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Alabama Prisoners’ Cry for Help

October 25, 2017

A COURT HEARS ALABAMA PRISONERS’ CRY FOR HELP

By: J.D. Davis, Volume 102 Staff Member

In June of 2017, Judge Myron Thompson issued his second major opinion in a three-part class action lawsuit.[1] This 302-page ruling came out of a massive 2014 lawsuit filed by inmates held by the Alabama Department of Corrections (ADOC).[2] In the lawsuit, inmates alleged discrimination under the ADA as well as Eighth Amendment violations regarding the quality of mental health treatment and other basic medical services.[3] This lawsuit was split into three parts, with the parties first litigating the ADA claim, followed by the mental health treatment, and finally the basic medical services.[4] At the time of this writing, the parties have settled the first phase of the lawsuit regarding the ADA claims.[5] This blog concerns the second phase of this lawsuit: whether ADOC’s treatment of mentally ill inmates violates the Eighth Amendment.

In his June ruling, Judge Thompson determined that ADOC’s treatment of “[inmates] with serious mental health needs” violated their Eighth Amendment rights.[6] He called ADOC’s mental-health care “horrendously inadequate.”[7] Judge Thompson ordered the parties to reach an appropriate remedy quickly “given the severity and urgency of the need for mental-health care.”[8] This blog will provide a brief introduction to Eighth Amendment jurisprudence before unpacking Judge Thompson’s findings in this case. This blog will conclude by opining on the future wellbeing of ADOC inmates.

I. BACKGROUND OF LAW

The Eighth Amendment provides that “[e]xcessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.”[9] In Trop v. Dulles, the Supreme Court determined that “[t]he basic concept underlying the Eighth Amendment is nothing less than the dignity of man” and that “[t]he Amendment must draw its meaning from the evolving standards of decency that mark the progress of a maturing society.”[10] Years later, the Supreme Court elaborated in Estelle v. Gamble that “[t]hese elementary principles establish the government’s obligation to provide medical care for those whom it is punishing by incarceration.”[11]

In the medical context, the Supreme Court requires a plaintiff to “allege acts or omissions sufficiently harmful” and these acts or omissions must “evidence deliberate indifference to serious medical needs.”[12] The Supreme Court later elaborated on the “deliberate indifference” standard in Farmer v. Brennan, defining it to include “subjective and objective requirements.”[13] The Court continued to require that a plaintiff show objectively “serious medical needs” to satisfy the harm portion,[14] but in its subsequent holding, the Supreme Court required that prison officials “must know[] of and disregard[] an excessive risk to inmate health and safety.”[15]

II. OPINION SUMMARY

Most of the Judge Thompson’s opinion concerns whether the prison conditions were sufficiently harmful.[16] This may be, in part, due to a potential confusion amongst the courts concerning the Eighth Amendment prongs.[17] When courts decide prison conditions are sufficiently harmful, they often rely on the existence of these conditions to further satisfy the subjective prong.[18] Thus, the test in practice seems to ask whether the judge is subjectively satisfied that prison conditions are sufficiently harmful, and if so, then objectively assumes staff were deliberately indifferent.[19] Despite these academic concerns, Judge Thompson seemed to struggle more with the depth of Eighth Amendment violations rather than questioning whether they exist at all.

A. Deliberate Indifference

Judge Thompson easily determined that ADOC prison officials acted with deliberate indifference.[20] This stemmed from the fact that “[m]ost of the evidence came from ADOC’s officials’ own mouths,” making the case “sui generis.”[21] ADOC officials were objectively aware of the issues in the inmates’ complaint.[22] The alleged harms were all well-documented in internal audits, reports, and emails.[23] Further, “the state of the mental-health care system [was] itself evidence of ADOC’s disregard of harm and risk of harm.”[24] In other words, the fact that ADOC officials knew of the issues for so long and failed to correct them led the Court to determine that the subjective disregard for these concerns was satisfied.[25]

