"44
(Rcv.9/o2)

CIVIL COVER SHEET

The JS •• 44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service ofpleadings or other papers as required by law, except as provided by local rWcs ofcourt This fonn. approved by the Judicial Conference of the United States in September J974, is required for the use ofthe Clerk ofeaurt for the pwpose of initiating the civil docket sheet. (SEE INSTRUCTIONS ON 1HE REVERSE OF THE FORM.)

Place an X in the a ro riate box:

D Green Ba Division

0 Milwaukee Division

I.(a) PLAINTIFFS

DEl'ENDANTS

United States of America

Jim Doyle, Governor, State ofWisconsin Rick Raemisch, Secretary, Wisconsin Department of Corrections Cathy!ess, Warden, Taycheedah Correctional Institution

(b) COUNTY OF RESIDENCE OF FIRST LJSTBD PLAINTIFF _ _ _ _ _ __ (EXCEPT IN U.S. PLAINTIFF CASES)

COUNTY OF RESIDENCE OF FIRST LISTED DEfENDANT. Dane (IN U.S. PLAINTIFF CASES ONLY)
NOTE; IN LAND CONDEMNATION CASES, USE THE LOCATION OFTHE TRACT OF LAND INVOLVED

Dan *,~iU~'l':'lUM'e!I6I1AME, ADDR.SS. ANIM!lW~II\\1'J'IlII

ATTORNEVS (IF KNOWN)

U.S. Dept. of Justice, Civil Rights Div Civil Chief, US Atty's office

Special Litigation Sec.

Eastern District of WI

950 Pennsylvania Ave., NW

517 E. Wisconsin Ave. #530

Washington, DC 20530

Milwaukee, WI 53202

1m. (20'il?li'A§ll50F JURISDICTION ~....",{~~4B2?,;,n!.\.Q)

CI1'IZEl'!SHIP OF PRINCIPAL PARTIES '....,.AN"X"~O"""''''......'''''''AN.

c:... (llor DrversA)' C_ 0Dfy)

BOX POR DEFENDANT)

[21 ] U.S. Government
Plaintiff
02 U.S. Government
Defendant

03 Federal Question (U.S. Government Not a Party)
04 Diversity (Indicate Citizenship of Parties In Item III)

Citizen of This State Citizen of Another State

PTF DEF 0101
0202

Inc~orated or PrinCi~ Place o usincss In This tate
lnconrrated and Princi~ Place o usincss in Another State

PTF DEF 0404
0505

Citizen or Subject ofa Foreign Country

0303 Foreign Nation

0606

IV. NATURE OF SUIT (PLACEAN ··X·'/NONEBOXONLYj

CONTRACT
OIIO~
,-0120 Mariaa
0130 MilIBf Ac:t
D 140 NcKOtitbIc lnstrwDIrzd
DlSORecovayor~ &;I!nfotcem=l of
DU I Mtdican: AeI
o 152 RecovCII)'ofDet.ultcd Svtud_ mt Lo.....Exd.
DI53RecovayOf~ ofV~_·.B
[] 160 Siockholdm' Buill 0190 0tlICIl" Ccmtr.ct
D 195 Contl"IC:I Product Liability
OI96FI"IIItbisc
REAL PROPERTY
D210l.alld~
oD 220 ForcdoIurc 230 ReP! Lcue A Ejemz.m
D 240 Tons 10 l.aPd
(] 245 Tort Produd u.bitiI:y
Pro"", 0290 All Otht:r Real

PERSQNALINJURY
C 310 AirpJanII
0315 A.irplaDt Product
,. '" D 3201fs:!13 Libel &:.
D330 Federal Eqloycl"I'
o u.bitil:y 340 Marine
0345 M.me Product
LiBbllily
D350MotorVehieic 0355 Motor VcblcIII
Product t.abllily
[J 360 0Ihcr PenouaI lqjury

TORTS
PERSONA.L INJURY
Cl 362 Pcnollllllr!iwy -
Mcd. Malpnctice
0,., ~,'=l.t.ll;y
0368 Alibc$l;os Pcrsoaai
bVutY Product LiIibiIiIy
PERSONAL PROPERTY D3700IhJII"Fraud
o0371 Truth fa I..mdiq 3BO Otha"PcJsoual Property DlDmse 0385 PJopatyDump
Product UabiIiIy

CIVIL RIGHTS
D441 VOIIag 0442 Emplo)'alli:lll
o443:::.:tlOdllions
0444 W,,,,-
o 445 ArIIIIfwIDisabiIitics-
...-[] 446AJtJJ:t wIDisabiIiticI-
"""" B440 00... Civil RipU

PRISONER PETITIONS
[] ~no Motiolllio VaclUl: S. . . . . . .
8 HA.BEAS CORPUs: 530 Gcacral
o 5]5 DuthP-.Jty :540 Maodunut &; Other
D SSO eMl Jtiabts
(] 555 Prisoo ClIJIdmo

FORFEITIJRE/PENALTY
80610 A&ricuJture 620 Olhor Foad &:. DruS 625 DIu Rekted Scizun
8 ofl4pcrty21 USC 881 630 Liquor Law. 640 R.R. &; Trude 06S0 Alrh Regs. 0660 ~ SafctyJHeaIth
C"""""

B BANKRUPTCY 422 Appal 28 USC lSI 423 WnlIdrawaI 21 USC 157
PROPERTY RIGHTS
D820Cop~ C83QPldCIII: OI40TACkrnNt

LABOR
[]710F... LaborStIllldardtAel
D 720 lAborIMp. RelliiollS
D 730 LabodMplt.
Rosportina: &:; Dilelosute AeI
D 140 Railway Latm Ad
D 1!HJ 0Ihc:r La\Ior l..itip.tkm
0791 Enlpl ReL Inc. &lcuriIy AeI

SOCIAL SECURITY
[]S6! HlA(I39~fI)
0862 Black J..i.IDa (923)
OS63 DIWC/DJWW(40S(iJ)
C 864 ssm TilJc. XVI
(]165 RSI (405(&)
FEDERAL TAX SUITS
o 870 T_ (U.S. PIUatiffor
-I
D 871 IRS - rues Put)'
26USC7609

01HER STATUTES
D400~rlioDDJelll
D410kditrust
.....,... [J430 BUlb md 8aItkin&
0450 CommcrccIICC
o 460 DcportatioD
D470Rlickmer JJ1.OucIzlcad aad
Bo CorrupI OflIIllli:c:aUoIII 41Q CoIIIumcr CrediI; 490 Cabkls.k1lQ: TV
o & , - 810 Sdtttivc Scrvk:c ISO SecwitblCommodiliesi
8[J 175 CusIoJnet ClWIeDp 12 USC 3410 I!U ApicuJlunI Acl5 sn Ik-onomic: .......... Ad
8894 M."'" DB93~ Energy ADocatioP Act 895 Freedom of lPlilmwioP Aet
0900=~Uoder Equl~IoJunic:o:
[]9S0~of
D Sble StaIldes 890 Other SIaI1lIory AeliDlII

V. ORIGIN
01 Original Proceeding

02 Removed from
State Court

(pLACEAN"XH /NONEBOXONLl)

03 Remanded from 04 Reinstated or

Appellate Court

Reopened

Os Transfem:d from another district

06 Multidistrict Litigation

VI. CAUSE OF ACTION ~JtlB~ilikYUofJAbWJ.~~~Bn~~~)ANDWRITEBRlEFSTATEMENTOFCAUSE.

Civil Rights of Institutionalized Persons Act of 1980, 42 U.S.C. § 1997. Inadequate Mental Health Care.

VII. REQUESTED IN CHECK IF TIUS IS A CLASS ACTION COMPLAINT: OUNDERF.R.C.P.23

DEMAND $

VIII. RELATED CASE(S) (S•• instructions):

IF ANY

JUDGE Rudolph T. Randa

or

m CHECK YES only ifdemanded in complaint:
JVRY DEMAND: 0 YES NO

u.~. J.~... , '(" I~Ot!,Tl
UNITED STATES DIS'llRI~r:rCQPR'l'(: ~"'. ''''!
FOR THE EASTERN DISTRICT OF'WISCPNSIN

'SS SEP 4 P2 :49

UNITED STATES OF AMERICA,
Plaintiff,
v.
JIM DOYLE, Governor of Wisconsin; RICK RAEMISCH, Secretary, Wisconsin Department of Corrections; and CATHY JESS, Warden, Taycheedah Correctional Institution,
Defendants.

'. ' ••1
Case No. 08-0-0 753

COMPLAINT

THE UNITED STATES OF AMERICA alleges: 1. The Attorney General files this complaint on behalf of
the United States of America pursuant to the Civil Rights of Institutionalized Persons Act of 1980, 42 U.S.C. § 1997, to enjoin the named Defendants from depriving persons incarcerated at the Taycheedah Correctional Institution ("TCI"), located in Fond du Lac, Wisconsin, of rights, privileges, or immunities secured and protected by the Constitution of the United States.
JURISDICTION AND VENUE 2. This Court has jurisdiction over this action under 28 U.S.C. §§ 1331 and 1345. 3. The United States is authorized to initiate this action
pursuant to 42 U.S.C. § 1997a.

4. The Attorney General has certified that all pre-filing requirements specified in 42 U.S.C. § 1997b have been met. The Certificate of the Attorney General is appended to this Complaint and is incorporated herein.
5. Venue in the Eastern District of Wisconsin is proper pursuant to 28 U.S.C. § 1391.
DEFENDANTS 6. Defendant Jim DOYLE is the Governor of the State of Wisconsin and has authority over TCl and over the care of women at TCl. Governor DOYLE is sued in his official capacity. 7. Defendant Rick RAEMlSCH is Secretary of the Wisconsin Department of' Corrections and is responsible for the general supervision and control of TCl and provides for the care and maintenance of women at TCl. Secretary RAEMlSCH is sued in his official capacity. 8. Defendant Cathy JESS is the Warden at TCl and is responsible for the day-to-day operations of TCl. Warden JESS has custody, control and charge of TCl and the women incarcerated at TCl. Warden JESS is sued in her official capacity. 9. Defendants are legally responsible, in whole or in part, for the operation and conditions of TCl, and for the health and safety of women incarcerated at TCl. 10. At all relevant times, the Defendants or their predecessors in office have acted or failed to act, as alleged
2

herein, under color of state law. FACTUAL ALLEGATIONS
11. TCI is an institution within the meaning of 42 U.S.C. § 1997 (1) .
12. TCI is a state-operated, post-conviction facility that houses over 600 maximum and medium security women and approximately 100 women who are being evaluated for placement within the Wisconsin prison system.
13. Defendants have engaged in and continue to engage in a pattern or practice of failing to provide adequate mental health care to women in Tel.
14. Defendants have been aware of the unlawful practices alleged in paragraph 13 for a substantial period of time and have failed to adequately address these practices, despite their knowledge of the deficiencies.
VIOLATIONS ALLEGED 15. Through the acts and omissions alleged in paragraphs 13 and 14, Defendants have exhibited deliberate indifference to the health and safety of TCI inmates, in violation of the rights, privileges, or immunities of those inmates as secured or protected by the Constitution of the United States. U.S. Const. amend. VIII, XIV. 16. Unless restrained by this Court, Defendants will continue to engage in the acts and omissions set forth in
3

!

continue to engage in the acts and omissions set forth in

j

paragraph 13 that deprive persons confined·in TCl of rights,

I

I

privileges, or inununities secured or protected by the

Constitution of the United States.

PRAYER FOR RELIEF.

17. The Attorney General is authorized under J
42 U.S.C. § 1997 to seek equitable and declaratory relief.

WHEREFORE, the United States prays that this Court enter an

order permanently enjoining Defendants, their officers, agents,

employees, subordinates, successors in office, and all those

acting in con·cert or participation with them from continuing .the

acts, omissions, and ·practices set forth in paragraph 13 above,.
" ..
and that this Court require Defendants to take such. .actions a. s
will ensure lawful conditions of confinement are afforded to

inmates at'TCl. The United States furthe~ prays that ·this Comrt

grant such other and fU1;ther eqqitable relief as it may deem just

and proper.

Respectfully submitted,
«l!~ Attorney General of the ·United States

4

• •
States Attorh~y Eastern District of Wisconsin

~UNG~feC~
Acting Assistant Attorney
Gene al

Assistant United States Attorney

Eastern District of Wisconsin

Special Litigation Section

530 Federal Building

517 East Wisconsin Avenue Milwaukee, WI 53202 (414) 297-1700 Facsimile: (4~4) 297-4394

~ !J~" DANIEL H. WEISS ~J4<

State Bar No. 1005513

Deputy Chief

E-mail: Matthew.Richmond@usdoj.gov

LAURA L. COON KENYAN R. McDUFFIE Trial Attorneys U.S. Department of Justice Civil Rights Division Special Litigation Section 950 Pennsylvania Avenue, N.W. Washington, D.C. 20530 (202) 514-1089 Facsimile: (202) 514-0212 E-mail: Laura.Coon@usdoj.gov

5

CERTIFICATE OF THE ATTORNEY GENERAL

I, Michael B. Mukasey, Attorney General of the United

States, certify that with regard to the foregoing Complaint, I

have complied with all subsections: of 42 U.S.C. § 1997b(a) (1). I

certify as well that I have complied with all subsections of -

42 U.S.C. § 1997b(a) (2). I further- certify, pursuant to

42 U.S.C. § 1997b(a) (3), my belief that this action by the United

States "is of general public importa.nce and will materially

-

further the vindication of rights, privileges, or immunities

secured or protected by the Constitution of the United States.

_In addition, I _certify that I have the "reasonable cause to believe," as set forth in 42- U.S.C. § 1997a, to initiate this action and that all prerequisites to the filing of this lawsuit pursuant to 42 U.S.C. § 1997 have been satisfied.

Pursuant to 42 U.S.C. § 1997a(c),' I have personally signed the foregoing Complaint. Pursuant to 42 U.S~C. § 1997b(b), I am personally signing this Certificate .

Signed this .;iMday of ...E~"'~

2.0~ at

Washington, D.C .

~. ~"="/ ~

Attorney General of the

United States

42 U.S~C. § 1997

 
 U.:i. '.

U'. I~'

IN THE UNITED STATES DIS~kiF~.c.Otifri:i"ill

FOR THE EASTERN DISTRICT OF WI'sCON'm::N

UNITED STATES OF AMERICA

)

'OS SEP -4 P2 :40

)

Plaintiff,

)

)

JOt-I; ,.1" ilF ILiPPO

v.

)

CIV NO: ~~f~K

.

)

08-G-0753

)

JIM DOYLE, Governor of

)

Wisconsin; RICK RAEMISCH,

)

Secretary, Wisconsin

)

Department of Corrections; )

and CATHY JESS, Warden,

)

Taycheedah Correctional

)

Institution,

)

)

Defendants.

)

JOINT MOTION FOR ENTRY OF CONDITIONAL DISMISSAL The United States, Plaintiff, and the State of Wisconsin, having entered into the attached Memorandum of Agreement, jointly move this Court for entry of an Order conditionally dismissing this action, pursuant to Fed. R. Ci v. P. 41 (a) (2), conditioned upon Defendants' achieving substantial compliance with the terms of the Memorandum of Agreement. The parties respectfully request that the Court place the case on its inactive docket while retaining jurisdiction over the case for four (4) years or until an earlier final dismissal with prejudice is entered.

FOR THE UNITED STATES:

Respectfully submitted,

STEVEN M. BISKUPIC United States Attorney

Y. CUTLAR
Special Litigation Section Civil Rights Division

MATTHEW RICHMOND
Assistant u.S. Attorney
530 Federal Building 517 East Wisconsin Avenue Milwaukee, WI 53202 Matthew.Richmond@usdoj.gov

- 2-

· FINKELMEYER t Attorney General W' c sin Department of Justice P. . Box 7857 Madison, WI 53707-7857 (608) 266-7342
~er--
Chief Legal Counsel Wisconsin Department of Corrections 3099 East Washington Avenue P.O. Box 7925 Madison, WI 53707-7925 (608) 240-5049
-3-

MEMORANDUM OF AGREEMENT BETWEEN THE UNITED STATES DEPARTMENT OF JUSTICE AND THE STATE OF WISCONSIN REGARDING
CONDITIONS AT THE TAYCHEEDAH CORRECTIONAL INSTITUTION

TABLE OF CONTENTS

I. II. ill. IV. V. VI. VII. Vll.

Introduction Definitions Care Required by the United States Constitution Substantive Measures for Mental Health Services Consultation Compliance and Quality Assurance Reporting Requirements and Right of Access Implementation and Termination

I. INTRODUCTION
(1) On March 25, 2005, the United States Department ofJustice (D01) notified State of Wisconsin (State) officials of its intent to investigate conditions of confinement at Taycheedah Correctional Institution (Taycheedah) pursuant to the Civil Rights ofInstitutionalized Persons Act (CRIPA), 42 U.S.C. §1997.
(2) DOJ staff toured Taycheedah with corrections and mental health care consultants on July 18 -21 and October 6 -7, 2005
(3) On May 1,2006, the United States issued a findings letter pursuant to 42 U.S.C. § 1997 (a) (1), which concluded that certain conditions at Taycheedah violated the constitutional rights of inmates commed at Taycheedah by failing to provide for their serious mental health needs and recommended remedial measures.
(4) Throughout the course of the investigation, DOl had the complete cooperation ofState officials and unfettered access to the facility, documents, and staff. The State and Taycheedah staff also demonstrated a willingness to proactively and voluntarily undertake measures to improve mental health care at Taycheeda:h. Consequently, the parties enter into this Memorandum of Agreement (Agreement) to use resources to support and improve mental health care at Taycheedah, rather than allocating such resources to the risks and burdens of litigation.
(5) The parties to this Agreement are the United States; the State of Wisconsin; the Wisconsin Department of Corrections CWDC); Rick Raernisch, Secretary ofthe Wisconsin Department of Corrections; Cathy Jess, Warden of the Taycheedah Correctional Institution; and their successors and agents. The State shall ensure that it takes necessary actions to comply with the provisions of this Agreement.
(6) No person or entity is intended to be a third-party beneficiary of the provisions of this Agreement for purposes of any civil, criminal, or administrative action, and accordingly, no person or entity may assert any claim or right as a beneficiary or protected class under this Agreement. This Agreement is not intended to impair or expand the right of any person or organization to seek relief against the State, WDC, or State officials, employees, or agents for their conduct or the conduct ofWDC employees; accordingly, this Agreement does not alter legal standards governing any such claims, including those under Wisconsin law.
(7) In entering into this Agreement, the State does not admit any violations ofthe constitutional rights of inmates confmed at Taycheeda:h nor does it admit any violation of state or federal law. This Agreement may not be used as evidence
1

ofliability in any other legal proceeding. However, the State remains finnly committed to improving medical and mental health care at Taycheedah.
II. DEFINITIONS
In this Agreement, the following defmitions apply:
(1) "DOJ" means the United States Department of Justice, which represents the United States in this malter.
(2) "Effective date" means the date the Agreement is executed by the parties.
(3) "Implement" means to give practical effect and ensure actual fulfillment by concrete measures.
(4) "Include" or "including" means "include, but not limited to" or "including, but not limited to."
(5) "Inmates" means individuals incarcerated at Taycheedah.
(6) "Inmates with a serious mental illness" means:
1. Inmates with a current diagnosis of, or are in remission from, the following conditions:
a. Schizophrenia (all sub types) b. Delusional disorder c. Schizophreniform disorder d. Schizoaffective disorder e. Psychosis NOS f. Major depressive disorders g. Bipolar disorder 1 & 2.
2. Inmates with current or recent symptoms ofthe following conditions:
a Brief psychotic disorder b. Substance induced psychotic disorder.
3. Inmates with head injury or other neurologic impairments that result in behavioral or emotional dyscontrol.
4. Inmates with a primary personality disorder that is severe, accompanied by significant functional impairment, and subjeclto periodic decompensation (that is, psychosis, depression, or suicidality).
2

r
I
I
I
I
!
I
i
r
!
I

5. Inmates with chronic and persistent mood or anxiety disorders or other conditions that lead to significant functional disability.

