Full opinion text
OPINION PETTINE, Chief Judge. This is a consolidated class action brought by five prisoners confined in the Rhode Island Adult Correctional Institutions (ACI) and by the National Prisoners Reform Association on behalf of all the prisoners incarcerated at the ACI. The plaintiff class, numbering over 650, includes pre-trial detainees as well as sentenced prisoners. Plaintiffs claim that the conditions under which they are confined violate the Eighth and Fourteenth Amendments to the United States Constitution, as well as various provisions of state law. They contend that the violations are so gross as to justify broad injunctive relief, including the permanent closing of the Maximum Security Building at the ACI complex in Cranston, Rhode Island. No damages are sought in this action. Plaintiffs make four principal claims. First, that the defendants subject inmates housed in the Maximum and Medium Buildings to constitutionally intolerable levels of fear and violence. Second, that the defendants subject those prisoners to constitutionally intolerable conditions of confinement, including gross filth, unsanitary living quarters, unsanitary food services, dangerously inadequate medical care, and near-total idleness, all causing the physical and mental deterioration of inmates. Third, that pre-trial detainees are punitively subjected to conditions even worse than those suffered by sentenced inmates, and far in excess of any conditions reasonably necessary to insure their presence at trial. Fourth, that prisoners in protective custody are subjected to conditions worse than those suffered by sentenced prisoners, an alleged violation of the equal protection clause of the Fourteenth Amendment. Jurisdiction of this action arising under 42 U.S.C. § 1983 is conferred by 28 U.S.C. §§ 1343(3) and (4). The class was certified by order of July 23,1976. Pendent jurisdiction is assumed over the state law claims, since they arise out of the same nucleus of fact as the federal constitutional claims and are likely to reduce the necessity for constitutional adjudication. Smith v. Sullivan, 553 F.2d 373 (5th Cir. 1977). I After extensive discovery, a trial was held which extended over two weeks. The findings of fact required by Fed.R.Civ.P. 52 are set forth herein, and are based on the testimony received at trial, stipulations by the parties and extensive exhibits, including depositions of various officers of the Department of Corrections. The Court’s task was made easier by the extensive assistance of experts from various fields of corrections, institutional environmental health and sanitation, and correctional psychology. Although their qualifications, with few exceptions, will not be recounted herein, it suffices to say that the Court found them all extremely well-qualified, articulate, and fair. Their testimony was hardly disputed or contradicted by the defendants. The Court also toured the institution during the trial. It should be noted that the Court has extensive familiarity with the ACI stretching over almost a decade. See, e. g., Morris v. Travisono, 310 F.Supp. 857 (D.R.I.1970); id., 373 F.Supp. 177 (D.R.I.1974), aff’d 509 F.2d 1358 (1st Cir. 1975); Ben David v. Travisono, 373 F.Supp. 177 (D.R.I.1974), aff’d 495 F.2d 562 (1st Cir. 1974); National Prisoners Reform Association v. Sharkey, 347 F.Supp. 1234 (D.R.I.1972); Souza v. Travisono, 368 F.Supp. 959 (D.R.I.), aff’d in part 498 F.2d 1120 (1st Cir. 1974). To avoid extending an already lengthy opinion, the Court will not, in most instances, make specific findings of fact regarding deficiencies and inadequacies as they pertain to individual inmates. Extensive testimony, from inmates and from experts who examined inmate records, documents the cumulative case presented here, a case which would be neither added to nor detracted from by recitation of additional incidents. Approximately 544 of the 661 plaintiff-inmates at the ACI are confined in two buildings at the ACI complex, which will be referred to as Maximum Security or Maximum and Medium Security or Medium. As will appear in greater detail, the latter name is a misnomer, for the inmates housed therein are with few exceptions all inmates classified as maximum security, but granted protective custody to protect them from other inmates, either at their own request or by decision of the Department. Approximately 117 other inmates, in' minimum custody and work-release programs, are housed in other buildings at the ACI complex. As did the parties at trial, this opinion will focus on the conditions under which the 544 inmates in Maximum and Medium are confined. 1. Living Conditions in Maximum Security The Maximum Security Building is over 100 years old, built for a capacity of 55 inmates at a time when penological practice dictated that prisoners be incarcerated in their cells throughout their imprisonment. It was well designed for that purpose, but it is inadequate for twentieth century correctional purposes. For at least the last five years, Maximum has held over 420 inmates, usually including 125 pre-trial detainees and 25 recently sentenced inmates, who by law are supposed to be confined apart from the general population for up to 30 days. At trial, the defendants finally conceded that Maximum has outlived its usefulness, and that it is unmanageable for anywhere near the number of inmates now confined there. The building consists of massive iron cellblocks, arranged usually with cells in three ascending tiers reached by catwalks. The walls of the building are made of porous stone. They are impossible to keep clean and are encrusted with literally decades of dirt and grime. Between the tiers and the outer wall there is a walkway. The huge windows on the outer wall contain numerous broken or missing panes of glass. The window ledges are heaped with dust, dirt, and assorted trash. It is plain that no serious attempt has been made to clean them in months, if not years. By all accounts, housekeeping has deteriorated throughout Maximum drastically, and irremediably, in the last decade. Without major reconstruction and renovation, it is impossible to maintain minimum standards of sanitation and cleanliness in Maximum. A number of experts with wide experience in managing and studying prisons across the country testified that Maximum was the filthiest prison they had ever encountered. The Court accepts this assessment as accurate; certainly, nothing that the Court observed on its view of Maximum would in any way undermine its credibility. Trash abounds on the floors and in empty cells. The entire structure is massively infested with cockroaches, rodents, mice, and rats, each of which carries disease throughout the prison. There are cats living in Maximum, and cat feces were observed on the floors of living areas and the showers. In parts of the building, the roof leaks rainwater, and tiles were falling off the ceiling onto the floor. Plumbing throughout Maximum is unsanitary, inadequate, and an imminent danger to public health. It is as old as the building. Only cold water is available in inmate cells, although minimum standards for correctional institutions formulated, inter alia, by the Department of Justice require hot water as a health measure. Pipes are not equipped with vacuum breakers, creating an ever-present danger that waste water will back up into the fresh water system, even in the food preparation area. There is no regular maintenance program to guard against