U.S. District Court District of Connecticut (New Haven) CIVIL DOCKET FOR CASE #: 3:20-cv-00594-JCH

Wilkes et al v. Lamont et al Assigned to: Judge Janet C. Hall Referred to: Judge Robert A. Richardson Cause: 42:1983 Civil Rights Act

Date Filed: 04/30/2020 Date Terminated: 01/14/2021 Jury Demand: None Nature of Suit: 440 Civil Rights: Other Jurisdiction: Federal Question

Plaintiff
Thomas Wilkes On behalf of themselves and all other persons similarly situated

represented by Karyl Lee Hall Connecticut Legal Rights Project, Inc. P.O. Box 351, Silver Street Middletown, CT 06457 860-262-5044 Fax: 860-262-5035 Email: klhall@clrp.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

Kirk W. Lowry Connecticut Legal Rights Project, Inc.-Mdltn Silver St., PO Box 351 Middletown, CT 06457 860-262-5017 Fax: 860-262-5035 Email: klowry@clrp.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

Mark J. Murphy Center for Public Representation 22 Green Street Northampton, MA 01060 202-670-1008 Fax: 413-586-5711 Email: mmurphy@cpr-ma.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

Plaintiff
Barbara Flood On behalf of themselves and all other persons similarly situated

Steven J. Schwartz Center for Public Representation 22 Green Street Northampton, MA 01060 413-586-6024 Email: sschwartz@cpr-ma.org LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ira Burnim Ira Burnim 1526 Live Oak Drive Silver Spring, MD 20910 301-589-0345 Email: irabster@gmail.com ATTORNEY TO BE NOTICED
Jennifer Mathis Bazelon Center for Mental Health Law 1090 Vermont Ave NW Suite 220 Washington Washington, DC 20005 202-467-5730 Email: jenniferm@bazelon.org ATTORNEY TO BE NOTICED
Virginia Martins Teixeira Connecticut Legal Rights Project, Inc. P.O. Box 351, Silver Street Middletown, CT 06457 860-262-5069 Fax: 860-262-5035 Email: gteixeira@clrp.org ATTORNEY TO BE NOTICED
represented by Karyl Lee Hall (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Kirk W. Lowry (See above for address)

Plaintiff
Vincent Ardizzone On behalf of themselves and all other persons similarly situated

LEAD ATTORNEY ATTORNEY TO BE NOTICED
Mark J. Murphy (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Steven J. Schwartz (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ira Burnim (See above for address) ATTORNEY TO BE NOTICED
Jennifer Mathis (See above for address) ATTORNEY TO BE NOTICED
Virginia Martins Teixeira (See above for address) ATTORNEY TO BE NOTICED
represented by Karyl Lee Hall (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Kirk W. Lowry (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Mark J. Murphy (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Steven J. Schwartz (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Plaintiff Gail Litsky On behalf of themselves and all other persons similarly situated
Plaintiff

Ira Burnim (See above for address) ATTORNEY TO BE NOTICED
Jennifer Mathis (See above for address) ATTORNEY TO BE NOTICED
Virginia Martins Teixeira (See above for address) ATTORNEY TO BE NOTICED
represented by Karyl Lee Hall (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Kirk W. Lowry (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Mark J. Murphy (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Steven J. Schwartz (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ira Burnim (See above for address) ATTORNEY TO BE NOTICED
Jennifer Mathis (See above for address) ATTORNEY TO BE NOTICED
Virginia Martins Teixeira (See above for address) ATTORNEY TO BE NOTICED

Carson Mueller On behalf of themselves and all other persons similarly situated

represented by Karyl Lee Hall (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Kirk W. Lowry (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Mark J. Murphy (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Steven J. Schwartz (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ira Burnim (See above for address) ATTORNEY TO BE NOTICED
Jennifer Mathis (See above for address) ATTORNEY TO BE NOTICED
Virginia Martins Teixeira (See above for address) ATTORNEY TO BE NOTICED

V.
Defendant
Ned Lamont Governor, in their official capacities

represented by Emily V. Melendez State of Connecticut Office of the Attorney General 165 Capitol Avenue Suite 4000 Hartford, CT 06106 860-808-5210 Fax: 860-808-5385 Email: emily.melendez@ct.gov LEAD ATTORNEY

Defendant

ATTORNEY TO BE NOTICED
Henry A. Salton Office of the Attorney General 165 Capitol Avenue PO Box 120 Hartford, CT 06106 860-808-5210 Fax: 860-808-5385 Email: Henry.Salton@ct.gov TERMINATED: 09/23/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Laura D. Thurston Office of the Attorney General 165 Capitol Avenue Hartford, CT 06106 860-808-5210 Fax: 860-808-5385 Email: laura.thurston@ct.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ralph E. Urban Attorney General's Office -Elm Htfd 55 Elm Street P.O. Box 120 Hartford, CT 06141 860-808-5210 Fax: 860-808-5385 Email: ralph.urban@ct.gov TERMINATED: 07/31/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Shawn L Rutchick Office of the Attorney General 165 Capitol Avenue Hartford, CT 06106 860-961-7989 Email: shawn.rutchick@ct.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED

Miriam E. Delphin-Rittmon Commissioner of DMHAS, in their official capacities
Defendant Hal Smith CEO of Whiting Forensic Hospital, in their official capacities

represented by Emily V. Melendez (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Henry A. Salton (See above for address) TERMINATED: 09/23/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Laura D. Thurston (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ralph E. Urban (See above for address) TERMINATED: 07/31/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Shawn L Rutchick (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Emily V. Melendez (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Henry A. Salton (See above for address) TERMINATED: 09/23/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Laura D. Thurston (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ralph E. Urban (See above for address)

Defendant State of Connecticut TERMINATED: 05/07/2020
Defendant Department of Mental Health and Addiction Services TERMINATED: 05/07/2020

TERMINATED: 07/31/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Shawn L Rutchick (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Emily V. Melendez (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Henry A. Salton (See above for address) TERMINATED: 09/23/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Laura D. Thurston (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ralph E. Urban (See above for address) TERMINATED: 07/31/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Emily V. Melendez (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Henry A. Salton (See above for address) TERMINATED: 09/23/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Laura D. Thurston

Defendant Whiting Forensic Hospital TERMINATED: 05/07/2020
Defendant Connecticut Valley Hospital TERMINATED: 05/07/2020

(See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ralph E. Urban (See above for address) TERMINATED: 07/31/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Emily V. Melendez (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Henry A. Salton (See above for address) TERMINATED: 09/23/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Laura D. Thurston (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ralph E. Urban (See above for address) TERMINATED: 07/31/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Emily V. Melendez (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Henry A. Salton (See above for address) TERMINATED: 09/23/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Lakisha Hyatt CEO of Connecticut Valley Hospital, in their official capacities

Laura D. Thurston (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ralph E. Urban (See above for address) TERMINATED: 07/31/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Emily V. Melendez (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Henry A. Salton (See above for address) TERMINATED: 09/23/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Laura D. Thurston (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Ralph E. Urban (See above for address) TERMINATED: 07/31/2020 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Shawn L Rutchick (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Date Filed #
04/30/2020 1

Docket Text
COMPLAINT against All Defendants ( Filing fee $400 receipt number ACTDC-5832340.), filed by Vincent Ardizzone, Barbara Flood, Gail Litsky, Thomas Wilkes, Carson Mueller.(Lowry, Kirk)

04/30/2020 04/30/2020 04/30/2020
04/30/2020 04/30/2020 05/01/2020
05/04/2020 05/04/2020 05/04/2020 05/04/2020

Modified on 4/30/2020 to correct filed by/against parties (Hushin, Z.). (Entered: 04/30/2020)
Judge Janet C. Hall added. (Oliver, T.) (Entered: 04/30/2020)
2 Order on Pretrial Deadlines: Amended Pleadings due by 6/29/2020. Discovery due by 10/30/2020. Dispositive Motions due by 12/4/2020. Signed by Clerk on 4/30/2020. (Reis, Julia) (Entered: 05/01/2020)
3 ELECTRONIC FILING ORDER FOR COUNSEL - PLEASE ENSURE COMPLIANCE WITH COURTESY COPY REQUIREMENTS IN THIS ORDER Signed by Judge Janet C. Hall on 4/30/2020. (Reis, Julia) (Entered: 05/01/2020)
4 STANDING PROTECTIVE ORDER Signed by Judge Janet C. Hall on 4/30/2020. (Reis, Julia) (Entered: 05/01/2020)
5 Standing Order re: Discovery Signed by Judge Janet C. Hall on 4/30/2020. (Reis, Julia) (Entered: 05/01/2020)
6 NOTICE TO COUNSEL/SELF-REPRESENTED PARTIES : Counsel or self-represented parties initiating or removing this action are responsible for serving all parties with attached documents and
copies of 1 Complaint, filed by Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes, Vincent Ardizzone, 2 Order on Pretrial Deadlines, 3 Electronic Filing Order, 4 Standing Protective Order, 5 Standing Order re: Discovery Signed by Clerk on 5/1/2020. (Reis, Julia) (Entered: 05/01/2020)
Request for Clerk to issue summons as to Ned Lamont. (Lowry, Kirk) (Entered: 05/04/2020)
Request for Clerk to issue summons as to Miriam E. DelphinRittmon. (Lowry, Kirk) (Entered: 05/04/2020)
Request for Clerk to issue summons as to Hal Smith. (Lowry, Kirk) (Entered: 05/04/2020)
Request for Clerk to issue summons as to Lakisha Hyatt. (Lowry, Kirk) (Entered: 05/04/2020)

05/04/2020 05/04/2020 05/04/2020 05/04/2020 05/04/2020
05/05/2020
05/06/2020 05/07/2020 05/07/2020 05/07/2020

Request for Clerk to issue summons as to State of Connecticut. (Lowry, Kirk) (Entered: 05/04/2020)
Request for Clerk to issue summons as to Department of Mental Health and Addiction Services. (Lowry, Kirk) (Entered: 05/04/2020)
Request for Clerk to issue summons as to Whiting Forensic Hospital. (Lowry, Kirk) (Entered: 05/04/2020)
Request for Clerk to issue summons as to Connecticut Valley Hospital. (Lowry, Kirk) (Entered: 05/04/2020)
7 NOTICE OF E-FILED CALENDAR: THIS IS THE ONLY NOTICE COUNSEL/THE PARTIES WILL RECEIVE.ALL PERSONS ENTERING THE COURTHOUSE MUST PRESENT PHOTO IDENTIFICATION. Telephonic Status Conference set for 5/7/2020 11:30 AM in Chambers Room 107, 141 Church St., New Haven, CT before Judge Janet C. Hall. Counsel are requested to participate in this conference, via telephone. Please use the following dial-in for this call: 1-877-873-8017; Access Code: 6415663#. (DeRubeis, B.) (Entered: 05/04/2020)
8 ELECTRONIC SUMMONS ISSUED in accordance with Fed. R. Civ. P. 4 and LR 4 as to *State of Connecticut, Connecticut Valley Hospital, Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Department of Mental Health and Addiction Services, Hal Smith, Whiting Forensic Hospital* with answer to complaint due within *21* days. Attorney *Kirk W. Lowry* *Connecticut Legal Rights Project, Inc.-Mdltn* *Silver St., PO Box 351* *Middletown, CT 06457*. (Reis, Julia) (Entered: 05/05/2020)
9 NOTICE of Appearance by Karyl Lee Hall on behalf of Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes (Hall, Karyl Lee) (Entered: 05/06/2020)
10 AMENDED COMPLAINT against Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith, filed by Vincent Ardizzone, Barbara Flood, Gail Litsky, Thomas Wilkes, Carson Mueller.(Lowry, Kirk) (Entered: 05/07/2020)
11 NOTICE of Appearance by Virginia Martins Teixeira on behalf of Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes (Teixeira, Virginia) (Entered: 05/07/2020)
12 Minute Entry for proceedings held before Judge Janet C. Hall: Telephonic Status Conference held on 5/7/2020. As stated on the record, the court will await plaintiffs' Motion and supporting

05/08/2020 05/08/2020 05/11/2020 05/11/2020 05/11/2020 05/11/2020 05/11/2020

memorandum of law, as required by Local Rule of Civil Procedure 7(a). Within one day after plaintiffs' Motion is filed, defendants shall submit a proposed briefing schedule for their response. Defendants shall confer with plaintiffs' counsel to ascertain their position on the proposed schedule. Total Time: 1 hours and 15 minutes (Court Reporter Terri Fidanza.) (DeRubeis, B.) (Entered: 05/07/2020)
13 MOTION for Attorney(s) Ira Burnim to be Admitted Pro Hac Vice (paid $75 PHV fee; receipt number ACTDC-5848451) by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Attachments: # 1 Affidavit Ira Burnim, # 2 Exhibit A)(Lowry, Kirk) (Entered: 05/08/2020)
14 MOTION for Attorney(s) Jennifer Mathis to be Admitted Pro Hac Vice (paid $75 PHV fee; receipt number ACTDC-5848506) by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Attachments: # 1 Affidavit and Attachment A)(Lowry, Kirk) (Entered: 05/08/2020)
15 ORDER granting 13 MOTION for Attorney Ira Burnim to be Admitted Pro Hac Vice. Certificate of Good Standing due by 7/10/2020. Signed by Clerk on 5/11/2020. (Reis, Julia) (Entered: 05/11/2020)
16 NOTICE of Appearance by Henry A. Salton on behalf of State of Connecticut, Connecticut Valley Hospital, Miriam E. DelphinRittmon, Lakisha Hyatt, Ned Lamont, Department of Mental Health and Addiction Services, Hal Smith, Whiting Forensic Hospital (Salton, Henry) (Entered: 05/11/2020)
17 NOTICE of Appearance by Ralph E. Urban on behalf of State of Connecticut, Connecticut Valley Hospital, Miriam E. DelphinRittmon, Lakisha Hyatt, Ned Lamont, Department of Mental Health and Addiction Services, Hal Smith, Whiting Forensic Hospital (Urban, Ralph) (Entered: 05/11/2020)
18 NOTICE of Appearance by Emily V. Melendez on behalf of State of Connecticut, Connecticut Valley Hospital, Miriam E. DelphinRittmon, Lakisha Hyatt, Ned Lamont, Department of Mental Health and Addiction Services, Hal Smith, Whiting Forensic Hospital (Melendez, Emily) (Entered: 05/11/2020)
19 NOTICE of Appearance by Laura D. Thurston on behalf of State of Connecticut, Connecticut Valley Hospital, Miriam E. DelphinRittmon, Lakisha Hyatt, Ned Lamont, Department of Mental Health and Addiction Services, Hal Smith, Whiting Forensic Hospital (Thurston, Laura) (Entered: 05/11/2020)

05/12/2020
05/15/2020 05/21/2020 05/22/2020 06/08/2020 06/08/2020

20 SUMMONS Returned Executed by Vincent Ardizzone, Barbara Flood, Gail Litsky, Thomas Wilkes, Carson Mueller. State of Connecticut served on 5/6/2020, answer due 5/27/2020; Connecticut Valley Hospital served on 5/6/2020, answer due 5/27/2020; Miriam E. Delphin-Rittmon served on 5/6/2020, answer due 5/27/2020; Lakisha Hyatt served on 5/6/2020, answer due 5/27/2020; Ned Lamont served on 5/6/2020, answer due 5/27/2020; Department of Mental Health and Addiction Services served on 5/6/2020, answer due 5/27/2020; Hal Smith served on 5/6/2020, answer due 5/27/2020; Whiting Forensic Hospital served on 5/6/2020, answer due 5/27/2020. (Lowry, Kirk) (Entered: 05/12/2020)
21 MOTION for Attorney(s) Mark J. Murphy to be Admitted Pro Hac Vice (paid $75 PHV fee; receipt number ACTDC-5861055) by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Attachments: # 1 Affidavit and Attachment A)(Lowry, Kirk) (Entered: 05/15/2020)
22 First MOTION for Extension of Time until June 26, 2020 to File Answer or Response to First Amended Complaint 10 Amended Complaint by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith. (Melendez, Emily) (Entered: 05/21/2020)
23 ORDER granting 22 First MOTION for Extension of Time until June 26, 2020 to File Answer or Response to First Amended Complaint 10 Amended Complaint. SO ORDERED by Judge Janet C. Hall on 5/22/2020. (Lewis, D) (Entered: 05/22/2020)
24 MOTION for Preliminary Injunction by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes.Responses due by 6/29/2020 (Lowry, Kirk) (Entered: 06/08/2020)
25 Memorandum in Support of 24 Motion for Preliminary Injunction by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes.Responses due by 6/29/2020 (Attachments: # 1 Exhibit Exhibit List to Memo In Support, # 2 Exhibit 1 Dr. Manian Declaration, # 3 Exhibit 2 Canavan-Jones Declaration, # 4 Affidavit 3 Mueller Affidavit, # 5 Affidavit 4 Ardizzone Affidavit, # 6 Affidavit 5 Litsky Affidavit, # 7 Affidavit 6 Clarke Affidavit, # 8 Affidavit 7 King Affidavit, # 9 Affidavit 8 Gudis Affidavit, # 10 Exhibit 9 CT DPH LTCF Guidance, # 11 Exhibit 10 CMS NH Reopening, # 12 Exhibit 11 CDC How to Protect Yourself, # 13 Exhibit 12 CDC Key Strategies to Prepare LTCFs, # 14 Exhibit 13 CDC Preparing for COVID-19 in NFs, # 15 Exhibit 14 CDC Responding to Coronavirus in NFs, # 16 Exhibit 15 CDC Testing Guidance for NHs, # 17 Exhibit 16 CDC Performing Facility-wide

06/09/2020 06/09/2020 06/10/2020 06/10/2020 06/10/2020
06/11/2020 06/11/2020 06/11/2020

Testing in NHs, # 18 Exhibit 17 CDC Infection Prevention and Control - IPC, # 19 Exhibit 18 SAMHSA Care and Tx of MH in COVID-19 Epidemic)(Lowry, Kirk) Modified on 6/26/2020 to change event type (Reis, Julia). (Entered: 06/08/2020)
26 NOTICE by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes re 24 MOTION for Preliminary Injunction Notice of Objection of Request for Additional Time to Respond (Lowry, Kirk) (Entered: 06/09/2020)
27 PROPOSED ORDER Defendants Proposed Briefing Schedule by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith. (Salton, Henry) (Entered: 06/09/2020)
28 NOTICE of Appearance by Ira Burnim on behalf of Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes (Burnim, Ira) (Entered: 06/10/2020)
29 MOTION for Attorney(s) Steven J. Schwartz to be Admitted Pro Hac Vice (paid $200 PHV fee; receipt number ACTDC-5908612) by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Attachments: # 1 Affidavit Declaration of Steven J. Schwartz and Attachment A)(Lowry, Kirk) (Entered: 06/10/2020)
30 ORDER re 27 Proposed Order filed by Hal Smith, Lakisha Hyatt, Ned Lamont, Miriam E. Delphin-Rittmon. The defendants' briefing schedule is approved, in light of the time plaintiffs needed to develop their motion and supporting materials, and the challenges that Covid 19 present in the defendants' preparing a response to the plaintiffs, including likely expert filings. The plaintiff is given 14 days to reply, but of course can seek more time. The court expects to schedule this for matter for oral argument the week of July 27, unless plaintiffs indicate they will only need a week to reply, in which case the court would likely advance the hearing. SO ORDERED by Judge Janet C. Hall on 6/10/2020.(DeRubeis, B.) (Entered: 06/10/2020)
31 NOTICE of Appearance by Shawn L Rutchick on behalf of Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith (Rutchick, Shawn) (Entered: 06/11/2020)
32 MOTION to Dismiss by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith.Responses due by 7/2/2020 (Urban, Ralph) (Entered: 06/11/2020)
33 Memorandum in Support re 32 MOTION to Dismiss filed by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith. (Attachments: # 1 Exhibit 1 Declaration of Kathryn Stackpole,

06/12/2020 06/13/2020 06/16/2020
06/16/2020 06/17/2020 06/18/2020 06/18/2020 06/19/2020
06/19/2020

# 2 Exhibit 2 Declaration of Charles Dike, # 3 Exhibit 3 Gloria Drummer v. State of Connecticut, et al. Amended Motion for Class Certification with attached complaint)(Urban, Ralph) (Entered: 06/11/2020)
34 Memorandum in Support re 32 MOTION to Dismiss Supplemental Memorandum in Support of Motion to Dismiss filed by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith. (Urban, Ralph) (Entered: 06/12/2020)
35 NOTICE by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes Corrected Memorandum in Support of Motion for PI (Lowry, Kirk) (Entered: 06/13/2020)
36 CERTIFICATE OF GOOD STANDING re 13 MOTION for Attorney(s) Ira Burnim to be Admitted Pro Hac Vice (paid $75 PHV fee; receipt number ACTDC-5848451) by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Lowry, Kirk) (Entered: 06/16/2020)
37 ORDER granting 21 Motion to Appear ; granting 29 Motion to Appear ; granting 14 Motion to Appear Certificate of Good Standing due by 8/15/2020. Signed by Clerk on 6/16/2020. (Lewis, D) (Entered: 06/16/2020)
38 NOTICE of Appearance by Steven J. Schwartz on behalf of Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes (Schwartz, Steven) (Entered: 06/17/2020)
39 NOTICE of Appearance by Jennifer Mathis on behalf of Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes (Mathis, Jennifer) (Entered: 06/18/2020)
40 NOTICE of Appearance by Mark J. Murphy on behalf of Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes (Murphy, Mark) (Entered: 06/18/2020)
41 CERTIFICATE OF GOOD STANDING re 29 MOTION for Attorney(s) Steven J. Schwartz to be Admitted Pro Hac Vice (paid $200 PHV fee; receipt number ACTDC-5908612) by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Schwartz, Steven) (Entered: 06/19/2020)
42 CERTIFICATE OF GOOD STANDING re 14 MOTION for Attorney(s) Jennifer Mathis to be Admitted Pro Hac Vice (paid $75 PHV fee; receipt number ACTDC-5848506) by Vincent Ardizzone,

06/25/2020
06/30/2020 06/30/2020 07/01/2020 07/02/2020 07/09/2020 07/09/2020

Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Mathis, Jennifer) (Entered: 06/19/2020)
43 NOTICE OF E-FILED CALENDAR: THIS IS THE ONLY NOTICE COUNSEL/THE PARTIES WILL RECEIVE. ALL PERSONS ENTERING THE COURTHOUSE MUST PRESENT PHOTO IDENTIFICATION. Oral argument re: 24 Motion for Preliminary Injunction set for 7/29/2020 09:30 AM before Judge Janet C. Hall. This matter will be held via video conferencing. Technical details for connecting to the conference will be docketed separately. (DeRubeis, B.) (Entered: 06/25/2020)
44 MOTION for Leave to File Excess Pages In Response to Plaintiffs' Motion for Preliminary Injunction by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith. (Melendez, Emily) (Entered: 06/30/2020)
45 RESPONSE re 44 MOTION for Leave to File Excess Pages In Response to Plaintiffs' Motion for Preliminary Injunction filed by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Lowry, Kirk) (Entered: 06/30/2020)
46 ORDER granting 44 Motion for Leave to File Excess Pages. SO ORDERED by Judge Janet C. Hall on 7/1/2020. (Lewis, D) (Entered: 07/01/2020)
47 Memorandum in Opposition re 32 MOTION to Dismiss filed by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Attachments: # 1 Exhibit A Drummer Complaint, # 2 Exhibit B Drummer Judge Frechette MOD)(Lowry, Kirk) (Entered: 07/02/2020)
48 MOTION in Limine by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith.Responses due by 7/30/2020 (Attachments: # 1 Memorandum in Support, # 2 Exhibit A)(Salton, Henry) (Entered: 07/09/2020)
49 OBJECTION re 24 MOTION for Preliminary Injunction filed by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith. (Attachments: # 1 Exhibit List, # 2 Exhibit A, # 3 Exhibit B, # 4 Exhibit C, # 5 Exhibit D, # 6 Exhibit E, # 7 Exhibit F, # 8 Exhibit G, # 9 Exhibit H, # 10 Exhibit I, # 11 Exhibit J, # 12 Exhibit K, # 13 Exhibit L, # 14 Exhibit M, # 15 Exhibit N, # 16 Exhibit O, # 17 Exhibit P, # 18 Exhibit Q, # 19 Exhibit R, # 20 Exhibit S, # 21 Exhibit T, # 22 Exhibit U, # 23 Exhibit V, # 24 Exhibit W, # 25 Exhibit X, # 26 Exhibit Y, # 27 Exhibit Z, # 28 Exhibit AA, # 29 Exhibit BB)(Salton, Henry) (Entered: 07/09/2020)

07/13/2020 07/14/2020 07/14/2020 07/15/2020 07/15/2020
07/15/2020 07/16/2020
07/16/2020

50 CERTIFICATE OF GOOD STANDING re 21 MOTION for Attorney(s) Mark J. Murphy to be Admitted Pro Hac Vice (paid $75 PHV fee; receipt number ACTDC-5861055) by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Murphy, Mark) (Entered: 07/13/2020)
51 Emergency MOTION for Status Conference by Miriam E. DelphinRittmon, Lakisha Hyatt, Ned Lamont, Hal Smith. (Salton, Henry) (Entered: 07/14/2020)
52 Emergency MOTION for Status Conference by Miriam E. DelphinRittmon, Lakisha Hyatt, Ned Lamont, Hal Smith. (Attachments: # 1 Supplement Email)(Salton, Henry) (Entered: 07/14/2020)
53 ORDER granting 52 Motion for Status Conference; ORDER terminating as duplicative 51 Motion for Conference. SO ORDERED by Judge Janet C. Hall on 7/15/2020. (DeRubeis, B.) (Entered: 07/15/2020)
54 NOTICE OF E-FILED CALENDAR: THIS IS THE ONLY NOTICE COUNSEL/THE PARTIES WILL RECEIVE.ALL PERSONS ENTERING THE COURTHOUSE MUST PRESENT PHOTO IDENTIFICATION. Telephonic Status Conference set for 7/16/2020 02:30 PM in Chambers Room 107, 141 Church St., New Haven, CT before Judge Janet C. Hall. Counsel are requested to participate in this conference, via telephone. Please use the following dial-in for this call: 1-877-873-8017; Access Code: 6415663#. (DeRubeis, B.) (Entered: 07/15/2020)
55 MOTION to Continue Hearing on Plaintiffs' Motion for Preliminary Injunction by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Lowry, Kirk) (Entered: 07/15/2020)
56 Minute Entry. Proceedings held before Judge Janet C. Hall: Telephonic Motion Hearing held on 7/16/2020 taking under
advisement 55 Motion to Continue Hearing on Plaintiffs' Motion for Preliminary Injunction filed by Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes, Vincent Ardizzone. Ruling to issue. 50 minutes(Court Reporter Terri Fidanza.) (Lewis, D) (Entered: 07/16/2020)
57 Oral MOTION to Withdraw 24 MOTION for Preliminary Injunction by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Lewis, D) Modified on 7/17/2020 (Lewis, D). (Entered: 07/17/2020)

07/17/2020
07/20/2020 07/21/2020 07/21/2020 07/22/2020 07/22/2020

58 ORDER withdrawing 24 Motion for Preliminary Injunction;
denying 55 Motion to Continue; granting 57 Motion to
Withdraw 55 MOTION to Continue Hearing on Plaintiffs' Motion for Preliminary Injunction. The plaintiffs Motion (Doc.
No. 55 ) for Continuance is denied, but the plaintiffs oral Motion to withdraw their Motion for Preliminary Injunction (Doc. No. 57 )is granted. The Clerk is directed to terminate the Motion for Preliminary Injunction as withdrawn. The parties are ordered to confer and submit a Rule 26(f) report, addressing all aspects, as well as deadlines, for discovery and case management, including the
issues raised in the remainder of the Motion (Doc. No. 55 ). Those aspects of that motion are terminated with leave to raise in connection with the 26f conference and subsequent scheduling conference to to be held with the magistrate judge. The case is referred to the magistrate judge for pre-trial case management, including discovery and scheduling matters. SO ORDERED by Judge Janet C. Hall on 7/17/2020. (Lewis, D) Modified on 10/27/2020 (Lewis, D). (Entered: 07/17/2020)
59 MOTION for Leave to File Supplemental Brief to Objection to MTD by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Attachments: # 1 Exhibit Proposed Supplement Brief)(Lowry, Kirk) (Entered: 07/20/2020)
60 OBJECTION re 59 MOTION for Leave to File Supplemental Brief to Objection to MTD filed by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith. (Urban, Ralph) (Entered: 07/21/2020)
61 ORDER granting 59 Motion for Leave to File. Motion granted. The court advises counsel that the opportunity to have a do over will not exist in the future. Defense counsel is given until August 4th to file their reply.. SO ORDERED by Judge Janet C. Hall on 7/21/2020. (Lewis, D) (Entered: 07/21/2020)
62 Memorandum in Opposition Plaintiffs' Supplemental Brief in Opposition re 32 MOTION to Dismiss filed by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Lowry, Kirk) (Entered: 07/22/2020)
63 ORDER re 60 Objection filed by Hal Smith, Lakisha Hyatt, Ned Lamont, Miriam E. Delphin-Rittmon. Having granted the motion at issue, the court treats this opposition as a Motion for Reconsideration

07/28/2020 07/30/2020 07/30/2020 07/31/2020 08/11/2020 08/19/2020 08/27/2020
08/27/2020

and grants it. However, the court adheres to its original ruling. The court has already given defendants time to reply. The court advises the plaintiffs that they are required to consult with opposing counsel on these types of motions before filing them. If they fail to do so in the future, the court will deny any such motion on that ground. SO ORDERED by Judge Janet C. Hall on 7/22/2020.(Lewis, D) (Entered: 07/22/2020)
64 MOTION for Ralph E. Urban to Withdraw as Attorney by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith. (Urban, Ralph) (Entered: 07/28/2020)
65 RESPONSE re 62 Memorandum in Opposition to Motion filed by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith. (Attachments: # 1 Exhibit Declaration of Debora KaszubaNeary)(Salton, Henry) (Entered: 07/30/2020)
66 Memorandum in Opposition re 48 MOTION in Limine filed by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Lowry, Kirk) (Entered: 07/30/2020)
67 ORDER granting 64 Motion to Withdraw as Attorney. Attorney Ralph E. Urban terminated. SO ORDERED by Judge Janet C. Hall on 7/31/2020. (Lewis, D) (Entered: 07/31/2020)
68 REPLY to Response to 48 MOTION in Limine filed by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith. (Attachments: # 1 Supplement Case Law)(Salton, Henry) (Entered: 08/11/2020)
69 ORDER REFERRING CASE to Magistrate Judge Robert A. Richardson for pretrial case management SO ORDERED by Judge Janet C. Hall on 8/19/2020.(Lewis, D) (Entered: 08/19/2020)
70 ORDER: A telephonic status conference is scheduled for 8/31/2020 at 11:00 AM with Judge Richardson to discuss the parties proposed 26(f) reports. Counsel have been provided with conference call instructions via email. Signed by Judge Robert A. Richardson on 8/27/2020. (Fries, J.) (Entered: 08/27/2020)
71 NOTICE OF E-FILED CALENDAR: THIS IS THE ONLY NOTICE COUNSEL/THE PARTIES WILL RECEIVE. ALL PERSONS ENTERING THE COURTHOUSE MUST PRESENT PHOTO IDENTIFICATION. A telephonic status conference is set for 8/31/2020 at 11:00 AM before Judge Robert A. Richardson. Call

08/31/2020 08/31/2020
09/01/2020 09/15/2020 09/15/2020

instructions have been sent to counsel via email. (Fries, J.) (Entered: 08/27/2020)
72 Minute Entry for proceedings held before Judge Robert A. Richardson: Telephonic status conference held on 8/31/2020. Total Time: 1 hours and 45 minutes.(Court Reporter: FTR.)(Fries, J.) (Entered: 08/31/2020)
73 SCHEDULING ORDER: Following a telephonic conference the Court has set the following deadlines in this case. Initial disclosures will be exchanged by 9/15/2020. Plaintiff's fact discovery will close on 11/30/2020 and for the defendant on 12/31/2020. Plaintiff will designate experts and provide reports by 12/31/2020 but will provide name and topic information to defendant by 10/15/2020. Defendant will designate experts and provide reports by experts by 2/15/2021. Plaintiffs expert depositions will be completed by 2/15/2021 and defendants expert depositions will be completed by 3/15/2021. Any motion for class certification will be filed by 3/1/2021. Any motion for summary judgment will be filed by 4/22/2021. The Joint trial memo will be filed 30 days after a ruling on summary judgment and the case will be ready 30 days thereafter. The parties agreed that reasonable access to both facilities will be provided. In addition, there is no waiver of privileged information resulting from inadvertent disclosure. However, if a party is alerted by opposing counsel to potentially privileged information inadvertently disclosed and fails to respond in a reasonable time then the privilege is waived. Signed by Judge Robert A. Richardson on 8/31/2020. (Fries, J.) (Entered: 08/31/2020)
74 ORDER denying as moot 48 Motion in Limine. On account of the court's 58 Order granting plaintiff's' 57 Motion to Withdraw, defendants' 48 Motion in Limine was rendered moot. If plaintiffs seek to rely on the same expert evidence in connection with a future motion or other proceeding, defendants may reclaim their 48 Motion In Limine by filing a one-sentence Motion to Reclaim.SO ORDERED by Judge Janet C. Hall on 9/1/2020. (Lewis, D) (Entered: 09/01/2020)
75 REPORT of Rule 26(f) Planning Meeting. (Lowry, Kirk) (Entered: 09/15/2020)
76 NOTICE OF COMPLIANCE WITH PRETRIAL ORDER by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes re 73 Scheduling Order,,,,, Initial Disclosures served (Lowry, Kirk) (Entered: 09/15/2020)

