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Braggs v. Dunn

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

February 11, 2019

EDWARD BRAGGS, et al., Plaintiffs,
v.
JEFFERSON S. DUNN, in his official capacity as Commissioner of the Alabama Department of Corrections, et al., Defendants.

          PHASE 2A SUPPLEMENTAL LIABILITY OPINION AND ORDER ON PERIODIC MENTAL-HEALTH EVALUATIONS OF PRISONERS IN SEGREGATION

          MYRON H. THOMPSON UNITED STATES DISTRICT JUDGE

         On June 27, 2017, the court issued a liability opinion in which it found that the Alabama Department of Corrections (ADOC)'s provision of mental-health care to prisoners violates the Eighth Amendment to the U.S. Constitution. That opinion noted “substantial evidence ... that ADOC is not conducting adequate periodic mental-health assessments of prisoners in segregation.” Braggs v. Dunn, 257 F.Supp.3d 1171, 1249 (M.D. Ala. 2017) (Thompson, J.). The court, “out of an abundance of caution and exercising its discretion, ” reserved its judgment and left the Eighth Amendment finding open as to this discrete issue in order to “solicit more input from the parties.”[1] Id. After further briefing and oral argument, the court now finds, based on a full reexamination of the record from the liability trial, that ADOC has not been conducting adequate periodic mental-health evaluations of prisoners in segregation, and that this failure has contributed to the ADOC defendants' violation of the Eighth Amendment discussed in the main liability opinion as to prisoners with serious mental-health needs in segregation.[2] See id.

         I. LEGAL STANDARD

         In its June 2017 opinion, the court discussed the applicable Eighth Amendment law at great length, both in the legal standard section and within the findings and facts and conclusions of law. In the interest of brevity, the court refers the reader to that earlier opinion.

         II. FINDINGS OF FACT AND CONCLUSIONS OF LAW

         Before turning to the evidence in the record that goes directly to the narrow issue presented, the court pauses to summarize those findings of fact and conclusions of law from the liability opinion that are most relevant to the decision today. However, this opinion is intended to be read in the context of the earlier liability opinion.

         A. Serious Mental-Health Needs

         To prove an Eighth Amendment claim based on inadequate mental-health care, plaintiffs must show that they have serious mental-health care needs. A serious need is “one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a lay person would easily recognize the necessity for a doctor's attention.” Farrow v. West, 320 F.3d 1235, 1243 (11th Cir. 2003). As this court previously found, “It is clear that a number of prisoners in ADOC's custody have serious mental-health needs, and the issue is undisputed.” Braggs, 257 F.Supp.3d at 1190. Because ADOC's contractor for mental-health care places on the mental-health caseload only those prisoners who have been diagnosed with a condition that requires treatment, all prisoners on the caseload meet the legal requirement for having a serious mental-health need. See Farrow, 320 F.3d at 1243.[3]

         The court found that ADOC systemically “fails to identify and classify appropriately those with mental illnesses, ” and that the effects of this under-identification “cascade[] through the system.” Braggs, 257 F.Supp.3d at 1201. ADOC's under-identification of prisoners results in an artificial, abnormally low number of ADOC prisoners on the mental-health caseload. Id. at 1201. Accordingly, the total number of prisoners with serious mental-health needs in ADOC's custody includes both all individuals on the caseload and those additional individuals with serious mental-health needs who ADOC has failed to identify.

         B. Serious Harm and Substantial Risks of Serious Harm Posed by Inadequate Periodic Mental-Health Evaluations in Segregation

         In addition to showing a serious mental-health need, plaintiffs must establish that they have been subjected to either serious harm, or a substantial risk of serious harm--the second part of the ‘objective' test under Eighth Amendment jurisprudence--as a result of inadequate mental-health care. Put another way, plaintiffs must show that their serious mental-health need, “if left unattended, ‘poses a substantial risk of serious harm.'” Farrow, 320 F.3d at 1243 n.13 (quoting Farmer v. Brennan, 511 U.S. 825, 834 (1970)).

         Defendants may be held liable for “incarcerating prisoners under conditions posing a substantial risk of serious harm.” Farmer, 511 U.S. at 834.

         Plaintiffs may bring an Eighth Amendment challenge to a condition to prevent serious harm which is substantially likely to occur in the future--a substantial risk of serious harm. That is, a showing of either actual serious harm or a substantial risk of serious harm is sufficient to sustain the harm requirement. See Helling v. McKinney, 509 U.S. 25, 33-34 (1993) (“a remedy for unsafe conditions need not await a tragic event, ” because “the Eighth Amendment protects against future harms to inmates, ” even when the harm “might not affect all of those exposed” to the risk and even when the harm would not manifest itself immediately). In other words, plaintiffs must show “that they have been subjected to the harmful policies and practices at issue, not (necessarily) that they have already been harmed by these policies and practices.” Dunn v. Dunn, 219 F.Supp.3d 1100, 1123 (M.D. Ala. 2016) (Thompson, J.).

