Case Title: Foster v. Commissioner of Correction (No. 1)

Citation: 

Docket Number: 

State: massachusetts

Court: Massachusetts Supreme Court

Date: 2020-06-02T00:00:00Z

Document:
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SJC-12935 
 
STEPHEN FOSTER1 & others2  vs.  COMMISSIONER OF CORRECTION & 
others3 (No. 1). 
 
 
 
Suffolk.     May 7, 2020. - June 2, 2020. 
 
Present:  Gants, C.J., Lenk, Gaziano, Lowy, Budd, Cypher, 
& Kafker, JJ. 
 
 
Commissioner of Correction.  Parole.  Commissioner of Public 
Safety.  Governor.  Imprisonment, Safe environment.  
Constitutional Law, Sentence, Imprisonment, Cruel and 
unusual punishment.  Due Process of Law, Sentence, 
Commitment.  Practice, Criminal, Sentence, Execution of 
sentence.  Practice, Civil, Civil commitment. 
 
 
 
 
Civil action commenced in the Supreme Judicial Court for 
the county of Suffolk on April 17, 2020. 
 
 
The case was reported by Cypher, J. 
 
 
 
James R. Pingeon for the plaintiffs. 
                     
1 On behalf of himself and all others similarly situated. 
 
 
2 Michael Gomes, Peter Kyriakides, Richard O'Rourke, Steven 
Palladino, Mark Santos, David Sibinich, Michelle Tourigny, 
Michael White, Frederick Yeomans, and Hendrick Davis, on behalf 
of themselves and all others similarly situated. 
 
 
3 Chair of the parole board, Secretary of the Executive 
Office of Public Safety and Security, and the Governor. 
2 
 
 
 
Stephen G. Dietrick for Commissioner of Correction & 
another. 
 
Ryan P. McManus, Special Assistant Attorney General, for 
the Governor. 
 
Michael R. Byrne for the parole board. 
 
The following submitted briefs for amici curiae: 
 
Tatum A. Pritchard for Disability Law Center, Inc. 
 
Rachael Rollins, District Attorney for the Suffolk 
District, & Hon. Jon Santiago, pro se. 
 
Matthew R. Segal for American Civil Liberties Union of 
Massachusetts & another. 
 
 
GAZIANO, J.  The plaintiffs, incarcerated inmates serving 
sentences or individuals who are civilly committed under G. L. 
c. 123, § 35, commenced this class action in the county court, 
alleging that their conditions of confinement expose them to 
unreasonable risks from the COVID-19 pandemic.  They claim, 
among other things, that the defendants' failure to take readily 
available steps to reduce the incarcerated population to safe 
levels so as to permit adequate physical distancing within 
prison walls constitutes cruel and unusual punishment in 
violation of the Eighth Amendment to the United States 
Constitution and art. 26 of the Massachusetts Declaration of 
Rights, and violates substantive due process requirements 
guaranteed under the Fourteenth Amendment to the United States 
Constitution and arts. 1, 10, and 12 of the Massachusetts 
Declaration of Rights. 
The plaintiffs sought a preliminary injunction enjoining 
the Department of Correction (DOC) from (1) housing any prisoner 
3 
 
 
in a facility where the population exceeds its design-rated 
capacity and (2) "[h]ousing any prisoner in a cell, room, dorm, 
or other living area where they must sleep, eat, or recreate 
within six feet of another person."4  To accomplish this, the 
plaintiffs asked that the DOC be ordered to reduce the number of 
incarcerated individuals such that the proper physical 
distancing can be maintained in all facilities.  They also 
requested that the parole board be ordered to expedite the 
release of certain groups of inmates, consider the risks of 
COVID-19 in all parole decisions, and adopt a presumption of 
release on parole for all inmates who are eligible for parole.5  
In addition, the plaintiffs sought to enjoin the DOC from 
continuing to confine individuals who are civilly committed 
pursuant to G. L. c. 123, § 35. 
                     
 
4 The plaintiffs also asked that the Department of 
Correction (DOC) be enjoined from housing any inmate in a cell, 
dormitory, or other living area that does not comply with the 
minimize size standards established by the Department of Public 
Health (DPH) as set forth in 105 Code Mass. Regs. §§ 451.320-
451.322 (2004); maintaining any medical services unit or 
medication distribution area in which inmates have to wait 
within six feet of each other; and transferring any inmate from 
a county jail to the DOC. 
 
 
5 The parole board sought to dismiss all claims against it 
on the grounds that it is not responsible for conditions of 
confinement in DOC facilities and has no control over them, and 
also that the plaintiffs' requests for relief exceed the bounds 
of the parole board's statutory authority; that motion was 
denied.  See Foster v. Commissioner of Correction (No. 2), 484 
Mass.     ,      (2020)(Foster [No. 2]). 
4 
 
 
 
The single justice reserved and reported the case to the 
full court.6  She also remanded the matter to the Superior Court 
"for fact-finding that will enable the full court to decide the 
case in the first instance."  A Superior Court judge, by special 
assignment, conducted a series of evidentiary hearings, took 
limited testimony from all parties over three days, collected 
affidavits, and submitted his findings to this court.  We also 
ordered the defendants to provide answers to additional 
questions pursuant to Mass. R. A. P. 16 (l), as appearing in 481 
Mass. 1628 (2019). 
 
The initial question before us at this stage is whether a 
preliminary injunction should issue.  This in turn requires a 
determination whether the plaintiffs are likely to succeed on 
the merits of their claims.  See Packaging Indus. Group, Inc. v. 
Cheney, 380 Mass. 609, 616-617 (1980). 
 
To prevail on an Eighth Amendment claim, an individual must 
establish that the punishment is inconsistent with "the evolving 
standards of decency that mark the progress of a maturing 
society."  See Trop v. Dulles, 356 U.S. 86, 100-101 (1958).  
Prison officials have a duty under the Eighth Amendment to 
protect inmates in their custody from the spread of serious, 
                     
 
6 The Governor moved in this court to dismiss the claims 
against him on the ground of sovereign immunity; that motion was 
allowed, and thus, the Governor is no longer a party to this 
case.  See Foster (No. 2), 484 Mass. at    . 
5 
 
 
communicable diseases, including where the complaining inmate 
does not show symptoms of the disease, or where "the possible 
infection might not affect all of those exposed."  Helling v. 
McKinney, 509 U.S. 25, 33 (1993) ("We have great difficulty 
agreeing that prison authorities may not be deliberately 
indifferent to an inmate's current health problems but may 
ignore a condition of confinement that is sure or very likely to 
cause serious illness and needless suffering the next week or 
month or year"). 
 
Thus, to be entitled to a preliminary injunction in their 
claims for unconstitutional conditions of confinement because of 
the risk of spread of a disease, the incarcerated plaintiffs 
must show that they are likely to establish that the defendants 
have been deliberately indifferent to a substantial risk of 
serious harm to their health or safety.  See Estelle v. Gamble, 
429 U.S. 97, 103-104 (1976); Torres v. Commissioner of 
Correction, 427 Mass. 611, 613-614, cert. denied, 525 U.S. 1017 
(1998). 
 
It is undisputed, as we recognized in Committee for Pub. 
Counsel Servs. v. Chief Justice of the Trial Court, 484 Mass. 
431, 445 (2020) (CPCS v. Trial Court), that, due to the COVID-19 
pandemic, the situation inside the Commonwealth's jails and 
prisons "is urgent and unprecedented, and that a reduction in 
the number of people who are held in custody is necessary."  
6 
 
 
Nonetheless, on the record here, we conclude that the 
incarcerated plaintiffs are unlikely to succeed on the merits of 
their claim for violations of the Eighth Amendment, and thus 
their motion for a preliminary injunction must be denied. 
 
As to the plaintiffs' argument that commitment to a secure 
facility for substance abuse treatment during the pandemic 
violates the substantive due process rights of the committed 
individual, on this record, the plaintiffs do not seem to have a 
representative class member at this point, and thus are unlikely 
to succeed on their petition for a class-based preliminary 
injunction.  Nonetheless, some immediate relief is necessary 
with respect to those who have been civilly committed pursuant 
to G. L. c. 123, § 35.  Under our supervisory authority pursuant 
to G. L. c. 211, § 3, we conclude that these individuals are 
entitled to a new hearing to enable a motion judge to take into 
account treatment limitations in the current circumstances, and 
to weigh the balance of potential benefits from treatment and 
the potential harms as a result of being held in wings of 
prisons and jails or other conditions of confinement during the 
pandemic.7 
                     
7 We acknowledge the amicus letters of the American Civil 
Liberties Union of Massachusetts and the Massachusetts 
Association of Criminal Defense Lawyers; of the district 
attorney for the Suffolk district and Hon. Jon Santiago, pro se; 
and of Disability Law Center, Inc. 
7 
 
 
 
Background.  1.  COVID-19 in Massachusetts correctional 
facilities.  Despite a massive, concerted global containment 
effort, COVID-19 has continued to spread, both around the world 
and in Massachusetts.8  Few inhabited places worldwide have been 
spared from infections; the Massachusetts correctional system is 
not among them. 
 
For many, the virus causes only mild symptoms.  For others, 
particularly the elderly or those with preexisting conditions, 
the disease poses a substantial likelihood of serious illness or 
death.  Indeed, since February 29, 2020, the disease has killed 
more than 100,000 people in the United States and more than 
6,700 people in Massachusetts.  The demographic distribution of 
severe cases is of particular importance here, because 
Massachusetts has the highest percentage of elderly prisoners 
relative to all other States.9  Prisoners also have been shown to 
age more rapidly than the general population, typically 
developing the chronic conditions and disabilities associated 
with old age ten to fifteen years earlier than their 
                     
 
8 According to data published by the DPH, on April 17, 2020, 
the date the plaintiffs' complaint was filed, there were 34,402 
confirmed cases of COVID-19 in Massachusetts.  By the date of 
oral argument on May 7, 2020, that number had more than doubled 
to 73,721 cases.  As of May 29, there were 95,512 confirmed 
cases in Massachusetts. 
 
 
9 As of May 11, 2020, thirteen percent of the prisoners in 
DOC custody (957 of 7,343) were age sixty or older and thirty-
one percent (2,265) were age fifty or older. 
8 
 
 
nonincarcerated counterparts.  According to estimates by the 
Commissioner of Correction (commissioner), fifty percent of the 
inmates under her care and control either are over sixty years 
of age or have an underlying medical condition that puts them at 
heightened risk for a severe course of COVID-19, should they 
contract the virus. 
 
In CPCS v. Trial Court, 484 Mass. at 456 (Appendix B), we 
appointed a special master and established daily reporting 
requirements in order to monitor the populations of 
Massachusetts correctional institutions, and the progression of 
COVID-19 within them.  As of May 25, 2020, the DOC reported 396 
confirmed cases among inmates.  The vast majority of these cases 
were found in three institutions:  the Massachusetts 
Correctional Institution (MCI)-Shirley (160 cases) and MCI-
Framingham (84 cases); and the Massachusetts Treatment Center 
(MTC) (130 cases).  Five other institutions had at least one 
case among the incarcerated, and the rest reported zero 
confirmed cases.  The data do not reveal how many of these 
individuals are actively symptomatic or how many have recovered 
from the disease.  Eight incarcerated individuals have died of 
COVID-19. 
 
Staff at a number of correctional institutions also have 
9 
 
 
tested positive for the virus.10  As of May 25, 2020, 182 DOC 
staff, across eleven DOC facilities, had confirmed cases of 
COVID-19.  While MCI-Shirley, the MTC, and MCI-Framingham again 
had the highest numbers of positive tests, the distribution of 
infections amongst staff is broader than that of the inmates.  
As we noted in CPCS v. Trial Court, 484 Mass. at 437, infections 
among staff are of particular concern.  They not only risk 
bringing the virus into prisons, thereby spreading it amongst a 
closely confined, captive, and especially vulnerable population, 
but they also risk spreading the virus from prisons into the 
broader community.  Id.  As with inmates, the data do not reveal 
how many staff are currently symptomatic or recovered.  
Currently, no correctional staff have died of COVID-19. 
As part of ascertaining how crowded these facilities are, 
the parties ask us to compare the total number of prisoners to 
dueling definitions of prison capacity:  operational capacity or 
design capacity.  Operational capacity is based on guidelines 
issued by the Association of State Correctional Administrators.  
CPCS v. Trial Court, 484 Mass. at 439 n.12.  Design capacity 
refers to "[t]he number of inmates that planners or architects 
intended for the institution," as revised by a rating official 
                     
 
10 In discussing staff, we include both those employed 
directly by the DOC and also vendors and subcontractors who work 
within correctional institutions. 
10 
 
 
from within the DOC.  See Governor, Quarterly Report on the 
Status of Prison Capacity, Fourth Quarter 2019, 10 (Apr. 2020) 
(defining design capacity).  In every facility in Massachusetts, 
the operational capacity is higher than the design capacity, 
sometimes significantly so.  In the most pronounced example, the 
North Central Correctional Institution at Gardner (NCCI-Gardner) 
has a design capacity of 568 inmates, but an operational 
capacity of 974 inmates. 
The metric matters.  As of May 25, 2020, no DOC facility 
was over its operational capacity, and five were operating at 
less than fifty percent of operational capacity.11  The DOC 
system as a whole was at approximately sixty-five percent of 
operational capacity (6,639 prisoners out of a total operational 
capacity of 10,209).  By contrast, five institutions were over 
their design capacities, including NCCI-Gardner (medium 
security), which was at 160 percent of its design capacity.  In 
aggregate, the DOC was operating at approximately eighty-nine 
percent of its design capacity (6,639 prisoners and design 
capacity of 7,492). 
                     
