[00:00:00] Speaker 03:
Good morning.

[00:00:01] Speaker 03:
Deputy Attorney General Oliver Wu on behalf of defendants.

[00:00:06] Speaker 03:
This appeal is about the scope of the Coleman Remedial Plan, which concerns mental health treatment for serious mental disorders.

[00:00:13] Speaker 03:
The Remedial Plan defines serious mental disorders to exclude personality disorders.

[00:00:18] Speaker 03:
So the district court overstepped when it ordered defendants to implement specific.

[00:00:23] Speaker 01:
It did indeed, but then it went on to talk about

[00:00:28] Speaker 01:
that the members of the class were covered if they had personality disorders, did it not?

[00:00:33] Speaker 03:
It did, Your Honor.

[00:00:34] Speaker 01:
However- Isn't that really what we're talking about here, whether Judge Mueller was incorrect in interpreting this order to say, yeah, you've got to treat personality disorders if these people are already members of the class.

[00:00:50] Speaker 03:
I have two responses to that.

[00:00:53] Speaker 03:
First, the remedial plan requires treatment for the Coleman class members.

[00:00:59] Speaker 03:
But personality disorders are explicitly excluded from that treatment.

[00:01:04] Speaker 01:
If, at least is my understanding, if you take them as a class by themselves, in other words, they're not part of the normal class, and you just say, OK, this is a new group of people, clearly they are excluded.

[00:01:14] Speaker 01:
But as I understood the judge's ruling, what she's saying is,

[00:01:19] Speaker 01:
Hey, if you're a member of the class and you have personality disorders, you're covered.

[00:01:23] Speaker 01:
And I think that's what she said.

[00:01:25] Speaker 03:
Well, I think our interpretation is that she's requiring specific treatment for the personality disorder.

[00:01:31] Speaker 03:
But the remedial plan doesn't require that treatment.

[00:01:34] Speaker 03:
It only requires treatment for access one mental disorders.

[00:01:37] Speaker 01:
Unless, unless they're members of the class and personality disorders is one of the plethora of problems that they have.

[00:01:47] Speaker 01:
Isn't that what Judge Mueller basically concluded?

[00:01:50] Speaker 03:
But Judge Mueller ordered, however, personality disorder treatment is not included.

[00:01:54] Speaker 03:
So to put it another way, if a class member has an Axis I mental disorder and a personality disorder, to the extent the personality disorder doesn't rise to a level of medical necessity, the Coleman Remedial Plan requires defendants to provide treatment for the Axis I mental disorder.

[00:02:10] Speaker 03:
But the residual mental health issues, such as personality disorders, are left to the discretion of the clinicians.

[00:02:16] Speaker 01:
They're not.

[00:02:17] Speaker 01:
So are you saying that

[00:02:21] Speaker 01:
If you have a member of the class who also has a personality disorder that is up to the discretion of the training professional, whether or not to provide treatment on the personality disorder aspect, is that correct?

[00:02:37] Speaker 03:
Yes.

[00:02:38] Speaker 03:
And to be clear, it's important to emphasize that defendant's mental health professionals provide mental health treatment for all class members, regardless whether they have a co-occurring personality disorder.

[00:02:50] Speaker 03:
It, and as a practical matter, the mental health clinicians treat the whole patient and provide individualized treatment.

[00:02:58] Speaker 03:
And so when they, so when they get a patient with personality disorders, they treat the entire patient and they don't pick and choose what disorders to treat and not see.

[00:03:06] Speaker 01:
Okay, but let's just, again, arguendo.

[00:03:10] Speaker 01:
If, when I read the report, I guess what we're talking about, we read the report and conclude that

[00:03:17] Speaker 01:
It's a reasonable interpretation of that document that if someone is a member of the class and also has personality disorders, it's a reasonable interpretation of that order to basically order them to be treated under this report.

[00:03:34] Speaker 01:
Is that right?

[00:03:35] Speaker 03:
So, yes, I have two responses to that.

[00:03:37] Speaker 03:
To first directly address your question, the

[00:03:40] Speaker 03:
The district court could have ordered treatment for medical necessity, because medically necessary treatment is covered by the program guide.

[00:03:49] Speaker 03:
We don't dispute that.

[00:03:50] Speaker 03:
But what the district court did here was it took a step beyond that and stated that defendants are required to treat personality disorders for the class in general, regardless whether it was medically necessary.