this threat. Plumbing leaks throughout the cell tiers, particularly in the service areas which run down the middle of each tier dividing the front from the back cells. Because these service areas house the electrical wiring, the leaking pipes present a serious risk of electrical fire. The damp conditions in the service areas are an ideal breeding area for the swarming cockroaches, which exist in all stages of development. In the lavatories, the Court observed large pools of standing water on the floor, and apparently this is always present. There was a stench of urine coming from this water. The shower areas were filthy, covered with mold and mildew on the floors and the walls. Glass, trash, and dead cockroaches are everywhere on the shower floors. Not infrequently, inmates burn themselves on the hot water pipes which rise uncovered in the showers. Lighting is inadequate for prisoners to read safely in their cells. Minimum standards require 30 foot-candles; the average range in Maximum was between 10 and 15. Aside from the adverse effects on prisoners’ vision, inadequate lighting increases tension and fatigue among prisoners and guards. Not incidentally, adequate lighting could serve as a significant deterrent to the appearance of roaches and rodents. The noise level throughout Maximum is deafening and maddening, and must inevitably increase the levels of both tension and psychological distress. There is a constant din from radios and televisions, each attached by a wire antenna from the cells to the outer windows in a grotesque Maypole effect. The heating and ventilation system is antiquated and incapable of providing minimally adequate heat and ventilation. Heating pipes are all located on the outer walls. There is no mechanical system to transfer and spread hot air, or fresh air. As a result, most cells are cold throughout the winter. One expert took readings in the lower cell areas and found the midday temperature at 50° in January and 55° in April. Minimum standards for institutional health are presently set by public health experts at 65°. Prisoners and guards make frequent complaint of winter cold, which lowers resistance to disease. Another expert observed that he had never before inspected a prison where inmates and guards wore heavy coats, day and night, during the winter. Nor is the unacceptable level of discomfort confined to the winter months. During the summer the institution is unbearably hot and damp, and the top tiers are particularly stifling. Indeed, it was not disputed that the present heating and ventilation system in Maximum is incapable of providing minimally adequate heating according to relevant public health standards, and that it cannot be upgraded without uneconomic expenditures. There are numerous fire hazards throughout the institution, a cause for grave concern. Many prisoner mattresses are made of a polyurethane foam material which for more than a year has been banned for consumer use by the Federal Consumer Product Safety Commission because of the poisonous fumes it releases on combustion. The Court takes judicial notice that between the time of trial and preparation of this opinion, 42 inmates died in a Tennessee jail fire, reportedly from inhaling fumes released by polyurethane used in mattresses and padded walls. The urgency of this situation cannot be overstated, for it is common for prisoners in Maximum to set fire to other prisoners’ cells. In an attempt to secure a measure of privacy, and to reduce cold drafts, many inmates have woven paper plates, magazine covers, and other paper goods between the iron bars of their cell doors. It is apparent that this practice is a major fire hazard. Worse, it occurs on many upper tiers which have only a single means of egress, inadequate by any minimum standards of fire safety. Among the other serious fire hazards, the Court particularly notes the clothes dryer area in the Behavior Control Unit (BCU), of Maximum, which is inadequately ventilated. Indeed, nearly all the laundry areas present a serious risk of electrical fire, with exposed electrical wiring and overused domestic washing machines designed for home use. Conditions in the food service area in Maximum were so deplorable that plaintiffs’ public health expert testified that the food service operation presented an imminent public health danger and that he would order it closed immediately if it were under his jurisdiction. There was evidence of rats, mice, and cockroaches throughout. The Court observed sacks of grain and boxes of crackers stored on top of garbage cans outside the kitchen door, which was wide open, with pigeons wandering about. Stoves and ventilation hoods were encrusted with grease and grime. Mice droppings were found in open food containers in both the dry and cold storage areas. The kitchen floor was filthy. One expert observed dead pigeons and flies surrounding the solid waste disposal area, which was just outside an open kitchen door in one of the recreation yards. Tools used to cut meat were filthy. Grease covered kitchen equipment. Peeling paint was falling from the ceiling throughout the kitchen area, especially in cold food storage area and the dishwashing area, a product of inadequate ventilation and maintenance. This paint is of such ancient vintage that it likely — though no tests were performed — contains lead. Tiles were missing from the walls, and the exposed underwall cannot be cleaned. There was water on the kitchen floor, as well as grease, a serious safety hazard. Plaintiff’s public health expert testified that the food temperature he found on a number of testings was in each instance far below the minimum standards necessary to retard bacterial growth. Food preparation, the experts testified, met none of the generally accepted minimum standards for institutional health. The plumbing in the food service area was also deficient. Hot water was leaking from one pipe. There are no handwashing facilities in this area, nor in an adjacent toilet used by the inmate-staff of the food services. The inmates who work in the food service receive no training. The lack of training and obvious lack of leadership by outside staff are major causes of the deficiencies observed. The industrial shops were similarly in a general state of disorder. The floors showed no evidence of recent sweeping. Dirt and grime were spread over machines. A public health expert noted numerous safety hazards, and concluded that no attempt is made to keep the shops either orderly, clean, or safe. There is no safety instruction for inmates working in the shops, nor are there any safety signs. Environmental health standards in the infirmary area were no better than in the other areas of the prison. The infirmary failed to meet minimum standards for the control of infectious disease. For example, two patients with suspected hepatitis were pfaced at the back of a ward, necessitating their having to pass through other sick inmates on their way to the shower or lavatory, which they shared with other inmates. Pre-trial detainees for whom there is no room in the Awaiting Trial section are often housed in the infirmary, together with infectious patients. There is no written infection control manual for the infirmary staff, which is largely untrained. There was dirt and trash on the floors, and the bathroom was no more sanitary than the bathroom facilities in the rest of Maximum. The shower drain was defective. Screens on the windows were