 

Current realities: The pandemic continues to highlight the importance of the JBBS teams around 

the state. Although services can differ substantially among JBBS teams in different jails, those 

teams remain the primary frontline mental health workforce for pretrial detainees. FST 

Navigators provide extra layers of verification, assurance, and collaboration, but most direct 

services are provided by JBBS staff. In addition, in the jails on outbreak status, the JBBS teams 

provide information to the FST Navigators because Navigators are prohibited from entering most 

jails on outbreak status. 

This quarter, the Department has attempted to respond to pandemic-related challenges in 

several ways. First, the FST Navigators continued to meet and communicate with pretrial 

detainees and their multi-disciplinary teams remotely. The FST continued to identify persons in 

most acute need, and they worked with CMHIP and JBBS to enhance mental health services and 

facilitate discharges to hospitals when necessary. 

Private hospital contracts increased inpatient restoration options in the Denver metro area, but 

those beds are fines-funded and are better suited for acute crisis management than longer-term 

restoration. Unfortunately, transferring individuals in acute crisis to inpatient care continued to 

be unusually difficult during this past quarter, largely due to pandemic-related barriers. Primarily, 

 

21 “Interim Jail Mental Health Treatment” means mental health treatment of a Pretrial Detainee that is 

performed in the County Jail where the Pretrial Detainee is held while the Pretrial Detainee awaits 

Community-Based or Inpatient Restoration Treatment per Court Order consistent with the time frames in 

the Consent Decree. It is not a substitute for competency restoration services. 

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CMHIP was unable to admit any patients during most of April and well into May. Additionally, 

emergency mental health holds in local jails continued to be challenging, with barriers regarding 

payment and transportation preventing most attempted admissions. FST Navigators worked with 

JBBS teams to find alternative solutions to inpatient care where possible.

We (the Special Masters) continued to review the weekly list of notes pertaining to each person 

on the on the ISC list awaiting inpatient restoration services. The list has expanded to more than 

200 detainees due to the delays described earlier in this report. Still, we remain generally 

satisfied with the Department’s attention to those who appear to be most vulnerable. We 

highlight individuals that appear particularly vulnerable as well as systemic issues that affect 

larger groups of people awaiting competency services; we then provide these highlights to OBH 

Forensic Services, DLC, and the fines-retained Legal Advocate as warranted. We have been 

pleased with the responses from OBH. Still, regardless of our efforts and those of the FST, the 

substantially limited options for treatment and transfer cannot be considered adequate for 

necessary services over the long term. 

The Department continues to explore avenues for both reducing wait times and reducing risks 

for those on the waitlist. The Forensic Support Team continues to work with existing programs 

(CBER, Restoration Housing, CREST Housing, Momentum, OCRP) to accept detainees from the 

inpatient restoration waitlist who may actually be more suitable for outpatient restoration and 

supportive services. In addition, the FST continues to work with several fines-funded efforts 

designed specifically to mitigate the impact of COVID-19 in local jails. These include Restoration 

Housing, new contracts with Denver Health to provide inpatient hospital beds, the CREST 

program, and an interim jail-based restoration program within Denver County Jails (the latter 

two programs are described later in this report).

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RELEASE OF PRETRIAL DETAINEES FOR COMMUNITY-BASED RESTORATION 

TREATMENT22 

35. Release of Pretrial Detainees for Community-Based Restoration Treatment. If the court releases 

the Pretrial Detainee on bond to commence Community-Based Restoration Treatment, the 

Department shall coordinate with the Court Liaison to develop a discharge plan (in a format approved 

by the Special Master) within seven days of the order to all parties involved in the Community-Based 

Services Recipient’s case, and the Court Liaison and community-based provider. 

The Department has continued to pursue the requirement to develop discharge plans for 

persons identified as appropriate for Outpatient Competence Restoration programming (OCRP) 

even amid the COVID-19 pandemic. While discharges from jails and hospitals were limited during 

this past quarter due to pandemic-related barriers, the Department continued their efforts in 

four main areas:

23

1. Housing Initiatives: The fines-funded Restoration Housing (formerly labeled Fusion

Studios) continues to serve as a primary outlet for some defendants. In short, while still 

unrestored, these individuals have shown clinical improvements and minimal public 

safety risk, making them appropriate for transition from jails or CMHIP to Outpatient 

Competence Restoration programming (OCRP) with dedicated residences at the 

Restoration Housing facility. At the time of this writing, the Forensic Support Team (FST) 

has coordinated 130 completed referrals for Restoration Housing, and 35 individuals 

have been placed there. Restoration Housing is finally full, and the project is described 

later in this report. 

Additionally, the CREST Housing initiative launched in December 2020. This fines-funded 

project provides an additional 25 housing beds in various locations across the Denver 

metro area for the persons adjudicated as incompetent to stand trial. It also provides 

intensive case management and crisis services for persons housed in the program. As 

with other new programs, this has launched more slowly than we hoped, but it has 

admitted at least a dozen individuals to date, and we anticipate it will reach full capacity.

 

22 “Community-Based Restoration Treatment” means Restoration Treatment of a Community-Based 

Recipient that is ordered to be performed out of custody and in conjunction with a community-based 

mental health center or community organization.

23 In previous reports w have reported on an effort sometimes labeled “Fast Track,” an effort to more 

rapidly identify those who were receiving restoration in CMHIP and may have restored to competence 

before their next scheduled evaluation. The program was temporarily sidelined during this past quarter 

due to the prioritization of pandemic mitigation efforts at CMHIP. The primary benefit of Fast Track is 

opening beds otherwise taken by persons who appear to have restored to competence. At the time of 

this writing, more than 80 beds remain open at CMHIP (due to delays attributable to quarantine 

procedures), and so we certainly understand CMHIP postponing rigorous implementation and monitoring 

of the Fast Track program until their census is again full. 