09/15/2020 09/21/2020 09/22/2020 09/23/2020 10/05/2020
10/15/2020 10/23/2020

77 NOTICE OF COMPLIANCE WITH PRETRIAL ORDER by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith Defendants' Initial Disclosures (Melendez, Emily) (Entered: 09/15/2020)
78 MOTION for Henry A. Salton to Withdraw as Attorney by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith. Motions referred to Robert A. Richardson(Salton, Henry) (Entered: 09/21/2020)
79 PRE-TRIAL ORDER. Dispositive Motions due by 4/22/2021. Status Report due by 12/18/2020. Trial Brief due by 4/22/2021. Signed by Judge Janet C. Hall on 9/22/2020. (Reis, Julia) (Entered: 09/22/2020)
80 ORDER granting 78 Motion to Withdraw as Attorney. Attorney Henry A. Salton terminated. SO ORDERED by Judge Janet C. Hall on 9/23/2020. (DeRubeis, B.) (Entered: 09/23/2020)
81 TRANSCRIPT of Proceedings: Type of Hearing: Telephonic Rule 26(f) Conference. Held on August 31, 2020 before Judge Robert A. Richardson. Court Reporter: Martha Marshall (Transcriber). IMPORTANT NOTICE - REDACTION OF TRANSCRIPTS: To remove personal identifier information from the transcript, a party must electronically file a Notice of Intent to Request Redaction with the Clerk's Office within seven (7) calendar days of this date. If no such Notice is filed, the court will assume redaction of personal identifiers is not necessary and the transcript will be made available through PACER without redaction 90 days from today's date. The transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. The policy governing the redaction of personal information is located on the court website at www.ctd.uscourts.gov. Redaction Request due 10/26/2020. Redacted Transcript Deadline set for 11/5/2020. Release of Transcript Restriction set for 1/3/2021. (Marshall, Martha) (Entered: 10/05/2020)
82 NOTICE OF COMPLIANCE WITH PRETRIAL ORDER by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes re 73 Scheduling Order,,,,, (Lowry, Kirk) (Entered: 10/15/2020)
83 Proposed Pretrial Order Joint Motion to Modify Scheduling Order and PTO by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Lowry, Kirk) (Entered: 10/23/2020)

10/26/2020 10/26/2020 11/25/2020 11/30/2020 12/11/2020
12/14/2020 12/17/2020 12/17/2020

84 ORDER granting 83 Proposed Pretrial Order filed by Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes, Vincent Ardizzone. The court does not expect to extend these deadlines. SO ORDERED by Judge Janet C. Hall on 10/26/2020.(DeRubeis, B.) (Entered: 10/26/2020)
Set Deadlines/Hearings: Fact Discovery due by 1/8/2021; Motion for Class Certification due by 4/9/2021; Dispositive Motions due by 5/31/2021; Status Report due by 1/26/2021; Trial Brief due by 5/31/2021. (DeRubeis, B.) (Entered: 10/26/2020)
85 Joint MOTION for Protective Order by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes.Responses due by 12/16/2020 (Attachments: # 1 Text of Proposed Order Protective Order)Motions referred to Robert A. Richardson(Lowry, Kirk) (Entered: 11/25/2020)
86 ORDER granting 85 Joint MOTION for Protective Order by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. Signed by Judge Janet C. Hall on 11/30/2020. (DeRubeis, B.) (Entered: 11/30/2020)
87 MOTION to Compel Production of Documents by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes.Responses due by 1/1/2021 (Attachments: # 1 Affidavit Of Kirk W. Lowry, # 2 Exhibit WFH Objections and Responses RFP, # 3 Exhibit CVH Objections and Responses to RFP, # 4 Exhibit OOC Objections and Responses to RFP, # 5 Memorandum in Support Memorandum in Support of Motion to Compel)Motions referred to Robert A. Richardson(Lowry, Kirk) (Entered: 12/11/2020)
88 ORDER REFERRING CASE to Magistrate Judge Robert A. Richardson for Motions including 87 MOTION to Compel Production of Documents. SO ORDERED by Judge Janet C. Hall on 12/14/2020. Motions referred to Robert A. Richardson. (DeRubeis, B.) (Entered: 12/14/2020)
89 Emergency MOTION to Compel Dkt. 87 by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes.Responses due by 1/7/2021 (Teixeira, Virginia) (Entered: 12/17/2020)
90 MOTION for Clarification 89 Emergency MOTION to Compel Dkt. 87 by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Teixeira, Virginia) (Entered: 12/17/2020)

12/18/2020 12/18/2020
12/21/2020 12/21/2020 12/22/2020 12/22/2020 12/22/2020

91 ORDER REFERRING CASE to Magistrate Judge Robert A. Richardson for Motions including 89 Emergency MOTION to Compel Dkt. 87, 90 MOTION for Clarification 89 Emergency MOTION to Compel Dkt. 87. SO ORDERED by Judge Janet C. Hall on 12/18/2020. Motions referred to Robert A. Richardson. (DeRubeis, B.) (Entered: 12/18/2020)
92 RULING granting in part and denying in part 32 MOTION to Dismiss by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith. The Motion to Dismiss is denied in part as to the defendants' arguments concerning primary jurisdiction doctrine and Colorado River abstention and granted in part as to the defendants' arguments concerning habeas corpus. The portion of the Amended Complaint petitioning for a writ of habeas corpus is dismissed. Signed by Judge Janet C. Hall on 12/18/2020. (DeRubeis, B.) (Entered: 12/18/2020)
93 ORDER: A telephonic status conference is scheduled for 12/22/20 at 12:30 PM with Judge Richardson. Conference call instructions have been sent to counsel via email. Signed by Judge Robert A. Richardson on 12/21/2020. (Fries, J.) (Entered: 12/21/2020)
94 NOTICE OF E-FILED CALENDAR: THIS IS THE ONLY NOTICE COUNSEL/THE PARTIES WILL RECEIVE. ALL PERSONS ENTERING THE COURTHOUSE MUST PRESENT PHOTO IDENTIFICATION. A telephonic status conference is set for 12/22/2020 at 12:30 PM before Judge Robert A. Richardson. (Fries, J.) (Entered: 12/21/2020)
95 Minute Entry for proceedings held before Judge Robert A. Richardson: Telephonic Status Conference held on 12/22/2020. Total time: 45 minutes. (Court Reporter FTR.) (Fries, J.) (Entered: 12/22/2020)
96 ORDER Setting telephonic hearing on 87 Plaintiff's motion to compel production of documents: A telephonic motion hearing is set for 1/6/2021 at 1:00 PM before Judge Robert A. Richardson. To connect to the call dial 1-877-848-7030 and when prompted enter the access code 4685046 followed by #. Signed by Judge Robert A. Richardson on 12/22/2020. (Fries, J.) (Entered: 12/22/2020)
97 ORDER: In light of the Court's proposal discussed during the status conference on 12/22/2020, motions 89 and 90 are denied as moot. Signed by Judge Robert A. Richardson on 12/22/2020. (Fries, J.) (Entered: 12/22/2020)

01/04/2021 01/05/2021 01/06/2021 01/08/2021
01/08/2021 01/13/2021 01/14/2021 01/14/2021

98 OBJECTION re 87 MOTION to Compel Production of Documents filed by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith. (Attachments: # 1 Exhibit 1, # 2 Exhibit 2, # 3 Exhibit 3, # 4 Exhibit 4, # 5 Exhibit 5)(Rutchick, Shawn) (Entered: 01/04/2021)
99 ANSWER to 10 Amended Complaint with Affirmative Defenses. by Miriam E. Delphin-Rittmon, Lakisha Hyatt, Ned Lamont, Hal Smith.(Melendez, Emily) (Entered: 01/05/2021)
100 Minute Entry for proceedings held before Judge Robert A. Richardson: Motion Hearing held on 1/6/2021 re 87 Plaintiff's Motion to Compel Production of Documents. Total Time: 1 hour and 30 minutes. (Court Reporter: FTR.) (Fries, J.) (Entered: 01/06/2021)
101 ORDER granting in part 87 Plaintiff's Motion to Compel. During the oral argument held in this matter plaintiff's counsel asserted that they would accept a spreadsheet containing patient names and units, limited to certain specific buildings and wings and only civil patients. Defendant has raised concerns on providing names or other identifying information in light of certain statutory privacy protections and privileges. In light of those concerns, but in an effort to keep this matter moving, the Court orders that defendant produce a spreadsheet for the specified locations without any names. The Court reserves the right to rule on the issue of, and any procedure for, further disclosure of names and other potentially identifying information and will do so as quickly as possible. Signed by Judge Robert A. Richardson on 1/8/2021. (Fries, J.) (Entered: 01/08/2021)
102 Minute Entry for proceedings held before Judge Robert A. Richardson: Motion Hearing held on 1/8/2021 re 87 Motion to Compel. Total Time: 1 hour. (Court Reporter FTR.) (Fries, J.) (Entered: 01/08/2021)
103 STIPULATION of Dismissal of Case by Vincent Ardizzone, Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes. (Lowry, Kirk) (Entered: 01/13/2021)
104 ORDER granting 103 Stipulation of Dismissal without prejudice filed by Barbara Flood, Gail Litsky, Carson Mueller, Thomas Wilkes, Vincent Ardizzone SO ORDERED by Judge Janet C. Hall on 1/14/2021.(Lewis, D) Modified on 1/14/2021 (Lewis, D). (Entered: 01/14/2021)
JUDICIAL PROCEEDINGS SURVEY - FOR COUNSEL ONLY: The following link to the confidential survey requires you to log into

CM/ECF for SECURITY purposes. Once in CM/ECF you will be prompted for the case number. Although you are receiving this survey through CM/ECF, it is hosted on an independent website called SurveyMonkey. Once in SurveyMonkey, the survey is located in a secure account. The survey is not docketed and it is not sent directly to the judge. To ensure anonymity, completed surveys are held up to 90 days before they are sent to the judge for review. We hope you will take this opportunity to participate, please click on this link:
https://ecf.ctd.uscourts.gov/cgi-bin/Dispatch.pl?survey (Lewis, D) (Entered: 01/14/2021)

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 Case 3:20-cv-00594-JCH Document 1 Filed 04/30/20 Page 1 of 26

IN THE UNITED STATES DISTRICT COURT DISCTRICT OF CONNECTICUT

Thomas Wilkes,

)

Barbara Flood,

)

Vincent Ardizzone,

)

Gail Litsky,

)

Carson Mueller,

)

On behalf of themselves and )

all other persons similarly )

situated,

)

Plaintiffs,

)

v.

)

)

Ned Lamont, Governor,

)

Miriam E. Delphin-Rittmon,

)

Commissioner of DMHAS,

)

Hal Smith, CEO of

)

Whiting Forensic Hospital,

)

Lakisha Hyatt, CEO of

)

Connecticut Valley Hospital,

)

State of Connecticut,

)

Department of Mental Health and )

Addiction Services,

)

Whiting Forensic Hospital, and )

Connecticut Valley Hospital,

)

Defendants. )

Civil No.: 3:20cv594
IMMEDIATE RELIEF SOUGHT April 30, 2020

CLASS ACTION COMPLAINT AND PETITION FOR A WRIT OF HABEAS CORPUS

Jurisdiction

1. This case is brought pursuant to 42 U.S.C. § 1983 to enforce

the constitutional right of all patients at Connecticut Valley Hospital (CVH)

and Whiting Forensic Hospital (WFH), two state inpatient psychiatric

1

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facilities, to safe conditions of confinement. Jurisdiction is based upon 28 U.S.C. §§ 1331 and 1343. Jurisdiction is also asserted pursuant to 28 U.S.C. 2241 for a writ of habeas corpus.
2. The Plaintiffs also assert the supplemental jurisdiction of the court for state statutory claims pursuant to the Connecticut Patients’ Bill of Rights, General Statutes §§ 17a-540 et seq. Federal supplemental jurisdiction is asserted pursuant to 28 U.S.C. § 1367. Venue
3. Venue is based upon 28 U.S.C. § 1392(b)(2) because all of the acts and omissions giving rise to the claims herein arose in the District of Connecticut. Parties
4. Thomas Wilkes is a 67-year-old honorably discharged Veteran of the Vietnam War who is civilly committed to Connecticut Valley Hospital. Mr. Wilkes currently is confined in CVH - Battell Hall 3 South. Mr. Wilkes is high risk to contract Covid-19. He has shown symptoms of Covid-19. His roommate tested positive for Covid-19. Mr. Wilkes is a patient as defined in the Connecticut Patients’ Bill of Rights, General Statutes § 17a-540(2).
5. Barbara Flood is a 64-year-old woman civilly committed to Connecticut Valley Hospital. Ms. Flood is currently confined to CVH -
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Woodward Hall 1 North. Ms. Flood has been discharge-ready for many months but has not been able to secure dialysis treatment in the community. Ms. Flood has kidney failure and needs weekly dialysis. Ms. Flood is at extreme high risk for Covid-19. Ms. Flood is a patient as defined in the Connecticut Patients’ Bill of Rights, General Statutes § 17a540(2).
6. Vincent Ardizzone is a 58-year-old man who is an acquittee committed to the jurisdiction of the Psychiatric Security Review Board pursuant to General Statutes § 17a-582. Mr. Ardizzone was committed to Whiting Forensic Hospital on March 4, 1993 for 35 years. Mr. Ardizzone has been diagnosed with emphysema and Stage IV prostate cancer with metastasis. Mr. Ardizzone is at very high risk for morbidity and mortality for Covid-19. Mr. Ardizzone is a patient as defined in the Connecticut Patients’ Bill of Rights, General Statutes § 17a-540(2).
7. Gail Litsky is a 53-year-old woman who is an acquittee committed to the jurisdiction of the Psychiatric Security Review Board pursuant to General Statutes § 17a-582. Ms. Litsky was committed to the Whiting Forensic Hospital on January 13, 2015 for forty years. Ms. Litsky is the only female on her unit, Dutcher North 2. Ms. Litsky has health conditions that put her at high risk for Covid-19. Ms. Litsky is a patient as
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defined in the Connecticut Patients’ Bill of Rights, General Statutes § 17a540(2).
8. Carson Mueller is a 45-year-old man who is an acquittee committed to the jurisdiction of the Psychiatric Security Review Board pursuant to General Statutes § 17a-582. Mr. Mueller was committed to Whiting Forensic Hospital on September 1, 2009 for sixty years. Mr. Mueller has been in psychiatric remission for many years, has a full Level 4 with all pass times, and was granted temporary leave by the PSRB. Mr. Mueller is a patient as defined in the Connecticut Patients’ Bill of Rights, General Statutes § 17a-540(2).
9. Ned Lamont is the Governor of the State of Connecticut. He is sued in his official capacity only. Governor Lamont, as the chief executive officer of the state, appoints the Commissioner of DMHAS and has authority to direct the control and operation of all state psychiatric facilities.
10. Commissioner Miriam E. Delphin-Rittmon is the Commissioner of the Department of Mental Health and Addiction Services with authority to hire the Chief Executive Officers and control and operate all state psychiatric facilities. The Commissioner is sued in her official capacity for prospective injunctive relief only.
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11. Defendant Hal Smith is the Chief Executive Officer of Whiting Forensic Hospital located in Middletown, Connecticut. Defendant is sued in his official capacity for prospective injunctive relief only.
12. Defendant Lakisha Hyatt is the Chief Executive Officer of Connecticut Valley Hospital located in Middletown, Connecticut. Defendant is sued in her official capacity for prospective injunctive relief only.
13. Defendants State of Connecticut, Department of Mental Health and Addiction Services, Whiting Forensic Hospital and Connecticut Valley Hospital all operate Whiting Forensic Hospital and Connecticut Valley Hospital as facilities as defined in the Connecticut Patients’ Bill of Rights, General Statutes § 17a-540(1). These defendants are sued as facilities under Count 3 for claims pursuant to the Connecticut Patients’ Bill of Rights only, and not pursuant to 42 U.S.C. § 1983. The State has waived sovereign immunity pursuant to the Connecticut Patients’ Bill of Rights, § 17a-550. Mahoney v. Lensink, 213 Conn. 548, 562 (1990). Statement of Facts
14. Connecticut Valley Hospital is a state-operated inpatient psychiatric facility with three residential hall buildings; Battell Hall, Woodward Hall and Merritt Hall. The total patients at CVH in the general psychiatry division is approximately 209.
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15. The legal status of almost all patients at Connecticut Valley Hospital is committed pursuant to General Statutes § 17a-498(c) or voluntary status pursuant to General Statutes § 17a-506.
16. Battell Hall has six units that have an approximate census of 15 to 20 patients each; B2N, B2S, B3N, B3S, B4N and B4S. This building is designated as a general psychiatric building with both men and women patients. B2S, B3S and B4S have been quarantined at times and have isolated patients who have tested positive for Covid-19.
17. CVH units are small units with sleeping rooms, a day room, a TV room, a comfort room, a restraint and seclusion room and rooms for staff. It is impossible for the patients to maintain at least six feet from other patients. No, or almost no, patients have a single room. Most patients sleep in open dorms with nothing but temporary walls that do not reach the ceiling.
18. Woodward Hall has four units that have an approximate census of 15 to 20 patients each; WW1S, WW1N, WW2S, and WW2N. Woodward two south is designated as a traumatic brain injury unit. The other units are general psychiatry patients treating both men and women. Woodward Hall generally treats older patients over 50 and patients with significant general medical needs.
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19. The units in Woodward have sleeping rooms, a day room, a TV room, restraint and seclusion rooms, and rooms for staff. Most patients sleep two to a room. A few patients have a single room. Woodward does not have open dorm-like sleeping rooms. Patients at Woodward tend to be older and more frail with general health needs.
20. On April 29, 2020, the last two elderly patients on Woodward 2 North were transferred off the unit. All of the other patients on that unit had tested positive for Covid-19 and were transferred to Middlesex Hospital for respiratory treatment, including ventilator treatment, or to the CVH GPD quarantine unit in Merritt Hall, M3D-E. Almost all of the nurses and MHA staff on WW2N were off work after testing positive for the coronavirus.
21. Merritt Hall 4D is a general psychiatric unit that is designated as the young adult services unit for patients age 18 to 25. The Young Adult Unit has 17 beds.
22. Merritt Hall 3D-E has been designated as the isolation unit for the general psychiatry division for patients who test positive for Covid-19.
23. Whiting Forensic Hospital holds patients with a legal status of civil commitment, civil-voluntary, acquittees committed to the jurisdiction of the Psychiatric Security Review Board (PSRB), competency restoration,
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Department of Corrections transfers, and forensic patients for forensic evaluations.
24. Whiting Forensic Hospital has two buildings for patients. Maximum Security Service is generally referred to as Whiting Max. Enhanced Security Service is in the Dutcher building and contains units where patients expect to be transitioned to the community and eventually discharged.
25. Whiting Maximum Service contains six units, five of which are fully staffed. Units 1, 2 and 3 are primarily competency restoration units and hold approximately 20 patients each. These three units accept patients upon order of the Superior Court pursuant to General Statutes § 54-56d. Patients receive psychiatric treatment and competency restoration education and evaluation. Patients may be held for the maximum possible sentence for their charges or for 18 months, whichever is less. General Statutes § 54-56d(i).
26. WFH Units 4 and 6 are longer term treatment units and hold a mix of patients, most of whom are acquittees committed to the jurisdiction of the PSRB. Units 4 and 6 generally hold approximately 20 patients. Unit 5 has only one patient and operates as an adjunct of Unit 4. Whiting Max has a total capacity of 91.
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27. Patients residing on Whiting Forensic Hospital Units 4 and 6 have various legal statuses. A majority are acquittees committed to the jurisdiction of the Psychiatric Security Review Board pursuant to General Statutes § 17a-582. A minority of the patients are civilly committed pursuant to General Statutes § 17a-498(c), Department of Corrections transfers committed pursuant to General Statutes §§ 17a-512 to 17a-520, civilly committed by a Physician’s Emergency Certificate pursuant to General Statutes § 17a-502, or post-conviction examinations pursuant to General Statutes § 17a-566a.
28. Dutcher Enhanced Security Service generally serves patients who are admitted to Whiting Forensic Hospital but do not require maximum security service. Dutcher has a competency restoration unit and five treatment units. The vast majority of the patients on the treatment units started in WFH max and transferred to Dutcher for ongoing treatment and transition to temporary leaves, conditional discharge or community integration. Dutcher has 138 beds.
29. At both CVH and WFH, all of the units are staffed with three shifts of staff. On the first shift, 7 a.m. to 3 p.m., professional staff of psychiatrist, psychologist, unit director, social worker, nurses, and rehabilitation staff work along with Forensic Treatment Specialists
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(FTS)(WFH) or Mental Health Associates (MHA)(Dutcher). Total staff on each unit for each shift depends on the needs of the patients and their observation level. Some patients may be on regular observation while others may need two to one observation.
30. Many FTS’s and MHA’s may be mandated, which means they are required to work overtime or a double shift if necessary to provide minimum staffing for a unit. This may necessitate a staff member to work on two different units in one day.
31. On March 24, 2020, DMHAS announced that the first staff at CVH had tested positive for Covid-19. The staff reported out sick on March 11, 2020, was tested on March 14, 2020 and notified DMHAS on March 23, 2020 that he or she was positive for Covid-19. Patients and staff in contact with the employee were quarantined.
32. On March 26, 2020, DMHAS reported that the first patient at CVH tested positive for Covid-19.
33. The DMHAS Commissioner stated that she was taking significant steps to protect clients and staff from Covid-19. Those steps included:
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a) Adjusting outpatient services while promoting social distancing including telephone check-ins and closing wellness centers and social clubs.
b) Restricting visitors from DMHAS facilities. c) Conducting health screenings of all individuals who enter DMHAS
facilities, including staff and clients. d) Approving over 900 employees for telework to promote social
distancing and minimize exposure to clients and staff at DMHAS facilities. e) Directing staff who are symptomatic or have been in close contact with individuals suspected of or having Covid-19. to stay home and self-quarantine to prevent infecting clients and other staff. 34. Neither the Commissioner nor any other defendant took steps to test all patients and staff to determine the scope of the infection in the hospitals, nor provide masks, nor ensure social distancing, nor take steps to decompress the units by discharging, granting temporary leave, conditional discharge or providing temporary shelters or tents. 35. By March 31, 2020, five patients at CVH, five patients at WFH and two staff at CVH had tested positive for Covid-19. Probably two to five times more than those tested were infected.
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36. On April 10, 2020, DMHAS and WFH, issued an isolation and quarantine protocol for inpatient psychiatric facilities. On April 13, 2020, WFH updated its isolation and quarantine protocol. On April 16, 2020, DMHAS updated its isolation and quarantine protocol for psychiatric facilities.
37. On April 21, 2020, DMHAS reported that 22 patients at CVH, 13 staff at CVH, 7 patients at WFH, and 13 staff at WFH tested positive for Covid-19.
38. As of April 28, 2020, patients and staff with confirmed Covid-19, are in every building in CVH and WFH. Numerous patients are so ill that they have had to be transferred to Middlesex Hospital for acute respiratory care.
39. On April 30, 2020 CVH had a patient die from Covid-19. 40. Almost all patients on every unit in both CVH and WFH live in close contact with 15-20 other patients and 5-10 staff at any one time. All patients share two phones on each unit. Almost all patients share one bathroom with all the other patients. A few units, WFH U1, DS3 and several units in CVH are coed units and patients share bathrooms with half the unit comprised of persons of similar gender or gender-identified. Patients eat together as a unit either in the dining room or on the unit.
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Social distancing is not consistently possible on an inpatient unit at CVH and WFH.
41. On March 10, 2020, the Governor declared a public health and civil preparedness emergency pursuant to General Statutes § 19a-131a and § 28-9, such emergency to be in effect through September 9, 2020.
42. From March 12, 2020 through April 24, 2020, the Governor has issued 32 executive orders aimed at limiting the spread of the Coronavirus, infection of the public, and deaths from Covid-19.
43. Only one of the Governor’s executive orders has addressed the dire danger of the Coronavirus to patients in state psychiatric facilities. Executive Order 7C, issued on March 15, 2020, suspended the Connecticut Patients’ Bill of Rights, General Statutes § 17a-547 and authorized the Commissioners of DPH and DMHAS to issue any and all orders restricting entrance into the facilities they deem necessary to protect the health and welfare of the patients, residents and staff. Executive Order 7C also waived the patients’ right to confidentiality in General Statutes, § 52-146f, allowing the Commissioner of DPH and local health directors to report cases of Covid-19 from psychiatric facilities.
44. The only other executive orders affecting patients in state psychiatric facilities are Executive Order 7F which waives patients’ rights to
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personal service of process and to the right to appear in person for any probate court hearing and Executive Order 7K which waives all time requirements of any kind for notice, service of process or to hold a hearing, even if the patient is held against their will in a state psychiatric hospital. Several patients have been quarantined on their CVH or WFH inpatient unit and have not been allowed to attend their probate hearing and the hearing has been held without their appearance either in person, on video or on the phone.
45. While there have been several executive orders waiving and suspending the constitutional and statutory procedural due process rights of psychiatric inpatients, no executive order has been issued directly to protect the health and welfare of confined patients from the risk of infection and death from Covid-19 by ordering testing of all patients and staff, social distancing of all patients, ordering masks, review of all patients for discharge, temporary leave, conditional discharge or transfer to temporary alternate housing.
46. On April 18, 2020, the Executive Director of the Connecticut Legal Rights Project wrote a letter to the Governor and the Attorney General requesting an executive order:
a) To immediately stop all new admissions to all state-operated psychiatric facilities; 14

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b) require that every facility review the present mental status of each patient;
c) require that each facility make every effort to discharge every patient who does not absolutely need inpatient hospital level of care; and
d) require that each facility make every effort to discharge every patient for whom the risks of inpatient psychiatric care in the face of the Covid-19 pandemic outweigh the benefits of that level of care when such discharge does not pose an unreasonable risk to the public.
47. On April 18, 2020, CLRP requested that the Governor act immediately due to the imminent and substantial risk that patients and staff would become gravely ill and many may die.
48. On April 29, 2020, CLRP was informed by staff at CVH that administrators at CVH were closing an entire ward, Woodward 2 North, because all but two patients were ill or symptomatic with Covid-19 and had been transferred to Middlesex Hospital and on ventilators or transferred to the CVH quarantine unit in Merritt Hall, M3D-E. On April 30, 2020, the first patient from CVH died of Covid-19.
49. Defendants have failed to plan for an infection outbreak in the hospitals. Such failure resulted in or substantially contributed to Covid-19. infections and outbreaks in staff and patients.
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50. Defendants have failed to provide and ensure social distancing of patients. Such failure resulted in or substantially contributed to Covid-19 infections and outbreaks in staff and patients.
51. Defendants have failed adequately and timely to test staff and patients for Covid-19 in order to measure the outbreak in February, March and up through the present. Such failure resulted in or substantially contributed to Covid-19 infections and outbreaks in staff and patients.
52. Defendants have failed adequately and timely to provide masks and personal protective equipment to patients and staff. Such failure resulted in or substantially contributed to Covid-19 infections and outbreaks in staff and patients.
53. Defendants have failed adequately and timely to isolate and quarantine patients and staff. Such failure resulted in or substantially contributed to Covid-19 infections and outbreaks in staff and patients.
54. Defendants acts and omissions were deliberately indifferent or done with reckless disregard and have resulted in unsafe conditions of confinement.
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Class Action Factual Allegations 55. The named Plaintiffs bring this suit on their own behalf and on
the behalf of all current CVH and WFH patients and all patients who will be admitted in the future during the Covid-19 pandemic.
56. This class is so numerous that joinder of all members is impractical. CVH and WFH currently have a census of approximately 438 patients, all of whom are similarly situated and in danger of infection, illness and death from Covid-19. Because patients are discharged and continue to be committed to both facilities the class includes all those future patients who are admitted but whose identities are not known at this time.
57. There are questions of law and fact common to all class members, including but not limited to Defendants’ deprivation of the class members’ substantive due process rights, the Defendants’ failure to provide constitutionally safe and humane conditions of confinement, Defendants’ failure to ensure that Plaintiffs are treated in the most integrated setting, and Defendants’ violation of the Plaintiffs’ rights under the Connecticut Patients’ Bill of Rights to adequate treatment and protection of their constitutional rights.
58. The named Plaintiffs will fairly and adequately represent the interests of the class. The Plaintiffs, as patients at WFH and CVH, possess
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strong personal interest in the subject matter of the lawsuit and are represented by counsel with experience in class action litigation. Counsel have the legal knowledge and resources to fairly and adequately represent the interests of all class members in this action.
59. Defendants have acted or refused to act on grounds generally applicable to the class in that Defendants’ policies and practices of violating the Plaintiffs’ constitutional and statutory rights have affected all class members. Accordingly, final injunctive and declaratory relief is appropriate to the class as a whole. Necessity for Emergency Injunctive Relief
60. The Defendants have acted, failed to act, and continue to act and fail to act, in violation of the law including their duty to provide safe conditions of confinement. The named Plaintiffs and the class they seek to represent do not have an adequate remedy at law. As a result of the policies, practices, acts, and omissions of the Defendants, the named Plaintiffs and the class they seek to represent, have suffered, are suffering, and will continue to suffer, serious, imminent, irreparable physical, mental, and emotional injuries as a result of the outbreak of Covid-19 in both hospitals. Such serious injuries are continuing, likely irreversible, and in some cases, fatal.
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Count 1: Violation of Patients’ Fourteenth Amendment Right to Safe Conditions of Confinement. Official capacity claims only against the Governor, Commissioner and CEO’s of WFH and CVH.
61. Plaintiffs incorporate by reference paragraphs 1 – 60 into this count.
62. The Due Process Clause of the Fourteenth Amendment provides that “no State shall deprive any person of life, liberty, or property without due process of law.”
63. The substantive component of the of the Fourteenth Amendment’s Due Process Clause requires the State to provide involuntarily committed patients with mental health conditions with such services as are necessary to ensure their reasonable safety from themselves and others. Youngberg v. Romeo, 457 U.S. 307, 314-325 (1982).
64. The Due Process Clause of the Fourteenth Amendment obligates the State to provide patients in its psychiatric hospitals with adequate food, shelter, clothing, medical care and safe conditions of confinement. Youngberg v. Romeo, 457 U.S. 307, 315-316 (1982).
65. The affirmative duty to protect the Plaintiffs and the Plaintiff Class arises not from the State’s knowledge of the individual’s predicament or from its expressions of intent to help them, but from the limitation which it
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has imposed on his and her freedom to act on her or his own behalf. DeShaney v. Winnebago County Dept. of Social Services, 489 U.S. 189, 200 (1989).
66. Defendants’ acts and omissions were under color of state law. 67. Defendants’ acts and omissions were done with deliberate indifference and reckless disregard for the patients’ right to safe conditions of confinement. 68. Defendants’ acts and omissions caused or substantially contributed to unsafe conditions of confinement for patients at WFH and CVH and resulted in numerous infections with Covid-19, physical and mental suffering of patients already dealing with mental health conditions, and risk of death from infection with the Coronavirus. 69. Defendants’ policies, practices, acts and omissions have placed and will continue to place the named Plaintiffs and the members of the class they seek to represent at an unreasonable risk of harm. 70. Plaintiffs are entitled to immediate injunctive relief and/or a writ of habeas corpus to relieve them from unconstitutionally unsafe conditions of confinement at CVH and WFH.
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Count 2 – Title II of the Americans with Disabilities Act 71. Plaintiffs incorporate by reference paragraphs 1 – 60 into this
count. 72. The named Plaintiffs and the Plaintiff Class are qualified
individuals with disabilities within the meaning of the Americans with Disabilities Act. The Plaintiffs and the Plaintiff Class have one or more physical or mental impairments that substantially limit one or more major life activities including caring for oneself, concentrating and thinking.
73. Plaintiffs and the Plaintiff Class have all been determined by the defendants to need inpatient psychiatric hospital level of care, which includes psychiatric treatment, nursing care and 24/7 supervision.
74. The State of Connecticut and its Department of Mental Health and Addiction Services is a public entity as defined in Title II of the ADA.
75. Defendants do not have sovereign immunity for claims pursuant to Title II of the ADA because of the long history of discrimination against people with disabilities by the State and for the failure to ensure safe conditions of confinement as required by the Due Process Clause of the Fourteenth Amendment. Lane v. Tennessee, 541 U.S. 509 (2004).
76. Defendants State of Connecticut and DMHAS have discriminated against Plaintiffs and the Plaintiff Class by repeatedly failing
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to reasonably modify its system to reduce the segregation of Plaintiffs with disabilities from their communities of non-disabled peers during emergencies that threaten the physical and mental health and safety of the Plaintiffs and undermine the clinical justification for such confinement.
77. Defendant State of Connecticut’s and DMHAS’s discrimination includes the failure to take reasonable steps such as ceasing admissions, ceasing involuntary civil commitments, assessing all patients to balance the necessity of their commitment against the risk of infection, illness and death from Covid-19, planning for discharge, temporary leaves, conditional release and providing safe permanent or temporary housing accommodations to decompress the density on each inpatient psychiatric unit. Count 3 – Connecticut Patients’ Bill of Rights
78. Plaintiffs incorporate by reference paragraphs 1 – 60 into this count.
79. Defendants WFH and CVH are facilities as defined in General Statutes § 17a-540(1).
80. Plaintiffs and Plaintiff Class are patients as defined in General Statutes § 17a-540(2).
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81. Defendants failed to provide safe conditions of confinement in violation of General Statutes § 17a-541.
82. Defendants failed to provide humane and dignified treatment in violation of General Statutes § 17a-542.
83. Defendants failed to provide for an adequate discharge plan and discharge planning once they knew or should have known that Covid19 was rampant in the facilities and posed an imminent risk of infection, illness and death to the patients in violation of General Statutes § 17a-542.
Prayer for Relief 1. Take jurisdiction of this matter. 2. Certify this case as a class action pursuant to Fed. R. Civ. P. 23(b)(2). 3. Declare that the Defendants violated Plaintiffs’ rights under the Due Process Clause of the Fourteenth Amendment. 4. Declare that Defendants violated Plaintiffs’ rights under the Americans with Disabilities Act. 5. Declare that Defendants violated Plaintiffs’ rights under the Connecticut Patients’ Bill of Rights.
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6. Enter injunctive relief and/or a writ of habeas corpus requiring Defendants to: a. Issue an Executive Order suspending all commitments for civil patients, competency restoration patients, DOC transfers and acquittees to the jurisdiction of the PSRB. b. Issue a writ of habeas corpus ordering Defendants to assess every patient in WFH and CVH and release a sufficient number of patients to enable the remaining patients to practice safe social distancing and to enable the staff to maintain the hospital in constitutionally safe conditions of confinement. c. Immediately take all actions within their power to discharge, grant temporary leaves, grant conditional discharge or order placement in the most integrated setting. d. Order that all necessary residential and community supports and services and treatment be provided in the most integrated setting in the community. e. Within 48 hours, conduct individual assessments of every patient in WFH and CVH with participation of the patient, their legal representative and a person of their choice to assess whether the person is within the CDC and/or DMHAS category
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of high risk to remain on an inpatient psychiatric unit and to get the informed consent of the patient to discharge them to the most integrated setting. f. Appoint an independent court monitor to enforce the Court’s orders. g. Grant the Plaintiffs other relief as the Court deems just. h. For the remaining patients, order that every patient and all staff be tested and regularly retested so that patients, staff and administrators no the nature and extent of the virus on each unit, building and hospital. i. For the remaining patients after decompression of the units, order patients be protected with adequate social distancing, including each patient have their own room. j. Order that bathrooms, rooms, phones and units be cleaned and disinfected at least once every shift. k. Order that staff have adequate personal protective equipment as required by the CDC guidelines for hospitals and order that patients be given masks and gloves upon request.
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Respectfully submitted, s/Kirk W. Lowry (#ct 27850) Legal Director Connecticut Legal Rights Project CVH – Beers Hall 2nd Floor P.O. Box 351 – Silver Street Middletown, CT 06457 (860) 262-5017 Fax (860) 262-5035 klowry@clrp.org
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 Case 3:20-cv-00594-JCH Document 24 Filed 06/08/20 Page 1 of 4

IN THE UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

Thomas Wilkes, et al.,

)

On behalf of themselves and )

all other persons similarly )

situated,

)

Plaintiffs,

)

v.