blocked with debris and dirt. Colostomy bags are simply deposited with other trash in a garbage barrel in the infirmary dormitory. The temperature of the food served to patients was tested and found to be inadequate to retard bacterial growth. Hospital staff were without training in use of the X-ray unit. Housekeeping throughout Maximum has broken down. Although there is abundant evidence of lack of attention to housekeeping in the cells of various prisoners, the situation is even worse in the common areas of the prison, which must be the basic responsibility of management. The condition of the floors was uniformly bad, with cigarette butts, wrappers, and coffee cups strewn everywhere. There was no evidence which would show that Rhode Island prisoners, unlike prisoners in other states, cannot be motivated to keep the prison acceptably clean. The abdication of any attempt by the Department to maintain a healthful and minimally clean institution was apparent and is a telling comment on the leadership ability of current management. Without question, the age and construction of the building itself are in part responsible. But even in newer parts of the ACI, the housekeeping situation was hardly better, stark evidence of the Department’s failure to lead and control. Plaintiffs’ public health expert testified that the kitchen area was of good construction and could be kept acceptably clean with proper attention and cleaning materials. It is not kept clean. It was not disputed that inmates request, and are refused, basic cleaning supplies, such as clean mopheads and soaps, to improve the conditions of their own cells and common passageways. In light of the overall situation it is hardly surprising that some inmates do not clean their own cells. As one witness asked, “what good is an island of cleanliness in a sea of filth?” Based on the foregoing, the uncontradicted testimony of each of the experts, the Court finds that Maximum presents an imminent public health, fire, and safety hazard. The Court was particularly struck by the testimony of one expert who had directed the prison systems in both Minnesota and Delaware for a number of years. He observed that the ACI was the only prison he had ever visited for which he could find nothing good to say. In common with other witnesses, he found every evidence of a management overwhelmed by the problem of managing a population of prisoners in a building of so many problems, and a staff so accustomed to conditions of deterioration that they had become inured to what they lived with. These conditions and this attitude have a devastating impact on inmates, reinforcing their low self-esteem and making rehabilitation impossible. An expert engaged by the state to counter this testimony was not produced at trial. As the Commissioner of Corrections explained to Governor Garrahy, “this individual was unable to say much good about these matters”. On the basis of the physical conditions alone, Maximum is clearly unfit for human habitation according to any criteria used by public health officers or professional corrections personnel. One public health officer with wide experience testified simply that' the ACI has “all the egregious deficiencies that could possibly exist”. As Governor Noel informed the Legislature last year: As a symbol, the current maximum security facility tells us a good deal about what is wrong. It is antiquated, in disrepair, and cannot support basic services. Time and events have left this brooding structure fixed, rigid, unresponsive; unable to meet the increasing demands of the passing years. And yet, tragically, ten decades after it was opened to admit 55 prisoners, nineteenth century architectural and penology concepts endure within a facility that now imprisons over 400 inmates. That recurring conflict results is inevitable. The mere numbers of inmates forced together in intolerable living conditions would produce dire consequences in any group of human beings, let alone those being punished for crimes committed against society. As a final note we might contemplate the fact that a substantial number of inmates confined in the maximum facility are classified by appropriate procedures, as prisoners capable of accepting responsibilities inherent in lesser securities; either medium, minimum, or work release. One can intuitively sense the frustrations and aggressions which inevitably must rise from such a fundamentally unjust administration of corrections and policies and facilities. [Message of Governor Noel to a Joint Session of the Legislature, February, 1976], 2. Living Conditions in Medium Security The Medium Security Building, housing approximately 160 prisoners in protective custody status, presented conditions that, on balance, were not much better than those in Maximum. Prisoners are housed in three large dormitories and a cellblock. The building itself, dating from the depression period, is made of materials which can, with proper maintenance, be kept reasonably clean. The floors are of excellent quality, non-porous and quick-drying. Heating and ventilation present few problems; lighting was adequate. Windows were in good repair. But the walls were filthy; floors had not been swept. Due to inadequate management, the building is quickly deteriorating. In the kitchen walls had spatterings of grease and dirt, as did the hoods over kitchen equipment. On my visit, the public health expert pointed out mouse droppings on food in open containers. As in Maximum, water outlets in the kitchen lacked vacuum devices, creating a danger that the entire potable water supply of the building could be contaminated by backed up waste-water. The good-quality tile on kitchen walls was cracked and fallen off in places from damage by carelessly-used push carts. In the lavatories, pools of standing water gave off a stench of urine. There was mold and mildew on the showers, and the hot water pipes were exposed. The Department admitted that water from the shower leaks through the floor and into the kitchen, onto the food. On the Court’s visit, many of the sinks and urinals were inoperable. Housekeeping and maintenance had broken down in Medium in much the same way as it has in Maximum, and here the building itself cannot be blamed. Prisoners are denied requested cleaning supplies, without which it is impossible to maintain a minimum level of sanitation and cleanliness. For example, the mopheads observed by the Court on its visit were inadequate for anything more than spreading the dirt evenly across the floor. In Medium, as in Maximum, although some inmates are undoubtedly deficient in maintaining cleanliness in areas surrounding their beds which are their responsibility alone, the basic responsibility for the massive default of minimum standards of sanitation and cleanliness is the Department’s. 3. Classification; Fear and Violence Classification is essential to the operation of an orderly and safe prison. It is a prerequisite for the rational allocation of whatever program opportunities exist within the institution. It enables the institution to gauge the proper custody level of an inmate, to identify the inmate’s educational, vocational, and psychological needs, and to separate non-violent inmates from the more predatory. These goals are recognized by state law, which provides that classification shall serve a rehabilitative function. Classification is also indispensible for any coherent future planning. The classification process