Braggs v. Dunn

• Decision Date: 27 June 2017
• Docket Number: CIVIL ACTION NO. 2:14cv601-MHT (WO).
• Parties: Edward BRAGGS, et al., Plaintiffs, v. Jefferson S. DUNN, in his official capacity as Commissioner of the Alabama Department of Corrections, et al., Defendants.
• Court: U.S. District Court — Middle District of Alabama

257 F.Supp.3d 1171

Edward BRAGGS, et al., Plaintiffs,

v.Jefferson S. DUNN, in his official capacity as Commissioner of the Alabama Department of Corrections, et al., Defendants.

CIVIL ACTION NO. 2:14cv601-MHT (WO).

United States District Court, M.D. Alabama, Northern Division.

Signed June 27, 2017

Andrew Philip Walsh, Patricia Clotfelter, William Glassell Somerville, III, Baker Donelson Bearman Caldwell & Berkowitz PC, Birmingham, AL, Brent L. Rosen, Baker Donelson Bearman Caldwell & Berkowitz PC, Brooke Menschel, Ebony Glenn Howard, Jack Richard Cohen, Latasha Lanette McCrary, Maria V. Morris, Rhonda C. Brownstein, Montgomery, AL, Eunice Cho, Atlanta, GA, James Patrick Hackney, William Van Der Pol, Jr., Tuscaloosa, AL, Miriam Fahsl Haskell, Miami, FL, Jaqueline Aranda Osorno, Natalie Lyons, Kristi L. Graunke, Caitlin J. Sandley, Southern Poverty Law Center, Montgomery, AL, for Plaintiffs.

Anne Adams Hill, Elizabeth Anne Sees, Joseph Gordon Stewart, Jr., Alabama Department of Corrections, Montgomery, AL, Bryan Arthur Coleman, Evan Patrick Moltz, Luther Maxwell Dorr, Jr., Mitchell David Greggs, Mitesh Bansilal Shah, Maynard, Cooper & Gale, PC, Birmingham, AL, David Randall Boyd, John Garland Smith, John W. Naramore, Balch & Bingham LLP, Montgomery, AL, Jenelle Rae Evans, Michael Leon Edwards, Steven C. Corhern, John Eric Getty, Susan Nettles Han, Balch & Bingham, LLP, Birmingham, AL, Matthew Reeves, William Richard Lunsford, Christopher Stephen Kuffner, Melissa K. Marler, Michael Paul Huff, Stephen Clarence Rogers, Maynard Cooper & Gale, PC, Huntsville, AL, Christopher Fred Heinss, The Heinss Law Firm, LLC, Birmingham, AL, for Defendants.

LIABILITY OPINION AND ORDER AS TO PHASE 2A EIGHTH AMENDMENT CLAIM

Myron H. Thompson, UNITED STATES DISTRICT JUDGE

I. INTRODUCTION 1180

II. PROCEDURAL BACKGROUND 1180

III. FACTUAL BACKGROUND 1181

A. ADOC Facilities and Organizational Structure 1181

B. MHM Organizational Structure 1183

C. Summary of Factual Findings 1184

1. Fact Witnesses 1184

2. Expert Witnesses 1186

IV. EIGHTH AMENDMENT LEGAL STANDARD 1188

V. FINDINGS OF FACT AND CONCLUSIONS OF LAW 1189

A. Serious Mental–Health Needs 1189

B. Actual Harm and Substantial Risks of Serious Harm Posed by Inadequate Care 1191

1. Contributing Conditions 1193

a. Overcrowding 1193

b. Mental–Health Understaffing 1194

c. Correctional Understaffing 1197

2. Identification and Classification of Prisoners' Mental–Health Needs 1201

a. Inadequate Intake Process 1201

b. Inadequate Referral Process 1203

c. Inadequate Classification of Mental–Health Needs 1204

d. Inadequate Utilization of Mental–Health Units 1205

3. Inadequate Treatment Planning 1206

4. Inadequate Psychotherapy 1208

5. Inadequate Inpatient Care 1212

a. Improper Use of Mental–Health Units 1212

b. Inadequate Out-of-Cell Time and Programming 1213

c. Lack of Hospital–Level Care 1217

6. Inadequate Suicide Prevention and Crisis Care 1218

a. Failure to Provide Crisis Care to Those Who Need It 1221

b. Placement of Prisoners in Crisis in Dangerous and Harmful Settings 1224

c. Inadequate Treatment in Crisis Care 1225

d. Unsafe Crisis Cells 1226

e. Inadequate Monitoring of Suicidal Prisoners 1229

f. Inappropriate Release from Suicide Watch and Inadequate Follow-up 1230

7. Inappropriate Use of Disciplinary Actions 1231

8. Inappropriate Placement and Inadequate Treatment in Segregation 1235

a. Background on Segregation 1236

i. Consensus among Correctional and Mental–Health Professionals on Segregation 1236

ii. ADOC's Segregation Units 1238

b. ADOC's Segregation of Mentally Ill Prisoners 1240

i. ADOC's Segregation–Placement Practices 1240

ii. Treatment and Monitoring in Segregation Units 1242

c. Segregation of Prisoners with Serious Mental Illness 1245

9. Tutwiler 1247

10. Other Issues 1249

C. Deliberate Indifference 1250

1. ADOC's Knowledge of Harm and Risk of Harm 1252

2. ADOC's Disregard of Harm and Risk of Harm 1255

a. ADOC's Failure to Exercise Oversight of the Provision of Mental–Health Care 1257

