Dunn et al v. Thomas et al

Filing 2332

PHASE 2A SUPPLEMENTAL LIABILITY OPINION AND ORDER ON PERIODIC MENTAL-HEALTH EVALUATIONS OF PRISONERS IN SEGREGATION: Accordingly, it is ORDERED that, by noon on February 18, 2019, counsel for plaintiffs and defendants, after conferring with each o ther in an attempt to reach agreement, are to file a joint report of suggestions of how proceed as to relief in light of the above opinion. The court recognizes that February 18 is a holiday, but there now appears to be an urgency regarding the resolution of the issue of segregation. Signed by Honorable Judge Myron H. Thompson on 2/11/2019. (kh, )

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE
MIDDLE DISTRICT OF ALABAMA, NORTHERN DIVISION
EDWARD BRAGGS, et al.,
Plaintiffs,
v.
JEFFERSON S. DUNN, in his
official capacity as
Commissioner of
the Alabama Department of
Corrections, et al.,
Defendants.

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CIVIL ACTION NO.
2:14cv601-MHT
(WO)

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

ADOC

That opinion noted “substantial evidence
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

serious mental-health needs in segregation.2

with

See id.

1. Because the court reserved this issue at the
time of entering its liability opinion on June 27,
2017, and because the parties declined to submit
additional evidence into the record, it now decides the
issue based on the record that existed at the time of
the liability opinion.
2. Defendants argued that a separate liability
opinion on this issue would be unnecessary because of
the court’s plan to hold a remedial trial on
segregation.
See Defs.’ Response to Pls.’ Proposed
Opinion (doc. no. 1549) at 3.
The court disagrees.
Identifying the full scope of the liability finding,
including
the
discrete
issue
analyzed
here,
is
necessary in order to determine the scope and elements
2

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.
of the necessary remedy. Moreover, to the extent that
defendants complain of the possibility of “stale
evidence,” this claim is unavailing given that the
parties both declined the opportunity to present
additional evidence on this issue.
3

A. Serious Mental-Health Needs
To

prove

inadequate

an

Eighth

mental-health

Amendment
care,

claim

plaintiffs

based
must

on
show

that they have serious mental-health care needs.

A

serious

a

need

physician

as

is

“one

mandating

that

has

been

treatment

or

diagnosed
one

that

by
is

so

obvious that even a lay person would easily recognize
the necessity for a doctor’s attention.”
West, 320 F.3d 1235, 1243 (11th Cir. 2003).

Farrow v.
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.

contractor

3d

at

1190.

Because

ADOC’s

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

4

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

under-identification
Braggs,

257

F.

under-identification

that

the

“cascade[]
Supp.
of

3d

effects
through
at

prisoners

of
the

1201.

this

system.”
ADOC’s

results

in

an

artificial, abnormally low number of ADOC prisoners on
the mental-health caseload.

Id. at 1201.

the

prisoners

total

number

of

Accordingly,

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.

3. As in the prior liability opinion, when the
court refers to ‘mentally ill prisoners’ in this
opinion, it is referring to only those with serious
mental-health needs.
See Braggs, 257 F. Supp. 3d at
1190.
5

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

addition
plaintiffs

to

showing

must

a

serious

establish

that

mental-health

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

substantially

to

likely

prevent
to

serious

occur

substantial risk of serious harm.

in

harm
the

which

is

future--a

That is, a showing

of either actual serious harm or a substantial risk of

6

serious

harm

is

requirement.

sufficient

to

sustain

the

harm

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
have

practices
already

practices.”

at

issue,

been

not

harmed

(necessarily)
by

they

policies

these

that

and

Dunn v. Dunn, 219 F. Supp. 3d 1100, 1123

(M.D. Ala. 2016) (Thompson, J.).
Moreover,
combine

to

multiple
deprive

policies
a

or

prisoner

practices
of

a

that

“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

7

Cir.

1985)

(recognizing

‘totality

of

conditions’

approach in prison-conditions cases).
For the following reasons, the court finds, by a
preponderance

of

the

evidence,

conducting

inadequate

that

defendants

periodic

are

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

decompensation
segregation.

risk
posed

of
by

psychological
extended

harm

and

placement

in

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,
8

long-term
solitary

isolation

resulting

confinement

mental health.

has

from

crippling

segregation
consequences

or
for

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

Hunter

psyche

Trial

Tr.

psychological
symptoms

and

harm

one’s

Vol.

palpitations,

II

from

including

mental
at

health

77:24-78:2.

segregation

can

hallucinations,

anxiety

attacks,

function.”

and

The

lead

chest

to

pain,

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

self-identity,”

as

well

as

9

of

the

physical

basic

sense

harm).

of
“The

potentially devastating effects of these conditions are
reflected
suicide

in

the

characteristically

deaths,

self-mutilation

and
that

incidents
occur

in

high

of

many

numbers

self-harm

of

these

of
and

units.”

Joint Ex. 459, Haney Expert Report (doc. no. 1038-1043)
at

130-31.

Moreover,

segregation--even

the

apart

harmful

from

effects

suicide--“can

of
be

irreversible,” and “can persist beyond the time that
prisoners are housed in isolation and lead to long-term
disability and dysfunction.”
Ayala,

135

S.

Ct.

2187,

Id.; see also Davis v.

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

10

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.
segregation

See id.

units,

the

These aspects of ADOC’s

court

found,

result

in

a

heightened risk of decompensation and development of
mental

illness,

and,

as

plaintiffs’

11

expert

Haney

testified, make it more difficult for staff to detect
decompensation.
The

See id. at 1238-39.

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
includ[ing]

“potentially
anxiety,

disturbances,

adverse

depression,

perceptual

effects
anger,

distortions,

thoughts, paranoia, and psychosis.”

...

cognitive
obsessive

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

12

healthy

individuals).

Further, as plaintiffs' expert Burns explained, it is
impossible to know in advance which prisoners have the
kinds

of

vulnerabilities

that

psychological harm from segregation.

will

result

in

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.”
257 F. Supp. 3d at 1237.
the

risk

of

Braggs,

Trial testimony revealed that

decompensation

in

segregation

increases

with both the duration of isolation and the severity of
the prisoner’s mental illness.
the

court

noted,

“a

See id. at 1235.

general

consensus

As

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.”

National

Commission

Id.
on

at

1237.

Correctional

For

example,

Health

Care

the
has

issued a position statement declaring that mentally ill

13

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

effects

on

isolation

mental

has

health,

especially

pre-existing mental illness.
experts

opined

correctional

that,

gravely

based

administrator,

detrimental

for

those

with

Even one of defendants’
on

his

mentally

experience
ill

as

a

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

14

who suffer from ‘serious mental illness.’4
American

Correctional

Psychiatric

Association

Association

take

and

the

Indeed, the
the

American

position

that

seriously mentally ill people should not be placed in
segregation
they

unless

should

possible

and

only
no

absolutely
remain
longer

for
than

necessary,
the

and

shortest

three

to

if

so,

duration

four

weeks.