(7) "Qualified medical professional" means a physician, nurse or other medical provider currently authorized under Wisconsin state law to provide the medical services he or she undertakes to provide.

(8) "Qualified mental health professional" means a mental health care provider currently authorized under Wisconsin state law to provide the mental health services he or she undertakes to provide.

(9) "Quality assurance program" means a system ofself-auditing and

I

improvement to assess the implementation and effectiveness of remedies instituted pursuant to this Agreement, to identify deficits that may exist, to effectuate new measures to cure deficits identified, and to establish and utilize

I

performance measures to evaluate the status of and to improve conditions of

confinementand treatment services.

(10) "Security staff' means all staff, irrespective ofjob title, whose regular duties include supervision of inmates at Taycheedah.

(11) "Staff' includes salaried and hourly employees, persons providing services under contract, volunteers, interns, and any other individuals providing services at Taycheedab.

(12) "Stilte" means officials of the State of Wisconsin, including the Wisconsin Department of Corrections, and their successors, and agents.

(13) "Taycheedah" means the Taycheedah Correctional Institution, located at 751 County Road K, Fond du Lac, Wisconsin.

(14) "Train" means to sufficiently instruct in the skills addressed. Training shall incorporate instructional methods that establish minimal standards for defining staff competency.

(15) "Treatment plan" means a series of written statements specifying an inmate's particular course oftherapy and the roles of qualified health care professional and qualified mental health care professional in carrying it out. This series of written statements should be in a consistent place in the inmate's files and should be easily identifiable by the viewer ofthe files. A treatment plan for inmates with a non-residential plan of care may be located in the treatment notes of the psychology or psychiatry staff.

(16) "WDC" means the Wisconsin Department of Corrections.

3

---_._--
III. CARE REQUIRED BY THE UNITED STATES CONSTITUTION
The purpose of this Agreement is to protect the Constitutional rights ofthe imnates at Taycheedah. The terms and requirements ofthis Agreement are not meant to expand or contract the Constitutional duties ofthe State or the Constitutional rights ofthe imnates. The terms and requirements of this Agreement, the Taycheedah Correctional Institution Standards (Standards), which is incorporated herein as Attachment A, and the Taycheedah Correctional Institution Action Plan (Action Plan), which is incorporated herein as Attachment B, are not to be interpreted as establishing minimum constitutional standards of health care for imnates with a serious mental illness.
IV. SUBSTANTIVE MEASURES FOR MENTAL HEALTH SERVICES
In determining what constitutes adequate and timely services, the parties shall be guided by the Standards and Action Plan, which are incorporated by reference into this Agreement as Attachments A and B, respectively.
(1) Serious Mental Health Needs The State agrees to provide services to address the serious mental health needs of all imnates.
(2) Psychiatrist Staifmg The State shall retain sufficient psychiatrists to enable Taycheedah to address the mental health needs of all inmates with a serious mental illness.
(3) Administration of Mental Health Medications The State shall develop and implement policies, procedures, and practices to ensure that psychotropic medications are prescribed, distributed, and monitored properly and safely.
(4) Serious Mental llIness Training The State shall conduct initial and periodic training for all security staff on how to recognize symptoms ofserious mental illness and respond appropriately.
(5) Mental Health Screening The State shall develop and implement policies, procedures, and practices to ensure that all inmates receive adequate initial mental health screening by appropriately trained staff, including nursing staff, within twenty-four (24) hours after intake.
(6) Mental Health Assessment and Referral The State shall develop and implement policies, procedures, and practices to ensure mental health assessments by qualified mental health professional for those inmates whose mental health histories or whose responses to initial screening questions indicate a need for such an assessment. The State shall ensure treatment for inmates with a serious mental illness, including for specialty care and regularly scheduled visits with qualified mental health professionals.
4

(7) Mental Health Treatment Plans The State shall ensure that a qualified mental health professional prepares and updates an individual mental health treatment plan for each inmate who requires mental health services. The State also shall ensure that the plan is implemented. Implementation of and any changes to the plan shall be documented in the inmate's medical/mental health record.
(8) Crisis Services The State shall ensure an array of crisis services to manage the psychiatric emergencies that occur among Taycbeedah inmates. Inmates in administrative segregation or observation status shall have access to the array of crisis services which are available to other inmates. Inmates shall have access to in-patient psychiatric care when clinically appropriate.
(9) Treatment for Inmates with a Serious Mental Illness The State shall ensure therapy, counseling, and other mental health programs for all inmates with a serious mental illness. The State shall ensure that inmates who are being treated with psychotropic medications are seen regularly by a physician or other licensed prescriber to monitor responses and potential reactions to those medications.
(10) Review of Disciplinary Charges for Inmates with a Serious Mental Illness The State shall ensure that disciplinary charges against inmates with a serious mental illness are reviewed by a qualified mental health professional (a) to determine the extent to which the charge is related to a serious mental illness; (b) to ensure that inmates who commit infractions resulting from a serious mental illness are not punished for behavior caused by the serious mental illness; and (c) to ensure that an inmate's serious mental illness is used as a mitigating factor, as appropriate, when punishment is imposed on inmates with a serious mental illness.
(II) Procedures for Inmates with a Serious Mental Illness. who are in Segregation or Observation Status The State shall implement policies, procedures, and practices to ensure that inmates with a serious mental illness who are in segregation receive treatment.
(12) Medical and Mental Health Record System The State shall develop and implement a record-keeping system in which all clinically appropriate documents for the treatment ofan inmate with a serious mental illness are readily available to each clinician. The record keeping system shall document assessments and treatment. Medical and mental health care staff shall have access to documents that are relevant to the care and treatment of inmates.
(13) Medication and Laboratory Orders The State shall develop and implement policies, procedures, and practices to ensure timely responses to orders for mental health medications and laboratory tests. Such policies, procedures, and practices shall be periodically evaluated to ensure that delays in the receipt of
5

medications and laboratory tests are prevented. In addition, files of inmates shall contain current and accurate information regarding medication changes.
v. CONSULTATION

(1) Consultant Selection The parties have jointly selected Jeffrey 1. Metzner,

M.D. to serve as the parties' jointly appointed consultant (Consultant).

Should the position become vacant, the parties will agree on a replacement.

Neither party, nor any employee or agent of either party, shall have any supervisory authority over the Consultant's activities, reports, fmdings, or

I

recommendations. The cost for the Consultant's fees and expenses shall be

I

borne. by the State. Th~ selection of the Consultant shall be conducted solely

pursuant to the procedures set forth in this Agreement, and will not be

governed by any fonnal or legal procurement requirements. The Consultant

may be tenninated only for good cause, unrelated to the Consultant's findings

or recommendations, and only with prior notice to, and approval of, both

parties.

(2) Consultant Qualifications The Consultant shall have experience and education or training in the field of correctional mental health care. The Consultant may also have education, training, or experience in systems of accountability or quality assurance.

(3) Consultant Access The Consultant shall have full and complete access to Taycheedah, all facility and WDC records, staff, and inmates. The State shall direct all employees to cooperate fully with the Consultant. All non-public infonnation obtained by the Consultant shall be maintained in a confidential manner.

(4) Consultant Ex Parte Communications The Consultant shall be permitted to initiate and receive ex parte communications.

(5) Limitations on Public Disclosures by Consultant Except as required or

authorized by the terms of this Agreement or the parties acting together, the Consultant shall not make any public statements or issue findings with regard to any act or omission of the State or its agents, representatives or employees,

I

or disclose non-public information provided to the Consultant pursuant to this

Agreement. Unless such conflict is waived by the parties, the Consultant shaIl

not accept employment or provide consulting services that would present a

conflict of interest with the Consultant's responsibilities under this

Agreement, iilcluding being retained (on a paid or unpaid basis) by any current

or future litigant or claimant, or such litigant's or claimant's attorney, in

connection with a claim or suit against the State or its departments, officers,

agents or employees. The Consultant is not a state or local agency or an agent

thereof; and accordingly the records maintained by the Consultant shall not be

deemed public records subject to public inspection. Neither the Consultant

6

nor any person or entity hired or otherwise retained by the Consultant to assist in furthering any provision of this Agreement shall be liable for any claim, lawsuit or demand arising out of the Consultant's perfonnance pursuant to this Agreement. This paragraph does not apply to any proceeding before a court related to perfonnance of contracts or subcontracts for monitoring this Agreement.
(6) Standards and Action Plan The Standards and Action Plan, which are incorporated into this Agreement as Attachments A and B respectively, will have been developed in consultation with the Consultant named above prior to signing the Agreement. The Standards and Action Plan will be implemented over a four (4) year period to be computed from the date that this Agreement is executed by the parties.
(7) Consultant Reports The Consultant shall provide the parties with detailed reports describing the steps taken by the State to implement this Agreement, including the Standards and Action Plan, and evaluate the extent to which the State has complied with the provisions of the Agreement, including the Standards and Action Plan. The Consultant shall issue the initial report within four (4) months of the effective date ofthis Agreement, and issue subsequent reports every six (6) months thereafter, unless both parties otherwise agree in writing. The reports shall be provided to the parties in draft fonn for comment at least two (2) weeks prior to their issuance. These reports shall be written with due regard for the interest of the State in protecting against disclosure of non-pUblic infonnation. In each report, the Consultant shall evaluate the status ofcompliance for each provision of the Standards and Action Plan, using the following standards: (a) substantial compliance, (b) partial compliance, (c) beginning compliance, and (d) non-compliance. In order to assess compliance, the Consultant shall review a sufficient number of pertinent documents to accurately assess current conditions; interview all pertinent staff; and interview a sufficient number of inmates to accurately assess current conditions. The Consultant shall be responsible for independently verifYing representations from the State regarding progress toward compliance, examining supporting documentation where applicable. Each Consultant's report shall describe the steps taken to analyze conditions and assess compliance, including documents reviewed and individuals interviewed, and the factual basis for each of the Consultant's findings. Each of the Consultant's reports shall include specific recommendations for actions needed to bring the State into compliance with the Standards and Action Plan.
VI. COMPUANCE AND QUALITY ASSURANCE
(I) Document Development and Revision The State shall revise or develop policies, procedures, protocols, training curricula, and practices to ensure that they are consistent with, incorporate, address, and implement the provisions of this Agreement, including the Standards and Plan ofAction. The State shall
7

revise or develop as necessary other written docwnents to effectuate the provisions of this Agreement. The State shall consult with the Consultant in the development or revision of policies and procedures prior to their promulgation. The State shall provide initial and ongoing training to all Taycheedah staffwith respect to newly implemented or revised policies and procedures. The State shall docwnent employee training in the new or revised policies and procedures.
(2) Quality Assurance Program The State shall develop and implement an adequate Quality Assurance Program for Taycheedah's provision ofmental health care services for inmates with a serious mental illness. The program shall include periodic audits and documentation ofthe status of compliance with the terms of this Agreement.
(3) Corrective Action The State shall develop and implement policies and procedures to address problems that are uncovered during the course of quality assurance activities. The State shall develop and implement corrective action to address these problems.
(4) Technical Assistance As appropriate, the State shall request and receive technical assistance from the Consultant. Further, DO] will assist the State in identifying additional fmancial or technical resources to supplement those resources currently allocated to Taycheedah.
VII. REPORTING REQUIREMENTS AND RIGHT OF ACCESS
(I) DO] Access The DOJ shall have full and complete access to Taycheedah, inmates, and WDC staff, and all docwnents relating to the topics addressed in this Agreement. The DO] shall have the right to conduct confidential interviews with staff, inmates, and former inmates. All non-public information obtained by the DOJ shall be maintained in a confidential manner.
(2) State Response to DOJ Ouestions The State shall provide written answers to written questions from the DO] concerning the State's compliance with this Agreement within thirty (30) days of receipt of the written questions.
(3) State Documentation of Compliance The State shall maintain sufficient records to document its compliance with all of the requirements of this Agreement, including the Standards and the Action Plan which are incorporated by reference into the Agreement as Attachments A and B, respectively. The State also shall maintain any and all records required by or developed under this Agreement for the duration ofthe Agreement.
(4) State Compliance Reports Every six (6) months, the State shall provide the Consultant and the US DOJ with status reports detailing the State's compliance with this Agreement, including the Standards and the Action Plan.
8

(5) Privileges The State shall not assert physician/patient or psychotherapist/patient privileges with respect to any infonnation requested under this Agreement.
VIll. IMPLEMENTATION AND TERMINATION
(1) Construction of Agreement Upon execution ofthis Agreement, the DO] shall file a complaint in the United States District Court for the Eastern District of Wisconsin, and contemporaneously file a Joint Motion for the Conditional Dismissal of the complaint pursuant to Federal Rule of Civil Procedure 41 (a)(2). The complaint will be based on its May 1,2006 fmdings letter, which was issued pursuant to 42 U.S.C. § 1997 (a) (I). A copy ofthis Agreement shall be attached to the Joint Motion for the Conditional Dismissal, and that motion shall: (a) request that the court place the case on its inactive docket; (b) request that the court retain jurisdiction over the case until a fmal dismissal is entered; and (c) request that the court dismiss the complaint upon the State's substantial compliance with the tenns of this Agreement or the passage of four (4) years from the date of its filing. This provision shall not be interpreted to provide for any judicial supervision of the actions ofthe parties under the Agreement. Should the DO] believe that the State has not substantially complied with the terms ofthis Agreement after a period ofthree (3) years and nine (9) months, the DOJ's sale remedy shall be reinstatement of its complaint. The parties agree that any such complalnt shall not include any breach of contract claims for violations ofthe Agreement, including the Standards and Action Plan.
(2) Infonnation to Employees The State shall ensure that all current and future relevant WDC employees are informed of the terms of this Agreement as those tenns affect their carrying out their duties and responsibilities.
(3) Agreement Coordinator Within thirty (30) days ofthe execution of the Agreement the State shall designate an Agreement Coordinator to coordinate and oversee implementation of and compliance with this Agreement. The Agreement Coordinator will serve as a liaison between the State, the Consultant, and DOJ.
(4) Termination This Agreement shall terminate four (4) years from the date it is executed by the parties. The Agreement may end earlier than four (4) years from the date it is signed by the parties ifthe State has substantially complied with all substantive provisions of the Agreement. The burden shall be on the State to demonstrate substantial compliance with aU substantive provisions of the Agreement. Noncompliance with mere technicalities, or temporary failure to comply during a period of otherwise sustained compliance will not constitute failure to maintain substantial compliance. At the same time,
9

temporary compliance during a period of sustained noncompliance shall not constitute substantial compliance. (5) Successors This Agreement shall be binding on all successors, assignees, employees, and agents of the State. (6) Notice "Notice" under this Agreement shall be provided by courier or overnight delivery and shall be provided to the Governor or the State and to the Attorney General of the State. (7) Unforeseen Delay Ifany unforeseen circumstance occurs which causes a failure to timely carry out any requirements of this Agreement, the State shall notify the DOJ in writing within twenty (20) calendar days ofthe time that the State becomes aware of the unforeseen circumstance and its impact on the State's ability to perform under the Agreement. The notice shall describe the cause of the failure to perform and the measures taken to prevent or minimize the failure. The State shall implement all reasonable measures to avoid or minimize any such failure. (8) Non-Retaliation No person reporting conditions which may constitute a violation of laws or the Constitution of the United States or this Agreement shall be subjected to retaliation in any manner for so reporting. See 42 U.S.C. §1997d. (9) Subheadings All subheadings in this Agreement are written for the convenience of location individual provisions. If questions arise as to the meaning of individual provisions, the parties shall follow the text of each provision. (10) Amendment The parties may make written amendments to any portion of this agreement if all parties to the Agreement so agree.
10

FOR THE UNITED STATES:
•
United States Attorney Eastern District of Wisconsin
~\2
MATTHEW v. RICHMOND
Assistant United States Attorney Eastern District of Wisconsin 5 I 7 East Wisconsin Avenue Milwaukee, WI 53202

~£ , ";'I~II(CC

~C,L££I

,,/G CEC.BE KER

Acting Assistant Attorney General

Civil Rights Division

R~~"dIur
SHANETTA Y. iUTLAR Chief Special Litigation Section
~
DANIEL H. WEISS Deputy Chief Special Litigation Section

11

FOR THE STATE OF WISCONSIN:
fU··cPLd
RlCK RAEMISCH Secretary Wisconsin Department of Corrections Chief Legal Counsel Wisconsin Department of Corrections
12

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH
ATTACHMENT A
TCI STANDARDS Plan to Address US DOJ Concerns
1. Serious Mental Health Needs: The state agrees to provide services to address the serious mental health needs of aU inmates.
• See specific standards described below.
2. Psychiatric Treatment: The state shall retain sufficient psychiatrists to enable TCI to address the mental health needs of inmates with serioDs mental illness. The state shall ensure that inmates who are being treated with psychotropic medications are seen regularly by a physician or other licensed prescriber to monitor responses and potential reactions to those medications.
• Psychiatrists shall have appropriate medical autonomy for clinical decisions. The state shall retain licensed and qualified psychiatrists for a sufficient number afhours per week to perform at least the following duties:
II See patients. (See Section 5 forintake assessment time frames.) II Prescribe and monitor psychotropic medication. II Participate in the development of comprehensive treatment plans for inmates with an
SMU level of care (Special Management Unit level ofcare which is also known as residential level of care). II Review charts in the context ofrendering mental health care. • Review and respond to the results ofdiagnostic and laboratory tests. .. Be familiar with and follow policies, procedures, and protocols. II Collaborate with psychology staffto render appropriate care for patients. III Communicate problems and resource needs to the Psychiatrist Supervisor, Psychology Supervisor, Health Services Unit Manager, or Warden as needed.
3. Administration orMental Health Medications: The state shall develop and implement policies, procedures, and practices to ensure that psychotropic medications are prescribed, distributed, and monitored properly and safely.
• Psychotropic medication in the Monarch and segregation units will be administered by qualified medical professionals or other health care personnel qualified under Wisconsin state law to administer medications. These staffwill consistently implement policies and procedures to monitor for adverse reactions and potential side effects and document the administration of such medications in Medication Records (MRs).
• Psychotropic medication in general population units will be distributed by appropriately trained staff. These staff will consistently implement policies and procedures to monitor for adverse reactions and potential side effects and document the administration of such medications in MRs.
1

