Chapter 6 – Adult Classification

Inmates committed to the Department who are identified as in need of special medical/psychiatric treatment shall be evaluated and placed into specialized medical/psychiatric treatment category programs.

This section establishes standard procedures for the orderly identification, evaluation, and acceptance of those inmates in need of special medical/psychiatric treatment programs.

Medical

• Assignment into and out of all medical treatment categories shall be through the classification process and endorsement by a CSRClassification Staff Representative. Classification committee referrals to a CSRClassification Staff Representative shall also include the appropriate medical recommendation on a CDCRCalifornia Department of Corrections and Rehabilitation Form 128-C3, Medical – Classification Chrono, signed by a physician and/or psychiatrist dated within 90 days of the CSRClassification Staff Representative’s review. The CDCRCalifornia Department of Corrections and Rehabilitation Form 128-C3 shall indicate that an agreement has been reached between sending and receiving physicians. Inmates endorsed for specific medical treatment categories shall receive at a minimum an annual medical evaluation to determine if continued medical placement is appropriate. The case shall be submitted to a CSRClassification Staff Representative for review and endorsement at least on an annual basis.

Category “H”

• Inmates who require medical services and/or surgical care in a general acute care hospital are designated Category “H.” “Category “H” care is provided at CMFCalifornia Medical Facility, CIMCalifornia Institution for Men, and California Men’s Colony – East (CMCCalifornia Men's Colony-E). Female inmates and male inmates with medical needs that cannot be met in CDCRCalifornia Department of Corrections and Rehabilitation hospitals may be transferred to a community hospital.

Category “N”

• Inmates with chronic medical illness requiring skilled nursing or intermediate level medical care are designated Category “N “. This program has licensed nursing staff on duty at all times and is provided at CMFCalifornia Medical Facility, CIMCalifornia Institution for Men, and CMCCalifornia Men's Colony-E. Female inmates requiring this level of service shall be transferred to a community hospital unless special arrangements can be made at the CIWCalifornia Institution for Women infirmary. This category is not for inmates in infirmaries undergoing short-term treatment of minor illness.

Category “O”

• Inmates who have recurrent, contagious, chronic, or other medical problems that do not require inpatient care but do require frequent outpatient diagnostic, treatment and/or rehabilitation services shall be designated Category “O”. This category includes those inmates on dialysis or unusual diets and those requiring treatment and who are wheelchair-bound or blind.

• This category is provided at the acute general hospitals at CMFCalifornia Medical Facility, CIMCalifornia Institution for Men, CMCCalifornia Men's Colony-E, and the CIWCalifornia Institution for Women infirmary. Inmates unable to climb stairs shall not be transferred to CMCCalifornia Men's Colony-E.

General

• Inmates who suffer impaired functioning sufficient to require a mental health treatment program due to symptoms of a major mental illness shall be transferred to CMFCalifornia Medical Facility, CMCCalifornia Men's Colony-E or CIWCalifornia Institution for Women for psychiatric evaluation. The psychiatric referral and diagnosis shall be consistent with the standards of the American Psychiatric Association, DSM-IVIntravenous-R, Classification Axis I, II and V.

• Reception Center psychiatric referrals shall be documented on a CDC Form 128-C and referred to a CSRClassification Staff Representative. The CSRClassification Staff Representative shall endorse reception center process cases to CMFCalifornia Medical Facility, CMCCalifornia Men's Colony, or CIWCalifornia Institution for Women for psychiatric evaluation.

• Upon completion of the psychiatric evaluation, the case shall be returned to a CSRClassification Staff Representative for confirmation of the recommended psychiatric program and placement at CMFCalifornia Medical Facility, CMCCalifornia Men's Colony-E or CIWCalifornia Institution for Women or DMHDepartment of Mental Health (see Department of State Hospitals DSH). Inmates not requiring a psychiatric program shall be placed at an institution in accordance with the classification score and other program needs.

Reception Center inmates designated psychiatric category on a prior term shall be evaluated by psychiatric staff for reestablishment of the category based on the current need for psychiatric intervention.

This evaluation shall be documented on a CDC Form 128-C and shall include a recommendation for housing at CMFCalifornia Medical Facility, CMCCalifornia Men's Colony-E or CIWCalifornia Institution for Women if intervention is indicated.

If psychiatric intervention is not indicated, staff shall recommend general population placement. The Category “U” shall not be used at reception centers.

