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DAVID' DOE, ERNEST HOE, TERRY TOE, SAMMY LOW, and MARY MOE, on behalf of themselves and all others similarly situated,
Plaintiffs,
-vs-
LARRY R. MEACHUM, Commissioner, Connecticut Department of Correction; THOMAS WHITE, Deputy Commissioner, Connecticut Department of Correction; EDWARD BLANCHETTE, M.D., Medical Director, Connecticut Correctional Institution at Somers, and JAMES McMAHON, R.N., Assistant to Director of Health Care Services, Connecticut Departof Correction, in their individual and official capacities,
Defendants.

CIVIL NO.

CLASS ACTION COMPLAINT I. INTRODUCTION
This civil rights class action challenges certain policies and practices of the defendant officials of the Connecticut Department of Correction ("DOC") pertaining to the care and custody of inmates with, or who are perceived to have,
Doe v. Meachum

PC-CT-005-001

Acquired Immune Deficiency Syndrome ("AIDS"), AIDS-Related Complex ("ARC"), or other Human Immunodeficiency Virus ("HIV") infections (conditions hereinafter collectively referred to as "HIV infection"). Specifically, plaintiffs, who are committed to defendant Meachum's care and -custody and who have, or are believed to have, HIV infection, challenge: (a) defendants' continued creationt use, and distribution, throughout DOC facilities, of a long list on which appear the names of all current or former inmates known or thought by DOC to have HIV infection; (b) defendants' open identification of inmates identified or suspected of having HIV infection through the placement of conspicuous red circles or dots on, inter alia. inmate court files, medical records and housing unit cards; (c) defendants' failure to establish policies and procedures to protect against unauthorized and unwarranted disclosures of the names of inmates with, or suspected of having, HIV infection both within and without DOC facilities; (d) defendants' failure to provide continuing, accurate, and culturally and linguistically appropriate HIVeducation to staff and to inmates; and (e) defendant's failure to provide inmates with HIV infection with adequate pre- and posttest counselling and with adequate medical and mental health care. Plaintiffs assert that defendants' actions, and knowing inactions, in the face of Connecticut's greatest public health crisis in recent times have deprived plaintiffs, and all other inmates similarly situated, of their rights as guaranteed by the First, Fourth, Eighth, Ninth and Fourteenth Amendments to the

United States Constitution, and by § 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794 et sea.. as amended by the Civil Rights Restoration Act of 1987. Plaintiffs seek declaratory and injunctive relief to remedy defendants' unconstitutional and illegal policies and practices.
II. JURISDICTION
1. This action is authorized by U.S.C. § 1983 and jurisdiction over this action is conferred by 28 U.S.C. §§ 1331 and 1343(3) and (4).
2. A declaratory judgment is authorized pursuant to 28 U.S.C. § 2201 and 2202 and Rule 57 of the Federal Rules of Civil Procedure. Injunctive relief is authorized by Rule 65 of the Federal Rules of Civil Procedure. An award of costs and attorneys' fees is authorized by 42 U.S.C. § 1988.
III. PARTIES
A. Plaintiffs
3. Plaintiff DAVID DOE is, and at all times pertinent herein was, a citizen of the United States. He is a sentenced inmate committed to the care and custody of defendant Meachum, and on his current charges has been incarcerated at the Bridgeport Correctional Center ("BCC"), the Bridgeport Correctional Center at North Avenue ("North Avenue"), and the Connecticut

Correctional Institution at Somers ("CCIS"). He is currently incarcerated at the New Haven Correctional Center ("NHCC"). He has been diagnosed as having HIV infection.
4. Plaintiff ERNEST HOE is, and at all times pertinent herein was, a citizen of the -United States. He is a sentenced inmate committed to the care and custody of defendant Meachum who, on his current charges, has been incarcerated at the BCC and now is incarcerated at CCIS. He has been diagnosed as having HIV infection.
5. Plaintiff TERRY TOE is, and at all times pertinent herein was, a citizen of the United States. He is a sentenced inmate committed to the care and custody of defendant Meachum, and, on his current charges, has been incarcerated at the Union Avenue Detention Center ("Union Avenue"), the NHCC, CCIS, BCC, the Hartford Correctional Center ("HCC"), the Carl Robinson Correctional Institution ("CRCI"), the Connecticut Correctional Institution at Cheshire ("CCI - Cheshire") and currently is incarcerated at the J.B. Gates Correctional Center ("Gates CC"). He has been diagnosed as having HIV infection.
6. Plaintiff SAMMY LOW is, and at all times pertinent herein was, a citizen of the United States. He is a sentenced inmate committed to the care and custody of defendant Meachum, and, on his current charges, has been incarcerated at the HCC, NHCC, CCIS, the Connecticut Correctional Institution at Enfield ("CCI - Enfield") and, now, is incarcerated at the CRCI. He has been labelled by defendants as having HIV infection.

7. Plaintiff MARY MOE is, and at all times pertinent herein was, a citizen of the United States. She is a sentenced inmate, currently incarcerated at the Connecticut Correctional Institution at Niantic ("CCIN"), who has been diagnosed as having HIV infection.
B. Defendants
8. Defendant LARRY R. MEACHUM is Commissioner of the Connecticut Department of Correction, having assumed said office in October, 1987. Pursuant to Conn. Gen. Stat. § 18-81, he is responsible for the overall supervision and direction of all DOC institutions and facilities in which plaintiffs are confined, for the promulgation and implementation of all Administrative Directives, policies and procedures of the DOC, and for protecting the safety and welfare of all inmates committed to his care and custody. He is sued in his individual and official capacities.
9. Defendant THOMAS WHITE is Deputy Commissioner of DOC in charge of institutional services. He is responsible for assisting defendant Meachum in formulating and implementing DOC policy and for supervising the operation of all DOC facilities. He is sued in his individual and official capacities.
10. Defendant EDWARD A. BLANCHETTE, M.D. is Medical Director at CCIS. As such, he is responsible for the medical diagnosis, care, treatment, counselling, referrals and maintenance of medical records of and for inmates at CCIS. In addition, pending the appointment of a new DOC Director of Health
5

Care Services to replace Edward M. Wurzel, M.D., Dr. Blanchette is, and has been, the primary DOC physician advising defendants Meachum and White on DOC policy decisions concerning HIV infection. . He also acts as medical consultant for other "DOC facilities regarding inmates in those facilities with HIV infection and served on DOC's "Departmental AIDS Committee." He is sued in his individual and official capacities.
11. Defendant JAMES McMAHON, R.N., is, and at all times pertinent herein was, the Assistant to the Director of Health Care Services at the Connecticut Department of Correction. Since the resignation of Edward Wurzel, M.D. as Director of Health Care Services and pending the appointment of a new Director, defendant McMahon has been responsible, in conjunction with defendant Blanchette, for overall health care policy and practices within the Connecticut Department of Correction. He is sued in his individual and official capacities.
IV. CLASS ACTION ALLEGATIONS 12. The named plaintiffs bring this action as a class
action pursuant to Rule 23(b)(l) and (2) of the Federal Rules of Civil Procedure.
13. Plaintiffs file this complaint on behalf of themselves and all other similarly situated and seek injunctive and declaratory relief from the unconstitutional and unlawful actions and inactions of defendants, as herein set forth.

14. The named plaintiffs, DAVID DOE, ERNEST HOE, TERRY TOE, SAMMY LOW, and MARY MOE, are all inmates who are committed to defendant Meachum's care and custody, who have either been diagnosed as having HIV-infection or have been labelled bydefendants as having HIV infection, and who have been subjected to defendants' unlawful and unconstitutional actions and inactions in that they have had their identities openly disclosed, have not been provided adequate AIDS education and counselling, and have been denied adequate medical and mental health care.
15. The class plaintiffs seek to represent is composed of all inmates who are, were, or will be subject to defendant Meachum's care and custody and who have, are perceived by defendants and their agents as having, or are at risk of contracting, HIV infection.
16. The class is so numerous that joinder of all members is impracticable.
17. There are questions of law and fact common to the members of the plaintiff class in that:
a. Defendants' challenged polices and practices have been imposed and operate systemwide, throughout all DOC facilities, they affect all class members, and they deny all class members their rights under the First, Fourth, Eighth, Ninth and Fourteenth Amendments to the United States Constitution and § 504 of the Rehabilitation Act of 1973;

b. All members of the plaintiff class seek injunctive and declaratory relief to prevent future violations of their constitutional and statutory rights.
18. The claims of the representative parties are typical of the claims of the -class in that the constitutional and statutory deprivations caused by defendants and claimed by the named plaintiffs are the same as for all other members of the class. The named plaintiffs, like all other class members, are inmates who are committed to defendant Meachum's care and custody, who have, or are perceived to have, HIV infection, who have been subjected to defendants' challenged policies and practices, and who challenge these polices and practices as violative of their federal constitutional and statutory rights.
19. The representative parties will fairly and adequately protect the interests of the class. The named plaintiffs have no interests antagonistic to those of the class. Further, all plaintiffs are represented by attorneys experienced in federal constitutional litigation.
20. The prosecution of separate actions by individual members of the class would create a risk of inconsistent or varying adjudications with respect to individual members of the class which would establish incompatible standards of conduct for defendants.
21. Defendants have consistently acted and refused to act on grounds generally applicable to the class, thereby making

appropriate final injunctive and declaratory relief with respect to the class as a whole.
V. STATEMENT OF FACTS
"A. HIV-Infection
22. "HIV infection" is a continuum of conditions associated with immune dysfunction which is caused by the Human Immunodeficiency Virus ("HIV"). HIV attacks certain white blood cells (T-lympocytes), undermining that part of the body's immune system which normally combats infections and malignancies. Fullblown AIDS, as defined for reporting purposes by the United States Centers for Disease Control ("CDC"), is HIV infection with one or more opportunistic infections or malignancies, or the presence of dementia or wasting syndrome.
23. The sole documented modes of transmission of HIV are sexual contact, use of contaminated needles or syringes, direct exposure to infected blood or blood products, transplanted tissue or organs from an infected donor, and from mother to child across the placenta or during delivery. Contact with other bodily fluids, including saliva, urine, and feces, has not been demonstrated to be a mode of transmission for HIV.
24. To date, there is no cure for HIV infection and no vaccine to prevent its transmission. Education and counselling to inform persons about HIV and to foster and sustain change in behaviors which pose a risk of transmission of HIV is the only

effective means of slowing transmission and thereby slowing the epidemic.
B. Incidence of HIV infection in inmates committed to defendant Meachum's care and custody.
25. Although homosexual and bisexual males remain the primary risk group for transmission of HIV nationally, HIV infection in Connecticut is found disproportionately among intravenous ("IV") drug users.
26. As of June 30, 1988, the Connecticut Department of Health Services ("DOHS") reported that 64% of all diagnosed AIDS cases among Connecticut women and 4 0% of all diagnosed AIDS cases among Connecticut men were in persons with a history of IV drug use, as compared to 52% of women with AIDS and 24% of men with AIDS nationally.
27.. Approximately 60% of the inmates committed to defendant Meachum's care and custody are known by defendants to have a history of drug abuse. Some inmates committed to defendant Meachum's care and custody are known by defendants to engage in homosexual or bisexual conduct. Other inmates are known to defendants to be the sexual or needle-sharing partners of persons with, or at high risk for, HIV infection. All of these persons are at greatly increased risk of HIV infection.
28. The number of inmates with HIV infection in DOC facilities has been increasing rapidly. In 1983 there was only one diagnosed case of full-blown AIDS in the entire DOC system. By 1988, the total number of diagnosed DOC AIDS cases to date had
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increased to more than 45, the total number of AIDS deaths in DOC facilities was at least 24, and there were at least 400 inmates already identified by defendants as HIV-infected.
29. Upon information and belief, defendants estimate, based on inmate surveys in other states and the incidence of IV drug use histories in the Connecticut inmate population, that at least 15% of the more than 30,000 inmates who are committed to defendant Meachum's care and custody each year currently are infected with HIV.
C. Defendants' identification and disclosure of the identities of HIV-infected inmates.
30. Consistent with the recommendations of federal and state public health authorities, defendants have not adopted a policy of mandatory testing of all inmates for HIV infection, but rather test certain inmates in high-risk groups who request voluntary testing, and other inmates when deemed necessary for medical diagnostic purposes. In addition, defendants require inmates who wish to work in certain institutional jobs, such as the kitchen, to have a negative HIV test before job placement is approved. See Exhibit A, attached hereto and incorporated herein by reference.
31. DOC officials recognized in 1983, or earlier, that HIV infection was going to pose serious problems within DOC facilities. However, DOC did not adopt formal written policy pertaining to HIV infection until 1985, after two years had elapsed.
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32. Since July 1, 1985, and continuing to today, the Wardens and Superintendents of all DOC facilities have been required by written DOC policy to assure that their staffs place a "solid red circle" of "appropriate 'attention getting' size" on the "outside of papers accompanying [an] inmate" whenever an inmate who has, or is suspected of having, "a communicable disease such as hepatitis B or AIDS" is transported to and from the DOC facility, including to court and to medical appointments. The red circle is to be used "even in undiagnosed cases" in order to "provide maximum protection and peace of mind to those responsible for the transportation and custody of the inmate." A copy of the DOC directive establishing this policy is attached hereto as Exhibit B and incorporated herein by reference.
33. Since November 1, 1985, and continuing to today, the Wardens and Superintendents of all DOC facilities have been directed by written DOC policy to ensure that the names of all individuals identified as HIV-infected are placed on a "Carriers of Specific Disease" or "CSD" list. This list which is, in the first instance, "prepared and kept current by the respective facility medical unit", is made "available to all staff members who may come into contact with [HIV-infected inmates] during the course of their duties." Forms for reporting, to DOC's Central Office, the names of all inmates suspected of having or carrying HIV infection are also provided to the DOC facilities and, as of January 1986, the Wardens and Superintendents of all DOC facilities periodically receive a "master" CSD list from DOC's Central
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office which the DOC Director of Health Care Services, or his agent, produces and distributes on a routine and frequent basis. See Exhibits C, D, and E, attached hereto and incorporated herein by reference.
34. Concurrent with DOC's creation and expanded distribution of a master CSD list, DOC adopted a set of Policies and Procedures Regarding AIDS/ARC Inmates in the Connecticut Department of Correction which specified, inter alia. that transportation personnel were to be notified when they were transporting an inmate with HIV infection and that each transporting vehicle was then to be equipped with a "special kit" consisting of plastic gloves, gowns, medical masks and nonfeedback respiratory devices to be used in case of an accident involving the inmate in which bodily fluids are present or CPR is required. Shortly thereafter, DOC extended these protective measures, directing that this "full CSD" kit be placed in all medical units, all transportation vehicles, and at other intrainstitutional locations, a practice which remains defendants' current practice. See Exhibits F and G, attached hereto and incorporated herein by reference.
i. The CSD List 35. The master CSD list, which the DOC defendants update frequently and continue to maintain on all past and current inmates thought by DOC to have HIV infection includes, for each inmate thereon, the DOC inmate identification number,
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name, entry date, DOC facility, status (sentenced/unsentenced), release date and town of residence. A copy of this CSD list, with identifying information redacted, is attached hereto as Exhibit H and incorporated herein by reference.
36. Defendants' policy of distributing the master CSD list to all DOC institutions on a regular basis ensures that personnel at each DOC facility have knowledge of the "HIV status of not just the inmates who are currently incarcerated at their facility, but also of all other inmates committed to the care and custody of defendant Meachum, as well as of persons who have been discharged from DOC facilities.
37. Though mandating the creation and continued distribution of the CSD list, the DOC defendants have adopted no policies and procedures to limit strictly the further disclosure and dissemination of the list, and the names thereon, as — for example — by requiring that the list be kept in locked cabinets, by permitting disclosure of the identities of persons on the list only to those specific members of the DOC medical staff with a legitimate "need to know" to provide proper medical care to the specific inmates named thereon for whom they are responsible, and by forbidding the release of the list and its contents to any other person, agency, and body.
38. The CSD list has repeatedly been placed or left by DOC personnel in places or areas to which inmates are allowed to have access, including, but not limited to:
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a) being posted from time to time within various DOC institutions in sites visible to inmates;
b) being distributed, on occasion, through the institutional mail without any designation that the list is "confidential" and without adequate precautions to prevent inmates working in job assignments involving mail distribution from gaining access to the list;
c) being left on desks and on the top of file cabinets in locations where inmates have access.
39. Because the DOC defendants do not require that the CSD list be maintained in a site totally inaccessible to inmates and unauthorized staff and that the list and its contents not be further disclosed, photocopies and hand-written copies of the CSD list have been made by inmates and DOC staff and distributed within and without DOC facilities.
40. Inmates and staff learn of inmates' HIV infection due to the CSD list and other breaches of medical confidentiality, and have prepared and distributed "unofficial" lists of those with, or believed to have, HIV infection. In some instances, upon information and belief, inmates with a negative HIV test have been named on these "unofficial" lists.
41. More than 4 00 inmates and former inmates currently are named on the defendants' CSD list, including plaintiffs Doe, Hoe, Low and Moe.
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42. In December 1987, plaintiff Moe was specifically identified by name and inmate number in a letter written by a male inmate at the NHCC to a female inmate at CCIN. This male inmate stated that he had copied her name from the CSD list to which he had access and had informed the persons thereon that they were carriers of the AIDS virus. A copy of this letter, with identifying names redacted, is attached hereto as Exhibit I and incorporated herein by reference. Plaintiff Moe has received similar letters from male inmates at other DOC facilities who have seen her name on the CSD list.
43. Plaintiff Moe's brother learned for the first time about Moe's HIV infection because of the distribution of the CSD list among inmates at another correctional facility where her brother was an inmate.
ii. The "red dot" policy
44. The DOC defendants' policy of requiring that all inmates named on the CSD list have prominently-displayed "red dots" placed on all papers accompanying said inmates when transported outside DOC facilities, see Exhibit C, has caused the identities of said inmates further to be disclosed to the public and has caused such inmates to suffer humiliating and discriminatory treatment by transporting officials, by sheriffs, by court personnel and by other persons who learn of their medical status through the defendants' intentional open disclosure of it.
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45. In early July, 1988, sheriffs who saw the "red dot" on plaintiff Doe's DOC transporting file required him to wear a mask and gloves while appearing in court for a hearing. He was also segregated from other inmates because of this public disclosure of his medical status.
46. Plaintiff Hoe's medical condition became a matter for a public hearing after the judge hearing his case learned of his HIV status through the prominent display of a "red dot" on his DOC transporting file and the refusal of the sheriffs to bring him to court. Concerned about contagion, the judge convened this hearing, which was covered by all the major news media in Connecticut, even though Hoe's medical condition was wholly unrelated to the offense with which he had been charged, and his medical condition posed no risk of transmission to others in the courtroom.
47. Plaintiff Low first learned of his possible HIV infection when he saw the "red dot" on his DOC court transport file and was told by an inmate who also had seen his file that the red dot meant he "had AIDS". Though told earlier by HCCC medical personnel that his HIV test was "negative," upon his return from court, the medical personnel at HCCC confirmed that they "remembered" that his test was positive, and had authorized the red dot, though his and others' HIV test results had been "lost," after being left on top of a filing cabinet at HCCC.
48. Sheriffs, informed of plaintiff Moe's HIV infection by the "red dot" placed on her DOC court transport file,
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conspicuously donned gloves whenever they unshackled and shackled her in the courthouse, thereby exposing her to humiliation, prejudice and the scorn of others in the courtroom. This treatment was not accorded to inmates who had not been openly identified by defendants as having HIV infection.
49. Upon information and belief, the prosecutor in another inmate's criminal case contacted the Warden at CCIN to confirm that the "red dot" on her DOC transporting file meant that she "had AIDS," and the Warden, without plaintiff's consent, confirmed. In addition, because of the presence of the "red dot" on her court papers and the prosecutor's knowledge of her HIV condition, this inmate's public defender advised her to inform her teenage son, who was present in the courtroom, about her medical condition because further disclosure in trial proceedings was likely. She was therefore forced to break her painful and tragic news to her son in a hurried manner, in a totally public place, and at a most inappropriate time.
50. Red circles and dots also have been placed from time to time by DOC personnel in other sites visible to inmates, including on inmate housing cards, cell doors, medical, medication and dental records, and inmates' personal property bags.
iii. Other breaches of confidentiality
51. Other breaches of the confidentiality of HIVinfected inmates have occurred, and routinely continue to occur, in other ways in DOC facilities, including but not limited to, by
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DOC staff disclosures to inmates, visitors, and relatives, by medical examinations and sick calls conducted in the presence or earshot of other inmates, forcing HIV-infected inmates to reveal their condition to other inmates, by inadequately controlled and inappropriate inmate access to medical records, and by the posting of various lists which identify specific inmates as seeking or receiving medical care for HIV infection.
52. Inmates at DOC facilities, including HCCC, CCICheshire, NHCC, CCIS and CCIN, have taken documents identifying suspected HIV-infected inmates, to which they have access through their institutional job assignments, and distributed them in the inmate population.
53. Plaintiffs Doe, Low, Moe and Hoe have all personally heard DOC staff disclose their identities as HIV-infected persons to other inmates, visitors or other staff.
54. Plaintiffs Doe, Low, and Moe have been forced to discuss with medical staff their HIV-infection and HIV-related problems in the presence or earshot of other inmates.
55. Plaintiffs Toe and Low have seen lists posted in sites visible to inmates which explicitly identify particular inmates as needing or requesting HIV-related medical care.
iv. Effects of breaches 56. Inmates openly identified as HIV-infected-within DOC facilities by defendants' policies and practices are ostracized, stigmatized, and subjected to frequent and serious
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harassment, threats to their personal safety, and, on occasion, physical injury.
57. Plaintiff Hoe, identified as HIV-infected through defendants' "red dots", CSD list, and other breaches of confidentiality, has been told of threats against his life, has been
» assaulted, has been burned out of his cell twice, and has had darts, disinfectants, urine, boric acid, feces and other materials thrown at him by other inmates while locked in his cell. DOC staff also, on occasion, have worn gloves and masks when around plaintiff Hoe, served him food on paper plates instead of dishes, and not allowed him to speak directly into a telephone receiver because of fears of contagion.
58. Plaintiff Doe recently was harassed repeatedly and called an "AIDS Breathing M-F" at a DOC facility, and ultimately was stabbed so severely as to require hospitalization. In the two weeks Doe subsequently was incarcerated at CCIS he was transferred in and out of at least five housing units, and finally to another DOC facility, because of attempted physical assaults, death warnings, and harassment by inmates who learned of his HIV infection by defendants' "red dots," guards' disclosures, and other breaches of his confidentiality.
59. Plaintiff Moe tries to avoid the harassment of other inmates by washing her own clothing by hand, purchasing a Tupperware dish so she could eat alone in her room, and avoiding social activities at CCIN.
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60. Defendants' knowledge of an inmate's HIV infection on occasion leads to curtailed or conditioned access to various DOC institutional jobs, activities, and services. Inmates known to defendants to have HIV infection are not permitted to work in certain job assignments, including kitchen, bakery, medical, dental, and optical. Inmates have experienced delays in or denials of services such as haircuts and dental care because of fear about HIV transmission in DOC staff. Access to the family visitation program continues to be conditioned upon the inmate's agreeing to allow DOC to disclose his/her HIV infection to the visitors, even if no risk of transmission is likely. See Exhibit J, attached hereto and incorporated herein by reference. Plaintiff Moe, for example, was required to consent to DOC's informing her mother of her HIV infection before an overnight visit with her children would be approved.
61. Because of the egregious breaches of confidentiality officially and intentionally authorized, or knowingly permitted, by the DOC defendants regarding inmates believed by them to have HIV infection, inmates who are unaware of their HIV status are deterred from being tested, though their actions both within and without DOC facilities may have placed them at great risk for HIV infection and though early diagnosis of HIV infection, with appropriate counselling and education, is essential to protect their health, as well as public health interests.
62. Though plaintiff Low received conflicting information from HCCC medical staff regarding the results of his
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HIV test, which HCCC claims to have "lost," he is unwilling to request a second test at CRCI knowing that a positive test result will become widely known within and without DOC facilities. His request to be tested outside of DOC at his own expense at an anonymous test site has been also rejected. Absent certain knowledge about his HIV status, he cannot make necessary plans regarding his young children.
63. Defendants are aware that their CSD lists, "red dots," non-private medical visits, staff disclosures, posted lists, inmate access to medical records, and other breaches of confidentiality have caused the identity of inmates with HIV infection entrusted to their care to become known to DOC staff, to other inmates, and to persons outside DOC, including to persons at other local and state agencies. Defendants are also aware that these disclosures not only subject HIV-identified inmates to harassment, threats and harm but also deter other inmates from agreeing to be tested for HIV. Nonetheless, defendants knowingly and intentionally have failed to change and adopt policy to limit strictly the disclosure of the identities of HIV-infected inmates.
64. Defendants' polices and practices, which command and allow public disclosure of an inmates' HIV status, have caused plaintiffs and those they represent to suffer severe emotional distress, depression, humiliation, stigmatization, harassment, intimidation, discrimination, and threats of, or actual, bodily harm.
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D. HIV testing, counseling, and education
65. Early diagnosis of HIV infection is essential for proper medical treatment and counselling of the infected person, and for meaningful education to reduce further transmission of HIV to others.
66. Defendants have adopted no policy which requires the informed written consent of all inmates prior to HIV tests.
67. Defendants have adopted no policy requiring pretest counselling for HIV tests, and inmates, including plaintiffs Low, Hoe, Toe, and Moe, have been and are provided little or no information, or on occasion are given misinformation, by DOC staff about the HIV test and its meaning prior to having blood drawn for the test.
68. Plaintiff Moe was informed by CCIN medical staff that the results of her HIV test would remain "absolutely confidential" and that no one would learn the results outside of the medical unit. She was not informed that a positive test result led to being listed on defendants' CSD list, labelled by "red dots," and other egregious breaches of her confidentiality.
69. Though post-test counselling for HIV-infected inmates is absolutely necessary to educate them about the cause of the disease, to foster and sustain risk reduction behavior, and to enable them to manage the anxiety and depression which accompanies diagnosis, defendants only very recently have retained three "AIDS" counsellors to service the thousands of
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inmates in DOC's sixteen institutions. These counsellors hold federally-funded positions, under a grant which ends in December, 1988, from the United States Centers for Disease Control, through DOHS, to DOC.
70. This staff shortage, coupled with the timeconsuming nature of the counselling required and inmate demand for ongoing counselling, requires the three AIDS counsellors to triage among the many inmates in need of their services. Certain HIV-infected inmates, such as those nearing release, are given first priority. Counselling for plaintiffs and other Hivinfected inmates frequently is delayed and abbreviated, or is wholly non-existent.
71. Due to defendants' failure to employ an adequate number of specially-trained AIDS counsellors, post-test "counselling", if done at all, is performed principally by community volunteers and by physicians, nurses, medics, and other, nonmedical staff at each DOC facility. Because these individuals have competing demands on their time, post-test "counselling" is typically cursory, brief, inconsistent, sometimes factually inaccurate, and not of a continuing nature.
72. Though persons diagnosed as having HIV infection are at greatly increased risk for serious depression and suicide, defendants have adopted no written protocols and policy which require a prompt evaluation by trained mental health personnel of all inmates who are newly diagnosed as having HIV infection, followup mental status evaluations, and, as needed, treatment.
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Without such professional evaluation and intervention, inmates with HIV infection suffer anxiety, depression and the risks attendant to attempts at suicide.
73. Plaintiff Doe slashed his wrist at NHCCC shortly after learning of his HIV infection, and was placed in the "hole" on suicide watch for nearly two days. Though correctional staff noted that Doe had reported that "AIDS is the problem and he cannot deal with it any longer," there is nothing in his medical record which indicates that a psychiatrist or other trained mental health personnel ever personally examined and counselled Doe during his stay at NHCCC.
74. Counselling for HIV infected inmates is so inadequate as to leave inmates confused about the difference between HIV seropositivity and full-blown AIDS and about the cause of the disease, and not fully informed about what they must do to protect themselves and others.
75. Defendants have not organized mutual support groups for HIV-infected inmates at all DOC facilities, though DOC provides such groups for inmates with problems with alcohol (Alcoholics Anonymous), drugs (Narcotics Anonymous) and parenting (Parents Anonymous).
76. Education about HIV infection, though currently agreed by medical and public health authorities to be the sole means to slow the epidemic and reduce irrational response toward persons with HIV infection, has been provided by defendants to inmates and staff on an irregular and infrequent basis. In
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addition, defendants' educational efforts principally rely on brochures and videos, which provide inmates and staff with little or no opportunity to ask questions and are not wholly appropriate for and accessible to illiterate inmates and inma-fces with cultural and linguistic differences. A single "AIDS Educator" currently funded only until December 1988 by a CDC grant through DOHS to DOC, is responsible for the AIDS education of the approximately 30,00-0 inmates committed to defendant Meachum's care and custody annually.
77. Defendants' failure to provide mandatory, timely, culturally and linguistically appropriate, and continuing HIV education has allowed a lack of information and misinformation to continue to exist among inmates and staff. This lack of information has serious health consequences for inmates who remain at risk for unwittingly giving or getting HIV infection through high risk behaviors while incarcerated, such as IV drug use, tattooing, and sexual activity. This lack of information also has serious security consequences, as the safety of inmates identified as HIV-infected is compromised, and a threat to the overall security of the facility is posed by hysterical and irrational staff and inmate reaction, unenlightened by knowledg* about actual risks and modes of transmission.
E. Medical care for inmates with ARC or who are seropositive.
78. Defendants currently house most inmates with HI infection short of diagnosed full-blown AIDS in the general
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inmate population. Male inmates with confirmed AIDS typically are housed in the AIDS ward or hospital at CCIS. Female inmates with confirmed AIDS typically are housed in the CCIN medical unit.
79. Defendants have not adopted and implemented comprehensive, systemwide medical and mental health protocols which fully and appropriately meet the medical and mental health needs of inmates with HIV infection which is short of full-blown AIDS.
80. Defendants have failed to provide individualized treatment plans for plaintiffs and other inmates with HIV infection short of full blown AIDS to ensure that their medical and mental health needs will be met in an adequate and timely manner.
81. Upon information and belief, some DOC health care staff have delayed or provided deficient medical or dental care to HIV-infected inmates because of fear of HIV transmission.
F. Federal financial assistance 82. DOC has received in excess of one million dollars
in federal funds in each of the last two years.
G. Defendants7 Response and Effects of Defendants' Polices and Practices. 83. Since 1983, when DOC first became aware of HIV
infection and alerted to the need to adopt and implement rational policies and practices pertaining to it, numerous state and
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federal bodies, agencies and task forces have provided DOC officials with substantial guidance and direction regarding what is appropriate policy and practice.
84. The reports, protocols, and guidelines produced by these various groups repeatedly have stressed the need for strict confidentiality regarding the identities of persons with HIV infection, written informed consent and adequate pre- and posttest counselling for HIV tests, non-discrimination against persons with HIV infection, the need for extensive, on-going, and appropriate education and risk-reduction counselling as the best means of combatting the epidemic, and the use of "universal" blood precautions as the most appropriate means of protecting non-infected persons from accidental exposure to HIV.
85. In disregard of these various explicit declarations of policy and principle regarding HIV infection in the State of Connecticut, and in knowing disregard of established public health principles and expertise, defendants have failed knowingly to change their policies and practices, and to secure adequate staff and resources, in the face of this public health crisis.
86. To date there has been no change in defendants' policy, which is embodied in full in Exhibits A, B, D, E, G, and J attached to this Complaint, except insofar as defendants have begun to initiate some mandatory AIDS education for inmates. Defendants persist in following the policies and practices adopted by their predecessors in office and thereby knowingly and
28

intentionally allowing the violations of plaintiffs' rights to continue unabated.
87. Defendants' policies and practices are causing plaintiffs to suffer irreparable harm for which they have no adequate remedy at law.
VI. CLAIMS FOR RELIEF
A. FIRST CLAIM FOR RELIEF - First, Fourth, Ninth and Fourteenth Amendments - Right of Privacy
88. Paragraphs one through eighty-seven are incorporated herein by reference the same as though pleaded in full.
89. Defendants have a duty to respect, ensure and protect the privacy and confidentiality of information about inmates' medical conditions and to protect the safety and wellbeing of inmates committed to their care and custody who risk harm from disclosure of such information within and without DOC facilities. Nonetheless, to date defendants intentionally, deliberately, and knowingly have commanded, and knowingly acquiesced in, policies and practices which openly disclose the identities of inmates known, or believed, to have HIV infection, thereby violating the rights of plaintiffs, and those they seek to represent, to have their sensitive medical information kept in strict confidentiality and to have their personal privacy protected as is guaranteed to them by the First, Fourth, Ninth, and Fourteenth Amendments to the United States Constitution.
29

B. SECOND CLAIM FOR RELIEF - Eighth, and Fourteenth Amendments — Right to Adequate Counselling, Medical Care and Mental Health Care
90. Paragraphs one through eighty-nine are incorporated herein by reference, the same as though pleaded in full.
91. Defendants have knowingly failed to adopt and implement policies and protocols systemwide to:
a. require informed written consent prior to the administration of an HIV test;
b. require, and provide through appropriately trained and sufficient staff, timely, comprehensive, accurate, and culturally and linguistically appropriate pre- and post-HIV test counselling;
c. require, and provide through appropriately trained and sufficient staff, a mandatory continuing HIV education program which is scientifically accurate, comprehensible and culturally and linguistically appropriate; and
d. provide adequate and timely counselling, medical, and mental health care to inmates with HIV infection which is short of full-blown AIDS. Defendants' knowing and intentional failures constitute deliberate indifference to the serious medical and mental health needs of the plaintiffs, and those they seek to represent, in violation of their rights under the Eighth and Fourteenth Amendments to the United States Constitution.
30

C. THIRD CLAIM FOR RELIEF - Eighth and Fourteenth Amendments — Right to Safe, Decent and Humane Environment. 93. Paragraphs one through ninety-two are incorporated
herein by reference, the same as though pleaded in full. 94. Defendants have a duty to ensure the safety,
security and wellbeing of all inmates committed to their care and custody. Nonetheless, they, through policy and practice which commands or allows open disclosures of the identities of persons with, or suspected of having, HIV infection, through wholly inadequate staff and inmate education about HIV infection and its modes of transmission, and through inadequate counselling of inmates with HIV infection, have exposed plaintiffs and members of their class to harassment, intimidation, threats, and physical harm and thereby violating the due process rights of plaintiffs, and those they seek to represent, to be maintained in a safe, secure and humane environment and their rights to be free of cruel and unusual punishment as are guaranteed to them by the Eighth and Fourteenth Amendments to the United States Constitution.
D. FOURTH CLAIM FOR RELIEF - § 504 of the Rehabilitation Act of 1973, as amended — Right to be Free of Discrimination Based on Physical Handicap
95. Paragraphs one through ninety-four are incorporated herein by reference the same as though pleaded in full.
31

96. Defendants' policies and practices which command and allow the open disclosure of the identities of inmates known and perceived to have HIV infection, and the curtailment of, delays in, and conditioning of access to medical services, programs, and facilities which are attendent thereto, violate the rights of plaintiffs, and those they seek to represent, to be free of unlawful discrimination based on handicap by a program or activity receiving federal financial assistance, as is guaranteed to them by § 504 of the Rehabilitation Act of 1973, as amended. 29 U.S.C. § 794 et seq.
VII. PRAYER FOR RELIEF
WHEREFORE, the plaintiffs respectfully request this Court to:
1. Assume jurisdiction over this action; 2. Certify this action as a class action; 3. Grant a preliminary and permanent injunction, restraining the defendants, their agents, and their successors in office from:
a. Continuing their use and distribution of the "CSD" list, creating, maintaining, and distributing any other list or compilation of information on which inmates are personally identified, directly or indirectly, as having HIV infection, and refusing to destroy all existing "CSD" and other HIV-identifying lists;
32

b. Continuing their use of "red dots", "red circles" and other marks to identify inmates with or suspected of having HIV infection, and from creating or maintaining any other system of open identification of such inmates;
c. Failing to adopt policies and protocols with strict sanctions to prohibit unauthorized disclosures of an inmate's HIV status;
d. Failing to adopt strict institutional recordkeeping requirements to limit stringently the disclosure of an inmate's HIV status and failing to apprise all DOC staff of their responsibility to safeguard the privacy of and not disclose the identities of HIV-infected inmates.
e. Failing to provide voluntary, confidential and anonymous testing to all DOC inmates;
f. Failing to provide timely, comprehensive and accurate, and culturally and linguistically appropriate pretest counselling to all inmates being tested for HIV infection;
g. Failing to require an inmate's written informed consent prior to testing to disclose the presence of HIV infection;
h. Failing to provide timely, comprehensive, accurate, and culturally and linguistically appropriate
33

post-test counselling and followup for all inmates who are identified as having HIV infection;
i. Failing to adopt, implement and adequately staff a mandatory, continuing education program for inmates and DOC staff concerning HIV infection, which is scientifically-accurate, comprehensible, and culturally and linguistically appropriate and which covers, inter alia, symptoms of infection, means of transmission and ways to reduce risk of transmission, the diagnosis and treatment of infection, and infection-control principles; and
j. Failing to provide adequate and timely counselling and medical and mental health' treatment for inmates with HIV infection short of full-blown AIDS which in no way discriminates against them based on their HIV-infected status;
k. Failing to provide safe, secure, and humane conditions to inmates with, or percieved to have, HIV infection while in defendants' care and custody by reducing the misinformation among staff and inmates and by forbidding all open disclosure of an inmate's HIV status. 4. Enter a declaratory judgment declaring that defendants' policies and practices violate plaintiffs' rights under the First, Fourth, Eighth, Ninth and Fourteenth Amendments
34

to the United States Constitution, and § 504 of the Rehabilitation Act of 1973, as amended.
5. Award plaintiffs compensatory and punitive damages, 6. Award plaintiffs costs and attorneys' fees. 7. Grant such other relief as this Court deems just and proper.
Respectfully submitted,
Shelley Geballe Martha Stone Connecticut Civil Liberties
Union Foundation 32 Grand Street Hartford, CT 06106 (203) 247-9823
35

WILLIAM A. O'MI:.H I CiOVliRNOK

May 20, 1907

OS- <-OKK$
V1|> < M IIMI
t l A i t i i (Mn>. < O M I I I ( Hi 111 or,|iir,
N M < i| II i M . | ()| < ' .'MMIS'iK )[ III'

The Hon. Cynthia Matthews The Kon. Paul Gionfriddo Co-Chairpersons Public Health Committee State Capitol Hartford* CT. 06l0o

Dear Co-Chairpersons Matthews & Gionfriddo:

The Department of Correction dees not recommend screening all inmates for AIDS and segregating those who are positive for HIV (Human Immunodeficiency Virus). This policy is a result of consultation with state and national. li'vi 1 Ui auUiori tier, and cjt.h'-.T correctional systems tl^roughout the country. At the current"" mc, there is unanimous agreement that testing should not be done en a EE.SS scale nor should segregation be practiced. This posll has been adopted by the National Center for Disease Control, the State Department of Health, and most of the other correctiona l departments because there is neither trc-i l.ir.rnt nor prevention available for the condition, thus the j n<] i vi'lun.1 concern'.-'! wt.nj \<] benefit froc the test and might possibly suffer because of society's reaction to those infected.

no',

The position against scprenation h.-is boen adopted hcc-iijr^ i.htr" is strong evidence that this virus cannot be transmitted thrcurn casual contacts.

The department continues to keep abro-ist of the latest i nforT,=.-: nr. on this subject and stands ready to altrr its policy should t!ie accepted scientific opinion en this matter be modified.

Sincorr-ly yours,

EMW/cdn

Edward M. WurzrJ, M.U. Director of Health Care Services

S1AT1I U!

