Full opinion text
MEMORANDUM MORTON, Chief Judge. I. INTRODUCTION This action pursuant to 42 U.S.C. § 1983 challenges the constitutionality of conditions of confinement in 12 of Tennessee’s adult penal institutions. The case originated as several separate pro se prisoner complaints, each of which challenged various related aspects of prison conditions in the state. Having determined that this court’s previous, consistently followed practice of abstention in favor of a pending state court action on the same issues was unjustifiable in light of a recent decision by the United States Court of Appeals for the Sixth Circuit, Hanna v. Toner, 630 F.2d 442 (6th Cir.1980), the instant cases were consolidated, and because of the seriousness and complexity of the issues raised, attorneys were appointed to represent the plaintiffs. Thereafter, an amended class action complaint was filed, seeking certification as a class of all present and future adult inmates committed to the custody of the Tennessee Department of Correction (TDOC). Pursuant to Fed.R.Civ.P. 23(c), the court entered an order certifying said class. The amended complaint challenged a wide range of living conditions in Tennessee’s prisons, including, inter alia, overcrowding, sanitation, medical care, violence, idleness and the classification system. The plaintiffs have asserted that these and other conditions lead to the wanton infliction of unnecessary pain and suffering, and therefore amount to cruel and unusual punishment, prohibited by the Eighth Amendment to the United States Constitution, as applied to the states through the due process clause of the Fourteenth Amendment. See Louisiana ex rel. Francis v. Resweber, 329 U.S. 459, 67 S.Ct. 374, 91 L.Ed. 422 (1947) (case wherein Supreme Court first assumed incorporation of the Eighth Amendment into the Fourteenth Amendment), and numerous subsequent cases, e.g. Furman v. Georgia, 408 U.S. 238, 92 S.Ct. 2726, 33 L.Ed.2d 346 (1972). The same conditions are alleged to violate provisions in the Tennessee Constitution as well. See, infra. Before proceeding further, the court deems it appropriate to digress a bit in order to clarify the record concerning the manner in which the instant action arose, and the reasons why this court is now faced with deciding issues previously litigated in the state courts of Tennessee. See Trigg v. Blanton, No. A-6047 (Dav. Ch. 978), retired on grounds of state abstention, sub nom., Trigg v. Alexander (Tenn. July 2, 1981). As is the trend in federal courts throughout the nation, this court in recent years has been inundated with complaints filed by state prisoners incarcerated within this district alleging violations on the part of prison authorities of various rights secured by the constitution and laws of the United States. Such complaints are typically filed pro se, and in this court’s experience, have often challenged the constitutionality of conditions of confinement within state prisons. In the past, this court has ruled on individual claims concerning prison conditions on a case by case basis. See, e.g., Carroll v. Murray, No. 77-3467, mem. op. (M.D.Tenn.1979). However, during the pendency of Trigg, supra, a class action very similar to the instant case, this court determined that principles of comity justified a policy of abstention in cases challenging prison conditions, pending a full and complete state court review of the situation. The court therefore developed a “retired docket” whereby cases challenging conditions of confinement in TDOC institutions were filed, so as to toll the applicable statutes of limitations, but were retired pending a final decision in Trigg, with the possibility of later reactivation upon simple motion in order to determine any issues not precluded by the state court judgment. See, e.g., McDonald v. Henderson, No. 77-3242, mem. op. (M.D.Tenn.1977). Then, in September 1980, the Sixth Circuit’s ruling in Hanna, supra, to the effect that abstention is improper in cases challenging institutional violations of constitutional rights prompted the court to reconsider its previous policy. While Hanna is arguably distinguishable from the instant case because of the presence here of potentially dispositive state constitutional claims, the court concluded that the likelihood of a state court decision that would preclude or alter consideration of the federal constitutional issues was at best slim, and would not justify contravention of the clear language of Hanna. See Dixion v. Bradley, Nos. 80-3578 et al., mem. op. (M.D.Tenn. June 2, 1981). Nevertheless, the court remained hopeful that there would ultimately be no need for substantial federal court intervention, since the Trigg case, dealing with many of the same issues as the case sub judice, was then on appeal to the Tennessee Supreme Court, and any final decision by the state courts would be entitled to full faith and credit here. Thus, if the instant action would not have been entirely foreclosed by res judica-ta, certainly many issues would have been subject to collateral estoppel in the event of a final state court decision. Unfortunately, there has been no final state court decision. On July 2, 1981, the Supreme Court of Tennessee, in a decision that so far as this court is aware is wholly unprecedented in the annals of our federal system, ordered abstention by the state courts pending federal resolution of the present case. Without considering whether such action may have amounted to an abdication of the duties assigned to state courts by the Constitution and laws of Tennessee, the effect of the decision is clear: The task of resolving the serious and politically sensitive constitutional claims raised by inmates incarcerated by the State of Tennessee has been passed to the federal courts. It is a task which this court does not take lightly, in part because of a natural reluctance to interfere with the State’s administration of its own prison system. Yet, to shrink from decision would be in contravention of the clear policy statement in Hanna that, where institutional violations of federal constitutional rights are concerned, federal courts must act to hear those claims. 630 F.2d at 444, citing, Procunier v. Martinez, 416 U.S. 396, 405-06, 94 S.Ct. 1800, 1807-08, 40 L.Ed.2d 224 (1978). That the state courts have chosen to sit and wait for a federal decision is simply an unfortunate curiosity, a decision which this court assumes will remain an aberration and not evolve into a new policy of state abstention. Trial of this cause was held on November 23-25 and December 7, 1981. At the conclusion of trial, some 20,000 to 30,000 pages of evidentiary material, including a plethora of detailed documents, reports, responses to discovery, depositions and other material considered by one or both parties to be relevant was filed and submitted for the court’s consideration. Objections to the introduction of particular exhibits were raised by the defendants. Those objections, along with the merits of the case itself, were taken under advisement by the court. Consideration of the issues properly before the court necessitates a detailed inquiry into specific conditions at each of the individual institutions encompassed by this litigation. In order to place the institutional conditions in their proper perspective, the court will first explore the TDOC system: Its organization of personnel and responsibilities, and the division of functions between the Department and