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UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA JACKSONVILLE DIVISION

DISABILITY RIGHTS FLORIDA, INC., On behalf of its Clients and Constituents,

Plaintiff,

vs.

Case No. 3:18-cv-179-J-25JRK

JULIE JONES, Secretary, Florida Department of Corrections in her Official Capacity and FLORIDA DEPARTMENT OF CORRECTIONS, an Agency of the State of Florida,

Defendants.

SETTLEMENT AGREEMENT

I. INTRODUCTION

A. This Settlement Agreement ("Agreement") comes before the Court on the Complaint filed by Plaintiff, Disability Rights Florida, Inc., on January 30, 2018 (DE 1), on behalf of its clients and constituents seeking declaratory and injunctive relief on behalf of inmates within the Florida Department of Corrections (FDC) who are currently clients and constituents of Disability Rights Florida and who are mentally ill and confined in a FDC inpatient mental health unit or who may be transferred to a FDC inpatient mental health unit. Plaintiff, Disability Rights Florida, (DRF), is an organization charged by federal law to protect the rights of individuals with mental illness in Florida. Defendants are Julie Jones, in her official capacity as Secretary ofthe Florida Department of Corrections, and the Florida Department of Corrections (collectively "Defendants" or "FDC"). The Defendants and the Plaintiff shall be referred to in this Agreement collectively as the "Parties."

B. Jurisdiction and Venue:

This action is brought by Disability Rights Florida, Inc., on

behalf of its clients and constituents, pursuant to 42 U.S.C. § 1983, the Americans with Disabilities

Act ("ADA"), codified at 42 U.S.C. § 12132 et seq., and the Federal Rehabilitation Act ("FRA"),

codified at 29 U.S.C. § 794. Accordingly, this Court has jurisdiction over the subject matter of

this action pursuant to 28 U.S.C. § 1331, and may grant declaratory and injunctive relief pursuant

to 28 U.S.C. §§ 2201-2202. This Court has personal jurisdiction over the Defendants. Venue lies

in this judicial district pursuant to 28 U.S.C. § 1391 because a substantial part of the events or

omissions giving rise to this claim occurred in this district- over 70% of the FDC inpatient mental

health beds are located in this district, and the largest number of inpatient health beds are located

in this division. For purposes of this Agreement, or any action to enforce this Agreement,

Defendants consent to the Court's jurisdiction over this Agreement or such action and over

Defendants, and consent to venue in this judicial district.

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 Create an Alert for This Case on RECAP

CLOSED, SL DOC

U.S. District Court Middle District of Florida (Jacksonville) CIVIL DOCKET FOR CASE #: 3:18-cv-00179-HES-JRK

Disability Rights Florida, Inc. v. Jones et al Assigned to: Senior Judge Harvey E. Schlesinger Referred to: Magistrate Judge James R. Klindt Cause: 29:0794 Job Discrimination (Handicap)

Date Filed: 01/30/2018 Date Terminated: 02/08/2018 Jury Demand: None Nature of Suit: 440 Civil Rights: Other Jurisdiction: Federal Question

Plaintiff
Disability Rights Florida, Inc. on behalf of its Clients and Constituents

represented by Andrea Costello Florida Legal Services 14260 W. Newberry Road, #412 Newberry, FL 32669 407-801-0332 Fax: 407-505-7327 Email: andrea@floridalegal.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

Christopher Michael Jones Florida Institutional Legal Services Suite 412 14260 W Newberry Rd Newberry, FL 32669 352/375-2494 Fax: 352/331-5202 Email: christopher@floridalegal.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

David Boyer National Disability Rights Network 820 1st St NE Ste 740 Washington, DC 20002 850/488-9071 Fax: 850/488-8640 Email: david.boyer@ndrn.org

V. Defendant

LEAD ATTORNEY ATTORNEY TO BE NOTICED
George E. Schulz , Jr. Holland & Knight, LLP Suite 3900 50 N Laura St Jacksonville, FL 32202 904/353-2000 Fax: 904/358-1872 Email: buddy.schulz79@outlook.com LEAD ATTORNEY ATTORNEY TO BE NOTICED
Kristen Cooley Lentz 140 Science Drive Durham, NC 27708 850/488-9071 Fax: 850/488-8640 Email: kristen.lentz@duke.edu LEAD ATTORNEY ATTORNEY TO BE NOTICED
Laura Beard Renstrom Holland & Knight, LLP Suite 3900 50 N Laura St Jacksonville, FL 32202 904/353-2000 Email: laura.renstrom@hklaw.com LEAD ATTORNEY ATTORNEY TO BE NOTICED
Peter Prescott Sleasman Disability Rights Florida 4723-B NW 53rd Avenue Gainesville, FL 32653 352/375-2494 Fax: 352/331-5202 Email: peters@disabilityrightsflorida.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

Julie Jones Secretary, Florida Department of Corrections in her Official Capacity

represented by Alexandria Elisse Williams Florida Department of Corrections 501 S Calhoun St Tallahassee, FL 32399-6548 850/717-3605 Fax: 850/922-4355 Email: Alexandria.Williams@fdc.myflorida.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Dorothy M. Burnsed Florida Department of Corrections 501 South Calhoun St. Tallahassee, FL 32399-6548 850-717-3616 Fax: 850-922-4355 Email: Dorothy.Burnsed@fdc.myflorida.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Ian B. Carnahan Florida Department of Corrections 501 S Calhoun St Tallahassee, FL 32399-6548 850/717-3622 Email: ian.carnahan@fdc.myflorida.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Joel Steven Carter Henry Buchanan, PA Post Office Drawer 14079 Tallahassee, FL 32317-4079 850/222-2920 Fax: 850/224-0034 Email: scarter@henryblaw.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Kenneth S. Steely Florida Department of Corrections 501 S Calhoun St Tallahassee, FL 32399-6548 251-439-7535

Fax: 251-433-4106 Email: Kenneth.Steely@fdc.myflorida.com LEAD ATTORNEY PRO HAC VICE ATTORNEY TO BE NOTICED

Miriam R. Coles Henry, Buchanan, Hudson, Suber & Carter, PA* 2508 Barrington Circle PO Box 14079 Tallahassee, FL 32317-4079 850-222-2920 Fax: 850-224-0034 Email: mcoles@henryblaw.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Jay Patrick Reynolds Florida Department of Corrections 501 S Calhoun St Tallahassee, FL 32399-6548 850/841-7511 Fax: 850/922-4355 Email: Patrick.Reynolds@FloridaDEP.gov ATTORNEY TO BE NOTICED

Defendant
Florida Department of Corrections an Agency of the State of Florida

represented by Alexandria Elisse Williams (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Dorothy M. Burnsed (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Ian B. Carnahan (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Jay Patrick Reynolds

(See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Joel Steven Carter (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Kenneth S. Steely (See above for address) LEAD ATTORNEY PRO HAC VICE ATTORNEY TO BE NOTICED
Miriam R. Coles (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Gayla Grant Department of Management Services Ste 160 4050 Esplanade Way Tallahassee, FL 32399-7016 850/921-4787 Fax: 850/922-6312 Email: gayla.grant@dms.myflorida.com ATTORNEY TO BE NOTICED

Date Filed 01/30/2018
01/30/2018 01/31/2018

# Docket Text

COMPLAINT against Florida Department of Corrections, Julie

1

Jones (Filing fee $ 400 receipt number JAX026611) filed by

Disability Rights Florida, Inc.. (Attachments: # 1 Civil Cover

Sheet)(TSW) (Entered: 01/31/2018)

2 NOTICE of pendency of related cases per Local Rule 1.04(d) by Disability Rights Florida, Inc. Related case(s): yes (TSW) (Entered: 01/31/2018)

3 Joint MOTION for miscellaneous relief, specifically Adoption of Settlement Agreement by Court by Disability Rights Florida, Inc.. (Attachments: # 1 Exhibit Settlement Agreement)(Lentz, Kristen) (Entered: 01/31/2018)

01/31/2018

4 ORDER transferring case to the Honorable Harvey E. Schlesinger, with his consent, for all further proceedings. Signed by Senior Judge Henry Lee Adams, Jr. on 1/31/2018. (MO) (Entered: 01/31/2018)

01/31/2018

7 Case reassigned to Senior Judge Harvey E. Schlesinger. New case number: 3:18cv179-J-20JRK. Senior Judge Henry Lee Adams, Jr no longer assigned to the case. (AET) (Entered: 02/02/2018)

02/01/2018

5 WAIVER of service returned executed on 2/1/18 by Disability Rights Florida, Inc. as to Julie Jones. (Sleasman, Peter) (Entered: 02/01/2018)

02/01/2018

6 WAIVER of service returned executed on 2/1/18 by Disability Rights Florida, Inc. as to Florida Department of Corrections. (Sleasman, Peter) (Entered: 02/01/2018)

02/07/2018

8 NOTICE of Appearance by Jay Patrick Reynolds on behalf of Julie Jones (Reynolds, Jay) (Entered: 02/07/2018)

02/07/2018

9 ORDER granting 3 Joint Motion for Court Adoption of Settlement Agreement; directing the Clerk to enter the attached Settlement Agreement as an Order of this Court; directing the Clerk to close this case; SEE ORDER FOR FURTHER DETAILS. Signed by Senior Judge Harvey E. Schlesinger on 2/7/2018. (Attachments: # 1 Settlement Agreement) (MGG) (Entered: 02/07/2018)

02/08/2018 10

SETTLEMENT AGREEMENT signed by Maryellen McDonald for Plaintiff and Julie L. Jones for Defendant, adopted as an Order of this Court. Signed by Deputy Clerk on 2/8/2018. (TSW) (TSW). (Entered: 02/09/2018)

03/09/2018

11 Joint MOTION for miscellaneous relief, specifically Court Entry of Stipulated HIPAA Qualified Protective Order by Disability Rights Florida, Inc.. (Attachments: # 1 Exhibit Proposed Stipulated HIPAA Qualified Protective Order)(Lentz, Kristen) (Entered: 03/09/2018)

03/09/2018

12 Joint MOTION to modify Deadline for Submission of Monitoring Instrument by Disability Rights Florida, Inc.. (Lentz, Kristen) (Entered: 03/09/2018)

03/15/2018

13 STIPULATED HIPAA QUALIFIED PROTECTIVE ORDER Signed by Senior Judge Harvey E. Schlesinger on 3/14/2018. (MGG) (Entered: 03/15/2018)

03/15/2018 06/18/2018 06/22/2018 07/10/2018
07/23/2018 07/31/2018

14 ORDER granting 12 Joint Motion for Modification of Deadline; extending deadline for submission of CMA-approved
monitoring instrument (see 10 Settlement Agreement) to 7/31/2018. Signed by Magistrate Judge James R. Klindt on 3/15/2018. (KAW) (Entered: 03/15/2018)
15 Joint MOTION for settlement conference Regarding Plaintiff's Attorneys' Fees and Costs by Disability Rights Florida, Inc.. (Sleasman, Peter) (Entered: 06/18/2018)
16 ORDER granting 15 Joint Motion for Settlement Conference with Magistrate Judge Regarding Plaintiff's Attorneys' Fees and Costs; representative speaking for the parties to contact Judge Klindt's chambers with dates for the conference by 7/3/2018; see Order for details. Signed by Magistrate Judge James R. Klindt on 6/22/2018. (KAW) (Entered: 06/22/2018)
17 ORDER Setting Settlement Conference for 8/7/2018 at 10:00 AM in Jacksonville Courtroom 5 D before Magistrate Judge James R. Klindt. Plaintiff shall submit for the Court's consideration the fees and costs that were requested of Defendants and Defendants shall submit for the Court's consideration the counteroffer that they previously submitted to Plaintiff no later than 7/31/2018. Any objections to the proposed procedure due no later than 7/16/18. Confidential Memoranda due no later than 7/31/2018. Signed by Magistrate Judge James R. Klindt on 7/10/2018. SEE ORDER FOR DETAILS AND INSTRUCTIONS REGARDING SUBMISSION. (Attachments: # 1 General Order)(MDC) (Entered: 07/10/2018)
18 NOTICE of Appearance by Joel Steven Carter on behalf of Florida Department of Corrections, Julie Jones (Carter, Joel) (Entered: 07/23/2018)
19 NOTICE by Disability Rights Florida, Inc. of Filing Monitoring Instruments (Attachments: # 1 Exhibit Discharge Planning Review, # 2 Exhibit Disciplinary Report Review, # 3 Exhibit Group Observation Checklist, # 4 Exhibit Inpatient Mental Health Review, # 5 Exhibit Institutional Tour, # 6 Exhibit MDST Observation Review, # 7 Exhibit Medical Records Review, # 8 Exhibit
Medication Administration Observation Checklist, # 9 Exhibit Mental Health Systems, # 10 Exhibit Psychiatric Medication Practices Review, # 11 Exhibit Mental Health Restraints Review, # 12 Exhibit Security Restraint Observation Checklist, # 13 Exhibit

Self-Injurious and Suicidal Behavior Review, # 14 Exhibit Suicide Isolation Room Checklist, # 15 Exhibit Treatment Refuser Review, # 16 Exhibit Mental Health Profession Interview Questions, # 17 Exhibit Nursing Interview Questions, # 18 Exhibit Patient Interview Questions, # 19 Exhibit Psychiatrist Interview Questions, # 20 Exhibit Psychologist Interview Questions, # 21 Exhibit Security Interview Questions)(Sleasman, Peter) (Entered: 07/31/2018)

08/07/2018 20

MINUTE Entry. Proceedings held before Magistrate Judge James R. Klindt: SETTLEMENT CONFERENCE held on 8/7/2018. (DIGITAL) (MDC) (Entered: 08/08/2018)

01/17/2019

21 NOTICE of Appearance by Gayla Grant on behalf of Florida Department of Corrections (Grant, Gayla) Modified on 1/17/2019 contacted counsel in regards to using the correct and complete case number on all pleadings (TSW). (Entered: 01/17/2019)

02/01/2019

22 NOTICE of Filing Revised Monitoring Instruments by Disability Rights Florida, Inc. (Attachments: # 1 Appendix Revised Monitoring Instruments)(Sleasman, Peter) Modified text on 2/4/2019 (KKH). (Entered: 02/01/2019)

10/14/2020

23 ORDER directing Clerk to file under seal a "Sealed Motion to Intervene" that the Court received; thereafter, the Clerk shall strike and return the motion to the filer. The electronic image shall remain part of the record. Signed by Magistrate Judge James R. Klindt on 10/14/2020. (KAW) (Entered: 10/14/2020)

10/15/2020

Sealed Document: S-24 (KEM) (Entered: 10/15/2020)

12/03/2020

25 NOTICE of Appearance by Ian B. Carnahan on behalf of Florida Department of Corrections, Julie Jones (Carnahan, Ian) (Entered: 12/03/2020)

12/04/2020

26 NOTICE of Appearance Appearance by Alexandria Elisse Williams on behalf of Florida Department of Corrections, Julie Jones (Williams, Alexandria) (Entered: 12/04/2020)

12/09/2020

27 Joint MOTION to Modify 10 Order Joint Motion to Modify Settlement Agreement by Extending Jurisdiction by Disability Rights Florida, Inc.. (Attachments: # 1 Exhibit Addendum A Stipulated Partial Amendment of Settlement Agreement)(Sleasman, Peter) (Entered: 12/09/2020)

12/15/2020

28 ORDER granting 27 Joint Motion to Modify Settlement Agreement by Extending Jurisdiction; the 2017 Settlement Agreement is modified to EXTEND JURISDICTION until June 30, 2022; directing the Clerk to close this case. Signed by Senior Judge Harvey E. Schlesin

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 Case 3:18-cv-00179-HES-JRK Document 1 Filed 01/30/18 Page 1 of 53 PageID 1
FILED ,.

UNITED STATES DISTRICT COURT

MIDDLE DISTRICT JACKSONVILLE

OF FLORIDA DIVISION

20IB

JAN

30

PH

,
,:

30

DISABILITY RIGHTS FLORIDA, INC., On behalf of its Clients and Constituents,

CLERK; us OISl RICT CO~Ri.
MIDDLE DISTRICT Of FLORIDA. JACKSONVILLE DISlRtCT

Plaintiff,

vs.

JULIE JONES, Secretary, Florida Department Of Corrections in her Official Capacity and FLORIDA DEPARTMENT OF CORRECTIONS, an Agency ofthe State of Florida,

Defendants.

----------------------------------~'
COMPLAINT FOR DECLARATORY AND INJUNCTIVE RELIEF

Plaintiff, Disability Rights Florida, Inc., hereby sues Defendants Julie Jones, in her

official capacity as Secretary of the Florida Department of Corrections, and the Florida

Department of Corrections, an agency of the State of Florida, alleging unconstitutional and

statutorily inadequate provision ofmental health treatment and services for inmates housed in the

Florida Department of Corrections' inpatient mental health units.