 
11 The three institutions at which there have been the most 
significant COVID-19 outbreaks do not stand out as notably 
crowded.  The MTC is at 80% of operational capacity and 94% of 
design capacity; MCI-Shirley (medium security) is at 81% of 
operational capacity and 121% of design capacity; and MCI-
Framingham is at 20% of operational capacity and 26% of design 
capacity. 
11 
 
 
 
2.  Efforts at containment in correctional institutions.  
This court and all parties agree that correctional institutions 
face unique difficulties in keeping their populations safe 
during this pandemic.  Because the constitutional adequacy of 
the DOC's measures to control the spread of COVID-19 in its 
facilities is central to this litigation, we review them at some 
length. 
 
a.  Policy directives.  When the Governor declared a state 
of emergency on March 10, 2020, the DOC began implementing its 
COVID-19 control plans.  Beginning on March 12, 2020, the 
commissioner delivered a series of directives, memoranda, and 
advisories to both inmates and staff.  These essentially weekly 
communications document escalating and responsive efforts to 
implement guidance from the Centers for Disease Control (CDC) 
and the Department of Public Health (DPH).  The interim guidance 
by the CDC itself recognizes that full compliance with best 
practices is not feasible in all facilities; therefore, the 
commissioner has required each facility in Massachusetts to 
create its own compliance plan.  See Interim Guidance on 
Management of Coronavirus Disease 2019 (COVID-19) in 
Correctional and Detention Facilities (Mar. 23, 2020) (Interim 
Guidance), https://www.cdc.gov/coronavirus/2019-
ncov/downloads/guidance-correctional-detention.pdf 
[https://perma.cc/MXY3-ETDL]. 
12 
 
 
 
For example, the first memoranda issued guidance concerning 
proper hand-washing technique, sanitation, and questions used to 
screen potentially symptomatic staff and inmates.  The advisory 
issued on March 20, 2020, limited transports between facilities, 
authorized staff to wear personal protective equipment (PPE) in 
high-risk parts of facilities, and upgraded cleaning and 
disinfection protocols.  One week later, the guidance required 
staff to wear masks, provided PPE to certain inmates in 
especially high-risk areas, and allowed alcohol-based hand 
sanitizer, something that previously had been discouraged in 
prison settings.  On April 3, 2020, the commissioner initiated a 
system-wide lockdown.  Since then, inmates who live in cells 
have been spending twenty-three hours per day in their cells, 
while inmates living in dormitory-style housing have been unable 
to leave their units. 
 
While the plaintiffs contest whether these various 
directives are sufficient ultimately to ensure inmate safety, it 
is difficult to dispute that they show ongoing attention -- at 
least at the level of planning and policy -- both to guidance 
from the CDC and DPH and to the evolving situation on the 
ground.  Nonetheless, as the boxer Mike Tyson once said, 
"Everyone has a plan until they get hit."  That is to say, even 
the most meticulous and exceptional planning by the DOC still 
might not meet constitutional muster if there are pervasive 
13 
 
 
failures in implementation.  We therefore examine the execution 
of these plans and procedures. 
 
b.  Physical distancing.  Physical distancing between 
individuals (so-called "social distancing") has been a 
cornerstone of the public health response to COVID-19, both in 
the United States and around the world.  See generally Interim 
Guidance, supra.  The CDC defines social distancing as "the 
practice of increasing the space between individuals and 
decreasing the frequency of contact to reduce the risk of 
spreading a disease (ideally to maintain at least [six] feet 
between all individuals, even those who are asymptomatic)."  Id. 
at 4.  By following these practices, the goal is to slow the 
rate at which the disease progresses through the population. 
Since the first case of COVID-19 was detected in a DOC 
facility, the DOC has taken steps to implement physical 
distancing within all of its facilities.  Initially it banned 
contact sports, and later banned all use of gyms, weights, and 
prison yards.  Some inmate beds were moved further apart, and, 
in accordance with CDC guidance, inmates were asked to sleep 
head to foot, so as to increase the distance between their 
faces.  Meals now are served in cells or dormitories to avoid 
congregation in dining areas.  Staff have attempted, apparently 
at times unsuccessfully, to reduce or eliminate medication 
lines. 
14 
 
 
 
Certain aspects of prison design limit the degree to which 
physical distancing is possible.  Due both to the fact that some 
single cells have been reserved for quarantining inmates and 
because of the underlying building designs, currently fifty-
eight percent of inmates sleep either in a two-person cell or in 
a dormitory-style room.  Since the lockdown, these inmates sleep 
and live within six feet of at least one other inmate, and 
sometimes many more.  Approximately seventy percent of prisoners 
eat within six feet of another prisoner. 
For example, plaintiff Michael White resides in a 
dormitory-style room at MCI-Concord that contains bunkbeds for 
approximately eighty inmates.  The beds are three feet apart, 
the sinks are one foot apart, and White generally eats within 
arm's reach of at least one other inmate.  White's account of 
attempting to maintain appropriate distance in a dormitory 
setting is consistent with accounts by plaintiffs Ryan Duntin 
and Dana Durfee.  Moreover, while the occupants of a dormitory 
may be siloed from other groups of inmates in the prison 
(something the DOC calls "cohorting"), if an asymptomatic guard 
or other staff member were to introduce the virus, this type of 
"cohorting" would be ineffective to prevent the spread of COVID-
19 to those housed in the unit. 
 
The DOC argues that, even if those in double cells are 
unable to maintain physical distance from their cellmates, the 
15 
 
 
conditions are consistent with physical distancing guidance 
provided by the CDC because each pair of cellmates is analogous 
to a family unit in the broader community -- not distanced from 
one another, but from every other set of cellmates.  This 
argument has merit as far as it goes, but runs up against basic 
aspects of prison design:  those housed in double and single 
cells still often must share showers, toilets, sinks, and 
telephones with those in other cells on their tier or in their 
block.  Inmate testimony credited by the Superior Court judge 
consistently reported a lack of physical distancing with those 
in other cells while individuals use these essential fixtures or 
await their turn to do so. 
 
c.  Facility sanitation and personal protective equipment.  
The DPH is statutorily required to conduct biannual inspections 
of DOC facilities for compliance with health and sanitation 
regulations and to report on its findings and recommendations.  
See G. L. c. 111, § 20; 105 Code Mass. Regs. §§ 451.401 et seq.  
The plaintiffs draw our attention to recent reports for each DOC 
facility showing that health code violations for most facilities 
number in the hundreds.  The plaintiffs emphasize violations of 
regulations that recommend a specific amount of floor space per 
prisoner, and point out that twelve DOC facilities house at 
least some inmates in cells that do not meet the DPH recommended 
standards.  These violations are concerning generally, and all 
16 
 
 
the more so under conditions of global pandemic. 
We note, however, that the mere number of violations only 
paints a partial picture.  It does not distinguish between 
mandatory regulations (105 Code Mass. Regs. §§ 451.100, 451.200) 
and recommended standards (105 Code Mass. Regs. §§ 451.300).  
Furthermore, the violations vary significantly in severity.  At 
MCI-Framingham, for example, violations range from a paper towel 
dispenser that was not stocked at the time of inspection and a 
dusty wall fan to evidence of a "chronic rodent and insect issue 
in the food service areas."  Counting the number of violations 
alone does not capture this distinction.  Some chipped paint has 
little bearing on our analysis here; bathroom and shower areas 
at the MTC that were so poorly maintained as to yield an 
"increased risk of disease transmission" are highly germane. 
In March 2020, the DOC began ordering large amounts of PPE 
and cleaning supplies.  Cleaning regimens at all DOC facilities 
have been enhanced, and disinfectant cleaning supplies have been 
made available to inmates so that they may clean their own 
cells.  As stated, the DOC also has begun to allow alcohol-based 
hand sanitizer, which it has distributed widely across its 
facilities.  Despite these efforts, both cleaning supplies and 
hand sanitizer periodically have run short.  The precise extent 
of these shortages varies by institution and remains the subject 
of some factual dispute. 
17 
 
 
 
While initially PPE was provided only to correctional staff 
in specific, high-risk areas, its use has expanded as the 
pandemic has progressed.  Since March, staff have been required 
to wear masks at all times within the facilities.  Between April 
24, 2020, and April 28, 2020, the DOC distributed surgical masks 
to all inmates.  Not all staff have complied entirely with PPE 
mandates; likewise, some inmates have not followed the DOC's 
"strong encouragement" to wear the masks provided.  Supervising 
officers have used video surveillance records to discipline 
officers who have failed to comply with PPE requirements, 
including one officer who was suspended for five days when he 
and all of his staff were found not to be wearing masks. 
 
d.  Entrance screenings and quarantines.  To prevent the 
introduction of the virus into its facilities, the DOC has 
limited access to prisons; it has allowed only staff and 
attorneys to enter, and has prohibited visitors and volunteers.  
Each facility screens all those who seek entry according to 
protocols developed with reference to the guidance issued by the 
CDC and DPH.  These protocols involve a questionnaire and self-
administered temperature check; those with temperatures over 
99.9 degrees Fahrenheit categorically are denied admittance.  
The effectiveness of these screenings are limited by the fact 
that, as all parties agree, asymptomatic individuals can spread 
the disease. 
18 
 
 
 
In every facility, the DOC has set aside areas to isolate 
and quarantine confirmed and suspected cases of COVID-19, as 
well as inmates who have refused to be tested.  Individuals 
entering DOC custody are quarantined for two weeks.  As of 
May 1, 2020, there were "many open cells in the quarantine 
unit[s]" available should COVID-19 cases spike.  Inmates who 
believe they are at heightened risk proactively may request 
isolation (being held in a single cell), subject to a medical 
evaluation, but there is not enough space to place all inmates 
at heightened risk, which would amount to one-half of the DOC 
population, in single cells.  Moreover, both the commissioner 
and the plaintiffs share a concern for the mental health 
implications of long-term single-cell isolation. 
 
e.  Testing.  The DOC's testing strategy has evolved as the 
pandemic has progressed.  The DOC conducted its first COVID-19 
test on March 19, 2020, when an inmate at the MTC presented with 
symptoms.  DOC reports that initially it followed CDC and DPH 
guidelines by deferring to the medical judgment of the medical 
providers at each facility as to the testing needed.  This 
generally involved testing inmates who were symptomatic or who 
had been in close contact with someone who tested positive. 
 
On April 22, 2020, large-scale mobile testing became 
available to the DOC, and it began administering tests to any 
inmate or patient who voluntarily agreed to be tested, facility 
19 
 
 
by facility.  As of May 25, 2020, the DOC had offered tests to 
all inmates or patients at thirteen facilities.  According to 
the schedule it submitted in its Mass. R. A. P. 16 (l) letter, 
all inmates will be offered an initial test by the end of May.  
Any staff member may receive a test at any time upon request. 
 
f.  Decreasing population.  The plaintiffs seek an order 
requiring the defendants to reduce the population of 
incarcerated persons until no prisoner is housed in a 
correctional facility where the population exceeds the design 
capacity of the institution or until no inmate is housed in a 
cell that does not meet the DPH-recommended floor space 
regulations.  It is unclear how many individuals would be 
required to be released in order to meet these criteria.  At the 
evidentiary hearing, the commissioner agreed that decreasing the 
inmate population at DOC facilities could help contain the 
spread of COVID-19, and that measures to do so should be taken, 
so long as they are lawful and appropriate in light of the over-
all health and safety of the public. 
 
