Dunn et al v. Thomas et al

Filing 3464

PHASE 2A OMNIBUS REMEDIAL ORDER: In accordance with the three remedial opinions entered today, it is the ORDER, JUDGMENT, and DECREE of the court that dfts Jefferson S. Dunn and Deborah Crook, in their official capacities, are ENJOINED and RESTRAI NED from failing to do the following, as further set out in order; This order is not final and remains open in that the parties must still submit proposals for further and/or different relief and monitoring may warrant consideration and reconsideration of issues; The court also retains jurisdiction. Signed by Honorable Judge Myron H. Thompson on 12/27/2021. (wcl, )

IN THE DISTRICT COURT OF THE UNITED STATES FOR THE
MIDDLE DISTRICT OF ALABAMA, NORTHERN DIVISION

EDWARD BRAGGS, et al.,

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)
)
)
)
)
)
)
)
)
)
)
)

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

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

PHASE 2A OMNIBUS REMEDIAL ORDER
In

accordance

with

the

three

remedial

opinions

entered today, it is the ORDER, JUDGMENT, and DECREE of
the court that defendants Jefferson S. Dunn and Deborah
Crook, in their official capacities, are ENJOINED and
RESTRAINED from failing to do the following:
1. Definitions
1.1.

“ADOC”

refers

Corrections.

to

the

Alabama

Department

of

While the court refers to the ADOC

often in this order, its order is directed to the

1

defendants; thus, when the court says that “ADOC”
shall take a certain action, it means that the
defendants must ensure that it takes that action.
1.2.

“ADOC major facility” refers to one or more of

the major adult correctional facilities operated by
or on behalf of ADOC, excluding any community-based
facilities and community work centers.
facilities

presently

Correctional

Facility,

include

ADOC major

Bibb

Bullock

County

Correctional

Facility, Donaldson Correctional Facility, Draper
Correctional
Facility,

Facility,

Elmore

Easterling

Correctional

Correctional

Facility,

Fountain

Correctional Facility, Hamilton Aged and Infirmed
Center,

Holman

Correctional

Correctional

Facility,

Facility,

Limestone

Kilby

Correctional

Facility, St. Clair Correctional Facility, Staton
Correctional Facility, Tutwiler Prison for Women,
and Ventress Correctional Facility.
1.3.

“Effective date” refers to 42 days after the

entry of this omnibus remedial order.

2

2. Staffing
2.1.

Correctional Staffing

2.1.1.

In

accordance

with

the

court’s

previous

order (Doc. 1657) directing it to comply with the
recommendations

of

Margaret

and

Merle

Savage

(Doc. 1813-1), ADOC must create an agency staffing
unit that will “write policy, enforce the staffing
decisions mandated by the court’s order, and take
steps so that another staffing analysis can be
conducted for every facility,” Doc. 1813-1 at 100.
2.1.2.

ADOC must work with the Savages to update

its staffing analysis.
2.1.3.

Within 21 days of the effective date, the

defendants are to submit to the court a proposal
for specific dates by which each of the above two
provisions can be accomplished.
2.1.4.

By

July

mandatory

and

1,

2025,

essential

ADOC
posts

must
at

fill
the

all
level

indicated in the most recent staffing analysis at
that time.

3

2.1.5.

By May 2, 2022, the defendants must develop

in collaboration with the Savages, and submit to
the court, realistic benchmarks for the level of
correctional
December

31

benchmarks

staffing
of
must

2022,

ADOC
2023,

prioritize

will
and

attain

2024.

filling

by

These

mandatory

posts and staffing the mental-health hubs and
intake facilities, and must put ADOC on track to
fill all mandatory and essential posts by July 1,
2025.
2.1.6.

ADOC

must

submit

correctional

staffing

reports to the court and the EMT on at least a
quarterly basis.

It may work with the EMT to

develop the format of these reports.

However,

until ADOC and the EMT have finalized a new report
format or else concluded that the existing report
format is adequate, ADOC shall continue to provide
mental-health staffing reports according to the
format currently in place.
2.1.7.

Ameliorating the Effects of Understaffing

4

2.1.7.1.

ADOC must check SU, suicide watch, and

RHU cells for suicide resistance whenever such
cells receive new occupants.
2.1.7.2.

ADOC must conduct a thorough check of

all SU, suicide watch, and RHU cells at least
once per quarter to verify that they satisfy
every element of the Hayes checklist (Doc.
3206-5).
2.1.7.3.

These checks must be documented.

By May 2, 2022, the parties must submit

proposals that will allow ADOC’s RHUs--with
the

exception

of

the

RHU

at

Tutwiler--to

function safely with the correctional staff
that ADOC currently employs.

These proposals

must address the following:
2.1.7.3.1.
risk

How ADOC shall address the serious
of

housing
deficits

harm

to

caused
so

inmates

by

severe

in

restrictive

correctional
that

the

staffing

consistent

provision of security checks, out-of-cell

5

time and mental-health treatment is simply
impossible.
2.1.7.3.2.