at the ACI is currently incapable of fulfilling any of its functions, and is inadequate under any minimum standards. It has deteriorated drastically over the past few years, and for all practical purposes has effectively ceased to function at all, contrary to the requirements of state law. Inmates are provided no psychological or psychometric examinations in the classification process, except in emergency cases. No written procedures exist to structure the classification process, which has been described by the Director of Classification as “informal” and “casual”. State law is flaunted by the Department’s failure to separate newly sentenced inmates from other inmates for an intensive classification process. Central to the collapse of classification is the almost total disappearance of medium security as a classification status. Nearly 100% of the capacity of the Medium Security Building has been used since at least 1973 fqr protective custody inmates from Maximum. As a result, there is no room in Medium for medium security prisoners, and these prisoners are therefore classified maximum and sent to the Maximum Building. The Director of Classification, who has held that position since 1956, has stated that if he had a medium security facility, only between 50 and 75 inmates would need maximum security, instead of the over 500 inmates now in maximum security custody. The effects of this over-classification rebound throughout the system, to the incalculable detriment of the correctional process in Rhode Island. The Director of Classification noted, for instance, that the Classification Board is hesitant to grant inmates minimum custody status because the change from maximum is so great, a hesitation which an intermediate classification to medium would erase. He found that the long wait to change classifications was a direct cause of a substantial portion of violence at the ACI, for inmates believe that the wait to get into a lower custody (i. e., minimum) is so long it is not worth their while to stay out of trouble. The classifications process as it presently exists serves no function at all. All entering inmates are classified as maximum custody, no matter what the length of sentence or characteristic of the offender. No attempt is made to determine the proper security level of an inmate on entry, nor his education, psychological, or vocational needs. Although there is a reclassification process, it, too, is a charade: to avoid raising hopes, the Department refuses to upgrade or change a classification unless the vacancy in a building or program is open, no matter what the inmate’s changed needs or condition. Rehabilitation, a goal of the correctional process in Rhode Island, is impossible under the Department’s approach, which is aptly characterized as “if we don’t have it, you don’t want it.” Educational tests are administered only to those who specifically request them. No vocational tests are administered at all. The complete product of the initial classification is generally a three-sentence descriptive summary of each incoming inmate. No plan is developed for each inmate. The consequences of the failure of the classification system are manifold. First, it is literally impossible in the absence of adequate data for the Department to plan intelligently with a view to alleviating the problems that everyone recognizes as overwhelming. In early 1976, the Department concluded that the new Maximum Security Building planned ought to have a capacity for 200 high-risk inmates, a figure reached on the basis of the Director’s “gut-feeling”. When an architectural and planning firm conducted a closer study of the Department’s needs, it was discovered on the basis of a more scientific study that the Director’s gut-feeling estimate had been grossly overstated and that the needed capacity was less than half the original estimate. The Department accepted these conclusions and scaled down by one-half the capacity for maximum security inmates in its proposed new structure, yet unaccountably has neither adopted the classification procedures used by its own planners or altered its own, useless procedures. The rampant violence and endemic fear of violence existing at the ACI are also direct consequences of the failure of the classification system. Classification is one of the cheapest ways to achieve a measure of security in a prison, enabling correctional officers to be placed where they are needed most. Yet, except by the crude method of granting all protective custody requests, victims are not separated out from predators at the ACI. In Maximum, over 420 inmates of vastly different experience and predatory potential, including lifers, pre-trial detainees, and newly sentenced inmates mix freely throughout the day. Inmates from various cellblocks must travel through other cellblocks to get to the medical facility, the dining room, the visiting room, and the recreation yard. Unless the prison were to undergo a permanent lockup, this situation is inescapable, absent an uneconomic reconstruction of the building. The most serious consequence of this commingling is probably the violence and sexual attacks which occur constantly throughout Maximum, and especially in the showers, which are virtually unguardable because of the blind corners behind which they are hidden. One expert reported finding a pair of bloody underwear in one of the shower rooms during a visit to the ACI. The Court received extensive evidence of sexual attacks, and other violent incidents. One inmate testified that, shortly after his entry into the ACI in 1973 when he was 18 years old, he was gang-raped in the shower room in Maximum. Released from prison soon thereafter, he was reincarcerated in May, 1976. Within a month, he was again viciously sexually assaulted in a shower room, this time while he was in protective custody in Medium. In December, 1976, while living in a different dormitory in Medium, he was again gang-raped. He suffered a nervous breakdown. In March, 1977, he was denied parole for the sole stated reason that he needed psychiatric counseling — counseling which has never been provided him. Contrary to what one might expect, Medium Security, housing the protective custody inmates, is little safer than Maximum. Many of the protective security inmates need protection from each other, and the Medium Security Building is therefore sealed into three compartments, each essentially a dormitory for 40 men. To keep each group of inmates from the other groups, each dormitory group must be locked in its dormitory for nearly the entire day. A review of the justifications for each inmate’s protective custody showed approximately an equal number of rapists and rape victims afforded protective custody. Of the 650 or so inmates at the ACI, 120 are currently in protective custody, and another 40 in punitive segregation. Many experts who testified at trial noted that the number of inmates in protective custody represented a percentage grossly out of proportion to any prison in America. Each found this to be an indicator of the level of fear and violence pervading the ACI. Other evidence confirmed the fear and violence. A study of reported incidents of violence during 1975 and 1976 indicates approximately 155 assaults, rapes, and major fights per year; 330 other incidents of violence, and personal harm to inmates, or mutinous acts; 35 fires; and over 400 reported drug violations per year. Prison officials estimate