the individual institutions. II. THE TDOC SYSTEM A. General Overview At the head of TDOC is the Commissioner of Correction, a post presently held by defendant Harold B. Bradley, an individual whose competence, dedication and professional credentials are beyond reproach. The department’s number two administrator is Deputy Commissioner Robert Mor-ford, who, along with Commissioner Bradley, oversees all TDOC functions. Reporting directly to the Commissioner or Deputy Commissioner are an assistant commissioner of community relations, the staff attorney, the director of internal affairs and the director of medical services. Those persons administer TDOC functions that, for one reason or another are not assigned to any of the five major divisions of the department. The Division of Adult Services is headed by Assistant Commissioner Dorothy M. Greer. Administrative staff for this division includes the director of rehabilitative services, the director of offender classification, the director of adult probation and the director of institutional programs. Individual prison wardens report to TDOC through the Division of Adult Services. The Division of Agri-Industries consists of two sections: Tennessee State Industries and Institutional Farms. Each section is headed by a director, who reports to the Assistant Commissioner for Agri-Industries, Larry Daniels. The Division of Agri-Indus-tries works closely with an independent nine-member Prison Agri-Industries Board, established by the legislature as an advisory body but utilized, according to Mr. Daniels, much like a board of directors for setting divisional policies and providing expertise in areas such as management, finance and marketing. Under the direction of Mr. Daniels, with the assistance of the board, agri-industries within TDOC have expanded considerably over the last few years. However, even now the division employs only about 1,150 inmates out of the total of more than 7,000 in TDOC custody. Two other divisions that are potentially relevant here are the Division of Organization Development and the Division of Administration, both headed by assistant commissioners. The former division has directors in charge of the following areas: Planning and research; internal audit; management information systems; volunteer services; and staff development and training. The Division of Administration has directors in the area of fiscal services, personnel and engineering. The remaining division is Youth Services and is not relevant to the present case. There are approximately 7,000 adult inmates in those TDOC institutions currently under this court’s review. The largest single facility is the Tennessee State Penitentiary (TSP or “main prison”), a maximum security facility located in Nashville which currently houses approximately 1,930 inmates, in addition to over 300 others administratively assigned there but not physically present. The Nashville Community Service Center (NCSC) which prior to July 1, 1981, was administratively part of TSP, houses approximately 350 minimum security and work release inmates. The Fort Pillow State Farm (FP), located in Lauderdale County, houses over 700 inmates and is a close security prison. The Tennessee Prison for Women (TPW) is the primary institution for housing the State’s female inmates and is also designated close security. Located in Nashville, TPW houses approximately 300 women. Brushy Mountain Prison (BM), located in Morgan County, is a maximum security prison with a population of about 450. The Turney Center for Youthful Offenders (TC) is a medium security facility housing about 630 inmates, and is located in Hickman County. The Memphis Correctional Center (MCC), also medium security, houses over 400 inmates and is now used as the classification and intake center for some new inmates from West Tennessee. DeBerry Correctional Institute for Special Needs Offenders (DCI) houses approximately 275 inmates assigned there for various types of psychological care and is a maximum security facility. The Nashville Regional Correctional Facility (NRCF), a medium security prison, is the primary intake and classification center for male inmates in the state, houses just under 600 inmates. Three other regional prisons, also medium security, are Bledsoe County Regional Correctional Facility (BCRCF), Morgan County Regional Correction Facility (MCRCF), and Lake County Regional Correctional Facility (LCRCF). They have populations ranging from approximately 400 at LCRCF to approximately 470 at MCRCF. In addition, TDOC operates community service centers in Memphis and Chattanooga, as well as the transitional center in Memphis, none of which are challenged in the present action. An additional 300 or so state prisoners are housed in county jails pursuant to contracts with the State. Conditions in those jails will not be directly reviewed herein. The current TDOC prisoner population of about 7,000 inmates is almost double the population of 10 years ago. Every indication is that the increase, which for the five years ending in 1979 averaged 454 inmates per year, is likely to continue. Using that figure in a 1980 program evaluation, the State Comptroller of the Treasury projected a total of 8,366 inmates in TDOC institutions by 1985. In fact, the population increase from 1979 to 1980 was over 800 inmates, well above the previous average. And, according to Commissioner Bradley, the rate of increase at the time of trial was about 100 inmates per month. Present TDOC projections place the inmate population at more than 12,000 by mid-1986. Although the regional prisons were built in response to the problem of overcrowding, the fact that those facilities already house inmates at or above their design capacity of 400 is indicative of the apparently persistent nature of the spiraling prison population. In fact, overcrowding has been a recognized problem in Tennessee’s prisons for many years, dating back at least to 1937. According to the State Comptroller’s 1980 evaluation, the actual prison population is consistently well in excess of nationally accepted minimum standards, a conclusion with which the experts in this action uniformly agree. And although average daily populations are maintained relatively close to the various prisons’ “design capacities,” that is accomplished through the juggling of figures, in which design capacities are routinely raised whenever it appears that the department is no longer able to keep the count at or near the previously designated capacity. In their post-trial brief, the defendants admit that TDOC institutions continue to face a serious problem in regard to crowded conditions. They argue, however, with the vague and conclusory nature of the term “overcrowding,” and contend that current conditions meet constitutional minima. Just as the prison populations continue to increase, so, too, do costs. The TDOC budget, which was under $15 million in fiscal year 1968-69, had risen to over $76 million in 1978-79. During the same period, the average annual cost per prisoner rose from $2,201 to $6,705. The department’s budget is now in excess of $100 million. In its appropriation request for 1982-83, TDOC indicates that expenditures of almost $127 million will be required to maintain a “base” budget, that is, to simply maintain services at current levels, with no additions of personnel. It now costs the state nearly $10,000 per year to house each inmate committed to TDOC custody. Thus, TDOC’s