How

ADOC

will

ensure

that

any

inmates moved out of the RHUs do not end up
in functionally identical units--that is,
units

that

offer

equivalently

deficient

levels of monitoring, out-of-cell time, and
treatment.
2.1.7.3.3.

How ADOC will ensure the safety of

inmates in the RHUs who require protective
custody, and, if it chooses to reduce the
number of inmates in the RHUs, how it will
manage the dangers posed by inmates who
would

present

a

significant

safety

or

security risk in general population.
2.1.7.3.4.

How this relief may be modified if

ADOC meets the benchmarks for correctional
staffing set forth above.
2.1.8.

Correctional Staff Positions

6

2.1.8.1.

Basic

cannot

Correctional

staff

positions

Officers
requiring

(BCOs)
firearms

training, including, but not limited to, tower
posts,

perimeter

posts,

perimeter

patrol

posts, transportation posts, and armory posts.
2.1.8.2.

Cubicle Correctional Operators (CCOs)

cannot staff any position other than secure
control

room

posts

with

no

direct

inmate

contact.
2.2.

Mental-Health Staffing

2.2.1.

ADOC must maintain levels of mental-health

staffing consistent with or greater than those
called for by the staffing ratios developed by
its

consultants,

subject

to

any

subsequent

modifications.
2.2.2.

The EMT shall review the staffing ratios

beginning
monitoring

one

year
and,

from
if

the

necessary,

recommendations for revising them.

7

initiation

of
make

2.2.3.

ADOC must achieve the staffing levels set

forth in the staffing matrix previously approved
by the court, see Phase 2A Order and Injunction
on

Mental-Health

Staffing

Remedy

(Doc.

2688),

subject to any subsequent modifications, June 1,
2025.
2.2.4.

ADOC

must

submit

mental-health

staffing

reports to the court and the EMT on at least a
quarterly basis.

It may work with the EMT to

develop the format of these reports.

However,

until ADOC and the EMT have finalized a new report
format or else concluded that the existing report
format is adequate, ADOC shall continue to provide
mental-health staffing reports according to the
format currently in place.
3. Restrictive Housing Units
3.1.

Exceptional Circumstances

3.1.1.

Inmates with serious mental illnesses may

not be placed in the RHUs unless a documented
exceptional circumstance applies.

8

3.1.1.1.

An

“exceptional

circumstance”

exists

where: (a) a safety or security issue prevents
placement of the inmate in alternative housing
(such

as

a

SU,

RTU,

or

SLU);

or

(b)

a

non-safety or non-security issue exists and
transfer

or

transportation

to

alternative

housing is temporarily unavailable.
of

safety

inmate’s

and

security

known

or

issues

unknown

Examples

include
enemies

an
in

alternative housing or the inmate’s creation
of a dangerous environment (to the inmate,
other inmates, and/or staff) by his or her
presence in alternative housing.
3.1.2.

An inmate placed in a RHU for safety or

security issues for 72 hours or longer will be
offered at least three hours of out-of-cell time
per day (which may be congregate out-of-cell time)
while he or she remains in the RHU.

9

3.1.3.

An inmate placed in a RHU for non-safety or

non-security issues must be removed from the RHU
within 72 hours.
3.1.4.

Every week, ADOC must file with the court

and the monitoring team reports on each prisoner
who has been in restrictive housing for longer
than

72

hours

under

during that week.

exceptional

circumstances

These reports must indicate

the amount of out-of-cell time offered to the
prisoner each day, the nature of the out-of-cell
time (i.e., exercise, group therapy, etc.), the
exceptional

circumstance

justifying

the

prisoner’s continued segregation placement, and
the date by which ADOC expects that exceptional
circumstance to be resolved.
3.2.

Screening for Serious Mental Illnesses

3.2.1.

Before being placed in a RHU, each inmate

must be screened by an RN, or an LPN under an RN’s
supervision.

The screening must assess whether

the inmate has been flagged as seriously mentally

10

ill; whether the inmate is at imminent risk of
suicide or serious self-harm; whether the inmate
exhibits

debilitating

symptoms

of

a

serious

mental illness; and whether the inmate requires
emergency

medical

care.

The

results

of

the

screening must be used to determine whether the
inmate should be placed in restrictive housing
and whether the inmate requires a medical and/or
mental-health referral.
3.2.2.

If mental-health staff determine that an

inmate who has yet to be placed in restrictive
housing

is

housing,

that

restrictive

contraindicated
inmate
housing

must

for
not

absent

be
a

restrictive
placed

in

documented

exceptional circumstance.
3.2.3.

If mental-health staff determine that an

inmate who has already been placed in restrictive
housing

is

contraindicated

for

continued

placement there, as evidenced by changes in the
inmate’s

mental

state

11

and

functioning,

that

inmate must be removed from restrictive housing
within 72 hours--or sooner, if a

psychiatrist,

psychologist, CRNP, or counselor determines that
the

need

for

restrictive

removal

housing

of
is

the

inmate

urgent--absent

from
a

documented exceptional circumstance.
3.3.

