Goodvine v. Ankarlo (9 F. Supp. 3d 899, 2014)

OPINION AND ORDER

WILLIAM M. CONLEY, District Judge.

Plaintiff Christopher Goodvine filed this lawsuit pursuant to 42 U.S.C. § 1983, alleging violations of his constitutional rights while incarcerated by the Wisconsin Department of Corrections (“WDOC”) at the Columbia Correctional Institution (“CCI”) in Portage. He contends primarily that defendants failed to prevent him from engaging in acts of self-harm, usually (but not exclusively) by cutting himself with sharp objects, on four occasions in October 2011, as well as a fifth occasion in July 2012. Along with common law malpractice claims against certain WDOC medical staff, he also contends that he was denied a constitutional right to (1) adequate medical care following one instance of self-harm and (2) placement for mental health care at the Wisconsin Resource Center (“WRC”). He further contends that prison policies and procedures are generally inadequate to keep him safe from self-harm.

On February 7, 2013, the court granted in part plaintiffs request for a preliminary injunction in light of: the life-threatening nature of at least one of plaintiffs acts of self-harm; the severity of other such acts; the apparent inability of CCI to prevent the plaintiff from procuring or fashioning sharp objects; and the opinions of WDOC’s own psychiatrist and psychologist that plaintiff would likely engage in equally dangerous acts in the future, whether because of a compulsive/obsessive disorder, other mental illness or, as they had concluded, a desire to manipulate staff. Specifically, the court required prison officials to place Goodvine in “observation” status and/or restraints as soon as reasonably practicable after plaintiff reports a strong urge to harm himself. (Dkt. # 59.) After defendants filed a joint motion for summary judgment on all of plaintiffs claims (dkt. #73), the court appointed a neutral psychiatric expert, Dr. Kenneth I. Robbins, to assist in resolving the claims in this case. (Dkt. # 109.) Dr. Robbins has since filed his own evaluation of Goodvine, possible treatment and report in this case. (Dkt. # 166.)

The parties have also conducted extensive discovery in connection with plaintiffs claims. Defendants subsequently filed an amended brief in support of their motion for summary judgment. (Dkt. # 212.) In response to which Goodvine cross-moved for summary judgment. (Dkt. # 234.) Although he has more than capably litigated this case on his own to date, Goodvine also continues to seek assistance from the court in locating volunteer counsel, as well as leave to supplement or amend the complaint with new allegations, additional in-junctive relief, and sanctions against defendants for failure to comply with the preliminary injunction. The pending motions are addressed below following an overview of the parties, the claims and the pertinent facts in this case.

PARTIES

After screening the pleadings pursuant to the Prison Litigation Reform Act, 28 U.S.C. § 1915A, the court granted (likely in retrospect inadvisedly) Goodvine leave to proceed with claims against 20 defendants. (Dkts. # 21, # 40, # 61.) Several of the defendants are supervisory officials, including Dr. Gary Ankarlo, who is the Director of Psychological Services for the WDOC in Madison, CCI Warden Michael Meisner and CCI’s Security Director Janel Nickel. Several of the defendants are psychologists or psychological associates working at the CCI Psychological Services Unit (“PSU”), including: Nicholas Buhr, Sonnette Coldwell-Barr, Tracy Johnson, Patrick Kumke, Teresa McLaren and Andrea Nelson. Defendant Jeff Heise is a psychologist who serves as Admissions Coordinator at the WRC, which is a state mental health facility operated by the Department of Health Services (“DHS”) in Winnebago. The remaining defendants are correctional or security personnel at CCI, including: Lieutenant Kevin Boodry, Lieutenant Nicholas Bredeman, Officer William Conroy, Officer Michael Julson, Officer Raymond Millonig, Captain Donald Morgan, Captain Sean Salter, Sergeant Randy Schneider, Officer Jeremy A. Wiley and Officer Jason Witterholt.

CLAIMS

As already mentioned and outlined more fully below, the pending complaint concerns five distinct incidents in which Good-vine inflicted harm upon himself while housed in disciplinary segregation at CCI. In particular, Goodvine contends that Dr. Kumke, Dr. Nelson, Dr. McLaren and Sergeant Schneider failed to protect him from self-harm that occurred on October 1, 2011. Goodvine contends that Dr. Kumke, Dr. McLaren, Officer Millonig and Officer Witterholt failed to protect him from self-harm that occurred on October 5, 2011. Goodvine contends that Dr. Johnson, Dr. Kumke, Dr. McLaren and Officer Julson failed to protect him from self-harm that occurred on October 12, 2011. Goodvine claims that Dr. Johnson, Officer Conroy and Officer Wiley failed to protect him from self-harm that occurred on October 13, 2011. Goodvine contends that Dr. Buhr, Dr. Caldwell-Barr, Lieutenant Boo-dry, Lieutenant Bredeman, and Captain Salter failed to protect him from self-harm that occurred on July 16, 2012. Goodvine also contends that Drs. Buhr, Johnson, Kumke, McLaren and Nelson were medically negligent or committed malpractice by providing sub-standard mental health care on each of the above-referenced occasions.

In addition to these claims, Goodvine contends that Ankarlo and Heise were deliberately indifferent to his need for mental health treatment by refusing to place him at WRC in February 2012. (See Dkt. # 21, at 8-9.) Goodvine contends further that the supervisory defendants (Meisner, Nickel and Morgan) failed to implement policies or procedures to keep him from harming himself at CCI. In that regard, Goodvine argues that defendants were deliberately indifferent to his need for protection from self-harm by failing to adopt a policy that would place him in “therapeutic restraints,” among other alternatives, at his request.

GENERAL BACKGROUND

Goodvine is a male inmate in his early 30’s who has been incarcerated by DOC since 2003. With the exception of transfers to WRC for treatment or stabilization, he has been in custody at CCI continuously since 2009.

Goodvine grew up in Milwaukee, almost certainly the product of an abusive home. For example, his mother and her boyfriend reportedly used drugs and beat him frequently. He ran away at the age of 12 or 13 and began committing crimes, resulting in his placement at one or more group homes. When not in foster care, Goodvine supported himself by selling drugs and staying in neighborhood “drug houses.” He has reported cutting himself at least twice a month since the age of 12, resulting in many emergency room visits and at least five or six stays in psychiatric hospitals related to his thoughts of self-harm. While marijuana has been his drug of choice since the age of 11, Goodvine also has a history of using or abusing alcohol, hallucinogens and ecstasy.