dilemma appears intractable. In the face of constantly rising numbers of prisoners and costs of incarceration, problems over which the department has no effective control, increased appropriations are needed just to maintain the status quo. Yet the political climate is such that the legislature is reluctant to authorize substantial increases in funding for TDOC at a time when other programs are being cut. TDOC’s task is at best a formidable one. It appears that the present administration, perhaps in response to Trigg and the instant litigation, are making some strides toward improvements in spite of the unenviable position in which the department finds itself. Substantial reorganization has occurred over the last few years, including restructuring the TDOC hierarchy with the creation of new assistant commissioners, the hiring of a health professional as director of medical services and the ongoing effort to implement standard department-wide policies and procedures. Just as clearly, the changes that have been made have been neither swift nor entirely effective to correct numerous admitted deficiencies of long standing. While the determination whether particular conditions amount to violations of the Eighth Amendment must necessarily be made on an institution by institution basis, two areas under dispute are so subject to central TDOC operation as to warrant systemic consideration. The first is classification. The classification function occurs upon the arrival of a new inmate into the system, and determines that inmate’s placement, security status and opportunity to participate in any work or educational programs. Although reclassification at least theoretically occurs at the institutional level from time to time, the initial process is clearly a systemic function and will be considered as such. The other arguably system-wide function that will be so considered here is the health care delivery system. Although primary health coverage is furnished at each local institution, TDOC at least monitors the level of care through the director of health services. The department also maintains a central hospital at TSP for referrals from throughout the system and funnels all inmates in need of acute mental health care to DCI for treatment. The plaintiffs have argued that various systemic deficiencies in this arrangement negatively affect the level of care actually delivered at the institutional level. Thus, following the classification discussion, but before embarking upon the institution by institution analysis of conditions, which will include individual health care delivery capabilities, the department’s system for assuring the delivery of care will be separately examined. B. Classification The function of the classification process is to determine each inmate’s security level, the institution to which he will be assigned, and the employment, educational or vocational program in which he or she should participate. It is essentially undisputed that a competent classification system is very important to the operation of a prison system, and should identify the medical, psychological, vocational and educational needs of inmates, as well as insuring the separation of violence prone prisoners from their potential victims and enabling closer supervision of higher escape risk inmates. The defendants’ classification expert, Mr. Ernest Reimer, described the classification function in his deposition as follows: [A] System of accumulating pertinent information about an inmate to allow programming and treatment and management of that inmate on an individual basis; to promote the safety and well being of the inmate, other inmates, staff and the public, and to enhance the social, vocational and personal growth of the inmate. As will be discussed, infra, there simply is no distinct constitutional right either to a particular security classification, assignment to a particular institution, or to participation in employment, vocational or educational programs while incarcerated. Thus, much of the proof submitted on classification deficiencies is entirely irrelevant and will not be addressed here. Nonetheless, there is substantial evidence that certain deficiencies in the classification system contribute to an unconstitutionally high level of violence in TDOC prisons, and for that reason, the classification process must be examined. Initial classification occurs at three facilities in the Tennessee prison system. Most male inmates are classified at NRCF, a facility which includes a 16-guild regional facility which opened in 1979 and is sometimes referred to as Cockrell Bend (CB), and a facility some two miles away now known as Guild 17, which was constructed in 1910. Beginning in the summer of 1981, the department began performing the initial classification of some inmates from the Memphis area (those with less than five years to serve) at MCC. All initial classification for women is done at TPW. Classification functions and procedures are substantially the same at each of these locations. Therefore, only the process at NRCF will be presently examined in detail, but because of the similarities, the findings reached will be deemed applicable across the board, unless expressly noted otherwise. New inmates going through classification at NRCF are taken first to Guild 17, at which time they are fingerprinted, photographed and asked to provide basic personal information. Soon after the inmate’s arrival, an intake medical screening that has been appropriately characterized as a “quick and dirty” assessment is made in order to isolate those inmates readily identifiable as needing immediate acute care. Within a day or two of the inmate’s arrival at Guild 17, he is given a “salient factor profile” which is designed to provide general information on that inmate’s security risk. Those inmates whose score on this profile indicates a low security risk remain at Guild 17 only until space is available at the CB facility, where they are transferred for the remainder of the classification process. Those whose score indicates a high security risk, as well as all “Class X” offenders are designated “keepers” and remain at Guild 17 for the entire classification process. The classification process takes about six weeks to complete. During that time, each inmate is assigned to a classification team that consists of a psychological examiner and a counselor. Those persons are responsible for completing the interviews and obtaining information about the inmates. The counselor also conducts an oral orientation program, providing the inmate with general descriptions of the other institutions in the TDOC system. During the classification process, each inmate is given a complete medical examination, including a TB skin test, a dental examination and a battery of psychological tests. The psychological tests regularly given include: the Beta II, an intelligence test; the Minnesota Multi-Phastic Personality Inventory (MMPI), designed to give a general idea of a person’s psychological make-up; the Wide Range Achievement Test, which recently replaced the California Achievement Test as the system’s measurement of basic educational skills; and the Wide Range Interest-Opinion Test, which recently replaced the General Aptitude Test Battery as a vocational aptitude test. Alternative tests are used for retarded or illiterate inmates. These include a taped version of the MMPI for inmates unable to read, and the Wechsler Adult