Transcript: Remarks by LAO analyst Drew Soderborg on the impacts of prison overcrowding on medical and mental health care in California’s prison system before the Assembly Select Committee on Justice Reinvestment on Oct. 21, 2013

Partial transcript of remarks by Drew Soderborg, Managing Principal Analyst, Corrections, Transportation, and Environment, at the Legislative Analyst’s Office, on the impacts of prison overcrowding on medical and mental health care in California’s prison system. The hearing before the Assembly Select Committee on Justice Reinvestment was held on Oct. 21, 2013:

So there are two major legal cases that have to do with prison overcrowding and the provision of mental and medical care.

The first is the Plata v. Brown case. In the Plata case filed in 2001, the plaintiffs contend that the state failed to meet U.S. constitutional standards for medical care for inmates. A federal court found among other problems that CDCR’s medical care program was poorly managed, that it provided inadequate access for sick inmates, that it had deteriorating facilities and disorganized medical records, that it lacked sufficient qualified physicians, nurses, and administrators to deliver medical services. In 2006, the court appointed a receiver to take over direct management and operation of the state’s prison medical system.

The second major case was the Coleman v. Brown case. In the Coleman case, which was filed in 1992, the plaintiffs alleged that the state prison system failed to provide constitutionally adequate psychiatric care. A federal court found that there were several different problems, including that CDCR was understaffed, that it lacked adequate screening processes for mental illness, that it didn’t provide timely access to care, and that it had deficiencies in its medication management. And in 1995, the federal court appointed a special monitor to oversee the state’s efforts to remedy the situation.

In 2006, the plaintiffs in these cases requested that the federal court form a three-judge panel that would assess first, whether or not prison overcrowding was contributing to the problems that were identified in the cases, and second, whether or not a prisoner release was the only way to remedy the deficiencies.

In 2009, the federal three-judge panel ruled in favor of the plaintiffs that overcrowding was the primary reason the state was unable to deliver constitutionally adequate level of care and ordered the state to reduce its prison to no more than 137.5% of design capacity. This ruling was upheld by the U.S. Supreme Court in May 2011, and the state currently has until Jan. 27, 201[4] to reduce the prison popular in its 34 prisons to 137.5% of design capacity. Currently as of the last CDCR population report, the state is about 8,500 inmates over that limit.

Now, the three-judge panel identified numerous examples of how overcrowding presents operational challenges for the health care program.

First of all, overcrowding tends to make prisons less secure. So at the height of the prison overcrowding crisis, CDCR was forced to house prisoners in day rooms and gyms, and because of that, the prisons became more difficult to manage and staff were frequently forced to make use of lockdowns. Now, when a lockdown occurs, inmates are generally kept in their cells and are only allowed out of their cells if they’re escorted by security staff and this really interfered with the ability of these inmates to get medication and to see the health care professionals they needed to see.

In addition, overcrowding makes the prisons difficult to staff adequately. When prisons are overcrowded, it’s a more stressful working environment for the medical professionals and so it became more difficult for CDCR to recruit. This was compounded by the fact that CDCR already has historically had a difficult time staffing its prisons with medical professionals because the prisons were located in rural areas that didn’t have many medical professionals, so there wasn’t a large pool to recruit from to begin with.

Overcrowding also increased evaluation costs. So when inmates are brought into the state prisons they go through a battery of health care, mental health and rehabilitation evaluations. And especially when the parolees were churning through the prison system, the reception centers were really burdened by having to spend so much time assessing and re-assessing individuals. And that meant that resources and staff that could have otherwise gone towards providing direct care were instead redirected to assessing the needs of individuals that were cycling in and out of the system.

Also overcrowding can really directly affect inmate health care because in overcrowded prisons infectious diseases, for example, spread more rapidly. And there are other medical impacts related to overcrowding. So that kind of gives you a sense of the legal history that led to the overcrowding reduction order and how overcrowding contributes to some of the problems identified by the federal courts.

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