B. Sufficiently Harmful

Judge Thompson identified seven key deficiencies whereby inmates “have suffered harm and are subject to a substantial risk of serious harm.”[26] The Court went to great length detailing each of the seven identified areas of risk.[27] Though each deficiency is independently important and harmful, the court noted that “persistent and severe shortages of mental-health staff and correctional staff, combined with chronic and significant overcrowding, are the overarching issues that permeate each of the . . . contributing factors.”[28]

The first area of risk regarded the “identification and classification of prisoners with mental illness.”[29] Inmates were not getting the mental health care they needed because ADOC staff did not know who needed treatment nor what they were being treated for.[30] ADOC employed unqualified medical staff to assess inmates at intake, resulting in missed and incorrect diagnoses.[31] Those that were identified at intake were placed in a classification system that did not accurately reflect the severity of their mental-illness.[32] These issues were exacerbated by a virtually non-existent referral system for those not identified at intake or whose symptoms worsened during incarceration.[33] All of this resulted in severe under reporting of mentally-ill inmates.[34]

The second area of risk pertained to the ADOC’s “[f]ail[ure] to provide individualized treatment plans” to inmates with mental-health needs.[35] The ADOC’s treatment plans were “not individualized to each prisoner’s symptoms and needs, resulting in ‘cookie cutter’ plans.”[36] Thus, even those inmates who were fortunate enough to be identified as mentally-ill were still not getting the treatment to meet their needs. ADOC further failed to implement adequate meetings between treatment providers.[37] The failure of medical staff to consult with one another exacerbated inmates’ symptoms, ultimately leading to serious injury or death.[38]

The third area addressed by the Court regarded failures by the ADOC to provide adequate psychotherapy services.[39] This area stemmed largely from serious understaffing by the ADOC.[40] On the treatment side, lack of qualified medical staff resulted in impossibly large caseloads.[41] Because of these large caseloads, ADOC’s mental-health provider created a burden sharing scheme that allowed underqualified medical staff to make treatment decisions that exceeded the scope of their training and authority.[42] These issues were exacerbated by correction staff shortages that severely restricted the ability of staff to transfer inmates between their cells and treatment appointments.[43]

The fourth area addressed by the Court concerned inmates who were identified as needing residential treatment.[44] The Court focused on ADOC’s failure to provide “out-of-cell time and treatment” along with “hospital-level care to those who need it.”[45] As an initial issue, ADOC refused to hospitalize, or provide hospital-equivalent services, to the most severely mentally-ill.[46] The residential treatment ADOC did provide was similarly lacking. The Court observed that “ADOC . . . had a persistent and long-standing practice of placing segregation inmates without mental-health needs in mental-health units.”[47] By using these beds for inmates without mental-health issues, ADOC effectively stripped these units from inmates who otherwise needed them. This practice had the added effect of detracting from the units’ effectiveness for those properly housed there by creating increased safety risks and all but eliminating the ability to provide therapeutic programming.[48]

The fifth area the Court addressed concerned the ADOC’s treatment, or lack thereof, of suicidal inmates.[49] Similar to ADOC’s failure to provide adequate residential care units for mentally-ill inmates, it also failed to provide adequate crisis units for those at risk of self-harm.[50] The units that were provided were horrendously inadequate, with inmates often being housed in offices, libraries, and segregation cells.[51] ADOC also suffered from a severe culture of minimizing inmates’ self-harm and suicidal ideations.[52] Even inmates whose threats were taken seriously were subject to ADOC’s poor classification system and received care that made matters worse.[53]

The sixth area addressed by the Court had to do with ADOC’s practice of punishing mentally ill inmates “for symptoms of their mental illness, and imposing disciplinary sanctions without regard for the impact of sanctions on prisoners’ mental health.”[54] On paper, ADOC had a policy requiring mental-health counselors to assess mentally-ill inmates threatened with disciplinary actions.[55] The purpose being that mentally-ill inmates should have their illnesses factored into any disciplinary decisions to prevent punishing an inmate for his illness as well as preventing unnecessary interference with treatment.[56] In practice, however, “these mental health evaluations [were] brief and perfunctory.”[57] Instead, ADOC “routinely disciplined [mentally-ill inmates] for harming themselves or attempting to do so.”[58] The resulting punishment, expectedly so, made matters significantly worse.[59]