Mental-Health Rounds

3.3.1.

Mental-health rounds must be conducted by a

qualified mental-health professional in each RHU
at least weekly, and should generally include a
discussion with the post officer(s) concerning
any changes in the behavior of inmates in the RHU;
a review of duty post logs and segregation unit
record

sheets

participation

for

information

about

inmates’

in

recreation,

showers,

meal

consumption and sleep patterns; a walk through
the RHU, with stops at each occupied cell to make
visual contact with the inmate inside the cell;
attempts

to

verbally

communicate

with

each

inmate, including a brief inquiry into how the

12

inmate

is

doing

and

whether

the

inmate

has

mental-health needs or a desire to speak with
mental-health

staff

privately;

and

a

brief

assessment of each inmate’s hygiene, behavior,
affect, and physical condition, and the condition
of his or her cell.
3.3.2.

Mental-health rounds must be appropriately

documented.

Such documentation must contain a

notation of any mental-health needs expressed by
inmates, or concerns identified by the qualified
mental-health professional conducting the round
as to any inmate.

Documentation of rounds must

be chronologically filed and maintained by the
mental-health

manager

or

other

designated

mental-health staff member.
3.4.

Mental-Health Assessments

3.4.1.

Each inmate must receive a mental-health

assessment by a psychiatrist, psychologist, CRNP,
or counselor within seven days of his or her
placement in restrictive housing.

13

Inmates coded

as mental-health code A must receive additional
assessments at least every 90 days, and inmates
coded as mental-health code B or C must receive
additional assessments at least every 30 days.
3.4.2.

Each

mental-health

assessment

must

be

appropriately documented.
3.4.3.

Each mental-health assessment must include

an examination or discussion of the following
topics:

the

inmate’s

past

response(s)

to

restrictive housing, if applicable; the inmate’s
general

appearance

or

behavior;

whether

the

inmate has a present suicidal ideation; whether
the inmate has a history of suicidal behavior;
whether

the

inmate

is

presently

prescribed

psychotropic medication; whether the inmate has a
current

mental-health

complaint;

whether

the

inmate is currently receiving treatment for a
diagnosed mental-illness; whether the inmate has
a history of inpatient or outpatient psychiatric
treatment; whether the inmate has a history of

14

treatment for substance abuse; whether the inmate
has a history of abuse and/or trauma; and whether
the inmate is presently exhibiting symptoms of
psychosis,

depression,

anxiety,

and/or

aggression.
3.4.4.

Each mental-health assessment must include

a determination of whether the inmate requires a
referral and, if so, how urgently.
3.5.

Out-Of-Cell Time

3.5.1.

All

inmates

in

RHUs

must

have

the

opportunity to exercise outside of their cells
for at least five hours per week, subject to the
following exception:
3.5.1.1.

ADOC

may

refrain

from

offering

out-of-cell time due to inclement weather, but
only if a safe, alternative space for inmates
to

exercise--such

unavailable.

15

as

a

gymnasium--is

3.5.2.

The days and times that out-of-cell time is

offered,

and

any

inmate’s

decision

to

refuse

out-of-cell time, must be documented.
3.6.

Security Checks

3.6.1.

ADOC must perform security checks in RHUs

at least twice per hour, but no more than 40
minutes apart.
3.6.2.

Security

checks

must

be

documented

accurately and contemporaneously.
3.6.3.

Correctional officers must regularly verify

that security checks are conducted as required.
3.1.

Restrictive Housing Cells

3.1.1.

Within three months of the effective date,

the cells in the RHUs must be cleaned.
3.1.2.

Cells in the RHUs must always be cleaned

before they receive new occupants, and inmates
must be provided access to cleaning supplies at
least every two weeks.
3.1.3.

Within six months of the effective date, all

cells in the RHUs must comply with the conditions

16

set forth in the checklist developed by Lindsay
M. Hayes (Doc. 3206-5).
4. Intake
4.1.

Each intake screening must be conducted by a

qualified mental-health professional.
4.2.

Documentation

of

screening--including

each
an

inmate’s

intake

interpretation

of

the

results of any psychological assessment--must be
filed in the inmate’s medical record.
4.3.

Inmates’ Previous Records

4.3.1.

If, either during or after intake, an inmate

reports having previously received mental-health
services

and

can

correctly

report

the

prior

mental-health provider, a records request to the
prior provider must be made within three working
days

of

the

time

the

inmate

reported

having

previously received mental-health services.
the

inmate

reports

mental-health
correctly

having

services

identify

17

and

the

previously
cannot
prior

If

received

remember

or

mental-health

provider, the mental-health staff must reasonably
attempt to locate records of the inmate’s prior
treatment.
4.3.2.

All health records from each inmate’s prior

facility

of

incarceration

must

be

requested

within three working days of intake if they are
not presented at intake.
5. Coding
5.1.