IK t' I

Exhibit A

INTERDEPARTMENTAL MESSAGE
J...I N. K3S W i n .

STATE OF CONNECTICUT Moke Dollo'J ond Senie tiVough Improvtd Ideos.
Obtom "STATE EMPLOYEE SUGGESTION!" form from, end vend your ideoi to Employee i Suggestion Awordt Proprom, 165 Cop'tol Avenue HoM<ord. Ct. 06^06.

To From
Subject:

..»•*( Till
Al1 Uar dens/Superi n t endent s Department of Correction Je^mes L. Singer, Deputy Comm i s« i oner
Department of Correction Administrative Procedures regarding Infectious

7/1/£?

Under some circumstances the agents causing such diseases a s H e p a t i t i s . B a n d A i d s m i g h t b e p a s s e d f r o m a n i n f e c t e d i n m a t e t o tr uninfected individual if the latter were t o come into intimate contact with the blood, saliva, urine, feces, o rother body fluic the infected individual. Usually these diseases are transmitted through sexual contact o rthe sharing ofcontaminated drug p a r a p h e r rial i d .
Under ordinary circumstances o fcasual contact these inmates pose risk. I t isonly b ycoming into intimate-contact with a body fluic such circumstances that itcould perpetrate the skin a n d mucous membrane barriers that infection might ensue. Thus ifo n e contactc i n f e c t e d b l o o d f r o m s u c h a c a r r i e r o f d i s e a s e o n o n e ' s s k i n . b u t tf skin were intact a n d ifthe blood were washed away without having o p p o r t u n i t y t oenter the body through skin abrasions o r injuries the mucous membranes, n oinfection would occur.

contacts as mentioned above.
In t h e g r e a t m a j o r i t y o f c a s e s t h e d a n gg e r o f i n f e c t i o n is m i n i m a l . H o w ee vv ee rr ,, inn o r d e r t oo p r o v i d e m a x i m u m p r o t*e. c_ t. ii o_ n- a n d1 _p .e a c e o f m i n e those responsible for the transportation a n d custody o f the inmatt t h e " r e d c i r c l e " w i l l b e u s e d , e v e n i n u n d i aa g n o s e d c j - s e s .
C o r r e c t i o n a l s t a f f o r s t a f f o f o t h e r a g e n c i e s w h o a r e t r * n s p o r t i r.c i n m a t e s s h o u l d b e a d v i s e d w h e n t h e i n m a t e h a s o r is- s u s p e c t e d o f having a communicable disease such a shepatitis B orAIDS. This wi be implemented b yp l a c i n g a solid r e d circle o n the outside o ftn« papers accompanying the inmate. Whoever initiates the transportati situation, e.o. court visit, medical appointment,etc. must assure that the r e d circle i s inthe appropriate place s othat the t r . n s p o r t ino, o f f i c e r w i l l b em a d e a w a r e o f t h e f a c t s .
It is emphasized that t h e r e i s n o d a n g e r fron-i o r d i n a r y • s o c i a l contact" with these inmates.
Exhibit B

The *dmi n i s trat i ve h e a d of each -facility is d i r e c t e d to implement p r o c e d u r e to assure that * red circle of a p p r o p r i a t e " a t t e n t i o n getting" sire will be displayed on the papers supplied to those transportino inmates described above. Identification of those inm re-ferred to above will be the r e s p o n s i b i l i t y of the f a c i l i t y medi author i ty.

P l m v »md your idr*.i to:

STATE OF CONNECTICUT

A Pioblrm SoUmg Idea CMJTI WIO An A » u d

*

t'Svttrjilon Awards Ptot'em, It} Cefiitol A*t., Hartford. 06106.

InlcrdcpnrJmcnt Message
STO-tDI REV. 10'!) STATE OF CONNECTICUT (Ste<* So H}! CI Oil
To NAMC A l l W a r d e n s / S u p e r i n t e n d e n t s
ACts°Depr;rtneri* of Correction

SAVE TIME: Hond*rinrn mrjiegei err ecctpieble.
Vie terbon if you teellj nertt o ropy. If l)prwrinen. tfnorr faint
TITLE
ADDRESS

From
SL'SJICT

es L. Singer Dep = rtr.ent of Correction
- 10-17-05

Deputy Corr-Tissloner
ADDRESS

TtLtrilOKE

The folloving Jter.s have been reccr.-ended to the Corjr.isEioner as approved by the departmental cor^ittee on AIDS in preparation for the Union meeting of 10-17-55:

1) attached tslease find a nev departmental policy entitled "Policy regarding irJfectlcus Diseases"//hi'ch goes into effect i.'ovejiber.-l, 1SB5-. • This policy proyides for staff ." • and inr.ate protection-vith respect, to special diseases. It also delineates a: procedure for sharing appropriate ir.fcrr.ition vith designated staff in all facilities ; *-

2) an infections disease ur.it of approximately 18 beds is scheduled i\>r Dece-ber at CCI-Sc.-.ers. A unit for fer.ales vill be established Et Mar.tic at a later date;

3) the department does not endorse mass testinr. of inrates to deterTri.-f the presence cf K7LV-III virus;

M

a speciax kit consisting of:

1) plastic gloves

2) hospital-type go-Tj •

- •

3) redic^l r.asks

ii) non-feedback respiratory device

• vill be placed in all vehicles transporting in.-.atcs in the

department, in the hcusir.f, units, and in line supervisors'

offices, as soon as possible.

•

. •

5) although not radically required, the department vill provide for innate kitchen workers to receive a stool/blood test after classification but prior to Job placement.

6) an educational and evarer.ess sub-comaittee vill be appointed as soon as possible by the Corrvnlsconcr to continue to generate a variety of educational materials for staff and the inmate population.

Exhibit C

Policy regarding Infectious Diseases
This directive establishes policy recording; irjr.ate carriers of specific diseases, hereafter referred to as C.S.D.
The' purpose of this policy is to provide staff as veil as in.~at.es the rest feasible protection against contracting specific diseases. The procedures are as follows:
The Cor—.issi oner, upon consultation fro~ the Perartrner.t's Kedical Director, will specify in written policy which diseases are to be included in this caterrry and referrei to as C.S.T. At the present tire they are Hepatitis E and ARC/AIDS.
Identification of these carriers will be initiated by Health Care personnel in the facilities, but the final designation will be ir.ade by the Department's Chief of Health Care Services.
When an individual is identified as C.S.P. his or her nane will be placed en a list prepared and kept current by the respective facility rr.edicalur.it. It will be submitted to the administrative head of the facility who will then assign supervisory personnel to assure that a red circle of "attention getting1' size is placed on necessary paperwork which would accompany transporting officials., i.e., correctional staff, sheriffs, etc. The list of these "red circle" C.S.D. inmates will be available to all staff members who nay cor.e in contact with them during the course of their duties.

'NTERDI-PARTMcNTAL MESSAGE
i ' O J03PEV :,84 i'of» MO 69js az e n

STATE OF CONNECTICUT Mote Dollars and Sense throuqh Improved Ideas.
Obtain "STATE EMPLOYEE SUGGESTION" forms from, Ond send your ideas to: Employee's Suggestion Awards Progrom, 165 Capitol Avenue Hartford. Ct. 06106.

To From
Subiect:

C*IE
List Decartment cf Correction, All Sites Edward M. Wurzel, M.D., Director, Health Carp ccr Department of Correction, 340 Caritcl Aver.ue. Har
Enclosed please find a ccpy of 2 form to be used as part of the Decartr-.c-.t' s policy for identification cf innate carriers of specific disease (C£D). Please submit completed fcr^s to Dr. Wurzel's office for each innate concerned. This form nay be reproduced locally.

cc: File

Edward M. Wurzel, "^4iD., Dir., Health Care Svs,

fe^*£»>^r£:;^^

\
.*,*•'.-' i ' " • * ' . . • . * . * *

.

^•

:

.

•

-

Exhibit D

• - .v

IDENTIFICATION OF INMATE CARRIERS OF SPECIFIC DISEASES

Submit this form to Central Office for all cases of inmates suspected of hav or carrying specific diseases.*

1. Facility:

2. Date:

3. Inmate Name:_

•=

D.0.3.

4. Disease:

Hecatitis B , ! Other:

AIDS/ARC L

BASIS FOR SUSPECTED DIAGNOSIS A. History': (To include risk group factors)

B. Physical Findings:

C. Lab Findings: (Include copies of lab reports)

Central office will act on this information to identify those inmates to carried on the "Red'Dot List".* If additional information is desire-d, '-'• will be requested by Central Office - where a positive determination is made, the inmate's name will bs added to the list and the new list will be distributed.
*See "Policy regarding Infectious Diseases" attached.

12/S5

w -*A

*

A Problem Solving Idea CAD Win Ac Award

*

P!eas« send your ideas w: Employee' Sutsation Awards Program. 165 Capitol Ave., Hartford, 06106.

Interdepartment Message
STO-201 REV. 10/83 STATE OF CONNECTICUT (Slock So. 693S-C31-O/)

NAMC

To

Raymond M. Lopes

AGENCY

Department of Correction

NAME
From James L. Singer
AGENCY
Department of Correction

SUBJECT

Departmental AIDS Committee

SAVE TIME: Handwritten messages are acceptable. Use carbon if you really need a copy. If typewritten, ignore faint lint

TITLE
Commissioner
ADDRESS

DATE
1/16/86

TITLE
Deputy Commissioner
ADDRESS

TELEPHONE

The Departmental committee met on January 6, 1986. The following were in attendance:

Dr. Ed. Wurzel Dr. E. Blanchette Dr. E. Serafini. James McMahon-' James L. Singer, Chairman ~"

Minutes of this meeting are as follows:

I. Dr. Blanchette reported on the recent AIDS meeting he attended in Arizona. He emphasized the following points:

, (a)

As a result of the data presented, the exchange of ideas that were generated, and the continued consensus of others, the policies/practices of other states were overwhelming that AIDS cases be segregated, but that the routine se-gregation of ARC diagnosed inmates is quite simply contraindicated.

(b) Subsequent to a comparison with other states, Connecticut DOC remains in the vanguard, both medically and programmatically, in the diagnosis and management of AIDS/ARC cases.

Based on additional discussion of item I. (a) above, the committee is recommencing that AIDS cases continue to be segregated in the Somers hospital and/or Niantic, respectively; and that diagnosed ARC cases are not routinely segregated, but housed in the general population of the department facilities.

Discussion focussed on an assessment of the present format for the compilation and distribution of names on the CSD list. It was decided that central office Health Care Director would publish the master CSD list and the wardens/superintendents would be added to the mailing list.

IV. Due to a problem of procuring ventilation masks, there was concern that the protective packets (AIDS kits) were not in place in all facilities. Dr. Singer requested that the solution be expedited and full packets be in place a snnp. as possible. A new CPR
ventilation mask was introduced and approved by the c

Exhibit E
S A V T I I M I': II mmriiirnt. Immln ntr rr/>/r /,» \nuhr nn / / I T T T T M T ^ W ?

- j ^.^^_i-=--.^^i>. v Policies and Procedures Regarding , . •

>. - Connecticut Department of Correction

•

I

I

.

••

.

•

.

•

•

•

•

•

(

The policy of Jhe Department of Correction is to provide complete health care ser-

vices which are equal to those available in the free community. State and Federal

law, court decisions, public expectations and concepts of humane concern all provide

parameters for the quality and quantity of these services. Among health care services,

treatment and management of the relatively new condition. Acquired Immune D e f i -

ciency Syndrome/AIDS related Complex (AIDS/ARC), presents unique problems.

-

The treatment and management of AIDS/ARC warrants a separate statement of

policy and procedure. This statement follows:

Knowledge of this AIDS/ARC is developing rapidly and the policies stated herein

are being constantly reviewed to assure that the department provides the best possible

responses in this difficult area. To provide him with reliable up to date information,

the Commissioner appointed an advisory committee on AIDS (see appendix 1). The

recommendations of this committee q.v. have been incorporated in the implementation

of this policy. As of this date, the final diagnosis of AIDS/ARC is made by facilities

only after consultation with the Director of Medical Services for the department.

Once diagnosed, inmates are housed in an area under the cognizance of the medical

department. All departmental staff coming in contact with these inmates in the

j

course of their duties are aware of their diagnoses.

i

!

Amplification of this policy, together with an overview of the procedures adopted.

are discussed under the following headings: I. Diagnosis and treatment I I . Transporta-

tion III. Housing.

•••-•' .y.

Exhibit F

-2-

I. Diagnosis and Treatment .

.

As in the case of the diagnosis of any other medical condition, the diagnosis of AIDS/ARC is based upon history, physical findings and laboratory data. In the majority of cases this diagnosis wilt be made upon information gathered during intake screening and physical examination. There are questions on the intake screening form which will result in the immediate referral of the inmate to the medical department whenever an answer is positive. This intake screening form has been updated several times' since the onset of A~IDS to reflect new information.

The history and physical examination includes careful questioning about risk factors and about the signs and symptoms of ARC and AIDS. Included are such things as general health, malaise, easy fatigability, persistent fever, night sweats, weight loss, skin rashes, enlarged lymph nodes, persistent diarrhea, bleeding disorders ancVor intravenous drug abuse. In the physical examination, particular attention is paid to the evaluation of lymph glands, skin and lungs. When indicated, special laboratory tests are performed. These tests include study of the T and B lymphocytes, the T4/T8 ration, serum A/C ratio, and HTLV 111 antibody test. When indicated, tests for anergy to PPD, mumps and Candida are included. Lymph gland biopsy is frequently done. Because there is no evidence in support of HTLV 111 being infective by casual contact, no mass screening of inmates is contemplated at this time.

Attached as appendix II is the protocaol in use at our diagnostic clinic where the final diagnosis of AIDS/ARC is made. Included with this appendix is the intake screening form mentioned above.

Until such time as a specific treatment is developed for AIDS/ARC, treatment is directed toward appropriate care of intercurrent infection or other medical needs as indicated. AIDS/ARC inmates are seen by health care personnel at least once % weekly even if they have no complaints.

1

The department provides information to all transportation personnel when an Inmate being transported has either AIDS or Hepatitis B. (see appendix III) Each vehicle is equipped with a special kit to be used if required. The kit consists of plastic gloves hospital type gown, medical masks and non-feed back respiratory devices. Requirements for the use of this kit will be in the case of an accident involving the inmate where their body fluids are spilled or CPR is required.
111. Housing
An infectious desease unit of approximately 18 beds is scheduled to be in use in December of 1985 at CCJ-5omers. It is contemplated that all sentenced inmates with AIDS/ARC will be housed in this unit. A similar unit will be established at CCl-Niantic for female inmates at a later date. The medical kit referred to in the appendix on transportation is also available in ail housing units and in all line supervisor's offices.
The housing of AIDS/ARC inmates in an area under the cognizances of the medical department is not considered medically necessary. None the less, the special conditions that exist in correctional facilities make their segregation desirable on at least an interim basis.

STATE Ob CONNLCTlCbl

•

A Problem Solving Idea C*a Win An Award

*

Pleue »end your ideas to: Employees' Situation Awards Program, 165 Capitol Ave.. Hartford, 06106.

Interdepartment Message
STO-201 REV. 10/83 STATE OF CONNECTICUT (Stock No. 6938-051-01)
NAMC
To Medical Unit Supervisors AGENCY Department of Correction
NAME
From Edward M. Wurzel, M.D. AGENCY Department of Correction
SUBJECT See Attached

SAVE TIME: Handwritten messages are acceptable. Use carbon if you really need a copy. If typewritten, ignore faint lines

Ci/YV\Ah).

TITLE

DATE
2/19/86

ADDRESS
All Sites

TITLE

TELEPHONE

Director, Health Care Serv. 566-3853

ADDRESS
340 Capitol Avenue, Hartford, CT 06106

The following excerpt i s from the Warden's meeting of January 17, 1986. This is for your information.

IV. Discussion took place regarding the current status of the CSD kits. A new ventilator was demonstrated by Dr. Wurzel for use in the facilities. Additionally, the following decisions are noteworthy:
(a) Full CSD kits are to contain gown, plastic gloves, masks and non-feedback respiratory device.
(b) Paper gowns may be used.
(c) Full CSD kits are to be located in the following areas:
1) All medical units
2) All transportation unit vehicles
3) In a readily accessible, centralized location in each facility
4} All first-aid kits are to contain a non-feedback respiratory device and plastic gloves.
5) All vehicles used to transport inmates are to contain non-feedback respiratory device and plastic gloves.
All facilities are to advise Dr. Singer or Mr. Tut hill, respectively, when such arrangements are completed.
.3/

Exhibit G
SAVE TIME: If convenient, handwrite reply / o sender on this same sheet.

NUBCR

NAJ1E

CONNECTICUT DEPARTMENT OF CORRECTION RCSLAHC1I AllO ltlfOntlATlOtt SYSTEHS DIVISION

O:JS MONDAY, SEPTEIUEIl

XIIIATES HITH CSO DESIGNATIONS

r-DATE

FACILITV

STATUS

RELEASE DATE

TPMN OF RESIULNCE

D'UAN87
0UUIB7 01AUGB7 10APRB7 O:SEI'O7 O1JULB7 01JUL87
01AUG67 11IUYB7
0?S£PB7 O.'SEPB7 01AUCO7
21H0VB6 0IAUGU7
0JJUL07 O.'SEPO7 10AWIU7 1CAPII67 01^tH07 JC(,PIIU7 01AUCO7 0M.LP07 luAriia; 01JUL U / DHAY07
01JUIO7
l)Ftb()7 11KU07
11IIAV07
OiStPQ7
1IFLU0 7 1'MA 1107 OJitl'07 21IIUVU6
t
01AUC07 2 11,1 I'Ut K'DlCUb

DISCHARUE

SENTENCED

H1ANTIC

SENIENCtO

OIUCtlAflCE

StNltNCfO

DI5CIIAIICE DISCHAI1CE

Stmtucto
SEtUtlJClO

OISCHAflCE

MrilUJCEO

P01-TUKARZ

GENTCNCED

D1SCMAHCE

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DISCHARGE

SEIJfEIICED

DISCHARGE

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OISCMARUE

UNSLNTEIICED

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SCIHENCED

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1907 ISO
Exhibit H

NUCER

NAI1£

CONNECTICUT DEPARTMENT OF CORRECTION RESEARCH AM) INFORMATION SYSTEMS D I V I S I O N

O;J<t MONDAY, SEPTtMDER ! < • , 1 1 8 7 l i t

IK1ATES HITM CSD DESIGNATIONS

E-DATE FACILITY

STATUS

niiAvar
O1JULO7 OiSEPO7 11MAY07 lZOLCHfe 21IIOVB6 1UAPR87 11NAY87 1HEB07 1ULIUI7 1O/.PRO7 OJSEPO7 01AUC87
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SENTEIICEO UIISEIITEIICEO SENTENCED UIISLNTENCEO SFNIENCEO SLNILIICEO
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RELEASE DATE O5FEO9O
2UJUNB9
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#
J0JAN89 10JUDO9 130EC67 I6JUL97 00DEC87
# #
23JAIJO3 10JUL09 O7JU1I89 2JJAN09 1J0CT07 ZJAI'Rtltt KIAUGUa
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T01IN OF RESIDCICE
CAST MAR HRANFORD IILH LONDON HARirORD HARTFORD HEM HAVEN
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RESEARCH AMU INF0HI1ATI0H SY5UM:; DIVISION

IMIATCS HITH CSO DESIGNATIONS

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IIAtlE

E-DATE

FACILITY

STATUS

RELEASE DATE

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DISCHARGE'

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01JUL07

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»AA«Eft NAME

CONMECTICur DEPARTMENT OF CORRECTION RESEARCH AND INFORMATION SYSTEMS DIVISION

HOHDAY, SEPUMDER 1<«, 1987 141

INMATES HI Til CSD DESIGNATIONS

E-OA1E
0]AUCO 7 OIJULO7
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FACILITY
OICCIIARGE DISCHARGE notirviiLE ROU1I43ON DISCIIAfiCE OISCHAnCE solicits DISCHARGE I'DS-PEOEZ OlOCHAItCE UlSCIURGE MfANTIC 01SCHARCE D/CIIC TU BOND D1SCHA00E UISCIIARGE DISCHARGE PU2-CAIUUAL0I ME-EHIHY C1IFS1URE CENTEH DISCHARCE l l t l l IIAVEIl NIAMTIC OISCHAnCE BlUOr.CI'OIIT CHt SHI lit CENTER DlSfllAllCE MIAMT1C D/CHC TO OONO MLH IIAVEM NIAMTIC
OIJCMARCE
OISCIIAIIGE tllFICLO CCI OISCUARGE UISCIIAIIUC U1SCIIAHUE U1SCIUI1C.L DISCHAnGE UlSCIIAItCE OISCIlAIIGE 50IICRS OISCIIAHGE I I I ! ULD CCI CHESHIRE CtMTEH D1SCHAI1CE 0 I I U I S , DRUG UISrilAHCE SOI It IIS SOME (15 PUZ-HOflAIJJ

STATUS

RELEASE OATE

UtISEMTtNCEU SittTEHCEU UtlStmCNCED
StIITEIICIO SEfirtUCLO
sturtiicco SCMTI ICED UII3EHTENCED SENIEUCEO SENIEIiCED SLHIEHCFU SLUTLMCtO
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NAME

COIHECTICUT DEPARTMENT OF CORRECTION RESEARCH AND INFORMATION SYSTEMS D I V I S I O N

0:J<« MONDAY, SEPTEMUER

1»7

1*2

1NMATCS l i l T H CSD DESICNATIOIIS

E-DATE
1JH»RU7 11I1AIIU7
08SEPO6
11MAYO7
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10APr(O7 11HAVO7 1JIIAUO7 OJJULU7 01JULO7 UDECOb 01AUGU7 IZDECHi
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FACILITY

STATUS

sotiEns

i
SENTENCED

DISCHARGE

UNSENTENCED

ClSCIIAnCE

SENTLNCEO

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SEfirENCED

DISCHARGE

SCIIIENCtD

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RELEASE DATE
23JUL92
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NUDE!

NAME

coiticcTicur DEPARTMENT OF CORRECTION RESEARCH Arm INFOIUIAIION SYSTEMS Division

INMATES H I T I I CSO OCSIGMATIOMS

C-OATE

FACILITY

STATUS

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SHI1EMCE0 UiUCNTEIICEO * StlimiCLD SENflMCLD LI MILIICI.U SLUIUICI 0 SENTEIICI D SEIirtMCln urjsciiitnciD si iiitriti.u StMKIILLO SENlCllCED SENrEllCEO Ulir.ElirEIICED SENIEIICtl). UNSlNILUCf 0
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0 : J ' . MONDAY, SEPIEM1IER

1987 14J

RELEASE OAlt
17JULH0 1VOCT07
100CI07
t
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17FEI1-J0 U(.ULCB7
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09JUL92

Totm or
RES1DLHCE
HALLIMGFORD MERlDftl H1I.L1IIAIIIIC NLH LONDON HAIUFORO OAKOALE HAnilUHO DRIDCLPORT HlllO'jOR NORHALK DUIUGEPORT NEII LONDON HAIITFOP.D HATERbURY UfilOGEPOflT
HAUIIUURY
IIAIirFORD NIM HAVIH BRIDGEPORT EA_,r HAHTFOHO ROCKVILLE NAUGATUCK NEM LONDON HAHTFOHO HLII HAVEM E . KILLIHGLY IIARTfORD NEN HAVEN MAMFORU HAHTFOHO HAIITFORO SL'UrHINUTON NIANTIC NEII HAVEN Nil IIMAIKIC MAIllltlUMY HAItRlUHY IIAftlltUIIY HAflTFURO NOIIIIALK BPlDGi PORT NLH HAVEN BHIUGI POHT UHIOGEI'OKT UII10GI PORT 111 It I Dt U
rUIIIIATfN NIH HAVEN itlllDGEPUHT II10DLI TOItl HAIIUtH

NLIBER

NAME

i u i 4 . i i . 11LUT OII'AIIYNI lir OF CullltECTION HCGEAIICII AIIO IKI'OHIIATIUM SYSTEMS DIVISION

It»1ATCS HITH CSO DCSIGNATIOUS

E-DATE

FACIHTV i

STATUS

O9JANO7
O1JUL87
lOU'llll/
ui:.tpur
l?0ECO6
io.\t'nt)7
21MUV06 U1AUGO7 21NDVO<> \IIIAYO7 O1JU137
OJSEP87 O9JAIW7 25AUG87 OJOEP87 111IA Ha 7 1VIAR07 OJ5EP87 01AUC87 OJAII07 1SMAU87 01AUCQ7 D1JUL87
01AUCU7 01AUW17
D1AUG11/ O1AUUU7
10APrill7 O1AUGO7 01AUCU7
11MAY07
l'.iuni)7 ZINOVOb
llllAUUT
0VJANU7
0»*UC8 7 lOAI'IIU/ UUUI ()/ 01AUCU7

OISCHADGE OlSCHAnCE
MAPLE ST HSE DISCHARGE UlAliriC
CUtSllinE CCNTER
7At NlAtJriC O/CIIG TO DONO DISCHARGE CMC SHI RE CENTER 01SCIIAHUE tllAHUC
fUANTIC SnilERS ENFICLO CCI OniOGEPOKT
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MESSAGE

Mo»t Delicts one Sense through Improved Ideas.
Obtom "STATE EMPLOYEE SUGGESTION" forms from, ond send your iaecrs to: Employee's Suggestion 'Awards T'ro^i om, 1<35 Caphoi Avenue
Hartford. Ct, 06106.

DATE

•

James L. Singer, E.D.D., Deputy Comnissioner

To

AOENCv. ADDRESS

9/9/85
'

Departirent of Correction, 340 Capitol Avenue, Hartford, CT 06106

From

Edward M. Wurzel, M.D., Director, Health Care Services
AGENCr. ACORESS
Department of Correction, 340 Capitol Ave., Hartford, CT

06106

!ElEP«O-wf
3853

Subject:

Family Visiting Program

In response to your request I offer the following advice on the Family Visiting Program involving inmates who have been diagnosed as having AIDS or ARC.
I reccrrmend that permission for fanuly visits be granted in some cases only if the inmate authorizes the department to inform the spouse of the potential for transmission of the virus in the course of the visit. This information should be provided to the spouse by a physician and prior to the visit. The discussion should emphasize present belief that the virus is not transmitted by casual contact and that children can visit with no danger to them.
_: Absent_such permission from the inmate, family visiting b2 suspended.

EMW:sc cc: File

' Edward M. W&rzel, M.D., Director, Health Care

Exhibit J

CERTIFICATE OF SERVICE
I hereby certify that a true copy of the foregoing
Plaintiffs' Memorandum of Law in Opposition to Defendants' Motion
to Dismiss was mailed, first-class, postage prepaid, this 9th day
of August, 1988, to defendants' counsel of record:
David B. Byrne, Jr. Robison & Belser 210 Commerce Street P.O. Drawer 1470 Montgomery, AL 36102
Bobby N. Bright Goggans, Mclnnish, Bright 540 South Perry Street P.O. Box 52 Montgomery, AL 36101
Harry A. Lyles General Counsel Alabama Department of Corrections Legal Division 101 South Union Street Montgomery, AL 36130

 
 Doe v. Meachum PC-CT-005-002

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

DAVID DOE, et a^..
-V8-
LARRY MEACHUM, e_t al,.

: CIVIL NO. H-88-562(PCD)

:

(JGM)

:

: MAY 16, 1989

CONSENT JUDGMENT ON AIDS EDUCATION AND ERE- AND POST-HIV TEST COUNSELLING
I. BACKGROUND 1. This action was filed on August 15, 1988. It
challenges certain policies and practices of the defendant officials of the Connecticut Department of Correction which pertain to education regarding the Human Immunodeficiency Virus ("HIV"), counselling prior and subsequent to testing for HIV infection, medical and mental health care provided to inmates with HIV infection, and protections for the confidentiality of persons with HIV infection.
2. This action was certified as a class action on February 10, 1989, by Order of United States District Judge Peter C. Dorsey, accepting and adopting Magistrate Joan Margolis' January 20, 1989 Recommended Ruling on Plaintiffs' Motion for Class Certification.
3. The class certified, by agreement of counsel, consists of all persons who were at any time since August 15, 1985, are, or will be subject to the care and custody of defendant Larry Meachum, Commissioner of the Connecticut Department of

Correction, but excluding those individuals in the class certified in Smith v. Meachum. Civ. No. H87-221 (JAC).
4. After extensive motion practice and discovery concerning plaintiffs' claims, plaintiffs filed a Motion for Preliminary Injunction on March 3, 1989. Plaintiffs sought interim relief on those claims relating to claimed deficiencies in the provision of information about infection with the Human Immunodeficiency Virus ("HIV") to the inmate population ("AIDS education") and to claimed deficiencies in counselling of inmates immediately prior to and upon the disclosure of the results of HIV-related tests ("pre- and post-HIV-test counselling").
5. A hearing on plaintiffs' Motion for Preliminary Injunction commenced on April 5, 1989 before the Honorable Joan Glazer Margolis and continued until May 8, 1989.
6. On May 9, 1989, after sixteen days of testimony, counsel for the parties met to discuss and negotiate settlement of the issues raised by plaintiffs' Motion for Preliminary Injunction, as specified in Paragraph 4.
7. The provisions of this Consent Judgment are the result of several discussions and careful negotiation among all the parties. They have been agreed upon solely as a means to put a reasonable end to the parties' dispute over the issues of AIDS education and pre- and post-HIV test counselling and to avoid the costs, time, and risks which would be involved in further litigation for both parties. The Consent Judgment embodies a compromise of the issues involved and, while its provisions are binding on the parties herein, its provisions are not to be
- 2-

construed to~be statements, rulings, or precedents with respect to the constitutional and other legal rights of persons who are parties or nonparties to this litigation in this or any other iaction.
8. The provisions of this Consent Judgment resolve all of the plaintiff class' existing claims in this case regarding inmate AIDS education and pre- and post- HIV test counselling, as of the date that counsel for the parties sign this Consent Judgment, against Commissioner Larry R. Meachum, Commissioner of the Connecticut Department of Correction ("DOC"), and the other named defendants, all of whom are officials and employees of DOC.
9. Notice to the plaintiff class members of this Consent Judgment shall issue pursuant to the notice provisions approved by the Court.
10. As used in this Consent Judgment, the following terms shall have the following meanings unless specifically stated otherwise:
a. "Commissioner of Correction" or "Commissioner" shall mean the Commissioner of the Connecticut Department of Correction ("DOC") or his designee.
b. "Warden" shall mean the Warden of any DOC facility or his/her designee.
c. "Inmate" shall mean any and all persons committed to the care and custody of the defendant Commissioner of Correction now or in the future, whether in pretrial or sentenced status, except for those in community confinement.
- 3-

d. "AIDS" means Acquired Immune Deficiency Syndrome, as defined by the Centers for Disease Control of the United States Public Health Service.
e. "HIV infection" means infection with the human immunodeficiency virus, or any other related virus identified as a probable causative agent of AIDS.
f. "HIV test" means any laboratory test or series of tests for any virus, antibody, antigen or etiologic agents whatsoever thought to cause or indicate the presence of HIV infection.
g. "Community confinement" shall mean any transfer to community residence programs pursuant to state law including but not limited to halfway houses, work release, education release, and supervised home release under C.G.S. 18100.
h. "Counsellor-educator" shall mean an infectious disease counsellor-educator and shall refer to a staff member of the Health Services Division of the DOC hired either in a permanent or contractual position whose primary responsibility shall be to provide counselling and education services to inmates at risk for HIV infection.
11. Now, therefore, without any additional proceedings and upon the consent of the parties to this action, it is hereby ORDERED as follows: II. STAFFING
12. The AIDS Program within the Department of Correction shall have an AIDS Coordinator whose responsibilities are
- 4-

specified in part in paragraphs 13 and 14, infra. In addition, DOC shall continue to implement the current Memorandum of Agreement ("MOA") with the Connecticut Department of Health . Services including the provision which calls for the assignment of nine counsellor/educators (or full-time equivalents) to DOC custodial facilities. Should the MOA terminate, or change, defendants shall provide plaintiffs' counsel, 60 days in advance of termination or change, their plan to reassign responsibilities among staff to fulfill defendants' obligations under this Judgment. DOC agrees to maintain sufficient staff to carry out the provisions of this Consent Judgment.
13. The AIDS Coordinator shall be a person designated by the defendant Director of Health Services of DOC who shall be responsible for supervision and coordination of the programs related to HIV infection within DOC. The duties of the AIDS Coordinator shall include coordination of the AIDS Program within DOC, generally, and shall specifically include ensuring that each DOC facility has available to inmates educationally and linguistically-appropriate AIDS education materials of comparable quality and quantity, and ensuring that all staff involved in the DOC AIDS education and counselling program periodically are given such retraining and updated information as are necessary to keep them current in the field.
14. The AIDS Coordinator is responsible for supervision and coordination of live inmate AIDS presentations, training staff to provide AIDS education to inmates and evaluation and assessment of the effectiveness of the AIDS education
- 5-

program, through devices including, but not limited to, inmate knowledge, attitude, and behavior surveys.
15. The recruitment and hiring of AIDS counselloreducators shall target qualified black and Hispanic persons in an effort to have the counselling staff reflect the racial and ethnic mix of the inmate population.
16. All counsellor-educators and other staff within the DOC charged with the responsibility of providing pre- and post- HIV test counselling shall complete the Connecticut Department of Health Services' training program for AIDS counsellors or shall have other comparable training or equivalent experience as approved by the defendant Director of Health Services for DOC.
17. The primary responsibility of the counsellor-educators shall be to provide appropriate pre- and post-HIV-test counselling.
18. All DOC facilities shall be accessible to the counsellor-educators as is necessary to carry out the provisions of this Consent Judgment and each facility shall provide appropriate space which affords inmates and staff confidentiality during the counselling sessions.
19. As determined appropriate by the Commissioner, defendants will continue to cooperate with, encourage, and allow reasonable access to their facilities to permit community efforts to provide AIDS education to inmates.
- 6-

H I . AIDS EDUCATION 20. The purpose of a systematic and comprehensive AIDS
education program within DOC is to ensure that the inmates are provided with appropriate information regarding the prevention of transmission of HIV.
21. All videos, curricula, oral presentations and written materials used for inmate AIDS education shall be appropriate, medically-accurate, not unduly repetitive, and culturally and linguistically appropriate to the target population.
22. There shall be provided as a part of the routine orientation process in each DOC facility a video about HIV infection, followed by a period for discussion and questions and answers. The AIDS video-discussion orientation program shall be held a minimum of three times each week on non-consecutive days at the following institutions: the Hartford Correctional Center, the Connecticut Correctional Institution at Niantic, the Morgan Street Detention Center, the Union Avenue Detention Center, the Bridgeport Correctional Center, the Gates Correctional Institution, the Montville Correctional Center, the New Haven Correctional Center, the Brooklyn Correctional Center, the Litchfield Correctional Center, Jennings Road and the Cheshire Correctional Center. The program shall be held a minimum of once each week as a part of orientation at the Northeast Pre-Release Center, the Eddy/DWI facility, the Connecticut Correctional Institution at Somers, the Hartell/ DWI facility,, the Enfield Correctional Institution, the Carl Robinson Correctional Institution and the
- 7-

Manson Youth Institution. The program shall be held additionally at the Hartell/DWI facility once each weekend. These initial orientation presentations shall include information about HIV transmission, methods and skills for protection against transmission, discrimination and confidentiality, the HIV test, community resources, and the need for compassion toward HIVinfected people.
23. All inmates shall also receive at intake into a DOC facility a copy of the "Stop the Spread" pamphlet about AIDS, printed in English and Spanish. Defendants shall periodically assess the need to make changes in this pamphlet based upon experience as new developments about AIDS arise and shall make such changes as are necessary to provide inmates with timely and culturally and linguistically appropriate written information. Should an AIDS HOTLINE be established in this State, or should some other phone number more appropriate and accessible to inmates than the Department of Health Services number become available, this information will be provided as a part of the pamphlet distributed to all inmates.
24. A variety of written AIDS materials, in English and in Spanish, shall be maintained in sufficient supply in areas of each DOC facility which are easily accessible to inmates, including but not limited to, the medical unit of each facility, counsellors' offices, at the weekly AIDS video sessions, as well as in the library if one exists.
25. A one to two hour voluntary weekly AIDS education seminar shall be available to all inmates in all DOC facilities.
- 8-

It shall generally include a lecture, video, and a question and answer discussion period led by a counsellor-educator or by an appropriately-trained staff member or volunteer. This weekly seminar shall be in addition to the video and question and answer sessions described in paragraph 22, supra.
26. Inmates shall be notified of the weekly AIDS seminars by appropriate notices in English and Spanish posted in readily viewable sites within the facilities, including the housing units, by announcements in inmate newspapers in facilities where newspapers are published, and in such other manner as the Wardens of the individual institutions deem appropriate, such as announcements over a public address system.
27. Defendants shall periodically assess and evaluate the inmate demand for the weekly AIDS education seminars to determine if inmate access is being deprived or unduly delayed because of excessive demand. Defendants shall consider and implement such changes as are necessary to ensure that no inmate who wishes to attend a weekly AIDS education seminar has his/her request unreasonably denied and/or delayed.
28. Inmates in protective custody, segregation or other restrictive custody statuses shall be provided with AIDS education services reasonably comparable to those provided to other inmates.
29. Inmates shall be advised at the orientation program on AIDS and at the weekly sessions on AIDS that if they have additional questions about HIV infection after completing these programs, they should contact a counsellor-educator or
- 9-

other qualified staff person for an individual educational

session. Inmates shall also be informed at these sessions as to

whom within the facility they should contact for further informa-

, tion and the method of contacting such persons.

I

30. The AIDS Coordinator shall ensure that the videos,

curricula, and written materials used within DOC for AIDS

education remain current and consistent throughout the Depart-

ment .

31. Defendants shall secure a sufficient number of

videos in Spanish to ensure that non-English or limited-English

speaking Hispanic inmates within each DOC facility are offered

and are able to view a video in Spanish about HIV infection. An

orientation video session in Spanish shall be conducted when non-

English or limited-English speaking Hispanic inmates are

identified through the intake process in each DOC facility. AIDS

seminars conducted in Spanish similar to those identified in

paragraph 25, supra, shall be available in each DOC facility,

using Spanish materials and led by a Hispanic counselor/educator,

a trained Hispanic staff person or other qualified Spanish-

speaking staff person, contract or volunteer AIDS educator on an

as-needed basis, i.e. when non-English or limited-English

speaking Hispanic inmates sign up to participate in a live AIDS

education seminar.

32. In order to provide initial AIDS education to the

current population as of the date of the entry of this Judgment,

defendants:

- 10 -

a. Shall provide each inmate with a copy of "Stop the Spread* in English and Spanish;
b. During the period from June 15, 1989 to July 7, 1989, shall schedule and hold such additional AIDS education weekly video-question and answer programs as to ensure that no weekly session exceeds forty inmates in size.
33. An AIDS education discharge packet will be distributed to all inmates leaving a DOC facility on discharge, release, or transfer to community confinement. The discharge packet shall at least include a brochure (in English and Spanish) listing community resources and information on how to prevent transmission of HIV through sex and sharing needles. In 1989, the packets shall begin being distributed effective on the date of delivery of discharge packets to each DOC facility. IV. PRE-AND POST-HIV-TEST COUNSELLING
34. All inmates who are considering or who are given an HIV test shall receive appropriate pre-test counselling prior to the HIV test. This pre-test counselling shall be provided by one of the counsellor-educators, or by another staff person who has equivalent background, training and time to provide comparable services.
35. The components of the pre-HIV test counselling session shall include, but not be limited to:
a. a description of the HIV test, including its purpose and results;
b. an assessment of inmate's risk status;
- 11 -

C I

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g. medical options, including appropriate medical !

and mental health care;

'

h. the availability of AZT and pentamidine;

i. an assessment of the inmate's potential for

suicide or depression, and appropriate referrals;

j. information about the early detection of

symptoms;

.

j

k. discussion of confidentiality and the poten-

tial of discrimination;

1. review of modes of transmission and methods of

prevention.