The commissioner has several tools at her disposal to 
reduce the population in DOC custody, including medical parole, 
good time credit, and furloughs.  The Superior Court judge found 
that the DOC has taken multiple steps to expedite the medical 
parole process, including shortening internal deadlines, 
reviewing home plans earlier in the process, and notifying 
20 
 
 
MassHealth so that the inmate has medical insurance upon 
release.  Since our decision in CPCS v. Trial Court, 484 Mass. 
at 435-436, 456-457 (Appendix B), twenty-six individuals have 
been approved for medical parole; it remains unclear how many of 
those individuals actually have been released.12 
 
Pandemic lockdown conditions effectively can lengthen 
sentences by limiting the opportunities by which inmates 
ordinarily would be able to earn good-conduct sentence 
deductions, or "good time credit."  See G. L. c. 127, § 129D.  
The statute permits 7.5 days of good time credit per activity, 
and fifteen days total per month.  See id.  In response to the 
pandemic, the commissioner awarded full good time credit for the 
month of March 2020 for anyone who had been earning such credit 
on March 1.  She also established a journaling program by which 
inmates can earn 7.5 days of good time credit for the month of 
April.  Therefore, in April, inmates were eligible for one-half 
the good time credits they ordinarily would have been able to 
obtain.  The commissioner indicated in her testimony that she 
was considering expanding these opportunities in May; the record 
does not indicate whether she has done so. 
The DOC has not used furloughs since the 1990s, based on a 
belief that it is "bad policy" to release an inmate who later 
                     
 
12 See Robert Malloy & another vs. Department of Correction, 
SJC No. 12961. 
21 
 
 
must be reincarcerated.  Accordingly, the DOC has not furloughed 
any inmates during the pandemic. 
The commissioner does not believe that she has statutory 
authority to allow inmates to serve any portion of their State 
prison sentence under home confinement.  We do not agree.  See 
G. L. c. 127, §§ 48, 49, 49A; Commonwealth v. Donohue, 452 Mass. 
256, 265 (2008); discussion part 6, infra. 
3.  Plaintiffs committed for substance abuse treatment.  
Under G. L. c. 123, § 35, Massachusetts courts are authorized to 
commit an individual for involuntary substance use disorder 
treatment upon a finding that the individual has a substance use 
disorder and that the disorder poses a likelihood of serious 
harm.  See Matter of G.P., 473 Mass. 112, 120 (2015). 
Generally, committed individuals are sent to unsecured 
treatment facilities licensed by the DPH or the Department of 
Mental Health.  See G. L. c. 123, § 35.  If DPH informs the 
judge issuing the commitment that no such facilities are 
available, or "if the court makes a specific finding that the 
only appropriate setting for treatment for the person is a 
secure facility," the judge may commit the individual to a 
secure facility designated by the commissioner.  Id.  Currently, 
there are three secure facilities in the Commonwealth.  The DOC 
operates the Massachusetts Alcohol and Substance Abuse Center 
(MASAC), which is located at the MCI-Plymouth prison.  The 
22 
 
 
Hampden County sheriff, under an agreement with the DOC, 
operates the Stonybrook Stabilization and Treatment Centers at 
Ludlow and Springfield, both of which are located at the Hampden 
County Correctional Center. 
a.  General precautions.  Both the DOC and the Hampden 
County sheriff's office have taken steps to protect their 
patients from COVID-19.  All persons entering their facilities 
are screened for symptoms of COVID-19 and are held in a medical 
quarantine unit for fourteen days.  Staff members are required 
to wear masks; for certain activities, they also wear gloves.  
The degree of compliance with these requirements remains in 
dispute.  A declarant and an affiant for the plaintiffs state 
that masks and gloves are not consistently used or changed 
between uses at MASAC.  All patients have been given masks and 
soap.  MASAC does not provide soap in the bathrooms, so patients 
must bring their personal soap with them.  At MASAC, a private 
vendor cleans and sanitizes the facility daily, including within 
patient rooms. Between March 13 and April 23, 2020, the MASAC 
population declined by eighty-two percent, and the Stonybrook 
population declined by fifty-seven percent.  As of May 25, 2020, 
MASAC held forty-three patients.  This amounts to twenty-nine 
percent of its design capacity and seventeen percent of its 
operational capacity.  Due to the low censuses, all patients 
have been given single occupancy rooms.  On May 23, 2020, MASAC 
23 
 
 
reported that two patients tested positive for COVID-19.  One 
MASAC staff member had also previously tested positive. 
b.  Treatment.  The parties offer divergent accounts of the 
degree to which treatment has been interrupted by the pandemic; 
the Superior Court judge did not make findings discrediting any 
of these differing reports.  Plaintiff Mark Santos was committed 
to MASAC on March 4, 2020.  He avers that because MASAC went 
into a lockdown on April 3, 2020, he was required to remain in 
his cell, and could leave only to go to the restroom, make a 
telephone call, or receive medication.  Santos states that most 
treatment classes were canceled in mid-March, and he attended 
only one daily group session before the lockdown.  The lockdown 
was still in effect when he was released on April 9, and Santos 
avers that he received no treatment during the lockdown.  The 
DOC concedes that it instituted a lockdown at MASAC in order to 
make COVID-19 response plans, but maintains that the lockdown 
lasted only three days. 
Declarant Robert Peacock was committed to MASAC on 
April 24, 2020, and executed his declaration on April 28, 2020.  
He stated that he had been locked in his cell continuously since 
being committed, and could leave only to shower.  He said as 
well that he had received no counselling or any other type of 
24 
 
 
treatment since his arrival.13 
The DOC asserts that, for the first three days of their 
fourteen-day intake, patients are restricted to an observation 
room and assessed daily by clinical staff.  After three days, 
patients who have been "detox cleared" are moved out of the 
observation room but remain in the separate unit.  For the 
remainder of the fourteen-day period, patients receive 
"individual services" from a substance use disorder counsellor.  
Thereafter, MASAC patients are moved to the general treatment 
unit, where they attend group sessions and other programming. 
The Hampden County sheriff's office reports that new 
patients are provided substance abuse treatment while in their 
initial fourteen-day quarantine, and that, due to the lower 
population, patients currently receive more programing overall 
than they would have prior to the pandemic. 
 
Discussion.  1.  Standard of review.  "A party seeking a 
preliminary injunction must show that success is likely on the 
merits; irreparable harm will result from denial of the 
injunction; and the risk of irreparable harm to the moving party 
                     
 
13 The DOC maintains that Robert Peacock initially exhibited 
signs of withdrawal and confusion, and therefore was kept in an 
observation room until April 28, 2020, when he was "detox 
cleared."  The DOC asserts that, on April 29, 2020, he met with 
a substance abuse counsellor, who described the program, 
explained the expectations of patients, and gave him some 
written treatment materials. 
25 
 
 
outweighs any similar risk of harm to the opposing party" 
(quotation and citations omitted).  Doe v. Worcester Pub. Sch., 
484 Mass. 598, 601 (2010).  "In cases in which a public entity 
is a party, a judge may also weigh the risk of harm to the 
public interest in considering whether to grant a preliminary 
injunction" (citations omitted).  Id.  See Fordyce v. Hanover, 
457 Mass. 248, 255 n.10 (2010); Packaging Indus. Group, Inc., 
380 Mass. at 616-617.  "[T]he movant's likelihood of success is 
the touchstone of the preliminary injunction inquiry.  [I]f the 
moving party cannot demonstrate that he is likely to succeed in 
his quest, the remaining factors become matters of idle 
curiosity."  (Quotations and citations omitted.)  Maine Educ. 
Ass'n Benefits Trust v. Cioppa, 695 F.3d 145, 152 (1st Cir. 
2012). 
 
2.  Class certification.  In their complaint and in their 
motion for injunctive relief, the plaintiffs purport to 
represent one over-all class of individuals that also is made up 
of two smaller subclasses.  They seek class certification for 
all classes.  The broad injunctive relief sought by the 
plaintiffs is possible only if there is a class that may be 
certified.  Thus, in order to determine whether their class 
claims have a reasonable likelihood of success, a prerequisite 
for granting a preliminary injunction, we first must determine 
whether the requested classes may be certified. 
26 
 
 
 
Under Mass. R. Civ. P. 23 (a), as amended, 471 Mass. 1491 
(2015), members of a class may represent the class "only if 
(1) the class is so numerous that joinder of all members is 
impracticable, (2) there are questions of law or fact common to 
the class, (3) the claims or defenses of the representative 
parties are typical of the claims or defenses of the class, and 
(4) the representative parties will fairly and adequately 
protect the interests of the class."  Additionally, the court 
must conclude that "the questions of law or fact common to the 
members of the class predominate over any questions affecting 
only individual members, and that a class action is superior to 
other available methods for the fair and efficient adjudication 
of the controversy."  Mass. R. Civ. P. 23 (b).  The plaintiffs 
bear the burden of providing "information sufficient to enable 
the motion judge to form a reasonable judgment that the class 
meets the requirements of rule 23" (quotation and citation 
omitted).  Gammella v. P.F. Chang's China Bistro, Inc., 482 
Mass. 1, 12 (2019). 
 
While the precise contours of the global class that the 
plaintiffs ask us to certify remain somewhat unclear, they are 
clear as two specific putative subclasses:  medically vulnerable 
individuals who are at high risk for serious complications or 
death from COVID-19 due to their underlying medical conditions 
or age, and those being held for treatment pursuant to G. L. 
27 
 
 
c. 123, § 35. 
 
We conclude that the plaintiffs have shown a substantial 
likelihood that a class of medically vulnerable inmates who are 
currently serving criminal sentences, or who will begin serving 
such sentences in the future, can be certified.  According to 
the commissioner, nearly one-half of the DOC population is 
potentially at heightened risk of a serious course of the 
disease, leaving little question of numerosity.  While there may 
be some variance between facilities, the legal claim and its 
basic factual underpinning are common to all potential class 
members:  that the increased risk of contracting COVID-19 caused 
by the current conditions of the correctional facilities, in 
concert with the individuals' medical vulnerability, constitutes 
cruel and unusual punishment.  Because this is precisely the 
claim of several of the named class members, they appear to be 
sufficiently typical and to have a substantial basis to show 
that they adequately and fairly can represent the class. 
 
Although the plaintiffs have shown that they are not 
precluded from establishing a substantial likelihood of success 
on the merits in at least one of their requests for class 
certification, we do not have an adequate basis in this record 
to ascertain the proper contours of who qualifies as medically 
vulnerable.  Nor, on this record, can we determine whether there 
is adequate commonality in the named plaintiffs and the 
28 
 
 
superclass of all incarcerated individuals the plaintiffs also 
seek to represent.  While we understand the pressing urgency of 
this litigation, the Superior Court judge is better positioned 
to take expert testimony and to determine the appropriate 
definition of medically vulnerable individuals for purposes of 
this litigation.  See Weld v. Glaxo Wellcome Inc., 434 Mass. 81, 
87 n.8 (2001), citing Carpenter v. Suffolk Franklin Sav. Bank, 
370 Mass. 314, 317–318 (1976) (unlike its Federal counterpart, 
rule 23 of Massachusetts Rules of Civil Procedure does not 
mandate early ruling on class certification). 
 
The second subclass that the plaintiffs seek to represent, 
those being held under G. L. c. 123, § 35, presents an entirely 
different issue.  As the defendants point out, Mark Santos, the 
proposed representative of this class, was released eight days 
before the filing of the complaint.  He makes no claim that he 
is likely to be committed again.  Thus, he would not be able to 
bring this claim on his own behalf because injunctive relief, 
preliminary or otherwise, would not redress his asserted 
injury.14  See Los Angeles v. Lyons, 461 U.S. 95, 102 (1983); 
LightLab Imaging, Inc. v. Axsun Techs., Inc., 469 Mass. 181, 194 
                     
 
14 Our holding in Matter of a Minor, 484 Mass. 295, 299-300 
(2020), that the minor's release from commitment did not render 
his appeal moot, is inapposite.  Santos does not appeal from the 
initial commitment decision.  Cf. id.  Rather, he argues, on 
behalf of the class, that the conditions of confinement during 
the pandemic render continued confinement unconstitutional. 
29 
 
 
(2014).  Because he could not bring an action on his own behalf, 
Santos cannot represent the purported class.15  See Doe v. 
Governor, 381 Mass. 702, 704–705 (1980). 
 
The plaintiffs' ability to locate a substitute class member 
seems virtually certain.  Indeed, even this limited record 
contains an affidavit from Peacock, who was relatively newly 
committed when the complaint was filed, setting forth his 
concerns about lack of programming, the close to twenty-four 
hours per day he was held in his room, proximity to others when 
using certain necessary facilities, and cleanliness of shared 
surfaces. 
 