that 70-80% of inmates in Maximum are current drug users, including perhaps 40 heroin addicts. The traffic in contraband is a major cause of violence. There is no drug abuse program at the ACI. Further review of the justifications proffered for placing individual inmates in protective custody makes it clear, as common sense dictates, that the true level of violence is grossly underreported. The Court received into evidence the collected reports of violence at the ACI from the Providence Journal-Bulletin from 1975-1976, a grotesque compendium of beatings, stabbings, fire-settings, and assaults. The image conveyed, to prisoners receiving the newspapers as well as the public, is that of an institution where violence is simply unchecked. The experts, without exception, agreed. The combination of a physical structure which is rife with blind corners and hidden shower areas, and which requires each group of inmates to pass through the area of other groups during the day, and the lack of classification has created an institution where no one is safe. The Director of Classification conceded at trial that the men in Maximum are in fear of their lives from physical harm or sexual harm, and that “because of the layout of the Maximum Security . . . it’s impossible or difficult to protect these men.” An additional. contributing factor to the ever-prevalent fear and violence at the ACI is the inadequacy of the guard complement at the ACI. Witnesses who toured the ACI never observed more than two guards in any cellblock but the Behavioral Control Unit; a number incapable of providing a reasonable level of security to inmates. The Director of the Department confessed his virtual inability to control the inmates during any sort of disturbance in the institution short of locking them all up. Other department officials agreed, and observed further that the Department was prevented by its arrangements with the correctional officers’ union from assigning qualified guards where they are most needed. Assistant Director Houle stated that he was forced, by the guards’ union, against his judgment, to assign young and inexperienced officers to the most difficult posts. In light of all the testimony, the Court finds that inmates exist in a state of constant violence and fear and that it is impossible for defendants to provide adequate protection to inmates at the ACI under the present classification system. 4. Program and Idleness in Maximum Security The experts testifying at trial also stated, and the Court so finds, that it is impossible to maintain safety, discipline, and order unless a substantial portion of the population is constructively occupied, whether by work, education, vocational training, or recreation. Idleness in the ACI is perhaps the central fact of existence for nearly all inmates in Medium and Maximum at nearly all hours of the day. It breeds boredom and a quest for excitement, and the defendants conceded that it is a major cause of the violence which has plagued the institution for years. This conclusion was reached by the 1972 Report of the Citizens Action Council to Governor Licht, and again in 1975 by the American Justice Institute. William Laurie, the Assistant Director of Corrections for Adult Services, the official with line responsibility for running the ACI, testified that the idleness among inmates has led to a loss of control by the Department. Yet he found himself incapable of remedying the situation, because both Maximum and Minimum simply have no adequate programming space. Plaintiffs’ experts agree with Laurie’s assessment of this problem. Opportunities for work in Maximum are wholly inadequate by any minimum standards, a point conceded by the defendants. Although approximately 240 inmates ostensibly hold jobs, the level of idleness cannot be gauged by that statistic: as the Associate Director of Maximum Security admitted, each of these jobs could literally be completed in fifteen minutes. For example, the license plate shop is staffed to produce approximately 80,000 plates monthly, but only 15,000 are required. It was estimated that the entire production run could be completed in two months of work a year. The effect of this situation on the work attitudes and habits of inmates can hardly be overestimated. One inmate testified that he managed to secure two jobs, which could both be completed in a total of fifteen minutes. When the authorities learned of this hoarding, they took the second job away, so that work could be more evenly spread around the population. There are approximately 65 positions in the three state-use shops in Maximum. Eleven prisoners work at a prisoner-initiated and non-state funded motorcycle repair shop. Other prisoners have attempted to set up other shops, purchasing necessary equipment with their own funds, only to be finally refused permission after months of indecision from the Department. Another 54 inmates in Maximum have non-industry jobs — lawn mowing, kitchen work, and the like. The rest of the jobs are simple cleanup, for which the cleaning materials provided prisoners are completely inadequate. The level of idleness is exacerbated by the paucity of educational or vocational training opportunities. There is only one vocational training program for the entiré maximum security program, a 16-week graphic arts program with a capacity for 10 inmates and 1 or 2 auditors at any one time. Because of inadequate funding, the program often stops for a few months. Again, some inmates who have tried to teach themselves trades have been thwarted by officials denying them permission to purchase tools with their own funds. Only four individuals spend most of their time teaching inmates at the ACI; only one of these is funded by Rhode Island. Only 29 prisoners attend the Adult Basic Educational Program in Maximum Security. Two afternoons a week no classes of any sort are conducted. The reading specialist sees only approximately 10 prisoners per week in Maximum, 6 per week in Medium. There are rarely more than 20 prisoners attending class in Maximum at any one time. Three experts with wide experience in managing and studying prisons testified that they had never seen more than 10 prisoners in class during any of his tours, and that nothing appeared to be going on in the classes which were in session. As one expert noted, “the classrooms showed every evidence of disuse.” Each testified that the quality of the instruction appeared to be extremely poor. Each testified that, in their experience, substantial numbers of prisoners will participate in institutional educational programs of good quality. As the plaintiffs note, the inadequacy of the educational programs at the ACI, and the resulting idleness and potentiality for violence, have been emphasized by every group that has studied the ACI since 1972. The deadening effect of a nearly complete lack of constructive work, vocational, or educational opportunity is made worse by the grossly inadequate recreation facilities or programs. The indoor recreational facilities, which must house the entire recreational program for a significant part of the year, are inadequate by any standard. No indoor facilities are available during weekdays in Maximum. One of the two rooms made available after the evening meal is too small and low-ceilinged to permit basketball or jogging or any active sports. It contains a pool table, some weights, and a boxing ring. The other exercise room in Maximum is available