37. The components of post-test counselling if the

test is negative shall include, but not be limited to:

a. the meaning of the test results;

b. discussion of the "window period" and assess-

ment of need for retesting in three to six months;

c. reinforcement of information about modes of

transmission and the methods and skills to prevent transmission

of HIV.

38. The post-testing counselling session shall be

routinely initiated and, unless refused, given to each inmate

immediately upon notifying the inmate of the test result. A

follow-up session shall be offered to each inmate approximately

one week after the notification of the test results if the inmate

so desires such session and is currently confined in a DOC

facility.

- 13 -

39. Consent to an HIV test shall be obtained without undue inducement or any element of compulsion, fraud, deceit, duress or other form of constraint or coercion.
40. Inmates shall be notified of their HIV test results, whether positive or negative, within five working days of receipt of the test results by DOC.
41. For those inmates who have been discharged or released from the custody of the Commissioner of DOC, reasonable efforts shall be made to notify the inmates of their test results.
42. Defendants shall develop and employ in all DOC facilities a standardized HIV test counselling protocol and forms to ensure compliance with the requirements of this Judgment. V. GENERAL PROVISIONS
43. In the event that a new DOC facility opens, the provisions of this Consent Judgment shall apply to that facility.
44. The parties recognize that knowledge of HIV infection is changing and that the policies and procedures described herein must be flexible to change appropriately in the future to conform with sound professional medical and public health policy and practice, as based on new information and circumstances. Therefore, it is agreed that any provision of this Consent Judgment may be changed or amended either by consent of all parties or by the Court, upon appropriate motion by a party and upon a showing of good cause and a need for change which is consistent with the goals and purposes of this Judgment in light of the changed circumstances.
- 14 -

45. The provisions of this Consent Judgment may be suspended or modified in part or in its entirety if the Commissioner, Warden, or person next in command, determines that a "genuine emergency" exists at a specific DOC facility or any portion thereof. Genuine emergency means any special circumstances, or combination thereof, under which it is reasonable to conclude that there is any actual or presumptive threat to (a) either the security and order of the specific DOC facility or any portion thereof, or to (b) the safety of the staff, inmates, or other person within that facility. If a "genuine emergency" lasts longer than 12 hours or recurs once or more in a one-week period, defendants shall report to plaintiffs' counsel, within forty-eight hours except for good cause, the date of the emergency, the nature of the emergency, and what provisions of the Consent Judgment were suspended and/or modified and how they were suspended and/or modified. Population increases alone and overcrowding shall not constitute a "genuine emergency."
46. The provisions of this Consent Judgment can be temporarily suspended or modified for a specific inmate by defendants when, in the opinion of prison authorities, disciplinary or security reasons require such action. Such suspension or modification may last only so long as the specific disciplinary or security reasons require.
47. Plaintiffs reserve the right to seek their costs and attorneys' fees. Defendants reserve the right to oppose such a request.
- 15 -

05/17-1989 13=13 ATTORNEY GENERALS OF.HART 2033235536 14801737 P.02

WHERE* RE, in consideration of the foregoing provisions the parties res tctfully request that the Court approve and adopt the Consent Jud went as being fair, reasonable, and adequate.

THE DEFENDAJfTS Larry Meachua, et al

THE PLAINTIPFS David Doe, et al

Xarry Me< chua, Commissioner
CLARINE NARI I RIDDLE DEPUTY ATTOI NEY GENERAL (ACTING ATTORNEY GENERAL)

BY* Shelley Geballe Connecticut Civil Liberties Union Foundation 32 Grand Street Hartford, CT 06106 (203) 247-9823

BY: Richard C outure
Assistan Attorney General HM1(aa12rc00tK3feS)onhrz5ad6imanCH7aT5l7Sl0tre0e6t105

BYJ
Martha Stone Connecticut Civil Liberties
Union Foundation 32 Grand Street Hartford, CT 06106 (203) 247-9823

BYt
Assistant torney General MacKenri Hall 110 Sherm in Street Hartford CT 06105 (203) 566i-1609

BYt Pottenger
rone N. Frank Legal Services Organization
Box 401-A Yale Station New Haven, CT 06520 (203) 432-4800

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ADOPTED, APPROVED, AND SO ORDERED. Dated at New Haven, Connecticut this

day of May, 1989

APPROVED, AND SO ORDERED.

Joan Glazer Margolis United States Magistrate

Dated at Hartford, Connecticut this

day of May, 1989

Peter C. Dorsey United States District Judge

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 UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

FILFO
'0 ri

IN RE CONNECTICUT PRISON OVERCROWDING AND AIDS CASES

I

MASTER FILE NO.

:

H80-506 (JAC)

DAVID DOE, et al. /

•

Plaintiffs

:

V.
LARRY R. MEACHUM, et a l . ,

CIVIL NO. H88-562 (PCD) (JGM)
:

Defendants

:

NOVEMBER 2, 1990

CONSENT JUDGMENT ON HEALTH CARE FOR HIV-INFECTED INMATES AND CONFIDENTIALITY OF HIV-RELATED INFORMATION

Doe v. Meachum PC-CT-005-003

- i-

TABLE OF CONTENTS

PAGE

I.

BACKGROUND

1

II.

HIV-REIiATED SPECIALTY SERVICES

5

A. Specialist Services

5

B. AIDS Coordinator

6

III. . IMPLEMENTATION OF POLICY MANUAL

7

IV.

INTAKE AND ASSESSMENT

7

A. Health Screening

7

B. Comprehensive Health History and Physical

Examination

11

C. HIV Disease Treatment Plan

15

D. Referrals to Infectious Disease Specialists... 19

V.

DELIVERY OF ROUTINE HEALTH SERVICES TO HIV-

INFECTED INMATES

24

VI.

ACCESS TO MEDICAL CARE FOR ACUTE ILLNESSES

26

VII. DRUG THERAPIES

28

VIII. HEALTH CARE RECORDS OF HIV-INFECTED INMATES

29

IX.

PRESCRIPTION AND ADMINISTRATION OF MEDICATIONS

FOR HIV-INFECTED INMATES

36

X.

EMERGENCY KITS

37

XI.

DIET FOR HIV-INFECTED INMATES

38

XII. MENTAL HEALTH CARE FOR HIV-INFECTED INMATES

41

XIII. DENTAL CARE FOR HIV-INFECTED INMATES

44

XIV. EYE CARE FOR HIV-INFECTED INMATES

46

XV.

ADDITIONAL CRITERIA FOR THE CARE OF HIV-INFECTED

WOMEN

46

XVI . DISCHARGE PLANNING

47

- iii -
EXHIBITS
BROCHURE FOR BANYAN STAT KIT 800
FORMS FORM A HIV-ASSOCIATED COMPLETE PHYSICAL EXAMS FORM B HIV-INFECTED PATIENT FLOW SHEET FORM C TREATMENT PLAN FOR HIV-INFECTED INMATES FORM D W-10 TRANSFER FORM FORM E TERMINATION/TRANSFER FORM FORM F MENTAL HEALTH SERVICES — INITIAL ASSESSMENT FORM G MENTAL HEALTH SERVICES — TREATMENT PLAN FORM H AUTHORIZATION FOR RELEASE OF INFORMATION FORM FORM I MEDICAL INCIDENT REPORT FORM J FOLLOWUP TO MEDICAL INCIDENT REPORT FORM K MORTALITY REVIEW FORM L COMPREHENSIVE CHART REVIEW SCREENING CRITERIA

- 2-
5. Since May, 1989, discovery has continued regarding the remaining issues in this action. The provisions of this Consent Judgment are the result of several discussions and careful negotiation among all parties after this additional discovery. They have been agreed to solely as a means to put a reasonable end to the parties' dispute over the issues of confidentiality and medical and mental health care for HIV-infected inmates and to avoid the costs, time, and risks which would be involved for both parties in further litigation. This Consent Judgment embodies a compromise of the issues involved and, while its provisions are binding on the parties herein, its provisions are not to be construed to be statements, ruling, or precedents with respect to the constitutional and other legal rights of persons who are parties or nonparties to this litigation in this or any other action.
6. As used in this Judgment, the following terms shall have the following meanings unless specifically stated otherwise:
a. "AIDS" shall mean Acquired Immune Deficiency Syndrome, as defined by the Centers for Disease Control of the United States Public Health Service.
b. "AZT" means Zidovudine, Azidothymidine or Retrovir. c. "CDC" shall mean the Centers for Disease Control of the United States Public Health Service.

- 4-
k. "FDA" shall mean the United States Food and Drug Administration.
1. "HIV" and "HIV-infection" shall mean infection with the human immunodeficiency virus, or any other related virus identified as the probable causative agent of AIDS.
. m. "HIV test" shall mean any laboratory test or series of tests for any virus, antibody, antigen or etiologic agents whatsoever thought to cause or to indicate the presence of HIVinfection.
n. "NIAID" shall mean the National Institute of Allergy and Infectious Diseases.
o. "Inmates at risk of having HIV-infection" shall mean all inmates with a health history indicative of possible HIVinfection, including without limitation intravenous drug use, transfusions, male homosexual contact, sexual promiscuity and/or other types of blood to blood contact with persons with HIVinfection.
p. "Physician's assistant" shall mean a graduate of an approved Physician's Assistant program who is licensed to practice as a physician's assistant in this State.
q. "Accepted professional standards" shall mean those standards in effect on the date of the signing of this Judgment.

- 6-
of the specialist assigned to their Complex or in the event that there are too few inmates to justify a separate clinic at that Complex. In addition, DOC shall provide for telephone consultation services and, as medically necessary, for nonregularly scheduled visits to the facility on an on-call basis by physicians with equivalent qualifications and experience.
• 8. Until such time as Infectious Disease Specialist services are established at the New Haven Correctional Center and the Bridgeport Correctional Center, DOC shall ensure that the HIV-related treatment plans of HIV-infected inmates within said facilities are reviewed by an Infectious Disease Specialist and shall transfer HIV-infected inmates to Complexes which have Infectious Disease Specialist services whenever medicallynecessary.
B. AIDS Coordinator 9. Within sixty days of judicial approval of this
Consent Judgment, the Commissioner of DOC shall designate for each DOC facility the medical staff person responsible for ensuring compliance with the terms of this Judgment (including the maintenance of necessary tickler systems) and otherwise |
I
acting as a liaison with the DOC Director of Health Services for purposes of ensuring quality of care for HIV infected inmates. \
i
This staff person shall be either the Medical Director of the I facility, CHNS or acting CHNS for the facility or Complex, or a i

- 8-
Consent Judgment, all correctional medical attendants and licensed practical nurses ["LPNs"] performing the medical screening examination will have received a six hour training course specifically dealing with medical screening procedures and important clinical aspects of HIV infection with the appropriate referral criteria.
12. One aspect of this health screening shall be to assess whether the inmate has or may have HIV infection, including by inquiring of the inmate if s/he is infected, assessing the inmate's past behaviors which pose a risk of transmission, and making a preliminary determination of any clinical indications of infection, including fever, night sweats, fatigue, dysphagia, cough, shortness of breath, lymph node enlargement, diarrhea, new skin lesions, pruritus, visual changes, headache, memory changes, weakness, numbness, paresthesias/dysesthesias, and recent weight loss. The health screening also shall be used to determine if the inmate is in need of immediate further evaluation, next-day physician referral, and/or other appropriate followup.
13. Inmates who have not tested positive in the past and who describe risk behaviors in the past related to, and/or who have significant findings suggestive of, HIV-infection shall be advised of the medical benefits of being tested to assess if they are HIV infected. HIV tests shall be available in all DOC facilities, but can only be ordered by a physician. No inmate

-10 -
following: a) an inmate on AZT, PCP prophylaxis, or any other prescribed medications for HIV disease or its complications; b) fever of 102 F or more in a patient suspected or known to be HIVinfected; c) obvious significant infection in a patient suspected or known to be HIV-infected, including dental abscess, cellulitis, peri-anal ulcerations, etc.; d) signs of respiratory distress, e.g. respiratory rate at rest greater than or equal to 25/minute, intercostal retractions, cyanosis, especially if these signs are associated with a non-productive cough; e) severe persistent headache in a patient suspected or known to be HIVinf ected; f) mental status abnormalities that are acute or clinically unexplained, e.g. confusion, poor memory, bizarre or inappropriate behavior; g) visual complaints in a patient suspected or known to be HIV-infected; h) a patient with suspected wasting syndrome (suspected on visual exam or by a documented 10% weight loss over the previous three months without obvious explanation); i) an inmate exhibiting skin lesions suggesting Kaposi's sarcoma, severe HSV or varicella-zoster; j) obvious muscle weakness or ataxia of recent onset in a patient suspected or known to be HIV-infected; k) a patient with a known T4 count below 200/mm3. Access to such specialist services shall not be denied based on custodial concerns or other non-medical issues. The time, date and nature of each referral shall be noted in the inmate's medical record, or, as appropriate, mental health record.

- 12 -
c. a basic examination of the soft tissues of the mouth, which shall include assessment of abnormalities indicative of HIV-infection (e.g. oral hairy leukoplakia, Candida, oral ulcerations, oral Kaposi's Sarcoma, and progressive periodontal disease).
d. a basic neurologic examination, which shall assess any disturbances in gait, cerebellar function, gross and fine motor function, reflexes, and sensory functioning.
e. a basic mental status examination, which shall assess any memory loss, speech difficulties, delusions, symptoms of psychotic or marginal behavior, clinical depression and/or suicidal ideation.
f. an evaluation of lymph node status in various chains including cervical, supraclavicular, axillary and inguinal areas.
g. a basic examination of the skin to assess any HIVrelated problems, e.g. with nonspecific rashes/dermatitis, folliculitis, psoriasis, seborrhea, and lesions suggestive of Kaposi's sarcoma.
h. an evaluation of the genitalia and perirectal areas (for men) or a Pap smear, pelvic and perirectal examination (for women). Such evaluations for women performed by a DOC nurse need not be repeated if such an exam was performed within the previous two months, and if the patient denies any gynecological complaints .

- 14 -
below 200/iran 3, the T cell profile need not be repeated unless medically appropriate.
h. a chest x-ray, to be repeated yearly. i. if the results of the comprehensive health history and physical examination, as reflected in an entry in the inmate's medical record, indicate that the inmate is not known to be HIV infected, only the tests specified in §IV.B.18.a-e, supra, need be performed. 19. If the medical staff conducting the comprehensive health examination detects any significant clinical findings in an inmate's mental status examination, the neurological examination, the examination of the mouth, and/or the laboratory tests requiring further evaluation, immediate referrals shall be made to specialists in psychiatry, ophthalmology, neurology, dentistry, diagnostic radiology, etc. so that the inmate's condition might be more fully assessed as soon as medically appropriate, subject to review by the Infectious Disease Specialist. Access to such specialist services shall not be denied based on custodial concerns or other non-medical issues. The time, date, and nature of each such referral shall be recorded in the inmate's medical or, when appropriate, mental health record. 20. The comprehensive health examination for new admittees, specified in §§16-18, supra, need not be conducted if, after review of the DOC medical records, it is established that

- 16 -
be completed by a DOC physician responsible for HIV-related care within that inmate's particular DOC facility.
24. The individualized health care summary, flow sheet and treatment plan for a symptomatic HIV-infected inmate shall be completed within ten days of the inmate's admission to a DOC facility or, for inmates diagnosed while within DOC care, within ten days of diagnosis. If all requisite laboratory reports have not been completed within this period or if the inmate is transferred to a community facility for health care treatment, the plan shall be prepared in draft form, and revised, as necessary, when all laboratory reports are complete or the inmate returns to a DOC facility. The treatment plan for an asymptomatic HIV-infected inmate shall in normal circumstances be completed within ten days of completion of requisite laboratory work, but in no event later than thirty days after admission or diagnosis. The Infectious Disease Specialist shall review the initial treatment plans of all HIV-infected inmates who have not been referred to him/her for in-person evaluation to ensure that the data base is complete, to assess if there are any laboratory or physical abnormalities which require referral to him/her, to assess the need for and timing of examinations by other specialists, and to alert the responsible facility physician as to needed changes in the treatment plan and to provide advice as to how to follow the inmate medically. All significant changes to an HIV treatment plan and the finding of new opportunistic

- 18 -
g. evaluation for and, when medically-appropriate, initiation of anti-retroviral therapy (with AZT, DDI, etc.).
h. evaluation for and, when medically-appropriate, initiation of primary and secondary opportunistic infection prophylaxis (e«g- for PCP, toxoplasmosis, cytomegalovirus, cryptococcus).
i. evaluation for, and, when medically-appropriate, initiation of anti-viral therapies (for CMV, herpes simplex, varicella-Zoster infections, etc.).
j. evaluation for and, when medically-appropriate, initiation of anti-fungal therapies (for Candida, cryptococcus, etc.).
k. evaluation for and, when medically-appropriate, initiation of treatment for M. tuberculosis and atypical TB infections.
1. evaluation for and, when medically-appropriate, provision of vaccination (for influenza, pneumococci).
m. evaluation for and, when medically-appropriate, initiation of treatment for Kaposi's sarcoma (alpha-interferon, chemotherapy, radiation therapy etc.).
n. evaluation for and, when medically-appropriate, initiation of treatment for other neoplasms.
o. a schedule for regular evaluation (by laboratory tests, inmate interviews and/or physical examinations) of the

- 20 -
a. HIV-infected inmates on AZT, DDI, PCP prophylaxis, and other HIV-related medications shall be seen within two weeks of referral;
b. HIV-infected inmates who are identified as having a T4 count under 400/mm3 shall be seen within two weeks of referral;
c. inmates who upon the initial health screening and/or physical examination, or subsequent to this initial examination, are found to exhibit symptoms suggestive of the following HIVrelated conditions:
- thrush not related to concomitant or recent antibiotic therapy. Such inmates shall be seen within two weeks of referral;
- skin lesions consistent with Kaposi's sarcoma, Herpes zoster, severe Herpes simplex infection. Such inmates shall be seen within one week of referral;
- unexplained dysphagia in a patient suspected or known to be HIV-infected. Such inmates shall be seen within one week of referral;
- persistent periodic fever of 102 F or more in a patient suspected or known to be HIV-infected. Such inmates shall be seen within one week of referral;
- persistent non-productive cough but negative chest x-ray for an acute infiltrate in a patient suspected or

- 22 -
appearance of a focal neurologic deficit or sudden ataxia, and mental status changes (confusion, personality change, unexplained sudden alterations in consciousness, etc.)*
- visual complaints compatible with retinal disease (suspected CMV or toxoplasmosis retinitis).
- clinically significant hemorrhagic episodes, e.g. documented acute GI blood loss.
e. HIV-infected inmates with an unintended weight loss of 10% of body weight or more within the past six months. Such inmates shall be seen within two weeks of referral.
f. HIV-infected inmates experiencing vomiting and/or diarrhea of more than three days duration notwithstanding dietary adjustments. Such inmates shall be seen within one week of referral.
g. HIV-infected inmates with progressive gingivitis, obvious dental abscess, unexplained oral lesion, or hairy leukoplakia. Such inmates shall be seen within one week of referral.
h. inmates housed in an infirmary setting specifically because of their HIV-related condition. These patients shall be evaluated at least weekly by an Infectious Disease Specialist, though they shall also be seen several times a week by the DOC physician assigned to this area.

- 24 -
V. DELIVERY OF ROUTINE HEALTH SERVICES TO HIV-INFECTED INMATES. 28. All HIV-infected inmates shall be routinely scheduled
for follow-up health examinations at a frequency consistent with current professional standards.
29. All HIV-infected inmates shall be routinely scheduled for all laboratory tests as are determined to be medicallynecessary by the treating physician in consultation with the Infectious Disease Specialist in accordance with accepted professional standards.
30. DOC shall institute a "tickler system" and such other procedures as are necessary to ensure that the examinations and laboratory work are scheduled for, and provided to, HIV-infected inmates at the intervals consistent with SV.28. to V.29, supra. These procedures shall include, but are not limited to, the use of the standardized form attached hereto as Form C and a requirement that if an inmate is transferred from one DOC facility to another without his/her medical file, the receiving facility shall promptly call the sending facility and/or the Health Services Division in Central Office for all information about that inmate on their tickler files, and shall promptly include said information on the receiving institution's tickler file. This system and its accompanying procedures shall also ensure that all necessary treatment identified in an inmate's HIV treatment plan is provided at the time(s) identified in the plan. Any "tickler system" and other procedures for ensuring ongoing

- 26 -
inmates interested in reading one or both Judgments have opportunity to do so within a reasonable time of their request.
33. Because of the relationship between HIV-infection and TB, DOC shall continue to implement policies and procedures for the identification, management and treatment of TB that meet accepted professional standards. VI. ACCESS TO MEDICAL CARE FOR ACUTE ILLNESSES.
34. Each DOC facility shall institute a system for sick call by which inmates, including those with HIV-disease, who seek medical attention shall be allowed to place their requests into a locked box or other equivalent confidential container or location which shall be checked at least daily when health care staff are present in the facility and access to which shall be limited to health care personnel. The collection schedule shall be posted on or near the box (or container).
35. Absent an emergency, any HIV-infected inmate who requests medical attention shall be placed on the next routine sick call. Any HIV-infected inmate identified by DOC medical staff as having an unresolved, clinically-significant acute illness or condition which has lasted for three consecutive days, or with a clinically-significant deterioration in neurological and/or respiratory status which has lasted for six hours, shall immediately and automatically be referred to the on-call Infectious Disease Consultant or the Complex's Infectious Disease Specialist for immediate attention. If this physician determines

- 28 -
which medications can and cannot be taken together, a summary of current illnesses including vital signs and relevant physical findings, and the results of all lab tests done in the previous two weeks. In the event of an emergency transfer precluding time for copying the necessary transfer documents, the physician, nurse, or medic shall, concurrent with the inmate's transfer, make direct telephonic contact with the physician or emergency room triage nurse at the outside hospital to relay all information necessary for the inmate's treatment and shall forward the completed and updated W-10 and flow sheet within twelve hours to the hospital.
38. All inmate transfers for medical and mental health care shall be managed so as to protect the confidentiality of the inmate's condition from disclosure to non-medical DOC staff and other non-medical personnel. VII. DRUG THERAPIES.
39. DOC shall offer to an HIV-infected inmate such drug therapies (including drugs approved by the FDA for "compassionate use" and FDA-approved Treatment Investigational New Drugs) as are determined to be medically necessary for him/her by the treating physician, in consultation with the Infectious Disease Specialist, in accordance with accepted professional standards. Said drugs shall be administered (in dosages and at frequencies) and monitored in accordance with accepted professional standards.

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status of HIV-infected inmates shall be implemented within 120

days of judicial approval of this Judgment.

44.

During the comprehensive, HIV-related health

examination, each HIV-infected inmate shall be questioned

regarding his/her prior health care providers, and asked to sign

Medical and Mental Health Release Forms to obtain all prior

medical and mental health records (unless already in DOC

possession). Any refusals to sign such release forms shall be

recorded in the inmate's health care record. DOC shall request

all health care records from the appropriate health care

providers within two working days of the inmate signing the

release. If there has been no response to a request for records

within two weeks, a followup request shall be sent.

45. The medical records of an HIV-infected inmate shall, at

a minimum, include:

a. past DOC medical records and those records obtained

pursuant to §VI11.44.

b. all inmate health screening forms, documentation

pertaining to the comprehensive health examination(s)(including

results of intake laboratory tests) and documentation pertaining

to any assessment(s) by the Infectious Disease Specialist.

c. current medication records and records of all HIV-

related medications and medication allergies.

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48. DOC health care staff shall neither examine and question an HIV-infected inmate about HIV-related issues nor discuss the HIV-related health care status of that HIV-infected inmate, without his/her consent, while in the presence or earshot of other inmates, non-medical DOC staff, or other persons who are not DOC health care staff, except to the limited extent currently permitted by P.A. 89-246.
49. Unsealed medical and mental health files of an HIVinfected inmate shall be available only to the DOC medical and mental health staff directly responsible for providing care to that inmate or to a consulting specialist or outside medical provider to whom the inmate is referred for medical/mental health treatment or evaluation, absent the inmate's informed written consent for disclosure of HIV-related records to a specificallyidentified individual. The foregoing provision shall not limit access to such files to attorneys for DOC, plaintiffs' counsel, and any Monitoring Panels or quality assurance staff established by this Judgment for the purposes of monitoring compliance with this Judgment and assessing the adequacy of the care being provided by DOC, or anyone else authorized under P.A. 89-246 to review such records. Neither non-medical DOC staff nor inmates, whether they work in the infirmary or not, shall have an opportunity to read any part of the contents of an HIV-infected inmate's medical and mental health record which identifies the inmate as being HIV-infected absent the inmate's informed

- 34 -
which pertains to the inmate being transferred in instances in | which there is a reasonable basis for an error in this regard.
Should said non-medical personnel thereupon become aware of confidential HIV-related information about an inmate, as said term is defined in P.A. 89-246, s/he shall be bound by the nonredisclosure provisions of said Act. In the extraordinary circumstance that an inmate's health care records are not transferred together with the inmate: a) the inmate's HIV Health Care Summary, Flow Sheet and Treatment Plan (Forms A-C) shall be faxed (on the next shift health care staff are on duty and in confidence) to the fax machine in the medical unit at the receiving facility; b) the sending facility medical staff shall make telephone contact with the receiving facility medical staff to transmit necessary information about that inmate's care; and
i
c) the health care records shall be delivered to the receiving facility within three to seven days.
52. DOC shall institute a system to ensure that the DOC HIV-Treatment Plan, Health Care Summary, Flow Sheet, and the Progress Notes of any inmate who is released from a DOC facility or transferred to community status are not transferred to a parole office, but are maintained within the releasing DOC facility and/or DOC's Central Office Health Services Office. Whenever an HIV-infected inmate is then readmitted to a DOC facility, the inmate's health care records shall be transported to the medical unit of the facility to which she/he has been

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kidney function, major electrolyte disturbance, and/or culture results which require immediate institution of antibiotic therapy, the inmate shall be notified within twenty-four hours of DOC's receipt of the test result, unless medically contraindicated. IX. PRESCRIPTION AND ADMINISTRATION OF MEDICATIONS FOR HIV-
INFECTED INMATES. 54. Other than "over-the-counter" medications, medications shall be administered to HIV-infected inmates only by a physician, physician assistant, registered nurse, licensed practical nurse, or other medical staff who have completed the DOC medication training curricula and who otherwise meet state statutory requirements for administration of medication within a DOC facility. 55. The inmate's medical records shall be maintained in such a way that it can be determined what drugs have been ordered for an inmate, by whom, for what purpose, when and in what manner they have been administered and/or offered and refused, the inmate's subjective symptoms or complaints, and any adverse reaction (or lack of response) to the medication. 56. Patient drug profiles and medication administration records shall be maintained for so long as medication is being dispensed and, when not active, shall be kept in the inmate's medical record. 57. No prescription medication may be administered to an HIV-infected inmate without a physician's order. If a physician

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manner. The kits shall be readily available to medical staff but not to inmates, i.e., they must be stored in a locked room or area. Emergency drug cassettes in the kit, as well as other kit contents, shall be inspected after each use of the kit, and at least monthly by medical staff, to remove deteriorated and outdated drugs and to ensure the completeness of the kit's contents. A list of the kit's contents, and instructions for use as deemed appropriate by the DOC Medical Director, shall be kept in close proximity to the kit.
60. Medical staff shall be appropriately trained in the use of the kits and their contents. XI. DIET FOR HIV-INFECTED INMATES.
61. A nutritional assessment shall be part of the initial comprehensive health assessment specified herein in Section IV.B., supra. All appropriate orders to implement any special dietary plan for the HIV-infected inmate shall be signed by the physician, placed in the inmate's medical record, and transmitted to the kitchen staff. DOC staff shall refer all inmate complaints of noncompliance with special dietary orders to the kitchen staff. Facility kitchen staff shall investigate all such complaints and act promptly to remedy any noncompliance. Complaints about noncompliance about which medical staff becomes aware shall be noted by such staff in the inmate's medical record.

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medically necessary, such as two to three cans of Ensure, Sustacal or comparable supplements.
67. Whenever nutritional supplements and multivitamins have been specially selected to meet the individualized dietary needs of an HIV-infected inmate, they shall be distributed and administered in such a manner as to ensure that the inmate receives such supplements and vitamins. Where determined to be appropriate by the facility physician and/or Infectious Disease Specialist, inmates may be provided with multiple doses of such supplements and/or vitamins for self-administration.
68. If DOC medical staff become aware, through inmate report or a report on an inmate's behalf by non-medical staff, that an HIV-infected inmate is experiencing vomiting and/or diarrhea, that inmate shall be evaluated by medical staff within twenty-four hours of the report to determine the cause of the condition and to make any appropriate adjustments in the inmate's diet. If serious vomiting and/or diarrhea persists for more than three days, notwithstanding the change in diet, a referral shall be made to the physician on call or the Infectious Disease Specialist to be examined at the next regularly scheduled visit, or sooner if medically-necessary.
69. Regardless of the manner in which food is delivered to inmates within an particular DOC facility, DOC shall ensure that specialized diets (including low fat, low fiber, bland, diabetic, soft) are made available to all inmates for whom they are

- 42 -
required in SIV.B.17, supra, and the findings shall be noted on the examination forms. The medical staff person conducting the comprehensive health history and physical examination shall encourage the inmate to be seen by facility mental health staff for further mental health assessment if such referral is deemed medically necessary. Upon receipt of a referral for mental health assessment/ a member of the mental health staff expressly authorized by §XII.7O, supra to perform such assessment shall conduct the assessment within five business days of the referral. In the event of any emergency, on-call mental health services shall be available at all times.
72. An individualized written mental health treatment plan shall be developed for each HIV-infected inmate who, after assessment, is determined to be in need of ongoing mental health care. This treatment plan shall be reviewed, approved, and signed by the facility mental health coordinator. The plan shall be reviewed and updated on a regular basis. It shall be maintained as part of the inmate's mental health record.
73. The protocols for the general components of the mental health assessments and mental health treatment plans used with HIV-infected inmates shall be as set forth in Forms F-G, attached hereto and incorporated herein.
74. Mental health staff treating an HIV-infected inmate shall document his/her findings and assessment in the inmate's mental health record, which shall be maintained in such a way as

- 44 -
infected inmates shall be advised of the existence of any and all peer support groups within their facility and how to become a part of them. The time and place of any support group's meetings shall be set in such a manner as to protect the privacy rights of the inmates involved in the group.
77. Each HIV-infected inmate shall be assessed for the presence of AIDS dementia at the time of each follow-up health status examination, see SIV.C.25., supra. XIII. DENTAL CARE FOR HIV-INFECTED INMATES.
78. Dental staff in each DOC institution shall follow universal infection control procedures for all inmates. These procedures shall be consistent with the current infection control procedures for dental treatment established by the CDC, the American Dental Association, and/or the National Institute for Dental Health. There shall be no postponement or delay of dental appointments for HIV-infected inmates solely in order to fulfill special infection control procedures, though appointments may be delayed for valid medical reasons.
79. If the initial health screening and/or comprehensive health examination reveal that an HIV-infected inmate has a painful severe dental condition, including extensive dental caries, severe periodontal disease and/or dental abscess, that inmate shall be referred to and examined by the facility dentist within seventy-two hours. If this screening and/or examination reveal such a condition but the inmate is not experiencing pain,

- 46 -
stop bleeding to avert transmission of the virus. When feasible, the inmate shall be held in the medical unit until the wound(s) stop bleeding.
XIV. EYE CARE FOR HIV-INFECTED INMATES.
82. HIV-infected inmates for whom chorioretinitis and/or other HIV-related ophthalmologic complications (e.g. cotton wool spots, CMV retinitis) are suspected shall immediately be referred for an ophthalmology consultation and, if confirmed, shall be provided with treatment (including gancyclovir therapy for retinitis) in accordance with current professional standards for persons with similar ophthalmological complications related to HIV-disease within seven days, or earlier if medically-necessary. XV. ADDITIONAL CRITERIA FOR THE CARE OF HIV-INFECTED WOMEN.
83. HIV-infected female inmates shall be provided with a PAP smear at least once a year. Any abnormal PAP smears shall be investigated aggressively, including with cervical biopsy and appropriate therapy.
84. Cultures for gonorrhea and serology for syphilis shall be taken at the comprehensive health examination, and syphilis serology annually thereafter.
85. HIV-infected inmates who are pregnant shall have absolute CD4 cell counts each trimester. If the absolute count falls to a range associated with a substantial risk of opportunistic infection, consultation shall be obtained and professionally-accepted treatments provided as needed. Gonorrhea

- 48 -
copy of the Inter-Agency Patient Referral Report Form ("W10") (Form D ) , the Termination/Transfer Summary Form (Form E) and the Authorization for Release of Information Form (Form H ) . The information which is provided in this Discharge Packet includes all current diagnoses, current problems, the treatments which have been provided and the inmate's response to treatment, complications noted, allergies noted, description of condition on discharge, and any followup instructions.
90. If given at least five to ten days notice of the inmate's discharge from a DOC institution, facility medical staff will schedule an exit interview with any HIV-infected inmates who have a medical condition requiring ongoing medical care or follow-up to discuss health maintenance, complete the Discharge Packet forms and inform the inmate where outside health care can be obtained and how to arrange for it. The name, address, and telephone number of appropriate outside health care providers will be included on the W10 form, and the inmate will be instructed to contact the appropriate community provider upon his/her release.
91. At the time an inmate is discharged from a DOC institution, a copy of the complete Discharge Packet forms will be placed in the inmate's medical file, a copy shall be offered to the inmate, and a copy shall be forwarded to the DOC Director of Community Health Services. If the inmate gives appropriate

- 50 -
the discharge. In such cases, the facility medical staff shall complete the Discharge Packet forms and forward them to the DOC Director of Community Health Services within two days of the date they were notified of the inmate's discharge. The DOC Community Health Services staff shall make all reasonable efforts to contact the inmate to discuss health maintenance, inform the inmate "where outside health care can be obtained and offer the inmate a copy of the Discharge Packet forms and the inmate's HIV treatment plan.
96. The provisions of this Section XVI do not apply to pretrial detainees, with the very limited exception that those persons confined within DOC as detainees for a sufficient period of time to complete the HIV assessment and receive an HIV treatment plan shall be mailed or otherwise provided with, upon their request and within three business days of it, a completed W10 and a copy of their HIV treatment plan.
97. When an HIV-infected inmate's medical condition renders him/her unable to participate in medical discharge planning, facility medical staff shall arrange an initial medical consultation in the community and notify the inmate (and, with his/her authorization, notify his/her family) of the time and place of said consultation.
98. Medical providers supplying health care to HIV-infected persons who have been in DOC custody shall be provided with copies of those portions of the DOC health care records which

- 52 -
B. Skilled Nursing Facility and Health Related Facility Beds. 101. In the event that the Connecticut Department of
Health Services or any other state agency should conduct a study to determine the Skilled Nursing Facility and/or hospice bed needs of HIV-infected persons in the State of Connecticut, DOC agrees to cooperate with such a study so that the needs of the DOC inmate population can be included in projections regarding the need for skilled nursing facility beds and/or hospice beds.
C. Medical Unit Beds. 102. HIV-infected inmates shall be housed in a setting
which meets their medical needs. For example, if inmates with HIV- infection do not require hospitalization but require frequent observation by a RN and/or are unable to walk to meals, they shall be housed, depending on their level of medical need, in an infirmary setting which meets the standards established by DOC for Transitional Units or Infirmary I, in its April 1989 "Proposal for the Reorganization of Health Services Within the DOC." Receipt of AZT and other HIV-related medications is not sufficient cause alone for placement in a facility infirmary/medical unit. The numbers of inmates in the facility's infirmary/medical unit shall not be so numerous as to compromise the medical care provided to the HIV-infected inmates housed therein.
103. HIV-infected inmates housed in an infirmary setting shall be visited by the facility physician three to four

- 54 -
or restricted, an alternative, comparable means of access to medical care shall be provided to the inmate.
107. HIV-infected inmates who are in respiratory distress, but not in need of in-patient hospitalization in a community hospital, shall be housed in an appropriate room or facility, where the temperature can be maintained at between sixty-eight and eighty degrees Fahrenheit. Temperature charts shall be maintained daily for this room or facility.
108. Non-ambulatory HIV-infected inmates will be provided access to the visiting area by wheelchair or stretcher or allowed visitation in a private room.
109. HIV-infected inmates housed in an infirmary/ medical unit shall be afforded opportunities for visitation, institutional programs, and activities comparable to that afforded to other inmates in the same infirmary/medical unit, unless participation is contraindicated for medical reasons or for legitimate security concerns unrelated to HIV status. Restrictions on participation in visitation programs and other activities may not be based solely on the fact that an inmate is HIV-infected or on unfounded fears of transmission of HIV among other inmates. XVIII. STAFF EDUCATION.
110. The Department of Correction will provide to all of its employees a minimum of one hour of training annually on HIVrelated subjects. This training will be provided by health

- 56 -
in DOC facilities shall receive in-service training for at least six hours every year regarding medical/mental health issues affecting HIV-infected inmates. The term "in-service training" as used herein shall not be construed to include training provided through staff meetings and supervision. This training shall be designed to update and supplement the prior training and experience of DOC medical and mental health staff persons and will include new medical and mental health information in the areas of cause, symptoms, assessments, treatments, nutrition, etc. These training sessions shall be conducted by persons with particular experience and/or training in the management of HIVdisease including physicians, RNs, psychologists, psychiatrists, social workers, nutritionists, etc. Further supplementary training shall be conducted whenever it is deemed necessary by the DOC Director of Health Services. The provisions of this section do not apply to medical and mental health professionals under contract with DOC to provide specialized services (e.g. radiology, surgery, neurology, etc) to the inmate population.
112. Newly hired medical and mental health staff shall be provided with eight hours of introductory training on the medical and mental health implications of HIV disease and the requirements of this Judgment to ensure that they possess an understanding of the disease, its manifestations, and medicallyappropriate responses to it. Depending upon the immediacy of the medical staffing needs of a particular facility, DOC shall make

- 58 -
this Judgment. The Quality Assurance Program will include a random review of the health care records of HIV-infected inmates, a review of the Medical Incident Report (Form I) and Mortality Review Form (Form K) for HIV-infected inmates, and site visits in order to ensure that the medical and mental health care provided to HIV-infected inmates is adequate. The Program shall conduct focused, outcome-oriented longitudinal reviews, using appropriate samplings of inmate records, regarding specific disease complications of AIDS, such as, but not limited to, reviews of the length of time inmates remain alive after diagnosis and the treatment outcomes of inmates who have HIV-related opportunistic infections.
116. The Quality Assurance Unit will randomly select and review each month the medical/mental health records of no fewer than thirty HIV-infected inmates, pursuant to the criteria enumerated in a Comprehensive Chart Review Screening Criteria Form (Form L ) . The Comprehensive Chart Review Screening Criteria Form shall be developed by the DOC Director of Health Services within thirty days of the approval of this Judgment, submitted to plaintiffs' counsel for review and comment, and thereafter implemented within thirty days and made a part of this Judgment as Form L. The Comprehensive Chart Review Screening Criteria Form will be dated and signed by the medical and mental health members of the Quality Assurance Unit upon their completion of the review of each set of records.