If, as appears virtually certain, the plaintiffs are able 
to obtain a suitable representative whose claims are typical of 
the class, we anticipate that they will succeed in meeting the 
certification requirements.  Multiple questions of law and fact 
                     
 
15 Any anticipated future mootness of the class 
representative's individual claims should not preclude class 
certification, where the "claims are so inherently transitory 
that the trial court will not have even enough time to rule on a 
motion for class certification before the proposed 
representative's individual interest expires" (citation 
omitted).  See County of Riverside v. McLaughlin, 500 U.S. 44, 
52 (1991), and cases cited.  See also Gammella v. P.F. Chang's 
China Bistro, Inc., 482 Mass. 1, 20 n.24 (2019); Gonzalez v. 
Commissioner of Correction, 407 Mass. 448, 452 (1990).  Thus, 
had Santos been committed when the complaint was filed, his 
subsequent release would not have prevented the class from being 
certified or Santos from continuing to represent it.  Here, 
however, the issue is not mootness; rather, Santos lacked 
standing from the start.  See County of Riverside, supra at 51 
(distinguishing mootness from lack of standing). 
30 
 
 
are common to all putative class members, including issues 
regarding conditions of treatment and the risk of transmission 
in these conjugate settings.  Based on the broad nature of the 
plaintiffs' arguments, the issues in common apparently 
predominate over those they may not share.  The numerosity 
requirement almost certainly will be met because dozens of class 
members likely exist, and new commitments are ongoing, rendering 
joinder of all members impracticable.  See Gammella, 482 Mass. 
at 11–12 & n.15.  Lastly, adequacy exists due to the apparent 
lack of conflict between class members, and class counsel's 
ability vigorously to pursue the action.  See In re Hyundai & 
Kia Fuel Economy Litigation, 926 F.3d 539, 566 (9th Cir. 2019). 
 
Thus, we defer the issue of certification to allow the 
plaintiffs to locate and substitute an appropriate 
representative.  See Gonzalez v. Commissioner of Correction, 407 
Mass. 448, 451-453 (1990) (holding that named plaintiff's claims 
were moot, denying defendant's motion to dismiss, and remanding 
matter to Superior Court with instructions to dismiss in set 
period of time if substitute plaintiff could not be found).  See 
also Mass. R. Civ. P. 15 (a), 365 Mass. 761 (1974) (party may 
amend pleading "by leave of court or by written consent of the 
adverse party; and leave shall be freely given when justice so 
requires"). 
 
Despite the open questions of class certification that we 
31 
 
 
remand for resolution in the Superior Court, we address the 
merits of the preliminary injunction, which has been briefed and 
argued before us.  See O'Sullivan v. Secretary of Human Servs., 
402 Mass. 190, 192 (1988) (reaching merits of case, despite 
mootness of named plaintiffs, because defendants did not argue 
mootness and because counsel "apparently [were] prepared to 
pursue this action on behalf of [a substitute plaintiff]"); 
Massachusetts Gen. Hosp. v. Rate Setting Comm'n, 371 Mass. 705, 
713 (1977) (no error where court ruled on merits of case without 
ruling on class certification); Gooch v. Life Investors Ins. Co. 
of Am., 672 F.3d 402, 432–433 (6th Cir. 2012) (no error where 
court ruled on preliminary injunction before class 
certification).  The urgency of the claims raised convinces us 
that delaying resolution of the motion would do an injustice. 
 
3.  Constitutional claims.  While the plaintiffs' briefs do 
not make this distinction entirely clear, because only inmates 
who have been convicted and are serving a sentence are subject 
to punishment by the Commonwealth, the Eighth Amendment claims 
are applicable only to this group.  Any relief sought by civilly 
committed individuals must be sought on the grounds of a 
violation of substantive due process rights; because they are 
not being punished, the Eighth Amendment's protections against 
cruel and unusual punishment do not apply.  See Youngberg v. 
Romeo, 457 U.S. 307, 315–316 (1982). 
32 
 
 
 
We consider first the claims of the incarcerated 
individuals. 
 
a.  Eighth Amendment claims.  The plaintiffs contend that 
their conditions of confinement, and the defendants' failure to 
expedite the release of a greater number of individuals from 
incarceration, using any of a number of mechanisms, violate 
their rights under the Eighth and Fourteenth Amendments and 
arts. 1, 10, 12, and 26. 
 
Because we have not held that art. 26 provides greater 
protections with respect to conditions of confinement than does 
the Eighth Amendment, and conditions for the civilly committed 
must be at least as good as for those who are serving sentences 
of incarceration, see Youngberg, 457 U.S. at 321-322, we 
consider first the plaintiffs' likelihood of success under the 
Eighth Amendment. 
 
"The Eighth Amendment . . . prohibits any punishment which 
violates civilized standards and concepts of humanity and 
decency."  Young v. Quinlan, 960 F.2d 351, 359 (3d Cir. 1992).  
As the plaintiffs observe, the Eighth Amendment applies to 
conditions of confinement that are separate from and independent 
of any condition imposed as a part of sentencing.  See Helling, 
509 U.S. at 32-33. 
"[W]hen the State takes a person into its custody and holds 
him there against his will, the Constitution imposes upon 
it a corresponding duty to assume some responsibility for 
33 
 
 
his safety and general well being. . . .  The rationale for 
this principle is simple enough:  when the State by the 
affirmative exercise of its power so restrains an 
individual's liberty that it renders him unable to care for 
himself, and at the same time fails to provide for his 
basic human needs -- e.g., food, clothing, shelter, medical 
care, and reasonable safety -- it transgresses the 
substantive limits on state action set by the Eighth 
Amendment . . . ."  (Quotation and citation omitted.) 
 
Id. at 32. 
 
In order to establish an unconstitutional condition of 
confinement, a claimant must show both an objective element and 
a subjective element.  Wilson v. Seiter, 501 U.S. 294, 298 
(1991).  The objective element requires an inmate to show that 
his or her living conditions amount to a "serious deprivation[] 
of basic human needs," Rhodes v. Chapman, 452 U.S. 337, 347 
(1981), which can include denial of medical care for serious 
medical needs, Estelle, 429 U.S. at 102-105. 
 
The subjective element requires an inmate to demonstrate 
that prison officials acted or failed to act with deliberate 
indifference.  Id. at 106.  See Torres, 427 Mass. at 614.  "[A] 
prison official cannot be found liable under the Eighth 
Amendment for denying an inmate humane conditions of confinement 
unless the official knows of and disregards an excessive risk to 
inmate health or safety; the official must both be aware of 
facts from which the inference could be drawn that a substantial 
risk of serious harm exists, and he [or she] must also draw the 
inference."  Farmer v. Brennan, 511 U.S. 825, 837 (1994).  While 
34 
 
 
subjective knowledge is a question of fact that a claimant must 
establish, and it is necessary to distinguish between obvious 
risks and a prison official's actual knowledge of the risk, 
where the risk is so obvious that a reasonable person would 
realize it, "a factfinder may conclude that a prison official 
knew of a substantial risk from the very fact that the risk was 
obvious."  Id. at 842. 
 
b.  Risk of contracting COVID-19 in the Commonwealth's 
prisons.  As stated, an inmate asserting unconstitutional 
conditions of confinement first must establish, objectively, 
that the conditions pose a "substantial risk of serious harm."  
See Farmer, 511 U.S. at 834, citing Helling, 509 U.S. at 35.  
See also Rhodes, 452 U.S. at 347 (Eighth Amendment violation 
requires showing that living conditions amount to "serious 
deprivation of basic human needs," including denial of medical 
care for serious medical needs). 
 
The defendants contend that the incarcerated plaintiffs 
will be unable to establish the objective component of their 
deliberate indifference claim; they argue, 
"No prisoner has been forced to endure an extreme 
deprivation or even an unreasonable risk to their health or 
safety.  The measures mentioned above, such as increased 
cleaning and sanitizing operations, distribution of PPE to 
all inmates and staff, posting of educational and 
institutional flyers and memoranda, and encouraging social 
distancing as much as possible, rival that which is being 
done in the community to help combat the spread of an 
insidious disease that all Americans, inmate or not, are at 
35 
 
 
risk of contracting." 
 
We do not agree.  Notwithstanding the claim that no inmate has 
had to endure an unreasonable risk to health or safety as a 
result of being incarcerated during the COVID-19 pandemic, there 
can be no real dispute that the increased risk of contracting 
COVID-19 in prisons, where physical distancing may be infeasible 
to maintain, has been recognized by the CDC and by courts across 
the country.16  See, e.g., Baez vs. Moniz, U.S. Dist. Ct., No. 
20-10753-LTS (D. Mass. May 18, 2020) ("There is, and can be, no 
meaningful dispute that COVID-19 presents a substantial risk of 
serious harm to health, to the proposed class of petitioners in 
this case as well as to members of society at large"); Refunjol 
vs. Adducci, U.S. Dist. Ct., No. 2:20-cv-2099 (S.D. Ohio May 14, 
2020) ("The objective component of the inquiry is beyond debate.  
Nobody can dispute that COVID-19 is a sufficiently serious 
medical need . . . ."); Frazier vs. Kelley, U.S. Dist. Ct., 
No. 4:20-cv-00434-KGB (E.D. Ark. May 4, 2020) ("[I]t cannot be 
disputed that COVID-19 poses an objectively serious health risk 
                     
 
16 That the CDC interim guidance for prisons recognizes that 
in some instances it may not be feasible to maintain the 
recommended six feet, and offers other guidance that may help to 
reduce the risk as far as possible in such circumstances, does 
not mean, as the defendants appear to suggest, that the CDC 
recommends maintaining a lesser distance among incarcerated 
individuals than among others; it clearly states repeatedly that 
six feet or more "ideally" should be maintained between 
incarcerated individuals, including in housing arrangements.  
See Interim Guidance, supra at 3, 4, 11, 13, 19, 20. 
36 
 
 
to named plaintiffs and the putative classes given the nature of 
the disease and the congregate living environment of the . . . 
facilities"). 
 
Having concluded that the incarcerated plaintiffs almost 
certainly will succeed in establishing the objective component 
of their claims under the Eighth Amendment, we turn to 
consideration of the subjective component, i.e., whether the 
plaintiffs are likely to be able to establish deliberate 
indifference on the part of the defendants. 
 
4.  Deliberate indifference.  a.  Applicable standard.  
"While Estelle[, 429 U.S. at 105-106,] establishes that 
deliberate indifference entails something more than mere 
negligence, the cases are also clear that it is satisfied by 
something less than acts or omissions for the very purpose of 
causing harm or with knowledge that harm will result."  Farmer, 
511 U.S. at 835.  "With deliberate indifference lying somewhere 
between the poles of negligence on the one end and purpose or 
knowledge at the other," courts frequently have described it as 
"recklessly disregarding" a substantial risk of harm.  Id. at 
836, and cases cited.  In other words, the subjective standard 
for deliberate indifference requires the same showing of 
"subjective recklessness" as would apply in the criminal 
context.  Id. at 839-840. 
 
This is not a static determination.  In a suit for 
37 
 
 
prospective relief, "the subjective factor, deliberate 
indifference, should be determined in light of the prison 
authorities' current attitudes and conduct," including "their 
attitudes and conduct at the time suit is brought and persisting 
thereafter."  Farmer, 511 U.S. at 845, quoting Helling, 509 U.S. 
at 36.  In making the requisite showing of subjective 
culpability, the prisoner may rely "on developments that 
postdate the pleadings and pretrial motions, as [prison 
officials] may rely on such developments to show that the 
[prisoner] is not entitled to an injunction."  Farmer, supra at 
846. 
 
b.  Analysis.17  Following the United States Supreme Court's 
reasoning in Estelle, 429 U.S. at 106, and Helling, 509 U.S. 
at 32-33, concerning prison officials' Eighth Amendment duty to 
take reasonable steps to protect inmates from the spread of 
serious communicable diseases, inmates across the country have 
                     
 
17 The plaintiffs urge that, rather than the objective and 
subjective components of deliberate indifference, this court 
apply the objective standard used in Kingsley v. Hendrickson, 
135 S. Ct. 2466, 2473 (2015), in evaluating their Eighth 
Amendment claims.  This reasoning is misguided.  Kingsley 
involved a claim by a pretrial detainee under 42 U.S.C. § 1983, 
concerning the use of excessive force.  The detainee asserted a 
violation of his substantive due process rights.  Accordingly, 
to prevail, he was required to show only that the intentional 
use of force was excessive or objectively unreasonable, and not 
that the official intended it to be so.  This standard, however, 
is inapplicable to claims of deliberate indifference under the 
Eighth Amendment. 
38 
 
 
brought a variety of actions successfully challenging the 
policies, or lack of policies, of prison officials regarding the 
spread of contagious diseases and other conditions that threaten 
health throughout a prison.  In Lareau v. Manson, 651 F.2d 96, 
109 (2d Cir. 1981), for example, the United States Court of 
Appeals for the Second Circuit applied this line of reasoning to 
hold prison officials liable for violating the Eighth Amendment 
when they made no efforts to screen incoming inmates for 
contagious diseases, despite significant overcrowding that 
further heightened the risk of infection.  The court held that 
aggrieved prisoners need not demonstrate that "an infectious 
disease has actually spread in an overcrowded jail before 
issuing a remedy."  Id.  See, e.g., DeGidio v. Pung, 920 F.2d 
525, 533 (8th Cir. 1990) (prison officials were deliberately 
indifferent to inmates' serious medical needs by consistent 
pattern of reckless or negligent conduct in failing to prevent 
and control prison's tuberculosis epidemic); Dunn v. White, 880 
F.2d 1188, 1195 (10th Cir. 1989), cert. denied, 493 U.S. 1059 
(1990) (observing that prison's failure to protect incarcerated 
inmates from human immunodeficiency virus [HIV] infection may 
violate Eighth Amendment); Smith v. Sullivan, 553 F.2d 373, 380 
(5th Cir. 1977) (concluding that housing scabies- and gonorrhea-
infected inmates with healthy prisoners violates Eighth 
Amendment). 
39 
 