NATURE OF THE ACTION

This is a civil action for declaratory and injunctive relief brought by Disability Rights

Florida, an organization empowered and charged by federal law to protect the rights of

individuals with mental illness in Florida. Disability Rights Florida has standing to bring this

action on behalf of its numerous clients and constituents confined in the inpatient mental health

units run by the Florida Department ofCorrections (FDC). Defendants, by their actions and

inactions, have deliberately and chronically denied mental health care to inmates with mental

Case 3:18-cv-00179-HES-JRK Document 1 Filed 01/30/18 Page 2 of 53 PageID 2
illness who were, and are, confined in the inpatient mental health units. Many ofthese inmates are confined in segregated, isolated and harsh conditions which exacerbate their illnesses. As a result of their segregation and isolation, these inmates are denied the benefits of many ofthe FDC's programs, services and activities. Defendants know that the denial ofcare and imposition of harsh conditions expose Plaintiff's clients and constituents housed in these inpatient mental health units to serious mental and physical harm or a substantial risk of serious mental and physical harm. Defendants' failure to provide constitutionally adequate mental health care to these inmates in non-segregated and therapeutic environments violates the Eighth Amendment to the United States Constitution, the Americans with Disabilities Act, 42 U.S.C. §12132, and the Federal Rehabilitation Act, 29 U.S.C. §794.
JURISDICTION AND VENUE 1. This action is brought pursuant to 42 U.S.C. §1983 to redress the deprivation, under color ofstate law, of rights secured by the Constitution ofthe United States, and pursuant to the Americans with Disabilities Act {ADA), 42 U.S.C. §12132 and the Federal Rehabilitation Act (FRA), 29 U.S.C. §794. 2. This Court has jurisdiction over this action pursuant to 28 U.S.C. §1331. Declaratory and injunctive relief are authorized by 28 U.S.C. §§2201 and 2202. 3. Venue lies in this district pursuant to 28 U.S.C. §1391 as a substantial part ofthe events or omissions giving rise to this claim occurred in this district.
PARTIES 4. Plaintiff, Disability Rights Florida, Inc., is the Protection and Advocacy System (P&A) mandated under federal law to "ensure that rights of individuals with mental illness are protected." 42 U.S.C. §10801(b)(1). The Protection and Advocacy for Individuals with Mental
2

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Illness Act, 42 U.S.C. §10801, et seq., provides for the establishment and funding of systems within each state that are designed to protect and advocate for the rights ofindividuals with mental illness, as well as to investigate incidents ofabuse and neglect of those with mental illness. Federal funding is provided to independent agencies or organizations which have the capacity to protect and advocate for the rights of individuals with mental illness. 42 U.S.C. §§10804, 10805. The system established by each State to protect and advocate for the rights of mentally ill individuals must have the authority to "pursue administrative, legal, and other appropriate remedies to ensure the protection of individuals with mental illness who are receiving care or treatment in the State." 42 U.S.C. §10805(a)(l)(B). Disability Rights Florida is designated as the P&A for the State of Florida under the Protection and Advocacy for Individuals with Mental Illness Act. 5. As a P&A, Disability Rights Florida is tasked under law to protect and advocate for the rights of individuals with mental illness to ensure the enforcement ofthe Constitution and Federal and State statutes. 42 U.S.C. §10801(b)(2)(A). Disability Rights Florida has the legal responsibility to investigate allegations ofabuse and neglect involving individuals with mental illness and to advocate for appropriate treatment and programs for such individuals. Disability Rights Florida also has the legal responsibility to ensure that the legal and civil rights of individuals with mental illness are protected; that these individuals are treated with dignity and respect; and that these individuals receive appropriate services to address their needs. To ensure the fulfillment ofthese legal responsibilities, Disability Rights Florida has the authority to sue the State and its agents to protect individuals with mental illness who are receiving care and treatment from the State or its agents. 42 U.S.C. §10805(a)(l)(B); see also Doe v. Stincer, 175 F.3d 879 (11th Cir. 1999).
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6. Disability Rights Florida has a multi-member board ofdirectors that includes persons with disabilities. Disability Rights Florida has an advisory council composed ofpeople with disabilities who have significant input into the goals and objectives of the organization. Disability Rights Florida provides the opportunity for the public, including its stakeholders, to comment on its goals and objectives. One of Disability Rights Florida's primary responsibilities is to investigate the failure ofpublic entities to comply with laws protecting Disability Rights Florida's members, clients and constituents. 7. Disability Rights Florida brings this action on behalfof inmates within the Florida Department of Corrections (FDC) who are cUITently clients and constituents ofthe P&A and who are mentally ill and confined in the FDC's inpatient mental health units or who may be transferred to the FDC's inpatient mental health units. These clients and constituents are confmed in "facilities" rendering care and treatment for the mentally ill as that term is defined in
42 u.s.c. §10802(3).
8. Plaintiff has no adequate remedy at law. Unless enjoined by this Court, Defendants will continue to subject Plaintiff's clients and constituents to violations of their statutory and constitutional rights. 9. Defendant, Julie Jones, (Secretary) is the Secretary ofthe FDC. Defendant Secretary is sued in her official capacity for the purpose of obtaining injunctive relief. Defendant Secretary has the statutory authority to implement the relief sought in this Complaint. See Fla. Stat. §20.315(3). 10. Defendant FDC is an agency of the State of Florida and administers and operates the Florida prison system, including the FDC's inpatient mental health units.
4

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11. Defendant FDC is a program or activity that receives federal financial assistance and is governed by the FRA. 12. Defendant FDC is a public entity within the meaning of Title II ofthe ADA.
STATEMENT OF THE FACTS A Brief Overview of the FDC Inpatient Mental Health Care System 13. Approximately 18,000 inmates in the custody of the FDC have a diagnosed mental illness that requires mental health treatment. The FDC acknowledges that many of these inmates have symptoms so severe that they require intensive inpatient mental health treatment. 14. The FDC currently operates ten inpatient mental health units in institutions around the state providing treatment to approximately 1,200 inmates whose mental illness significantly impairs their ability to function in a general prison environment. 15. The inpatient mental health units serve more than just the inmates within each institution. The FDC operates the units as a state-wide system serving inmates from any institution in the state. Admissions and discharges from inpatient units are coordinated and authorized by the FDC Office of Mental Health Services in Tallahassee. Some inmates requiring inpatient care may be transferred between institutions for treatment at three or more units over the course of a single inpatient stay. 16. Deficiencies in care at even one inpatient unit can affect the quality ofcare provided to hundreds ofinmates throughout the FDC system and can significantly impact an inmate's ability to recover and return to a more normal, less segregated, prison setting. 17. FDC operates three levels of inpatient mental health care: Transitional Care Unit (TCU), Crisis Stabilization Unit (CSU), and Mental Health Treatment Facility (MHTF).
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18. These units are housed in buildings that are segregated from the general prison population. 19. The TCU level ofcare is intended by FDC to provide psychiatric and psychological treatment in a structured residential setting. This level ofcare is designated to inmates who have significant impairments due to serious chronic or residual mental illness. According to FDC, the TCU level ofcare is supposed to include traditional mental health treatments such as group and individual therapy, activity therapy, recreational therapy and psychotropic medications in the context ofa structured residential setting. TCU beds are available at all ten inpatient mental health institutions. 20. The CSU level of care is intended by FDC to provide briefbut intensive psychiatric and psychological care in a highly structured setting. The CSU level of care is designated for inmates who are experiencing acute emotional distress and who cannot be adequately treated in a TCU or infirmary isolation room. CSU admission criteria requires that inmates have significant mental impairments that require intensive psychiatric and psychological mental health care and treatment in a highly structured setting. This level ofcare is supposed to include a broad range of evaluation and intensive treatment devoted to rapid stabilization of acute symptoms and conditions of mental illness. CSU beds are available at all ten inpatient mental health units. 21. The MHTF level ofcare is intended by FDC to provide extended treatment or hospitallevel psychiatric or psychological care for inmates with acute or chronic mental impairments that interfere with their ability to correctly perceive or interpret reality and exercise control over their actions. Admission to MHTF requires a court order from a state circuit court finding that the inmate is mentally ill and demonstrating a refusal to care for himself or herself that poses a real and present threat ofsubstantial harm to his or her well-being; or there is a substantial likelihood
6

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that in the near future the inmate will inflict serious bodily hann on himself or herself or another person, as evidenced by recent behavior causing, attempting, or threatening such harm. The MHTF represents what is supposed to be the highest level of therapeutic intervention for an inmate with mental illness. Inmates admitted to a MHTF are supposed to receive the most intensive mental health care in the most structured environment in the FDC. 22. MHTF beds are available at Lake CI and Suwannee CI for men and at the Florida Women's Reception Center for women. 23. The FDC contracts with a private vendor, Centurion of Florida, LLC (Contractor), to provide mental health and medical services in its inpatient mental health units. 24. The FDC has written policies called "Health Services Bulletins" (HSBs) that set out standards for the provision of inpatient mental health care. 25. The Contractor is contractually obligated to follow these HSBs in their operation of the inpatient units. The FDC monitors the Contractor's compliance with the HSBs and other aspects of the contracts through periodic monitoring of the inpatient units. 26. The HSBs require that inmates admitted to inpatient mental health services receive a timely psychological and psychiatric assessment upon admission to detennine his or her mental health needs. 27. The HSBs require the development of Individualized Service Plans (ISPs) for each inmate admitted for inpatient services. The ISP is supposed to identify the inmate's mental health diagnoses and problems, the inmate's goals, and the individualized care and treatment needed to achieve the goals. The ISP is also supposed to monitor the progress ofthe treatment toward the identified goals.
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28. The HSBs require that inpatient treatment must include out-of-cell therapeutic services. The ISPs must include out-of-cell structured therapeutic care and treatment specific to the inmate to target a specific problem in the ISP. For TCU and CSU inmates, 12 hours of out-of-cell structured therapeutic services per week is required. For MHTF inmates, 15 hours of out-of-cell structured therapeutic services per week is required. Such services must actually be therapeutic and the required hours are meant to act as a minimum rather than a maximum. 29. The HSBs require that inmates on psychotropic medications must be monitored for the mental, behavioral, and physical health effects of the medication and its side effects. Multiple psychotropic medications for individual inmates must be authorized and monitored by qualified mental and health care staffand psychiatric care must be provided over the course ofthe psychotropic medication treatment. 30. The HSBs also address the procedure and criteria for use ofpsychiatric restraints on inpatient units. 31. HSBs acknowledge that inmates discharged from an inpatient unit will need follow up mental health care to prevent decompensation and the need for readmission to inpatient services. Accordingly, each inmate is to have a discharge plan for the provision of mental health services on an outpatient basis. 32. The FDC and its Contractor understand that the mental health services required by the HSBs are the minimum necessary to alleviate the disabling symptoms of the inmates' mental illness. 33. The FDC has been aware for more than four years that there is massive widespread noncompliance with critical aspects of the HSBs governing the inpatient units. This situation continues in the inpatient units as of the filing of this Complaint.
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34. The FDC has been aware for more than four years that the care provided in a large majority, if not all, of its inpatient units is so inadequate that it violates the rights ofinpatient inmates to adequate mental health care as guaranteed by the Eighth Amendment to the United States Constitution.
The Defendants' Systemic Failure to Provide Adequate Mental Health Care 35. Defendants were, and are, aware of the serious harm or risk of serious harm caused by the inadequate mental health care and treatment provided throughout its inpatient mental health system, including: 36. Lack of treatment: Inmates receive a lack of meaningful treatment activity. Individual counseling is rare and when it does occur it is often little more than a status check at an inmate's cell door. Group therapy is infrequent and when it does take place, it usually lacks any meaningful content and has little or no direct relationship to the inmate's actual problems or his individual service plans. Inmates denied adequate treatment languish for years on inpatient units, either regressing or making no progress toward recovery. Their treatment plans go for months or years with no significant change. 37. Lack of meaningful ISPs: Most service plans are "cookie-cutter" plans that list identical interventions regardless of the inmate's symptoms or needs. In addition, ISPs are rarely amended or changed if the inmate is not making progress or if the inmate's needs change. 38. Excessive isolation and segregation: Absent appropriate treatment, assignment to an inpatient unit amounts to little more than prolonged isolation similar to disciplinary confmement or close management. Inpatient inmates, especially those confmed on the inpatient units at Suwannee CI, Charlotte CI, FWRC and Santa Rosa CI - Annex, are locked in small singleperson cells. For a majority of the week they spend 24 hours a day confined in their cells. The
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lack of individualized risk assessments at the institutions further exacerbates the use of confinement and lack of any personal interaction. They have limited out-of-cell activities, are restricted to outdoor exercise in small solitary cages, and their access to programs such as visitation, religious services, reading material, and other privileges are highly restricted. These harsh conditions often exacerbate the symptoms of mental illness and prolong their confinement in inpatient units. 39. La~k of basi~ primary medi~al ~are and ~oordination between psy~hiatric and medical providers: Multiple inpatient inmate medical records indicate a lack ofrequired physical exams. Vital signs and weights are not recorded as required. In addition, required nursing assessments are frequently missing. Records often have incomplete or inaccurate Medication Administration Records. There is a lack of required laboratory exams and followups. There is frequently no communication or collaboration between the mental health staff and the medical staff which adversely affects the medical as well as mental health care ofthe patients. 40. Inpatient units la~k suffi~ient numbers of qualified ~lini~al staff: Many inpatient units rely on a single psychiatrist when two or more are required. In addition, many inpatient units are forced to rely on a locum tenens psychiatrist, which severely undermines the timeliness, quality, and continuity of care provided to the inmates. FDC has been made aware on multiple occasions through its contract monitoring and through reports from organizations such as the Correctional Medical Authority ("CMA") that many of the inpatient units are critically understaffed-especially professional staff. In addition, none of the inpatient units have professional mental health staffavailable for treatment or mental health emergencies on any of the inpatient units after 5:00PM.
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41. Inpatient units lack sufficient numbers of security staff: Many inpatient mental health units lack sufficient numbers of security staff necessary for appropriate supervision and escort of the inmates to various treatment activities. Often treatment activities must be canceled as a result ofa lack ofappropriate security staff to escort and supervise inmates. 42. Inadequate supervision on SHOS: Inpatient units provide inadequate supervision of inmates who have attempted or threatened self-harm and have been placed in self-harm observation status (SHOS). In several instances inmates in SHOS have died as a result ofthe lack ofappropriate supervision. Further, the FDC has not taken action in these cases to correct known deficiencies. 43. Lack of treatment for SIB: There is a lack of specialized behavioral treatments for individuals who engage in self-injurious behavior (Sffi) due to mental illness. A significant number of inmates housed in inpatient mental health units engage in multiple instances of selfinjurious behavior due to their mental illness. The FDC fails to provide appropriate assessments for the causes of SIB and fails to provide specialized therapeutic treatment programs for addressing SIB. 44. Inappropriate treatment settings: Several inpatient mental health units, including but not limited to Union CI and Suwannee CI, lack appropriate treatment settings. Units lack physical space to conduct appropriate group or individual counseling. Inmates wishing to participate in therapeutic activities are required to sit in outdoor "cages" at the inpatient mental health units in Union CI and Santa Rosa CI - Annex. At Suwannee Cl, inmates desiring to participate in group therapy are placed in a locked room while the therapist speaks to them from a different room over a microphone. At several inpatient mental health units, individual
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''therapy" takes place at the inmate's cell with the inmate and the counselor attempting to communicate through a solid door. These sessions are usually brief and ineffective. 45. Lack of discharge planning for follow-up mental health care: Inmates discharged from inpatient mental health units are not provided with appropriate discharge plans for followup mental health care. Many inpatient inmates are discharged directly to solitary confinement where they receive little or no follow-up mental health care. Many ofthese inmates quickly decompensate resulting in a new cycle of inpatient admission. 46. Inappropriate use of involuntary medication and restraints: FDC does not enforce standardized criteria for the use of force to involuntarily medicate inpatient inmates. FDC fails to enforce standardized criteria for the use of physical restraints on inpatient inmates. As a result forcible treatment orders and physical restraints are prone to misuse and arbitrary application. In addition, the FDC does not enforce standardized criteria for the use of physical force to require compliance with treatment orders. The result is that uses of force on inpatient units greatly exceed uses of force in all other areas ofthe prison population, including for those inmates placed in confinement statuses such as disciplinary confinement or close management. 47. Disciplinary punishment for behavior caused by mental illness: The FDC fails to enforce its own policy for mental health review of disciplinary reports issued to inmates on inpatient mental health units. Mental health officials are required to evaluate disciplinary reports issued to any inmate on an inpatient unit and provide input to the discipline hearing team on how an inmate's behavior may have been influenced by his or her mental illness. FDC is aware that this requirement is routinely ignored on inpatient units. As a result inmates are often punished for behaviors that are a direct manifestation oftheir mental illness. This results in a further restriction ofprivileges and often extends the duration oftheir placement on the inpatient unit.
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FDC is also aware that many inmates on inpatient units cannot utilize FDC procedures to

challenge these disciplinary actions because oftheir mental illness.

48. Lack of appropriate oversight, investigation and quality management: The FDC has

no system to identify and correct systemic deficiencies in the quality ofcare in the inpatient

mental health units. The contractor has failed to provide constitutionally adequate care in terms

of quality or quantity and the FDC has not taken meaningful action to correct the situation. In

instances involving serious abuse or death of inmates on inpatient mental health units,

investigations drag on for years with no meaningful action. The FDC has no system to identify

or remove mental health practitioners who are providing constitutionally inadequate care.

John Doe#l1

Examples of Defendants' Constitutional Violations Against Plaintiffs Client and Constituents

49. John Doe #1 had been incarcerated in the FDC since 2013. John Doe #1 was scheduled

to be released from incarceration in July 2017. He died while housed on the inpatient mental

health unit at Union CI in late 2015.

50. John Doe #1 had a long history of serious mental illness. He was diagnosed with

Schizophrenia. During a previous incarceration in FDC, John Doe #1 had several lengthy

admissions to FDC inpatient units. In fact, he was released from an inpatient unit to the street

when his previous sentence expired in 2010.

51. After being charged in his most recent offense, the court determined him to be

incompetent to stand trial and ordered him to be admitted to a state hospital for competency

restoration.