II Documentation in the MRs will include a clear and consistent indication ofwhether the inmate received, refused or otherwise missed any doses ofmedication.
• A qualified medical professional shall review MRs on a regular basis to determine whatber poliCies and procedures are being followed.
• Correctional staffthat administer or distribute psychotropic medication will receive medication administration training as part ofnew employee orientation and at least annually thereafter.
4. Serious mental illness training: The state shall conduct initial and periodic training for all security staff on how to recognize symptoms of serious mental illness and respond appropriately.
• Eight (8) hours of mental health training will be provided to security staffin preseTVice training at the onset of employment. Training shall include suicide prevention, symptoms of mental illness and proper response to inmates with mental health problems.
II At least three (3) hours ofannual mental health training will be provided to security staff. Training shall include suicide prevention, symptoms of mental illness and proper response to inmates with mental health problems.
S. Mental Healtb Screening: Tbe state shall develop and implement policies, procedures, and practices to ensure that all inmates receive adequate initial mental health screening by appropriately trained staff.
• Nursing staff will conduct on the day of intake an initial healtbscreening interview, which includes whether the inmate has a history of mental illness, whether the inmate is currently receiving or has received psychotropic medication. and whether the inmate has attempted suicide or has suicidal propensities. Documentation ofthe screening shall be maintained in the appropriate medical record.
II Incoming inmates who are in need of emergency mental health services shall receive such cafe immediately after intake.
II During business hours, emergency services shall be provided by on-site PSU clinical staffand/or psychiatry staff.
.. During off-hours, emergency services shall be provided by on-site HSU staff, on-call PSU clinical staff aDd an on-call physician. PSU clinical staff shall be physically available to the institution when necessary. Consultation with the treating psychiatrist or Psychiatry Director will be available.
• Inmates who have been on psychotropic medication prior to intake will be assessed by a psychiatrist as to the need to continue those medications no later than ten (10) days after intake or sooner if clinically appropriate. Inmates shall remain on previously prescribed psychotropic medication pending psychiatrist assessment. Incoming inmates who require resumption of psychotropic medication shall be seen by a psychiatrist as soon as clinically appropriate.
• Licensed prescribers shall review and sign medication orders within twenty four (24) hours of intake from a facility outside DOC.
2

6. Mental Health Assessment and Referral: Tbe state sball develop nnd implement policies, procedures, and practices to ensure mental bealth assessments by qualified mental bealth professionals for those inmates whose mental health bistories or whose responses to initial screening questions indicate a need for snch an assessment. The slate shall ensure treatment for inmates with a serioDS mental illness, including for specialty care and regularly scheduled visits with qualified mental health professionals.
II Psychological Services clinical slaffwill conduct mental health assessments of inmates within seventy two (72) hours of intake from outside DOC. Assessments will include:
II Mental health screening and assessment as outlined on form DOC-3472.
II Assignment of a provisional diagnosis and mental health code. II Referral for psychiatric or medical care ifneeded. II An initial treatment plan for those inmates who require additional services. The plan
will address identified problems, goals, follow-up care, program and specialty referrals, and any need for special housing placement.
• At times other than intake, Psychological Services clinical staff will conduct a mental health assessment within seventy two (72) hours ofthe time such a need is recognized.
II Psychological Services clinical staff will conduct file reviews on all inmates on the mental health caseload transferred to TCI from another institution within five (5) working
days of transfer.
• Inmates shall have access to a confidential self-referral system by which they may request non-emergency mental health care without revealing the substance oftheiT request to security staff.
II Psychology Service Requests will be collected from housing units daily and forwarded to PSU clinical staff during the work week and to HSU nursing staff on weekends and holidays. Triage ofthese requests shall occur within twenty four (24) hours ofreceipt. Urgent needs will be addressed immediately. For non-urgent requests, an appointment or written response shall occur within three (3) working days of receipt.
• Health Service Requests will be collected from the housing units on a daily basis and forwarded to HSU nursing staff. Triage ofthese requests shall occur within twenty four (24) hours ofreceipt.
II Inmates in segregation may give Psychology Service Requests or Health Service Requests directly to health care staffon a daily basis.
7. Mental Health Treatment plans: The state shall ensure that a qualified mental health professional prepares and updates an individual mental health treatment plan for each inmate who requires mental health services. The state shall also ensure that the plan is implemented. Implementation of any changes to the plan shall be documented in the inmate's medieaVmental health record.
II Comprehensive treatment plans will be developed and implemented for inmates requiring an SMU level of care. These treatment plans will be created and reviewed by a multidisciplinary team at least every six (6) months and changes to the plan documented in the PSU record.
3

• Outpatient treatment plans will be created an(l updated annually for inmates who require outpatient-level mental health services.
8. Crisis Services: The state shall ensore an array of crisis services to manage the psychiatric emergencies that occor alllong TCI inmate•• Inmates in segregation or ohservation status sball bave access to the array ofcrisis services which are available to other inmates. Iomate sball have access to inpatient psychiatric care when clinically appropriate.
I Inmates, including those in segregation and observation status, will have access to an array of crisis services that are timely and clinically appropriate_ These will include:
• Crisis intervention contacts with PSU clinical staff. • Placement within Clinical Observation. (See Section 11 for services while in Clinical
Observation.) • Placement within Monarch Unit for SMU-Ievel care. I Psychiatric referral and intervention. • Emergency room care. I Inpatient psychiatric care (currently Winnebago Mental Health Institution; expanding
to the Wisconsin Resource Center in 2011). I 24-hour on-call services via PSU clinical staff.
9. Treatment for inmates with a serious mental illness: The state shall ensure therapy, counseling, and other mental bealth programs for all inmates with a serions mental illness.
• Monarch inmates with a serious mental illness shall be provided with a minimum often (10) hours per week of out-of-cell 8truetured therapeutic activity, including one (1) hour per week of individual clinical contact with a PSU staffmember. In order to reliably achieve ten (10) hours per week, twelve (12) to fifteen (15) hours per week shall be scheduled. Out-of-cell structured therapeutic activities may include:
I Psycho-educational groups (e.g., soeial skills development, stress management, medication education, problem solving).
I Guided activities (e.g., structured recreation, community service crafts, gardening). • Education (e.g., special education, ABE, GED, voluntary classes. • Work assignments. • Religious activities. • Psychiatry appointments. I Psychotherapy groups (e.g., cognitive behavioral groups, trauma-specific groups,
dual diagnosis groups). • Individual psychotherapy. • Crisis intervention. • Release planning activities. • Unstructured day space and recreation time will not be counted.
I General Population inmates with a serious mental illness shall be provided with the following services:
• Psychiatry appointments consistent with the provisions of Section 2.
4

I
I
I

----------- -------.--
• Regular and periodic individual contacts with PSU clinical staffat a frequency determined by clinical need. Staffing for this purpose shall be sufficient to provide an average of one routine contact every four (4) weeks for the population ofinmates with serious mental illness.
• Mental health group therapy as determined by clinical need. Staffing for this purpose shall be sufficient to provide an average offOUT (4) 12-week therapy groups per year for the popUlation of inmates with serious mental illness.
• General Population inmates on the MH caseload but without serious mental iIlhess shall be provided with the following services:
• Psychiatry appointments consistent with the provisions of Section 2. • Regular and periodic individual contacts with PSU clinical staff at a frequency
determined by clinical need. Staffing for this purpose shall be sufficient to provide an average of one (I) routine contact every six (6) weeks for this population. • Mental health group therapy as determined by clinical need. Staffing for this purpose shall be sufficient to provide an average of two (2) 12-week therapy groups per year for the population of inmates with serious mental illness.
• There shall be adequate space and facilities to conduct treatment and provide programs listed in this document.
10. Review of disciplinary charges for inmates with a serious mental illness: The state shall ensure that disciplinary charges against inmates with a serious mental illness are reviewed by a qualified mental health professional (a) to determine the extent to which the cbarge is related to a serious mental illness; (b) to ensure that inmates who commit infractions resulting from a serious mental illness are not punished for behavior caused by the serious mental illness; and (c) to ensure tbat an inmate's serious mental illness is used as a mitigating factor, as appropriate, when punishment is imposed on inmates with a serious mental illness.
• Disciplinary charges for inmates with a serious mental illness wbo receive major conduct reports will be reviewed by PSU clinical staff. Written input will be provided to the Security Director or designee !o address mental health factors that may have affected the inmate's responsibility or may represent mitigating factors.
11. Procedure for inmates witb a serious mental illness, who are in segregation or observation status: the state sball implement policies, procedures, and Pl1lctices to ensure that inmutes with a serious mental illness who are in segregation receive treatment.
• PSU clinical -staffshall evaluate all segregated inmates who are on the mental health caseload within one (I) working day ofplacement in segregation. This evaluation shall include an assessment of the potential effects of segregation on the inmate's mental health and an assessment of whether continued segregation or graduated alternatives are appropriate for the inmate.
• Segregated inmates with an SMU level ofcare shall be provided with a minimum often (IO) hours per week of out-of-cell strucnJred therapeutic activity that includes at least one (I) hour per week of individual clinical contact. In order to reliably achieve ten (I 0)
5

- - - - - - - - _ . _....,'
hours of activity per week, twelve (12) to fifteen (15) hours per week shall be scheduled. (See Section 9 for potential activities.)
• Segregated inmates on the MH caseload but without serious mental illness shall be provided with the following services:
• Psychiatry appointments consistent with the provisions of Section 2. • A minimum of two (2) hours per week of out-of-cell structured therapeutic activity.
(See Section 9 for potential activities.) • At least one (1) cell-side contact with PSU clinical staff each week with the
opportunity to request and receive out-of-cell contact.
• Inmates in clinical observation status shall be provided with the following services:
• Psychiatry appointments consistent with the provisions of Section 2. • An initial evaluation by PSU clinical staffwithin twenty four (24) hours ofplacement
and daily thereafter. Evaluations shall address the continued need for placement, level ofallowed property, and the need for psychiatric services or an SMU level of care. R Nursing rounds once per shift while in observation status. • A minimum of two (2) additional PSU contacts within seven (J) days ofrelease from observation statlls.
• Inmates in segregation or Monarch who require an SMU-Ievel ofcare shan be provided with at least ten (10) hours of unstructured recreation each week.
12. Medical and mental bealth record system: Tbe state shaD develop and implement a record-keeping system in wbich 'all clinically appropriate docnments for tbe treatment of an inmate with a serious mental illness are readily available to each clinician. The record keeping system shall document assessments and treatment. Medical and mental bealtb care staff shall have access to documents that are relevant to the care aud treatment ofinmates.
• Documents will be filed in the appropriate chart in a timely manner.
• Psychological Services files will maintain a complete record ofmenIal health documents including clinical contacts, inmate requests for service, psychiatric dictations, group notes, and relevant referrals.
• Health Service Unit files will contain psychiatry records. Relevant PSU documents, including screening interviews, clinical contacts, and psychological reports, will be copied to the HS U chart for review by psych iatrists and other medical staff.
13. Medication and laboratory orders: The state sball develop and implement policies, procedures, and practices to ensure timely responses to orders for mental healtb medication and laboratory tests. Sncb policies, procedures, and practices shall be periodically evalnatcd to ensure that delays in the receipt of medications and laboratory tests are prevented. In addition, files of inmates shall contain current and accurate information regarding medication changes.
6

• Routine psychotropic medication orders will be processed and signed-off by nursing staff within twenty four (24) hours of being written. Such medications will be received in accordance with the priority code assigned by the prescriber.
• Urgent psychotropic mediation orders (identified in the priority code by tbe prescriber)
will be processed and signed-off by nursing staffthe same day. Sucb medications will be
received by the inmate on the same day. • Stat psychotropic medication orders (identified in the priority code by the prescriber) will
be processed and signed-off by nursing staffwithin one bour ofreceipt or sooner if
clinically indicatcd. Such medications will be received by the inmate within one (J) hour
or sooner if clinically indicated. • For patients who refuse or miss psychotropic medications for three (3) consecutive days
(excluding PRN medication), staffresponsible for distributing or administering the . medication will notify HSU nursing staff. HSU nursing staffwtll either interview the inmate to determine the reason for refusal or refer the inmate to the psychiatrist in a clinically appropriate time frame. • Routine Jaboratory orders will be processed and signed-offby nursing staffwithin twenty four (24) hours of being written. Specimens will be obtained within the time frame specified by the prescriber. • Stat laboratory orders will be processed and signed-off by nursing staff within one (1) hour of receipt or sooner if clinically indicated. Specimens will be collected and processed within the time frame specified by the prescriber. • Criticallaboralory results will be relayed to a practitioner immediately.
7

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH ATTACHMENT B
officers receive training in mental health topics and suicide
Psychiatrists see patients on psychotropic medication within 7-10 days ofadmission (fonnerly6-10 weeks). • Inmates who require resumption ofmedication are seen as soon as clinically appropriate.
on the
1

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH
ATTACHMENTB

following LTE and contract positions

Monarch, and Segregation Units:

13

Nurse Clinician 2

4.5

Lie. Prae. Nurse

12.6

Office Operations Associate

0.5

Program Assistants for HSU

2.5

Medical Assistant 2

1.5

2.0 LTE

There is enhanced support to psychiatrists, including more timely transcription and processing ofmedication orders (medications started within 72 hours, or sooner ifneeded).

• There is more consistent scheduling of mental health and health care appointments.

• Health care personnel distribute mediciltion in the Monarch and Segregation units~ with more accurate doc:u":1entation in MRs.

• Health care staff collect Health Service Requests in the Monarch and Segregation units and see patients within 24-48 hours ofrequest.

• There are individual nursing care plans for all Monarch patients.

• Nurses participate in MOIl arch and segregation MH treatment plans.

• There is improved filing ofpsychiatry, psychology, and health care

and documentation. _...

. ...

assessments are conducted within 3 working days ofintake 1 working day when needed. • All inmates in segregation are reviewed by PSU staffwithin 1- 2 working days ofplacemen~ and then seen weekly for rounds.

• Psychologists provide an average of2 hours per week ofmental health programming for SMU patients in Monarch. Topics include: o STEPPS program o Trauma-based treatment o Cognitive-behavioral therapy for depression o Art therapy o Anger management o Parenting

o Cognitive interventions o Problem solving o Stress management o MH education o Life skills

• In addition, Monarch staff provide an average of2-3 hours per week of education, structured recreatio~ religious activities. and meetings with

2
--------------.--~------

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH

ATTACHMENTB

• Inmates assigned to the Dual Diagnosis AODA program average more

than 15 hours oftrealment and programming per week.

• PSU staffregularly participate in the segregation review committee.
• There is improved collaboration between Ter and Winnebago providers.

incl udin~ a monthly meeting to coordinate care of shared patients.

2

Increase Monarch Unit psychiatry time to J6 hours per week (out of64 • Closer psychiat:y monitoring for inmates with SMU-level of care.

total hours per week).

Governor Doyle's Budget proposes 3325 positions at TCI for mental health, nursing. and support staff. Some ofthese proposed staff are intended to replace contract and LTE staffthat were added in August
Proposal approved by Legislature in October 2007.Current planned opening date is February 201 J.
• Quality and quantity ofapplications increases in late 2007 for 20082009 year.
• Pre-doctoral interns provide additional staff resources to meet treatment and oroe.ramminir needs and assist in filling vacancies for permanent
3
. - - - _...-._..,_._---_.-_.

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH
ATTACHMENT B
Nursing staffconducts rounds on per shift. • PSU staff meets with inmates in clinical observation each working day and provides therapeutic activities.
• psu staff has phone contact with nursing or security staff on weekends

group

• t--umltUre and matenals \...·ere purcllased, auowmg Tel to provide an

Gro:Jp programming topics include:

average of 4-5 hours of out-of-cell programming weekly to 18-20 SMU-

JeveJ inmates in segregation and Wing 1 Monarch.

• Stress Management and Relaxation

• Life Skills

• Anger Management

• Self-Esteem

• Coping strategies

• Basic Substance Abuse

• Problem Solving

• Relationships

•

3

Begin regular review ofMRs by a qualified

professional.

•

to ensure proper

• Monarch Annex will contain staffoffices and program space for

individual and group treatment

'

• Segregation Annex will contain staffoffices, program space for

individual and group treatment, and indoor recreation.

• Outdoor recreation for tbe segregation unit will provide

socialization opportunities for inmates located in separate

• There will be sufficient space for staff offices.
• There will be sufficient space for adequate treatment, programming and recreation.

4
'--------------------------_.

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH

ATTACHMENTB

2. 5, 7~ 8, Increase TCI psychiatry hours to 80 hours per week. 11

l;\./A

Establish a Mental Health Qua!ity AssurancelQuality Improvement

team.

• ;

• There is sufficient psychiatry time to meet the needs of those with

serious mental illness.

• There is more timely assessment and monitoring of inmates on

psychotropic medication.

• There is increased collaboration between Monarch psychiatrist and chief

psychologist.

• Team meets monthly to assess progress on Tel Action Plan.

• Develop and implement additional ongoing quality improvement

activities.

• QAiQj p:o'T:a:n and processes are in development.

, I

11,12, 13

budget:

permanent

2.0 Nurse Clinician 2 9.5 LPNs 2.0 Medical Assistant 2 2.5 Medical Program Assistant 0.5 Nurse Practitioner 0.5 OOA for PSU

2009 budget:

permanent

2.0 Licensed Psychologist IS Psychological Associate
1.0 assigned to Monarch 0.5 assigned to General Population

Contract and LTE positions from August are replaced by permanent FTE positions. Permanent staff will perform the same functions as descn'bed for temporary medical staff in August 2006.

• Interviews, offers and hiring are in process. Hired to date:

o 5 LPNs o 2 Nurse Clinician 2

o 2 Medical Assistant

a 1.5 Medical Program Assistant

o 0.5 Nurse Practitioner

0.5 PSU

per

• Increase individual out-of-cell contacts for approximately 18-20 SMU-

level inmates who are on the segregation unit or in Levell Monarch.

Add group therapy as space alloWS.

• Increase individual out-of-ceU contacts for Monarch inmates. Add

groups as space allows including cognitive behavioral, stress

management, self-esteem and interpersonal skills.

• Increase programming for Seriously Mentally III inmates housed in

General Population including groups on topics such as:

a STEPPS program

o Trauma-based treatroent

5

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH

ATTACHMENTB

I

6. 7

Modify t~e psyc;,olDgy i:1take 5creenir.g for.n (DOC-34 72).

0 Stress management o Increase individual treatment for Seriously MentaIIy IIJ inmates housed
in General Population. o Provide 2 additionaI.hours of out-of-ceIl group therapeutic activity for
each MSMU inmate per week for a total of4 hours per week. o 1,0 Licensed Psychologist from this section may change places with the
1.0 Psychology Supervisor from April 2009. If this reallocation is approved, the Psychologist Supervisor position would become available immediately and the Psychologist-Licensed position available in April 2009. • Recruitment is in process. 1 Psychology intake 3ssessme:1ts a:1d treatmen: plans. are doc'lmented on one 1 form.

6, II

Implement new Psychology Service Requests (PSRs).

o New PSRs implemented in December 2007 allow for better tracking and

documentation ofinmate requests.

o Inmates have a confidential self-referral system for requesting mental

health care,

o Inmates in segregation are able to give service requests directly to health

care or mental health staff.

o Response to inmate requests is tracked for timeliness,

4

Provide six-hour mandatory training for DOC nurses- in mental hea1th • Topics include identification of menta1 iI1ness symptoms, criteria for

topics.

mental health referral, medication training, and psychiatric presentations

of medical illness.