- 60 -
commission which results in the administration of health care that deviates in any way from the accepted professional standards of care required for HIV-infected inmates. The Medical Incident Report shall be signed by the person preparing the report, and shall be sent to the Medical Director of the facility. Action taken in response to the incident shall be documented and retained, as well as documentation regarding any follow-up indicated by the Medical Director. The Medical Director shall review each report, and when indicated, will fill out the Followup to Medical Incident Report, attached hereto as Form J.
122. The Mortality Review Forms shall be retained by the Director of Health Services for DOC. The Medical Incident Report Forms shall be retained by the medical directors of the various DOC facilities. The Comprehensive Chart Review Screening Criteria Forms shall be retained by the Quality Assurance Unit. XXI. CONFIDENTIALITY
123. DOC staff, and inmates whose job responsibilities potentially expose them to HIV-infection, shall follow universal blood and body fluid precaution standards as established by the DOHS, CDC, and the Occupational Safety and Health Administration (OSHA), and shall be provided with all necessary materials to do so.
124. DOC staff shall conform their conduct to the various requirements of P. A. 89-246, including its non-disclosure provisions. In the event that Public Act 89-246 is repealed or

- 62 -
payment within thirty days of their receipt of the Court Order. Disputed portions of any requests shall be referred to the Court for resolution in whatever fashion the Court deems appropriate. The fee shall not exceed $20,000.00 per panel member per year for any and all services rendered, excepting for any payments which may be ordered by the Court for services rendered for their participation in contempt and other proceedings related to noncompliance. The hourly rate of each member of the AMP shall be reasonable and set by a separate Court Order. The expenses incurred by the AMP shall be only those reasonable necessary to carry out their functions under this Judgment. If the Panel remains in operation for longer than three years, Panel members shall be permitted to make application to the Court for an appropriate cost of living increase in the fees awarded. Defendants agree to represent and to hold harmless to the same extent as State employees the members of the AMP in any litigation initiated by third parties involving the AMP in its performance of its duties under this Judgment.
128. The AMP shall devise procedures for the monitoring of this Judgment which shall include on-site inspections of the facilities. Defendant's representative may, at his election, give two days prior notice to defendants of any intended inspection. During their inspections, the panel shall have access to all medical and mental health records of HIV-infected inmates, including, without limitation, such records when obtained from

- 64 -
permitted to conduct interviews with HIV-infected inmates, provided each inmate consents. The AMP shall be provided with copies of any new and/or revised DOC written protocols and policies pertaining to the delivery of medical and mental health care to HIV-infected inmates.
132. The DOC shall file written compliance reports on the same schedule as the AMP, as set forth in §XXII.129, supra. These written Compliance Reports shall list and include all blank forms and protocols developed pursuant to this Judgment since the preceding such Compliance Report, to the extent they have not already been provided to the AMP under the preceding section. A description of HIV-related activities undertaken by DOC, including staff training, shall also be included in these reports. The first of the reports shall include staffing summaries (name, position, shifts worked) for DOC's health care staff who perform tasks under this Judgment and the names, professional degrees and licenses of physicians. These reports shall be provided to the Court and counsel for the parties.
133. Nothing contained in this "Monitoring" section shall be deemed to interfere with or alter any monitoring arrangements made pursuant to judicial rulings or decrees in other actions; rather, these provisions are in addition to any other such monitoring arrangements.
134. When the defendants believe in good faith that they
have fully and faithfully implemented the provisions of this

- 66 -
arise concerning compliance with this Judgment and appropriate remedial action which cannot be resolved between the AMP or the parties in a timely fashion, a party may request a status hearing with a Settlement Judge or Magistrate. If neither is available, the Chief Judge shall appoint another Judge or Magistrate to resolve the dispute. If any dispute, issue or matter is not resolved by the Settlement Judge or Magistrate, that issue or matter shall be referred to the Trial Judge for adjudication pursuant to any proceeding which the Trial Judge shall deem feasible. At any such proceeding, the members of the AMP may be called as a witness by a party or the Judge.
136. This Consent Judgment satisfies and resolves the claims of the plaintiffs and the plaintiffs' class for injunctive and declaratory relief in the above-entitled case as of the date of judicial approval of this Consent Judgment. Plaintiffs and members of their class shall be permitted to opt out of the class for purposes of preserving their claims for monetary relief only.
137. The parties recognize that this Consent Judgment does not address future changes in recommendations and standards regarding medical/mental health care for HIV-infected persons. The plaintiffs reserve the right as a part of this litigation to initiate judicial proceedings to alter the provisions of this Judgment in light of such changed recommendations and/or standards for HIV care. Should the plaintiffs at any time

- 68 -
specific DOC facility or any portion thereof, or to (b) the safety of the staff, inmates, or other person within that facility. If a "genuine emergency" lasts longer than twelve hours or recurs once or more in a one week period, defendants shall report to plaintiffs' counsel, within forty-eight hours except for good cause, the date of the emergency, the nature of the emergency, and what provisions of the Consent Judgment were suspended and/or modified and how they were suspended and/or modified. Current population levels and population increases alone shall not constitute a "genuine emergency". Plaintiffs may contest the emergency action by motion for relief directed to the Court.
140. Nothing contained in this Judgment shall be deemed to reduce the requirements and obligations imposed on DOC by the terms of prior judicial rulings, decrees, and consent judgments in other actions. XXIV. NOTICE TO CLASS
141. Notice to the plaintiff class members of this Consent Judgment shall issue pursuant to the notice provisions approved by the Court, and shall inform plaintiffs and members of their class of their opportunity to opt out for purposes of preserving their claims for damages. XXV. COSTS AND ATTORNEYS' FEES
142. Plaintiffs' counsel shall submit their request for costs and attorneys' fees within thirty days of the signing of

- 70 -

THE DEFENDANTS Larry Meachum, et al.

THE PLAINTIFFS David Doe, et al.

irry Meachum, Conanissioner Connecticut Department of
Correction /(?~3/-~?O 340 Capitol Avenue Hartford, CT 06106

BY: Shelley Geballe Connecticut Civil Liberties
Union Foundation 32 Grand Street Hartford, CT 06106

CLARINE NARDI RIDDLE ATTORNEY GENERAL

BY:

f

Richard Couture

Assistant Attorney General

MacKenzie Hall

110 Sherman Street

Hartford, CT 06105

BY: XyC^^—
Steven Strom / Assistant Attorney General MacKenzie Hall 110 Sherman Street Hartford, CT 06105

BY: . V.
Jotfn) L. Pottengerv\Jr7 Jerome N. Frank Legal
Services Organization Box 401-A Yale Station New Haven, CT 06520
BY: Martha Stone Connecticut Civil Liberties Union Foundation 32 Grand Street Hartford, CT 06106

Dated at New Haven, Connecticut, this 1990.

day of December,

Joan Glazer Margolis United States Magistrate

So Ordered and Approved:

Jose A. Cabranes United States District Judge

EORM A

HIV - ASSOCIATED COMPLETE PHYSICAL EXAMS

INMATE NAME:

INMATE NUMBER:_

DOB:

DATE OF EACH EVALUATION WITH NAME AND TITLE OF CUNICIAN RESPONSIBLE FOR EVALUATION

1)

2)

3)

4)

.

(NOTE: INFECTIOUS DISEASE SPECIALIST SHALL PLACE HIS/HER INITIALS AT END OF LINE AFTER REVIEWING THE EVALUATION)

Note: If no abnormality Is noted, mark 0 In box. If an abnormality Is noted, briefly describe.

Date:

Date:

Date:

A. Vital Signs (give figures)
Pulse Blood Pressure Respiratory Rate Weight Temperature
B. HEENT
Fundoscopic
C. Mouth
Oral Hairy Leukoplakia Candida Oral Ulcerations Oral Kaposi's Sarcoma Progressive Periodontal Disease Other Fungal Infection
D. Neurological
Gait Cerebellar Function Gross Motor Function Fine Motor Function Reflexes Sensory Functioning

HIV-INFECTED PATIENT FLOW SHEET

FORM B

INMATE NAME: DATE *Hb/HCT *WBC with diff •PLATELETS *BILI/LDH *SGOT/SGPT *ALK PHOS/ALB *BUN/CREATININE *VDRL/FTA-ABS TOXO TITER SYPHILIS RX *HBsAg/HBsAb *PPD (mm.) •CHEST PA & LAT *T4 OR CD4 COUNT T4/T8 RATIO *WEIGHT/VS NEW SX/SIGNS AZT ANTI-TB MEDS PCP PROPHYLAXIS OTHER MEDS ORDERED OR VACCINES

INMATE NUMBER:

X-RAYS/CULTURES OTHER STUDIES SPECIAL REFERRALS SPECIAL DIETS

.'" •
»
Inmate Name:

' D.O.C. TREATMENT PLAN FOR HTV-INFECTED PATIENTS

.

.

•

•

_ _ _ _ _ _ _ _ _ _ ^ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Inmate Numben

Date;

DOB:

Evaluating DOC Physidan:

ID Consultant:

FORM C "

Date when next T4, T4/T8 ratio to be done: Date of next routine periodic evaluation (Usually DOC Physidan): Date of next complete physical exam, ID re-evaluation:

Blood work, cultures, x-rays ordcred:_ (Specify test and date to be done) (Give schedule if test needed periodically)

If any consultations ordered or spedal studies to be done, please give details below. Summarize results below as welL

Outline spedal dietary or nutritional recommendations: A2T or DDI orders PCP Prophylaxis orders:_ Other prophylaxis orders (Cryptococcus/Toxo): Anti-Viral therapy orders: Anti-Fungal therapy orders: Anti-TB therapy orders: (indude PPD placement order if indicated) Vaccination orders (DT, pneumococcal, influenza, etc): Special studies/other indicated orders:

W '.0 RCV. */*>» > NAME (lo»l. ftnt. Mlrfi<HJ
rATJENTS HOME ADORES* (N». m4S+m*. Tmm m O * . ttata. 2 » C * * j •E^roNsau retsoN ot AOENCV I N M ^ A « M I

FDUOW-UP «Y | M M «
I.

*r O M 4

sex

BIRTH DATE

ADMISSION DATE

DISCHARGE DATE

I HOME PHONE NO.

MMBU1RAM

RHKrtON

TEIEPHONENO.

CONTACT PERSON C * UNIT

TELEPHONE NO.

CONTACT PERSON OK

TElEPHONENO.

MK or KZI t/romrma

MEMCAi RECORD NO.

MEDICARE NO.

SOQAl SECURITY NO.

DETT. OF I N C MAINT. NO.

PBtTMENT HttTORY fhdud* 4**m if 0f< nil «wrf>ntli»»j Al«> PLAN OF CARE flncfcfc

<*»t. ecfMly jwrmmw;

OTHER
FORM D

|
MEDICATIONS (Orvf.

FREQUENCY

LAST GIVEN

MEDICATIONS MnfcJ

FREOUENCY

LAST GIVEN

S. 7. AUBtGKS
THERAPEUTIC GOALS

DIAGNOSIS GIVEN

EXPLAINED TO
JQ

PROGNOSIS

EXPLAINED TO

f*TKWl l « v STAXT

SERViaS REQUESHD

OATt

D Munli*

D Oct.

•

UI—I Hxr^T

Uf—i H.U. H..

U r—i

n y - D "• S TREATMENT K5* CONDITION FOR WHICH PATIENT WAS HOSPITAIIZED (» NO

I HEREBY CERTIFY THAT THE ABOVE SERVtCES SHOULD BE I'ROVIDED BY

R ^ « b SIGNED (fhr^

CD Acw«« Hnr. D CKr^ik MMf. O SNF D I C F L J M»olrt Agy. D C««««r

ONE

r—i
LJ O t U r
PATIENT tUENTIAILT HOMflOUND
DATE StGNED

•

.

•

HEALTH SERVTCEfe

Termination / Transfer Summary* •

FORM E

Client Name

. •-

Facility/Location

.

—Date of Admission

Allergies

DOC Number
Date of Release/Discharge Special Diet

Type of Recommended Discharge Placement

Diagnosis (use DSM III R Axes) Current Medications

Upcoming Appointments
Summary Of Treatment (include presenting problem, Medication history, focus of treatment, prognosis, recommendtions) _j

!ompleted by

Date

FACILITY/LOCATION INMATE NAME DATE OF M.H. ADMISSION LAST RESIDENCE
! PRESENTING PROBLEMS

MENTAL HEALTH SERVICES • INITIAL ASSESSMENT - . '

DOB SEX

INMATE NUMBER PLACE OF BIRTH RACE

PSYCHIATRIC HISTORY CURRENT MEDICATIONS RELEVANT MEDICAL PROBLEMS
ALLERGIES SUBSTANCE ABUSE HISTORY (SUBSTANCES USED & TREATMENT RECEIVED)

PRESENT OFFENSES(S) DATE OF SENTENCING PAST ARREST HISTORY

LENGTH OF SENTENCING

PRIOR INCARCERATIONS EDUCATION LEVEL & SCHOOL ATTENDED (INCLUDE SCHOOL ADJUSTMENT)

VOCATIONAL/OCCUPATIONAL HISTORY SIGNIFICANT OTHERS, SUPPORT SYSTEMS AND RELIGIOUS HISTORY

WHS 02 - REV.8/90

:iUTY/LOCATtON,
1ATE NAME
ERAPIST

TE f E OF PLAN UPDATE

\TE

# PROBLEM

MENTAL HEALTH SERVICES TREATMENT PLAN
DATE OF M.H. ADMISSION INMATE NUMBER THERAPIST SIGNATURE

QUARTERLY TEAM CONFERENCE
MEMBERS PRESENT DIAGNOSIS

GOAL

INTERVENTION

RESOLVtD

» •

DEPARTMENT OF CORRECTION HEALTH SERVICES DIVISION
f
AUTHORIZATION FOR RELEASE OF INFORMATION'

I hereby authorize the State of Connecticut, Department of Correc-

tion and its staff at

to OBTAIN the following information

from:

.

I hereby authorize the State of Connecticut, Department of Correc-

tion and its staff at

to REVEAL the following information

to:

a

.

INITIAL APPROPRIATE ITEM(S):

Dates of Admission/Discharge.

Pertinent Medical and/or Psychiatric information relevant to my

diagnosis and/or treatment, including diagnosis.

Alcohol and/or Drug abuse information.

Other information (please be specific):

.

RELEASE OF INFORMATION RELATING TO AN HIV DIAGNOSIS:
Pertinent medical and/or Psychiatric information relevant to a diagnosis of HIV. I may withdraw this consent at any time prior to the release of the above information.
"This information has been disclosed to you from records whose confidentiality is protected by state law. State law prohibits you from making any further disclosure of it without the specific written consent of the person to whom it pertains, or as otherwise permitted by said law. A general authorization for the release of medical or other information is NOT sufficient for this purpose." P.A. 89-246

The specific purpose of this request is:

This consent, if not withdrawn, will expire on after it is signed.

or 90 days

Date of Birth: / /

Date of signature: / / ID#

Witness Signature

Requester's Signature
Parent or Guardian (If requester is a minor)

FORM !*:•
CONFIDENTIAL — MEDICAL REVIEW PROCEDURE — PRIVILEGED INFORMATION

No.

This form is to be used in connection with the Incident or Disdplinary Reports; or whenever a speciflc event results in the need for medical treatment, or any omission or commission by a staff member.

Person Injured:. Place Where Treated: Medical Incident Prepared By {PUeue Prim):

Date: Date & Hour of Treatment:
On (Date):

Summarize incident:

Signature Diagnosis:. "reatment Administered: ollow-up Action Required: /here Assigned After Treatment: ther Remarks:

Signature of Supervisor

Title •spare Original & 5 Copies

CONFIDENTIAL — MEDICAL REVIEW PROCEDURE — PRIVILEGED INFORMATION
No.
Medical Incident Form Numbers): Dale(s) of Incident Location:. Follow-up Action Taken:

Response is/is not requested:.

Supervisor IMedical Director

Supervisor/Medical Director

FORM K
CONFIDENTIAL — MEDICAL REVIEW PROCEDURE— PRIVILEGED INFORMATION

1. Problem

2. Could the problem have been diagnosed earlier or prevented? • Comment:

3. Was the patient monitored properly with lab/x-ray/consutt? Comment:

4. Should the patient have been transferred to an outside hospital sooner? Comment:

5. Could this problem have been avoided? Comment:

6. Was the patient treated correctly?

Comment:

.

•

6. Was patient compliance a contributing factor to this problem? Comment:

Comments:

DEPARTMENTAL REVIEW

Action:

Name of Patient (optional):, Medical Director

Date

Jifl
QQ Q Q Q Q Q Q Q Q Q Q

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r

Contents & Price

•tat Kit 800 In gray -

>olyethy!ene case •

^intensions: >.* . ',

ta torn --.AMI.

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LV

Calcium Chlondf II) Dntrtnedl DUupim (Vtllum) (2) Epuvrphrinrl l/2'iwdlrd) EpuXfhrlrxJ l / r nrrjlt(l) ' " * m' . (2)
m Blnrtxm.lt (}) Il tOO-l)

Amyl Nilnlf (2)

Aromatic Ammonii (2)

Bnudryl(l)

Calcium Glucmut* (I)

CCompanntd)

EpinrphriM (I)

Indnll(l)

IpKacSynipd) Uupnl (2)

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500ml (I) : A ' , . Incravmoua CannuliU, . . _ , . K , I V. Admlnl«r,iiajS*fl):Tt\g

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EXHIBIT 1

Stat Kif 800

) ciwm
I*

S tat Kit 800 is the most extensively equipped Banyan kit. It has 26 different drugs, plus an emergency oxygen system and "ambu-rype" resuscitator. You have the drugs, equip-

ment, and oxygen to start treatment on virtually any life-

threatening emergency associated with an office based practice.

Essential drugs and equipment, not in disarray, but stored in one location,

When you open the kit you'll find ten drugs considered essential to emergency cardiac care by leading national medical organizations. Most are in prefilled syringes for quick prep and administration. Additional drugs are supplied in glass ampules. You'll also find endotracheal rubes, a complete I.V. set, Welch Allyn laryngoscopes with light source, and monitoring equipment. (The complete contents are listed below.) This is one of the most thorough groupings of office emergency equipment you'll ever find in one case, organized and ready for use.

Although larger than the 400 or 600 (see comparative photo in this brochure), the Stat Kit 800 is portable at 27 pounds. Each item fits safely and securely in its own spot, cushioned by a 1/2" layer of polyethylene foam. It can take rough treatment with little chance of breakage, making it practical for you to depend on it in your office as well as out.

Peace of mind about maintenance, because we make sure you remember

To take the burden of remembering to inspect the kit from

your shoulders, Banyan sends quarterly Update Notifications

that include an easy-to-use Reorder Form and postage paid en-

velope. It's simple for you or a staff member to identify and

replace expired or used items by mail or toll free number.

< i. = r

A preset O2flowrate for speed; a quality

< I'-

resuscitator for higher O2 concentrations.

The portable oxygen system has a preset flow rate for speed of setup and administration. Simply attach the mask and turn the handle; it's preset to deliver 6LPM for approximately 30 minutes. You'll have enough oxygen for the early, critical stages. The complete system includes a mask with strap and seven feet of tubing. The standard medical "B" cylinder is easily refilled at oxygen supply houses.
Laerdal's Resuscitator 8700 is universally considered one of the finest, delivering high concentrations of ambient oxygen. It is made from a newlv developed resilient silicon*.-. You can

!

 
 UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

FILED
L U ji

IN RE CONNECTICUT PRISON OVERCROWDING AND AIDS CASES

MASTER FILE NO. H80-506 (JAC)

DAVID DOE, et al 1

i

Plaintiffs

:

V
LARRY R. MEACHUM r et al.,

CIVIL NO. H88-562 (PCD) (JGM)
:

Defendants

:

NOVEMBER 2 , 19 90

CONSENT JUDGMENT ON HEALTH CARE FOR HIV-INFECTED INMATES AND CONFIDENTIALITY OF HIV-RELATED INFORMATION

Doe v. Meachum PC-CT-005-005

TABLE OF CONTENTS

PAGE

I.

BACKGROUND

1

II .

HIV-RELATED SPECIALTY SERVICES

5

A. Specialist Services

5

B. AIDS Coordinator

6

III. '. IMPLEMENTATION OF POLICY MANUAL

7

IV.

INTAKE AND ASSESSMENT

7

A. Health Screening

7

B. Comprehensive Health History and Physical

Examination

11

C. HIV Disease Treatment Plan

15

D. Referrals to Infectious'Disease Specialists... 19

V.

DELIVERY OF ROUTINE HEALTH SERVICES TO HIV-

INFECTED INMATES

24

VI.

ACCESS TO MEDICAL CARE FOR ACUTE ILLNESSES

26

VII. DRUG THERAPIES

28

VIII. HEALTH CARE RECORDS OF HIV-INFECTED INMATES

29

IX.

PRESCRIPTION AND ADMINISTRATION OF MEDICATIONS

FOR HIV-INFECTED INMATES

36

X.

EMERGENCY KITS

37

XI.

DIET FOR HIV-INFECTED INMATES

38

XII. MENTAL HEALTH CARE FOR HIV-INFECTED INMATES

41

XIII. DENTAL CARE FOR HIV-INFECTED INMATES

44

XIV. EYE CARE FOR HIV-INFECTED INMATES

4 6

XV.

ADDITIONAL CRITERIA FOR THE CARE OF HIV-INFECTED

WOMEN

4 6

XVI. DISCHARGE PLANNING

47

- ii -

XVII. HOUSING OF SYMPTOMATIC HIV-INFECTED INMATES

51

A. Chronic Care Ward at Connecticut Correctional

Institution at Niantic

51

B. Skilled Nursing Facility and Health Related

Facility Beds

52

C. Medical Unit Beds

52

XVIII. STAFF EDUCATION

54

XIX. "STAFFING

57

XX.

QUALITY ASSURANCE

57

XXI. CONFIDENTIALITY

6 0

XXII. MONITORING OF CONSENT JUDGMENT

61

XXIII. GENERAL PROVISIONS

65

XXIV. NOTICE TO CLASS

6 8

XXV. COSTS AND ATTORNEYS ' FEES

6 9

- iii -
EXHIBITS
1 BROCHURE FOR BANYAN STAT KIT 800
FORMS FORM A HIV-ASSOCIATED COMPLETE PHYSICAL EXAMS FORM B. HIV-INFECTED PATIENT FLOW SHEET FORM C TREATMENT PLAN FOR HIV-INFECTED INMATES FORM D W-10 TRANSFER FORM FORM E TERMINATION/TRANSFER FORM FORM F MENTAL HEALTH SERVICES — INITIAL ASSESSMENT FORM G MENTAL HEALTH SERVICES — TREATMENT PLAN FORM H AUTHORIZATION FOR RELEASE OF INFORMATION FORM FORM I MEDICAL INCIDENT REPORT FORM J FOLLOWUP TO MEDICAL INCIDENT REPORT FORM K MORTALITY REVIEW FORM L COMPREHENSIVE CHART REVIEW SCREENING CRITERIA

- 1I. BACKGROUND
1. This action was filed on August 15, 1988. It challenges certain policies and practices of the defendant officials of the Connecticut Department of Correction which pertain to education concerning the Human Immunodeficiency Virus ("HIV"), counselling prior and subsequent to testing for HIV-infection, medical and mental health care provided to inmates with HIV-infection, and protections for the confidentiality of the identities of inmates with HIV-infection.
2. This action was certified as a class action on February 10, 1989 by Order of the United States District Judge Peter C. Dorsey, accepting and adopting Magistrate Joan Margolis' January 20, 1989 Recommended Ruling on Plaintiffs' Motion for Class Certification.
3. After extensive motion practice, discovery, and several weeks of trial, the parties met to discuss and negotiate settlement of the issues raised by plaintiffs' March 3, 1989 Motion for Preliminary Injunction, which pressed certain of plaintiffs' claims regarding inmate AIDS education and pre- and post-HIV test counselling.
4. On May 16, 1989 the parties entered into a Consent Judgment on Inmate AIDS Education and Pre- and Post-HIV Test Counselling which, after appropriate notice to the class and a hearing, was approved by the Court.

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5. Since May, 1989, discovery has continued regarding the

remaining issues in this action. The provisions of this Consent

Judgment are the result of several discussions and careful

negotiation among all parties after this additional discovery.

They have been agreed to solely as a means to put a reasonable

end to the parties' dispute over the issues of confidentiality

and medical and mental health care for HIV-infected inmates and

to avoid the costs, time, and risks which would be involved for

both parties in further litigation. This Consent Judgment

embodies a compromise of the issues involved and, while its

provisions are binding on the parties herein, its provisions are

not to be construed to be statements, ruling, or precedents with

respect to the constitutional and other legal rights of persons

who are parties or nonparties to this litigation in this or any

other action.

6. As used in this Judgment, the following terms shall have

the following meanings unless specifically stated otherwise:

a.

"AIDS" shall mean Acquired Immune Deficiency

Syndrome, as defined by the Centers for Disease Control of the

United States Public Health Service.

b. "AZT" means Zidovudine, Azidothymidine or Retrovir.

c. "CDC" shall mean the Centers for Disease Control of

the United States Public Health Service.

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d. "Commissioner of Correction" or "Commissioner" shall mean the Commissioner of the Connecticut Department of Correction or his/her designee.
e. "DOC shall mean the Connecticut Department of Correction.
f. "DOC's medical complexes" shall refer to the current groupings of DOC facilities, which at the time of the signing of this Judgment are six in number: Somers, Niantic, Cheshire, Hartford, New Haven, and Bridgeport. Should this term cease to be used by DOC to designate the current configuration of health care delivery, the term shall be interpreted to mean those groupings of DOC facilities currently in operation which are in the same general area of the state and which serve approximately the same number of inmates as the current complexes serve.
g. "DOHS" shall mean the Connecticut Department of Health Services.
h. "DOHS-certified HIV counsellor" shall mean persons who are certified by DOHS to do HIV-test counselling.
i. "Infectious Disease Specialist" as used in this Judgment shall mean a person meeting the qualifications specified in Section II.A, infra.
j. "Inmate" shall mean any and all persons committed to the care and custody of the defendant Commissioner of Correction now or in the future, whether in pretrial or sentenced status.

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k. "FDA" shall mean the United States Food and Drug Administration.
1. "HIV and "HlV-infection* shall mean infection with the human immunodeficiency virus, or any other related virus identified as the probable causative agent of AIDS.
. m. "HIV test" shall mean any laboratory test or series of tests for any virus, antibody, antigen or etiologic agents whatsoever thought to cause or to indicate the presence of HIVinfection.
n. "NIAID" shall mean the National Institute of Allergy and Infectious Diseases.
o. "Inmates at risk of having HIV-infection" shall mean all inmates with a health history indicative of possible HIVinfection, including without limitation intravenous drug use, transfusions, male homosexual contact, sexual promiscuity and/or other types of blood to blood contact with persons with HIVinfection.
p. "Physician's assistant" shall mean a graduate of an approved Physician's Assistant program who is licensed to practice as a physician's assistant in this State.
q. "Accepted professional standards" shall mean those standards in effect on the date of the signing of this Judgment.

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II. HIV-RELATED SPECIALTY SERVICES A. Specialist Services 7. Within 120 days of judicial approval of this Consent
Judgment, the Commissioner of DOC shall establish Infectious Disease Specialist services in or for each DOC Complex (except in the New Haven Correctional Center and the Bridgeport Correctional Center where such services shall be established in July, 1991), to which particular inmates with HIV-infection, as specified in this Judgment, SSIV.A.15, IV.C.24, and D.27., infra, shall be referred for health care related to their HIV-infection. These specialist services shall be provided by physicians who either are Infectious Disease Specialists, Infectious Disease Fellows, or physicians who are Board-certified in internal medicine, family practice or preventive medicine and who have two years of experience in in- and out-patient management of persons with HIV infection. The total number of hours of Infectious Disease Specialist service provided by DOC shall be determined by the number of referrals and the clinical need for the services, as measured by the criteria set forth in this Judgment. The specialist services shall be provided as necessary to fulfill the terms of this Judgment and to meet the clinical need for such services, as defined in this Judgment. It is anticipated that there will generally be a weekly clinic at each Complex. Inmates who need to be seen by an Infectious Disease Specialist may be transported to another Complex in the event of the unavailability

of the specialist assigned to their Complex or in the event that there are too few inmates to justify a separate clinic at that Complex. In addition, DOC shall provide for telephone consultation services and, as medically necessary, for nonregularly scheduled visits to the facility on an on-call basis by physicians with equivalent qualifications and experience.
• 8. Until such time as Infectious Disease Specialist services are established at the New Haven Correctional Center and the Bridgeport Correctional Center, DOC shall ensure that the HIV-related treatment plans of HIV-infected inmates within said facilities are reviewed by an Infectious Disease Specialist and shall transfer HIV-infected inmates to Complexes which have Infectious Disease Specialist services whenever medicallynecessary.
B. AIDS Coordinator 9. Within sixty days of judicial approval of this
Consent Judgment, the Commissioner of DOC shall designate for each DOC facility the medical staff person responsible for ensuring compliance with the terms of this Judgment (including the maintenance of necessary tickler systems) and otherwise acting as a liaison with the DOC Director of Health Services for purposes of ensuring quality of care for HIV infected inmates. This staff person shall be either the Medical Director of the facility, CHNS or acting CHNS for the facility or Complex, or a

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Registered Nurse assigned to the facility who is thoroughlytrained in the management of HIV disease. III. IMPLEMENTATION OF POLICY MANUAL
10. A written comprehensive policy and procedure manual setting forth the standards for health care treatment of inmates with HIV-infection as summarized in the pertinent elements of this Judgment and as incorporated in DOC's HIV-related protocols and forms shall be submitted to the Monitoring Panel described herein within sixty days of judicial approval of this Consent Judgment for the Panel's review and comment/ and fully implemented within sixty days thereafter. The forms attached to this Consent Judgment may be modified as needed to improve upon the efficiency of the form and to accommodate changes in medical knowledge and standards, provided that the Monitoring Panel, before new forms are implemented, shall have opportunity to review and comment on any changes in the forms to ensure that they conform to then-current accepted professional standards. IV. INTAKE AND ASSESSMENT
A. Health Screening 11. Within twelve hours of admission to a DOC facility
from any place other than another DOC facility, each inmate shall receive a health screening examination. This screening examination must be performed in private by a correctional medical attendant, licensed nurse, nurse clinician, physician assistant, or physician. Within sixty days after judicial approval of this

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Consent Judgment, all correctional medical attendants and licensed practical nurses ["LPNs"] performing the medical screening examination will have received a six hour training course specifically dealing with medical screening procedures and important clinical aspects of HIV infection with the appropriate referral criteria.
" 12. One aspect of this health screening shall be to assess whether' the inmate has or may have HIV infection, including by inquiring of the inmate if s/he is infected, assessing the inmate's past behaviors which pose a risk of transmission, and making a preliminary determination of any clinical indications of infection, including fever, night sweats, fatigue, dysphagia, cough, shortness of breath, lymph node enlargement, diarrhea, new skin lesions, pruritus, visual changes, headache, memory changes, weakness, numbness, paresthesias/dysesthesias, and recent weight loss. The health screening also shall be used to determine if the inmate is in need of immediate further evaluation, next-day physician referral, and/or other appropriate followup.
13. Inmates who have not tested positive in the past and who describe risk behaviors in the past related to, and/or who have significant findings suggestive of, HIV-infection shall be advised of the medical benefits of being tested to assess if they are HIV infected. HIV tests shall be available in all DOC facilities, but can only be ordered by a physician. No inmate

- 9-
may be tested for HIV-infection unless the HIV-test counselling mandated by the 1989 Consent Judgment on AIDS Education and Preand Post-HIV Test Counselling in this action is provided. Except as otherwise specified in P.A. 89-246, no inmate shall be tested for HIV infection unless the inmate has consented to the performance of the test, in such manner as required by P. A. 89246. ••'.
14. All inmates at the initial screening shall be given written materials in English and Spanish which describe available medical and mental health services for HIV-related care, the confidentiality of these services, and the procedures for gaining access to such services. DOC shall ensure that this information is communicated verbally in a timely manner to illiterate inmates, and by translation to inmates with a native language other than English or Spanish.
15. If the screening examination indicates that an inmate's HIV-related condition may require immediate medical and/or mental health treatment, that inmate shall be referred immediately for such additional care to appropriate DOC medical and/or mental health staff. This staff shall promptly assess the inmate's status, provide appropriate treatment, and make all necessary additional referrals, including, as appropriate, to the Infectious Disease Specialist. Medical findings that would trigger such additional referrals to the Infectious Disease Specialist would include, but would not be limited to, the

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following: a) an inmate on AZT, PCP prophylaxis, or any other prescribed medications for HIV disease or its complications; b) fever of 102 F or more in a patient suspected or known to be HIVinfected; c) obvious significant infection in a patient suspected or known to be HIV-infected, including dental abscess, cellulitis, peri-anal ulcerations, etc.; d) signs of respiratory distress, e.g. respiratory rate at rest greater than or equal to 25/minute, intercostal retractions, cyanosis, especially if these signs are associated with a non-productive cough; e) severe persistent headache in a patient suspected or known to be HIVinf ected; f) mental status abnormalities that are acute or clinically unexplained, e.g. confusion, poor memory, bizarre or inappropriate behavior; g) visual complaints in a patient suspected or known to be HIV-inf ected; h) a patient with suspected wasting syndrome (suspected on visual exam or by a documented 10% weight loss over the previous three months without obvious explanation); i) an inmate exhibiting skin lesions suggesting Kaposi's sarcoma, severe HSV or varicella-zoster; j) obvious muscle weakness or ataxia of recent onset in a patient suspected or known to be HIV-infected; k) a patient with a known T4 count below 200/mm3. Access to such specialist services shall not be denied based on custodial concerns or other non-medical issues. The time, date and nature of each referral shall be noted in the inmate's medical record, or, as appropriate, mental health record.

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B. Comprehensive Health History and Physical Examination 16. Each newly admitted inmate who is known to DOC to
have HIV infection, who demonstrates symptoms suggesting HIV infection, and/or who has notified DOC staff that s/he is HIV infected shall be given a comprehensive health history and physical examination ["CHH"] of all systems by a physician, nurse clinician, or physician assistant with adequate training in the assessment of HIV disease within ninety-six hours of admission, provided that in those DOC facilities in which such staff is present two or fewer times each week or during holiday weeks, the assessment shall be completed within one week of admission. All inmates diagnosed as having HIV infection while within DOC custody shall be given this same examination by the same DOC medical personnel within ninety-six hours of diagnosis.
17. The comprehensive health history and physical examination shall be conducted in private and the results recorded in the inmate's medical record using, as appropriate, the HIV Health Care Summary, Flowsheet, and Rolling Treatment Plan, attached hereto as Forms A-C and incorporated herein by reference. It shall include the following components:
a. a complete physical examination (including a baseline weight, temperature, pulse, blood pressure, and respiratory rate and an examination of the lungs, cardiovascular system and abdomen).
b. a fundoscopic examination.

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c. a basic examination of the soft tissues of the mouth, which shall include assessment of abnormalities indicative of HIV-infection (e.g. oral hairy leukoplakia, Candida, oral ulcerations, oral Kaposi's Sarcoma, and progressive periodontal disease).
d. a basic neurologic examination, which shall assess any disturbances in gait, cerebellar function, gross and fine motor function, reflexes, and sensory functioning.
e. a basic mental status examination, which shall assess any memory loss, speech difficulties, delusions, symptoms of psychotic or marginal behavior, clinical depression and/or suicidal ideation.
f. an evaluation of lymph node status in various chains
I
including cervical, supraclavicular, axillary and inguinal areas. g. a basic examination of the skin to assess any HIV-
related problems, e.g. with nonspecific rashes /dermatitis, folliculitis, psoriasis, seborrhea, and lesions suggestive of Kaposi's sarcoma.
h. an evaluation of the genitalia and perirectal areas (for men) or a Pap smear, pelvic and perirectal examination (for women). Such evaluations for women performed by a DOC nurse need not be repeated if such an exam was performed within the previous two months, and if the patient denies any gynecological complaints .

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18. In addition, the following laboratory tests shall be included as a routine part of the comprehensive health examination for those inmates known to be HIV-antibody positive once the comprehensive health history and physical examination have been completed:
a. a PPD-intermediate (which shall be read forty-eight to seventy-two hours after application), unless the inmate is PPD positive and/or has a past history of TB.
b. a CBC with differential which shall be repeated twice a year at a minimum.
c. a Chem 20 (or similar chemistry profile) which shall be done when the CBC is first done, and thereafter repeated with the CBC.
d. a dipstick urinalysis, which shall be repeated thereafter at the yearly physical examination.
e. VDRL. f. HBsAg and HBsAb unless the HBSAb is known to be positive. g. a T cell profile, which shall include an absolute CD4 count and a CD4/CD8 ratio and which shall be repeated twice a year (or more often if there is evidence of clinical deterioration consistent with advancing HIV disease or if the inmate's most recent T4 count was approaching a level for which s/he would qualify, under currently-accepted professional standards, for a treatment that had not yet been offered. Once the T4 count falls

- 14 -
below 200/nun 3, the T cell profile need not be repeated unless medically appropriate.
h. a chest x-ray, to be repeated yearly. i. if the results of the comprehensive health history and physical examination, as reflected in an entry in the inmate1 s. medical record, indicate that the inmate is not known to be HIV infected, only the tests specified in §IV.B.18.a-e, supra, need be performed. 19. If the medical staff conducting the comprehensive health examination detects any significant clinical findings in an inmate's mental status examination, the neurological examination, the examination of the mouth, and/or the laboratory tests requiring further evaluation, immediate referrals shall be made to specialists in psychiatry, ophthalmology, neurology, dentistry, diagnostic radiology, etc. so that the inmate's condition might be more fully assessed as soon as medically appropriate, subject to review by the Infectious Disease Specialist. Access to such specialist services shall not be denied based on custodial concerns or other non-medical issues. The time, date, and nature of each such referral shall be recorded in the inmate's medical or, when appropriate, mental health record.
20. The comprehensive health examination for new admittees, specified in §§16-18, supra, need not be conducted if, after review of the DOC medical records, it is established that

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the inmate has been discharged from the DOC system and subsequently readmitted AND has had a comparable comprehensive health examination within a DOC facility within the previous sixty days AND the initial screening/comprehensive health history at the time of readmission has revealed no acute medical or mental health conditions.
21. A repeat comprehensive health history and physical examination are not required for those inmates who are transferred from one DOC facility to another UNLESS such comprehensive health history and physical examination are medically indicated by the initial medical screening which is done by the receiving DOC facility at admission.
C. HIV Disease Treatment Plan 22. After the physician's review of the HIV-infected
inmate's existing medical and mental health records, including those pertaining to the personal examination of the inmate, review of reports of any other specialists, and completion of such other tests and assessments as are determined to be necessary, an individualized, goal-directed and outcome-oriented HIV-disease health care summary, flow sheet, and treatment plan, using the attached Forms A-C as standardized forms, shall be developed and implemented for the medical care of each HIVinfected inmate.
23. The individualized health care summary, flow sheet and treatment plan (Forms A-C) for each HIV-infected inmate shall

- 16 -
be completed by a DOC physician responsible for HIV-related care within that inmate's particular DOC facility.
24. The individualized health care summary, flow sheet and treatment plan for a symptomatic HIV-infected inmate shall be completed within ten days of the inmate's admission to a DOC facility or, for inmates diagnosed while within DOC care, within ten days of diagnosis. If all requisite laboratory reports have not been completed within this period or if the inmate is transferred to a community facility for health care treatment, the plan shall be prepared in draft form, and revised, as necessary, when all laboratory reports are complete or the inmate returns to a DOC facility. The treatment plan for an asymptomatic HIV-infected inmate shall in normal circumstances be completed within ten days of completion of requisite laboratory work, but in no event later than thirty days after admission or diagnosis. The Infectious Disease Specialist shall review the initial treatment plans of all HIV-infected inmates who have not been referred to him/her for in-person evaluation to ensure that the data base is complete, to assess if there are any laboratory or physical abnormalities which require referral to him/her, to assess the need for and timing of examinations by other specialists, and to alert the responsible facility physician as to needed changes in the treatment plan and to provide advice as to how to follow the inmate medically. All significant changes to an HIV treatment plan and the finding of new opportunistic

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infections or other new AIDS-defining conditions also shall be reviewed by the Infectious Disease Specialist. This review shall be completed within seven business days of the completion of, or revision to, the treatment plan or new finding.
25. The individualized HIV health care summary, flow sheet and treatment plan shall follow the standardized format of the attached Forms A-C, and may refer to and incorporate by reference any pertinent DOC protocols for HIV-related care. The treatment plan shall include at least the following:
a. a record of the inmate's current T-cell level. b. a schedule according to which appropriate T-cell and other laboratory studies will be performed — starting immediately. c. a determination of toxoplasmosis titer for those HIV-infected patients whose T4 count is below 250/mm3. Once a toxoplasmosis titer has been obtained in the past and the results recorded, it need not be repeated. d. a schedule for follow-up check-ups to review past and current symptomatology, to repeat and to review T-cell and other laboratory results, and to order medication as appropriate. e. Referrals to appropriate specialists, including but not limited to neurology, ophthalmology, psychiatry, diagnostic radiology. f. nutrition and diet restrictions or recommendations.