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2. Forensic Support Team (FST): The FST team has historically focused on incompetent 

defendants either in jails or in CMHIP. FST Navigators have monitored clinical status and 

restoration progress for those in jails awaiting transfer to CMHIP—primarily defendants 

who have been categorized as Tier 2 and therefore waiting longer for admission. Their 

day-to-day efforts include, for example, securing emergency mental health holds and 

transfers for detainees who are decompensating, or coordinating discharge and OCRP 

plans for detainees that have stabilized while in jail. They also trigger re-evaluations of 

competency (for defendants who appear to have become less symptomatic while waiting 

in jail), provide updates to attorneys and courts, and identify detainees who might be 

eligible for the many specialized programs (e.g., community housing and services). We 

affirm this important work. FST Navigators are currently assigned to 836 individuals 

across Colorado, including 297 persons in jails, and the remainder in hospitals or

community settings. For individuals awaiting restoration services this quarter, the FST has

logged a total 135 face-to-face contacts with defendants in jail, 5,978 contacts with care 

teams or stakeholders, coordinated more than 100 referrals to outpatient settings, and 

intervened with 90 individuals in crisis situations.

24 For persons awaiting competency 

evaluations, the FST recorded a total of 67 face-to-face contacts and 2,019 contacts with 

care teams or other stakeholders. The FST director estimates that 790 bed days at CMHIP 

have been “saved” through the efforts of the FST during this quarter, through diversion, 

early release from CMHIP, advancing court dates, advocating for dismissal of minor 

charges, and so on. The FST director also estimates that 3,958 CMHIP bed days have 

been saved since January 2020. 

After an extended period of restricted access, about half of Colorado’s county jails have 

reopened their doors to allow FST Navigators to meet with detainees in person. Through 

a combination of face-to-face visits, telephone calls, and video updates, Navigators 

continue to identify and mitigate the most acute mental health crises. Between February 

and April 2021, for example, 90 Pretrial Detainees were identified as decompensating 

and in need of urgent, intensive mental health care; these defendants received enhanced

clinical services and monitoring, with some transferred to CMHIP and others referred for 

additional supports. A total of 23 Pretrial Detainees were transferred to a hospital setting 

for acute care—either CMHIP or local hospitals. Of course, the tight restrictions on 

CMHIP admissions have made transfers to CMHIP extremely difficult since mid-April. The

FST has become the primary source of information and intervention for these detainees, 

and we believe they identify and mitigate the most acute mental health crises among

pretrial detainees statewide. Navigators also continue to facilitate transfers and 

placements to various settings affiliated with OBH’s outpatient competency restoration 

program (OCRP). 

 

24 According to the Department’s April 2021 Special Master Compliance Plan report dated May 7, 2021, 

pp. 47-49 and analogous sections in previous monthly compliance reports. 

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The Department also continues to coordinate crisis and case management services with 

the State of Colorado’s Transition Specialist Program and the “Momentum” Program. 

Since early 2020, FST has referred a total of 200 persons to the Momentum Program. A 

total of 110 clients have been accepted into the program and assigned a case manager, 

with 56 active current clients—persons who would have otherwise likely remained in 

county jails or CMHIP. 

As mentioned previously, FST Navigators also coordinated the transition of at least 35

Pretrial Detainees into Housing Initiatives. In addition, the FST is working with a local 

Colorado veteran’s program to secure additional releases and community supports for 

veteran Pretrial Detainees (22 clients have been linked with V.A. services to date), and 

work continues in transitioning appropriate Denver Pretrial Detainees to the CommunityBased Enhanced Restoration program (CBER; discussed below). 

Finally, FST Navigators have begun identifying persons on the waitlist who may have 

restored to competency during their waits in jail. As the wait times increase, some 

detainees receiving medication and other services may have indeed stabilized to the 

point of being restored to competency, even without accessing formal restoration 

services such as education on court proceedings. We agree with the Department and DLC 

that these individuals should be formally re-evaluated by Court Services to determine 

their updated competency status. As a result, FST Navigators have begun identifying and 

referring those detainees that appear to have demonstrated extended stability for reevaluation, after coordinating with defense attorneys, JBBS staff, and others. To date, 

two individuals have been re-evaluated while in jail and opined as restored; 

approximately one dozen others appear to be ready for similar re-evaluations. 

3. Coordination with the Bridges program: As mentioned in previous quarterly reports, the 

Bridges Court Liaison Program and FST must work together to facilitate discharges and 

share responsibilities for competency-related cases. They both rely on similar (partially, 

but not entirely, overlapping) bodies of information. Thus, the Department and the 

Bridges team have been actively working to coordinate services, so that they can 

collaborate in a way that minimizes redundancies and gaps. The percentage of OBH 

competency cases assigned to a Bridges liaison has increased to 44%—the largest 

percentage reported to date. Generally, the two programs have collaborated efficiently, 

though there are occasionally instances of confusion or disagreement, including recently. 

Generally, we have been pleased with the Department’s response to challenges and their 

ongoing efforts to collaborate. 

4. CBER (Community-Based Enhanced Restoration): The CBER program is a pilot program 

based in Denver that provides enhanced mental health and case management services to 

a community-based restoration program. OBH is funding the program and has contracted 

Mental Health Center of Denver to provide the wraparound and restoration services. 

Participants are drawn from metro-area county jails; Tier 2 individuals are targeted for 

inclusion. To date, 26 individuals have been placed into the program, with approximately 

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7-12 individuals in the program at any one time. Funding exists for a total of 30 

concurrent participants, so all parties have been concerned that the program is 

underutilized. 