At the age of 15, Goodvine was incarcerated at the Lincoln Hills School. He was sentenced to state prison as an adult for the first time at the age of 17, after assaulting a guard at the Lincoln Hills facility. Goodvine was out of prison from 2001 through 2003, living on the streets and selling drugs to support himself. In 2003, he was convicted of first-degree recklessly endangering safety and substantial battery causing intentional bodily harm in Milwaukee County Case No. 2002CF4916, as well as unlawful possession of a firearm by a felon in Milwaukee County Case No. 2002CF5261. While imprisoned in 2007, Goodvine was also convicted of battery by a prisoner for assaulting a correctional officer, who he punched in the face. See Columbia County Case No. 2007CF266. On September 28, 2011, Goodvine repeatedly punched and stabbed another inmate with a weapon he had made from pencils. As a result of that incident, which was captured on surveillance video, Good-vine has been charged with yet another felony for battery by a prisoner in Columbia County Case No. 2012CF85. That case remains pending.

In addition to his criminal record, Good-vine has a lengthy record of misconduct while in prison. (Dkt. # 90, Ex. 1.) As of March 7, 2012, Goodvine had amassed 106 major conduct reports and 27 minors. (Ex. # 101, at 155.) Among others, these offenses include battery, disobeying orders, disruptive conduct, disfigurement, threats, damage/alteration of property, possession of contraband, lying, group resistance and petitions, manufacturing a weapon.

Unsurprisingly, as a result of these repeated instances of misconduct, Goodvine has resided in disciplinary segregation for much of the time period pertinent to this lawsuit. Also unsurprisingly, Goodvine has continued to struggle with a number of serious mental or psychiatric conditions while incarcerated.

According to the expert report prepared by the court’s neutral expert, Dr. Robbins, Goodvine feels “anxious and sad” much of the time, intermittently to the point that he feels “out of control” and believes he must cut himself or kill himself to decrease the intensity of his pain. He has difficulty managing his emotions and maintaining his motivation, attention and concentration. Goodvine reports that these feelings are much worse when he is in segregation, where there is little to do, while in the past he was able to manage his psychiatric symptoms by distracting himself with activities or with substance abuse. Goodvine is sensitive to criticism and believes he is treated poorly by security staff, particularly in segregation. He often feels angry about the “lack of respect” he believes he has been shown. He has cut himself, taken overdoses, or attempted to suffocate himself numerous times, as documented in WDOC records. He believes he has injured himself at least 50 times while incarcerated, but suspects it is likely closer to 100 times. He believes he has been sent to the hospital at least 20 times related to his self-injury.

Goodvine has been diagnosed with a borderline personality disorder. According to Dr. Robbins, this diagnosis is based on his long history of unstable interpersonal relationships, an unstable self-image, emotional or affective instability with recurrent suicidal and self-mutilating behaviors, chronic feelings of emptiness and marked impulsivity. See also Amer. Psychiatric Ass’N, Diagnostic and Statistical Manual 663-64 (5th ed.2013) (noting that individuals -with borderline personality disorder commonly display “recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior,” with “completed suicide” occurring in 8%-10% of such individuals). Goodvine has also has been diagnosed with antisocial personality disorder, which is a form of “psychopathy” or “sociopathy” featuring a “pervasive pattern of disregard for, and violation of, the rights of others,” as well as frequent use of deceit and manipulation as a means to procure some form of secondary gain. See also id. at 659-60.

During his incarceration, Goodvine has been treated with a variety of antidepressant medications (including Prozac, Pame-lor, Wellbutrin, Trazodone and Remeron), antipsychotic medications (including Loxi-tane, Thorazine, Seroquel and Risperdal), anti-anxiety medication (Buspar), and mood stabilizers (Depakote and Lithium).

POLICIES, PROCEDURES AND CONDITIONS OF CONFINEMENT AT CCI

CCI has three segregation units: Disciplinary Segregation 1 (DS-1), Disciplinary Segregation 2 (DS-2), and the Special Management Unit (Unit 7). DS-1 houses inmates who have just arrived in segregation or are having behavioral problems and have been placed in observation. DS-2 is a transitional or “step-down” unit that houses inmates who have been in DS-1. Unit 7 serves a variety of purposes, but mainly houses the severely mentally ill and other vulnerable inmates.

CCI employs 6 psychologists, a crisis intervention worker and a program assistant. Each unit has an assigned psychologist. Inmates at CCI are informed that if they need to see PSU staff immediately (urgeni/emergent-type situations), they need to alert unit staff of their problem or concern. PSU staff responds directly to the units in emergencies or urgent situations when contacted or asked to do so by unit staff. If an inmate requires non-emergency psychological attention they must submit a Psychological Services Request (“PSR”) to the PSU. PSU staff triage the PSRs daily and will schedule an inmate for an appointment with PSU staff if his stated problem requires attention. If the request is urgent or emergent in nature, arrangements will be made for a same-day or immediate evaluation as determined by PSU staff.

In addition to providing care on an “as needed” basis, PSU staff conducts routine rounds in the segregation units, going to the cell front and talking to the inmates. On the two, more acute units — DS-1 and Unit 7 — routine rounds are generally conducted every week, but psychological staff may see an inmate at cell front more frequently if staff or the inmate requests that he be seen.

CCI operates under a “unit management” concept, which means that all correctional employees on a given cell block, tank, pod or wing work as a team to provide custody, support and rehabilitative services in a single coordinated package. All inmates in the segregation building are reviewed by members of the unit team on a weekly basis. All inmates on the segregation building are discussed formally or informally at least weekly. If staff members observe subtle changes in inmates, this information can be shared and promptly followed-up on if necessary. Information is shared between PSU, Health Services Unit (“HSU”) and security staff to promote awareness of inmate concerns and so that staff can monitor inmates closely. Defendants note that it is not uncommon for segregation inmates to prompt others in segregation to commit self-harm. While this poses a challenge, unit staff attempts to manage this dynamic by using the limited resources available to separate inmates who may pose a negative influence on other inmates that may result in self-harm behaviors.

Security personnel at CCI are trained to address the problems associated with mental illness in the prison population, including those who engage in self-harm or suicidal conduct. Officials at CCI have adopted a number of institutional policies and procedures to protect inmates from self-harm. Measures have been put in place to decrease the risk of self-harm and suicide in DOC facilities, including: staff training, early identification of at-risk inmates, prompt intervention, effective treatment in accordance with professional judgment and standards, and collaboration among staff. CCI staff members working in the segregation units, in particular, receive “Crisis Intervention Training” to facilitate an understanding of mental illness.

