Proposition 36, on the November ballot, would unwind portions of a 2014 initiative, known as Proposition 47, that reduced most shoplifting and drug possession offenses to misdemeanors that rarely carried jail time.

Critics say that has allowed criminality to flourish and given those suffering from addiction little incentive to break the cycle. The law also has become a political weapon for former President Donald Trump and other Republican politicians who have tried to tie it to Vice President Kamala Harris to paint her as soft on crime. As California attorney general she took no position on the issue.

Much of the Proposition 36 debate has focused on the increased penalties for shoplifting, but the drug policy changes are even more dramatic. In addition to boosting penalties for some drug crimes, the measure would create a new “treatment-mandated felony” that could be imposed on people who illegally possess what are called “hard” drugs, including fentanyl, heroin, cocaine, and methamphetamine, and have two or more prior convictions for certain crimes.

Those who admit to the new felony would be required to complete drug or mental health treatment, job training, or other programs intended to “break the cycle of addiction and homelessness.” Those who complete the treatment program would have their charges dismissed, while failure could bring three years in prison.

The measure has opponents, including Gov. Gavin Newsom, warning about renewing a “war on drugs” that once helped swell California’s prison population.

Supporters counter that stricter penalties are necessary as overdose deaths from fentanyl crowd morgues. They also point to studies showing that more than 75% of people experiencing chronic homelessness struggle with substance abuse or a severe mental illness.

“We crafted this not to move people into any kind of custody setting, but to incentivize them into treatment,” said Greg Totten, chief executive officer at the California District Attorneys Association and a spokesperson for the initiative’s supporters.

Totten and others cast the measure as a way to revive drug courts, which they say waned in effectiveness after Proposition 47 removed the stick from what had been a carrot-and-stick approach.

Drug courts are led by a judge with a specialized caseload, use a collaborative approach to promote rehabilitation, and have been found to be effective in California and nationwide. Participants in California had “significantly lower rates of recidivism,” according to a study in 2006 commissioned by the Judicial Council of California: 29% were rearrested compared with 41% of a group who didn’t receive treatment.

The Center for Justice Innovation, a nationwide research and reform group that grew out of the New York state court system, found that drug court caseloads dropped across California after Proposition 47.

Still, advocates who favor decriminalization challenge the idea that the approach is effective and say coerced treatment violates people’s rights. Meanwhile, Lenore Anderson, a co-author of Proposition 47, said “we cannot pretend that this sort of feel-good idea that we’re going to arrest and incarcerate out of it is going to work. It never has.”

Proposition 47 led to an increase in property crime, but there is no evidence that changes in drug arrests sparked any increases in crime, found a recent study by the nonprofit, nonpartisan Public Policy Institute of California.

The latest reform effort leaves many questions, said Darren Urada of the University of California-Los Angeles Integrated Substance Abuse Programs. He was the principal investigator on UCLA’s evaluation of an earlier attempt to promote treatment.

“When policies are properly implemented, treatment obtained through courts can help people. However, there are a lot of details here that are not clear, and therefore a lot of opportunities for this to go poorly,” Urada said.

For instance, the ballot measure doesn’t say what would happen to someone who enters treatment but relapses, as is common; how long they would have to complete the program; or what would constitute completion for someone in long-term treatment for mental illness or substance abuse.

Those details were deliberately left vague so that local experts like community corrections partnerships, which are already established under existing law, could decide what works best in their jurisdictions, Totten said.

Totten expects a range of approaches including diversion programs and inpatient and outpatient treatment, and that judges would be guided by the recommendations of treatment professionals.

“I’m hopeful that that will help people who are really struggling with addiction, living on the streets, who engage in petty theft and other crimes in order to support their habit — that it will be a doorway into treatment for them,” said Anna Lembke, a Stanford University addiction expert.

The November ballot measure also would allow judges to send drug dealers to state prisons instead of county jails and boost penalties for possessing fentanyl. It would make it easier to charge someone with murder if they provide illegal drugs that kill someone.

The changes could increase California’s prison population, currently about 90,000, and its county jail and community supervision population, currently around 250,000, each by “a few thousand people,” projects the state’s nonpartisan Legislative Analyst’s Office. Opponents of the measure project that the increase would be far higher: 65,000 people, most for drug offenses and most of them people of color.

Newsom, one of the initiative’s most outspoken critics, argues that the November ballot measure lacks any funding; would reduce the $800 million in Proposition 47 savings, much of which has gone to treatment and diversion programs; and would only aggravate an existing lack of treatment alternatives.

“Prop. 36 takes us back to the 1980s,” Newsom, a Democrat, said in August as he signed a package of 10 property crime bills that he and legislative leaders tout as an alternative to the broader ballot measure.

Yet, illustrating the contentiousness of the debate, the ballot measure has been endorsed by some Democratic leaders, including San Francisco Mayor London Breed, San Diego Mayor Todd Gloria, and San Jose Mayor Matt Mahan, who often highlight its treatment requirement.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

PBMs have been under fire for years for alleged profiteering and anticompetitive conduct, but efforts to regulate the industry at the federal level have stalled in Congress.

The three largest PBMs are owned by insurers and retail pharmacy chains, and about 80% of prescription drug sales in the United States are controlled by them: OptumRx, owned by UnitedHealth Group; CVS Caremark, owned by CVS Health, which also owns the insurer Aetna; and Express Scripts, owned by The Cigna Group.

The proposed law, spearheaded by state Sen. Scott Wiener of San Francisco, a Democrat, would require PBMs to apply for a license by 2027 and would mandate that licensed PBMs pass along 100% of pharmaceutical manufacturers’ rebates to health plans or insurers. Drug companies often offer substantial discounts on medications to boost demand, and one of the major criticisms of PBMs is that they pocket rebates rather than pass savings along to customers.

The law would also mostly bar PBMs from steering patients to pharmacies they own, which includes the major mail-order pharmacies. And it would prohibit them from giving independent pharmacies lower insurance reimbursements than they offer the big chains — a major issue for the dwindling number of independents around the country.

Wiener said the law aimed to rein in what he called “the worst abuses by PBMs.” Proponents of the legislation say the experiences in the 25 states that require PBM licensing and the 16 that ban steering of patients to preferred vendors show that regulations reduce costs for consumers.