We requested that the fines-funded Legal Advocate (see p. 39 for more information 

about this position) research some of the barriers that CBER has encountered at the 

judiciary to help determine viability of the program. She reported, after a thorough 

review, that barriers appeared to be related to lack of housing options, lack of visibility 

and knowledge of the program, a restriction in eligible charges, and an inefficient referral 

process. Among judges and attorneys who had made use of the program, she reported, 

reviews were quite positive. The Department reported that low referrals may be 

attributable to the short length of time the program has been in operation (less than one 

year) and the impact of COVID-19 on referrals and community resources. Given the 

Department’s continued optimism for the program’s viability, and their interest in 

responding to the barriers reported by the Judiciary, all parties agreed to continue the 

project well into 2021. 

Since then, the Department worked with stakeholders to make some detainees with 

more serious (though still lower-level) charges eligible for the program, and authorized 

FST Navigators to make referrals directly to the program, rather than rely solely on 

defense counsel to make referrals. These changes appear to have prompted increased 

referrals to CBER already. Though the program is still not at full capacity, it has 

experienced greater referrals and admissions than at any prior point. We will continue to 

monitor the effect of these changes on CBER enrollment and outcomes, but we are 

optimistic this marks a shift towards greater utilization of a potentially valuable program. 

 

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TRANSPORTATION OF PRETRIAL DETAINEES 

36. Transportation of Pretrial Detainees. If a Pretrial Detainee is transported to the Hospital for an 

Inpatient Competency Evaluation and the Department or a medical professional opines that the 

Pretrial Detainee is incompetent and the provisions of C.R.S. § 27-65-125 have been met, the 

Department shall not transport the Pretrial Detainee back to his/her originating jail. 

Over the past quarter, six defendants were admitted to CMHIP for inpatient competency 

evaluations, with five of those meeting C.R.S. § 27-65-125 criteria, according to hospital staff.

25

This number of admissions aligns with totals from prior quarters (1, 6, and 8 for prior quarters). 

Most admissions occurred in February and March, before inpatient admissions were halted at 

CMHIP. Even so, wait times for inpatient competency evaluations far exceeded Consent Decree 

time frames, with most admissions taking more than three months to occur. The Department 

has not indicated any other delays or barriers to transportation with jails around Colorado. 

 

 

25 According to the April 2021 Special Master Compliance Report dated May 7, 2021, pp. 17-19. 

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NOTIFICATION OF NON-COMPLIANCE WITH TIME FRAMES 

38. Notification of Non-Compliance with Timeframes. The Department shall notify the Special 

Master and DLC weekly regarding any non-compliance with timeframes. 

(a) Only one notice per Pretrial Detainee shall be provided and should include: (i) The name of the 

Pretrial Detainee; (ii) The Pretrial Detainee’s location; (iii) The Pretrial Detainee’s charges based on 

information available to the Department; (iv) The Pretrial Detainee’s bond amount based on 

information available to the Department; (v) Whether a forensic assessment has been made on 

whether restoration in the community is appropriate; (vi) Whether the Pretrial Detainee has 

previously been found incompetent; (vii) What efforts are being made to provide timely Competency 

Services to the Pretrial Detainee, including communications with the court, Court Liaisons, and 

community mental health providers;

(b) The Department shall accompany its Monthly Data Report (see Paragraph 52) with a separate 

“Fines Report” which will include the names of the Pretrial Detainees for whom the Department has 

accrued a fine during the preceding month, the number of days each Pretrial Detainee waited in the 

County Jails past the timeframes for compliance, and the total fines owed by the Department for the 

preceding month. 

(c) The Department shall pay the total fines owed on the date the Fines Report is submitted to the 

Special Master to be deposited in a trust account created for the purpose of funding non-Department 

mental health services. The account will be managed by a court-appointed administrator. Decisions 

concerning payments out of the account will be made by a committee consisting of a representative 

from the Plaintiff, a representative from the Department, and the Special Master. Any disputes 

regarding the fines shall be handled through the dispute resolution process identified in Paragraph 59. 

Historical context for calculating fines: The Department has continued to provide reliable

notification of non-compliance of time frames on a weekly basis, as required by the Consent 

Decree since June 1, 2019. Of course, the past several quarters have featured significant changes 

with respect to fines, due to the increasing number of people designated Individual Special 

Circumstances (ISC), the mechanism that absolves the Department from fines in situations 

beyond their control. As you recall, after negotiation with DLC, the Department utilizes an 

approach in which they invoke ISC on every individual case whose progress has been slowed by 

the COVID-19 pandemic response. This includes, for example, defendants who cannot be 

evaluated promptly because jails forbade external evaluators and did not allow for videoconferenced evaluations, and defendants who were found incompetent but could not be 

promptly transitioned to the hospital because of delays necessary for safety. As you recall, the 

ISC approach is advantageous to the Department in that it drastically reduces the fines they 

would otherwise pay. But the process of designating ISC, and monitoring data with respect to 

ISC, has required tremendous time and labor from the Department. 

Current realities: As we approach the second anniversary of the June 1, 2019 starting date for 

fines, the Department has proposed an alternate approach for handling fines. Rather than 

continue the labor-intensive process of designating ISC for every detainee whose movement has 

been slowed by pandemic-attributable delays, the Department has proposed a capped, lumpsum fine. You may recall the Department made a similar proposal last year, but DLC declined the 

proposal, conveying they would prefer individual-level attention and documentation required by 

ISC.