-~----.--

o Annual updates for new nursing staff.
--

programs and recreation.
6

-------,----

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH
ATTACHMENT B

~!A

of!lelected mental

program delivery to Cfetem:ine it addltlonal resources are needed in agency budget request for 201 0-2011. Potential areas include security escort5, mental health and AODA programming,
pennanent

• DetermIne if additional resources are needed to assure the provision of adequate care.
support for general nursing activities for GP backup for nurses assigned to segregation & Monarch during • Complete enumerated budget request by September 2008.
presented to Project Managers and Administrators better

and primary distribution of medication and documentation ofsuch within

7
------>------------

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH

ATTACHMENT B

N/A 2,9,12

Primary care physicians a~d Advanced Practice create two teams to manage medical care ofTCI patients. Psychiatric diagnoses are placed within the psychology database.

2,3,12, lnitiate Quality Improvement audit tool for medical services_

13

2, 12, 1j1'jflitiate project workgroup for computer physjcian order entry for

prescription drug orders.

3

'\'u':"s::1g staff distibcte Schedule II and 111 medkat!o~s :n ge;}eaI

All

I J::i:o£!ulation. Start \vriting new pOlicies and procedures to correspond to Tel

Standards.

• Provides for greater continuity of care and more systematic method of
manamnlt medical caseloads.
• Provides a method ofcross-checking psychiatric and psychologic.1
diagnoses.
• Tool is being imp1emented by DOC nurse coordinator with experience
as an NCCHC reviewer. • Set up a staged approach for implementation.

• Achieve more cO:1sistent docurr.e!1ta:ion ~n MRs i I

• Policies and Procedures will be complete by March 2009.

I

13 2,3,13

andHSU
softWare.
Hire 1.0 PTE

ready access to

access to a database listing current
DOC health care Quality Improvement regular monitoring, auditing, and submitting reports

inmates with mental illness.

• Recommend changes to the legislature that would allow greater flexibility in discipline and options for shorter-term sanctions for

8

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH
ATTACHMENT B

_~._ _ ~ . . -

for the following permanent FTE positions:

1.5 Psyc!lologist Supervisor

pennanent
3.75 Psychological Associate 2.0 Assigned to MSMU and Segregation 1.75 Assigned to General Population

1.0 OOA for PSU

pennanent

following pennaneDt

1.5 Medical Assistant 2

12

Initiate hiring

pennanent FTE position:

• Deliver direct services to inmates. • Increase psychiatric presence at Tel from 80 to 120 hours per week. ~ • C('Ir.duct nsvd:otropic medication training for staff. • Provide additional mental health training to Tel staff inciuding
recognizing signs and symptoms of mental illness • !v1ore bR':~pth :e\,Je-,,\, oftreatr:1ent plans for SMI inmates in :\'1ona:ch. • Wo:,k with DHFS staff to develop cr;teda for adm:ssio!1 to the off-si:e
inpatient unit. e Develcp a tT~nsit:o;: program for lnma~cs being retu:-nea from the
proposed female WRC program.
•
• Add group and individual lreabuent for SMI inmates on Monarch and in Segregation sufficient to maximize use ofavailable space by scheduling a total of 7 hours ofout-of-cell programming per week including individual treatment and additional groups noted in sections above.
• Enhance treatment planning activities for inmates with SMl in general population.
• fncrease individUal psychotherapy for inmates with a SMI in general for an avera£e of one
• File documents created by additional staff and programs in a timely manner.
• Develop methods to monitor treabuent outcomes.
Advanced Care Practitioners with patient care.
• Perfonn vital signs, EKG, and phlebotomy as trained and assigned:
• Assist with filing into the medical record. • Assist nurses with patient care. • Provide direct care and assistance with ADLs to patients housed in

9
----------

- -..-~---

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH

ATTACHMENT B

1.0 Medical Program Assistant

N/A

Ir.itiate hiring for the following pennanent FTE position:

, 0.5 :';!;fS': Practitioner

2.5, n fr.itja.~e hiring for the following permanent FTE positiO-:1s:

1.5 ~crse Clinician 2

8

Commence construction of the 45R bed female mental health unit.

-

--

-

----

• Assist with patient appointment scheduling (psychiatry, optical,

mammography, and offi;ite appointments).

• Assist with preparation ofrequired reporting documents.

• Coordinate patient transportation with security.

• Perform intake physical examinations in a timely manner.

i (.! • Provide additional medical care (chronic care, acute care, routine care). Eilf,<1.nCe patient education rclc.ted to d15er.se proCtSS and \velbess.

• Provide case management t'U'.,atients with co~ex medical issues.

1 • Improve delivery of care to patients wid,: chronic iJJness.

( .. Imp:ove education to patients with chronic ill nesses.

I

• Promote education related to wellr.ess (e.g., reinstate the Let's Get

Healthy Program).

• Provide increased number of patient care appointments.

• Improve continuity of care within general population and specifically

within the mentally ill population.

• Provide case mana~ement to patients with complex medical issues.

• E"J>e",-e<l<:olllpl~io~dl\te is February 2011. _ _

-

• Additional resources will help assure the provision ofadequate care.

treatment

•

•

expands from 6 to 10 interns.

•

space, treatment
assure to meet treatment
vacancies for permanent

10
.

~.~.

;:) ,II

IN THE UNITED STATES DIS~fiJ:bT COUR:ttt: T-It:

FOR THE EASTERN DISTRICT OF li/ISCamsIN

UNITED STATES OF AMERICA

)

)

Plaintiff,

)

)

v.

)

)

JIM DOYLE, Governor

)

of Wisconsin; RICK RAEMISCH )

Secretary, Wisconsin

)

Department of Corrections;

)

CATHY JESS, Warden, Taycheedah)

Correctional Institution,

)

)

)

Defendants.

)

--------------------------)

'08 Sf? -4 P2 :40 JOi, '( .i·F iLiPPO
CIV NO: e.ERK
08-0-0 753

ORDER

For good cause shown, and in consideration of the parties'

Joint Motion for Entry of Settlement Agreement, the Court hereby

GRANTS the Joint Motion; conditionally dismisses this action

pursuant to Fed. R. Civ. P. 41(a) (2), subject to Defendants

achieving substantial compliance with the terms of the Settlement

Agreement; and retains jurisdiction to enforce the Settlement

Agreement in the event of a dispute.

DATED this

day of ________~--' 2008.

SO ORDERED:

UNITED STATES DISTRICT COURT JUDGE

 
 IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF WISCONSIN

UNITED STATES OF AMERICA

)

)

Plaintiff,

)

)

v.

)

)

JIM DOYLE, Governor

)

of Wisconsin; RICK RAEMISCH )

Secretary, Wisconsin

)

Department of Corrections; )

CATHY JESS, Warden, Taycheedah)

Correctional Institution,

)

)

)

Defendants.

)

______________________________)

CIV NO:

ORDER

For good cause shown, and in consideration of the parties’

Joint Motion for Entry of Settlement Agreement, the Court hereby

GRANTS the Joint Motion; conditionally dismisses this action

pursuant to Fed. R. Civ. P. 41(a)(2), subject to Defendants

achieving substantial compliance with the terms of the Settlement

Agreement; and retains jurisdiction to enforce the Settlement

Agreement in the event of a dispute.

DATED this 15th day of September, 2008.

SO ORDERED:

s/ Rudolph T. Randa UNITED STATES DISTRICT COURT JUDGE

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF WISCONSIN

UNITED STATES OF AMERICA

)

)

Plaintiff,

)

)

v.

)

)

JIM DOYLE, Governor

)

of Wisconsin; RICK RAEMISCH )

Secretary, Wisconsin

)

Department of Corrections; )

CATHY JESS, Warden, Taycheedah)

Correctional Institution,

)

)

)

Defendants.

)

______________________________)

CIV NO: 08-C-753

ORDER

For good cause shown, and in consideration of the parties’

Joint Motion for Entry of Settlement Agreement, the Court hereby

GRANTS the Joint Motion; conditionally dismisses this action

pursuant to Fed. R. Civ. P. 41(a)(2), subject to Defendants

achieving substantial compliance with the terms of the Settlement

Agreement; and retains jurisdiction to enforce the Settlement

Agreement in the event of a dispute.

DATED this 15th day of September, 2008.

SO ORDERED:

s/ Rudolph T. Randa UNITED STATES DISTRICT COURT JUDGE

 
 MEMORANDUM OF AGREEMENT BETWEEN THE UNITED STATES 
 DEPARTMENT OF JUSTICE AND THE STATE OF WISCONSIN REGARDING 

CONDITIONS AT THE TAYCHEEDAH CORRECTIONAL INSTITUTION 


TABLE OF CONTENTS

I. 11. 111.
Iv.
v.
VI.
VII. VIII.

Introduction Definitions Care Required by the United States Constitution Substantive Measures for Mental Health Services Consultation Compliance and Quality Assurance Reporting Requirements and Right of Access Implementation and Termination

I. INTRODUCTION
(1) On March 25,2005, the United States Department of Justice (DOJ) notified State of Wisconsin (State) officials of its intent to investigate conditions of confinement at Taycheedah Correctional Institution (Taycheedah) pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. 51997.
(2) DOJ staff toured Taycheedah with corrections and mental health care consultants on July 18 -21 and October 6 -7,2005
(3) On May 1,2006, the United States issued a findings letter pursuant to 42 U.S.C. $1997 (a) (I), which concluded that certain conditions at Taycheedah violated the constitutionalrights of inmates confined at Taycheedah by failing to provide for their serious mental health needs and recommended remedial measures.
(4) Throughout the course of the investigation, DOJ had the complete cooperation of State officials and unfettered access to the facility, documents, and staff. The State and Taycheedah staff also demonstrated a willingness to proactively and voluntarily undertake measures to improve mental health care at Taycheedah. Consequently, the parties enter into this Memorandum of Agreement (Agreement) to use resources to support and improve mental health care at Taycheedah, rather than allocating such resources to the risks and burdens of litigation.
(5) The parties to this Agreement are the United States; the State of Wisconsin; the Wisconsin Department of Corrections (WDC); Rick Raemisch, Secretary of the Wisconsin Department of Corrections; Cathy Jess, Warden of the Taycheedah Correctional Institution; and their successors and agents. The State shall ensure that it takes necessary actions to comply with the provisions of this Agreement.
(6) No person or entity is intended to be a third-party beneficiary of the provisions of this Agreement for purposes of any civil, criminal, or administrative action, and accordingly, no person or entity may assert any claim or right as a beneficiary or protected class under this Agreement. This Agreement is not intended to impair or expand the right of any person or organization to seek relief against the State, WDC, or State officials, employees, or agents for their conduct or the conduct of WDC employees; accordingly, this Agreement does not alter legal standards governing any such claims, including those under Wisconsin law.
(7) 
 In entering into this Agreement, the State does not admit any violations of the constitutional rights of inmates confined at Taycheedah nor does it admit any violation of state or federal law. This Agreement may not be used as evidence

of liability in any other legal proceeding. However, the State remains firmly committed to improving medical and mental health care at Taycheedah.
11. DEFINITIONS
In this Agreement, the following definitions apply:
(1) "DOJ" means the United States Department of Justice, which represents the United States in this matter.
(2) "Effective date" means the date the Agreement is executed by the parties.
(3) "Implement" means to give practical effect and ensure actual fulfillment by concrete measures.
(4) "include" or "including" means "include, but not limited to" or "including, but not limited to."
( 5 ) " h a t e s " means individualsincarcerated at Taycheedah.
( 6 ) "Inmates with a serious mental illness" means:
1. Inmates with a current diagnosis of, or are in remission fiom, the following conditions:
a. Schizophrenia (all sub types) b. Delusional disorder c. Schizophreniform disorder d. Schizoaffective disorder e. Psychosis NOS f. Major depressive disorders g. Bipolar disorder 1 & 2.
2. Inmates with current or recent symptoms of the following conditions:
a. Brief psychotic disorder b. Substance induced psychotic disorder.
3. Inmates with head injury or other neurologic impairments that result in behavioral or emotional dyscontrol.
4. Inmates with a primary personality disorder that is severe, accompanied by significant functional impairment, and subject to periodic decompensation (that is, psychosis, depression, or suicidality).

5. Inmates with chronic and persistent mood or anxiety disorders or other conditions that lead to significant functional disability.
(7) "Qualified medical professional" means a physician, nurse or other medical provider currently authorized under Wisconsin state law to provide the medical services he or she undertakes to provide.
(8) "Qualified mental health professional" means a mental health care provider currently authorized under Wisconsin state law to provide the mental health services he or she undertakes to provide.
(9) "Quality assurance program" means a system of self-auditing and improvement to assess the implementation and effectiveness of remedies instituted pursuant to this Agreement, to identify deficits that may exist, to effectuate new measures to cure deficits identified, and to establish and utilize performance measures to evaluate the status of and to improve conditions of confinement and treatment services.
(10) "Security staff' means all staff, irrespective ofjob title, whose regular duties include supervision of inmates at Taycheedah.
(11) "Staff' includes salaried and hourly employees, persons providing services under contract, volunteers, interns, and any other individuals providing services at Taycheedah.
(12) "State" means officials of the State of Wisconsin, including the Wisconsin Department of Corrections, and their successors, and agents.
(13) "Taycheedah means the Taycheedah Correctional Institution, located at 751 County Road K, Fond du Lac, Wisconsin.
(14) "Train" means to sufficiently instruct in the skills addressed. Training shall incorporate instructional methods that establish minimal standards for defining staff competency.
(15) "Treatment plan" means a series of written statements specifying an inmate's particular course of therapy and the roles of qualified health care professional and qualified mental health care professional in carrying it out. This series of written statements should be in a consistent place in the inmate's files and should be easily identifiable by the viewer of the files. A treatment plan for inmates with a non-residential plan of care may be located in the treatment notes of the psychology or psychiatry staff.
(16) "WDC" means the Wisconsin Department of Corrections.

111. CARE REQUIRED BY THE UNITED STATES CONSTITUTION
The purpose of this Agreement is to protect the Constitutional rights of the inmates at Taycheedah. The terms and requirements of this Agreement are not meant to expand or contract the Constitutional duties of the State or the Constitutional rights of the inmates. The terms and requirements of this Agreement, the Taycheedah Correctional Institution Standards (Standards), which is incorporated herein as Attachment A, and the Taycheedah Correctional Institution Action Plan (Action Plan), which is incorporated herein as Attachment B, are not to be interpreted as establishingminimum constitutional standards of health care for inmates with a serious mental illness.
IV. SUBSTANTIVE MEASURES FOR MENTAL HEALTH SERVICES
In determining what constitutes adequate and timely services, the parties shall be guided by the Standards and Action Plan, which are incorporated by reference into this Agreement as Attachments A and B, respectively.
(1) Serious Mental Health Needs The State agrees to provide services to address the serious mental health needs of all inmates.
( 2 ) Psychiatrist Staffing The State shall retain sufficient psychiatrists to enable Taycheedah to address the mental health needs of all inmates with a serious mental illness.
(3) Administration of Mental Health Medications The State shall develop and implement policies, procedures, and practices to ensure that psychotropic medications are prescribed, distributed, and monitored properly and safely.
(4) Serious Mental Illness Training The State shall conduct initial and periodic training for all security staff on how to r e c o ~ i z esymptoms of serious mental illness and respond appropriately.
( 5 ) Mental Health Screening The State shall develop and implement policies, vrocedures, and practices to ensure that all inmates receive adequate initial mental health screening by appropriately trained staff, including nursing staff, within twenty-four (24) hours after intake.
( 6 ) Mental Health Assessment and Referral The State shall develop and implement policies, procedures, and practices to ensure mental health assessments by qualified mental health professional for those inmates whose mental health histories or whose responses to initial screening questions indicate a need for such an assessment. The State shall ensure treatment for inmates with a serious mental illness, including for specialty care and regularly scheduled visits with qualified mental health professionals.

(7) Mental Health Treatment Plans The State shall ensure that a qualified mental health professional prepares and updates an individual mental health treatment plan for each inmate who requires mental health services. The State also shall ensure that the plan is implemented. Implementation of and any changes to the plan shall be documented in the inmate's medical/mental health record.
(8) Crisis Services The State shall ensure an array of crisis services to manage the psychiatric emergencies that occur among Taycheedah inmates. Inmates in administrative segregation or observation status shall have access to the array of crisis services which are available to other inmates. Inmates shall have access to in-patient psychiatric care when clinically appropriate.
(9) Treatment for Inmates with a Serious Mental Illness The State shall ensure therapy, counseling, and other mental health programs for all inmates with a serious mental illness. The State shall ensure that inmates who are being treated with psychotropic medications are seen regularly by a physician or other licensed prescriber to monitor responses and potential reactions to those medications.
(10) Review of Disciplinary Charges for Inmates with a Serious Mental Illness The State shall ensure that disciplinary char-ges ag-ainst inmates with a serious mental illness are reviewed by a qualified mental health professional (a) to determine the extent to which the charg-e is related to a serious mental illness; (b) to ensure that inmates who commit infractions resulting from a serious mental illness are not punished for behavior caused by the serious mental illness; and (c) to ensure that an inmate's serious mental illness is used as a mitigating factor, as appropriate, when punishment is imposed on inmates with a serious mental illness.
(11) or Observation Status The State shall implement policies, procedures, and practices to ensure that inmates with a serious mental illness who are in segregation receive treatment.
(12) Medical and Mental Health Record System The State shall develop and implement a record-keeping system in which all clinically appropriate documents for the treatment of an inmate with a serious mental illness are readily available to each clinician. The record keeping system shall document assessments and treatment. Medical and mental health care staff shall have access to documents that are relevant to the care and treatment of inmates.
(13) medication and Laboratow Orders The State shall develop and implement policies, procedures, and practices to ensure timely responses to orders for mental health medications and laboratory tests. Such policies, procedures, and practices shall be periodically evaluated to ensure that delays in the receipt of

medications and laboratory tests are prevented. In addition, files of inmates shall contain current and accurate information regarding medication changes.
V. CONSULTATION
(1) Consultant Selection The parties have jointly selected Jeffrey L. Metzner, M.D. to serve as the parties' jointly appointed consultant (Consultant). Should the position become vacant, the parties will agree on a replacement. Neither party, nor any employee or agent of either party, shall have any supervisory authority over the Consultant's activities, reports, findings, or recommendations. The cost for the Consultant's fees and expenses shall be borne by the State. The selection of the Consultant shall be conducted solely pursuant to the procedures set forth in this Agreement, and will not be governed by any formal or legal procurement requirements. The Consultant may be terminated only for good cause, unrelated to the Consultant's findings or recommendations, and only with prior notice to, and approval of, both parties.
(2) Consultant Qualifications The Consultant shall have experience and 
 education or training- in the field of correctional mental health care. The 
 Consultant may also have education, training, or experience in systems of accountability or quality assurance.
(3) Consultant Access The Consultant shall have full and complete access to Taycheedah, all facility and WDC records, staff, and inmates. The State shall direct all employees to cooperate fully with the Consultant. All non-public information obtained by the Consultant shall be maintained in a confidential manner.
(4) Consultant Ex Parte Communications The Consultant shall be permitted to initiate and receive exparte communications.
( 5 ) Limitations on Public Disclosures bv Consultant Except as required or authorized by the terms of this Agreement or the parties acting together, the Consultant shall not make any public statements or issue findings with regard to any act or omission of the State or its agents, representatives or employees, or disclose non-public information provided to the Consultant pursuant to this Agreement. Unless such conflict is waived by the parties, the Consultant shall not accept employment or provide consulting services that would present a conflict of interest with the Consultant's responsibilities under this Agreement, including being retained (on a paid or unpaid basis) by any current or future litigant or claimant, or such litigant's or claimant's attorney, in connection with a claim or suit against the State or its departments, oEcers, agents or employees. The Consultant is not a state or local agency or an agent thereof, and accordingly the records maintained by the Consultant shall not be deemed public records subject to public inspection. Neither the Consultant

nor any person or entity hired or otherwise retained by the Consultant to assist in furthering any provision of this Agreement shall be liable for any claim, lawsuit or demand arising out of the Consultant's performance pursuant to this Agreement. This paragraph does not apply to any proceeding before a court related to performance of contracts or subcontracts for monitoring this Agreement.