American Correctional Association, Restrictive Housing
Performance
Psychiatric

Based

Standards,

Association,

August

Position

2016;

American

Statement

on

Segregation of Prisoners with Mental Illness (2012).
Associate

Commissioner

Naglich

candidly

agreed

with

4. ‘Serious mental illness’ is a term of art in the
field of psychiatry--distinct from the far broader
Eighth Amendment concept of ‘serious mental-health
needs’--that refers to a certain subset of particularly
disabling conditions. Serious mental illness is defined
by the diagnosis, duration, and severity of the
symptoms. Certain diagnoses, such as schizophrenia and
disorders accompanied by psychosis, are by definition
serious mental illnesses, because they last a lifetime
and are accompanied by debilitating symptoms; others,
such as major depression and anxiety disorder, may be
considered serious mental illnesses depending on the
severity of the individual’s symptoms.

15

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.”
Vol. V at 73.

Naglich Testimony

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
serious

inappropriate

mental

extenuating
extenuating

illness

to

place

in

circumstances;
circumstances

prisoners

segregation
in

exist,

absent

addition,
decisions

with

when

regarding

the placement of such prisoners should be made with the
involvement and approval of appropriate mental-health
staff,

and

segregation

the
as

prisoners
soon

as

should

possible

be
and

moved
have

out

of

access

to

treatment and monitoring in the meantime.
Despite the significant risks of harm created by
segregation

and

by

ADOC’s

particular,

“overwhelming

segregation
evidence

facilities

makes

clear

in

that

ADOC does not ensure that those with a heightened risk

16

of serious harm from mental illness are not placed in
segregation

or

that

they

dangerously long periods.”
1240.

are

not

sent

there

for

Braggs, 257 F. Supp. 3d at

ADOC lacks an effective system for evaluating

mental-health risks both when deciding whether to place
prisoners

in

segregation

and

when

length of a segregation placement.

determining

the

The result is that

prisoners whose mental illness makes them likely to be
harmed by segregation are placed there anyway; indeed,
mentally

ill

prisoners

segregation units.
the

needs

of

are

overrepresented

See id. at 1248.

prisoners

with

in

ADOC

Tragically, while

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

treatment,

have
due

very
in

little

large

17

access

part

to

to
a

individual

shortage

of

correctional officers to provide security and escort
for

segregation

treatment.

prisoners

who

need

mental-health

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

especially

finding

heightened

that
by

the

segregation units in particular.

18

the

risk

conditions

of

harm
in

is

ADOC's

2.
While

Previous Findings on Mental-Health
Monitoring in Segregation
the

previous

liability

opinion

ultimately

reserved judgment on whether the ADOC's provision of
certain

periodic

segregation
violation

mental-health

contributed

found

at

to

that

evaluations

the

time,

it

Eighth
noted

in

Amendment

“substantial

evidence that [these] evaluations for all prisoners in
segregation are inadequate.”
at 1249.
the

Before making additional findings based on

parties’

summarizes
evaluations

Braggs, 257 F. Supp. 3d

subsequent

its
and

prior

briefing,

findings

ADOC's

the

court

regarding

mental-health

now

periodic

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

90-day interval thereafter.
Reg.

§ 625

(doc.

no.

placement,

and

at

each

See Joint Ex. 127, Admin.

1038-150).

In

addition,

the

regulation requires ADOC to “evaluate inmates who are
19

receiving treatment for serious mental illness within
one

working

day

segregation cell.”

of

the

Id.5

inmate’s

placement

in

a

(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.
id.)

See

A separate regulation further requires ADOC to

5. Defense counsel maintained at oral argument that
§ 625 requires 30-day and subsequent 90-day evaluations
for only inmates receiving treatment for serious mental
illness. However, the plain language of the regulation
requires such an evaluation “[w]henever an inmate is
maintained in a segregation cell for longer than thirty
days,”
and
“[f]ollowing
each
ninety-day
period
thereafter.”
Joint Ex. 127, Admin. Reg. § 625 (doc.
no. 1038-150) (emphasis added).
Indeed, defendants’
own
brief
clearly
states
that
“any
inmate”
in
segregation is to receive such evaluations under the
regulation, cites testimony to that effect from ADOC
psychologist Dr. Scott Holmes, and relies on that
understanding as evidence that ADOC is currently
providing adequate evaluations. See Defs.’ Response in
Opposition to Liability Finding Related to Segregation
Monitoring (doc. no. 1418) at 14.
This understanding
is further evident from ADOC’s provision of such
evaluations--albeit in an inconsistent and cursory
manner--to individuals not identified as having serious
mental illness. Finally, defense counsel could produce
no
evidence
at
oral
argument
supporting
his
then-understanding that § 625 applies to only inmates
with serious mental illness.
Accordingly, the court
concludes that this regulation applies to all inmates
held in segregation.
20

conduct

“regular

segregation
inmates,

administrative
to

rounds

identify

difficulty

in

and

mental

monitor

inmates

this

the

who

may

restrictive

be

disciplinary
status

of

experiencing

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 by § 625, consisting
primarily of a “brief interview,” and are to occur much
more frequently than evaluations--at least five times
per week on different days, including three times by
ADOC

staff

(one

of

which

is

for

Segregation

Review

Board) and two times by contracted mental-health staff.6
Id.
As
risks

the
of

court

explained,

psychological

harm

because
that

of

the

extended

serious

isolation

6.
The
court
previously
misstated
that
the
regulation required segregation rounds occur at least
twice per week.
However, the regulation in fact
required that ADOC staff perform these rounds at least
twice per week, and that contracted mental-health staff
perform rounds an additional two times per week, on
days different from those on which ADOC staff did
rounds.
21

poses to prisoners, “it is ... essential to identify
those who need mental-health treatment in segregation.”
Braggs, 257 F. Supp. 3d at 1249.

While the previous

opinion declined to fully reach the issue of periodic
mental-health evaluations, it noted evidence that those
evaluations were inadequate and that “such assessments
at ADOC are cursory at best.”
court

noted

the

case

of

Id.

In particular, the

plaintiff

R.M.W.,

a

female

prisoner who had a segregation mental-health evaluation
conducted the same month that she had twice been sent
to

suicide

watch

and

had

multiple

incidents

self-injury prior to the evaluation.
form,

however,

did

not

mention

of

The evaluation

her

suicide-watch

placements or self-injury episodes nor did it include a
suicide risk-assessment tool. Instead, it simply had
some

check

placement”

marks
and

and

stated

“segregation

inmate’s mental health.”
March

28,

2014

Review

of

“inmate
placement

appropriate
not

for

impacting

Id. (citing Joint Ex. 404,
Segregation

(doc. no. 1038-859) at MR017081).

22

Inmates

R.M.W.

As to the issue of segregation rounds, the court
found that to extent they were occurring, substantial
evidence demonstrated that they were cursory in nature
and ineffective at identifying signs of mental illness
and decompensation.
rounds

are

not

Id. at 1243-44.

meant

to

replace

Although these
psychotherapy

or

periodic evaluations, the court found these rounds “do
not adequately serve even the limited purpose they are
intended

to

segregation

serve.”
rounds

Id.

as

Dr.

‘drive-bys,’

Hunter

described

which

sometimes

occur even without verbal exchanges between prisoners
and

staff.

Dr.