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This year, however, both parties seem to perceive the lump-sum approach as preferable. In 

response to the Department’s offer, DLC has made a counter-proposal. At this point we are 

awaiting the Department’s response to this counter-proposal. Generally, we strongly support 

this simplified lump-sum fine (versus the labor-intensive process of designating ISC in so many 

cases) and we are hopeful the parties can reach a satisfactory agreement. Once the parties have 

reached an agreement (or an impasse) we will notify the Court. Until then, the Department will 

continue to invoke ISC for most detainees, and fewer fines accrue.

Throughout the past two years that fines have accrued, the Department has routinely completed 

the “Fines Report,” as prescribed by the Consent Decree. Also, as prescribed by the Consent 

Decree, the Department continues to pay these fines into a trust account (managed by Cordes & 

Company, LLP), which is used to support additional special projects that support the broad goals 

of the Consent Decree. In this era of widespread ISC, the Department has paid very little in fines 

for the past two quarters, though this has increased in the past two months as the number of 

people waiting for admission now far exceeds available inpatient capacity.

Projects funded by the Fines Committee

The funds from these fines have been used to benefit the population in the competency service 

system. A small committee comprising Department administration, DLC representatives, and the 

Special Master, have all met regularly for the past year to address use of these fines. The broad 

goal is to use the funds in ways that help those involved in the mental health and criminal justice 

systems (i.e., those who are, or are likely to become, involved in competency-related services), 

and to reduce Colorado’s “competency crisis,” by providing new services or interventions that do 

not already fall within the Department’s responsibilities. In other words, funds from the fines 

should supplement, but not replace, existing services. 

As previously reported, the first opportunity to use these funds for prompt services emerged 

when the Colorado Coalition for the Homeless (CCH) renovated a hotel to create “Fusion

Studios,” which comprises 182 single-unit residences for homeless individuals. In October 2019, 

the Fines Committee contributed $3.5 million to the “Restoration Housing” project (within

Fusion Studios), in exchange for 28 dedicated residences for competence-involved individuals 

whom the Department refers, over the next five years. Currently, all of those units are filled by 

persons receiving competency services (or the few whose competency was resolved shortly after 

they moved in). The Department’s FST continues to identify and refer potential candidates for 

the Restoration Housing project, which has become an important resource for those in the 

competency service system.

Other proposals for potential fines-funded projects—a competency court, diversion projects, an 

audit of jail-based behavioral services, a detailed data analysis of OBH competency services, 

improved OCRP competency curriculum, and a case manager for Restoration Housing—were 

paused in light of the COVID-19 pandemic. Although we will likely return to some of these 

projects within the next quarter (particularly competency court/docket and diversion proposals),

our priorities for the past several quarters shifted to more time-sensitive projects focused on 

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alleviating the impact of the pandemic on competency-involved individuals. 

Recent projects funded by the Fines Committee include:

• CREST (COVID-19 Response Services Taskforce) housing: This project provides $1.5 million 

dollars to the Colorado Coalition for the Homeless to provide emergency and interim 

housing for 25 individuals in the competency system, transferring from jails or CMHIP. 

Housing will be provided for up to two years, and assertive case management and other 

services will be afforded to participants. Given that most stakeholders identify the lack of 

housing as the most significant barrier to both community release and sustained 

community tenure, the Fines Committee has prioritized housing-related projects. 

Through Restoration Housing and CREST, fines funds have paid for 53 beds for the next 

several years, all dedicated to the Pretrial Detainee population. At this point, these are 

not filled to capacity, but we anticipate they will be within the next quarter. 

• A CREST (COVID-19 Response Services Taskforce) “Legal Advocate” position has also been

created and filled with an experienced attorney, who has now been working for almost 

five months. She advocates for the release of appropriate candidates at court and 

monitors their progress in both transition and in the community. She also explores 

systemic problems or challenges that can benefit from a legal expert, and helps other 

attorneys navigate the competency system in ways consistent with the goals of the 

Consent Decree. This position is based in Mental Health Colorado, so that the advocate is 

distinct from the Department. Since her start on October 1, 2020 she has assisted in 

many cases, helping avoid unnecessary inpatient hospitalization for restoration. 

• Private hospital contracts: More than $3,000,000 in fines-generated funding has added

15 short-term beds at two local private hospitals for competency-involved individuals in 

need of emergency services (we anticipate an eventual total of $4,000,000 spending for 

this service as the pandemic continues). There was some recent revision to these 

contracts as Peakview Hospital was less able to provide services than originally promised, 

but Denver Health was able to increase capacity, and the project has fully launched. 

These emergency hospital beds allow more flexibility for people who need urgent, 

inpatient mental health care, and allow for much more nimble movement between 

community, jails, and hospitals, particularly amid pandemic-related logistical challenges.

• Technology for ITP defendants: Cell phones have been provided to persons in need of 

competency evaluations or restoration in the community. When COVID-19 precluded inperson evaluations and restoration sessions, many defendants did not have adequate 

access to video-enabled technology. Therefore, participation from some defendants was

difficult, if not impossible. More than $50,000 has been used to purchase phones and the 

subsequent service packages to allow these individuals to more easily participate in 

evaluation and restoration services (thereby avoiding further delays). Fines continue to 

support some monthly service expenses to continue these.

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• Jail-based Restoration pilot program: The Denver Jail’s mental health unit has developed

a small pilot program to begin providing restoration services for defendants awaiting 

hospitalization at CMHIP. The DCJ has the largest segment of the competency-involved 

population, and the state’s most robust jail-based mental health unit; it is the only jail 

that can authorize the use of involuntary medication. Mental health staff at the DCJ have 

documented the competency-related progress of several Pretrial Detainees, and they 

have created a proposal to offer enhanced restoration services to these individuals. 

Although the pilot program will not replicate the RISE program’s approach of dedicated 

competency restoration staff, and we do not support a broader move towards full “jailbased restoration” we believe that this interim model of restoration services will benefit 

individuals who face lengthy waits for CMHIP, by initiating intensive treatment. 