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g. evaluation for and, when medically-appropriate, initiation of anti-retroviral therapy (with AZT, DDI, etc.).
h. evaluation for and, when medically-appropriate, initiation of primary and secondary opportunistic infection prophylaxis (e.g. for PCP, toxoplasmosis, cytomegalovirus, cryptococcus).
' i. evaluation for, and, when medically-appropriate, initiation of anti-viral therapies (for CMV, herpes simplex, varicella-Zoster infections, etc.).
j. evaluation for and, when medically-appropriate, initiation of anti-fungal therapies (for Candida, cryptococcus, etc.).
k. evaluation for and, when medically-appropriate, initiation of treatment for M. tuberculosis and atypical TB infections.
1. evaluation for and, when medically-appropriate, provision of vaccination (for influenza, pneumococci).
m. evaluation for and, when medically-appropriate, initiation of treatment for Kaposi's sarcoma (alpha-interferon, chemotherapy, radiation therapy etc.).
n. evaluation for and, when medically-appropriate, initiation of treatment for other neoplasms.
o. a schedule for regular evaluation (by laboratory tests, inmate interviews and/or physical examinations) of the

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toxic side effects of each medication administered when medically

appropriate.

p. a determination of the frequency with which a

complete repeat physical shall be done on that inmate.

q.

a list of all consultations requested for the

inmate, including the date the request was made, the type of

consultation requested, the date of any followup calls, the date

on which the consultation occurred, and any summary of the out-

come of the consultation, provided that any summary of a mental

health consultation shall be recorded in the inmate's mental

health record.

26. A CHH shall be conducted and an individualized

treatment plan and flowsheet as described above shall be

completed within 120 days of judicial approval of this Consent

Judgment for each inmate who has been diagnosed as having HIV-

infection and who is in DOC custody at the time of the approval

of this Judgment. If inmate has had the CHH specified in

§IV.B.17-18, supra, in last six months, this exam need not be

repeated.

D. Referrals to Infectious Disease Specialists

27. The following categories of inmates shall immediately

be referred to the Infectious Disease Specialist, to be seen

within the response time noted after each basis for referral

outlined below:

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a. HIV-infected inmates on AZT, DDI, PCP prophylaxis, and other HIV-related medications shall be seen within two weeks of referral;
b. HIV-infected inmates who are identified as having a T4 count under 400/mm3 shall be seen within two weeks of referral;
.c. inmates who upon the initial health screening and/or physical examination, or subsequent to this initial examination, are found to exhibit symptoms suggestive of the following HIVrelated conditions:
- thrush not related to concomitant or recent antibiotic therapy. Such inmates shall be seen within two weeks of referral;
- skin lesions consistent with Kaposi's sarcoma, Herpes zoster, severe Herpes simplex infection. Such inmates shall be seen within one week of referral;
- unexplained dysphagia in a patient suspected or known to be HIV-infected. Such inmates shall be seen within one week of referral;
- persistent periodic fever of 102 F or more in a patient suspected or known to be HIV-infected. Such inmates shall be seen within one week of referral;
- persistent non-productive cough but negative chest x-ray for an acute infiltrate in a patient suspected or

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known to be HIV-infected. Such inmates shall be seen within one week of referral;
- other localized infections including cellulitis, infected wounds or ulcers, etc. in a patient suspected or known to be HIV-infected. Such inmates shall be seen within one week of referral.
d. HIV-infected inmates with a clinicallysignificant deterioration in an HIV-related condition. Such inmates shall be either evaluated by the Infectious Disease Specialist within twelve hours or less of the referral or they shall be referred to an emergency room attached to an accredited community hospital within this timeframe. Conditions requiring such medical disposition would include, but would not be limited to, the following:
- respiratory distress with a respiratory rate greater than or equal to 25/minute at rest not related to a known chronic respiratory disorder, e.g. asthma, COPD. The presence of cyanosis or mental status changes thought to be related to hypoxemia would require immediate transfer to a hospital emergency room as above.
- signs and symptoms compatible with encephalopathy due to HIV itself, toxoplasmosis, or other HIVassociated CNS disease including lymphoma and cryptococcal meningitis. Such signs and symptoms would include severe unrelenting headache, neurological changes such as the sudden

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appearance of a focal neurologic deficit or sudden ataxia, and

mental status changes (confusion, personality change, unexplained

sudden alterations in consciousness, etc.).

- visual complaints compatible with retinal

disease (suspected CMV or toxoplasmosis retinitis).

- clinically significant hemorrhagic episodes,

e.g. documented acute GI blood loss.

e. HIV-infected inmates with an unintended weight

loss of 10% of body weight or more within the past six months.

Such inmates shall be seen within two weeks of referral.

f. HIV-infected inmates experiencing vomiting

and/or diarrhea of more than three days duration notwithstanding

dietary adjustments. Such inmates shall be seen within one week

of referral.

g.

HIV-inf ected inmates with progressive

gingivitis, obvious dental abscess, unexplained oral lesion, or

hairy leukoplakia. Such inmates shall be seen within one week of

referral.

h. inmates housed in an infirmary setting

specifically because of their HIV-related condition. These

patients shall be evaluated at least weekly by an Infectious

Disease Specialist, though they shall also be seen several times

a week by the DOC physician assigned to this area.

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i.

HIV-infected inmates with a documented new

infiltrate on chest X-ray. Such inmates shall be seen within one

week of referral.

j.

Inmates with a newly documented white cell

count between 1000/mm3 and 3500/mm3. Such inmates shall be seen

within two weeks of referral. Inmates with a newly documented

white cell count under 1000/mm3 shall be seen within one week of

referral.

k. Inmates with a newly-documented platelet count

between 50,000 and 100,000 shall be seen within two weeks of

referral. Inmates with a platelet count under 50,000 shall be

seen within one week of referral. Those inmates with physical

signs of internal hemorrhage (many petechiae, large, scattered

purpura and ecchymoses, especially if associated with GI blood

loss) may require immediate referral to a local emergency room

following phone consultation with the Infectious Disease

Specialist.

1. Inmates with a hematocrit less than 27% who

shall be seen within one week.

m. Inmates with such additional symptoms and

conditions as the DOC Director of Health Services, in consulta-

tion with the Infectious Disease Specialists, determines to be

medically-appropriate bases for referral in light of new medical

developments. The time and reason for referral shall be noted in

the inmate's health care record.

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V. DELIVERY OF ROUTINE HEALTH SERVICES TO HIV-INFECTED INMATES.

I

28. All HIV-infected inmates shall be routinely scheduled

for follow-up health examinations at a frequency consistent with

current professional standards.

29. All HIV-infected inmates shall be routinely scheduled

for all laboratory tests as are determined to be medically-

necessary by the treating physician in consultation with the

Infectious Disease Specialist in accordance with accepted

professional standards.

30. DOC shall institute a "tickler system" and such other procedures as are necessary to ensure that the examinations and laboratory work are scheduled for, and provided to, HIV-infected inmates at the intervals consistent with SV.28. to V.29, supra. These procedures shall include, but are not limited to, the use of the standardized form attached hereto as Form C and a requirement that if an inmate is transferred from one DOC facility to another without his/her medical file, the receiving facility shall promptly call the sending facility and/or the Health Services Division in Central Office for all information about that inmate on their tickler files, and shall promptly include said information on the receiving institution's tickler

j file. This system and its accompanying procedures shall also ensure that all necessary treatment identified in an inmate's HIV treatment plan is provided at the time(s) identified in the plan.

Any "tickler system" and other procedures for ensuring ongoing

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care for infected inmates shall maintain the confidentiality of an inmate's HIV status by limiting disclosures regarding HIV status only to the health care personnel involved in providing HIV-related health care to that inmate,
31. DOC shall establish a system for preventive health care maintenance for HIV-infected inmates which ensures that inmates are apprised of treatments and vaccines deemed medically necessary and appropriate for them. HIV-infected inmates shall receive, in accordance with current recommendations of CDC or NIAID:
a. pneumococcal vaccine. b. influenza vaccine. c. PCP prophylaxis. 32. DOC shall incorporate into the introductory AIDS education program for inmates mandated by the May 16, 1989 Partial Consent Judgment in this action information about AZT, DDI, PCP prophylaxis, and any other advances in HIV-related therapies deemed appropriate for inclusion in such program by the DOC Director of Health Services as well as an explanation that Consent Judgments relating to AIDS-related care have been entered and where, within the institution, a copy of these Judgments is maintained for an interested inmate to read. Defendants shall maintain within each DOC facility, either in the medical unit or another appropriate site, a copy of the two Consent Judgments entered in this action and shall establish a procedure whereby

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inmates interested in reading one or both Judgments have opportunity to do so within a reasonable time of their request.
33. Because of the relationship between HIV-infection and TB, DOC shall continue to implement policies and procedures for the identification, management and treatment of TB that meet accepted professional standards. VI. ACCESS TO MEDICAL CARE FOR ACUTE ILLNESSES.
34. Each DOC facility shall institute a system for sick call by which inmates, including those with HIV-disease, who seek medical attention shall be allowed to place their requests into a locked box or other equivalent confidential container or location which shall be checked at least daily when health care staff are present in the facility and access to which shall be limited to health care personnel. The collection schedule shall be posted on or near the box (or container).
35. Absent an emergency, any HIV-infected inmate who requests medical attention shall be placed on the next routine sick call. Any HIV-infected inmate identified by DOC medical staff as having an unresolved, clinically-significant acute illness or condition which has lasted for three consecutive days, or with a clinically-significant deterioration in neurological and/or respiratory status which has lasted for six hours, shall immediately and automatically be referred to the on-call Infectious Disease Consultant or the Complex's Infectious Disease Specialist for immediate attention. If this physician determines

- 27 -
that further evaluation is required, s/he shall either come promptly to the facility to examine the inmate or the inmate shall be transported promptly to a hospital emergency room. If this physician decides that no further action should be taken or treatment administered, he/she shall note the rationale therefore in the inmate's medical record and the inmate shall be informed of the "decision by DOC medical staff. Inmates shall be afforded the opportunity to review their medical records and shall be informed of the procedure by which they can raise questions regarding the medical care being provided to them.
36. When an HIV-infected inmate develops fever or other sign of infection and when any physician (or registered nurse, if the physician is not available) believes that the inmate is in need of a transfer to an outside hospital, that inmate shall immediately be transferred to such an outside hospital.
37. A W-10 Transfer Form, attached hereto as Form D, shall be prepared for each HIV-infected inmate who is to be transferred outside DOC for in-patient care. For inmates transported for out-patient care, significant problems and medications shall be documented on a consultation sheet which shall accompany that inmate to the appointment. A copy of the inmate's HIV flow sheet (Form B) shall also accompany the inmate at the time of transfer for inpatient care. The documents shall be updated, as necessary, to include a list of all current medications, doses, dose schedules, and allergies, as well as instructions as to

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which medications can and cannot be taken together, a summary of current illnesses including vital signs and relevant physical findings, and the results of all lab tests done in the previous two weeks. In the event of an emergency transfer precluding time for copying the necessary transfer documents, the physician, nurse, or medic shall, concurrent with the inmate's transfer, make direct telephonic contact with the physician or emergency room triage nurse at the outside hospital to relay all information necessary for the inmate's treatment and shall forward the completed and updated W-10 and flow sheet within twelve hours to the hospital.
38. All inmate transfers for medical and mental health care shall be managed so as to protect the confidentiality of the inmate's condition from disclosure to non-medical DOC staff and other non-medical personnel. VII. DRUG THERAPIES.
39. DOC shall offer to an HIV-infected inmate such drug therapies (including drugs approved by the FDA for "compassionate use" and FDA-approved Treatment Investigational New Drugs) as are determined to be medically necessary for him/her by the treating physician, in consultation with the Infectious Disease Specialist, in accordance with accepted professional standards. Said drugs shall be administered (in dosages and at frequencies) and monitored in accordance with accepted professional standards.

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40. Prior to the initiation of any treatment, HIV-infected inmates shall be informed of the nature of the treatment, the possible risks, benefits and side effects of the treatments, and the methods to monitor the efficacy of the treatments. DOC shall prepare a written Informed Consent Form for AZT, DDI, and any treatment IND drug. This form shall be in English and Spanish, and shall detail the requisite components of. an informed consent, shall be signed by an inmate prior to receipt of the drug, and shall be included in the inmate's medical record.
41. An inmate receiving AZT, DDI, PCP prophylaxis, and/or other HIV-related medications shall be monitored at medicallyindicated frequencies by the Infectious Disease Specialist. This monitoring shall be on an ongoing basis according to accepted professional standards and shall include all requisite lab work at the medically-accepted frequencies.
42. The hematocrit (HCT) of each inmate receiving AZT shall be appropriately monitored by an R.N. or M.D. on an on-going basis. All inmates with a hematocrit (HCT) below twenty (as well as those with a hematocrit above twenty when clinically indicated) will be transferred to an appropriate medical facility for the purpose of receiving transfusions, unless medically contraindicated or the patient refuses transfer. VIII. HEALTH CARE RECORDS OF HIV-INFECTED INMATES.
43. A uniform, statewide recordkeeping system for maintaining the information about the medical and mental health

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status of HIV-infected inmates shall be implemented within 120

days of judicial approval of this Judgment.

44.

During the comprehensive, HIV-related health

examination, each HIV-infected inmate shall be questioned

regarding his/her prior health care providers, and asked to sign

Medical and Mental Health Release Forms to obtain all prior

medical and mental health records (unless already in DOC

possession). Any refusals to sign such release forms shall be

recorded in the inmate's health care record. DOC shall request

all health care records from the appropriate health care

providers within two working days of the inmate signing the

release. If there has been no response to a request for records

within two weeks, a followup request shall be sent.

45. The medical records of an HIV-infected inmate shall, at

a minimum, include:

a. past DOC medical records and those records obtained

pursuant to §VIII.44.

b. all inmate health screening forms, documentation

pertaining, to the comprehensive health examination(s)(including

results of intake laboratory tests) and documentation pertaining

to any assessment(s) by the Infectious Disease Specialist.

c. current medication records and records of all HIV-

related medications and medication allergies.

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d. records of any in-patient treatment within DOC, or in community hospitals (to the extent such records have been provided to DOC).
e. reports from all consultants (including the Infectious Disease Specialist).
f. copies of all signed Release of Information forms. g. the HIV Health Care Summary, Flow Sheet and Treatment Plan (Forms A-C). h. copies of all W-lOs (Form D) and Termination/ Transfer Forms (Form E) and any other discharge summaries. i. a substantive record of all contacts with medical staff as recorded in progress notes. 46. To ensure that an HIV-infected inmate's current and past medical problems, treatment status, and medication status can be accurately determined, entries (including out-patient clinic and doctor's notes) in DOC medical records pertaining to treatment provided while in DOC custody on an outpatient basis (whether scheduled or sick call) shall include the date of visit and year, purpose of visit and chief complaint, examinations and tests performed, diagnosis, and disposition. 47. DOC shall expand its efforts to increase the number of health care providers at each DOC facility who are fluent in Spanish. These efforts shall include attempting to recruit trained bilingual medical staff (e.g. from Puerto Rico) and offering interested current medical staff Spanish-language tapes.

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48. DOC health care staff shall neither examine and question an HIV-infected inmate about HIV-related issues nor discuss the HIV-related health care status of that HIV-infected inmate, without his/her consent, while in the presence or earshot of other inmates, non-medical DOC staff, or other persons who are not DOC health care staff, except to the limited extent currently permitted by P.A. 89-246.
49. Unsealed medical and mental health files of an HIVinfected inmate shall be available only to the DOC medical and mental health staff directly responsible for providing care to that inmate or to a consulting specialist or outside medical provider to whom the inmate is referred for medical/mental health treatment or evaluation, absent the inmate's informed written consent for disclosure of HIV-related records to a specificallyidentified individual. The foregoing provision shall not limit access to such files to attorneys for DOC, plaintiffs' counsel, and any Monitoring Panels or quality assurance staff established by this Judgment for the purposes of monitoring compliance with this Judgment and assessing the adequacy of the care being provided by DOC, or anyone else authorized under P.A. 89-246 to review such records. Neither non-medical DOC staff nor inmates, whether they work in the infirmary or not, shall have an opportunity to read any part of the contents of an HIV-infected inmate's medical and mental health record which identifies the inmate as being HIV-infected absent the inmate's informed

- 33 -
written consent (except to the extent permitted by P.A. 89-246). It is understood that there may be certain documents in an inmate's central file which may contain information pertaining to medical and mental health issues about that inmate, however such documents shall not include any confidential HIV-related information as said term is defined in P.A. 89-246.
50. All DOC employees shall receive periodic training as to their obligations, under P.A. 89-246 and the DOC Administrative Directive on AIDS, to maintain the confidentiality of any HIVinfected inmate's condition.
51. The medical and mental health records of an inmate transferred from one DOC facility to another shall accompany that inmate, together with his/her master institutional file. The medical and mental health files shall be sealed by the medical/ mental health unit staff before being delivered to the correctional staff responsible for making inmate transfers. Each DOC facility transferring an inmate to another DOC facility shall ensure that the inmate's health care records are transferred simultaneously with the inmate. The Warden of each DOC facility shall designate staff on each shift who shall be responsible for ensuring that this simultaneous transfer of inmate health records occurs and who shall have access to such records to accomplish this end, provided that non-medical personnel shall not be permitted to look into any inmate's health records, except when necessary for the limited purpose of identifying the file as that

- 34 -
which pertains to the inmate being transferred in instances in which there is a reasonable basis for an error in this regard. Should said non-medical personnel thereupon become aware of confidential HIV-related information about an inmate, as said term is defined in P.A. 89-246/ s/he shall be bound by the nonredisclosure provisions of said Act. In the extraordinary circumstance that an inmate's health care records are not transferred together with the inmate: a) the inmate's HIV Health Care Summary/ Flow Sheet and Treatment Plan (Forms A-C) shall be faxed (on the next shift health care staff are on duty and in confidence) to the fax machine in the medical unit at the receiving facility; b) the sending facility medical staff shall make telephone contact with the receiving facility medical staff to transmit necessary information about that inmate's care; and c) the health care records shall be delivered to the receiving facility within three to seven days.
52. DOC shall institute a system to ensure that the DOC HIV-Treatment Plan, Health Care Summary/ Flow Sheet, and the Progress Notes of any inmate who is released from a DOC facility or transferred to community status are not transferred to a parole office, but are maintained within the releasing DOC facility and/or DOC's Central Office Health Services Office. Whenever an HIV-infected inmate is then readmitted to a DOC facility, the inmate's health care records shall be transported to the medical unit of the facility to which she/he has been

- 35 -
readmitted within three to seven days of the new admission. In those instances in which the health care records do not arrive at the inmate's facility within forty-eight hours of his/her admission, the receiving facility shall promptly contact the DOC Health Services Office and/or the facility in which the inmate was last confined and request all relevant HIV-related medical information maintained by that office and/or facility about that inmate. Such information shall thereafter be faxed by the DOC Health Services Office or facility to the receiving facility within one business day of the request.
53. All lab work, procedures, and tests performed on an HIV-infected inmate shall be recorded in the inmate's medical record, and as appropriate on the HIV Health Care Summary, Flow Sheet and Treatment Plan Forms. Medications ordered also shall be included and maintained in the medical chart and the medications prescribed and administered reflected on the Treatment Plan and Flow Sheet Forms. The Infectious Disease Specialist shall review, at the appropriate and medicallyindicated frequencies, the reports of HIV-related lab work, procedures and tests and shall document his/her impressions regarding the results and subsequent course of treatment. Unless medically contraindicated, inmates shall be informed within three business days of the results of abnormal lab work and/or tests, and their significance, provided that in the case that there are test results indicating major abnormalities in renal, liver or

- 36 -
kidney function, major electrolyte disturbance, and/or culture results which require immediate institution of antibiotic therapy, the inmate shall be notified within twenty-four hours of DOC's receipt of the test result, unless medically contraindicated. IX. PRESCRIPTION AND ADMINISTRATION OF MEDICATIONS FOR HIV-
INFECTED INMATES. 54. Other than "over-the-counter" medications, medications shall be administered to HIV-infected inmates only by a physician, physician assistant, registered nurse, licensed practical nurse, or other medical staff who have completed the DOC medication training curricula and who otherwise meet state statutory requirements for administration of medication within a DOC facility. 55. The inmate's medical records shall be maintained in such a way that it can be determined what drugs have been ordered for an inmate, by whom, for what purpose, when and in what manner they have been administered and/or offered and refused, the inmate's subjective symptoms or complaints, and any adverse reaction (or lack of response) to the medication. 56. Patient drug profiles and medication administration records shall be maintained for so long as medication is being dispensed and, when not active, shall be kept in the inmate's medical record. 57. No prescription medication may be administered to an HIV-infected inmate without a physician's order. If a physician

- 37 -
is not present at the DOC facility, a registered nurse, LPN, or medic (but only if no RN or LPN is on duty), may relay information to the physician by telephone regarding the inmate's symptoms and condition. If medication is consequently initiated, or changed, by a physician by telephone, a physician must sign the telephone order recorded by the registered nurse, LPN, or medic on. the physician's next working day, but in no event later than forty-eight hours after the verbal order. Telephone orders may not be used to initiate AZT and other medications with potentially deleterious side effects for HIV-infected inmates, except when the inmate arrives in custody while currently receiving such medication (as evidenced either by the inmate's possession of the medication itself or by a current prescription) .
58. An HIV-infected inmate shall not be barred from receiving medication solely by reason of the inmate being unavailable to request and/or obtain the medication at the specified time. Only a member of the medical staff may make the necessary medication dosage adjustments due to a delay in the administration of such medications. X. EMERGENCY KITS
59. The defendant Commissioner shall secure for each DOC facility a standard emergency response kit, which shall include the items described in the attached Exhibit "1", and shall ensure that all standard updates to the kits are secured in a timely

- 38 -
manner. The kits shall be readily available to medical staff but | not to inmates, i.e., they must be stored in a locked room or
area. Emergency drug cassettes in the kit, as well as other kit j contents, shall be inspected after each use of the kit, and at
least monthly by medical staff, to remove deteriorated and outdated drugs and to ensure the completeness of the kit's contents. A list of the kit's contents, and instructions for use as deemed appropriate by the DOC Medical Director, shall be kept in close proximity to the kit.
60. Medical staff shall be appropriately trained in the use of the kits and their contents. XI. DIET FOR HIV-INFECTED INMATES.
61. A nutritional assessment shall be part of the initial comprehensive health assessment specified herein in Section IV.B., supra. All appropriate orders to implement any special dietary plan for the HIV-infected inmate shall be signed by the physician, placed in the inmate's medical record, and transmitted to the kitchen staff. DOC staff shall refer all inmate complaints of noncompliance with special dietary orders to the kitchen staff. Facility kitchen staff shall investigate all such complaints and act promptly to remedy any noncompliance. Complaints about noncompliance about which medical staff becomes aware shall be noted by such staff in the inmate's medical record.

- 39 -
62. Monitoring for special nutritional and dietary needs shall be incorporated in the regular follow-up examinations of each HIV-infected inmate, as specified in SIV.C.25.d and 25.p., supra. As a part of these regular follow-up examinations, the inmate's weight shall be measured, the inmate shall be asked about any loss of appetite and any other change in status which alters the inmate's ability to eat.
63. Medical staff shall inform all HIV-infected inmates (orally and/or in writing) about the importance of a balanced diet and provide them with information about basic nutrition and weight maintenance.
64. If any member of the medical staff learns that an HIVinfected inmate has failed to eat three successive meals for whatever reason, that fact shall be noted in the inmate's medical record and brought to the attention of the physician of the facility and, when medically necessary in the judgment of that physician, the Infectious Disease Specialist.
65. HIV-infected inmates shall be provided with a daily multivitamin pill if medically-indicated.
66. If an HIV-infected inmate develops wasting syndrome or experiences an unintended weight loss of 10% of body weight or more within six months or less, his/her weight shall be monitored with increased frequency and s/he shall be provided with high caloric dietary supplements to the regular institutional diet, if

- 40 -
medically necessary, such as two to three cans of Ensure, Sustacal or comparable supplements.
67. Whenever nutritional supplements and multivitamins have been specially selected to meet the individualized dietary needs of an HIV-infected inmate, they shall be distributed and administered in such a manner as to ensure that the inmate receives such supplements and vitamins. Where determined to be appropriate by the facility physician and/or Infectious Disease Specialist, inmates may be provided with multiple doses of such supplements and/or vitamins for self-administration.
68. If DOC medical staff become aware, through inmate report or a report on an inmate's behalf by non-medical staff, that an HIV-infected inmate is experiencing vomiting and/or diarrhea, that inmate shall be evaluated by medical staff within twenty-four hours of the report to determine the cause of the condition and to make any appropriate adjustments in the inmate's diet. If serious vomiting and/or diarrhea persists for more than three days, notwithstanding the change in diet, a referral shall be made to the physician on call or the Infectious Disease Specialist to be examined at the next regularly scheduled visit, or sooner if medically-necessary.
69. Regardless of the manner in which food is delivered to inmates within an particular DOC facility, DOC shall ensure that specialized diets (including low fat, low fiber, bland, diabetic, soft) are made available to all inmates for whom they are

- 41 -
ordered, including, as needed, nutritionally-equivalent substitutions for those items in the standard inmate diet which are not permitted in any particular specialized diet. XII. MENTAL HEALTH CARE FOR HIV-INFECTED INMATES.
70. All HIV-infected inmates shall be made aware of the availability of mental health services by DOC staff, including those persons who do HIV test counselling, and, upon request, shall be referred to a mental health staff person for further assessment. Mental health services shall be offered to all HIVinfected inmates, who, following assessment by DOC mental health professionals (psychiatrists, psychologists, correctional psychiatric treatment workers and psychiatric nurses) are determined to be in need of such services. HIV-related mental health services shall be provided only by appropriate mental health staff who possess that level of professional training and competence which meets the particular inmate's need for treatment (including psychiatrists, psychologists, Correctional Psychiatric Treatment Workers, psychiatric nurse practitioners, psychiatric nurses, Correctional Treatment Officers, thanatologists, recreation therapists and/or supervised and trained volunteers). A designated facility mental health coordinator shall assign appropriately trained staff to all referrals.
71. The initial comprehensive health history and physical examination of an HIV-infected inmate shall include a basic neurological examination and mental status examination as

- 42 -
required in SIV.B.17, supra, and the findings shall be noted on the examination forms. The medical staff person conducting the comprehensive health history and physical examination shall encourage the inmate to be seen by facility mental health staff for further mental health assessment if such referral is deemed medically necessary. Upon receipt of a referral for mental health assessment, a member of the mental health staff expressly authorized by SXII.70, supra to perform such assessment shall conduct the assessment within five business days of the referral. In the event of any emergency, on-call mental health services shall be available at all times.
72. An individualized written mental health treatment plan shall be developed for each HIV-infected inmate who, after assessment, is determined to be in need of ongoing mental health care. This treatment plan shall be reviewed, approved, and signed by the facility mental health coordinator. The plan shall be reviewed and updated on a regular basis. It shall be maintained as part of the inmate's mental health record.
73. The protocols for the general components of the mental health assessments and mental health treatment plans used with HIV-infected inmates shall be as set forth in Forms F-G, attached hereto and incorporated herein.
74. Mental health staff treating an HIV-infected inmate shall document his/her findings and assessment in the inmate's mental health record, which shall be maintained in such a way as

- 43 -
to protect the confidentiality of the records and as is consistent with the requirements of Conn. Gen. Stat. SS52-146d to 52-146i. All findings relevant to the inmate's medical care shall be reported promptly to the responsible facility physician and, when medically-indicated, to the Infectious Disease Specialist.
75. At least every two weeks, mental health staff for each DOC facility shall review with facility medical staff the status of HIV-infected inmates receiving on-going mental health treatment to ensure the coordination of medical/mental health treatment. A notation that the review took place along with a listing of any recommendations resulting from the review shall be entered in the inmate's medical and mental health files.
76. The DOC has permitted some HIV-infected inmates to participate in HIV support groups in certain facilities. The decision whether and to what extent to permit inmates to participate in such groups depends upon several factors, including the number of inmates requesting participation, the size of the facility, the space limitations of the facility, classification status of the inmate, security concerns of the facility, availability of staff to monitor the meetings, frequency of the meetings, behavior of inmates at the meetings, etc. The DOC will continue to try and accommodate requests for participation in HIV-support groups whenever it is practical to do so upon consideration of the many factors involved. HIV-

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infected inmates shall be advised of the existence of any and all peer support groups within their facility and how to become a part of them. The time and place of any support group's meetings shall be set in such a manner as to protect the privacy rights of the ^inmates involved in the .-group.
77. Each HIV-infected inmate shall be assessed for the presence of AIDS dementia at the time of each follow-up health status examination, see SIV.C.25., supra. XIII. DENTAL CARE FOR HIV-INFECTED INMATES.
78. Dental staff in each DOC institution shall follow universal infection control procedures for all inmates. These procedures shall be consistent with the current infection control procedures for dental treatment established by the CDC, the American Dental Association, and/or the National Institute for Dental Health. There shall be no postponement or delay of dental appointments for HIV-infected inmates solely in order to fulfill special infection control procedures, though appointments may be delayed for valid medical reasons.
79. If the initial health screening and/or comprehensive health examination reveal that an HIV-infected inmate has a painful severe dental condition, including extensive dental caries, severe periodontal disease and/or dental abscess, that ' inmate shall be referred to and examined by the facility dentist within seventy-two hours. If this screening and/or examination reveal such a condition but the inmate is not experiencing pain,

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the inmate shall be referred to and examined by the facility dentist within one week, unless a sooner consultation is medically-necessary. In all other cases, the dentist assigned to each DOC facility shall, within ten weeks of an HIV-infected inmate's admission and/or diagnoses* of HIV infection, examine that inmate. The dentist's examination of the inmate's hard and soft tissues sha.ll include charting the status of each tooth and recording any restorations or dental caries, examining periodontal conditions, looking for abnormalities indicative of HIV infection (e.g. oral hairy leukoplakia, Candida, oral ulcers, oral Kaposi's Sarcoma, and progressive periodontal disease), and conducting panoramic and individual film x-ray examinations as needed.
80. At the conclusion of the dental examination, the dentist shall devise a dental treatment plan for each HIVinfected inmate. The timing of subsequent visits to the dentist shall be determined by that plan. In addition, each HIV-infected inmate with an HIV-related oral condition which is more appropriately treated by the Infectious Disease Specialist shall immediately be referred to him/her., to be seen at the next regularly scheduled Clinic, or earlier if medically appropriate.
81. A platelet count shall be obtained before tooth extraction, periodontal curettage or surgery and biopsy on HIV-infected inmates. HIV-infected inmates upon whom oral surgery is performed shall be instructed on how to handle the gauze used to

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stop bleeding to avert transmission of the virus. When feasible, the inmate shall be held in the medical unit until the wound(s) stop bleeding.
XIV. EYE CARE FOR HIV-INFECTED INMATES.
82. HIV-infected inmates for whom chorioretinitis and/or other HIV-related ophthalmologic complications (e.g. cotton wool spots, CMV retinitis) are suspected shall immediately be referred for an ophthalmology consultation and, if confirmed, shall be provided with treatment (including gancyclovir therapy for retinitis) in accordance with current professional standards for persons with similar ophthalmological complications related to HIV-disease within seven days, or earlier if medically-necessary. XV. ADDITIONAL CRITERIA FOR THE CARE OF HIV-INFECTED WOMEN.
83. HIV-infected female inmates shall be provided with a PAP smear at least once a year. Any abnormal PAP smears shall be investigated aggressively, including with cervical biopsy and appropriate therapy.
84. Cultures for gonorrhea and serology for syphilis shall be taken at the comprehensive health examination, and syphilis serology annually thereafter.
85. HIV-infected inmates who are pregnant shall have absolute CD4 cell counts each trimester. If the absolute count falls to a range associated with a substantial risk of opportunistic infection, consultation shall be obtained and professionally-accepted treatments provided as needed. Gonorrhea

• - 47 -
cultures and chlamydia antigen tests shall be obtained and syphilis serologies drawn in the first and third trimesters of pregnancy for an HIV-infected inmate. Serologic tests for HBsAg shall be obtained no less than once during the pregnancy. If syphilis is diagnosed, treatment shall be provided consistent with professionally-accepted standards of therapy for HIVinfected pregnant women.- Mycobacterium tuberculosis shall be ruled out.
86. HIV-infected pregnant inmates shall be advised of the risk that the fetus may be infected, of the current CDC guidelines regarding breast feeding, and of their rights under P.A. 90-113.
87. HIV-infected inmates shall be advised as a part of any family planning discussion that the intrauterine device is contraindicated and that the latex condom, in conjunction with nonoxyl-9, if used routinely and properly, combines effective contraception with protection against transmission of HIV disease to sexual partners. XVI. DISCHARGE PLANNING.
88. When release or community "transfer planning commences for an inmate, the inmate's counsellor shall notify facility medical staff of the anticipated release or transfer date.
89. Facility medical staff shall prepare a Discharge Packet for each HIV-infected inmate who has a medical complication requiring ongoing medical care or follow-up which shall include a

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copy of the Inter-Agency Patient Referral Report Form ("W10") (Form D ) , the Termination/Transfer Summary Form (Form E) and the Authorization for Release of Information Form (Form H ) . The information which is provided in this Discharge Packet includes all current diagnoses, current problems, the treatments which have been provided and the inmate's response to treatment, complications noted,•- allergies noted, description of condition on discharge, and any followup instructions.
90. If given at least five to ten days notice of the inmate's discharge from a DOC institution, facility medical staff will schedule an exit interview with any HIV-infected inmates who have a medical condition requiring ongoing medical care or follow-up to discuss health maintenance, complete the Discharge Packet forms and inform the inmate where outside health care can be obtained and how to arrange for it. The name, address, and telephone number of appropriate outside health care providers will be included on the W10 form, and the inmate will be instructed to contact the appropriate community provider upon his/her release.
91. At the time an inmate is discharged from a DOC institution, a copy of the complete Discharge Packet forms will be placed in the inmate's medical file, a copy shall be offered to the inmate, and a copy shall be forwarded to the DOC Director of Community Health Services. If the inmate gives appropriate

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authorization, a copy shall be sent to the inmate's outside medical provider.
92. If an HIV-infected inmate is on prescribed medication(s), the remaining portion of the prescription, up to a fourteen day supply, will be dispensed to the inmate at the time of discharge from a DOC institution. The inmate will be encouraged to apply immediately for any appropriate medical benefits available in the community.
93. If the facility medical staff believe that an HIVinfected inmate will require home health care upon discharge, the local Visiting Nurse Association or community home care agency will be listed on tha W10 form. In such cases, with the inmate's authorization, the DOC medical staff will notify the agency of the inmate's discharge and provide the agency with a copy of the Discharge Packet forms.
94. When the inmate authorizes release of HIV related information to his/her family and the inmate's medical condition upon discharge requires family involvement, the DOC medical staff shall make reasonable efforts to make contact with the inmate's family to assist in the discharge planning process.
95. In the event that an HIV-infected inmate who has a medical condition requiring ongoing medical care or followup is discharged from a DOC institution with less than five to ten days notice to DOC medical staff, the facility medical staff shall be notified of the inmate's discharge within two business days of

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the discharge. In such cases, the facility medical staff shall complete the Discharge Packet forms and forward them to the DOC Director of Community Health Services within two days of the date they were notified of the inmate's discharge. The DOC Community Health Services staff shall make all reasonable efforts to contact the inmate to discuss health maintenance, inform the inmate where outside health care can be obtained and offer the inmate a copy of the Discharge Packet forms and the inmate's HIV treatment plan.
96. The provisions of this Section XVI do not apply to pretrial detainees, with the very limited exception that those persons confined within DOC as detainees for a sufficient period of time to complete the HIV assessment and receive an HIV treatment plan shall be mailed or otherwise provided with, upon their request and within three business days of it, a completed W10 and a copy of their HIV treatment plan.
97. When an HIV-infected inmate's medical condition renders him/her unable to participate in medical discharge planning, facility medical staff shall arrange an initial medical consultation in the community and notify the inmate (and, with his/her authorization, notify his/her family) of the time and place of said consultation.
98. Medical providers supplying health care to HIV-ihfected persons who have been in DOC custody shall be provided with copies of those portions of the DOC health care records which

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they request of DOC within seven working days of the providers' request, provided that the inmate has signed an appropriate release of information form.
99. Upon diagnosis of HIV disease within DOC, an inmate shall be offered a list of community resources for HIV-infected persons so that the inmate may initiate contact with them in anticipation of his/her release. XVII. HOUSING OF SYMPTOMATIC HIV-INFECTED INMATES.
A. Chronic Care Ward at Connecticut Correctional Institution at Niantic. 100. Female HIV-infected inmates, including those
currently housed at the Connecticut Correctional Center at Niantic, who are experiencing a level of chronic disease which requires continuous medical observation, supervision, and/or care which, if they were male inmates, would warrant their being housed in the Chronic Care Ward at -the Connecticut Correctional Institution at Somers (or a like facility), shall be provided— either within the medical unit at CCIN or any other woman's DOC facility or at an outside in-patient facility — with health care comparable in its quality to that now provided to male inmates with comparable medical conditions housed on Somers' Chronic Care Ward as a result of the Consent Judgment entered in Smith v. Meachum, Civ. No. H87-221 (JAC). The term "health care of comparable quality" as used in this section shall not be interpreted to require identical medical charting procedures for male and female inmates.