Intelligence Scale for retarded inmates. The Peabody Picture Vocabulary is also used for educationally deficient inmates. However, none of the tests are specifically designed to identify violence-prone inmates. The major tests are usually administered in groups by a testing diagnostician, and the results are forwarded to the psychological examiner for evaluation. The testing occurs by the end of the inmate’s third week at the classification center. After the scores are tabulated by the testing diagnostician, they are forwarded to the psychological examiner for evaluation. During the inmate’s fourth week of incarceration, he or she is interviewed by the psychological examiner, who formulates recommendations based upon his impressions from the interview and his evaluation of the test results. After the tests and interviews have been completed, usually in the fourth or fifth week, the inmate meets with the classification committee. The committee’s composition is apparently fluid, but always includes a counselor, a security officer, and an “administrative” member, drawn from some other area of the institution. The psychological examiner may attend if he or she desires to, and the warden or associate warden may also be in attendance. It is this committee, acting upon the recommendation of the inmate’s classification team, which actually makes the classification decisions, i.e., the institution to which the inmate will go, his security classification and his job and programming recommendations. Usually within two weeks of the classification committee’s decision, the inmate is transferred to the designated facility referred to as the “time building” institution. Once, there, the inmate’s classification and programming recommendations are reviewed either by a counselor or the reclassification committee. A determination is then made, subject to approval of the warden, concerning the inmate’s housing and programming assignments. Although the classification recommendations are by policy considered by the receiving institution, they are not always implemented. Further, inmates of differing security classifications are routinely housed together in the same unit and often even within the same cell. Even though housing assignments are not, as a matter of policy, made on a space available basis, in reality space availability is the main determinant in most housing assignments. And, as will appear, infra, programs are so scarce that recommendations as to placement in them frequently simply cannot be followed. The security classification assigned to inmates by the classification committee determines the level of custody required for what is considered to be effective supervision of each inmate. The classifications are maximum, close, medium and minimum. The minimum security classification is further subdivided according to the type of supervision required when the inmate is outside the security perimeter of a facility, into minimum direct (direct supervision by TDOC employee), minimum trusty (supervision by other state employees) and minimum community (work or educational release). An inmate may be classified as maximum or close security because of his violence potential, escape risk or some other factor indicative of a need for a high level of supervision. It is undisputed that the vast majority of inmates coming into the TDOC system receive initial classification as medium security prisoners. In fact, both of the classification experts who appeared in this case agreed that some inmates are routinely classified as medium security who would be appropriate candidates for minimum security classifications. The reasons for the phenomenon are to some extent disputed and are of questionable relevance in any event. There is agreement, however, that one primary cause of the initial classification procedure’s failure to accurately classify low risk inmates is the problem of obtaining a verified criminal record in the form of an F.B.I. “rap sheet” prior to the termination of the classification process. According to Warden Stephens of NRCF, only in an extremely low percentage of cases does the department receive a rap sheet before an inmate leaves NRCF. Yet, without that rap sheet, the only way for an inmate to be classified below medium security is upon the recommendation of the Director of Offender Classification and the concurrence of the Commissioner, a procedure that is utilized only in rare circumstances. The problem of this “overclassification” of inmates is that it leads both to increased levels of violence and to the psychological deterioration of non-violent inmates housed with a tougher element of the prison population. The problem was acknowledged by both classification experts, and is most severe in its impact upon young first offenders, whose chances for rehabilitation are lessened by incarceration with the hard core elements of prison society. In fact, the Tennessee Law Enforcement Planning Commission recognized as much in its 1975 report: The correctional system must be able to screen out those individuals who are dangerous to the community and must be incarcerated. However, the underlying problem is that so often offenders who could better be served in a community based treatment or residential treatment program are incarcerated in a penal institution. It is quite evident that once a person is exposed and indoctrinated into the hardcore elements of a prison society, the lesser his chances are for adjustment or habilitation back into society. T.L.E.P.C., “Comprehensive Plan for the Improvement of Law Enforcement in the State of Tennessee” (1975) Ex. No. 8922 at 72. Even as early as 1937, a Citizens’ Committee established by the Commissioner of Institutions found that the state’s prisons were “giving a post graduate course in crime .. . that ... will continue as long as boys of tender age are mixed with sex perverts, the venereal diseased and prisoners serving terms for three or four felonies.” Report, “Prisons, Reformatories and Penal Institutions in Tennessee,” (1937), Ex. No. 8914, at 53. Yet, as the defendants’ classification expert, Mr. Reimer, made clear in his deposition, the adverse impact resulting from ov-erclassification is not restricted either by age or the nature of the offense for which the inmate is incarcerated. The most important consideration appears to be simply the propensity of a given inmate to participate in violence. William G. Nagel, a nationally acclaimed authority on corrections, described the problem in terms of the psychological impact of housing non-violent prisoners together with those who actually require a more restrictive setting. In that situation, Mr. Nagel testified, the non-violent prisoner begins to perceive himself as just “as bad as the next guy,” and starts to behave accordingly. The result is that the system makes “problems out of people who shouldn’t be problems.” In Tennessee, the overclassification problem is exacerbated by the incarceration of many inmates convicted of non-violent property offenses who would not even go to prison in most states. While currently only 25% of the inmates in TDOC institutions are classified as minimum security, it is readily admitted that many more would qualify for that status. Furthermore, those inmates who are classified as medium security are usually housed in institutions that also contain close or maximum security inmates, and often share individual units or even cells with higher classification