Braggs, et al. v. Jefferson Dunn, et al.

The Alabama Department of Corrections (ADOC) systemically puts the health and lives of prisoners at risk by ignoring their medical and mental health needs and discriminating against prisoners with disabilities – violations of federal law by a prison system that has one of the highest mortality rates in the country. The SPLC and the Alabama Disabilities Advocacy Program (ADAP) filed suit to end the deplorable conditions in Alabama prisons.

Shortly before filing the lawsuit, the SPLC and ADAP released a report on the conditions within Alabama prisons, Cruel Confinement: Abuse, Discrimination and Death Within Alabama’s Prisons. The report’s findings were based on inspections of Alabama prisons, interviews with prisoners and a review of medical records, depositions and media accounts as well as the policies, contracts and reports of ADOC and two major contractors.

The lawsuit, filed in the U.S. District Court for the Middle District of Alabama, describes how prisoners, including those with disabilities and serious physical and mental illnesses, were confined to prisons where discrimination and dangerous – sometimes life-threatening – conditions were the norm. Strokes, amputations and prisoner deaths that may have been prevented with proper care are detailed in the lawsuit.

Lack of testing, medication and other examples of poor conditions

The lawsuit, filed in 2014, cites numerous examples of conditions that threaten the health and lives of prisoners:

• The department had a policy and practice of not treating hepatitis C. In April 2014, 2,280 prisoners in ADOC custody had been diagnosed with it, but only seven prisoners were receiving treatment. A prisoner at Holman Correctional Facility died of complications from hepatitis C.
• A prisoner who had survived prostate cancer had a blood test indicating his cancer had probably returned, but no follow-up test was given until a year and a half later. By that time, the cancer had spread to his bones and was terminal. He died.
• A prisoner stabbed 15 times with an icepick did not have his wounds cleaned or treated. Instead, he was placed in segregation for three months. He also suffered a cracked lens in his right eye at the county jail where he was held before being transferred to prison. He was told the lens would not be treated because he still has one good eye.
• At Limestone Correctional Facility, a prisoner committed suicide using a state-issued razor blade. When he was found bleeding out, he stated that he had cut himself because he was “not getting enough medical attention.”
• At Staton Correctional Facility, a prisoner with no bottom teeth spent years without bottom dentures, resulting in weekly choking episodes because of his inability to chew his food properly.

In addition, prisoners were placed under “do not resuscitate” or “allow natural death” orders without their consent or knowledge, according to the lawsuit. Moreover, although “do not resuscitate” forms refer only to not resuscitating prisoners experiencing cardiac arrest, the department relied on them to deny other treatment to prisoners with such orders.

Prisoners with serious mental illnesses were routinely housed in solitary confinement and provided with little to no mental health care. The Alabama Department of Corrections has the highest suicide rate in the nation, with most such deaths occurring in solitary confinement and solitary-like units. In ADOC prisons, there have been over 200 suicide attempts requiring hospitalization between the filing of the case and January 2019, and there have been 31 completed suicides.

The lawsuit also describes how ADOC leaves prisoners with disabilities isolated and deprived of the care and accommodations they need. Several prisoners reported incidents in which they were verbally or physically mistreated due to their disabilities, including guards taunting blind or wheelchair-bound prisoners about their disabilities. An agreement was reached with the Alabama Department of Corrections in March 2016 to ensure that prisoners with disabilities receive treatment and services required under the Americans with Disabilities Act.

Federal judge declares mental health system in Alabama to be “horrendously inadequate”

The first part of the case to go to trial was the mental health claim. After a two-month trial, a federal judge declared the mental health care system in Alabama prisons to be “horrendously inadequate” – an unconstitutional failure that has resulted in a “skyrocketing suicide rate” among prisoners. In the June 2017 opinion, U.S. District Judge Myron H. Thompson ordered the state to reform the system and directed them to work with the SPLC and others who filed the lawsuit.

Within his 302-page ruling, Thompson identified multiple areas where ADOC has failed to maintain a constitutionally adequate mental health care system – ranging from a failure to identify prisoners with serious mental health needs to inadequate treatment for suicidal prisoners.