1 Pseudonyms are used here to protect the inmates' confidential medical and mental health information. The identities ofJohn and Jane Does will be provided to the Defendants once a protective order is in place to safeguard the confidentially oftheir information.
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52. During his recent and final incarceration in FDC, John Doe #1 had been housed nearly continuously on FDC inpatient mental health units since March 2014. 53. In 2015, John Doe #I was in and out of the TCU and CSU for mood shifts and difficulty attending to daily needs such as personal hygiene. His ISPs include problem codes for mood swings, hallucinations, thought disorder and resistance to treatment. He was prescribed Tegretol to help manage these issues. 54. From April2015 until the date of his death, John Doe #1 refused almost every psychiatric appointment, group session, individual counseling session or other activity offered to him. His refusals were directly related to his mental illness. John Doe #1 was spending nearly 24 hours a day, seven days a week in his cell. He was unkempt and neglecting his hygiene. He was noted to be smearing feces in his cell. He often refused to eat. 55. Security and mental health staffroutinely noted there were "no behaviors or appearance ofconcern" but they were ''unable to assess his progress toward treatment goals" because ofhis refusal to participate in any activities. 56. Additionally, during this same time period, John Doe #1 'slab results indicated "critically low" blood sodium levels. Low blood sodium levels, also known as hyponatremia, can be a side effect ofTegretol and if left uncorrected can be fatal. 57. Six weeks before his death, the psychiatrist discontinued the Tegretol. However, no other labs or follow up occurred to monitor the blood sodium levels. Additionally, John Doe #1 was not prescribed a replacement psychotropic after the Tegretol was discontinued. The medical and mental health staff failed to appropriately follow up or address this serious medical need. On the day before John Doe #1 's death, the psychiatrist ordered labs because "no follow up sodium levels" had ever been completed.
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58. The next day, John Doe #1 was found dead in his cell. Institutional medical records indicate John Doe #1 was non-responsive and the institution's doctor described John Doe #1 as having "poor hygiene, severe dehydration, cachectic looking." 59. Prison medical staff initiated resuscitation efforts but the autopsy detennined that John Doe #1 had been deceased for some time with rigor mortis setting in before paramedics arrived at the institution. 60. An autopsy listed the cause of John Doe #1 's death to be "undetennined." 61. However, the medical examiner described John Doe #1 as "malnourished" and the autopsy findings detennined John Doe #1 was suffering from "malnutrition" at the time of his death. 62. The FDC listed John Doe #1 's height and weight as 5'9" and 175 pounds at theltime of his incarceration. The autopsy states that at the time of his death he weighed just 115 pounds. This dramatic drop in weight was not caused by any physical illness or disease. 63. The autopsy findings also found John Doe #1 to be in a general unwashed condition with feces on his body. 64. John Doe #1 's autopsy findings suggest that he was subjected to abuse and neglect while housed in the inpatient mental health unit before his death. 65. Medical and mental health staff failed to intervene as John Doe #1 repeatedly refused to eat, wash, or care for himself. These failures placed John Doe #1 at a significant risk of harm and ultimately resulted in his death. Staffallowed John Doe #1, who was actively diagnosed as treatment resistant and had been refusing all treatment for months, to refuse himselfto death. 66. Defendants were and are aware ofthe serious harm or risk of serious harm caused by the inadequate mental health care and treatment at Union CI and they have failed to take reasonable
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measures to address it. Defendants have actual knowledge ofthe inadequate mental health care and treatment for inpatient inmates with mental illness at Union CI through CMA and FDC's own monitoring and other sources and they have failed to take prompt action to stop it. John Doe#2 67. John Doe #2 entered FDC in 2006. During his incarceration he had an extensive inpatient history with a number of serious self-inflicted injuries. He has served nearly all of his FDC incarceration in inpatient mental health units which is where he ultimately died. 68. John Doe #2 began receiving mental health treatment in the community at the age of 18 when he was involuntarily committed under Florida's Baker Act. Throughout the years prior to incarceration, he received outpatient treatment at well as residential treatment. His diagnosis was Major Depressive Disorder with Psychotic Features. 69. In September 2013, John Doe #2 was admitted to the inpatient unit at Charlotte CI after he bit through an artery on his arm. After a few months on the inpatient unit, he was discharged to an outpatient setting in February 2014 and transferred to Martin Cl. 70. Mental health staff at Charlotte CI did not develop a discharge plan for dealing with John Doe #2's self-injurious behavior on an outpatient basis as required by FDC policy. 71. John Doe #2 was at Martin CI for less than three months when he severely injured himself by biting through a vein in his wrist. He was placed in a Self-Harm Observation Status (SHOS) cell at Martin CI and referred to an inpatient mental health unit. 72. John Doe #2 was transferred back to Charlotte CI and placed in the CSU. When he arrived, John Doe #2 met with staffwho noted that he "[d]enies suicidal thoughts at this time but states he intends to hang himself."
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73. Over the next few weeks, staffnoted that John Doe #2 continued to state an intention to hann himself. Staffnoted, however, that John Doe #2 "appears to be exaggerating symptoms." 74. Two weeks later, John Doe #2 was discovered in his inpatient cell with a shirt tied around his neck in an attempt to hang himself. At approximately 8:55 p.m., a nurse informed security of John Doe #2's attempt to hang himself. Charlotte CI has no regular mental health staffpresent on the inpatient mental health unit after 5:00p.m. Because this incident occurred in the evening there was no mental health staffavailable to intervene, the only medical staff on the inpatient unit was licensed practical nurses (LPNs) without any specialized training to work on the inpatient mental health unit. 75. At approximately 9:00p.m., one of the LPN nurses contacted the institution's psychiatrist by telephone who authorized the use of force to stop John Doe #2's behavior and to place him on SHOS. The psychiatrist also authorized an emergency treatment order (ETO) for an injection of Ativan. 76. At approximately 9:36 p.m., security gave John Doe #2 a final order to stand up and submit to hand cuffing. When John Doe #2 did not comply with this order a "cell extraction team" consisting of four correctional officers entered his cell, forced him to the floor and placed him in hand, ann and leg restraints. John Doe #2 suffered significant injuries to his face and mouth during the extraction. 77. John Doe #2 was removed from his cell and forcibly placed in a SHOS shroud. During this process, John Doe #2 was attempting to spit on the officers. He was placed in a "spit shield" which is a type of hood that covers the lower part of an inmate's face, including his mouth.
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78. John Doe #2 was then forcibly carried back to his cell where a nurse administered the injection ofAtivan. The officers removed the restraints and exited his cell. The spit shield was not removed. 79. The psychiatrist's order placing John Doe #2 on SHOS status also required IS-minute checks. 80. The IS-minute observations are recorded by staff writing their initials on a checklist. Between the observations there is no requirement that staff remain in close proximity to the cell. In addition, there is no assurance that the observations are actually done in a timely manner or that observations are anything more than a cursory glance.
81. John Doe #2 was never evaluated by medical staff other than the LPN after the use of force prior to the ETO or prior ito his placement back in the cell. 82. The psychiatrist ordering the ETO was not informed that John Doe #2 was in a spit shield
and was bleeding from injuries to his face and mouth. This was critical information because one of the known cautions regarding the use ofAtivan is that it can cause respiratory distress. 83. FDC policy, consistent with most policies around the nation, requires that any inmate placed in a spit shield be continuously monitored for respiratory distress. 84. FDC policy, consistent with most policies around the nation, precludes use ofthe spit shield on an individual who is bleeding from the nose or mouth area. 8S. Correctional and medical staff at Charlotte CI violated both of these policies in their treatment of John Doe #2. 86. Approximately 20 minutes after John Doe #2 was placed back in his cell and given the
ETO, the nurse conducting a cell front check was not able to determine whether or not John Doe
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#2 was breathing. The cell extraction team returned to the cell to accompany the nurse for a wellness check. John Doe #2 was not breathing and the nurse started CPR. 87. John Doe #2 was transferred to Lee County Hospital where he was pronounced dead. 88. An autopsy was conducted the next day and the manner ofdeath was listed as "Homicide." Specifically, John Doe #2's death was due to "Complications of asphyxia; Hemoaspiration [inhalation ofblood] associated with blunt traumatic injuries of oral cavity & obstruction ofairways by spit shield." 89. John Doe #2 was placed on the inpatient mental health unit at Charlotte CI in 2014 to protect him from self-harm caused by his known mental illness. However, the sequence of events from his admission to his death illustrates gross deficiencies in treatment and supervision of inmates on the inpatient mental health unit. 90. Inpatient mental health unit staff failed to adequately treat John Doe #2 through individualized or appropriately specialized treatment for individuals who engage in self-injurious behavior due to mental illness. Additionally, there was no trained mental health staffavailable on the inpatient mental health unit to try to deal with John Doe #2's apparent suicide attempt. As a result, the psychiatrist and security staff resorted to a use of force to cope with a mental health issue which caused additional injury to John Doe #2. 91. Clinical and correctional staff were either unaware of or ignored FDC's own policies regarding the use of the spit shield. Clinical staff failed to adequately assess John Doe #2's injuries and the appropriateness of use ofthe spit shield. Clinical staff failed to apprise the oncall psychiatrist of critical information relevant to the decision to issue the ETO for Ativan to John Doe #2. Clinical staff failed to appropriately monitor John Doe #2 for signs of respiratory or other distress immediately after the administration of the ETO. The instances of gross
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negligence and direct violations ofFDC policy were the proximate cause ofJohn Doe #2's death on the inpatient unit. 92. Florida Department of Law Enforcement (FDLE) and the FDC conducted an investigation into the circumstances of John Doe #2's death. They concluded that no criminal intent was associated with John Doe #2's death and closed the investigation. 93. In 2015, the FDC Inspector General opened an "administrative investigation" into the circumstance of John Doe #2's death. 94. More than two years after John Doe #2's death the investigation remains "open" and no disciplinary or corrective action has been taken by FDC against correctional or medical staff. Medical staff involved in John Doe #2's death continue working in the Charlotte CI inpatient mental health unit. 95. Defendants were and are aware of the serious harm or risk of serious harm caused by the inadequate mental health care and treatment at Charlotte CI and they have failed to take reasonable measures to address it. Defendants have actual knowledge of the inadequate mental health care and treatment for inpatient inmates with mental illness at Charlotte CI through CMA and FDC's own monitoring and other sources and they have failed to take prompt action to stop it. Further, the failure to provide John Doe #2 with any meaningful treatment for individuals who engaged in self-injurious behavior due to mental illness placed John Doe #2 at a significant risk of harm which ultimately resulted in his death. John Doe#3 96. John Doe #3 had been incarcerated in the FDC since May 2007. He died while housed on the inpatient mental health unit at Charlotte CI in 2015.
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97. Since his incarceration, John Doe #3 had numerous inpatient hospitalizations, all of which were prompted by self-harm or threats ofself-harm. John Doe #3 was diagnosed with depression and antisocial personality disorder. 98. In May 2015, John Doe #3 was housed in the general population at Charlotte CI where his mental illness was to be treated on an outpatient basis. The following month, John Doe #3 received disciplinary reports for lying to staff, missing count and being in an unauthorized area. He was placed in disciplinary confinement. In spite ofhis history of serious mental health issues and self-injurious behavior, he was cleared by mental health staff for confinement housing with no restrictions or cautions. 99. A few months later, at 2:30a.m., an officer heard banging coming from John Doe #3's disciplinary confinement cell. The officer found John Doe #3 cutting his left arm with an unknown object. The officer ordered him to stop and gassed him with chemical agents. 100. John Doe #3 had seriously injured his arm from the cutting with significant loss of blood. He was taken to the prison infinnary for treatment ofhis wound. Because Charlotte CI had no mental health staff present at the institution at night he was not seen by a psychiatrist or psychologist. Instead, an LPN on duty received a telephone order from an advanced registered nurse practitioner (ARNP) authorizing John Doe #3 to be placed in an Isolation Management Room/Self Harm Observation Status (IMR/SHOS) with 15-minute checks. 101. The LPN also requested an urgent mental health referral for John Doe #3. 102. John Doe #3 was placed in an IMR cell on Charlotte CI's inpatient mental health unit. He was to be observed by staff every 15 minutes. I 03. The 15-minute observations are recorded by staff writing their initials on a checklist. Between the observations there is no requirement that staffremain in close proximity to the cell.
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In addition, there is no assurance that the observations are actually done in a timely manner or that observations are anything more than a cursory glance. Clinicians also have the option to order more frequent or continuous observation of inmates in SHOS. I04. John Doe #3 was seen the next morning at his cell by a mental health counselor who noted that John Doe #3 stated that he still intended to harm himself. In spite of this, John Doe #3 was not seen by a psychiatrist or psychologist and there is no indication that a psychiatrist or psychologist reviewed his records. There was no other mental health treatment or intervention attempted for John Doe #3 other than the single visit by the counselor. He remained on IMRJSHOS on the inpatient mental health unit with I 5-minute observations on the inpatient unit. 105. At 7:40p.m., the housing Sergeant during his routine rounds (not the IS-minute checks) found John Doe #3 bleeding from his left arm while lying on his bunk in the IMR. A large amount ofblood was on the cell floor. John Doe #3 had used a paint chip to re-open his previous injury to his arm. I06. At 7:57 p.m., three officers entered John Doe #3 's cell and transported him on a gurney to the facility's institutional emergency room. John Doe #3 received treatment for his injury and he was returned to the IMR. 107. No mental health staff was informed of John Doe #3's second instance of self-injury. There was no change to his IS-minute observation status. 108. The following morning, at 5: 10 a.m., an officer conducting a routine security check saw John Doe #3 in his cell lying on the floor and he appeared to be unresponsive. The officer notified the LPN assigned to the unit who then conducted a cell front observation. The LPN did not enter John Doe #3's cell and no attempt was made to try to rouse him. The LPN dismissed
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the officer's concern and stated that he "could see [John Doe #3's] stomach rise and fall." No other effort was made at that time to determine John Doe #3's well-being. 109. Twenty minutes later, a different officer looked into John Doe #3's cell and saw him "lying on the floor with no clothes on his back. He seemed unresponsive and could not clearly see his chest or stomach rising or falling." The officer called the LPN and several other security staffto the cell. Ten minutes later, they entered the cell and could not fmd a pulse. CPR was initiated. John Doe #3 was pronounced dead at 6:15 a.m. 110. The Charlotte County Medical Examiner determined that John Doe #3 died due to blood loss from self-inflicted cuts on his left arm and classified the manner ofdeath as a suicide. 111. Inmates placed on IMR/SHOS are placed in particular cells that have had all items with which an inmate could harm himself removed. It is fundamental that these cells be in good repair and condition. Even relatively minor items such as peeling paint can be used by a suicidal inmate to harm himself. 112. The CMA conducted an inspection ofCharlotte CI in April of 2015 - prior to John Doe #3 's death. The CMA found many deficiencies in the inpatient mental health unit. One specific finding was that paint was peeling from the IMR cells on the inpatient mental health unit. In addition, the CMA found that in 6 of 15 SHOS admissions the documentation did not indicate that the inmate was observed at the frequency ordered by the clinician. The institution and the FDC was notified ofthese deficiencies in a written report on Apri127, 2015 and the FDC was to have a corrective action plan developed by May 27,2015 well before John Doe #3's death. 113. The deficiency regarding the condition ofthe IMRs had not been corrected at the time John Doe #3 was placed in the IMR in August. The deficiencies regarding IMRs and the observation of SHOS inmates were still not corrected at the time of a CMA follow-up visit to
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assess implementation of the corrective action plan in late October 2015. The CMA was never informed of John Doe #3's death in an IMR during their corrective action plan follow-up visits. 114. More than a year after John Doe #3's death, the FDC's investigation of his death is listed as "pending." There has been no determination on how John Doe #3 managed to kill himself while allegedly under close observation on SHOS. To date, no remedial action has been taken byFDC. 115. Defendants were and are aware of the serious harm or risk of serious harm caused by the inadequate mental health care and treatment at Charlotte CI and they have failed to take reasonable measures to address it. Defendants have actual knowledge of the inadequate mental health care and treatment for inpatient inmates with mental illness and the dangerous conditions ofthe IMRISHOS cells at Charlotte CI through CMA and FDC's own monitoring and other sources and they have failed to take prompt action to correct them. Further, the failure to provide John Doe #3 with any meaningful treatment for individuals who engage in self-injurious behavior due to mental illness, the failure to provide John Doe #3 with a safe and secure cell and the failure to observe John Doe #3 at the frequency ordered by the clinician placed John Doe #3 at a significant risk of harm which ultimately resulted in his death. JohnDoe#4 116. John Doe #4 has been incarcerated in the FDC since December 2005. He is serving a life sentence. John Doe #4 is presently confined in the inpatient unit at Dade Cl. 117. John Doe #4 has a current diagnosis of schizoaffective disorder. He has also been diagnosed in the FDC as "schizophrenia unspecified." 118. Between 2009 and 2010, John Doe #4 routinely cycled between confinement and inpatient mental health units in the FDC.
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119. In the few instances he was discharged from an inpatient mental health unit, he was placed in solitary disciplinary confmement or close management confinement where he received little or no comprehensive mental health follow-up care. In each instance, he quickly decompensated and had to be returned to the inpatient mental health unit. 120. Since March of2011, John Doe #4 has been on inpatient units nearly continuously. He has been confined on inpatient mental health units at Union CI and Lake Cl. His only discharge from the inpatient unit was to disciplinary solitary confinement for about four months in 2013. Again, John Doe #4 received little or no comprehensive mental health follow-up care and his mental state decompensated resulting in a return to the inpatient mental health unit. 121. Since 2012, John Doe #4 has had multiple MHTF admissions. A psychiatrist's summary prior to a transfer from Union CI to the MHTF unit at Lake CI in early 2015 states: "inmate is delusional, believes he is God, refusing meds and treatment, not eating all meals. Will likely need MHTF for stabilization due to chronic refusal." 122. John Doe #4's ISP identifies his resistance to treatment as a problem to be addressed by his treatment plan. However, the interventions listed in his ISP to address this problem are identical to every other inmate on the inpatient unit regardless ofwhether they are treatment resistant or not. His inpatient progress notes contain no indication that John Doe #4's treatment resistance is being addressed. 123. John Doe #4's ISP indicates that he is currently delusional and is refusing all treatment and therapy sessions. John Doe #4 is spending nearly 24 hours a day each day in his cell. There is no indication in his clinical records that the treatment staff is making any effort to engage him in treatment activities. Other than the interventions listed in the ISP, the notes do not include any plan or recommendations on how to engage John Doe #4 in therapeutic activities.
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124. John Doe #4 is scheduled to receive group three times per week for a total ofsix hours, case management once per week, individual counseling once per week, activity therapy four hours per week and therapeutic community once per week for a total ofat least 12 hours per week. Instead, John Doe #4 is offered, on average, less than half of those hours. Two ofthose hours offered are spent simply watching television. The records indicate the reason for offering less than half the required hours is shortage of security staff. The cancelation oftreatment activities due to lack of security staffhas been a chronic problem in the Union CI inpatient mental health units. 125. John Doe #4 sees a psychiatrist less than once a month. These visits are brief, usually less than 10 minutes, and the doctor speaks to John Doe #4 cell front through the solid cell door. 126. John Doe #4 is receiving grossly inadequate treatment for his mental illness. Not surprisingly, a recent treatment note indicated John Doe #4 is "making no progress toward his treatment goals." Ifhe continues on his current course he will (as he has in the past) require readmission to the MHTF for "stabilization." This will extend his continued segregation and confinement in FDC inpatient units. 127. John Doe #4 has not received a disciplinary report since September 2013. His behavioral risk assessment places him in the mild or lowest risk category. 128. In spite ofthis low risk, his movement on the inpatient unit is highly restricted and he is placed in handcuffs any time he is taken out of his cell for any reason, including any therapeutic or recreational activity. His privileges and living conditions on the inpatient unit are essentially equivalent to long-term solitary confinement. 129. Defendants were and are aware of the serious harm or risk of serious harm caused by the inadequate mental health care and treatment at the Union CI and Lake CI and they have failed to
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take reasonable measures to address it. Defendants have actual knowledge of the inadequate mental health care and treatment for inpatient inmates with mental illness at Union CI and Lake CI through CMA and FDC's own monitoring reports and other sources and they have failed to take prompt action to stop it. Further, the failure to provide John Doe #4 with any meaningful treatment to address his delusions or his refusal to attend treatment and therapy sessions places him at a continued risk of harm. John Doe#S 130. John Doe #5 has been incarcerated in the FDC since November 2006. He is serving a 30year sentence. John Doe #5 is presently confined in the MHTF at Lake CI. 131. John Doe #5 has a diagnosis of schizoaffective disorder and bipolar disorder. 132. Since May 2013, John Doe #5 has been confmed continuously in FDC inpatient mental health units. From May to November 2013, he was confined at the Suwannee CI unit. In November 2013, he was transferred to the inpatient mental health unit at Union CI where he remained for four months until his mental status deteriorated to the point that he was admitted to the MHTF at Lake CI in March 2014. 133. John Doe #5 was confined at Lake for two months. In May 2014, clinicians at Lake CI believed he was stable enough to be discharged to the TCU at Suwannee CI. He remained at Suwannee for eight months until he again decompensated to the point that he was again admitted to the MHTF at Lake CI where he remained for six weeks. 134. Lake CI again discharged John Doe #5 to the inpatient mental health unit at Santa Rosa CI- Annex in March 2015. He remained at Santa Rosa CI- Annex for only two months before he decompensated and was readmitted to the MHTF at Lake CI in May 2015.
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135. Between May 2015 and November2015, John Doe #5 was housed on MHTF level of care at Lake CI. 136. Treatment and medication compliance was and is a long-standing issue with John Doe #5 and was directly related to his mental illness. While at Lake CI, John Doe #5 was treated with Risperdal Consta, a long-action injectable form ofthe psychotropic medication Risperidone that is effective and often used for individuals who may be noncompliant with medication. 137. John Doe #5 was stabilized and discharged from MHTF. He was transferred to the TCU at Union CI in November 2015. Upon arrival at Union CI inpatient unit, a few days after his transfer, a psychiatrist found him to be lucid and stable on his medication. The psychiatrist noted however that Risperdal Consta was "not available" at Union CI. Instead, he was placed on a daily dose of Risperdal a medication regimen that had been unsuccessful with John Doe #5 in the past. The psychiatrist note indicates that John Doe #5 would receive a follow-up in 14 days. That follow-up never happened. 138. Over the next three months, John Doe #5 received virtually no treatment for his mental illness. His records indicate that, in November and December 2015 and January 2016, nearly all ofthe individual counseling sessions with mental health professionals for John Doe #5 were canceled as a result of the lack of security staffat the Union CI inpatient mental health unit. The only notes by mental health professionals in John Doe #5's record during this time indicate that they were "unable to assess" him or that his current functioning could "not be determined." 139. On February 1, 2016, during a search of John Doe #5's cell, security found multiple doses of his medication. Staffdetermined that he had been hoarding his medications. 140. John Doe #5 was finally seen by a psychiatrist on February 3, 2016. He had gone three months without seeing a psychologist or psychiatrist. By that time John Doe #5's mental status
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had significantly deteriorated. He was found to be "disheveled," "unkempt" and "actively responding to internal stimuli." The psychiatrist recommended his transfer to the CSU on that date. 141. John Doe #5 's psychiatrist made two more recommendations for a transfer to the higher level ofCSU care on February 18 and February 29,2016. A note by a psychiatrist on February 29th indicated that John Doe #5 was "in need of immediate transfer to CSU level ofcare." John Doe #5 was not transferred to a CSU level ofcare until March 16, 2016. In the interim six weeks between the initial referral to a higher level ofcare on February 3rd and his transfer on March 16, John Doe #S's condition and mental status continued to decline. 142. When John Doe #5 was finally transferred to CSU level ofcare at Union Cl, his condition had deteriorated to the point that the psychiatrist filed a petition seeking court order for his admission to MHTF level ofcare at Lake Cl. 143. On April14, 2016, the state circuit court issued an order directing John Doe #5's admission to MHTF level ofcare. John Doe #5 was admitted to the MHTF level ofcare at Lake CI for the fourth time in two years. John Doe #5 remains at Lake CI at this time. 144. Defendants were and are aware of the serious harm or risk of serious harm caused by the inadequate mental health care and treatment at Suwannee CI, Union Cl, Santa Rosa CI - Annex and Lake CI and the have failed to take reasonable measures to address it. Defendants have actual knowledge of the inadequate mental health care and treatment for inpatient inmates with mental illness at Suwannee CI, Union CI, Santa Rosa CI - Annex and Lake CI through the CMA and FDC's own monitoring and other sources and they have filed to take prompt action to stop it. Further, the failure to provide John Doe #5 with any meaningful treatment to address his
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deteriorated mental status or his refusal to take medication places him at a continued risk of harm. Jane Doe#ti 145. Jane Doe #6 has been incarcerated in the FDC since 2009. Jane Doe #6 was in and out of inpatient mental health care from 2009 to 2011. Since 2011, Jane Doe #6 has consistently been housed in an inpatient mental health unit. Jane Doe #6 is currently confmed in the Florida Women's Reception Center (FWRC) inpatient unit. 146. Jane Doe #6 has been diagnosed with Schizoaffective Disorder and Borderline Personality Disorder. Jane Doe #6 has cycled between the TCU and CSU levels of care. 147. Jane Doe #6 has a long history of exhibiting behaviors caused by her mental illness including experiencing auditory hallucinations, screaming out at random momentS, engaging in loud arguments with people who are not there during psychotic episodes, not taking showers, refusing medications and refusing meals. 148. In January 2016, Jane Doe #6 was confined in the TCU at FWRC. A psychologist requested a transfer to the CSU level ofcare because Jane Doe #6 had engaged in self-injurious behavior by head banging in her cell, was refusing medication, was "psychotic and delusional" and was "decompensating" and required a higher level ofmental health care. 149. In March 2016, after Jane Doe #6 spent six weeks waiting in the TCU for a bed in the higher level of care, the FDC Office of Mental Health finally approved the transfer request. 150. Jane Doe #6's ISPs developed in the CSU identify hallucinations and resistance to treatment as her two problem codes and outline treatment interventions. 151. Some of Jane Doe #6's treatment plans note that she "will identify and implement two coping skills for symptom reduction" and "demonstrate compliance with treatment and therapy."
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However, the treatment notes contain no indication that this treatment activity was actually carried out or attempted. There is no mention in the treatment notes of what coping skills Jane Doe #6 should use, how she would learn those coping skills, or what progress, ifany, Jane Doe #6 has made towards learning or utilizing the coping skills. 152. For the six months that these plans were in effect, the notes indicate "unsatisfactory" progress toward treatment goals and "unsatisfactory" medication compliance. Most weeks Jane Doe #6 was not participating in any groups or recreation and she is often not medication compliant. 153. During this same time, Jane Doe #6 has engaged in at least two serious acts ofself-injury including punching herself in the face and banging her head in her cell to the point that she was bleeding, required medical attention and required ETOs. These events are not addressed in her treatment plans or treatment interventions. 154. The inpatient mental health staff has not engaged in any treatment activities to address Jane Doe #6's behavior and underlying personality disorder. Although she has made no progress, her ISPs have looked virtually identical for every month she has been in the CSU. 155. Although Jane Doe #6 was housed on an inpatient mental health unit, she received multiple disciplinary reports (DRs) and the psychiatrist never once determined that Jane Doe #6's mental health contributed to her actions. 156. One such incident occurred when Jane Doe #6 received a DR for "unauthorized physical touching" because she tried to remove her wrist from psychiatrist-ordered five-point psychiatric restraints. The five-point restraints were ordered by a psychiatrist because Jane Doe #6 was in the midst ofan acute mental health crisis in the CSU. There was no finding by any staffthat Jane Doe #6's mental health contributed to her actions.
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157. Jane Doe #6 received another DR for "failure to maintain personal hygiene" on the inpatient mental health unit because she was not coming out of her cell to take showers. This is a common manifestation for people with serious mental illness on an inpatient mental health unit. 158. The psychiatrist determined there was no reason to believe Jane Doe #6's mental health impaired her ability to make decisions about leaving her cell to shower. Jane Doe #6 was found guilty of the DR and was punished with ten days of disciplinary confinement. Remarkably, the failure to maintain personal hygiene was not addressed in Jane Doe #6's next ISP update. 159. Jane Doe #6 also received multiple DRs in the inpatient mental health unit for "disobeying an order" because she was yelling uncontrollably and was unable to obey the correctional officers' orders to stop, for "disrespecting officials" for cursing at a correctional officer while in the midst ofa mental health crisis and for "battery on a correctional officer'' for tossing a small amount ofjuice out her food flap and onto a correctional officer because she was upset about her medication while housed in the CSU. 160. In each of these DRs, the psychiatrist determined Jane Doe #6's mental illness in no way contributed to her behaviors. 161. The FDC's HSBs state the CSU level ofcare is meant to be "relatively brief, typically less than two weeks." Jane Doe #6 has been in the CSU level of care for over six months. Jane Doe #6 continues to be non-compliant with medication and rarely participates in treatment. Jane Doe #6 is being harmed by the inadequate care being provided for the severity of her symptoms. The inadequate care prevents her from participating in activities and keeps her in solitary confinement conditions with limited privileges on the inpatient mental health unit longer than necessary.
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162. Defendants were and are aware ofthe serious harm or risk of serious harm caused by the inadequate mental health care and treatment at FWRC and they have failed to take reasonable measures to address it. Defendants have actual knowledge ofthe inadequate mental health care and treatment for inpatient inmates with mental illness at FWRC through CMA and FDC's own monitoring and other sources and they have failed to take prompt action to stop it. Further, the failure to provide Jane Doe #6 with any meaningful treatment to address her serious mental health issues and related disciplinary issues place her at a continued risk ofharm. JohnDoe#7 163. John Doe #7 has been incarcerated in FDC since 2011. John Doe #7 had been in the MHTF level ofcare at Lake CI since September 2012. He recently died on that unit. Autopsy results and case of death are pending. 164. John Doe #7's records include a diagnosis of schizophrenia and history of thought disorder and mood swings. 165. On July 22,2016, the FDC filed its most recent request for a court order authorizing John Doe #7's continued placement in MHTF for another year. 166. In the request to the court, the psychiatrist noted John Doe #7 "experiences auditory hallucinations, severely disorganized thoughts, bizarre behavior, talking to himself, poor hygiene, agitation, poor insight and poor judgment." The psychiatrist also noted John Doe #7 "is known to defecate in his hands and immediately eat his own feces," "yells incoherently" from his cell, requires cell extractions for "forced hygiene," smashes his fists on the window of his cell which "resulted in chronic swelling of his hands" and stands for extended periods of time in his cell resulting in chronic swelling of his feet and ankles.
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167. John Doe #7's ISPs identify mood swings, resistance to treatment and thought disorder as his problems. The interventions for each problem in his ISP are identical. The interventions are also virtually identical to the interventions of many other inmates in MHTF regardless of their diagnoses or problem codes. 168. The interventions for John Doe #7 include case management once per week, individual counseling once per week, group twice per week, and recreation twice per week. His goals include "discussing methods ofmaintaining his mental ability" in each counseling session until January 2017, "learning coping skills" and "discussing the benefits oftreatment" during each counseling session and only reporting thought disorder ''three out ofseven times per week" during a six-month period. 169. These interventions are proposed for someone who eats his own feces, screams and yells in his cell and rarely, ifever, attends group therapy or recreation sessions during his four years in MHTF. Ifhe does attend individual counseling, it is only because individual counseling and case management are one in the same. This "attendance" occurs when the counselor stands outside John Doe #7's door and talks at him for 15 minutes once per week. 170. John Doe #7's records indicate he attends therapy or receives treatment for less than one hour per week. This has been the case for months, if not years. The notes in John Doe #7's records indicate his symptoms remain "severe" and his "adjustment is poor," yet John Doe #7's ISPs have remained virtually unchanged since at least January 2014 with John Doe #7 making no progress at all in treatment. 171. Prior to his death, John Doe #7 had neither made any progress toward his goals, nor participated in therapeutic activities in years. If anything, he was regressing. Little to no effort
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was made to engage him in treatment. John Doe #7 remained in virtual solitary confinement with limited privileges as the result ofthe inadequate mental health care being provided to him. 172. Defendants were and are aware ofthe serious harm or risk of serious harm caused by the inadequate mental health care and treatment at Lake CI. Their failure to take reasonable measures to address it contributed to John Doe #7's death. Defendants have actual knowledge of the inadequate mental health care and treatment for inpatient inmates with mental illness at Lake CI through CMA and FDC's own monitoring and other sources and they have failed to take prompt action to stop it. John Doe#8 173. John Doe #8 has been incarcerated in the FDC since 2011. John Doe #8 is presently confined in the MHTF level of care at Lake CI. 174. John Doe #8 has a long and documented history of mental illness while in the FDC. His diagnoses include paranoid schizophrenia with a history of acute psychosis and suicidal tendencies. John Doe #8 has co-occurring neurocognitive disorder secondary to traumatic brain injury. 175. Beginning in 2012, John Doe #8 has required multiple admissions to the TCU, CSU and MHTF levels of care to address his serious mental health needs. Over the last three years, John Doe #8 has bounced around the FDC's inpatient mental health units going from Suwannee CI to Lake CI MHTF to Union CI to Suwannee CI then back to Lake CI where he has spent over a year in his current MHTF admission. 176. In April2015, John Doe #8 was in the CSU at Suwannee CI for "unpredictable behavior, limited ability to function, speaking incoherently, not coming out of his cell for anything and disorganized thoughts."
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177. On May 1, 2015, the Suwannee CI mental health staff made a referral for John Doe #8 to be moved to the MHTF level ofcare because of his continued deterioration. 178. After this referral was sent to FDC central office, John Doe #8 languished in the Suwannee CI CSU for an entire month before he was finally moved to the appropriate level of inpatient mental health care. The reason for the delay: there was a ''wait list" for people in acute mental health crises to be moved to MHTF care. 179. When John Doe #8 finally arrived to the MHTF, he was described as disheveled, frail, disoriented and only eating one or two bites offood when he received his food tray. 180. John Doe #8's ISP indicates his problems include thought disorder and resistance to treatment. Every ISP for years, regardless ofthe level of inpatient mental health care, has noted John Doe #8 "continues to refuse treatment" and "does not come out of his cell." The plans note John Doe #8 "has not shown any improvement" and "continues to be confused and thinking is disorganized." 181. Remarkably, John Doe #8's current MHTF ISPs are virtually identical to the ISPs from previous unsuccessful inpatient stays. Even though none of the prior plans proved effective, the same interventions continue to be included virtually unchanged through his current 2016 ISPs. 182. Year after year, John Doe #8's ISPs suggest individual counseling once per week, group therapy session weekly and recreation weekly. This plan is nearly identical to the service plans of many other inmates in the FDC's inpatient care regardless of their diagnosis or problem code. 183. John Doe #8's plans have these same interventions listed in sections where the problem area is left blank by mental health staff. The interventions are simply pre-filled on almost every ISP to be used for inmates regardless of what the problem code or issue may be.
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184. As a result of inadequate treatment interventions, John Doe #8 continues to languish at Lake CI. He does not attend any activities, group therapy sessions or individual counseling sessions. Notes consistently indicate John Doe #8 is making ''poor progress" yet no attempt is made to modify his treatment interventions or seek consultation regarding how to help this inmate try to progress. 185. Although the mental health staffhave not substantively modified John Doe #8's interventions or service plans for years, they have spent many hours documenting every single one of John Doe #8's "refusal" ofservices. John Doe #8's records include hundreds ofpages of well-documented "refusals" of care. Stunningly, there are hardly any pages dedicated to discussing how to modify ineffective treatment interventions or help John Doe #8 progress in treatment. 186. Defendants were and are aware of the serious harm or risk of serious harm caused by the inadequate mental health care and treatment at Suwannee CI, Union CI and Lake CI and they have failed to take reasonable measures to address it. Defendants have actual knowledge ofthe inadequate mental health care and treatment for inpatient inmates with mental illness at Suwannee CI, Union CI and Lake CI through CMA and FDC's own monitoring and other sources and they have failed to take prompt action to stop it. The failure to provide John Doe #8 with any meaningful treatment to address his "refusals" of care places him at a continued risk of harm. John Doe#9 187. John Doe #9 has been incarcerated in the FDC since May 2013. John Doe #9 was in the MHTF at Lake CI from October 2015 to October 2016. He was then discharged to the TCU at
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Union Cl. Within a matter ofweeks, he was returned to the inpatient unit at Lake CI. John Doe #9 is currently housed in the inpatient unit at Suwannee CI. 188. John Doe #9 has a diagnosis of schizoaffective disorder, bipolar type with psychotic features. He has also been diagnosed since his incarceration in FDC with borderline personality disorder, antisocial personality disorder, and depression. 189. Since his incarceration John Doe #9 has been involved in numerous instances of selfinjurious behavior. As a result ofthese incidents he has had multiple admissions to FDC inpatient mental health units including Charlotte CI, South Florida Reception Center, Union CI, and Lake Cl. 190. John Doe #9 has been continuously housed in FDC inpatient units since June 5, 2015. 191. While confined at the Union CI inpatient mental health unit from June to October 2015, John Doe #9 engaged in multiple acts of self-harm. The inpatient mental health unit at Union CI lacked sufficient trained staffto appropriately address John Doe #9's mental illness. 192. While John Doe #9 was confined on the inpatient mental health unit at Union CI, his behaviors caused by his untreated mental illness resulted in multiple uses of physical force and emergency involuntary injections ofpsychotropic medications to deal with his "agitation." 193. On several ofthese occasions John Doe #9 was disciplined for the behavior that gave rise to the use ofthe psychotropic medications. For example, on consecutive days September 2015 while John Doe #9 was confmed on the Union CI inpatient mental health unit, the psychiatrist issued ETOs allowing force to be used to involuntarily medicate John Doe #9 because of extreme agitation related to his mental illness. The inpatient clinical staff issued multiple disciplinary reports against John Doe #9 during that same time for "attempted battery on staff''
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and "disobeying a verbal order" for actions that occurred while the staff were trying to involuntarily medicate him due to being in the throes of psychiatric emergencies. 194. At the time ofJohn Doe #9's disciplinary hearing, the mental health staff provided no infonnation to the disciplinary team on how John Doe #9's mental illness contributed to the behavior giving rise to the disciplinary report even though the behavior cited in the discipline report was directly related to the need for the emergency injection ordered by the psychiatrist. As a result, John Doe #9 was disciplined for his behavior. 195. Shortly thereafter, Union CI mental health staff obtained an order admitting John Doe #9 to the MHTF at Lake CI. 196. For the year that he was admitted to the MHTF at Lake Cl, John Doe #9 engaged in repeated instances ofserious self-harm. Several of the incidents were so serious that they required transport to outside medical facilities for emergency care. His actions included ingestion of pieces ofmetal wire, hoarding and overdosing on his prescription medications, and multiple instances of stabbing himself in the abdomen with sharpened wire, paperclips, and nails while confmed to the inpatient mental health unit. Several of these incidents occurred while he was in suicide observation status as a result ofearlier attempts to harm himself. 197. John Doe #9's ISPs developed at Lake CI from October 2015 through April2016listed self-injurious behavior as the primary focus of his treatment. Each monthly treatment plan stated that his self-injurious behavior would be addressed by having John Doe #9 identify and utilize ''three adaptive behaviors" to replace his self-injurious behaviors. 198. During the six months that these ISPs were in effect, his treatment notes contain no indication that this treatment activity was actually carried out or attempted. There is no mention
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in his treatment notes ofthe adaptive behaviors, how John Doe #9 would learn those behaviors, or what progress, if any, John Doe #9 made towards learning or utilizing the adaptive behaviors. 199. Instead, the treatment staff's response to these incidents has consisted of placing John Doe #9 in isolation cells, ordering emergency treatment via chemical restraints, using physical restraints or a combination ofthe above. The inpatient mental health staff did not engage in any treatment activities to address John Doe #9's behavior and underlying personality disorder. 200. In May 2016, John Doe #9's ISP was amended to delete the unattained goal oflearning and utilizing the adaptive behaviors. It was replaced with a simple declaration that John Doe #9 would not engage in any self-injurious behavior for multiple consecutive weeks by May 2017. There was no indication in John Doe #9's ISPs or in his records how this goal might be achieved. 201. John Doe #9's self-injurious behaviors continued and were cited as the justification for obtaining a renewed court order continuing his confinement on the Lake CI MHTF just a few months ago. 202. Recently, John Doe #9 was discharged from the Lake CI MHTF and transferred to the Union CI TCU. In the Union CI TCU, treatment activities are routinely canceled due to a lack of security staff. What treatment activities are received consist of sitting outside in a cage or watching television for two hours on the weekend. Within weeks of being discharged to the Union CI TCU, John Doe #9 was returned to the inpatient unit at Lake Cl. John Doe #9 is currently housed in the inpatient unit at Suwannee CI. 203. Defendants have failed to ensure that inpatient mental health units are capable of providing individualized appropriate treatment for individuals who engage in self-injurious behavior.
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204. The FDC knows that this type ofcare is necessary. Prior to privatization ofFDC mental health care, the inpatient mental health staff at Lake CI provided specialized care for individuals who engaged in self-harm due to mental illness such as borderline personality disorder. After privatization, these therapeutic treatments were abandoned and the FDC has not required the Contractor to provide it. 205. The failure to provide John Doe #9 with any meaningful treatment intervention to modifY his self-injurious behavior places him at continued risk ofharm or death. 206. Defendants were and are aware ofthe serious harm or risk of serious harm caused by the inadequate mental health care and treatment provided at the various inpatient institutions at which John Doe #9 was and is confined and they have failed to take reasonable measures to address it. Defendants have actual knowledge ofthe inadequate mental health care and treatment for inpatient inmates with mental illness at these inpatient units through the CMA and FDC's own monitoring and other sources and they have failed to take prompt action to stop it. John Doe#lO 207. John Doe #10 entered the FDC in 1991. He is currently housed in the inpatient unit at Suwannee Cl. His current diagnoses are Schizophrenia, Paranoid Type and Antisocial Personality Disorder. 208. From 1991 to 1994, John Doe #10 lived in general population and held job assignments. In 1995, John Doe #10 was put into disciplinary confinement. From 1995 until 2010, John Doe #10 cycled between close management and disciplinary confinement with an occasional admission to inpatient mental health care in the FDC. 209. After 15 years in confinement, John Doe #10 was admitted to inpatient mental health care in 2010. He has been there continuously for six years.
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210. For at least the last few years, John Doe #10 has refused almost all treatment offered to him. This includes refusing individual counseling, group counseling, activity therapy and medications. He also refuses recreation. One clinician labeled him a "chronic refuser." 211. John Doe #10 rarely leaves his cell or participates in treatment as a result of his mental illness. 212. John Doe #10's ISPs all look the same. For years, the FDC's ISPs identify John Doe #10 as resistant to treatment, I00% non-compliant and/or refusing all treatment. But there is no indication his treatment resistance is being addressed in any meaningful way. 213. John Doe #10's interventions in his ISP mirror the interventions of almost every other ISP for inpatient residents regardless of their mental health stability, identified problem codes or diagnoses. 214. John Doe #to's goals in his ISP are tied to the percentage oftreatment activities in which he participates. Rather than try to engage John Doe #10 in treatment or activities, the clinicians
simply keep decreasing the expected level ofparticipation. One ISP included a goal of 25%
participation in treatment activities. On the next ISP it was lowered to 10% participation. On the next ISP it was lowered to 5% participation. None ofthe interventions or treatments have been modified during this same period. 215. John Doe #IO's refusals of treatment and out-of-cell activities are well documented by the FDC. A review ofJohn Doe #tO's inpatient mental health file reveals hundreds ofpages of "refusal oftreatment" forms signed off by clinicians and other inpatient mental health unit staff for each activity in which John Doe #1 0 does not participate. 216. Group therapy is offered together with individual therapy and ''therapeutic community" once per week and refused. Activity therapy is offered twice per week and refused. Even ifJohn
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Doe #1 0 participated in these treatment opportunities, the number ofdays that treatment and outof-cell time are offered is woefully inadequate. 2t7. Additionally, mental health staffdutifully create a weekly summary ofJohn Doe #tO's refusals of every treatment and out-of-cell activity offered to him. However, there are hardly any records in John Doe #tO's extensive file noting clinicians' attempts to get him to engage in treatment or even leave his cell for recreation. 2t8. John Doe #tO's living conditions and lack of treatment essentially amount to long-term solitary confinement. The lack of treatment and attempts to engage John Doe #t0 in at least leaving his cell will result in extended confinement and segregation in the inpatient mental health unit and limited privileges. 2t9. Defendants were and are aware ofthe serious harm or risk of serious harm caused by the inadequate mental health care and treatment at Suwannee CI and they have failed to take reasonable measures to address it. Defendants have actual knowledge ofthe inadequate mental health care and treatment for inpatient inmates with mental illness at Suwannee CI through CMA and FDC's own monitoring and other sources and they have failed to take prompt action to stop it. Further, the failure to provide John Doe #10 with any meaningful treatment to aid in his refusal to engage in treatment or leave his cell for recreation places him at a continued risk of harm.
The FDC Knows of the Inadequate Care Being Provided at Inpatient Units and bas Failed to Correct the Deficiencies
220. From at least 2013 to the present date, the FDC has been aware that inmates with serious mental illness in the inpatient mental health units have been denied necessary mental health care to address their known serious mental health needs. Reports provided to the FDC from other
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agencies and the FDC's own monitoring of its Contractor's compliance, or lack thereof, with HSBs has demonstrated gross deficiencies in care. 221. The FDC knows, and has known, that the deficiencies in medical and mental health care on inpatient mental health units has caused significant harm to and deaths of inmates confined on those units. 222. The FDC knows its Contractor consistently fails to provide the number ofhours ofoutof-cell structured mental health treatment to the mentally ill inmates in the inpatient units. FDC's reviews ofinpatient mental health records for contract monitoring has demonstrated wide spread failure to provide the required hours of structured out-of-cell mental health treatment therapy services. When inpatient inmates were allowed out oftheir cells they were rarely, if at all, provided therapeutic services. Most out-of-cell hours were for unstructured recreation time not meeting the HSB definition of "out-of-cell structured therapeutic activities." 223. In multiple routine contract monitoring visits, the FDC found zero percent performance in providing out-of-cell structured therapeutic services for the inpatient inmates in the TCU, CSU, and MHTF. 224. In multiple contract monitoring visits, the FDC found grossly inadequate performance on the creation and revision ofthe ISPs, documents which are the foundation for provision of appropriate mental health care to inmates. 225. In multiple contract monitoring visits, the FDC found grossly inadequate performance for
provision of psychiatric evaluations to inmates requiring psychotropic medications. 226. In spite ofthis knowledge, the Defendants have failed to correct the widespread constitutional deficiencies.
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COUNT I VIOLATION OF THE EIGHTH AMENDMENT DUE TO INADEQUATE MENTAL
HEALTH CARE AND TREATMENT UNDER 42 U.S.C. §1983
~EFENDANTSECRETAR~
227. This count is brought under the Eighth Amendment to the U.S. Constitution pursuant to 42 U.S.C. §1983 against Defendant Secretary in her official capacity. 228. Plaintiff repeats and realleges the prior paragraphs in this Complaint as if fully set forth herein. 229. The Eighth Amendment's prohibition on cruel and unusual punishment obligates prison officials to provide inmates with adequate medical and mental health care. 230. The Plaintiff's clients and constituents housed in FDC's inpatient units are individuals with serious medical needs in the form of severe mental iiinesses. 231. The Plaintiff's clients and constituents housed in FDC's inpatient mental health units have faced and continue to face a significant risk of harm, including death, due to Defendant Secretary's failure to provide adequate mental health care, as described herein, to individuals housed in FDC's inpatient mental health units. 232. Defendant Secretary knows, and has known, that the persons in FDC custody in the inpatient mental health units described herein have serious medical needs in the form of serious mental illnesses, yet Defendant Secretary has failed and deliberately refused to provide the necessary aid and treatment that would alleviate those serious medical needs. 233. Defendant Secretary knows, and has known, of the inadequate mental health treatment of inmates in her inpatient mental health units and knew that this posed a pervasive risk of harm, including death, to those inmates. Defendant Secretary's response to the risk has been so inadequate and unreasonable that it constitutes deliberate indifference to the inmates' rights as guaranteed by the Eighth Amendment to the United States Constitution.
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234. Defendant Secretary's pattern and practice of failing to provide constitutionally adequate mental health care and treatment for inmates with mental illnesses in the inpatient mental health units violates the Eighth Amendment rights ofthese inmates. Defendant Secretary has been deliberately indifferent to the serious medical needs of the persons confmed in FDC's inpatient mental health units. While Defendant Secretary has contracted with private entities to provide medical care, she nonetheless has a non-delegable duty to ensure adequate medical care for all inmates in her custody. 235. As a direct and proximate cause ofDefendant Secretary's pattern, practice, and deliberate indifference, Plaintiff's clients and constituents have suffered, and continue to suffer from harm and violation oftheir Eighth Amendment rights. These harms will continue unless enjoined by this Court.
COUNT II VIOLATIONS OF THE AMERICANS WITH DISABILITIES ACT
(DEFENDANT FDC) 236. Plaintiffrepeats and realleges the prior paragraphs in this Complaint as if fully set forth herein. 237. This count is brought under Title II ofthe Americans with Disabilities Act (ADA), 42
U.S.C. §12101, et seq. & 42 U.S.C. §12131, et seq., and its implementing regulations against the Defendant Florida Department of Corrections. 238. Title II ofthe ADA prohibits disability-based discrimination by any public entity. 42
u.s.c. §§12131-12132.
239. Defendant FDC is a public entity. 42 U.S.C. §12131(1). 240. All individuals mentioned herein who are in FDC custody are qualified individuals with a disability. 42 U.S.C. §§12131(2) & 12101(1).
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Case 3:18-cv-00179-HES-JRK Document 1 Filed 01/30/18 Page 47 of 53 PageID 47
241. The ADA imposes an affirmative duty on public entities to create policies or procedures and to implement policies or procedures to prevent discrimination based on disability. 242. Defendant FDC has a pattern and practice of excluding qualified individuals with disabilities from participation i~ and denying those individuals the benefits of services, programs, and activities, by reason of those disabilities. 42 U.S.C. §12132 243. Visitation, religious services, canteen services, library services, recreation, and work programs, are services, programs or activities of the FDC. 244. Defendant FDC excludes Plaintiffs clients and constituents housed in the FDC's inpatient mental health units from participating and benefiting in these programs, services, and activities, and subjects them to discrimination because of their disabilities. 245. As a result oftheir continued isolation in the inpatient mental health units resulting from constitutionally inadequate provision of mental health care, the inmates housed in these units were and continue to be denied the ability to participate in the FDC's activities, services or programs provided to inmates in non-isolated settings. This discrimination is the result oftheir disabilities by FDC's agents and employees. Such a denial of services constitutes discrimination against individuals based on their disability in violation ofTitle II ofthe ADA. 246. Defendant FDC's practice ofallowing inmates with mental illness to be disciplined and punished for conduct that was the direct result of their mental illness constitutes discrimination against individuals based on their disability in violation of the ADA. 247. Defendant FDC has discriminated against Plaintiffs clients and constituents in inpatient mental health units by failing to provide non-segregated and non-isolated housing and adequate mental health care as a reasonable accommodation to prevent the exacerbation of the inmates'
47