)

)

Ned Lamont, Governor, et al., )

Defendants. )

Civil No.: 3:20cv594 June 8, 2020

PLAINTIFFS’ MOTION FOR PRELIMINARY INJUNCTION Plaintiffs, on behalf of themselves and a class of all individuals who

are patients at Connecticut Valley Hospital and Whiting Forensic Hospital

(hereinafter collectively “Plaintiffs”), seek a preliminary injunction to remedy

the undue risk of contracting and dying from COVID-19 that exists at these

facilities.

Plaintiffs seek relief under the Due Process Clause of the Fourteenth

Amendment to the U.S. Constitution, which affords individuals

institutionalized in state mental health facilities a right to safety and

protection from harm. Youngberg v. Romeo, 457 U.S. 307 (1982); Society

for Good Will to Retarded Children v. Cuomo, 737 F.2d 1239, 1246 (2d Cir.

1984). These rights are violated when, as here, those who run state

mental facilities depart substantially from professional standards and

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thereby jeopardize the health and safety of residents. Youngberg, 457 U.S. at 323. Plaintiffs’ are entitled to a preliminary injunction to end and correct Defendants’ illegal practices.
Plaintiff’s request that the Court issue a preliminary injunction ordering the defendants to:
1. Conform their testing protocols to CDC standards, 2. Take steps to ensure that staff consistently wear masks and that Plaintiffs are encouraged and supported in wearing masks including through education, 3. Improve hygiene and decontamination practices, 4. Implement social distancing to the maximum extent possible including by reducing patient census, 5. Undertake a clinical review in order to accelerate discharges, and 6. Grant such other or different relief the Court deems appropriate. Wherefore, Plaintiffs request that the Court issue a preliminary injunction to enforce their constitutional right to safe conditions of confinement. In support of this motion Plaintiffs submit an accompanying memorandum.
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The Plaintiffs
By:
s/Kirk W. Lowry Kirk W. Lowry, ct#27850 Karyl Lee Hall, ct#19320 Virginia Teixeira, ct#29213 Connecticut Legal Rights Project CVH – Beers Hall 2nd Floor P.O. Box 351 – Silver Street Middletown, CT 06457 (860) 262-5017 Fax (860) 262-5035 klowry@clrp.org
s/Ira Burnim Ira A. Burnim, pro hac vice Jennifer Mathis, pro hac vice pending Judge David L. Bazelon Center for Mental Health Law 1090 Vermont Avenue, NW Suite 220 Washington, D.C. 20005 (202) 467-5730 Fax (202) 223-0409 irab@bazelon.org jenniferm@bazelon.org
s/Mark J. Murphy Mark J. Murphy, pro hac vice pending Center for Public Representation 1825 K Street, NW Suite 600 Washington, D.C. 20006 (202) 670-1008 Fax (413) 586-5711 mmurphy@cpr-ma.org
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Certificate of Service On June 8, 2020 a copy of the foregoing Motion for Preliminary Injunction was filed electronically and served by mail on anyone unable to accept electronic filing. Notice of this filing will be sent by email to all parties by operation of the Court’s electronic filing system or by mail to anyone unable to accept electronic filing as indicated on the Notice of Electronic Filing. Parties may access this filing through the Court’s CM/ECF System.
s/Kirk W. Lowry_________ Kirk W. Lowry
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Case 3:20-cv-00594-JCH Document 25 Filed 06/08/20 Page 1 of 40

IN THE UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

Thomas Wilkes, et al.,

)

On behalf of themselves and )

all other persons similarly )

situated,

)

Plaintiffs,

)

v.

)

)

Ned Lamont, Governor, et al., )

Defendants. )

Civil No.: 3:20cv594 June 8, 2020

PLAINTIFFS’ MEMORANDUM OF LAW IN SUPPORT OF MOTION FOR PRELIMINARY INJUNCTION

I. INTRODUCTION

Plaintiffs, on behalf of themselves and a class of all individuals who

are patients at Connecticut Valley Hospital and Whiting Forensic Hospital

(hereinafter collectively “Plaintiffs”), seek a preliminary injunction to remedy

the undue risk of contracting and dying from COVID-19 that exists at these

facilities.

Plaintiffs seek relief under the Due Process Clause of the Fourteenth

Amendment to the U.S. Constitution, which affords individuals

institutionalized in state mental health facilities a right to safety and

protection from harm. Youngberg v. Romeo, 457 U.S. 307 (1982); Society

for Good Will to Retarded Children v. Cuomo, 737 F.2d 1239, 1246 (2d Cir.

1984). These rights are violated when, as here, those who run state
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mental facilities depart substantially from professional standards, including for infection control, and thereby jeopardize the health and safety of residents. Youngberg, 457 U.S. at 323. To protect Plaintiffs’ safety and health, this Court should issue a preliminary injunction requiring Defendants to conform their actions to professional norms.
II. FACTS In Connecticut Valley Hospital (CVH) and Whiting Forensic Hospital
(WFH), patients and staff live and work in very close quarters. There is an especially high risk that COVID-19 will spread into and through facilities, like CVH and WFH, that congregate residents and staff in confined spaces—and indeed outbreaks have already occurred in both CVH and WFH. These risks have been widely recognized, including in correctional facilities, see, e.g., Wilson v. Williams, 2020 WL 2904706 (6th Cir. June 1, 2020) (denying stay of preliminary injunction); Martinez-Brooks v. Easter, 2020 WL 2405350 (D. Conn. May 12, 2020) (granting TRO), nursing homes, see, e.g., McPherson v. Lamont, 2020 WL 2198279 (D. Conn. May 6, 2020) (nursing home residents at high risk of severe illness from COVID19), and psychiatric hospitals. See, e.g., Costa v. Bazron, 2020 WL 2025701 (D. D.C. May 24, 2020) (issuing preliminary injunction). See also, Declaration of Farrin A. Manian, M.D., M.P.H (“Manian Decl.”) ¶ 7
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(attached to this Memorandum as Exhibit 1) (“the risk of transmission of SARS-CoV-2 is much higher wherever people reside or congregate in confined spaces, such as … prisons, and long-term care facilities, including psychiatric hospitals.”)
One-third of deaths from COVID-19 in the United States have involved residents or staff of such facilities, “where people live in a confined environment and workers move from room to room, at times unknowingly infecting the residents or getting infected themselves.” Id. ¶ 8. This “constant close contact, coupled with the presence of risk factors for severe disease . . . among residents, provide the elements for a ‘perfect COVID19 storm’ with its attendant complications and mortality.” Id.
The risks at CVH and WFH are real, and the results have been tragic. Five patients at CVH have died from COVID-19. At CVH and WFH, Defendants have confirmed 73 cases of COVID-19 among patients and 64 cases among staff, since testing began. As of June 8, 2020, at least one unit at CVH remains under quarantine.
Recognizing the health risks that inherently exist in congregate facilities, the Centers for Disease Control and Prevention (CDC) have issued widely accepted guidelines for limiting the spread of COVID-19 in such facilities. These guidelines emphasize testing, the use of personal
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protective equipment (PPE), social distancing, and isolation of individuals with symptoms or confirmed cases. Centers for Disease Control and Prevention, How to Protect Yourself and Others, available at https://www.cdc.gov/coronavirus/2019-ncov/prevent-gettingsick/prevention.html (attached to this Memorandum as Exhibit 11).
Defendants were slow to take action to protect Plaintiffs from COVID19. However, they have adopted some of the measures that national guidelines require. For example, they have adopted a policy requiring staff, and encouraging residents, to wear masks, although the evidence indicates that the policy is not being consistently implemented at CVH and WFH. Affidavit of Vincent Ardizzone (attached to this Memorandum as Exhibit 4) (“Ardizzone Aff.”) ¶¶ 18, 32; Affidavit of Gail Litsky (attached to this Memorandum as Exhibit 5) (“Litsky Aff.”) ¶¶ 10, 14, 16, 28, 32, 33, and 36. Defendants have also committed to improved hygiene and decontamination practices, which are not being consistently followed. Affidavit of Carson Mueller (attached to this Memorandum as Exhibit 3 (“Mueller Aff.”) ¶¶ 29, 38, 39, 42, 45, 47, and 48. Defendants are now conducting weekly testing of staff, but they are not regularly testing patients. Plaintiffs’ understanding is that testing of both patients and staff remains voluntary.
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The failure to regularly test patients and to ensure that staff consistently wear masks creates health risks that this Court needs to address. What is placing Plaintiffs at greatest risk, however, is Defendants’ failure to ensure social distancing within the facilities. Social distancing is an essential strategy for protecting individuals from COVID19. Manian Decl. at ¶ 12. However, under the circumstances now present at CVH and WFH, Plaintiffs are unable to practice social distancing. E.g., Mueller Aff. ¶¶ 11,12,13, 14, 15, 17, and 21; Ardizzone Aff. ¶¶ 19, 20, 21, and 26.
Defendants contend that Plaintiffs’ safety and health can be maintained without social distancing. However, as Plaintiffs’ experts explain, Defendants are wrong and the lack of social distancing at CVH and WFH is placing Plaintiffs at great risk. Manian Decl. ¶¶ 12, 23, Declaration of Patrick J. Canavan, Psy.D, and Elizabeth Jones (attached to this Memorandum as Exhibit 2 (“Canavan/Jones Decl.”) ¶ 15.
Instead of implementing professional standards and CDC requirements on social distancing, Defendants are instead using a practice they call “unit segregation,” which is essentially an attempt to keep units as a whole apart, rather than individuals. But, as Plaintiffs’ experts explain, this practice does not provide sufficient protection for Plaintiffs or staff. Manian
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Decl. ¶ 23. “As relates to designated units, ‘COVID-negative’ does not mean ‘COVID-impervious.’ As long as new cases of COVID-19 are being diagnosed in the community, long-term care facilities remain vulnerable to the importation of the virus from the outside world, particularly through unsuspected infected healthcare providers who live in the community, visitors, or residents who may need to temporarily leave the unit to seek medical care.” Id.
In order to comply with professional standards and CDC requirements on social distancing at CVH and WFH, the number of patients at the facility would need to be reduced. However, Defendants have taken little action aimed at reducing the patient census at CVH or WFH. While admissions are down, largely through the efforts of courts, which have reduced both civil and criminal commitments, discharges are stagnant.
The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) has said that, during the pandemic, inpatient psychiatric care should be used only when absolutely necessary to protect the life or safety of the individual. In all other circumstances, outpatient arrangements should be utilized. SAMHSA, Considerations for the Care and Treatment of Mental and Substance Use Disorders in the COVID-19 Epidemic (revised May 7, 2020), https://www.samhsa.gov/sites/default/
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files/considerations-care-treatment-mental-substance-use-disorderscovid19.pdf (attached to this Memorandum as Exhibit 18). Defendants have not heeded this call.
Accordingly, Plaintiffs seek a preliminary injunction requiring, in addition to improved practices within the hospitals, that Defendants change their approach to discharges. As Plaintiffs’ experts urge, Defendants should promptly complete a clinical review of every patient at CVH and WFH to determine whether it would be feasible, under present circumstances, to discharge the patient. According to Plaintiffs’ experts, “there are individuals who could be discharged without posing significant safety risks.” Canavan/Jones Decl. ¶ 21.
The details of the clinical review Plaintiffs seek are more fully explained below. At its core, the clinical review would “identify those who can be discharged, determine what supports would be needed, and implement strategies to effectuate these plans.” Canavan/Jones Decl. ¶ 22. In so doing, “DMHAS should apply a different standard than it would in ordinary times and should focus on such basic questions as where the person can live, have access to food and needed medication, and take appropriate COVID precautions, with available assistance, if necessary, without being a danger to self or to others.” Id. The review should be
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conducted by professionals with extensive knowledge of the community service system and by staff who could identify family and friends willing to provide the patient housing and other support during the pandemic. Canavan/Jones Decl. ¶¶ 22, 25.
A. The Risks Posed by COVID-19 Plaintiffs, indeed all residents of the State of Connecticut, are facing extraordinary risks caused by the coronavirus pandemic. As of June 8, 2020, there were approximately 1.939 million confirmed cases of COVID19 and 110,375 deaths in the U.S., with 17,919 new cases and 475 new deaths on June 8 alone. Centers for Disease Control and Prevention, Cases, Data, Surveillance, available at https://cdc.gov/coronavirus/2019ncov/cases-updates/cases-in-us.html (last visited June 8, 2020). As of June 8, Connecticut has suffered 44,092 infections and 4,084 COVID-19 deaths, including 124 new cases and 13 new deaths occurring on that date. https://portal.ct.gov/Coronavirus/COVID-19-Data-Tracker (last visited June 8, 2020). Despite its small size, Connecticut has incurred more deaths than some significantly more populous states, including Texas, Florida, and Ohio, and even more than some countries. Id. (last visited June 6, 2020). On a per capita basis, Connecticut’s death rate, 1,231 per 100,000, ranks sixth in the nation. Center for Disease Control and Prevention, “Death
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rates from coronavirus (COVID-19) in the United States as of June 8, 2020 by state,” available at https://www.cdc.gov/covid-data-tracker/index.html (last visited June 8, 2020). As discussed above, the risks posed by the pandemic are even higher for Connecticut’s citizens in the tightly confined spaces of CVH and WFH. Yet, Defendants have not taken needed steps to protect the safety and health of these individuals.
B. The CDC’s Guidelines for Protecting Against Transmission of COVID-19. The CDC has issued a variety of guidance on limiting the spread of this highly communicable virus. Central to its guidance is the recommendation to practice social distancing, i.e., staying six feet away from others. Frequent hand washing and disinfecting commonly used surfaces on a regular basis are also critical. Centers for Disease Control and Prevention, How to Protect Yourself and Others, https://www.cdc.gov/coronavirus/ 2019-ncov/prevent-gettingsick/prevention.html (attached to this Memorandum as Exhibit 11). The CDC has issued specific guidelines on addressing COVID-19 in nursing homes and other long-term care facilities. See, e.g., Key Strategies to Prepare for COVID-19 in Long-term Care Facilities, https://www.cdc.gov/ coronavirus/2019-ncov/hcp/long-term-carestrategies.html (attached to this Memorandum as Exhibit 12) Preparing for
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COVID-19 in Nursing Homes, https://www.cdc.gov/coronavirus/2019ncov/hcp/long-term-care.html (attached to this Memorandum as Exhibit 13). Testing Guidance for Nursing Homes, https://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-homestesting.html (attached to this Memorandum as Exhibit 15). Experts agree that these guidelines should be followed in inpatient psychiatric facilities. Manian Decl. at ¶ 10.
Following these CDC guidelines for COVID-19, which constitute “minimally acceptable professional practice,” is “essential” for protecting Plaintiffs’ safety and health. Manian Decl. ¶ 10. The CDC guidelines require the following steps once COVID-19 has been identified in a facility or achieves widespread community transmission, both of which have been present at CVH and WFH and in Connecticut for months:
1. Enforce social distancing among residents; 2. Cancel all groups activities and communal dining; 3. Ensure all residents wear a cloth face covering whenever they
leave their room or are around others; 4. Ensure all staff wear a facemask or cloth face covering while in the
facility; and
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5. If COVID-19 is identified in the facility, restrict all patients to their rooms and have staff wear all recommended PPE regardless of symptoms on the affected unit.
Centers for Disease Control and Prevention, Key Strategies to Prepare for COVID-19 in Long-term Care Facilities, Exh. 12.
In addition, hand washing with soap and water, covering of coughs and sneezes, daily cleaning and disinfecting of frequently touched surfaces, and monitoring of health status must be maintained. Centers for Disease Control and Prevention, How to Protect Yourself and Others, Exh. 11. Manian Decl. ¶¶ 15, 17 (residents should have ‘ready access to proper hand hygiene” and facilities “should enforce a schedule for regular cleaning and disinfection of shared equipment, and high-touch surfaces in rooms and common areas”).
The guidelines on Preparing for COVID-19 in Nursing Homes also require enforcing social distancing, cancelling group activities, and face masks for staff and face coverings for residents. Centers for Disease Control and Prevention, Preparing for COVID-19 in Nursing Homes, Exh. 13. In addition, they call for:
1. A plan for “testing residents and healthcare personnel” with the capacity to perform testing of “all residents and HCP [health care
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personnel, i.e. staff],” as well as a “procedure for addressing residents or HCP who decline or are unable to be tested [i.e., isolation and quarantine].
2. Hand hygiene supplies in every resident room; tissues and trash cans in common areas and patient rooms; and environmental cleaning and disinfection of frequently touched surfaces in resident rooms and common areas.
The CDC provided detailed guidance on testing in nursing homes, including: screening staff for fever and COVID-19 symptoms at the start of their shift and testing any who screen positive; screen and test any resident who exhibits fever or symptoms consistent with COVID-19; test all residents if there is a new confirmed case of COVID-19, including during reopening when there is a suspected or confirmed case in any resident or a confirmed case in any HCP; and, test all residents and staff weekly until the testing identifies no new cases of COVID-19 among residents or staff over at least 14 days.
Centers for Disease Control and Prevention, Testing Guidance for Nursing Homes, available at https://www.cdc.gov/coronavirus/2019ncov/hcp/nursing-homes-testing.html (attached to this Memorandum as Exhibit 15).
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C. Applying the CDC Guidelines to CVH and WFH 1. Testing SARS-CoV-2 can be transmitted by people without symptoms. Manian Decl. ¶ 6. Staff or patients may have the virus for days with no symptoms, yet be infectious. Id. This unique property of SARS-CoV-2 makes it easy for the virus to spread through a population. Id. On average, two to three people become infected from each individual infected with SARS-CoV-2 and sometimes many more, resulting in persons described as “super-spreaders.” Id. Since the virus may be spread by infected persons who are asymptomatic, the only way to know whether there is virus in CVH and WFH is to test. Manian Decl. ¶ 17. According to Dr. Manian, professional standards require that CVH and WFH perform baseline testing of all residents and staff, and test at least once a week all previously negative residents and staff until the testing identifies no new cases of COVID-19 for at least 14 days since the most positive result. Manian Decl. ¶ 16.1 Defendants have just begun weekly testing of staff, but only on a voluntary basis, and have no plan for regular testing of residents.
1 Dr. Manian explains, that when it comes to testing, the CDC Guidance for Nursing Homes is the appropriate professional standard. Manian Aff. ¶ 11
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Despite the obvious importance of testing in controlling the spread of the virus, as of late May only some 600 of 1,000 staff at CVH and WFH had been tested. See DMHAS News Releases for May 26 and May 29, 2020, available at https://portal.ct.gov/DMHAS-COVID-19. Patient testing was very limited until May 13. Litsky Aff. ¶ 36. And as testing has become more available in the past two weeks, the number of confirmed infections has continued to increase, demonstrating that the failure to take comprehensive protections a month ago has contributed to several patients’ deaths and an increase in the number of staff and patients becoming infected. See, DMHAS periodic reports at https://portal.ct.gov/DMHAS-COVID-19.
Defendants’ practices are contrary to accepted professional norms for fighting COVID-19. See Manian Decl. ¶ 16.
2. Personal Protective Equipment According to Plaintiffs’ expert Dr. Farrin Manian, staff in CVH and WFH “should have access to PPE” and “should always wear a face mask while they are in the healthcare facility.” Manian Decl. ¶ 14. Residents “should be encouraged to routinely wear a cloth face covering” as appropriate and those with “significant exposure to COVID-19 or suspected
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of having COVID-19 should wear a face mask when outside their rooms.” Id. at 15.
Defendants delayed implementing such guidelines and have not ensured that they are practiced consistently or that residents are encouraged to wear masks. Ardizzone Aff. ¶¶ 18, 32; Litsky Aff. ¶ 33. DMHAS mandated the use of masks by staff at CVH and WFH on April 10, 2020, stating that “there is growing evidence of transmission risk from infected persons without symptoms or before the onset of recognized symptoms.” DMHAS Protocol for Quarantine and Isolation, “PPE Use: General Guidelines for Use of Face Masks,” May 17, 2020, available at https://portal.ct.gov/DMHAS-COVID-19. Until April 23, 2020, masks were not even offered to patients in either hospital, and to this day they are not required as a matter of practice. Affidavit of Carson Mueller ¶ 34 (May 18, 2020) (“Mueller Aff.”); Affidavit of Gail Litsky ¶ 14 (May 18, 2020) (“Litsky Aff.”); Affidavit of Vincent Ardizzone ¶ 17 (May 18, 2020) (“Ardizzone Aff.”). When patients asked for masks, they were refused. Litsky Aff. ¶ 14.
After April 23, masks were finally made available for patients to wear on a voluntary basis, without regard to the impact on all patients from a failure of some to wear them. On one unit at WFH, Dutcher North 2, staff offered no encouragement to use the masks, nor did they provide any
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education about the importance of wearing them in light of the COVID-19 crisis. Litsky Aff. ¶¶ 17, 36. Use of masks by both staff and patients remains intermittent and unenforced, resulting in ongoing but avoidable risk of infection to both. Ardizzone Aff. ¶¶ 18, 32; Litsky Aff. ¶ 33.
3. Hygiene and Decontamination Dr. Manian states that all residents “should have ready access to proper hand hygiene within the facility.” Manian Decl. ¶ 15. In addition, facilities should enforce a schedule for regular cleaning and disinfection of shared equipment and high-touch surfaces in rooms and common areas (including shower knobs, curtains, and bathroom surfaces) with an EPAregistered, hospital-grade disinfectant. Id. at ¶ 17. “Ready access to proper hand hygiene” requires providing hand sanitizer to patients, with supervision if needed, and that all patients be taught about infection control strategies. Canavan/Jones ¶ 14. Patient testimony indicates that proper hygiene and decontamination practices are not being consistently followed. Even after patients began to test positive, maintenance staff on did not thoroughly clean Dutcher South 3, where 15 men live there. Mueller Aff. ¶ 39. All of the men on that unit use the same bathroom, with several men using the two showers, sinks, urinals, and toilets at the same time. Id.at ¶12. On another unit, Dutcher
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North 3, 22 men share a shower room and restroom, Ardizzone Aff. ¶ 15, making it impossible to clean the fixtures and surfaces between each use by individual patients.
On Dutcher North 3 and Dutcher South 3, maintenance staff do not work on the weekend, so soap dispensers in the bathroom are not replaced when they become empty. Ardizzone Aff. ¶ 16; Mueller Aff. ¶ 39. On Dutcher South 3, a patient asked that a stethoscope and pulse oximeter be sanitized before they were used to take his vitals. His request was viewed by staff as “oppositional.” Mueller Aff. ¶ 38. When patients asked for hand sanitizer, the request was denied because the administration considered the risk that patients would ingest the alcohol-based product more serious than the risk of infection or death. Ardizzone Aff. ¶16; See Mueller Aff. ¶ 47.
4. Social Distancing Although it is a critical strategy for reducing the spread of COVID-19 in CVH and WFH, Manian Decl. ¶ 12, social distancing is not part of the protocol at WFH or CVH in any meaningful way. Defendants do not appear to dispute that social distancing, as described by Dr. Manian, is not being practiced at WFH or CVH.
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Patient testimony provides examples: using an elevator in which up to 10 people crowd in, walking in a group down a narrow stairwell, patients from several units eating together in a dining room with staff. Mueller Aff. ¶ ¶ 13, 14. When the patients on the Dutcher North 2 unit were quarantined after one of the unit residents tested positive, they were directed to eat on the unit under circumstances in which social distancing could not be observed. Litsky Aff. ¶ 26
On March 15, 2020, Governor Lamont issued an order restricting visits to DMHAS facilities, including CVH and WFH. See Exec. Order 7C, His Excellency Ned Lamont, State of Connecticut (March 15, 2020), available at https://portal.ct.gov/Coronavirus/Pages/Emergency-Ordersissued-by-the-Governor-and-State-Agencies. Yet even as efforts were made to reduce visitors, hospital staff were working double shifts on different units, including a quarantined unit, see Litsky Aff. ¶ 27), increasing the number of individuals going onto units and interacting with patients.
While it may be more challenging to achieve social distancing in congregate facilities compared to the community, it is necessary to protect the Plaintiffs and should be implemented to the maximum extent possible. Manian Decl. ¶ 12. To effectuate social distancing, CVH and WFH should develop a plan to move all patients into single-bed sleeping rooms or into
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rooms with sufficient space to allow sleeping in beds that are at least six feet apart. Canavan/Jones Decl. ¶ 14. In addition, patients should be taught social distancing and other infection control strategies. Id. at ¶ 13. Meals should be delivered so that all patients could eat in a socially distanced manner. Id at ¶ 10. The number of people using elevators at one time be limited and/or an alternative such as a stairway be permitted. Id at ¶ 11.
CVH and WFH have failed to implement social distancing on units. No education is provided to patients about the importance of social distancing. No accommodations in living areas or adjustments in eating routines are undertaken to promote social distancing. Despite the obvious transmission threat the virus poses, almost all patients on every unit in CVH and WFH live in close contact with 15-20 other patients and 5-10 staff. Amended Compl. ¶ 43. Mueller Aff. ¶ 7. They share bathroom facilities and use those facilities simultaneously. Id. Ardizzone Aff. ¶ 15. They eat together, either on the units or in a communal dining room. Id. See Ardizzone Aff. ¶¶ 19.20; Mueller Aff. ¶¶ 10,11. Patients sleep in the same room with other patients, and their beds are closer than the required social distance of six feet. Mueller Aff. ¶ 21.
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“Facilities should reduce their census as soon as possible to enable social distancing of residents as needed.” Manian Decl. at ¶ 14. This is an essential strategy both to allow social distancing and to reduce the risk of infection and death. Census reduction can be done in two basic ways: stopping new admissions and increasing discharges. Manian Decl. ¶¶ 14 and 20.
The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) has said that, during the pandemic, inpatient psychiatric care should be used only when absolutely necessary to protect the life or safety of the individual. In all other circumstances, outpatient arrangements should be utilized. SAMHSA, Considerations for the Care and Treatment of Mental and Substance Use Disorders in the COVID-19 Epidemic (revised May 7, 2020), https://www.samhsa.gov/sites/default/ files/considerations-care-treatment-mental-substance-use-disorderscovid19.pdf (attached to this Memorandum as Exhibit 18). Similarly, CDC Guidelines instruct nursing facilities to “[c]onsider temporarily halting admissions to the facility, at least until the extent of the transmission can be clarified and interventions can be implemented.” Centers for Disease Control and Prevention, Responding to Coronavirus (COVID-19) in Nursing Homes, at 3, available at https://www.cdc.gov/coronavirus/2019-
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ncov/hcp/nursing-homes-responding.html (attached to this Memorandum as Exhibit 14).
Dr. Canavan and Elizabeth Jones concur that distancing is essential and that it can and should be accomplished by limiting admissions and accelerating discharges. They state that admissions should be limited by stopping most civil admissions, discouraging forensic admissions (including individuals admitted for competency restoration or after being found not guilty by reason of insanity) and working closely with the Superior Court to ensure diversion to other settings “while taking into account the current situation and balancing risk.” Canavan/Jones Decl. ¶¶ 15-16. They opine that WFH should follow its own policies for maintaining patients on “temporary leaves” in the community during this emergency and return only patients who present the highest level of risk. Further, DMHAS should make use of other hospitals, crisis services, transitional housing and respite services to prevent readmissions of individuals under civil commitment. Id. ¶¶ 18-19.
Since admissions have already been reduced, through the actions of courts, the most important strategy for implementing social distancing is accelerating discharges. To accelerate discharges in light of the current crisis, “DMHAS should develop a plan to promptly assess all residents for
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discharge, identify those who can be discharged, determine what supports would be needed, and implement strategies to effectuate these plans.” It should “apply a different standard than it would in ordinary times,” focusing on whether the person has a place to live, has access to food and needed medication, and can take appropriate COVID precautions with available assistance in the community without being a danger to self or others. Id. ¶ 22. Evaluations “should identify potential community-based supports and wherever possible, recommend discharge.” Id. ¶ 24. Individuals who may have family and friends who might be able to take them in should be identified and appropriate supports offered, and any available capacity in community programs (including temporary housing) should be considered. Id. ¶ 25. To expedite discharge planning, community providers should be included as part of the assessment process and assist in discharge planning.” Id.
Despite the urgency of taking these actions, Defendants have failed to take even preliminary steps to identify patients who can safely return to the community, or to granting temporary leave or conditional discharges to those patients for whom such actions would be appropriate. Instead, patients at CVH and WFH continue to be unnecessarily and unsafely confined in small spaces, contrary to professional standards.
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Beginning in March, temporary leaves have been canceled. Two patients who were already in the community on temporary leaves were brought back to WFH, making the hospital more crowded and increasing the risks to those two patients. Mueller Aff. ¶27.
CVH and WFH continue to admit new patients. While Superior Court and Probate Courts have operated in a limited manner after onset of the pandemic, commitments continue. If no effort is made to increase discharges and temporary leaves for appropriate individuals, the population of the units will continue to grow, making it increasingly difficult to prevent the spread of contagion. Defendants’ ongoing failure “to reduce the number of people hospitalized as safely and quickly as possible given the risks of COVID-19 is inconsistent with the exercise of reasonable professional judgment.” Canavan/Jones Decl. ¶ 25.
III. LEGAL STANDARD To obtain a preliminary injunction that results, as here, in the
alteration of the status quo, the moving party must show: “(1) irreparable harm and (2) either (a) likelihood of success on the merits or (b) sufficiently serious questions going to the merits to make them fair ground for litigation plus a balance of hardships, tipping decidedly in favor of the moving party.” Oneida Nation of New York v. Cuomo, 645 F.3d 154, 164 (2d Cir. 2011)
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(quoting Monserrate v. N.Y. State Senate, 599 F.3d 148, 154 (2d Cir. 2010)). In addition, the moving party must show that the preliminary injunction is in the public interest. Id. (citing Winter v. Natural Res. Def. Council, Inc., 555 U.S. 7, 19-20 (2008)).
IV. ARGUMENT A. Irreparable Harm In the Second Circuit, a “showing of irreparable harm is the single
most important prerequisite in the issuance of a preliminary injunction.” Faiveley Transp. Malmo AB v. Wabtec Corp., 559 F.3d 110, 118 (2d Cir. 2009); Basank v. Decker, 2020 WL 1481503 at *2 (S.D.N.Y. March 26, 2020). The irreparable harm alleged must not be remote or speculative but must instead be actual and imminent. Grand River Enter, Six Nations, Ltd. v. Pryor, 481 F.3d 60, 66 (2d Cir. 2007).
There can be no dispute that Plaintiffs face actual, imminent, and ongoing irreparable harm as a result of Defendants’ failure to take necessary actions to protect Plaintiffs from COVID-19. Plaintiffs’ risk of being infected by and transmitting the virus is greatly increased by living in the congregate and confined setting of a psychiatric hospital. Manian Decl. at ¶4. CVH and WFH “provide the elements for a ‘perfect Covid-19 storm,’ with its attendant complications and mortality.” Id. At least five patients
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have died, dozens more have been infected, and as expert testimony demonstrates, Plaintiffs are at “imminent risk to their health, safety and lives.” Henrietta D. v. Giuliani, 119 F.Supp.2d 181, 214 (E.D.N.Y 2000); Barbecho v. Decker, 2020 WL 1876328 at *6 (S.D.N.Y. April 15, 2020). “A substantial risk of serious illness or death has been found to constitute irreparable harm.” Martinez-Brooks v. Easter, 2020 WL 2405350 (D. Conn. May 12, 2020) at 57, citing Innovative Health Systems, Inc. v. City of White Plains, 117 F.3d 37, 43-44 (2d Cir. 1997).
Accordingly, Plaintiffs have met their burden of demonstrating irreparable harm.
B. Success on the Merits Defendants have violated Plaintiffs’ rights under the Fourteenth Amendment in their failure to adequately protect Plaintiffs from the risks associated with COVID-19. As explained in more detail below, Defendants’ ongoing failure to provide Plaintiffs with reasonably safe conditions constitutes a substantial departure from accepted professional judgment in violation of the Fourteenth Amendment.
1. Defendants Are Violating Plaintiffs’ Fourteenth Amendment Guarantees to Reasonably Safe Conditions of Confinement.
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The Due Process Clause of the Fourteenth Amendment protects the right of Plaintiffs, as persons in a state psychiatric hospital, to be held in safe conditions, free from unreasonable risks of harm. Youngberg v. Romeo, 457 U.S. 307 (1982). “If it is cruel and unusual punishment to hold convicted criminals in unsafe conditions, it must be unconstitutional to confine … [those] who may not be punished at all – in unsafe conditions.” Id. at 315-316. See also Ingraham v. Wright, 430 U.S. 651, 673 (1977) (safety is a “historic liberty interest”).
The Second Circuit has recognized that Youngberg’s right to safe conditions extends to both voluntary and involuntary residents of state mental health facilities. Society for Good Will to Retarded Children v. Cuomo, 737 F.2d 1239, 1246 (2d Cir. 1984). Voluntary residents, the Second Circuit declared, “are entitled to rights of personal freedom at least as great as those of prison inmates.” Id. “. . . [Once] it chose to house those voluntary residents, thus making them dependent on the state, it was required to do so in a manner that would not deprive them of constitutional rights.” Id., citing Youngberg, 457 U.S. at 317; Perry v. Sindermann, 408 U.S. 593, 597 (1972); see also, Helling v. McKinney, 509 U.S. 25, 33 (1993) (even the criminally convicted may not be subjected to “a condition
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of confinement that is . . . very likely to cause serious illness and needless suffering.”).
The standard for determining whether Defendants have violated Plaintiffs’ rights under Youngberg is whether Defendants’ decisions constitute “such a substantial departure from accepted professional judgment, practice, or standards as to demonstrate that the person responsible actually did not base the decision on such a judgment.” Youngberg, 457 U.S. at 323. Such a departure is demonstrated when the care provided residents is substantially below the standard of care. Messier v. Southbury Training School, 562 F. Supp. 2d 294, 301 (D. Conn 2008). Deference is not owed to decisions made by individuals who are not qualified professionals. Id. at 300. If CVH and WFH did not have a board-certified infectious disease physician on staff or consulting to make determinations about mitigation strategies, the Court need not give deference to an unqualified administrator or physician. Id. As discussed below and shown in the affidavits submitted by Plaintiffs and their experts, Defendants have violated this standard in several key ways.
a. The CDC’s COVID-19 Guidance Constitute Professional Standards that Must Be Met in Psychiatric Hospitals.
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The CDC standards constitute the professional standards that apply to combatting COVID-19 in psychiatric hospitals like CVH and WFH. Manian Decl. ¶ 11. Infectious disease specialists and healthcare epidemiologists routinely look to the CDC for guidance. Id. ¶ 10. Following the CDC’s guidelines is crucial during the current pandemic. With a virus that has never been seen before, “reliance on the wisdom and knowledge in the experts of the field of virology, epidemiology, and disease transmission is essential to minimizing the spread of SARS-CoV-2 in high risk settings.” Id. The CDC guidelines are “essential to the professional practice of healthcare epidemiology and infection control and prevention” at CVH and WFH. Id. Departure from the CDC guidelines at these facilities “places patients and staff—and potentially the community at large—at risk of a preventable disease and death.” Id.
In rendering his opinions, Dr. Manian relied primarily on CDC guidelines. He also took into account other prominent national guidelines, including those of the American Health Care Association, the National Center for Assisted Living, and the Substance Abuse and Mental Health Services Administration, as well as his own experience as an infection control officer and healthcare epidemiologist for nearly 30 years. Id. ¶ 11.
b. Defendants Have Substantially Departed from Professional Standards.
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Social Distancing. Social distancing is a key strategy for infection control. “Patients should maintain at least six feet distance from each other and staff. This practice should apply to all aspects of life within the state psychiatric facilities, including interaction with other residents, dining, and distance between sleeping quarters.” Manian Decl. ¶ 13.
Defendants have not implemented social distancing, as described by Dr. Manian, at CVH and WFH. Their alternative practice, which they call “unit segregation,” is not an acceptable alternative without social distancing and census reduction. Manian Decl. ¶ 23 (“Separating activities to occur only within each unit, allowing for COVID-19 and non-COVID-19 units, is not an adequate means of infection control. It is a substantial departure from the basic science of infection control and prevention to not require. . .social distancing in places such as bedrooms, dining rooms, group therapy and day hall. . .”)
All three of Plaintiffs’ experts concur that, if social distancing cannot be consistently and successfully implemented at CVH and WFH, census reduction, including discharges, is imperative and must be pursued. Social distancing could be accomplished if there were fewer people on each unit. Manian Decl. ¶ 14, Canavan/Jones Decl. ¶ 15-25.
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Census Reduction. According to Dr. Manian, Dr. Canavan, and Elizabeth Jones, it is imperative, for the safety and health of Plaintiffs, that Defendants aggressively pursue census reduction. Fortunately, admissions to CVH and WFH are being limited by the courts. To reduce census from present levels, discharging patients who could be safely served in the community is required. As Dr. Canavan and Elizabeth Jones stress, the review should apply a different standard than in ordinary times, focusing on basic questions such as whether the person has a place to live, has access to food and needed medication, and can take appropriate COVID precautions with available assistance and live in the community without being a danger to self or others. Canavan/Jones Decl. ¶ 22.
There is no indication that Defendants have identified social distancing or census reduction as necessary to mitigate patient infection and death. Nor do they appear to have considered that some patients at CVH and WFH are elderly or have health conditions that put them at high risk. Manian Decl. ¶ 8. Plaintiff Vincent Ardizzone has Stage IV prostate cancer and is currently undergoing radiation therapy. Ardizzone Aff. ¶ 9. Plaintiff Gail Litsky has asthma, high blood pressure, high cholesterol, prediabetes, and is overweight. Litsky Aff. ¶ 8. Plaintiff Barbara Flood is 64 years old and receives weekly dialysis for kidney failure. Gudis Aff. ¶ 14.
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According to Plaintiffs’ experts, “there are individuals who could be discharged without posing significant safety risks.” Canavan/Jones Decl. ¶ 18. One possible candidate is WFH resident Francis Clarke is a 72-yearold honorably discharged veteran who was arrested for driving under the influence and on a suspended license. He was found not competent to stand trial and sent to WFH in November 2019 for restoration to competency on minor charges. He has never been committed or treated for a mental illness until now. As far as Plaintiffs are aware, Defendants are not taking steps to secure his discharge.
Despite actual knowledge that these and other CVH and WFH residents face significant risk from the COVID-19 virus, Defendants have failed to undertake a program of census reduction, including especially by accelerating discharges.
Testing. Defendants’ failure to have a plan for testing of residents and to conduct repeat testing of residents following a confirmed case of COVID-19 is a substantial departure from professional standards. As Dr. Manian and the CDC guidelines make clear, professional standards require a plan for testing all residents and staff and the capacity to perform such testing. While Defendants have finally begun testing all staff on a weekly basis, they lack an acceptable plan for testing residents. Professional
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standards require that Defendants perform baseline testing of all residents and staff, and also test at least once a week all previously negative residents and staff until the testing identifies no new cases of COVID-19 for at least 14 days after the most recent positive result. Manian Decl. ¶ 16; Testing Guidance for Nursing Homes, Exh. 15.
Such testing of residents is critical to prevent transmission of the virus. Staff or patients may be infectious for days while exhibiting no symptoms, allowing the virus to spread rapidly through these facilities. Id. ¶ 6. Defendants have not conducted weekly testing of residents following confirmed cases at CVH and WFH. Even today, although some patients are in quarantine in CVH, residents are not being tested weekly. This is a substantial departure from professional judgment that puts residents at grave risk of harm.
PPE. Defendants’ failure to ensure that staff consistently wear face masks and to encourage residents to wear face masks constitutes a substantial departure from professional judgment. Staff in CVH and WFH “should always wear a face mask while they are in the healthcare facility.” Manian Decl. ¶ 14. Residents “should be encouraged to routinely wear a cloth face covering” as appropriate and those with “significant exposure to COVID-19 or suspected of having COVID-19 should wear a face mask
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when outside their rooms.” Id. at 15. Defendants initially delayed in implementing these guidelines, and did not even offer masks to patients in either hospital until April 23, 2020. Mueller ¶ 34. When patients asked for masks, they were refused. Litsky Aff. ¶ 14.
While staff are now required to wear masks and patients are now offered one mask per week, Defendants still do not ensure that PPE guidelines are practiced consistently or that residents are encouraged to wear masks. Ardizzone Aff. ¶¶ 18, 32; Litsky Aff. ¶ 17, 32, 33, 36. Moreover, staff continues to work on multiple units, as need dictates. Litsky Aff. ¶ 23. Use of masks by both staff and patients remains intermittent and unenforced, resulting in ongoing but avoidable risk of infection to both. Ardizzone Aff. ¶¶ 18, 32; Litsky Aff. ¶ 33. This failure to follow professional standards violates plaintiffs’ Fourteenth Amendment rights.
Hygiene and Decontamination. Defendants’ failure to ensure that CVH and WFH are appropriately decontaminated and that patients have access to proper hand hygiene during the pandemic is a substantial departure from professional standards.
Professional standards require that all residents “should have ready access to proper hand hygiene within the facility,” and that facilities should
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enforce a schedule for regular cleaning and disinfection of shared equipment and high-touch surfaces in rooms and common areas (including shower knobs, curtains, and bathroom surfaces) with an EPA-registered, hospital-grade disinfectant. Manian Decl. at ¶¶ 15, 17. “Ready access to proper hand hygiene” requires providing hand sanitizer to patients, with supervision if needed, and that all patients be taught about infection control strategies. Canavan/Jones Decl. ¶ 14.
Yet Defendants have failed to ensure that hygiene and decontamination standards are consistently followed. Even after patients began to test positive, maintenance staff did not thoroughly clean Dutcher South 3, where 15 men live and share a bathroom, with several men using the two showers, sinks, urinals, and toilets at the same time. Mueller Aff. ¶¶ 12, 39. On another unit, Dutcher North 3, 22 men share a shower room and restroom, Ardizzone Aff. ¶ 15, making it impossible to clean the fixtures and surfaces between each use by individual patients. On each of those units, soap dispensers sometimes go empty on the weekends, because maintenance staff do not work on weekends. Ardizzone Aff. ¶ 16; Mueller Aff. ¶ 39. On Dutcher South 3, a patient’s request that a stethoscope and pulse oximeter be sanitized before they were used to take his vitals was considered “oppositional” and denied. Mueller Aff. ¶ 38. Patients’ requests
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for hand sanitizer have been denied because the administration considered the risk of patients ingesting the alcohol-based product more serious than the risk of infection or death. Ardizzone Aff. ¶16; See Mueller Aff. ¶ 47. These failures to ensure basic hygiene and decontamination practices constitute a substantial departure from professional standards in violation of Plaintiffs’ Fourteenth Amendment rights.
2. The Defendants Are Violating the Fourteenth Amendment Right to Safe Conditions for Pre-Trial Detainees.
If, as to some Plaintiffs, Defendants’ actions are governed by Fourteenth Amendment standards for the treatment of pre-trial detainees rather than state hospital patients, Defendants have violated these standards as well. The Fourteenth Amendment right of pre-trial detainees to safe conditions is violated when they are subjected to conditions that create an unreasonable risk of serious harm, including to physical health, Darnell v. Pineiro, 849 F.3d 17, 30 (2d Cir. 2017), amounting a reckless disregard for safety, id. at 32. There is no requirement of subjective intent: “. . .[T]o establish a claim for deliberate indifference to conditions of confinement under the Due Process Clause of the Fourteenth Amendment, the pretrial detainee must prove that the defendant-official acted intentionally to impose the alleged condition, or recklessly failed to act with reasonable care to mitigate the risk that the condition posed to the pretrial
35