Institution requests for psychiatric evaluation shall be documented on a CDC Form 128-C and referred to a CSRClassification Staff Representative for endorsement to CMFCalifornia Medical Facility, CMCCalifornia Men's Colony-E or CIWCalifornia Institution for Women as “psychiatric evaluation and return” cases.

Inmates determined not to be in need of psychiatric intervention shall be returned by the C&PRClassification & Parole Representative to the sending institution, providing the CDC Form 128-C documenting the psychiatric evaluation is available and dated within 90 days of C&PRClassification & Parole Representative review.

Inmates endorsed for specific psychiatric treatment categories shall receive at least annually, a psychiatric evaluation to determine if continued psychiatric treatment is necessary. This annual evaluation shall result in a classification review and referral to a CSRClassification Staff Representative for confirmation of the inmate’s category designation.

C&PRs at CMFCalifornia Medical Facility, CMCCalifornia Men's Colony-E and CIWCalifornia Institution for Women may re-designate between Category “I” and “J” inmates based on current program status by using a CDCRCalifornia Department of Corrections and Rehabilitation Form 840, CDCRCalifornia Department of Corrections and Rehabilitation Reclassification Score Sheet.

Inmates housed at CMFCalifornia Medical Facility, Atascadero State Hospital (ASHAtascadero State Hospital) or Metropolitan State Hospital (MSHMetropolitan State Hospital) who demonstrate impaired functioning due to symptoms of a major mental disorder shall be designated Category “I”.

Category “I”

• This category shall include inmates determined to be:

  • Unable to perform normal institution routines.

  • Unable to provide for their basic needs or utilize available treatment resources.

  • Suicidal or self-abusive.

  • Inmates who demonstrate impaired functioning or other abnormal behavior of unknown etiology may be admitted for observation and diagnostic study.

• Cases shall be designated Category “I” only by CMFCalifornia Medical Facility/DMHDepartment of Mental Health (see Department of State Hospitals DSH), CMCCalifornia Men's Colony (ASHAtascadero State Hospital cases) or CIWCalifornia Institution for Women (MSHMetropolitan State Hospital cases) staff.

Other institutions with inmates appearing to meet Category “I” criteria shall provide this information to the designated contact person at CMFCalifornia Medical Facility/DMHDepartment of Mental Health (see Department of State Hospitals DSH) or CIWCalifornia Institution for Women. This may be accomplished by telephone interview.

Upon verbal acceptance the DMHDepartment of Mental Health (see Department of State Hospitals DSH) evaluation team will notify CMFCalifornia Medical Facility C&PRClassification & Parole Representative who will request FAX approval for transfer as “inpatient observation, unclassified.” (Refer to 62080.16.1).

Female inmates needing inpatient psychiatric services shall be referred to a state hospital by CIWCalifornia Institution for Women staff. Male inmates at CMCCalifornia Men's Colony needing inpatient psychiatric services shall be referred to ASHAtascadero State Hospital or CMFCalifornia Medical Facility/DMHDepartment of Mental Health (see Department of State Hospitals DSH).

DMHDepartment of Mental Health (see Department of State Hospitals DSH) provides inpatient services for inmates transferred from psychiatric programs at CMFCalifornia Medical Facility, CMCCalifornia Men's Colony, and CIWCalifornia Institution for Women to a state hospital pursuant to PCPenal Code 2684. These inmates shall be designated Category “I” during their state hospital placement.

Outpatient care shall provide a supportive milieu in a program designed to maintain or improve social and psychiatric functioning.

Category “J”

• Inmates in an outpatient psychiatric treatment program shall be designated Category “J”. They may be received from reception centers or other institutions diagnosed as suffering from a major mental illness sufficiently disabling to prevent adjustment to the general population without psychiatric intervention.

These individuals shall have a DSM-III-R Axis I diagnosis of:

• Schizophrenia.

• Delusional Disorder.

• Brief Reactive Psychosis.

• Schizophreniform Disorder.

• Schizoaffective Disorder.

• Induced Psychotic Disorder.

• Atypical Psychosis.

• Bipolar Disorder – sufficiently disabling to preclude general population placement.

• Major Depression – Depressive disorder not otherwise specified.

• Other Axis I diagnosis concomitant with an Axis V Global Assessment Function Score of 50 or less.

Category “J” designation shall not include inmates in need of acute psychiatric hospitalization as provided for by Category “I” criteria.