 
 
Where the risk of serious harm is substantial, but prison 
officials have undertaken significant steps to try to reduce the 
harm and protect inmates, courts have concluded that there was 
no Eighth Amendment liability.18  In Butler v. Fletcher, 465 F.3d 
340, 345 (8th Cir. 2006), cert. denied, 550 U.S. 917 (2007), for 
example, the United States Court of Appeals for the Eighth 
Circuit determined that the sheriff in charge of a county jail 
was not deliberately indifferent to the risk of a tuberculosis 
infection within the jail where the county adopted "policies 
[that] specifically acknowledged the risk and promulgated 
detailed procedures for the diagnosis, segregation, and 
treatment of . . . inmates infected with active cases of 
[tuberculosis]."  See Johnson v. United States, 816 F. Supp. 
1519, 1522-1525 (N.D. Ala. 1993) (applying reasoning in Lareau, 
651 F.2d at 109, and concluding that inmate did not establish 
violation of Eighth Amendment from being housed in cell with 
patient who was dying from acquired immune deficiency syndrome, 
where prison officials' policies educated inmates on "universal 
precautions" and prohibited type of high risk behavior that 
                     
 
18 Courts have relied on similar reasoning in considering 
prison officials' policies with respect to other widespread 
risks to health and safety.  See, e.g., Rish v. Johnson, 131 
F.3d 1092, 1099 (4th Cir. 1997) (requiring inmates to clean up 
blood and bodily fluids without providing them gloves); Wallis 
v. Baldwin, 70 F.3d 1074, 1077 (9th Cir. 1995) (requiring inmate 
to clean attic full of asbestos, known carcinogen, without 
protective equipment). 
40 
 
 
could result in HIV infection). 
 
While there are as yet no appellate court decisions on 
claims asserting a violation of the Eighth Amendment due to the 
increased risk of exposure to COVID-19 in prisons, a number of 
Federal District Courts have considered the issue using a 
similar analysis.  For example, in Baez, No. 20-10753-LTS, the 
United States District Court for the District of Massachusetts 
concluded that the inmate-petitioners had not established a 
likelihood of success on the merits.  Given prison officials' 
"many measures and policies aimed at keeping COVID-19 from 
entering the facility," and the "meaningful actions" undertaken 
"aimed at controlling and mitigating against the spread of 
COVID-19 within the facility," the plaintiffs were unlikely to 
show that prison officials had been "obdurate, wonton, or 
reckless with respect to [the risk of COVID-19], or . . . 
otherwise failed to take reasonable steps aimed at preventing or 
mitigating the risk that COVID-19 presents to those detained."  
Id.  In Kevin M.A. vs. Decker, U.S. Dist. Ct., No. 20-4593 (KM) 
(D.N.J. May 1, 2020), the United States District Court for the 
District of New Jersey concluded that, due to the "numerous 
affirmative steps to try and stop the spread of COVID-19" taken 
by jail officials, and the "protocols for individuals who 
exhibit symptoms," the inmate-petitioner had failed to 
demonstrate deliberate indifference, notwithstanding that he 
41 
 
 
became ill with COVID-19 while in custody. 
 
To combat the spread of COVID-19 as far as possible, the 
DOC has undertaken a number of measures, set forth in the 
appointed judge's findings of fact, many of which are stipulated 
to by the parties.  These measures included lockdowns of the 
facilities; prohibiting all outside visitors; restrictions and 
self-examination on entry to any facility; isolation of 
symptomatic inmates and those who have tested positive; 
requiring staff to stay home for fourteen days if they have any 
symptoms; mandating that staff wear masks when in contact with 
inmates; distribution of additional cleaning supplies to all 
inmates; increased cleaning of frequently touched surfaces; 
making alcohol-based hand sanitizer available to inmates in 
numerous facilities; having inmates eat in their cells or 
housing units rather than at tables in larger groups; and 
instructions, posters, and information on COVID-19 and its 
spread, in both Spanish and English.  To reduce inmates 
congregating in close contact with each other, the DOC has 
eliminated most group programming, work release, and academic 
and job skills classes, as well as outdoor recreation time and 
access to gyms and libraries, i.e., any activities where groups 
of inmates would be together. 
 
Over the course of this litigation, the DOC has obtained 
and distributed PPE to staff and, recently, all inmates.  It has 
42 
 
 
required that staff in contact with inmates, and all inmates who 
leave their cells or dormitories, wear masks at all times.  The 
DOC also recently has instituted some limited amount of outdoor 
time for all inmates, in small groups approximately every four 
days, so that physical distancing can be maintained. 
 
In evaluating whether deliberate indifference has been 
established, courts often have examined guidelines and standards 
from professional associations and State codes.  "Published 
standards of medical care or adopted guidelines such as the 
tuberculosis manuals . . . do not establish absolute standards 
for measuring the constitutionality of official actions.  But 
neither may they be ignored by [S]tate officials, however.  Such 
standards and guidelines are useful measures for 'determining 
whether contemporary standards of decency have been met.'"  
DeGidio v. Pung, 704 F. Supp 922, 956 (D. Minn. 1989), aff'd, 
920 F.2d 525 (8th Cir. 1980), quoting Ramos v. Lamm, 639 F.2d 
559, 567 n.10 (10th Cir. 1980), cert. denied, 450 U.S. 1041 
(1981).  See, e.g., Lareau, 651 F.2d at 106 ("To inform itself 
of contemporary standards, the district court considered 
correctional guidelines and standards from a number of 
organizations").  See also Williams v. Edwards, 547 F.2d 1206, 
1214 (5th Cir. 1977) ("In the past we have affirmed findings of 
constitutional violations based in part on [S]tate code 
violations. . . .  Such a standard is a valuable reference for 
43 
 
 
what is minimal for human habitation in the public view, thus 
serving as an indicator of evolving notions of decency" 
[quotation and citation omitted]). 
 
At oral argument, the plaintiffs were unable to point to 
any area in which they assert that the DOC is not in compliance 
with the CDC's interim guidance on prisons and jails with 
respect to COVID-19.  When questioned, the plaintiffs conceded 
that the DOC in fact is in compliance with all CDC interim 
guidance for correctional facilities.  While compliance with 
professional guidance is not enough, on its own, to establish 
constitutionality (or a lack thereof), see Bell v. Wolfish, 441 
U.S. 520, 543 n.27 (1979), such compliance does provide useful 
indications to be considered in conjunction with other factors, 
see Ramos, 639 F.2d at 567 n.10 ("a variance from [S]tate 
standards or from standards promulgated by certain professional 
organizations does not establish a per se constitutional 
violation[;] it is a factor to be considered in determining 
whether contemporary standards of decency have been met").  The 
DOC's current compliance with CDC's interim guidance weighs 
against a determination that the plaintiffs are likely to 
succeed on the merits of their claims. 
 
Another notable factor is the DOC's current widespread 
testing program.  As stated, testing, contact tracing, and 
quarantine are considered the sine qua non of any effort to 
44 
 
 
control the COVID-19 pandemic.  See generally Interim Guidance, 
supra.  On March 19, 2020, the DOC first tested a symptomatic 
inmate for COVID-19.  Thereafter during that early period, only 
inmates who presented as symptomatic, or, in a few cases, those 
who had been in close contact with an inmate who had tested 
positive, were being tested for COVID-19.  When the plaintiffs 
first commenced this action, the special master in CPCS v. Trial 
Court, 484 Mass. at 456-457 (Appendix B), was presenting daily 
reports showing little to no testing for COVID-19 at many 
facilities, and, in particular, no testing of inmates at 
facilities where a correction officer or other staff member had 
tested positive for COVID-19.  Based on the special master's 
reports, the plaintiffs and the amicus American Civil Liberties 
Union urged this court to conclude that there had been an Eighth 
Amendment violation due to an apparent lack of basic contact 
tracing, testing, and isolation, as recommended by the CDC, and 
asked us to order testing of all inmates in DOC facilities.  At 
the same time, when the complaint in this case first was filed, 
and even after the matter was assigned to the Superior Court 
judge for fact finding, the DOC was asserting difficulty in 
obtaining tests and a shortage of tests in all facilities. 
 
Since that initial period of a few tests for symptomatic 
inmates, if a test was recommended by an individual clinician 
and as tests were available, the DOC has modified its testing 
45 
 
 
strategies substantially.  After oral argument in this case, and 
increasingly throughout the month of May, the DOC has begun 
widespread testing of nonsymptomatic inmates, as well as 
offering testing to all correction officers upon request. 
 
At oral argument, the attorney for the DOC stated that the 
DOC had access to 10,000 COVID-19 tests, and that the DOC was 
planning a large-scale testing program.  In response to requests 
by this court for additional information on the subject pursuant 
to Mass. R. A. P. 16 (l), the DOC clarified that, as of May 11, 
2020, it had 2,073 tests in its possession, was using a mobile 
testing van to conduct tests, had been assured that there was 
now no limit on the number of tests that it would be able to 
obtain, and had begun to implement a system-wide testing plan.  
Under this plan, all inmates and all staff at each facility, 
regardless of whether they are symptomatic, will be offered 
tests, and all facilities will have been tested by May 31, 2020, 
following a schedule of approximately two days of testing at 
each site. 
 
Current widespread DOC testing efforts, if continued as 
planned, will provide much of the testing relief that the 
plaintiffs, and the amicus American Civil Liberties Union, urge 
this court to order.  This further supports the conclusion that 
the plaintiffs are not likely to succeed on the merits of their 
claims for violations of the Eighth Amendment. 
46 
 
 
 
In sum, on this record, it appears unlikely that the 
plaintiffs will be able to establish deliberate indifference on 
the part of the DOC regarding their conditions of confinement as 
a result of the pandemic.  We turn to consider their claims for 
violations of substantive due process. 
 
5.  Substantive due process claims for individuals 
committed under G. L. 123, § 35.  The plaintiffs argue that 
commitment to a secured facility for substance abuse treatment 
during the COVID-19 pandemic violates committed individuals' 
substantive due process rights. 
 
a.  Professional judgment.  In Youngberg, 457 U.S. at 315–
316, individuals who had been civilly committed based on 
intellectual disabilities brought substantive due process 
challenges regarding their conditions of confinement.  The 
United States Supreme Court concluded that, "[i]f it is cruel 
and unusual punishment to hold convicted criminals in unsafe 
conditions, it must be unconstitutional to confine the 
involuntarily committed -- who may not be punished at all -- in 
unsafe conditions."  Id.  Therefore, "when the State takes a 
person into its custody and holds him [or her] there against his 
[or her] will the Constitution imposes upon it a corresponding 
duty to assume some responsibility for his [or her] safety and 
general well-being."  DeShaney v. Winnebago County Dep't of 
Social Servs., 489 U.S. 189, 199-200 (1989), citing Youngberg, 
47 
 
 
supra at 317.  See Williams v. Hartman, 413 Mass. 398, 403 
(1992). 
 
Relying on these holdings, the plaintiffs maintain that 
commitment for substance abuse treatment during the COVID-19 
pandemic creates unsafe conditions of confinement.  Under 
Youngberg, 457 U.S. at 323, however, to establish a violation of 
substantive due process, it is not sufficient to allege only 
that conditions are unsafe.  Rather, the test is whether a 
"decision by [a] professional is such a substantial departure 
from accepted professional judgment, practice, or standards as 
to demonstrate that the person responsible actually did not base 
the decision on such a judgment."19  See Hopper v. Callahan, 408 
Mass. 621, 626–627 (1990), quoting Youngberg, supra. 
 