(6) Standards and Action Plan The Standards and Action Plan, which are incorporated into this Agreement as Attachments A and B respectively, will have been developed in consultation with the Consultant named above prior to signing the Agreement. The Standards and Action Plan will be implemented
over a four (4) year period to be computed from the date that this Agreement is executed by the parties.

(7) Consultant Reports The Consultant shall provide the parties with detailed reports describing the steps taken by the State to implement this Agreement, including the Standards and Action Plan, and evaluate the extent to which the State has complied with the provisions of the Agreement, including the Standards and Action Plan. The Consultant shall issue the initial report within four (4) months of the effective date of this Agreement, and issue subsequent reports every six (6) months thereafter, unless both parties otherwise agree in writing. The reports shall be provided to the parties in draft form for comment at least two (2) weeks prior to their issuance. These reports shall be written with due regard for the interest of the State in protecting against disclosure of non-public information. In each report, the Consultant shall evaluate the status of compliance for each provision of the Standards and Action Plan, using the following standards: (a) substantial compliance, (b) partial compliance, (c) beginning compliance, and (d) non-compliance. In order to assess compliance, the Consultant shall review a sufficient number of pertinent documents to accurately assess current conditions; interview all pertinent staff; and interview a sufficient number of inmates to accurately assess current conditions. The Consultant shall be responsible for independently verifying representations from the State regarding progress toward compliance, examining supporting documentation where applicable. Each Consultant's report shall describe the steps taken to analyze conditions and assess compliance, including documents reviewed and individuals interviewed, and the factual basis for each of the Consultant's findings. Each of the Consultant's reports shall include specific recommendations for actions needed to bring the State into compliance with the Standards and Action Plan.

VI. COMPLIANCE AND QUALITY ASSURANCE

(1) Document Development and Revision The State shall revise or develop

policies,

procedures,
A

protocols,

trainin-g

curricula,

and

practices

to

ensure

that

they are consistent with, incorporate, address, and implement the provisions of

this Agreement, including the Standards and Plan of Action. The State shall

revise or develop as necessary other written documents to effectuate the provisions of this Agreement. The State shall consult with the Consultant in the development or revision of policies and procedures prior to their promulgation. The State shall provide initial and ongoing training to all Taycheedah staff with respect to newly implemented or revised policies and procedures. The State shall document employee training in the new or revised policies and procedures.
Qualitv Assurance Promam The State shall develop and implement an adequate Quality Assurance Program for Taycheedah's provision of mental health care services for inmates with a serious mental illness. The program shall include periodic audits and documentation of the status of compliance with the terms of this Agreement.
Corrective Action The State shall develop and implement policies and procedures to address problems that are uncovered during the course of quality assurance activities. The State shall develop and implement corrective action to address these problems.
Technical Assistance As appropriate, the State shall request and receive technical assistance from the Consultant. Further, DOJ will assist the State in identifying additional financial or technical resources to supplement those resources currently allocated to Taycheedah.
VII. REPORTING REQUIREMENTS AND RIGHT OF ACCESS
(1) DOJ Access The DOJ shall have 111and complete access to Taycheedah, inmates, and WDC staff, and all documents relating to the topics addressed in this Agreement. The DOJ shall have the right to conduct confidential interviews with staff, inmates, and former inmates. All non-public information obtained by the DOJ shall be maintained in a confidential manner.
State Resvonse to DOJ Questions The State shall provide written answers to written questions from the DOJ concerning the State's compliance with this Agreement within thirty (30) days of receipt of the written questions.
State Documentation of Comuliance The State shall maintain sufficient records to document its compliance with all of the recluirements of this
A 

Agreement, including the Standards and the Action Plan which are incorporated by reference into the Agreement as Attachments A and B, respectively. The State also shall maintain any and all records required by or developed under this Agreement for the duration of the Agreement.
State ComulianceReports Every six (6) months, the State shall provide the Consultant and the US DOJ with status reports detailing the State's compliance with this Agreement, including the Standards and the Action Plan.

( 5 ) Privileges The State shall not assert physicianlpatient or psychotherapist/patient privileges with respect to any information requested under this Agreement.
VIII. IMPLEMENTATION AND TERMINATION
(1) Construction of Ameement Upon execution of this Agreement, the DOJ shall file a complaint in the United States District Court for the Eastern District of Wisconsin, and contemporaneously file a Joint Motion for the Conditional Dismissal of the complaint pursuant to Federal Rule of Civil Procedure 41(a)(2). The complaint will be based on its May 1,2006 findings letter, which was issued pursuant to 42 U.S.C. § 1997 (a) (1). A copy of this Agreement shall be attached to the Joint Motion for the Conditional Dismissal, and that motion shall: (a) request that the court place the case on its inactive docket; (b) request that the court retain jurisdiction over the case until a final dismissal is entered; and (c) request that the court dismiss the complaint upon the State's substantial compliance with the terms of this Agreement or the passage of four (4) years from the date of its filing. This provision shall not be interpreted to provide for any judicial supervision of the actions of the parties unde;the ~grekment.should the DOJ believe that the State has not substantially complied with the terms of this Agreement after a period of three (3) years and nine (9) months, the DOJ's sole remedy shall be reinstatement of its complaint. The parties agree that any such complaint shall not include any breach of contract claims for violations of the Agreement, including the Standards and Action Plan.
(2)
 Information to Employees The State shall ensure that all current and future relevant WDC employees are informed of the terms of this Agreement as those terms affect their carrying out their duties and responsibilities.
(3) Agreement Coordinator Within thirty (30) days of the execution of the Agreement the State shall designate an Agreement Coordinator to coordinate and oversee implementation of and compliance with this Agreement. The Agreement Coordinator will serve as a liaison between the State, the Consultant, and DOJ.
(4) Termination This Agreement shall terminate four (4) years from the date it is executed by the parties. The Agreement may end earlier than four (4) years from the date it is signed by the parties if the State has substantially complied with all substantive provisions of the Agreement. The burden shall be on the State to demonstrate substantial compliance with all substantive provisions of the Agreement. Noncompliance with mere technicalities, or temporary failure to comply during a period of otherwise sustained compliance will not constitute failure to maintain substantial compliance. At the same time,

temporary compliance during a period of sustained noncompliance shall not constitute substantial compliance.
(5) Successors This Agreement shall be binding on all successors, assignees, employees, and agents of the State.
( 6 ) m e "Notice" under this Agreement shall be provided by courier or overnight delivery and shall be provided to the Governor or the State and to the Attorney General of the State.
(7) Unforeseen Delay If any unforeseen circumstance occurs which causes a failure to timely carry out any requirements of this Agreement, the State shall notify the DOJ in writing within twenty (20) calendar days of the time that the State becomes aware of the unforeseen circumstance and its impact on the State's ability to perform under the Agreement. The notice shall describe the cause of the failure to perform and the measures taken to prevent or minimize the failure. The State shall implement all reasonable measures to avoid or minimize any such failure.
(8) Non-Retaliation No person reporting conditions which may constitute a violation of laws or the Constitution of the United States or this Agreement shall be subjected to retaliation in any manner for so reporting. See 42 U.S.C.
3 1997d.
(9) Subheadings All subheadings in this Agreement are written for the convenience of location individual provisions. If questions arise as to the meaning of individual provisions, the parties shall follow the text of each provision.
(10) Amendment The parties may make written amendments to any portion of this agreement if all parties to the Agreement so agree.

FOR THE UNITED STATES: 


STEVEN M. BISKUPIC United States Attorney Eastern District of Wisconsin
MATTHEW V. RICHMOND Assistant United States Attorney Eastern District of Wisconsin 517 East Wisconsin Avenue Milwaukee, WI 53202

GRACE C. BECKER Acting Assistant Attorney General Civil Rights Division
SHANETTA Y. CUTLAR Chief Special Litigation Section
DANIEL H. WEISS Deputy Chief Special Litigation Section
LAURA L. COON KENYAN R. McDUFFIE Trial Attorneys U.S. Department of Justice Civil Rights Division Special Litigation Section 950 Pennsylvania Avenue, N.W. Washington, D.C. 20530

FOR THE STATE OF WISCONSIN: 

%CK RAEMISCH Secretary Wisconsin Department of Corrections
&TR&$ R. ANDERSON
Chief Legal Counsel Wisconsin Department of Corrections

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH
ATTACHMENT A
TCI STANDARDS Plan to Address US DOJ Concerns
1. Serious Mental Health Needs: The state agrees to provide services to address the serious mental health needs of all inmates.
See specific standards described below.
2. Psychiatric Treatment: The state shall retain sufficient psychiatrists to enable TCI to address the mental health needs of inmates with serious mental illness. The state shall ensure that inmates who are being treated with psychotropic medications are seen regularly by a physician o r other licensed prescriber to monitor responses and potential reaetions to those medications.
Psychiatrists shall have appropriate medical autonomy for clinical decisions. The state shall retain licensed and qualified psychiatrists for a sufficient number of hours per week to perform at least the following duties:
Is See patients. (See Section 5 for intake assessment time frames.) B Prescribe and monitor psychotropic medication. 6%1 Participate in the development of comprehensive treatment plans for inmates with an
SMU level of care (Special Management Unit level of care which is also known as residential level of care). mi Review charts in the context of rendering mental health care. Review and respond to the results of diagnostic and laboratoly tests. Be familiar with and follow policies, procedures, and protocols. S Collaborate with psychology staff to render appropriate care for patients. Communicate problems and resource needs to the Psychiatrist Supervisor, Psychology Supervisor, Health Services Unit Manager, or Warden as needed.
3. Administration of Mental Health Medications: The state shall develop and implement policies, procedures, and practices to ensure that psychotropic medications are prescribed, distributed, and monitored properly and safely.
Psychotropic medication in the Monarch and segregation units will be administered by qualified medical professionals or other health care personnel qualified under Wisconsin state law to administer medications. These staff will consistently implement policies and procedures to monitor for adverse reactions and potential side effects and document the administration of such medications in Medication Records (MRs).
Psychotropic medication in general population units will be distributed by appropriately trained staff. These staff will consistently implement policies and procedures to monitor for adverse reactions and potential side effects and document the administration of such medications in MRS.

Documentation in the MRs will include a clear and consistent indication of whether the inmate received, refi~sedor otherwise missed any doses of medication.
A qualified medical professional shall review MRs on a regular basis to determine whether policies and procedures are being followed. Correctional staff that administer or distribute psychotropic medication will receive medication administration training as part of new employee orientation and at least annually thereafter.
4. Serious mental illness training: The state shall conduct initial and periodic training for all security staff on how to recognize symptoms of serious mental illness and respond appropriately.
I Eight (8) hours of mental health training will be provided to security staff in preservice training at the onset of employment. Training shall include suicide prevention, symptoms of mental illness and proper response to inmates with mental health problems.
I At least three (3) hours of annual mental health training will be provided to security staff. Training shall include suicide prevention, symptoms of mental illness and proper response to inmates with mental health problems.
5. Mental Health Screening: The state shall develop and implement policies, procedures, and practices to ensure that all inmates receive adequate initial mental health screening by appropriately trained staff.
I Nursing staff will conduct on the day of intake an initial health screening interview, which includes whether the inmate has a history of mental illness, whether the inmate is currently receiving or has received psychotropic medication, and whether the inmate has attempted suicide or has suicidal propensities. Documentation of the screening shall be maintained in the appropriate medical record.
I Incoming inmates who are in need of emergency mental health services shall receive such care immediately after intake.
IDuring business hours, emergency services shall be provided by on-site PSU clinical staff andlor psychiatry staff.
B During off-hours, emergency services shall be provided by on-site HSU staff, on-call PSU clinical staff and an on-call physician. PSU clinical staff shall be physically available to the institution when necessary. Consultation with the treating psychiatrist or Psychiatry Director will be available.
I Inmates who have been on psychotropic medication prior to intake will be assessed by a psychiatrist as to the need to continue those medications no later than ten (10) days after intake or sooner if clinically appropriate. Inmates shall remain on previously prescribed psychotropic medication pending psychiatrist assessment. Incoming inmates who require resumption of psychotropic medication shall be seen by a psychiatrist as soon as clinically appropriate.
I Licensed prescribers shall review and sign medication orders within twenty four (24) 
 hours of intake from a facility outside DOC. 


6. Mental Health Assessment and Referral: The state shall develop and implement policies, procedures, and practices to ensure mental health assessments by qualified mental health professionals for those inmates whose mental health histories or whose responses to initial screening questions indicate a need for such an assessment. The state shall ensure treatment for inmates with a serious mental illness, including for specialty care and regularly scheduled visits with qualified mental health professionals.
Psychological Services clinical staff will conduct mental health assessments of inmates within seventy two (72) hours of intake from outside DOC. Assessments will include:
Ea Mental health screening and assessment as outlined on form DOC-3472. Assignment of a provisional diagnosis and mental health code.
B Referral for psychiatric or medical care if needed. a An initial treatment plan for those inmates who require additional services. The plan
will address identified problems, goals, follow-up care, program and specialty referrals, and any need for special housing placement.
B At times other than intake, Psychological Services clinical staff will conduct a mental health assessment within seventy two (72) hours of the time such a need is recognized.
Psychological Services clinical staff will conduct file reviews on all inmates on the mental health caseload transferred to TCI from another institution within five (5) working days of transfer.
B Inmates shall have access to a confidential self-referral system by which they may request non-emergency mental health care without revealing the substance of their request to security staff.
81 Psychology Service Requests will be collected from housing units daily and forwarded to PSU clinical staff during the work week and to HSU nursing staff on weekends and holidays. Triage of these requests shall occur within twenty four (24) hours of receipt. Urgent needs will be addressed immediately. For non-urgent requests, an appointment or written response shall occur within three (3) working days of receipt. Health Service Requests will be collected &om the housing units on a daily basis and forwarded to HSU nursing staff. Triage of these requests shall occur within twenty four (24) hours of receipt. Inmates in segregation may give Psychology Service Requests or Health Service Requests directly to health care staff on a daily basis.
7. Mental Health Treatment plans: The state shall ensure that a qualified mental health professional prepares and updates an individual mental health treatment plan for each inmate who requires mental health services. The state shall also ensure that the plan is implemented. Implementation of any changes to the plan shall he documented in the inmate's medicaVmenta1health record.
Comprehensive treatment plans will be developed and implemented for inmates requiring an SMU level of care. These treatment plans will be created and reviewed by a multidisciplinary team at least every six (6) months and changes to the plan documented in the PSU record.

Outpatient treatment plans will be created and updated annually for inmates who require outpatient-level mental health services.
8. Crisis Services: The state shall ensure an array of crisis services to manage the psychiatric emergencies that occur among TCI inmates. Inmates in segregation or observation status shall have access to the array of crisis services which are available to other inmates. Inmate shall have access to inpatient psychiatric care when clinically appropriate.
H Inmates, including those in segregation and observation status, will have access to an array of crisis services that are timely and clinically appropriate. These will include:
Crisis intervention contacts with PSU clinical staff. E Placement within Clinical Observation. (See Section 11 for services while in Clinical
Observation.) 
 BB Placement within Monarch Unit for SMU-level care. 
 B Psychiatric referral and intervention. 

Emergency room care. 81 Inpatient psychiatric care (currently Winnebago Mental Health Institution; expanding
to the Wisconsin Resource Center in 201 1). I 24-hour on-call sewices via PSU clinical staff.
9. Treatment for inmates with a serious mental illness: The state shall ensure therapy, counseling, and other mental health programs for all inmates with a serious mental illness.
Monarch inmates with a serious mental illness shall be provided with a minimum of ten (10) hours per week of out-of-cell structured therapeutic activity, including one (1) hour per week of individual clinical contact with a PSU staff member. In order to reliably achieve ten (10) hours per week, twelve (12) to fifteen (15) hours per week shall be scheduled. Out-of-cell structured therapeutic activities may include:
E8 Psycho-educational groups (e.g., social skills development, stress management, medication education, problem solving).
W Guided activities (e.g., structured recreation, community service crafts, gardening) a Education (e.g., special education, ABE, GED, voluntaq classes. @ Work assignments.
Religious activities. B Psychiatry appointments. IPsychotherapy groups (e.g., cognitive behavioral groups, trauma-specific groups,
dual diagnosis groups). 
 IIndividual psychotherapy. 

Crisis intervention. 
 ag Release planning activities. 

Unstructured day space and recreation time will not be counted. 