CCI has established additional measures to decrease the risk of self-harm by vulnerable inmates in DS-1, including:

• inmates are strip searched before going to segregation, before an inmate is placed in a DS-1 cell, and before going into observation status;

• the cell is searched to remove any contraband or damaged items in that cell that could be used for self-harm;

• mail is inspected for contraband;

• unit staff conduct frequent searches of segregation and observation cells;

• unit staff conduct frequent rounds of the segregation unit to visibly identify that inmates are not causing self-harm; and

• inmates are provided programming and counseling.

In addition, inmates in the DS-1 unit are limited in what property they may have. If there are safety concerns, certain restrictions may be imposed to prevent that inmate from causing self-harm. Restrictions may be individualized based on the type of self-harm or threat posed by the inmate. Some of the restrictions may include:

• sharps (for inmates that have used hard plastic items to cause sfelf-harm; this restriction includes placing the inmate on a “bag meal” that does not require the use of eating utensils);

• officer controlled medication (for inmates that have abused or attempted to overdose on stored up medication);

• “hook for medication” (for inmates who are “mouthing meds” or storing up medication in their cells);

• linen (for inmates who may use linens in an attempt to hang themselves);

• pen insert (to prevent inmates from using metal parts or hard plastic found in a pen insert to cause self-harm); and

• other restrictions that may be specific to the self-harm gesture/attempt would be considered.

Defendants note that these forms of restriction are not punitive measures. Rather, they are simply a tool used on the segregation unit to manage the disruptive types of behaviors exhibited by inmates and to protect the inmate and staff when an inmate’s behavior poses a serious risk to the health and safety of the inmate and/or others.

OBSERVATION STATUS

Numerous times during his confinement in disciplinary segregation, Goodvine has been placed in “observation status” for his own' safety. Observation status is a highly restrictive, non-punitive placement that is used to ensure the safety of the inmate or the safety of others. See Wis. Admin. Code § DOC 311.04(1). An inmate may be placed in observation for mental health purposes if (a) the inmate is mentally ill and a danger to himself or herself or others; or (2) the inmate is dangerous to himself or herself. Id. An inmate is considered “dangerous” and therefore amenable to a mental health placement in observation if there is “a substantial probability that the inmate will cause physical harm to himself or herself or others” as manifested by any of the following:

a. Recent homicidal or other violent behavior.

b. The reasonable belief of others that violent behavior and serious physical harm is likely to occur because of a recent overt act, attempt or threat to do such physical harm.

c. Serious self-destructive behavior or a threat of such behavior.

d. The inability to cope with life in the institution to the degree that himself or herself or others are thereby endangered.

Wis. Admin. Code § DOC 311.04(3). If — in the opinion of a clinician, crisis intervention worker, or physician — observation is not sufficient to properly handle the mental health concerns of a particular inmate, commitment procedures under Wis. Stat. § 51.20 or transfer procedures under Wis. Stat. § 51.37(5) may be pursued. Wis. Admin. Code § DOC 311 (Appendix). Mental health institutions, however, are generally reluctant to accept transfers of inmates for placement under these provisions, presumably for reasons of institutional safety, security and cost. Id.

An inmate may be placed in observation status by a clinician, crisis intervention worker, physician, the Warden, a registered nurse, or physician’s assistant. Wis. Admin. Code § DOC 311.04(4)(a)-(c). An inmate may also be placed in observation status by the security director or shift captain if a clinician, crisis intervention worker or physician is not available for consultation either directly or by telephone. § 311.04(4)(d).

Any property that an inmate can use to injure himself is supposed to be removed before he is placed in observation. Any staff member with authority to place an inmate in observation may change the inmate’s conditions of confinement by imposing restrictions in observation if the staff member reasonably believes any of the following are true:

a. Privileges or properties may be used by the inmate or another inmate also in the observation unit for self-harm or to harm others.

b. Properties cannot be moved conveniently to the observation cell.

b. Privileges cannot be offered due to the secured nature of the observation unit.

d. Properties or privileges are clinically or medically contraindicated.

Wis. Admin. Code § DOC 311.14(1).

For example, PSU clinicians have the discretion to choose which level of observation they believe is appropriate in the situation: close observation; constant observation; mechanical restraints; or closed circuit television monitoring. Every inmate who is placed in clinical observation shall, at a minimum, be placed in close observation status. While in close observation, security staff shall check on and briefly observe the inmate’s activities at staggered intervals not to exceed 15 minutes. Observations shall take place at cell-front and be recorded on a particular ledger or form for that purpose, referred to as “DOC-112.”

Inmates at high risk for imminent suicidal behavior are placed on constant observation. Constant observation involves continuous line-of-sight monitoring by correctional officers whose task is dedicated to the monitoring. Observations in constant observation shall be recorded in a DOC-112 at intervals not to exceed 15 minutes. Closed circuit television monitoring may be used in addition to, but never as a substitute for, these monitoring levels.

PSU staff is responsible for determining the level of supervision (close or constant observation) while an inmate is in observation status. This determination is made based on the clinician’s observation, review of the situation, and professional judgment. Any decrease in the level of supervision must be authorized by PSU staff or a physician.

An inmate may require mechanical restraint while in clinical observation status. Commercially manufactured devices used according to the manufacturer directions in order to restrict or impede free movement of the inmate’s hands/arms, feet/legs, and/or torso. Restraint materials may include leather, vinyl, nylon, canvas, or rubber. Bed restraints, restraint chairs, and mitts are examples of acceptable restraints.

REFERRAL FOR TREATMENT AT WRC

CCI psychologists also have the professional discretion to refer any inmate-patient to the WRC, which is run by the Wisconsin Department of Health Services (“DHS”), not WDOC. A prisoner may be referred to WRC for two reasons: (1) to treat a specific mental illness; and (2) to enable them to develop coping skills that will allow them to function in a regular correctional environment such as CCI. The fact that a patient is referred to WRC, however, does not mean that WRC will accept the patient. WRC and individual WDOC institutions negotiate most transfers on a case-by-case basis. Ultimately, WRC has the discretion to determine which patients it will accept, and PSU personnel working at WDOC facilities have no power to compel them to accept a particular patient.