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B. Skilled Nursing Facility and Health Related Facility Beds. 101. In the event that the Connecticut Department of
Health Services or any other state agency should conduct a study to determine the Skilled Nursing Facility and/or hospice bed needs of HIV-infected persons in the State of Connecticut, DOC agrees to cooperate with such a study so that the needs of the DOC inmate population can be included in projections regarding the need for skilled nursing facility beds and/or hospice beds.
C. Medical Unit Beds. 102. HIV-infected inmates shall be housed in a setting
which meets their medical needs. For example, if inmates with HIV- infection do not require hospitalization but require frequent observation by a RN and/or are unable to walk to meals, they shall be housed, depending on their level of medical need, in an infirmary setting which meets the standards established by DOC for Transitional Units or Infirmary I, in its April 1989 "Proposal for the Reorganization of Health Services Within the DOC." Receipt of AZT and other HIV-related medications is not sufficient cause alone for placement in a facility infirmary/medical unit. The numbers of inmates in the facility's infirmary/medical unit shall not be so numerous as to compromise the medical care provided to the HIV-infected inmates housed therein.
103. HIV-infected inmates housed in an infirmary setting shall be visited by the facility physician three to four

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times each week, or more frequently if medically-indicated, for an interval history and examination and, when needed, for ordering additional laboratory tests and changes in medication. The physician shall write a note about each visit in the inmate's medical record.
104. HIV-infected inmates housed in an infirmary setting shall be visited no less than once each shift by nursing staff, who, if the inmate is awake, shall take the inmate's vital signs and speak with the inmate about the inmate's condition. Appropriate notes shall be made in the inmate's medical record.
105. HIV-infected inmates housed in an infirmary setting shall be examined by the Infectious Disease Specialist weekly, or more frequently if medically-indicated. Appropriate notes shall be made in the inmate's medical record regarding the examination.
106. A call button system (or alternative, comparably effective device or procedure for notifying medical staff of the need for care) shall be implemented in all medical unit/infirmary rooms in which symptomatic HIV-infected inmates are housed. When the patient is non-ambulatory, access to the call button or alternative system shall be provided. Nothing in this paragraph shall be construed as prohibiting the restriction or removal of the call button for individual security reasons or because of misuse by the inmate, provided that if the call button is removed

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or restricted, an alternative, comparable means of access to medical care shall be provided to the inmate.
107. HIV-infected inmates who are in respiratory distress, but not in need of in-patient hospitalization in a community hospital, shall be housed in an appropriate room or facility, where the temperature can be maintained at between sixty-eight and eighty degrees Fahrenheit. Temperature charts shall be maintained daily for this room or facility.
108. Non-ambulatory HIV-infected inmates will be provided access to the visiting area by wheelchair or stretcher or allowed visitation in a private room.
109. HIV-infected inmates housed in an infirmary/ medical unit shall be afforded opportunities for visitation, institutional programs, and activities comparable to that afforded to other inmates in the same infirmary/medical unit, unless participation is contraindicated for medical reasons or for legitimate security concerns unrelated to HIV status. Restrictions on participation in visitation programs and other activities may not be based solely on the fact that an inmate is HIV-infected or on unfounded fears of transmission of HIV among other inmates. XVIII. STAFF EDUCATION.
110. The Department of Correction will provide to all of its employees a minimum of one hour of training annually on HIVrelated subjects. This training will be provided by health

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services personnel or by others (teachers, counselors, training officers, etc.) with specific training in HlV-related subjects. This training will be reviewed no less than annually and revisions will be made as appropriate based on new medical and epidemiological information. Additionally, the basic orientation training for correctional officers and correctional treatment officers who are not responsible for providing mental health care will address at least the following issues:
a. a description of the various health and counseling services available for HIV-infected inmates at the facility and in the community;
b. a summary of information needed to access services in the facility;
c. what HIV is, and how it is and is not transmitted; d. the various diseases, infections, and physical and behavioral conditions for which HIV-infected persons are at increased risk; e. a description of the HIV antibody test and its limitations; f. infection control practices, including the use of mouthpieces for CPR; g. the need to avoid disclosure of confidential HIV related information as required by Public Act 89-246. 111. All medical and mental health staff (including correctional treatment officers providing mental health services)

- 56 -
in DOC facilities shall receive in-service training for at least six hours every year regarding medical/mental health issues affecting HIV-infected inmates. The term "in-service training" as used herein shall not be construed to include training provided through staff meetings and supervision. This training shall be designed to update and supplement the prior training and experience of DOC medical and mental health staff persons and will include new medical and mental health information in the areas of cause, symptoms, assessments, treatments, nutrition, etc. These training sessions shall be conducted by persons with particular experience and/or training in the management of HIVdisease including physicians, RNs, psychologists, psychiatrists, social workers, nutritionists, etc. Further supplementary training shall be conducted whenever it is deemed necessary by the DOC Director of Health Services. The provisions of this section do not apply to medical and mental health professionals under contract with DOC to provide specialized services (e.g. radiology, surgery, neurology, etc) to the inmate population.
112. Newly hired medical and mental health staff shall be provided with eight hours of introductory training on the medical and mental health implications of HIV disease and the requirements of this Judgment to ensure that they possess an understanding of the disease, its manifestations, and medicallyappropriate responses to it. Depending upon the immediacy of the medical staffing needs of a particular facility, DOC shall make

- 57 -
its best efforts to complete this training within two months of the date of hire, but in no event shall training be completed later than four months after the date of hire.
113. DOC shall maintain a record of compliance with the training requirements of this Judgment which shall document/ for each member of the DOC staff, the date and number of hours of HIV-reiated training, the subject of the training and the name of trainer. These training records shall be available for review by plaintiffs' counsel and the Agreement Monitoring Panel. XIX. STAFFING
114. The Department of Correction shall make good faith efforts to provide for one or more Infectious Disease Specialists to be available "on call" for twenty-four hour telephone consultation. The DOC shall maintain sufficient medical and mental health staff (including Infectious Disease Specialists as defined in II.A, supra) to carry out all of the provisions of this Judgment. XX. QUALITY ASSURANCE
115. Within three months after judicial approval of this Consent Judgment, the Director of Health Services of DOC shall designate a medical department staff member and a mental health department staff member as a Quality Assurance Unit to implement an Infectious Disease Quality Assurance Program. These staff persons will have training and experience in the management of HIV disease and receive special training on the requirements of

- 58 -
this Judgment. The Quality Assurance Program will include a random review of the health care records of HIV-infected inmates, a review of the Medical Incident Report (Form I) and Mortality Review Form (Form K) for HIV-infected inmates, and site visits in order to ensure that the medical and mental health care provided to HIV-infected inmates is adequate. The Program shall conduct focused, outcome-oriented longitudinal reviews, using appropriate samplings of inmate records, regarding specific disease complications of AIDS, such as, but not limited to, reviews of the length of time inmates remain alive after diagnosis and the treatment outcomes of inmates who have HIV-related opportunistic infections.
116. The Quality Assurance Unit will randomly select and review each month the medical/mental health records of no fewer than thirty HIV-infected inmates, pursuant to the criteria enumerated in a Comprehensive Chart Review Screening Criteria Form (Form L ) . The Comprehensive Chart Review Screening Criteria Form shall be developed by the DOC Director of Health Services within thirty days of the approval of this Judgment, submitted to plaintiffs' counsel for review and comment, and thereafter implemented within thirty days and made a part of this Judgment as Form L. The Comprehensive Chart Review Screening Criteria Form will be dated and signed by the medical and mental' health members of the Quality Assurance Unit upon their completion of the review of each set of records.

-sail?. The members of the Quality Assurance Unit shall schedule their site visits to assure that each facility is visited at least once every three months. The site visits shall include the record review specified in SXX.116/ supra and a review of the tickler system specified in §V.3O, supra. 118. Either or both members of the Quality Assurance Unit shall discuss any problems or inadequacies noted during the course of these site visits and record reviews with the medical/ mental health department staff members involved, and shall devise a plan of correction, which may include referral of the issue to the DOC Director of Health Services. 119. The Director of Health Services of DOC shall complete a Mortality Review Form, attached hereto as Form K, whenever an HIV-infected inmate dies while in the custody of DOC, either in a DOC correctional facility or at an outside hospital. This review shall be based on the DOC health care records as well as on available hospital medical records. The Director of Health Services may consult with members of the facility's medical or mental health staff, if necessary, and shall make specific comments and document all action taken on the form. The Director of Health Services shall discuss any problems noted with appropriate staff members. 120. A Medical Incident Report Form, attached hereto as Form I, shall be completed by each medical department staff person involved in or witnessing an incident of omission or

- 60 -
commission which results in the administration of health care that deviates in any way from the accepted professional standards of care required for HIV-infected inmates. The Medical Incident Report shall be signed by the person preparing the report, and shall be sent to the Medical Director of the facility. Action taken in response to the incident shall be documented and retained, as well as documentation regarding any follow-up indicated by the Medical Director. The Medical Director shall review each report, and when indicated, will fill out the Followup to Medical Incident Report, attached hereto as Form J.
122. The Mortality Review Forms shall be retained by the Director of Health Services for DOC. The Medical Incident Report Forms shall be retained by the medical directors of the various DOC facilities. The Comprehensive Chart Review Screening Criteria Forms shall be retained by the Quality Assurance Unit. XXI. CONFIDENTIALITY
123. DOC staff, and inmates whose job responsibilities potentially expose them to HIV-infection, shall follow universal blood and body fluid precaution standards as established by the DOHS, CDC, and the Occupational Safety and Health Administration (OSHA), and shall be provided with all necessary materials to do so.
124. DOC staff shall conform their conduct to the various requirements of P. A. 89-246, including its non-disclosure provisions. In the event that Public Act 89-246 is repealed or

- 61 -
amended, the plaintiffs shall be permitted, as a part of this action, to challenge whatever actions DOC staff might take in response to such repeal or amendment. XXII. MONITORING OF CONSENT JUDGMENT
125. An Agreement Monitoring Panel ("AMP") shall be established to monitor the provisions of this Consent Judgment.
126. The AMP shall consist of three persons who shall be appointed by the Court within three weeks of judicial approval of this Judgment: a physician with an expertise in infectious disease chosen by the defendants, a physician with an expertise in infectious disease chosen by the plaintiffs, and a mental health expert with experience with. HIV-infection chosen by a consensus of those persons already selected. Should one or more of the originally-designated members of the AMP be unable to serve the full duration of the AMP, replacements shall be made in the same manner as the original members were chosen. Either party may replace its AMP member with judicial approval.
127. The members of the AMP shall submit on a monthly basis to defendants' counsel (with a copy to plaintiffs' counsel) their requests for payment of fees and expenses incurred in monitoring this Consent Judgment. Defendants' counsel shall review said requests within ten days of receipt and promptly submit an Order for Payment of all non-disputed portions of the requests to the Court. The members of the AMP shall be paid by the State of Connecticut for all non-disputed portions of their request for

- 62 -
payment within thirty days of their receipt of the Court Order. Disputed portions of any requests shall be referred to the Court for resolution in whatever fashion the Court deems appropriate. The fee shall not exceed $20,000.00 per panel member per year for any and all services rendered, excepting for any payments which may be ordered ? by the Court for services rendered for their participation iri contempt and other proceedings related to noncompliance. The hourly rate of each member of the AMP shall be reasonable and set by a separate Court Order. The expenses incurred by the AMP shall be only those reasonable necessary to carry out their functions under this Judgment. If the Panel remains in operation for longer than three years, Panel members shall be permitted to make application to the Court for an appropriate cost of living increase in the fees awarded. Defendants agree to represent and to hold harmless to the same extent as State employees the members of the AMP in any litigation initiated by third parties involving the AMP in its performance of its duties under this Judgment.
128. The AMP shall devise procedures for the monitoring of this Judgment which shall include on-site inspections of the •facilities. Defendant's representative may, at his election, give two days prior notice to defendants of any intended inspection. During their inspections, the panel shall have access to all medical and mental health records of HIV-infected inmates, including, without limitation, such records when obtained from

- 63 -
third parties such as outside hospital records. All quality assurance forms specified in this Judgment shall be made available.
129. The AMP shall provide its first monitoring report four months after judicial approval of this Consent Judgment. The second and third reports shall be provided four and eight months later, respectively. In the second year of the Judgment, the AMP shall provide a monitoring report every six months, and in subsequent years once yearly on the anniversary date of the approval of the Judgment. AMP monitoring reports shall be provided to the Commissioner of DOC, counsel for the parties, and the Court. In preparing for these reports, the members of the AMP shall conduct such on-site inspections and review of records as they deem necessary in order to perform their monitoring function.
130. In monitoring this Judgment, the AMP shall focus on patterns of compliance and noncompliance, as well as on individual cases of substantial deviation from the standard of care provided herein.
131. Upon request, the AMP shall have access within two days to all policies, records, procedures and files at each institution relevant to medical and mental health treatment of HIV-infected inmates, as well as access to all staff and consulting physicians with respect to such medical and mental health treatment. During their inspection, the panel shall be

- 64 -
permitted to conduct interviews with HIV-infected inmates, provided each inmate consents. The AMP shall be provided with copies of any new and/or revised DOC written protocols and policies pertaining to the delivery of medical and mental health care to HIV-infected inmates.
132. The DOC shall file written compliance reports on the same schedule as the AMP, as set forth in SXXII.129, supra. These written Compliance Reports shall list and include all blank forms and protocols developed pursuant to this Judgment since the preceding such Compliance Report, to the extent they have not already been provided to the AMP under the preceding section. A description of HIV-related activities undertaken by DOC, including staff training, shall also be included in these reports. The first of the reports shall include staffing summaries (name, position, shifts worked) for DOC's health care staff who perform tasks under this Judgment and the names, professional degrees and licenses of physicians. These reports shall be provided to the Court and counsel for the parties.
133. Nothing contained in this "Monitoring" section shall be deemed to interfere with or alter any monitoring arrangements made pursuant to judicial rulings or decrees in other actions; rather, these provisions are in addition to any other such monitoring arrangements.
134. When the defendants believe in good faith that they have fully and faithfully implemented the provisions of this

- 65 -
Consent Judgment in their entirety and have been in substantial compliance for a period of one year, defendants may move that some or all of the monitoring and reporting requirements of this Judgment be discontinued; provided that no such motion may be filed prior to twenty-four months from the date this Consent Judgment is judicially approved and defendants must give ninety days advance notice of their intention to file such a motion. Discontinuance of the monitoring and reporting requirements of this Judgment will be granted unless, within thirty days after receipt of defendants' motion, plaintiffs file an objection. If such objection is filed, the Court shall hold a hearing on the motion, and the burden will be on the defendants to demonstrate that they have faithfully implemented all provisions of this Consent Judgment and maintained substantial compliance with them. Nothing in this section shall be construed to preclude the reinstitution of some or all of the monitoring and reporting requirements of this Judgment upon a subsequent showing by plaintiffs of noncompliance with this Judgment and plaintiffs' counsel shall be allowed to investigate allegations of non-compliance. XXIII. GENERAL PROVISIONS
135. Should two or more members of the AMP assert a claim of noncompliance with the terms of this Judgment, the AMP shall make a report to the parties concerning the claim(s) of noncompliance and recommendations to remedy it (with, if necessary, a minority report). In the event a dispute should

- 66 -
arise concerning compliance with this Judgment and appropriate remedial action which cannot be resolved between the AMP or the parties in a timely fashion, a party may request a status hearing with a Settlement Judge or Magistrate. If neither is available, the Chief Judge shall appoint another Judge or Magistrate to resolve the dispute. If any dispute, issue or matter is not resolved by the Settlement Judge or Magistrate, that issue or matter shall be referred to the Trial Judge for adjudication pursuant to any proceeding which the Trial Judge shall deem feasible. At any such proceeding, the members of the AMP may be called as a witness by a party or the Judge.
136. This Consent Judgment satisfies and resolves the claims of the plaintiffs and the plaintiffs' class for injunctive and declaratory relief in the above-entitled case as of the date of judicial approval of this Consent Judgment. Plaintiffs and members of their class shall be permitted to opt out of the class for purposes of preserving their claims for monetary relief only.
137. The parties recognize that this Consent Judgment does not address future changes in recommendations and standards regarding medical/mental health care for HIV-infected persons. The plaintiffs reserve the right as a part of this litigation to initiate judicial proceedings to alter the provisions of this Judgment in light of such changed recommendations and/or standards for HIV care. Should the plaintiffs at any time

- 67 -
initiate such further proceedings seeking to have the defendants comply with what they perceive to be changed accepted professional standards, the burden shall be on the plaintiffs to show that the defendants' failure to adopt such changes constitutes a violation of the plaintiffs' constitutional rights. In the event of any such future judicial proceedings, neither party waives their right to appeal any final ruling or order of the Court, nor do plaintiffs waive their right to seek their costs and attorneys' fees in connection with such proceedings. The plaintiffs shall give the defendants thirty days notice prior to initiating any such proceedings.
138. This Consent Judgment may be modified by the mutual agreement of all parties. The AMP may not, without the express consent of all parties to the Judgment, alter, amend or change the provisions of the Judgment. The Court shall be notified in writing of all such modifications, but need not approve such modifications.
139. The provisions of this Consent Judgment may be suspended or modified in part or in its entirety if the Commissioner, Warden, or person next in command in his/her absence, determines that a "genuine emergency" exists at a specific DOC facility or any portion thereof. Genuine emergency means any special circumstances, or combination thereof, under which it is reasonable to conclude that there is any actual or presumptive threat to (a) either the security and order of the

- 68 -
specific DOC facility or any portion thereof, or to (b) the safety of the staff, inmates, or other person within that facility. If a "genuine emergency" lasts longer than twelve hours or recurs once or more in a one week period, defendants shall report to plaintiffs' counsel, within forty-eight hours except for good cause, the date of the emergency, the nature of the emergency, and what provisions of the Consent Judgment were suspended and/or modified and how they were suspended and/or modified. Current population levels and population increases alone shall not constitute a "genuine emergency". Plaintiffs may contest the emergency action by motion for relief directed to the Court.
140. Nothing contained in this Judgment shall be deemed to reduce the requirements and obligations imposed on DOC by the terms of prior, judicial rulings, decrees, and consent judgments in other actions. XXIV. NOTICE TO CLASS
141. Notice to the plaintiff class members of this Consent Judgment shall issue pursuant to the notice provisions approved by the Court, and shall inform plaintiffs and members of their class of their opportunity to opt out for purposes of preserving their claims for damages. XXV. COSTS AND ATTORNEYS' FEES
142. Plaintiffs' counsel shall submit their request for costs and attorneys' fees within thirty days of the signing of

- 69 -
this Judgment. Said request shall not exceed $130,000. Any disputes concerning this request shall be submitted to the Court for a final ruling. Payment of plaintiffs' request shall constitute full and complete satisfaction of any and all costs, fees and expenses, including experts' and attorneys' fees, of any kind up to and including the date of the signing of this Judgment by counsel.
WHEREFORE, in consideration of the foregoing provisions the parties respectfully request that the Court approve and adopt the Consent Judgment as being fair, reasonable, and adequate.

- 70 -

THE DEFENDANTS Larry Meachum, et al.

THE PLAINTIFFS David Doe, et al.

^»aj.i.j Yteachum, commissioner Connecticut Department of
Correction J0~~3/—fo 340 Capitol Avenue Hartford, CT 06106

BY: Shelley Geballe Connecticut Civil Liberties
Union Foundation 32 Grand Street Hartford, CT 06106

CLARINE NARDI RIDDLE ATTORNEY GENERAL

Richard Couture Assistant Attorney General MacKenzie Hall 110 Sherman Street Hartford, CT 06105

BY: Joftn) L. PottengerP Jerome N. Frank Legal Services Organization Box 401-A Yale Station New Haven, CT 06520

BY:

j

Steven S t r o m /

Assistant Attorney General

MacKenzie Hall

110 Sherman Street

Hartford, CT 06105

BY: Martha Stone Connecticut Civil Liberties Union Foundation 32 Grand Street Hartford, CT 06106

Dated at New Haven, Connecticut, this 1990.

day of December,

Joan Glazer Margolis United States Magistrate

So Ordered and Approved:

Jose A. Cabranes United States District Judge

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

FILED

IN RE CONNECTICUT PRISON OVERCROWDING AND AIDS CASES
DAVID DOE, ET AL.

Master File No.

'30

u.s. c;:.r"

NEW hii'

V.
LARRY R. MEACHUM, ET AL.

Civil No. H-88-562 (PCD) (JGM)

ORDER

The consent Judgment on Health Care for HIV-lnfected

Inmates and Confidentiality of HIV-Related Information (filed

Nov. 2, 1990) ("Consent Judgment") having been approved by

United States Magistrate Joan Glazer Margolis, following notice

to interested parties, an evidentiary hearing held on December

4, 1990, and a review of the comments of all concerned, and the

proposed Consent Judgment having been independently reviewed by

me in light of the full record of this case and related cases,

the proposed Consent Judgment is hereby approved and entered.

If and when any questions arise between the parties

regarding implementation of paragraph 142 (Costs and Attorneys'

Fees), those questions shall be, and are hereby, referred to

Magistrate Margolis. Any appeal to a district judge from a

determination by Magistrate Margolis on any such question

(only) shall be referred to Judge Alan H. Nevas, who has

consented to this referral if and when it is appropriate or
i*.

^t«ce8sary/v;.^:.-:••••:;.'•

"" -• • • : • ' / ' - ^ : v : ~ " > - ':;

s o o r d e r e d . • ' '.-

• '

'. -v-- ": . . ^ ^ v ^ - v y ^ v . ;

-~<r

New Haven, Connecticut"this 6th day of December, ,^^

Jose A. Cabranes -?.^-J> ed States District Judgevj

 
 U.S. District Court District of Connecticut (Hartford) CIVIL DOCKET FOR CASE #: 2:88−cv−00562−JGM

CLOSED

Doe, et al v. White, et al Assigned to: Judge Joan G. Margolis Demand: $0 Cause: No cause code entered
Plaintiff
David Doe

Date Filed: 08/15/1988 Date Terminated: 04/26/1994 Jury Demand: None Nature of Suit: 550 Prisoner: Civil Rights Jurisdiction: Federal Question
represented by Brett Dignam Morningside Heights Legal Services, Inc. 435 West 116th Street − Room 831 New York, NY 10027 212−854−4291 Fax: 212−854−3554 Email: bdigna@law.columbia.edu TERMINATED: 08/13/2010 LEAD ATTORNEY ATTORNEY TO BE NOTICED
David J. McGuire American Civil Liberties Union − CT 765 Asylum Ave., 1st Floor Hartford, CT 06105 860−523−9146 Ext. 212 Fax: 860−586−8900 Email: dmcguire@acluct.org TERMINATED: 12/08/2016 LEAD ATTORNEY ATTORNEY TO BE NOTICED
J. Livingston Pottenger , Jr. Jerome N. Frank Legal Services Organization Yale Law School PO Box 209090 New Haven, CT 06520−9090 203−432−4800 Fax: 203−432−1426 Email: j.pottenger@yale.edu LEAD ATTORNEY ATTORNEY TO BE NOTICED
Jonel Newman Connecticut Civil Liberties Union Foundation 32 Grand St. Hartford, CT 06106 860−247−9823 TERMINATED: 08/02/1996 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Martha Stone Center for Children's Advocacy, Inc UCONN School of Law 65 Elizabeth St. Hartford, CT 06105−2290 860−570−5327 Fax: 860−570−5256

Plaintiff Ernest Hoe

Email: mstone@kidscounsel.org TERMINATED: 02/16/1999 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Philip D. Tegeler Poverty & Race Research Action Council 1015 15th St. NW #400 Washington, CT 20005 202−360−3906 Email: ptegeler@prrac.org TERMINATED: 08/31/2010 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Shelley D. Geballe 19 Flying Point Rd. Stony Creek, CT 06405 TERMINATED: 12/08/2016 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Dan Barrett American Civil Liberties Union − CT 765 Asylum Ave., 1st Floor Hartford, CT 06105 860−471−8471 Email: dbarrett@acluct.org ATTORNEY TO BE NOTICED
represented by Brett Dignam (See above for address) TERMINATED: 08/13/2010 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Dan Barrett (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
David J. McGuire (See above for address) TERMINATED: 12/08/2016 LEAD ATTORNEY ATTORNEY TO BE NOTICED
J. Livingston Pottenger , Jr. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Jonel Newman (See above for address) TERMINATED: 08/02/1996 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Philip D. Tegeler (See above for address) TERMINATED: 08/31/2010 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Plaintiff Terry Toe
Plaintiff Sammy Low

Shelley D. Geballe (See above for address) TERMINATED: 12/08/2016 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Brett Dignam (See above for address) TERMINATED: 08/13/2010 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Dan Barrett (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
David J. McGuire (See above for address) TERMINATED: 12/08/2016 LEAD ATTORNEY ATTORNEY TO BE NOTICED
J. Livingston Pottenger , Jr. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Jonel Newman (See above for address) TERMINATED: 08/02/1996 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Martha Stone (See above for address) TERMINATED: 02/16/1999 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Philip D. Tegeler (See above for address) TERMINATED: 08/31/2010 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Shelley D. Geballe (See above for address) TERMINATED: 12/08/2016 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Brett Dignam (See above for address) TERMINATED: 08/13/2010 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Dan Barrett (See above for address) LEAD ATTORNEY

Plaintiff Mary Moe

ATTORNEY TO BE NOTICED
David J. McGuire (See above for address) TERMINATED: 12/08/2016 LEAD ATTORNEY ATTORNEY TO BE NOTICED
J. Livingston Pottenger , Jr. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Jonel Newman (See above for address) TERMINATED: 08/02/1996 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Martha Stone (See above for address) TERMINATED: 02/16/1999 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Philip D. Tegeler (See above for address) TERMINATED: 08/31/2010 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Shelley D. Geballe (See above for address) TERMINATED: 12/08/2016 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Brett Dignam (See above for address) TERMINATED: 08/13/2010 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Dan Barrett (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
David J. McGuire (See above for address) TERMINATED: 12/08/2016 LEAD ATTORNEY ATTORNEY TO BE NOTICED
J. Livingston Pottenger , Jr. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Jonel Newman (See above for address) TERMINATED: 08/02/1996 LEAD ATTORNEY

V.
Defendant
White, Thomas, Dep. Comm., Ct Dept. Of Corrections, I/o

ATTORNEY TO BE NOTICED
Martha Stone (See above for address) TERMINATED: 02/16/1999 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Philip D. Tegeler (See above for address) TERMINATED: 08/31/2010 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Shelley D. Geballe (See above for address) TERMINATED: 12/08/2016 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Michael J. Lanoue Attorney General's Office Public Safety & Special Revenue MacKenzie Hall, 110 Sherman St. Hartford, CT 06105 860−808−5450 Fax: 860−808−5591 Email: michael.lanoue@po.state.ct.us LEAD ATTORNEY ATTORNEY TO BE NOTICED
Richard T. Couture Attorney General's Office Public Safety & Special Revenue MacKenzie Hall, 110 Sherman St. Hartford, CT 06105 860−808−5450 Fax: 860−808−5591 Email: richard.couture@po.state.ct.us TERMINATED: 06/15/2009 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Stephen J. O'Neill Attorney General's Office Public Safety & Special Revenue MacKenzie Hall, 110 Sherman St. Hartford, CT 06105 860−808−5450 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Steven R. Strom Office of the Attorney General 110 Sherman Street Hartford, CT 06105 860−808−5450 Fax: 860−808−5591 Email: steven.strom@ct.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Blanchette, Edward, Md, Medical Dir., Cci, Somers, I/o
Defendant McMahon, James, Rn, Asst To Dir., Health Services, I/o

Terrence M. O'Neill Attorney General's Office 110 Sherman St. Hartford, CT 06105 860−808−5450 Fax: 860−808−5591 Email: terrence.oneill@ct.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Michael J. Lanoue (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Richard T. Couture (See above for address) TERMINATED: 06/15/2009 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Stephen J. O'Neill (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Steven R. Strom (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Terrence M. O'Neill (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Michael J. Lanoue (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Richard T. Couture (See above for address) TERMINATED: 06/15/2009 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Stephen J. O'Neill (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Steven R. Strom (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Terrence M. O'Neill (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Meachum, Larry, Comm. Of Corrections
Movant Raymond Alvarez Interested Party John Michael DiNunzio

represented by Michael J. Lanoue (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Richard T. Couture (See above for address) TERMINATED: 06/15/2009 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Stephen J. O'Neill (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Steven R. Strom (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Terrence M. O'Neill (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Raymond Alvarez #59645 Osbourne Correctional Inst, P.O. Box 100 Somers, CT 06071 PRO SE
represented by John Michael DiNunzio D.O.C # 221724 Brooklyn Correctional Inst. 59 Hartford Road Brooklyn, CT 06234 PRO SE

Date Filed 09/06/1988 08/05/1991
12/10/1991 12/26/1991 12/31/1991 01/06/1992

# Docket Text
7 ORDER REFERRING CASE to Magistrate Judge Joan G. Margolis ( signed by Judge Jose A. Cabranes ) (Graham, T.) (Entered: 12/11/1991)
253 MOTION by Terry Toe, Mary Moe, Sammy Low, Ernest Hoe, David Doe for injunctive relief and enforcement of judgment (Brief Due 8/26/91 ) (Graham, T.) (Entered: 12/11/1991)
270 NOTICE of Filing of Third Compliance Report by White, McMahon, Blanchette (Moore, P.) (Entered: 12/12/1991)
271 LETTER dated 12/17/91:Third Agreement Monitoring Panel (AMP) Report fld by Doctors Belitsky, Blanchette and Cohen. (Former Employee) (Entered: 12/27/1991)
274 ORDER the State of Ct shall pay Dr. Belitsky the sum of $7,457.35. ( signed by Mag. Judge Joan G. Margolis ) (Moore, P.) (Entered: 04/24/1992)
272 LETTER dated 12/26/91 to JGM from Dr. Blanchette re: Supplement to Third Agreement Monitoring Panel Report. (Moore, P.) (Entered: 01/24/1992)

02/05/1992 03/19/1992
06/01/1992 07/02/1992 07/02/1992 09/21/1992 09/21/1992 09/22/1992 01/04/1993
05/10/1993
08/10/1993 09/23/1993
10/07/1993
04/26/1994
04/26/1994 05/06/1994 05/06/1994

273 ORDER that the State of CT reimburse the Court Monitor for services as reflected in Dr R. Cohen's bill of 1/20/92 the sum of $2,151.00 (signed by Magistrate Judge Joan G. Margolis ) (Moore, P.) (Entered: 02/06/1992)
ENDORSEMENT withdrawing for clerical purposes & w/o prej to any future application purs to the phone conversation with chambers today [253−1] motion for injunctive relief and enforcement of judgment ( signed by Judge Jose A. Cabranes ) (Moore, P.) (Entered: 03/19/1992)
275 ORDER. The St of CT shall pay forthwith Dr.Robert L. Cohen the sum of $2,786.00. See Order for details. ( signed by Mag. Judge Joan G. Margolis ) (Moore, P.) (Entered: 06/03/1992)
276 NOTICE of filing of Fourth Compliance Report by White, McMahon, David Doe (Moore, P.) (Entered: 07/02/1992)
277 COMPLIANCE REPORT (Moore, P.) (Entered: 07/02/1992)
278 ORDERi, the State of CT shall pay forthwith Dr. Robert L. Cohen the sum of $2,030.00. See Order for details. ( signed by Mag. Judge Joan G. Margolis ) (Moore, P.) (Entered: 09/23/1992)
279 ORDER the State of CT shall pay forthwith Dr. Richard Belitsky the sum of $8,250.00. See Order for details. ( signed by Mag. Judge Joan G. Margolis ) (Moore, P.) (Entered: 09/23/1992)
280 FOURTH AGREEMENT MONITORING PANEL REPORT (Moore, P.) (Entered: 09/24/1992)
281 ORDER: Pursuant to Consent Jgm of 11/2/90 & Court's Rlg setting Hourly Rate for Agreement Monitoring Panel, dated 5/9/91, it is hereby ordered that the State of Ct. shall reimburse the Court appointed monitor for svcs from 2/28/91 to 12/17/91 as reflected in bill submitted by Dr Blanchette. State of Ct. shall pay forthwith Dr. Blanchette sum of $16,750. ( signed by Mag. Judge Joan G. Margolis ) (Jefferson, V.) (Entered: 01/06/1993)
282 ORDER: Pursuant to Consent Jgm of 11/2/90 & Court's Ruling setting Hrly Rate for Agreement Monitoring Panel, it is hereby ordered that State of Ct. reimburse the Court appointed monitor for services rendered from 3/4/93−4/8/93 as reflected in the bill submitted by Dr. Cohen. State of Ct. shall pay forthwith Dr. R. Cohen sum of $5,084.25. ( signed by Mag. Judge Joan G. Margolis ) (Jefferson, V.) (Entered: 05/14/1993)
283 FIFTH AGREEMENT MONITORING PANEL REPORT (Jefferson, V.) (Entered: 08/12/1993)
284 MEMORANDUM of status Conference held on 9/23/93. By further agreement of counsel, the AMP's responsibility under the Consent Decree includes the issues of pre−test & post−test counseling. ( signed by Mag. Judge Joan G. Margolis ) (Former Employee) (Entered: 09/24/1993)
285 ORDER: in accordance w/colloquy w/counsel on the record in open court at the hearing held on 10/4/93 : cases are to be closed by 10/18/93 if no obj received: 2:88cv562. ( signed by Chief Judge Jose A. Cabranes ) (Jefferson, V.) (Entered: 10/28/1993)
286 ORDER of Dismissal: Notice of proposed dismissal having been given to counsel in open court on 10/4/93 and no obj having been received by 10/18/93 pursuant to Court's Order filed on 10/7/93, it is ORDERED this action is hereby dismissed w/o costs to any party ( signed by Chief Judge Jose A. Cabranes ) (Jefferson, V.) (Entered: 04/28/1994)
Case closed (Graham, T.) (Entered: 05/05/1994)
287 LETTER dated 5/2/94 by pltfs from Atty Newman re Order of Dismissal (Jefferson, V.) (Entered: 05/06/1994)
ENDORSEMENT re: [287−1] letter. Clerk shall docket this letter. The Order of Dismissal in this action, entered on 4/26/94, is hereby MODIFIED such that the action

05/20/1994 07/19/1994 12/14/1994 02/14/1995 02/22/1995 03/22/1995
04/06/1995
05/09/1995 08/08/1995 09/20/1995 10/26/1995

shall remain under the court's active supervision with respect to monitoring the defts' compliance w/Consent Jgm of 5/16/89 & 12/6/90 ( signed by Chief Judge Jose A. Cabranes ) (Jefferson, V.) (Entered: 05/06/1994)
288 ORDER: per Consent Jgm of 11/2/90, & the Court's Ruling setting the Hrly Rate for Agreement Monitoring Panel, of 5/9/91, it is hereby ordered that the State of Ct. shall reimburse the Court−appted monitor for svces rendered 11/13/93 as reflected in the bill submitted by Dr. Blanchette. State of Ct. shall pay forthwith Dr. Blanchette sum of $1,125. ( signed by Mag. Judge Joan G. Margolis ) (Jefferson, V.) (Entered: 05/23/1994)
289 ORDERED: The State of Connecticut shall reimburse the Court appointed monitor for the services rendered from 10/26/93 through 6/30/94. The State of Connecticut shall pay forthwith Dr. Robert L. Cohen the sum of $5,495.00. ( signed by Mag. Judge Joan G. Margolis ) (Grady, B.) (Entered: 07/20/1994)
290 ORDER: Pursuant to 127 of the Consent Jgm dated 11/2/90, and the Court's Ruling setting the Hourly Rate for the Agreement Monitoring Panel dated 5/9/91, it is hereby ordered that the State of Ct. shall reimburse the Court appointed monitor for the services rendered from 6/9/94 − 11/15/94 as reflected in the bill submitted by Dr. Blanchette. State of Ct. shall pay forthwith Dr. Blanchette sum of $6,312.50. ( signed by Mag. Judge Holly B. Fitzsimmons ) (Jefferson, V.) (Entered: 12/14/1994)
291 ORDER: Pursuant to Consent Judgment of 11/2/90, and the Court's Ruling setting the Hourly Rate for Agreement Monitoring Panel, it is hereby ordered that the State of Ct. shall reimburse the Court appointed monitor for services from 12/15/94 − 1/27/95, sum of $8,125, to Dr. Edward Blanchette. ( signed by Mag. Judge Holly B. Fitzsimmons ) (Jefferson, V.) (Entered: 02/15/1995)
292 ORDER:Pursuant to Consent Judgment dated Nov. 2, 1990 and the Court's Ruling, dated May 9, 1991, it is hereby ordered that the State of CT shall reimburse the court appointed monitor for services rendered from Dec. 15, 1994 through Feb. 9, 1995, as reflected in the bill submitted by Dr. Robert L. Cohen. State of CT shall pay forwith Dr. Robert L. Cohen the sum of $4,390.50. ( signed by Mag. Judge Holly B. Fitzsimmons ) (Former Employee) (Entered: 02/23/1995)
293 AMENDED ORDER:Pursuant to 127 of the Consent Judgment dated 11,2,90 and the Court's ruling setting the Hourly rate for the Agreement Monitoring Panel, dated 5/9/91, it is hereby ordered that the State of Connecticut shall reimburse the Court appointed monitor in this case for the services rendered from 12/15/94 through 2/9/95 as reflected in the amended bill submitted by Dr. Robert L. Cohen, dated 3/14/95. The State of Connecticut shall pay forthwith Dr. Robert L. Cohen the sum of $4,398.50. SO ORDERED. ( signed by Mag. Judge Holly B. Fitzsimmons ) (Depino, F.) (Entered: 03/22/1995)
294 ORDER: Pursuant to 127 of the Consent Judgment dated 11/2/90 and the Court's ruling setting the Hourly rate for the Agreement Monitoring Panel,dated 5/9/91, it is hereby ordered that the State of Connecticut shall reimburse the Court appointed monitor in this case for the services rendered from October 1993 through March 13,1995 as reflected in the bill submitted by Dr. Richard Belitsky, dated March 13,1995. The State of Connecticut shall pay forthwith to Dr. Richard Belitsky the sum of $12,325.00 SO ORDERED. ( signed by Mag. Judge Holly B. Fitzsimmons ) (Depino, F.) (Entered: 04/06/1995)
295 ORDER: The State of Connecticut shall pay forthwith Dr Edward Blanchette the sum of $1,437.50. ( signed by Mag. Judge Holly B. Fitzsimmons ) (Depino, F.) (Entered: 05/09/1995)
296 ORDER to destroy all Exhibits: Exhibits Destroyed, including sealed exhibits ( signed by Clerk ) (Bauer, J.) (Entered: 08/09/1995)
297 ORDER: The State of Connecticut shall pay forthwith Dr. Edward A. Blanchette the sum of $4,375.00. SEE ORDER FOR FURTHER DETAILS. ( signed by Mag. Judge Holly B. Fitzsimmons ) (Depino, F.) (Entered: 09/21/1995)
298 ORDER: State of Connecticut shall reimburse the Court appointed monitor for services rendered from 4/20/95 through 9/7/95, as reflected in the bill submitted by Dr.