when it is not being used as a chapel or as a theater. It is large enough to accommodate ten men playing basketball, and nothing more. 5. Program and Idleness in Medium Security In nearly every relevant respect, the approximately 160 inmates in protective custody are subjected to a regime of idleness more complete, and more devastating, than that suffered by prisoners incarcerated in the Maximum Security building. These inmates have not committed disciplinary violations, and their placement in protective custody is not intended as punishment. They literally fear for their lives, and in return for a measure of safety have been forced to bargain away a substantial part of the already meager program activity available to inmates in the general population. Worse, protective custody inmates are deprived of any semblance of personal privacy. They live in dormitories of 40 men, a practice condemned by experts for any but minimum security inmates. There are no vocational training programs for protective custody inmates. Only the six inmates who work in the upholstery shop and the garment shop hold jobs requiring any skill or offering opportunity for constructive vocational growth. These jobs are scheduled for four hours daily, but are done in much less time. The other inmates theoretically hold maintenance jobs. It was undisputed that these “jobs” can be completed in only fifteen minutes and are rendered even more farcical by the lack of basic adequate cleaning equipment such as soap and mop. Prisoners in different protective custody dormitories are not permitted to attend classes with each other. As a result, no prisoner may attend class for more than 4 half-days a week. In one dormitory prisoners are not permitted to attend classes at all. Other inmates, who attend classes for about 7V4 hours a week, are not permitted to participate in any other program activity, including work. Provision for recreation or physical exercise in Medium is wholly inadequate. There is no organized recreation program for inmates in protective custody. Nor is there any indoor exercise facility. The room designated for indoor exercise is in the basement, too low-ceilinged and small to permit basketball or any other physical activity, save pool, pingpong, and table games. There is no weight-lifting equipment. During the long winter months, or in inclement weather, prisoners are permitted to use this room for a half hour a day. The recreation program and opportunity for exercise are inadequate under any minimum standards, including the minimum standard set by the Department’s own regulations. In short, inmates in protective custody suffer almost total idleness. On my visit to the ACI during this suit, I was besieged with complaints about the absence of any constructive program by the men in one of the protective custody dormitories, who were all sitting around with nothing to do on a warm, April day. They are, quite literally, warehoused. William G. Nagel, a noted expert on corrections, present Director of the Institute of Corrections of the American Foundation, and for eleven years the deputy superintendent of the New Jersey Correctional Institution at Bordentown, testified that the idleness suffered by protective custody inmates was different not only in degree, but in kind from that normally entailed by incarceration in America. He found it more complete than he had ever observed in an American prison. He pointed also to the total lack of privacy for inmates in protective custody, their total lack of protection from the other thirty-odd men in each dormitory, the high level of fear at night, and the incessant noise. His expert opinion, joined by other witnesses and uncontradicted, was that the debilitating conditions are so extreme that inmates in protective custody deteriorate while so incarcerated. “I don’t know what is more punishing than letting a person rot,” he concluded. The Court credits this testimony. 6. Pre-trial Detainees In recent months, the number of pre-trial detainees has varied from between 120 to 175. Because the awaiting trial (AT) cell-block in Maximum can house only 99 inmates, there are nearly always awaiting trial inmates housed in protective custody, the Behavioral Control Unit (B.C.U.), the hospital area, and the main cellblocks in Maximum. Even for those pre-trial inmates housed in AT, there is constant daily contact with sentenced inmates. They must pass through the South State cellblock to eat, to go outdoors, to the commissary, to the medical facility, or to meet visitors, for example. They have no separate recreation facilities, nor separate shower facilities. Shower facilities used by AT inmates are freely used by inmates from all sections of Maximum during the day, and they are not visible to a person standing anywhere but directly in front of the showers. There were no guards positioned near the showers used by awaiting trial inmates during any of the numerous visits of witnesses at trial. This intermingling of the awaiting trial inmates with the general population has been described by the Associate Director of Maximum Security as a major security problem. He noted that the pre-trial detainees suffer most of the violence, and that they are “often the victims of homosexual acts from the state population, theft, you know.” Because pre-trial detainees are not classified in any way, no attempt is made to determine which detainees need maximum security confinement or whose presence would be adequately guaranteed for trial by incarceration in Medium or Minimum custody. Nor are any pre-trial inmates screened for mental health problems or program needs. Indeed, they are forbidden from participating in any of the educational, vocational, or work opportunities that do exist. They can earn no money, and are not permitted to occupy themselves with constructive activity. In short, pre-trial inmates are exposed to conditions worse than those suffered by sentenced inmates in either Maximum or Medium. Nor can the state plead that this intermingling is caused by any sort of emergency conditions. Over the past five years, the situation has been repeatedly called to the attention of the officials responsible. See American Justice Report to Governor Noel (1975); Report of the Committee to Investigate the Uprising at the Maximum Security Facility of the Adult Correctional Institution on April 2, 1973 (1973); Report of the Citizens Action Council on the Adult Correctional Institution to Frank Licht, Governor of the State of Rhode Island (1972). The conclusion is inescapable that pre-trial inmates are not provided minimally adequate protection against assault, that they are exposed to punishment even worse than that endured by other inmates, and that they are incarcerated under conditions far harsher than anything necessary to guarantee their presence at trial. So long as pretrial inmates are housed in Maximum Security, these conditions cannot be significantly improved. 