“When they’re licensed like we’re looking at, the cost goes down. States without licensing saw costs go up,” said Assembly member Devon Mathis, one of two Republicans to co-author the bill, citing the National Community Pharmacists Association.

Health insurance premiums increased an average of 16.7% nationwide from 2015 to 2019, the association calculated, with premiums in states that license PBMs increasing 0.3 of a percentage point below the national average and those without, 0.4 above. The association claimed similar benefits from several other reforms affecting pharmacies.

The Pharmaceutical Care Management Association, which represents pharmacy benefit managers, said Wiener’s bill “blatantly” favors independent retail pharmacies over chains.

“This legislation does nothing to lower costs for patients; it simply seeks to financially promote one industry over another with no consumer benefit,” the group said.

Insurance companies argue that the California bill would reduce the PBMs’ ability to negotiate lower drug prices, resulting in higher coverage premiums for everyone. But drugmakers argue that reforms don’t raise premiums.

Supreme Court Decision Looms

States have stepped in to regulate PBMs in the absence of any federal action; Congress has been holding oversight hearings on PBMs, and the Federal Trade Commission in July said PBMs “may be profiting by inflating drug costs and squeezing Main Street pharmacies,” but there has been no new legislation or efforts to crack down based on existing laws barring anticompetitive conduct.

The U.S. Supreme Court could soon weigh in on whether states have the authority to regulate PBMs. A federal appellate court blocked Oklahoma regulations on PBMs on the grounds that federal law held sway, and a group of 35 state attorneys general, including California’s Rob Bonta, have asked the Supreme Court to overturn the ruling.

A central complaint about PBMs is that they take money from pharmaceutical companies, in the form of “rebates,” to give their drugs preferential treatment on health plans’ lists of medications that are covered by insurance, known as formularies. Those rebates may play a role in raising drug prices, found a 2020 paper by the University of Southern California’s Schaeffer Center for Health Policy & Economics.

Under the California bill, those rebates are to be used “for the sole purpose of lowering deductibles and out-of-pocket cost for consumers,” said Assembly member Jim Wood, a Democrat. “There is a perverse incentive by PBMs to choose for their formulary the drugs that will give them the biggest rebate, the largest rebate, even if there are other drugs just as effective and lower-cost. That alone should send shivers down your spine.”

Crackdown in California

California collected more than $215 million last year from the nation’s largest Medicaid insurer, Centene, after it failed to disclose or pass along drug discounts negotiated by its PBM to the state Medicaid agency.

Independent pharmacies say provisions in the proposed California law requiring PBMs to offer them the same pricing as the chains could be a lifeline.

Clint Hopkins, who has co-owned Pucci’s Pharmacy in Sacramento for eight years, said he’s forced to regularly turn away customers rather than lose hundreds of dollars each time he fills their high-cost prescriptions.

For instance, he said his cost for a monthly dose of Biktarvy, used to treat HIV, is $3,881.68. But he said pharmacy benefit managers short him up to $360 on the reimbursement.

“They dictate the rates to us, and they will not negotiate,” said Hopkins, who testified for the bill on behalf of the California Pharmacists Association. “Sometimes I have to say, ‘I’m sorry, I want to help you, but I can’t lose this much money on your prescription.’”

While the bill passed with unusual legislative support, it faces an uncertain future with the Democratic governor, who has until Sept. 30 to sign or veto it.

Newsom vetoed a 2021 bill that would have barred PBMs from steering patients to their own pharmacies, citing potential unintended consequences.

And his Department of Finance said administering the licensing and collecting the data required by the law would cost several million dollars. In vetoing other legislation, Newsom has repeatedly cited costs, as the state struggles with a massive budget deficit.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Yet Verdugo didn’t know that hundreds of millions of dollars annually are flowing to California communities to combat the opioid crisis, a payout that began in 2022 and continues through 2038.

The money comes from pharmaceutical companies that made, distributed, or sold prescription opioid painkillers and that agreed to pay about $50 billion nationwide to settle lawsuits over their role in the overdose epidemic. Even though a recent Supreme Court decision upended a settlement with OxyContin maker Purdue Pharma, many other companies have already begun paying out and will continue doing so for years.

California, the most populous state, is in line for more than $4 billion.

“You can walk down the street and you see someone addicted on every corner — I mean it’s just everywhere,” Verdugo said. “And I’ve never even heard of the funds. And to me, that’s crazy.”

Across the nation, much of this windfall has been shrouded in secrecy, with many jurisdictions offering little transparency on how they’re spending the money, despite repeated queries from people in recovery and families who lost loved ones to addiction.

Meanwhile, there’s plenty of jockeying over how the money should be used. Companies are lobbying for spending on products that range from medication bottles that lock to full-body scanners to screen people entering jails. Local officials are often advocating for the fields they represent, whether it’s treatment, prevention, or harm reduction. And some governments are using it to plug budget gaps.

In California, local governments must report how they spend settlement funds to the state’s Department of Health Care Services, but there’s no requirement that the reports be made public.

KFF Health News obtained copies of the documents via a public records request and is now making available for the first time 265 spending reports from local governments for fiscal year 2022-23, the most recent reports filed.

The reports provide a snapshot of the early spending priorities, and tensions.

Naloxone an Early Winner

As of June 2023, the bulk of opioid settlement funds controlled by California cities and counties — more than $200 million — had yet to be spent, the reports show. It’s a theme echoed nationwide as officials take time to deliberate.

The city and county of Los Angeles accounted for nearly one-fifth of that unspent total, nearly $39 million, though officials say that since the report was filed they’ve begun allocating the money to recovery housing and programs to connect people who are homeless with residential addiction treatment.

Among local governments that did use the cash in the first fiscal year, the most popular object of spending was naloxone, a medication that reverses opioid overdoses and is often known by the brand name Narcan. The medication accounted for more than $2 million in spending across 19 projects.

One of those projects was in Union City, in the San Francisco Bay Area. The community of about 72,000 residents had five suspected fentanyl overdoses, two of them fatal, within 24 hours in September.

The opioid settlement money “was invaluable,” Corina Hahn, the city’s director of community and recreation services, said in her report. “Having these resources available helped educate, train and distribute the Narcan kits to parents, youth and school staff.”