Case 3:18-cv-00179-HES-JRK Document 1 Filed 01/30/18 Page 48 of 53 PageID 48
mental illness and the unnecessary continuation of their confinement on the inpatient mental health units. 248. The denial of necessary services to inmates housed in the FDC's inpatient mental health units by its agents and employees denies the inmates the benefits ofthe services, programs, or activities ofFDC's inpatient units in violation of Title II of the ADA. 249. Defendant FDC fails to house inmates with mental illness in the most integrated setting appropriate to their needs; places inmates with mental illness in inappropriate security classifications; places inmates with mental illness in facilities that do not offer the same programming as other facilities; and deprives inmates with mental illness of visitation with family members by placing them in distant facilities where they would not otherwise be housed. 250. Defendant FDC has known about the violations noted herein but has failed to correct them, thereby exhibiting deliberate indifference to the rights of Plaintiff's clients and constituents in inpatient units in FDC custody. 251. As a direct and proximate cause ofthis pattern, practice, and deliberate indifference, Plaintiff's clients and constituents have suffered, and continue to suffer from harm and violation oftheir ADA rights. These harms will continue unless enjoined by this Court.
COUNT III VIOLATIONS OF THE FEDERAL REHABILITATION ACT
(DEFENDANT FDC) 252. Plaintiffrepeats and realleges the prior paragraphs in this Complaint as if fully set forth herein. 253. The Federal Rehabilitation Act (FRA) prohibits discrimination against an individual based on disability by any program or entity receiving federal funds. 29 U.S.C. §§794(a) and (b)(2)(B).
48