Tytell,

who

served

as

an

ADOC

psychologist at Donaldson Correctional Facility before
taking his current position, testified that segregation
rounds for over 120 prisoners at Donaldson took between
one-and-a-half

and

two

hours,

including

the

time

to

walk between cell blocks--with the result that no more
than one minute was spent per prisoner on average.

See

id.

A former counselor at the Bibb facility testified

that

it

would

take

her

35

23

minutes

to

an

hour

to

complete the rounds at all six housing units with 18
double-celled cells, with the result that she spent one
to two minutes per prisoner, including the time to walk
between six housing units.
The

court

found

that

segregation

rounds,

in

addition to being cursory, do not occur as frequently
as they should and likely did not happen at all at some
facilities.

See id. at 1244.

A lack of documentation

of segregation rounds combined with the acute staffing
shortages

led

defense

expert

Ayers

to

express

doubt

that ADOC was able to conduct segregation rounds as
often
Holman

as

required.

facility

testifying

that

The

confirmed

site

administrator

Ayers’

insufficient

belief

segregation

by

for

the

credibly

rounds

have

been a problem at Holman since 2008 due to staffing
shortages, and that the problem has only worsened since
then.

Id.

According to the site administrator, at

Holman, instead of a separate mental-health segregation
round,

a

counselor

accompanies

the

warden

and

other

security officers during a weekly segregation review

24

board, where the warden and other officials walk from
cell

to

cell
and

status

to

review

each

potentially

segregation

change

prisoner’s

the

prisoner’s

segregation sentence based on her conduct.

Due to the

correctional staffing shortage, she (the warden?) is
sometimes

able

to

visit

only

one

prisoner

in

segregation per week.
Moreover, the previous liability opinion found that
monitoring by security staff for signs of self-harm and
suicide

occurred

with

inadequate

correctional understaffing.

frequency

due

to

“Correctional expert Vail

credibly opined that ADOC lacked enough correctional
staff to conduct monitoring rounds in segregation every
30

minutes--the

level

of

monitoring

in

segregation

units necessary to keep prisoners safe from self-harm
and suicide.”

Id.

suggested

that

hours

a

at

implied

that

no

time.

Vail saw multiple logs at ADOC that
segregation
Defense

monitoring

was

25

checks
expert

were
Ayers

inadequate,

done

for

similarly

noting

that

better monitoring of segregation inmates would address
the high suicide rates within ADOC.
In

addition

to

significant

levels

of

understaffing, a lack of visibility in ADOC segregation
units contributes to the inadequacy of mental-health
monitoring.
are

of

See id. 1243 (“‘Segregation rounds’ ...

limited

utility

visibility

issues.”).

testified,

as

difficult

a

for

due
As

general

staff

to

understaffing

plaintiffs’
matter,

to

detect

“it

expert
is

and
Haney

much

more

decompensation

of

prisoners while they are housed in segregation: when
prisoners

remain

in

their

cells

around

the

clock,

mental-health staff have a harder time observing the
patient

and

diagnosing

illnesses

effectively,

and

correctional officers and fellow prisoners also lack
sufficient regular contact with the prisoner to notice
the

onset

1238-39.
lack

of
In

symptoms
addition,

visibility

windows

on

of

the

into

mental

“ADOC

segregation

cells,

doors,

which

26

illness.”

both
are

units

because
often

Id.

of

at

often
small

grated

or

difficult to see through, and because of the layout of
the

cells

and

throughout

units.”

These

facilities.

ADOC

Id.

For

problems
example,

exist
the

Easterling facility’s segregation unit has tiny windows
that

do

inside

not

allow

without

correctional

being

officers

directly

in

to

front

observe
of

the

door--which correctional officers often avoid because
of a risk of having bodily fluids or food thrown at
them

through

a

food

slot

on

the

door.

The

court

witnessed firsthand that the Donaldson and St. Clair
facilities have very little visibility into the cells
from the officers’ station due to small windows and dim
lighting.

Bibb’s segregation units “might be the most

egregious in terms of visibility,” having no line of
sight from the central officer station.7

Id.

Further,

ADOC facilities frequently permit prisoners to cover
their cell door windows with papers, which the court
7. Haney recommended that Bibb’s segregation units
be closed immediately due to a lack of monitoring,
which rendered the risk of harm too great.
He
explained that in four decades of doing this work, he
has
never
recommended
any
unit
to
be
closed
immediately. See id.
27

found “heightens the risk of suicide” by inhibiting the
ability

of

observe

prisoners.

segregation

correctional

units

The

and
lack

therefore

mental-health
of

staff

visibility

“makes

it

in

even

difficult to provide effective monitoring.”

to

ADOC
more

Id. at

1244.
The inadequacy of ADOC’s mental-health monitoring
of prisoners in segregation is further aggravated by a
lack of privacy in segregation units, which discourages
prisoners

from

having

frank

discussions

mental health with mental-health staff.

about

their

As the court

noted, “most ADOC segregation units are not conducive
to having a cell-front conversation, due to heavy solid
doors and very loud units with dozens of cells in a
single unit. As the court saw during its tours of five
prisons,

none

of

the

units--even

the

ones

at

Bibb,

where only three cells are in a unit--were conducive to
confidential conversations, because of the proximity to
other cells and prisoners.”

Id. at 1243 n.71.

The

lack of a private setting therefore contributes to the

28

inability of ADOC to detect signs of mental illness and
decompensation among prisoners in segregation, who are
forced to discuss the status of their mental health in
front of other prisoners and correctional staff.
While the previous opinion declined to reach fully
the adequacy of periodic mental-health evaluations in
segregation, it nevertheless concluded: “the evidence
is clear that ADOC’s segregation practices--inadequate
screening

for

the

impact

of

segregation

on

mental

health, and inadequate treatment and monitoring--pose a
substantial

risk

of

serious

serious mental-health needs.”

harm

to

prisoners

Id. at 1245.

with

Moreover,

the court found, “The dearth of individual encounters
outside the cell, haphazard cell-front encounters, and
inadequate monitoring in ADOC all show that ADOC fails
to provide adequate treatment and monitoring.”
1245.

The

segregation
isolation,

opinion

concluded

more

broadly:

practices

perpetuate

a

vicious

inadequate

treatment,

and

Id. at
“ADOC’s

cycle

of

decompensation.

The skyrocketing number of suicides within ADOC, the

29

majority of which occurred in segregation, reflects the
combined effect of the lack of screening, monitoring,
and treatment in segregation units and the dangerous
conditions in segregation cells.”

3.

Id. at 1245.

Additional Findings on Periodic Mental-Health
Evaluations in Segregation

Having solicited further briefing from the parties,
the

court

now

makes

additional

findings

regarding

ADOC’s provision of periodic mental-health evaluations
to

prisoners

in

segregation.

The

parties

were

instructed to “point[] to where the relevant evidence
is

in

the

current

record

on

this

issue,”

and

“to

address whether additional evidence, expert testimony,
and

an

evidentiary

hearing

are

needed.”