The seventh and final area the Court addressed concerned placing mentally-ill inmates in segregation.[60] The Court observed that these cells were in “significant disrepair”[61] and, similar to the residential treatment cells, the treatment available for those housed here was severally lacking.[62] Because ADOC lacked a “functioning system” for preventing seriously mentally ill from being sent to segregation units and for their limiting time spent there, inmates were subjected to serious risk of harm.[63]

III. AFTERMATH

As of the writing of this blog, the parties continue to litigate and mediate these issues.[64] Given the host of issues identified by the Court, it is unlikely the parties will reach a simple and readily attainable remedy. ADOC attorneys recently proposed doubling the current mental health staff to meet Judge Thompson’s order.[65] While this significant increase in mental health workers would likely address many of the identified risk areas, it is unclear where ADOC will get the additional $10 million to spend, whether the governor and legislature will approve it, and, even if they do, whether ADOC will find 125 qualified mental health workers interested in prison work.[66] But these efforts are critical to the wellbeing of Alabama prisoners. “Simply put, ADOC’s mental-health care is horrendously inadequate.”[67] Needless to say, Alabama inmates with mental health needs have come a long way in three years. While their future is uncertain, it is clear both parties are striving to remedy these issues. If the parties gauge the political climate just right, inmates within the ADOC just might see the mental health care for which they fought and, in some tragic cases, died.[68]