Union City bought 500 kits, each containing two doses of naloxone. The kits cost about $13,500, with an additional $56,000 set aside for similar projects, including backpacks containing Narcan kits and training materials for high school students.

Union City also plans to expand its outreach to homeless people to fund drug education and recovery services, including addiction counseling.

Those are the sorts of lifesaving services that Verdugo, the Los Angeles advocate, said are desperately needed as deaths of people living on the streets pile up.

She lost her 46-year-old husband, Jesse Baumgartner, in June of last year to an addiction that started after he was prescribed pain medications for a high school wrestling injury. He tried kicking his habit for six years using methadone, but each time prescribers lowered his dosage the cravings drove him back to illicit drugs.

“It was just this horrible roller coaster of him not being able to get off of it,” Verdugo said.

By then the couple had survived 4½ years of being homeless and had been in stable housing for about two years.

Fentanyl use, particularly among homeless people, “is just rampant,” she said. People sometimes are initially exposed to the cheap, highly addictive substance unknowingly when it is mixed with something else.

“Once they start using it, it's like they just can't backtrack,” said Verdugo, who works as a community organizer for Ground Game LA.

So she leaves boxes of naloxone at homeless encampments in the hope of saving lives.

“They definitely use it, because it's needed right then — they can't wait for an ambulance to come out,” she said.

Cities Backtrack on Spending for Law Enforcement

By contrast, the cities of Irvine and Riverside, both in Greater Los Angeles, listed plans to prioritize law enforcement by buying portable drug analyzers, though neither city did so in the first fiscal year, 2022-23. Their inclination mirrored patterns elsewhere in the country, with millions in settlement funds flowing to police departments and jails.

But such uses of the money have stirred controversy, and both cities backed away from the drug analyzer purchase after the Department of Health Care Services issued rules that opioid settlement funds may not be used for certain law enforcement efforts. The rules specifically excluded “equipment for the purpose of evidence gathering for prosecution, such as the TruNarc Handheld Narcotics Analyzer.”

In Hawthorne, also near Los Angeles, the police department had already spent about $25,000 of settlement funds on an initial installment to buy 80 BolaWraps, devices that shoot Kevlar tethers to wrap around a person’s limbs or torso.

After the state said BolaWraps were not an allowable expense, the city said it would find other funding sources to pay the remaining installments.

Santa Rosa, in California’s wine country, spent nearly $30,000 on police officer wellness and support.

The funds allowed the police department to boost its contracted wellness coordinator from a part-time to a full-time position, and to buy a mobile machine to measure electrical activity in the brain, said Sgt. Patricia Seffens, a spokesperson.

The goal is to use the technology on police officers to help “assess the traumatic impact of responding to the increasing overdose calls,” Seffens said in an email.

In Dublin, east of San Francisco, officials are using part of their $62,000 in settlement cash for a D.A.R.E. program.

D.A.R.E., which stands for Drug Abuse Resistance Education, is a series of classes taught by police officers in schools to encourage students to resist peer pressure and avoid drugs. It was initially developed during the “Just Say No” campaign in the 1980s.

Studies have found inconsistent results from the program and no long-term effects on drug use, leading many researchers to dismiss it as “ineffective.”

But on its website, D.A.R.E. cites studies since the program was updated in 2009, which found “a positive effect” on fifth graders and “statistically significant reductions” in drinking and smoking about four months after completing the program.

“The D.A.R.E. program when it first came out looks a lot, lot different than what it looks like right now,” said Nate Schmidt, the Dublin police chief.

Schmidt said additional settlement money will be used to distribute naloxone to residents and stock it at schools and city facilities.

Other local governments in California spent modest sums on a wide range of addiction-related measures. Ukiah, in Mendocino County, north of San Francisco, spent $11,000 for a new heating and air conditioning system for a local drug treatment center. Orange and San Mateo counties spent settlement funds in part on medication-assisted treatment for people incarcerated in their jails. The city of Oceanside spent $16,000 to showcase drug prevention art and videos made by middle school students in local movie theaters, in public spaces, and on buses and taxis.

The Department of Health Care Services said it plans to release a statewide report on how the funds were spent, as well as the individual city and county reports, by year’s end.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

Chief U.S. District Judge Kimberly Mueller on June 25 ordered the state to pay $112 million in fines at a time when the state is trying to close a multibillion-dollar budget deficit. The fines have been accumulating since April 2023, after Mueller said she was fed up with the state prison system’s inadequate staffing despite years of court orders demanding that the state address the issue.

“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,” Mueller said in her order in the long-running class-action lawsuit.

The ongoing harm “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,” she added.

Mueller ordered the state to pay the fines within 30 days and said they “will be used exclusively for steps necessary to come into compliance with the court’s staffing orders.” She ordered California to keep paying additional fines for each month the state remains in violation of court orders.

The ruling was unwelcome news for Gov. Gavin Newsom, who is struggling with a budget deficit that’s forcing reductions in numerous state programs.

The contempt finding “is deeply flawed, and it does not reflect reality,” said Diana Crofts-Pelayo, a Newsom spokesperson. “Amid a nationwide shortage of mental health therapists, the administration has led massive and unprecedented efforts to expand care and recruit and retain mental health care professionals.”

California Department of Corrections and Rehabilitation spokesperson Terri Hardy said the state will appeal Mueller’s order. Prisoners “often have greater access to mental health care in custody than what presently exists for people outside” because of the state’s “extraordinary steps to expand access to mental health care,” Hardy said.

Mueller’s contempt finding comes as Newsom, a Democrat, has prioritized improving mental health treatment statewide, partly to combat California’s seemingly intractable homelessness crisis. His administration has argued that Mueller is setting impossible standards for improving treatment for about 34,000 imprisoned people with serious mental illnesses — more than a third of California’s prison population.

Attorneys representing prisoners with mental illness vehemently disagree.

“It’s very unfortunate that the state officials have allowed this situation to get so bad and to stay so bad for so long,” said Ernest Galvan, one of the prisoners’ attorneys in the long-running litigation. “And I hope that this order, which the judge reserved as an absolute last resort, refocuses officials’ attention where it needs to be: bringing lifesaving care into the prisons, where it’s urgently needed.”