Phase

2A

Liability Order Re Segregation (doc. no. 1364) at 2.
However, because the parties did not request to submit
additional evidence or conduct a further evidentiary
hearing, the court now makes its findings based on the
evidentiary record as it existed at the time of its
previous

liability

opinion,
30

and

with

the

benefit

of

additional briefing and highlighting of information in
the quite voluminous record.
Plaintiffs highlighted three categories of evidence
in the record that, in conjunction the above evidence,
demonstrated, by a preponderance of the evidence, that
periodic mental-health evaluations do not occur with
adequate frequency, and that even when they do occur
the evaluations are so cursory as not to be worth the
paper they are written on.
medical

records

and

First, plaintiffs point to

movement

histories

for

three

prisoners who were not on the caseload during extended
periods

in

segregation,

and

who

self-harm while in segregation.
received

no

evaluations
that

the

placement,

periodic

that

despite

were

checked

stable

previous

to

engage

in

These prisoners either

evaluations,

uniformly

prisoners

began

or

boxes

and

incidents

received
indicating

appropriate
of

for

self-harm.

Second, there are the records of three prisoners who
were on the caseload during their time in segregation,
but

who

nevertheless

received

31

inadequate

periodic

evaluations.

Despite

being

identified

as

having

serious mental-health needs, these prisoners received
‘periodic’

mental-health

evaluations

at

irregular

intervals, and far less often than required by ADOC’s
own regulation.

Like the evaluations of those not on

the caseload, and sometimes despite the prisoner having
suffered multiple mental-health crises in segregation,
each of these forms uniformly indicate that placement
in

segregation

prisoner’s
analysis

is

mental

of

the

appropriate
health,

prior

and

and

not

contain

mental-health

affecting
no

the

mention

crises.

or

Third,

plaintiffs point to the psychological autopsies of five
prisoners who committed suicide while in segregation
between April 2014 and February 2016, who were not on
the

mental-health

described

as

caseload

“not

mental-health staff.
supports

that

and

anticipated”

whose
by

suicides

were

correctional

and

Together, this evidence further

periodic

mental-health

evaluations

in

ADOC segregation units likely occur irregularly when
they

occur

at

all,

and

in

32

any

case

are

likely

a

perfunctory exercise that fails to detect and assess
adequately

signs

of

serious

psychological

harm

and

decompensation.
The record contains the medical records of three
prisoners--R.M.W.,

L.P.,

and

J.D.--who

were

in

segregation for extended periods of time and who were
not on the caseload.

Each of these prisoners engaged

in

in

self-harm

irregular

while

and

segregation,

patently

yet

inadequate

received

mental-health

evaluations from ADOC, if at all.
The court’s previous liability opinion noted the
case of R.M.W., a transgender female prisoner who spent
36

days

in

early 2014.

segregation

at

the

on

facility

in

See Joint Ex. 181, ADOC0392220-221; Joint

Ex. 404, MR016842, MR016932.
not

Fountain

the

mental-health

During this time, she was

caseload:
issues

at

although
her

intake

she

presented

screening

at

admission to ADOC custody, ADOC determined at that time
that she did not need treatment and therefore declined
to place her on the caseload.

33

Beginning three days

after placement in segregation, and over the following
two

weeks,

she

self-mutilation,
shoulder,

and

engaged
including

ankle.

MR016980-985,

in

multiple

instances

lacerations

See

Joint

MR016988-89,

Ex.

to

her

404,

of
arm,

MR016897,

MR01700-01.

R.M.W.

testified at trial that on another occasion while in
segregation she attempted to hang herself.
Trial

Tr.

at

17:20-25.

She

further

See R.M.W.

testified

that

placement in segregation makes her depressed, and that,
while she has suffered from mental illness while not in
segregation, she has engaged in self-harm only while in
segregation.
During
multiple

See id. at 13:11-14:5; 17:15-25.
this

stint

incidents

mental-health

staff

of

in

segregation,

self-harm,

only

twice:

R.M.W.

was

despite
seen

the

suicide watch cell, and again for a 30-day review.

See

review

reflects

psychological
checked

that

associate

several

boxes

it

The record of the 30-day

was

quite

conducting
indicating

34

while

by

in

Joint Ex. 404, MR017066-081.

once

and

the
that

cursory.
review
R.M.W.

The
merely
was

in

good

condition;

placement”;

and

wrote
circled

“Inmate
the

appropriate

portion

of

the

for
form

stating, “Segregation placement not impacting inmate’s
mental health.”

Id. at MR017081.

The review does not

mention R.M.W.’s repeated incidents of self-harm while
in segregation, nor contain any progress notes in the
comments section or additional documentation.

See id.

L.P. spent over a year in isolation at the Holman
facility

from

July

2013

through

August

2014,

during

which time he went back and forth between segregation
and the crisis cell.

See Joint Ex. 177, ADOC039134-36.

He was not on the caseload during this period, despite
being

placed

on

suicide

watch

five

times

between

December 2013 and June 2014, including for ten days or
more on two separate occasions.

See Joint Ex. 272,

MR011840; Joint Ex. 177, ADOC039134-36, Joint Ex. 272,
MR012076-78.
evaluation

L.P.
in

mental-health

2013,

received
but

then

evaluations

for

a

30-day
received
the

and
no

90-day
further

following

nine

months, despite ADOC Admin Regulation § 625 requiring

35

an evaluation at each 90-day interval, and despite L.P.
being placed on suicide watch five times during that
period.

See Joint Ex. 272, MR012021-093.

The two

assessments L.P. received have the same boxes checked
as R.M.W.’s 30-day evaluation, indicating that he was
in good condition, and that segregation placement was
not

impacting

his

mental

health.

The

only

written

comments state that L.P. is “stable,” and neither form
contains

additional

progress

notes

or

documentation.

Id.
Finally, J.D. spent 10 months in segregation at St.
Clair from June 2013 through March 2014, during which
time he was not on the caseload.
ADOC038841-44;

Joint

Ex.

244,

See Joint Ex. 175,
MR004759,

MR004918, MR--4922, MR004927, MR004929.

MR004914,

After several

months in segregation, beginning in September 2013, he
engaged in several incidents of serious self-harm, the
last of which resulted in his hospitalization.

See id.

at MR004812-13, MR004819, MR004824, MR004854, MR004887.
In

January

2014

he

requested

36

placement

in

a

mental-health unit, but remained in segregation through
March.

See id. at MR004914.

His extensive records

contain no indication that he ever received a periodic
mental-health evaluation while in segregation, despite
the fact that ADOC regulation § 625 would have required
at least four such evaluations: at 30 days, 90 days,
180 days, and 270 days.
In

sum,

the

evidence

demonstrates

that

these

prisoners, who spent extended periods in segregation,
and

who

were

not

on

the

caseload,

did

not

receive

mental-health evaluations with sufficient frequency or
at all.

Moreover, even when periodic evaluations did

occur they were done in a pro forma way that failed to
detect

significant

decompensation,
self-harm

and

signs

even

of

among

experiencing,

psychological
prisoners
or

on

harm

and

engaging

in

the

brink

of

experiencing, mental-health crises.
The

evidence

in

the

record

also

includes

the

records of three prisoners on the caseload who spent
extended

periods

in

segregation,

37

which

similarly

indicate

that

even

those

with

identified

serious

mental-health needs do not receive adequate periodic
mental-health evaluations.
C.J. recently spent several years in segregation.
He

spent

the

September

entire

period

from

2014--six-and-a-half

March

2008

years--ycling

through
between

segregation and suicide watch at St. Clair, Donaldson,
and Holman correctional facilities.
subsequent

year

and

10

months

in

He also spent a
segregation,

from

January 2015 through November 2016, except for brief
periods in general population in August 2015 and April
2016.