inmates. The proof is clear that an inmate’s potential for violence is simply not, to any appreciable degree, taken into account in the initial decision where in the TDOC system he is to be housed. And, to the extent that an inmate’s violent or non-violent nature is considered at all in the classification process, all distinctions are effectively obliterated by the pervasive practice of classifying the overwhelming majority of new arrivals as medium security or higher. Furthermore, particular institutions almost uniformly house inmates of various security classifications, often within the same'units or even cells. The fact that housing assignments within an institution are made largely on a “space available” basis, further reduces the system’s ability to effectively separate those inmates who may somehow have been identified as more or less violent. The conclusion is inescapable that the increased violence and psychological deterioration which the experts uniformly attribute to overclassification occurs to a significant extent in Tennessee’s prisons. The court views the remainder of the plaintiffs’ complaints about the initial classification process, such as the lack of “objective criteria,” and insufficient participation by inmates in the process, as raising problems of classification theory properly left to the sound discretion of prison administrators. There is no substantive evidence to indicate that those factors, even to the extent that there might be deficiencies in the classification process, negatively impact any constitutionally protected right. Furthermore, to the extent that the plaintiffs would have the court order specific relief in areas such as the alleged deficiencies in numbers and training of staff, such areas represent the sort of minutiae of details with which this court will not interfere. See § IV, infra. In contrast to the situation at the time of the Chancery Court decision in Trigg, TDOC now has a policy requiring periodic review and reclassification of inmates. That policy requires reclassification of each inmate every six months. However, compliance with the policy has been less than total, and Commissioner Bradley doubts whether it will ever be practicable to reclassify all inmates every six months. In addition to the six-month review policy, the department has a policy that each inmate’s classification recommendation be reviewed within two weeks of his receipt at his “time-building” institution. Other factors that can trigger an early reclassification are a disciplinary action, the lodging or dropping of a detainer, or the arrival of a rap sheet. Both Dr. Fisher and Dr. Reimer criticized the apparently frequent failure to automatically review classification recommendations upon the receipt of the rap sheet. And, while Warden Rose said that such review should occur, neither he nor the Director of Offender Classification, Evans Fine, knew of any policy requiring it. In fact, the court is persuaded that such a review rarely occurs, and that the predominant overclassification of inmates to medium security (in part because of the absence of the rap sheet) is not often corrected in a timely fashion. Furthermore, it is clear that the six-month reclassification, when it occurs, is not successful in curing much of the initial overclassification. There exists neither a department wide policy setting forth the goals of periodic reclassification, nor any sense of consistency in the way the process is carried out at various institutions. For example, although Commissioner Bradley has identified transfers, job assignments, counseling and special programs as among the decisions that ought to be determined in a reclassification hearing, job and program placements at a number of institutions are apparently determined by a job board (which may consist of a single person) without consultation with the reclassification committee. At its worst, the reclassification process is, as found by Mr. David Fo-gel, a corrections expert called by the plaintiffs, little more than a mockery. Such is apparently the case at least part of the time at BCRCF, where inmate participation in the process at times seems limited to “just [signing] the papers,” without even meeting the reclassification Board. Beyond the lack of definition and consistency in the reclassification process, however, the system’s failure to remedy initial overclassification is evident in the department’s admission, see supra, that a large number of inmates who could be handled on a minimum security basis continue to be confined as medium security prisoners. Although it has been asserted that the problem is partially attributable to the lack of minimum security programs and bed space, there is a consistent problem of filling spaces in the minimum security community service centers. In fact, each institution has now been assigned a monthly quota for transfers to the CSC’s. Yet, despite the admitted presence of many minimum security candidates, the various reclassification committees have been unable to consistently meet those quotas. Consequently, over-classification often continues throughout an inmate’s stay in TDOC custody, and reclassification has to date not gone far toward alleviating the increased violence and psychological deterioration that result. C. The Health Care Delivery System The evidence is convincing that the health care needs of inmates are greater than the needs of the general free world population. A variety of factors seem responsible for that phenomenon, some of which are related to the socio-economic and family backgrounds of the prison population. Other factors equally important, however, stem from the prison environment itself: overcrowded conditions and the concomitant ease with which communicable diseases can spread, and the propensity of prisoners for violent attacks upon one another, to state but two of the most obvious. At the same time as these factors enhance the likelihood of physical disease or injury, many of them also lead to or worsen psychological and emotional problems as well. Thus, the fundamental fact against which the level of health services must be evaluated, is that within a prison system, a variety of serious physical and mental health problems can be anticipated. Sobering but true is the further realization that the physical and mental conditions of many inmates can actually be expected to deteriorate during their stay behind the walls. The health care delivery system must be capable of meeting those needs in at least a minimally adequate fashion, so as to prevent needless pain and suffering. That deficiencies exist in the delivery of health care to prisoners in the TDOC system is beyond serious cavil. Chancellor Cantrell, in the Trigg decision, found that the level of medical care in the system was “inadequate to protect life and limb, ... [causing] needless human suffering.” Trigg (Dav.Ch.Op. at 31). That conclusion was supported by extensive factual findings, the accuracy of which has been admitted by the present defendants. Although there have been some changes in the intervening years, deficiencies clearly remain. Even the defendants’ expert witness on health care, Richard A. Kiel, while concluding that the health care delivery system is “adequate” has acknowledged the continued existence of many persistent problems and the resulting need for many additional improvements. The defendants’ Director of Health Services, Jamie S. Brodie, has likewise