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Patterson wrote that he has repeatedly sought -- to no avail -- improvements in staff training, the way welfare checks are conducted on inmates in cells and how follow-up checks are done on suicidal inmates.

Patterson, who has compiled 14 annual reports on suicides in California prisons for the court's special master on mental health, wrote that his latest would be his last, because "continued repetition of these recommendations would be a further waste of time and effort."

State suicide rate up, expert's report says

Patterson's latest annual report, covering 15 suicides in the first half of 2012, found the suicide rate in California prisons last year was 23.72 per 100,000 inmates, an increase over the previous year and a rate substantially higher than the national average of 16 per 100,000 inmates. Most of the 2012 deaths were a result of hangings.

These suicide rates and the level of mental health care provided in prisons are expected to be the subject of furious argument in court this month as the two sides square off before U.S. District Judge Lawrence K. Karlton in Sacramento.

(A separate court battle looms over whether the state must continue to adhere to the terms of a 2009 federal court order mandating a reduction in its overall prison population).

At the heart of the tug-of-war over mental health care are the claims of inmate advocates that the welfare of suicidal and other mentally ill inmates is being ignored in favor of political point scoring and cost-cutting.

"Everyone from the governor on down have failed to demonstrate they understand their obligations under the Constitution," said Michael Bien, lead attorney for the inmates. "This is a life and death struggle."

Inmate HH was serving a six-year sentence for terroristic threats and driving under the influence, and was due to be released June 24, 2012. The special master concluded that "this death was more likely than not a suicide." Corrections officials, who initially reported the case as a suicide, later decided the inmate had been killed by his cellmate and his body positioned to appear as a suicide.

The case was turned over to the Solano County district attorney, but no charges were ever filed, corrections officials say.

Lawyers for the state objected to the federal court allowing "Inmate HH" to be counted as a suicide, and on Friday Judge Karlton overruled their objections and ordered them to provide a copy of the coroner's final report on the death, under seal, to the special master.

The clash over whether one inmate killed himself highlights how critical the suicide rate will be in determining whether California regains control of its prisons.

Mental health care under spotlight

The state of mental health care in California state prisons has been in the spotlight since 1995 when Karlton, in response to a class-action lawsuit, issued a published opinion that ordered improvements, established himself as overseer of care while the fixes were being made, and required appointment of a special master "to monitor compliance with court-ordered injunctive relief." Karlton adopted findings and recommendations following a trial before U.S. Magistrate John F. Moulds.

The magistrate judge found inadequate screening of mentally ill inmates, understaffed mental health units, delays in access to care, inadequate treatment records and routine use of Tasers and stun guns on inmates with serious mental disorders.

Moulds further found corrections officials were deliberately indifferent to these shortcomings in violation of the Constitution's bar on cruel and unusual punishment.

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