[00:04:02] Speaker 01:
And is that not a reasonable construction of the report language?

[00:04:06] Speaker 03:
The no, your honor.

[00:04:08] Speaker 03:
Why?

[00:04:08] Speaker 03:
Because the first the report identified 470 inmates that may benefit from special treatment.

[00:04:15] Speaker 03:
And that language there is important because there are several shortcoming methodological shortcomings to the report.

[00:04:21] Speaker 03:
These class members, these identified class members have a wide range of personality disorders.

[00:04:25] Speaker 03:
some of which aren't treatable, and some class members also didn't have personality disorder diagnoses on their medical records.

[00:04:34] Speaker 03:
But even if we assume, for the sake of argument, that mental health personality disorder treatment was medically necessary for all 470 inmates, there's still the problem that the district court went beyond ordering medically necessary treatment.

[00:04:49] Speaker 01:
When you go back to the beginning,

[00:04:51] Speaker 01:
I mean, this is a long-going, ongoing situation, and we have it, of course, in the second case.

[00:04:57] Speaker 01:
It's just gone on forever.

[00:04:59] Speaker 01:
But the bottom line is what Eighth Amendment rights do incarcerated persons that are covered by this action have to get medical treatment, psychiatric and other treatment?

[00:05:15] Speaker 01:
Personality disorders is one of a plethora of things that can happen.

[00:05:20] Speaker 01:
The language of the report perhaps was not drafted.

[00:05:23] Speaker 01:
It was like it was drafted by a committee.

[00:05:26] Speaker 01:
So it wasn't as exact as it might have been.

[00:05:28] Speaker 01:
But it's clearly within what was intended to be able to treat people.

[00:05:34] Speaker 01:
So if you have somebody with a serious disorder,

[00:05:37] Speaker 01:
and they either newly manifest personality disorders or they're there all along and they're in kind of a smoldering set, it's still part of the treatment that's necessary to help them as members of the class to be treated, right?

[00:05:51] Speaker 03:
So with respect, Your Honor, I disagree with that premise.

[00:05:53] Speaker 01:
Okay, why?

[00:05:53] Speaker 03:
The original 95 judgment was focused on serious mental disorders and that had a very specific meaning in that case.

[00:06:01] Speaker 01:
So you're saying that personality disorders cannot be a serious mental disorder when combined with other things?

[00:06:06] Speaker 03:
It wasn't understood as one of those disorders.

[00:06:09] Speaker 03:
It was or was not?

[00:06:10] Speaker 03:
It wasn't understood as one of the serious mental disorders.

[00:06:13] Speaker 03:
In the 95 judgment, the district court made clear that it was concerned with what it called organic brain syndrome, which have now been renamed Axis I mental disorders.

[00:06:23] Speaker 03:
Personality disorders are not one of those Axis I mental disorders.

[00:06:27] Speaker 03:
The program guide, when it was compiled in 2006, specifically enumerated

[00:06:33] Speaker 03:
specific Axis I mental disorders that were targeted for treatment.

[00:06:37] Speaker 03:
That's in page 370, volume 4 of the excerpts.

[00:06:41] Speaker 03:
On top of that, the program guide also makes clear that its focus and emphasis is on those enumerated disorders.

[00:06:48] Speaker 03:
And the reason why personality disorders could not have been included within the scope of the original judgment is because in 1995 and in 2006, personality disorders were not well understood and were largely thought to be untreatable.

[00:07:01] Speaker 03:
And so it makes no sense for the district court to have ordered defendants to treat an untreatable condition as part of the constitutional remedy.

[00:07:10] Speaker 03:
And so now, even today, some personality disorders still do not have

[00:07:15] Speaker 03:
evidence-based treatment.

[00:07:16] Speaker 03:
And for some disorders, the treatments that are available are not effective because they require buy-in and participation by the patient.

[00:07:25] Speaker 03:
So with that historical context, the treatment, the word treatment in the program guide could not refer to personality disorder treatment.

[00:07:33] Speaker 01:
Instead... So in other words, 1995, I think you said, personality disorders were essentially viewed as untreatable.

[00:07:41] Speaker 01:
Is that what you're saying?

[00:07:42] Speaker 01:
So they couldn't possibly have meant that, but they did conclude that if you're a member of a class, they're supposed to be treated.

[00:07:53] Speaker 01:
So if there's some new thing that comes up that makes it essential for them in order to get appropriate treatment that you've got to treat personality disorders, why would that not be included?

