Telepsychiatry policy for California prisons is OK’d minus state’s proposed revisions

SACRAMENTO, Calif. (CN) — A federal judge gave final approval to a policy to provide psychiatric care to inmates in California prisons by telephone rather than in person in a decades-old lawsuit over inadequate mental health care at state prisons.

Chief U.S. District Judge Kimberly Mueller in Sacramento however rejected a last-minute bid by the California Department of Corrections and Rehabilitation to further expand the scope of telepsychiatry and reduce the requirements for on-site psychiatric care in more severe cases.

The parameters of telespsychiatry were agreed upon in 2020 after settlement discussions between plaintiff lawyers, CDCR and a court-appointed special master. The provisionally approved policy had been monitored for 18 months by the special master before submitting it for final approval, according to Wednesday's ruling.

"Any proposed expansion of the telepsychiatry policy advanced without specific findings to support the expansion from the special master and his experts is problematic," Mueller wrote. "The court cannot and will not entertain the proposal, which is widely outside the scope of the policy the special master was tasked with monitoring, as presented here."

Mueller didn't address the merits of the state's proposed revisions to the 2020 policy. But since that policy was based on court orders from 2017 and 2018, which had imposed mandatory limitations on the use of telepsychiatry and which the state had unsuccessfully appealed, Mueller said California would have to file motions to modify these previous orders if it believes there has been a "significant change in circumstances."

A CDCR spokeswoman said the department has received the order and will be reviewing it.

Mueller's order is part of a class action on behalf of all California state prisoners with serious mental illness that dates back to 1990. The case challenges an inadequate mental health care system that places prisoners at serious risk of death, injury and prolonged suffering. After a 1995 trial, California was ordered to implement major changes in the prison mental health system. 

Years later, in 2018, a whistleblower report by the chief psychiatrist for the prison system led the judge to conclude that CDCR had provided misleading data that downplayed the extent of the mental health crisis in the state prisons. One particularly graphic detail in the report involved a female inmate who ripped out her own eye and swallowed it during a psychotic episode when she wasn't medicated.

Since a chronic shortage of psychiatrists and other mental health workers has been a big of the problem in providing care to inmates, the special master in 2017 had recommended an expanded use of telepsychiatry but with some important caveats, such as that remote psychiatric care should only be a supplement to, not a substitute for, in-person psychiatric care.

The judge adopted these recommendations in her 2017 and 2018 orders, which then formed the basis for the policy CDCR agreed to in 2020. However, when after 18 months of monitoring the implementation of this policy the special master wanted to submit the policy for final approval, the state objected and wanted to remove some of the limitations on the use of telepsychiatry, such as the on-site psychiatrist requirement for enhanced outpatient programs.

CDCR also sought to scrap a “last resort in emergency situations” standard for use of telepsychiatry in so-called mental health crisis bed and psychiatric inpatient program levels of care. The state also requested to be absolved from a requirement of "continued good faith recruitment and retention of on-site psychiatrists."  

"The court acted correctly to prevent California from switching entirely to remote psychiatric care for incarcerated patients with the most severe mental health conditions," Amy Xu, an attorney representing the inmates in the lawsuit, said in an email. "We urge the defendants to implement the final telepsychiatry policy, which draws a balance between live and remote psychiatry that is consistent with the relevant literature and prioritizes patient safety."

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