Rasho v. Jeffreys, 011222 FED7, 19-1145

Docket Nº19-1145, 19-1375, 19-1978
Opinion JudgeSykes, Chief Judge.
Party NameAshoor Rasho, et al., Plaintiffs-Appellees, v. Rob Jeffreys, Director of the Illinois Department of Corrections, and Melvin Hinton, Acting Statewide Mental Health Supervisor of the Illinois Department of Corrections, Defendants-Appellants.
Judge PanelBefore Sykes, Chief Judge, and Ripple and Kanne, Circuit Judges. Ripple, Circuit Judge, dissenting.
Case DateJanuary 12, 2022
CourtUnited States Courts of Appeals, United States Court of Appeals (7th Circuit)

Ashoor Rasho, et al., Plaintiffs-Appellees,


Rob Jeffreys, Director of the Illinois Department of Corrections, and Melvin Hinton, Acting Statewide Mental Health Supervisor of the Illinois Department of Corrections, Defendants-Appellants.

Nos. 19-1145, 19-1375, 19-1978

United States Court of Appeals, Seventh Circuit

January 12, 2022

Argued May 20, 2020

Appeal from the United States District Court for the Central District of Illinois. No. 07-C-1298 - Michael M. Mihm, Judge.

Before Sykes, Chief Judge, and Ripple and Kanne, Circuit Judges.

Sykes, Chief Judge.

Ashoor Rasho, on behalf of a class of mentally ill inmates in the custody of the Illinois Department of Corrections ("IDOC"), sued IDOC officials for failing to provide constitutionally adequate mental-health care. The


parties eventually reached a settlement requiring IDOC to meet certain benchmarks across more than a dozen areas of mental-health treatment. A year later IDOC had failed to substantially comply with several portions of the agreement, so the plaintiffs returned to the district court for relief. Under the terms of the agreement, they needed to prove that the defendants' breach itself caused an Eighth Amendment violation.

The district judge held that the plaintiffs made such a showing in five areas of mental-health treatment and noted that IDOC's deficiencies were primarily attributable to a chronic, severe shortage of mental-health staff. Because IDOC had known about its staffing problem for several years and displayed a "lack of a sense of urgency" in fixing the issue, the judge concluded that the defendants were deliberately indifferent to the risk of harm associated with inadequate mental-health care. He entered a permanent injunction requiring IDOC to hire and maintain a specific minimum number of staff in multiple areas of care and imposing other specific requirements for the delivery of mental-health services-all on a court-imposed, mandatory timetable.

We reverse the district court's order and vacate the injunction. IDOC officials took reasonable steps to cure the deficiencies identified by the plaintiffs-in particular, the understaffing-and those actions cannot be squared with the judge's finding of deliberate indifference. Even if those steps were not fully successful, their reasonable effort to address a known risk of harm shows that they did not recklessly disregard that risk.


The court's order also exceeds the remedial limitations set by the Prison Litigation Reform Act ("PLRA"). In the corrections context, prospective remedies must be "narrowly drawn, extend[] no further than necessary to correct the violation of the Federal right, and [be] the least intrusive means necessary to correct the violation of the Federal right." 18 U.S.C. § 3626(a)(1)(A). The permanent injunction goes well beyond these bounds by prescribing specific staffing levels and treatment timelines without evidence that such requirements go no further than necessary to correct an Eighth Amendment violation.

I. Background

The details of this lengthy litigation are largely irrelevant for present purposes. Here are the basics: in 2007 Rasho filed a pro se § 1983 complaint against several IDOC officials claiming that IDOC's treatment of his mental illness was constitutionally deficient in violation of the Eighth Amendment.1 With the help of counsel, Rasho amended his complaint to assert the same claim on behalf of a proposed class of all mentally ill IDOC inmates. The class-action complaint sought declaratory and injunctive relief compelling IDOC to overhaul its system of mental-health care. After the district court certified the class, the parties spent years in protracted settlement negotiations.