12/15/1995 12/18/1995 03/20/1996
03/29/1996
07/30/1996 08/02/1996
09/11/1996 11/13/1996 02/11/1997 02/11/1997 02/11/1997 02/11/1997
02/12/1997 11/19/1998 11/19/1998 12/14/1998 01/26/1999

Cohen. State shall pay forthwith Dr. Cohen sum of $4,960 ( signed by Mag. Judge Joan G. Margolis ) (Jefferson, V.) (Entered: 10/26/1995)
300 Status Conference held ( JGM) (Former Employee) (Entered: 12/21/1995)
299 MEMORANDUM of Status Conference held on 12/15/95 ( signed by Mag. Judge Joan G. Margolis ) (Former Employee) (Entered: 12/18/1995)
301 ORDER: it is ORDERED that the State of Connecticut shall reimburse the Monitoring Panel Member for fees for services rendered on 11/30/95, 12/12/95 and 12/15/95 in the amount of $2,000. State of Connecticut shall pay forthwith Edward Blanchette, MD, sum of $2,000. ( signed by Mag. Judge Joan G. Margolis ) (Jefferson, V.) (Entered: 03/20/1996)
302 ORDER: Connecticut shall reimburse the Monitoring Panel Member for fees for services rendered from 4/95 − 3/96 in the amount of $8,787.50, as reflected in the bill submitted by Richard Belitsky, MD. State of Connecticut shall pay the sum of $8,787.50 ( signed by Mag. Judge Joan G. Margolis ) (Jefferson, V.) (Entered: 03/29/1996)
303 MOTION by Terry Toe, Mary Moe, Sammy Low, Ernest Hoe, David Doe for JoNel Newman to Withdraw as Attorney (Lopez, B.) (Entered: 07/30/1996)
ENDORSEMENT granting [303−1] motion for JoNel Newman to Withdraw as Attorney (Terminated attorney Jonel Newman for David Doe, for Ernest Hoe, for Sammy Low, for Mary Moe, Terry Toe ( signed by Chief Judge Peter C. Dorsey ) (Jefferson, V.) (Entered: 08/02/1996)
305 MOTION by David Doe for Attorney Fees and Costs (Jefferson, V.) (Entered: 02/12/1997)
304 ORDER: State of Ct. shall reimburse the Monitoring Panel Member for services rendered in amount of $2,187.50 as reflected in the bill by E. Blanchette, MD ( signed by Mag. Judge Joan G. Margolis ) (Jefferson, V.) (Entered: 11/14/1996)
ENDORSEMENT granting [305−1] motion for Attorney Fees and Costs to the extent set forth in the stipulation, filed today ( signed by Mag. Judge Joan G. Margolis ) (Jefferson, V.) (Entered: 02/12/1997)
306 STIPULATION re Attorney Fees and Costs by David Doe, Meachum (Jefferson, V.) (Entered: 02/12/1997)
ENDORSEMENT SO ORDERED, [306−1] stipulation re Fees and Costs ( signed by Mag. Judge Joan G. Margolis ) (Jefferson, V.) (Entered: 02/12/1997)
307 ORDER re: [305−1] motion for Attorney Fees and Costs, re: [306−1] stipulation: ORDERED that State of Connecticut shall pay, within 30 days of this Order, to Ct. Civil Liberties Union Fndtn. sum of $40,000. ( signed by Mag. Judge Joan G. Margolis ) (Jefferson, V.) (Entered: 02/12/1997)
308 SUPPLEMENTAL JUDGMENT on Attorneys Fees: ORDERED that State of Connecticut pay, within 30 days of Order filed 2/11/97, to Ct. Civil Liberties Union Fndn sum of $40,000. ( signed by Clerk ) (Jefferson, V.) (Entered: 02/13/1997)
CASE reassigned to Judge Christopher F. Droney (Former Employee) (Entered: 11/20/1998)
309 MOTION by Raymond Alvarez for Contempt , for Ruling & Order (Brief Due 12/10/98 ) (Blue,A.) (Entered: 11/20/1998)
310 ORDER referring: [309−1] motion for Contempt , [309−2] motion for Ruling & Order referred to Mag. Judge Joan G. Margolis (signed by Judge Christopher F. Droney ) (Blue,A.) (Entered: 12/14/1998)
311 ORDER paying Monitoring Panel Member Edward Blanchette M.D. $3,312.50 pursuant to Consent Judgment of 11/2/90 ( signed by Mag. Judge Joan G. Margolis ) (Former Employee) (Entered: 01/27/1999)

02/04/1999 02/22/1999 10/12/1999 10/26/1999 01/10/2000 02/10/2000 02/10/2000 02/10/2000 03/07/2000 03/10/2000 03/17/2000
03/20/2000 03/30/2000 03/30/2000
03/31/2000 04/04/2000 04/04/2000 05/08/2000 05/18/2000

312 ORDER re courtesy copies: copies of all filings should be forwarded to chambers ( Signed by Mag. Judge Joan G. Margolis ) (Former Employee) (Entered: 02/04/1999)
ENDORSEMENT denying without prejudice as moot [309−1] motion for Contempt, [309−2] motion for Ruling & Order ( signed by Mag. Judge Joan G. Margolis ) (Former Employee) (Entered: 02/23/1999)
313 STATUS REPORT by Drs. Belitsky and Cohen re: Consent Agreement (Former Employee) (Entered: 10/13/1999)
314 Response to Lawrence Smith's Motion for Temporary Injunction by White, Meachum, McMahon, Blanchette (No Motion filed) (Former Employee) (Entered: 10/28/1999)
315 Status Conference held ( JGM) (Warner, R.) (Entered: 01/11/2000)
316 STATUS REPORT: Final AMP Recommendations (Brown, S.) Modified on 02/14/2000 (Entered: 02/14/2000)
ENDORSEMENT: re [316−1] Status Report: Final AMP Recommendations "Adopted by agreement of the parties. So Ordered" ( signed by Mag. Judge Joan G. Margolis ) (Brown, S.) Modified on 02/14/2000 (Entered: 02/14/2000)
317 Status Conference held ( JGM) (Brown, S.) (Entered: 02/14/2000)
318 Proposed Scheduling Order re: Agreement Monitoring Panel (Brown, S.) (Entered: 03/07/2000)
ENDORSEMENT approving and adopting [318−1] Scheduling report re: Agreement Monitoring Panel (AMP) ( signed by Mag. Judge Joan G. Margolis ) (Brown, S.) (Entered: 03/10/2000)
319 ORDER: Pursuant to 11/2/90 Consent Judgment and Court's 5/9/91 Ruling, State of Connecticut is to reimburse Monitoring Panel Member Robert L. Cohen, M.D. for services rendered from 2/10/00 through 2/24/00 in the amount of $6,625.00 payable forthwith ( signed by Mag. Judge Joan G. Margolis ) (Brown, S.) (Entered: 03/17/2000)
320 MOTION by Terry Toe, Mary Moe, Sammy Low, Ernest Hoe, David Doe to Extend Time until 3/17/00 to file their statement of issues & memorandum (Blue,A.) (Entered: 03/21/2000)
ENDORSEMENT granting [320−1] motion to Extend Time until 3/17/00 to file their statement of issues & memorandum ( signed by Mag. Judge Joan G. Margolis ) (Depino, F.) Modified on 03/31/2000 (Entered: 03/31/2000)
321 MEMORANDUM regarding court jurisdiction over issues pertaining to outpatien and in patient medical services provided to inmates at the John Dempsey Hospital by Terry Toe, Mary Moe, Sammy Low, Ernest Hoe, David Doe to (Depino, F.) (Entered: 03/31/2000)
322 STATEMENT OF ISSUES TO BE REVIEWED BY THE COURT by Terry Toe, Mary Moe, Sammy Low, Ernest Hoe, David Doe Estimated trial time is not given (Depino, F.) (Entered: 03/31/2000)
323 STIPULATION re: Agreement Monitoring Panel by White, Terry Toe, Mary Moe, Meachum, McMahon, Sammy Low, Ernest Hoe, David Doe, Blanchette (Blue,A.) (Entered: 04/04/2000)
324 Memorandum by White, Meachum, McMahon, Blanchette regarding court's lack of jurisdiction of over issues concerning visitation and use of constraints at the University of Connecticut Health Center (Former Employee) (Entered: 04/04/2000)
ENDORSEMENT [323−1] stipulation re hourly rate for plaintiff ordered accordingly ( signed by Mag. Judge Joan G. Margolis ) (Former Employee) (Entered: 05/09/2000)
325 RULING on Jurisdictional Issues Regarding John Dempsey Hospital: Counsel shall confer re: additional discovery needs on limited issue of inmate access to hospital prison ward ( signed by Mag. Judge Joan G. Margolis ) 5 Page(s) SEE Ruling for details (Brown, S.) (Entered: 05/19/2000)

07/28/2000
08/10/2000
10/19/2000 10/19/2000
10/31/2000 01/29/2001
01/29/2001 02/05/2001
02/14/2001 06/06/2001
08/22/2001 09/11/2001 09/28/2001 01/16/2002 07/11/2002 08/08/2002 02/24/2003
06/07/2004
07/01/2004
04/21/2006
05/12/2006

326 STIPULATION regarding attorneys'fees & costs by White, Terry Toe, Mary Moe, Meachum, McMahon, Sammy Low, Ernest Hoe, David Doe, Blanchette (Brown, S.) (Entered: 07/31/2000)
327 ORDER The State of Connecticuit shall pay within thirty days of this order to the Connecticut Civil Liberties Union the sum of $2,513.85 SEE ORDER FOR OTHER DETAILS (signed by Senior Judge Peter C. Dorsey) (Depino, F.) Modified on 08/11/2000 (Entered: 08/11/2000)
328 Letter MOTION by Meachum for payment of services of Robert L. Cohen, MD in the amount of $4427.00 (Torday, B.) (Entered: 10/20/2000)
329 ORDER granting [328−1] motion for payment of services of Robert L. Cohen, MD in the amount of $4427.00 by the State of Connecticut ( signed by Mag. Judge Joan G. Margolis ) (Torday, B.) (Entered: 10/20/2000)
330 Status Conference held ( JGM) (Torday, B.) (Entered: 11/02/2000)
331 CONSENT to trial before a Magistrate Judge. Case transferred to Mag. Judge Joan G. Margolis for trial ( Ordered by Judge Christopher F. Droney ) (Blue,A.) (Entered: 01/30/2001)
CASE NO LONGER REFERRED TO Mag. Judge Joan G. Margolis (Blue,A.) (Entered: 01/30/2001)
332 ORDER... The State of Connecticut shall pay forthwith Edward A. Blanchette, MD the sum of $3,125.00...So Ordered ( signed by Mag. Judge Joan G. Margolis ) (Basile, F.) (Entered: 02/06/2001)
333 Status Conference held ( JGM) (Depino, F.) (Entered: 02/14/2001)
334 ORDER: The State of Connecticut shall pay forthwith Robert L. Cohen sum of $8,933.00 ( signed by Mag. Judge Joan G. Margolis ) (Basile, F.) (Entered: 06/07/2001)
335 APPEARANCE of Attorney for Terry Toe, Mary Moe, Sammy Low, Ernest Hoe, David Doe −− Brett Dignam (Torday, B.) (Entered: 08/22/2001)
336 Challenge to Consent Judgment by John Michael DiNunzio (Brown, S.) (Entered: 09/17/2001)
337 Telephone Status Conference Calendar held ( JGM) (Malone, P.) (Entered: 10/02/2001)
338 Status Conference held ( JGM) (Brown, S.) (Entered: 01/16/2002)
339 Status Conference held ( JGM) (Falcone, K.) (Entered: 07/12/2002)
340 ORDER directing State to pay Dr. Robert Cohen $13,448.00 ( signed by Mag. Judge Joan G. Margolis ) (Brown, S.) (Entered: 08/09/2002)
341 ORDER directing State of Connecticut to forthwith reimburse Plaintiffs' counsel $683.01 for services rendered from 5/1/00 through 2/13/03 ( signed by Mag. Judge Joan G. Margolis ) (Brown, S.) (Entered: 02/25/2003)
342 ORDER directing State of CT to pay Edward Blanchette, M.D., the sum of $8,575.00. Signed by Magistrate Judge Joan G. Margolis on 6/4/04. (Rodko, B.) (Entered: 06/08/2004)
343 ORDER directing the State of Connecticut to pay forthwith Edward A. Blanchette, MD, the sum of $8,487.50 for services rendered from 3/6/02 through 7/8/02 . Signed by Magistrate Judge Joan G. Margolis on 7/1/04. (Rodko, B.) (Entered: 07/02/2004)
344 NOTICE of Intention to Inititate Further Proceedings filed by Eugene P. Mercer (Ernest Hoe). (Inferrera, L.) Modified on 5/12/2006 (Inferrera, L.). (Entered: 05/12/2006)
Docket Entry Correction re 344 Notice of Intention; correcting filer (Inferrera, L.) (Entered: 05/12/2006)

05/22/2006
08/17/2006 09/14/2006
06/10/2009 06/15/2009
02/11/2010 08/06/2010 08/06/2010 08/13/2010
08/30/2010 08/31/2010
10/22/2013
10/29/2013 03/25/2014

345 RESPONSE re 344 Notice of Intention to Initiate Further Proceedings filed by White, Thomas, Dep. Comm., Ct Dept. Of Corrections, I/o, Blanchette, Edward, Md, Medical Dir., Cci, Somers, I/o, McMahon, James, Rn, Asst To Dir., Health Services, I/o, Meachum, Larry, Comm. Of Corrections. (Attachments: # 1 Attachment A)(Inferrera, L.) (Entered: 05/24/2006)
346 MOTION for Status Conference to Alter Provisions of Consent Judgment by Mary Moe, David Doe, Ernest Hoe, Terry Toe, Sammy Low. (Brown, S.) (Entered: 08/18/2006)
347 ELECTRONIC ORDER denying 346 Motion for Conference, substantially for the reasons stated in defendants' response, filed 5/22/06 (Dkt. #345), without prejudice to renewal by plaintiffs' counsel, if appropriate. THIS IS THE ONLY NOTICE THE COURT WILL ISSUE. Signed by Judge Joan G. Margolis on 9/14/06.(Margolis, Joan) (Entered: 09/14/2006)
348 MOTION for Richard Couture to Withdraw as Attorney by Blanchette, Edward, Md, Medical Dir., Cci, Somers, I/o, McMahon, James, Rn, Asst To Dir., Health Services, I/o, Meachum, Larry, Comm. Of Corrections. (Brown, S.) (Entered: 06/11/2009)
349 ELECTRONIC ORDER granting 348 Motion to Withdraw as Attorney. The Magistrate Judge extends her deep appreciation to Attorney Couture for his many years of service to the citizens of Connecticut. THIS IS THE ONLY NOTICE COUNSEL WILL RECEIVE FROM THE COURT. (Attorney Richard T. Couture terminated). Signed by Judge Joan G. Margolis on 6/15/09. (Margolis, Joan) (Entered: 06/15/2009)
350 NOTICE of Appearance by Terrence M. O'Neill on behalf of White, Thomas, Dep. Comm., Ct Dept. Of Corrections, I/o, Blanchette, Edward, Md, Medical Dir., Cci, Somers, I/o, McMahon, James, Rn, Asst To Dir., Health Services, I/o, Meachum, Larry, Comm. Of Corrections (Garguilo, B) (Entered: 02/11/2010)
351 NOTICE of Appearance by David J. McGuire on behalf of David Doe, Ernest Hoe, Sammy Low, Mary Moe, Terry Toe (McGuire, David) (Entered: 08/06/2010)
352 MOTION for Brett Dignam to Withdraw as Attorney by David Doe. (Dignam, Brett) (Entered: 08/06/2010)
353 ELECTRONIC ORDER granting 352 Motion to Withdraw as Attorney. The Magistrate Judge thanks Attorney Dignam for her years of service on this file. THIS IS THE ONLY NOTICE COUNSEL WILL RECEIVE FROM THE COURT. (Attorney Brett Dignam terminated.) Signed by Judge Joan G. Margolis on 8/13/10. (Margolis, Joan) (Entered: 08/13/2010)
354 MOTION for Philip D. Tegeler to Withdraw as Attorney by David Doe, Ernest Hoe, Sammy Low, Mary Moe, Terry Toe. (McGuire, David) (Entered: 08/30/2010)
355 ELECTRONIC ORDER granting 354 Motion to Withdraw as Attorney. The Magistrate Judge thanks Attorney Teleger for his services on this file. THIS IS THE ONLY NOTICE COUNSEL WILL RECEIVE FROM THE COURT. Attorney Philip D. Tegeler terminated. Signed by Judge Joan G. Margolis on 8/31/10. (Margolis, Joan) (Entered: 08/31/2010)
356 NOTICE OF E−FILED CALENDAR: THIS IS THE ONLY NOTICE COUNSEL/THE PARTIES WILL RECEIVE.ALL PERSONS ENTERING THE COURTHOUSE MUST PRESENT PHOTO IDENTIFICATION. A Telephonic Status Conference is set for 10/29/2013 at 10:00 AM before Judge Joan G. Margolis. **Plaintiffs' counsel shall initiate the conference call. Chambers: 203−773−2350. (Rodko, B.) (Entered: 10/22/2013)
357 Minute Entry for proceedings held before Judge Joan G. Margolis: Telephonic Status Conference held on 10/29/2013. Time: 30 minutes (Rodko, B.) (Entered: 10/29/2013)
358 NOTICE OF E−FILED CALENDAR: THIS IS THE ONLY NOTICE COUNSEL/THE PARTIES WILL RECEIVE.ALL PERSONS ENTERING THE COURTHOUSE MUST PRESENT PHOTO IDENTIFICATION. A Telephonic Status Conference is set for 4/1/2014 at 10:00 AM before Judge Joan G. Margolis. **Plaintiff's counsel will initiate the conference call. Chambers: 203−773−2350.

04/01/2014 12/08/2016 12/08/2016 12/08/2016

(Rodko, B.) (Entered: 03/25/2014)
359 Minute Entry for proceedings held before Judge Joan G. Margolis: Telephonic Status Conference held on 4/1/2014. Time: 15 minutes (Rodko, B.) (Entered: 04/01/2014)
360 Consent MOTION to Substitute Attorney by David Doe. (Barrett, Dan) (Entered: 12/08/2016)
361 ELECTRONIC ORDER granting 360 Motion to Substitute Attorney. Signed by Judge Joan G. Margolis on 12/8/16. (Margolis, Joan) (Entered: 12/08/2016)
362 ORDER: On December 7, 2016, the Court received a letter, dated December 2, 2016, from a former inmate regarding the consent judgment entered in this case. In light of defense counsel's representations that the author of said letter is no longer residing in a DOC facility, and thus, is no longer a class member, further judicial response is not required under the terms of the consent decree. Signed by Judge Joan G. Margolis on 12/8/2016.(Watson, M.) (Entered: 12/08/2016)

 
 Doe v. Meachum, 126 F.R.D. 437 (1988)

126 F.R.D. 437 United States District Court,
D. Connecticut.
David DOE, et al. v.
Larry R. MEACHUM, et al.
Civ. No. H–88–562(PCD). | Nov. 22, 1988.
Attorneys and Law Firms
*438 Shelley Geballe, Martha Stone, Connecticut Civ. Liberties Union Foundation, Hartford, Conn., J.L. Pottenger, Jr., Jerome N. Frank Legal Services Organization, New Haven, Conn., for plaintiffs.
Stephen O’Neill, Steve Strom, Richard Couture, Asst. Attys. Gen., Hartford, Conn., for defendants.
Opinion

RULING ON OBJECTION TO MAGISTRATE’S RULING AND PROTECTIVE ORDER

DORSEY, District Judge.
[1] Defendants seek review of the magistrate’s ruling granting, in part, plaintiffs’ motion for a protective order.1 The ruling of a magistrate on a discovery motion will be set aside only if “found to be clearly *439 erroneous or contrary to law.” Rule 2(b), Local Rules for U.S. Magistrates. See Fed.R.Civ.P. 72(a). Thus, on review of the entry of a protective order, it need only be shown that there was a substantial basis for a finding of “good cause” to support such an order under Fed.R.Civ.P. 26(c) and that the magistrate did not abuse her discretion in framing an appropriate order. See, e.g., Sherrell Perfumes, Inc. v. Revlon, Inc., 77 F.R.D. 705, 707 (S.D.N.Y.1977).

1

Before entering the protective order, the magistrate had

the benefit of extensive briefing and oral argument.

Defendants have not submitted an additional

memorandum in support of their objections, but rely on

their earlier brief.

Discussion [2] Plaintiffs sought and the magistrate ordered only limits
to the use of inmate names and personally-identifiable
information obtained from plaintiffs through discovery.

See Protective Order (the “Order”), ¶ 1. Thus, the Order affects only information created in the course of the litigation and does not limit defendants’ use of their own files and records, nor of information obtained from independent sources. The Order permits disclosure of inmate identities:
(a) to the named defendants to the extent necessary to litigate this case; and
(b) to other persons upon notice to plaintiffs’ counsel and application to the court; or
(c) for exigent penal or law enforcement purposes.
[3] Defendants argue that plaintiffs made no showing that such information would be disseminated contrary to the safety or privacy interests of plaintiffs. However, the magistrate had before her the complaint, verified by affidavits, alleging that information about the suspected or actual status of inmates as HIV carriers has already been widely disseminated, Complaint, ¶¶ 33, 37–38; Exhibit B; Exhibit I, and that this dissemination has resulted in harassment and sometimes violence directed at plaintiffs. Complaint, ¶¶ 56–59. Regardless of defendants’ professional obligations, care, and good intentions, plaintiffs are entitled to protection from the possibility that their own lawsuit will worsen the alleged conditions for which they seek redress. Moreover, in evaluating the danger to plaintiffs, the magistrate was entitled to rely on her familiarity with prison conditions gained from past experience in prisoners’ litigation. Her finding that plaintiffs have a significant privacy interest in their identities as HIV victims, when revealed in their own responses to discovery, is reasonable. See Doe v. Coughlin, 697 F.Supp. 1234 (N.D.N.Y.1988), Memorandum Decision at 10 (recognizing privacy interest in non-disclosure of AIDS diagnosis).
Defendants also object to the terms of the Order as an unwarranted intrusion on their ability to prepare a defense and to administer the prison system. Defendants do not, however, suggest an alternative order which would accomplish the level of protection found warranted by the magistrate. Their defense is not shown to be compromised by the Order. Administration of the prison system is not shown to be dependent on information obtained in these proceedings.
[4] The burden lies upon defendants to show that the Order was an abuse of discretion. See Galella v. Onassis, 487 F.2d 986, 997 (2d Cir.1973). Defendants’ various hypothetical situations, under which they contend the Order would hinder their defense or prison administration, are simply straw men. For example, defendants contend that the Order hinders prison administration because it “seems to preclude” dissemination of information about
1

Doe v. Meachum, 126 F.R.D. 437 (1988)
an inmate’s propensity for assaultive behavior or escape. However, civil discovery is not intended to be an aid to defendants’ administration of the prisons, but to permit the full and fair litigation of this action without surprise. If there were no lawsuit, there would be no discovery responses and defendants would have to operate the correctional system without information generated by plaintiffs in discovery. Moreover, it is not shown that information about an inmate’s propensities obtained from plaintiffs would be more current, reliable, or complete than that otherwise available from defendants’ own sources which are not restricted in any fashion. In the rare circumstances *440 where plaintiffs’ discovery reveals material of immediate penal or law enforcement value, the magistrate’s Order permits disclosure without prior notice or approval, providing that in the event of such disclosure plaintiffs’ counsel is notified “as expeditiously as possible.” Such exceptions are broad enough to accommodate defendants’ concerns, but if they are not, in particular circumstances, defendants can then seek a modification of the Order.
Contrary to defendants’ claims, nothing in the Order compels defendants to share with plaintiffs’ counsel the results of defendants’ investigation relative to this action. To the extent that the Order requires defendants to give notice to plaintiffs’ counsel before revealing identity information to potential witnesses or expert consultants, only the names of witnesses will be revealed and not the substance of the contacts. Once plaintiffs have agreed to, or the court has approved, disclosure to a particular person, and that person has signed an acknowledgment of the Order, independent approval need not be sought for subsequent disclosures to that person. There is no showing that that procedure is burdensome or onerous.
For the foregoing reasons, and because defendants have not shown that the magistrate’s ruling was clearly erroneous or contrary to law, the objections to the ruling are overruled and the ruling is affirmed and adopted.
SO ORDERED.
RULING ON PLAINTIFFS’ MOTION FOR PROTECTIVE ORDER
JOAN GLAZER MARGOLIS, United States Magistrate.
On August 15, 1988, plaintiffs filed their thirty-five page complaint, challenging various practices of defendants with respect to the handling of inmates with Acquired Immune Deficiency Syndrome (“AIDS”), AIDS–Related Complex, or other Human Immunodeficiency Virus (collectively referred to as “AIDS”). That same day,

Judge Cabranes granted plaintiffs’ motion to prosecute this suit in fictitious names.
On October 11, 1988, plaintiffs filed a motion for protective order, brief in support, and proposed order, which seeks to place strict parameters on defendants’ ability to disclose the identities of the named plaintiffs and putative class members. On October 21, 1988, defendants filed their brief in opposition, which argues that the proposed order would gravely jeopardize the security of the state correctional system and would infringe upon defendants’ ability to defend this lawsuit. Plaintiffs’ reply brief was filed on October 25, 1988.1 Oral argument was held on October 27, 1988. For the reasons stated herein, plaintiffs’ motion is granted in part.

1

The three briefs collectively were seventy-four pages

long; oral argument lasted for one hour. The Court

hopes that in the future such substantial energy can be

used to resolve similar matters in a more amicable

fashion.

While several decisions have upheld the right of prison officials to identify and isolate suspected AIDS carriers, e.g., Baez v. Rapping, 680 F.Supp. 112, 115 (S.D.N.Y.1988); Judd v. Packard, 669 F.Supp. 741, 743 (D.Md.1987); Cordero v. Coughlin, 607 F.Supp. 9, 10 (S.D.N.Y.1984), at least one court has recognized that an inmate infected with AIDS has a constitutional right to privacy in his medical records. Woods v. White, 689 F.Supp. 874, 876 (W.D.Wis.1988). This Court need not resolve whether an inmate’s privacy rights here rise to the level of a constitutional one, for defendants do not object to the imposition of a protective order per se, but rather to the restrictive nature of the one proposed by plaintiffs.
The court agrees that the proposed order is more restrictive than is necessary, even taking into account the significant interests of the plaintiffs in keeping their illness as confidential as possible. Accordingly, the Magistrate will enter the protective order attached hereto.
See 28 U.S.C. Section 636(b) (written objections to ruling must be filed within ten days after service of same); F.R.Civ.P. 72; Rule 2 of the Local Rules for United States *441 Magistrates, United States District Court for the District of Connecticut.

PROTECTIVE ORDER
JOAN GLAZER MARGOLIS, United States Magistrate. In order to protect the privacy of inmates involved in this
2

Doe v. Meachum, 126 F.R.D. 437 (1988)
action and to safeguard them from harassment and retaliatory actions, all responses to discovery which include inmate names or personally-identifiable information about inmates shall be treated in the following manner:
1. Inmate names and personally-identifiable information about inmates obtained through discovery shall be disclosed only to defendants’ counsel herein, and such information shall not be redisclosed by defendants’ counsel except as provided below.
2. Attorneys for the defendants may disclose the identities of inmates involved in this action to the named defendants, but only to the minimum extent necessary to litigate this case.
3. Should attorneys for the defendants have a demonstrated need to disclose the identities of such inmates to persons other than the named defendants, they shall give appropriate notice to plaintiffs’ counsel. If, within two (2) business days of such notice, plaintiffs’ counsel fails to give approval to such disclosure, defendants’ counsel shall file an appropriate application with this Court.
4. Any person to whom disclosure is to be made pursuant to paragraphs 2 and 3 of this Order shall first read this Protective Order, shall be strictly bound by the obligation not to redisclose such inmate names and other personallyidentifiable information about inmates to the extent provided herein, and shall sign the form attached hereto acknowledging such responsibility prior to having access to such information.
5. Defendants, and any other person to whom disclosure is made pursuant to the provisions of this Order, shall engage in no retaliatory or disciplinary actions against inmates whose identities are so disclosed solely on account of such disclosure. Nothing in this protective order shall prohibit disclosure of an inmate’s name for exigent penal or law enforcement purposes, such as the investigation or prosecution of criminal activity within *442 the prison or the prevention of a suicide. In the event of disclosure under such exigent circumstances, defendants’ counsel shall notify plaintiffs’ counsel thereof as expeditiously as possible, following which plaintiffs’ counsel may file an appropriate application with this Court.
6. All documents which include inmate names and personally-identifiable information about inmates (including inmate numbers) shall be sealed when filed with the Court. The parties are also to redact inmate names and personally-identifiable information about inmates from all documents filed with the Court and/or used in this litigation.

RULING ON CROSS–MOTIONS FOR CLARIFICATION
JOAN GLAZER MARGOLIS, United States Magistrate.
[5] Familiarity is presumed with this Magistrate’s Ruling on Plaintiffs’ Motion for Protective Order, filed October 27, 1988 (Dkt. # 40), and the Protective Order filed that same day (Dkt. # 41). Said Ruling and Protective Order were approved on November 22, 1988 in a written ruling by Judge Dorsey (Dkt. # 61), over defendants’ objection.
On December 5, 1988, both sides filed motions for clarification of the Protective Order; by agreement of counsel at the impromptu discovery conference held that day, both motions were placed under seal. At issue is paragraph 5 of the Protective Order, which reads in full:
Defendants, and any other person to whom disclosure is made pursuant to the provisions of this Order, shall engage in no retaliatory or disciplinary actions against inmates whose identities are so disclosed solely on account of such disclosure. Nothing in this protective order shall prohibit disclosure of an inmate’s name for exigent penal or law enforcement purposes, such as the investigation or prosecution of criminal activity within the prison or the prevention of a suicide. In the event of disclosure under such exigent circumstances, defendants’ counsel shall notify plaintiffs’ counsel thereof as expeditiously as possible, following which plaintiffs’ counsel may file an appropriate application with this Court.
Both sides agree that ¶ 5 does not curtail the ability of defendants to respond promptly when informed, through the discovery process, of impending difficulties. The instant controversy arises regarding what response, if any, defendants may take when prison officials learn, again through the discovery process, of past activities which may warrant the institution of disciplinary measures or criminal prosecution. Defendants argue that to prevent prison officials from taking appropriate measures results in granting plaintiffs and other inmates total “immunity”; plaintiffs, on the other hand, argue that leaving them without protection will have a “chilling effect” upon the
3

Doe v. Meachum, 126 F.R.D. 437 (1988)
plaintiffs’ willingness to prosecute this action and upon the cooperation of other inmates.
As plaintiffs’ counsel accurately has stated, due to the uniqueness of this case, this issue needs a “sensitive balancing” between the privacy interests of the plaintiffs and the institutional security concerns of the defendants. Accordingly, ¶ 5 of the Protective Order is hereby amended as follows:
Defendants, and any other person to whom disclosure is made pursuant to the provisions of this protective order, shall engage in no retaliatory or disciplinary actions against inmates whose identities are so disclosed solely on account of disclosure of such identities.
(a) Nothing in this protective order shall prohibit disclosure of an inmate’s name for exigent penal or law enforcement purposes, such as the investigation or prosecution of ongoing or anticipated criminal activity within the prison or the prevention of a suicide.
(b) Nothing in this protective order shall prohibit disclosure of an inmate’s name for penal or law enforcement purposes with respect to past activity

which may warrant the institution of disciplinary measures or criminal prosecution, provided, however, that such past activity occurred within three months prior to such disclosure and was of a serious nature.
(c) Nothing in this protective order shall prohibit the disclosure of an inmate’s name for penal or law enforcement purposes with respect to disciplinary actions taken against state employees.
In the event of disclosure under the circumstances set forth in subparagraphs (a), (b), or (c), supra, defendants’ counsel shall notify plaintiffs’ counsel as expeditiously as possible, following which plaintiffs’ counsel may file an appropriate application with this Court.
See 28 U.S.C. Section 636(b) (written objections to ruling must be filed within ten days after service of same); F.R.Civ.P. 72; Rule 2 of the Local Rules for United States Magistrates, United States District Court for the District of Connecticut.
	  

4

 
 Doe v. Meachum, 126 F.R.D. 437 (1988)
126 F.R.D. 437 United States District Court,
D. Connecticut. David DOE, et al.,
v. Larry R. MEACHUM, et al. Civ. No. H–88–562 (PCD). | Dec. 6, 1988.
Attorneys and Law Firms Shelley Geballe, Martha Stone, Connecticut Civ. Liberties Union Foundation, Hartford, Conn., J.L. Pottenger, Jr., and Jerome N. Frank, Legal Services Organization, New Haven, Conn., for plaintiffs. Stephen O’Neill, Steve Strom, and Richard Couture, Asst. Attys. General, Hartford, Conn., for defendants.
RULING FOLLOWING IN CAMERA REVIEW OF DOCUMENTS
Opinion JOAN GLAZER MARGOLIS, United States Magistrate.
The Memorandum of Status Conference, filed October 27, 1988 (Dkt. # 39), provided as follows: “With respect

to incident reports and correspondence identifying inmates, defense counsel agreed to submit such materials to the Magistrate for her in camera review with respect to relevancy and detrimental impact upon defendants’ security concerns.” Such materials were so provided on December 3, 1988.
After careful review, the Magistrate finds that with the exception of the last document, an undated memorandum which is covered by the work-product privilege, the remaining documents are relevant to plaintiffs’ various claims and disclosure thereof will not have a detrimental impact upon defendants’ security concerns, and thus are to be produced for plaintiffs’ counsel. However, to the extent such documents pertain to inmates who are not named plaintiffs in this action and whose names already have been revealed to defendants, all inmate names, prisoner numbers, criminal docket numbers, home street addresses, names of next of kin, and similar identifying information shall be redacted. To the extent a particular inmate is mentioned in more than one document, that shall be so indicated in an appropriate fashion.
Because this ruling is subject to review, see 28 U.S.C. Section 636(b) (written objections to ruling must be filed within ten days after service of same); F.R.Civ.P. 72; Rule 2 of the Local Rules for United States Magistrates, United States District Court for the District of Connecticut, the documents submitted shall be placed under seal.
	  

1

 
 Doe v. Meachum, 126 F.R.D. 442 (1989)

126 F.R.D. 442 United States District Court,
D. Connecticut.
David DOE, et al. v.
Larry R. MEACHUM, et al.
Civ. No. H–88–562 (PCD). | Feb. 10, 1989.
Attorneys and Law Firms
*443 Shelley Geballe, Martha Stone, Connecticut Civ. Liberties Union Foundation, Hartford, Conn., J.L. Pottenger, Jr., Jerome N. Frank Legal Services Organization, New Haven, Conn., for plaintiffs.
Stephen O’Neill, Steve Strom, Richard Couture, Asst. Attys. Gen., Hartford, Conn., for defendants.
Opinion
ORDER
DORSEY, District Judge.
Absent objection, the Magistrate’s ruling is accepted and adopted.
SO ORDERED.
RECOMMENDED RULING ON PLAINTIFFS’ MOTION FOR CLASS CERTIFICATION
JOAN GLAZER MARGOLIS, United States Magistrate.
On August 15, 1988 plaintiffs filed their thirty-five page complaint which challenges, on a statewide basis, the manner in which the Connecticut Department of Correction handles inmates who have, or are believed to have, Acquired Immune Deficiency Syndrome (“AIDS”), AIDS–Related Complex (“ARC”), or other Human Immunodeficiency Virus (“HIV”), collectively referred to as HIV. The five named plaintiffs, who are pursuing this litigation under fictitious names, have or are being incarcerated at correctional institutions scattered across the state. Two additional plaintiffs, who also are litigating this matter anonymously, have intervened. (See Dkt. # 81).

On September 26, 1988, plaintiffs filed their motion for class certification and brief in support. (Dkt. ## 16–17). On January 6, 1989, defendants filed their brief in partial opposition to plaintiffs’ motion for class certification. (Dkt. # 80). Defendants objected not so much to the maintenance of this action as a class action, but to the “overbroad” and “ambiguous” definition proposed by plaintiffs. Defendants instead suggested that the class be divided into three subclasses. Plaintiffs’ reply brief was filed on January 20, 1989 (Dkt. # 85), in which they proposed a single revised class.
[1] [2] There is little dispute that class certification is appropriate when plaintiffs make widespread allegations with respect to the conditions of their confinement. See, e.g., Jane B. by Martin v. New York City Department of Social Services, 117 F.R.D. 64 (S.D.N.Y.1987) (challenging conditions at two centers for adolescent girls with behavioral and emotional problems); Dean v. Coughlin, 107 F.R.D. 331 (S.D.N.Y.1985) (regarding allegedly inadequate dental care at correctional facility). Class certification similarly is proper in actions brought by HIV victims with respect to the scope of their treatment. See, e.g., Weaver v. Reagen, 701 F.Supp. 717, 721–723 (W.D.Mo.1988), 1988 U.S. Dist LEXIS 14317, at 9–16 (regarding Medicaid recipients with HIV who were unable to obtain the drug AZT, the only approved treatment for AIDS).
*444 [3] At oral argument held on January 20, 1989 an agreement was reached with respect to the definition of the class—namely all persons who were at any time since August 15, 1985, are or will be subject to the care and custody of defendant Meachum, excluding the class certified in Smith v. Meachum, Civ. No. H87–221(JAC).
On or before January 24, 1989, plaintiffs will file a proposed notice and suggested manner of notice; defendants shall file their response on or before January 30, 1989.
Accordingly, plaintiffs’ motion for class certification is granted by agreement, as set forth above.
See 28 U.S.C. Section 636(b) (written objections to ruling must be filed within ten days after service of same); F.R.Civ.P. 72; Rule 2 of the Local Rules for United States Magistrates, United States District Court for the District of Connecticut.
Dated at New Haven, Connecticut, this 20th day of January, 1989.
	  
1

Doe v. Meachum, 126 F.R.D. 442 (1989) 2

 
 Doe v. Meachum, 126 F.R.D. 444 (1989)
126 F.R.D. 444 United States District Court,
D. Connecticut. David DOE, et al.
v. Larry R. MEACHUM, et al. Civ. No. H–88–562(PCD). | April 12, 1989.
Attorneys and Law Firms
*446 Shelley Geballe and Martha Stone, Connecticut Civ. Liberties Union Foundation, Hartford, Conn., and J.L. Pottenger, Jr., Jerome N. Frank Legal Services Organization, New Haven, Conn., for plaintiffs.
Stephen O’Neill, Steve Strom and Richard Couture, Asst. Attys. Gen., Hartford, Conn., for defendants.
Opinion
ORDER
DORSEY, District Judge.
Absent objection, the magistrate’s ruling is accepted and adopted.
SO ORDERED.
RULING ON PLAINTIFFS’ MOTION TO COMPEL
JOAN GLAZER MARGOLIS, United States Magistrate.
On August 15, 1988, plaintiffs commenced this action with respect to the various policies of the Connecticut Department of Corrections regarding inmates who are infected with the Human Immunodeficiency Virus (“HIV”)1; that same day, Judge Cabranes granted plaintiffs’ motion for permission to prosecute suit in fictitious names. By agreement of counsel, on January 20, 1989, the court certified a class consisting of all inmates who were (since August 15, 1985), are, or will be committed to the custody of Commissioner Meachum, excluding the class certified in Smith v. Meachum, Civ. No. H87–221(JAC). (See Dkt. # 88, approved absent objection on February 13, 1989).2

1

For convenience purposes only, the acronym HIV shall

be interchangeable with the acronyms AIDS (Acquired

Immune Deficiency Syndrome) and ARC (AIDS–

Related Complex).

2

The parties further agreed as to content and manner of

notice to class members. (See Dkt. # 102, filed March

2, 1989).

On February 27, 1989, plaintiffs filed the pending motion to compel production of documents and brief in support. (Dkt. ## 99–100). Attached to the motion or brief were six exhibits—continued deficiencies in defendants’ response to plaintiffs’ request for production (Exh. A); copy of letter from Attorney Couture to Attorney Geballe, dated January 19, 1989 (Exh. B); requests for production to which defendants have formally objected (or informally objected by not producing or by redacting information) (Exh. C); a proposed protective order (Exh. D); affidavit of Attorney Geballe (Exh. E); and copy of plaintiffs’ motion to compel and Judge Cabranes’ endorsement thereon, filed November 7, 1988, in Smith v. Meachum, supra (Exh. 1). On *447 March 15, 1989, defendants made the following four filings—defendants’ response to the production deficiencies alleged in Exhibit A to the plaintiffs’ motion to compel production of documents; defendants’ response to the plaintiffs’ request for the production of the documents listed in Exhibit C to the plaintiff’s motion to compel; defendants’ motion for protective order;3 and defendants’ brief in opposition to plaintiffs’ motion to compel and in support of defendants’ motion for protective order.4 (Dkt. ##### 108–11). Lengthy oral argument was held on March 20, 1989. For the reasons stated herein, plaintiffs’ motion is granted in part and denied in part.

3

Attached to the motion were copies of orders issued in

CARC v. Geri Care, Civ. No. H81–494(TEC) (D.Conn.