As part of her tentative contempt ruling in March, Mueller ordered Newsom personally, along with five of his top state officials, to read testimony by prison mental health employees describing the ongoing problem during a trial last fall.  

The other five were the directors of his departments of Corrections and Rehabilitation, State Hospitals, and Finance; the corrections department’s undersecretary for health care services; and the deputy director in charge of its statewide mental health program.

Mueller limited her formal contempt finding to Corrections Secretary Jeff Macomber and two aides, Undersecretary Diana Toche and Deputy Director Amar Mehta.

“Fundamentally, the overall record reflects defendants are following a ‘business as usual’ approach to hiring, recruitment and retention that does very little if anything to transform the bureaucracy within which the hiring practices are carried out,” Mueller wrote.

Mueller had ordered state officials to calculate each month what they owe in fines for each unfilled position exceeding a 10% vacancy rate among required prison mental health professionals. The fines are calculated based on the maximum annual salary for each job, including some that approach or exceed $300,000.

The 10% vacancy limit dates to a court order by Mueller’s predecessor more than 20 years ago, in 2002, in the class-action case filed in 1990 over poor treatment of prisoners with mental disorders.

The $112 million in pending fines for understaffing is one of three sets of fines Mueller imposed.

She imposed $1,000-a-day fines in 2017 for a backlog in sending imprisoned people to state mental health facilities. But that money, which now tops $4.2 million, has never been collected, and Mueller postponed a planned hearing on the fines after prisoners’ attorneys said the state was making improvements.

In April 2023, Mueller also began assessing $1,000-a-day fines for the state’s failure to implement court-ordered suicide prevention measures. A court-appointed expert said his latest inspection of prisons showed the state was still not in full compliance.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

The minimum wage hike for more than 400,000 health workers, which will be phased in over several years, was to start June 1, but will now begin no earlier than Oct. 15 and no later than Jan. 1 under a budget deal announced June 22. The legislature is expected to approve the changes and Gov. Gavin Newsom to sign them into law before the new fiscal year begins July 1.

The delay is just one of several health-related measures in the nearly $300 billion state spending plan. The budget includes about $800 million in cuts to public health and health care workforce programs, but they are less severe than what Newsom initially proposed. It includes an 8% reduction in public health spending and preserves in-home support for Medi-Cal recipients regardless of their legal status. It counts on nearly $1.8 billion in additional revenue from the Managed Care Organization tax.

Newsom, a Democrat, had wanted an annual trigger that would have delayed the health worker wage bumps in tight budget years like this one, when the state faced a nearly $47 billion deficit.

Instead, Democratic leaders who control the legislature agreed to a one-time trigger that will start the increases in October if state revenues come in 3% higher than expected, or no later than in January after the state increases what is known as the Hospital Quality Assurance Fee, which allows hospitals to tax themselves to draw in federal money for Medi-Cal, the state’s Medicaid program.

Budget officials expect the fee increase to cover about 30% of the minimum wage increases. The fee currently provides about $8.4 billion to California hospitals each year and officials project that the unspecified increase will bring in billions of dollars more.

The fee increase requires federal approval, but budget officials said they believe even such a large increase is allowed under federal guidelines. The Newsom administration plans to hash out the details with hospitals over the next several months.

The managed care plans will still have to compensate for the remaining increased minimum wage costs with higher Medi-Cal managed care rates, budget officials said.

However, the administration said hospitals expect the wage bumps “will not result in significant additional costs.” That differs from what the California Hospital Association said in successfully contesting a $25 minimum wage in one Southern California city. The association said it was reviewing the plan.

The California Association of Health Plans did not comment. The California Kidney Care Alliance said many dialysis providers already increased wages ahead of the new requirements.

The law originally excluded employees at the Department of State Hospitals, and state budget officials said the new bill extends that to exclude an estimated 21,000 employees at all health care facilities operated by the state, with the exception of the University of California system. Proponents have said the wage increases would have included employees at the departments of Corrections and Rehabilitation, Developmental Services, and Veterans Affairs.

“Of course, workers are disappointed that not every low-wage worker in health care will receive raises this summer as the law initially scheduled,” said Dave Regan, president of Service Employees International Union-United Healthcare Workers West, which pushed for the increases over the state’s $16 minimum wage. But he praised Democratic leaders for recognizing that “despite a historic budget deficit, California’s patient care and health care workforce crisis must be addressed.”

The University of California-Berkeley Labor Center projected that more than 469,000 health workers would get wage increases, with the biggest benefits going to women and workers of color. The law covers lower-income employees including certified nursing assistants, patient aides, food service workers, janitors, groundskeepers, and security staff. California separately increased the minimum wage for fast-food workers to $20 an hour.

The health worker law originally was set to raise the hourly minimum at large health facilities and dialysis clinics to $23 this year, $24 in 2025, and $25 in 2026. It would have increased hourly wages at community clinics to at least $21 in 2024, $22 in 2026, and $25 in 2027. Other health facilities were to go to at least $21 an hour in 2024, $23 in 2026, and $25 by 2028.

The initial increases will be pushed back several months based on the one-time trigger.

Because the increases will start partway through the fiscal year, Newsom’s administration now projects the first-year cost to be $1.4 billion, down from its earlier full-year estimate of $4 billion.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

As states increasingly fracture along partisan lines, California Democrats are stamping their supermajority on legislation that they will consider until they adjourn at the end of August. But the cost of these proposals will be a major factor given the enormity of the state’s deficit, currently estimated at between $38 billion and $73 billion.

Health Coverage

Lawmakers are again considering whether to create a government-run, single-payer health care system for all Californians. AB 2200 is Democratic Assembly member Ash Kalra’s second such attempt, after a similar bill failed in 2022. The price tag would be enormous, though proponents say there would also be related savings. The high potential cost left Assembly Speaker Robert Rivas and others skeptical it could become law while the state faces a deficit.

AB 4 would require Covered California, the state’s health insurance exchange, to offer health insurance policies to people who are otherwise not able to obtain coverage because of their immigration status, to the extent it can under federal law. That could eventually lead to subsidized insurance premiums similar to those offered in Colorado and Washington.