OVERVIEW OF GOODVINE’S TREATMENT AT CCI: OCTOBER 2010 • THROUGH OCTOBER 2011 '

It is undisputed that Goodvine received extensive mental health treatment while confined at CCI, including therapy and acute psychological services by PSU staff. Following a suicide attempt in September 2010, Goodvine spent three weeks at the WRC for the purpose of stabilization. Upon his return to CCI in October 2010, Goodvine was examined by Dr. Leslie Baird for potential placement in observation. (Exh. # 101, at 1). Although Good-vine denied having any suicidal intentions, Dr. Baird determined that observation was warranted because Goodvine wrote in a letter while at WRC that he would “stop at nothing to kill himself’ if he was returned to a WDOC segregation unit. (Id.). Dr. Baird classified him with a mental health code of MH-1, and made a plan to continue routine monitoring for his diagnoses of Axis I Mood Disorder NOS (Not Otherwise Specified) and Axis II Antisocial Personality Disorder.

On October 18, 2010, Dr. Baird and members of PSU staff followed up by monitoring Goodvine while he was in observation. Goodvine remained in observation until October 20, 2010, when he assured Dr. Baird that he was not at risk to harm himself. (Exh. # 101, at 6). Dr. Baird met with Goodvine several more times in October 2010, reviewing adjustments to his medication regimen (Lithium, Loxapine, Mirtazapine, Quietiapine) prescribed by a unit psychiatrist (Dr. Maier) and advising him about the treatment interventions that were planned for him, which would require him to demonstrate willingness rather than willfulness. (Exh. # 101, at 9, 12). Dr. Baird advised Goodvine that part of his treatment depended on his willingness to stop resorting to self-harm as a “default,” rather than using the coping skills he was learning. (Id. at 9).

On November 5, 2010, Dr. Baird met with Goodvine out of his cell at his request. (Exh. # 101, at 11). Goodvine asked about whether Baird would consider making a recommendation to the security director to lift his restrictions. Dr. Baird presented information on mindfulness skills and he was given worksheets to complete independently before his next weekly session.

On November 10, 2010, Goodvine reported having a desire to “rip[ ] his arm open,” noting that “there’s many ways to carry that out.” (Id. at 13). He also reported having urges to stop eating and drinking. Goodvine’s cell was searched and he was placed in observation without incident. Later, however, Goodvine used metal from a “peak flow meter,” which is a small, handheld device used by Goodvine to manage his asthma, to cut his right arm. (Exh. # 101, at 14). He was transported to the emergency room for treatment, which required over 20 stitches. (Id.)

Dr. Baird checked on Goodvine while he was in observation and he was continued in that status to ensure his safety. Goodvine told another clinician (Dr. Tobiasz) that he had stopped taking his medications. (Dkt. # 101, at 16). When Goodvine indicated that he had made progress with Dr. Baird in the study of “core mindfulness skills,” Dr. Tobiasz encouraged him to make use of these DBT (dialectical behavior therapy) skills when he was feeling upset, frustrated or depressed, as opposed to engaging in self-harm. (Exh. # 101, at 18). Good-vine indicated that he wanted to be transferred to WRC in the future for more extensive training in DBT skills. On November 15, 2010, Dr. Tobiasz released Go-odvine from observation after determining that he did not pose a threat to harm himself.

Goodvine continued receiving therapy during bi-weekly sessions with Dr. Baird. During one of these sessions on November 16, 2010, Goodvine acknowledged that his recent decision to self-harm was an impulsive act. (Exh. # 101, at 19). Dr. Baird advised Goodvine that he needed to let people know if he felt like acting on thoughts of self-harm. Dr. Baird' noticed that Goodvine did not come prepared for their session and had not completed his worksheets as assigned. She indicated, however, that she would consider a referral to WRC.

Goodvine was seen by Dr. Maier and Dr. Baird on November 17, 2010, to evaluate his medication regimen. (Exh. # 101, at 20). Goodvine reported feeling stressed about depositions in an unspecified court ease, but was observed smiling and laughing at various points in' the conversation.

On November 23, 2010, Dr. Baird met with Goodvine at his cell during clinical rounds. At that time, Goodvine reported that he was “struggling” with a growing feeling of despair. (Ex. # 101, at 21.) Go-odvine had also declared a hunger strike. Dr. Baird asked whether he had tried to use coping skills rather than engaging in potentially self-destructive behavior and Goodvine indicated that he had tried a variety of things. He had not, however, attempted to complete any of his worksheets on the skills of mindfulness or acceptance.

When Goodvine inquired about a referral to WRC, Dr.'Baird informed him that it was important to gauge his “treatment readiness” and that his noncompliance with treatment-related work was demonstrating a lack of commitment. Dr. Baird further observed that Goodvine did not appear willing to do anything different as he was currently engaging in a hunger strike, apparently without trying any of the treatment-related skills he had been provided. (Ex. # 101, at 21.) Goodvine disagreed, stating that the treatment expectations were “not fair.” (Id.)

On December 1, 2010, Dr. Tobiasz met with Goodvine at his cell after a referral by security staff for possible placement in observation. (Ex. # 101, at 22.) . When Dr. Tobiasz arrived, Goodvine indicated that he was concerned about his diet and asked Tobiasz to contact the HSU because he would like to receive a nutritional supplement (“Boost”). Noting that Goodvine was not at risk for self-harm, Tobiasz advised Goodvine that it was inappropriate to request placement in observation or to request PSU staff for the purpose of contacting HSU when he was able to do so on his own.

Dr. Baird met with Goodvine on December 8, 2010, to further discuss a referral to WRC. (Ex. # 101, at 23-24.) Baird reminded Goodvine that his treatment plan required him to demonstrate a commitment to treatment and willingness to engage in work similar to the program that he would be required to undertake at WRC. Before a referral would be made, Goodvine needed to complete all four DBT modules (mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation) as this would be expected for the program at WRC. Instead, she noted that Goodvine had several. observation placements, had engaged in a hunger strike and had not completed his assigned work. Dr. Baird advised him that he would not be referred to WRC before Christmas and encouraged him to participate in coping skills treatment and his regularly scheduled clinical contacts. She also encouraged him to complete the remaining modules necessary for the DBT program.

At his next appointment on December 15, 2010, Goodvine completed all of his work- accurately and in full. (Ex. # 101, at 25.) Dr. Baird praised Goodvine for completing the work in a timely manner and provided him with additional worksheets on distress tolerance as these appeared to be helpful in managing his stress effectively without self-harm. Baird provided Go-odvine with a copy of his DBT treatment plan on December 16, 2010. The following day, Goodvine’s referral to the DBT program was discussed with WRC admission staff.