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detainee even though the defendant-official knew, or should have known, that the condition posed an excessive risk to health or safety. In other words, “deliberate indifference” should be defined objectively.” Darnell, 849 F.3d at 35.
The same actions and inactions that violate the Youngberg rights of patients at CVH and WFH constitute violations of the right to safe conditions held by pre-trial detainees. As described above, Defendants have failed to adequately protect Plaintiffs from the risks of COVID-19.
Recent court decisions confirm the above analysis. For example, in Basank v. Decker, 2020 WL 1481503 (S.D.N.Y. March 26, 2020), the court granted a temporary restraining order for the immediate release of immigration detainees in the Hudson, Bergen, and Essex County Correctional Facilities due to the health risks in these facilities. The court noted that the detainees were likely to succeed on the merits because the facilities were exhibiting deliberate indifference by failing to follow professional standards for protecting the detainees. Id. at *2.
C. The Balance of Equities Tips Decidedly in Favor of Plaintiffs, and an Injunction Will Serve the Public Interest. “Where the Government is the opposing party,” the final two factors in the analysis—“the balance of the equities and the public interest—merge.” Martinez-Brooks v. Easter, 2020 WL 2405350 at *27 (D. Conn. May 12,
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2020), quoting Coronel v. Decker, 2020 WL 1487274, at *7 (S.D.N.Y. Mar. 27, 2020).
Given the evidence that Plaintiffs, psychiatric patients in state hospitals, are at serious risk including of death, there can be no reasonable dispute that the balance of the equities favors them and that an injunction is in the public interest. “[I]t is always in the public interest to prevent the violation of a party’s constitutional rights.” G & V Lounge, Inc. v. Michigan Liquor Control Com’n, 23 F.3d 1071, 1079 (6th Cir. 1994). See also Coronel, 2020 WL 1487274, at *7 (“the public interest is best served by ensuring the constitutional rights of persons within the United States are upheld,” quoting Sajous v. Decker, 2018 WL 2357266, at *13 (S.D.N.Y. 2018)); Barbecho v. Decker, 2020 WL 1876328, at *7 (S.D.N.Y. Apr. 15, 2020); Doe v. University of Connecticut, 2020 WL 406356, at *6 (D. Conn. Jan. 23, 2020). “Moreover, the … interest in avoiding serious illness or death must weigh heavily on the scales.” Martinez-Brooks, 2020 WL 2405350 at *28.
In addition, granting Plaintiffs’ motion will serve the larger public interest of reducing the risk of transmission of the COVID-19 virus from the hospitals to the community. Fewer COVID-19 cases – even less of a risk of such cases – at CVH and WFH will benefit staff who enter and leave the
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facilities on a daily basis, reducing the risk to the community at large. Accordingly, it is clear that Plaintiffs meet the final two factors for granting a preliminary injunction.
V. CONCLUSION For the reasons above, this Court should grant a preliminary
injunction. The preliminary injunction should be granted on a class basis. The
Court should certify a class in order to ensure that all patients at CVH and WFH enjoy the benefits of relief granted in a preliminary injunction. The class seeking a preliminary injunction -- all patients at CVH and WFH – meets the requirements for certification under Rule 23 of the Federal Rules of Civil Procedure. The class is so numerous, about 438 in all, that joinder of all members is impracticable. There are questions of law or fact common to the class, including what the Fourteenth Amendment demands of Defendants and whether Defendants’ conduct is a substantial departure from professional standards. The claims of the named plaintiffs are typical of the claims of the class as a whole. The named plaintiffs are represented by competent counsel and will fairly and adequately protect the interests of the class. Defendants have acted or refused to act on grounds that apply
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generally to the class, so that final injunctive relief is appropriate respecting
the class as a whole.
Plaintiffs respectfully request that the preliminary injunction direct
Defendants to:
1. Conform their testing protocols to CDC standards,
2. Take steps to ensure that staff consistently wear masks and
that Plaintiffs are encouraged and supported in wearing masks including
through education,
3. Improve hygiene and decontamination practices,
4. Implement social distancing to the maximum extent possible
including by reducing patient census,
5. Undertake the clinical review described above in order to
accelerate discharges, and
6. Grant such other or different relief the Court deems appropriate.
Respectfully submitted, The Plaintiffs By: s/Kirk W. Lowry Kirk W. Lowry, ct#27850 Karyl Lee Hall, ct#19320 Virginia Teixeira, ct#29213 Connecticut Legal Rights Project CVH – Beers Hall 2nd Floor P.O. Box 351 – Silver Street Middletown, CT 06457
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(860) 262-5017 Fax (860) 262-5035 klowry@clrp.org
s/Ira Burnim Ira A. Burnim, pro hac vice Jennifer Mathis, pro hac vice pending Judge David L. Bazelon Center for Mental Health Law 1090 Vermont Avenue, NW Suite 220 Washington, D.C. 20005 (202) 467-5730 Fax (202) 223-0409 irab@bazelon.org jenniferm@bazelon.org
s/Mark J. Murphy Mark J. Murphy, pro hac vice pending Center for Public Representation 1825 K Street, NW Suite 600 Washington, D.C. 20006 (202) 670-1008 Fax (413) 586-5711 mmurphy@cpr-ma.org
Certificate of Service On June 8, 2020 a copy of the foregoing Memorandum in Support of Their Motion for Preliminary Injunction was filed electronically and served by mail on anyone unable to accept electronic filing. Notice of this filing will be sent by email to all parties by operation of the Court’s electronic filing system or by mail to anyone unable to accept electronic filing as indicated on the Notice of Electronic Filing. Parties may access this filing through the Court’s CM/ECF System.
s/Kirk W. Lowry_________ Kirk W. Lowry
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Wilkes v. Lamont Exhibit List
Exhibit 1 Dr. Manian Declaration Exhibit 2 Dr. Jones and Dr. Canavan Declaration Exhibit 3 Mueller Affidavit Exhibit 4 Ardizzone Affidavit Exhibit 5 Litsky Affidavit Exhibit 6 Clarke Affidavit Exhibit 7 King Affidavit Exhibit 8 Gudis Affidavit Exhibit 9 CT DPH Guidance for LTCFs Exhibit 10 CMS Nursing Home Reopening Recommendations Exhibit 11 CDC – How to Protect Yourself Exhibit 12 CDC – Key Strategies to Prepare for COVID-19 in LTCFs Exhibit 13 CDC – Preparing for COVID-19 in Nursing Homes Exhibit 14 CDC – Responding to Coronavirus in Nursing Homes Exhibit 15 CDC – Testing Guidance for Nursing Homes Exhibit 16 CDC – Performing Facility-wide SARS-CoV-2 Testing in Nursing Homes Exhibit 17 CDC – Infection Prevention and Control (IPC) Assessment Tool for Nursing Homes Preparing for COVID-19 Exhibit 18 SAMHSA Considerations for the Care and Treatment of Mental and Substance Use Disorders in the COVID-19 Epidemic: March 20, 2020; Revised May 7, 2020

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 Case 3:20-cv-00594-JCH Document 32 Filed 06/11/20 Page 1 of 3

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

THOMAS WILKES,

:

BARBARA FLOOD,

:

VINCENT ARDIZZONE,

:

GAIL LITSKY,

:

CARSON MUELLER,

:

On behalf of themselves and

:

all other persons similarly

:

situated,

:

Plaintiffs

:

:

v.

:

:

NED LAMONT, Governor

:

MIRIAM E. DELPHIN-RITTMAN,

:

Commissioner of DMHAS,

:

HAL SMITH, CEO of Whiting Forensic :

Hospital,

:

LAKISHA HYATT, CEO Connecticut :

Valley Hospital,

:

Defendants

:

CIVIL NO. 3:20CV594-JCH June 11, 2020

MOTION TO DISMISS The defendants respectfully move the Court pursuant to F.R.Civ.P. 12(b)(1) and 12(b)(6) to dismiss plaintiffs’ claims in this matter. In support of this motion, the defendants submit that: i) plaintiffs’ claims for habeas corpus relief are barred by their failure to exhaust their state court remedies; ii) the Court should decline to entertain plaintiffs’ claims pursuant to the doctrine of primary jurisdiction; and iii) the Court should abstain from ruling on plaintiffs’ assessment and discharge claims. In further support of this motion the defendants respectfully submit the accompanying memorandum of law and supporting declarations and exhibits.

Case 3:20-cv-00594-JCH Document 32 Filed 06/11/20 Page 2 of 3
DEFENDANTS NED LAMONT, ET AL.
WILLIAM TONG ATTORNEY GENERAL
BY: /s/ Ralph E. Urban Ralph E. Urban Assistant Attorney General Federal Bar No. ct00349 ralph.urban@ct.gov
/s/ Henry A. Salton Henry A. Salton Assistant Attorney General Federal Bar No. ct07763 henry.salton@ct.gov
/s/ Emily V. Melendez Emily V. Melendez Assistant Attorney General Federal Bar No. ct21411 emily.melendez@ct.gov
/s/ Laura D. Thurston Laura D. Thurston Assistant Attorney General Federal Bar No. ct30612 laura.thurston@ct.gov
/s/ Shawn L. Rutchick Shawn L. Rutchick Assistant Attorney General Federal Bar No. ct24866 shawn.rutchick@ct.gov 165 Capitol Avenue P.O. Box 120 Hartford, CT 06141-0120 Tel: (860) 808-5210 Fax: (860) 808-5385
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Case 3:20-cv-00594-JCH Document 32 Filed 06/11/20 Page 3 of 3 CERTIFICATION
I hereby certify that on June 11, 2020, a copy of the foregoing was filed electronically and served by mail on anyone unable to accept electronic filing. Notice of this filing will be sent by e-mail to all parties by operation of the Court’s electronic filing system or by mail to anyone unable to accept electronic filing as indicated on the Notice of Electronic Filing. Parties may access this filing through the Court’s CM/ECF system.
/s/ Ralph E. Urban Ralph E. Urban Assistant Attorney General
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Case 3:20-cv-00594-JCH Document 33 Filed 06/11/20 Page 1 of 18

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

THOMAS WILKES,

:

BARBARA FLOOD,

:

VINCENT ARDIZZONE,

:

GAIL LITSKY,

:

CARSON MUELLER,

:

On behalf of themselves and

:

all other persons similarly

:

situated,

:

Plaintiffs

:

:

v.

:

:

NED LAMONT, Governor

:

MIRIAM E. DELPHIN-RITTMAN,

:

Commissioner of DMHAS,

:

HAL SMITH, CEO of Whiting Forensic :

Hospital,

:

LAKISHA HYATT, CEO Connecticut :

Valley Hospital,

:

In their official capacities,

:

Defendants

:

CIVIL NO. 3:20CV594-JCH June 11, 2020

MEMORANDUM IN SUPPORT OF MOTION TO DISMISS The defendants respectfully submit this memorandum and accompanying declarations and exhibits in support of their motion to dismiss, filed herewith. On April 30, 2020, plaintiffs, four patients at Whiting Forensic Hospital (“Whiting”) committed to the custody of the Department of Mental Health and Addiction Services (“DMHAS”) and under the auspices of State’s Psychiatric Security Review Board (“PSRB”) pursuant to Conn. Gen. Stat. §§ 54-56d and 17a-582, and two patients at Connecticut Valley Hospital (“CVH”) civilly committed to the custody of DMHAS pursuant to Conn. Gen. Stat. §§ 17a- 495 et seq., alleged to be adequate representatives of a putative class of similarly situated