Case 3:18-cv-00179-HES-JRK Document 1 Filed 01/30/18 Page 49 of 53 PageID 49
254. The inmates housed in the FDC's inpatient mental health units are persons with disabilities as defined in the FRA. 255. Defendant FDC is a program or entity which receives federal financial assistance. 256. Defendant FDC's inpatient mental health units are facilities and their operation comprises a program and services for purposes of the FRA. 257. The inmates housed in the FDC's inpatient mental health units are qualified to participate in or receive the benefit ofFDC's services, programs, or activities. 258. As a result oftheir continued isolation in the inpatient mental health units resulting from constitutionally inadequate provision of mental health care, the inmates housed in these units were and continue to be denied the ability to participate in the FDC's activities, services or programs provided to inmates in non-isolated settings. This discrimination is the result oftheir disabilities by FDC's agents and employees. Such a denial of services constitutes discrimination against individuals based on their disability in violation of the FRA. 259. Defendant FDC's practice ofallowing inmates with mental illness to be disciplined and punished for conduct that was the direct result oftheir mental illness constitutes discrimination against individuals based on their disability in violation ofthe FRA. 260. The FRA imposes an affirmative duty on public entities to create policies or procedures and to implement policies or procedures to prevent discrimination based on disability. 261. Defendant FDC has a pattern and practice of excluding qualified individuals with disabilities from participation in, and denying those individuals the benefits of services, programs, and activities, by reason ofthose disabilities. 262. Visitation, religious services, canteen services, library services, recreation, and work programs are services, programs or activities of the FDC.
49

Case 3:18-cv-00179-HES-JRK Document 1 Filed 01/30/18 Page 50 of 53 PageID 50
263. Defendant FDC excludes Plaintiff's clients and constituents housed in the FDC's inpatient mental health units from participation in, and denies them the benefits of these programs, services, and activities, and subjects them to discrimination, because of their disabilities. 264. As a result of their continued isolation in the inpatient mental health units resulting from constitutionally inadequate provision of mental health care, the inmates housed in these units were and continue to be denied the ability to participate in the FDC's activities, services or programs provided to inmates in non-isolated settings. This discrimination is the result of their disabilities by FDC's agents and employees. Such a denial of services constitutes discrimination against individuals based on their disability in violation of the FRA. 265. Defendant FDC has discriminated against Plaintiff's' clients and constituents in inpatient units by failing to provide non-segregated and non-isolated housing and adequate mental health care as a reasonable accommodation to prevent the exacerbation ofthe inmates' mental illness and the unnecessary continuation of their confinement on the inpatient units. 266. The denial of necessary services to inmates housed in the FDC's inpatient mental health units by its agents and employees denies the inmates the benefits of the services, programs, or activities ofFDC's inpatient units in violation ofthe FRA. 267. Defendant FDC fails to house inmates with mental illness in the most integrated setting appropriate to their needs; places inmates with mental illness in inappropriate security classifications; places inmates with mental illness in facilities that do not offer the same programming as other facilities; and deprives inmates with mental illness ofvisitation with family members by placing them in distant facilities where they would not otherwise be housed.
so

Case 3:18-cv-00179-HES-JRK Document 1 Filed 01/30/18 Page 51 of 53 PageID 51
268. Defendant FDC has known about the violations noted herein but has failed to correct them, thereby exhibiting deliberate indifference to the rights of Plaintiff's clients and constituents in inpatient units in FDC custody. 269. As a direct and proximate cause ofthis patte~ practice, and deliberate indifference, Plaintiff's clients and constituents have suffered, and continue to suffer from harm and violation of their FRA rights. These harms will continue unless enjoined by this Court.
REQUEST FOR RELIEF WHEREFORE, Disability Rights Florida, on behalfof inmates with mental illness who are currently confmed in the FDC's inpatient mental health units, requests that this Court: A. Accept jurisdiction of this case and set it for trial at the earliest opportunity; B. Declare that the actions and inactions ofthe Defendants are unlawful and unconstitutional for the reasons specified above; C. Enjoin Defendants from continuing to violate the constitutional and statutory rights of the mentally ill inmates confined in the FDC's inpatient mental health units as well as those inmates who may, at some point in the future, be transferred to those units. Specifically, Plaintiff seeks an injunction requiring Defendant Secretary to change her customs, policies, and practices to ensure that inmates with serious mental illness receive constitutionally adequate mental health treatmen~ and Plaintiffseeks an injunction requiring Defendant FDC to stop discriminating against the inmates on the FDC's inpatient mental health units on the basis of their disabilities; D. Retain jurisdiction over this matter to ensure that the terms of any injunction are fully implemented; E. Award Plaintiff its costs and reasonable attorneys' fees pursuant to 42 U.S.C. §1988 and 42 U.S.C. §12205; and
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Case 3:18-cv-00179-HES-JRK Document 1 Filed 01/30/18 Page 52 of 53 PageID 52
F. Award all other necessary and appropriate relief that this Court may deem appropriate.
Peter P. Sleasman Trial Counsel Fla. Bar No. 367931
Kristen Cooley Lentz Fla. Bar No. 649635 Disability Rights Florida 4723-B NW 53rd Ave Gainesville, FL 32563 850-488-9071 (telephone) 850-488-8640 (facsimile) KristenL@disabilityrightsflorida.org PeterS@DisabilityRightsFlorida.org
David Allen Boyer Fla. Bar. No. 090917 Disability Rights Florida 1930 Harrison St., Suite 104 Hollywood, FL 33020 850-488-9071 (telephone) 850-488-8640 (facsimile) DavidB@disabilityrightsflorida.org
Andrea Costello Fla. Bar No. 532991 Christopher M. Jones Fla. Bar No. 994642 Florida Legal Services 14260 W. Newberry Road, #412 Newberry, FL 32669 (407) 801-0332 (telephone) (401} 505-7327 (facsimile) Andrea@floridalegal.org Christopher@floridalegal.org
George E. Schulz, Jr. Fla. Bar No. 169507 Laura Renstrom Fla. BarNo. 108019 Holland & Knight LLP 50 North Laura Street Suite 3900
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Case 3:18-cv-00179-HES-JRK Document 1 Filed 01/30/18 Page 53 of 53 PageID 53 Jacksonville, FL 32202 (904) 353-2000 (telephone) (904) 358-1872 (facsimile) Buddy.Schulz@hklaw.com Laura.Renstrom@hklaw.com Attorneys for Plaintiff
53

 
 Case 3:18-cv-00179-HES-JRK Document 3 Filed 01/31/18 Page 1 of 14 PageID 58

UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA JACKSONVILLE DIVISION

DISABILITY RIGHTS FLORIDA, INC., On behalf of its Clients and Constituents,

Plaintiff,

vs.

Case No. 3:18-cv-00179-HLA-JRK

JULIE JONES, Secretary, Florida Department Of Corrections in her Official Capacity and FLORIDA DEPARTMENT OF CORRECTIONS, an Agency of the State of Florida,

Defendants. _____________________________________________/

JOINT MOTION FOR COURT ADOPTION OF SETTLEMENT AGREEMENT

The Plaintiff, Disability Rights Florida, and Defendants, Florida Department of

Corrections and Secretary Julie Jones, jointly move this Honorable Court to adopt the attached

Settlement Agreement (“Agreement”) (Exhibit #1) as an order of the Court to resolve the above-

styled case and state as follows:

1. In late 2016, Plaintiff completed an investigation into conditions and the provision

of mental health treatment and services in the Defendants’ inpatient mental health units. Plaintiff

drafted a federal court Complaint against the Florida Department of Corrections and its

Secretary, Julie Jones, alleging violations of the Eighth Amendment to the United States

Constitution, the Americans with Disabilities Act, 42 U.S.C. §12132, and the Federal

Rehabilitation Act, 29 U.S.C. §794.

