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California State Prison Case 2:90-cv-00520-LKK-JFM Document 4308 Filed 01/25/13 Page 1 of 354 Raymond F. Patterson, M.D., D.F.A.P.A1 1904 R Street, N.W. Washington, D.C. 20009 Telephone: 301-292-3737 Facsimile: 301-292-6272 REPORT ON SUICIDES COMPLETED IN THE CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION IN CALENDAR YEAR 2011 I. Introduction This is the thirteenth Report on Completed Suicides in the California Department of Corrections and Rehabilitation (CDCR or Department), covering the 34 such deaths which occurred in calendar year 2011.2 It is submitted as part of the Special Master’s continuing review of the defendant’s compliance with court ordered remediation in the matter of Coleman v. Brown, No. CIV S-90-0520 LKK JSM P (E.D.Cal). As discussed in detail below, a number of significant findings that are very concerning emerged from this reviewer’s examination of all 34 suicides in 2011. Among these are the following: In 2011, a CDCR inmate died by suicide every 10.73 days on average. The rate of CDCR inmate suicides in 2011 was 21.01 per 100,000, which was essentially unchanged since 2010, when it was 21.1 per 100,000. The rate for 2012 rose to 23.72 per 100,000, based on a reported CDCR inmate population of 134,901 at mid-2012.3 These rates stand in stark contrast to the rate of 16 suicides per 100,000 across U.S. State prisons in 2010.4 They also compare unfavorably with the average rates during the decade from 2001 to 2010 among the eight largest state prison systems during that decade, and with average rate of the U.S. Federal prison 1 Curriculum Vitae attached as Exh. A. 2The CDCR reported 33 suicide deaths, but based on this reviewer’s examination, an additional death, identified as case number 34 below, was more likely than not to have been a suicide, for a total of 34 suicide deaths in 2011. 3 Source: CDCR Website, archives, population as of midnight June 30, 2012. 4 The source of all citations in this report to other prison systems’ suicide rates is the Website, U.S. Department of Justice, Bureau of Justice Statistics. 2010 is the most recent year for which the U.S. Bureau of Justice Statistics has published data on suicide rates in U.S. State prisons, and 2008 is the most recent year for which it has published data on suicide rates in U.S. Federal prisons. 1 Case 2:90-cv-00520-LKK-JFM Document 4308 Filed 01/25/13 Page 2 of 354 system from 2001 to 2008 (the most recent year for which the U.S. Bureaus of Justice Statistics reports suicide rates in U.S. Federal prisons): o Florida, 2001-2010: 8 per 100,0005 o U.S. Federal Prisons, 2001-2008 (most recent year reported): 9 per 100,0006 o Georgia, 2001-2010: 12 per 100,0007 o Ohio, 2001-2010: 12 per 100,0008 o Michigan, 2001-2010: 14 per 100,0009 o Pennsylvania, 2001-2010: 15 per 100,00010 o Texas, 2001-2010: 16 per 100,00011 o Illinois, 2001-2010: 17 per 100,00012 o New York, 2001-2010: 20 per 100,00013 Thirty-minute welfare checks for inmates newly admitted to administrative segregation units were not conducted consistently. Mandatory custodial checks were not completed consistently in administrative segregation units or in general population. In five of the suicide cases in 2011, identified as inmates G, R, X, AA, and EE, rigor mortis had already begun prior to the discovery of the inmate’s body.14 In three of these five cases, the inmate was housed in administrative segregation at the time of the suicide. The onset of rigor mortis indicates that in these five cases, at least two to 5 Approximated average prison population of 89,768, based on population report closest to mid-point of period, i.e. 12/31/05. Website, U.S. Bureau of Justice Statistics. 6Approximated average prison population of 187,618, based on population report closest to mid-point of period, i.e. 12/31/05. Website, U.S. Bureau of Justice Statistics. 7 Approximated average prison population of 48,749, based on population report closest to mid-point of period, i.e. 12/31/05. Website, U.S. Bureau of Justice Statistics. 8 Approximated average prison population 45,484, based on population report closest to mid-point of period, i.e. 12/31/05. Website, U.S. Bureau of Justice Statistics. 9Approximated average prison population of 49,546, based on population report closest to mid-point of period, i.e. 12/31/05. Website, U.S. Bureau of Justice Statistics. 10 Approximated average prison population 42,380, based on population report closest to mid-point of period, i.e. 12/31/05. Website, U.S. Bureau of Justice Statistics. 