identified numerous deficiencies in the present level of health care available to inmates in Tennessee. The issue of concern here, therefore, is precisely what and how serious the present deficiencies are. The present section will examine the TDOC health care delivery program from a systemic perspective, for indeed, many of the complaints raised by the plaintiffs are systemic in nature. In the following sections, dealing with challenged conditions at the institutional level, the court will address the facilities, staffing and the level of care actually available at each individual prison. The linchpin in the ostensibly centralized TDOC health care delivery system is the TSP hospital, which is used as a referral center for male inmates throughout the system who require inpatient treatment. Emergency and infirmary type care are provided at each institution, and civilian hospitals are utilized when needed. Inmates in need of extensive mental health care, including treatment for alcohol and drug dependency are referred to DCI, as individual institutions are not equipped to provide such services. The TDOC health care system is under the supervision of the Director of Health Services, Jamie S. Brodie, a registered nurse who has served in his present capacity since February 1981. Although Mr. Bro-die’s title is “Director,” he actually has no direct authority to control the provision of health services. Rather, his role is merely advisory. Mr. Brodie reviews the department’s health care delivery system, including equipment, facilities and staffing at each institution, and makes such recommendations as he deems necessary. However, Mr. Brodie is able to implement his recommendations only to the extent that he can convince Commissioner Bradley or local wardens to do so. His only real power is to study, recommend, and lobby for his position. Ultimately, it is individual wardens who retain the power to control the provision of health services at their respective institutions. The wardens are responsible for institutional health care budgets in conjunction with their general operating budgets, and are similarly responsible for hiring health care personnel, and for the requisition of necessary equipment and supplies. In the development of institutional budgets, the wardens are often faced with balancing the needs of the health care delivery system against competing demands upon the scarce fiscal resources allocated to their facilities. And, when the friction is between health care and security needs, health services are frequently the hardest hit and the first to be cut. Both Mr. Brodie and the defendants’ medical expert, Mr. Kiel, are satisfied with the present system wherein Mr. Brodie functions in an advisory “staff” position without direct line authority to implement his recommendations. Mr. Brodie and Mr. Kiel assert that the system allows input and influence by the Director of Health Services, without infringing on the ability of wardens to manage their own institutions. It is their belief that Mr. Brodie can be effective in his supervision of medical services by virtue of his close working relationship with the Commissioner and the wardens who, it is asserted, will usually go along with Mr. Brodie’s recommendations out of respect for his judgment. Yet, in reality, those recommendations are often not followed. As an example, a number of health staff positions that Mr. Brodie deemed essential were subsequently abolished by the wardens, who considered them expendable. The clearest example of Mr. Brodie’s inability to effect meaningful changes can be found in the way his recommendations for the TSP hospital have apparently fallen on the deaf ears of Warden Rose. Easily correctable problems cited in his September 1981 report, including the presence of outdated I.V. solutions and pharmaceuticals in the emergency room, and the use of open cupcake tins for bulk storage and dispensing of medications, have not been corrected. Warden Rose has simply not responded to numerous other recommendations. These include: (1) replacing the present hospital administrator, Harley Seimer, with a professionally qualified administrator (a move which Mr. Brodie deems “essential”); (2) restructuring the delivery of patient care according to the principles of levels of care; (3) freezing the opening of the West 100 psychiatric unit at TSP hospital; (4) use of the hospital’s third floor for a therapeutic community; (5) removing hospital beds from institutional capacity and restricting their use to medical patients only; (6) achievement of licensure for the hospital; (7) reform of the budget process; (8) developing a master staffing plan with criteria for measuring performance and planning changes; (9) developing a central pharmacy; and (10) instituting quality assurance mechanisms. Another proposal, to establish a permanent cadre of security staff assigned full time to the hospital, was acknowledged and rejected. It thus appears that Mr. Brodie is often simply ineffective in persuading the wardens to adopt his proposals, at least at budget time, when health services compete with security needs for scarce dollars. With the wardens thus firmly in charge of the TDOC health care delivery system, and in light of the glaring absence of any effective centralized authority to mandate changes, it is not surprising that the level and quality.of care varies widely from one institution to another. For example, annual expenditures for health care services recently ranged from $297 per inmate at FP, to $1,152 per inmate at TPW. At the same time, TPW needed emergency equipment that would have cost less than $100, in contrast to the expenditure of over $50,000 at TSP to purchase three new x-ray machines, when only one machine was needed. Centralized health care planning and budgeting would surely eliminate some of the irrationality that is apparent in the present system. The problem, however, is exacerbated by the absence of comprehensive system-wide health care policies and treatment protocols. This dearth of policies and protocols is a widely recognized problem of long standing which has impacted areas ranging from hiring practices and the proper qualifications for health care providers, to the level of emergency care that is available at each institution. And, while there is evidence that comprehensive policies are now being developed, the project is proceeding at a snail’s pace, and at the time of the submission of the record in this case, only two health care policies had been adopted and inserted into the policy manual. In addition, the absence of treatment protocols continues unabated, leaving the health care staff at each institution to respond ad hoc to emergency situations that may arise at times when the personnel on duty may be unqualified to develop a proper response. Indeed, the department has failed to develop any sort of comprehensive plan for the organization of either personnel or equipment to properly handle emergency situations. Similarly, there is no functioning program or device to assure the maintenance of quality control in the delivery of health care to inmates. Recommendations for quality assurance mechanisms have come from several sources over the years, and Mr. Brodie himself views quality assurance as “absolutely essential.” Yet, in the absence of a quality assurance program, the evidence indicates that nurses routinely perform functions beyond the level of their license or