General Population inmates with a serious mental illness shall be provided with the following services:
Psychiatry appointments consistent with the provisions of Section 2

BI Regular and periodic individual contacts with PSU clinical staff at a frequency determined by clinical need. Staffing for this purpose shall be sufficient to provide an average of one routine contact every four (4) weeks for the population of inmates with serious mental illness.
E Mental health group therapy as determined by clinical need. Staffing for this purpose shall be sufficient to provide an average of four (4) 12-week therapy groups per year for the population of inmates with serious mental illness.
General Population inmates on the MH caseload but without serious mental illness shall be provided with the following services:
B Psychiatry appointments consistent with the provisions of Section 2. @ Regular and periodic individual contacts with PSU clinical staff at a frequency
determined by clinical need. Staffing for this purpose shall be sufficient to provide an average of one (1) routine contact every six (6) weeks for this population. B Mental health group therapy as determined by clinical need. Staffing for this purpose shall he sufficient to provide an average of two (2) 12-week therapy groups per year for the population of inmates with serious mental illness.
There shall be adequate space and facilities to conduct treatment and provide programs listed in this document.
10. Review of disciplinary charges for inmates with a serious mental illness: The state shall ensure that disciplinary charges against inmates with a serious mental illness are reviewed by a qualified mental health professional (a) to determine the extent to which the charge is related to a serious mental illness; (h) to ensure that inmates who commit infractions resulting from a serious mental illness are not punished for behavior caused by the serious mental illness; and (c) to ensure that an inmate's serious mental illness is used a s a mitigating factor, a s appropriate, when punishment is imposed on inmates with a serious mental illness.
Disciplinary charges for inmates with a serious mental illness who receive major conduct reports will be reviewed by PSU clinical staff. Written input will be provided to the Security Director or designee to address mental health factors that may have affected the inmate's responsibility or may represent mitigating factors.
11. Procedure for inmates with a serious mental illness, who are in segregation o r observation status: the state shall implement policies, procedures, and practices to ensure that inmates with a serious mental illness who are in segregation receive treatment.
I PSU clinical staff shall evaluate all segregated inmates who are on the mental health caseload within one (1) working day of placement in segregation. This evaluation shall include an assessment of the potential effects of segregation on the inmate's mental health and an assessment of whether continued segregation or graduated alternatives are appropriate for the inmate.
Segregated inmates with an SMU level of care shall be provided with a minimum of ten (10) hours per week of out-of-cell struchued therapeutic activity that includes at least one (1) hour per week of individual clinical contact. In order to reliably achieve ten (10)

hours of activity per week, twelve (12) to fifteen (15) hours per week shall be scheduled. (See Section 9 for potential activities.)
Segregated inmates on the MH caseload but without serious mental illness shall be provided with the following services:
Psychiatry appointments consistent with the provisions of Section 2. rn A minimum of two (2) hours per week of out-of-cell structured therapeutic activity.
(See Section 9 for potential activities.) At least one (1) cell-side contact with PSU clinical staff each week with the opportunity to request and receive out-of-cell contact.
Inmates in clinical observation status shall be provided with the following services:
Psychiatry appointments consistent with the provisions of Section 2. KS An initial evaluation by PSU clinical staff within twenty four (24) hours of placement
and daily thereafter. Evaluations shall address the continued need for placement, level of allowed property, and the need for psychiatric services or an SMU level of care. rn Nursing rounds once per shift while in observation status. A minimum of two (2) additional PSU contacts within seven (7) days of release from observation status.
Inmates in segregation or Monarch who require an SMU-level of care shall be provided with at least ten (10) hours of unstructured recreation each week.
12. Medical and mental health record system: The state shall develop and implement a record-keeping system in which all clinically appropriate documents for the treatment of an inmate with a serious mental illness are readily available to each clinician. The record keeping system shall document assessments and treatment. Medical and mental health care staff shall have access to documents that are relevant to the care and treatment of inmates.
Documents will be filed in the appropriate chart in a timely manner.
Psychological Services files will maintain a complete record of mental health documents including clinical contacts, inmate requests for service, psychiatric dictations, group notes, and relevant referrals.
Health Service Unit files will contain psychiatry records. Relevant PSU documents, including screening interviews, clinical contacts, and psychological reports, will be copied to the HSU chart for review by psychiatrists and other medical staff.
13. Medication and laboratory orders: The state shall develop and implement policies, procedures, and practices to ensure timely responses to orders for mental health medication and laboratory tests. Such policies, procedures, and practices shall be periodically evaluated to ensure that delays in the receipt of medications and laboratory tests are prevented. In addition, files of inmates shall contain current and accurate information regarding medication changes.

Routine psychotropic medication orders will be processed and signed-off by nursing staff within twenty four (24) hours of being written. Such medications will be received in accordance with the priority code assigned by the prescriber.
Urgent psychotropic mediation orders (identified in the priority code by the prescriber) will be processed and signed-off by nursing staff the same day. Such medications will be received by the inmate on the same day.
Stat psychotropic medication orders (identified in the priority code by the prescriber) will be processed and signed-off by nursing staff within one hour of receipt or sooner if clinically indicated. Such medications will he received by the inmate within one (1) hour or sooner if clinically indicated.
For patients who refuse or miss psychotropic medications for three (3) consecutive days (excluding PRN medication), staff responsible for distributing or administering the medication will notify HSU nursing staff. HSU nursing staff will either interview the inmate to determine the reason for refusal or refer the inmate to the psychiatrist in a clinically appropriate time frame.
Routine laboratory orders will be processed and signed-off by nursing staff within twenty four (24) hours of being written. Specimens will be obtained within the time frame specified by the prescriber.
Stat laboratow orders will be processed and signed-off by nursing staff within one (1) hour of receipt or sooner if clinically indicated. Specimens will be collected and processed within the time frame specified by the prescriber.
I Critical laboratory results will be relayed to a practitioner immediately

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH

ATTACHMENT B
I TCI ~ctiorrplan

I I Section Aetios.

I Benchmarks I N ~ t e s

_-

1

November 2004

. I I Add 8 hours of mental Iicnlth and suicide pre\ention training to otlicer A11 inctr oiliccrs rccci\e tmininr-: in mental hcalth topics and suicide

I pre-service academy.

prevention.

I
I U .A
NIA

--

February 2006

I I . Ke3llocate 5.0 I:I'L Corrcctionnl Oflicers to TCI for ~nedicnl

Inm2tci rel>rr~.dfor off-site 3~ p-pointmcnts are scheduled and transponed

I I transports.

in a timely manner.

I Reallocate 0.5 FTE Physician to TCI.

I Inmates have medical needs addressed in a timely manner.

of admission (formerly 6-10 weeks). lnmates who require resumption of medication are seen as soon as clinically appropriate. Achieve closer follow-up of patients on the psychiatry caseload.

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH
ATTACHMENT B

Monarch, and Segregation Units:

Nurse Clinician 2

4.5

Lic. Prac. Nurse

12.6

Office Operations Associate

0.5

Program Assistants for HSU

2.5

Medical Assistant 2

1.5

transcription and processing of medication orders (medications started within 72 hours, or sooner if needed). There is more consistent scheduling of mental health and health care
Health care personnel distribute medication in the Monarch and Segregation units, with more accurate documentation in MRS. Health care staff collect Health Service Requests in the Monarch and
.Segregation units and see patients within 24-48 hours ofrequest. There are individual nursing care plans for all Monarch patients. Nurses participate in Monarch and segregation MH treatment plans. try, psychology, and health care occurs within 1-2 days of receipt. cted within 3 workin-r day.s of intake and within 1 working day when needed. All inmates in segregation are reviewed by PSU staff within 1- 2 working days of placement, and then seen weekly for rounds. Psychologists provide an average of 2 hours per week of mental health programming for SMU patients in Monarch. Topics include: o STEPPS program o Trauma-based treatment o Cognitive-behavioral therapy for depression o Art therapy o Anger management o Parenting o Cognitive interventions o Problem solving o Stress management o MH education o Life skills In addition, Monarch staff provide an average of 2-3 hours per week of education, structured recreation, religious activities, and meetings with social workers, psychiahists, and psychologists.

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH

ATTACHMENT B

Inmates assigned to the Dual Diagnosis AODA program average more

.than 15 hours of treatment and programming per week. PSU staff regularly participate in the segregation review committee. There is improved collaboration between TCI and Winnebago providers,

2

I 1/ Increase Monarch Unit psychiatry time to 16 hours per week (out of 64

including amonthly meeting lo coordinate care of shared Closer psychiatry monitoring for inmates with SMU-level of care.

I

I total hours per week).

I

1

IN/\ . ...

Decembg 2OU6

Dr. Mctzner conducrs 3 s i t ~\ i s , ~10 TCI and provides technicill

' Completed

I assistance regarding mental health care and Gaffing levels.

-
--

Jonrtary 2007

All

I Governor I)ovlc's Ijudxet proposes 33.75 positions at I C I i i r menlsl I A.n.n r o \ d Ocldher 2007

health, nursing, and support staff. Some of these proposed staff are

intended to replace contract and LTE staff that were added in August

. .
for a freestanding, 45-bed mental health treatment facility for female inmates. Staffing would include approximately 100 FTEs.

. .
opening date is February 201 1.

- 7
I

2009 year. Pre-doctoral interns provide additional staff resources to meet treatment and programming needs and assist in filling vacancies for permanent staff positions upon completion of internship.

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH
ATTACHMENT B

status.

per shift. PSU staff meets with inmates in clinical observation each working day and provides therapeutic activities. PSU staffhas phone contact with nursing or security staff on weekends or holidays.

staff. Acquire furniture I materials for group programming in segregation. Group programming topics include:
Stress Management and Relaxation Life Skills Anger Management Self-Esteem Coping strategies Basic Substance Abuse Problem Solving Relationships Social Skills Begin regular review of MRs by a qualified medical professional.
Initiate planning for three construction projects on the grounds of TCI. Monarch Annex will contain staff offices and program space for individual and group treatment. Segregation Annex will contain staff offices, program space for individual and group treatment, and indoor recreation. Outdoor recreation for the segregation unit will proiide socialization opportunities for inmates located in separate recreation spaces.

Furniture and materials were purchased, allowing TCI to provide an average of 4-5 hours of out-of-cell programming weekly to 18-20 SMUlevel inmates in segregation and Wing 1 Monarch.
.Quarterly reviews by a Nursing Supervisor to ensure proper documentation of medication administration. There will be sufficient space for staffoffices. There will be sufficient space for adequate treatment, programming and recreation.

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH

ATTACHMENT B

Increase TCI psychiatry hours to 80 hours per week.
Establish a Mental Health Quality AssuranceIQuality Improvement team.

There is sufficient psychiatry time to meet the needs of those with serious mental illness.
.There is more timely assessment and monitoring of inmates on psychotropic medication. There is increased collaboration between Monarch psychiatrist and chief psychologist. Team meets monthly to assess progress on TCI Action Plan. Develop and implement additional ongoing quality improvement activities. QAiQI program and processes are in development.

Allocate the following permanent FT'E positions per the 2007-2009 budget:
2.0 Nurse Clinician 2 9.5 LPNs 2.0 Medical Assistant 2 2.5 Medical Program Assistant 0.5 Nurse Practitioner 0.5 OOA for PSU
Initiate hiring for the following permanent FTE positions per the 20072009 budget:
2.0 Licensed Psychologist 1.5 Psychological Associate
1.0 assigned to Monarch 0.5 assigned to General Population

Contract and LTE positions from August 2006 will be phased out as they are replaced by permanent FTE positions. Permanent staff will perform the same functions as described for temporary medical staff in August 2006.
Interviews, offers and hiring are in process. Hired to date: o 5 LPNs o 2 Nurse Clinician 2 o 2 Medical Assistant o 1.5 Medical Program Assistant o 0.5 Nurse Practitioner o 0.5 PSU OOA
lncrease individual out-of-cell contacts for a.~.uroximatelv18-20 SMU-
level inmates who are on the segregation unit or in Level I Monarch. Add group therapy as space allows. lncrease individual out-of-cell contacts for Monarch inmates. Add groups as space allows including cognitive behavioral, stress management, self-esteem and interpersonal skills. lncrease programming for Seriously Mentally 111inmates housed in General Population including groups on topics such as:
o STEPPS program o Trauma-based treatment o Cognitive-behavioral therapy for depression

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH

ATTACHMENT B

Modify the psychology intake screening form (DOC-3472).

o Stress management Increase individual treatment for Seriously Mentally I11 inmates housed in General Population. Provide 2 additional hours of out-of-cell group therapeutic activity for each MSMU inmate per week for a total of 4 hours per week. 1.0 Licensed Psychologist from this section may change places with the 1.0 Psychology Supervisor from April 2009. If this reallocation is approved, the Psychologist Supervisor position would become available immediately and the Psychologist-Licensed position available in April 2009. Recruitment is in process. Psychology intake assessments and treatment plans are documented on one form.

Implement new Psychology Service Requests (PSRs).

New PSRs implemented in December 2007 allow for better tracking and

documentation of inmate requests.

Inmates have a confidential self-referral system for requesting mental

health care.

I .Inmates in segregation are able to give service requests directly to health care or mental health staff. Response to inmate requests is tracked for timeliness.

4

I Provide six-hour mandatory training for DOC nurses in mental health / Tovics include identification of mental illness s.vmv.toms. criteria for

topics.

mental health referral, medication training, and

presentations

of medical illness.

Annual updates for new nursing staff.

8

/ / . FY 2008 Quurter 3: Juttuary, Februury, March 2008

Work wlrh UHFS st;11'itodc\elop 3 45-bed ie~naleacute care r;lcilit) approved in the 2007-2009 budget.

Idc~lri.ry.pru.ie~m.~anagement leaders and create tareeted work -crou.ps. First phase of program development to continue until September 2008.

3

/ Increase frequency of Medication Record (MR) audits.

/ Audits occur monthly by a Nursing Supervisor and comprise 10% of

charts.

Continue planning for additional permanent space for offices,

Architects begin project study for Monarch and Segregation Annexes

programs and recreation.

Begin planning for renovation of current structures for additional office

space to accommodate new staff.

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH
ATTACHMENT B

I

I

/ process for inmates with serious mental illness.
1 Pilot new process for psychology input for self-harm attempts.

1

NIA

1 / Start monthly reporting of selected mental health Quality Improvement Benchmarks will be expanded over time.

8

13

2, 13

!

.

12
3
12, 13 12

needed in agency budget request for 2010-201 I . Potential areas include security escorts, mental health and AODA programming, occupational therapy and recreation therapy. Initiate hiring for the following permanent FTE position:

I.0- Uurse Cliniciiin Z Submit building-~prn~ i-cr requesti ;I$ piin of ir:irc u;lpltal hurlget requeit.
I This will include Monarch and segregation ~ n n e x e sr,ecreation space, and renovation of current structures for additional ofice space.
I Continue work with DHFS staff to develop a 45-bed female acute care
facility approved in the 2007-2009 budget.
Pharmacy services move to a newly renovated building (16,000 sq. ft.
versus 3800 sq. ft.).
\Hire I .O FTE Psychiatry Director. I-l.el-oc.ate mcdicdtion rodm into J larger sp;lcc. Create two ildditi,~nillotticc; tor p,!chiatrists in Ciuirer bu~lilir~;.

Relocate storage of medical records of Monarch patients to the

Monarch Unit.

