SACRAMENTO, Calif. (AP) – Top California corrections officials are misleading a federal judge and attorneys representing inmates about the quality of mental health care behind bars, according to a report released Wednesday that cites a case where a woman received care so poor she plucked out her eye and ate it.

The whistleblower report by chief corrections psychiatrist Dr. Michael Golding that was made public by U.S. District Judge Kimberly Mueller says prison officials overruled psychiatrists and misrepresented how often inmates were receiving proper care.

Golding says Mueller, who oversees prison mental health care under a lawsuit involving treatment, and others likely underestimated the adequacy of staffing in prisons as a result.

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California Department of Corrections and Rehabilitation spokeswoman Vicky Waters said the agency strongly disagrees with the allegations.

“We worked closely with lawyers representing prisoners, as well as the court appointment monitors, for many years to improve the mental health of inmates,” Waters said in an email. “Our dedicated and well-trained staff will continue to provide appropriate care and treatment.”

Mueller has set a Monday court hearing to delve into Golding’s claim and its potential impact on the lawsuit, and to consider appointing an independent investigator to look into the claim.

The 161-page report and dozens of exhibits containing emails, records and other documents says corrections officials “reset the clock” every time a mentally ill prisoner is transferred to a new prison.

As a result, an inmate might not be seen by a psychiatrist for nine months – three times as long as required by the court. Yet that appointment is recorded as being on time, the report said.

Officials recorded other visits as meeting court-ordered requirements, even if they were two months late, it said.

Officials counted as proper mental appointments “brief encounters with patients in the prison yard surrounded by other inmates, three-minute, non-confidential cell side visits,” and wellness checks in which a worker holds a laptop in front of a cell door for a teleconference, forcing the inmate and psychiatrist to shout back and forth.

The department reported that an average 95 percent of patients were seen on schedule. But the true percentage is lower than 46 percent because the department excluded patients who refused an appointment, missed one because of a scheduling error, or simply didn’t show up, Golding wrote.

“In failing to mention that fewer than 50 percent of patients are being seen when psychiatrists schedule them to be seen, the CDCR staffing reports significantly understate how many psychiatrists are needed, given how grossly inefficient the system is,” he wrote.

“It might not be surprising to find high rates of hospitalization and suicide in such a poorly designed and run system,” Golding wrote. California’s longtime suicide rate of 20.4 per 100,000 inmates exceeds the national state prison rate of 16 per 100,000 inmates.

Mental health leaders have “created a biased and inaccurately positive picture of what is actually a troubled system of care,” Golding wrote.

He said psychiatrists, who are medical doctors, routinely report to non-medically trained psychologists who make the bulk of system-wide decisions.

That was part of the problem with the woman who ate her own eye, he said, because she was treated at times by a psychologist who couldn’t order that she be given proper medication.

The woman, who was on suicide watch, was screaming every 15 minutes for most of a four-hour period in which she received no medication, he said, noting the psychiatrist on duty was never called.

Michael Bien, an attorney representing inmates, said he was particularly concerned by allegations in the report that psychologists were making life-and-death decisions without consulting psychiatrists, and that officials at one prison are accused of changing their procedures whenever the court’s special master visited to give the impression that inmates were receiving confidential care.

“If that is in fact the case, that means the whole monitoring procedure has to be revised. We would advocate for some kind of unannounced visits,” Bien said. “When there’s intentional misrepresentations being made … we have to be extra diligent.”

Copyright 2018 The Associated Press.