By Denny Walsh and Sam Stanton
The state began its defense Tuesday of how it treats mentally ill inmates, with a psychiatrist from the California State Prison at Corcoran testifying that the use of pepper spray and strong restraints against prisoners in their cells sometimes is necessary to save an inmate's life.
Testifying in U.S. District Court in Sacramento, Dr. Ernest Wagner described his treatment of a prisoner known in court only as "Inmate A," a suicidal inmate who was sprayed repeatedly with pepper spray and pulled forcibly from his cell because he was refusing his medication. Wagner said he was present at the cell extraction.
Lawyers for the inmates, who are seeking court orders for sweeping changes in state prison policy on the handling of the mentally ill, played a graphic video of the cell extraction in court earlier this month to bolster their case for change.
In it, the naked prisoner is doused with pepper spray, forcibly removed from his cell in a mental health crisis unit at Corcoran, then strapped to a gurney and injected with anti-psychotic medication.
The inmates' attorneys are hoping the video of the cell extraction - as well as five others that have been played in court - will convince U.S. District Judge Lawrence K. Karlton to order limits on the use of force and pepper spray against the prisoners.
But the state contends the scenes shown in court this month are not representative of the efforts made by medical and custody staff to ensure patients are not injured.
Tuesday morning's testimony focused in Inmate A, who was placed in the mental health crisis unit at Corcoran on July 1, 2012.
"He was psychotic," Wagner said. "In meeting with him, he could not present an organized history.
"He was suffering from auditory hallucinations which were telling him to kill himself."
The inmate also refused to accept medication or, when he would allow it to be handed to him, threw it in the cell toilet, Wagner said.
The inmate once agreed to meet with Wagner outside his cell - in a metal cage roughly the size of a telephone booth. After that, Wagner said, he refused to leave his cell and deteriorated over the course of more than three weeks.
He stopped eating, took off his clothes and remained naked in his cell, talking to himself and sometimes screaming, Wagner said. He urinated on his mattress and finally flooded his cell.
Wagner said he made regular visits to the front of the inmate's cell, seeing him at least 12 times and trying to talk to him, but he was unresponsive.
On July 24, 2012, Wagner decided it was an emergency and issued an order for involuntary medication, a move that resulted in the forcible removal of the inmate from his cell by force, and eventually held in a five-point restraint for nearly 72 hours.
Without the cell extraction and medication, Wagner said, "he would have died."
He conceded under cross examination by inmate attorney Lori Rifkin he did not follow state corrections policy that inmates be held only for eight days in a mental health crisis bed unit before a referral to the Department of State Hospitals for care.
Inmate A remained in the crisis unit at Corcoran from July 1, 2012, until Aug. 14, Wagner testified, adding that he did not move him because he did not trust state hospital officials to follow through on medication administered involuntarily.
He also conceded that at one point, on July 16, he ordered the inmate released from the crisis unit to a lower level of care.
"It was obvious that we weren't being effective, we weren't doing anything," Wagner said.
He later thought better of it and rescinded that order.
Attorneys for the state plan to call witnesses for much of this week to testify about the need at times for the use of force to protect an inmate and staff from injury.
Wagner testified that incidents like the one depicted on the Inmate A video are not that common.
"If they accept handcuffs (when being removed from their cells) then there's no struggle," he said. "If they do not accept handcuffs then we'd have to go to Plan B, I guess you'd call it."
The videos shown in court to date have displayed large high levels of physical force and massive quantities of pepper spray that the inmate attorneys' experts say is beyond anything they have seen in other states.
But Wagner said he has not seen any lasting harm from the use of pepper spray and that, typically, it does not take more than one blast.
"Most of the time just one spray and they comply," Wagner said.