The plaintiffs contend that commitment to a secured 
facility during the COVID-19 pandemic is so contrary to 
                     
 
19 In determining whether there was a violation of 
substantive due process, some courts have applied the standard 
of deliberate indifference to decisions made by 
nonprofessionals.  See, e.g., Lanman v. Hinson, 529 F.3d 673, 
684 (6th Cir. 2008).  This court, however, has rejected the 
application of the deliberate indifference standard to 
individuals who have been civilly committed because of their 
intellectual disabilities.  See Hopper v. Callahan, 408 Mass. 
621, 627 & n.4 (1990).  Additionally, the United States Supreme 
Court's decision in Kingsley, 135 S. Ct. at 2473, casts doubt on 
the applicability of a subjective standard to claims challenging 
conditions of confinement for nonsentenced individuals.  See 
Smith v. Washington, 781 Fed. Appx. 595, 597-598 (9th Cir. 
2019), quoting Castro v. County of Los Angeles, 833 F.3d 1060, 
1071 (9th Cir. 2016), cert. denied, 137 S. Ct. 831 (2017) 
(applying objective test to civil detainees). 
48 
 
 
substance abuse treatment principles that it necessarily 
constitutes a substantial departure from professional judgment.  
They rely on the COVID-19 guidance from the Substance Abuse and 
Mental Health Services Administration (SAMHSA), an entity within 
the United States Department of Health and Human Services, which 
states that residential treatment "has not been shown to be 
superior to intensive outpatient treatment."  Therefore, 
"[b]ecause of the substantial risk of coronavirus spread with 
congregation of individuals in a limited space such as in an 
inpatient or residential facility, SAMHSA is advising that 
outpatient treatment options, when clinically appropriate, be 
used to the greatest extent possible."  SAMHSA, Considerations 
for the Care and Treatment of Mental and Substance Use Disorders 
in the COVID-19 Epidemic (rev. May 7, 2020). 
 
Contrary to the plaintiffs' characterizations, this 
guidance does not state that inpatient treatment is never 
advisable during the pandemic.  Rather, SAMHSA states that 
"[i]npatient facilities and residential programs should be 
reserved for those for whom outpatient measures are not 
considered an adequate clinical option[, such as] those with 
mental disorders that are life threatening."  Id.  Commitment 
under G. L. c. 123, § 35, intended to be a "carefully 
circumscribed . . . tool of last resort," by definition is 
limited to situations in which the individual poses a likelihood 
49 
 
 
of serious harm.  See Matter of a Minor, 484 Mass. 295, 311 
(2020).  If outpatient treatment, or any other plausibly 
available option, would "bring the risk of harm below the 
statutory thresholds that define a likelihood of serious harm," 
a judge may not commit the subject of a petition to any 
facility, secure or unsecure.  See id. at 310, citing Matter of 
G.P., 473 Mass. at 128-129. 
 
Commitment to a secure facility requires an additional 
finding that an unsecure facility is unavailable or 
insufficient.  See G. L. c. 123, § 35.  Once committed, the 
superintendent of the facility may release an individual early 
if there is not a likelihood of serious harm.  See id.  These 
restrictions, if followed, should limit commitment to 
individuals "for whom outpatient measures are not considered an 
adequate clinical option," as recommended by SAMHSA. 
 
The plaintiffs have presented no evidence of individuals 
having been committed in contravention of these requirements.  
Nonetheless, the plaintiffs maintain that commitment for 
substance use disorder during the pandemic constitutes a 
violation of professional judgment in every case.  Without a 
more complete factual record, and without expert guidance, we 
are not able to reach such a broad conclusion. 
 
b.  Reasonable relation.  The plaintiffs argue also that 
civil commitment for substance abuse treatment during the COVID-
50 
 
 
19 pandemic does not advance sufficiently the treatment goals of 
G. L. c. 123, § 35, and therefore violates their substantive due 
process rights.  Due process under the Federal Constitution 
"requires that the conditions and duration of confinement under 
the [statute] bear some reasonable relation to the purpose for 
which persons are committed."  Seling v. Young, 531 U.S. 250, 
265 (2001), citing Foucha v. Louisiana, 504 U.S. 71, 79 (1992).  
As the DOC notes in its opposition, however, under the 
Massachusetts Declaration of Rights, civil commitment is subject 
to a higher level of judicial review, i.e., strict scrutiny.  
See Matter of a Minor, 484 Mass. at 309.  Under strict scrutiny 
review, a statute cannot stand unless it is "narrowly tailored 
to further a legitimate and compelling governmental interest and 
[is] the least restrictive means available to vindicate that 
interest."  Commonwealth v. Weston W., 455 Mass. 24, 35 (2009). 
 
Both the "reasonable relation" standard and review under 
strict scrutiny require the government to identify a purpose for 
which a statute was enacted, and to show how the government 
action is connected to that purpose.  Review under strict 
scrutiny, however, requires the government meet a much higher 
burden for both elements of the test.  Rather than simply 
identifying a permissible purpose, the government must show that 
the statute is designed to address a compelling government 
interest.  Otherwise put, here, rather than requiring only that 
51 
 
 
the civil confinement be reasonably related to the government's 
interest, the confinement must be narrowly tailored to that 
interest as well as the least restrictive means by which to 
accomplish the intended goal. 
 
Because the plaintiffs presented their arguments to us 
under the Federal standard, we address it first.  In Doe v. 
Gaughan, 808 F.2d 871, 874 (1st Cir. 1986), the plaintiffs 
argued that, because they were committed to a correctional 
institution, rather than a mental health facility, the nature of 
their confinement was not reasonably related to the purpose for 
which they were confined.  The United States Court of Appeals 
for the First Circuit disagreed; the court concluded that the 
secure facility bore a "reasonable relationship both to the 
[S]tate's public safety needs and to the patients' own 
therapeutic interests in a secure environment."  See id. at 878.  
Conversely, in Jackson v. Indiana, 406 U.S. 715, 738-739 (1972), 
the United States Supreme Court held that the confinement of an 
incompetent defendant for more than three years bore no 
reasonable relation to his commitment because there was no 
substantial probability of his becoming competent. 
 
General Laws c. 123, § 35, states that the purpose of 
commitment is "inpatient care for the treatment of an alcohol or 
substance use disorder."  This treatment is intended to promote 
the health and safety of the individual committed and others, as 
52 
 
 
demonstrated by the statutory requirement that a committed 
individual pose a danger to him- or herself, or a member of the 
community.  See G. L. c. 123, § 35.  Therefore, if patients are 
not receiving meaningful and reasonably effective treatment for 
substance use disorders, which advances their health and safety, 
their commitment violates Federal due process requirements. 
 
The DOC and the Hampden County sheriff's office report that 
committed individuals are held for the first fourteen days in a 
separate unit and do not participate in group programming.  The 
plaintiffs argue that, during those fourteen days, committed 
individuals receive "next to no treatment," and thus that their 
confinement bears no reasonable relationship to the purpose of 
commitment.  The DOC reports, however, that after an initial 
three-day observation period has ended, and the individual has 
been "detox cleared," the individual receives daily "individual 
services" from a substance abuse disorder counsellor.  The 
Hampden County sheriff's office reports that individuals receive 
substance abuse treatment during their first fourteen days of 
commitment.  The record contains no information regarding the 
nature and extent of these services. 
 
We agree that, if the first fourteen days involve no real 
treatment, or only minimal treatment, the plaintiffs would have 
a strong claim.  The DOC's deputy commissioner of clinical 
services and reentry avers that many individuals are released 
53 
 
 
after thirty days of confinement.  As the plaintiffs note, the 
first fourteen days of confinement account for almost one-half 
of the total period of commitment for those individuals.  
Without more information regarding the limited treatment 
provided, however, and without expert testimony regarding the 
efficacy of that limited treatment, we cannot conclude that 
commitment during the pandemic bears no reasonable relation to 
the purposes of the statute. 
 
c.  Strict scrutiny.  As stated, the plaintiffs' complaint 
and its arguments before this court rest on substantive due 
process requirements under the Federal standard.  Because civil 
commitment involves a loss of liberty, a fundamental 
constitutional right, however, we also consider the plaintiffs' 
constitutional claims under the more stringent standard embodied 
in the Massachusetts Declaration of Rights.  "In substantive due 
process analysis, the nature of the individual interest at stake 
determines the standard of review that courts apply when 
deciding whether a challenged statute meets the requirements of 
the due process clause."  Aime v. Commonwealth, 414 Mass. 667, 
673 (1993).  See R.B., petitioner, 479 Mass. 712, 717–718 
(2018); Commonwealth v. Travis, 372 Mass. 238, 246 (1977). 
 
Freedom from physical restraint is a paradigmatic 
fundamental right, essential to a free society.  See Pembroke 
Hosp. v. D.L., 482 Mass. 346, 347 (2019), citing Matter of E.C., 
54 
 
 
479 Mass. 113, 119 (2018).  Civil commitment under G. L. c. 123, 
§ 35, thus is subject to strict scrutiny under the due process 
protections in the Massachusetts Declaration of Rights.  
Accordingly, the statute "must be narrowly tailored to serve a 
compelling governmental interest" and "also be the least 
restrictive means available to vindicate that interest."  
Massachusetts Gen. Hosp. v. C.R., 484 Mass. 472, 489 (2020). 
 
Here, the question whether G. L. c. 123, § 35, could 
survive strict scrutiny review, absent a pandemic, is not before 
us.  As nothing in the plaintiffs' filings or the record touches 
on the question of strict scrutiny, we assume without deciding, 
as we did in Matter of a Minor, 484 Mass. at 309 n.9, that the 
statute at baseline does not violate substantive due process.  
Accordingly, we examine whether the current public health crisis 
alters the strict scrutiny analysis such that commitment to a 
secure facility during the COVID-19 pandemic must be 
unconstitutional. 
 
As stated, the purpose of commitment for substance abuse 
treatment is to promote the health and safety of the committed 
individual and others through such treatment.  We have no 
evidence that the dangers of substance use disorders, or the 
need for treatment, have diminished during the COVID-19 
pandemic.  Thus, issues regarding COVID-19 have no impact on the 
question whether there is a compelling and legitimate government 
55 
 
 
interest. 
 
The pandemic, however, may affect whether commitment is 
narrowly tailored to that interest.  If the commitment and 
treatment do not promote effectively the government's interest 
in the individual's and others' health and safety, the 
government action cannot survive strict scrutiny.  See Grutter 
v. Bollinger, 539 U.S. 306, 333 (2003) ("means chosen . . . must 
be specifically and narrowly framed to accomplish [their] 
purpose" [citation omitted]).  In this regard, the increased 
risk of COVID-19 transmission in congregate settings is highly 
pertinent. 
 
As we recognized in CPCS v. Trial Court, 484 Mass. at 436, 
"confined, enclosed environments increase transmissibility" of 
COVID-19.  "[M]aintaining six feet of distance between oneself 
and others . . . may be nearly impossible" in these settings.  
Id.  As with the jails and prisons at issue in that case, 
"proper sanitation is also a challenge" for the commitment 
facilities, as shown by DPH inspections in January and February 
of 2020, identifying dozens of repeat violations at MASAC and 
the Stonybrook facilities.20  Id. at 436-437. 
                     
 
20 The record here contains only the plaintiffs' summaries 
of what the DPH reports state, and not the actual reports.  We 
have taken judicial notice of some of the publicly accessible 
reports, which are available for download on the DPH's website, 
and which are consistent with the plaintiffs' representations. 
56 
 
 
 
At the same time, these facilities have taken significant 
steps to lessen the risk of transmission of COVID-19.  Staff 
members are required to wear masks when in contact with 
patients, as well as gloves for some activities, and all 
committed individuals have been given masks.  Newly committed 
individuals are placed in a separate unit for the first fourteen 
days and are not permitted to attend group sessions.  All 
persons entering the facilities are screened for symptoms of 
COVID-19.  Soap and hand sanitizer are widely available, and 
multiple other hygiene-related protocols have been instituted. 
 
Although the expert affidavits discuss the general risk of 
transmission in correctional facilities, they do not 
specifically address conditions at MASAC or in the Stonybrook 
facilities.  Nor do they address whether the pandemic changes 
the need for or the efficacy of commitment to a secure facility 
for substance use disorder treatment.  Moreover, on this record, 
the plaintiffs have not presented evidence indicating that a 
less restrictive alternative would have been sufficient to avoid 
a likelihood of serious harm for any currently committed 
individuals.  See Massachusetts Gen. Hosp., 484 Mass. at 483–484 
("record . . . reveals no realistic alternative").  Given the 
limited record before us, we cannot say that there has been a 
57 
 
 
fundamental change in the need for or efficacy of commitment.21  
We conclude that the plaintiffs have not shown a likelihood of 
success on the merits.  See Garcia v. Department of Hous. & 
Community Dev., 480 Mass. 736, 747 (2018). 
 