Each inmate must be assigned a mental-health

code

and,

if

appropriate

to

necessary,
address

an

his

SMI
or

flag,

her

that

is

mental-health

needs, as determined by clinical judgment.
5.2.

Each inmate’s mental-health code and SMI flag

must

be

accurately

and

consistently

indicated

throughout all documents related to his or her care.
6. Referral
6.1.

A referral must result in a timely clinical

assessment and/or intervention by a psychiatrist,
psychologist,
referrals

must

CRNP,

or

result

18

in

counselor.
a

clinical

Emergent
assessment

and/or intervention as soon as possible but no more
than four hours from the determination that the
referral is emergent.

Urgent referrals must result

in a clinical assessment and/or intervention within
24 hours of the time the referral was made.
referrals

must

result

in

a

clinical

Routine

assessment

and/or intervention within 14 calendar days of the
time the referral was made.
6.2.

Communication of Referrals

6.2.1.

An

emergent

or

urgent

referral

must

be

communicated verbally, in person or by telephone,
to the appropriate mental-health staff member or
members as soon as possible, but in no case longer
than

one

hour

from

the

time

the

referral

is

identified as emergent or urgent, absent unusual
circumstances which detain staff for an extended
period of time such as a medical emergency or an
incident involving safety or security of staff or
inmates.
members

The
to

mental-health

whom

the

19

staff

referral

member
should

or
be

communicated

will

be

determined

by

the

mental-health staff.
6.2.2.
the

Routine referrals must be communicated to
appropriate

mental-health

staff

member

or

members, as indicated above, by the next shift by
leaving the referral form in a location that ADOC
has

designated

to

the

correctional

and

mental-health staff, and inmates, as appropriate.
The monitoring team may alert the court if ADOC
fails to clearly designate the location.
6.3.

An appropriate triage or mental-health staff

member

or

members

must

regularly

monitor

any

designated location for completed referral forms.
Said staff must review and triage the completed
referral forms at least once per shift.
6.4.

After

an

inmate

has

received

an

emergent

referral, including a referral for suicide watch,
correctional or mental-health staff must maintain
constant, line-of-sight observation of the inmate

20

until the inmate has been assessed by an appropriate
mental-health provider.
7. Confidentiality
7.1.

Individual

counseling

medication-management
mental-health
suicide-risk

sessions,

encounters,

assessments
assessments,

periodic

of

inmates

in

RHUs,

and

therapeutic

group

sessions must take place in settings that provide
for confidentiality and that, if applicable, are
out-of-cell, subject to the following exception:
7.1.1.

Such

services

may

be

provided

in

a

non-confidential setting if confidentiality is
not

possible

due

to

safety

otherwise not appropriate.

concerns

or

is

The question whether

confidentiality is otherwise not appropriate must
be answered according to clinical determinations.
7.1.2.

If confidentiality is not possible, then

that fact, the reason for it, and any actions
taken

to

maximize

confidentiality

documented in a progress note.

21

must

be

8. Treatment Teams and Plans
8.1.

Treatment teams must meet at regular intervals,

to be determined based on the team chair’s clinical
judgment, taking into account each inmate’s assigned
mental-health

code,

housing

unit,

and

level

of

psychotherapy.
8.2.

Each treatment team meeting must last for an

adequate period of time, based on the team chair’s
clinical judgment.
8.3.

All members of each inmate’s treatment team must

have access to clinically relevant documents.
8.3.1.

Clinically

relevant

documents

documents

related

to

condition

of

the

inmate--including

the

inmate’s

related

to

the

current

housing

are
and

all
past

documents
status,

disciplinary history, and interactions with other
inmates--that are necessary to inform clinical
judgment.
8.4.

Each inmate on the mental-health caseload must

have a treatment plan that is adequately detailed

22

and

individualized

to

address

his

or

her

mental-health needs, based on clinical judgment.
8.5.

Treatment

inmate’s

teams

must

mental-health

appropriate,
necessary,

and
each

must
inmate’s

review

and

code

as

review

and

treatment

revise

each

clinically
amend,
plan

if

after

changes in the inmate’s mental-health code, transfer
to a new housing unit, or any other circumstance
resulting

from

or

likely

to

affect

an

inmate's

mental-health in a significant way.
8.6.

Coordination of Transfers and Treatment

8.6.1.

ADOC must consider inmates’ mental-health

codes and symptoms in making decisions concerning
transfer between facilities.
8.6.2.

In the event of a transfer of an inmate on

the mental-health caseload, the staff member in
charge of the inmate’s care at the transferring
facility must send a transfer note to the staff
member in charge of the inmate’s care at the

23

receiving facility within a reasonable time after
the transfer is initiated.
9. Psychiatric and Therapeutic Care
9.1.

Access to Treatment

9.1.1.

ADOC

must

comply

with

the

Mental-Health

Treatment Guidance set forth in Appendix A.
9.1.2.