See Pls. Ex. 1258, ADOC0400233-245; Pls. Dem.

Ex. 131.

Under ADOC regulation § 625, he should have

received

approximately

evaluations
combined

amount

segregation.
periodic

during

30

these
to

periodic

two

extended

more

than

mental-health
stints,

eight

which

years

in

Yet his medical records contain only one

evaluation,

which

occurred

on

July

19,

2013--over five years after his initial placement in
segregation

in

March

2008.

38

See

Joint

Ex.

163,

MR007796.

Moreover, despite the fact that C.J. had

been on suicide watch three times in the three months
prior to that evaluation, the evaluation has all the
same

boxes

checked

as

in

L.P.’s

and

R.M.W.’s

evaluations, indicating that he was in good condition,
has

a

checkmark

next

to

“segregation

placement

not

impacting inmate’s mental health,” and in the comments
section merely states, “Stable.”

There is no notation

of his three recent placements on suicide watch, nor
any

indication

psychological

of
harm

his

increased

vulnerability

in

segregation

based

on

to
his

identified mental illness, nor any attempt to cohere
that

fact

of

those

placements

with

the

positive

assessments in the form (for instance, by indicating
that he had recovered since placement on suicide watch,
or that his treatment or conditions of confinement had
been

modified

to

help

him

better

cope

with

segregation).
H.C. was held in segregation at the Holman, St.
Clair, and Donaldson facilities from approximately May

39

2011 to May 2014.
Over

this

See Joint Ex. 173, ADOC038881-885.

three-year

period,

he

received

only

three

periodic evaluations, on November 5, 2012, September
2013 (the record does not indicate a specific date),
and

November

5,

2013,

despite

the

fact

that

ADOC

regulation § 625 would have required approximately 13
such evaluations during that period.8

Both assessments

8.
Given
H.C.’s
multiple
transfers
between
segregation and hospital units, across multiple ADOC
facilities, the exact duration of each stint in
segregation is unclear to the court.
See Joint Ex.
173, ADOC038881-885.
Counsel for the plaintiffs
maintained at oral argument that H.C. was held in
segregation for multiple years during this time, and
defense
counsel
did
not
challenge
this
characterization. In any case it is apparent that H.C.
spent significant (even if not continuous) time in
segregation
during
this
period.
The
court
is
persuaded, in light of its previous findings regarding
the psychological harms of segregation, that even
assuming that H.C. was in and out of segregation, three
mental-health evaluations over the course of three
years are insufficient to determine the appropriateness
of segregation placement and any treatment needs during
this period.
Moreover, insofar as H.C.’s time in
segregation was viewed as “resetting”--for instance,
based upon brief placement in a hospital unit--that
determination likely should have resulted in more
evaluations under ADOC regulation § 625, not fewer.
That is, the regulation would have again required a
30-day evaluation after the segregation time was
“reset,” in addition to an evaluation at 90 days and
40

have

boxes

checked

indicating

“Segregation

not impacting inmate’s mental health.”

placement

Joint Ex. 222

at ADOC0079816, ADOC007971, ADIC007973.
Finally, K.N. spent time in segregation at Tutwiler
prison from August 5 through November 11, 2015.
Joint Ex. 470, ADOC0400169-70.
the

caseload,

disorder

and

having

been

borderline

See

At the time she was on
diagnosed

personality

with

bipolar

disorder,

and

prescribed psychotropic medication.

See, e.g., id. at

AODC0385165,

court

ADOC0385172.

As

the

has

found,

bipolar disorder by definition constitutes a serious
mental illness, because it “last[s] a lifetime and [is]
accompanied by debilitating symptoms.”
F. Supp. 3d at 1190 n.11.

See Braggs, 257

During K.N.’s 98-day period

in segregation, when she should have received a 30-day
and 90-day periodic evaluation, there was only one such
evaluation: a “30-day review” conducted on October 19,
2015,

75

days

after

she

was

Joint Ex. 252, ADOC0385201.

placed

in

segregation.

The evaluation has all

each 90-day period thereafter--rather than simply at
90-day intervals, had the time not been reset.
41

boxes checked indicating she is in good condition, and
the

box

checked

stating

“Segregation

impacting inmate’s mental health.”

placement

Id.

not

The written

comments state “None,” and do not contain any notation
of

K.N.’s

diagnosed

serious

mental

illness,

nor

any

indication of additional treatment or monitoring that
might be necessary in light of her illness.
The records of prisoners on the caseload who spent
extended periods in segregation thus confirm that, even
for this population, periodic mental-health evaluations
occur at infrequent and irregular intervals.
In addition to the medical records of prisoners
both on and off the caseload while in segregation, the
psychological autopsies of several suicides committed
by

prisoners

hindsight,
periodic

a

in

segregation

finding

of

mental-health

support,

inadequacy

with
as

evaluations.

tragic

to

ADOC's

The

record

contains evidence of five such suicides that occurred
between
committed

April
by

2014

and

prisoners

February

2016,

not

the

42

on

which

were

mental-health

caseload: C.P., D.H., J.H., J.J., and T.H.
1110

at

MHM040806-07

(T.H.),

Pls. Ex.

MHM040814-15

(J.J.),

MHM040816-18 (J.H.0); Pls. Ex. 1215 at MHM 041802-04
(C.P), MHM041808-10 (D.H.).

Each of these suicides was

described in the psychological autopsy report as “not
anticipated” by correctional and mental-health staff.
Such

a

suicides
that

significant
in

ADOC's

ADOC

number

of

segregation

monitoring

wholly

units

unanticipated

further

suggests

mechanisms--including

periodic

mental-health evaluations--are simply failing to detect
prisoners’

decompensation

while

in

segregation,

and

exacting a terrible price.
Defendants do not dispute any of the plaintiffs’
arguments
periodic
prisoner’s

regarding

the

evaluations
case.

Nor

existence

conducted
do

in

defendants

or

content

a
point

of

particular
to

other

cases in which prisoners either on or off the caseload
received periodic evaluations in accordance with ADOC’s
regulations, or in which such an evaluation caused ADOC
to reconsider placement in segregation or to provide

43

additional
assert,

mental-health

without

particular

treatment.

citation

prisoners,

to

that

the

Instead
records

segregation

they

of

any

rounds

and

periodic evaluations “do in fact occur, but the content
and

conduct

Defs.’

of

Response

them
in

is

not

to

Opposition

Plaintiffs’
to

liking.”

Liability

Finding

Related to Segregation Monitoring (doc. no. 1418) at
10.9
With regard to the issue of periodic mental-health
evaluations--and

notwithstanding

representations

to

the

defense

contrary

counsel’s
at

oral

argument--defendants point to ADOC Regulation § 625 and

9. To the extent defendants attempt to re-litigate
the issue of segregation rounds, which the previous
liability opinion already found to be cursory and
insufficiently frequent, they ignore both the court’s
prior findings and its order for additional briefing.
That order solicited additional input on the “discrete
issue” of whether ADOC is “conducting adequate periodic
mental-health assessments of prisoners in segregation.”
Phase 2A Liability Order Re Segregation (doc. no. 1364)
at 1.
Because the Eighth Amendment liability finding
remained open only as to the issue of periodic
evaluations, the court declines to disturb its previous
findings on the inadequacy of ADOC's segregation
rounds.

