By Bob Egelko
San Francisco Chronicle
SACRAMENTO, Calif. — California’s chief prison psychiatrist has issued a scathing report on management of mental health care in the prisons, saying officials are misrepresenting the care given to thousands of prisoners and are jeopardizing the health of inmates — including a woman who, in a horrifying 2017 incident, pulled out her eye and swallowed it.
“A large majority of patients are not getting psychiatric care when scheduled or otherwise when they need it,” Dr. Michael Golding said in a 161-page report to a federal judge in Sacramento who oversees the prison mental health system.
A central problem, Golding said, is that medical decisions, on the drugs inmates need and the type and frequency of care they receive, are assigned to psychologists and other non-physicians rather than psychiatrists, who are medical doctors. “This group has created a biased and inaccurately positive picture of what is actually a troubled system of care,” Golding said.
The report comes at a critical time for the prison system, which a federal court said in 1995 was violating inmates’ constitutional rights against cruel and unusual punishment by providing poor mental health care. The system has been under court supervision since then, with a court-appointed monitor. But, improvements in recent years led both sides in the case to anticipate a return to state oversight.
Golding’s report “changes the whole ballgame,” Michael Bien, a lawyer for the 30,000 state prisoners receiving mental health care, said Wednesday. He said he and his clients were about to accept the prison system’s proposal to reduce psychiatric staff positions by nearly 20 percent — from 405 to 326 — but backed away after seeing the report.
The prisons have made “tremendous progress” in recent years, Bien said, but if their own statistics on patient care are false, “we really don’t know what’s going on.”
Vicky Waters, spokeswoman for the California Department of Corrections and Rehabilitation, said the department “strongly disagrees with (Golding’s) allegations, and looks forward to a fair and thorough review and hearing of all the facts. ... Our dedicated and well-trained staff will continue to provide appropriate care and treatment.”
The next hearing, before U.S. District Judge Kimberly Mueller, is scheduled for Monday.
Golding said the dangers of failing to involve trained psychiatrists in medical decisions were illustrated gruesomely at the California Institution for Women in Chino (San Bernardino County) in April 2017.
A woman who had been refusing to take medications was diagnosed as gravely disabled by a staff psychologist and placed in a prison hospital on suicide watch, attended by a nurse, the report said. After screaming periodically for four hours, the woman, while lying on the floor, pulled out her left eye, and then, after guards arrived, put her eye in her mouth and swallowed it.
Prison psychiatrists reviewing the incident agreed that the woman should have been medicated, by force if necessary, Golding said. But he said the supervising psychologist decided not to forcibly administer medication or to contact the on-duty psychiatrist. Later, Golding said, a prison safety committee, whose members had no medical training, found no connection between the patient’s self-mutilation and the lack of medication.
Prison administrators and managing psychologists “appear to discount expert medical opinion and make decisions allowing, and even mandating, non-medically-trained individuals to override doctors’ medical orders,” Golding said.
His report also accused the prison system of greatly exaggerating its administration of mental health care.
For example, Golding said, in describing the number of mental health “appointments” provided each month to the most severely ill patients, the department classified as appointments a staff member’s brief encounters with inmates in a prison yard, surrounded by other prisoners, as well as an inmate’s phone conversations with a psychiatrist through a laptop computer held outside the cell door.
Golding also said the state reported that less-seriously-ill inmates were seen at their “scheduled appointments” 95 percent of the time, but failed to count appointments that were canceled because of the patient’s refusal, a scheduling error or other reasons — which would have reduced the number to 46 percent or less.
Likewise, he said, when a mentally ill inmate is transferred to another prison, the prison system “restarts the clock” on health care appointments, so that an inmate who was due for treatment within a week at the former institution might have to wait another 90 days or longer.
As a result, he said, the department’s reports to the court “significantly overstate” its compliance with health care standards while understating the need for more staff psychiatrists.