In addition to the Mental-Health Treatment

Guidance set forth in Appendix A, each inmate must
receive any additional care prescribed by his or
her

treatment

team,

subject

to

the

following

exception:
9.1.2.1.

While ADOC must provide each inmate in

restrictive

housing

with

any

medication

or

individual therapy prescribed by his or her
treatment team, it need not provide other forms
of care prescribed by an inmate’s treatment
team if those kinds of care cannot be provided
safely in the restrictive housing environment.

24

9.1.3.

Each treatment session must last for an

adequate period of time, according to clinical
judgment.
9.1.4.

Each housing unit must offer appropriate

types

and

numbers

of

therapeutic

groups

to

accommodate the inmates housed there.
9.2.

Out-Of-Cell Time

9.2.1.

Inmates in the RTU, SU, and SLU must receive

ten hours of structured, therapeutic out-of-cell
time and ten hours of unstructured out-of-cell
time per week, unless clinically contraindicated,
subject to the following exception:
9.2.1.1.

ADOC

unstructured

need

not

out-of-cell

provide
time

ten
per

hours

week

to

inmates in the RTU Level Three who are housed
in open dormitories rather than cells.
9.2.2.

An inmate’s out-of-cell appointments with

his or her treatment team, psychiatric provider,
counselor, or therapeutic group will count as
structured, therapeutic out-of-cell time.

25

9.3.

Inmates

who

are

not

on

the

mental-health

caseload must be seen by mental-health staff in the
event of a mental-health crisis or after receipt of
a mental-health referral, as clinically indicated.
9.4.

Progress Notes

9.4.1.

For

each

significant

clinical

encounter

between an inmate and a member of his or her
treatment team, or any qualified mental-health
professional, a progress note must be created and
placed in the inmate’s mental-health record.
9.4.1.1.

A

consists

significant
of

a

clinical

communication

or

encounter
interaction

between an inmate and qualified mental-health
professional
information
inmate,

involving
used

excluding

administrative
communications
inmate’s

in

the
any

an

exchange

treatment
casual

mental

do

condition

mental-health treatment.

26

not

of

the

exchanges,

communications,
which

of

or

relate
or

other
to

the

ongoing

9.4.2.

Progress notes must be sufficiently detailed

to facilitate treatment and ensure continuity of
care
10. Suicide Prevention
10.1. Immediate Response to Suicide Attempts
10.1.1. If

ADOC

or

mental-health

vendor

staff

observe an inmate who is attempting suicide or
who is unresponsive after apparently attempting
or completing suicide, the staff must immediately
call for assistance.
10.1.2. If

ADOC

or

mental-health

vendor

staff

observe a suicide threat or attempt, the staff
must

immediately

respond

with

efforts

to

interrupt the behavior or attempt.
10.1.3. Immediate

life-saving

measures

must

be

performed by ADOC or vendor staff as soon as it
is deemed safe by correctional staff to do so
(typically,

when

at

least

two

correctional

officers are present), and must continue until
paramedics or other appropriate medical personnel

27

arrive and assume care or a physician declares
such measures are no longer necessary.
10.1.4. Each ADOC major facility must maintain an
appropriate cut-down tool in each RHU, SU, RTU,
SLU, and crisis unit.
10.1.5. When continued medical care is necessary,
an inmate who has attempted suicide must be moved
to the medical or healthcare unit at the ADOC
major facility for continued medical care as soon
as ADOC staff may safely move the inmate, unless
medically contraindicated.
10.1.6. If an inmate dies as a result of a suicide,
the

inmate’s

body

must

be

moved

as

soon

as

possible to a private area outside of any occupied
housing

unit

and

outside

the

view

of

other

inmates.
10.2. Suicide Watch Placement
10.2.1. After each inmate’s initial placement on
constant

observation,

evaluated

using

a

the

suicide

28

inmate
risk

must

assessment

be
to

determine if the inmate is not suicidal or is
either acutely suicidal or non-acutely suicidal.
10.2.2. An inmate who is admitted to suicide watch
must

be

considered

for

placement

on

the

mental-health caseload.
10.2.3. If an inmate admitted to suicide watch is
not placed on the mental-health caseload, the
clinical

rationale

for

that

decision

must

be

documented in the inmate’s medical chart.
10.2.4. Before an inmate is placed on suicide watch,
a nurse must examine the inmate and complete a
body chart.
10.3. Suicide Watch Cells
10.3.1. All suicide watch and stabilization unit
cells

in

ADOC

major

suicide-resistant.

facilities

must

be

On a quarterly basis during

the term of this order, all suicide watch cells
in

ADOC

inspected

major
to

facilities
determine

suicide-resistant.

29

must
whether

be

physically

they

remain

10.3.1.1.

Cells shall be deemed suicide-resistant

if they meet the requirements set forth in
Lindsay M. Hayes’s Checklist for the “Suicide
Resistant” Design of Correctional Facilities
(Doc. 3206-5).
10.3.1.2.