44

testimony from Dr. Scott Holmes, the ADOC psychologist
at Tutwiler, to the effect that periodic evaluations
are occurring at that facility as required under the
regulation.

See

Holmes,

Trial

Tr.

at

62:22-64:20.

Holmes’s testimony did not cite his knowledge of any
particular inmate’s case, much less provide supporting
medical

records;

occurring

at

rather,

Tutwiler

he

by

explained

describing

requirements of ADOC regulation § 625.
also

testified

that

segregation

what
the

was

formal

Notably, Holmes

mental-rounds

were

occurring as written in ADOC regulation, and that he
knew of no prisoners in segregation at Tutwiler who had
decompensated or were at risk of decompensation.

In

light of its findings that mental-health rounds were
cursory

and

infrequent;

that

extended

placement

in

segregation poses a serious risk of psychological harm
and

decompensation

to

even

previously

healthy

prisoners; that certain prisoners at Tutwiler have been
placed
Holmes

in

segregation

acknowledged

for

extended

during

45

his

periods;

and,

testimony,

as

that

prisoners have attempted suicide while in segregation
at Tutwiler, the court finds that Holmes’s unwaveringly
rosy testimony regarding ADOC’s mental-health care of
prisoners in segregation at Tutwiler, in the absence of
supporting

documentation,

credibility.10
contrary--such

tends

Therefore,
as

the

to

given

records

of

undermine

evidence
K.N.,

the

to

his
the

Tutwiler

prisoner who spent 98 days in segregation, attempted
suicide while there, and did not receive the required
periodic

evaluations

in

compliance

with

the

ADOC

10. In addition, although this opinion is based on
the record as existed at the time of the 2017 liability
opinion,
the
court
cannot
close
its
eyes
to
overwhelming
and
disturbing
evidence
presented
throughout
the
segregation
remedial
trial
during
February-April 2018, that officials of ADOC and its
mental-health contractor, throughout the command chain,
were consistently unaware of the day-to-day activities
occurring in segregation units--including officials who
were tasked to monitor one specific facility. Namely,
officials presented testimony as to various policies
and practices in segregation units that was wildly
inconsistent with one another, with the representations
of defense counsel, and with documentary evidence as to
what was in fact occurring on the ground.
In this
particular context, testimony from Holmes to the effect
that segregation mental-health monitoring was occurring
exactly as required by regulation, without further
supporting evidence, rings particularly hollow.
46

regulation and the voluminous evidence the court has
heard about how understaffing impacts the ability of
the

mental-health

contractors

to

comply

with

the

regulations--the court declines to infer from the mere
existence of a regulation that evaluations are in fact
occurring

as

testimony

in

prescribed,
the

or

absence

of

to
any

credit
supporting

Holmes’s
medical

records.
In sum, with regard to prisoners both on and off
the

caseload,

the

court

finds

that

ADOC's

periodic

mental-health evaluations are cursory, perfunctory, and
inadequate

for

identifying

the

serious

psychological

harms and risk of decompensation that may result from
segregation.

This

conclusion

is

based

on

the

evaluations’ uniform indication that segregation is not
affecting

a

prisoner’s

mental

health,

near-uniform

indication that prisoners are in good condition, and
striking
the

dearth

serious

and

of

substantive

comments--all

well-documented

despite

psychological

harm

inflicted by extended periods of isolation, and despite

47

documented (and sometimes severe) mental illness and
incidents of self-harm among the prisoners in question.
In addition, this conclusion is supported by evidence
of

several

wholly

unanticipated

suicides

in

ADOC

custody, as well as the court’s previous findings that
the

ADOC’s

other

monitoring--namely,

practices

mental-health

of

segregation

rounds

and

security

rounds--are also cursory, infrequent, and inconsistent.
More

fundamentally,

if

the

stated

purpose

of

ADOC’s

periodic evaluations is “[t]o determine if segregation
placement
mental

is

contraindicated

status

[or]

[t]he

by

...

potential

[t]he
for

inmate’s

significant

deterioration in the inmate’s functioning by continued
placement

in

the

restrictive

environment,”

ADOC

regulation § 625.II.C, it is remarkable that not once
did an evaluation in these cases--nor in any case cited
to the contrary by defendants--determine that placement
in

segregation

health,

much

was

less

impacting
appear

to

a

prisoner’s

result

directly

prisoner’s transfer out of segregation.

48

mental
in

a

In sum, the

plaintiffs have carried their preponderance-of-evidence
burden

in

evaluations

demonstrating
in

that

ADOC

periodic

segregation

mental-health
units

occur

infrequently and irregularly; are largely perfunctory
in nature; and are inadequate at identifying signs of
psychological harm and decompensation.

4. Conclusions of Law Regarding Actual Harm and
Substantial Risk of Serious Harm
The evidence in the record amply demonstrates that
ADOC's’

failure

evaluations

of

to

provide

prisoners

periodic

in

mental-health

segregation

poses

a

substantial risk of serious harm to plaintiffs.
As the previous liability opinion found, extended
placement in segregation poses a substantial risk of
serious, potentially permanent psychological harm and
decompensation.
with

mental

The risk is heightened for prisoners

illness.

And,

for

the

population

with

‘serious mental illness,’ that risk is so acute that
the court concluded that placement of such prisoners in

49

segregation
extenuating

is

categorically

circumstances,

inappropriate

and

that

even

absent

under

such

circumstances placement should only be made with the
consultation of mental-health staff and for as short a
period

as

possible.

Because

extended

isolation

may

cause mental illness in previously healthy individuals,
as well as aggravate existing mental illness, ongoing
monitoring

is

necessary

in

order

to

determine

the

appropriateness of a prisoner’s continued placement in
segregation

in

mental-health
treatment.

light

needs,

of

and

the
to

prisoner’s

identify

any

current
necessary

As the court put simply, given the serious

risks of extended isolation, “it is ... essential to
identify

those

segregation.”
Further,

who

need

Braggs,

as

mental-health
257

Burns

evaluations--separate

F.

Supp.

testified,

from

mental-health

treatment
3d

at

in

1249.

mental-health
rounds

and

other monitoring--are important to “catch[] signs of
mental illness at its earliest point to be able to
intervene.”

Burns Trial Tr. Vol. I at 212:9-14.

50

It must also be noted that factual support for, and
import

of,

these

conclusions

is

magnified

by

the

particular conditions in ADOC's segregation units.
The

court

has

before

it

evidence

that

three

prisoners on the caseload and three prisoners not on
the caseload at a range of prisons received periodic
evaluations at erratic intervals or not at all, and
that those evaluations they received were perfunctory.
In

addition,

evidence

the

that,

mental-health
providers
prisoners
required

largely

by

also
due

repeatedly

segregation
ADOC

contains
to

understaffing,

have
in

record

correctional

ADOC’s
failed

the

regulations,

voluminous

mental-health
to

provide

mental-health
such

and

as

to

services

mental-health

rounds and security checks, and that those prisoners
receive little in the way of out-of-cell contact with
mental-health

providers.