Medical Debt

Health care providers and collection agencies would be barred from sharing patients’ medical debt with credit reporting agencies under SB 1061. The bill would also prohibit credit reporting agencies from accepting, storing, or sharing any such information without consumer consent. Last year, the Biden administration announced plans to develop federal rules barring unpaid medical bills from affecting patients’ credit scores. California would be the third state to remove medical bills from consumer credit reports.

Medi-Cal

The Medi-Cal program, which provides health care for low-income people, would be required to cover medically supportive food and nutrition starting July 1, 2026, under AB 1975. The bill builds on an existing but limited pilot program. The legislation says Californians of color could benefit from adequate food and nutrition to combat largely preventable chronic health conditions, and it’s one of 14 measures sought by the California Legislative Black Caucus as part of reparations for racial injustice.

More than 1.6 million California residents, disproportionately Latinos, have been kicked off Medi-Cal since the state resumed annual eligibility checks that were halted during the covid-19 pandemic. AB 2956 would have the state seek federal approval to slow those disenrollments by taking steps such as letting people 19 and older keep their coverage automatically for 12 months.

Violence Prevention

An increase in attacks on health workers is prompting lawmakers to consider boosting criminal penalties. In California, simple assault against workers inside an ER is considered the same as simple assault against almost anyone else, and carries a maximum punishment of a $1,000 fine and six months in jail. In contrast, simple assault against emergency medical workers in the field, such as an EMT responding to a 911 call, carries maximum penalties of a $2,000 fine and a year in jail. AB 977 would set the same maximum penalties for assaulting emergency health care workers on the job, whether they are in the field or an ER.

California could toughen penalties for interfering with reproductive health care services. Posting personal information or photographs of a patient or provider would be a felony if one of them is injured as a result. AB 2099 also boosts penalties for intimidation or obstruction.

Under SB 53, gun owners would have to lock up their weapons in state-approved safes or lockboxes where they would be inaccessible to anyone but the owner or another lawfully authorized user. Democratic Sen. Anthony Portantino, the bill’s author, says that would make it tougher for anyone, including children, to use guns to harm themselves or others or use the weapons to commit crimes. Critics say it would make it harder to access the weapon when it’s needed, such as to counter a home invasion. Relatedly, AB 2621 and AB 2917 address gun violence restraining orders.

Substance Use

The spike in drug overdoses has prompted several responses: AB 3073 would require the state’s public health department to partner with local public health agencies, wastewater treatment facilities, and others to pilot wastewater testing for traces of dangerous drugs in an effort to pinpoint drug hot spots and identify new drugs. AB 1976 would require workplace first-aid kits to include naloxone nasal spray, which can reverse opioid overdoses. And senators have proposed at least nine bills aimed at curbing overdose deaths, particularly from the deadly synthetic opioid fentanyl.

Youth Welfare

Under AB 2229, backed by a “Know Your Period” campaign, school districts’ sex education curricula would have to include menstrual health. There was no registered opposition.

Public schools would have to make free condoms available to all pupils in grades nine to 12 under SB 954, which would help prevent unwanted pregnancies and sexually transmitted infections, according to the author, Democratic Sen. Caroline Menjivar. Democratic Gov. Gavin Newsom vetoed a similar bill last year.

Reality show star Paris Hilton is backing a bipartisan bill to require more reporting on the treatment of youth in state-licensed short-term residential therapeutic programs. SB 1043 would require the state Department of Social Services to post information on the use of restraints and seclusion rooms on a public dashboard.

California would expand its regulation of hemp products, which have become increasingly popular among youths as a way to bypass the state’s adults-only restrictions on legal cannabis. AB 2223 would build on a 2021 law that Assembly member Cecilia Aguiar-Curry said in hindsight didn’t go far enough.

Public schools would, under AB 2316, generally be barred from providing food containing red dye 40, titanium dioxide, and other potentially harmful substances, which are currently used in products including Froot Loops and Flamin’ Hot Cheetos. It’s Democratic Assembly member Jesse Gabriel’s follow-up to his legislation last year that attempted to ban a chemical used in Skittles.

Women’s Health

AB 2515 would ban the sale of menstrual products with intentionally added PFAS, also known as “forever chemicals.” PFAS, short for perfluoroalkyl and polyfluoroalkyl substances, have been linked to serious health problems. Newsom vetoed a previous attempt.

Public grade schools and community colleges would, under AB 2901, have to provide 14 weeks of paid leave for pregnancies, miscarriages, childbirth, termination of pregnancies, or recovery. Newsom vetoed a similar bill in 2019.

AB 2319 would improve enforcement of a 2019 law aimed at reducing the disproportionate rate of maternal mortality among Black women and other pregnant women of color.

Social Media

Social media companies could face substantial penalties if they don’t do enough to protect children, under AB 3172. The measure would allow financial damages of up to $1 million for each child under age 18 who proves in court they were harmed, or three times the amount of the child’s actual damages. The industry opposes the bill, calling it harmful censorship.

Cyberbullies could face civil liabilities up to $75,000 under SB 1504, and those damages could be sought by anyone. Under current law, damages are capped at $7,500 and may be pursued only by the state attorney general.

Wellness

Bosses could be fined for repeatedly contacting employees after working hours under AB 2751, a “right to disconnect” bill patterned after similar restrictions in 13 countries. The bill’s author, Democratic Assembly member Matt Haney, said despite the advent of smartphones that “have blurred the boundaries between work and home life,” employees shouldn’t be expected to work around the clock. The measure is opposed by the California Chamber of Commerce.

Finally, Democrat Anthony Rendon, a long-serving state Assembly speaker, is spending his last year in the chamber leading a first-in-the-nation Select Committee on Happiness and Public Policy Outcomes. The committee isn’t planning any legislation but intends to issue a report after lawmakers adjourn in August.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

A medical industry challenge to a new minimum wage ordinance in one Southern California city suggests layoffs and reductions in hours and benefits, including cuts to premium pay and vacation time, could be one result of a state law set to begin phasing in in June. However, some experts are skeptical of that possibility.

The California Hospital Association brought a partly successful legal challenge to Inglewood’s $25 minimum wage ordinance, which barred employers from taking those sorts of steps to offset their higher costs.