[00:08:05] Speaker 03:
So that sentence in the program guide refers to treatment for Axis I mental disorders and medically necessary treatment.

[00:08:15] Speaker 03:
It doesn't attempt to encompass treatment for all mental health issues, only the serious disorders that are enumerated in the guide.

[00:08:23] Speaker 03:
The purpose of that sentence, under our interpretation and our understanding, is that

[00:08:27] Speaker 03:
It serves as a safety, as a backstop to prevent defendants from denying mental health treatment to individuals who would otherwise be part of the Coleman class.

[00:08:37] Speaker 01:
According to the state, how many people are we talking about?

[00:08:40] Speaker 01:
If Judge Mueller's order is carried out, how many new situations do we have?

[00:08:47] Speaker 01:
It's the same people, right?

[00:08:48] Speaker 01:
Same members of the class.

[00:08:49] Speaker 01:
It's just a question of treating them for additional conditions.

[00:08:54] Speaker 01:
Is that right?

[00:08:55] Speaker 03:
Yes, Your Honor.

[00:08:56] Speaker 01:
But no new people.

[00:08:57] Speaker 03:
I don't have the specific numbers on how many individuals have personality disorders, but the 470 that were identified represents less than half a percent of the entire Coleman class.

[00:09:08] Speaker 03:
So essentially what the district court did here was it identified a small problem, a small need, and expanded the remedy dramatically to include all personality disorders suffered by the Coleman class.

[00:09:21] Speaker 01:
But it's the class.

[00:09:23] Speaker 01:
Only members of the class.

[00:09:25] Speaker 01:
In other words, if they were not members of the class, they're not covered for personality disorders, right?

[00:09:29] Speaker 03:
That's right, Your Honor.

[00:09:31] Speaker 03:
But the program guide specifically excludes personality disorders from the scope of treatment options required under the Coleman remedy.

[00:09:42] Speaker 03:
And so that line in the program guide requiring treatment simply serves to ensure that inmates who have a personality disorder are not denied mental health treatment because of that disorder.

[00:09:56] Speaker 03:
They are still provided mental health treatment for their access one mental disorders or medical necessity.

[00:10:01] Speaker 01:
So I want to be sure, Anders, that you were talking about the 450 or whatever.

[00:10:06] Speaker 01:
The judge's order doesn't expand the number of people involved, right?

[00:10:13] Speaker 03:
It doesn't, it does, Your Honor, because the judge's order requires defendants to carry out these personality disorder pilot programs.

[00:10:20] Speaker 03:
It doesn't make any reference to, it doesn't narrow the scope of its order to the 470 individuals.

[00:10:27] Speaker 01:
It doesn't... But they're members of the class though, right?

[00:10:30] Speaker 03:
It does.

[00:10:31] Speaker 03:
It is limited to class members.

[00:10:32] Speaker 03:
But it goes beyond just the 470 individuals identified by the unmet needs assessment.

[00:10:41] Speaker 02:
How does it go beyond that number?

[00:10:44] Speaker 03:
Well, the district court simply stated that defendants are required to provide personality disorder treatment under the Coleman guide.

[00:10:51] Speaker 02:
Exactly.

[00:10:51] Speaker 02:
But if it applies only to the Coleman class members, how can it be broader than that?

[00:10:57] Speaker 03:
I guess I should clarify.

[00:10:58] Speaker 03:
So there are Coleman class members with personality disorders beyond just the 470 identified individuals.

[00:11:06] Speaker 03:
And so this order requires defendants to provide personality disorders class-wide, not just for the 470 people identified by the assessment.

[00:11:16] Speaker 01:
Do you have any idea how many people we're talking about in addition to the 450 or 75 or whatever you're talking about?

[00:11:22] Speaker 01:
I don't have that number.

[00:11:24] Speaker 01:
You're guessing it's going to increase the number, but you don't know.

[00:11:28] Speaker 03:
Yes.

[00:11:28] Speaker 03:
But the problem is that the district court simply expanded the scope of the remedy and disregarded the program guide's explicit language that personality disorders are not included within the scope of the remedy.

[00:11:40] Speaker 03:
And so by doing that, the court overstepped the bounds of the remedial plan.

[00:11:45] Speaker 03:
And the court can reverse for a second reason as well, which is that the district court didn't even mention the PLRA and didn't even attempt to conduct a PLRA analysis.