The pilot restoration program launched this month (May) and as of May 21, nine of the 

twelve beds were full, providing psychiatric services to those awaiting transfer to CMHIP. 

It is likely that some of these individuals will be restored to competence, or greatly 

stabilized, by the time they would be transferred to CMHIP. 

Several additional projects have been proposed for fines funding, and we anticipate awarding 

funding to some in the next quarter. The most promising, in our view, are diversion programs

that propose to provide treatment and services to those with low-level charges even before 

competence is raised, ultimately diverting them from the competency system (and the criminal 

justice system more generally). We will provide updates on any funded programs in the next 

quarterly report.

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DECREE SECTION VII UPDATES 

CIVIL BED FREEZE 

39. Civil Bed Freeze. The Department’s 2018 Plan included an effort to freeze civil admissions to its 

beds to devote Hospital beds to perform Inpatient Restoration Treatment services. On February 7, 

2019, the Department agreed to stop this practice. The Department will continue to leave the state’s 

civil and juvenile beds allocated as of the execution of this Consent Decree for civil and juvenile 

psychiatric admissions and will not freeze or convert those beds to provide competency services for 

Pretrial Detainees, unless the Department receives prior agreement from the Special Master to use 

unutilized beds for such purposes. This strategy to facilitate compliance with the Consent Decree 

shall only be re-implemented in the future upon agreement of the Special Master. 

The Department removed the “civil bed freeze” as mandated by the Consent Decree. That is, 

they have not re-purposed the civil beds at CMHIFL for competence restoration, as they had 

proposed in 2018. Indeed, since the Consent Decree, the Department has been resolute in 

protecting civil beds, even amid forensic pressures. A small number of beds are occasionally used 

for competency services, when all parties agree doing so will improve efficiency and prompt or 

local care for detainees. As of their most recent report, the CMHIFL population included a total 

of 79 patients, 75 of whom were civil patients.26 

The Department continues to renovate two CMHIFL units, which will add 44 forensic beds at the 

end of 2021. In addition, the new L2 unit at CMHIP opened in May 2021, which added 22 

additional inpatient beds to CMHIP capacity. Moreover, these beds will likely provide immediate 

admission options, even with other units unable to accept admissions due to COVID-related 

protocols. Because it is a brand-new unit, there has been limited risk of outbreak or spread of 

the COVID-19 virus – thereby providing some admission capability at an especially critical time.

Civil inpatient capacity remains precariously low throughout Colorado. The Department must 

begin advocating for additional civil bed capacity in the near future. We (Special Masters) have 

partnered with the Department in exploring options for harnessing pandemic stimulus-type state 

funds to acquire and renovate existing facilities, fund capital construction, and contract with 

smaller properties throughout Colorado to expand civil inpatient capacity. 

 

 

26 According to the Department’s April 2021 Special Master Compliance Plan report dated May 7, 2021 p. 

36.

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COMPREHENSIVE AND COHESIVE PLAN 

40. Comprehensive and Cohesive Plan. The Special Master’s first recommendation was to revise the 

Department’s 2018 Plan into a more comprehensive and cohesive plan. Dkt. 146. By or about January 

2020, the Department will produce an initial plan resulting from a long-term visioning process with 

DLC, the Special Master, and stakeholders that will consolidate disparate pieces of the Department’s 

current plan, along with legislative initiatives, in a cohesive package for courts, administrators, 

service providers, and legislators to consider. As referenced in the Special Master’s Recommendation 

Number 7, the 2020 Plan will highlight the methods to prioritize quality amid quantity and time 

pressures. Dkt. 146 at 42. On an annual basis thereafter, the Department will review and revise the 

plan as appropriate based upon data provided by the Department. 

The Department finalized a comprehensive, cohesive plan on February 27, 2020, in keeping with 

the Consent Decree. As we detailed in prior quarterly reports, the Department met routinely 

with stakeholders, and coordinated their work with the Governor’s Blueprint Task Force 

subcommittee that is addressing competence-related issues. Crucially, the Department 

conceptualized competency-related services in a far broader way than they had in their 

December 2018 report. They detailed much of their progress to date, and remaining goals, all of 

which reflect a much more comprehensive, multi-faceted approach to the competency crisis, as 

compared to their earlier efforts. Unfortunately, certain aspects of the plan were paused when 

the pandemic began. 

Regarding the required 2021 revision of the plan, you may recall our dilemma: a wholesale 

revision of the Comprehensive Plan seemed impractical in light of the current focus on a 

pandemic response. Therefore, as memorialized in our December 26, 2020 letter to the Court

(and your subsequent approval of the plan), all parties agreed on a procedure in which the 

Department would prepare an interim plan that is more specific to the pandemic-related 

challenges in the immediate future. As you know, they formally submitted on March 1 that

interim plan that detailed their plans for competency-related services amid the pandemic. We 

considered the plan reasonable and detailed, particularly in light of current circumstances. 

The Department’s next step, per the revised agreement, is to prepare the prescribed annual 

revision of the Comprehensive Plan and submit it by September of 2021, when we anticipate the 

harshest impact of the pandemic will have subsided, allowing for a broader focus to the 

Comprehensive Plan. At this point, we anticipate much of that Comprehensive Plan may need to 

address ways to ameliorate the damage the pandemic has done to competency services; for 

example, the document will likely address plans to reduce the wait list (and wait times) that have 

grown during the pandemic. But the Comprehensive Plan will also need to take a broad vision of 

adjacent and “upstream” strategies (such as diversion) that can reduce the overall competencyinvolved population. Though these have always been an aspect of the Department’s planning, 

they were (understandably) de-prioritized during the pandemic, and will need to take higher 

priority. 