This category shall be provided at CMFCalifornia Medical Facility, CMCCalifornia Men's Colony-E and CIWCalifornia Institution for Women and shall only be designated by staff at these institutions.

CMFCalifornia Medical Facility shall house Category “J” inmates who are assaultive or otherwise present management problems. CMCCalifornia Men's Colony-E shall house inmates chronically disabled by mental illness who are not a danger to others and require little therapeutic programming beyond medication maintenance.

When a Category “J” or “K” inmate is found guilty of a rule infraction requiring a SHUSecurity Housing Unit term be established, the Institution Classification Committee shall determine whether the act was likely a result of a developmental disability or a mental condition or if continued supportive milieu housing is necessary.

If it is determined that the inmate’s disability or mental condition makes SHUSecurity Housing Unit programming impractical, the term shall be suspended or commuted and the inmate retained or transferred to the appropriate institution.

If it is determined that a male inmate continues to need supportive care, an evaluation for the Psychiatric Services Unit housing shall be recommended and/or completed by CMFCalifornia Medical Facility staff. (Refer to DOMDepartment Operations Manual 62050.1.2.) If it is determined that supportive housing is no longer required, the inmate shall be recommended for Category “U”, the SHUSecurity Housing Unit term assessed, and an appropriate SHUSecurity Housing Unit program recommended or the term suspended or commuted and an institution and alternate recommended to the CSRClassification Staff Representative.

Category “K”

• Inmates with pronounced social inadequacies due to mental retardation and/or developmental disabilities that preclude general population placement shall be designated Category “K”. These inmates shall have a DSM III-R Axis V diagnosis concomitant with a Global Assessment Function Score of 50 or less.

• This category shall be provided at CMCCalifornia Men's Colony-E, CMFCalifornia Medical Facility and CIWCalifornia Institution for Women. Male inmates with this designation who are assaultive or otherwise a management problem shall be housed at CMFCalifornia Medical Facility.

Category “X”

• Category X is a 90-day evaluation program ordered by the BPHBoard of Parole Hearings (formerly Board of Prison Terms) for specific psychiatric or psychological assessment. Inmates shall be endorsed for Category X and return to the sending institution. FAX approval is required prior to transfer.

Category “T”

• Male inmates with identified psychiatric problems requiring outpatient group therapy or individual psychotherapy in a structured environment shall be designated Category “T.” Normal participation in this program shall not exceed 12 months, and upon completion of the program, inmates are expected to return to the sending institution or transfer to another institution, if the sending institution is no longer appropriate. Category “T” is provided only at CMCCalifornia Men's Colony and is normally limited to those cases recommended by the BPHBoard of Parole Hearings (formerly Board of Prison Terms). FAX approval by Classification Services is required prior to transfer. In addition, Category “T” cases shall be presented to a CSRClassification Staff Representative with a placement recommendation at the completion of or after 12 months in the program, whichever comes first.

Category “U”

• Inmates who have recovered from a major illness requiring inpatient or outpatient psychiatric services shall be designated Category “U”. A significant period (normally 180 days) of no serious psychiatric symptoms shall be considered evidence of recovery.

• Category “U” shall include inmates no longer in need of psychotropic medication and those who are asymptomatic as a result of compliance with psychotropic medication. These inmates may be expected to function within a general population setting.

• All inmates classified as Category “U” for a period of two years shall be reviewed for possible reclassification and deletion of the category designation.

Professional differences of opinion regarding an inmate’s placement in a psychiatric category may occur amongst clinical staff at an institution. If these differences cannot be resolved informally, the case shall be referred to the institution’s Chief Psychiatrist for resolution.

If the differences of opinion occur between clinical staff at separate institutions and agreement cannot be reached, the case shall be referred to the Chief Psychiatrist, Mental Health Services Branch, for resolution.

Inmates who have been diagnosed as transgender or intersex, as documented on the Medical Classification Chrono, shall be referred to a classification committee for review of all case factors and determination of appropriate institutional placement and housing assignment. In order to ensure inmate-patients receive the necessary medical care/mental health treatment, transgender or intersex inmate-patients, to the maximum extent practical, shall be housed at the following institutions:

• California Medical Facility (CMFCalifornia Medical Facility)

• Richard J. Donovan (RJDRichard J. Donovan Correctional Facility at Rock Mountain)

• San Quentin State Prison (SQCalifornia State Prison, San Quentin)

• Mule Creek State Prison (MCSPMule Creek State Prison)