         Moreover, multiple policies or practices that combine to deprive a prisoner of a “single, identifiable human need, ” such as mental-health care, can support a finding of Eighth Amendment liability. Gates v. Cook, 376 F.3d 323, 333 (5th Cir. 2004); see also Hamm v. DeKalb Cnty., 774 F.2d 1567, 1575-76 (11th Cir. 1985) (recognizing ‘totality of conditions' approach in prison-conditions cases).

         For the following reasons, the court finds, by a preponderance of the evidence, that defendants are conducting inadequate periodic mental-health evaluations of prisoners in segregation, and that this inadequacy subjects prisoners with serious mental-health needs to a substantial risk of serious harm.

         1. Psychological Harms of Segregation

         In order to understand the harm of failing to provide adequate evaluations of the mental health of prisoners in segregation, it is necessary to understand the substantial risk of psychological harm and decompensation posed by extended placement in segregation. Therefore, the court now summarizes its previous findings on the harms posed by segregation.

         As mental-health and correctional professionals have recognized, and as this court previously observed, long-term isolation resulting from segregation or solitary confinement has crippling consequences for mental health. Dr. Hunter, the medical director for ADOC's mental-health contractor, testified that it is “generally recognized” in the profession, including within ADOC, that “prolonged segregation is deleterious to one's psyche and one's mental health function.” Hunter Trial Tr. Vol. II at 77:24-78:2. The psychological harm from segregation can lead to symptoms including hallucinations, chest pain, palpitations, anxiety attacks, and self-harm. See Burns Trial Tr. Vol. I at 209; see also Palakovic v. Wetzel, 854 F.3d 209, 225-26 (3d. Cir. 2017) (summarizing the “robust body of legal and scientific authority recognizing the devastating mental health consequences caused by long-term isolation in solitary confinement, ” including “anxiety, panic, paranoia, depression, post-traumatic stress disorder, psychosis, and even a disintegration of the basic sense of self-identity, ” as well as physical harm). “The potentially devastating effects of these conditions are reflected in the characteristically high numbers of suicide deaths, and incidents of self-harm and self-mutilation that occur in many of these units.” Joint Ex. 459, Haney Expert Report (doc. no. 1038-1043) at 130-31. Moreover, the harmful effects of segregation--even apart from suicide--“can be irreversible, ” and “can persist beyond the time that prisoners are housed in isolation and lead to long-term disability and dysfunction.” Id.; see also Davis v. Ayala, 135 S.Ct. 2187, 2210 (2015) (Kennedy, J., concurring) (summarizing case law and historical texts that “understood[] and questioned” the “human toll wrought by extended terms of isolation” and observing that “research still confirms what this Court suggested over a century ago: Years on end of near-total isolation exact a terrible price.”).

         As experts from both sides testified and the court found, the conditions in ADOC segregation units are not just conducive, but especially so, to psychological harm and decompensation. “ADOC prisoners receive very little out-of-cell time; they are left idle for almost all hours of the day with very little property allowed in the cell; the physical conditions of the segregation cells are often deplorable; and the design of the cells often makes it difficult to monitor the well-being of the prisoners.” Braggs, 257 F.Supp.3d at 1238. The segregation cells are in significant disrepair and are often poorly lit, with little natural light and only small grated windows, if any. See id. The segregation units are often filled with the smell of burning paper and urine and some are extremely dirty with what appears to be dried excrement smeared on the walls and floors. Loud noises travel through the segregation units, some of which house between 20 to 50 people on multiple levels. See Id. These aspects of ADOC's segregation units, the court found, result in a heightened risk of decompensation and development of mental illness, and, as plaintiffs' expert Haney testified, make it more difficult for staff to detect decompensation. See Id. at 1238-39.

         The psychological harms of isolation can affect anyone subjected to segregation, including those who were not previously mentally ill. As Haney testified, citing a study by defendants' consultant, Dr. Jeffrey Metzner, “Isolation can be harmful to any prisoner, ” threatening “potentially adverse effects ... includ[ing] anxiety, depression, anger, cognitive disturbances, perceptual distortions, obsessive thoughts, paranoia, and psychosis.” Joint Ex. 459 at 105; see also Burns Trial Tr. Vol. I at 209 (explaining that the physical symptoms of psychological harm in segregation may be experienced even among previously healthy people); Hunter Trial Tr. Vol. III, 72:24-73:1 (“[A]nyone, if they were in segregation long enough, would run the risk of deterioration in their mental health functioning.”); Tytell Trial Tr. at 189:9-20 (stating that segregation could trigger psychosis and cause delusions in previously healthy individuals). Further, as plaintiffs' expert Burns explained, it is impossible to know in advance which prisoners have the kinds of vulnerabilities that will result in psychological harm from segregation. See Burns Trial Tr. Vol. I at 209:11-10:2.