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INCREASE COMMUNITY RESTORATION SERVICES 

41. (a) Implement a coordinated wide-scale outpatient (community-based) competency restoration 

(OCR) system. This system shall be integrated and submitted with the “Comprehensive and Cohesive 

Plan” referenced in Paragraph 40 herein. This plan shall be approved by the Special Master. 

The Department’s formal outpatient competency restoration program (OCRP) began in March of 

2018. Referrals for outpatient restoration ranged from 55 to 61 defendants per month during 

this past quarter.

27 This figure represents a consistently high number of referrals, relative to 

most previous quarters. Approximately 450 individuals participate in Colorado OCRP at any one

point, and we are pleased to continue to report there remains no waitlist for OCRP services. We 

commend the Department on building sufficient outpatient restoration capacity. Colorado’s 

OCRP continues to be the largest, most robust statewide OCRP program in the country. 

OCRP data systems 

As we always emphasize, data collection and analysis for OCRP is critical. It identifies markers for

success and failure, provides areas for improvement, and allows for quality control with

individual providers. The Department is tracking and reporting more robust and comprehensive 

data than ever before. There are a few gaps in data that persist, and we continue to discuss 

those areas with the Department and outside consultants. 

The Department reports OCRP outcomes on a rolling annual basis. Data from May 2020 – April 

2021 reveal a 25.2% restoration rate. This is lower than most OCRP restoration rates in other 

programs around the country. But case dismissals occur for 35.6% of cases, and an additional 

14.7% have either had services stopped by the court for undefined reasons or have been found 

permanently incompetent (with charges dismissed). We consider the combination of these 

outcomes (restored, case dismissals, etc.) as largely positive, and are pleased that they comprise 

75% of all outcomes. On the other hand, approximately 23.5% of participants have been 

hospitalized. Arrest rates and rates of total non-compliance or missing participants are not 

reported. We consider the 23.5% hospitalization rate as a “negative” outcome in the sense that 

the OCRP was not able to divert a potential patient away from CMHIP. Nevertheless, the 23.5% 

rate is not substantially different than rates in other states’ programs; some defendants with 

psychiatric illness will inevitably require hospitalization. Most recently, however, hospitalization 

rates have increased substantially (52% of all outcomes reported in April 2021), suggesting that 

community treatment may be increasingly difficult amid the pandemic. We will monitor these 

changing rates to determine if they reflect a short-term anomaly or a longer-term trend, and will 

work with the Department to investigate root causes and solutions. 

Other OCRP developments

OBH has continued to work with the 17 CMHCs around Colorado to provide most OCR services

 

27 All data in this section retrieved from the April 2021 Department’s Special Master Compliance Plan 

report, dated May 7, 2021, pp. 40-46. 

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(though they retain contracts with some private providers). As previously reported, this move 

allows OBH to guarantee capacity for defendants, provide uniform restoration efforts, and 

provide defendants with one location for competency, mental health, and psychosocial services. 

OBH continues to train CMHC staff about OCRP practices and related case management 

strategies. The Department anticipates that most OCR participants will be served by the CMHCs 

by summer 2021. 

41. (b) The Department may utilize private hospital beds to meet the needs of Pretrial Detainees 

meeting C.R.S. § 27-65-105(a) civil commitment criteria and with prioritization to Pretrial Detainees 

already residing within the same geographic location. The Department shall create a plan to 

implement this subsection (b) to be approved by the Special Master. 

The Department continues to contract with local hospitals to provide 15 inpatient beds for shortterm competency-related services. These beds are currently filled. The Department contracts 

with two providers, Peak View Behavioral Health in Colorado Springs (5 beds) and Denver Health 

(10 beds). These overflow beds have proven especially critical in light of long pauses in admission 

to CMHIP. 

41. (c) The Department currently estimates that 10-20% of Pretrial Detainees admitted for inpatient 

restoration do not need hospital-level care. Dkt. 146 at 29. The Department will make best efforts to 

reduce inpatient restoration hospitalizations by 10% and increase community restorations by 10% in 

six-month increments beginning June 1, 2019. The baseline for the preceding sentence will be 

determined by the Special Master by June 1, 2019, utilizing data provided by the Department. On 

June 1, 2020, the Special Master will establish a modification of this guideline based upon a survey of 

the data collection and implementation of the Department’s Plan.

OCRP baselines 

As prescribed in the Consent Decree, we established a baseline for improvement by calculating a

six-month period of available data (i.e., Nov 2018 - April 2019) prior to the June 1, 2019 deadline. 

That is, we identified 40% as an optimal proportion of defendants referred for outpatient (versus 

inpatient) restoration. We remain satisfied with the benchmark of 40% of all competency 

restoration orders, and we consider it a natural ceiling for referrals appropriate to OCR. Although 

this ceiling cannot be determined with certainty, we believe that 40% is a reasonable figure—

certainly higher than any other state of which we are aware—and that other benchmarks may 

indeed be more relevant going forward. Still, we report progress towards that 40% OCR rate

below:

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Inpatient Restorations 

 

 

Outpatient Restorations 

 

Initial baseline Nov 2018 – April 2019: 69% Nov 2018 – April 2019: 31%

May 1, 2021 goal 60% maximum 40% minimum

Recent progress (past 6 months) Nov 1, 2020 – May 1, 2021: 62% Nov 1, 2020 – May 1, 2021: 38%

Note: All percentages rounded to nearest 1%.

The Department has largely maintained the progress attained between November 2020 and May 

2021 and generally met benchmark goals. A total of 38% of all restoration orders were to 

outpatient restoration between November 2020 and May 2021, with recent decreases in March 

and April. 