Case 3:20-cv-00594-JCH Document 33 Filed 06/11/20 Page 2 of 18
patients at Whiting and CVH, filed this action asserting various federal and state law claims and seeking certain immediate injunctive relief stemming from Whiting’s and CVH’s actions and responses to the ongoing novel Covid-19 pandemic. Thereafter, an amended complaint was filed on May 7, 2020, claiming violation of substantive due process, Title II of the Americans with Disabilities Act, 42 U.S.C. §§ 12131 et seq. (“ADA”), and Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 504 (“§ 504”), invoking the Court’s habeas corpus powers, and again seeking various forms of immediate injunctive relief. The amended complaint dropped plaintiffs’ claim under the Connecticut Patients’ Bill of Rights, Conn. Gen. Stat. §§ 17a-540 et seq. (“CTPBR”).
For the reasons set forth more fully below, this Court should dismiss plaintiffs’ habeas corpus claims for failure to exhaust State court remedies and dismiss the balance of plaintiffs’ claims under the doctrine of primary jurisdiction. Plaintiffs claims regarding assessment and discharge should further be dismissed because the Court should abstain from entertaining them.
A federal action seeking habeas relief is subject to dismissal pursuant to F.R.Civ.Proc. 12(b)(1) for failure to exhaust state remedies; Kane v. Comm’r., 2019 WL7037685 (D.Vt .) at *3; dismissal pursuant to the doctrine of primary jurisdiction may be raised via a motion pursuant to F.R.Civ.Proc. 12(b)(6). Tassy v. Brunswick Hosp. Center, Inc., 296 F.3d 65, 66-67 (2d Cir.2002). Abstention pursuant to Colorado River v. U.S.¸ 424 U.S. 800 (1976) is properly raised by a motion to dismiss pursuant to F.R.Civ.P. 12(b)(1). Pike Company, Inc. v. Universal Concrete Products, Inc., 284 F.Supp.3d 376, 384 (W.D.N.Y.2018) (Internal quotations and citations omitted).
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I. Plaintiffs’ Claims for Habeas Corpus Relief Must be Dismissed for Failure to Exhaust State Remedies Federal law, codified at 28 U.S.C. § 2254, requires the exhaustion of federal claims in
State court before those claims can be addressed by the federal courts. In pertinent part, 28 U.S.C. § 2254 provides that
[a]n application for a writ of habeas corpus on behalf of a person in custody pursuant to the judgment of a State court shall not be granted unless it appears that-(A) the applicant has exhausted the remedies available in the courts of the State; or (B)(i) there is an absence of available State corrective process; or
(ii) circumstances exist that render such process ineffective to protect the rights of the applicant. This statute codifies a rule of comity that predates the statute and applies not just to those held in state custody as the result of criminal convictions, but all those in custody as the result of State court orders. Baldwin v. Lewis, 442 F.2d 29, 33 (7th Cir.1971); Duncan v. Walker, 533 U.S. 167, 176 (2001). This includes those confined at Whiting Forensic Hospital who have been committed to the custody of DMHAS under the auspices of the PSRB who have been found not guilty by reason of insanity. See Conn. Gen. Stat. §§ 54-56d; 17a-583; Narcisee v. Delphin-Rittman, 2017 WL 396137 at *1 (D.Conn.) (Challenging one’s confinement at Whiting via habeas requires fully exhausting available State remedies); accord, Buthy v. Comm’r. of Office of Mental Health, 818 F.2d 1046, 1049 (2d Cir.1987). This requirement to exhaust state court avenues of relief before a person can assert habeas claims in federal court has long been held to apply to the mentally ill and those deemed incompetent and thus committed by state court orders into state custody. Williams v. Dalton, 23 F.2d 646 (6th Cir. 1956); U.S. ex rel. Spinks v. Zeller, 188
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F.Supp. 767 (N.D.W.Va.1960); Miller v. Director, Middletown State Hosp., 146 F. Supp. 6745 (E.D.N.Y.1956) aff’d. 242 F.2d 527 (2d Cir.1959).
The purpose and policy behind this now statutorily codified rule of law is grounded in the primary respect federal courts are duty bound to show to state judicial processes. Wade v. Mayo, 334 U.S. 672, 680 (1948); Velez v. People of the State of New York, 941 F. Supp. 300, 309 (E.D.N.Y.1996) The rule further protects the state courts’ role in the enforcement of federal rights and prevents judicial disruption of state judicial processes. Rose v. Lundy, 455 U.S. 509, 518 (1982) The rule acknowledges, again under principles of comity, that state courts are coequals of the federal courts in the responsibility to adjudicate federal constitutional issues, giving state courts the opportunity to resolve such issues. Howard v. Sigler, 325 F.Supp 278, 283 (D.Neb.1971) Thus the rule is not one of defining power but rather the appropriate exercise of power; if both the state and federal courts are open to persons in state custody, the state door to review should be opened first. Clark v. Nickeson, 321 F.Supp. 415, 419 (D.Conn.1971); in this sense, the rule is not strictly one of jurisdiction, but comity. Hopkinson v. Shillinger, 954 F.2d 609, 610 (10th Cir. 1991) cert. den. 112 S.Ct. 959 (1992); Hammond v. Lenfest, 398 F.2d 705, 714 (2d Cir.1968); Snyder v. Kelly, 769 F.Supp. 108,110 (W.D.N.Y.1991) aff’d. 972 F.2d 1328 (2d Cir.1992); U.S. ex rel. Lynch v. Sandahl, 793 F.Supp. 787,794 (N.D.Ill. 1992).
While the rule is grounded in principles of federalism and comity, it also has the salutary effect of enhancing the state courts’ familiarity with federal constitutional issues, recognizing that state courts, no less than federal courts, are bound to safeguard the federal rights of those in custody. Jones v. Keane, 329 F.3d 290, 294 (2d Cir. 2003) cert den. 540 U.S. 1046 (2003). The
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rule is an essential element of the federal scheme and it ensures that the states are afforded the opportunity to set their own constitutional houses in order before the power of the federal courts is invoked. Fielding v. LeFevre, 548 F.2d 1102,1106 (2dCir. 1977) Because the federal-state relationship is subjected to considerable stress whenever a federal court is asked to review such state court orders pertaining to custody, the rule is intended to ensure federal intrusions are confined to those instances where absolutely necessary. U.S. ex rel. Cleveland v. Cassches, 479 F.2d 15, 19 (2d Cir. 1973); U.S. ex rel. Goodman v. Kehl, 456 F.2d 863, 869 (2d Cir.1972).
The rule requires that all federal claims must be raised as federal claims in state court. Jones v. Annucci, 124 F.Supp.3d 103, 115 (N.D.N.Y. 2015); Finetti v. Harris, 609 F.2d 594, 597 (2d Cir.1979), and even an obvious denial of federal rights does not itself excuse the failure to exhaust state remedies. Duckworth v. Serrano, 454 U.S. 1, 3 (1981). In addition, the federal courts have clearly established that this principle applies to claims of federal civil rights violations. Howard v. Koch, 575 F.Supp. 1299, 1302 (E.D.N.Y. 1982); Miller v. Rockefeller, 327 F.Supp. 542, 548 (S.D.N.Y.1971) (42 U.S.C. §1983 cannot be used to circumvent rules of comity and § 2254’s requirement to exhaust state remedies in habeas claims); Phipps v. McGinnis, 327 F.Supp. 1, 2 (D.C.N.Y. 1970). This includes claimed violations of the federal due process clause and constitutional claims challenging conditions of confinement. Jiminez v. Walker, 458 F.3d 130 (2d Cir.2006) cert. den. 549 U.S. 1133 (2007); U.S. ex rel. Whiteside v. Slavin, 309 F.2d 322 (2d Cir. 1962), cert. den. 372 U.S. 966 (1963); Campbell v. State of Georgia, 459 F.2d 1039 (5th Cir. 1972) cert. den. 409 U.S. 984 (1973), rehearing den. 412 U.S.
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933 (1973). See also, U.S. ex rel. Leeson v. Damon, 496 F.2d 718, 719 ( 2d Cir.1974) cert. den. 419 U.S. 954 (1974); Lage v. Chapdelaine, 2010 WL 4688820 (D.Conn.) at *3.
To be sure, there are limited exceptions to the rule as recognized by the courts, none of which are applicable here, including where there is the complete absence of a state court remedy, or the circumstances establish that state policies render any state processes to address the claims wholly ineffectual. Copeland v. Walker, 258 F.Supp. 2d 105, 141 (E.D.N.Y.2003). Thus, to excuse the duty to exhaust state remedies, the State remedy must be inadequate or unavailable. Preiser v. Rodriquez, 411 U.S. 475, 477 (1973); Young v . Ragen, 337 U.S. 235, 238 (1949); U.S. ex rel. Santiago v. Follette, 298 F.Supp. 973, 974 (D.C.N.Y. 1969). The ineffectiveness of the state remedy cannot be established if no attempt has been made to obtain relief in the state courts. Daegele v. Crouse, 429 F.2d 503, 505 (10th Cir. 1970) cert. den. 400 U.S. 1010 (1971). Moreover, anticipation of an adverse state court ruling does not establish the insufficiency of the state remedy for purpose of excusing the failure to exhaust the state court remedy. Graziano v. Lape, 358 F.Supp.2d 64, 67 (N.D.N.Y.2005), reconsideration den. 2005 WL 1176567.
Here, the plaintiffs have not plead, nor could they, that they have exhausted their state court remedies. Moreover, the avenues of remedy in the state courts are fully open to them. As set forth in the accompanying declaration of Kathryn Stackpole (Exhibit 1 hereto), the State
habeas courts and dockets have been operating since the onset of the pandemic in Connecticut with very minimal if any interruptions in service or availability to hear emergency motions and petitions related to conditions of confinement, and certainly were operating and available on April 30, 2020, the date this lawsuit was filed. See Fay v. Noia, 372 U.S. 391,398-99 (1963) (The issue is whether the state remedy is available as of the date of filing the federal action); accord, Dana v. Tracy, 360 F.2d 545, 548 (1st
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Cir.1966) cert. den 385 U.S. 941 (1966). In addition, the declaration establishes that none of the named plaintiffs herein have filed habeas petitions or actions in the Superior Court; indeed, this Court may take judicial notice of that fact. Mangiafico v. Blumenthal, 471 F.3d 391, 398 (2d Cir.2006) (Docket sheets are public records of which a court may take judicial notice of); Gillums v. Semple, 2018 WL 3404145 at *5 (D.Conn.).
This Court should decline to follow Judge Arterton’s decision on the habeas exhaustion issue in McPherson et al. v. Lamont, et al., No. 3:20-cv-534(JBA). In McPherson, apparently based on the evidence available to the Court at that juncture, the Court concluded that there was “diminished capacity” in the State court system to handle habeas claims at least during those early days of the pandemic; the Court expressed concern that the State courts “may not be able to respond to a massive volume of emergency habeas petitions” that the Court anticipated would be filed. Id. at 13. Such a situation, the McPherson Court observed, could result in a “consequence of potentially catastrophic health outcomes.” Id. at 14. As reflected in Ms. Stackpole’s declaration, at the time this lawsuit was filed, the State court system was suffering no such “diminished capacity”; habeas petitions and motions related to conditions of confinement were getting prompt attention and being treated, as they should, as high priority matters within the State court system. Moreover, Ms. Stackpole’s declaration further establishes that there has been no “massive volume of emergency habeas petitions,” even though the State courts also anticipated there might be significantly increased volume. Notably, the McPherson matter has been settled, and so a significant increase in Covid-19 related petitions filed on behalf of state prisoners is not likely to occur. Finally, as this Court heard at the last status conference, Whiting
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and CVH patients have not suffered catastrophic health outcomes as compared to those outside the hospitals, and the evidence is likely to show the situation has even improved since then.
Plaintiffs’ state court habeas remedies were available to them when they filed this lawsuit, and it cannot reasonably be disputed that they failed to avail themselves of such remedies. As such, plaintiffs’ habeas claims must be dismissed.
II. The Court Should Decline to Entertain Plaintiffs’ Claims in Accord with the Doctrine of Primary Jurisdiction The longstanding doctrine of primary jurisdiction applies “where a claim is originally
cognizable in the courts, but enforcement of the claim requires, or is materially aided by, the resolution of threshold issues, usually of a factual nature, which are placed within the special competence of …[an] administrative body.” Golden Hill Paugussett Tribe v. Weicker, 39 F.3d 51, 58-59 (2d Cir.1994) (citing U.S. v. Western Pc. R.R., Co., 352 U.S. 59, 63-64 (1956)). The doctrine “allows an agency to decide factual issues that require specialized, technical knowledge that are particularly within its area of expertise and have been legislatively committed to its judgment.” Read v. Corning, 351 F.Supp.3d 342, 350 (W.D.N.Y.2018) (citing Johnson v, Nyack Hosp., 964 F.2d 116, 122 (2d Cir.1992)). The doctrine is especially useful for dealing with “issues of fact not within the ordinary ken of judges and which required administrative expertise should be resolved preliminarily by the agency in which Congress has vested authority over the subject matter ….” Golden Hill, 39 F.3d at 60. The primary jurisdiction doctrine “recognizes that even though Congress had not empowered an agency to pass on the legal issues presented by a case raising issues of federal law, the agency’s expertise may, nevertheless prove helpful to the
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court in resolving the factual issues.” U.S. v. 43.47 Acres of Land, 45 F.Supp. 2d 184, 192 (D.Conn.1999) quoting Johnson, 964 F.2d at 122 (Emphases in original). As plaintiffs’ recent preliminary injunction filings amply demonstrate, here, myriad threshold factual issues predominant.
While the doctrine’s usefulness “decreases in proportion as legal issues predominate over factual [issues],” its application is particularly appropriate where “[t]he ultimate legal question heavily relies on the factual determination[s] which does not fall within the conventional competence of the courts.” U.S. v. 43.47 Acres, 45 F.Supp.2d at 192-93 (Internal quotations omitted). Thus, the doctrine “serves two interests: consistency and uniformity in the regulation of an area which Congress entrusted to a federal agency; and the resolution of technical questions of fact through the agency’s specialized expertise, prior to judicial consideration of the legal claims.” Golden Hill, 39 F.3d at 59 (citing Nader v. Allegheny Airlines, 426 U.S. 290, 303-4 (1976)); Goya Foods, Inc. v. Tropicana Products, Inc., 846 F.2d 848, 851 (2d Cir.1988). One “aim of the doctrine … is to ensure that courts and agencies with concurrent jurisdiction do not work at cross purposes.” Martin v. Shell Oil Co., 198 F.R.D. 580, 585 (D.Conn.2000) (Internal quotations omitted). The doctrine extends to state agencies with specialized expertise as well. Read, 351 F.Supp.3d at 354.
Because application of the doctrine is a discretionary and prudential determination by the courts, it is not -- despite its name, and unlike the related doctrine of failure to exhaust administrative remedies -- actually jurisdictional in nature. Collins v. Olin Corp., 418 F.Supp. 2d 34, 42 (D.Conn.2006) (citing Tassy v. Brunswick Hosp. Center, Inc., 296 F.3d 65, 72 (2d
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Cir.2002)). Rather, in recognizing that the doctrine of primary jurisdiction applies in a given case, the court is staying its judicial hand pending reference of plaintiffs’ claims to the agency for its views.” Golden Hill, 39 F.3d at 61. While the federal court retains final authority, it is availing itself of the agency’s aid in gathering facts and marshalling them into a meaningful pattern.” Id. at 60.
In this circuit, the federal courts have cited to four factors to be considered in determining whether a court should stay its hand under the primary jurisdiction doctrine, namely: (i) whether the factual questions are within the conventional experience of judges or involves technical or policy considerations within the agency’s particular field of expertise; (ii) whether the issues are particularly within the agency’s discretion; (iii) whether if the doctrine is not invoked will there be a substantial danger of inconsistent rulings or guidance; and (iv) whether prior application to the agency has been made. Martin, 198 F.R.D, at 585; Collins, 418 F. Supp 2d at 43 (citing Niehaus v. AT & T Corp., 218 F.Supp.2d 531, 537 (S.D.N.Y.2002); National Communs. Assoc., Inc. v. AT & T Co., 46 F.3d 220, 222-23 (2d Cir.1995)).
In an important Covid-19 related decision involving many of the same factual questions around maintaining the safety of critical facilities, the Court in Rural Community Workers Alliance, et al. v. Smithfield Foods, Inc., 2020 WL 2145350 (W.D.Mo.) held it was prudentially appropriate to stay its hand pursuant to the primary jurisdiction doctrine in light of the complex technical and medical factual issues in play. The Smithfield Court determined that complex factual issues involving personal protective equipment, engineering controls, contact tracing methods, workplace rules and space utilization and the like militated in favor of deferring to the
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specialized expertise of the Occupational Safety and Health Administration (“OSHA”) and the Centers for Disease Control (“CDC”), noting that OSHA and the CDC had issued relevant joint guidance on such issues. The Smithfield Court, citing Access Telecommuns. v. S.W. Bell Tel. Co., 137 F.3d 605, 608 (8th Cir.1998), noted that the primary jurisdiction doctrine allows a district court to refer a matter to the appropriate administrative agenc[ies] for a determination in the first instance even though the matter is initially cognizable by the district court. In invoking the primary jurisdiction doctrine, the Smithfield Court was particularly concerned with the risk of inconsistent regulation of this crucial area, and that the area involved a special competency that resided within the agencies. Smithfield, 2020 WL 2145350 at *8 (citing Sprint Spectrum L.P. v. AT & T Corp., 168 F.Supp.2d 1095, 1098 (W.D.Mo.2009) in turn quoting U.S. v. Western Pac. R.R. Co., 352 U.S. 59, 64) (1956)).
Applying the four factors noted above to the circumstances presented in this matter reveals three of the four factors readily apparent here. The detailed factual questions at issue here -- pertinent both inside and outside the psychiatric hospital setting -- regarding: i) medical testing regimens of patients; ii) sanitation and cleaning; iii) isolation and quarantine; iv) patient housing transfers and space deployment; v) deployment of protective equipment; vi) intake and discharge practices; vii) screening and testing of staff and visitors; viii) deployment of medical and other staff; ix) social distancing in psychiatric care and clinical settings; and x) consultation with medical and psychiatric experts and other consultants, as well as published guidances, all reflect significant, and notably rapidly evolving technical issues, knowledge and policy considerations beyond the conventional experience and ken of judges.
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These complex factual and technical issues and considerations are, however, within the particular expertise of both the CDC and the Connecticut Department of Public Health (“DPH”). As reflected in the attached affidavit of Dr. Charles Dike, DMHAS’ Medical Director (Exhibit 2 attached hereto), the CDC has issued numerous and evolving guidance documents regarding the application of appropriate medical and infection control practices during this pandemic in hospital and other such settings, and DPH has for months been providing guidance and expertise on these issues to hospitals, psychiatric hospitals, nursing homes and other congregate housing settings, to name just some of DPH’s work since the onset of the pandemic. As knowledge about this particularly insidious virus and the illnesses it causes grows, these agencies are working feverishly to disseminate the best and latest information to assist and guide those operating such facilities. These issues are particularly within the ambit of these agencies’ expertise and experience, and that expertise and experience is growing daily. As the declaration reflects, DMHAS professionals, in the exercise of their professional judgment, have been consulting and relying on such evolving information since the pandemic began.
A court, in ferreting through these complicated, technical and evolving factual issues, and electing to, in effect, choose winners and losers amongst the options presented for those charged with operating such facilities, plainly increases substantially the danger of inconsistent rulings and instructions for those on the front lines of care, possibly creating even greater risk for patients and staff.
As to the fourth factor -- whether prior application of these questions has been made to the relevant administrative agen[cies] -- while it appears no formal complaints have been filed
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with the CDC or DPH (see Conn. Gen. Stat. § 19a-494a regarding DPH’s power to issue emergency remedial orders), such a complaint could have been so filed, and notably, this factor is not in itself dispositive or mandatory for appropriate application of the primary jurisdiction doctrine, since the federal courts themselves may initiate such referrals. See U.S. v. Western Pac. R.R. Co., 352 U.S. at 67-68; Smithfield, 2020 WL 2145350 at *9. In addition, as noted, both the CDC and DPH have already provided significant guidance referred to and employed by Whiting and CVH. Also, pursuant to Conn. Gen. Stat. § 19a-494a, the Commissioner of Public Health, if she finds that the health, safety or well-being of any patient served by an “institution,” (which is defined at Conn. Gen. Stat. § 19a-490 to include Whiting, but not CVH) imperatively requires emergency action, she may issue a summary order to, among other things, compel compliance with state statutes and regulations, and even reduce patient capacity and services. In a similar vein, DPH’s Facility Licensing & Inspection section, as an approved agent for the federal Center for Medicare and Medicaid Services, is empowered to investigate claimed unsafe hospital conditions, which would include overview of CVH, and require plans of correction. Finally, DMHAS itself has a process plaintiffs have failed to avail themselves of for the filing of grievances concerning hospital conditions and the like. See, https://portal.ct.gov/DMHA/Programs-and-Services/Advocacy/Grievance-Procedure.
This Court, in the prudential exercise of its discretion, based on the primary jurisdiction doctrine, should stay its hand until it has available to it the considered judgement of these agencies on the factual issues in play in this lawsuit.
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III. The Court Should Abstain from Entertaining Plaintiffs’ Assessment and Discharge Claims
While generally an action pending in state court does not bar proceedings involving the same matters in federal court, under the Colorado River doctrine,1 a federal court may defer to state proceedings if certain conditions are present. This form of abstention is based on considerations of wise judicial administration, giving regard to conservation of judicial resources and comprehensive disposition of litigation. Smulley v. Mutual of Omaha Bank; 634 Fed. Appx. 335 (2d Cir 2016); Burnett v. Physicians Online, Inc., 99 F.3d 72, 76 (2d Cir.1996).
A court may abstain under the Colorado River doctrine if there are parallel state and federal proceedings; the court must consider and balance some six factors, namely, whether either the state or federal court has assumed jurisdiction over a res; the relative inconvenience of the federal forum; the desirability of avoiding piecemeal litigation; the order in which the actions were filed; whether state or federal law provides the rule of decision; and whether the state action will protect the federal plaintiff’s rights. Smulley, 634 Fed. Appx. at 335 ; Burnett, 99 F.3d at 76. Under the doctrine “[s]uits are parallel when substantially the same parties are contemporaneously litigating substantially the same issue in another forum.” Krondes v. Nationstar Mortgage, LLC, 789 Fed. Appx. 913 (2d Cir.2020). The test is not a mechanical checklist, and the court must balance the factors in reaching its decision on abstention. Burnett, 99 F.3d at 77 (Internal citations and quotations omitted).
1 Colorado River Water Conservation District v. U.S.¸ 424 U.S. 800 (1976). 14

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As reflected in the pleadings in Exhibit 3 attached hereto, in Drummer v. State of Connecticut et al., MMX-CV-18-5010661-S, pending in the Connecticut Superior Court for Judicial District of Middlesex, an action also brought by plaintiffs’ attorneys in this matter from the Connecticut Legal Rights Project, plaintiff Drummer, a court-committed patient at Whiting, claims she is a suitable representative of a putative class of court-committed patients who have been denied appropriate discharge to community settings to which they are allegedly entitled pursuant to due process principles and the State’ obligations under the ADA and § 504, which the plaintiff in Drummer asserts are incorporated into the CTPBR. The Drummer complaint was filed on or about January 25, 2018, and the matter remains pending. In Drummer, the plaintiff, on behalf of a putative class, expressly seeks reviews of all patients for possible prompt discharge into community settings, the creation of new and more extensive services and supports to purportedly allow for such discharges into community settings, increased “capacity for community supports and services, included supportive housing” and “the funding of such community supports and services.” These legal claims and demands for relief are directly comparable to plaintiffs’ claims in this lawsuit for population wide assessments for possible discharge into the most integrated setting where possible and the provision of all needed supports in such integrated settings, which plaintiffs herein claim they are entitled to under due process principles, the ADA and § 504. An honest assessment of the juxtaposition the two sets of claims and prayers for relief in these lawsuits legitimately raises the concern that the Covid-19 pandemic may be being exploited in the second lawsuit as a convenient basis for pursuing a deinstitutionalization agenda for these patients notwithstanding that given their mental health
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challenges, placement in community settings, where control over social contacts and interactions would be much more difficult to achieve, may actually be more medically risky for them.
Examining and applying the Colorado River factors here reveals nearly all the factors favor abstention. Substantially the same parties are litigating in the two cases, although in this case the named plaintiffs include some who have been court ordered into the hospital(s) for either restoration of competency or because they have been found not guilty by reason of insanity for serious crimes, as opposed to just civil commitees; this however is a distinction without a meaningful difference, as all are involuntarily hospitalized as the result of court orders, and the legal claims plaintiffs in both actions pursue are not impacted by this distinction. There is no “res” at issue here, so that factor is inapplicable. As to the inconvenience of the federal forum, defendants now find themselves defending their current discharge practices in two forums at the same time, with plaintiffs effectively having “two bites at the apple,” a circumstance certainly neither fair nor convenient for defendants. The state forum is certainly not inconvenient for the putative class, as indicated by their choice of the state forum first, before they had the Covid-19 pandemic as a further basis on which to argue their claims. Given that the claims in the two cases are nearly if not wholly the same, if both go forward simultaneously the danger of piecemeal litigation is readily evident. The state matter was filed first, and thus should be the vehicle for pursuit of these claims. The last two factors are closely related -- whether state or federal law will provide the basis of decision, and whether the state lawsuit will protect the plaintiffs’ federal rights. Here plaintiffs themselves in their complaint in Drummer have answered both these questions; plaintiffs claim in Drummer that there is no daylight between plaintiffs’ rights to
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assessment and placement in such purportedly therapeutic integrated settings under Connecticut law, in particular the CTPBR, due process principles, and ADA and § 504 rights, claiming that the Connecticut law incorporates such due process, ADA and § 504 mandates and principles. Thus, plaintiffs themselves assert in Drummer that the rule of decision to be applied in the two matters is wholly consistent.
Accordingly, under Colorado River and its progeny, this Court should abstain from entertaining plaintiffs’ assessment and discharge claims.
IV. Conclusion
For the reasons set forth above, the defendants respectfully urge the Court to dismiss plaintiffs’ claims.
Dated at Hartford, Connecticut, this 11th day of June, 2020. DEFENDANTS NED LAMONT, ET AL. WILLIAM TONG ATTORNEY GENERAL
BY: /s/ Ralph E. Urban Ralph E. Urban Assistant Attorney General Federal Bar No. ct00349 ralph.urban@ct.gov /s/ Henry A. Salton Henry A. Salton Assistant Attorney General Federal Bar No. ct07763 henry.salton@ct.gov
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/s/ Emily V. Melendez Emily V. Melendez Assistant Attorney General Federal Bar No. ct21411 emily.melendez@ct.gov
/s/ Laura D. Thurston Laura D. Thurston Assistant Attorney General Federal Bar No. ct30612 laura.thurston@ct.gov
/s/ Shawn L. Rutchick Shawn L. Rutchick Assistant Attorney General Federal Bar No. ct24866 shawn.rutchick@ct.gov 165 Capitol Avenue P.O. Box 120 Hartford, CT 06141-0120 Tel: (860) 808-5210 Fax: (860) 808-5385
CERTIFICATION
I hereby certify that on June 11, 2020, a copy of the foregoing was filed electronically
and served by mail on anyone unable to accept electronic filing. Notice of this filing will be sent
by e-mail to all parties by operation of the Court’s electronic filing system or by mail to anyone
unable to accept electronic filing as indicated on the Notice of Electronic Filing. Parties may
access this filing through the Court’s CM/ECF system.
/s/ Ralph E. Urban Ralph E. Urban Assistant Attorney General
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Case 3:20-cv-00594-JCH Document 33-3 Filed 06/11/20 Page 1 of 31

STATE OF CONNECTICUT

Docket No.: MMX-CV18-5010661-S Gloria Drummer, Plaintiff, Individually and on behalf of all persons similarly situated,
v. State of Connecticut, et al., Defendants.

: Superior Court : : : : : Judicial District of : Middlesex : at Middletown : : : : June 29, 2018

AMENDED MOTION FOR CLASS CERTIFICATION Gloria Drummer moves the Court for class certification pursuant to Connecticut General Statutes § 51-105 and Practice Book §§ 9-7 and 98(2). In support of her motion she states as follows: Factual Context Gloria Drummer is a 60 year-old woman who was involuntarily civilly committed to Connecticut Valley Hospital, Whiting Forensic Division, on October 14, 2016. She was declared discharge ready on August 2, 2017. At her annual review judicial hearing held by Judge Joseph D. Marino, Probate Court Judge, on October 13, 2017, the case was continued because the evidence was uncontested that Ms. Drummer did not meet commitment standards. The case was continued because there was no

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appropriate place for her discharge, resulting in discriminatory, unconstitutional and illegal segregation and unnecessary institutionalization. Standing
Ms Drummer has been aggrieved and has suffered injury to her person because she was denied a periodic review as soon as she had stabilized and was no longer a danger to self or others or gravely disabled. Her treatment team declared her ready for discharge on August 2, 2017. Moreover, Ms. Drummer was unnecessarily institutionalized from at least September 2, 2017 until March 14, 2018, six months. Ms. Drummer was discharged on March 14, 2018 to Lotus House, a residential services group home with full-time staff.
Ms. Drummer’s claims are not moot because they are capable of repetition and likely to recur due to her long history of psychiatric conditions and psychiatric treatment. Class Certification
Ms. Drummer brings this action on her own behalf and on behalf of two classes defined as follows:
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Periodic Review Class All psychiatric inpatients involuntarily civilly committed to a stateoperated psychiatric facility who are likely to no longer meet commitment standards before their annual or biennial review, and who have not had a probate court periodic review requested by the facility. Community Integration to Most Integrated Setting Class All psychiatric inpatients involuntarily civilly committed to a stateoperated psychiatric facility, who have been declared discharge ready by their treatment teams or not meeting commitment standards by the probate court, but who remain in the facility unnecessarily institutionalized and segregated for an unreasonable period of time because of a lack of appropriate placements, supports and services in the community. The plaintiff classes are so numerous that joinder is impracticable. Inpatient units in state-operated facilities usually hold 15-20 patients at any given time. Connecticut Valley Hospital has eleven general psychiatry inpatient units. Greater Bridgeport Community Mental Health Center has three inpatient units. Connecticut Mental Health Center in New Haven has two inpatient units. Whiting Forensic Hospital has civil patients integrated
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into its five inpatient units. Capitol Region Mental Health Center has one inpatient unit. In 2017, at Connecticut Valley Hospital alone, there were 84 new civil commitments filed, 107 annual reviews, and 48 periodic reviews.
There are questions of law and fact common to the proposed classes, including:
Fasulo Class Common Questions of Law and Fact 1. Is Conn. Gen. Stat. § 17a-498(g) unconstitutional? 2. Does the Connecticut constitution and Fasulo v. Arafeh require
state psychiatric facilities to request a probate court hearing as soon as their patient is stabilized and likely not to meet the legal commitment standard? 3. Were Ms. Drummer and all Fasulo Class members denied their constitutional due process probate court hearing to determine whether their present mental status met the legal standard for commitment? Olmstead Class Common Questions of Law and Fact 1. Does the Connecticut Patients’ Bill of Rights incorporate the federal civil right from the Americans with Disabilities Act, the Rehabilitation Act and Olmstead v. L.C., 527 U.S. 581 (1999) to receive services in the community in the most integrated setting?
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2. Does the Connecticut mental health community services and supports system have adequate capacity to ensure that all patients who no longer meet commitment standards are discharged to the most integrated setting within a reasonable time?
3. Does the Connecticut Patients’ Bill of Rights, integration mandate and the Commissioner’s Policy require that state inpatient psychiatric facilities presume that supportive housing is the most integrated setting?
Are the Olmstead class members being discharged to the most integrated setting within a reasonable time after their Fasulo hearing determines that the person no longer meets commitment standards?
Ms. Drummer’s claims are typical of the claims of the plaintiff proposed classes:
A. The named plaintiff and the members of the proposed classes are all civilly committed to a state-operated inpatient psychiatric facility;
B. The facility did not request a periodic review by a probate court;
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C. The members of the proposed plaintiff classes are or will be discharge ready or not meet commitment standards;
D. The members of the proposed plaintiff classes will be unnecessarily institutionalized and segregated because of the failure of the state to have an Integration Plan for psychiatric inpatients;
E. The members of the proposed classes are all people for whom the state has failed to measure and respond to the need for residential services and supports in the community resulting in their continued confinement as patients who are ready for discharge or do not meet commitment standards and who the state has failed to discharge to the most integrated setting within a reasonable time.
The named plaintiff will fairly and adequately protect the interests of the proposed plaintiff classes.
Plaintiff’s counsel are experienced litigators and have the resources to adequately represent the interests of the proposed plaintiff classes. Counsel are attorneys with the Connecticut Legal Rights Project (CLRP), the legal services organization created by federal consent decree to represent patients at all state-operated inpatient psychiatric facilities.
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Counsel have spent many years developing the class claims in this case
regarding the constitutional and civil rights provided in the Connecticut
Patients’ Bill of Rights, including the right to liberty when patients do not
meet commitment standards, the right to periodic review of commitment,
and the right to discharge to the most integrated setting with adequate
supports and services in the community. CLRP will devote the attorney
time and expenses necessary to prosecute the case. Counsel have not
previously represented a certified class.
Plaintiff’s claims satisfy the requirements of Practice Book § 9-8(2) in
that the defendant has acted on grounds generally applicable to the
proposed plaintiff classes, thereby making appropriate final injunctive and
declaratory relief with respect to the proposed classes as a whole.
Wherefore, plaintiff requests that two classes be certified and that
matter proceed as a class action.
Respectfully submitted,
s/Kirk W. Lowry Kirk W. Lowry, Juris No. 429577 Legal Director Kathleen M. Flaherty, Juris No. 413221 Executive Director Sally Zanger, Juris No. 069554 Karyl Lee Hall, Juris No. 405577 Senior Staff Attorneys Virginia Teixeira, Juris No. 433079 Staff Attorney
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Connecticut Legal Rights Project Beers Hall 2nd Floor P.O. Box 351 Silver Street Middletown, CT 06457 (860) 262-5017 Fax (860) 262-5035 klowry@clrp.org Certification I hereby certify that all the parties have consented to accept papers served electronically and that a copy of the foregoing was sent via electronic mail on June 29, 2018 to: Walter Menjivar Walter.menjivar@ct.gov Jacqueline Hoell Jacqueline.hoell@ct.gov
s/Kirk W. Lowry Kirk W. Lowry
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 Case 3:20-cv-00594-JCH Document 47 Filed 07/02/20 Page 1 of 17

IN THE UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

Thomas Wilkes, et al.,

)

On behalf of themselves and )

all other persons similarly )

situated,

)

Plaintiffs,

)

v.

)

)

Ned Lamont, Governor, et al., )

Defendants. )

Civil No.: 3:20cv594 (JCH) July 2, 2020

MEMORANDUM OF LAW IN SUPPORT OF PLAINTIFFS’ OPPOSITION TO DEFENDANTS’ MOTION TO DISMISS

I. INTRODUCTION

Plaintiffs, on their own behalf and on behalf of a class of patients at

Connecticut Valley Hospital and Whiting Forensic Hospital (collectively

“Plaintiffs”), seek relief under the Fourteenth Amendment, pursuant to 42

U.S.C. §1983, Title II of the Americans with Disabilities Act (ADA), 42

U.S.C. § 12132, and Section 504 of the Rehabilitation Act (Section 504),

29 U.S.C. § 794, in order to vindicate their rights to safe conditions of

confinement, protection from harm, and unnecessary institutionalization.

Plaintiffs commenced this action on April 30, 2020, then filed an Amended

Complaint on May 7, 2020.