2. In December 2016, Plaintiff provided a copy of the draft Complaint to Secretary

Jones and notified Defendants of its intention to file federal litigation regarding alleged

Case 3:18-cv-00179-HES-JRK Document 3 Filed 01/31/18 Page 2 of 14 PageID 59
constitutional and statutory violations in the provision of mental health services and treatment at the Florida Department of Corrections’ inpatient mental health units around the state.
3. The Defendants, through counsel, responded and the Parties agreed to prelitigation mediation.
4. In January 2017, Plaintiff consulted with the Jacksonville Division of the Middle District Federal Court regarding its availability to preside over pre-litigation mediation sessions. The Honorable Harvey E. Schlesinger, U.S. District Court Judge, agreed to preside over mediation with the consultation and approval of the other Division Judges. The Defendants agreed to participate in pre-litigation mediation with Judge Schlesinger. The first mediation session occurred that same month.
5. At the first mediation session, the Parties agreed that the Plaintiff would send a team of mental health experts to conduct site visits at two of the largest inpatient mental health units to assess the treatment and services provided to the patients on the units. Defendants would send their own team of clinicians to the assessments.
6. In February 2017, the Parties’ teams conducted site visits to assess the treatment and services provided to the patients on the inpatient mental health units. Plaintiff’s expert team consisted of two psychiatrists and one psychologist, all of whom had extensive experience providing mental health treatment and services in institutional settings. Defendants’ team consisted of its own regional and state-level clinical staff and ombudsmen. The site visits included interviews with security staff, interviews with clinical staff, interviews with patients, review of patient records, review of policies, observation of treatment activities and observation of unstructured out of cell activities.
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Case 3:18-cv-00179-HES-JRK Document 3 Filed 01/31/18 Page 3 of 14 PageID 60
7. In March 2017, the Plaintiff’s team submitted expert reports to Defendants and Defendants provided their own institutional evaluations for review and consideration by the Plaintiff. Based on the observations and conclusions of both teams, the Parties began negotiating a resolution to this matter with Judge Schlesinger’s assistance.
8. The Parties engaged in an extensive series of mediations and calls over the course of a twelve-month period. During this time, the Parties exchanged multiple settlement proposals and worked diligently toward finding a mutually agreeable resolution that addressed Plaintiff’s concerns. The expert reports and institutional evaluations were discussed among the Parties and with Judge Schlesinger during mediation. The findings from the Parties’ reports and evaluations became the basis for the relief the Parties ultimately negotiated with the assistance of Judge Schlesinger.
9. At their final mediation session on December 5, 2017, the Parties reached an agreement in principle. On December 22, 2017, the Parties executed the Agreement.
10. The Agreement is designed to remedy the constitutional deficiencies alleged by the Plaintiff in its Complaint as to the provision of treatment and services in the Defendants’ inpatient mental health units. The Agreement provides for independent monitoring of implementation and of compliance with the Agreement.
11. Additionally, the Parties agreed the Agreement would be adopted as an order of the Court. The Agreement provides that the jurisdiction of the Court over the Agreement shall commence upon the date of the Court’s adoption of the Agreement as an order and shall extend from the date of adoption until December 31, 2020 or 60 days after receipt of the final monitoring report, whichever is sooner.
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12. The Parties agreed that, when filed, the case should be presided over by Judge Schlesinger because of his intimate involvement in assisting with the negotiated resolution of this matter.
13. For the purposes of this lawsuit only and in order to settle this matter, Defendants stipulate that the conditions in the Defendants’ inpatient mental health units necessitate the remedial measures contained in the Agreement, including providing individualized treatment services, providing adequate number of hours for structured out of cell treatment and unstructured out of cell activities, providing specialized treatment for patients engaging in selfinjurious behavior, providing appropriate psychotropic medication practices, providing adequate discharge planning, eliminating the excessive use of isolation and restraint on the inpatient mental health units, providing increased protections for patients on the inpatient mental health units charged with disciplinary violations, providing greater coordination of care between medical and mental health staff for patients on the inpatient mental health units and providing adequate training of clinical and security staff assigned to the inpatient mental health units.
14. The Parties stipulate that the Agreement complies in all respects with the Prison Litigation Reform Act, 18 U.S.C. §3626. The Parties further stipulate that the prospective relief in the Agreement is narrowly drawn, extends no further than necessary to correct the violations of federal rights alleged in the Complaint, is the least intrusive means necessary to correct these violations, and will not have an adverse impact on public safety or the operation of a criminal justice system.
15. As discussed in more detail below, this Court should adopt the Agreement as an order of the Court because the settlement is “fair, adequate, reasonable, and not the product of collusion,” Day v. Persels & Assoc., LLC, 729 F.3d 1309, 1326 (11th Cir. 2013), and because it
4

Case 3:18-cv-00179-HES-JRK Document 3 Filed 01/31/18 Page 5 of 14 PageID 62
complies with the Prison Litigation Reform Act in that the relief is “narrowly drawn, extends no further than necessary to correct the violation of the federal rights, and is the least intrusive means necessary to correct the violations of the federal rights.” 18 U.S.C. §3626.
MEMORANDUM OF LAW I. Procedural History
a. Plaintiff’s Complaint Plaintiff’s Complaint against the Florida Department of Corrections and its Secretary, Julie Jones, alleged violations of the Eighth Amendment to the United States Constitution, the Americans with Disabilities Act, 42 U.S.C. §12132, and the Federal Rehabilitation Act, 29 U.S.C. §794, as a result of the constitutionally and statutorily inadequate mental health treatment and services being provided to patients in the Defendants’ inpatient mental health units. The Complaint specifically alleged constitutional and statutory violations including a lack of individualized treatment planning, a lack of individualized treatment services, an inadequate number of hours for structured out of cell treatment and unstructured out of cell activities, limited or no treatment for patients engaging in self-injurious behavior, inappropriate psychotropic medication practices and inadequate discharge planning. The Complaint also alleged excessive use of isolation and restraint on the inpatient mental health units, an inadequate and punitive disciplinary process for patients on the inpatient mental health units, limited or no coordination of the medical and mental health teams on the inpatient mental health units and inadequate training of clinical and security staff assigned to the inpatient mental health units. b. The Mediation Process In December 2016, Plaintiff notified Defendants of its intention to file federal litigation regarding the allegedly unconstitutional and statutorily inadequate provision of mental health
5

Case 3:18-cv-00179-HES-JRK Document 3 Filed 01/31/18 Page 6 of 14 PageID 63
treatment and services in the Defendants’ inpatient mental health units. (Ex. #1 at 2). Plaintiff provided its draft federal court Complaint along with a letter suggesting the Parties engage in pre-suit mediation to immediately address Plaintiff’s concerns due to the alleged ongoing harm to patients. Beginning in January 2017, the Parties engaged in pre-litigation mediation sessions with The Honorable Harvey E. Schlesinger, U.S. District Court Judge, to negotiate a resolution to the dispute. Id.
The mediation process included the Parties sending teams of experts and mental health clinicians to the Defendants’ inpatient mental health units to observe and evaluate the mental health treatment and services provided to patients to provide a foundation for determining the state of the services at the institutions. Id. These reports and evaluations were based on many interviews with staff and patients, review of thousands of pages of patient records and policies, and observation of treatment services and activities on the inpatient mental health units. These reports and evaluations became the basis for negotiating appropriate relief. Id.
After twelve months of mediation, in December 2017, a final Agreement was reached and executed by the Parties. Id. at 22. The Agreement includes an implementation timeline, a comprehensive approach to addressing the constitutional violations alleged in the Complaint, a requirement for an independent monitoring team and compliance assessment and attorneys’ fees and costs. See id.
c. The Agreement The Agreement thoughtfully addresses Plaintiff’s allegations that Defendants violated the Eighth Amendment to the United States Constitution, the Americans with Disabilities Act, 42 U.S.C. §12132, and the Federal Rehabilitation Act, 29 U.S.C. §794, as a result of the allegedly unconstitutional and statutorily inadequate mental health treatment and services being provided
6

Case 3:18-cv-00179-HES-JRK Document 3 Filed 01/31/18 Page 7 of 14 PageID 64
to patients in the Defendants’ inpatient mental health units. The Agreement specifically includes substantive relief addressing the creation and revision of individualized treatment plans, the minimum number of hours required for structured out of cell treatment and unstructured out of cell activities, the creation of a systematized program for patients engaging in self-injurious behavior, appropriate psychotropic medication practices and discharge planning. (Ex. #1 at 514). The Agreement also addresses excessive use of isolation and restraint on the inpatient mental health units, the disciplinary process utilized on the inpatient mental health units, coordination of the medical and mental health teams on the inpatient mental health units and training of clinical and security staff assigned to the inpatient mental health units. Id.
Additionally, the Agreement provides for an independent monitoring team, contracted by the Correctional Medical Authority (“CMA”), to conduct a series of compliance assessments over a two-year period of time. Id. at 14-17. The CMA was created in 1986 and its mission is to monitor and promote delivery of cost-effective health care that meets accepted community standards to inmates in the Florida Department of Corrections. The CMA is already involved in regularly monitoring health care provided in the Florida Department of Corrections. Under the Agreement, the CMA team will evaluate each inpatient mental health unit’s compliance with the Agreement twice over the life of the current Agreement. Id. The monitoring team will provide compliance assessment reports for each institution to the Parties. Id.
In the event there is a dispute over an alleged lack of substantial compliance, the Plaintiff must provide the Defendants, in writing, the specific reasons it believes the Defendants are not in substantial compliance and reference specific provisions of the Agreement. Id. at 18-19. Defendants will have 30 days to respond to Plaintiff with a description of the steps they took to investigate the issues addressed in the notice, the results of the investigation and any corrective
7

Case 3:18-cv-00179-HES-JRK Document 3 Filed 01/31/18 Page 8 of 14 PageID 65
action steps to address the issues. Id. Plaintiff must advise Defendants whether it accepts or rejects FDC’s response within ten days of receipt. Id. If Plaintiff rejects Defendants’ response, the Parties must meet to attempt to resolve remaining disputes within 20 days of Plaintiff’s rejection. Id. The monitoring team will participate in those meetings and the Parties may engage a mediator to assist with resolution of the dispute. If the meeting is not successful, only then may the Plaintiff seek relief from the Court. Id.
The Agreement becomes effective upon the date of the Court’s adoption of the Agreement as an order of the Court. Id. at 21. The Parties agreed the Court’s jurisdiction should extend until December 31, 2020 or 60 days after the receipt of the final monitoring report, whichever is sooner, unless the Plaintiff files a motion to extend jurisdiction based on the argument that prospective relief remains necessary to correct a current and ongoing violation of Federal rights. Id. The Parties agreed that the case should be presided over by Judge Schlesinger because of his intimate involvement in year-long mediation and the ultimate settlement of this case.
II. Legal Standard There is a “strong judicial policy favoring settlement as well as the realization that compromise is the essence of the settlement.” Bennet v. Behring Corp., 737 F.2d 982, 986 (11th Cir. 1984). When adopting a settlement as an order of the Court, the Court should ensure the settlement is “fair, adequate, reasonable, and not the product of collusion,” Day, 729 F.3d at 1326 (11th Cir. 2013). Additionally, because this Agreement constitutes prospective relief regarding prison conditions, the Court must find the Agreement complies with the Prison Litigation Reform Act (PLRA), 18 U.S.C. §3626. The PLRA requires the Court to find the relief in the Agreement is “narrowly drawn, extends no further than necessary to correct the violation
8

Case 3:18-cv-00179-HES-JRK Document 3 Filed 01/31/18 Page 9 of 14 PageID 66
of the Federal right, and is the least intrusive means necessary to correct the violation of the Federal right.” 18 U.S.C. §3626(a) & (c).
a. The Agreement Meets the Standard for Adoption of Settlements, Generally The law requires the agreement to resolve a genuine dispute between the parties; provide fair, adequate and reasonable relief; and not be the result of collusion. Day, 729 F.3d at 1326 (11th Cir. 2013). The Agreement requested to be adopted by the Court in this instant case meets each of these requirements. First, the Agreement resolves a genuine dispute among the Parties. Plaintiff sent Defendants a demand letter and draft Complaint prior to filing litigation. The negotiation process to resolve the matter took twelve months and required the assistance of a Federal District Court Judge. The final negotiated Agreement resolves all disputes outlined in the Complaint filed with the Court. Second, the Agreement provides fair, adequate and reasonable relief. The Agreement is a comprehensive document outlining the relief that addresses the particular constitutional violations that Plaintiff alleged in its Complaint. The Parties validly and willingly consented to the Agreement. The Agreement does not violate the Constitution, statutes or public policy. In fact, the Agreement secures the constitutional and statutory rights of the patients in the Defendants’ inpatient mental health units. The Agreement does not extend any further than necessary to address the Plaintiff’s allegations and provides for an end date to the Court’s jurisdiction. Finally, the Agreement is not the result of collusion. The Agreement is the result of twelve months of arms-length negotiations with the assistance of a Federal District Court Judge. The Parties were represented by teams of “experienced litigators” who engaged in “a process of
9

Case 3:18-cv-00179-HES-JRK Document 3 Filed 01/31/18 Page 10 of 14 PageID 67
compromise in which ‘in exchange for the savings of cost and elimination of risk, the parties each give up something they might have won had the proceeded with litigation.’” U.S. v. City of Jackson, Miss., 519 F.2d 1147, 1152 (5th Cir. 1975). Each Party provides this Court with the assurance that the Agreement is not the product of collusion.
b. The Agreement Complies with the Prison Litigation Reform Act The Defendants have stipulated for the purposes of this lawsuit that the conditions in the inpatient mental health units necessitate the remedial measures contained in the Agreement. The mediation negotiations ensured that the relief in the Agreement is narrowly tailored to correct the particular constitutional violations alleged in the Complaint. The Parties stipulated that this Agreement is narrowly drawn, extends no further than necessary to correct the violations of Federal rights as alleged by the Plaintiff in the Complaint, is the least intrusive means necessary to correct these violations, and will not have an adverse impact on public safety or the operation of a criminal justice system. Throughout negotiations, the Parties ensured the Agreement was specifically targeted at achieving and maintaining constitutional requirements without extending further than necessary to correct the alleged violations. The Parties stipulated the conditions in the units necessitate the remedies outlined in the Agreement. The Defendants specifically agreed that “the services and treatment required by this Agreement are necessary to satisfy patient needs.” (Ex. #1 at 2). Additionally, the Agreement calls for independent monitoring by contractors for the Correctional Medical Authority (“CMA”). As explained supra, the CMA is already involved in regularly monitoring health care provided in the Florida Department of Corrections. Under the Agreement, the CMA team will evaluate each inpatient mental health unit’s compliance with the Agreement twice over the life of the current Agreement. Utilizing a state agency that already
10

Case 3:18-cv-00179-HES-JRK Document 3 Filed 01/31/18 Page 11 of 14 PageID 68
monitors the Defendants medical and mental health system is the least intrusive means of monitoring this Agreement.
Finally, the dispute resolution process includes a non-judicial component prior to exercising the Court’s jurisdiction. As described supra, the Agreement provides for an extensive non-judicial dispute resolution process prior to seeking relief from the Court. If the Parties are not successful in their attempts to resolve the dispute, then Plaintiff may seek relief from the Court to effect compliance. The dispute resolution process is far less intrusive than the Parties seeking relief from the Court immediately upon an allegation the Defendants are not in substantial compliance.
Courts have found that if the scope and substance of the remedial measures is agreeable to a state agency defendant, then it is almost by definition less intrusive than a remedy imposed non-consensually and must be taken to mean it is precisely tailored to the needs of the conditions presented in the litigation. See Morales Feliciano v. Calderon Serra, 300 F. Supp. 2d 321, 334 (D.P.R. 2004)(stating “the very fact that the defendant [state agency] chose to join the plaintiffs in selecting this remedy would seem to mean – and must be taken to mean – that they understood it to be precisely tailored to the needs of the occasion, that it is narrowly drawn and least intrusive – in fact not intrusive at all.”); Little v. Shelby Cnty., Tenn., 2003 WL 23849734, *2 (W.D. Tenn. 2003)(stating the proposed remedy in a jail reform case was clearly the least intrusive means because it was “advocated by the parties themselves and determined by the parties…”).
For the reasons stated above, the Agreement is narrowly drawn, extends no further than necessary to correct the violations of Federal rights as alleged by the Plaintiff in the Complaint,
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Case 3:18-cv-00179-HES-JRK Document 3 Filed 01/31/18 Page 12 of 14 PageID 69

is the least intrusive means necessary to correct these violations, and will not have an adverse impact on public safety or the operation of a criminal justice system.
III. Conclusion The Parties share the goal of ensuring the constitutional provision of mental health treatment and services to patients in the Defendants’ inpatient mental health units. The Parties agree that the Agreement resolves all claims alleged in the Complaint and, when properly implemented, will ensure constitutional provision of mental health treatment and services in the inpatient mental health units. The Parties also agree that the Agreement meets the requirements of the PLRA. This Agreement, negotiated with the assistance of the Honorable Judge Schlesinger, will resolve the Parties’ disputes in the most effective manner. Voluntary compliance through a negotiated Agreement adopted by the Court is more likely to accomplish the constitutional goals, minimize litigation expenses and respect judicial economy than will an order imposed at the end of expensive and protracted litigation. See U.S. v. City of Miami, 664 F.2d 435, 441 (5th Cir. 1981). WHEREFORE, the Parties jointly request that this Court enter an order adopting the Settlement Agreement in its entirety as to the Complaint and entering it as an order of the Court. Respectfully Submitted,

/s/ Peter P. Sleasman Peter Prescott Sleasman Fla. Bar No. 367931
Kristen Cooley Lentz Fla Bar No. 649635
Disability Rights Florida 4723-B NW 53rd Ave

/s/ Kenneth S. Steely Kenneth S. Steely, General Counsel Florida Bar Number: 084714
Dorothy M. Burnsed, Deputy General Counsel Florida Bar Number: 0172782
Florida Department of Corrections 501 South Calhoun Street
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Case 3:18-cv-00179-HES-JRK Document 3 Filed 01/31/18 Page 13 of 14 PageID 70

Gainesville, FL 32563 850-488-9071 (telephone) 850-488-8640 (facsimile) PeterS@DisabilityRightsFlorida.org KristenL@Disabilityrightsflorida.org
David Allen Boyer Fla. Bar. No. 090917 Disability Rights Florida 1930 Harrison St., Suite 104 Hollywood, FL 33020 850-488-9071 (telephone) 850-488-8640 (facsimile) DavidB@disabilityrightsflorida.org
Andrea Costello Fla. Bar No. 532991 Christopher M. Jones Fla. Bar No. 994642 Florida Legal Services 14260 W. Newberry Road, #412 Newberry, FL 32669 (407) 801-0332 (telephone) (407) 505-7327 (facsimile) Andrea@floridalegal.org Christopher@floridalegal.org
George E. Schulz, Jr. Fla. Bar No. 169507 Laura Renstrom Fla. Bar No. 108019 Holland & Knight LLP 50 North Laura Street Suite 3900 Jacksonville, FL 32202 (904) 353-2000 (telephone) (904) 358-1872 (facsimile) Buddy.Schulz@hklaw.com Laura.Renstrom@hklaw.com
Attorneys for Plaintiff

Tallahassee, Florida 32399-2500 Tel. (850) 717-3605 Fax (850) 922-4355 Kenneth.Steely@fdc.myflorida.com Dorothy.Burnsed@fdc.myflorida.com
Attorneys for the Defendants

13

Case 3:18-cv-00179-HES-JRK Document 3 Filed 01/31/18 Page 14 of 14 PageID 71 CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of this pleading was served upon all Parties by electronic mail on January 31, 2018.
/s/ Peter P. Sleasman Attorney for Plaintiff
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 Case 3:18-cv-00179-HES-JRK Document 10 Filed 02/08/18 Page 1 of 22 PageID 146

UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA JACKSONVILLE DIVISION

DISABILITY RIGHTS FLORIDA, INC., On behalf of its Clients and Constituents,

Plaintiff,

vs.

Case No. 3:18-cv-179-J-25JRK

JULIE JONES, Secretary, Florida Department of Corrections in her Official Capacity and FLORIDA DEPARTMENT OF CORRECTIONS, an Agency of the State of Florida,

Defendants.
----------------------------------~'
SETTLEMENT AGREEMENT

I. INTRODUCTION

A. This Settlement Agreement ("Agreement") comes before the Court on the Complaint filed by Plaintiff, Disability Rights Florida, Inc., on January 30,2018 (DE 1}, on behalf of its clients and constituents seeking declaratory and injunctive relief on behalf of inmates within the Florida Department of Corrections (FDC) who are currently clients and constituents of Disability Rights Florida and who are mentally ill and confined in a FDC inpatient mental health unit or who may be transferred to a FDC inpatient mental health unit. Plaintiff, Disability Rights Florida, (DRF}, is an organization charged by federal Jaw to protect the rights of individuals with mental illness in Florida. Defendants are Julie Jones, in her official capacity as Secretary ofthe Florida Department of Corrections, and the Florida Department of Corrections (collectively "Defendants" or "FDC"). The Defendants and the Plaintiffshall be referred to in this Agreement collectively as the "Parties."