certification, former military medics are used interchangeably with nurses without apparent regard to the individual’s actual qualifications, and staff remain largely unaccountable for the level or quality of care actually delivered. This lack of accountability extends beyond the quality of services, and has produced a situation in which staff idleness is a common problem, and which in one case revealed extensive falsification of time records by a staff dentist. Perhaps the single most serious systemic defect that results from lack of the central administration of the TDOC health system is the failure to follow up on patient treatment. One common manifestation of the lack of follow up is the transfer of inmates among institutions for treatment, unaccompanied by their medical records. As a result, the experience of the BM health staff is not exceptional, when they stated that approximately 60% of Brushy inmates transferred to TSP for hospital care never receive the needed treatment. Even within a particular institution, continuity of care is often woefully lacking. There is no system for regular periodic physical examinations even for certain high risk inmates for whom close monitoring is indicated. Furthermore, even when treatment is provided and particular followup ordered, such followup often never occurs. The defendants contend that the full implementation of a new “problem oriented” medical records system will help to remedy many of the problems related to continuity of care and assurance of adequate followups. The new system has been two years in the making, and if the schedule goals set by Mr. Brodie have been met, should be fully effective at the present time. The system consists of three components: A health records manual, containing forms and detailed descriptions of procedures to be followed; a newly designed problem-oriented record folder; and 40 or 50 standardized forms. One of the main features of the folder is the supposed ease with which an accurate summary of an inmate’s medical condition and required treatment can be obtained. A standard form has been developed to accompany an inmate on transfer among institutions which is to describe precisely the type of care, testing or followup needed by the inmate upon transfer. Evidence also shows that the TDOC health care system has been unable to provide adequate safeguards against the possible outbreak of communicable disease, particularly hepatitis. The need for such safeguards is clear. Overcrowding and the attending poor sanitation are major factors contributing to the outbreak of the disease, which is highly communicable and sometimes fatal. Several major hepatitis outbreaks have been identified in TDOC institutions in recent years, and have risen to epidemic levels at FP and TSP in 1976, and again at TSP in 1977 and 1979. The incidence of the disease at TSP continued to be high in 1980, and has also been identified as high at MCC. Reports prepared by epidemiologists at both the National Center for Disease Control in Atlanta and the Tennessee Department of Public Health have criticized TDOC’s failure to institute a mechanism for monitoring the incidence of hepatitis. Yet, despite the studies and recommendations, no action has been taken to either monitor occurrence of the disease or reduce the likelihood of an outbreak. Furthermore, the wardens at the institutions most affected persist in maintaining that no problem exists. Similar deficiencies exist in the monitoring and control of both tuberculosis and venereal disease, both of which present serious problems in the institutional setting. Evidence was presented that policy memo-randa establishing a mechanism for monitoring and reporting TB cases, and for requiring routine pre-employment screenings and mandatory followup for prison staff, have been largely ignored. Indeed, Mr. Brodie’s 1981 evaluation of health services at TSP included the observation that cases of communicable diseases at the prison are apparently not even being reported to the local health department, as required by state law. And while Mr. Brodie believes that effective screening for VD is essential in the prison setting, Dr. Lambert King found that the health staff at MCC, one of the two intake and classification centers for male prisoners, did not even know how to screen for gonorrhea. Clearly, the department has not been effective in taking measures to control the outbreak of communicable diseases. Further illustrations of the problems generated by the lack of a central administrative leadership for TDOC’s health care system include: Inefficient and poorly organized pharmacy services, in the face of repeated recommendations that the system would be better served by a single centralized pharmacy; the absence of even a titular director of dental services, with the attendant lack of coordination among facilities and widely variable levels of care; and the lack of coordination of mental health services, including an almost total absence of any meaningful correlation of mental health and physical treatment. With respect to both dental care and mental health care, Mr. Brodie is unqualified to provide informed professional leadership even if his role allowed him an effective voice, and even if the other duties required of him allowed adequate time to devote to those areas. Neither condition is present in the existing administrative scheme. The presence of the systemic problems noted above, as well as others perhaps as serious, has been evident for a number of years. Indeed, as noted, supra, Chancellor Cantrell in the Trigg decision included specific findings regarding the same deficiencies. Studies conducted by independent sources in both 1977 and 1979 also identified many of the same problem areas. Although some steps toward reform have been taken, and although Mr. Brodie appears determined to do his best to steer the department in the right direction, the overall improvement has been slow. The departmental system for assuring the delivery of minimally adequate health care to inmates remains beset by numerous problems that clearly have an adverse impact upon the level of care available in the TDOC system. It is, of course, the level of care actually provided at each institution by which the constitutionality of the system as a whole must ultimately be judged. The discussion to follow will therefore include an examination of health care delivery at each TDOC facility as part of the broader analysis of conditions of confinement within the individual prisons. III. CONDITIONS OF CONFINEMENT A. Introduction A leviathan body of evidence (much of which is of questionable relevance) was introduced concerning what are broadly referred to as conditions of confinement within TDOC prisons. Of concern are only those conditions which, either alone or in combination, so affect the quality of life that the incarceration of inmates under such conditions may amount to cruel and unusual punishment in violation of both the federal and state constitutions. The evidence took many forms, including the reports and testimony of expert witnesses who offered factual testimony as well as conclusions and opinions regarding the impact (and at times, even the constitutionality) of particular conditions. The plaintiffs presented the testimony of three expert witnesses with regard to housing conditions. Samuel W. Hoover, an expert in the field of environmental health and sanitation, inspected conditions in four Tennessee