Before an inmate is placed in an SU or

suicide watch cell, the cell must be cleaned
and any contraband must be removed from the
cell.
10.3.2. ADOC may designate areas or cells where
inmates could be temporarily placed when a suicide
watch
inmate

cell

is

unavailable,

provided

on

observation

remains

constant

that

the

during

this time.
10.4. Observation
10.4.1. Any inmate determined to be acutely suicidal
must be monitored through a constant observation
procedure.
10.4.2. Any

inmate

determined

to

be

non-acutely

suicidal must be monitored through a close watch

30

procedure that ensures monitoring at staggered
intervals not to exceed 15 minutes.
10.4.3. During constant observation or close watch,
an observer must contemporaneously document his
or her observations at staggered intervals not to
exceed 15 minutes.

Upon an inmate’s discharge

from suicide watch, his or her observation records
must be maintained in his or her medical record.
10.4.4. ADOC must take appropriate steps to ensure
that observers perform their duties as required.
10.5. Suicide Watch Conditions
10.5.1. Unless clinically contraindicated, inmates
on

suicide

watch

suicide-resistant

must

be

implements

provided
for

adequate

hygiene

and

eating as clinically appropriate.
10.5.2. Inmates on suicide watch must receive the
same privileges afforded by their last housing
assignment as clinically appropriate.
10.5.3. Inmates
cells,

or

housed
the

in

crisis

infirmary

31

must

cells,
be

medical
provided

appropriate

out-of-cell

activity,

unless

clinically contraindicated, after 72 hours.
10.6. Referrals to Higher Levels of Care
10.6.1. If an inmate remains on suicide watch for
72 hours, then he or she must be considered for
referral to a different or higher level of care
based on clinical judgment.

If the inmate is not

referred to a different or higher level of care,
then the clinical rationale must be documented in
the inmate’s medical chart and tracked in the
crisis

utilization

log

or

a

similar

tracking

mechanism.
10.6.2. If an inmate remains on suicide watch for
168 hours, then the he or she must be considered
for referral to a different or higher level of
care based on clinical judgment.

If the inmate

is not referred to a different or higher level of
care,

then

documented

the
in

the

clinical
inmate’s

32

rationale
medical

must
chart

be
and

tracked in the crisis utilization log or a similar
tracking mechanism.
10.6.3. If an inmate remains on suicide watch for
240 hours or longer and does not meet the criteria
for discharge to outpatient mental-health care,
then he or she must be considered for referral to
a different or higher level of care based on
clinical judgment.

If the inmate is not referred

to a different or higher level of care, then the
clinical

rationale

must

be

documented

in

the

inmate’s medical chart and tracked in the crisis
utilization log or a similar tracking mechanism,
and documentation of the decision must be sent to
the mental-health vendor’s director of psychiatry
for review and evaluation.
10.6.4. Any inmate who is returned to suicide watch
within 30 days of discharge from a suicide watch
and/or who has three suicide watch placements
within six months must be considered for referral
to a different or higher level of care based on

33

clinical judgment.
to

a

different

clinical

If the inmate is not referred

or

higher

rationale

mental-health

must

staff

must

level
be

of

care,

documented,

notify

OHS

of

the
and
the

decision and provide the clinical rationale to
OHS within 72 hours.
10.7. Discharge
10.7.1. Discharge Evaluation
10.7.1.1.

Prior to being discharged from suicide

watch, an inmate must receive an out-of-cell,
confidential

evaluation

by

a

psychiatrist,

psychologist, CRNP, or counselor, unless such
evaluation is not possible due to documented
clinical concerns.
10.7.1.2.

If

an

out-of-cell,

confidential

evaluation is not possible due to documented
clinical concerns, staff must consider whether
referral to a different or higher level of care
is appropriate.
10.7.2. Discharge to RHU

34

10.7.2.1.

An inmate discharged from suicide watch

must not be transferred to an RHU, unless there
is a documented exceptional circumstance.
10.7.2.2.

Any transfer of an inmate from suicide

watch to an RHU must be approved by the Deputy
Commissioner

of

Operations

(for

male

facilities) or Deputy Commissioner of Women’s
Services

(for

female

facilities)

or

their

designee.
10.8. Follow-Up
10.8.1. After an inmate’s discharge from suicide
watch,

mental-health

follow-up

staff

mental-health

must

examination

conduct
with

a
the

inmate on each of the first three days following
discharge, unless there is a documented clinical
determination that the inmate was not suicidal at
the time the inmate was placed on suicide watch
and did not become suicidal during the watch
placement.

