Braggs v. Dunn

          PHASE 2A REMEDIAL JUDGMENT ON IMMEDIATE RELIEF FOR SUICIDE PREVENTION

          MYRON H. THOMPSON, UNITED STATES DISTRICT JUDGE

         In accordance with the opinion entered today, it is the ORDER, JUDGMENT, and DECREE of the court as follows:

         (1) Plaintiffs' motion for immediate relief (doc. no. 2276) is granted as set forth in this judgment.

         (2) Defendants Jefferson Dunn and Ruth Naglich are ENJOINED and RESTRAINED from failing to comply with the following requirements, which, for the most part, come verbatim from the Interim Agreement Regarding Suicide Prevention Measures (doc. no. 1106-1) between the plaintiffs and the defendants:

         (A) Licensed Mental Health Professionals (“MHPs”)^[1] will be hired for the mental-health program in the Alabama Department of Corrections (“ADOC”). Each Major Facility^[2] will have at least one full time (1 FTE) licensed MHP, and the treatment hubs--Bullock, Donaldson, and Tutwiler--will have at least two (2 FTEs) licensed MHPs. There will be two (2) licensed MHPs on site for at least 8 hours per day every business day at each treatment hub. There will be at least one (1) licensed MHP at each treatment hub on the weekends and holidays.

         (B) Any employee of ADOC or Wexford^[3] (or any other contractor retained to provide medical or mental-health care in ADOC facilities) may present an inmate to mental-health or medical staff for assessment for suicide watch. Whoever places an inmate on watch must notify appropriate Wexford staff. If the inmate is identified when no Wexford staff is on site, the appropriate Wexford on-call staff must be notified.

         (C) Upon being presented to mental-health or medical staff for assessment for suicide watch, each inmate will be maintained under “constant watch”^[4] at least until they have been evaluated as described in part D below.

         (D) After an inmate's initial placement on suicide watch and referral for mental-health evaluation, each inmate must be evaluated using the Wexford suicide risk assessment to determine if the individual is “acutely suicidal” or “nonacutely suicidal, ” as these terms are defined in the National Commission on Correctional Health Care standard MH-G-04. These evaluations will be conducted out of cell and in a confidential setting.

(i) Licensed psychiatrists or licensed psychologists may conduct these evaluations either in person or by telepsychiatry.

(ii) In the event that they are conducted by telepsychiatry, the inmate being evaluated will be in a room with a licensed MHP or a Certified Registered Nurse Practitioner (“CRNP”), and the evaluation must comply with the telepsychiatry requirements set forth in the Psychotherapy and Confidentiality Remedial Order (doc. no. 1899-1) at 8.

(iii) CRNPs and licensed MHPs may conduct these evaluations but only if they are conducted in person. Upon conducting any such evaluation, a CRNP or licensed MHP must confirm their assessment with a psychiatrist or psychologist either in person, by telepsychiatry, or over the phone. The psychiatrist or psychologist must be provided with and review the risk assessment and the notes of the mental-health evaluations and counseling that have been conducted in the past 14 days.

(iv) Prior to conducting any such evaluations, licensed MHPs and CRNPs must complete a training on suicide prevention, assessing suicidality, and procedures of suicide watch. This training must be approved by plaintiffs' expert Dr. Kathryn Burns and defendants' expert Dr. Mary Perrien, who each testified that she would be willing to assist ADOC with any additional training that becomes necessary.

         (E) Any inmate who is determined to be acutely suicidal shall be monitored through a constant watch procedure.

         (F) Any inmate who is determined to be nonacutely suicidal shall be monitored through a “ close watch procedure” that ensures monitoring by ADOC staff at staggered intervals not to exceed every 15 minutes.

         (G) Both constant watch and close watch shall be contemporaneously documented at staggered intervals not to exceed 15 minutes on a record maintained on each individual cell door. Upon discharge from suicide watch, these records will be maintained in a facility-based suicide watch log and in the individual inmate's medical record.

         (H) ADOC Administrative Regulation 630, which currently mandates 15-minute intervals for monitoring on suicide watch, will be revised to reflect the constant watch process and the staggered ...