[00:11:55] Speaker 03:
The PLRA, however, is mandatory, and the district court must consider whether any prospective relief is necessary, narrow, or at least intrusive.

[00:12:05] Speaker 03:
I'd like to reserve the remainder of my time.

[00:12:07] Speaker 02:
All right.

[00:12:07] Speaker 02:
Thank you, counsel.

[00:12:08] Speaker 02:
Thanks.

[00:12:21] Speaker 00:
Good morning.

[00:12:22] Speaker 00:
My name is Lisa Ells.

[00:12:23] Speaker 00:
I represent the plaintiff class.

[00:12:26] Speaker 00:
The state is simply incorrect that the judgment in this case or the program guide excludes treatment for personality disorders.

[00:12:35] Speaker 00:
The only thing that the state has cited is a footnote from the original injunction, which they claim limits treatment to only what are now known as access one disorders.

[00:12:48] Speaker 00:
However, that is not correct.

[00:12:50] Speaker 00:
First of all, the language in that footnote specifically says that some offenders with non-psychotic disorders may be sufficiently impaired to meet the relevant criteria for the class.

[00:13:08] Speaker 00:
And that is very clearly what a personality disorder patient has.

[00:13:14] Speaker 00:
They have sufficient impairments that prevent them from functioning without sufficient treatment in a prison setting or otherwise.

[00:13:24] Speaker 00:
But more importantly, the context of what they're claiming is this personality exclusion from the judgment is really just the district court saying that the definition of the class

[00:13:35] Speaker 00:
and the scope of the injunction, which are for serious mental disorders, is sufficiently clear on its face.

[00:13:43] Speaker 00:
So that is the definition of the class.

[00:13:44] Speaker 00:
That is the scope of the judgment.

[00:13:46] Speaker 00:
It is prisoners with serious mental disorders.

[00:13:49] Speaker 00:
There is no dispute here that personality disorders are serious mental disorders.

[00:13:54] Speaker 00:
They must be treated.

[00:13:55] Speaker 00:
The exclusionary language that they're claiming under the program guide exactly as you said, Your Honor Judge Smith,

[00:14:02] Speaker 00:
It has nothing to do with an exclusion.

[00:14:04] Speaker 00:
It says, as long as they're class members, they receive treatment.

[00:14:07] Speaker 00:
The program guide itself requires individualized treatment for all of a patient's mental health disorders.

[00:14:13] Speaker 00:
This is a mental health disorder.

[00:14:14] Speaker 01:
If I understand your friend's comment, he seems to concede that if someone is a member of the class and has personality disorder, they should be treated, if I understood him correctly.

[00:14:26] Speaker 01:
Do you have any sense of, are there any additional people that other than, I know whether it's 450 or 475, how many more people are we talking about that would be included in the class that were not before because of the addition of the personality disorder issue?

[00:14:45] Speaker 00:
Well, to be clear, they were always members of the class.

[00:14:47] Speaker 01:
Right, right.

[00:14:48] Speaker 01:
But I mean, how many people, we've got certain number of people being treated now.

[00:14:52] Speaker 01:
Yeah.

[00:14:53] Speaker 01:
Is the number of the people in the class that are being treated expanding, and if so, roughly how much?

[00:15:00] Speaker 00:
No, the number of people being treated is not expanding.

[00:15:04] Speaker 00:
So the scope of the study that identified this 470 patients, the clinicians, CDCR's own clinicians were instructed to look for three things and put people in three buckets.

[00:15:15] Speaker 00:
They only looked at class members.

[00:15:17] Speaker 00:
They looked at class members with personality disorders that were receiving appropriate treatment.

[00:15:23] Speaker 00:
They looked at class members who were not receiving appropriate treatment but could be treated within existing programs CDCR already offered.

[00:15:31] Speaker 00:
The only bucket we are talking about

[00:15:33] Speaker 00:
is patients that the state explicitly found had personality disorders, were class members, and were not receiving constitutionally adequate care.

[00:15:42] Speaker 00:
So it's not an expansion of the class.

[00:15:44] Speaker 00:
It's actually the judge funneling down in the remedy to end federal oversight.

[00:15:49] Speaker 00:
This is a gap in the remedial plan that has existed for a very, very, very long time.

[00:15:54] Speaker 01:
Do you have any idea how many people we're talking about that were members of the class but had not been treated?

[00:16:01] Speaker 00:
470 is what I mean some of those were previously being treated though, right Not in that they were all being treated, right?