7. Drug Abuse and Treatment The extensive availability and use of drugs inside the ACI is a substantial cause of violence between inmates, and defeats the Department’s efforts at securing an orderly institution. Rehabilitation in an environment where 70% or more of the inmates are abusing drugs, as at the ACI, is obviously impossible. The ACI’s facilities and program for diagnosing and treating drug addiction are wholly inadequate. The deliberate indifference displayed by the defendants to the serious medical needs of drug dependent inmates leads to unnecessary and inevitable suffering. Dr. Anthony Raynes, a psychiatrist with extensive expertise in the field of drug addiction treatment and diagnosis in correctional settings, who has previously consulted for the ACI, noted that the records maintained by the Department in connection with drug abuse diagnosis and treatment were completely inadequate in terms of history taking, notation of physical symptoms associated with drug abuse, treatment provided, and follow-up. Screening procedures were seriously deficient. No in-house drug tests were available, and the time required for tests performed on incoming inmates to be returned from Boston laboratories substantially reduces the value of those tests. As a result, many prisoners are misdiagnosed and physical and mental deterioration associated with certain forms of drug abuse continue unabated and even unnoted. Because its record-taking is so inadequate, the Department is unable to ascertain the extent of drug usage at the ACI. A study performed for the Department in 1975 found that between 15 and 40 inmates at the ACI maintain themselves on heroin inside the institution; another 70-80% of the population abuses drugs at any given time. Dr. Donahue, the chief physician at the ACI, estimates that perhaps 50-70% of inmates resident at the ACI are drug-dependent. He believes that the same proportion of inmates enter the ACI as drug-dependent. The Court received the appalling testimony, uncontradicted by anyone, that much of the drug traffic originates with the guards. The ACI also has a significant number of inmates using a number of drugs (poly-drug users) at any given time, although the Department has no reliable figures on the extent and combinations of drugs, and alcohol, used. Of course, it is impossible to design treatment resources without these statistics, even if inmates were properly screened and diagnosed, which they are not. The medical staff has no formal protocols for the withdrawal or treatment of heroin, barbiturate, or poly-drug users, nor even commonly understood unwritten policies. Dr. Donahue informed Dr. Raynes that he believes in waiting for symptoms, and then treating symptoms (often with tranquilizers and emetics), a method of treatment which Dr. Raynes likened to treating a patient with leeches. In Dr. Raynes’ expert opinion, which is unrebutted, Dr. Donahue is either unable or unwilling to follow current medical practice regarding chronic or acute reactions to drugs. Detoxification is unavailable either for heroin addicts or for inmates who had recently been maintained on methadone. Addicts are provided no drug counselling, nor are inmates already admitted to the ACI screened to detect continuing drug usage with a view to effective treatment. On the basis of his conversations with medical personnel at the ACI, Dr. Raynes was able to state with assurance that it is impossible to provide adequate medical treatment for drug users in the ACI with current personnel, attitudes, and knowledge. The failure properly to identify or treat drug users in the ACI has a devastating impact on the entire inmate population. Of most obvious importance, much of the violence rampant at the ACI is related to the drug traffic which occurs within the walls of the institution. There is increased risk of suicide gestures, and increased pain and suffering on the part of inmates addicted while ostensibly under the secure custody and control of the state. And because drug addiction acts like an infectious disease, with one addict commonly “infecting” a number of other unaddicted persons each year, there is a real risk that non-addicted inmates will become addicted while incarcerated. Finally, a matter which may be of little constitutional significance but of great consequence to the citizens of Rhode Island, this pattern of failure leads inexorably to the release of seriously addicted inmates who will maintain their habits by renewed criminal activity. 8. Medical Care The Court received extensive testimony regarding the delivery of medical services to inmates at the ACI. Here again, a series of reports commissioned by the Department over the past four years describes, highlights, and reiterates the life-threatening deficiencies which have plagued the medical services staff in the past. It appears that some effort is finally being made to take steps to improve care which as recently as 1976 was described as “fragmented” and “episodic” and “minimal.” However, the unrebutted, credible testimony of plaintiffs’ two experts in the delivery of medical services in a correctional setting leads inexorably to the conclusion that the system of medical care delivery at the ACI is inadequate by any accepted standard to meet the inmates’ routine and emergency health care needs. In light of the fact that the Department has been aware of this dangerous situation since 1973, the Court finds that the defendants have consciously disregarded a grave and substantial risk to the health and well-being of the inmates entrusted to their care, in the form of the needless occurrence, prolongation, or exacerbation of serious injury, illness, or suffering. It is true, as the defendants assert, that there has not been in recent years a serious outbreak of infectious disease, nor have the plaintiffs attempted to prove specific instances where the illness or injury of a particular inmate was exacerbated by the deliberate indifference of staff members. Neither of these facts is determinative. Given the dangerously low standard of medical care that prevails at the ACI, the Court would be remiss in its duty were it to wait until an inmate bleeds to death, or suffers a heart attack which defendants are unequipped to diagnose or treat in an emergency, before it acts. Inmates are wholly dependent on the medical services staff for their medical needs. Unlike the general population, they cannot self-treat even the most minor ailments, nor do they have the privilege of making their own choice of physicians. The Department of Corrections is fortunate that the ACI, situated adjacent to the state medical center, can use that facility with a fair degree of ease in certain situations. But the frightening fact remains, that the ACI medical care system is simply unable to provide satisfactory emergency service or satisfactory routine care for the inmates. Indeed, Dr. Lambert King, the Director of the prison hospital at the Cook County Correctional Center in Chicago and a physician of extensive experience in managing a medical service in a correctional setting, testified that the medical services provided at the ACI were inferior to any correctional medical services he had ever inspected. Without going into extensive detail, the following deficiencies display the extent of the problem. The infirmary has no capability of performing elementary blood or urine tests, which are crucial for quickly diagnosing commonly encountered medical problems among inmates for which prompt diagnosis is essential. The infirmary has no centrifuge, and blood counts cannot be performed. The Department was advised as early as 1973 that such tests were the first priority in an upgraded system. There is no electrocardiogram at the ACI, and as a result medical staff cannot make an adequate emergency diagnosis of an inmate having chest pains. The infirmary is not equipped to take specimens from wound infections for culture or sensitivity tests, nor is