On January 3, 2011, Dr. Baird submitted a referral for mental health placement to WRC for Goodvine’s participation in the DBT program and to evaluate him for a potential eating disorder. (Ex. # 101, at 226-27.) In that referral, Dr. Baird noted that (1) Goodvine was assigned to segregation and (2) his personality disorder appeared to impede his ability to function optimally in segregation status. Dr. Baird further noted that Goodvine had engaged in a pattern of self-harm while in segregation, as well as engaged in a pattern of litigation against DOC and encouraged other inmates to do the same while in segregation at CCI. According to Dr. Baird, this latter behavior reflects an exacerbation of his personality disorder in that Goodvine reportedly “sets up” staff members for this type of litigation. As an example, Dr. Baird noted that Goodvine recently filed a lawsuit claiming an eating disorder that had gone untreated while in WDOC.

Dr. Baird also noted that Goodvine had engaged in self-harm and hunger strikes in the recent past, which Goodvine claimed were related to an eating disorder and concerns about his appearance, though this had not been consistent. Dr. Baird opined that: (1) Goodvine’s symptoms appeared primarily related to his personality disorder; and (2) there often appeared to be some type of secondary gain from his maladaptive behaviors, particularly in the form of lawsuits against the WDOC. Dr. Baird believed that Goodvine would benefit from structured programming that incorporated boundaries, interpersonal effectiveness skills related to his personality disorder, and distress tolerance skills. According to Dr. Baird, Goodvine acknowledged that these skills have been helpful to him and demonstrated at least some insight about his behaviors. Goodvine further appeared motivated to return to WRC for programming, demonstrated a willingness to engage in treatment, recently completed work skills and demonstrated an understanding of skills. Dr. Baird noted that Goodvine’s engagement in treatment at CCI appeared to be an avenue to “earn” a referral to WRC.

While Dr. Baird’s referral to WRC was pending, PSU staff continued monitoring Goodvine and counseling him on coping skills to help him manage his destructive thoughts without resorting to self-harm. These efforts were met with mixed success as Goodvine alternated between segregation in DS-1 and observation.

On January 5, 2011, Goodvine requested and was put in observation. (Ex. # 101, at 27, 228.) The unit was described as chaotic that day. At one point, Goodvine grabbed a medication card from an officer who was distributing medication, explaining later that it was an impulsive act done “to play with” the officer. (Ex. # 101, at 27.) Goodvine was released from observation the following day after advising Dr. Baird that he was doing “alright.”

Goodvine returned to observation on January 13, 2011, after indicating that he was feeling stressed, depressed, and anxious. (Ex. # 101, at 30.) He told Dr. Baird he was harboring thoughts and had developed a plan for self-harm. In particular, Goodvine reported thinking of overdosing and had stored pills in his possession for that purpose. (Ex. # 101, at 30.) The following day, Dr. Nelson elected to continue Goodvine’s placement in observation for his own safety, advising Goodvine that he should not store up pills. {Id. at 31.)

On January 18, 2011, Goodvine was again released from observation. During his post-observation review with Dr. Baird, Goodvine told her that he was not going to tell anyone anymore when he had thoughts of harming himself because of what happened when he did — namely, placement in observation. (Ex. # 101, at 33.) Dr. Baird counseled that observation placement was for the purpose of safety and noted that he had successfully avoided hurting himself by alerting her to his state of mind.

On February 8, 2011, Goodvine announced that he intended to embark on a “campaign of self-harm,” which Dr. Baird interpreted as a “planned effort to engage in ineffective behavior” to get what he wants. (Dkt. # 101, at 34.) In particular, Goodvine was focused on transferring to WRC and threatened to begin doing “anything he could think of’ to hurt himself unless he received an answer regarding his referral by next week. Dr. Baird reminded Goodvine that his statements were contraindicated for treatment and that if he were really motivated he would look for ways to improve his own behavior rather than to engage in bargaining or “negotiating.” Acknowledging that this type of behavior could be interpreted as manipulative or a threat, because it related wholly to external gain, Goodvine relented and indicated that he no longer planned to harm himself. Goodvine also “contracted” or agreed with Dr. Baird that he would maintain personal responsibility for his safety. Specifically, Goodvine stated that he would notify staff if he began to feel unsafe, as he had before his last observation placement; Goodvine also acknowledged that it was imperative to his treatment that he be motivated to keep himself safe. (Ex. # 101, at 34-35.)

Nevertheless, Goodvine continued to cope poorly while awaiting a response to Dr. Baird’s referral to WRC. On February 16, 2011, Dr. Baird was summoned to Go-odvine’s cell at his request. (Ex. # 101, at 36.) Goodvine stated that he did not think he could “make it” the estimated three, more weeks until he received notice of an upcoming step-2 review process, which apparently concerned his security classification and potential transfer from DS-1 to DS-2. Fearing that he may get a conduct report, Goodvine denied having any intention of harming himself or needing placement in observation; Dr. Baird noted that, once again, this contact appeared related to Goodvine’s focus on access to external gain, which was evidently the primary purpose for his arguable improvement.

On February 22, 2011, Heise, as Admissions Coordinator for WRC, declined to admit Goodvine for treatment based on Dr. Baird’s referral. (Ex. # 101, at 37.) Heise determined that Goodvine’s placement at WRC was not appropriate at that time after discussing his ongoing “mental health behavior management treatment plan” with WDOC staff from CCI, the Green Bay Correctional Institution, Wau-pun Correctional Institution and the WDOC central office in Madison. Based on that plan, Heise believed that Good-vine’s needs could be met at the WDOC facility where he currently resided (ie., CCI), and where he was already receiving coping skills instruction in preparation for the DBT program.

After his referral to WRC was denied, Goodvine’s behavior worsened. On February 25, 2011, security staff informed Dr. Baird that Goodvine was cutting himself. (Ex. # 101, at 38.) Dr. Baird observed that his wrist had been cut and was bleeding. Goodvine stated that he had cut himself on the trap door to his cell because he was feeling “anxious.” Dr. Baird opined that Goodvine had chosen to self-harm as a means to solve his problem. Despite his previous agreement with Dr. Baird, Good-vine had not reported having thoughts of self-harm before cutting himself. Good-vine was treated at the hospital and placed in clinical observation upon his return to CCI.

