A California federal judge has ordered state officials to hand over more than $111 million for failing to bring prison mental health staffing up to levels set by the court in 2009 in a 30-year-old case, saying Tuesday that "given defendants' contumacy, it is for the court to effect compliance."

The decision from U.S. District Judge Kimberly J. Mueller relates to the approximately 34,000 California state prisoners with serious mental disorders, a class that continues to increase in size, the judge said.

In 1995, the court found "overwhelming evidence of significant and chronic understaffing" in the mental health care staffing within California's prisons, in a class action brought on behalf of inmates in 1990.

"The class has been waiting for nearly three decades for the state to meet its constitutional obligations when it comes to the delivery of mental health care," Judge Mueller states in her order. "As defendants have known it would, the court finds defendants in civil contempt and imposes fines of $111,939,244.003."

The substandard staffing levels violate the Eighth Amendment, the judge said.

Back in 1991 and 1992, the vacancy rate in authorized mental health care positions was 25%, according to the judge.

Today it is higher, the judge underscores, "greater than twenty-nine percent among psychiatrists, psychologists, social workers, recreation therapists, and medical assistants, collectively," for inmates within the scope of the enforcement proceedings.

As of April 2024, the state reported that 70.5% of 2,254 authorized mental health staff positions were filled, the judge said. 

"The ongoing harm to the plaintiff class caused by these high vacancy rates is as clear today as it was thirty years ago and the harm persists despite multiple court orders requiring defendants to reduce those rates," Judge Mueller states.

The staffing ratios at issue were set out by a federal court in 2009, but the state dragged its feet on meeting the requirement, the judge said.

In October 2017, "after several more years of remedial work without achievement of adequate mental health staffing levels, the court concluded that enforcement proceedings would be required," the judge states.

By February 2023, the court issued an order setting out a framework for staffing enforcement, including a system of fines that would begin accumulating.

Nonetheless, despite being "faced with the threat of fines, defendants still had not complied with their obligations to the plaintiff class, and they did not dispute their noncompliance," the judge said. In late 2023, the court launched evidentiary proceedings to decide whether and how to enforce its orders.

State officials told the court during those proceedings that statewide and nationwide shortages of mental health care providers made it impossible for them to achieve the 90% minimum fill rate required by the court's October 2017 order.

An expert for the state testified about the shortages among mental health professionals, but did not say it was impossible for defendants to hire psychologists or other needed staffers.

"Fundamentally, the record before the court shows it may be more difficult or expensive for defendants," the judge states. "But none of the evidence establishes defendants' compliance with the October 10, 2017, order is impossible."

The state also asked the court to hold off on imposing the fines and touted new efforts to comply with the court's mandates.

"The additional steps defendants are now taking, while laudable and necessary, support the court's finding that prior to the contempt hearing defendants had not taken all reasonable steps available to them to comply with the court's October 10, 2017 order," the judge states.

Further, nothing stops the state from continuing with their bolstered efforts, she said.

"To the contrary, the sanctions imposed here are necessary to sharpen that focus and magnify defendants' sense of urgency to finally achieve a lasting remedy for chronic mental health understaffing in the state's prison system," the judge states.

The monetary sanctions imposed by the court will be put into a fund that will be exclusively used to increase prison staffing, the judge said, ordering the state to deposit the amount into the court's registry within 30 days.

The amount of $111.9 million represents the total amount of fines that have accumulated since April 2023, but that tab will continue to grow while the state remains out of compliance with the staffing order, said the judge, who gave the state one year to fully comply.

"The court will address next steps in a separate order, to be issued soon," she added.

The suit's defendants include Gov. Gavin Newsom, California Department of Corrections and Rehabilitation Secretary Jeff Macomber, CDCR Undersecretary for Health Care Services Diana Toche, CDCR Deputy Director of the Statewide Mental Health Program Amar Mehta, Director of California Department of State Hospitals Stephanie Clendenin, and Director of the California Department of Finance Joe Stephenshaw.

A lawyer for the plaintiffs, Lisa Ells of Rosen Bien Galvan & Grunfeld, told Law360 in an email that the CDCR should have taken the necessary steps to ensure that inmates have sufficient numbers of mental health clinicians to provide them with treatment.

"But after thirty years of entrenched non-compliance, CDCR has left us and the court with no other option," Ells wrote. "We are hopeful the fines, which will be exclusively used to support measures to increase clinical staffing, will finally provide class members with the lifesaving mental health care they urgently need."

Representatives for the state did not immediately respond Wednesday to requests for comment, but the court docket shows that California appealed the court's Tuesday order that same day.

The plaintiffs are represented by Donald Specter and Margot Mendelson of the Prison Law Office, Claudia Center of the Disability Rights Education and Defense Fund, Inc., and Michael W. Bien, Ernest Galvan, Lisa Ells, Jenny S. Yelin, Thomas Nolan, Michael S. Nunez, Marc J. Shinn-Krantz, Alexander Gourse, Adrienne Pon Harrold, Amy Xu, Adrienne Spiegel, Benjamin W. Holston, Maya E. Campbell, Luma Khabbaz and Jared Miller of Rosen Bien Galvan & Grunfeld LLP.

Newsom and the other California officials are represented by Rob Bonta, Monica N. Anderson, Damon McClain, Elise Ownes Thorn, Namrata Kotwani of the Office of the Attorney General, and Paul B. Mello, Samantha D. Wolff, Kaylen Kadotani, and David C. Casarrubias of Hanson Bridgett LLP.

The case is Ralph Coleman v Gavin Newsom, case number 2:90-cv-00520, in the U.S. District Court for the Eastern District of California.

--Editing by Kelly Duncan.