         Although the serious psychological harms stemming from segregation can affect anyone, they are “even more devastating for those with mental illness.” Braggs, 257 F.Supp.3d at 1237. Trial testimony revealed that the risk of decompensation in segregation increases with both the duration of isolation and the severity of the prisoner's mental illness. See Id. at 1235. As the court noted, “a general consensus among correctional and psychiatric professionals, while not necessarily establishing a constitutional floor, has developed in the last ten years: placement and duration of segregation should be strictly limited for mentally ill prisoners.” Id. at 1237. For example, the National Commission on Correctional Health Care has issued a position statement declaring that mentally ill prisoners should not be placed in segregation absent extenuating circumstances, and even in those circumstances, the stay should be shorter than 30 days. Multiple witnesses, including ADOC's chief psychologist, agreed that overwhelming research shows that prolonged isolation has gravely detrimental effects on mental health, especially for those with pre-existing mental illness. Even one of defendants' experts opined that, based on his experience as a correctional administrator, mentally ill prisoners should generally not be placed in segregation; if they are, it should only occur with the explicit approval and hands-on involvement of mental-health staff, and such prisoners should be placed on a fast-track to be moved into more therapeutic settings.

         The substantial risk of harm posed by extended placement in segregation is even more acute for the subset of prisoners with serious mental-health needs who suffer from ‘serious mental illness.'[4] Indeed, the American Correctional Association and the American Psychiatric Association take the position that seriously mentally ill people should not be placed in segregation unless absolutely necessary, and if so, they should only remain for the shortest duration possible and no longer than three to four weeks. American Correctional Association, Restrictive Housing Performance Based Standards, August 2016; American Psychiatric Association, Position Statement on Segregation of Prisoners with Mental Illness (2012). Associate Commissioner Naglich candidly agreed with plaintiffs' expert Burns that placing seriously mentally ill prisoners in segregation is “categorically inappropriate, ” and that such placement is tantamount to “denial of minimal medical care.” Naglich Testimony Vol. V at 73. Given the consensus on the substantial risk of harm of decompensation for these most severely mentally ill prisoners, the court concluded that it is categorically inappropriate to place prisoners with serious mental illness in segregation absent extenuating circumstances; in addition, when extenuating circumstances exist, decisions regarding the placement of such prisoners should be made with the involvement and approval of appropriate mental-health staff, and the prisoners should be moved out of segregation as soon as possible and have access to treatment and monitoring in the meantime.

         Despite the significant risks of harm created by segregation and by ADOC's segregation facilities in particular, “overwhelming evidence makes clear that ADOC does not ensure that those with a heightened risk of serious harm from mental illness are not placed in segregation or that they are not sent there for dangerously long periods.” Braggs, 257 F.Supp.3d at 1240. ADOC lacks an effective system for evaluating mental-health risks both when deciding whether to place prisoners in segregation and when determining the length of a segregation placement. The result is that prisoners whose mental illness makes them likely to be harmed by segregation are placed there anyway; indeed, mentally ill prisoners are overrepresented in ADOC segregation units. See Id. at 1248. Tragically, while the needs of prisoners with mental illness are significantly greater in segregation due to the severe effects of isolation, access to care is “gravely more limited than in general population, and nonexistent at some facilities.” Id. at 1242. Prisoners in segregation are not allowed to leave their cells for mental-health groups providing therapeutic activities; they also have very little access to individual treatment, due in large part to a shortage of correctional officers to provide security and escort for segregation prisoners who need mental-health treatment. See Id. at 1243.

         In sum, this court found that long-term isolation in segregation can inflict devastating and sometimes permanent psychological harm; that the harms of isolation can affect anyone placed in segregation, but they can be especially severe for those with mental illness; and that the risk of serious harm is most acute for prisoners with ‘serious mental illness,' whom the court concluded it is categorically inappropriate to place in segregation absent extenuating circumstances, and even then only with the involvement of appropriate mental-health staff and for as short a period as possible. It is also important to understand that these findings were made against the backdrop of the additional finding that the risk of harm is especially heightened by the conditions in ADOC's segregation units in particular.

         2. Previous Findings on Mental-Health Monitoring in Segregation

         While the previous liability opinion ultimately reserved judgment on whether the ADOC's provision of certain periodic mental-health evaluations in segregation contributed to the Eighth Amendment violation found at that time, it noted “substantial evidence that [these] evaluations for all prisoners in segregation are inadequate.” Braggs, 257 F.Supp.3d at 1249. Before making additional findings based on the parties' subsequent briefing, the court now summarizes its prior findings regarding periodic evaluations and ADOC's mental-health monitoring in segregation more broadly.

         ADOC is required by Administrative Regulation § 625 to conduct periodic mental-health evaluations of all prisoners in segregation, whether or not they are on the caseload, 30 days after placement, and at each 90-day interval thereafter. See Joint Ex. 127, Admin. Reg. § 625 (doc. no. 1038-150). In addition, the regulation requires ADOC to “evaluate inmates who are receiving treatment for serious mental illness within one working day of the inmate's placement in a segregation cell.” Id.[5] (Notably, the regulation does not require ADOC to move the prisoner if the evaluation reveals that continued placement in segregation would be detrimental to the prisoner's mental health. See id.) A separate regulation further requires ADOC to conduct “regular administrative and disciplinary segregation rounds to monitor the mental status of inmates, identify inmates who may be experiencing difficulty in this restrictive environment and to ensure their access to mental health services.” Joint Ex. 126, Admin. Reg. § 624 (doc. no. 1038-149). These ‘segregation rounds' are to be substantially shorter than the ‘evaluations' provided ...


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