Goodvine cut himself twice more on February 27, 2011, requiring trips to the emergency room. (Ex'. # 101, at 39.) Goodvine had reportedly told a staff member that he needed to be restrained before leaving for the hospital to receive treatment that evening. A security supervisor notified Dr. Baird when Goodvine returned from the hospital and full-bed restraints were authorized as Goodvine had exhibited behavior that evidenced on-going instability and unwillingness to behave in a safe manner. Goodvine was released from observation into full-bed restraints due to the severity of the harm and his attempts to conceal self-harm. (Ex. # 101, at 40^11.)

After being released from the full-bed restraints on February 28, 2011, Goodvine was returned to observation status but continued to prove a difficult patient. On March 8, 2011, Dr. Baird met with Good-vine at length during an out-of-cell consultation to discuss some concerns he had raised in a letter the previous day.. (Ex. # 101, at 42.) Specifically, Goodvine stated that he was no longer going to be eating, despite telling Dr. Baird he would when in observation status. In his letter, Goodvine further acknowledged telling Baird this, while actually planning to continue his hunger strike.

When confronted with his dishonesty, Goodvine explained that he had changed his mind about his promise after receiving some unexpected conduct reports and restrictions the previous night. Dr. Baird noted that Goodvine’s behavior appeared “planful and willful,” continuing to demonstrate that staff could not trust him.

During his March 8 meeting with Dr. Baird, Goodvine also expressed anger about staff reaction to his multiple cuttings on February 27, as well as the failure of security to communicate with PSU staff about his problems and statements of self-harm. (Ex. # 101, at 42.) When Goodvine asked whether Dr. Baird was notified of his statements of intent to self-harm, Dr. Baird informed him that no advance notification was provided and that this was likely due to the fact that Goodvine was already in observation status.

Dr. Baird also discussed with Goodvine his request for a “protocol” for “therapeutic restraints.” (Ex. # 101, at 42.) Good-vine wanted to have the authority to determine what type of restraint was necessary (e.g., chair or bed restraints). Should a protocol be put in place for the use of therapeutic restraints, Dr. Baird explained that Goodvine would not be given the authority to choose his own restraints for a variety of reasons related to the clinically/medically indicated duration of different restraint options, as well as the necessity for clinical/medical service professionals to assess this need. Attempting to engage Goodvine in a conversation about safety, Dr. Baird reminded Goodvine that he had to care about his own safety as much as clinical staff did in order for anyone to be able to assist him in keeping himself safe. Dr. Baird reminded Goodvine of recent times in which he had misled her about his safety and failed to uphold his safety plan. She discussed how his dishonesty adversely affected their clinical relationship, trust, ongoing treatment interactions and safety assessments. Dr. Baird explained to Go-odvine that it would be difficult or impossible to guess his current safety status if he failed to report any problems to staff, emphasizing that was his responsibility as he appears to be externalizing “blame” for his recent behavior that, by his own indication, appear to have been “planful acts of self-harm.”

Goodvine was offered an appointment on March 21, 2011, to address his hunger strike, but Goodvine refused the appointment. (Ex. # 101, at 44.) Although he was seen for a psychiatry appointment on March 30, 2011, he again refused to speak with Dr. Baird. (Ex. # 101, at 44.)

During Dr. Baird’s routine clinical rounds on April 5, 2011, Goodvine asked to be seen immediately and reported that it was an “emergency.” (Ex. # 101, at 46.) In the ensuing discussion, Goodvine (1) noted that there had been a “step-down” meeting with the administrative captain and (2) wanted to be on a “no razor restriction” when he moved from DS-1 to DS-2. Dr. Baird agreed that the restriction appeared warranted and observed further that Goodvine appeared to be taking a proactive approach to remaining safe as he progressed through the step process. Go-odvine denied feeling “self-harmful” at that time, stating that although the urge to hurt himself was “always” present to some degree, it was not then strong.

During this April 5 discussion, Goodvine again asked Dr. Baird about a protocol for being preemptively placed in restraints. After a brief discussion, Goodvine was once again informed that this type of protocol did not exist at the time. Dr. Baird discussed the importance for Goodvine to practice bolstering coping skills to better manage distress as it came up, as well as how restraints could potentially interfere with this goal if applied unnecessarily. Dr. Baird also noted that Goodvine’s mental health code had changed, reflecting designations of both MH-1 and MH-2b, as the result of further discussion with PSU staff regarding the recent increase in behavioral symptoms associated with his personality disorder.

On April 6, 2011, Goodvine was seen individually out of his cell by Dr. Baird and Dr. Schwebke to discuss his ongoing treatment plan. (Ex. # 101, at 47-48.) Dr. Schwebke began by discussing Goodvine’s request for a more specific restraint protocol. Dr. Schwebke shared Baird’s concerns with utilizing restraints too liberally, which could interfere with the development and use of coping skills when exposed to uncomfortable experiences. Dr. Schwebke discussed the importance of brief exposure and an incremental process of evaluation and intervention. Dr. Baird also discussed the importance of honesty in this type of evaluation and talked about situations in which Goodvine had not engaged honestly in safety assessments, making it more difficult or impossible to assist him in remaining safe.

Goodvine reportedly acknowledged a few periods in which he had been dishonest with PSU staff about his safety and access to potentially harmful items. Dr. Baird also pointed out times in which Go-odvine had been able to redirect himself and utilize coping strategies to effectively manage emotions, even during periods of time in which he initially seemed resigned to engaging in self-harm. Dr. Baird encouraged Goodvine to take self-harm off the table in order to engage in treatment fully and in the process of accessing alternative methods of coping with his distress. Dr. Baird explained how retaining the idea of self-harm as an option for coping with his problems would likely impede his growth in these areas because he could always default to utilizing these less adaptive methods when other methods seemed to be challenging. Dr. Schwebke discussed Goodvine’s use of self-harm and restrictive eating patterns as having a variety of functions, including drawing external attention to his problems and also periods of emotional instability and problematic ways of thinking about himself.

On April 22, 2011, Drs. Baird and Schwebke again met with Goodvine following his step-down placement in DS-2. (Ex. # 101, at 49.) They observed that Good-vine appeared to be doing better in terms of his emotional adjustment to the unit. He had been on the DS-2 unit for about a week and was coping adequately. Good-vine discussed some of his recent thoughts and feelings, including how the scars he incurred from his past attempts at self-harm have influenced his thoughts, feelings and urges. In particular, Goodvine felt some sense of anxiety about his responses to other peers who might inquire about the scars and his general well-being. Drs. Schwebke and Baird discussed those thoughts and feelings in more detail, as well as different strategies to cope. At that time, Goodvine had been able to wear long sleeve shirts to cover his scars and felt more comfortable by not having them revealed to both himself and others.