Moreover,

defendants

have

been unable to point to any medical records reflecting
the

timely

provision

of

the

required

evaluations.

Thus, while the six prisoners’ records might not be

51

enough in a vacuum to find that ADOC is failing to
provide adequate periodic evaluations, in light of the
overwhelming evidence that understaffing has prevented
the mental-health staff from fulfilling a variety of
requirements,
prisoners

and

received

the

lack

adequate

of

records

showing

evaluations

in

a

that

timely

manner, these “[r]epeated examples of delayed or denied
medical care” sufficiently demonstrate that ADOC fails
to provide adequate periodic evaluations on a systemic
basis.

Rogers v. Evans, 792 F.2d 1052, 1059 (11th Cir.

1986) (holding that “[r]epeated examples of delayed or
denied medical care” may reveal systemic deficiencies).
The

lack

of

sufficient

demonstrated

by,

instances

which

in

periodic

among

other

staff

evaluations

evidence,

indicated

that

is

multiple

segregation

placement was not affecting a prisoner’s mental health,
and that continued placement was appropriate, despite
the

fact

that

significant
crisis.

a

prisoner

self-harm

or

had

recently

suffered

a

engaged

in

mental-health

See Gates v. Cook, 376 F.3d 323, 333 (5th Cir.

52

2004)

(holding

finding

can

be

that

an

Eighth

supported

by

Amendment
multiple

liability

policies

or

practices combining to deprive a prisoner of a “single,
identifiable human need”) (citing Wilson v. Seiter, 501
U.S.

294,

304

(1991)).

Indeed,

in

light

of

the

significant number of wholly unanticipated suicides in
ADOC segregation units, by individuals who were not on
the mental-health caseload, defendants’ contention that
“the system works” is astonishing.
in

Opposition

to

Liability

See Defs.’ Response

Finding

Related

to

Segregation Monitoring (doc. no. 1418) at 8.
Defendants raise several objections to a finding of
harm, all of which are unavailing.
First,
policies

defendants

regarding

administrative

contend

segregation

regulations,

that

ADOC's

rounds,
are

written

including

its

constitutionally

sufficient, and that a finding of liability is further
precluded because plaintiffs have not challenged the
sufficiency of these policies.

This argument misses

the mark because plaintiffs’ challenge is directed at

53

ADOC's actual practices, not the policies, and, as the
record

shows,

meaningful

mental-health

way

follow

staff

do

in

any

compliance

policy:

not

is

inconsistent, superficial, and frequently nonexistent.
Second,

defendants

argued

that

ADOC

has

already

taken substantial steps to address the risk of suicide
in its facilities, because of which no inmate in ADOC
custody had committed suicide since January 1, 2017.
Defs.’

Response

in

Opposition

to

Liability

Finding

Related to Segregation Monitoring (doc. no. 1418) at
18; see Amended Phase 2A Interim Relief Order Regarding
Suicide

Prevention

Measures

(Doc.

No.

1106).

Therefore, they asserted, there is no current risk of
suicide in ADOC facilities.
As
brief,

an

initial

the

matter,

parties

have

since

the

presented

filing

of

evidence

increasing number of suicides in segregation.

of

if

eliminated

defendants
the

risk

were
of

correct

suicide

54

in

that

an

However,

the court need not rely on that evidence here.
even

that

they

segregation,

For
have
the

potential

harms

of

insufficient

mental-health

monitoring in segregation are plainly not limited to
increased risk of suicide.
both

sides

testified,

segregation--which

are

Rather, as experts from
the

harms

aggravated

of

when

extended

placement

and

treatment are not informed by an accurate understanding
of

a

prisoner’s

“hallucinations,

mental-health

chest

pain,

needs--include

palpitations,

anxiety

attacks, and self-harm,” Burns Trial Tr. Vol. I at 209,
as well as psychosis and delusions, see Tytell Trial
Tr. at 189:9-20.
is

no

units,

current
the

Thus, even if it were true that there
risk

of

failure

decompensation

to

among

suicide
detect

in

ADOC

segregation

psychological

prisoners

in

harm

segregation

and

still

could result in serious and potentially permanent harm.
Third,

defendants

impermissibly

seek

to

assert
expand

that

the

plaintiffs

definition

of

the

plaintiff class by seeking relief on behalf of mentally
healthy

inmates.

plaintiffs

represent

They
a

thus

class

55

argue
of

that

prisoners

because
“with

a

serious mental-health disorder or illness,” a liability
finding

cannot

mental-health

extend

needs

to

before

prisoners
entering

without

segregation.

Similarly, defendants state, “A serious mental health
need does not exist as to any mentally healthy inmate.”
Defs.’

Response

in

Opposition

to

Liability

Finding

Related to Segregation Monitoring (doc. no. 1418) at 3.
These assertions all misunderstand the nature of the
groups subject to ADOC's practices in segregation, as
well as the court’s power to order relief for those
groups.
In light of ADOC’s systemic under-identification of
individuals

with

mental

illness,

and

the

fact

that

placement in segregation can cause previously healthy
individuals to develop mental illness, there are three
categories

of

prisoners

with

serious

mental-health

needs who are subject to ADOC’s’ care in segregation.
First,

there

are

prisoners

who

are

not

on

the

mental-health caseload and do not have a mental illness
prior to placement in segregation, who develop mental

56

illness requiring treatment because of the conditions
in segregation.
not

on

the

Second, there are prisoners who are

mental-health

caseload

but

who

have

unidentified mental illness requiring treatment prior
to placement in segregation, whose illness may worsen
as a result of placement in segregation. Third, there
are prisoners on the mental-health caseload (that is,
with identified mental illness) prior to placement in
segregation, whose illness also may worsen as a result
of placement in segregation.

In addition, there is a

fourth group of prisoners who are not on the caseload
and

who

do

segregation.

not

develop

Groups

mental

Two

and

illness

while

Three--those

in
with

unidentified mental illness and those who are on the
caseload--both have serious mental-health needs and are
therefore by definition members of the plaintiff class.
Group One--prisoners who enter segregation healthy but
then become mentally ill in segregation--pass into the
plaintiff class when they become ill.

Group Four do

not have serious mental-health needs, and at no point

57

develop such needs despite placement in segregation.
To the extent that defendants argue that Group Four
exists and is not part of the plaintiff class, the
court agrees.
Supreme Court precedent makes clear that the court
is

permitted

(PLRA)

to

prisoners.

under

order

the

relief

Prison
even

Litigation
for

Reform

currently

Act

healthy

In Brown v. Plata, 563 U.S. 493 (2011), a

case challenging the adequacy of medical care provided
to

prisoners,

the

Court

affirmed

a

prisoner-release

order that covered both unhealthy and healthy inmates.
As the Court explained, “Even prisoners with no present
physical or mental illness may become afflicted, and
all prisoners ... are at risk so long as the State
continues to provide inadequate care.” 563 U.S. at 531.
Because of the fluid nature of the composition of the
plaintiff

class,

“[r]elief

targeted

only

at

present

members of the plaintiff classes may therefore fail to
adequately

protect

future

class

members

develop serious physical or mental illness.”