Nonetheless, we see fit to address the situation under our 
supervisory authority.  Going forward, a judge shall not commit 
an individual under G. L. c. 123, § 35, unless the judge finds 
that the danger posed by the individual's substance use disorder 
outweighs the risk of transmission of COVID-19 in congregate 
settings.  "Given the high risk posed by COVID-19 for people who 
are more than sixty years of age or who suffer from a high-risk 
condition as defined by the CDC, the age and health of [the 
individual] should be factored into [the] determination."  CPCS 
v. Trial Court, 484 Mass. at 449.  Additionally, the judge must 
find that commitment is necessary notwithstanding the treatment 
limitations imposed by quarantine protocols.  A judge's findings 
may be made in writing or orally on the record.  These 
requirements will remain in effect for the duration of the 
                     
 
21 These considerations apply as much to nonsecure, 
inpatient treatment facilities as they do to the secure 
facilities at issue here.  The record is devoid of any 
information regarding the conditions present in nonsecure 
treatment facilities in the Commonwealth.  Therefore, we have no 
basis for determining whether COVID-19 transmission is more 
likely in secure locations, and accordingly are unable to make a 
determination on the plaintiffs' alternative request for 
transfers to nonsecure facilities. 
58 
 
 
COVID-19 state of emergency, unless altered by further order of 
this court.  These are additional, temporary requirements beyond 
those imposed by G. L. c. 123, § 35, due process principles, and 
any other applicable law.  See Matter of a Minor, 484 Mass. at 
307-310; Matter of G.P., 473 Mass. at 120-122, 124-129. 
 
Furthermore, as with the bail determinations that were the 
subject of much of our decision in CPCS v. Trial Court, 484 
Mass. at 434-436, current orders of commitment may have been 
made without consideration of the crisis currently ravaging the 
planet.  We therefore conclude that the risks of COVID-19 
transmission constitute a "material change in circumstances" 
with regard to any order of commitment currently in effect.  See 
Littles v. Commissioner of Correction, 444 Mass. 871, 878 
(2005); Commonwealth v. Cronk, 396 Mass. 194, 196 (1985).  See 
also CPCS v. Trial Court, supra at 435 ("risks inherent in the 
COVID-19 pandemic constitute a changed circumstance" under bail 
statutes).  Any individual who is committed pursuant to G. L. 
c. 123, § 35, at the time of the issuance of the slip opinion in 
this case may file a motion for reconsideration of the 
commitment order.  Hearings shall take place by videoconference 
or teleconference no later than two business days after the 
filing of the motion.  A decision on the motion shall be 
rendered promptly. 
 
6.  Ongoing response to the continuing pandemic.  
59 
 
 
Conditions as a result of the pandemic, and society's response 
to them, are changing rapidly.  The CDC's interim guidance 
itself states that it is subject to change and that individual 
guidelines "may need to be adapted based on individual 
facilities' physical space, staffing, population, operations, 
and other resources and conditions."  Interim Guidance, supra 
at 1.  While the court acknowledges the DOC's significant 
efforts to reduce the risks for incarcerated individuals due to 
the pandemic, to date the crisis generated by the pandemic 
continues worldwide.  All of the defendants must remain vigilant 
in continuing to respond swiftly to ongoing and changed 
conditions brought about as a result of the pandemic, while 
retaining the testing, contact tracing, and quarantining 
policies they now have put in place, that the CDC recognizes as 
the heart of any plan to combat the pandemic. 
 
Moreover, as the commissioner's counsel acknowledged at 
oral argument, while the pandemic continues, the lockdown 
conditions instituted by the DOC to prevent a serious risk of 
harm themselves risk becoming Eighth Amendment violations.  The 
CDC's interim guidance notes that measures taken by correction 
facilities to reduce transmission of COVID-19, such as canceling 
activities and visitation, may be deleterious to the mental 
health of inmates.  These effects necessarily will be even more 
pronounced for inmates in solitary cells, who are segregated 
60 
 
 
from all other humans for twenty-three or more hours per day.  
Solitary confinement, even when imposed for good reason, "bears 
'a . . . terror and peculiar mark of infamy.'"  See Davis v. 
Ayala, 135 S. Ct. 2187, 2209 (2015) (Kennedy, J., concurring), 
quoting In re Medley, 134 U.S. 160, 170 (1890).  "[C]ommon side-
effects of solitary confinement include anxiety, panic, 
withdrawal, hallucinations, self-mutilation, and suicidal 
thoughts and behaviors."  Davis, supra at 2210, citing Grassian, 
Psychiatric Effects of Solitary Confinement, 22 Wash. U.J.L. & 
Pol'y 325 (2006).  "Suicides, attempts at suicide, and self-
mutilations are common among inmates thus confined."  Ruiz v. 
Estelle, 503 F. Supp. 1265, 1360 (S.D. Tex. 1980), aff'd in 
part, rev'd in part, 679 F.2d 1115, amended in part, vacated in 
part, 688 F.2d 266 (5th Cir. 1982), cert. denied, 460 U.S. 1042 
(1983).  Thus, "even the permissible forms of solitary 
confinement might violate the Eighth Amendment if 
[i]mposed . . . for too long a period" (quotations and citation 
omitted).  Jackson v. Meachum, 699 F.2d 578, 582 (1st Cir. 
1983).  See Hardwick v. Ault, 447 F. Supp. 116, 126 (M.D. Ga. 
1978) ("indefinite duration of confinement shock[ed] the 
conscience," especially in cell block "where prisoners [would] 
go for several days without leaving their cell except briefly"). 
 
Similarly, deprivation of exercise may be "'reasonable' in 
certain situations, such as during a 'state of emergency.'"  
61 
 
 
Thomas v. Ponder, 611 F.3d 1144, 1155 (9th Cir. 2010).  Long-
term "deprivation of exercise" on the other hand, "may 
constitute an impairment of health forbidden under the [E]ighth 
[A]mendment."  Miller v. Carson, 563 F.2d 741, 751 n.12 (5th 
Cir. 1977), citing Estelle, 429 U.S. at 97.  See Spain v. 
Procunier, 600 F.2d 189, 199 (9th Cir. 1979) ("denial of fresh 
air and regular outdoor exercise and recreation [over period of 
years] constitutes cruel and unusual punishment"); Ruiz, 503 F. 
Supp. at 1367 ("Even if accomplished according to appropriate 
procedures and for valid reasons, long term confinement of 
inmates in administrative segregation, without opportunities for 
recreation, constitutes cruel and unusual punishment"); Sinclair 
v. Henderson, 331 F. Supp. 1123, 1131 (E.D. La. 1971) 
("Confinement for long periods of time without the opportunity 
for regular outdoor exercise does, as a matter of law, 
constitute cruel and unusual punishment . . ."). 
 
At this juncture, it appears that the COVID-19 pandemic 
will continue to demand extraordinary, and coordinated, efforts 
by all parties, as well as the courts.  This is so also with 
respect to the different entities within the executive branch.  
Even the commissioner acknowledged at oral argument that 
reducing the number of incarcerated individuals being held in 
any given facility, if it can be done lawfully, is a desirable 
goal for controlling the spread of communicable diseases such as 
62 
 
 
COVID-19.  In their brief, the plaintiffs point to numerous 
measures that they assert have been undertaken in other States 
to reduce prison populations, among them release to home 
confinement, enhanced good time sentence deductions, and early 
parole. 
 
With respect to one such measure, release to home 
confinement for those who have been serving a sentence, for 
example, the commissioner asserted before the hearing judge that 
she believes the DOC has no authority to authorize such releases 
for inmates who are serving sentences.  We agree with Chief 
Justice Gants that G. L. c. 127, §§ 48, 49, 49A, and this 
court's holding in Donohue, 452 Mass. at 265, indeed would allow 
the commissioner to release certain individuals who currently 
are serving a sentence in a prison or house of correction to 
home confinement, under specified conditions, prior to the 
completion of their committed sentences, for certain 
educational, employment, and training programs.  See post 
at     . 
 
The specific measures the defendants might choose to reduce 
the number of incarcerated individuals in DOC custody are not as 
important as the goal of reduction, and not ordinarily for a 
court to decide.  Nonetheless, the DOC's argument that, due to 
concerns regarding separation of powers under art. 30 of the 
Massachusetts Declaration of Rights, this court would never have 
63 
 
 
authority to order a reduction in the prison population is 
unavailing; should the court conclude, at a later point, that 
the defendants have held inmates under unconstitutional 
conditions of confinement, it would have authority to issue 
orders necessary to remedy that situation. 
 
As two justices of the United States Supreme Court 
commented recently with respect to the determination by a United 
States Court of Appeals to stay a Federal District Court judge's 
order granting a preliminary injunction sought by a group of 
particularly vulnerable incarcerated inmates due to their 
conditions of confinement, "[i]t has long been said that a 
society's worth can be judged by taking stock of its prisons.  
That is all the truer in this pandemic, where inmates everywhere 
have been rendered vulnerable and often powerless to protect 
themselves from harm.  May we hope that our country's facilities 
serve as models rather than cautionary tales."  Valentine vs. 
Collier, U.S. Supreme Court, No. 19A1034 (May 14, 2020). 
 
Conclusion.  The motion for a preliminary injunction is 
denied.  The matter is transferred to the Superior Court, where 
litigation on the complaint shall proceed as an emergency 
matter, with due speed in consideration of the circumstances, 
before the same Superior Court judge who was designated to make 
findings of fact with respect to the motion for a preliminary 
injunction.  In addition to rulings on the merits, the judge 
64 
 
 
shall resolve all questions of class certification, including 
any amendment of the complaint or substitution of parties. 
 
 
 
 
 
 
 
So ordered. 
 
 
GANTS, C.J. (concurring, with whom Lenk and Budd, JJ., 
join).  The essence of this case is summarized in a single 
sentence in the judge's findings of fact:  "Commissioner Mici 
[(commissioner)] believes that [the Department of Correction 
(DOC)] is doing the best it can to manage the COVID-19 crisis 
given the physical layout of the facilities and the inmate 
population."  The record supports her belief that the DOC is 
doing "the best it can" to attempt to prevent the COVID-19 virus 
from entering prisons and to limit its spread within the 
facilities that it has entered.  And it is likely true that, for 
all practical purposes, the "physical layout" of prison 
facilities is a "given," in that it cannot be materially altered 
quickly enough to make a significant difference. 
But even acknowledging that public safety would not permit 
a drastic reduction of the prison population, the inmate 
population is not a "given."  The commissioner herself 
recognizes, as do the World Health Organization1 and the United 
                     
 
1 "Enhanced consideration should be given to resorting to 
non-custodial measures at all stages of the administration of 
criminal justice, including at the . . . post-sentencing 
stage[].  Priority should be given to non-custodial measures for 
alleged offenders and prisoners with low-risk profiles and 
caring responsibilities . . . ."  World Health Organization 
Regional Office for Europe, Preparedness, Prevention and Control 
of COVID-19 in Prisons and Other Places of Detention, at 4 (Mar. 
15, 2020), http://www.euro.who.int/__data/assets/pdf_file/0019 
/434026/Preparedness-prevention-and-control-of-COVID-19-in-
prisons.pdf [https://perma.cc/4ZGQ-RN5U]. 
2 
 
 
States Department of Justice,2 that measures should be taken to 
reduce the inmate population and that doing so can help to 
contain the spread of COVID-19.  To be sure, the commissioner 
makes clear that any such reduction should be done in a manner 
that is consistent with law and appropriate in light of the 
health and safety of the public.  I agree, and I write 
separately from the court's opinion (with which I wholeheartedly 
agree) to make three points.  First, there is considerably more 
that the DOC and the parole board can do to reduce the inmate 
population, consistent with law and appropriate in terms of 
public health and safety.  Second, as the pandemic drags on, it 
is even more important to press forward with such reductions 
because the current lockdown that is being used by the DOC to 
contain the virus cannot reasonably continue indefinitely.  And 
third, although what the DOC and parole board are doing now may 
not likely demonstrate a reckless disregard for the health and 
safety of prisoners arising from the risk of transmission of the 
                     
 
2 On March 26, 2020, and again on April 3, 2020, the United 
States Attorney General instructed the Federal Bureau of Prisons 
to prioritize the use of home confinement as a tool for 
combatting the risk that COVID-19 poses to vulnerable inmates 
while protecting public safety.  See Office of the Attorney 
General, Prioritization of Home Confinement as Appropriate in 
Response to COVID-19 Pandemic (Mar. 26, 2020), https://www 
.justice.gov/file/1262731/download [https://perma.cc/3RKS-8FYN]; 
Office of the Attorney General, Increasing Use of Home 
Confinement at Institutions Most Affected by COVID-19 (Apr. 3, 
2020), https://www.justice.gov/file/1266661/download [https: 
//perma.cc/RK4L-4B93]. 
3 
 
 
COVID-19 virus, continuing unchanged along that same path in the 
months ahead might constitute reckless disregard, especially if 
we are hit with a new wave of COVID-19 cases. 
1.  More can be done to reduce the prison population.  In 
2019, approximately 600 inmates were released each month from 
DOC custody.  Those releases were offset by 557 admissions per 
month, yielding a net monthly reduction of 43 inmates.  However, 
as a result of the pandemic, the number of criminal admissions 
has dramatically fallen, from 190 in January and 161 in February 
2020, to 87 in March and 15 in April.  Given the sharp reduction 
in criminal admissions, one would expect that the over-all 
prison population would naturally fall, and it has by 
approximately eight percent between January 1 and May 21.3  But 
the vast majority of this decrease arises from the drop in 
admissions; actual releases grew only modestly in April 2020 to 
526 (compared to an average of 424 in January through March 
2020), with virtually all of the increase in releases arising 
from an increase in parole permits in April to 141 (compared to 
a monthly average of 52 in January through March 2020).  In 
contrast, the county jail population, in large part fueled by 
                     