  1. Federal Judge in SPLC Case Orders Drastic Overhaul of Alabama Prison Mental Health Care System, Southern Poverty Law Center (June 27, 2017), https://www.splcenter.org/news/2017/06/27/federal-judge-splc-case-orders-drastic-overhaul-alabama-prison-mental-health-care-system [hereinafter SPLC]. ↑
  2. Id. ↑
  3. Id. ↑
  4. Id. ↑
  5. Dunn v. Dunn, NO. 2:14-cv-00601-MHT-TFM, slip. op. at 1–2 (M.D. Ala. Mar. 15, 2016). The parties have not yet scheduled a date to litigate the Eighth Amendment violations regarding basic medical services. SPLC, supra note 1. ↑
  6. Braggs v. Dunn, No. 2:14CV601-MHT(WO), 2017 WL 2773833, at *299 (M.D. Ala. June 27, 2017). ↑
  7. Id. ↑
  8. Id. at *302. ↑
  9. U.S. Const. amend. VIII. ↑
  10. Trop v. Dulles, 356 U.S. 86, 100–01 (1958). ↑
  11. Estelle v. Gamble, 429 U.S. 97, 103 (1976). ↑
  12. Id. at 106. The Court further noted that “[m]edical malpractice does not become a constitutional violation merely because the victim is a prisoner.” Id. ↑
  13. Farmer v. Brennan, 511 U.S. 825, 846 (1994). ↑
  14. Estelle, 429 U.S. at 104. ↑
  15. Farmer, 511 U.S. at 837. Restated another way, a defendant must “both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and he must also draw the inference.” Id. ↑
  16. See Braggs v. Dunn, No. 2:14CV601-MHT(WO), 2017 WL 2773833 (M.D. Ala. June 27, 2017). ↑
  17. Brittany Glidden, Necessary Suffering?: Weighing Government and Prisoner Interests in Determining What Is Cruel and Unusual, 49 Am. Crim. L. Rev. 1815, 1826–27 (2012) (“[T]he objective prong has become highly subjective.”). ↑
  18. Id. at 1834–35. ↑
  19. Id. ↑
  20. Braggs, 2017 WL 2773833, at *250. ↑
  21. Id. at *249. ↑
  22. See id. at *250–60. ↑
  23. Id. ↑
  24. Id. at *261. ↑
  25. Id. ↑
  26. Id. at *43. ↑
  27. Id. ↑
  28. Id. at *301. Indeed, the court identifies these issues as a significant contributor underling each of the seven risk areas. See id. ↑
  29. Id. at *300. ↑
  30. Id. at *72. As Judge Thompson so eloquently put it, “as common sense would dictate, mental-health treatment cannot begin unless providers are aware of who needs treatment and for what.” ↑
  31. Id. at *72–73 ↑
  32. Id. at *83. The Court recounted the situation of one inmate who was classified as having only mild impairment. This inmate’s delusions led him to kill another inmate. Id. at *85. ↑
  33. Id. at *79–83. ↑
  34. Id. at *72 (“[T]he average rate of mental illness for men in correctional systems ranges between 20% and 30%; ADOC’s prevalence rate is between 14% and 15%.”). ↑
  35. Id. at *300. ↑
  36. Id. at *91. ↑
  37. Id. at *94. ↑
  38. Id. ↑
  39. Id. at *96. ↑
  40. Id. at *109 ↑
  41. Id. at *97–101 (“[S]ome facilities have only one counselor, who treats more than 100 patients.”). ↑
  42. Id. at *105–06 (“[O]nly four out of 47 [mental health professionals] employed at ADOC were licensed as of February 2016.”). ↑
  43. Id. at *101–05 (noting that this often required “cell-front sessions” that lacked any hint of confidentiality). ↑
  44. Id. at *300. ↑
  45. Id. ↑
  46. Id. at *129 (“ADOC virtually never transfer[ed] patients to hospitals.”). ↑
  47. Id. at *110–11. ↑
  48. Id. at *112–13. ↑
  49. Id. at *133. ↑
  50. Id. ↑
  51. Id. at *153, *160–62 (noting that these makeshift crisis cells frequently contained features that facilitated suicide attempts). The dangerousness of these makeshift crisis cells was compounded by officers’ inability to prevent inmates from smuggling dangerous objects in. Id. at *165–66. ↑
  52. Id. at *146–47, *149 n.7. ↑
  53. Id. at *157, *167. ADOC only began assessing inmates for suicide risk once litigation began, and even then these assessments were conducted only at intake. Id. at *143. Inmates were inappropriately released from care and received poor follow-up treatment. Id. at *173. ↑
  54. Id. at *301. ↑
  55. Id. at *184. ↑
  56. Id. ↑
  57. Id. at *185. ↑
  58. Id. at *178. ↑
  59. Id. at *183–84 (“[S]anctions, such as placement in segregation, expose mentally ill prisoners to a substantial risk of worsening symptoms and significantly reduced access to monitoring and treatment.”) ↑
  60. Id. at *190. ↑
  61. Id. at *200–01 (noting these cells were “poorly lit,” “filled with the smell of burning paper and urine,” and some were “extremely dirty with what appeared to be dried excrement smeared on the walls and floors”). ↑
  62. Id. at *214–15 (“Mental-health patients’ needs are considerably greater in segregation due to the harsh effects of isolation, yet instead of receiving more treatment to mitigate these effects, prisoners in segregation have less access to care than in general population and are not adequately monitored . . . .”). ↑
  63. Id. at *207 (noting that mentally-ill inmates who stand to suffer the most from segregation are placed there anyway). ↑
  64. See id. at *302 (ordering the parties to meet and discuss a remedy and noting the “severity and urgency of the need for mental-health care”). See also Alabama Judge’s Consent Decree Protects Rights of Prisoners Who Receive Involuntary Medication, Southern Poverty Law Center (Sept. 8, 2017), https://www.splcenter.org/news/2017/09/08/alabama-judge%E2%80%99s-consent-decree-protects-rights-prisoners-who-receive-involuntary-medication (noting that the parties have neither reached an agreement on this phase of the litigation nor set a date for the final phase). ↑
  65. Mike Cason, Alabama Tells Federal Court It Will Double Mental Health Staff in Prisons, AL (Oct. 10, 2017), http://www.al.com/news/index.ssf/2017/10/alabama_tells_federal_court_it.html. ↑
  66. Id. ↑
  67. Braggs, 2017 WL 2773833, at *299. ↑
  68. Ten days after testifying before the Court, petitioner Jamie Wallace hung himself in his cell. Id. at *16. Judge Thompson was particularly moved by his tragic story, noting his suicide “draped all the subsequent testimony like a pall.” Id. ↑
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