35

10.8.2. Follow-up mental-health examinations must
not

take

the

mental-health

place

of

appointments,

other
although

scheduled
they

may

occur in connection with or contiguous with such
appointments.
10.8.3. Follow-up mental-health examinations must
occur

in

a

confidential,

out-of-cell

setting,

unless such examination is not possible due to
documented clinical concerns.
10.8.4. During

the

follow-up

mental-health

examinations, the mental-health staff conducting
such follow-up mental-health examinations must
assess whether the inmate released from suicide
watch is showing signs of ongoing crisis, whether
the inmate needs further follow-up mental-health
examinations, and whether the inmate should be
added to the mental-health caseload or assigned a
different mental-health code.
10.8.5. An inmate’s transfer from suicide watch to
another institution prior to the completion of

36

the three ordered follow-up examinations restarts
the

requirement

to

complete

a

follow-up

mental-health examination on each of the three
days following the transfer.
11. Higher Levels of Care
11.1. ADOC

must

ensure

that

inmates

who

require

hospital-level care receive it within a reasonable
period of time, as determined by clinical judgment.
11.2. Inpatient Beds
11.2.1. ADOC must supply enough beds to accommodate
10 % of its mental-health caseload at the time of
the effective date.
11.2.2. In collaboration with the EMT, ADOC must,
on at least an annual basis, reassess (1) the
number

of

caseload,

inmates
and

(2)

on

ADOC’s

whether

10%

mental-health
is

in

fact

an

accurate estimate of the percentage of the mentalhealth caseload requiring inpatient treatment.
If ADOC determines that more than 10 % of the
inmates

on

the

mental-health

37

caseload

require

inpatient

beds,

or

that

the

mental-health

caseload has grown, or both, it must adjust its
number of inpatient beds accordingly.
11.2.3. At

all

times,

ADOC

must

ensure

that

inpatient beds are housed in treatment spaces that
allow for confidentiality, including by creating
any new treatment spaces if necessary.
11.3. ADOC must devise a plan and procedures to address
the serious risk posed by high temperatures in the
mental-health units, which it must submit to the
court by May 2, 2022.

The plan and procedures must

address, specifically, how it happened that Tommy
Lee Rutledge’s cell reached 104 degrees, causing him
to die of hyperthermia, in a unit that was supposedly
air conditioned, and how the ADOC will prevent that
from ever occurring again.
must

also

address

how

The plan and procedures

ADOC

plans

to

determine

whether cells in each of its facilities have reached
dangerously high temperatures, and should such a

38

finding be made, what measures ADOC will take to
ensure their occupants’ safety.
12. Discipline
12.1. ADOC must comply with §§ V.B.2, V.C.3.a, and
V.C.3.d of ADOC Administrative Regulation 626, all
of which are set forth in Appendix B.
12.2. ADOC must comply with §§ V.D.3 and V.D.3.b, and
the

excerpted

provision

of

§

V.D.4,

of

ADOC

Administrative Regulation 626, all of which are set
forth in Appendix B.
13. Training
13.1. ADOC must document its provision of training
regarding

the

Curriculum,

suicide

Comprehensive
prevention,

Mental-Health
confidentiality,

mental-health rounds in restrictive housing units,
emergency

preparedness,

assessments,

discipline,

correctional

risk

suicide

risk

factors,

and

observation on suicide watch.
13.2. For training purposes, on a quarterly basis,
ADOC and/or its mental-health vendor must conduct

39

emergency preparedness drills at each ADOC major
facility, including scenarios involving self-injury
and

suicide

attempts.

During

the

emergency

preparedness drills, the trainers must evaluate the
correctional and medical staff response time to the
emergency

code

and

their

preparedness

for

the

emergency code (including, as appropriate, presence
of

an

emergency

defibrillator

(or

bag,
AED),

automatic
and

cut-down

external
tool).

Additionally, the emergency preparedness drills must
include role-playing for participants to practice
the

response

to

an

emergency,

including,

for

example, using a cut-down tool, rendering first aid,
and

performing

cardiopulmonary

resuscitation

(or

CPR).
13.3. Observers

must

receive

additional

training

related to their observation obligations, including
where they must be positioned and how to access
assistance if an inmate requires medical care or
there is an emergency.

40

14. Unforeseen Circumstances
14.1. “Unforeseen circumstances” refer to a situation
in which an event or series of events (such as a
natural disaster, fire, medical epidemic, pandemic,
or outbreak, and lockdown) make performance under
this

omnibus

remedial

order

inadvisable,

impracticable, illegal, impossible, detrimental to
the health and/or safety of inmates and/or staff, or
detrimental to the public interest.
14.2. In
omnibus

monitoring
remedial

ADOC’s
order,

compliance
the

EMT

with

shall

this

consider

unforeseen circumstances, their effects on ADOC’s
ability

to

comply

with

the

remedial

order,

and

ADOC’s efforts to mitigate the effects of those
circumstances.
15. This order is not final and remains open in that
the parties must still submit proposals for further
and/or different relief and monitoring may warrant
consideration and reconsideration of issues. The court
also retains jurisdiction.