Begin two-hour annual training for TCI officers in medication

distrihution

and
~~~~~~

side ~

e~f~f~e~c~ ts~.-

1 Implement digital radiography.

I Start project to remove unnecessary material from medical records

I statewide.

adequate care.

Continue support for general nursing activities for GP inmates and

provide backup for nurses assigned to segregation & Monarch during

I -. \acarions and nbscnces.

..

1 . - Conlplctc c11u11ier~rtb.dudrzr request by. Se.ptcnibcr 2008.

- / Proeram olan will be resented to Proiect Manaeers and Administrators in September 2008. '
Allows for more streamlined workflow, better operational service, and improved efficiencies. Provides closer oversight of and consultation to DOC psychiatrists.
Prov~dubgrexer 5ruru:r. sp~cra.nd allows @r_br.n~rp~g~nizntion. Crc~tespsychi:~rricuitice i p ~ c closer to the lie~lthServicei Unit, allowing for closer coordination of services. Easier access to Monarch medical records for psychiatrists and primary care practitioners. Improve distribution of medication and documentation of such within .M..R..s-.
1 Turnaround time for radiology reports is less than 24 hours. / TCI is the first institution within the project. 1 Relevant records should be easier to access by practitioners.

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH

ATTACHMENT B

NIA

Primary care physicians and Advanced Practice create two teams to

Provides for greater continuity of care and more systematic method of

manage medical care of TCl patients.

1 2,9, 12 Psychiahic diagnoses are placed within the psychology database.

1

- /

2, 3, 12, Initiate Quality Improvement audit tool for medical services.

13

managing medical caseloads.
Provides a method of cross-checking- p.sy.chiatric and p.sy.cholog-ical diagnoses. Tool is being implemented by DOC nurse coordinator with experience as an NCCHC reviewer.

2, 12, 13 Initiate project workgroup for computer physician order entry for

Set up a staged approach for implementation.

prescription drug orders.

3

Nursing staff distribute Schedule I1 and 111 medications in general

/ population.

Achieve more consistent documentation in MRs

All

Start writing new policies and procedures to correspond to TCI

Policies and Procedures will be complete by March 2009.

standard^

-

---- -------

FY 2009 Qcturler 2: October, .Voventber, December 2008

. ---

- .-

/ / - 8, 0, I .I- - -.C.ontin.u.e. d.e.v.. e.l- opment of mental he:jlth care programming.

NIA

Continue monitoring of selected benchmarks utilizing TCl's quality

/ assurancelquality improvement committee.

13

// Provide PSU and HSU staff with ready access to the DOC Pharmacy Management software.

2.3, 13 1 Hire 1.0 FTE Nursing- Director.

Continue to maximix avail;ible staffand space.__-

I ./ • Expand benchmarks as staffing allows.
1 / Each clinician will have access to a database listing current prescribed
medication and doses.

1

- . . I Resoonsible for oversight of DOC health care O.ualitv lm~rovement

activities including regular monitoring, auditing, and submitting reports

to DAI and Secretary's Office.

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH
ATTACHMENT B

1.0 Psychiatrist Initiate hiring for the following permanent FTE positions: 1.5 Psychologist Supervisor

9, I l

I Initiate hiring for the following permanent FTE positions:

3.75 Psychological Associate 2.0 Assigned to MSMU and Segregation 1.75 Assigned to General Population

Initiate hiring for the following permanent FTE position: I .O OOA for PSU Initiate hiring for the following permanent FTE positions: 1.5 Medical Assistant 2

12

I I Initiate hiring for the following permanent FTE position:

Deliver direct services to inmates.

Increase psychiatric presence at TCI from 80 to 120 hours per week.

Conduct psychotropic medication training for staff.

Provide additional mental health training to TCI staff including

recognizing signs and symptoms of mental illness

More in-depth review of treatment plans for SMI inmates in Monarch.

Work with DHFS staff to develop criteria for admission to the off-site

inpatient unit.

/

. . - Develop a transition program for inmates being returned from the
orooosed female WRC o,romam. Continue development of additional programming at TCI.

/ Add -rrou.o and individual treatment for SMI inmates on Monarch and in

Segregation sufficient to maximize use of available space by scheduling

a total of 7 hours of out-of-cell programming per week including individual treatment and additional groups noted in sections above.

Enhance treatment planning activities for inmates with SMI in general

population.

Increase individual psychotherapy for inmates with a SMI in general

population for an average of one visit every 6 weeks.

File documents created by additional staff and programs in a timely

manner.

Develop methods to monitor treatment outcomes.

Assist with expanded quality improvement program.

Assist Advanced Care Practitioners with patient care.

Perform vital signs, EKG, and phlebotomy as trained and assigned.

Assist with filing into the medical record.

Assist nurses with patient care.

Provide direct care and assistance with ADLs to patients housed in

/ 1

medical observation in HSU. Provide clerical suooort for HSU.

MEMORANDUM OF AGREEMENT BETWEEN THE US DOJ AND THE WDC REGARDING CONDITIONS AT TAYCHEEDAH

ATTACHMENT B

1.0 Medical Program Assistant

Assist with patient appointment

NIA

I Initiate hiring for the following permanent FTE position:

0.5 Nurse Practitioner

mammography, and offsite appointments). Assist with nreoaration of reauired reoortine documents.
I . . - Coordinate patient transportation with security.
I Perform intake p.hy.sical examinations in a timely manner.
Provide additional medical care (chronic care, acute care, routine care).
Enhance patient education related to disease process and wellness.

Initiate hiring for the following permanent FI'E positions:

.. Pr.ov...ide case 111311ogementto plrtidnrs wit11 complex medi~a!~issues. Impro\e Jcli\en c~t'uaret u P ~ I I L ' I I\~\ iSth cllron~cillness.

1.5 Nurse Clinician 2

lmprove education to patients with chronic illnesses.
- Promote education related to wellness (e.g., reinstate the Let's Get Healthy Program). Provide increased number of patient care appointments.

Improve continuity of care within general population and specifically

I within the mentall.y ill p.op.ulation. Provide case management to patients with complex medical issues.

8

( Commence construction of the 45-bed female mental health unit.

1 Expected completion date is February 201 1.

- - FY 2010 .ZO&Julv
/ Add an) staff llrdt .Ire ap~ro\elills penn;lnent resources in lhe 2010201 l bidget including Geatment &d security staff.

- 2009 J11ne2011
1 I111ditiot~3r1esources \ \ i l l lleln assure tlle orovi>ionof adeauate cdre.

9, 1 1
8, 9, 11 8,9, l 1
9

Evaluate additional resource needs. Continue to develop programming and individual treatment in Monarch, Segregation, and General Population. Begin operation of 45-bed off-site acute care facility Begin construction projects on TCI grounds approved in the 2009201 1 budget. Psychology Pre-doctoral Internship expands from 6 to 10 interns.

.Programming and treatment will maximize available space, treatment staff and security staff. Scheduled to open in early 201 1.
Additional building space will help assure the provision of adequate care. Pre-doctoral interns provide additional staff resources to meet treatment and programming needs and assist in filling vacancies for permanent staff positions upon completion of internship.

 
 U.S. Department of Justice
Civil Rights Division
Assistant Attorney General 950 Pennsylvania Avenue, NW - RFK Washington, DC 20530
May 1, 2006
The Honorable Jim Doyle Governor State of Wisconsin Office of the Governor 115 East State Capitol Madison, WI 53702
Re: Investigation of the Taycheedah Correctional
 Institution

Dear Governor Doyle:
I am writing to report the findings of the Civil Rights Division’s investigation of conditions and practices at the Taycheedah Correctional Institution (“Taycheedah”), in Fond du Lac, Wisconsin. On March 25, 2005, we notified you of our intent to investigate conditions at Taycheedah pursuant to the Civil Rights of Institutionalized Persons Act (“CRIPA”), 42 U.S.C. § 1997. CRIPA gives the Department of Justice authority to seek remedies for any pattern or practice of conduct that violates the constitutional or federal statutory rights of persons who are served in public institutions such as Taycheedah.
On May 16-18, July 18-21, and October 6-7, 2005, we conducted on-site inspections of Taycheedah with consultants in the fields of sexual misconduct prevention and correctional mental health care. While on-site, we interviewed administrative and correctional staff, mental health care providers, and inmates. Before, during, and after our on-site inspections we received and reviewed a large number of documents, including policies and procedures, clinical records, and other materials provided to us by Taycheedah staff. Consistent with our commitment to provide technical assistance and conduct a transparent investigation, we provided an extensive debriefing at the conclusion of each of our inspections, in which our consultants expressed their initial impressions and concerns. We appreciate the full cooperation we received from State and

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Taycheedah officials throughout our investigation. We also wish to extend our appreciation to the administrators and staff at Taycheedah for their professional conduct and timely response to our requests.
Having completed our investigation of Taycheedah, we conclude that sexual misconduct prevention practices meet or exceed constitutional requirements. We commend Taycheedah for implementing policies and procedures aimed at preventing, minimizing, and detecting sexual misconduct, particularly the facility’s development and dissemination of brochures for staff and inmates regarding sexual misconduct.
Based on our investigation, however, and as described more fully below, we conclude that certain conditions at Taycheedah violate inmates’ constitutional rights by failing to provide for inmates’ serious mental health needs. We detail our findings below.
I. BACKGROUND
Taycheedah is a state-operated, post-conviction facility that currently houses approximately 600 maximum and medium security female inmates. In 2002, Taycheedah expanded its physical plant to include a 64-bed mental health unit, a 64-bed segregation unit, and a 240-bed minimum security unit. In December 2004, the State of Wisconsin (“State”) relocated the female inmates’ Assessment and Evaluation Unit to Taycheedah. This 75-bed unit provides intake screening for all women entering the Wisconsin Department of Corrections.
II. FINDINGS
Prison officials have an affirmative duty under the Eighth Amendment to ensure that inmates receive adequate food, clothing, shelter, and medical care. Farmer v. Brennan, 511 U.S. 825, 832 (1994). Inmates’ Eighth Amendment rights are violated when prison officials exhibit deliberate indifference to their serious mental health needs. See Estelle v. Gamble, 429 U.S. 97, 100-105 (1976); Maggert v. Hanks, 131 F.3d 670, 671 (7th Cir. 1997). Deliberate indifference may be inferred when the quality of care provided to inmates is “such a substantial departure from accepted professional judgement, practice, or standards as to demonstrate that the person responsible did not base the decision on such judgment.” Estate of Cole by Pardue v. Fromm, 94 F.3d 254, 261-62 (7th Cir. 1996).

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Taycheedah fails to provide inmates with mental health care that complies with these constitutional standards. We found that Taycheedah: 1) fails to timely and appropriately provide psychiatric treatment, including monitoring of psychotropic medications and performing laboratory tests; 2) fails to provide an adequate array of mental health services to treat its inmates’ serious mental health needs; 3) fails to ensure that administrative segregation and observation status is used appropriately; 4) fails to ensure that mental health records are accessible, complete, and accurate; 5) fails to respond to medical and laboratory orders in a timely manner; and 6) fails to ensure that an adequate quality assurance system is in place.
A. Psychiatric Treatment
Taycheedah fails to provide sufficient mental health care staff to meet the inmates’ serious mental health needs. See Wellman v. Faulkner, 715 F.2d 269, 274 (7th Cir. 1983) (understaffing of prison medical personnel and delays in treatment led to constitutionally inadequate care). Access to a psychiatrist is a basic constitutional requirement for correctional mental health care because a psychiatrist is necessary to address psychiatric emergencies and to provide ongoing evaluation for and ongoing monitoring of administration of psychotropic medications. Id.
Psychiatrist staffing at Taycheedah is grossly inadequate. Taycheedah employs only two part-time psychiatrists who carry a caseload of more than 400 patients at a time, which is well above the maximum recommended caseload, according to generally accepted standards. The care that Taycheedah’s two psychiatrists are able to provide is further limited by the lack of adequate support staff, causing them to spend an inordinate amount of time searching for charts, looking for medication records, and handling other administrative functions.
As a result, inmates suffer from lack of treatment and are continually placed at risk of becoming a danger to themselves and others. For example, there are unacceptably long delays between the time inmates’ mental health needs are identified and their initial visit with a psychiatrist. Further, when the psychiatrist is not at work, there is no one to fulfill her responsibilities. As a result, inmates with serious mental health needs are left untreated, sometimes for as long as several months, which causes them to suffer and puts them at risk of harm to themselves and others.

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1. Failure to Appropriately Evaluate and Monitor Psychotropic Medications
Taycheedah fails to timely and appropriately evaluate inmates for the administration of psychotropic medications and monitor their continued administration. Many Taycheedah inmates require psychotropic medications to avoid the unnecessary suffering of acute episodes of mental illness. A physician, preferably a psychiatrist, is needed to evaluate whether psychotropic medications should be initiated and to evaluate the continued administration for proper dosage and effectiveness. See Wellman, 715 F.2d at 272-73. Generally accepted correctional mental health care standards require that a physician see a patient usually before, but clearly shortly after, a prescription for psychotropic medication is written. Patients who remain untreated, or who are treated without being seen by a physician, may suffer from a worsening of their symptoms, including suicidal and homicidal thoughts, or from the potentially lethal side effects of medication. Taycheedah consistently fails to follow this practice. Instead, inmates on psychotropic medications formerly prescribed by another facility continue to receive the medications without active monitoring by a physician of the consequences, effectiveness, or potential side effects.
For example, Inmate #131 was identified upon initial screening as having bipolar disorder, a mood disorder characterized by serious mood swings, impulsive behavior, suicidality and potential psychosis. On December 20, 2004, she was started on Lithium Carbonate, a mood stabilizer prescribed for bipolar disorder, by a nurse’s order stating “per County Jail.” The order was co-signed by a physician, but there was no indication that the physician ever saw the inmate. On February 23, 2005, the order for Lithium was renewed for three months. This order specifically stated “not seen,” and was accompanied by a request for a “new psychiatry appointment,” reflecting that the inmate had still not been seen by a psychiatrist. Based upon the date of the first psychiatry report, April 16, 2005, Inmate #13 was prescribed psychotropic medications but did not see a psychiatrist at Taycheedah until almost four months after she was admitted.

1


For the purposes of this letter, we identify all

Taycheedah inmates by the number assigned to the inmates by the

United States’ mental health experts in their report. A key with

the inmate names will follow under separate cover.

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In another case, the intake screen for Inmate #19, dated February 16, 2005, indicated that she had a history of depression and anxiety attacks, and had been on numerous psychotropic medications in the past. Medication orders for Lexapro (an antidepressant) and Amitryptyline (also an antidepressant) were written by a nurse, “per health transfer summary,” and co-signed by someone who might have been a physician. However, there was no indication that she had been seen by the physician. On February 22, 2005, the Lexapro was discontinued and Celexa (another antidepressant) was started. Again, there was no indication that a physician saw her, nor was there any notation reflecting why her medication was changed. On April 28, 2005, both the Amitryptyline and Celexa were renewed, with a note that clearly stated that she had not yet been seen by a physician. Based upon the date of the first psychiatry report, June 6, 2005, Inmate #19 was prescribed psychotropic medications but did not see a psychiatrist at Taycheedah until almost four months after she was admitted.
Inmate #15's intake screen, dated March 3, 2005, noted that she was previously diagnosed with bipolar disorder and had attempted to commit suicide numerous times. A medication order for Depakote (a mood stabilizer used for bipolar disorder) was written by a nurse, “per Racine County Jail.” Again, while the order was co-signed by a physician, there was no indication that the physician actually saw the inmate. A doctor’s order, dated June 6, 2005, stated, “please schedule new psychiatric evaluation, any psychiatrist,” clearly indicating the physician’s concern that the patient had not yet been evaluated by a psychiatrist. The first psychiatric note was dated June 10, 2005, more than two months after Inmate #15's admission to Taycheedah. While that note stated that she was to be seen for follow up in two weeks, as of July 2005, there were no further psychiatric notes in her chart. This indicates that Inmate #15 had been prescribed psychotropic medications but had not seen a psychiatrist for at least four months after her admission to Taycheedah.
Patients on psychotropic medications must be seen regularly by a physician, preferably a psychiatrist. As noted by our mental health consultants, generally accepted correctional mental health care practices require that a psychiatrist actively monitor the consequences, effectiveness, and potential side effects of psychotropic medications. Our mental health consultants further noted that gross delays between administering a psychotropic medication to an inmate and having the inmate see

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a psychiatrist, such as the multiple four-month delays at Taycheedah, represent a significant departure from generally accepted correctional mental health care standards.
2. Failure to Appropriately Administer Psychotropic Medications
Taycheedah lacks sufficient nursing staff to meet inmates’ serious mental health needs for long-term maintenance on psychotropic medications. Wellman, 715 F.2d at 272 (recognizing treatment of mental disorders, such as with psychotropic medications, as a serious medical need). Because there are too few nurses, many nursing functions, such as medication monitoring and documentation, are relegated to the correctional staff. The correctional staff is not trained to perform these functions, placing inmates’ safety in jeopardy from dangerous errors and omissions.
One of the nursing functions that is being performed by the correctional staff is the distribution of medication and monitoring of potential adverse reactions or side effects. Taycheedah correctional officers informed us that they do not receive training on the potential adverse reactions or precautions that should be taken when distributing psychotropic medications. As a result, they would not be able to ensure that medication is taken properly or to identify the signs of potentially dangerous adverse reactions. For example, initial doses of antipsychotic medications can result in what is referred to as an oculogyric crisis, in which the patient’s eyes roll back in her head and are stuck there. If the patient does not receive immediate treatment, the paralysis can progress down the airway and possibly lead to death from suffocation.
The nursing staff has also relegated the responsibility for completion of Medication Administration Records (MARs) to correctional officers. Nurses receive extensive and specific training on MARs. Relegating the responsibility for MARs to correctional officers who do not receive such training falls well below correctional mental health care standards. This issue is further explained below in subsection D.
B. Mental Health Services
Taycheedah fails to provide adequate mental health services to meet the serious mental health needs of its inmates. See Wellman, 715 F.2d at 272 (recognizing treatment of mental disorders of mentally disturbed inmates as a “serious medical need”); Balla v. Idaho State Board of Corrections, 595 F. Supp.

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1558, 1577 (D. Idaho 1984) (mental health treatment must involve psychiatric and psychological counseling as well as psychotropic drugs). Taycheedah falls well below these standards through its failure to provide a minimal array of mental health programming, crisis services, and specialized treatment for inmates with acute mental illness.
1. Screening and Evaluation for Mental Illness
Staffing for psychologists at Taycheedah is insufficient to provide timely and systematic screening and evaluation for mental illness among inmates. Generally accepted correctional mental health care standards dictate that inmates be seen by a psychologist within 24 hours if they are acutely mentally ill, or within a week of admission, at the latest. Insufficient staffing in Taycheedah’s Assessment and Evaluation Unit impedes the facility from having an adequate systematic intake assessment and triage process. The psychologist supporting intake assessments at Taycheedah is unable to see referred inmates for two to four weeks. Inadequate systemization of the intake and assessment process and delays in referrals put inmates who are in need of immediate attention at severe risk of harm to themselves and others.
2. Crisis Services
Taycheedah fails to provide adequate crisis services to adequately manage the psychiatric emergencies that occur among its inmates. We observed that a large number of Taycheedah’s inmates are severely psychotic, imminently suicidal, or physically aggressive, due to decompensation of their conditions. Their decompensation is no doubt due, in part, to the lack of programming and use of segregation to control behaviors associated with their illnesses. We noted a large void in crisis services available to inmates, resulting in actual harm and significant risk of harm. As is typically the case where no other alternative exists, Taycheedah staff resort to the use of segregation and observation status to control inmates’ dangerous behavior, which not only fails to solve the problem, but often exacerbates it.
Staff informed us that there are many instances when inmates require inpatient psychiatric care but do not receive it. Staff also stated that some inmates are housed in administrative segregation solely because their psychiatric symptoms are so severe that there is simply no other place to put them. Part of the problem is likely because there is only one psychiatric inpatient facility in the area where inmates are sometimes sent.

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Staff acknowledge that this facility, known as the Winnebago Mental Health Institution (“Winnebago”), is often full to capacity and ill-equipped to handle the behavioral issues that arise when housing inmates. As a result, inmates in need of critical care remain at Taycheedah, where they do not get the care they need, and end up being placed in administrative segregation or observation status. This often leads to decompensation and further dangerous behavior. For example:
• On June 19, 2005, Inmate #58 fatally asphyxiated herself while in administrative segregation. This inmate was severely mentally ill, exhibiting almost daily incidents of aggression and self-injurious behavior, using virtually any property she could access to harm herself. She swallowed pen inserts and other solid objects, resulting in numerous trips to the emergency room. She went on periodic hunger strikes, during which she would refuse to ingest food and liquids for days at a time. This inmate had only recently returned to Taycheedah at the time of her death, after a long stay at Winnebago. She was discharged from that facility when it was determined that she could no longer benefit from the services and her behavior was too difficult to manage in the less secure environment.
Inmate #58 clearly needed an intensity of mental health services that the State was unable to provide given the current options for incarceration of seriously mentally ill female inmates.
• Inmate #51 has a very severe degree of mental illness and exhibits serious suicidal ideation. She has been back and forth between Winnebago and Taycheedah for over a year. Her behavior is difficult to manage in both facilities because of her serious attempts at self mutilation. She expressed her ability to manipulate both institutions when she stated, “I know what to do to get back to Winnebago.” However, Winnebago staff members state that after significant attempts, they have no further treatment options that will improve her condition; thus, they send her back to Taycheedah. At the time of our second visit to Taycheedah, this inmate was under one-on-one supervision, while in observation status, to prevent her from hurting or killing herself. None of the staff members we spoke with regarding this inmate believe that she is receiving appropriate treatment, yet noted that they had no better alternative.

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This inmate is also in need of therapeutic treatment, such as individual and group counseling, that Taycheedah does not presently offer.
Taycheedah’s failure to provide alternatives to manage psychiatric emergencies is unacceptable. Not only does it jeopardize the safety of the inmates, but it creates a strain on existing resources due to the reoccurrence of dangerous behavior.
3. Acute Mental Illness
Taycheedah fails to provide adequate treatment to inmates with acute mental illness. Taycheedah operates its Monarch Special Management Unit (“Monarch”) to provide specialized treatment to those inmates at Taycheedah with the most acute mental illnesses. We found, however, that this unit provides almost no programming and, as a result, the vast majority of inmates are unoccupied for most of the day. This lack of active treatment creates a high risk of exacerbating psychiatric symptoms and dangerous behavior, especially in inmates who are already in need of critical care.