there any means of performing tests for gonorrhea. As an inevitable result of these deficiencies in laboratory testing capability, inmate medical problems are likely to go undiagnosed, and the efficacy of any treatment administered cannot be competently evaluated. The institution is missing certain essential emergency equipment such as a defibrilator for the treatment of coronary problems and suction equipment for the removal of secretions from a windpipe to aid a choking patient. The size of the medical staff is inadequate by the Department’s own admission. The Department has one full-time doctor, who in practice works fifteen hours a week but is paid for forty hours’ work. At present, he has stopped work completely, apparently due to a disagreement with the Department. Two part-time physicians work approximately 24 hours a week. The medical staff is expected to provide physical examinations (these have recently been made more thorough) to all incoming inmates. They are also responsible for the other medical needs of 650 inmates who, because of the excessive violence at the institutions, require a good deal of patching up. Necessarily, much of the burden of treatment falls on the nursing staff, an expedient that is medically unobjectionable provided there is adequate supervision. In practice, however, necessary training and guidance for the nursing staff is almost' totally lacking, a situation which constitutes reckless disregard for, and deliberate indifference to, the medical needs of inmates. For example, medications which outside the institution routinely require a physician’s prescription are generally dispensed at the ACI by nurses, based on their own interpretations of patient needs and without physicians’ orders. Physicians are not consulted or informed before potentially harmful medications, including tranquilizers and antibiotics, are administered. These practices violate the standards for institutional health care delivery of the American Public Health Association, and the unrebutted testimony of Dr. King was that they are likely to result in serious injury to inmate patients. In addition, nurses, on their own, without physician approval and without guidance by written instructions or policy, sometimes decide that some patients’ complaints are imaginary and treat them with placebos. Although the nursing staff are the only medical personnel available outside of normal working hours, they are not provided with guidance for use in commonly occurring emergencies. They are not trained in cardio-pulmonary resuscitation for supporting respiration or circulation in cases of cardiac or respiratory arrest. There are no protocols or in-service training programs concerning the emergency treatment of inmates with seizures, drug overdoses, or exposure to teargas or other chemical control agents. Although nurses are authorized to use sodium luminol in the emergency treatment of epileptic seizures, they are provided no guidance in the use of this medication, notwithstanding the risk that its use with other-than-epileptic patients carries a serious risk of death. Dr. Donahue’s opinion that training for sodium luminol and other treatments mentioned above is unnecessary was contradicted by the more credible testimony of Dr. King, holding that the lack of such guidance fell far below acceptable medical practice. Dr. Donahue does not even know the types of gas available at the ACI, such as mace, and, of course, he has not planned in any way for treatment of its side-effects. Although he has instructed the nursing staff to call him if they have a problem while he is not at the ACI, on numerous occasions attempts to reach him have been unsuccessful. No written agreement exists between the Department and a mobile rescue unit, and there is a continuing substantial risk that delay resulting frota difficulty in arranging transportation could, in cases such as heroin overdoses, cause the death of an inmate. Even more shocking, there is no disaster plan prepared by the physician in charge of medical services at the ACI, although this is a commonly accepted practice in correctional institutions. The ACI employs no pharmacist and maintains no formulary, violations of minimum standards that render impossible the compilation of meaningful data on medication usage at the ACI and increase the difficulty of controlling diversion of medication for improper use. The infirmary is similarly deficient in coping with inmates suspected of having infectious diseases, such as hepatitis or tuberculosis, and a substantial risk exists that an outbreak may occur. No written procedures exist for staff guidance. No provision is made to administer gamma globulin to inmates who may have been exposed to hepatitis, a failure which the Court is advised is unacceptable medical practice. Rooms set aside for infectious patients are wholly inadequate to contain disease: they have neither doors, nor separate ventilation systems, nor separate toilet facilities, and infectious patients must walk through the general infirmary area. In one case, medical staff were not even advised by the physician that an inmate placed in the “isolation” area was suspected of having hepatitis. All of these deficiencies in staff, equipment-and procedures are exacerbated by the lack of organization that characterizes the medical services system as a whole, a failing which in addition renders less effective any strong points that the system might have. Under the present chaotic regime, staff performance is not evaluated, written guidelines as to how the service will operate are non-existent, and there are no written plans or instructions available on how to use the outside medical facilities upon which the ACI is heavily dependent. Indeed, there is not even a check made as to whether staff licenses are current. All of this, of course, results in inappropriate and haphazard treatment, as plaintiffs’ expert testified, and great risk of prolonged or exacerbated illness or injury. The lack of system is perhaps best illustrated by the near total lack of available statistical information. When the trial of this case started last April, there were no statistics available about any aspect of health care at the ACI, not even such basic information as the type or quantity of medication prescribed for common health problems or the number of inmates with diabetes, asthma, or tuberculosis. While the Court received testimony in late May that this situation had been partially remedied, and that the new Medical Services Coordinator, John Fournier, has recently begun devising forms and keeping statistics, the Court has no indication of the extent or adequacy of these improvements from any qualified witness. Instead, the unrebutted testimony showed that the cumulative effects of the deficiencies noted in the medical care system lead directly to increased morbidity and to the prolongation of disease, and result in a clear and every-present danger that emergency situations will not be treated properly. It was Dr. King’s opinion that the medical services system, as it was set up at the time he testified, may result in unnecessary death, and met no minimum standards for delivery of health care in a correctional setting. Based on the undisputed testimony of a number of well-qualified witnesses, the Court also concludes that psychiatric and psychological evaluations and treatment are inadequate to meet the needs of the inmate population. Dr. Carl Clements