[00:16:10] Speaker 00:
They were all members of the class receiving the standard treatment But their clinicians said actually our standard treatment that we have isn't sufficient to treat these people We need something else for these patients.

[00:16:22] Speaker 01:
That's the state's so basically You got people who are being treated

[00:16:27] Speaker 01:
The clinicians, psychiatrists, or others are just saying, you know, we really need to treat these people for personality disorders, or we're not going to be able to help them in effect.

[00:16:36] Speaker 01:
Is that right?

[00:16:36] Speaker 00:
Correct.

[00:16:37] Speaker 01:
Okay.

[00:16:38] Speaker 00:
Yeah.

[00:16:39] Speaker 00:
And then the state, first of all, the state never objected to having to study whether these people exist.

[00:16:46] Speaker 00:
They know they exist.

[00:16:47] Speaker 00:
They know they're class members.

[00:16:48] Speaker 00:
The history of this case shows this is a very troubled population.

[00:16:52] Speaker 00:
They cycle in and out of segregation.

[00:16:55] Speaker 00:
They have very high risk of self-harm and suicide.

[00:16:58] Speaker 00:
30% of all suicides are patients with personality disorders in CDCR.

[00:17:03] Speaker 00:
This is a very troubled group of people who really need mental health interventions.

[00:17:08] Speaker 00:
The state identified mental health interventions that exist, that are being used in other correctional systems.

[00:17:15] Speaker 00:
It was not an error in any way for the court to require them to actually implement the pilot that they said they were going to do anyway.

[00:17:23] Speaker 01:
Correct me if I'm wrong.

[00:17:25] Speaker 01:
My reading of the record is so massive.

[00:17:28] Speaker 01:
I confess I didn't read every thing, but it seems like Judge Mueller finally just got so frustrated that there was this resistance to everything that she moved forward with this.

[00:17:40] Speaker 01:
Is that your perspective as well?

[00:17:41] Speaker 00:
I think it's partially that.

[00:17:43] Speaker 00:
I also think that the judges being very carefully to move this case as quickly as possible to ending federal oversight.

[00:17:50] Speaker 00:
As I mentioned, this is a gap in the remedy that's existed a long time, but it was never totally clear what the contours of that gap were.

[00:17:58] Speaker 00:
And so that's why she instituted the study.

[00:18:01] Speaker 00:
And defendants studied the patients, identified them very clearly, said they need additional care, and then found appropriate care.

[00:18:10] Speaker 00:
So one of the things I think the court intended to do by ordering the pilot, as opposed to just letting it voluntarily proceed, is two things.

[00:18:18] Speaker 00:
To prevent the state from abandoning the pilot, it's abandoned many, many other appropriate treatments for these patients in the past that it's tried.

[00:18:26] Speaker 00:
and abandoned.

[00:18:27] Speaker 00:
So I think the judge wanted to make sure this remedy actually sticks.

[00:18:31] Speaker 00:
And then also, I think the judge wanted to ensure that it was appropriately implemented, and that's why she's ordered the special master to oversee the implementation and make suggestions about any future actions for a larger rollout.

[00:18:45] Speaker 02:
Counsel, what's your response to opposing counsel's position that the judge failed to comply with the requirements of the PLRA?

[00:18:53] Speaker 00:
Your honor, I think this is not a case where the judge overstepped her bounds with respect to the PLRA.

[00:19:00] Speaker 00:
The Armstrong cases make very clear there's no magic words requirement.

[00:19:04] Speaker 00:
What's necessary is that the judge articulate the facts and the circumstances giving rise to the order.

[00:19:09] Speaker 00:
In this case, the facts and circumstances are that there's an ongoing constitutional violation, denial of access to care.

[00:19:19] Speaker 00:
So that is very clear.

[00:19:21] Speaker 00:
It's also suicide prevention is part of the ongoing constitutional violation in this case.

[00:19:26] Speaker 00:
These patients are at very high risk of suicide.

[00:19:30] Speaker 00:
She's been very narrow about how she's tailored this.

[00:19:34] Speaker 00:
She's let them pick every single aspect of how they want to roll this pilot out.

[00:19:38] Speaker 00:
They picked the timeline.

[00:19:40] Speaker 00:
They picked which

[00:19:41] Speaker 00:
prisons to start with over our objections.

[00:19:45] Speaker 00:
They picked which protocol they wanted to implement.

[00:19:49] Speaker 00:
All of that was left to the state's discretion.