Further, inmates in the segregation unit of Monarch receive no treatment except for medication. The Seventh Circuit has recognized that there is extensive medical and psychological literature establishing the harmful effects of isolation and segregation on mentally ill inmates. Scarver v. Litscher, 434 F.3d 972, 975 (7th Cir. 2006); Davenport v. DeRobertis, 844 F.2d 1310, 1316 (7th Cir. 1988). Despite the increased need for treatment of mentally ill inmates in segregation, those inmates do not even receive consistent psychotropic medication management, a most basic correctional mental health deficiency. See, e.g., Wellman v. Faulkner, 715 F.2d 269, 272 (7th Cir. 1983) (defendants’ recognition that the most obvious serious deficiency of their medical system was the lack of access to psychiatric care). For example, Inmate #43 told us that when an inmate with mental illness is sent to segregation, “they are bumped down the waiting list” to see the psychiatrist. One of the psychiatrists informed us that visits to segregation are difficult in an already overwhelming day, as they must work around security restrictions and rules.
Moreover, correctional officers working in the Monarch Unit receive little or no specialized training, which falls below generally accepted correctional practices for such units. It is critical that correctional officers, especially those working in

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specialized units, be able to recognize the signs of mental illness since they are generally the first to respond to behaviors and need to decide whether the behavior warrants disciplinary measures. In short, inmates at Taycheedah who are in the greatest need of care are the least likely to receive it.
4. Mental Health Programming to Address Serious Mental Illness
Taycheedah fails to provide adequate mental health programming to treat the serious mental health illnesses of its inmates. As a result of the limited number of psychologists, psychologists are limited to performing initial diagnostic assessments and managing crises. The significant attention that these duties require prohibits psychologists from performing active treatment, such as programming and counseling, which has been shown to decrease patients’ serious mental health symptoms and help prevent mental health crises. See Wellman, 715 F.2d at 272 (treatment of mental disorders is a serious medical need). Counseling for seriously mentally ill inmates is necessary to prevent serious psychiatric crises, dangerousness to self and others, decompensation of mental health, and the need to place inmates in segregation and observation status. Indeed, in the absence of therapeutic measures, staff resort to managing serious behaviors with disciplinary, rather than therapeutic, responses. To address such potential harm, the Seventh Circuit has upheld court-ordered correctional mental health care staffing that mandate psychiatric social workers, clinical psychologists, and behavioral clinicians. French v. Owens, 777 F.2d 1250, 1255 (7th Cir. 1985). In addition, generally accepted correctional mental health practice is to provide non-medication therapy for inmates to address self-injurious behavior.
Although Taycheedah’s Annual Report for Fiscal Year 2005 describes an elaborate array of programming, we found that very little actually exists. In fact, most of the inmates we interviewed stated that they receive no programming or they wait as long as three years to receive it. This lack of sufficient programming falls well below generally accepted correctional mental health care standards and results in an increase in psychiatric emergencies.
C. Inappropriate Use of Segregation and Observation Status
Taycheedah’s use of administrative segregation and observation status for inmates with severe mental illness violates their constitutional rights because Taycheedah imposes

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a significant penalty on inmates whose behaviors are symptomatic of their mental illness. See Hallett v. Morgan, 296 F.3d 732, 746-47 (9th Cir. 2002) (distinguishing between sanctions that are minor and intended to deter behavior versus sanctions that punish inmates for symptoms of their mental illness and upholding the former); Coleman v. Wilson, 912 F. Supp. 1282, 1320 (E.D. Cal. 1995) (constitutional violation when prison staff punished mentally ill inmates without regard to what caused inmates’ behaviors or without considering effect of punitive measures on inmates’ mental illnesses); Arnold v. Lewis, 803 F. Supp. 246, 249-51 (D. Ariz. 1992) (finding that defendants improperly punished inmates for symptoms of mental illness by placing them in lockdown). This practice is ineffectual, falls below correctional mental health care standards, and can be extremely detrimental for persons with mental illness because it can severely worsen their symptoms, especially self-destructive behavior. See Scarver, 434 F.3d at 975 (noting it was “a fair inference” that conditions including isolation aggravated the symptoms of inmate’s mental illness); Davenport, 844 F.2d at 1316 (Seventh Circuit’s recognition of ill psychological effect of solitary confinement or segregation). We found that 44 out of 59 individuals in segregation during our tour in July 2005 had serious mental illnesses and were observed to be in significant distress.
We found that many inmates at Taycheedah with mental illness are placed in administrative segregation due to threats or attempts to kill themselves. During our review of inmate disciplinary charges which resulted in segregation, we found that, as a result of attempting to harm themselves with writing instruments or parts of mattresses, certain inmates had been charged with “misuse of state property” (i.e., facility writing instruments and mattresses). Executive staff corroborated this finding by informing us that inmates are sometimes charged with self-abuse as a disciplinary infraction.
Punishing inmates for behaviors that they lack control over is ineffectual and destructive, but appears to be a practice that Taycheedah consistently resorts to because of the lack of appropriate alternatives. For example, we interviewed Inmate #2, who was housed in segregation, during our visit. She was deemed to be a danger to herself, having been observed punching herself in the eye, a clear symptom of psychosis. Her charts revealed that she has a long history of serious mental illness, exhibiting symptoms such as eating her feces and drinking her urine. During our interview of this inmate, she made such comments to us as:

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“I eat rotworms,” “I see more Gods when I take Haldol,” I blackened my eye with my fist,” and “I get upset over the melody that plays in my head.” According to notes, she was in segregation due to “inappropriate behavior.” However, correctional staff informed us that she was in segregation because she received “lots of tickets” for soliciting sex from numerous male and female staff members, which the officers described to us as “crazy.” During our interview, Inmate #2 told us that she had been housed in segregation four or five times since 2002 for “disrespect.”
Moreover, Taycheedah does not have a “step down” process in place to allow inmates to earn their way out of segregation by exhibiting positive behavior. See Hallett, 296 F.3d at 746-47 (noting that acceptable sanctioning system imposed only minor sanctions on potentially mentally ill inmates who engaged in self-harm). A system such as this is a necessary component according to generally accepted correctional mental health care standards. Without a “step down” process, inmates have no motivation to change their behavior. Long periods of segregation, often with no end in sight, are particularly damaging for persons with mental illness because the lack of stimulation, active treatment, and social interaction exacerbates their symptoms. Indeed, several inmates expressed to us that they had so much additional time added to their segregation status due to bad behavior that they had no motivation to change. Our consultants supported this conclusion, based upon review of the segregation status report prepared by the facility on July 20, 2005. This report indicated that most inmates were sent to segregation for six months to a year, and in some cases, 18 months or more. Absent a “step-down” process to potentially reduce such long segregation periods, inmates have little incentive to improve their behavior while in segregation.
We observed one particular example in which Taycheedah placed a 15-year-old girl in long-term segregation. This inmate, Inmate #3, was reportedly placed in administrative segregation on November 21, 2004. She was adjusted back to segregation on July 14, 2005 and her current release date is June 26, 2006. We interviewed the inmate through her spit mask since spitting was reportedly a problematic behavior of hers. She was quite cooperative and pleasant, but admitted that she felt that she will “never” get out of administrative segregation because staff members “just keep adding time.” As of July 2005, she was not receiving any education services, as she allegedly “refuses” from the door of her cell. The inmate was diagnosed as suffering from

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attention deficit disorder and intermittent explosive disorder; however, she was not receiving any medication as of our July 2005 visit, reportedly because her mother would not consent. Placing an un-medicated, mentally-ill teenager in segregation, with little or no stimulation, and no education services causes psychological damage that may be irreversible. The waiting time for her release from segregation would feel like a lifetime to a girl of this age. Punishing inmates for mental health symptoms that are beyond their control is unacceptable and ineffectual at modifying the behavior.
D. Mental Health and Medication Records
Taycheedah fails to keep centralized, complete and accurate records to adequately provide mental health care to its inmates. There is no central record-keeping system and the records themselves contain errors and omissions that jeopardize inmates’ mental health treatment and can have dangerous consequences. Accessible and up-to-date records are essential for treating professionals to provide adequate care.
The absence of a centralized record-keeping system inhibits treating professionals from accessing the necessary information to provide treatment. For example, psychological notes are kept by the Psychology Department, and psychiatric notes are kept by the Health Services Unit. We noted that while the psychiatric notes are included in the Psychological Services charts, psychological notes, which contain important information about the inmate’s history, symptoms, and behavior, were only sometimes found in the Health Services notes. In fact, one psychiatrist informed us that important information gathered by psychology staff was consistently unavailable. Lack of necessary information can lead to significant mistakes in diagnosis and treatment.
Moreover, we found that the charts themselves were inadequately maintained. Oftentimes there were unacceptable delays, as much as several months, in getting notes into charts, and some notes were missing altogether. For example, we noted many errors and omissions during our review of Medication Administration Records (“MARs”). MARs are critical to patient care because they contain information on when medications were ordered, when the orders were filled, whether the patient actually received the medication, and, if not, the reason the patient did not receive it. Physicians rely on the accuracy of this information to make informed decisions regarding patients’ medication regimens.

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The deficiencies we found in these documents were further supported by our observations of several correctional officers as they distributed medication to inmates. Even though staff were aware that we were monitoring them, we noted several errors in the recording of information, including the failure to note that inmates received a dose and the failure to record an inmate’s refusal to take a dose. The correctional staff involved expressed great discomfort with performing this daily duty because they felt inadequately prepared. Several staff members indicated to us that it is frequently unclear whether an inmate actually received the medication that was ordered. Indeed, the psychiatrist relayed to us that she has been quite upset over the MARS because she is unable to determine whether a dosage change is appropriate due the lack of recorded information. These omissions in documentation can lead to serious consequences, as the following examples illustrate.
• A medication order for an inmate was placed in her chart on August 25, 2005. On September 1, 2005, a nurse removed the order from the chart for filling by the pharmacy. The medication arrived on September 13, 2005; however, no notation was made in the MAR that it had been received or whether it had been administered to the inmate. The physician, who was unaware that the inmate was not receiving the medication for this long period of time, saw that the inmate’s symptoms were worsening, and changed the inmate’s dosage.
This situation put the inmate at serious risk of harm, as this change in dosage may have been unnecessary or even contraindicated, and could have resulted in serious side effects. In another instance:
• As discussed earlier, Inmate #58 fatally asphyxiated herself while in administrative segregation on June 19, 2005. Prior to that, she was ordered several medications to be taken orally and two others to be given intravenously, as needed. While the progress notes intermittently stated that she refused her oral medications and requested injections, the MARs were unintelligible as to what she had been given on any given day. For instance, some entries reflected “R” or had a circled “R,” which could mean medication “received” or could reflect the officer’s initials. The lack of a consistent system for indicating medication received made it impossible to determine

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from the records what medications the inmate was actually receiving, as well as what measures were needed to control her dangerous behavior. Staff acknowledged to us that they were aware of this problem.
Some of these documentation deficiencies would likely be addressed if Taycheedah had an adequate quality assurance system in place; however, we noted that Taycheedah does very little, if anything, by way of practices in quality assurance.
E. Medication and Laboratory Delays
Taycheedah fails to respond to medication and laboratory orders in a timely manner, preventing inmates from receiving adequate treatment. See Wellman, 715 F.2d at 274 (significant delays in providing treatment led to constitutionally inadequate care). Our investigation revealed significant delays between the time medication and laboratory tests are ordered and when the inmates actually receive the necessary medication or test. This deficiency falls well below generally accepted correctional mental health care standards and puts inmates’ mental health at risk.
1. Medication Orders
Taycheedah fails to provide inmates with the medication ordered to treat their mental illnesses in a timely manner. Timely response to medication orders is necessary to provide accurate and appropriate treatment, and to prevent symptoms from worsening. We observed significant delays in providing ordered medications during our review of Taycheedah’s medical records, which was reinforced during our interview of clinical staff members. The source of the delays appears to arise from a number of problems in the process of filling medication orders.
First, psychiatrists often do not write prescriptions until late in the day. This delays nurses from taking prescriptions from the charts for processing. Second, the nurses do not consistently take the prescriptions from the charts in a timely manner, and, in some instances neglect to do it at all. Next, all prescription processing is done at a centralized Wisconsin Department of Corrections pharmacy, where there are only 14 pharmacists serving the entire State correctional system. Pharmacy staff stated that the average turnaround time is 72 hours; however, Taycheedah staff members strongly objected to

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that estimate and stated that it often takes much longer, sometimes even weeks, for the pharmacy to fill prescriptions. Fourth, once prescriptions are filled, they must be processed by the Health Services Unit, which creates another opportunity for delay. Finally, after processing, the medication must be documented properly in the inmate’s medication chart, which is yet another opportunity for delay.
As a result of these significant delays in providing prescription medications, inmates with severe psychiatric symptoms go untreated or are under-treated for unreasonably long periods of time, causing them to suffer and putting them at risk to themselves and others.
2. Laboratory Orders
Taycheedah fails to respond to laboratory orders in a timely manner, and sometimes, not at all. Laboratory tests are often critical for physicians to make accurate diagnoses and to ensure that psychotropic medications are adequately monitored. Indeed, a number of medical illnesses have symptoms that are very similar to psychiatric illnesses and must be ruled out by laboratory tests to make an accurate diagnosis. For example, low thyroid function may mimic depression, while high thyroid function may mimic mania. Thus, a thyroid screening should be performed before an accurate diagnosis of bipolar disorder can be made. Morever, certain psychotropic medications require frequent blood analysis to monitor for side effects, some of which may be dangerous if undetected. For instance, some psychotropic medications may cause diabetes; life threatening increases in cholesterol; pancreatic, liver, or kidney damage; or immune dysfunction.
Our investigation revealed serious delays and omissions in completing laboratory orders. For example, Inmate #13 was diagnosed with bipolar disorder and prescribed Lithium Carbonate, a mood stabilizing medication. A lithium level and thyroid stimulating hormone test (necessary to monitor any potential thyroid problems caused by the lithium) were ordered on April 16, 2004. As of July 2005, no results from those tests were in the inmate’s chart, and it was unclear whether the tests were actually ever done.
Taycheedah is not providing adequate mental health care because it fails to ensure that inmates are receiving prescribed medications and necessary laboratory tests. Significant delays and omissions such as those described cause inmates to suffer and their symptoms to worsen.

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F. Quality Assurance
Taycheedah’s quality assurance system is grossly inadequate. See Coleman, 912 F. Supp. at 1308 (requiring quality assurance program for correctional mental health system). Quality assurance programs are necessary in a correctional mental health setting to identify basic minimal individual and systemic issues that need to be addressed in the delivery of mental health services. Lack of quality assurance leads to focusing efforts and resources on problems and issues that may not be critical or compelling. A quality assurance system is especially necessary in a system struggling with insufficient resources to ensure that its limited resources are channeled in the most efficient manner possible.
We found very little, if any, practices to ensure quality assurance at Taycheedah. Further, the formal efforts that are in place are severely undercut by Taycheedah’s totally inadequate data systems. For instance, when the Mental Health Director’s office attempts to monitor prescribing practices, this can only be done by a hand count of the medications listed on a several hundred page printout. The absence of an adequate quality assurance system results in errors or omissions left undetected that put inmates at risk of serious harm. For example:
• The medication records for Inmate #19 reflect that her Celexa (an antidepressant medication) was discontinued; however, there was no notation in her chart as of the following week to reflect whether she had been seen by a physician or why this medication change had occurred.
The absence of any clinical documentation made it unclear whether Inmate #19 no longer had the diagnosis of depression, whether she had some untoward effects or allergy, or whether she was simply refusing to take it. In another case:
• Inmate #20 was seen by a psychiatrist on March 17, 2005, and a follow up appointment was ordered in six weeks. Four months later, there were no further psychiatrist notes in the chart, although orders for medication changes were written three months after the appointment was ordered.
Again, without any notes, it is impossible to determine the reason for the medication change. Review of these charts to ensure that they are completed properly is necessary to ensure that inmates are receiving adequate treatment and are not put at risk from medical errors.

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III. RECOMMENDED REMEDIAL MEASURES
In order to address the constitutional deficiencies identified above and to protect the constitutional rights of inmates, Taycheedah should implement, at a minimum, the following measures with respect to mental health care:
A. Psychiatric Treatment
1. Provide adequate on-site psychiatry coverage for inmates’ serious mental health needs. Ensure that psychiatrists see inmates in a timely manner and that psychotropic medication orders are reviewed by a psychiatrist on a regular, timely basis.
2. Ensure that medications are provided to inmates in a timely manner and that they are properly monitored.
3. Provide nurse staffing adequate for inmates’ serious mental health needs. Ensure that nursing functions, such as distribution of medications, are performed by nurses or other properly trained staff.
B. Mental Health Services
1. Provide adequate on-site psychology coverage to ensure that psychologists see inmates in a systematic and timely manner to evaluate inmates for their serious mental health needs. Provide adequate staffing to ensure timely and appropriate mental health screening and referrals.
2. Provide an adequate array of mental health programming, including individual and group therapy, to meet inmates’ serious mental health needs and prevent decompensation and mental health crises.
3. Ensure that adequate crisis services are available to address the psychiatric emergencies of inmates.
4. Provide adequate programming in the Monarch Unit to meet inmates’ critical mental health needs.

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C. Segregation and Observation Status
1. Ensure that administrative segregation and observation status are not used to punish inmates for symptoms of mental illness and behaviors that are, because of mental illness, beyond their control.
D. Mental Health Records
1. Ensure that Taycheedah’s mental health records are centralized, complete, and accurate.
E. Medication and Laboratory Delays
1. Ensure timely responses to orders for medication and laboratory tests and prompt documentation thereof in inmates’ charts.
F. Quality Assurance
1. Ensure that Taycheedah’s quality assurance system is adequate to identify and correct serious deficiencies with the mental health system.
* * * * * * * * * * * * * * * * *
We hope to continue working with the State in an amicable and cooperative fashion to resolve our outstanding concerns regarding Taycheedah’s mental health care. Assuming that our cooperative relationship continues, we will be sending you under separate cover our consultants’ evaluations. Although their evaluations do not necessarily reflect the official conclusions of the Department of Justice, their observations, analysis, and recommendations provide further elaboration of the issues discussed in this letter and offer practical assistance in addressing them.
We are obligated to advise you that, in the entirely unexpected event that we are unable to reach a resolution regarding our concerns, the Attorney General may initiate a lawsuit pursuant to CRIPA to correct deficiencies of the kind identified in this letter 49 days after appropriate officials have been notified of them. 42 U.S.C. § 1997b(a)(1).

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We would prefer, however, to resolve this matter by working cooperatively with you and are confident that we will be able to do so in this case. The lawyers assigned to this investigation will be contacting the facility’s attorney to discuss this matter in further detail. If you have any questions regarding this letter, please call Shanetta Y. Cutlar, Chief of the Civil Rights Division’s Special Litigation Section, at (202) 514-0195.
Sincerely,
/s/ Wan J. Kim
Wan J. Kim Assistant Attorney General
cc: The Honorable Peggy A. Lautenschlager Attorney General Wisconsin Department of Justice
Matthew J. Frank
 Secretary
 Wisconsin Department of Corrections

Ana Boatwright Warden Taycheedah Correctional Institution
Steven M. Biskupic United States Attorney Eastern District of Wisconsin

 
 United States District Court Eastern District of Wisconsin (Milwaukee) CIVIL DOCKET FOR CASE #: 2:08−cv−00753−RTR

CLOSED

United States of America v. Doyle et al Assigned to: Chief Judge Rudolph T Randa Cause: 42:1983 Civil Rights Act
Plaintiff United States of America

Date Filed: 09/04/2008 Date Terminated: 09/15/2008 Jury Demand: None Nature of Suit: 440 Civil Rights: Other Jurisdiction: U.S. Government Plaintiff
represented by Charlene McMillan United States Department of Justice (DC) Civil Rights Div 950 Pennsylvania Ave NW Washington , DC 20530 202−514−1089 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Kenyan R McDuffie United States Department of Justice (DC) Civil Rights Div 950 Pennsylvania Ave NW Washington , DC 20530 202−514−1089 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Laura L Coon United States Department of Justice (DC) Civil Rights Div 950 Pennsylvania Ave NW Washington , DC 20530 202−514−6255 Fax: 202−514−6237 Email: laura.coon@usdoj.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED
Matthew V Richmond United States Department of Justice (ED−WI) Office of the US Attorney 517 E Wisconsin Ave − Rm 530 Milwaukee , WI 53202 414−297−1700 Fax: 414−297−4394 Email: matthew.richmond@usdoj.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED

V.
Defendant
James E Doyle, Jr Governor of Wisconsin

represented by Corey F Finkelmeyer Wisconsin Department of Justice Office of the Attorney General 17 W Main St PO Box 7857 Madison , WI 53707−7857

Defendant Rick Raemisch Secretary, Wisconsin Department of Corrections
Defendant Cathy Jess Warden, Taycheedah Correctional Institution

608−266−7342 Fax: 608−267−8906 Email: finkelmeyercf@doj.state.wi.us LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Kathryn R Anderson Wisconsin Department of Corrections 3099 E Washington Ave PO Box 7925 Madison , WI 53707−7925 608−240−5049 Fax: 608−240−3306 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Kathryn R Anderson (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Date Filed 09/04/2008 09/04/2008 09/04/2008
09/15/2008

# Docket Text
1 COMPLAINT. Consent forms distributed for Magistrate Judge Aaron E. Goodstein. (vlh) (vlh).
2 JOINT MOTION for Entry of Conditional Dismissal (vlh) (Additional attachment(s) added on 9/5/2008: # 1 Porposed Order) (vlh).
3 PDF document requirement letter addressed to AUSA Matthew V. Richmond regarding Complaint, Motion, and Proposed Order filed on September 4, 2008. (vlh)
4 ORDER signed by Chief Judge Rudolph T Randa on 09/15/2008 granting 2 Motion to Dismiss. (cc: all counsel) (Koll, J) (Additional attachment(s) added on 9/15/2008: # 1 Corrected Order (case no. included)) (vlh).