• California Substance Abuse Treatment Facility (SATFCalifornia Substance Abuse Yreatment Facility & State Prison, Corcoran)

• California State Prison – Sacramento (SACCalifornia State Prison, Sacramento)

• Salinas Valley State Prison (SVSPSalinas Valley State Prison)

• Correctional Institution for Men (CIMCalifornia Institution for Men)

• Kern Valley State Prison (KVSPKern Valley State Prison)

• California Men’s Colony

• California Health Care Facility

• Central California Women’s Facility (CCWFCentral California Women's Facility)

• California Institution for Women (CIWCalifornia Institution for Women)

• Folsom Women’s Facility

In cases where an inmate-patient has multiple case factors which make it difficult to house them in one of the above listed institutions, a case conference consisting of Health Care Placement Oversight Program, Classification Services Unit, California Correctional Health Care Services, and Population Management Unit staff, shall be conducted to determine the most appropriate level of care/institution suitable for housing consistent with the inmate-patient’s case factors.

Inmates identified as transgender or intersex on the Medical Classification Chrono shall, upon request, be provided with state issued brassieres or boxer shorts via the institution clothing room and permitted to purchase such items as needed.

Routine medical/psychiatric transfer requests shall be referred to a CSRClassification Staff Representative with a recommendation from an appropriate classification committee.

Routine transfers for medical/psychiatric reasons generally are to resolve a specific short-term medical problem, psychiatric problem, or evaluation as a “medical/psychiatric return” placement or for special prolonged placement needs.

No medical transfer for evaluation and/or short-term treatment shall be approved until a statement of acceptance has been obtained from the receiving institution’s Chief Medical Executive (CME) or Chief Psychiatrist as appropriate. If the transfer request is within CDCRCalifornia Department of Corrections and Rehabilitation policy, the CSRClassification Staff Representative shall indicate endorsement in the usual manner. If the inmate is to be returned to the sending institution upon completion of evaluation or treatment, it shall be indicated on the CDC Form 128-G, Classification Chrono, by “Medical (Psychiatric) and Return.” Male inmates serving life without possibility of parole in need of emergency medical/psychiatric care shall be exempted from Departmental Review Board review requirements and shall be presented to a CSRClassification Staff Representative for transfer approval.

A medical officer’s report on a CDCRCalifornia Department of Corrections and Rehabilitation Form 128-C3 shall be attached defining, in lay language, the medical/psychiatric problem or reason for the evaluation; the relative seriousness of the case; the period of time within which the transfer should be effected; the type of transportation necessary; whether an attendant is required; if any medication or care is necessary while en route; and a statement that acceptance by the receiving CME/Chief Psychiatrist has been obtained.

The responsibility for locating treatment or specialist resources shall rest with the medical/psychiatric department and not with the CSRClassification Staff Representative. Such transfers shall usually be approved unless there is an extremely serious overriding reason, in which case the CSRClassification Staff Representative shall consult with the referring CME or psychiatrist. If after the consultation the CSRClassification Staff Representative determines the endorsement inappropriate, the case shall be discussed with the Chief, CSUClassification Services Unit, who shall consult with the Assistant Deputy Director, Health Services, to develop a transfer plan. Inmates transferred for medical/psychiatric reasons may be admitted directly to the hospital, if necessary, pending an evaluation by a physician/psychiatrist.

When the medical procedures are completed for “medical and return” cases, the C&PRClassification & Parole Representative shall be notified. The C&PRClassification & Parole Representative shall review the case to ascertain if any medical, custodial or program considerations contraindicate the inmate’s return to the sending institution. If there are contraindications, or an alternate program/institution is deemed preferable, the C&PRClassification & Parole Representative shall refer the case to a classification committee. If no contraindications exist, the C&PRClassification & Parole Representative shall refer the case to the institution’s CCRMCorrectional Case Records Manager for return to the sending institution.

For placements in a medical or psychiatric program, the following additional procedure is required:

• The CDC Form 128-C shall indicate that the inmate meets the criteria established for the program, as indicated above, and note the name of the accepting physician.

There are no referrals or waiting lists for transfers to the Inpatient Psychiatric Observation, Unclassified, Category “I,” as transfers are to be accomplished within 72 hours.

The medical/psychiatric category designation shall be assigned at the time the inmate is approved for the program.

Clinical progress reports on a CDC Form 128-C shall be made quarterly, but may be completed more frequently if conditions warrant. A summary CDC Form 128-C report, a classification action, and CSRClassification Staff Representative endorsement are required whenever an inmate is changed from a program category.