On June 8, 2020, Plaintiffs filed a Motion for Preliminary Injunction to

remedy Defendants’ failure to protect Plaintiffs’ health and safety during the

Case 3:20-cv-00594-JCH Document 47 Filed 07/02/20 Page 2 of 17
COVID-19 pandemic, in violation of the Fourteenth Amendment.1 The Motion seeks an order requiring that Defendants: 1) conform their testing protocols to Centers for Disease Control and Prevention (CDC) standards; 2) act to ensure that staff consistently wear masks and that Plaintiffs are encouraged and supported in wearing masks; 3) improve hygiene and decontamination practices; 4) implement social distancing to the maximum extent possible, including by reducing patient census; and 5) undertake a clinical review of patients’ ability to move to the community in order to accelerate discharges.
In advance of the hearing on the Motion, Defendants have asked this Court to dismiss all of Plaintiffs’ claims. Defendants make no argument that Plaintiffs’ Amended Complaint fails to state claims under the Fourteenth Amendment and the ADA and Section 504. As Plaintiffs show in their Memorandum of Law in Support of Motion for Preliminary Injunction, U.S. Supreme Court decisions establish that Defendants have a Fourteenth Amendment obligation to protect the safety and health of institutionalized persons with mental disabilities, Youngberg v. Romeo, 457 U.S. 307 (1982), and an obligation under the ADA and Section 504 to
1 A corrected version of Plaintiffs’ Memorandum of Law in Support of Motion for Preliminary Injunction (ECF Doc. 35) was filed on June 13, 2020.
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prevent unnecessary institutionalization, Olmstead v. L.C., 527 U.S. 581 (1999). For decades, federal courts have actively protected these rights, resulting in scores of judicial decisions. See, e.g., New York State Association for Retarded Children v. Carey, 393 F. Supp. 715 (E.D.N.Y. 1975), 551 F. Supp. 1165 (E.D.N.Y 1982), aff’d in part and rev’d in part, 706 F.2d 956 (2d Cir.1983), cert. denied, 464 U.S. 915 (1983) (14th Amendment right to safety and protection from harm); Society for Good Will to Retarded Children v. Cuomo, 572 F. Supp. 1300 (E.D.N.Y. 1983), vacated and remanded, 737 F.2d 1239 (2d Cir. 1984) (same); Association of Retarded Citizens of Connecticut v. Thorne, 30 F.3d 367 (2d Cir. 1994), cert denied, 513 U.S. 1079 (1995) (same); State Office of Protection & Advocacy for People with Disabilities v Connecticut, 706 F. Supp. 2d 266 (D. Conn. 2010) (ADA and Section 504 right to be free from unnecessary institutionalization); Messier v. Southbury Training School, 562 F. Supp. 2d 294 (D. Conn. 2008) (Section 504 right to be free from unnecessary institutionalization). Defendants’ Motion to Dismiss seeks to upend the decades-long practice of federal courts protecting the civil rights of institutionalized individuals with mental disabilities. Neither law nor logic support Defendants’ contention that the doctrines of primary jurisdiction
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and abstention bar this Court from hearing Plaintiffs’ life-and-death federal civil rights claims.
Defendants’ arguments, if accepted, would delegate to the Department of Mental Health and Addiction Services (DMHAS) and Defendant state officials the authority to adjudicate the very federal rights raised in this case and to determine liability under the Constitution and federal civil rights statutes. In addition, the administrative procedures Defendants claim Plaintiffs must use cannot provide Plaintiffs the relief they seek, and the state judicial proceeding to which Defendants point is not adjudicating the federal legal claims Plaintiffs raise here. Plaintiffs would have no forum, let alone a federal forum, in which to vindicate the federal civil rights they assert here if this Court were to grant Defendants’ motion.
Habeas relief is not central to Plaintiffs’ claims, since the Court can grant all the relief Plaintiffs seek by means of an injunction enforcing their Fourteenth Amendment and ADA and Section 504 rights. Therefore, the Court need not consider Defendants’ exhaustion argument.
Accordingly, Defendants’ Motion to Dismiss should be denied in its entirety.
II. ARGUMENT A. The Doctrine of Primary Jurisdiction Does Not Compel Dismissal of Plaintiffs’ Claims Under Youngberg and Olmstead.
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The doctrine of “primary jurisdiction” has no application to this case. The doctrine is designed to promote the proper relationship between courts and administrative agencies charged with addressing particularly complicated regulatory matters, when the resolution of those administrative issues are central to the litigation, are better resolved by the administrative agency, and are not within the competence of a federal court. The doctrine counsels courts, in some situations, to stay their hand while the parties invoke the administrative agency’s processes to obtain a determination of issues presented in the judicial action. Inherent in the doctrine is that the agency has a process for adjudication that can resolve in a binding way the dispute presented in the judicial action. With respect to the issues in dispute in this case, there is no administrative agency with the charge or the authority to resolve in a binding way Plaintiffs’ claims to safe conditions of confinement under the Constitution or to unnecessary institutionalization under federal civil rights laws. Hence, there is no administrative agency whose “jurisdiction” in this matter is “primary” to this Court’s.
Primary jurisdiction is a discretionary, common-law doctrine that has been narrowly applied, typically when the validity of a commercial rate or practice is at issue, and where Congress has assigned responsibility for
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initial decision-making to a federal agency. Golden Hill Paugussett Tribe of Indians v. Weicker, 39 F.3d 51, 59 (2d Cir. 1994). The doctrine “allows an agency to decide factual issues that … have been legislatively committed to its judgment.” Read v. Corning, 351 F. Supp. 3d 342, 350 (W.D.N.Y. 2018).
Significantly, Defendants do not cite to a single case asserting Youngberg or Olmstead claims that has been dismissed on primary jurisdiction grounds. In fact, as the cases cited on page 3, above, show, the Second Circuit Court of Appeals and the District Court of Connecticut have decided such claims in numerous similar cases. Thus, as these cases demonstrate, the legal claims in the case are well within the competence of judges, and this Court can issue a binding resolution of the parties’ legal dispute.2
In addition, for the primary jurisdiction doctrine to apply, the administrative agency must have the duty and power to resolve the matters in dispute in the federal court action. No such agency exists here – not DMHAS, the Department of Public Health (DPH), or the CDC.
2 Defendants’ argument also is in conflict with the general rule that exhaustion of, or even resort to, administrative remedies is not required before filing an action in federal court under 42 U.S,C. § 1983. Patsy v. Board of Regents of State of Florida, 457 U.S. 496 (1982). The same is true for Title II of the ADA and Section 504.
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Defendants essentially argue that, under the doctrine of primary jurisdiction, courts must defer to administrative agencies whenever an agency has information or insight about the matter. They then claim that the Court should defer to either the CDC, DMHAS, and/or DPH since all have some knowledge of public health, mental health, and medical treatment issues. But this Court can obtain that information or insight through expert witnesses familiar with the work of the agency, or it can invite the agency to testify or otherwise make its views known. The mere existence of expertise in some administrative agency does not render a federal court powerless to adjudicate substantial federal civil rights claims.
Deferral to the CDC is both unwarranted, unprecedented, and, as a practical matter, unrealistic. The CDC has no enforcement authority and lacks procedures for resolving disputes like the one presented here. In addition, the CDC has already provided definitive guidance on how to address COVID-related issues, including in congregate settings like psychiatric hospitals. As Plaintiffs describe in their Motion for Preliminary Injunction, those guidelines establish the professional judgment that must be exercised in order for Defendants to avoid liability under the Fourteenth Amendment. But the CDC is not an entity to which this Court can defer to decide federal civil rights claims.
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Similarly, DPH has no authority to resolve the legal dispute between the parties. It may have authority to take action on its own initiative against DMHAS. However, the possibility that DPH could theoretically take action against DMHAS does not, under the doctrine of primary jurisdiction, bar the Court from adjudicating Plaintiffs’ claims.
Nor is DMHAS an appropriate forum to resolve Plaintiffs’ claims. Whatever its expertise concerning mental health treatment issues, neither federal nor state law has committed to DMHAS the task of adjudicating disputes concerning the application of the Fourteenth Amendment or the ADA and Section 504 to systemic claims made by a class of hospital residents. And, of course, deferring to the jurisdiction of DMHAS in this matter is especially problematic since DMHAS is itself one of the alleged wrongdoers from whom Plaintiffs seek relief. It seems highly disingenuous for Defendants to argue that this Court should stay its hand in order to allow DMHAS to opine on the appropriateness of its own actions, especially since DMHAS already has made clear that it rejects the validity and urgency of Plaintiffs’ claims.
Finally, the cases Defendants cite are not apposite. They all address disputes between private parties concerning economic matters that are routinely resolved, or at least significantly impacted, by administrative
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agencies that regulate those very same business interests. See, e.g., Read v. Corning Inc., 351 F. Supp. 3d 342 (W.D.N.Y. 2018) (deferring to an administrative process to which the Plaintiff had already applied for a remedy); Niehaus v. AT&T Corp., 218 F. Supp. 2d 531 (S.D.N.Y. 2002) (deferring to the Federal Communication Commission for resolution of dispute concerning internet generated calls and billing practices); Collins v. Olin Corp., 418 F. Supp. 2d 34 (D. Conn. 2006) (deferring to state Department of Environmental Protection where action was already pending); Rural Community Workers Alliance v. Smithfield Foods, Inc., 2020 WL 2145350 (W.D. Mo. May 5, 2020) (deferring to OSHA’s enforcement process concerning business safety inactions, where the agency could order emergency relief); Martin v. Shell Oil Co., 198 F.R.D. 580 (D. Conn. 2000) (deferring to OSHA’s regulatory authority to decide and issue relief concerning the legal dispute before the court). These cases do, however, direct courts to be mindful of the possible costs of delaying a judicial procedure. Martin v. Shell Oil Co., 198 F.R.D. at 587. The threat of death and illness on the units of Connecticut Valley Hospital (CVH) and Whiting Forensic Hospital (WFH) weighs heavily here against further delay.
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Accordingly, Defendants’ attempt to have Plaintiffs’ civil rights claims adjudicated by administrative entities under the doctrine of primary jurisdiction should be rejected.
B. The Court Should Not Abstain From Hearing This Case. There are no exceptional circumstances here that would warrant abstention and relieve a federal court from its responsibility to adjudicate the civil rights claims in this case. Woodford v. Community Action Agency of Greene Co., Inc., 239 F.3d 517 (2d Cir. 2001). Federal courts have a “virtually unflagging obligation” to exercise their jurisdiction. Colorado River Water Conservation Dist. v. United States, 424 U.S. 800, 817 (1976) (“Colorado River”). Abstention under Colorado River is a narrow doctrine permitting a federal court to abstain only in “exceptional circumstances,” id. at 813, where concurrent state and federal proceedings are parallel, i.e., the same parties are litigating substantially the same issues in another forum. See Dittmer v. County of Suffolk, 146 F.3d 113, 117-18 (2d Cir. 1998). In evaluating an argument for Colorado River abstention, “the task is to ascertain whether there exist `exceptional' circumstances, the `clearest of justifications,' that can suffice under Colorado River to justify the surrender of that jurisdiction." Niagara Mohawk Power Corp. v.
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Hudson River-Black River Regulating District, 673 F.3d 84, 101 (2d Cir. 2012) (quoting Moses H. Cone Mem. Hosp. v. Mercury Construction Corp., 460 U.S. 1, 25-26 (1983)). “When a Federal court is properly appealed to in a case of which it has by law jurisdiction, it is its duty to take such jurisdiction . . . The right of a party plaintiff to choose a Federal court where there is a choice cannot be properly denied.” New Orleans Public Service, Inc. v. Council of the City of New Orleans, 491 U.S. 350, 358-59 (1989) (quoting Willcox v. Consolidated Gas Co., 212 U.S. 19, 40 (1909)).
Unlike Colorado River, here there is no parallel state court litigation that could result in “comprehensive disposition of [this] litigation,” and thus it would not conserve judicial resources for Plaintiffs to split their claims in the way Defendants urge. Colorado River, 424 U.S. at 817-18; Woodford, 239 F.2d at 522.
1. There is No Parallel State Court Litigation Raising Similar Claims or Seeking Similar Relief.
The claims in Drummer v. State of Connecticut, which Defendants claim is a “parallel state court case,” are not substantially similar to the claims here. That case is based solely on state law – the Connecticut Patients’ Bill of Rights, General Statutes § 17a-540 et seq. (See Drummer Complaint, attached as Exhibit A.) There is no certified class. (See Judge Frechette Memorandum of Decision, attached as Exhibit B.) In Drummer,
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Plaintiffs seek more frequent judicial reviews of whether hospital patients meet civil commitment standards.3 Plaintiffs also seek an order requiring patients to be discharged within a reasonable period of time after being determined to no longer meet commitment standards.
In Drummer, Plaintiffs have not asserted any federal claims, including Fourteenth Amendment and ADA and Section 504 claims related to the protection of their safety and health due to the COVID-19 pandemic. In addition, Drummer seeks discharge only for patients who, under normal circumstances and through DMHAS’s usual process or after a full probate court hearing, have been determined to no longer meet commitment standards. The relief Plaintiffs seek here is solely designed to address the unusual conditions and harms that are now present at CVH and WFH due to COVID-19, including accelerated discharges needed to protect patients and based on a process different from DMHAS’s usual practices.
Accordingly, Drummer v. Connecticut is not parallel to the present case and, if resolved, would not result in the “comprehensive disposition of [this] litigation.”
3 In Drummer, no plaintiff is a forensic patient, and no relief has been sought affecting forensic commitments.
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2. The Six Factors Identified in Colorado River Do Not Weigh in Favor of Abstention.
Even if the Court were to find that Drummer is a parallel state proceeding, abstention still would not be proper. In deciding whether to abstain from hearing a case, a court must consider six factors identified in Colorado River. Those six factors, “with the balance heavily weighted in favor of the [federal court] exercise of jurisdiction,” Moses H. Cone, 460 U.S. at 16, are:
(1) whether the controversy involves a res over which one of the courts has assumed jurisdiction; (2) whether the federal forum is less inconvenient than the other for the parties; (3) whether staying or dismissing the federal action will avoid piecemeal litigation; (4) the order in which the actions were filed, and whether proceedings have advanced more in one forum than in the other; (5) whether federal law provides the rule of decision; and (6) whether the state procedures are adequate to protect the plaintiff’s federal rights. Woodford, 239 F.3d at 522. None of these factors weighs in favor of abstention. Neither Drummer nor this case involves a res. There is not a substantial difference in convenience between the two forums. As discussed above, given that the claims in Drummer and this case are different, staying or dismissing the federal action will not avoid piecemeal litigation, and even if the Drummer plaintiffs won, it would not resolve this case. And federal law provides the rules for decision in this case, but not in
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Drummer, so the resolution of Drummer is not adequate to protect the federal rights asserted by Plaintiffs here.
Accordingly, the Court should not decline to hear this case based on Colorado River abstention, and Defendants’ arguments to the contrary should be rejected.
C. This Court May Grant Habeas Relief to Plaintiffs Under 28 U.S.C. § 2241.
The Amended Complaint references the authority of this Court to grant habeas relief for the Fourteenth Amendment violations asserted by Plaintiffs. (ECF Doc. 10, ¶ 3). But there is no need for the Court to reach this issue, or address Defendants’ exhaustion argument, since full relief can and should be awarded under the presented claims of violations of the Fourteenth Amendment, the ADA, and Section 504.
Although the issue is mostly academic for purposes of this case, in the Second Circuit, habeas relief is available under 28 U.S.C. § 2241 to address unsafe conditions of confinement, like those pleaded here. Carmona v. U.S. Bureau of Prisons, 243 F.3d 629, 632 (2d Cir. 2001); Chambers v. United States, 106 F.3d 472, 474 (2d Cir. 1997); Kingsley v. Bureau of Prisons, 937 F.2d 26, 30 n.5 (2d Cir. 1991). The exhaustion of state remedies is not jurisdictional under § 2241, and the failure to do so may be excused. Beharry v. Ashcroft, 329 F.3d 51, 56-57 (2d Cir. 2003).
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Thus, the Court has the authority under § 2241 to grant habeas relief to Plaintiffs, without the need for exhausting state court remedies, if the Court chooses.
Plaintiffs are not seeking habeas relief from any criminal conviction, nor are they seeking such relief by challenging any state commitment order. Thus, Defendants’ arguments pursuant to 28 U.S.C. § 2254, a different habeas statute that deals with challenges to such convictions or commitment orders, are irrelevant to this case.
In short, the Court need not rely on any habeas statute to grant the relief Plaintiffs request in this case. An injunction under Youngberg (Fourteenth Amendment) and/or Olmstead (ADA and Section 504) would fully remedy the legal violations of which Plaintiffs complain.
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III. Conclusion

For the reasons set forth above, Plaintiffs respectfully request that

Defendants’ Motion to Dismiss be denied in its entirety.

Respectfully submitted,

The Plaintiffs,

By:

s/Kirk W. Lowry Kirk W. Lowry, ct#27850 Karyl Lee Hall, ct#19320 Virginia Teixeira, ct#29213 Connecticut Legal Rights Project CVH – Beers Hall 2nd Floor P.O. Box 351 – Silver Street Middletown, CT 06457 (860) 262-5017 Fax (860) 262-5035 klowry@clrp.org

s/Ira A. Burnim Ira A. Burnim, phv ct#10689 Jennifer Mathis, phv ct#10718 Judge David L. Bazelon Center
for Mental Health Law 1090 Vermont Avenue, N.W. Suite 220 Washington, D.C. 20005 (202) 467-5730 Fax (202) 223-0409 irab@bazelon.org jenniferm@bazelon.org

s/Steven J, Schwartz Steven J. Schwartz, phv ct#23604 Mark J. Murphy, phv ct#01126 22 Green Street Northampton, MA 01060 (413) 586-6024 Fax (413) 586-5711 sschwartz@cpr-ma.org mmurphy@cpr-ma.org

16

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Certificate of Service On July 2, 2020, a copy of the foregoing Memorandum of Law in Support of Plaintiffs’ Opposition to Defendants’ Motion to Dismiss was filed electronically and served by mail on anyone unable to accept electronic filing. Notice of this filing will be sent by email to all parties by operation of the Court’s electronic filing system or by mail to anyone unable to accept electronic filing as indicated on the Notice of Electronic Filing. Parties may access this filing through the Court’s CM/ECF System.
s/Kirk W. Lowry_________ Kirk W. Lowry
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Exhibit A Drummer Complaint

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Exhibit B Drummer Judge Frechette Memorandum Decision

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 Case 3:20-cv-00594-JCH Document 49 Filed 07/09/20 Page 1 of 57

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

THOMAS WILKES,

:

BARBARA FLOOD,

:

VINCENT ARDIZZONE,

:

GAIL LITSKY,

:

CARSON MUELLER,

:

On behalf of themselves and all other :

persons similarly situated,

:

Plaintiffs

:

v.

:

NED LAMONT, Governor

:

MIRIAM E. DELPHIN-RITTMAN,

:

Commissioner of DMHAS,

:

HAL SMITH, CEO of Whiting Forensic :

Hospital,

:

LAKISHA HYATT, CEO Connecticut :

Valley Hospital,

:

In their official capacities,

:

Defendants

:

CIVIL NO. 3:20CV594-JCH JULY 9, 2020

OBJECTION TO MOTION FOR PRELIMINARY INJUNCTION

The Defendants, Ned Lamont, Governor; Miriam E. Delphin-Rittman, Commissioner of

DMHAS; Hal Smith, CEO of Whiting Forensic Hospital; and Lakisha Hyatt, CEO Connecticut

Valley Hospital, in their official capacities, hereby object to the Plaintiff's Motion for

Preliminary Injunction dated June 8, 2020 seeking an order directing the Defendants to take

various actions including to move psychiatric patients from Whiting Forensic Hospital

(“Whiting”) and Connecticut Valley Hospital (“CVH”) and urges the Court to deny the motion.

[Dkt. # 24]. The bases for the Defendants’ objection follow.

As addressed at length below, Plaintiffs’ Motion and related filings level many grave

charges of alleged malfeasance against the Defendants related to Defendants’ response to the

ongoing COVID-19 pandemic. While each of these ultimately unfounded allegations are in and

of themselves serious, and Defendants have responded to each, in the broadest sense the real

gravamen of Plaintiffs’ allegations, filed almost two and half months ago, is that Defendants’ 1

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actions or inactions have put Plaintiffs in significant medical danger for some 70 or more days.1 However, the tale told by the history of those 70 or more days at CVH and Whiting simply belies Plaintiffs’ claims. For example, the date that a patient at CVH last tested positive for COVID-19 was on May 16, 2020. See Defs. Exs. D, Dr. Carvalho Decl. ¶ 13; Defs. Ex. B, Dr. Martinello Decl. ¶ 36. The date that a patient at Whiting last tested positive was on April 21, 2020. Two patients who tested positive at Whiting on May 19, 2020 had previously tested positive and did not represent new cases. Defs. Ex. C, Dr. Wasser Decl. ¶ 13; Defs. Ex. B, Dr. Martinello Decl. ¶ 9. As discussed more fully below, at CVH and Whiting the number of cases, the number of deaths, and the numbers of patients and staff testing positive all reflect a remarkable record of containment, which record would, as noted by Defendants’ experts, be the envy of many health care congregate settings, let alone those who, like CVH and Whiting, serve seriously mentally ill patients.
While Youngberg v. Romeo, 457 U.S. 307, 323 (1982), and its progeny establish that a lack of success or efficacious outcomes does not in and of itself establish a violation of substantive due process, such outcomes are surely probative evidence that no such violation has occurred. The probative evidence here reflects success. Seventy days of effective control of the virus, in these challenging settings, with these challenging populations, cannot reasonably be attributed to accident or luck, and the Defendants respectfully urge this Court to so recognize.
1 The Plaintiffs’ filed their Complaint on April 30, 2020. 2

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I. BACKGROUND A. The Department of Mental Health and Addiction Services, Connecticut Valley Hospital and Whiting Forensic Hospital The Connecticut Department of Mental Health and Addiction Services (“DMHAS”)
operates both Whiting and CVH. (Conn. Gen. Stat. § 17a-450(b)).2 CVH and Whiting serve a variety of patients who manifest in-patient mental health needs. Patients come to these facilities via a number of routes.
At CVH, some patients are voluntarily admitted in order to address acute mental health or addiction issues. Other patients are committed to CVH by the Connecticut Probate Courts via the civil commitment process, having been adjudicated by clear and convincing evidence that they suffer from psychiatric disabilities and are either gravely disabled or a danger to themselves or others, pursuant to Conn. Gen. Stat. §§ 17a-495 et seq. Such civilly committed patients are entitled to at least annual review of their commitment status (Conn. Gen. Stat. § 17a-498), among other statutory rights.
Whiting serves, in addition to civilly committed individuals who require a high level of treatment, patients who have been charged with crimes but have been determined incompetent to stand trial. These individuals are committed to Whiting for the purpose of attempting to restore their competency to address their criminal charges pursuant to Conn. Gen. Stat. § 54-56d. Still other patients have been found by the courts to be not guilty of the crimes with which they have been charged by reason of insanity (“NGRI”) pursuant to Conn. Gen. Stat. §53a-13, such that they then fall under jurisdiction of the statutorily created Psychiatric Security Review Board (“PSRB”). Conn. Gen. Stat. §§ 17a-581 et seq.
2 CVH is certified as a hospital to participate in Medicare and Whiting is licensed as a hospital by the Department of Public Health.
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Notably, the PSRB, as informed by reports from the state hospitals, periodically review such cases ( Conn. Gen. Stat. § 17a-585), can order conditional release or temporary leaves (Conn. Gen. Stat. §§ 17a- 587, 17a-588), and may order discharge from custody (Conn. Gen. Stat. § 17a-592), among other powers. PSRB orders are subject to judicial review (Conn. Gen. Stat. § 17a-597). Finally, some patients are sent to these facilities because their acute psychiatric needs cannot be adequately addressed in Department of Corrections facilities. Thus, while CVH and Whiting patients come to these facilities via a variety of routes, all require inpatient psychiatric hospitalization.
The named plaintiffs in this lawsuit, alleged to be suitable representatives of a putative class of similarly situated patients at Whiting and CVH, include two patients civilly committed to CVH (Thomas Wilkes, Barbara Flood) and three NGRI patients under the jurisdiction of the PSRB (Vincent Ardizzone, Carson Mueller, Gail Litsky) who receive treatment at Whiting. The Plaintiffs have also attached affidavits of two additional individuals who receive treatment at Whiting. . Francis Clarke came to Whiting for restoration to competency to stand trial, and was found by the Superior Court not to be restorable. Thereafter Mr. Clarke was civilly committed as a voluntary patient at Whiting. Mr. Rahab King was found NGRI and is under the jurisdiction of the PSRB.
B. COVID-19 Planning and Response The Plaintiffs assert that the Defendants were slow to take action to protect Plaintiffs from COVID-19. Pls. Mem. at p. 4. Contrary to the Plaintiffs’ assertion, the Defendants acted timely in responding to and implementing policies, procedures, and protocols in response to the COVID-19 pandemic. Certain State agencies including DMHAS have created Incident Command Teams (“ICT”) to respond to and manage disasters or community incidents through a coordinated structure. Defs. Mem. Ex. F, DiLeo Decl. ¶ 4. The DMHAS ICT was activated in
4

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response to the threat of the COVID-19 pandemic in the first week of March 2020. Defs. Mem. Ex. F, DiLeo Decl. ¶ 10. Since the start of the COVID-19 pandemic, the ICT has had frequent meetings, including daily meetings, meetings on the weekends. Defs. Mem. Ex. F, DiLeo Decl. ¶ 11. The ICT has worked with DMHAS facilities, including CVH and Whiting to implement response plans. Defs. Mem. Ex. F, DiLeo Decl. ¶¶ 13,14.
CVH utilizes a planning tool, the National Incident Management System (“NIMS”), issued/developed by the Federal Emergency Management Agency (“FEMA”) to develop responses to all types of incidents that can affect CVH operations such as weather related emergencies, water or power systems failure, and health emergencies. Defs. Ex. H, Denier Decl. 3. When an emergency occurs or is anticipated, such as a storm, CVH activates the Hospital Incident Command System (“HICS”). Defs. Ex. H, Denier Decl. 4 -6. HICS was activated in response to the threat of COVID-19 in the first week of March 2020 and the response plans are constantly updated and revised in response to events and guidance from agencies, including but not limited to the Office of the Governor, the Connecticut DPH and the CDC. Defs. Ex. H, Denier Decl. ¶¶ 7, 8.
Whiting created its own Coronavirus Pandemic Incident Action Plan in response to the COVID-19 pandemic. Plaintiffs’ experts opine that Whiting’s Coronavirus Pandemic Incident Action Plan was not finalized until May 26, 2020. Pls. Ex. 2, Canavan and Jones Aff., ¶ 5. However, Whiting’s plan was implemented in March 2020 and has been revised in response to the evolving guidance from the Connecticut DPH and the CDC. Defs. Ex. L.
II. APPLICABLE LEGAL STANDARDS FOR PRELIMINARY INJUNCTIONS There are four basic requirements recognized in this Circuit for the granting of
preliminary injunctive relief. “A plaintiff seeking a preliminary injunction must demonstrate... 5

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[1] that they have some likelihood of success on the merits and [2] will suffer irreparable harm absent an injunction, [and] [3] that the “the balance of equities tips in his favor and [4] an injunction is in the public interest.” Local 1159 of Counsel 4 AFSCME, AFL-CIO v. City of Bridgeport, 435 F. Supp. 3d 400 (D. Conn. 2020) (quoting Otoe-Missouria Tribe of Indians v. New York State Dep't of Fin. Servs., 769 F.3d 105, 112 n.4 (2d Cir. 2014) (citing Winter v. Natural Res. Def. Council, Inc., 555 U.S. 7, 20 (2008)). However, there are two important modifications to this standard that are applicable in this case given that the relief sought would enjoin government action and alter the status quo.
First, "when the preliminary injunction seeks to enjoin government action taken in the public interest pursuant to a statutory or regulatory scheme the moving party must satisfy the more rigorous likelihood of success on the merits standard." South Lyme Property Owners Association, Inc. v. Town of Old Lyme, 121 F.Supp.2d 195 (D. Conn 2000)(citing Able v. United States, 44 F.3d 128, 130 (2d Cir.1995)). Litigants seeking to enjoin the activity of a government agency also must contend with “the well-established rule that the Government has traditionally been granted the widest latitude in the dispatch of its own internal affairs.” Allen v. Wright, 468 U.S. 737, 761 (1984) (quoting Rizzo v. Goode, 423 U.S. 362, 378–79 (1976)). See also Messier v. Southbury Training Sch., No. 3:94-CV-1706(EBB), 1999 WL 20910, at *21 (D. Conn. Jan. 5, 1999).
Second, "[w]here the injunction at issue will either alter, rather than maintain the status quo, or provide the movant with substantially all the relief sought, the injunction will be characterized as 'mandatory' rather than 'prohibitory.'" Pinckney v. Board of Education of Westbury Union Free School District, 920 F.Supp. 393, 399 (2000)(citing Tom Doherty Associates, Inc. v. Saban Entertainment, Inc., 60 F.3d 27,33-34 (2d Cir.1995)). “A party seeking
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a mandatory injunction must make ‘a ‘clear’ or ‘substantial’ showing of a likelihood of success” on the merits, in addition to a showing of irreparable harm.” Illinois Tool Works Inc. v. J-B Weld Co., LLC, 419 F. Supp. 3d 382, 389 (D. Conn. 2019), modified, No. 3:19-CV-01434 (JAM), 2019 WL 7816510(quoting Jolly v. Coughlin, 76 F.3d 468, 473 (2d Cir. 1996)).
The relief the Plaintiffs seek would not “maintain the status quo,” thus the injunction they seek is a mandatory one. In addition, the ultimate relief the Plaintiffs seek through the First Amended Complaint is to discharge patients requiring inpatient level of care into the community. Granting that relief as set forth in paragraphs 4 and 5 of their preliminary injunction memorandum would have that consequence. The Plaintiffs’ preliminary injunction motion is therefore subject to the higher standard.3 Thus the applicable standard that this Court must apply to the Plaintiffs’ motion is that Plaintiffs must show irreparable injury and a clear/substantial likelihood of success on the merits of the complaint.
"[I]nterim injunctive relief is an 'extraordinary and drastic remedy which should not be routinely granted.'" Velez v. McGuire, 992 F.Supp. 125, 127 (D. Conn. 1998) (quoting Buffalo Forge Co. V. Ampco-Pittsburgh Corporation, 638 F.2d 568, 569 (2d Cir.1981)). "In addition, a federal court should grant injunctive relief against a state or municipal officer 'only in situations of most compelling necessity.'" Id. (quoting Vorbek v. McNeal, 407 F.Supp. 733, 739 (E.D. Mo.), aff'd, 426 U.S. 943 (1976)). The U.S. Supreme Court recently underscored this principle in denying an application for injunctive relief against an executive order issued by the Governor
3 The Plaintiffs seek an order directing the Defendants to: “1. Conform their testing protocols to CDC standards; 2. Take steps to ensure that staff consistently wear masks and that Plaintiffs are encouraged and supported in wearing masks including through education, 3. Improve hygiene and decontamination practice, 4. Implement social distancing to the maximum extent possible including by reducing patient census; 5. Under take the clinical review described above in order to accelerate discharges. . ..” Pls. Mem. at p. 39.
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of California limiting the size of gatherings in the midst of the COVID-19 pandemic. Chief
Justice Roberts supported the denial and reasoned that:
[O]ur Constitution principally entrusts “[t]he safety and the health of the people” to the politically accountable officials of the States “to guard and protect.” Jacobson v. Massachusetts, 197 U.S. 11, 38, 25 S.Ct. 358, 49 L.Ed. 643 (1905). When those officials “undertake[ ] to act in areas fraught with medical and scientific uncertainties,” their latitude “must be especially broad.” Marshall v. United States, 414 U.S. 417, 427, 94 S.Ct. 700, 38 L.Ed.2d 618 (1974). Where those broad limits are not exceeded, they should not be subject to second-guessing by an “unelected federal judiciary,” which lacks the background, competence, and expertise to assess public health and is not accountable to the people. See Garcia v. San Antonio Metropolitan Transit Authority, 469 U.S. 528, 545, 105 S.Ct. 1005, 83 L.Ed.2d 1016 (1985). That is especially true where, as here, a party seeks emergency relief in an interlocutory posture, while local officials are actively shaping their response to changing facts on the ground. South Bay United Pentecostal Church v Newsom, 140 S. Ct. 1613, (Mem)–1614 (2020).
Finally, the court is not required to accept a Plaintiff's allegations as true on a motion for
preliminary injunction. Sinisgall v. Town of Islip Housing Authority, 865 F.Supp.2d. 307,
331(E.D.N.Y. 2012).
III. ARGUMENT Plaintiffs bear the burden of proving that in the response to the COVID-19 pandemic, the
conduct or decisions made at CVH and Whiting “[are] such a substantial departure from
accepted professional judgment, practice, or standards as to demonstrate that the person
responsible actually did not base the decision on such judgment.” Youngberg v. Romeo, 457
U.S. 307, 323 (1982).
Plaintiffs evidence in support their Motion for Preliminary Injunction is not sufficient to
meet this burden. As set forth in Defendants’ Motion In Limine or To Exclude Testimony of
Patrick Canavan and Elizabeth Jones and Affidavit of Richard Gudis, testimony from Canavan
and Jones and Attorney Gudis does not meet the requirements under Federal Rule of Evidence 8

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702 and the U.S. Supreme Court decision in Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993) and its progeny. Defendants incorporate by reference the grounds set forth in said Motion and supporting memorandum of law which demonstrate that Canavan and Jones offer expert testimony in infectious disease control and responses to COVID-19 and other subjects without the requisite qualifications and expertise. Contrary to Federal Rule of Evidence 702, Canavan and Jones improperly borrow and apply the expert testimony of Dr. Manian to back stop their opinions. Pls. Ex. 2, Decl. of Canavan and Jones, ¶ 6, 12.
Canavan and Jones make assertions regarding the actions and omissions of CVH and Whiting solely in reliance of affidavits from three plaintiffs and two additional patients and 17 “State documents” of which 14 predate 2020 and only two relate to Defendants’ COVID-19 response. Pls. Ex. 2, Decl. of Canavan and Jones, ¶ 3. They did not review the treatment records of any patient at the hospitals, including the plaintiffs. Canavan and Jones did review a single policy form Whiting regarding COVID-19, but none from CVH.
Canavan and Jones reliance on the six patients’ affidavits providing anecdotal evidence of practices at CVH and Whiting is grossly insufficient for the Court to find due process violations justifying Plaintiffs’ demands for systemic changes at both hospitals. Anecdotal stories and isolated incidents do not rise to the level of a constitutional violation. Society for Good Will, 737 F.2d 1239, 1245 (2d Cir. 1984) (“While there have been occasions when patients' specific medical problems have been treated improperly, the district court's decision should not have been based on isolated instances of improper treatment, but on a finding that medical care was inadequate on a class-wide basis. Isolated instances of inadequate care, or even of malpractice, do not demonstrate a constitutional violation.”); United States v. Commonwealth of Pennsylvania, 902 F. Supp. 565, 589 (W.D. Pa. 1995), aff’d sub nom., U.S. v. Ridge, 96 F.3d
9