58

who

will

Id. at

532.

Similarly here, the court would not be precluded

from ordering relief regarding mental-health monitoring
of

prisoners

who

do

not

have

current

mental-health

needs who, as the Court noted in Plata, are “in no
sense ... remote bystanders in [the State’s] medical
care

system.

victims.”

They

are

that

system’s

next

potential

Id.

Moreover, defendants fail to perceive the way in
which

the

inadequacy

of

their

monitoring

results

precisely in the inability to detect which prisoners
have

serious

mental-health

needs

members of the plaintiff class.

and

are

therefore

Because prisoners in

Groups One and Two either develop serious mental-health
needs while in segregation or previously had such needs
but were unidentified, the only way to discern between
these

prisoners

conducting

and

adequate

those

necessary

to

Group

mental-health

prisoners in segregation.
than

in

Four

is

by

evaluations

of

all

Such relief goes “no further

correct

the

violation,”

18

U.S.C.

§ 3626(a)(1)(A), despite providing incidental relief to

59

those who are not in the plaintiff class.

See Plata,

563 U.S. at 531.
Defendants’ argument that prisoners without serious
mental-health needs are not in the plaintiff class is,
therefore, simply beside the point: today’s liability
finding extends to prisoners who enter segregation with
unidentified

serious

mental-health

needs

and

who

develop such needs in segregation at the point those
needs

develop.

To

provide

relief

to

these

groups

within the plaintiff class, ADOC must provide adequate
evaluations to all prisoners.
Fourth,
posed

defendants

by

inadequate

segregation

is

too

argue

that

the

mental-health

amorphous,

obscure,

support a finding of liability.

risk

of

harm

monitoring
or

remote

in
to

They emphasize that

the holding in Helling v. McKinney, 509 U.S. 25, 33-34
(1993), was limited to those risks that are “sure or
very

likely

to

cause

serious

illness

and

needless

suffering” and that result in “sufficiently imminent
damages.”

Defs.’ Response in Opposition to Liability

60

Finding
1418)

Related

at

21

to

Segregation

(citing

Helling,

Monitoring
509

U.S.

(doc.
at

no.

33-34).

Moreover, defendants cite dicta from a Supreme Court
case

about

courts

access

should

to

not

prison

allow

“a

libraries,
healthy

stating

inmate

that

who

had

suffered no deprivation of needed medical treatment ...
to

claim

violation

medical

care,

medical

facilities

of

simply

on

were

his

constitutional

the

ground

inadequate

that

right
the

....”

to

prison

Lewis

v.

Casey, 518 U.S. 343 (1996).
As the court previously observed in response to the
above passage from Casey, “this pronouncement has no
bearing

on

this

case.

The

plaintiffs

here

are

prisoners with serious mental illnesses, not healthy
prisoners.”

Dunn v. Dunn, 219 F. Supp. 3d 1100, 1123

(M.D. Ala. 2016).

Again, defendants confuse the groups

of

issue.

prisoners

at

Today’s

liability

opinion

extends to prisoners who enter segregation with mental
illness (whether previously identified or not), and who
develop

mental

illness

while

61

in

segregation.

In

addition,

as

the

Supreme

Court

approved

in

Plata,

relief here--providing adequate periodic mental-health
evaluations

to

those

necessarily

also

in

extend

to

in

segregation--will

healthy

prisoners.

The

Casey dicta thus has no bearing here.
More

fundamentally,

ADOC's

inadequate

however,

the

provision

risk

of

posed

by

mental-health

evaluations, in conjunction with other inadequate forms
of monitoring, is by no means obscure or amorphous.

To

the contrary, as the court has explained, the severe
and potentially permanent harm regularly inflicted by
extended segregation is well documented, and monitoring
prisoners

in

segregation

for

signs

of

psychological

harm and decompensation is essential in order to avoid
exposing
provide
sides

prisoners
any

necessary

testified

previously

to

that

healthy

risk

of

further

treatment.
this

Experts

risk

individuals,

harm,

but

extends
is

and

from
even

to

both
to

significantly

heightened for those with existing mental illness, and
especially

for

those

with

62

‘serious

mental

illness.’

Indeed, contrary to defendants’ assertion, one need not
stretch far to compare the pathogenic agent at issue in
Helling to ADOC's exposure of prisoners with serious
mental-health

needs

to

extended

segregation

without

adequate monitoring.11

C. Deliberate Indifference
The previous liability opinion noted overwhelming
evidence that defendants were aware of the harm and
risk

of

harm

adequately
segregation,

produced

the
and

by

mental
that

ADOC’s
health

they

failure
of

to

monitor

prisoners

disregarded

failed to act reasonably to alleviate it.

that

harm

in
or

See Braggs,

11. Defendants further argue that “No evidence
exists in the record that a mentally healthy inmate
entered segregation at an ADOC facility and developed a
mental illness as a direct result of inadequate
monitoring.”
Defs.’
Response
in
Opposition
to
Liability Finding Related to Segregation Monitoring
(doc. no. 1418) at 3. However, under Helling, evidence
of such a particular case is unnecessary given
overwhelming and uncontradicted testimony from both
experts on both sides that even mentally healthy
individuals face a significant risk of psychological
harm from extended segregation, and that adequate
monitoring is necessary in order to identify signs of
psychological harm and decompensation.
63

257 F. Supp. 3d at 1252-55; see also Thomas v. Bryant,
614 F.3d 1288, 1312 (11th Cir. 2010) (describing Eighth
Amendment
addition

deliberate
to

regulations

those

indifference

findings,

providing

for

the

standard).

existence

segregation

of

In
ADOC’s

rounds

and

periodic evaluations, in order to detect signs of harm
and decompensation, show that ADOC is well aware that
placement in segregation poses a substantial risk of
serious harm, and that regular monitoring is necessary
in order to mitigate that risk and reevaluate continued
placement.

Accordingly,

the

court

concludes

that

defendants were deliberately indifferent with regard to
their failure to provide adequate periodic evaluations
of mental health to prisoners in segregation.

III. CONCLUSION
For the above reasons, the court finds that ADOC’s
failure

to

assessments

provide
of

adequate

prisoners

in

periodic

mental-health

segregation

creates

a

substantial risk of serious harm for those prisoners,

64

and that this failure has contributed to the Eighth
Amendment

violation

discussed

in

the

main

liability

opinion.
Despite having reached this conclusion, the court
is

uncertain

in

light

of

recent

developments,

which

include what appears to be a crisis of suicides in the
ADOC,

whether

an

additional

remedy

is

warranted.

Accordingly, before the court sets this opinion down
for a relief hearing, the parties will be given an
opportunity to address this issue.

***

Accordingly,
February

18,

defendants,

it

is

2019,

after

ORDERED

counsel

conferring

that,
for

with

by

noon

plaintiffs
each

other

in

on
and
an

attempt to reach agreement, are to file a joint report
of suggestions of how proceed as to relief in light of
the above opinion.

The court recognizes that February

65

18 is a holiday, but there now appears to be an urgency
regarding the resolution of the issue of segregation.
DONE, this the 11th day of February, 2019.
/s/ Myron H. Thompson
UNITED STATES DISTRICT JUDGE

66