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State defends its treatment of mentally ill prison inmates

The state launched its defense Tuesday of its handling of mentally ill inmates, with a psychiatrist from the California State Prison at Corcoran testifying that the use of pepper spray and prolonged restraint of prisoners is sometimes necessary to save an inmate’s life.

Testifying in U.S. District Court in Sacramento, Dr. Ernest Wagner described his treatment of a prisoner known in court only as “Inmate A,” a suicidal man who was repeatedly pepper-sprayed and pulled forcibly from his cell because he refused his medication. Wagner said he was present at the cell extraction.

Lawyers for the inmates, who are seeking court orders for sweeping changes in state prison policy on the handling of the mentally ill, played a graphic video of the cell extraction in court earlier this month to bolster their case for change.

In it, the naked prisoner is doused with pepper spray, dragged from his cell in a mental health crisis unit at Corcoran, then strapped to a gurney and injected with antipsychotic medication.

The inmates’ attorneys are hoping the video of the cell extraction – as well as five others that have been played in court – will persuade U.S. District Judge Lawrence K. Karlton to impose limits on the use of force, including pepper spray, on the prisoners.

But the state contends the scenes shown in court are not representative of the efforts made by medical and custody staff to ensure patients are not injured.

Tuesday’s testimony focused on Inmate A, who was placed in the mental health crisis unit at Corcoran on July 1, 2012.

“He was psychotic,” Wagner said. “In meeting with him, he could not present an organized history.

“He was suffering from auditory hallucinations, which were telling him to kill himself.”

The inmate also refused to accept medication or, when he did, he threw it in the cell toilet, Wagner said.

The inmate once agreed to meet with Wagner outside his cell – in a metal cage roughly the size of a telephone booth. After that, Wagner said, he refused to leave his cell and deteriorated over the course of more than three weeks.

He stopped eating, remained naked in his cell, talked to himself and sometimes screamed, Wagner said. He urinated on his mattress, rubbed feces on himself, and finally flooded his cell.

Wagner said he made regular visits to the front of the inmate’s cell, seeing him at least 12 times and trying to talk to him, but the prisoner was unresponsive.

On July 24, 2012, Wagner decided he was faced with an emergency and ordered involuntary medication, a move that resulted in the removal of the inmate from his cell by force. He was held strapped to a gurney for nearly 72 hours.

The inmates’ attorneys contend such force was unnecessary, and that the attempt at “clinical intervention” to persuade the inmate to come out of his cell before he was pepper-sprayed “lasted approximately 32 seconds.”

Without the extraction and medication, Wagner testified, the inmate “would have died.”

He conceded under cross-examination by inmate attorney Lori Rifkin that he did not follow state corrections policy that inmates be held only 10 days in a mental health crisis bed unit before a referral to the Department of State Hospitals for longer-term care.

But he added later that the 10-day limit can be overruled if it is in the patient’s best interests.

Inmate A remained in the crisis unit at Corcoran from July 1, 2012, until Aug. 14, Wagner testified, adding that he did not move him because he did not trust state hospital physicians to follow through with involuntary medication.

He also conceded that at one point, on July 16, he ordered the inmate released from the crisis unit to a lower level of care.

“It was obvious that we weren’t being effective, we weren’t doing anything,” Wagner said.

He later thought better of it and rescinded the order.

Wagner said Inmate A’s condition improved after he was forced to take his medication, and he eventually was sent to the Department of State Hospitals’ Salinas Valley Psychiatric Program. He continued to improve, was returned to prison and was paroled last February, Wagner said.

Attorneys for the state plan to call witnesses for much of this week to testify about the need at times for the use of force to protect an inmate and staff from injury.

Wagner testified that incidents like the one depicted on the Inmate A video are not that common.

“If they accept handcuffs (when being removed from their cells) then there’s no struggle,” he said. “If they do not accept handcuffs then we’d have to go to Plan B, I guess you’d call it.”

The videos shown in court to date have displayed high levels of physical force and massive quantities of pepper spray that the inmate attorneys’ experts say is beyond anything they have seen in other states.

But Wagner said he has not seen any lasting harm from the use of pepper spray and that, typically, it does not take more than one blast.

“Most of the time just one spray and they comply,” Wagner said.

He was followed to the witness stand by Dr. John Christopher Lindgren, a senior psychiatrist and supervisor at the California Department of Corrections and Rehabilitation’s headquarters facility in Elk Grove. Before he assumed that post, Lindgren treated mentally sick parolees.

Lindgren testified that “use of force incidents do not exacerbate mental health conditions.”

His direct examination was frequently interrupted by a very skeptical Karlton. In answer to the judge’s grilling, he swore no patient ever told him “pepper spray was a stressor,” and he knows of no psychotic episode linked to a use of force incident.

“It would never happen, no matter how severe,” he declared, much to Karlton’s astonishment. “In my experience, I have never heard of any long-term consequences.”

By way of explanation, he told the judge that people with serious mental illnesses “will not have good recollection” and they “have a higher threshold for pain.”