b. ADOC's Unreasonable Responses to Identified Deficiencies 1260

D. Ongoing Violation 1262

E. Ex parte Young Defenses 1265

VI. CONCLUSION 1267

I. INTRODUCTION

The plaintiffs in this phase of this class-action lawsuit are a group of seriously mentally ill state prisoners and the Alabama Disabilities Advocacy Program (ADAP), which represents mentally ill prisoners in Alabama. The defendants are the Commissioner of the Alabama Department of Corrections (ADOC), Jefferson Dunn, and the Associate Commissioner of Health Services, Ruth Naglich, who are sued only in their official capacities. The plaintiffs assert that the State of Alabama provides constitutionally inadequate mental-health care in prison facilities and seek injunctive and declaratory relief. They rely on the Eighth Amendment, made applicable to the States by the Fourteenth Amendment and as enforced through 42 U.S.C. § 1983. Jurisdiction is proper under 28 U.S.C. § 1331 (federal question) and § 1343(a)(3) (civil rights).

After a lengthy trial, this claim is now before the court for resolution on the merits. Upon consideration of the evidence and arguments, the court finds for the plaintiffs in substantial part. Surprisingly, the evidence from both sides (including testimony from Commissioner Dunn and Associate Commissioner Naglich as well as that of all experts) extensively and materially supported the plaintiffs' claim.

II. PROCEDURAL BACKGROUND

This extremely complex case has been split into three phases: Phase 1 involved claims under Title II of the Americans with Disabilities Act (ADA), codified at 42 U.S.C. § 12131 et seq., and § 504 of the Rehabilitation Act, codified at 29 U.S.C. § 794, claiming discrimination on the basis of physical disabilities and failure to accommodate those disabilities. The parties settled Phase 1. See Dunn v. Dunn , 318 F.R.D. 652 (M.D. Ala. 2016) (Thompson, J.). Phase 2A involves Eighth Amendment, ADA, Rehabilitation Act, and due-process claims regarding mental-health care. The parties settled the Phase 2A ADA and Rehabilitation Act claim. The due-process claims are pending before the court for settlement approval.¹ Phase 2B will focus on medical-care and dental-care claims under the Eighth Amendment.

This opinion resolves only the Phase 2A Eighth Amendment claim of inadequate mental-health care.² The court has certified a Phase 2A plaintiff class consisting of all persons with a serious mental illness who are, or will be, confined within ADOC's facilities, excluding Tutwiler Prison for Women and the work-release centers. See Braggs v. Dunn , 317 F.R.D. 634 (M.D. Ala. 2016) (Thompson, J.). While mentally ill prisoners at Tutwiler are not part of the class, ADAP, as Alabama's designated protection and advocacy organization for the mentally ill, brought claims on their behalf. A seven-week trial followed.

III. FACTUAL BACKGROUND

Mental-health care in this opinion refers to screening, treatment, and monitoring of mental illnesses, as well as ADOC's policies and practices regarding mentally ill prisoners, including decisions on disciplinary sanctions and housing placements.³ Before diving in to the details of weeks' worth of testimony and thousands of pages of documentary evidence regarding mental-health care within ADOC, the court pauses to provide some background information on ADOC and its mental-health contractor, as well as a summary of the factual findings.

A. ADOC Facilities and Organizational Structure

ADOC runs 15 major facilities (14 for men and the Tutwiler Prison for Women) and houses around 19,500 prisoners in its major facilities.⁴ Approximately 3,400 prisoners are on the mental-health caseload, meaning that they receive some type of mental-health treatment, such as counseling or psychotropic medications.

MAJOR ADOC FACILITIES⁵

                Facility Location Population
                Bibb         Brent           1847
                Bullock      Union Springs   1522
                Donaldson    Bessemer        1474
                Draper       Elmore          1144
                Easterling   Clio            1457
                Elmore       Elmore          1186
                Fountain     Atmore          1242
                Hamilton     Hamilton        275
                Holman       Atmore          941
                Kilby        Mt. Meigs       1126
                Limestone    Harvest         2214
                St. Clair    Springville     975
                Staton       Elmore          1382
                Ventress     Clayton         1254
                Tutwiler     Wetumpka        880
                

Three of the major facilities, Bullock, Donaldson, and Tutwiler, serve as 'treatment hubs' for mental-health services, containing a residential treatment unit (RTU) and/or a stabilization unit (SU). These two types of units, together referred to as 'mental-health units' or 'inpatient-care units,' house and treat the most severely mentally ill prisoners. The rest of those on the mental-health caseload receive their care through outpatient services: they live in a unit that is not focused on treatment and ordinarily must go to a different part of the prison to see a mental-health provider.

Under the administrative regulations governing ADOC's mental-health care, RTUs are for mental-health patients who suffer from "moderate impairment in mental health functioning" that puts them at risk in a general-population setting. Joint Ex. 107, Admin. Reg. § 613–2 (doc. no. 1038–130). RTUs are intended to provide a therapeutic environment to mentally ill patients and to help them develop coping skills necessary for placement in general population. RTUs can be 'closed,' meaning that each patient lives in an individual cell with little time spent outside the cell; 'semi-closed,' meaning that the patient still stays in an individual cell but is let out of the cell more often; or 'open,' meaning that the patient lives in an open dormitory with other RTU patients.

SUs are for patients who are suffering from acute mental-health problems—such as acute psychosis

or other conditions causing an acute risk of self-harm—and have not been stabilized through other interventions. SUs are intended to stabilize the patient as quickly as possible so that the patient can return to a less restrictive environment. All SU patients are housed in...