The parties entered into a comprehensive settlement agreement in 2016, almost ten years after the suit was filed. The agreement requires IDOC to make dozens of changes to


its mental-healthcare system, including implementing a revised screening system for new inmates, providing individualized mental-health treatment plans, and augmenting mental-health staff. The parties appointed Dr. Pablo Stewart to monitor IDOC's compliance. They also agreed to cabin the judge's authority to fashion relief for violations of the agreement: "[A]ny order granting such relief must include a finding that the relief sought is narrowly drawn, extends no further than is necessary to correct the violation of the federal right, and is the least intrusive means for doing so." This remedial constraint, lifted verbatim from the PLRA, effectively prohibits judicial enforcement unless IDOC's noncompliance causes an Eighth Amendment violation-the "federal right" at issue. The district court retained jurisdiction to oversee compliance with the agreement.2

Dr. Stewart's first annual report, released in June 2017, sharply criticized IDOC's progress in fulfilling the agreement. After analyzing IDOC's compliance in exacting detail, Dr. Stewart reached a blunt bottom line: "[T]he lack and quality of psychiatric services negatively impacts all aspects of the Settlement and contributes to IDOC being non-compliant in the vast majority of areas of the Settlement." Stewart's concerns persisted for several months, leading him


to write to Dr. Melvin Hinton, IDOC's Chief of Mental Health, that IDOC was "in a state of emergency." On the heels of this letter, the plaintiffs moved for a preliminary injunction, focusing on IDOC's noncompliance in five areas identified by Dr. Stewart: mental-health evaluations, treatment planning, medication management, crisis care, and segregation care.

The judge held an evidentiary hearing on the plaintiffs' motion over six days in late 2017 and early 2018. Witness testimony revealed that IDOC had clearly made progress in revamping its mental-healthcare system: it spent $45 million to build new residential treatment units at several facilities and $75 million to develop a new data system for intake assessments; it procured another $150 million to construct a new inpatient facility; it delivered mental-health training to its entire staff; and it hired administrative personnel to coordinate inmate care. Nevertheless, witnesses for both the plaintiffs and defendants opined that IDOC still could not provide treatment at the level required under the agreement. Undisputed testimony attributed IDOC's shortcomings to systemic shortages in mental-health staff. Dr. Hinton admitted that IDOC budgeted for 65 psychiatrists but currently employed less than half that many.

In May 2018 the judge entered a preliminary injunction. He concluded that IDOC's "persistent" staffing deficiencies had created an "emergency situation" and that IDOC's failure to address those deficiencies-despite being aware of them for "an unreasonable period of time"-amounted to deliberate indifference. He therefore ordered IDOC to take measures to address the five areas identified by the plaintiffs


and to "provide sufficient staff" to remedy the constitutional violations in those areas.

Two days later Dr. Stewart delivered his second annual report, again finding that IDOC was noncompliant in the same areas. The plaintiffs moved for a permanent injunction on the same grounds as the preliminary injunction.

Over several days in August and September 2018, the judge held an evidentiary hearing on the permanent-injunction motion. The parties agreed that pursuant to Rule 65(a)(2) of the Federal Rules of Civil Procedure, the judge should also consider the evidence presented at the preliminary-injunction hearing. The new evidence told a familiar story: inadequate staffing had caused backlogs in inmate care, failures to tailor treatment to individual needs, and an overall inability to satisfy the terms of the settlement in the same five areas.

Still, the evidence also showed that the situation had improved in the first half of 2018. Importantly, IDOC had taken several steps to cure the personnel shortage, including: • increasing the number of full-time-equivalent psychiatric providers from 33.53 to 50.55 and qualified mental-health professionals from 111 to 117;[3]

• authorizing unlimited overtime;

• partnering with a local university to provide psychiatric care;

• expanding use of telepsychiatry;

6 • offering travel stipends and bonuses for providers willing to take on extra work at different facilities;

• setting salaries at the 90th percentile nationwide; and

• coordinating with state officials to streamline the licensing process for IDOC psychiatric providers.

These measures, along with revisions to care procedures, contributed to a decrease in treatment backlogs at several facilities.

IDOC witnesses also testified about the difficulties of recruiting mental-health professionals in the corrections field. A nationwide shortage left 57% of Illinois counties without any such professionals, and it was hard to persuade medical professionals to move (or commute) from major cities to work in the challenging corrections environment. As a result, Wexford Health Sources, IDOC's staffing vendor, struggled to meet recruitment goals.

The judge granted the plaintiffs' motion for a permanent injunction.4 Rasho v. Walker, 376 F.Supp.3d 888, 892-93 (C.D. Ill. 2019). Before addressing IDOC's deficiencies in the five specific areas at issue, the judge emphasized that his finding was "based generally on the fact that there is insufficient mental health staffing at … IDOC." Id. at 901. Although he acknowledged that IDOC had made some improvements, he found that the use of unlimited overtime was "unsustainable"


and that IDOC's "efforts have been generally ineffective-and have gone on far too long without any significant attempt to adapt or modify based on the knowledge gained from their recruiting efforts." Id. at 906-07. The judge also criticized IDOC for continuing to rely on Wexford and for exhibiting an "overall lack of a sense of urgency" in delivering adequate...

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