As mentioned in our previous quarterly report, we have requested that the Department provide 

a secondary analysis of OCR referrals. In the summer of 2020, we began specifically monitoring 

the numbers of persons found ITP in jails who are referred to OCRP (i.e., excluding those 

referred to OCRP after on-bond evaluations). This is the population that the Consent Decree 

addresses. We used initial data to calculate a six-month baseline of referral rates specific to this 

population: i.e., defendants evaluated in jail and ordered to OCR. That baseline was 20%. 

Following the original model of the Consent Decree, we expect a quarterly 10% increase for the 

subsequent six-month period (January 2021 – June 2021) resulting in a goal of 24%, on average, 

for that period. 

Unfortunately, the Department has consistently reported much lower monthly proportions than 

was estimated based on the 6-month historical figure of 20%. The current figure, reflecting six 

months’ worth of data between October 2020 – March 2021 (a lag in data is unavoidable, as 

restoration orders are not always received within the month that the restoration hearing 

occurs), indicates an 11.9% OCR rate from all evaluations conducted in jails. Monthly averages 

dipped as low as 6.6% in November 2020 and 7.9% in February 2021. Clearly this falls well below 

the goal. 

We caution that this data is still preliminary and may be unduly influenced by the pandemic. 

Evaluators have conducted far more evaluations via video, and may be hesitant to recommend 

OCR for these cases. Still, we ask the Department to maintain this database so that we can see 

longer-term trends into 2021 and as the pandemic begins to subside. Any proportion of 

defendants in jail that are diverted to the community saves a bed at CMHIP, and we remain 

keenly interested in this proportion. If the 20+% figure seems unrealistic as more normal postpandemic evaluation procedures resume, we may adjust the expected base rates. Still, we 

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believe that the Department should maintain a healthy proportion of pretrial detainees ordered 

to OCR, and we believe that with good assessment (and continued success of OCR services) that 

proportion can increase over time. 

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CONCLUSION 

For the first year following the Consent Decree, the Department made significant and 

meaningful progress in enacting changes. There has now been ample time to see several key 

interventions prescribed by the Consent Decree (e.g., the triage system, the Forensic Support 

Team) substantially improve competency services and reduce harm among pretrial detainees in 

Colorado. However, the COVID-19 pandemic has halted some of that progress, and it has created 

new challenges. As the pandemic has persisted, wait times and the number of persons on the 

waitlist has grown considerably, and the number of pretrial detainees designated as Individual 

Special Circumstances often exceeds those who are not. This quarter (like last one) appeared to 

feature the pandemic’s harshest impact on competency services yet, pausing CMHIP admissions

again, after an earlier pause during winter. Both of these substantially increased wait times for 

restoration services. 

At the same time, there appears to be some very recent progress: the Denver Jail now allows for 

more access, and the Department’s Court Services have just recently been able to accomplish 

timely evaluations without designating anyone ISC. Efforts by the Forensic Services Team and the 

Outpatient Competency Restoration Program have remained robust. 

Of course, the pandemic will continue to slow progress for many more months, particularly given 

the frequent, ongoing COVID-19 infections at CMHIP, which prompt quarantine procedures that 

delay admissions. We will continue to work with the Department on the Consent Decree goals 

and efforts to mitigate the challenges from the pandemic, and we encourage you to contact us 

with any questions or requests. As always, we appreciate the opportunity to serve the Court, and 

the state of Colorado, in these important efforts.

Neil Gowensmith, Ph.D.

President, Groundswell Services Inc. 

Special Master, Civil Case 11-cv-02285-NYW

Daniel Murrie, Ph.D.

Special Master, Civil Case 11-cv-02285-NYW

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APPENDIX A 

May 24, 2021

Velton Showell IV, MPH

Charles Howsare, MD, MPH

Colorado Department of Public Health and Environment

4300 Cherry Creek Drive South

Denver, CO 80246

We are writing in our role as the Special Masters in the Case No 1:11 cv-02285-NYW, appointed 

by the Honorable Judge Nina Y. Wang from the United States District Court for the District of 

Colorado. As court-appointed Special Masters in this case, we operate with court-authorized 

discretion to oversee the transformation of the competency to proceed (“CTP”) service system in 

Colorado. 

Competency to proceed is a legal concept, codified in statute, that ensures that all persons 

accused of a crime can understand, and assist their attorney in, the criminal proceedings against 

them. In short, if a defendant cannot understand legal proceedings due to severe mental illness, 

the defendant will be adjudicated as incompetent to proceed (“ITP”) and ordered to competency 

restoration services. Historically, competency restoration services were offered solely at the 

Colorado Mental Health Institute – Pueblo (“CMHIP”); even today most defendants are ordered 

to competency restoration at CMHIP when alternative options are not appropriate. 

Unfortunately, due to limited capacity at CMHIP, many defendants ordered to inpatient 

restoration faced long waits in county jails prior to admission. Some of them endured severe

physical and mental injuries while waiting, because untreated psychiatric illness can lead to them 

refusing to eat or attend to basic self-care, committing serious self-injury or suicide, or even

harming to others due to their psychiatric symptoms.

In April 2019, both parties named in the case (Disability Law Center or “DLC” and the Colorado 

Department of Human Services or “CDHS”) agreed through mediation to a signed Consent 

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Decree to address the problem of severely mentally ill individuals waiting too long for admission 

to CMHIP. In short, the Consent Decree outlined new expectations and mandates for individuals 

in Colorado’s competency services system. The intent of the Consent Decree is essentially to: 1) 

reduce the number of pretrial detainees who are waiting in county jails pending admission to 

CMHIP, 2) reduce the time that pretrial detainees wait before admission to CMHIP, and 3) 

reduce the suffering or harm pretrial detainees endure while awaiting admission. 