Oct. 29, 1981) and in West v. Manson, Civ. No. H83–

366 (AHN) (D.Conn. Nov. 12, 1983); a letter from

Attorney Geballe to Attorney O’Neill, dated Jan. 31,

1985, with a medical release form in the West suit; and

the proposed protective order.

4

Attached to the brief was Attorney Geballe’s January

31, 1985 letter with the medical release form in West.

See note 3 supra.

DISCUSSION Using the format set forth by the parties in plaintiffs’
1

Doe v. Meachum, 126 F.R.D. 444 (1989)
Exhibit A and defendants’ response thereto, and focussing initially on the items at issue at the March 20th oral argument, plaintiffs’ motion to compel is granted in part and denied in part as follows:
I. FIRST REQUEST FOR PRODUCTION.
A. CENTRAL OFFICE RESPONSE. [1] Requests ## 1–4—Policy Formation. Denied to the extent plaintiffs seek personal notes of individual participants in the Correctional Health Care Committee, granted to the extent defendants have within their possession any minutes of meetings held by any successor committee.
[2] Request # 7—Funding Requests. Denied, defendants having provided all documents which pertain specifically to HIV matters. Defendants agreed, however, to produce any new memoranda which come into their possession with respect to any funding by the Center for Disease Control.
Request # 8—Proposals and Contracts for HIV–Related Services. Granted to the extent agreed to by defendants.
[3] Request # 13—Union Documents. Denied, defendants having conducted two “very extensive searches” and having found no documents subsequent to 1986.
[4] Request # 19—Budget Options. Denied, defendants having provided all documents which pertain specifically to HIV matters; granted, however, to the extent defendants have in their possession any documents which pertain to Dr. Hauser’s proposed reorganization of employee responsibilities with respect to HIV matters.
[5] Requests ## 22–23—Incident Reports. Granted, subject to the protective order filed today.
[6] Request # 26—Other Cases and Administrative Procedures. Denied, defendants having no other documents within their possession.

A. CENTRAL OFFICE RESPONSES. [8] Request # 2—Hiring of Medical Staff. Granted to the extent set forth with respect to Request # 19 (Budget Options) supra.
Requests ## 7–8—Annual, Quarterly and Monthly Reports. Granted to the extent agreed upon by plaintiffs’ counsel and defense counsel.
*448 III. FOURTH REQUEST FOR PRODUCTION. Request # 21—Training Records. Granted to the extent agreed to by defense counsel.
With respect to those items for which production has been ordered or for which defendants have agreed to conduct a further search and/or provide responsive documents, all production shall be made on or before April 3, 1989, if such documents presently are within the possession of the defendants.
Using the format set forth by the parties in plaintiffs’ Exhibit C and defendants’ response thereto, and focussing initially on the items at issue at the March 20th oral argument, plaintiffs’ motion to compel is granted in part and denied in part as follows:
FIRST REQUEST FOR PRODUCTION. Request # 5—“Weekly Blood Drawing List.” Granted, subject to the protective order filed today, for the same reasons as set forth in Enfield Request # 5 supra.
Request # 6—Curricula Vitae. Granted to the extent agreed to by defense counsel, such compliance to be made on or before April 17, 1989.
Request # 23—Incident Report. Granted, subject to the protective order filed today.
Request # 28—Most Recent CSD List. Granted, subject to the protective order filed today.

B. INDIVIDUAL INSTITUTIONS—Enfield. [7] Request # 5—“Weekly Blood Drawing List” and Current CSD List. Granted, subject to the protective order filed today. While defendants are correct that the blood drawing list is not responsive to the instant request, it is, however, responsive to other requests.
II. THIRD REQUEST FOR PRODUCTION.

THIRD REQUEST FOR PRODUCTION. [9] Request # 4—Lab Invoices. Granted, subject to the protective order filed today.
Requests # # 7–8—Quarterly and Annual Reports. Granted to the extent agreed to by defense counsel and subject to the protective order filed today.
FOURTH REQUEST FOR PRODUCTION. 2

Doe v. Meachum, 126 F.R.D. 444 (1989)
[10] Request # 1—Death Certificates and Coroner’s Reports. Granted to the extent such documents are within defendants’ possession.
Request # 4—CSD List. Granted, subject to the protective order filed today.
[11] Request # 9—CSD Lists Confiscated or Otherwise Obtained. Denied, defendants representing that no other lists exist.
[12] Request # 22—Documents on Hospitalization. Granted, subject to the protective order filed today, such compliance to be made on or before April 17, 1989.
[13] Request # 23—Documents on Suicides or Attempted Suicides. Granted, subject to the protective order filed today.
With respect to those items for which production has been ordered or for which defendants have agreed to provide responsive documents, unless otherwise provided, all production shall be made on or before April 3, 1989.
[14] The question of production of medical and mental health records, as requested in the Second Request for Production, is a sensitive one. As Judge Munson observed in Doe v. Coughlin, 697 F.Supp. 1234, 1234 (N.D.N.Y.1988), the resolution of this issue requires the court to consider “the difficult task ... of determining the nature and extent of privacy rights of inmates who have tested positive for exposure to ... HIV ...” Here, as there, the court must “tread[ ] on relatively unexplored territory.” Id. at 1236.
Defendants’ argument is as follows: (1) disclosure is prohibited under Conn.Gen.Stat. §§ 52–146c to 52–146j absent written consent by each class member; (2) the Court has discretion under F.R.Civ.P. 23(d)(2) to require notice to all class members that they may sign consent forms with respect to the confidential health records;5 *449 and (3) in the absence of written consent forms the court should permit only a random selection of redacted medical records.

5

Defendants argue that absentee class members are not

considered “parties” subject to discovery under

F.R.Civ.P. 33 and 34, citing Wainwright v. Kraftco

Corp., 54 F.R.D. 532, 534 (N.D.Ga.1972). That

decision, however, reflects the minority view on that

issue:

While it is true that discovery against absentee

class members under Rule 33 and 34 cannot be

had as a matter of course, the overwhelming

majority of courts which have considered the

scope of discovery against absentees have

concluded that such discovery is available, at least

when the information requested is relevant to the

decision of common questions, when the interrogatories or document requests are tendered in good faith and are not unduly burdensome, and when the information is not available from the representative parties. M. Berenson Co. v. Faneuil Hall Marketplace, Inc., 103 F.R.D. 635, 637 (D.Mass.1984). See also U.S. v. Trucking Employers, Inc., 72 F.R.D. 101, 104–05 (D.D.C.1976) (& numerous citations therein); Robertson v. National Basketball Ass’n, 67 F.R.D. 691, 698–701 (S.D.N.Y.1975) (& numerous citations therein). However, none of the above-mentioned decisions are applicable here, for among the concerns expressed therein was that defendants were serving discovery requests upon absentee class members for harassment and intimidation purposes only, whereas here it is the class members who are seeking discovery from defendants.
[15] Plaintiffs are correct, however, that in a civil rights action brought pursuant to a federal claim, state statutory privileges are not binding. F.R.Evid. 501. As Judge Weinstein ruled in Lora v. Board of Education of City of New York, 74 F.R.D. 565, 569 (E.D.N.Y.1977), regarding New York State’s statutorily created privilege between students or parents and school psychiatrists, psychologists, and social workers, “The New York law of privileges is not decisive because the claim arises under federal law.... Nevertheless, ... New York’s view of the matter and the expectations of its professionals and its patients may not be ignored....” (citations omitted). The Lora decision is particularly instructive, in that plaintiffs were minority students attending schools for socially maladjusted and emotionally disturbed students, who contended that such schools were being operated in a racially discriminatory manner. Judge Weinstein developed the following four-part test:
In determining whether disclosure in this case will unreasonably interfere with justifiable privilege expectations of students and their families four significant factors must be considered. First, is the identification of the individuals required for effective use of the data? Second, is the invasion of privacy and risk of psychological harm being limited to the narrowest possible extent? Third, will the data be supplied only to qualified personnel under strict controls over confidentiality? Fourth, is the data necessary or simply desirable?
Id. at 579. The court ordered disclosure to plaintiffs of fifty randomly selected diagnostic and referral files,
3

Doe v. Meachum, 126 F.R.D. 444 (1989)
subject to a strict protective order, including the redacting of all identifying data. Id. at 582–83, 587.
The second and third factors clearly militate in favor of disclosure, both sides having submitted proposed protective orders. The fourth element also compels disclosure, as the data sought is critical to plaintiffs’ experts. The first element is the troubling one, in that to some extent, the experts’ use of the files would not be hampered by eliminating identifying data. According to defendants, there are approximately 350 to 400 inmates presently incarcerated who are HIV positive. With such a large number of individual medical files, and given that HIV can be transmitted by sexual contact or by shared needles and the like, it may be critical to plaintiffs’ experts and their counsel to be aware of the names of individual inmates, in order to evaluate their medical records over time and in comparison with those of other HIV-infected inmates. Thus, all four factors to be considered in Lora point towards disclosure of the requested medical records.
This conclusion is not inconsistent with the applicable Connecticut statutes, however. Conn.Gen.Stat. § 52– 146c(c)(2) provides that communications between a psychologist and patient are privileged unless “in a civil proceeding, a person introduces the person’s psychological condition as an element of his claim ..., and the judge finds that it is more important to the interests of justice that the communications be disclosed than that the relationship between the person and psychologist be protected.” Section 52–146f(5) similarly provides as follows: “Communications or *450 records may be disclosed in a civil proceeding in which the patient introduces his mental condition as an element of his claim ... and the court or judge finds that it is more important to the interests of justice that the communications be disclosed than that the relationship between patient and psychiatrist be protected.” In one of the largest class actions ever pending in this circuit, Judge Pratt rejected one plaintiff’s claim of privilege against disclosure of his

medical records, “Plaintiff is deemed to have waived any privilege that he may have had when he put his medical condition into issue by initiating this lawsuit.” In re “Agent Orange” Product Liability Litigation, 91 F.R.D. 616, 618 (E.D.N.Y.1981). There can be little doubt that the psychological and mental condition of HIV-infected inmates is an element, if not a large element, of this class action. Given that disclosure is sought by professionals whose purpose it is to protect the constitutional rights of the plaintiff class, the court finds that it is more important to the interests of justice that the communications be disclosed, under the strict parameters set forth in the protective order, than that the relationship between patient and psychologist/psychiatrist be protected.6

6

Defendants further argue that plaintiffs cannot use Rule

23 as an “end run” around the Connecticut statute. But

see note 5 supra.

Accordingly, plaintiffs’ motion to compel production of these medical and mental health records is granted, subject to the protective order issued today. The records are to be limited to those of the named plaintiffs; all HIVinfected inmates currently incarcerated; HIV-infected inmates who died, attempted suicide, or were hospitalized while in DOC custody since August 15, 1985; and those HIV-infected inmates identified in the various incident reports produced by defendants. Compliance shall be made on or before March 31, 1989.
See 28 U.S.C. Section 636(b) (written objections to ruling must be filed within ten days after service of same); F.R.Civ.P. 72; Rule 2 of the Local Rules for United States Magistrates, United States District Court for the District of Connecticut.
Dated at New Haven, Connecticut, this 22nd day of March 1989.
	  

4

 
 Doe v. Meachum, 126 F.R.D. 450 (1989)
126 F.R.D. 450 United States District Court,
D. Connecticut.
David DOE, et al. v.
Larry R. MEACHUM, et al.
Civ. No. H–88–562 (PCD). | March 22, 1989.
Attorneys and Law Firms
*450 Shelley Geballe, Martha Stone, Connecticut Civ. Liberties Union Foundation, Hartford, Conn., J.L. Pottenger, Jr., Jerome N. Frank Legal Services Organization, New Haven, Conn., for plaintiffs.
*451 Stephen O’Neill, Steve Strom, Richard Couture, Asst. Attys. Gen., Hartford, Conn., for defendants.
Opinion
PROTECTIVE ORDER
JOAN GLAZER MARGOLIS, United States Magistrate.
In order to protect the privacy of inmates involved in this action and to safeguard them from harassment and retaliatory actions, and in order to protect the security interests of Department of Corrections facilities, all defendants’ responses to plaintiffs’ discovery which include inmate names or personally-identifiable information about inmates (including, but not limited to, medical records, psychiatric records, lists of inmates, and inmates discussed in depositions) shall be treated in the following manner:
1. These discovery responses which include inmate names and personally-identifiable information about inmates obtained by plaintiffs’ counsel through discovery from defendants shall be disclosed only to plaintiffs’ counsel herein, and such information shall not be redisclosed by plaintiffs’ counsel except as provided below.
2. Attorneys for the plaintiffs may disclose these discovery responses which include inmate names and personally-identifiable information about inmates to their expert consultants, but only to the minimum extent necessary to litigate this case.
3. Should attorneys for the plaintiffs have a demonstrated need to disclose the identities of such inmates to persons other than their expert consultants, they shall give

appropriate notice to defendants’ counsel. If, within two business days of such notice, defendants’ counsel fails to give approval to such disclosure, plaintiffs’ counsel shall file an appropriate application with this Court.
4. Any person to whom disclosure is to be made pursuant to paragraphs 2 and 3 of this Order (including assistants to expert consultants) shall first read this Protective Order, shall be strictly bound by the obligation not to redisclose such inmate names and other personally-identifiable information about inmates to the extent provided herein, and shall sign the form attached hereto acknowledging such responsibility prior to having access to such information.
5. Plaintiffs’ counsel, upon giving three (3) working days notice to defense counsel, shall be permitted to have plaintiffs’ counsel and experts examine and copy (at their own expense) medical and mental health records of the following people: the named plaintiffs; all HIV-infected inmates presently incarcerated; HIV-infected inmates who died, attempted suicide, or were hospitalized while in DOC custody since August 15, 1985; and those HIV-infected inmates identified in the various incident reports produced by defendants. Such examination shall be conducted in such a manner so as to minimize disruption of, undue burden upon, or interference with the daily institutional routines of the Department of Correction’s facilities.
6. Plaintiffs shall provide defendants with a list of each record or document of which a copy was requested.
7. All documents which include inmate names and personally-identifiable information about inmates (including inmates’ numbers) shall be sealed when filed with the Court.
SO ORDERED.
APPENDIX
ACKNOWLEDGEMENT OF DUTY NOT TO DISCLOSE
I, ____________________, am assisting counsel for the plaintiffs in this action.
I have read the Protective Order in this case and I understand that I am barred from divulging to anyone inmate names and any personally-identifiable information about inmates that I have, or will become aware of as a
1

Doe v. Meachum, 126 F.R.D. 450 (1989)
result of discovery in this case.
I further understand that I may be subject to contempt of Court if I violate the terms of the Protective Order. _______________
SIGNATURE *452 Signed and sworn to before me this day of , 1989.

_______________
NOTARY PUBLIC
	  

2

 
 Doe v. Meachum, 126 F.R.D. 452 (1989)

126 F.R.D. 452 United States District Court,
D. Connecticut.
David DOE, et al. v.
Larry R. MEACHUM, Commissioner, et al.
Civ. No. H–88–562 (PCD). | March 27, 1989.
Attorneys and Law Firms
*452 Shelley Geballe, Martha Stone, Connecticut Civ. Liberties Union Foundation, Hartford, Conn., J.L. Pottenger, Jr., Jerome N. Frank, Legal Services Organization, New Haven, Conn., for plaintiffs.
Stephen O’Neill, Steve Strom, Richard Couture, Asst. Attys. Gen., Hartford, Conn., for defendants.
Opinion

RULING ON PLAINTIFFS’ MOTION TO TESTIFY IN FICTITIOUS NAMES AND IN CHAMBERS

JOAN GLAZER MARGOLIS, United States Magistrate.
On August 15, 1988, plaintiffs commenced this action with respect to the various policies of the Connecticut Department of Corrections regarding inmates who are *453 infected with the Human Immunodeficiency Virus (“HIV”)1; that same day, Judge Cabranes granted plaintiffs’ motion for permission to prosecute suit in fictitious names.2

1

For convenience purposes only, the acronym HIV shall

be interchangeable with the acronyms AIDS (Aquired

Immune Deficiency Syndrome) and ARC

(AIDS–Related Complex).

2

By agreement of counsel, a class was certified in this

matter (see Dkt. # 88, filed January 20, 1989 and

approved absent objection on February 13, 1989);

counsel further agreed as to the content and manner of

notice to class members (see Dkt. # 102, filed March 3,

1989).

On March 3, 1989, plaintiffs filed the pending motion to testify in fictitious names and in chambers (Dkt. # 103) with respect to the hearing on plaintiffs’ motion for preliminary injunction, scheduled to commence on April

5, 1989; their brief in support was filed on March 20, 1989 (Dkt. # 116). Defendants’ brief in opposition was filed on March 17, 1989. (Dkt. # 115). Plaintiff’s reply brief was filed on March 22, 1989. (Dkt. # 117). Oral argument was held on March 23, 1989. For the reasons stated herein, plaintiffs’ motion is granted in part and denied in part.
The significant privacy interest of plaintiffs was noted in this Magistrate’s Ruling on Plaintiffs’ Motion for Protective Order, filed October 27, 1988 (Dkt. # 40), which observed as follows:
While several decisions have upheld the right of prison officials to identify and isolate suspected AIDS carriers, e.g., Baez v. Rapping, 680 F.Supp. 112, 115 (S.D.N.Y.1988); Judd v. Packard, 669 F.Supp. 741, 743 (D.Md.1987); Cordero v. Coughlin, 607 F.Supp. 9, 10 (S.D.N.Y.1984), at least one court has recognized that an inmate infected with AIDS has a constitutional right to privacy in his medical records. Woods v. White, 689 F.Supp. 874, 876 (W.D.Wis.1988).
Some five months ago, District Judge Munson similarly was required to face “the difficult task of ... determining the nature and extent of the privacy rights of inmates who have tested positive for exposure to ... HIV ...” Doe v. Coughlin, 697 F.Supp. 1234, 1234 (N.D.N.Y.1988). The court ruled that each plaintiff
... is fully aware that he is infected with a disease which at the present time has inevitably proven fatal. In the court’s view there are few matters of a more personal nature, and there are few decisions over which a person could have a greater desire to exercise control, than the manner in which he reveals that diagnosis to others. An individual’s decision to tell family members as well as the general community that he is suffering from an incurable disease, particularly one such as AIDS, is clearly an emotional and sensitive one fraught with serious implications for that individual. Certain family members may abandon the AIDS victim while others may be emotionally unprepared to handle such news. Within the confines of the prison the infected prisoner is likely to suffer from harassment and psychological pressures. Beyond the prison’s walls the person suffering from AIDS is often subject to discrimination.
... It may be even more essential for a prisoner than a person who enjoys the freedoms associated with life outside of prison, and the personal strength derived
1

Doe v. Meachum, 126 F.R.D. 452 (1989)

from those freedoms, that the prisoner be accorded the ability to protect and shape his identity to as great a degree as possible. There is little question but that the prisoner identified as having AIDS will be severely compromised in his ability to maintain whatever dignity and individuality a prison environment allows.
Id. at 1237–38 (footnotes omitted).
Plaintiffs have been permitted to commence lawsuits anonymously in cases involving abortion, mental illness, personal safety, homosexuality, transsexuality, illegitimacy, and abandonment of children, “[t]he common thread” being “the presence of some social stigma or the threat of physical harm to the plaintiffs attaching to disclosure of their identities to the public record.” Doe v. Rostker, 89 F.R.D. 158, 161 (N.D.Cal.1981) (footnotes omitted). *454 Defendants agree that this case is one where fictitious names are appropriate.3

3

Defendants have reserved the right, however, to ask for

modifications, as needed.

[1] The more problematic issue is whether plaintiffs ought to be able to testify in chambers and to have the transcript of their testimony sealed to the extent necessary so as not to reveal their identities.4 As in Doe v. Coughlin, supra, the court here must “tread[ ] on relatively unexplored territory.” 697 F.Supp. at 1236. Juxtaposed against plaintiffs’ privacy interests is the weight of the First Amendment, which ensures the right of the public and of the press to attend judicial proceedings. The United States Supreme Court has made abundantly clear that the First Amendment “guarantees” such right with respect to criminal trials. Press–Enterprise Co. v. Superior Court of Cal., 478 U.S. 1, 6–15, 106 S.Ct. 2735, 2739–44, 92 L.Ed.2d 1 (1986); Press–Enterprise Co. v. Superior Court of Cal., 464 U.S. 501, 505–13, 104 S.Ct. 819, 821–26, 78 L.Ed.2d 629 (1984); Richmond Newspapers, Inc. v. Virginia, 448 U.S. 555, 575–81, 100 S.Ct. 2814, 2826–30, 65 L.Ed.2d 973 (1980). In his plurality opinion and in his concurrence in Richmond Newspapers, Chief Justice Berger and Justice Stewart, respectively, observed that historically both civil and criminal trials have been presumptively open. 448 U.S. at 580 n. 17, 599, 100 S.Ct. at 2829 n. 17, 2840. The Second Circuit has agreed that First Amendment guarantees apply equally to civil trials. Westmoreland v. Columbia Broadcasting System, Inc., 752 F.2d 16, 22–23 (2d Cir.1984), cert. denied sub nom. Cable News Network, Inc. v. United States District Court, 472 U.S. 1017, 105 S.Ct. 3478, 87 L.Ed.2d 614 (1985) (rejecting cable network’s request to film live well-publicized defamation trial).

4

Plaintiffs have agreed to disclose to defense counsel the

true names of their HIV-infected witnesses, so that

defendants may prepare their defense, provided any

persons to whom defense counsel make redisclosure be

required to file an Acknowledgement of Duty Not to

Disclose, attached to the Protective Order, filed

October 27, 1988. (Dkt. # 41). See Ruling on

Defendants’ Request for Permission to Disclose the

Identities of Certain Named Plaintiffs to Department of

Correction Staff and for Partial Modification of the

Protective Order Dated October 27, 1988, also filed

today.

At issue in Brown & Williamson Tobacco Corp. v. F.T.C., 710 F.2d 1165 (6th Cir.), reh. denied on other issues, 717 F.2d 963 (6th Cir.1983), a seminal decision in this field, were documents with respect to the tar and nicotine contents of cigarettes, which documents were placed under seal in the pending litigation. The Sixth Circuit stated that despite the significant justifications for an open courtroom, the First Amendment right of access is “not absolute”:
Courts have carved out several distinct but limited common law exceptions to the strong presumption in favor of openness. The exceptions to the practice of maintaining openness in the courtroom fall into two broad categories: those based on the need to keep order and dignity in the courtroom and those which center on the content of the information to be disclosed to the public....
It is the second group of limitations on access to court proceedings that concerns us here. Under the common law, content-based exceptions to the right of access have been developed to protect competing interests. In addition to the defendant’s right to a fair trial, these interests include certain privacy rights of participants or third parties, trade secrets and national security....
Simply showing that the information would harm the company’s reputation is not sufficient to overcome the strong common law presumption in favor of public access to court proceedings and records....
Id. at 1179 (citations omitted).
In Publicker Industries, Inc. v. Cohen, 733 F.2d 1059 (3d Cir.1984), another leading case, the Third Circuit set forth certain procedural and substantive requirements which must be satisfied before a hearing may be closed to the public and press. Publicker involved a hearing on a motion for preliminary injunction in a proxy fight over control of a corporation; the hearing *455 was closed due to “sensitive” information regarding improper activities by Publicker’s foreign subsidiary. The appeals court reversed, holding:
2

Doe v. Meachum, 126 F.R.D. 452 (1989)
Procedurally, a trial court in closing a proceeding must both articulate the countervailing interest it seeks to protect and make “findings specific enough that a reviewing court can determine whether the closure order was properly entered.” ... Substantively, the record before the trial court must demonstrate “an overriding interest based on findings that closure is essential to preserve higher values and is narrowly tailored to serve that interest.” ...
Id. at 1071 (citations omitted). The substantive requirements were not met, in that the closure was not “narrowly tailored,” the court suggesting “a less restrictive alternative such as a bifurcated hearing.” Id. at 1074. See also Rushford v. New Yorker Magazine, Inc., 846 F.2d 249, 253, 254 (4th Cir.1988) (requiring district court to give the public adequate notice of the sealing of documents, to provide interested persons with an opportunity to object to the request, and to state its reasons for such closure on the record, supported by specific findings).
As Judge Munson so eloquently wrote in Doe v. Coughlin, supra, “there are few matters of a more personal nature” than the privacy interests of plaintiffs here. If any interests are sufficiently “overriding” to overcome the strong presumption in favor of public access, surely the plaintiffs’ interests here are. The difficulty lies in evaluating whether there is “a less restrictive alternative” to a blanket order of in chambers testimony and the sealing of transcripts with respect to the testimony of all present or former inmates. The Magistrate must conclude, reluctantly, that a less restrictive alternative does exist, the exact parameters of which may need further refinement between now and April 5, 1989.
[2] On March 7, 1989, this Magistrate issued an order (Dkt. # 105) directing both sides to address the feasibility and implications of holding a portion of the preliminary injunction hearing at a correctional institution. There appears to be a role reversal here, with plaintiffs arguing

that “the privacy rights of incarcerated inmates are more likely to be preserved if testimony is taken outside of a DOC facility” (Plaintiffs’ Brief in Support at 4–5) (emphasis in original), while the defendants advocate that trials in correctional institutions are open to the public. (Defendants’ Brief at 11–12). It is clear that plaintiffs, for whatever reason, have a greater fear of disclosure of their identities within the prison walls than in the outside community. There can be no argument that security interests are better served, and overall expenses dramatically reduced, if the testimony of incarcerated inmates were taken within a centrally located correctional institution. As legitimate as defendants’ security concerns are, they must bend, however, to plaintiffs’ significant privacy interests, as expressed in Doe v. Coughlin, supra.
Accordingly, the hearing on plaintiffs’ motion for preliminary injunction shall be held in an open courtroom in the District Court in Bridgeport. Testifying class members may testify under fictitious names and there shall be no testimony of a sufficiently detailed nature to compromise their identities. If any testifying class member so wishes, he or she may appear in the courtroom in a disguised manner, so that he or she will not be recognized by facial or other characteristics. Lastly, to the extent there are any witnesses whose circumstances are so unusual that the above guidelines are insufficient to protect their identities, on or before March 30, 1989, plaintiffs may file a motion for reconsideration of this ruling with respect to such individuals, attached to which shall be an affidavit or affidavits, filed under seal, setting forth in detail the underlying circumstances and why the protections described above are inadequate.
See 28 U.S.C. Section 636(b) (written objections to ruling must be filed within ten days after service of same); F.R.Civ.P. 72; Rule 2 of the Local Rules for United States Magistrates, United States District Court for the District of Connecticut.
	  

3

 
 Doe v. Meachum, 126 F.R.D. 456 (1989)
126 F.R.D. 456 United States District Court,
D. Connecticut. David DOE, et al.
v. Larry R. MEACHUM, et al. Civ. No. H–88–562 (PCD). | April 12, 1989.
Attorneys and Law Firms
*456 Shelley Geballe, Martha Stone, Connecticut Civ. Liberties Union Foundation, Hartford, Conn., J.L. Pottenger, Jr., Jerome N. Frank, Legal Services Organization, New Haven, Conn., for plaintiffs.
Stephen O’Neill, Steve Strom, Richard Couture, Asst. Attys. Gen., Hartford, Conn., for defendants.
Opinion
ORDER
DORSEY, District Judge.
Absent objection, the magistrate’s ruling is accepted and adopted.
SO ORDERED.
RULING ON DEFENDANTS’ REQUEST FOR PERMISSION TO DISCLOSE THE IDENTITIES
OF CERTAIN NAMED PLAINTIFFS TO DEPARTMENT OF CORRECTION STAFF AND
FOR PARTIAL MODIFICATION OF THE PROTECTIVE ORDER DATED OCTOBER 27, 1988
JOAN GLAZER MARGOLIS, United States Magistrate.
Familiarity is presumed with the factual and procedural history of this litigation. Paragraph 3 of the Protective Order, filed October 27, 1988 (Dkt. ## 41), provides in full:
Should attorneys for the defendants have a demonstrated need to disclose the identities of such inmates to persons other than the named defendants, they shall give

appropriate notice to plaintiffs’ counsel. If, within two (2) business days of such notice, plaintiffs’ counsel fails to give approval to such disclosure, defendants’ *457 counsel shall file an appropriate application with this Court.
The Protective Order was approved by Judge Dorsey on November 22, 1988 over defendants’ objection. (See Dkt. # 61).1

1

Paragraph 5 of the Protective Order later was modified,

in accordance with the Ruling on Cross–Motions for

Clarification, filed December 5, 1988. (Dkt. # 68).

On March 27, 1989, defendants filed the instant request for permission to disclose the identities of certain named plaintiffs to Department of Correction Staff and for partial modification of the protective order dated October 27, 1988. (Dkt. # 121). Attached to the request were two exhibits—copy of letter, dated January 3, 1989, from Attorney Couture to Attorney Stone (Exh. A); and copy of letter, dated January 5, 1989, from Attorney Geballe to Attorney Couture (Exh. B).2 Oral argument was held on March 23, 1989. For the reasons stated herein, defendants’ request is granted in part and denied in part.

2

By agreement of counsel at the oral argument on March

23, 1989, both exhibits were placed under seal.

Defendants’ request is three-fold: (1) they seek permission to disclose inmate identities as to the wardens for whom plaintiffs have made objection (see Exh. B, at 3–5); (2) they seek permission to disclose inmate identities to individuals identified only by their title and/or first names (e.g., “ ‘Oriental’ physician at J.B. Gates CC” or “Medic Steve ____ of Hartford CC” or “DOC AIDS counsellors regarding allegation of lack of information”) (see Exh. B, at 2–3);3 and (3) they seek to modify the Protective Order to eliminate ¶ 3, arguing that because of the “very tight pre-trial schedule in this case,” defendants “simply do not have the time” to disrupt their investigative efforts by continually seeking plaintiffs’ and/or the Court’s permission prior to interviewing their own employees or agents.4

3

Defendants do not dispute that these individuals, like

everyone else to whom disclosure is made, will sign the

acknowledgement form.

4

See note 4 supra.

1

Doe v. Meachum, 126 F.R.D. 456 (1989)
[1] At oral argument, plaintiffs agreed to disclosure to any warden as long as an incident at issue in this litigation arose while he or she was warden at such institution. To the extent there are any wardens not included in this agreement, defendants are correct that each warden bears the ultimate responsibility for institutional practices and under administrative procedures is an individual to whom complaints are to be directed. In light of the warden’s position within each institution, defendants’ request to disclose inmate identities to all the wardens listed in Exhibits A and B is granted.
At oral argument, plaintiffs further agreed to disclosure to the individuals identified by last name. (See Exh. B, at 5–6). As to those individuals identified only by job title and/or first name, plaintiffs also agreed to disclosure, once the individuals have become known to defendants and upon execution of the acknowledgement form. Defendants may renew this request if such individuals’ complete identities can only be ascertained through disclosure of inmates’ names.
[2] The Court recognizes the burden that ¶ 3 of the Protective Order places upon defendants. During argument on this issue, defendants, however, offered no alternative other than carte blanche authority to disclose plaintiffs’ identities to any DOC employee. Such blanket

authority would give little protection to plaintiffs. Plaintiffs have agreed to some relaxation of the Protective Order, however. To the extent information develops during on-site investigations by defense counsel, about which defense counsel wishes to make immediate inquiry to other DOC personnel, the requirements of ¶ 3 are waived, so long as the recipient of the disclosed information has read the Protective Order and signs the acknowledgement form prior to the disclosure. Similarly, to the extent information develops during the course of the hearing on plaintiffs’ motion for preliminary injunction, about which defense counsel wishes to make immediate inquiry, the requirements of ¶ 3 are waived, so long as the recipient of the disclosed information has read or is *458 read the Protective Order and signs the acknowledgement form prior to the disclosure or promptly thereafter.
See 28 U.S.C. Section 636(b) (written objections to ruling must be filed within ten days after service of same); F.R.Civ.P. 72; Rule 2 of the Local Rules for United States Magistrates, United States District Court for the District of Connecticut.
Dated at New Haven, Connecticut, this 27th day of March, 1989.
	  

2

 
 Doe v. Meachum, 126 F.R.D. 458 (1989)
126 F.R.D. 458 United States District Court,
D. Connecticut. David DOE, et al.
v. Larry R. MEACHUM, et al. Civ. No. H–88–562 (PCD). | April 21, 1989.
Attorneys and Law Firms *458 Shelley Geballe, Martha Stone, Connecticut Civ. Liberties Union Foundation, Hartford, Conn., J.L. Pottenger, Jr., Jerome N. Frank, Legal Services Organization, New Haven, Conn., for plaintiffs. Stephen O’Neill, Steve Strom, Richard Couture, Asst. Attys. Gen., Hartford, Conn., for defendant. Opinion
ORDER
DORSEY, District Judge. Absent objection, the magistrate’s opinion is accepted and approved. SO ORDERED.
RULING ON FOUR MOTIONS FOR RECONSIDERATION
JOAN GLAZER MARGOLIS, United States Magistrate. On March 27, 1989 and March 30, 1989, plaintiffs filed two motions for full or partial reconsideration of two recent rulings issued by the Magistate (see Dkt. ## 124 and 128); on March 31, 1989, defendants filed two requests for partial reconsideration of two recent rulings issued by the Magistrate (see Dkt. ## 125 and 126). An impromptu conference was held on these four motions late in the afternoon on Friday, March 31, 1989.
A. PARTIAL RECONSIDERATION OF MARCH 22, 1989 DISCOVERY RULING

By agreement of counsel at the March 31, 1989 conference, defendants will produce the medical/mental health records of *459 members of the plaintiff-class who are not currently incarcerated when such individuals have been specifically identified by plaintiffs, without waiving defendants’ right to object to production thereof with respect to the burdensomeness of any individual list submitted to them or cumulation of lists.

B. PARTIAL RECONSIDERATION OF MARCH 27, 1989 PROTECTIVE ORDER RULING
By agreement of counsel at the March 31, 1989 conference, the first full sentence on p. 5 of Dkt. # 122 shall be modified as follows: “Similarly, to the extent information develops during the course of the hearing on plaintiffs’ motion for preliminary injunction, about which defense counsel wishes to make immediate inquiry, the requirements of ¶ 3 are waived, so long as the recipient of the disclosed information has read or is read the Protective Order and signs the acknowledgement form prior to the disclosure or within a reasonable time thereafter.” In addition, to the extent there is no notary public or attorney reasonably available to take the recipient’s oath on the acknowledgement form, the recipient may make a sworn declaration under penalty of perjury, pursuant to 18 U.S.C. § 1621.

C. FULL OR PARTIAL RECONSIDERATION OF MARCH 27, 1989 RULING ON TESTIMONY IN
CHAMBERS
In an affidavit placed under seal, plaintiff Gary Roe argues that “it is somehow demeaning and makes me feel like a freak” if he is compelled to appear in court in a disguise and also expresses concern that his wife’s employment could be placed into jeopardy if his illness were to become known in the community. He further fears that his children might become stigmatized as well.
As expressed in Dkt. # 123, in resolving this sensitive issue, this Court must balance plaintiffs’ significant privacy interests against the First Amendment right of the public and of the press to attend judicial proceedings. As justifiable as plaintiff Roe’s concerns are in a society which unfortunately treats AIDS victims and their families as pariahs, his circumstances are simply not “so unusual” as to require reconsideration of the March 27, 1989 ruling.1

1

Plaintiffs may renew this motion by submitting

1

Doe v. Meachum, 126 F.R.D. 458 (1989)
affidavits from other witnesses prior to taking their testimony.
Defendants request partial reconsideration of the prohibition against “testimony of a sufficiently detailed nature to compromise [plaintiffs’] identities.” While the Court has no desire to unduly curtail defendants’ ability to cross-examine witnesses or offer rebuttal evidence, as discussed at the March 31, 1989 conference, clarification of this language can only be accomplished, painstakingly, on a question-by-question basis at the preliminary injunction hearing.

D. CONCLUSION
Accordingly, Dkt. ## 124 and 128 are granted to the extent set forth in Parts A & B supra. Dkt. ## 125 and 126 are denied for the reasons set forth in Part C supra.
See 28 U.S.C. Section 636(b) (written objections to ruling must be filed within ten days after service of same); F.R.Civ.P. 72; Rule 2 of the Local Rules for United States Magistrates, United States District Court for the District of Connecticut.
Dated at New Haven, Connecticut, this 3rd day of April, 1989.
	  

2

 
 Doe v. Meachum, 126 F.R.D. 459 (1989)
126 F.R.D. 459 United States District Court,
D. Connecticut. David DOE, et al.
v. Larry R. MEACHUM, et al. Civ. No. H–88–562 (PCD). | April 21, 1989.
Attorneys and Law Firms *460 Shelley Geballe, Martha Stone, Connecticut Civ. Liberties Union Foundation, Hartford, Conn., J.L. Pottenger, Jr., Jerome N. Frank, Legal Services Organization, New Haven, Conn., for plaintiffs. Stephen O’Neill, Steve Strom, Richard Couture, Asst. Attys. Gen., Hartford, Conn., for defendants. Opinion
ORDER
DORSEY, District Judge. Absent objection, the magistrate’s ruling is accepted and approved.
SO ORDERED.
RULING ON PLAINTIFFS’ RENEWED MOTION FOR RECONSIDERATION OF RULINGS
REGARDING IN CAMERA TESTIMONY OF INMATE WITNESSES
JOAN GLAZER MARGOLIS, United States Magistrate. Familiarity is presumed with the numerous filings and two rulings with respect to plaintiffs’ request that they be allowed to testify in chambers. (See Dkt. ### 103, 115, 116, 117, 123, 126, 128, 129). On Tuesday, April 4, 1989, plaintiffs filed an objection to the two rulings (Dkt. # 130), in which they proposed that plaintiffs’ chambers testimony be tape-recorded, with a redacted tape immediately released to the public and to the press for the

purpose of guaranteeing first amendment rights. At the conclusion of oral argument on this objection on Friday, April 7, 1989, Judge Dorsey overruled plaintiffs’ objection but also remanded the matter back to the Magistrate for further reconsideration of this new proposal.
A telephonic conference was held between counsel and the Magistrate shortly after Judge Dorsey’s oral ruling, in which defense counsel continued to object to this new suggestion. As directed by the Magistrate, plaintiffs promptly filed this renewed motion. (Dkt. # 131).
While plaintiffs’ suggestion is certainly a creative one, plaintiffs’ renewed motion is denied to the extent it asks that all inmate testimony be heard in chambers. In their motion for reconsideration (Dkt. # 128), plaintiffs proposed that daily transcripts be appropriately redacted to delete personally identifying information and thereafter be made available to the press and public. Plaintiffs’ newest proposal, in substance, is not materially different, in that it similarly excludes the press and public from access to the complete court proceedings—its only advantage lies in that while depriving the press and public of access to the full testimony, it at least provides audial access to the drama of the human voice, as opposed *461 to resort to the cold (and often barren) transcript.
This ruling is without prejudice to plaintiffs’ renewal thereof when the preliminary injunction hearing resumes on April 11, 1989, with respect to the testimony of individual witnesses or limited lines of examination, at which time a “closure proceeding” would be held, as required in Publicker Industries, Inc. v. Cohen, 733 F.2d 1059, 1071 (3d Cir.1984), to determine whether the record demonstrates “an overriding interest based on findings that closure is essential to preserve higher values ...” If such a determination were made, the Court would then utilize the method recently suggested by plaintiffs.
See 28 U.S.C. Section 636(b) (written objections to ruling must be filed within ten days after service of same); F.R.Civ.P. 72; Rule 2 of the Local Rules for United States Magistrates, United States District Court for the District of Connecticut.
Dated at New Haven, Connecticut, this 10th day of April, 1989.
	  

1