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1436 (3rd Cir. 1996)(citing Shaw v. Strackhouse, 920 F.2d 1135, 1143 (3rd Cir. 1992). Canavan and Jones reliance on the often incomplete and erroneous patient affidavits is demonstrated below. Defs. Ex. A, Decl. of Dr. Geller ¶¶ 19-20.
Although Attorney Gudis has no expertise in infectious diseases, medical diagnoses, psychiatric treatment, psychiatric hospitals or psychiatric hospital administration, he offers opinions about two patients’ psychiatric and medical conditions as well as COVID-19-related risks. Pls. Ex. 8, Aff. Gudis ¶¶ 8-10, 13-15. Attorney Gudis also offers an opinion regarding DMHAS’ obligations and shortcomings in responding to COVID-19 without any expertise in any relevant area. Id. ¶¶ 17-19.
Finally, Plaintiffs rely upon the declaration of Dr. Manian, who provides an extensive elucidation of his views of the required responses to COVID-19. Plaintiffs’ sole expert in infectious disease makes no determinations regarding CVH or Whiting, including whether either facility departed from the standards he posits are controlling. Plaintiffs’ evidentiary basis for their motion is facially inadequate to support the mandatory injunction sought, one that would have profound impacts on the operations of these two critically important hospitals.
A. The Plaintiffs Cannot Show a Likelihood of Success on the Merits The Supreme Court has held involuntarily committed persons to state facilities have a Fourteenth Amendment substantive due process right to be protected from confinement in unsafe conditions, to adequate medical care and treatment, and to be free from the use of excessive force/bodily restraint. Youngberg v. Romeo, 457 U.S. 307, 315-19 (1982)4; Johnson v.
4 In Youngberg, plaintiff was a severely retarded adult man who was committed to a state inpatient facility. Youngberg, 457 U.S. at 309. Plaintiff had the mental capacity of an eighteenmonth-old child. Id. His mother sought his commitment after the death of plaintiff’s father because she was unable to care for plaintiff or control his violent behavior. Id. Plaintiff was injured numerous times while a patient because of his own acts and because of other residents’ reactions to his violent behavior. Id. at 310. Plaintiff, through his mother acting as next friend,
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Newburgh Enlarged School Dist., 239 F.3d 246, 253 (2d Cir. 2001) (free from excessive force); See also, Olivier v. Robert L. Yeager Mental Health Ctr., 398 F.3d 183, 188-89 (2d Cir. 2005)(professional judgment standard applied to substantive due process violations alleged by involuntarily committed patients against professionals.)
The standard for determining whether an involuntarily committed patient’s substantive due process rights have been violated by hospital administrators or licensed professionals calls for determining whether the conduct or decisions of such persons “[are] such a substantial departure from accepted professional judgment, practice, or standards as to demonstrate that the person responsible actually did not base the decision on such judgment.” Youngberg v. Romeo, 457 U.S. 307, 323 (1982). This standard is highly deferential to the decisions of the state's professionals and is intended to strike a balance between the “liberty interest of the individual” and the “legitimate interests of the State, including the fiscal and administrative burdens additional procedures would entail.” Youngberg at 321-22, 102 S.Ct. 2452 (citing Parham v. J.R., 442 U.S. 584, 599–600 (1979)). Under this standard, a “decision, if made by a professional, is presumptively valid.” Id. at 323.
“It is not appropriate for the courts to specify which of several professionally acceptable choices should have been made.” Id. at 321. A professional is defined as “a person competent, whether by education, training or experience, to make the particular decision at issue . . .
brought an action against two hospital supervisors and the hospital director for injuries suffered by plaintiff on at least sixty-three different occasions. Id. The Supreme Court held that plaintiff’s rights as a civilly committed patient stemmed from the Fourteenth Amendment’s substantive Due Process Clause. Id. at 320–24. The Supreme Court noted that plaintiff abandoned his claim on appeal that the Eighth Amendment was the source of his constitutional rights and instead relied solely upon the Fourteenth Amendment’s substantive Due Process Clause. Id. at 314, n.16. Plaintiff alleged, and the Court agreed, that he had both a right to be confined in a safe environment and a right to be free from physical restraints. Id. at 319–24.
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[including] persons with degrees in medicine or nursing, or with appropriate training in areas such as psychology, physical therapy or the care and training of the retarded.” Id. at 323 n.30.
When determining whether the state has complied with the standard, “decisions made by appropriate professionals are entitled to a presumption of correctness. Moreover, such presumption is necessary to enable institutions of this type -- -often, unfortunately, overcrowded and understaffed --to continue to function. . . The administrators, and particularly professional personnel, should not be required to make each decision in the shadow of an action for damages.” Id. at 324-25
This standard acknowledges that administrative officials are also, “responsible to the state and to the public for making professional judgments of their own, encompassing institutional concerns as well as individual welfare.” Cameron v. Tomes, 990 F.2d 14, 20 (1st Cir. 1993); See also LaShawn A. v. Dixon, 762 F. Supp. 959, 994 D.D.C. 1991) (courts must consider “any relevant state interests, including fiscal constraints and administrative burdens.”). In this case, such practical constraints, including those imposed by this unprecedented public health emergency, surely qualify.
Even if there were deficiencies in care – which there are not -- notwithstanding plaintiffs’ claims, such deficiencies alone would not establish a violation of their due process rights. The Fourteenth Amendment does not establish a negligence regime under which any “objectively unreasonable” action gives rise to a constitutional due process claim. Rather, the Supreme Court has emphasized that constitutional due process violations require more than mere negligence by government actors. Kingsley v. Hendrickson, 576 U.S. 389, 396 (2015) (“[L]iability for negligently inflected harm is categorically beneath the threshold of constitutional due process” (Court’s emphasis)); Davidson v. Cannon, 474 U.S. 344, 347 (1986) (“[T]he Due Process Clause
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of the Fourteenth Amendment is not implicated by the lack of due care of an official causing unintended injury to life, liberty or property.”); accord Hargett v. Adams, Civil Action No. 021456, 2005 WL 399300, at *17 (N.D. Ill. Jan. 14, 2005) (observing that a due process action under Youngberg is “not a negligence case where any deviation from the standard of care could impose liability.”)
The Court in Youngberg made explicit that while states have “a duty to provide certain services and care” to those who are institutionalized, “even then a State necessarily has considerable discretion in determining the nature and scope of its responsibilities.” 457 U.S. at 317. In accord with this principle, in cases involving those involuntarily committed to the state’s care, due process “only requires that the courts make certain that professional judgment in fact was exercised” by appropriate staff, without mandating that any specific judgment should have been made. Youngberg, 457 U.S. at 321. “[E]vidence establishing mere departures from the applicable standard of care is insufficient to show a constitutional violation.” Patten v. Nichols, 274 F.3d 829, 845 (4th Cir. 2001). Rather, any given decision, “if made by a professional, is presumptively valid.” Youngberg, 457 U.S. at 323. The inquiry “is whether the decision was so completely out of professional bounds as to make it explicable only as an arbitrary, nonprofessional one.” Patten, 274 F.3d at 845 (citation and internal quotation marks omitted).
A constitutional violation cannot be inferred from challenging circumstances alone. Hanson v. Madison Cnty. Det. Ctr., 736 F. App’x 521, 539 (6th Cir. 2018) (“There is no res ipsa loquitur principle for constitutional torts.”); Kent v. Sziebert, Civil Action No. 15-05553, 2016 WL 3248077, at *4 n.3 (W.D. Wash. Apr. 19. 2016) (“Res ipsa loquitur, if applicable, allows only for an inference of negligence, which cannot constitute a violation of the stricter standards of deliberate indifference or Youngberg’s professional judgment standard.”). Plaintiffs must
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point to a specific decision and show that the decision itself—regardless of the result—was “so completely out of professional bounds as to make it explicable only as an arbitrary, nonprofessional one.” Patten, 274 F.3d at 845. Plaintiffs have not and cannot make such a showing with respect to the Hospitals’ infection control measures or for the provision of mental health treatment services and care.
1. The Defendants Are Providing Adequate Care and Safety Plaintiffs are unlikely to succeed on their claim for relief under the Fourteenth Amendment’s Due Process Clause. Am. Compl. Count One. First, Plaintiffs cannot show that they have at any point been denied “adequate” care or “reasonable safety.” Youngberg, 457 U.S. at 324. The record demonstrates that DMHAS fully activated its ICT in the first week of March 2020 to prepare to respond to COVID-19. Defs. Ex. F, DiLeo Decl. ¶ 10. The record further reflects that as early as the first week of March 2020, DMHAS leadership began taking measures to guard against the spread of COVID-19, in accordance with public health guidelines. Defs. Ex. F, DiLeo Decl. ¶¶ 11-13. Visitation to these facilities was suspended on March 17, 2020. Defs. Ex. D, Dr. Carvalho Decl. ¶ 7; Defs. Ex. C, Dr. Wasser Decl. ¶ 7.5 Patients and staff were educated and trained on proper hand-hygiene and social distancing. Defs. Ex. D, Dr. Carvalho Decl. ¶¶ 37, 66; Defs. Ex. C, Dr. Wasser Decl. ¶ 67. Staff received instruction on the proper use of personal protective equipment. Defs. Ex. D, Dr. Carvalho Decl. ¶ 35; Defs. Ex. C, Dr. Wasser Decl. ¶ 32. Patients received instruction on the proper use of personal protective equipment. Defs. Ex. D, Dr. Carvalho Decl. ¶ 37; Defs. Ex. C, Dr. Wasser Decl. ¶ 35. The facilities also have been cohorting patients based on their COVID-19 status. Defs. Ex. D, Dr. Carvalho Decl. ¶ 51; Defs. Ex. C, Dr. Wasser Decl. ¶¶ 48, 51, 55.
5 As of July 1, 2020, visitation has resumed subject to requirements and guidance from the Connecticut Department of Public Health (“DPH”) and the Center for Disease Control. (“CDC”).
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With regard to treatment, treatment teams have continuously provided patients with individualized care throughout the pandemic. Defs. Ex. D, Dr. Carvalho Decl. ¶ 37; Defs. Ex. C, Dr. Wasser Decl. ¶ 35. Additionally, satellite offices were created for staff outside of Whiting to continue provide services to patients using digital technology while minimizing the number of people inside of Whiting. Defs. Ex. C, Dr. Wasser Dec. ¶ 64. Group therapy services continued to occur in smaller groups of five participants. Defs. Ex. D, Dr. Carvalho Decl. ¶ 61; Defs. Ex. C, Dr. Wasser Decl. ¶ 59. Plaintiffs cannot show that they are being subjected to inadequate care or treatment, unreasonable risks to their health and safety, or any other deficiencies. Indeed, the evidence demonstrates the opposite.
2. The Defendants Have Exercised Professional Judgment. Plaintiffs fail to identify any decision falling outside the bounds of the exercise of professional judgment nor can they successfully assert any constitutional deficiency in any of the following professional decisions.
a) Testing The Plaintiffs without an evidentiary basis of the testing performed make a conclusory statement that the Defendants have not conducted weekly testing of all staff and residents and that this is a substantial departure from professional judgment. Pls. Mem. at p. 31. The Plaintiffs identify specific guidelines issued by that the CDC that they assert as being the authority for COIVD-19 testing. Pls. Mem. at pp. 3-4, 9; Pls. Exs. 12, 13 and 15. The Plaintiffs’ rely upon the CDC Guidelines as the minimally acceptable practice and make conclusory statements that the Defendants are not adhering to CDC Guidelines. Pls. Mem. at pp. 12, 13, 31, and 32. Specifically, the Plaintiffs state that the CDC requires a plan for screening and testing both staff and patients. Pls. Mem. at pp. 11-12, 31; Ex. 13 and 15. The Plaintiffs assert that the testing is only “on a voluntary basis” and that the Defendants have no “have no plan for regular testing of
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residents.” Pls. Mem. at p. 13. Additionally, the Plaintiffs state that according to Dr. Manian, professional standards require that CVH and Whiting perform baseline testing of all residents and staff, and test at least once a week all previously negative residents and staff until the testing identifies no new cases of COVID-19 for at least 14 days since the most positive result. Pls. Ex. 1, Manian Decl. ¶ 16.1. . While the declaration of Dr. Manian details the guidance that should be followed as to testing, the declaration does not reach conclusions about how the Defendants have not complied with the CDC guidelines. Without citation to their experts’ opinion, the Plaintiffs’ rely on their conclusory statements that the Defendants failed to exercise professional judgment with respect to testing.
Moreover, the Plaintiffs’ only cite to a portion of the CDC Guidance with regard to testing and repeat testing by stating that “all residents and staff should be tested once there is a confirmed case and that repeat testing of all patients and staff should be performed.” Pls. Mem. at p. 32. With regard to testing for new cases, the CDC Guidance additionally provides that “[i]f testing capacity is limited, CDC suggests directing testing to residents and Healthcare Providers (“HCP”) on the same unit or floor of a new case. If testing all residents on the same unit or floor is also not possible, CDC suggests directing testing to symptomatic residents and HCP and residents who have known exposure.” Pls. Ex. 15, p. 3. With regard to repeat testing, the CDC Guidance provides “[i]f testing capacity is limited, the CDC suggests directing repeat rounds of testing to residents who leave and return to the facility or have known exposure to a case. For large facilities with limited testing capacity, testing all residents on an affected unit could be considered, especially if a facility-wide serial testing demonstrates no new transmission beyond a limited number of units. If testing capacity is limited, CDD suggests directing repeat HCP testing to HCP who work at other facilities.” Pls. Ex. 15, p. 3.
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Importantly, as has been the case since the pandemic began, guidance on COVID-19
testing changes and continues to change. The CDC’s Testing Guidelines for Nursing Home
Residents and Healthcare Personnel was updated on July 2, 2020. Defs. Ex. T. The CDC
separated its previous guidance that addressed testing of both patients and HCP by creating
separate guidance for testing HCP. Defs. Ex. U. The updated CDC’s Guidelines provides that if
there is an outbreak in the facility, the facility should “[p]erform expanded viral testing
of all residents if there is an outbreak in the facility. If viral testing capacity is limited, CDC
suggests first directing testing to residents who are close contacts (e.g., on the same unit or floor
of a new confirmed case or cared for by infected HCP).” Defs. Ex. T.
With regard to repeat testing of patients, the CDC suggests:
Continue repeat viral testing of all previously negative residents, generally every 3 days to 7 days, until the testing identifies no new cases of SARS-CoV-2 infection among residents or HCP for a period of at least 14 days since the most recent positive result. If viral test capacity is limited, CDC suggests directing repeat rounds of testing to residents who leave and return to the facility (e.g., for outpatient dialysis) or have known exposure to a case (e.g., roommates of cases or those cared for by a HCP with confirmed SARS-CoV-2 infection). For large facilities with limited viral test capacity, testing only residents on affected units could be considered, especially if facility-wide repeat viral testing demonstrates no transmission beyond a limited number of units.
Defs. Ex. T. The CDC’s Interim Guidance for Testing Healthcare Professionals for SARS-CoV-
2 advise:
To test HCP with symptoms when there is a concern of potential COVID-19. Viral testing is recommended for HCP who have had close contact with persons with SARS-CoV-2 infection in the community. Expanded viral testing includes initial testing of all HCP with known or suspected exposure followed by repeat testing of all previously negative HCP, generally between every 3 days to 7 days, until the testing identifies no new cases of SARS-CoV-2 infection among residents or HCP for a period of at least 14 days since the most recent positive result. Testing asymptomatic HCP without known or suspected exposure to SARS-CoV-2 is recommended for HCP working in nursing homes as part of the recommended reopening process.
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Defs. Ex. U. The Plaintiffs state that “Defendants’ practices are contrary to accepted professional norms for fighting COVID-19.” Pls. Mem. at p. 14; Pls. Ex. 2, Decl. Dr. Manian ¶ 16. However, Dr. Manian sets forth guidance as to testing, but is void of any opinion as to how, why or in what way the Defendants’ practices are contrary to the guidance. In fact, as discussed more fully below, the Defendants have implemented policies and protocols related to the criteria set forth in ¶ 16 of Dr. Manian’s declaration, such as staff and patient screening baseline testing, and repeat testing. Defs. Exs. B, C, D, L, and P.
Contrary to Plaintiffs’ assertion that “as testing has become more available in the past two weeks, the number of confirmed infections has continued to increase, demonstrating that the failure to take comprehensive protections a month ago has contributed to several patients’ deaths and an increase in the number of staff and patients becoming infected” Pls. Mem. at p. 14, the data demonstrates a decline in COVID-19 cases amongst patients and staff at CVH. Defs. Exs. X and Y. The data also demonstrates a decline in COVID-19 cases amongst patients and staff at Whiting. Defs. Ex. Z and AA.
In order to succeed in their Due Process claim, the Plaintiffs have the burden of providing evidence that the actions by the Defendants to provide testing has been and is such a departure from professional standards that in effect no professional judgment was exercised at all. As discussed below, Plaintiffs fail to meet their burden.
(1) Testing of the Patient Population CVH and Whiting have been and continue to evaluate and test patients where appropriate based on applicable CDC Guidelines. As the guidelines have changed throughout the pandemic, CVH has adhered to and made changes in accordance with the guidelines. CVH has protocols in place with regard to testing in response to the COVID-19 pandemic. The most recent update to these protocols was on June 29, 2020. Defs. Ex. P, CVH
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COVID-19 Response Plan Testing Protocol; Defs. Ex. B, Dr. Martinello Decl. ¶ 35. CVH conducts daily COVID-19 screening of patients by checking temperatures, monitoring their breathing and oxygen saturation level with the use of pulse oximeters and asking series of questions about current COVID-19 symptoms. Defs. Ex. D, Dr. Carvalho Decl. ¶ 10. The questionnaire is frequently updated to reflect evolving CDC guidance. Defs. Ex. D, Dr. Carvalho Decl. ¶ 9. All new patients are tested prior to or upon entry to CVH and are quarantined for 14 days. Defs. Ex. D, Dr. Carvalho Decl. ¶ 10.
On March 19, 2020, CVH began monitoring all patients for COVID-19. Defs. Ex. D, Dr. Carvalho Decl. ¶ 11. All patients who are suspected for COVID-19 are tested. Defs. Ex. D, Dr. Carvalho Decl. ¶ 11. On March 21, 2020, CVH tested its first suspected case of COVID-19. Defs. Ex. C, Dr. Carvalho Decl. ¶ 11. Baseline testing of patients at CVH was completed on May 6, 2020. Defs. Ex. D, Dr. Carvalho Decl. ¶ 12; Defs. Ex. B, Dr. Martinello Decl. ¶ 36. Notably, the date that a patient at CVH last tested positive for COVID-19 was on May 16, 2020. Defs. Ex. D, Dr. Carvalho Decl. ¶ 13; Defs. Ex. B, Dr. Martinello Decl. ¶ 36. Since May 16, 2020, no new patients at CVH have tested positive for COVID-19. Defs. Ex. D, Dr. Carvalho Decl. ¶ 14.
As of July 1, 2020, a total of 63 patients out of 243 patients at CVH tested positive for COVID-19 since the pandemic began. Defs. Ex. D, Dr. Carvalho Decl. ¶ 15. As of July 1, 2020, a total of 57 patients who tested positive for COVID-19 have recovered from COVID-19 since the beginning of the pandemic. Defs. Ex. D, Dr. Carvalho Decl. ¶ 16. As of July 1, 2020, 239 CVH patients in total have been tested for COVID-19 since the pandemic began. The current CVH census is 217 patients. Defs. Ex. D, Dr. Carvalho Decl. ¶ 17.
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If a patient tests positive for COVID-19, CVH conducts contract tracing and testing of staff and residents who may have been exposed to the patient. Defs. Ex. C, Dr. Carvalho Decl. ¶ 26; Defs. Ex. B, Dr. Martinello Decl. ¶¶ 19, 38. CVH cannot mandate patient testing for COVID-19. Defs. Ex. C, Dr. Carvalho Decl. ¶ 27. If a patient who displays COVID-19 symptoms refuses COVID-19 testing, CVH treats the patient as if he or she has COVID-19 and follows the hospital’s protocol for treating COVID-19 positive patients. Defs. Ex. C, Dr. Carvalho Decl. ¶ 28. If a new admission refuses COVID testing, CVH treats the patient as if he or she has COVID-19 and follows the hospital’s protocol for COVID-19 positive patients. Defs. Ex. C, Dr. Carvalho Decl. ¶ 29.
Whiting conducts daily screening of patients for COVID-19 by checking temperatures and monitors patients for COVID-19 symptoms. Defs. Ex. C, Dr. Wasser Decl. ¶ 9. New patients coming from the Department of Corrections or another hospital are tested for COVID-19 prior to admission. New patients from the community are offered a test for COVID-19 immediately upon admission. Defs. Ex. C, Dr. Wasser Decl. ¶ 10. All patients who are symptomatic for COVID-19 are tested. Testing of symptomatic patients began on March 16, 2020. Defs. Ex. C, Dr. Wasser Decl. ¶ 11. Among 30 symptomatic patients tested before May 19, 2020, 10 were found positive. Defs. Ex. B, Dr. Martinello Decl. ¶ 9. Baseline testing of patients at Whiting was completed on May 19, 2020. Defs. Ex. C, Dr. Wasser Decl. ¶ 12. The date that a patient at Whiting last tested positive for COVID-19 was on April 21, 2020. Two patients who tested positive on May 19, 2020 had previously tested positive and did not represent new cases of COVID-19. Defs. Ex. C, Dr. Wasser Decl. ¶ 13; Defs. Ex. B, Dr. Martinello Decl. ¶ 9. Since May 19, 2020, no new patients at Whiting have tested positive for COVID-19. Defs. Ex. C, Dr. Wasser Decl. ¶ 14.
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As of July 1, 2020, a total of 10 patients out of 169 patients at Whiting tested positive for COVID-19 since the pandemic began. Defs. Ex. C, Dr. Wasser Decl. ¶ 15. As of July 1, 2020, a total of 10 patients who tested positive for COVID-19 have recovered from COVID-19 since the beginning of the pandemic. Defs. Ex. C, Dr. Wasser Decl. ¶ 16. As of July 1, 2020, 135 cumulative patients at Whiting have been tested for COVID-19 since the pandemic began. The current Whiting census is 169 patients. Defs. Ex. C, Dr. Wasser Decl. ¶ 17.
If a patient tests positive for COVID-19, Whiting conducts contact tracing and recommends testing of staff and residents who may have been exposed to the patient. Defs. Ex. C, Dr. Wasser Decl. ¶ 25. Whiting cannot mandate patient testing for COVID-19. Defs. Ex. C, Dr. Wasser Decl. ¶ 26. If a patient who displays COVID-19 symptoms refuses COVID-19 testing, Whiting treats the patient as if he or she has COVID-19 and follows the hospital’s protocol for treating COVID-19 positive patients. Defs. Ex. C, Dr. Wasser Decl. ¶ 27. If a new admission refuses COVID-19 testing, Whiting treats the patient as if he or she has COVID-19 and follows the hospital’s protocol for COVID-19 positive patients. Defs. Ex. C, Dr. Wasser Decl. ¶ 28.
Both CVH and Whiting have been and continue to evaluate and test patients where appropriate based on applicable CDC Guidelines. The testing protocols that CVH and Whiting are implementing follow CDC guidance which demonstrates that they have exercised professional judgment. The Plaintiffs have not provided any evidence to the contrary and thus have not carried their burden of showing likelihood of success on the merits.
(2) Testing the Staff CVH and Whiting have been and continue to evaluate and test staff where appropriate based on applicable CDC Guidelines. As the guidelines have changed throughout the pandemic, CVH has adhered to and made changes in accordance with the guidelines.
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CVH conducts daily COVID-19 screening of those entering the hospital, including staff, by checking temperatures and asking series of questions about current COVID-19 symptoms, potential COVID-19 exposures and recent travel. Defs. Ex. D, Dr. Carvalho Decl. ¶ 8; Defs. Ex. B, Dr. Martinello Decl. ¶¶ 34, 36. The questionnaire is frequently updated to reflect evolving CDC guidance. Defs. Ex. D, Dr. Carvalho Decl. ¶ 8. Baseline testing of staff at CVH was completed on May 28, 2020. Defs. Ex. D, Dr. Carvalho Decl. ¶ 18. On July 6, 2020, CVH began repeat testing of staff. Defs. Ex. D, Dr. Carvalho Decl. ¶ 19. The date that a direct care staff member at CVH last tested positive for COVID-19 was on May 19, 2020. Defs. Ex. D, Dr. Carvalho Decl. ¶ 20. The date that a non-direct care staff member at CVH last tested positive for COVID-19 was on May 21, 2020. Defs. Ex. D, Dr. Carvalho Decl. ¶ 21.
As of July 1, 2020, a total of 45 staff members out of 1095 staff members at CVH tested positive for COVID-19 since the beginning of the pandemic. Defs. Ex. D, Dr. Carvalho Decl. ¶ 22. As of July 1, 2020, a total of 44 staff members who tested positive for COVID-19 have recovered from COVID-19. Defs. Ex. D, Dr. Carvalho Decl. ¶ 23. As of July 1, 2020, 541 staff members out of 1095 staff members at CVH have been tested for COVID-19 since the pandemic began. Defs. Ex. D, Dr. Carvalho Decl. ¶ 24. As of July 1, 2020, 504 staff members of the 541 staff members at CVH who have been tested for COVID-19 since the pandemic began are direct care staff. Defs. Ex. D, Dr. Carvalho Decl. ¶ 25.
If a staff member tests positive for COVID-19, CVH conducts contract tracing and testing of staff and residents who may have been exposed to the patient. Defs. Ex. D, Dr. Carvalho Decl. ¶ 30. As of July 6, 2020, testing for COVID-19 is mandatory for direct care staff and those who regularly interact with patients. Defs. Ex. D, Dr. Carvalho Decl. ¶ 31.
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WHITING conducts COVID-19 screening of all those entering the hospital, including staff, by checking temperatures and asking a detailed series of questions about possible COVID symptoms, potential COVID-19 exposures and recent travel. Defs. Ex. C, Dr. Wasser Decl. ¶ 8; Defs. Ex. B, Dr. Martinello Decl. ¶¶ 17, 34. The questionnaire is frequently updated to reflect evolving CDC guidance. Defs. Ex. C, Dr. Wasser Decl. ¶ 8. Baseline testing of staff at Whiting was completed on June 4, 2020. Defs. Ex. C, Dr. Wasser Decl. ¶ 18. On June 15, 2020, Whiting began repeat testing of staff. Defs. Ex. C, Dr. Wasser Decl. ¶ 19. The date that a direct care staff member at Whiting last tested positive for COVID-19 was on May 7, 2020. Defs. Ex. C, Dr. Wasser Decl. ¶ 20. The date that a non-direct care staff member at Whiting last tested positive for COVID-19 was on June 15, 2020. Defs. Ex. C, Dr. Wasser Decl. ¶ 21.
As of July 1, 2020, a total of 22 staff members out of 522 staff members at Whiting tested positive for COVID-19 since the beginning of the pandemic. Defs. Ex. C, Dr. Wasser Decl. ¶ 22. As of July 1, 2020, a total of 22 staff members who tested positive for COVID-19 have recovered from COVID-19. Defs. Ex. C, Dr. Wasser Decl. ¶ 23. As of July 1, 2020, 333 staff members out of 522 staff members at Whiting have been tested for COVID-19 since the pandemic began. Defs. Ex. C, Dr. Wasser Decl. ¶ 24. If a staff member tests positive for COVID-19, Whiting conducts contract tracing and recommends testing of staff and residents who may have been exposed to the patient. Defs. Ex. C, Dr. Wasser Decl. ¶ 29. As of June 22, 2020, testing for COVID-19 is mandatory for direct care staff and those who regularly interact with patients at Whiting. Defs. Ex. BB, Smith Decl. ¶ 6.
The testing protocols for patients and staff that both CVH and Whiting are implementing follow CDC guidance which demonstrates that it has exercised professional judgment. “The leadership and staff of CVH and Whiting exercised excellent professional judgement and were
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most proactive in implementing measures to minimize the impact of COVID-19 on the residents and staff of the institutions. The relatively low occurrence of COVID-19 at both CVH and Whiting is the result of their highly effective response to COVID-19.” Defs. Ex. B, Dr. Martinello Decl. ¶ ¶ 41, 42. The Plaintiffs have not provided any evidence to the contrary and thus have not carried their burden as set forth in Youngberg of showing likelihood of success on the merits.
b) Hygiene The Plaintiffs identify specific guidelines issued by the CDC that they assert are “widely accepted” as being the authority for limiting the spread of COVID-19 citing guidance on testing, the use of PPE, frequent hand washing, social distancing, and disinfecting commonly used surfaces frequently. Pls. Mem. at pp. 3-4,9; Pls. Exs. 11, 12,13,15. Dr. Manian has opined that “[e]xperts agree that these guidelines should be followed in inpatient psychiatric facilities and that they are minimally acceptable practice and are essential for protecting Plaintiffs health and safety.” Pls. Mem. at p. 10; Pls. Ex. 1, Decl. Dr. Manian, ¶ 10. This includes handwashing, daily cleaning and disinfecting of frequently touched surfaces. Pls. Mem. at p. 11; Pls. Ex. 1 Decl. Dr. Manian, ¶ 15,17; Ex. 11. The Plaintiffs conclude, based solely upon the affidavits of two of the five named Plaintiffs, that “proper hygiene and decontamination practices are not being consistently followed” and that the” Defendants’ failure to ensure that CVH and Whiting are appropriately decontaminated and that patients have access to proper hand hygiene is a substantial departure from professional standards” such that it violates their Fourteenth Amendment Rights. Pls. Mem. at pp. 16, 33, 34, 35; Pls. Ex. 3, Mueller Aff.; Pls. Ex. 4, Ardizzone Aff. The Plaintiffs provide scant evidence to support their claim. When one reads the declarations of Dr. Manian, Dr. Canavan and Ms. Jones, it becomes readily apparent that they do not reach conclusions about whether the Defendants have complied
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with the CDC guidelines they identify as being “widely accepted” in the areas of hygiene and decontamination. Rather they list what practices should be followed. Without citation to their experts’ opinion, for which there is none, the Plaintiffs’ rely on their own statements to conclude that the Defendants did not exercise professional judgment with respect to hygiene and decontamination.
Specifically, the Plaintiffs’ rely on Plaintiff Mueller’s assertion that Dutcher South 3 was “not thoroughly cleaned”. Pls. Mem. at pp. 16,34; Pls. Ex. 3, Mueller Aff., ¶ 12,39. A statement by Plaintiff Ardizzone that due to the number of individuals using the showers and rest room that it is “impossible to clean the fixtures and surfaces between each use by individual patient.” was also cited to as proof that the Defendants are not following accepted guidelines. Pls. Mem. at pp. 17, 34; Pls. Ex. 4, Ardizzone Aff. ¶ 5. Both Plaintiff Muller and Ardizzone allege that the maintenance staff do not work on the weekend so that the “soap dispensers in the bathroom are not replaced when they become empty.” Pls. Ex 3, Mueller Aff., ¶ 39; Pls. Ex. 4, Ardizzone Aff. ¶ 16. Such anecdotal stories and isolated incidents do not rise to the level of a constitutional violation. United States v. Commonwealth of Pennsylvania, 902 F. Supp. 565, 580 W.D. Pa. 1995, aff’d sub nom., U.S. v. Ridge, 96 F.3d 1436 3d Cir. 1996 (citing Shaw v. Strackhouse, 920 F.2d 1135,1143 (3rd Cir. 1992)). The Plaintiffs have the burden of offering evidence that the actions by the Defendants to provide supplies and opportunities for proper hand hygiene and to clean the facilities has been and is such a departure from professional standards that in effect no professional judgment was exercised at all. The Plaintiffs cannot meet this burden.
The custodial staff at CVH consists of 60 individuals. Defs. Ex. G, Lizotte Decl. ¶ 2. The custodial staff at CVH work Monday through Friday between 6:45 am and 10:00 pm Monday through Friday. Defs. Ex. G, Lizotte Decl. ¶ 3. During the weekend the custodial staff
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work hours are from 6:00 am to 2:00 pm. Defs. Ex. G, Lizotte Decl. ¶ 4. When an issue arises that needs to be addressed when the custodial staff are not on duty, Ms. Lizotte, the Building Superintendent for CVH, responds, as she is on call for emergencies, or a member of the custodial “E-Man” group responds. Defs. Ex. G, Lizotte Decl. ¶ 5. The “E-Man” group is a made of custodial staff who volunteer to be on call for emergencies. Defs. Ex. G, Lizotte Decl. ¶ 5. The Plaintiffs’ claim that custodial staff do not work on weekends, is simply incorrect. Pls. Mem. Ex 3, Mueller Aff., ¶ 2, 39; Ex. 4, Ardizzone Aff. ¶ 2, 16.
CVH has adopted and implemented Environmental Services Protocols in response to the COVID-19 pandemic. Defs. Ex. G, Lizotte Decl. ¶ 6. In accord with CDC guidance, CVH utilizes cleaning agents and sanitizers most of which are EPA registered products. Pls. Mem. at Ex. 13, p. 6, CDC “Preparing for COVID-19 in Nursing Homes”, Updated May 19, 2020; Defs. Ex. G, Lizotte Decl. ¶ 7a-g. Defs. Ex. 2, Dr. Martinello Decl. ¶ .
There are different protocols for different areas. All bathrooms are cleaned thoroughly once daily or twice depending on circumstances that arise. Defs. Ex. G, Lizotte Decl. ¶ 8. Cleaning of patient occupied rooms is done on a daily basis utilizing Fusion Bleach or Virex. Defs. Ex. G, Lizotte Decl. ¶ 9. The common areas are cleaned daily and high touch areas are sanitized twice daily using the BioSpray D2 surface sanitizer; patient phones are also sanitized. Defs. Ex. G, Lizotte Decl. ¶ 10. Disinfecting wipes are available to patients. Defs. Ex. G, Lizotte Decl. ¶¶ 11,12. Soap dispensers are checked twice a day by the custodial staff; once in the morning and once before the end of their shift. Defs. Ex. G, Lizotte Decl. ¶ 14. The custodial staff will refill the soap dispenser if it is getting low or it is found to be empty. Id. When the custodial staff are not on duty and a soap dispenser runs out of product E-Man is called and they will refill the soap dispenser. Defs. Ex. G, Lizotte Decl. ¶ 15.
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Specific cleaning procedures are utilized in those areas where patients are quarantined or are in isolation. Defs. Ex. G, Lizotte Decl. ¶ 16. The custodial staff don all PPE prior to the entry into the isolation unit. Defs. Ex. G, Lizotte Decl. ¶ 17. After cleaning is complete staff remove all PPE except gloves, all supplies and equipment are washed with an approved germicidal solution. Defs. Ex. G, Lizotte Decl. ¶ 15. Mop heads and linens are placed in a bag along with the gloves. Defs. Ex. G, Lizotte Decl. ¶ 17. The bag is tied off and labeled as biohazardous and disposed in the appropriate manner. Id.
The hygiene and decontamination processes that CVH has developed and implemented follow CDC guidance, which demonstrates that CVH staff have exercised professional judgment. Defs. Ex. 2, Dr. Martinello Decl. ¶¶ 23,39,41,42. The Plaintiffs have not provided any evidence to the contrary and thus have not carried their burden of showing likelihood of success on the merits.
As previously noted, the Plaintiffs rely on affidavits that allege deficits in hygiene and decontamination processes exist at Whiting, even though neither Dr. Manian, Dr. Canavan, nor Ms. Jones actually make conclusions to support that claim. The facts once again show that the Plaintiffs claims are not supported as Whiting, in adopting and implementing hygiene and decontamination protocols, has exercised professional judgment. Defs. Ex. 2, Dr. Martinello Decl. ¶¶ 24,39,41,42.
The custodial staff at Whiting consists of 16 individuals, including one supervisor with some assigned to Whiting Service and others to Dutcher Service. Defs. Ex. I, Crego Decl. ¶ 5. The custodial staff works from 4:45 am to 7:45 pm Monday through Friday. Defs. Ex. I, Crego Decl. ¶ 6. Contrary to the assertions of Plaintiffs Mueller and Ardizzone, there are custodial staff who work on the weekends. Pls. Mem. Ex 3, Mueller Aff. para 39; Ex. 4 Ardizzone Aff. ¶ 16.
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On Saturday and Sunday, there are 3 custodial staff for all Whiting units between the hours of 4:45 am through 7:45 pm. Defs. Ex. I, Crego Decl. ¶ 7. Issues that occur at any time, including weekends, are covered by the custodial manager who will respond or send a staff member to respond. Defs. Ex. I, Crego Decl. ¶ 8.
Whiting has followed CDC guidance and utilizes cleaning agents and sanitizers that are EPA registered products. Pls. Mem. at Ex. 13, p. 6, CDC “Preparing for COVID-19 in Nursing Homes,” Updated May 19, 2020; Defs. Ex. I, Crego Decl. ¶¶ 9a-d. To clean the bathrooms, the custodial staff utilizes the KaiVac 1750 touchless cleaning system and the procedures associated with its use. Defs. Ex. I, Crego Decl. ¶ 10; Ex. Q. If necessary, the custodial staff are able and in fact do more cleaning using appropriate disinfecting products. Defs. Ex. I, Crego Decl. ¶ 11.