“[T]he evidence from both sides … materially supported the plaintiffs’ claim,” Thompson wrote. He later added: “Simply put, ADOC’s mental-health care is horrendously inadequate.”

Thompson highlighted a key issue facing the system: “persistent and severe shortages of mental-health staff and correctional staff, combined with chronic and significant overcrowding.” The judge noted that during the trial, Corrections Commissioner Jeff Dunn “described the prison system as wrestling with a ‘two-headed monster’: overcrowding and understaffing.” Notably, he held that “ADOC’s low correctional-staffing level, in the context of its severely overcrowded prisons, creates a substantial risk of serious harm to mentally ill prisoners, including continued pain and suffering, decompensation, self-injury, and suicide.”

The judge also noted that ADOC fails to provide individualized treatment plans to prisoners with serious mental health needs as well as psychotherapy by qualified and properly supervised staff and with adequate frequency and sound confidentiality. He also described a system that disciplines mentally ill prisoners for the symptoms of their illnesses and segregates them for prolonged periods.

Alabama Department of Corrections continues to fail to comply with federal judge’s mental health remedial orders

After Thompson issued the liability opinion declaring the mental health system “horrendously inadequate,” the court issued a series of remedial orders and injunctions requiring ADOC to make changes to address an array of systemic problems.

In the wake of the court’s liability opinion, ADOC has failed to materially ameliorate conditions in Alabama prisons and has repeatedly failed to comply with the court’s remedial orders. As a result, the SPLC is also litigating these failures.

One such failure was not hiring an adequate number of mental health staff. The SPLC filed a “Motion for Order to Show Cause Why Defendants Should not be Held in Contempt,” on Aug. 1, 2018, and on Jan. 22, 2019, ADOC and the SPLC agreed to a series of stipulations intended to conclusively address the problems that undergirded the SPLC’s motion.

Another failure has been the continued high rate of suicides in Alabama prisons, resulting in part from ADOC’s failure to comply with a “Suicide Prevention Order” issued by the court in January 2017. On Jan. 18, 2019, after five prisoners took their own lives in less than two months, the SPLC filed an “Emergency Motion for Temporary Restraining Order or Preliminary Injunction Regarding Placement of High-Risk Prisoners in Segregation.”

During the spring of 2021, Thompson held a seven-week trial during which ADOC asked the court not to order remedies that would address the provisions of mental health services. The agency claimed that it had improved its operations in the years since the court’s liability opinion. The SPLC and the Alabama Disabilities Advocacy Program joined the law firms of King & Spalding and Hogan Lovells in presenting evidence that the current horrific and inhumane conditions inside the prisons continue to support the need for remedies.

Thompson issued a sweeping order on Dec. 27, 2021, requiring ADOC to remedy unconstitutional mental health services. Monitoring by an external team of experts was expected to begin immediately to ensure compliance with this latest court order and that people with serious mental health needs receive the care they need – and that the Constitution requires.

Thompson’s opinion acknowledged that while some areas had shown improvement since the suit was filed, “[s]erious problems with the provision of mental-health care in ADOC facilities persist.” He highlighted the impact that both correctional and mental health understaffing have on providing adequate care.

State contracts with Corizon Inc., despite company failing every major health care audit

Alabama had the most overcrowded prisons in the nation and spent one of the lowest amounts, per inmate, on health care. The prison system contracted with Corizon Inc. to provide medical care, and with MHM Correctional Services to provide mental health care. In 2012, when ADOC released a “Request for Proposal” for a new health care contract, applicants were scored on a 3,000- point scale. Out of a possible 3,000 points, contract price accounted for a possible 1,350 points. Qualifications and experience counted for only 100 points.

ADOC renewed its contract with Corizon in 2012, even though Corizon (the company providing health care in Alabama prisons since 2007) failed every major audit of its health care operations in Alabama prisons under its first contract with the state.

In 2017, ADOC changed providers, granting a single contract for medical and mental health care to Wexford Health Sources. That same year, the Florida Department of Corrections terminated its contract with Wexford due to “numerous deficiencies” and “life-threatening” conditions, and the state of Mississippi sued the company for allegedly using consultants to pay bribes and kickbacks to then-Mississippi prison commissioner Chris Epps, who was sentenced to almost 20 years in prison in the bribery scheme.