41

DONE, this the 27th day of December, 2021.
/s/ Myron H. Thompson
UNITED STATES DISTRICT JUDGE

42

Appendix A
The Defendants’ Mental-Health Treatment Guidance
Treatment Category

Initial Assessment

Subsequent Care

SU

An RN will assess the
inmate on an emergent
basis after arrival to
the SU and make any
necessary arrangements
on an emergent, urgent,
routine, or another
basis for a psychiatric
assessment and/or
counseling assessment.
An RN will assess the
inmate on an urgent
basis after arrival to
the RTU and make any
necessary arrangements
on an emergent, urgent,
routine, or another
basis for a psychiatric
assessment and/or
counseling assessment.
An RN will assess the
inmate on an urgent
basis after arrival to
the SLU and make any
necessary arrangements
on an emergent, urgent,
routine, or another
basis for a psychiatric
assessment and/or
counseling assessment.

Typically, structured,
out-of-cell activities
during each week will
include a daily
interaction with a RN,
psychologist, or
counselor and more than
one clinical encounter
with a psychiatrist or
CRNP.
Typically, structured,
out-of-cell activities
during each week will
include multiple
interactions with an RN,
psychologist, or
counselor and a clinical
encounter with a
psychiatrist or CRNP.

RTU (Levels 1-3)

SLU

Outpatient

A treatment team member
will assess the inmate
on a routine basis.

Typically, structured,
out-of-cell activities
during each week will
include multiple
interactions with an RN,
psychologist, or
counselor and a clinical
encounter with a
psychiatrist or CRNP
based on clinical
judgment.
Psychiatrist or CRNP:
Every 90 days, unless
otherwise clinically
indicated.
Psychologist or
counselor: Every 90
days, unless otherwise
clinically indicated.

1

Appendix B
ADOC Administrative Regulation 626, § V.B.2:
“A mental health consultation may be sought at the time
of the rule or regulation violation or after review of
the disciplinary report.
A mental health consultation
must be sought if the inmate is on the mental health
caseload and has a mental health code of C or higher
and/or an SMI designation; or, even if the inmate has a
lower mental health code or is not on the mental health
caseload, where the inmate has an intellectual or
developmental disability, or the inmate’s behavior at the
time of the alleged actions giving rise to the
disciplinary or at any time prior to or during the
disciplinary process demonstrates signs of psychological
distress or mental impairment.”
ADOC Administrative Regulation 626, § V.C.3.a:
“A mental health staff member performing the mental
health consultation will evaluate: (1) an inmate’s
current and then-existing (at the time of the incident)
mental state, including the inmate’s capacity to
proceed with a disciplinary hearing; (2) an inmate’s
mental health diagnosis or, for an inmate not
previously diagnosed, the presence of mental illness;
(3) an inmate’s treatment and medication (including any
compliance issues) over the past six (6) months; (4)
any crisis placements over the past six (6) months; (5)
whether the inmate’s behavior resulting in an ADOC rule
or regulation violation is the direct result of or
related to his or her mental illness; (6) the likely
impact of confinement to restrictive housing on an
inmate’s mental health and, based on the likely impact,
if confinement to restrictive housing for a medium- or
high-level rule violation is contraindicated; (7) the
1

potential impact of other disciplinary sanctions on the
inmate’s mental state, including whether any specific
disciplinary sanction is clinically contraindicated for
the inmate and, in such instances, what alternative
sanctions are not clinically contraindicated; and (8)
the need for mental health staff to be present during
the disciplinary hearing.”
ADOC Administrative Regulation 626, § V.C.3.d:
“The mental health staff member performing the mental
health consultation will document his or her evaluation
and provide any comments, notes, and recommendations in
the ADOC computer module. A mental health staff member
may
identify
disciplinary
sanctions
that
are
contraindicated for the inmate and any appropriate
alternative disciplinary sanctions. A copy of the mental
health consultation evaluations and recommendations will
be (a) provided to the disciplinary hearing officer for
consideration and to maintain with the inmate’s
disciplinary action file, and (b) placed in the inmate’s
mental health record to ensure the inmate’s treatment
team may receive and review it.”
ADOC Administrative Regulation 626, § V.D.3:
“During the disciplinary hearing and/or before the
disciplinary
officer
adjudicates
the
disciplinary
action, the disciplinary officer must consider the mental
health consultation, including any evaluation, comments,
or recommendations, in deciding an inmate’s guilt or
innocence and, if guilty, in imposing any disciplinary
sanctions.”
ADOC Administrative Regulation 626, § V.D.3.b:

2

“If the mental health staff member performing the mental
health consultation concludes that the rule or regulation
violation was related to, but not the direct result of,
the inmate’s mental illness, then the disciplinary
hearing
officer
must
take
that
conclusion
into
consideration in imposing any disciplinary sanctions.”

ADOC Administrative Regulation 626, § V.D.4:
“[I]f the mental health staff member who conducted the
mental health consultation determined that any specific
disciplinary sanction is clinically contraindicated for
the inmate, including confinement to restrictive
housing for a medium- or high-level rule or regulation
violation, then the decision of the mental health staff
member who performed the mental-health consultation
will be outcome determinative and binding on the
disciplinary hearing officer, except where exceptional
circumstances exist.”

3