In terms of a program to address Good-vine’s self-harm going forward, PSU staff, in consultation from Dr. Ankarlo, áddéd some additional precautionary elements, including the option of a “direct vigil” while he was in observation under certain circumstances. Goodvine seemed pleased with this plan as a way to assist him in feeling more secure. Goodvine also learned that Dr. Schwebke would be primarily seeing him for treatment purposes in the future and that he planned to refer Goodvine to the “Personality Disorder Group” at WRC in- the future, while Dr. Baird would continue to assist with any additional coaching on DBT skills as needed. Dr. Schwebke noted that Goodvine had been making an adequate adjustment to the DS-2 unit and coping appropriately. During Goodvine’s transition from DS-1 to DS-2, PSU staff had also shared with him some information and material on mindfulness, anger control/management and nutrition.

On May 2, 2011, Goodvine was on track for release from segregation into the general population at CCI. (Ex. # 101, at 50.) PSU staff continued to monitor him and provide him with materials on coping skills and mindfulness. (Ex. # 101, at 51.)

On May 24, 2011, Goodvine met with Dr. Baird and members-of the WRC outreach team. (Ex. # 101, at 52.) Dr. Baird initiated this discussion for the purpose of a preliminary interview and assessment of Goodvine’s motivation for potential ongoing treatment at WRC when the personality disorder program was developed. A member of the outreach team discussed the way in which the program would be structured, the timeline, and likely expectations for completion and participation. Goodvine agreed that he would complete “new freedom materials” independently if they were sent to him and WRC would plan to follow up with him again in the future.

On June 7, 2011, Dr. Nelson met with Goodvine, following his release from segregation and transfer back into the general population at CCI. (Ex. # 101, at 53.) Dr. Nelson noted that Goodvine seemed to be doing “pretty well” and was getting along with others on his unit. Goodvine asked about his .referral to WRC for the personality disorder program; Dr. Nelson told him she would follow up. In the meantime, Goodvine continued to be followed by psychiatry for purposes of monitoring his medication and PSU staff members. (Ex. # 101, at 53-55.)

On July 25, 2011, Goodvine met with Dr. Baird, who noted that Goodvine was on another hunger strike. (Ex. # 101, at 56.) Goodvine had met with his lawyer earlier that day and expressed frustration regarding how his legal calls were being handled by the unit social worker. He was encouraged to write to the unit social worker and/or unit manager about this and Dr. Baird followed up with the unit manager. Dr. Baird attempted to redirect the discussion to managing his distress regarding the current situation and Goodvine continued to request that Dr. Baird assist him in remedying the situation. Goodvine also inquired about an assessment that was being requested in conjunction with his referral at WRC. Goodvine asked whether he could be given clinical authorization to take his meals in his cell because he reportedly felt anxious eating in the dayroom with other inmates. Dr. Baird advised Goodvine that continued avoidance of this anxiety could exacerbate the issue further, but agreed to consult with the other PSU staff about the requested authorization as this was typically a group decision.

During an out-of-cell meeting on August 11, 2011, Goodvine reported feeling “restless” because he had not gotten any answers about his potential referral to WRC. (Ex. # 101, at 58.) Dr. Baird briefly discussed this with Goodvine and explained some of the reasons for the delays, but also encouraged him to use coping skills to tolerate the distress. Goodvine was applying for jobs and believed that a position in the kitchen looked promising. He had also applied to take part in an educational program at CCI, although he reported having an unsatisfactory interaction with the teacher, who he believed was being unfair to him. Dr. Baird discussed appropriate social skills, interpersonal effectiveness skills and a way to approach the teacher by inviting her to have a conversation with him about his concerns.

On September 8, 2011, Dr. Baird met with Goodvine out of his cell. (Ex. # 101, at 60.) Goodvine reported feeling “restless” and “sick of the same routine.” Goodvine reported attending an anger management class and going to school “to keep himself sharp.” Goodvine further reported that the night before he thought about hurting himself and going to observation, but denied having an intention to harm himself at that time and stated that the thoughts of self-harm were only in the “periphery of his mind.” Goodvine reported that he spent much of his time exercising, studying and reading and acknowledged that he was currently working with another PSU staff member (Dr. Trinidad) on identifying and modifying irrational thinking. Dr. Baird inquired how Goodvine thought that applied to the current situation and engaged him in a discussion about mindfulness, recognizing that he frequently reacted to situations that may potentially occur in the future, rather than remaining “in the moment” and responding to the current situation and context. When Go-odvine commented that he believed something “bad” was going to happen, Dr. Baird discussed ways that this thought could become a “self-fulfilling prophecy.” Dr. Baird engaged him in a discussion about thought-stopping activities and this was practiced. She also encouraged Good-vine to “build purposeful structure and mastery” into his routine by engaging in activities with an identified goal and purpose in mind.

Three weeks later, on September 29, 2011, Goodvine attacked another inmate, stabbing him several times with a weapon made of pencils. As a result of this incident, Goodvine returned to segregation status in DS-1. This dramatic setback also set off a chain of four incidents of self-harm during the month of October 2011. Those incidents are summarized in more detail below and form the principal basis for the pending lawsuit.

SPECIFIC INCIDENTS OF SELF-HARM IN OCTOBER 2011

I. Incident of Self-Harm on October 1

On September 29, 2011, Dr. Kumke saw Goodvine at his cell door for a clinical evaluation following the attack on another inmate that resulted in Goodvine’s placement in DS-1. Goodvine reported that he was on a hunger strike because he “want[ed] to die.” Goodvine also expressed fear that: (1) he was going to be stuck in “security” or segregation status, and unable to extricate himself; and (2) he might at some point go back to cutting himself like he had in the past, although he denied thinking of cutting himself at that time. Dr. Kumke encouraged Goodvine, noting that he had been able to be in the general population and could get himself out of segregation again. Goodvine requested to be placed in a cell in the back area of DS-1 because he would feel “safer” there. Kumke consulted security staff, but apparently there were no cells available in the back area.