11 Approximated average prison population of 169,003, based on population report closest to mid-point of period, i.e. 12/31/2005. Website, U.S. Bureau of Justice Statistics. 12 Approximated average prison population of 44,919, based on population report closest to mid-point of period, i.e. 12/31/05. Website, U.S. Bureau of Justice Statistics. 13 Approximated average prison population of 62,743 based on population report closest to mid-point of period, i.e. 12/31/05. Website, U.S. Bureau of Justice Statistics. 14 Rigor mortis is defined as “the stiffness of joints and muscular rigidity of a dead body, caused by depletion of ATP in the tissues. It begins two to four hours after death and lasts up to about four days, after which the muscles and joints relax.” COLLINS ENGLISH DICTIONARY (2003 ed.) 2 Case 2:90-cv-00520-LKK-JFM Document 4308 Filed 01/25/13 Page 3 of 354 four hours had passed since the time of death before the bodies were discovered, underscoring the importance of timely welfare checks and custodial checks. In 25 or 73.5 percent of the 34 CDCR suicide cases in 2011, there was at least some degree of inadequacy in assessment, treatment, or intervention, which is essentially unchanged since the rate of 74 percent among suicides which occurred in 2010. Inadequacies appeared among conduct of suicide risk evaluations, treatment and/or clinical interventions, non-completion of timely custody welfare checks, and potential lifesaving interventions such as administration of CPR or problems with the use of an automated external defibrillator. Trend analysis shows a disturbing rise in the rate of suicides across the seven-year period of 2005 through 2011, when the average suicide rate was 21.6 per 100,000. This is compared to the average rate shown by trend analysis for the six-year period of 1999 through 2004, when the average rate was 16.2 per 100,000. Alarmingly, in 50 percent of the suicide cases in 2011, inmate suicide risk evaluations were either not done, or found levels of “low” or “no appreciable” risk of suicide, without adequate consideration of risk factors, past history, and/or review of medical records. As a result, interventions that could have been appropriate were not implemented. Among 16 of the 34 suicides -- identified as inmates B, C, D, G, H, I, J, Q, T, V, W, X, Z, BB, CC, and FF – cardiopulmonary resuscitation, including availability or use of the Automated External Defibrillator (AED) and/or first aid, were not performed in a timely and/or appropriate manner. Among these 16 cases were 11 cases – identified as inmates B, C, H, I, J, Q, T, Z, BB, CC, and FF - involving failures to follow policies regarding availability and/or use of the AED. There were no suicide deaths by CDCR inmates in any Department of State Hospitals (DSH) facilities or CDCR Mental Health Crisis Beds (MHCBs). There was one suicide in an Outpatient Housing Unit (OHU) and two suicides in a Psychiatric Services Unit (PSU) in calendar year 2011. In 2011, there were four suicides at the California Men’s Colony (CMC). This follows six suicides at the same institution in 2010, which was an unprecedented high for any single CDCR institution from 1999 through 2011. None of the four suicides at CMC in 2011 were determined to have been more likely foreseeable and/or preventable than not. 3 Case 2:90-cv-00520-LKK-JFM Document 4308 Filed 01/25/13 Page 4 of 354 CDCR failed to comply with post-suicide review and reporting timeframes in seven or 20.6 percent of cases in 2011, which was an improvement over preceding years, but in five cases there was no signed review and approval by the Directors or their designees of the Statewide Mental Health Program or Adult Institutions in the documents provided, as required by the Program Guide. II. Format, Terminology and Definitions Unlike past annual suicide reports by the special master’s expert, this report is presented in narrative format. It is supported by tables, charts, and graphs which appear in Appendices A through E, and by reviews of each of the individual suicide cases in 2011, appearing in Appendix F. The terms “foreseeable” and “preventable” are used in this report as they have been in previous reports. They describe the adequacy and implications of CDCR suicide prevention policies and procedures, staff training and supervision, clinical judgments, and utilization of clinical and custodial alternatives to reduce the likelihood of completed suicides. The term “foreseeable” refers to those cases in which available information about an inmate indicates the presence of substantial or high risk for suicide, and requires reasonable clinical, custodial, and/or administrative intervention(s).
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