B. Jurisdiction and Venue:

This action is brought by Disability Rights Florida, Inc., on

behalfof its clients and constituents, pursuant to 42 U.S.C. § 1983, the Americans with Disabilities

Act ("ADA"), codified at 42 U.S.C. § 12132 et seq., and the Federal Rehabilitation Act ("FRA"),

codified at 29 U.S.C. § 794. Accordingly, this Court has jurisdiction over the subject matter of

this action pursuant to 28 U.S.C. § 1331, and may grant declaratory and injunctive relief pursuant

to 28 U.S.C. §§ 2201-2202. This Court has personal jurisdiction over the Defendants. Venue lies

in this judicial district pursuant to 28 U.S.C. § 1391 because a substantial part of the events or

omissions giving rise to this claim occurred in this district- over 70% ofthe FDC inpatient mental

health beds are located in this district, and the largest number of inpatient health beds are located

in this division. For purposes of this Agreement, or any action to enforce this Agreement,

Defendants consent to the Court's jurisdiction over this Agreement or such action and over

Defendants, and consent to venue in this judicial district.

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C. In the Complaint, Plaintiff alleges Defendants, by their actions and inactions, have deliberately and chronically denied mental health care to individuals with mental illness who were and are confined in inpatient mental health units operated and managed by Defendants. Plaintiff alleges that many ofthese patients are confined in segregated, isolated and harsh conditions which exacerbate their illnesses. As a result of their segregation and isolation, Plaintiff claims that these patients are denied the benefits of many ofthe Defendants' programs, services and activities.
D. On February 20-23, 2017, the FDC allowed PlaintifFs expert team access to Union CI and Lake CI to view and tour the physical plant, including the housing areas, treatment space, staff office space, recreation areas, indoor recreation space, dayroom, medication and administration areas. PlaintifFs experts were also pennitted to observe daily operations, group treatment, individual treatment, treatment team meetings, medication passes, meal time and disciplinary or classification meetings. The experts were pennitted to interview FDC management staff and health services staff and 4-5 patients per inpatient level of care at each facility.
E. The Defendants state that prior to and since the initiation of this litigation, the FDC commenced significant initiatives to improve recruiting and retention of qualified security staff and enhance the delivery of mental health services. This process has been ongoing prior to and throughout the course of this litigation. To date, the FDC's initiatives include, but are not limited to, the following: Creation of a Central Office Mental Health Ombudsman and Mental Health Ombudsman four at (4) inpatient units; Creation of a Behavior Risk Management Team (BRMn comprising one (1) psychologist, a part-time psychiatrist and a part-time psychiatric nurse; development and implementation of two (2) Quality Assurance instruments (MHIMI - Mental Health Inpatient Monitoring Instrument and STAMI - Structured Therapeutic Activities Monitoring Instrument) to monitor mental health services in inpatient units; policy revisions; targeted training for security staff; site visits conducted by OHS leadership.
F. Beginning in January 20 17, the Parties engaged in multiple mediation sessions with the Honorable Harvey E. Schlesinger, U.S. District Judge, to see if they could come to an amicable, mutually agreeable resolution of this matter prior to filing a Complaint. To immediately address the significant and urgent conditions state-wide, to avoid costly and protracted litigation, and to settle the disputes in this action fully and finally, the Parties have voluntarily agreed, subject to the tenns and conditions of this Agreement, to resolve all claims and issues in this action by entering into and requesting the Court's approval of this Agreement. The Parties agree that the
representations made in this Agreement are in compliance with 18 U.S.C. § 3626, fair, reasonable,
and adequate to protect the interests of all Parties. The Parties further believe that this Agreement will benefit mentally ill patients who are housed in a FDC inpatient mental health unit.
G. The tenns of this Agreement shall be applicable to and binding upon the Defendants in their official capacities, and their officers, agents, employees, assigns, and successors for the duration ofthe time specified herein. This Agreement applies to aU ofthe FDC's existing inpatient mental health units and any new facilities that will provide inpatient mental health care during the life ofthis Agreement. The FDC agrees that the services and treatment required by this Agreement are necessary to satisfy patient treatment needs and the FDC further agrees, in the event it engages
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a third party to perform any act needed to comply with the terms of the Agreement, it will contractually obligate such third party to satisfy the terms of the Agreement.
H. The Agreement becomes effective at the time of adoption by the Court. The Parties will file this Agreement with the Court and ask that the Court adopt the terms of the Agreement as an
order of the Court and retain jurisdiction to enforce its provisions as specified in Section XIV of
this Agreement. Adoption of the Agreement by the Court is a condition precedent to the Agreement's enforcement.
II. DEFINITIONS
A. Deoartment: means the Florida Department of Corrections (FDC).
B. Confidentiality Agreement: means the agreement entered into by the parties allowing access to and protecting the confidentiality ofany protected health information ofcurrent or former mentally ill patients housed in an inpatient unit within the FDC. The Confidentiality Agreement will be submitted to the Court no later than March 1S, 2018.
C. Core Mental Health Services: means individual and group therapy, case management, therapeutic community and medication management. These services must be provided by a mental health care professional who is qualified in accordance with applicable Florida statutes and regulations.
D. Corrections Mental Health Treatment Facility CCMHTF): means any extended treatment or hospitalization-level unit that the assistant secretary for health services specifically designates by Rule 33-404.201, F.A.C., to provide acute mental health care and that may include involuntary treatment and therapeutic intervention, in contrast to less intensive levels of care such as out-patient mental health care, infirmary mental health care, transitional mental health care, or crisis stabilization care.
E. Crisis Stabilization Care CCSUl: means a level ofcare that is less restrictive and intensive than care provided in a corrections mental health treatment facility that includes a broad range of evaluation and treatment services provided within a highly structured residential setting. It is intended for patients who are experiencing debilitating symptoms of acute mental impairment and who cannot be adequately evaluated and treated in a transitional care unit or in infirmary mental health care. Such treatment is also more intensive than in transitional care units as it is devoted principally toward rapid stabilization of acute symptoms and conditions.
F. Policy: means Procedure Manuals (PM) and Health Services Bulletins (HSB) that provide requirements and guidelines for the provision of inmate health care which is a component of the DepartmenCs comprehensive health care delivery system. HSBs do not take the place of or override Department of Corrections' rules or PMs. HSBs provide additional guidance as a supplement to sound clinical judgment for the delivery of health services within each institution.
G. Individualized Services Plan USPl: means a dynamic, written description of an patient's current mental health problems, goals, and services that is developed and implemented by a multi· disciplinary services team and the patient.
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H. Multi-Disciplinary Services Team (MDST): means the staff representing different professions, disciplines, or service areas, which comprise a team that provides assessment, care, and treatment to the patient, and develops, implements, reviews, and revises an "Individualized Service Plan," as needed.
I. Self-Harm Observations Status CSHOSl: means to a clinical status ordered by the attending clinician that provides for safe housing and close monitoring of patients who are detennined to be suicidal or at risk for serious self-injurious behavior, by mental health staff, or in the absence of mental health staff, by medical staff.
J. Serious Self-Injurious Behavior: means an patient's deliberate self-hann behavior that
has or could have caused serious bodily hann as assessed by mental health staff, or in the absence of mental health staff, by medical staff, as evidenced by the need for medical care.
K. Structured Out of Cell Treatment and Services (SOCTSl: means weekly scheduled individualized treatment services, psychoeducational groups and therapeutic activities to ameliorate disabling symptoms of mental illness and improve behavioral functioning as identified in the ISPs.
L. Psvchoeducational Group and Therapeutic Activitv: means a treatment service designed to improve resiliency in behavioral functioning and self-directed recovery as identified in the ISP.
M. Transitional Mental Health Care CTCUl: means a level of care that is more intensive than outpatient and infirmary care but less intensive than crisis stabilization care, characterized by the provision of mental health treatment in the context of a structured residential setting. Transitional mental health care is indicated for a person with chronic or residual symptomology who does not require crisis stabilization care or placement in a corrections mental health treatment facility but whose impairment in functioning nevertheless renders him or her incapable ofadaptive functioning within the incarceration environment.
N. Unstructured Out of Cell Time: means out of cell activities monitored by security staff without involvement of mental health staff. Examples include outdoor recreation, dayroom, visitation, telephone calls, showers, etc.
III. IMPLEMENTATION TIMELINE
The Parties agree that systemic refonn will require a significant modification to the current delivery ofmental health services, and that such reform will require a multi-year approach. Further, the Parties acknowledge that all funds required to meet the requirements of this Agreement must be appropriated by the Florida Legislature, and that this Agreement does not bind the Legislature to any specific appropriations.
A. Upon the effective date of this Agreement, the FDC will:
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1. Within ninety (90) calendar days of the effective date of this Agreement, patients on the Lake inpatient mental health units shall receive individualized assessment for use of restraints.
2. The Parties agree the FDC will discontinue the use of the TCU at UCI for inpatient mental health care by the execution date of this Agreement. The FDC may, however, resume use of these dorms if adequate modifications are made to the facility to provide sufficient treatment space.
3. One year after the effective date of the Agreement:
a. Implement the Oversight requirements of paragraph IV. G. and continue those provisions for the duration of this Agreement;
b. Complete relevant policy and procedure review and initiate rule making process;
c. Complete modification to training materials and train staff as required in Section IV.
4. Two years after the effective date ofthe Agreement:
a. Continue training of inpatient mental health and security staff as needed or as they are assigned to the inpatient mental health units;
b. Complete construction of open court or yard area for those inpatient mental health units without current access to an open court or yard.
B. Whenever the FDC has agreed to adopt new procedures, HSBs, policies, or rules in this Agreement, unless otherwise specified, the time frame for submission of such proposed procedures, HSBs, policies, or rules to Plaintiff shall not exceed six (6) months from the approval date.
C. Whenever a specific time frame for the achievement of a particular goal is not specified herein, the time frame shall be a "reasonable time" as interpreted initially by the CMA monitoring team.
IV. RELIEF
A. Individualized Treatment
The FDC shall provide individualized treatment for patients assigned to inpatient mental health units as follows:
1. Creation and Revision of ISPs: Individualized treatment requires the creation of an ISP. The FDC will:
a. Provide treatment plans individualized to the patients' needs. Treatment goals will match the documented problems identified for each patient.
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b. Ensure ISPs include measurable goals. The process to achieve the goals will include, as clinically appropriate, group therapy, individual psychotherapy, medication management and transition planning.
c. Ensure ISPs are updated in accordance with policy to reflect changes in patienfs treatment progress.
d. MOST meetings will be scheduled to address initial placement on the unit, refusal of treatment for more than five days, receipt of a DR, refusing to maintain hygiene for more than seven days, significant changes in mental status and/or behavioral functioning, "significant events" as referenced in policy and transfer to a different level of care.
e. The patient will be invited to attend the MOST meeting. If the patient is not able to attend or refuses, an incidental note will be entered in the mental health record, identifying the reason for non-attendance and encouragement that was provided.
f. For each patient being discussed at the MOST meeting, each staff member on the patient's ISP will provide input. The patient should be asked how treatment is progressing from his or her perspective, and to participate in the development of a collaborative plan of care.
g. The supervising psychologist or Psychological Services Director, in consultation with the inpatient unit's OIC and the treating mental health clinician, will have the authority to modify property, activity, and privileges available in the level system based on the individual treatment needs of the patient. If such modifications will be ongoing, the MDST must review and approve them and will be documented in the patient's mental health records.
h. The MOST team will review the treatment plan in its entirety with the patient, and will give the patient an opportunity to read and review the treatment plan before signing. The patient shall be provided a copy of the plan, unless the patient is on SHOS, and the attending clinician documents the specific clinical justification for withholding it.
i. Patients who have been in the CSU for sixty (60) days or longer, or the TCU for one (I) year or longer will be reviewed by a regional mental health consultant to determine whether additional services or a higher level of care is clinically indicated. The consultation and determination regarding care will be documented via an incidental note in the patient's mental health record and reported to the FDC ChiefofMental Health Services, or his or her designee, for review.
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2. Provision of Treatment and Services: To provide treatment and services, the FDC will:
a. Provide mental health treatment and services that uses evidence-based practices and measures for treatment progress to guide continued or modified treatment.
b. Ensure all patients in the inpatient units are offered a minimum often hours per week of SOCTS tied to the patient's ISP. Unstructured recreation time shall not be counted toward the minimum required hours of SOCTS.
c. Patients on the units shall receive unstructured out-of-cell time in accordance with an individual determination assessing their required level of restraint and freedom of movement. In no case shall any patient be offered less than ten hours ofunstructured out-of-cell time per week unless there is an individualized determination by the MOST and the clinical justification is documented in the inpatient mental health record. Five hours of the unstructured out-of-cell time shall be exercise outdoors.
d. The minimum number of hours required for SOCTS and unstructured out of cell time shall be offered to all patients regardless of their privilege level.
e. Tailor SOCTS to the individual needs of the patient.
f. Offer individual psychotherapy, group therapy, and clinical encounters with psychiatric and psychology clinicians in treatment rooms that provide for an appropriate level of confidentiality.
g. Offer therapeutic community group in a location with all participants able to share their issues with each other and the clinicians. The goals of therapeutic community are to identify concerns and develop verbal problem solving skills.
h. Provide appropriately credentialed clinical staff.
3. Serious Self-Injurious Behavior ("Sffi") Treatment: The FDC will provide the following treatment for SIB:
a. Provide appropriate assessment for the causes of serious SIB.
b. Require clinicians to create treatment plans as warranted by the SIB assessments to include the antecedent, triggers and consequences of each incident of SIB.
c. Modify treatment plans over time as needed.
d. Train staff to assess, create, implement and modify treatment plans.
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e. A psychologist will be assigned to each inpatient unit to create, implement and modify treatment plans collaboratively with other members of the MOST and the patient.
f. Create a systematized program to provide appropriate interventions, including, but not limited to, cognitive behavioral therapy and dialectical behavioral therapy, for inpatient patients identified as at risk for serious self-injurious behavior.
4. Self-Harm Assessments and SHOS Supervision: In order to better identify and remediate cases of self-harm, the FDC will:
a. Train staff Qn policies regarding attending clinicians' orders for required supervision, and checks for patients on SHOS, including ordering continuous observation as warranted.
b. Train staffon FDC suicide and self-injury prevention policy in accordance with PM404.001.
c. Provide certified IMR cells in accordance with procedure PM 404.002.
5. Treatment Refusers: For patients who resist treatment, including refusal of prescribed psychotropic medication(s), documented as a problem on their ISPs, the FDC will:
a. Train security staff in motivational interviewing.
b. Require mental health staff to document engagement with patients identified as treatment refusers and attempting to address those reasons in the ISP.
c. Within 24 hours from an patient's refusal to attend a scheduled clinical encounter, the patient will be visited by the patient's case manager or other clinician member of the patient's MOST, who will counsel with the patient so that he or she will attend or participate in future clinical appointments. This will also be documented via an incidental note in the mental health record.
d. If an patient refuses to come out of his/her cell for any SOCTS for more than one week, efforts will be made to bring the patient out ofhis/her cell to conduct a wellbeing check and mental status exam. These efforts and the result of the wellbeing check and mental status exam will be documented in the patient's mental health record. The MOST will meet to consider changing the patient's ISP.
e. If a patient fails to attend an average of at least 50% of the scheduled structured therapeutic activities over a 30-day period, then the MOST will meet to consider changing the patient's ISP.
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f. Clinical staff will consult with the appropriate clinical regional staff for treatment resistant or difficult cases. Patients in the TCU with resistance to treatment issues documented on their ISP will be reviewed quarterly by regional mental health staff, and this consultation will be documented with an incidental note in the inpatient record.
g. Patients in the CSU with resistance to treatment issues documented on their ISP will be reviewed every thirty days by regional mental health staff, and this consultation will be documented with an incidental note in the inpatient record. If the condition has not improved within a reasonable period of time further consultation is clinically indicated, then regional staff will continue consulting up their chain of command for additional options, and such consultations shall be documented with an incidental note in the inpatient record.
6. Discharge Planning: The FDC will:
a. Transfer to a different level of inpatient care or discharge from inpatient care is accomplished by consensus of the MOST. Clinical rationale for transfer or discharge must be clearly documented in the patienfs records. When a patient is discharged from inpatient care, a Discharge Summary for Inpatient Mental Health Care will be completed and will include an outpatient aftercare plan to ensure the patient will be able to function adequately in the setting to which he/she is discharged.
b. Provide clinical justification for discharge from inpatient units to a special housing setting. The MDST will meet to determine whether there is a clinical justification that, with outpatient level mental health care, the patient's mental status and level of functioning will enable satisfactory adjustment to the special housing to which the patient will be assigned. The clinical justification for discharge from inpatient to a special housing setting will be clearly documented in the patient's records, an aftercare plan will be completed prior to discharge from the inpatient unit, and the patient will have gone at least seven (7) days since the end of the last episode of psychiatric seclusion, psychiatric restraints, or self-harm observation status. Patients will not be discharged from an inpatient unit to an outpatient level of care if there has been an incident of psychiatric seclusion, psychiatric restraints or SHOS within the past seven (7) days.
7. Psychotropic Medication Practices: The FDC will:
a. Ensure patients are seeing their psychiatric practitioner in the intervals required in the FDC's policies.
b. Ensure practitioner notes are completed in a timely manner and contain all of the required clinical information.
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c. Ensure the psychotropic medication ordered is appropriate for the patient's symptoms and diagnosis.
d. Ensure drug exception request dispositions are considered and documented in accordance with FDC policy, including HSB 15.05.19.
e. Ensure psychotropic medication is properly and timely administered to patients. f. Ensure that the treating mental health clinician is informed when an patient
refuses any psychotropic medication.
g. Ensure there are no lapses in the availability of prescribed psychotropic medications for patients on the inpatient mental health units.
h. Ensure Medication Administration Records (MARs) are completed m accordance with FDC Policy.
B. Excessive Isolation and Restraints: I. Excessive Isolation:
The FDC will:
a. Complete individualized risk assessments to determine the level of restrictions on movement.
b. Incorporate results of the Risk Assessment Team ("RAT..) as specified in Rule 33404.108, F.A.C, or as amended, to assess patients to determine appropriateness for multi bed-ceiling to allow for additional interaction with others.
2. Excessive Use of Restraints:
The FDC will:
a. Conduct an individualized risk assessment, to include a validated violence risk assessment instrument to assess which patients need to be in correctional restraints.
b. Correctional restraints will not be utilized for any out of cell activities unless an individualized determination is made in accordance with the process outlined in Rule 33-404.108, F.A.C, or as amended.
c. Security will not be present in the room during treatment activities unless there is an individualized determination of risk by the treating mental health clinician warranting security presence during the activity.
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d. Implement a policy that when patients are admitted to an inpatient mental health unit, prior confinement or close management status shall be suspended; for patients admitted to the CSU, a risk assessment shall be completed within 3 working days; for patients admitted to TCU or CMHTF the initial risk assessment shall be completed within 7 working days; and after the initial risk assessment restrictions on housing, program participation and clinical activities shall be determined by the MOST and shall be documented in the patient's inpatient mental health record.
e. Implement a policy that, after the initial risk assessment upon admission to the inpatient mental health unit, security restraints shall not be applied to patients when they are out of their cells by default because of their suspended close management status.
f. Patients not requiring security restraints based on their risk assessment shall have recreation in an open court or yard instead of the secured individual recreation areas. For those inpatient mental health units without current access to an open court or yard, the FOC will construct an open court or yard area for all inpatient mental health units and provide wellness equipment in accordance with statutory authority.
C. Disciplinary Reports in the Inpatient Units
I. The FOC will:
a. Require staff to comply with policy pertinent to inpatient mental health treatment and services.
b. Prior to issuing a DR, require staff to consult with either the superv1smg psychologist or the unit psychiatrist. The consultation will be documented via an incidental note made in the mental health record.
c. If a DR is issued, ensure the supervising psychologist or the unit psychiatrist, documents on the DC6-1 008 that the patient's mental condition either did or did not contribute to the alleged offense. If the supervising psychologist or the unit psychiatrist determines that the patient's mental condition did contribute to the offense, then s/he will make recommendations for alternate disposition or treatment interventions in lieu ofa sanction.
d. Ensure that mental health staff attempts to resolve lower level offenses on the Inpatient Unit through behavioral techniques. These efforts will be documented in the patient's mental health record. The Parties agree the goal is to deal with those behaviors through the MOST rather than through the disciplinary process.
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D. Medical Records
I. The FDC will:
a. Train staff regarding the elements of an organized and complete medical record.
b. Monitor medical records on the inpatient mental health units to ensure the records are organized, complete, and up to date and have all ofthe documentation necessary to support the provision of adequate treatment and care to patients.
E. Coordination Between Medical and Mental Health Providers
I. The FDC will:
a. Order labs on DC4-714B clinician order sheet
b. Ensure that mental health encounter sheets are completed.
c. Ensure that mental health encounters are forwarded to data entry for appropriate entry in OBIS and laboratory system. All entries will have an appropriate clinician staffiD.
d. Once lab results are received, they will be separated by ordering clinicians and forwarded to Mental Health Providers for review.
e. Ensure that, 48 hours from the time labs are received, the results will be entered into OBIS and data entry will generate a lab tracking log to forward to the ordering clinicians. Upon request, medical records staff can also generate a report from laboratory record system listing all mental health labs ordered and results by clinician.
f. Ensure that, on weekends, the on-call psychiatrist will be contacted about any abnormal lab results. Further, lab reports will be put in provider's mailboxes on the unit for review of abnormal lab results. That review will occur by the next business day.
g. Ensure that all prescribing staff will have OBIS and laboratory record system accounts with passwords. The staff will receive training on both systems, both initially and periodically as needed.
h. Require clinicians to follow the guidelines outlined in Appendix 1 to HSB 15.05.19 regarding baseline laboratory tests and timeframes for follow up laboratory tests.
i. Ensure each inpatient unit has unit clerks responsible for monitoring the entry of lab requests and the return ofthe lab results. The clerks will maintain a log for lab
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requests that includes the lab order date, the draw date, and the date that results were received.
J. Provide at least two computers on each Inpatient Unit so that providers will be able to access both the OBIS and the laboratory record systems.
k. Incorporate primary care into MOST meetings to develop effective communication and include documentation in the records of communications between medical and mental health staff.
I. Ensure there will be a MOST note indicating medical and mental health providers have consulted regarding coordination of care for any patients attending a chronic care clinic.
F. Training
1. The FOC will oversee that the following training is provided on an annual basis, as follows:
a. Mental health clinical staff will receive training on the development, implementation, and revision of ISPs.
b. All clinical and nursing staff, classification, and security staffworking in the mental health inpatient unit will receive training regarding the purpose, required attendees and substance of an appropriate MOST meeting. The training will include a discussion about both routine MOST meetings for patients as well as events triggering the need for an MOST meeting for an patient.
c. Clinical and security staff will receive training on the prevention, management, and treatment ofpatients at risk to engage in self injurious behavior.
d. Clinical staff will receive training on appropriate organization and timely completion of medical records.
e. Psychologist, psychiatrist, and security staff will receive training on the proper procedure, documentation and considerations in determinations regarding whether to discipline a patient for behavior on the mental health inpatient units.
f. Clinical and security staff will receive training on the identification and assessment of suicide risk, suicide prevention, SHOS procedures and required supervision of patients on SHOS.
g. Clinical and security staff routinely assigned to the inpatient mental health units will receive training on how to conduct individualized assessments for use of restraints, the application of restraints on the inpatient mental health units, and the useofETOs.
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h. Security staff routinely assigned to an inpatient mental health unit will receive CIT training, and at least eight hours of specialized training pertinent to the inpatient mental health units.
G. Oversight
1. The FDC will:
a. Maintain central office and regional ombudspersons.
b. Maintain BRMT and reviews.
V. MONITORING TEAM
A. Monitoring Team Selection
I. Monitoring of the implementation of this Agreement shall include the processes and authority of the Correctional Medical Authority (CMA), as provided in Section 945.601, et. seq., Florida Statutes. The CMA shall select a Monitoring Team to monitor implementation of this Agreement. The CMA shall provide the names and CVs of each team member to the Parties for review and comment prior to hiring.
2. The CMA will draft a monitoring tool based on the content of the Agreement. The Parties will jointly review and comment on the monitoring instrument to be used by the CMA monitoring team to measure compliance with this Agreement. The CMA will be the final decisionmaker with regard to the monitoring instrument.
3. The Parties shall file the CMA-approved monitoring instrument with the Court no later than March 15,2018.
4. Neither Party, nor any employee or agent of either Party, shall have any supervisory authority over the CMA monitoring team's activities, reports, findings, or recommendations.
5. Should the Parties agree that the CMA monitoring team or individual CMA team members are not fulfilling their duties in accordance with this Agreement, the Parties may amend this Agreement to immediately remove and replace the CMA monitoring team with an agreed upon monitor.
B. Monitoring Team Qualifications
The Monitoring Team shall be hired as independent contractors of the CMA. The Team shall, at a minimum, consist of a psychiatrist, a psychologist, a psychiatric nurse practitioner, a registered nurse, and at least two licensed clinical social workers or licensed mental health clinicians. The CMA monitoring team shall have appropriate experience and education or training related to the subject areas covered in this Agreement. Each member
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of the CMA monitoring team should have significant experience working on an inpatient mental health unit either in the community, a jail, or a state or federal prison.
C. Monitor Access
1. The CMA monitoring team shall have full and complete access to the FDC's inpatient units, all unit records, patient medical and mental health records, staff, and patients.
2. FDC will direct all employees and agents to cooperate fully with the CMA monitoring team. All information obtained by the team shall be maintained in a confidential manner.
D. Monitoring Team Ex Parte Communications
The CMA monitoring team, through the CMA executive director, shall be permitted to initiate and receive ex parte communications with all Parties.
E. Monitoring Team Distribution of FDC Documents, Reports, and Assessments
The FDC will continue its contract monitoring, BRMT assessments and any other routine monitoring or assessments of the inpatient mental health units. Any assessments, reports or monitoring shall be provided to the CMA monitoring team within seven days of completion. Within seven days of receipt by the team, the team shall distribute the assessments, reports or routine monitoring documents to DRF. Additionally, any documents the CMA monitoring team requests and receives from the FDC to determine compliance will be copied and sent to DRF within seven days of receipt.
F. Limitations on the Monitoring Team
I. The Parties agree that the monitoring team shall be limited as follows:
a. If the CMA is required to contract for additional staff, the Parties' experts shall not be eligible to be retained to provide monitoring of this Agreement
b. The CMA shall monitor this Agreement separate and apart from its statutorily mandated survey requirements.
c. Reports issued by the CMA monitoring team shall not be admissible against the FDC in any proceeding other than a proceeding related to the enforcement of this Agreement or the filing ofa new case in accordance with the circumstances outlined in Section VIII(H) below.
G. Technical Assistance by the Monitoring Team
The CMA monitoring team shall provide the FDC with technical assistance as requested by the FDC. Technical assistance should be reasonable and should not interfere with the team's ability to assess compliance.
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VI. COMPLIANCE ASSESSMENTS
A. Compliance Assessments
I. The CMA monitoring team shall evaluate the level of compliance for each relevant provision of the Agreement using a monitoring instrument reviewed by the Parties.
2. The CMA's monitoring team shall evaluate the level of compliance for each relevant provision in the Agreement based on a multi-day site visit to each inpatient mental health unit that includes, but is not limited to, the monitoring team:
a. Receiving demographic information for the inpatient mental health unit, a unit roster, the unit restraint logs and any other information the monitoring team deems necessary prior to the site visit;
b. Interviewing a representative sample consisting of a minimum of I0% of the patients on the inpatient mental health unit ;
c. Reviewing records for the randomly selected patients on site; d. Review disciplinary action taken against patients on the inpatient mental health unit
on site; e. Interviewing mental health and correctional staff on site; f. Observe SOCTS; g. Observe rounds and medication administration; h. Observe an MDST meeting; i. Observe recreation.
3. The CMA monitoring team shall conduct a compliance assessment for each inpatient unit as outlined in the implementation schedule below, and shall develop a report for each inpatient facility.
4. Each CMA monitoring team report shall describe the steps taken by each member of the CMA monitoring team to analyze conditions and assess compliance, including documents reviewed and individuals interviewed, and the factual basis for each ofteam's findings.
5. For any deficiency found by the CMA monitoring team, the team shall determine whether insufficient clinical, nursing or security staffing levels may have caused or contributed to such deficiency.
6. Any deficiencies found by the CMA monitoring team to be life·threatening or otherwise serious shall be immediately reported to the Secretary ofthe Department of Corrections as provided in Section 945.6031 (3) and to the Parties.
7. The FDC will achieve seventy (70) percent compliance at each institution for each of the items in the agreed upon monitoring tool for the first compliance monitoring period.
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8. Substantial compliance shall be reached when the FDC obtains eighty (80) percent compliance at each institution for each of the items in the agreed upon monitoring tool for the second compliance monitoring period.
9. The Parties shall have the right to observe the assessments.
B. Implementation
This Agreement shall be implemented as follows:
1. The CMA Monitoring Team shall conduct two rounds of monitoring with each inpatient unit being assessed at least once during each monitoring period as outlined below.
2. The first monitoring period shall begin December 2018 and be completed no later than October 2019.
3. The second monitoring period and the final reports shall be completed no later than October 2020.
4. The CMA monitoring team shall provide reports to the Parties no later than 30 days after completion of each assessment.
5. If more than one visit per monitoring period is necessary for an inpatient unit, the CMA monitoring team shall inform the Parties of the reason(s) for the follow up visit(s).
C. Monitoring Team's Reports
1. The CMA monitoring team shall provide to the Parties reports evaluating the extent to which the FDC has complied with each substantive provision of the Agreement. The Parties shall have seven days to provide a written response to the findings. The written response will be submitted to the CMA and the other Party.
2. The CMA monitoring team shall consider the Parties' responses and make appropriate changes, if any, and issue the final report within seven days of receiving the Parties' response(s), if any. These reports shall be written with due regard for the privacy interests of individual patients and staff, and the interest of Defendants in protecting against disclosure of information not permitted by this Agreement.
VII. DOCUMENTS TO BE PRODUCED TO DRF
During the duration ofthis Agreement, the FDC will provide to DRF the following documents on a quarterly basis:
A. Contract Monitoring Reports for institutions with inpatient units; B. BRMT Reports and STAMis for inpatient units; C. Name and location of death for any patient who died while assigned to an inpatient unit;
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D. All DC-4-781J Psychiatric Restraint Log, regarding use of psychiatric restraints on the inpatient units;
E. Inpatient unit schedules ofactivities; and F. A roster of patients assigned to each inpatient unit from the first of each month that
includes, at a minimum, admission date and S-grade.
VIII. DISPUTE RESOLUTION AND ENFORCEMENT
A. If Plaintiff believes the FDC is not in substantial compliance with any provision of this Agreement, Plaintiff shall provide the FDC, in writing, specific reasons why they believe that the FDC is not in substantial compliance with such provision or provisions, referencing the specific provision or provisions. Plaintiff may not allege that FDC is not in substantial compliance based on minor or isolated delays in compliance. Substantial compliance, as provided for in this Agreement, shall be achieved if:
1. The FDC performs its essential, material components of this Agreement, even in the absence of strict compliance with the exact terms, or
2. Any delays in compliance with the Agreement are minor and/or isolated.
B. To the extent Plaintiff relies on observations or opinions of the CMA to support an allegation that the FDC is not in substantial compliance, Plaintiff shall make a reference to the written reports of the monitoring team and to portions thereof which support Plaintiff's belief. To the extent Plaintiff relies upon documents provided by the FDC to support an allegation that the FDC is not in substantial compliance, Plaintiffshall make reference to the specific performance measures which support Plaintiff's belief.
C. The FDC shall have the opportunity to consult their designated expert, if any, with respect to Plaintiff's allegations that the FDC is not in substantial compliance with such provision or provisions. The FDC shall provide Plaintiff with a written response to the notification within thirty (30) days of its receipt. The FDC's response shall contain a description of the steps it took to investigate the issues addressed in the Plaintiffs notice, the results ofthe investigation, and, where the FDC proposes corrective action, a specific plan and corrective action for addressing the described issues. If no corrective action is proposed by reason of legal considerations or for other reasons, the FDC's response shall specifically state those reasons and any statutes, regulations, expert opinion, or technical bases upon which they are relying in reaching such conclusion.
D. Plaintiff agrees to advise the FDC of its acceptance or rejection of the FDC's response within ten (1 0) days ofits receipt. The Parties shall meet to discuss and attempt to resolve any disputes addressed in the written submissions. The FDC and Plaintiff shall meet within twenty (20) days of Plaintiff's rejection of the FDC's response, unless a later meeting is agreed by both sides. The CMA monitoring team will participate in these meetings to offer evaluations of the disputed conditions and recommendations for resolution. The Parties may engage a Mediator to assist with resolution of the dispute.
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E. Ifthe FDC and Plaintiffare not successful in their efforts to resolve their dispute, Plaintiff may seek relief from the Court to effect substantial compliance with the provisions of the Agreement alleged to have been breached. All remaining provisions of the Agreement will remain in full force and effect.
F. In the case that the CMA Monitoring Team identifies a situation that is life-threatening or otherwise serious and contemplated by this Agreement, DRF may, after 72 hours notice to the Defendants, omit the notice and cure requirements herein and seek relief from the Court.
G. In the case that DRF identifies a non-systemic situation that is life-threatening or otherwise serious and contemplated by this Agreement, DRF may, after 72 hours notice to the Defendants, omit the notice and cure requirements herein and seek relief from the Court.
H. The Parties recognize that the Agreement includes plans for activities extending beyond the current fiscal year. The FDC will exercise reasonable efforts to secure the legislative appropriations necessary to meet the terms ofthe Agreement. The inability to perform any act required under the Agreement due to non-appropriation of funds, so long as those funds are necessary to implement or support the Agreement, shall not be a basis for holding the Secretary in contempt so long as the FDC exercised reasonable efforts to secure the appropriation at issue. If the inability to perform is the result of non-appropriation of funds, DRF may file a motion to enforce the Agreement with respect to those issues which it contends amount to a breach of the Agreement, or tile a new lawsuit with respect to those issues which it contends amount to systemic violations of federal law and the official capacity agency head of the FDC will not raise the defense of collateral estoppel or res judicata in an action for prospective declaratory and injunctive relief.
I. The Parties acknowledge that failure to obtain necessary funding does not preclude the Court from entering any order to achieve compliance with this Agreement that comports with the applicable provisions of the Prison Litigation Reform Act, 18 U.S.C. section 3626 and with other applicable law, provided that the FDC reserves the right to assert that the lack of funding should be taken into account in any remedial order.
J. If Plaintiff contends that the FDC has not complied with an order entered under the preceding paragraphs, they may, after reasonable notice and a meeting with the FDC, move for further relief from the Court to obtain compliance with the Court's prior order. The Court may apply equitable principles and may use any appropriate equitable or remedial power available to it.
IX. PLAINTIFF'S ACCESS TO CLIENTS AND CONSTITUENTS
Nothing in this Agreement shall be construed to limit Plaintiff's federally-mandated access to its clients and constituents at any ofthe inpatient mental health units.
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X. PLAINTIFF'S ATTORNEYS' FEES AND COSTS