[00:19:51] Speaker 00:
And similarly, the judge here has been extraordinarily patient.

[00:19:57] Speaker 00:
She's been watching this remedy.

[00:20:00] Speaker 00:
All of us have known about this group of patients for a very long time.

[00:20:04] Speaker 00:
They are in every special master report as receiving unconstitutional care.

[00:20:11] Speaker 00:
The state doesn't really dispute that.

[00:20:13] Speaker 00:
They just identify that they also have access one disorders.

[00:20:16] Speaker 00:
That's not really the point.

[00:20:18] Speaker 00:
We know they have dual diagnoses, but the point is they're required to treat every single aspect of the mental health condition.

[00:20:26] Speaker 00:
And in terms of tailoring, I don't know how you could more narrowly tailor this, frankly.

[00:20:31] Speaker 00:
It's a pilot program and it's limited to the patients that the state itself has identified as needing care that didn't exist prior to this order.

[00:20:41] Speaker 00:
So I think there's no question that in this case where prior remedial efforts have failed, they've abandoned many promising programs in the past.

[00:20:53] Speaker 00:
The court is required to advance remediation of this case and end federal oversight.

[00:20:57] Speaker 00:
She's taken appropriate steps here to do exactly that.

[00:21:00] Speaker 00:
And I think unless this court has further questions for me.

[00:21:05] Speaker 02:
I wanted to ask you about the request for judicial notice.

[00:21:08] Speaker 00:
Yes.

[00:21:08] Speaker 02:
Was that opposed?

[00:21:10] Speaker 00:
No.

[00:21:13] Speaker 02:
Any other questions?

[00:21:15] Speaker 02:
It appears not counsel.

[00:21:16] Speaker 00:
Thank you.

[00:21:31] Speaker 03:
Thank you.

[00:21:33] Speaker 03:
So first I want to clarify a few things.

[00:21:35] Speaker 03:
Defendants aren't arguing that the district court's order expanded the class.

[00:21:38] Speaker 03:
They're arguing that it expanded the scope of the remedy.

[00:21:41] Speaker 03:
And so I think a helpful example would be a hypothetical of a patient with schizophrenia and narcissistic personality disorder.

[00:21:49] Speaker 03:
The program guide requires treatment for the schizophrenia.

[00:21:52] Speaker 03:
It does not require treatment for the narcissistic personality disorder.

[00:21:56] Speaker 03:
What the district court did here was expand the remedy of the program guide to now require a defendant to provide that personality disorder treatment.

[00:22:04] Speaker 03:
And that's the expansion that defendants are concerned with.

[00:22:08] Speaker 01:
But counsel, if I understand correctly, you're talking about a group of people who have suicidal tendencies and so on.

[00:22:17] Speaker 01:
It's kind of important, don't you think?

[00:22:19] Speaker 03:
Plaintiffs make a big deal about the suicidal tendencies and suicide rates, but that's a red herring because the program guide already covers these patients under the medical necessity clause.

[00:22:30] Speaker 03:
So we're talking about patients who have personality disorders that do not cause significant dysfunction, do not rise to the level of medical necessity.

[00:22:38] Speaker 01:
And how many of the 470 people we're talking about fit into your classification?

[00:22:45] Speaker 01:
So for the $470, the assessment didn't make that very clear because it's simply... So basically, you're saying, hey, you know, it's your problem, prisoner.

[00:22:55] Speaker 01:
We don't know exactly which one of you need it, which don't.

[00:22:58] Speaker 01:
So you're not going to get it.

[00:23:00] Speaker 03:
So two responses.

[00:23:01] Speaker 03:
First is that for the 470, the district court could have issued a narrow order within the scope of the program guide.

[00:23:09] Speaker 03:
It could have ordered defendants to provide medically necessary personality disorder treatment.

[00:23:13] Speaker 03:
That's not what it did.

[00:23:15] Speaker 03:
It ordered treatment across the class with no qualifications on medical necessity and just simply stated, you have to provide personality disorder.

[00:23:22] Speaker 02:
But wasn't there expert opinion that said these

[00:23:26] Speaker 02:
the person who could not be completely treated unless for mental health issues, unless these personality disorders were taken into account in addition to the other mental health treatment they were given.

[00:23:41] Speaker 03:
Not in connection with the 470 identified patients.

[00:23:45] Speaker 03:
In fact, the assessment specifically stated that it wasn't clear about what would be effective because some of the patients did not even have a personality disorder in the medical records.