“Layoffs, reductions in premium pay rates, reductions in non-wage benefits, reductions in hours, and increased charges are consequences of an employer having less money to spend—which will necessarily be the case given the significant increase in spending on wages due to the minimum wage,” the association said in its lawsuit. Additional examples include reducing health coverage and charging for parking or work-related equipment.

Inglewood voters approved the ordinance in November 2022, nearly a year before California legislators enacted a $25 minimum wage for health workers. Those statewide higher wages are to be phased in starting in June under California’s first-in-the-nation law, but Gov. Gavin Newsom has since said they are too expensive as the state faces a deficit estimated between $38 billion and $73 billion. It’s unclear if lawmakers will agree to a delay or take other steps to reduce the cost.

U.S. District Judge Dale S. Fischer agreed with the hospital industry in a March 11 tentative ruling when he shot down the portion of Inglewood’s ordinance banning layoffs and clawbacks by employers, while allowing the rest of the ordinance to remain in effect. He gave the sides time to object to his preliminary decision, though none did.

The California Hospital Association represents more than 400 hospitals and was a key backer of the state’s carefully crafted compromise law, which notably contains none of the employee safeguards included in the Inglewood ordinance.

Spokesperson Jan Emerson-Shea said the association doesn’t know how providers will react once the state law takes effect. “We don’t have any insights,” she said.

“The challenge for any health care organization is figuring out how to pay for the higher wages,” said Joanne Spetz, director of the Philip R. Lee Institute for Health Policy Studies at the University of California-San Francisco. “Since labor costs are the largest part of any health care organization’s costs, it’s hard to figure out how to reduce spending without looking at labor costs.”

Providers can try to increase revenues by bargaining for higher reimbursements from commercial insurers, she said. Public hospitals, nursing homes, and community clinics get most of their money through Medi-Cal, the state’s Medicaid program.

Providers could reduce the services they offer, pare back charity care, and cut or delay capital investments, Spetz said. In the long term, she expects some combination of spending cuts and revenue increases.

Both the state law and local ordinance cover far more than doctors and nurses, with a definition of health worker that includes janitors, housekeepers, groundskeepers, security guards, food service workers, laundry workers, and clerical staff.

The most recent estimate by the Health Care Program at the University of California-Berkeley Labor Center is that as many as 426,000 health workers would make an average of $6,400 extra in the law’s first year, a 19% average pay bump mainly benefiting lower-income workers of color and women. State finance officials project that well over 500,000 workers will benefit.

Researchers didn’t include layoffs and other potential staffing and benefit reductions when they projected the state law’s costs and benefits, said Laurel Lucia, the program’s director. But she pointed to initial projections by hospitals, doctors, and business and taxpayer groups that the wage hike would cost $8 billion annually, thereby imperiling services and resulting in higher premiums and higher costs for state and local governments.

“It seems like a contradiction to say this law’s going to cost billions of dollars while at the same time saying it’s going to reduce workers’ total compensation,” said Lucia, who projects a far lower price tag.

She added that state finance officials had anticipated that Medi-Cal reimbursements would reflect the increased labor costs, while Medicare would eventually at least partially compensate for the higher labor costs.

Michael Reich, chair of the Center on Wage and Employment Dynamics at UC Berkeley’s Institute for Research on Labor and Employment, and affiliated economist Justin Wiltshire recently argued that California’s new $20 minimum wage law for fast-food workers won’t result in mass layoffs and price increases, as some have predicted.

Health care is much different than fast food, Reich acknowledged, but he argued for much the same positive result.

“A higher minimum wage will make it easier and cheaper for hospitals to recruit and retain these workers. The cost savings, and the productivity benefits of more experienced workers, could offset much of the labor cost increase,” Reich said.

The hospital association filed its lawsuit against Inglewood’s ordinance in July, while it was still opposing early versions of the statewide minimum wage legislation. Among many other provisions, the statewide law put on hold an initiative to cap hospital executives’ salaries in Los Angeles.

The hospital association’s legal challenge referenced in part layoffs and reduced working hours imposed by Centinela Hospital Medical Center after Inglewood’s ordinance took effect.

But Centinela said the reduction was entirely unrelated to the ordinance and that all staff were offered alternate positions, which many accepted.

“Centinela Hospital also has since added many more jobs in new clinical positions above minimum wage scale,” the hospital said in a statement.

Service Employees International Union-United Healthcare Workers West, the prime backer of both the local ordinance and the statewide law, sued the hospital in April 2023 alleging that it cut workers’ hours to offset the higher minimum wage. The case is still pending.

The union did not respond to repeated requests for comment.

In a court filing, however, the union and city of Inglewood said similar employer restrictions in previous minimum wage laws have survived.

The ordinance “merely sets the backdrop for collective bargaining negotiations,” and does not bar employers from locking out employees or hiring replacement workers during a strike. Employers can still lay off workers or reduce their hours, they said, so long as they don’t do so to fund the higher minimum wage.

But Fischer agreed with the hospital association that layoffs and reductions in employees’ total compensation packages are “obvious responses by an employer to rising compensation costs.”

Restricting employers’ options would violate federal labor relations rules, he said.

“The minimum wage an employer has to pay its employees will invariably affect the total amount of compensation it is able or willing to pay,” he wrote “This will then invariably affect the number of employees it can retain and the number of hours those employees will be scheduled to work.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

U.S. District Judge Claudia Wilken’s rulings on March 20 centered on the prison system’s need to help deaf, blind, and low-vision prisoners better prepare for parole hearings, though the decisions are also likely to improve accommodations for hundreds of other prisoners with those disabilities.

“I believe I should have the same opportunity as hearing individuals,” a prisoner, deaf since birth, said in court documents.

The lawsuit is one of several class-action proceedings that have led the courts to assume oversight of the prison system’s treatment of those who are sick or suffer from mental illnesses.

“It is difficult not to despair,” a blind prisoner said in written testimony. “I am desperate for some kind of assistance that will let me prepare adequately for my parole hearing.”

The parole process can begin more than a year before an incarcerated person’s hearing and last long afterward. And the consequences of rejection are great: People denied parole typically must wait three to 15 years before they can try again.

Prisoners are expected to review their prison records and a psychologist’s assessment of whether they are at risk for future violence, write a release plan including housing and work plans, write letters of remorse, and prepare a statement to parole officials on why they should be released.