During their discussion on September 29, Goodvine reportedly told Kumke that he was hearing negative voices and feeling very hopeless. (Dkt. # 236, at ¶ 115.) Go-odvine asked to be put in observation for his own safety.. (Id. at ¶ 117.) On evaluation, however, Kumke found that Goodvine was not in imminent threat of self-harm and decided not to place him in observation status at that time. (See Ex. # 101, at 62.) Based on this evaluation, Kumke made a plan to have PSU staff check in with Goodvine the next day to reassess how he was doing. (See id.)

Drs. Nelson and McLaren followed up with Goodvine the following day on September 30, 2011. By that time, Goodvine reported that he had not eaten or taken any liquids in two days, but accepted responsibility for the behavior that resulted in his placement in segregation (attacking another inmate) and felt upset and disappointed about being in segregation again. Drs. Nelson and McLaren drew upon Go-odvine’s past experience in general population as evidence of progress. They encouraged him to use the coping skills he had applied in order to leave segregation previously and maintain general-population status as he faced this new challenge. Go-odvine admitted.that he had thoughts of cutting himself recently, but had chosen to sleep instead as a way to cope. Drs. Nelson and McLaren gave Goodvine some books to help him occupy his time and noted that he appeared amenable to refraining from self-harm. Nelson and McLaren notified unit staff, the shift supervisor, and HSU of Goodvine’s continued refusal of food and liquids. (See Ex. # 101, at 63.)

At approximately 6:31 p.m. on October I, 2011, security staff working in the DS-1 unit requested assistance after noting that Goodvine had cut himself and smeared blood on his cell window. (Incident Report # 15608.) When additional officers arrived, Goodvine was removed from his cell and placed in restraints. At that time, officers recovered two pieces.of metal that Goodvine had hidden in his hair. At approximately 7:00 p.m., Goodvine was transported to the local hospital (Divine Savior Hospital in Portage) for sutures. He returned to CCI later that evening at around 9:30 p.m. and was placed in observation status. Goodvine claims that he asked Sergeant Schneider to contact PSU staff so that he could be put in observation status before cutting himself, but that Schneider ignored him and did nothing to prevent harm.

II. Incident of Self-Harm on October 5

Following the October 1 incident, Good-vine was placed in observation in DS-1. On October 3, Dr. McLaren met with Good-vine to review his observation placement. Goodvine denied having current thoughts of self-harm, but said that his placement in observation was “no good,” that he had “nothing to look forward to,” and that he “needs a change of environment.” Dr. McLaren agreed to check on Goodvine’s referral to WRC and update him the next day. When Goodvine requested a blanket, McLaren informed him that if he was able to demonstrate “behavioral stability” and no further intent to self-harm, she would revisit the blanket issue with him in the morning. On examination, Dr. McLaren noted that Goodvine’s eye contact was poor and his affect was depressed. Based on her evaluation; McLaren continued Good-vine’s observation placement due to his recent behavior and his continued appearance of being depressed. (See Ex. # 101, at 00066.)

Dr. McLaren met with Goodvine again on October 4 to review his placement in observation. She noted that Goodvine continued to refuse food and liquids, at least according to DS-1 security staff. Goodvine repeated his request for a security blanket, stating that he no longer had thoughts of self-harm. Goodvine reportedly informed McLaren that he would use his coping skills to manage distress if he were released from observation and then noted that the lack of sleep that he had been experiencing while in observation would “lead to a breakdown.” When Goodvine inquired about his referral to WRC, McLaren informed him that he would not be going to WRC due to his recent battery of another inmate. (See Ex. # 101, at 00067.) After consulting with another doctor, McLaren approved a security blanket for Goodvine. She also continued Good-vine’s observation placement based on his recent episode of self-harm and his difficulty in demonstrating emotional and behavioral stability. (See id.)

On October 5, 2011, Dr. McLaren met with Goodvine at his cell front for review of his observation status. At that time, she noted that Goodvine appeared depressed and withdrawn. His gaze was primarily directed at the floor and his voice was extremely soft. Goodvine reported that he continued to refuse food and liquids. When McLaren asked him how he felt, Goodvine stated, “I just want to die” and “I want to kill myself’ numerous times. McLaren made emphatic statements regarding Goodvine’s situation, and brought up his ability to cope with setbacks, but Goodvine made no further statements. (See Ex. # 101, at 00068.) Based on this evaluation and Goodvine’s continued expression of a desire to harm himself, Dr. McLaren maintained Good-vine’s observation status. (See id.)

After Goodvine stated that he was going to force them to take him to the hospital “because he was bored,” security staff conducted a search of his cell. (Incident Report, # 15862.) Nothing was found. At approximately 1:55 p.m. on October 5, Go-odvine was nevertheless able to cut his left wrist. (Incident Report, # 15952.) As a result, Goodvine was escorted to Divine Savior Hospital for sutures. Goodvine claims that he told defendant Officer Wiley and defendant Officer Millonig that he was having thoughts of self-harm before he cut himself, but that neither officer contacted PSU or a supervisory officer on his behalf.

III. Incident of Self-Harm on October 12

In the days leading up to the October 12 incident, Goodvine was evaluated on a daily basis by Dr. Kumke. Dr. Kumke had checked on Goodvine after he returned from the hospital on October 5, 2011. (Ex. # 101, at 69.) At that time, Goodvine reported that he was feeling better, although he felt slightly nauseous. Dr. Kumke noted that Goodvine did not appear agitated and denied any current thoughts of self-harm. Based on his evaluation and Good-vine’s actions that day, Dr. Kumke found that Goodvine remained at risk for self-harm and continued him in observation status. (See Ex. # 101, at 69.)

Dr. Kumke met with Goodvine again the following day on October 6. At that time, Drs. Kumke and Johnson reviewed Good-vine’s placement in observation status given his statements about going to the hospital because he was bored. Goodvine complained that he was feeling depressed and needed to be released from observation status before the weekend. Goodvine stated that he “[couldn’t] stay in here over the weekend,” and that he “would not do anything stupid” if he were released from observation the next day. When asked if he would make it through the weekend without engaging in any self-harm, Good-vine replied that he was positive he would. Goodvine was informed that he would be seen the next day for re-evaluation and was encouraged to refrain from any self-harm behaviors. (See Ex. # 101, at 71.) Drs. Kumke and Johnson still elected to continue Goodvine in observation status as a precaution based on their evaluation and his recent actions of self-harm.

On October 8, Dr. Kumke met with Go-odvine at his cell door for clinical follow-up upon his release from observation. Good-vine reported that he was doing “OK” and denied having any thoughts of self-harm. Since Goodvine was feeling