 
3 There were 7,923 inmates in DOC custody on January 1, 
2020, see MA DOC Jan 1 Inmate Snapshot, https://public.tableau 
.com/profile/madoc#!/vizhome/MADOCJan1Snapshot/Jan1Snapshot, 
dropping to 7,278 by May 21, see May 21, 2020 Special Master's 
Report. 
4 
 
 
our decision in Committee for Pub. Counsel Servs. v. Chief 
Justice of the Trial Court, 484 Mass. 431 (2020), fell more than 
thirty per cent between April 5 and May 21, 2020.  See May 21, 
2020 Special Master's Report.  To be sure, it is far easier to 
release detainees who have yet to be tried than sentenced 
prisoners.  But the fact remains that more inmates can be 
released in accordance with law, without compromising public 
health and safety. 
a.  Home confinement.  The commissioner claims that she 
does not have the legal authority to allow any sentenced 
prisoner to serve any part of a prison sentence in home 
confinement.  The commissioner is mistaken. 
Under G. L. c. 127, § 48, "[t]he commissioner shall 
establish and maintain education, training and employment 
programs for persons committed to the custody of the [DOC]. 
. . . Such programs shall include opportunities for academic 
education, vocational education, vocational training, other 
related prevocational programs and employment, and may be made 
available within correctional facilities or, subject to the 
restrictions set forth in [G. L. c. 127, §§ 49 and 86F], at 
other places approved by the commissioner or administrator" 
(emphasis added).  Id.  General Laws c. 127, § 49, provides: 
"The commissioner of correction, or the administrator of a 
county correctional facility, subject to rules and 
regulations established in accordance with the provisions 
5 
 
 
of this section, may permit an inmate who has served such a 
portion of his sentence or sentences that he would be 
eligible for parole within eighteen months to participate 
in education, training, or employment programs established 
under [§ 48] outside a correctional facility . . . .  In 
the case of a committed offender who participates in any 
program outside a correctional facility established under 
[§ 48], the time spent in such participation shall be 
credited toward the serving of his sentence in the same 
manner as though he had served such time within the 
facility. . . .  The commissioner or such administrator 
shall make and promulgate rules and regulations regarding 
programs established under [§ 48] outside correctional 
facilities.  Such rules and regulations shall include 
provisions for reasonable periods of confinement to 
particular correctional facilities before a committed 
offender may be permitted to participate in such programs 
and provisions for feeding, housing and supervising 
participants in such programs in such manner as will be 
calculated to maintain morale and prevent the introduction 
of contraband to the facility."4,5 
 
In Commonwealth v. Donahue, 452 Mass. 256 (2008), we 
considered whether a sheriff had the authority under § 48 and 
§ 49 to release a prisoner from a house of correction and place 
him in home confinement under a global positioning system (GPS) 
monitoring program where the prisoner had an approved home and 
work plan and was monitored by a GPS bracelet.  We concluded 
that "G. L. c. 127, §§ 48, 49, and 49A, provide specific 
legislative authorization for the GPS program and for the 
                     
 
4 Participation in such programs is limited for prisoners 
serving a life sentence, for sex offenders, and for prisoners 
who were sentenced for specified violent crimes.  See G. L. 
c. 127, § 49. 
 
 
5 General Laws c. 127, § 86F, applies only to sheriffs, not 
to the commissioner. 
6 
 
 
placement of Donohue, or similarly situated inmates, in it."  
Id. at 265.  We specifically rejected the argument that these 
statutes did not permit home confinement, declaring that "[t]o 
the contrary, the statutory scheme suggests a legislative intent 
to allow this kind of arrangement."  Id. at 266.  The 
commissioner has the same authority under these statutes to 
place prisoners in home confinement, monitored by a GPS 
bracelet, as part of an inmate's participation in an education, 
training, or employment program. 
General Laws c. 127, § 49A, requires the commissioner to 
establish in each correctional facility a committee to evaluate 
the behavior and conduct of inmates within the prison and 
recommend whether an inmate "shall be permitted to participate 
in any program outside a correctional facility, exclusive of 
parole."  There is nothing in the record regarding the 
activities of these committees and no explanation as to why, 
especially at a time when the commissioner recognizes the need 
to reduce the prison population, eligible prisoners who have 
demonstrated good behavior and conduct have not been approved 
for home confinement to participate in education, employment, or 
training programs. 
b.  Parole release.  As I have noted, the parole board has 
stepped up its pace of activity and has released nearly three 
times more prisoners in April than it did on average in the 
7 
 
 
first three months of this year.  But there are at least two 
ways in which the parole board can release more prisoners, 
consistent with its statutory obligation to release a prisoner 
on parole "only if the board is of the opinion, after 
consideration of a risk and needs assessment, that there is a 
reasonable probability that, if the prisoner is released with 
appropriate conditions and community supervision, the prisoner 
will live and remain at liberty without violating the law and 
that release is not incompatible with the welfare of society."  
G. L. c. 127, § 130. 
First, § 130 requires the parole board to make two 
determinations:  whether "there is a reasonable probability that 
. . . the prisoner will live and remain at liberty without 
violating the law" and whether "release is not incompatible with 
the welfare of society."  Id.  With respect to the second 
determination, it is appropriate for the parole board to 
consider whether the prisoner has tested positive for COVID-19 
and, if so, whether he or she could be safely quarantined and 
medically monitored or treated upon release.  But it is also 
appropriate for the parole board to consider the increased risk 
to the inmate, to fellow inmates, and to the general public of 
continuing custody in a prison where he or she is particularly 
vulnerable to an outbreak of COVID-19 given the close quarters 
and difficulties of social distancing in a prison.  This 
8 
 
 
consideration is most acute in prisoners who are at special risk 
of death or serious illness from COVID-19 because of their 
advanced age or compromised immune system.  In Christie v. 
Commonwealth, 484 Mass. 397, 401-402 (2020), we declared in the 
context of a judge's determination whether to stay a defendant's 
execution of sentence pending appeal: 
"We also note that the health risks to persons in custody 
arising from this pandemic require that we adjust the 
analysis applied to motions to stay the execution of 
sentence pending appeal.  In ordinary times, in considering 
the second factor, a judge should focus on the danger to 
other persons and the community arising from the 
defendant's risk of reoffense.  See [Commonwealth v. Cohen 
(No. 2), 456 Mass. 128, 132 (2010); Commonwealth v. Hodge 
(No. 1), 380 Mass. 851, 855 (1980)].  In these 
extraordinary times, a judge deciding whether to grant a 
stay should consider not only the risk to others if the 
defendant were to be released and reoffend, but also the 
health risk to the defendant if the defendant were to 
remain in custody.  In evaluating this risk, a judge should 
consider both the general risk associated with preventing 
COVID-19 transmission and minimizing its spread in 
correctional institutions to inmates and prison staff and 
the specific risk to the defendant, in view of his or her 
age and existing medical conditions, that would heighten 
the chance of death or serious illness if the defendant 
were to contract the virus."  (Emphases in original.) 
 
A comparable adaptation to the pandemic should be made to the 
parole board's evaluation of whether "release is not 
incompatible with the welfare of society" under § 130. 
Second, some inmates who are granted parole because they 
meet the criteria in § 130 do not promptly obtain the parole 
permits needed for release and must first obtain a transfer to a 
long-term residential facility or a step-down to a lower-
9 
 
 
security facility before they can receive their permits.  In 
this pandemic era, such a condition of release would prove a 
"Catch-22" situation for many inmates otherwise eligible for 
parole release:  because all transfers among facilities have 
ceased, such inmates could not meet the condition established 
for their release.  The parole board should reevaluate all such 
conditions where they prevent the release of those whom the 
board has already determined will be unlikely to reoffend upon 
their release. 
c.  Earned good time.  The majority of prisoners who are 
released from custody are released because they have completed 
their sentence.  The DOC declares that it "has no control" over 
the completion of sentences.  But to the extent that the 
commissioner has the authority to grant good time credit of up 
to fifteen days per month under G. L. c. 127, § 129D, plus an 
additional ten days of credit for the successful completion of a 
program, the commissioner has the ability to reduce a prisoner's 
sentence by approximately one-half (180 days per year if the 
prisoner receives fifteen days per month, and another ten days 
for each completed program).  The pandemic put a temporary end 
to the programs that enabled inmates to earn good time, and the 
commissioner deserves credit for allowing inmates to earn seven 
and one-half days per month by maintaining a diary.  But with 
more than two months having passed since the Governor's 
10 
 
 
announcement that a state of emergency existed, it is time for 
the commissioner to devise new programs that can be accomplished 
by inmates in the midst of a pandemic that would enable them to 
earn the full complement of possible good time, including 
completion credit, and reduce the over-all length of their 
sentences. 
2.  Planning beyond the lockdown.  To prevent the COVID-19 
virus from entering DOC facilities and to mitigate its spread in 
those facilities that already had cases, the commissioner 
initiated a system-wide lockdown on April 3, 2020.  In practice, 
this means that inmates who are housed in cells remain there for 
twenty-three hours a day, and those who live in dormitory-style 
housing cannot leave their units.  Inmates eat meals in their 
cells or units; use of gyms, weight rooms, and outdoor spaces is 
strictly limited; and work opportunities and classes have been 
suspended. 
These stringent policies might have been necessary to quell 
the outbreak by reducing contact between inmates and by making 
it easier to conduct contact tracing when positive cases were 
identified.  But while this may have averted a worst-case 
scenario in the early days of the pandemic, the court's opinion 
notes that the DOC may soon face another challenge:  the mental 
health impact of an extended lockdown, with its own implications 
11 
 
 
under the Eighth Amendment to the United States Constitution and 
art. 26 of the Massachusetts Declaration of Rights. 
According to the DOC, this is the first time in recent 
memory that the entire Massachusetts prison system has been 
locked down because of health risks.  The longest recorded 
lockdown at any DOC facility lasted for four months in 1995 
following an assault on a correction officer at the 
Massachusetts Correctional Institution at Cedar Junction.  This 
system-wide lockdown has already been in place for two months, 
but I believe that the DOC recognizes that it cannot reasonably 
continue for the many months that will pass until a COVID-19 
vaccine becomes widely available.  The isolation arising from a 
lockdown over time will have increasingly severe mental health 
ramifications, particularly in a population that already has a 
higher-than-average prevalence of mental health issues.  And if 
the lockdown were to continue, there may come a time when the 
lockdown itself raises serious questions about the DOC's 
deliberate indifference to inmate mental health. 
I do not profess to know what should be the next step 
beyond lockdown; I know only that there will be a need for a 
next step, that it must be carefully considered by correctional, 
public health, and mental health professionals, and that, as we 
are learning from our experience outside the prison walls, 
reopening to permit increased human interaction poses even more 
12 
 
 
challenges than the formidable challenges arising from 
sheltering in place.  Soon, the DOC will have to develop 
protocols that are, to the extent possible, protective of both 
inmate physical health and mental health.  And doing so will be 
easier and more likely to succeed with a smaller prison 
population, which will provide greater potential for social 
distancing and give prison superintendents more flexibility in 
their use of available prison space, cells, and facilities. 
3.  Planning ahead for a second wave.  I recognize that, 
when it became apparent that COVID-19 had spread through 
Massachusetts communities, the DOC had to improvise quickly and 
make adjustments to avoid rampant spread of the virus in its 
correctional facilities.  But what is appropriate in reacting to 
an immediate and unpredictable threat might not be appropriate 
as the threat drags on over many months.  Reducing the size of 
the prison population, especially the size of the elderly and 
infirm prison population, in a manner that is consistent with 
law and public safety takes time, both to identify appropriate 
candidates for release and to ensure that they have appropriate 
release plans.  But there will be time before the fall to 
accomplish sensible reductions in the size of the prison 
population, including the release or transfer to home 
confinement of many elderly and medically vulnerable prisoners, 
to give prison superintendents the better options to protect the 
13 
 
 
physical and mental health of inmates that come with fewer 
prisoners.  With experts warning of a potential resurgence of 
COVID-19 in the winter, see CDC Director Warns Second Wave of 
Coronavirus Is Likely to Be Even More Devastating, Wash. Post, 
Apr. 21, 2020, https://www.washingtonpost.com/health/2020/04 
/21/coronavirus-secondwave-cdcdirector [https://perma.cc/3SVZ 
-BQCX], the DOC has the opportunity and, indeed, the obligation 
to begin preparing for that possibility.  Policies that pass 
constitutional muster in the face of an unprecedented emergency 
may not be constitutionally sufficient after the department has 
had time to consider and plan its response to a now-foreseeable 
threat.