“It is a very time-consuming and important process,” said Gay Grunfeld, one of the attorneys representing about 10,000 prisoners with many different disabilities in the federal class-action lawsuit. “All of these tasks are harder if you are blind, low-vision, or deaf.”

The California Department of Corrections and Rehabilitation and its Board of Parole Hearings “remain committed to conducting fair hearings and ensuring access to the hearings for all participants. We are assessing the potential impact of the order and exploring available legal options,” said spokesperson Albert Lundeen.

The department counts more than 500 prisoners with serious vision problems and about 80 with severe hearing problems, though Grunfeld thinks both are undercounts.

California’s prison system has lagged in adopting technological accommodations that are commonly used in the outside world, Wilken found in her ruling.

For instance, California gives prisoners digital tablets that can be used for communications and entertainment, and since late 2021 has gradually been providing secure laptops to prisoners who are enrolled in college, GED, and high school diploma programs.

But officials balked at providing computers that Wilken decided are needed by some prisoners with disabilities. She required the department to develop a plan within 60 days of her order to, among many things, provide those individuals with laptops equipped with accommodations like screen magnification and software that can translate text to speech or Braille.

“It would make a huge difference to me to have equipment that would let me listen to and dictate written words, or produce written documents in another accessible manner,” testified the blind prisoner. He added that such accommodations “would finally let me properly prepare for my parole hearing with the privacy, independence, and dignity that all humans deserve.”

Similarly, California routinely uses video cameras during parole proceedings, including when it conducted hearings remotely during the coronavirus pandemic. But prison policy has prohibited videotaping the hearings, including sign language translations that some deaf prisoners rely on to understand the proceedings.

The deaf-since-birth prisoner, for example, testified that he also doesn’t speak, his primary method of communication is American Sign Language, and his English is so poor that written transcripts do him no good. He advocated for recorded sign language translations of the hearings and related documents that he could review whenever he wanted, in the same way that other inmates can review written text.

Wilken ordered prison officials to comply.

“They need to be able to watch it later, not read it later,” said Grunfeld. “It’s going to make a huge difference in the lives of deaf signers.”

The department recently acquired 100 portable electronic video magnifiers, at a cost of $1,100 each, that prisoners with low vision can check out to use in their cells. The technology will augment similar devices in prison libraries that prisoners say aren’t private and can be used only during libraries’ limited hours.

Wilken said officials acquired the magnifiers only after prodding by prisoners and their attorneys.

Grunfeld said the judge’s detailed order, which includes requirements like better assistance from attorneys, will “make sure that people with disabilities are on an equal footing as people who don’t have disabilities.”

“My colleagues and I have been working for several years to persuade CDCR to adopt this technology, and it’s been slow-going. But they’ve gradually accepted that they do need to do this,” Grunfeld said. “It’s long past due, but at least it’s coming.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

But corrections officials won’t disclose basic details of the now-stalled study — even the cost to taxpayers for two consulting firms and more than two dozen national experts retained to examine the issue in 2023. State lawyers cited attorney-client privilege and ongoing litigation in denying KFF Health News’ public records requests for the information. Independent legal experts questioned the blanket denials.

The legal saga began in 1990, when attorneys representing prisoners sued California for violating the U.S. Constitution’s ban on cruel and unusual punishment by providing inadequate mental health care in prisons.

The court ruled against the state in 1995, and since then a federal judge, guided by a court-appointed special master, oversees the state’s treatment of about 31,000 prisoners with serious mental illness. It’s one of several major federal lawsuits that have largely stripped the state of control of its own prison system.

California officials set out nearly four years ago to show that care has improved beyond the constitutional threshold, retaining Colorado-based Voorhis/Robertson Justice Services and Chicago-based Falcon Correctional and Community Services to undertake a study. In August 2022, their analysts reported that the state’s treatment guidelines and its required levels of staffing exceed national standards “and exceed the levels needed for providing clinically adequate care for patients in a correctional setting.”

The state then retained the same firms to conduct “a broader, systemwide study” of mental health services in California prisons and how they compare to national standards and other similar systems.

California could seek to end or modify court supervision based on the experts’ findings and recommendations, though they “have not made any decision to move for termination,” Paul Mello, one of the attorneys representing the state, said in a letter in court documents.

“They’re being cagey about exactly what the purpose is, but they’re reserving the right to use it to terminate,” said Michael Bien, an attorney representing the rights of prisoners with mental illness in the case.

Despite the potential significance of the study, corrections officials repeatedly declined to provide even basic details about it.

They initially denied that it was their contract at all, pointing to a different state agency. A week later, and after KFF Health News’ further inquiries, corrections officials acknowledged it was indeed their contract. But they denied KFF Health News’ repeated public records requests for the contracts, the costs, or the expense invoices filed by the consultants, citing attorney-client privilege, attorneys’ confidential work product, and the ongoing litigation.

Brittney Barsotti, general counsel of the California News Publishers Association, said the state could have kept sensitive information confidential while still responding to other aspects of the records request.

“The courts have held time and time again that redaction of documents is preferred over blanket denials like this,” she said. The use of blanket denials without any context or explanation is “an ongoing and I’d say even expanding issue,” she said in advance of Sunshine Week, a collaborative effort to emphasize the importance of public records and open government, observed this year March 10-16.

Without information on how exemptions to public records laws apply to specific documents, it is difficult for reporters or other members of the public to challenge such denials or tailor their requests, Barsotti added.

“They should be able to provide some figures on cost,” she added. “They should at least be able to provide aggregate general information that shouldn’t come under these various exemptions.”

The California Public Records Act allows exemptions for documents prepared specifically for use in pending litigation, said David Loy, legal director of the nonprofit, nonpartisan First Amendment Coalition, which supports government transparency. And a new law says government contracts, “including the price and terms of payment,” are generally public records, while listing the same legal exemptions.

In their latest denial, on March 11, department officials cited a prior court ruling that legal privacy covers invoices, including the aggregate cost.

In court documents, however, the state’s lawyers deny that the study is specifically tied to the litigation but is part of their self-evaluation of mental health care, casting doubt on the rationale given for denying the records requests.