From April 2019 to June 2020, there was substantial progress in meeting the goals of the 

Consent Decree. The numbers of people waiting in jails for inpatient restoration decreased, the 

average time spent waiting decreased, and suffering was greatly reduced. However, the onset 

and impact of the COVID-19 pandemic in 2020 shifted priorities and options for CDHS and 

CMHIP. Infection rates and infection-mitigation efforts slowed CMHIP admissions drastically, 

leading to a complete stop in admissions from mid-November to mid-December 2020. This 

increased the number of people waiting from 124 at the end of October 2020 to 189 at the end 

of December 2020. Most recently, another extended pause in admissions has lasted from early 

April 2021 to present, such that now the number of people waiting has more than doubled, to 

308. Average wait times have also increased significantly, and the longest wait times have 

increased to more than 200 days and counting. Because inpatient restoration requires an 

average turnaround time of around 90-120 days, and because the number of defendants 

ordered for inpatient restoration has hit record highs for several months running, we see wait 

lists and wait times increasing exponentially throughout 2021, even if pandemic-related 

restrictions ended immediately. In short, due to the restricted admissions to CMHIP from 

October 2020 to the present, the waitlist has more than doubled, as have wait times. Twice as 

many people with severe mental illness in jails are awaiting admission to CMHIP, and they are 

waiting twice as long.

We recognize the challenge in balancing different public health priorities, and we fully support 

Colorado’s efforts to mitigate the impact of COVID-19. We have no doubt that stringent public 

health protocols are necessary, and we are grateful for your work in mandating these.

At the same time, we are also keenly aware of the simultaneous public health crisis among 

pretrial detainees with serious psychiatric illness in jails across Colorado. These pretrial detainees 

have been repeatedly evaluated by psychologists and psychiatrists, identified as needing urgent 

inpatient hospital care, and ordered by courts to be admitted within 35 days. But wait times for 

many of them now exceed six months, as CMHIP quarantine procedures have led to reduced 

admissions or lengthy halts in admissions. These acutely, severely psychiatrically ill individuals 

are left in jails without access to the care they need and that judges have ordered them to 

receive promptly. 

Consider the practical consequences of these delays: some individuals have such severe 

psychiatric illness that, acting on acute symptoms, they have covered themselves with urine 

and/or feces, eaten feces, cut or mutilated themselves, refused to shower for weeks, refused to 

eat for days, attempted suicide, and at times been victimized or injured by staff or other 

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inmates. Some have also attacked staff or other inmates, when acting on paranoid delusions or 

hallucinations that are symptoms of their untreated psychotic illness. 

Please understand that untreated psychosis is life-threatening illness with mortality rates around 

7%. Even the majority that survive untreated psychosis face serious cognitive damage and 

become increasingly refractory to treatment (when it is eventually received) the longer they wait 

for treatment via antipsychotic medication. This, too, is a grave public health crisis. 

Many of these individuals need urgent inpatient mental health care. With CMHIP unable to 

admit, safe and reasonable options are virtually non-existent. Forced medications are not 

allowed in most county jails. Private hospital beds (contracted by CDHS at extra expense) are all

full; other private hospitals refuse to admit these individuals citing safety concerns for staff and 

other patients. In-jail mental health resources are wholly inadequate, hence the court orders for 

inpatient treatment. In short, untreated psychosis is a serious public health crisis in Colorado 

jails, exacerbated by the lengthy delays in admission to CMHIP.

We acknowledge and affirm the efforts that CDHS has made to try to monitor and intervene with 

those suffering while they await inpatient admission. We believe these efforts and proposals for 

altered admission protocols are reasonable responses to COVID-related challenges. However, 

without inpatient admissions, these mitigation efforts are simply insufficient for those with 

severe psychotic symptoms. Of course, Colorado is not the only state facing hospital-admission 

delays due to COVID-infection-mitigation precautions. But we have also spoken with many state

hospitals that are able to strike a balance between COVID-infection-prevention efforts and the 

need for urgent admissions; these hospitals have not paused admissions. 

We urge CDPH&E to reconsider policies and protocols for admissions to CMHIP so that 

admissions can resume. Again, we recognize that public safety precautions are absolutely 

essential, and certainly do not suggest ending precautions. But we do urge greater flexibility or 

creativity in how some of these are mandated. Perhaps CMHIP admissions might occur directly 

to treatment units, cohort sizes increase, quarantine times reduce, or greater vaccination for 

pretrial detainees occur. Perhaps CDHS medical staff could administer vaccines within county 

jails, or vaccinations of CMHIP staff could become mandatory. We suspect there are many

potential strategies—and that your team understands them better than we do. But, regardless of 

the specific mechanisms or changes employed, we recommend safety precautions that allow

CMHIP admissions to resume. Without substantial admissions to CMHIP, we foresee serious 

injury and/or death occurring within this population of severely, acutely ill people who have 

been court-ordered to treatment at CMHIP. We affirm CMHIP’s efforts to admit patients in 

stringent COVID-related restrictions, but we also beg you to consider restrictions that respect 

safety but allow for greater opportunity for admissions. In short, we ask that along with your

very important efforts to limit the spread of COVID-19, you also prioritize the very real public 

health crisis among pretrial detainees with untreated psychosis, who are facing real harm as they 

await admission to CMHIP. 

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Thank you for your attention and consideration of these issues. If we can provide any further 

information or clarification, we would be happy to discuss this with you further at your 

convenience. 

Neil Gowensmith, PhD

Daniel Murrie, Ph.D.

Special Masters, Case No. 1:11 cv-02885-NYW

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