United States District Court, M.D. Alabama, Northern Division
PHASE 2A REMEDIAL JUDGMENT ON IMMEDIATE RELIEF FOR
H. THOMPSON, UNITED STATES DISTRICT JUDGE
accordance with the opinion entered today, it is the ORDER,
JUDGMENT, and DECREE of the court as follows:
Plaintiffs' motion for immediate relief (doc. no. 2276)
is granted as set forth in this judgment.
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:
Licensed Mental Health Professionals
(“MHPs”) will be hired for the mental-health
program in the Alabama Department of Corrections
(“ADOC”). Each Major Facility 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
employee of ADOC or Wexford (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.
Upon being presented to mental-health or medical staff for
assessment for suicide watch, each inmate will be maintained
under “constant watch” at least until they have
been evaluated as described in part D below.
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
(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.
inmate who is determined to be acutely suicidal shall be
monitored through a constant watch procedure.
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.
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.
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