Corrections officials provided KFF Health News with a single, two-page August 2020 letter to the consultants outlining the hourly rates the state would pay for the initial 18-month study. Managing partners or principals in the consulting firms were to receive $350 an hour; technical experts, $300; associates, $200; and support staff, $120. In addition, California agreed to reimburse the consultants for such expenses as airfare, lodging, meals, car rental, and gas.

Although the state declined to provide any records related to the bigger subsequent study, court documents outline the sweeping, exhaustive nature of what was anticipated.

One hired consultant, Elizabeth Falcon, the founder of Falcon, said in a written declaration that the research involved was a “massive logistical undertaking.” The consulting firms hired about 30 top specialists in behavioral health, psychiatry, security, operations, nursing, programming, staffing, and data analytics, she said. They spent eight months developing a scientifically validated method to study the mental health care at prisons.

Prisoners’ attorneys have objected that the state’s plan for extensive visits to all 28 prisons where mental health care is provided is overly burdensome for patients and attorneys, as well as expensive.

The consultants had completed partial tours of five prisons in July 2023 before Chief U.S. District Judge Kimberly Mueller temporarily halted the visits while she considered their scope.

Mueller rejected the state’s request to resume the tours in a March 6 order.

“The record is devoid of several pieces of threshold evidence necessary to support the costly and time-consuming prison tours,” she wrote in part. Those include evidence backing the initial study’s finding that California’s standards exceed national standards or that those national standards themselves are sufficient.

Moreover, the tours would distract from the state’s ongoing and, so far, deficient efforts to bring mental health care to constitutionally adequate levels, she wrote. They also would be redundant to ongoing reviews by the special master, she wrote, including his expert’s findings that the state still is not doing enough to prevent prisoners’ suicides.

Department officials are reviewing the order, said spokesperson Terri Hardy, who, because of the ongoing lawsuit, would not say whether they will appeal Mueller’s decision.

Gov. Gavin Newsom is the second consecutive Democratic governor to toy with ending the litigation. His predecessor, Jerry Brown, tried unsuccessfully more than a decade ago, citing similar findings by the state’s experts, but then-U.S. District Judge Lawrence Karlton ruled in April 2013 that the state was still providing substandard care.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

SACRAMENTO, Calif. — California could face more than $40 million in fines after it failed to improve suicide prevention measures in state prisons despite a federal judge’s warning that she would impose financial penalties for each violation.

Chief U.S. District Judge Kimberly Mueller told state officials over a year ago that she would start imposing fines unless they implemented 15 suicide prevention protocols that had been lacking for nearly a decade.

But court expert Lindsay Hayes reported March 1 that the state continues to lag on 14 of the 15 safeguards. The state even regressed in such areas as failing to house prisoners in suicide-resistant cells when they are first placed in segregation, often including solitary confinement, in which prisoners are particularly vulnerable. The special cells lack hooks, wire grates, or other protrusions from which prisoners can hang themselves, for instance.

Suicides have long been a problem in California prisons and are considered a bellwether of a broader, decades-long lack of adequate prison mental health care. They are one of several ongoing issues at the center of a class-action federal lawsuit that dates to 1990.

“Mr. Hayes’ finding of backsliding with respect to some of the remaining recommendations is deeply concerning, particularly in light of the nine years that have passed since he initially offered these recommendations,” wrote Matthew Lopes Jr., the special master retained by Mueller to help oversee prison mental health care.

California Department of Corrections and Rehabilitation spokesperson Pedro Calderón Michel said officials are reviewing the report and will file a formal response April 2. He said the department has a robust suicide prevention program, which has expanded since 2020. A team of psychologists follows a guidebook on suicide prevention practices modeled after the monitoring done by the special master’s own experts. Additionally, that team provides real-time feedback, and the department reviews each suicide.

“The health and well-being of every person in our care are of the utmost importance,” Calderón Michel said.

And as the state continues to experience a shortage of mental health care providers, he said, the department has taken steps to expand the use of telepsychiatry, as well as increasing salaries and benefits to attract more workers.

Thirty California state prisoners died by suicide last year. That’s an increase from 20 suicides in 2022 and 15 in 2021 but fewer than in the preceding two years. California’s rate of 32 suicides per 100,000 prisoners in 2023 exceeded the most recently available national state prison rate of 27 per 100,000.

Hayes’ report included eight instances in which prisoners’ bodies were not discovered until rigor mortis had set in, a stiffening of the joints and muscles that occurs several hours after death. Some of those prisoners were supposed to be monitored regularly to make sure they did not harm themselves; the delay in discovering their deaths cast doubt on whether they were being checked adequately.

In another case, a prisoner was supposed to be under constant suicide watch after he twice tried to kill himself the same day that he sent farewell notes to family members. Yet he was allowed to keep his tennis shoes against the chief psychiatrist’s orders, and he was placed unmonitored in a standard cell instead of a suicide-resistant cell.

An hour later, he was found hanging from the upper bunk by a shoestring.

“You realize this is not a game, these are human beings,” said Michael Bien, an attorney representing prisoners in the lawsuit. “Certainly, you shouldn’t be making the same mistakes that are preventable and foreseeable again and again and again.”

Mueller in a February 2023 order said she would impose $1,000 daily fines starting April 1, 2023, for each unmet safeguard at each prison that failed to comply. The protocols include such things as suicide prevention training and treatment planning, suicide risk evaluations, using suicide-resistant cells, and checking on susceptible prisoners every 30 minutes.

Hayes and Lopes did not say in their court filings how many fines accumulated. But their court filings contain identical charts outlining how many prisons still failed to meet each of the 15 standards during Hayes’ recent inspections. They tally 124 areas of ongoing noncompliance carrying $1,000 daily fines.

If Mueller levied fines for the 11 months between last April and when Hayes filed his report, they would top $41.5 million. But her order has the daily fines continuing indefinitely, and other variables might affect the total.

“No matter how you calculate it, it’s still going to be a very substantial number,” Bien said.

If Mueller follows previous practice, she will next hold a hearing on Hayes’ report and the pending fines. She has not said what the fines would be used for, but the goal is to encourage a resolution of the ongoing problems, not to punish the state.

Hayes’ report comes as Mueller is already considering collecting fines topping $95 million for state officials’ yearlong failure to hire enough mental health professionals to provide adequate treatment in state prisons.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).