The C&PRClassification & Parole Representative is delegated the authority to act as a CSRClassification Staff Representative for program changes between Categories “I” and “J”, “J” and “H”, and “N” and “O”.

Prior to all medical/psychiatric transfers, the C&PRClassification & Parole Representative of the sending institution shall notify the receiving institution’s C&PRClassification & Parole Representative by telephone if the inmate has enemies at the receiving institution, so proper precautions may be taken. If the enemy situation precludes the transfer, the sending institution shall make an alternate institutional transfer arrangement to facilitate the inmate’s needs.

Upon acceptance of an emergency case by the CME of the receiving institution and completion of transportation arrangements, the C&PRClassification & Parole Representative at the receiving institution shall contact the CSUClassification Services Unit for FAX transfer approval

The CDCRCalifornia Department of Corrections and Rehabilitation air and land ambulance service shall be administered by CMFCalifornia Medical Facility. Personnel assigned to the ambulance operation shall be familiar with the policies and procedures governing the transportation of inmates and the necessary procedures governing medical and psychiatric patients.

The land or air ambulance shall be used only for cases in which the CME/Psychiatrist of the sending institution has determined that such transportation is required. An MTA from CMFCalifornia Medical Facility or the sending institution shall arrange to accompany the land or air ambulance. Requests for land or air ambulance use shall include information regarding custodial classification, degree of violence and any other useful information.

The land or air ambulance may also be used for transporting inmates to a parole placement or to return parolees to an institution when a medical/psychiatric statement is obtained indicating that this type of emergency transportation is medically/psychiatrically necessary. The CMOE at CMFCalifornia Medical Facility shall schedule and route the air and land ambulance. Requests for ambulance use shall be directed to that office.

Upon approval and completion of transportation arrangements, the Associate Warden, Health Care Access Unit, at CMFCalifornia Medical Facility shall contact the CSUClassification Services Unit to request FAX transfer approval.

Inmates involuntarily transferred to CMFCalifornia Medical Facility for psychiatric treatment are entitled to a hearing regarding the transfer (Whitaker v. Rushen, No. C-81-3284 SAW). Upon arrival at CMFCalifornia Medical Facility, such inmates shall be served with a Notice of Transfer to CMFCalifornia Medical Facility. The notice explains the inmate’s rights. The inmate may sign the notice waiving the rights or may request a hearing if opposed to the transfer. Inmates shall have this hearing at CMFCalifornia Medical Facility.

The hearing shall be held within seven calendar days after arrival at CMFCalifornia Medical Facility. If the hearing cannot be held within seven days, the inmate shall be informed in writing of that fact, the reason for the delay, and an estimated date by which he may expect the hearing. The inmate’s counselor shall be assigned to assist the inmate in gathering evidence and interviewing witnesses and shall be present at the hearing. The hearing shall consist of a classification committee review of the case and shall include the following:

Inmate Due Process

• Determination that the inmate received written notice of the transfer to CMFCalifornia Medical Facility stating that the inmate has a right to a hearing and that such hearings are normally held within seven days after arrival at CMFCalifornia Medical Facility.

• The information relied upon in ordering the transfer to CMFCalifornia Medical Facility shall be disclosed to the inmate. The inmate shall be heard in person and be permitted to present evidence, including witnesses, on his behalf. One of the members of the classification committee shall be a psychiatrist employed by CDCRCalifornia Department of Corrections and Rehabilitation. This person shall be an “independent decision maker” and shall not be the inmate’s treating psychiatrist at either the sending or receiving institution. Following the hearing, the independent decision-maker shall inform the inmate in writing of the committee’s decision and the information relied upon in arriving at the decision (Whitaker v. Rushen). The inmate may appeal the decision, using a CDCRCalifornia Department of Corrections and Rehabilitation Form 602, Inmate/Parolee Appeal; within 30 days of receipt of the hearing documentation. A ruling on the appeal shall be returned within 20 working days.

The Deputy Director, Facility Operations, DAIDivision of Adult Institutions (formerly Institutions Division) or designee shall ensure that the content of this Article is current.

CCRCalifornia Code of Regulations § 3379.

PCPenal Code §§ 2684, 2690, 2962, 2911, 5058, 5054, 5068, 5080, 1170, and 11191.

Whitaker v. Rushen, No. C-81-32-84 SAW.