prisons, TSP, TPW, FP and BMP. William G. Nagel, a nationally acclaimed corrections and criminal justice authority, examined TSP, FP, BMP and MCC with regard primarily to housing and idleness, two areas that he believes are of paramount importance. Mr. David Fogel, another nationally recognized corrections expert (and a former commissioner of corrections in Minnesota), inspected six TDOC facilities, TSP, BMP, FP, TC, TPW and MCRCF. Mr. Fogel’s examinations also included housing and idleness, but were much more wide ranging, touching upon, inter alia, security coverage and the existence vel non of standard departmental policies and procedures for various aspects of prison operations. Accordingly, his opinions include systemic conclusions as well as conclusions regarding the particular institutions inspected. The sole expert witness for the defendants with respect to most issues raised by Messrs. Hoover, Nagel and Fogel, was Commissioner Bradley, who, as stated previously, is himself well respected in the correctional field. No challenges have been raised to the qualifications of any of these individuals as expert witnesses. Other evidence concerning conditions in TDOC prisons was offered in a variety of forms. The findings which follow reflect the court’s review of the entire record, including trial and deposition testimony and the thousands of pages of documents introduced at the conclusion of trial. Conditions at each institution will be examined separately. . B. Tennessee State Penitentiary 1. Housing Facilities Built in 1898 in the then classic “fortress” design, the Tennessee State Penitentiary is the largest of the state’s adult penal institutions. Originally constructed to house a maximum of 1,600 inmates, TSP now regularly contains in excess of 1,900 prisoners. An additional 300-350 are assigned to the facility administratively, but are not actually housed there. The current population is down from an apparent high of approximately 2,300 in the months preceding the Chancery Court opinion in Trigg, supra. The facility is classified as a maximum security institution, but approximately 98% of the men there are medium security prisoners. Of the 21 buildings in the TSP compound, 4 are actually used for housing prisoners in 7 separate cellbloeks or units. The largest of these housing units is a long and narrow structure extending both to the left and right directly behind the administration building. These buildings comprise the entire front side of the rectangular principal compound at TSP and combine to impress observers with the imposing image of a seemingly impenetrable, if aging, fortress. This main housing building is divided into four cellbloeks, Units I-IV, which together house nearly 80% of the total population at TSP. Units I-IV are similar in design, although there are some minor variations. Each unit has five levels of cells extending down the center of the unit, with two rows or “walks” of cells positioned back-to-back on each level. The hall in front of each upper level walk is essentially a narrow catwalk, suspended in the air, which faces the building’s outside wall and the vertical, arched windows that provide the cells with at least some fresh air and natural light, albeit from a number of feet away. Units I and III each consist of 109 38-square foot cells and 80 53-square foot cells. Units II and IV each contain 189 45-square foot cells. All or virtually all of the cells in Units I-IV are “double bunked,” that is, they house two inmates per cell. Thus, when fully occupied, Units I and III each confine 218 inmates in cells that afford 19 square feet per inmate and 160 men in cells providing 26.5 square feet per inmate. Units II and IV house, when full, 378 inmates each in cells providing 22.5 square feet per inmate. Units I-IV at TSP are maintained regularly at population levels very near these capacities. For example, on July 24, 1981, Unit I housed 369 inmates, Units II and III each contained a full house of 378 inmates, and Unit IV housed 374. Unit I houses inmates in protective custody or “check-ins” (so called because they voluntarily check in for their own protection) and general population inmates. Units II-IV are general population cellbloeks. In July 1981, 18 of the prisoners in these 4 units were classified as close security and the remainder were medium security inmates. Immediately behind Units III and IV is a building containing the prison gymnasium/auditorium, dining room and, on the floor above the dining room, housing Unit V. Unit V is a single level cellblock containing 54 cells on 6 parallel corridors. Of these, 48 cells have 100 square feet and house 4 inmates each. The remaining 6 cells have approximately 50 square feet each and are double occupancy. As of July 24, 1981, the unit was fully occupied with 204 general population inmates, 2 of whom were close security, with the remaining 202 classified as medium security. A separate single-story structure situated behind Units I and II contains the prison’s maximum security cellblock, Unit VI. Unit VI consists of 48 cells ranging in size from 35 square feet to 44 square feet, which, except for those inmates on “death row,” are double occupancy cells. In addition to death row inmates, Unit VI houses inmates on administrative and disciplinary segregation, and at times some check-ins. The remaining housing unit is the Self Determination Center (SDC), located near the extreme opposite end of the TSP compound from Units I-VI, and used to house inmates on “honor” status. The SDC is a three-story structure which contains, on the ground floor, its own kitchen, laundry area and activity rooms. The second floor consists of 22 rooms, 2 of which house 4 inmates each in areas of 200 square feet and 150 square feet. The other 20 rooms are approximately 100 square feet each and are all double occupancy. On the third floor, 21 rooms of approximately 95 square feet (actually partitioned cubicles of a former dormitory area) house 2 inmates each. Four rooms on the third floor are single occupancy rooms of about 60 square feet. Finally, some additional prisoners are housed temporarily at the TSP hospital, although at any given time, some or all of those may be inmates on administrative transfer from another TDOC institution. However, primarily because of the shortage of cell space at TSP, inmates who enter the prison hospital lose their cells and must often remain in the hospital after the need for treatment has passed, awaiting an available cell. There is no dispute about the fact that TSP housing facilities are seriously overtaxed. Ninety percent or more of the prison’s 1,900 plus inmates are double bunked in cells ranging from 38 square feet to 53 square feet in size. Over 1,400 inmates at TSP are housed, 2 to a cell, in areas about the size of a ping pong table, 45 square feet, or less. Each of those cells contains two bunks, a sink and a toilet, as well as any personal belongings that the inmates are allowed to keep. Little imagination is required to realize that considerable anguish and inconvenience necessarily accompany the confinement of two individuals in such close quarters. The burdens include the lack of room for two men to do more than simply stand up at the same time and the difficulty a relatively tall inmate has in fully extending either his arms or his legs inside the cell. Further, the close proximity of the shared toilet facilities, which are often old and in serious need