[00:23:56] Speaker 03:
I think what the court might be referring to are other special master reports about individual patients.

[00:24:01] Speaker 03:
But for those individual patients, in the examples highlighted by plaintiffs, all of those patients needed treatment because it was medically necessary.

[00:24:09] Speaker 02:
I'm just curious.

[00:24:10] Speaker 02:
Why would the state be fighting this so hard to not give mental health treatment to prisoners, even if it's a personality disorder as opposed to

[00:24:19] Speaker 02:
And X is one.

[00:24:21] Speaker 02:
Why is the state fighting so hard against giving this treatment to inmates?

[00:24:26] Speaker 03:
I know, sorry.

[00:24:27] Speaker 03:
My time is up.

[00:24:27] Speaker 02:
Please answer.

[00:24:29] Speaker 03:
I think there is a practical reason.

[00:24:30] Speaker 03:
So first, treatments that's governed by the Coleman remedy are subject to various additional requirements.

[00:24:37] Speaker 03:
They're subject to monitoring by the special master.

[00:24:41] Speaker 03:
Any fine tuning or revamping of these treatment modalities have to be accepted by plaintiffs and the special master and ratified by the district court.

[00:24:48] Speaker 03:
treatment within governed by the program guide are subject to administrative requirements such as extra documentation requirements and various other hurdles.

[00:24:58] Speaker 03:
Personality disorder treatment or treatment for residual mental health issues don't have to be subject or not subject to all of those requirements and defendant's mental health professionals therefore have the flexibility to use the professional judgment in providing this treatment.

[00:25:12] Speaker 02:
But the state has been resistant to not just this remedy but

[00:25:18] Speaker 02:
has been resistant to the remedies that have been imposed throughout this litigation.

[00:25:23] Speaker 02:
I just don't understand why the state is resistant to doing something that would

[00:25:29] Speaker 02:
work to the benefit of the state in having prisoners who don't have these mental issues within the inmate population.

[00:25:36] Speaker 02:
I don't understand the rationale, I guess, for it.

[00:25:39] Speaker 02:
Can you help me?

[00:25:40] Speaker 03:
The rationale is because this would increase judicial entanglement, judicial management of the mental health system.

[00:25:49] Speaker 01:
Isn't that really money?

[00:25:50] Speaker 01:
I'm sorry.

[00:25:51] Speaker 01:
Isn't that what we're really talking about is money?

[00:25:53] Speaker 01:
The state doesn't want to put more money into this?

[00:25:56] Speaker 03:
It's not just money, Your Honor.

[00:25:57] Speaker 01:
It's also- Not just money, but money is a big issue, right?

[00:26:00] Speaker 03:
It is certainly a issue, but it's more about the micromanagement of the prison system.

[00:26:04] Speaker 02:
Well, but if you complied with the orders, then the court would be out of the business of managing.

[00:26:10] Speaker 02:
That's what opposing counsel's point is.

[00:26:14] Speaker 02:
If the state just complied with the orders that have been entered, the recommendations from the

[00:26:21] Speaker 02:
from the person who's been assigned to oversee the prison, then they would be out of it.

[00:26:27] Speaker 03:
Well, I think this appeal kind of demonstrates the difficulty with that argument, because the district court is adding on to the orders that defendants have to comply with.

[00:26:37] Speaker 03:
It's not just about serious mental disorders and access one mental disorders anymore.

[00:26:41] Speaker 03:
The district court has now made it about personality disorders as well.

[00:26:45] Speaker 03:
So there is the ever-expanding.

[00:26:46] Speaker 02:
But if the state had to comply years ago

[00:26:50] Speaker 02:
we wouldn't be in the situation where the court was, in your view, broadening the issues, because the court would have been out of the case.

[00:26:59] Speaker 02:
So it's kind of a dilemma of the state's own making, that this case has dragged on so long that now more modalities have been discovered.

[00:27:13] Speaker 02:
And the court is saying, well, these modalities should now be included.

[00:27:18] Speaker 03:
But I guess I just disagree with the premise of that.

[00:27:22] Speaker 02:
All right, OK.

[00:27:23] Speaker 02:
I understand.

[00:27:24] Speaker 02:
I understand your position.

[00:27:25] Speaker 02:
Thank you to both counsel for your helpful arguments.

[00:27:27] Speaker 02:
The case just argued is submitted for decision by the court.