A.

Fees and Costs: The FDC agrees that Plaintiff is entitled to payment ofreasonable fees

and costs up to adoption ofthe Agreement by the Court in an amount to be detennined

by the Parties. Ifthe Parties cannot reach resolution, the issue will be resolved through

mediation. Ifthe Parties cannot reach resolution through mediation, then the Court will

detennine reasonable fees and costs.

B.

Timing:

I. The FDC agrees it will pay the Plaintiff its reasonable fees and costs accrued through the date of adoption ofthis Agreement. Within 30 days of adoption of the Agreement by the Court, Plaintiff will submit its fees and costs to the FDC. FDC will respond to Plaintiff's fees and costs request within 60 days of receipt. The Parties will have 30 days from receipt ofthe FDC's response to resolve the fees and costs before submitting a motion to the Court for resolution offees and costs.

2. In the event enforcement proceedings are initiated, Plaintiff may seek additional fees and costs for successful enforcement activities during the duration ofthe Order.

XI. MODIFICATION

A. The Parties recognize the change of some conditions or practices may reduce the necessity of change to other conditions or practices. Therefore, it may be appropriate that the Agreement be modified from time to time. After no less than six (6) months of operation under the Agreement, FDC may ask Plaintiff to review a proposed modification, amendment, or alteration of any of the rights or obligations in any portion of this Agreement.

B. If Plaintiff agrees with the proposed modification, the Parties will seek Court approval of the modification, amendment, or alteration.

C. If Plaintiffdisagrees with the proposed modification, the Parties will meet and confer as to whether they can reach agreement. If the Parties cannot agree within thirty (30) days, the Parties will seek the assistance of a mediator to resolve the dispute.

D. If mediation is not successful, then appropriate relief may be sought from the Court in the fonn ofa motion for modification.

XII. PLRA

Pursuant to 18 U.S.C. § 3626(a)(l)(A), the Parties have submitted this Agreement to the Court seeking a finding that the relief agreed to by Plaintiffand the FDC and required by this Agreement is narrowly drawn, extends no further than necessary to correct the alleged violation ofthe patients' constitutional rights, and is the least intrusive means necessary to correct the violation. The Parties agree that the Court must consider any adverse impact on public safety or the operation of a

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criminal justice system. The Parties stipulate that no provision of this Agreement has an adverse impact on public safety or the operation of the criminal justice system. Additionally, the FDC agrees it will not move to terminate the Agreement pursuant to 18 USC 3626(b) any sooner than than the termination of the jurisdiction of the Court pursuant to Section XIII(C)(2).
Xlll. COURT APPROVAL AND JURISDICTION A. Scope: The Parties hereby memorialize the terms of their agreement in this Agreement.
This Agreement constitutes the entire agreement of the parties and, except for any Protective Order entered by the Court, supersedes all prior agreements, representations, negotiations and undertakings in this litigation not set forth or incorporated herein. B. Court Adoption: The Agreement is not effective absent adoption by the Court as an order of the Court. C. Jurisdiction: I. The Court shall be the sole forum for the enforcement of this Agreement. 2. The terms ofthis Agreement and the jurisdiction ofthe Court shall commence upon the
date of the Court's adoption ofthis Agreement as an order ofthe Court and shall extend from the date of adoption until December 31, 2020 or 60 days after the receipt of the final monitoring report, whichever is sooner. 3. The jurisdiction of the Court shall terminate on December 31, 2020 or 60 days after the receipt of the final monitoring report, whichever is sooner, unless Plaintiff files a motion to extend jurisdiction based on the argument that prospective relief remains necessary to correct a current and ongoing violation ofthe Federal rights. 4. Nothing in this Agreement shall limit the Parties' rights to challenge or appeal any finding as to whether the FDC is not in substantial compliance, i.e., in substantial noncompliance, or consequent order entered by the Court.
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IN WITNESS WHEREOF, the Parties to this Settlement Agreement have executed the same through the signatories below:
/'
For Plaintiff:

h Dated:

~

I /~ ~ ~11
I

For Defendants:

Julie~ cpvv-
Secretaryt Florida Department of Corrections

Dated:

I

I

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