The occupied patient rooms are cleaned on a daily basis utilizing Fuzion Bleach or Virex. Defs. Ex. I, Crego Decl. ¶ 13. All common and high touch areas are sanitized twice daily using the BioSpray D2 surface sanitizer including patient phones. Defs. Ex. I, Crego Decl. ¶ 14. Disinfecting wipes are available to patients. Defs. Ex. I, Crego Decl. ¶ 15. Soap dispensers which contain liquid soap are checked on a daily basis by the custodian assigned to the respective unit. Defs. Ex. I, Crego Decl. ¶ 16. The custodial staff will replace it if the product is low and feels it will not last through the next interval. Defs. Ex. I, Crego Decl. ¶ 16. However, if a patient or a staff member finds that the dispenser is empty, then the unit director or the nurse supervisor will contact the custodial staff or the nurse supervisor’s office in the off hours to ensure a quick resolution is afforded. Defs. Ex. I, Crego Decl. ¶ 17. While Plaintiff Mueller asserts that the soap in the soap dispensers ran out on two occasions, once on a Sunday and then again on a Tuesday, he does not allege that they were not refilled in a timely manner or that hand soap was not available at all. Pls. Mem. Ex. 3, Muller Aff. ¶ 39, 45.
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Specific cleaning procedures are utilized in those areas where patients are quarantined or are in isolation. Defs. Ex. I, Crego Decl. ¶ 19. The custodial staff don all PPE prior to the entry into the isolation unit. Defs. Ex. I, Crego Decl. ¶ 20. After cleaning is complete staff remove all PPE except gloves, and all supplies and equipment are washed with an approved germicidal solution. Defs. Ex. I, Crego Decl. ¶ 20. Mop heads and linens are placed in a bag along with the gloves. Defs. Ex. I, Crego Decl. ¶ 20. The bag is tied off and labeled as biohazardous and appropriately disposed. Defs. Ex. I, Crego Decl. ¶ 20.
The hygiene and decontamination processes that Whiting is implementing follow CDC guidance, which demonstrates Whiting staff have exercised professional judgment. The Plaintiffs have not provided any evidence to the contrary and thus have not carried their burden of showing likelihood of success on the merits.
c) Personal Protective Equipment (“PPE”) With respect to PPE, Plaintiffs concede that “[w]hile staff are now required to wear masks and patients are now offered one mask per week,” they claim that “Defendants still do not ensure that PPE guidelines are practiced consistently or that residents are encouraged to wear masks.” Pls. Mem. at 33. Plaintiffs further assert that “use of masks by both staff and patients remains intermittent and unenforced, resulting in ongoing but avoidable risk of infection to both.” Id. Plaintiffs’ Ardizzone’s and Litsky’s affidavits, while sometimes seemingly contradicting one another and the above assertions (e.g., Ardizzone asserts staff do not always wear their masks (Pls. Ex. 4, Ardizzone Aff. ¶¶ 18, 32), while Litsky asserts staff are almost always wearing masks (Pls. Ex. 5, Litsky Aff. ¶ 33)), appear to be the factual foundation for plaintiffs’ claims on this issue. It is well settled, however, that such anecdotal reports do not themselves constitute adequate or competent evidence of violation of Youngberg’s standard requiring the exercise of professional judgment. Shaw v. Strackhouse, 920 F.2d 1135, 1143 (3d
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Cir.1990); Casey v. Ohio Metal Products, 877 F.Supp. 1380, 1385 (N.D.Cal.1995); Bushore v. Dow Corning-Wright Corp., 1999 WL 1116920 at *5 (M.D.Fla.1999).
The declarations of Drs. Wasser and Carvalho), the Medical Directors of Whiting and CVH respectively, set forth that PPE use at the hospitals has evolved with CDC guidance on the subject, and that all direct care staff have available to them all the requisite PPE needed, and have received ongoing training in proper PPE use, including proper donning and doffing techniques. Defs. Ex. C, Decl. Dr. Wasser ¶¶ 30, 31, 32; Defs. Ex. D, Decl. Dr. Carvalho ¶¶ 32, 33, 34, 35, 36, 66, 68; Defs. Ex. I, Decl. Crego ¶¶ 3, 4; Defs. Ex. M; Defs. Ex. J, Decl. Boutin ¶¶ 2.3; Defs. Ex. N. In addition, staff have been mandated to wear surgical masks in all patient settings, and higher levels of PPE as may be needed to safely carry out various medical procedures or as they work with COVID-19 positive or exposed patients. Staff education is ongoing on these subjects, and staff have been reeducated where any noncompliance has been detected. Defs. Ex. C, Decl. Dr. Wasser ¶ 33 ; Defs. Ex. D, Decl. Dr. Carvalho ¶¶ 33, 35, 66, 68.
With respect to patients, Drs. Wasser and Carvalho describe that patients are provided masks weekly, and more often if they become soiled or damaged. All patients receive masks unless mask use is medically contraindicated, or providing a mask presents a risk of self-injury to the patient. Further, education for patients encouraging their use of their masks is ongoing. Defs. Ex. C, Decl. Dr. Wasser ¶¶ 34, 35; Defs. Ex. D, Decl. Dr. Carvalho ¶¶ 37, 67, 68.
Finally, despite the very serious challenges around PPE supplies that Connecticut and indeed the nation have experienced, especially earlier in the pandemic, the declarations of Messrs. Crego and Boutin establish that Whiting and CVH never lacked for needed PPE supplies, and currently have more than adequate supplies on hand. Defs. Ex. I, Decl. Crego; Defs. Ex. M; Defs. Ex. J, Decl. Boutin; Defs. Ex. N.
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Dr. Geller’s findings confirm these protective practices. Defs. Ex. A, Decl. Geller (¶¶ 4.b. (masks required upon entry); 4.k. (masks provided to staff); 4.m. (patients expected to wear masks when outside their rooms); 5.e.xiii. (4 of 8 patients wearing masks, all staff wearing masks); 5.e.xx. (new masks provided to patients weekly or more often if soiled or ripped); 34. (masks provided to all patients and staff with either the requirement or expectation that they will be used)). Dr. Geller also noted areas dedicated for donning and doffing PPE. Ex. A ¶ 4.c. Dr. Martinello found CVH focused on patient use of facemasks and ensuring that PPE is fully available, and its use is monitored. Defs. Ex. B., Decl. Martinello ¶15. Dr. Martinello observed that both CVH and Whiting had not run out of PPE, including eye protection, respirators, gloves and gowns, and that staff had received proper training on PPE use, further noting that facemasks are available for all patients and staff. Def. Ex. B. ¶¶ 31, 32.
Plaintiffs cannot demonstrate that the Youngberg standard has been violated with respect to PPE at CVH and Whiting.
d) Social Distancing To support their conclusion that CVH and Whiting should, at all costs, release patients from CVH and Whiting, Plaintiffs claim that Defendants’ social distancing efforts at CVH and Whiting have substantially departed from professional standards. Pls. Memo at pp. 1, 28. Plaintiffs’ base this claim on inaccurate and unsupported claims about Defendants’ social distancing practices, a wholesale attack on Defendants’ unit-segregation practices at CVH and Whiting and the anecdotal claims of three plaintiffs. Pls. Memo at pp. 5, 6, 29; Pls. Ex. 4, Aff. of Ardizzone ¶¶ 1, 2; Pls. Ex. 5, Aff. of Litsky ¶¶ 1, 2; Pls. Ex. 3, Aff. of Mueller ¶¶ 1, 2. Plaintiffs’ social distancing claim hinges on their inaccurate assertion that Defendants have not implemented social distancing and other CDC guidance at CVH and Whiting, but instead use “unit segregation” as a response to the pandemic. Id.
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Plaintiffs and their experts reference CDC guidance6 regarding long-term care facilities and nursing homes, but inexplicably fail to note that the CDC has issued guidance specific to psychiatric facilities. CDC infection prevention and control recommendations for COVID-19 apply to psychiatric hospitals; however, CDC has stated “as with any guidance, facilities can tailor certain recommendations to their setting. For example, inpatient psychiatric care includes communal experiences and group activities that may need to continue. If so, these activities might need to be adapted to align with social distancing recommendations.” Defs. Exhibit R. CDC Healthcare Infection Prevention and Control FAQs for COVID-19 (Updated June 5, 2020) (emphasis added). Plaintiffs and their experts’ insistence that unit segregation as a means of securing social distancing is unacceptable is inconsistent with CDC guidance that psychiatric hospitals can tailor the recommendations to their setting. On this basis alone, plaintiffs cannot establish that the unit segregation practices are such a substantial departure from professional judgment as to demonstrate that the person responsible actually did not base the decision on such judgment. Youngberg, 457 U.S. at 323. CDC calls on hospitals like CVH and Whiting to tailor the social distancing recommendation rather than mandate its strict application; and CVH and Whiting have answered that call through their treatment teams exercising professional judgment to balance the need to continue to provide inpatient care and prevent infections.
CDC does recommend that social distancing within a unit be implemented in facilities when cohorting of infected patients is not possible. Defs. Exhibit R., CDC Healthcare Infection Prevention and Control FAQs for COVID-19 p. 2. CVH and Whiting have implemented comprehensive cohorting plans and meaningful social distancing practices at both facilities.
6 Plaintiffs’ expert, Dr. Manian, states that “[f]ollowing the CDC’s guidelines is even more crucial during [this COVID-19 pandemic]…. Pls. Ex. 1, Decl. of Manian ¶ 10.
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(1) CVH and Whiting are Following CDC’s Patient Cohorting Guidance.
As suggested above by the referenced CDC psychiatric hospital guidance, cohorting is a preferred and important tool to combat COVID-19 in psychiatric facilities. After consulting with DPH and, in CVH’s case a Middlesex Hospital Epidemiologist, CVH and Whiting implemented a system to cohort patients and keep them separate. Defs. Ex. D, Decl. of Dr. Carvalho ¶¶ 53, 54; Defs. Ex. C, Decl. of Dr. Wasser ¶ 48; Defs. Ex. A, Dr. Geller Decl. ¶ 11. Generally, CVH and Whiting use the same patient cohorting plan: (1) Patients who tests positive for COVID-19; (2) Patients who test negative for COVID-19 but were exposed to others who tested positive for COVID-19; and (3) Patients that test negative for COVID-19 who were not exposed to a person who tested positive for COVID-19.7 Defs. Ex. D, Decl. of Dr. Carvalho, ¶¶ 53, 54; Defs. Ex. C, Decl. of Dr. Wasser ¶ 48.
Whiting isolates patients who test positive for COVID-19 and other members of their unit from other patients who have not tested positive; and cohorts all patients who have tested positive for COVID-19 together on the same unit. Defs. Ex. C, ¶ 51, 52, Decl. of Dr. Wasser. In addition to an isolation unit with its own bathroom and dining room, Whiting’s isolation and cohorting plan includes, if necessary, using available facility space to create a negative pressure isolation unit and an isolation unit in a gymnasium. Id., ¶¶ 55, 56.
Whiting also isolates patients who have COVID-19 symptoms, as defined by the CDC, but who have not tested COVID-19 positive, from other patients and tests them for COVID-19. Id. ¶ 49. If the Whiting patient tests COVID-19 negative, but clinical suspicion for COVID-19 remains high, the Whiting patient is re-tested and remains in quarantine. Id. Whiting patients who have not tested positive for COVID-19 who are exposed to confirmed COVID-19 positive 7 CVH also employs an enhanced protocol for patients who are exhibiting lack of behavior control. Defs. Ex. D, Decl. of Carvalho ¶ 59; Defs. Ex. B, Decl. of Dr. Martinello, ¶ 28.
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patients are quarantined to their unit and prevented from interacting with patients in the other units for fourteen (14) days. Id. ¶ 52. Whiting also places new patients in an isolation unit away from other patients in the isolation unit until their COVID-19 test results return. Id., ¶ 53. At CVH, COVID-19 positive patients reside in one of the two isolation units, which are equipped with negative pressure rooms and enough space to allow for social distancing; people suspected of having COVID-19 (“PUIs”), based on CDC guidelines, reside in an isolation room with floorto-ceiling walls and a separate bathroom. Def. Ex. D, Decl. of Carvalho ¶¶ 54, 55. Also, CVH places patients who are suspected of having COVID-19, based on CDC guidelines, in an isolation room with floor-to-ceiling walls and a separate bedroom. Id. ¶ 53. In addition, CVH cohorts and quarantines patients exposed to a COVID-19 positive person who tests negative for COVID-19 for fourteen (14) days. Id., ¶ 56.
Although CVH and Whiting have implemented comprehensive, CDC-recommendationbased patient cohorting strategies, both facilities have also implemented significant social distancing measures. Plaintiffs and their experts rely on a few vague anecdotes advanced by patients Ardizzone, Litsky and Mueller as the support for their claim that Defendants have not implemented and enforced social distancing measures at Whiting and CVH. As discussed below, these anecdotes do not reflect the reality at CVH or Whiting.
(2) CVH and Whiting have modified patient use of the physical space at CVH and Whiting to support cohorting and social distancing.
Consistent with CDC’s guidance,8 CVH and Whiting each reviewed their respective therapeutic patient groups to determine whether the groups should continue during the pandemic. Whiting performed an analysis to determine whether continuing a therapeutic group outweighs 8 Defs. Ex. R, Centers for Disease Control and Prevention, Coronavirus Disease 2019 (COVID19) Healthcare Infection Prevention and Control FAQs for COVID-19 (updated June 5, 2020), p. 1, (discussing group therapy sessions and reducing group size).
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the risk associated with COVID-19 transmission. Defs. Ex. C, Decl. of Dr. Wasser, ¶ 59. If this process did not lead to the closing of a Whiting therapeutic group, this process led to altering the group’s frequency and meeting duration, limiting the group-size to five participants and limiting groups to members of the same unit (i.e., no cross-unit member participation). Id., ¶ 59. CVH also went through a similar process. Defs. Ex. D, Decl. of Carvalho ¶ 61; Defs. Ex. B, Decl. of Dr. Martinello, ¶ 29. CVH employs unit-based, rather than congregate dining. Defs. Ex. D, Decl. of Carvalho, ¶ 58. Patients eat their meals in their rooms or other rooms within the unit. Id., ¶ 58. Also, to the extent possible, CVH staggers patient bathroom use and showering. Defs. Ex. D, Decl. of Carvalho, ¶¶ 58.
Whiting ceased multi-unit dining and organized the provision of meals into two separate dining spaces, one of which was newly created, so that each unit dines separately, and rearranged the physical space to maximize social distancing. Id., ¶ 60. Further, Whiting assessed the risks and benefits of continued elevator use, which usage Plaintiffs claim as a concern (see Pls. Mem., p. 18, and further discussion regarding elevator use below) and enacted a process to maximize stairwell use under staff supervision to account for reduced elevator occupancy due to social distancing requirements. Id., ¶ 61; Defs. Ex. B, Decl. of Dr. Martinello, ¶ 27.
Consistent with SAMHSA guidance, CVH and Whiting have also modified patient movement. Defs. Ex. S, SAMHSA Covid19: Interim Considerations for State Psychiatric Hospitals, p. 2. For example, Whiting enacted measures to prevent its patients from mingling with CVH patients. Defs. Ex. C, Decl. of Dr. Wasser ¶ 62.a, b. Whiting also enacted measures to keep members of separate units separate in the outdoor spaces. Id., ¶ 62 c, d. Similarly, CVH also limits courtyard use to members of a unit and limits the number of patients using it at any given time. Defs. Ex. D, Decl. of Carvalho, ¶ 62. CVH also prevents patients from congregating
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in other areas and mingling with patients from other units at CVH and prevents patients from accessing other areas at CVH and Whiting. Id.
CVH and Whiting have also modified the time, place and frequency of on-site Probate Court proceedings to support social distancing. Rather than being held in a single location, CVH and Whiting now conduct probate proceedings at CVH and Whiting. Id., ¶ 63. In addition, CVH and Whiting instituting staff teleworking arrangements and use telemedicine where appropriate. Defs. Ex. D, Decl. of Dr. Carvalho, ¶ 63; Defs. Ex. C, Decl. of Dr. Wasser, ¶ 64; Defs. Ex. B, Decl. of Dr. Martinello, ¶ 30. As another example, CVH and Whiting have enabled patients to have meaningful visitor contact through virtual visitation in addition to in-person visitation. Defs. Ex. D, Decl. of Dr. Carvalho, ¶ 60; Defs. Ex. C, Decl. of Dr. Wasser, ¶ 58.
In addition, in double-occupant rooms at CVH, CVH placed beds so that the head of one bed faces the foot of the other bed to aid in social distancing within the room. Defs. Ex. D, Decl. of Dr. Carvalho, ¶ 58; Defs. Ex B, Dr. Martinello Decl., ¶ 26.
(3) CVH and Whiting have implemented significant staff and patient social distancing training and education.
CVH and Whiting have provided patients and staff with ongoing, updated relevant COVID-19 training that includes social distancing. Defs. Ex. A, Decl. of Dr. Geller, ¶¶ 4.b, c, k, m, 34; Defs. Ex. B, Decl. of Dr. Martinello, ¶ 41.
“Whiting staff and patients have been and continue to be instructed on an on-going basis to maximize social distancing opportunities and maintain social distancing to the greatest extent possible.” Defs. Ex. C, Decl. of Dr. Wasser, ¶ 68. Whiting “provides staff with significant, ongoing social distancing training.” Id., ¶ 65. In addition, Whiting patients “have been provided clear educational materials on COVID-19 precautions; posters and unit-based meetings also encourage the practice of approval precautions…” including social distancing. Id., ¶¶ 35, 57, 66,
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67. This education has been provided multiple times through community meetings during which patients were provided educational materials on, among other things, social distancing. Id., ¶ 66.
At CVH, “CVH staff and patients are instructed to maximize social distancing opportunities and maintain social distancing to the greatest extent possible.” Defs. Ex. D, Decl. of Dr. Carvalho, ¶ 70. CVH staff use the Talking Points Regarding Masks and PPE, which instructs staff to “[r]einforce social distancing…,” among other things. Id., ¶ 66. All CVH staff have received frequent communication about providing patients with COVID-19 prevention education and modelling COVID-19 prevention measures for the patients. Id., ¶ 68.
CVH provides patients with ongoing social distancing education through handouts, posters and unit-based meetings. Id.,¶¶ 37, 64, 65. Each patient’s chart contains documentation of social distancing training. Id., ¶ 37. In addition, CVH has provided patient reeducation regarding, among other things, social distancing and is implementing a CVH developed nine (9) session patient education program. Id., ¶¶ 67, 68.
(4) Defendants have failed to demonstrate that Defendants have failed to exercise professional judgment regarding social distancing.
Plaintiffs’ claim that Defendants have been slow to protect Plaintiffs from COVID-19 and that Defendants’ failure to ensure social distancing within facilities is placing Plaintiffs at great risk. Pls. Mem., pp. 4, 28. Plaintiffs also claim that, as of the date of the Memorandum, Plaintiffs are unable to practice social distancing at CVH and Whiting. Id. Given the comprehensive social distancing efforts at CVH and Whiting and their resulting effects, as discussed above, Plaintiffs claim lacks merit.
As discussed above, Plaintiffs’ social distancing claims are based on their experts, Canavan and Jones, and Manian, and the affidavits of three plaintiffs. Pls. Mem., pp 5, 6, and 29 (citing to Pls. Ex. 4, Aff. of Ardizzone; Pls. Ex. 5, Aff. of Litsky and Pls. Ex. 3, Aff. of Mueller.
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Canavan and Jones are not competent to provide the “expert” opinions on infectious disease control. See Defendants’ Motion In Limine Or To Exclude Testimony In The Declaration Of Patrick Canavan And Elizabeth Jones And Affidavit Of Richard Gudis, dated July 9, 2020. Anecdotal stories and isolated incidents do not rise to the level of a constitutional violation. United States v. Commonwealth of Pennsylvania, 902 F. Supp. 565, 589 (W.D. Pa. 1995), aff’d sub nom., U.S. v. Ridge, 96 F.3d 1436 (3rd Cir. 1996) (citing Shaw v. Strackhouse, 920 F.2d 1135, 1143 (3rd Cir. 1992). See also, Society for Good Will, 737 F.2d at 1245. The problem with reliance on anecdotal evidence is illustrated in these patient affidavits.
For example, regarding evidence of alleged lack of social distancing, Plaintiffs cite to the Mueller affidavit and claim that patient testimony is that there is an elevator in which up to 10 people crowd; however, Mueller actually only makes a vague assertion regarding the elevator without mentioning ten people crowding in. Pls. Mem. p. 18; Pls. Ex. 3, Mueller Aff., ¶¶ 13, 14. More importantly, Whiting has addressed social distancing in the elevator by maximizing supervised stairwell use to reduce elevator occupancy. Defs. Ex. C, Decl. of Dr. Wasser ¶ 61; Defs. Ex. B, Decl of Dr. Martinello, ¶ 27. Regarding Plaintiffs’ anecdotal claims about dining, Whiting created two separate dining spaces so that each unit can dine separately and arranged the physical layout to maximize social distancing. Defs. Ex. C, Decl. of Dr. Wasser ¶ 60. Thus, even if some of the claims in plaintiffs’ affidavits were true at some point in time, they do not reflect current practice at Whiting.
As Dr. Martinello, a board-certified infectious disease physician , after pointing out the numerous steps that CVH and Whiting have taken to support social distancing, Defs. Ex. B, Decl. of Dr. Martinello, ¶¶ 26-30, 33, opine that CVH and Whiting’s “ administrative actions have met or exceeded guidance provided by the CDC and CT DPH and … the leadership and
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staff of CVH and WFH exercised excellent professional judgement and were most proactive in implementing measures to minimize the impact of COVID on the residents and staff of the institutions.” Defs. Ex. B, Decl. of Dr. Martinello, ¶¶ 41.
For these reasons, the Plaintiffs have not demonstrated that the Defendants implementation of social distancing was such a departure from acceptable professional judgment as to demonstrate that the person responsible actually did not base the decision on such judgment. Youngberg, 457 U.S. at 323.
e) Patient Census Reduction. Plaintiffs assert that census reduction must be implemented in order to maximize the overriding priority of social distancing in CVH and Whiting. They urge a reduction in admissions and accelerated discharge of inpatients at the hospitals. Pls. Memo at 21. As previously noted, admission to CVH is through either voluntary admission pursuant to Conn. Gen. Stat. § 17a-506 or by involuntary commitment by order of a Probate Court finding by clear and convincing evidence that the person suffers from a psychiatric disabilities and is either gravely disabled or a danger to them self or others. Conn. Gen. Stat. §§ 17a-495 et seq. Whiting admits civilly committed individuals who require a high level of treatment and criminal defendants who have been determined incompetent to stand trial for restoration of competency. Whiting also admits NGRI patients. Conn. Gen. Stat. §53a-13. Whiting also admits inmates of the Department of Corrections whose acute psychiatric needs require treatment at a maximumsecurity psychiatric hospital. Conn. Gen. Stat. § 17a-517. Plaintiffs assert that in order to maximize social distancing in CVH and Whiting, admissions should be restricted for all of these patients. Pls. Memo at 21; Pls. Ex. 2 Canavan & Jones Decl. ¶ 15,16. Plaintiffs do not assert that the admission of any individual patient was in violation of due process in the absence of the social distancing. Plaintiffs have failed to
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demonstrate that the failure to cease or severely limit admissions is in violation of the acceptable minimum professional standards. Soc'y for Good Will to Retarded Children, Inc. v. Cuomo, 737 F.2d 1239, 1248 (2d Cir. 1984).
Plaintiffs’ experts have different opinions as to what is the minimum professional standard on restricting admissions to maximize social distancing. Two of plaintiffs’ experts urge without limitation the “cessation of most civil admissions and discouraging forensic admissions.” Pls. Ex. 2, Decl. Canavan & Jones, ¶ 15. Plaintiffs’ infectious disease expert opines that stopping new admissions should be implemented only “when there is evidence for ongoing transmission of SARS-CoV-2 within the facility or when adequate staffing levels and PPE to manage COVID-19 positive resident cannot be assured.” Pls. Ex. 1, Decl. of Manion, ¶ 19. This expert does not state that either circumstance exists at CVH or Whiting. Id. Defendants have established herein, these conditions do not exist in the facilities. Plaintiffs cannot prove a due process violation when their experts cannot even agree on the applicable professional standard.
Plaintiffs’ provide an incomplete representation of the CDC’s position on this issue. Plaintiffs point to a single reference in a single CDC guideline that nursing homes “[c]consider temporarily halting admissions to the facility, at least until the extent of transmission can be clarified and interventions can be implemented” but fail to note that the recommendation applies only when the facility identifies a resident with new-onset suspected or confirmed COVID-19. It is unrelated to establishing social distancing. Pls. Ex. 14, CDC, Responding to COVID in Nursing Home, at p 3 (emphasis added). The same CDC guidance provides instruction on creating a plan for managing new admissions and readmissions of residents whose COVID-19 status is unknown. Id. at 2. More recently updated CDC guidance do not mention any restriction on admissions under any circumstances. Pls. Ex. 13, Preparing for COVID-19 in Nursing
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Homes updated 5/19/20 and 6/25/20 (https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-
term-care.html); Pls. Ex. 10, Centers for Medicare & Medicaid Services, Nursing Home
Reopening Recommendations for State and Local Officials, at 5-6.
The Plaintiffs’ position that restricting admissions is the minimum professional standard
is further inconsistent with the positions taken by other States. Massachusetts has adopted a “No
Reject Admission Policy for COVID-19 Pandemic. Defs. Ex. V, Commonwealth of
Massachusetts, Department of Mental Health, COVID-19 EMERGENCY GUIDANCE,
Admission, COVID-19 Testing, and EPIA. It states that facility may deny admission to a patient
only if such admission would result in a census exceeding the facility’s operational capacity or if
the admission has been determined by the facility medical director to exceed the facility’s
capability at the time admission is sought. Id. at 1.
Plaintiffs also rely upon guidance from SAMHSA9 which they characterize as “during the
pandemic, inpatient psychiatric care should be used only when absolutely necessary to protect
the life or safety of the individual. In all other circumstances, outpatient arrangements should be
utilized.” Pls. Mem. at p. 20. However, SAMHSA’s advice is more expansive. It states:
SAMHSA is advising that outpatient treatment options, when clinically appropriate, be used to the greatest extent possible. Inpatient facilities and residential programs should be reserved for those for whom outpatient measures are not considered an adequate clinical option; i.e.: for those with mental disorders that are life threatening, (e.g.: the severely depressed suicidal person or persons with life threatening substance use disorders (e.g.: at high risk for overdose, complications from withdrawal). It is recommended that intensive outpatient treatment services be utilized whenever possible. Comprehensive longterm residential treatment programs, where COVID related precautions can be implemented (social distancing, isolating, testing, etc.) remain a viable treatment option when clinically indicated. Pls. Ex. 18, SAMSHA Guidance Considerations for Care and Treatment during COVID (dated May 7, 2020) (emphasis added).
9 The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to address behavioral health.
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The next day SAMSHA issued guidance specifically addressed to State Psychiatric Hospitals that contains this statement:
While SAMHSA has preferentially recommended outpatient treatment during the COVID-19 crisis as telehealth technology and social distancing can be more effectively implemented, inpatient psychiatric care will inevitably be required for a number of patients. Psychiatric care on an inpatient service is typically reserved for the most severe conditions, and inpatient care at state psychiatric hospitals is typically reserved for the most refractory cases. Defs. Ex. S, SAMHSA, Covid19: Interim Considerations for State Psychiatric Hospitals, (emphases added). Instead of cessation of admissions, SAMHSA recognizes the need for continued inpatient care in appropriate cases. Plaintiffs have not demonstrated that a ban on admissions for social distancing purposes is required by minimum professional standards. If the Plaintiffs only prove a difference of professional opinion as to which practices are appropriate and which are not, this does not establish a constitutional deprivation. Doe by Roe v. Gaughan, 617 F. Supp. 1477, 1487 (D. Mass. 1985), aff'd sub nom. Doe v. Gaughan, 808 F.2d 871 (1st Cir. 1986). See also Thomas S. v. Flaherty, 902 F.2d 250, 252 (4th Cir.), cert. denied, 498 U.S. 951 (1990). Plaintiffs do not consider the impact of the denial of care to patients determined to need care at a psychiatric hospital by either the Superior Court or the Probate. The Probate Court is required to consider whether a less restrictive placement is available in reaching the decision by clear and convincing evidence that an order of commitment should be issued. Conn. Gen. Stat. § 17a-498(c)(3). The Superior Court must find the hospital is the least restrictive placement appropriate in order to place a criminal defendant for restoration of competency in the hospital. Conn. Gen. Stat. § 54-56d(i). These orders turn on the court’s determination that inpatient psychiatric hospital care is needed. Notwithstanding these judgments, plaintiffs assert social distancing trumps the need for care. If admission of patients under the jurisdiction of the PSRB
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or sent for restoration of competency to stand trial was prohibited, the patients in almost all circumstances would remain in a correctional facility without the same level of treatment as provided at Whiting. Ex. C, Decl. of Dr. Wasser ¶ 47; Defs. Ex. A, Decl. of Dr. Geller, ¶ 25. From March 1, 2020 until June 30, 2020, CVH admitted 31 patients to the General Psychiatric Division and Whiting admitted 21 patients10. These patients almost of all whom were determined by courts to require inpatient hospitalization, would be barred by the Plaintiffs from the hospitals to maximize social distancing. “If CVH or WFH was the most integrated setting appropriate to a patient’s need before the pandemic, then it is the most integrated setting appropriate to the persons need during the pandemic. There is no evidence there is increased safety, all things considered, for such patients outside of CVH or WFH, than inside.” Defs. Ex. A, Decl. of Dr. Geller, ¶ 30.
The discharge process utilized by the hospitals’ professionals is in accord with due process. Discharge of inpatients at CVH and Whiting follow similar processes. All patients at each hospital are part of a treatment team made up of clinicians that collaboratively plan and provide care to the patient. The team consists of a of a psychiatrist, medical doctor, psychologist, social worker, rehabilitation therapist, nurses, and mental health assistants (who assist in therapeutic engagements). Defs. Ex. C. , Decl. of Dr. Wasser, ¶ 36: Defs. Ex. D. , Decl. of Dr. Carvalho, ¶ 38.
10 Plaintiffs erroneously criticize Whiting for cancelling patients on temporary leave making the hospital more crowded. Pls. Memo at 23. Beginning in March 2020, PSRB patients who had been granted temporary leaves of 7 nights in the community were allowed to remain in community placement except for those identified as posing too great a risk to remain in the community placement. Leaves for patients who were on less than 7-ovenight temporary leaves were cancelled rather than have them continuing short term leaves to avoid the risk of being infected in the community and returning to the hospital. Defs. Ex. C, Decl. of Dr. Wasser, ¶ 46.
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Taking into account the limits of court-imposed confinement and in accord with governing policies, each hospital actively pursues the appropriate discharge of every patient deemed discharge ready by their treatment team. There is a monthly treatment meeting with the patient. Planning for discharge begins upon admission to the hospital. Treatment planning by the team addresses the particular considerations for each patient bearing on discharge and identifies barriers to discharge. Defs. Ex. C. , Decl. of Dr. Wasser, ¶¶ 37- 38; Defs. Ex. D. , Decl. of Dr. Carvalho, ¶¶ 39-40.
At every treatment plan review (which occur at least monthly), the treating physician will document in the chart and discuss with the patient the specific factors that the physician is considering to determine the patient's current clinical need for hospital level of care and the patient's readiness for discharge. Such factors include the patient's physical and mental status, results of medical/psychological tests, the patient's cognitive and behavioral status, the patient's functional capacities, and evaluative explorations or treatment protocols yet to be completed. Extrinsic factors which present barriers to discharge, such as the patient's willingness to leave the hospital or the availability of a residential placement must be documented in the chart. Defs. Ex. C. , Decl. of Dr. Wasser, ¶¶ 39-40; Defs. Ex. D. , Decl. of Dr. Carvalho, ¶¶ 41-42.
Each team includes a clinical social worker who maintains a knowledge base of community support services and provides oversight to the discharge planning process. Typically, the clinical social worker will be communicating with community providers regarding a patient’s discharge in advance of the patient being determined as ready for discharge. Thus, each month, there has been a professional judgment by the physician informed by the team as to whether a patient is discharge ready. During the course of the pandemic, the treatment teams at both CVH and Whiting continued to address discharge readiness and barriers reflected in the treatment
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plans including those posed by the COVID-19 pandemic. Defs. Ex. C, , Decl. of Dr. Wasser ¶¶ 41-43; Defs. Ex. D. , Decl. of Dr. Carvalho, ¶¶ 43-45.
The most significant component of the injunction Plaintiffs’ seek would require Defendants to abandon the clinical and professional standards for determining when a psychiatric hospital inpatient can be safely and appropriately discharged. Plaintiffs’ experts do not state that the provision of inpatient hospital level of care for any patient constitute a due process violation. Plaintiffs’ demand for ordering these patients out of the hospital is solely based on the overriding goal of social distancing. Plaintiffs demand that both hospitals “apply a different standard than it would in ordinary times,” Pls. Mem. at p. 22, because “the most important strategy for implementing social distancing is accelerating discharges.” Id. Plaintiffs would displace the treatment team’s application of professional judgment regarding a patient’s discharge readiness for an alternative designed to expedite social distancing in the hospital buildings. Id. Plaintiffs’ process is simply to find a place for the patient to live, including temporary housing such as hotels, provide access to food and medicines, assure the patient can take appropriate COVID precautions with available assistance in the community without being a danger to self or others. Pls. Ex. 2, Decl. of Canavan & Jones ¶ 22. Beyond medications no consideration is given to the inpatients’ access to care to address their needs and the ability for community providers to address their needs. Id. at 22. Plaintiffs assert that due process requires moving from the physician’s and treatment team’s holistic evaluation of the patient’s need for continued hospital care to an evacuation process to achieve social distancing.
Plaintiffs cannot secure such relief without first demonstrating that the failure to discharge otherwise appropriately placed hospital inpatients in order to secure social distancing violates acceptable minimum professional standards. Soc'y for Good Will to Retarded Children,
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Inc. v. Cuomo, 737 F.2d at 1248. Plaintiffs ignore CDC guidance and other national organizations’ guidance on responding to COVID-19. Neither Plaintiffs nor their experts cite to a single CDC guidance that states that health care facilities of any kind should discharge patients in order to secure social distancing. No CDC guidance recommends or even mentions discharging patients in health care facilities to achieve social distancing; this belies any argument that discharges for this purpose are required by accepted professional judgment, practice, or standards.
Contrary to the Plaintiffs’ position that social distancing overrides professional standards and judgment on discharge readiness, the CDC has expressly recognized that in psychiatric hospitals, the CDC interim infection prevention and control recommendations may be adjusted to meet the needs of psychiatric patients. In response to the question of whether the “CDC interim infection prevention and control recommendations for COVID-19 apply to psychiatric hospitals or other behavioral health facilities” CDC stated the following:
Yes. To keep patients and healthcare personnel (HCP) healthy and safe, CDC’s infection prevention and control guidance applies to all settings where healthcare is delivered. However, as with any guidance, facilities can tailor certain recommendations to their setting. For example, inpatient psychiatric care includes communal experiences and group activities that may need to continue. If so, these activities might need to be adapted to align with social distancing recommendations. Defs. Ex. R, CDC Healthcare Infection Prevention and Control FAQs for COVID-19 (emphasis added). SAMHSA’s COVID-19 guidance for State Psychiatric Hospitals does not mention discharging patients for social distancing purposes or changing professional standards that apply to discharging patients. Defs. Ex. S, SAMHSA, Covid19: Interim Considerations for State Psychiatric Hospitals. Rather SAMHSA recognizes “[w]hile SAMHSA has preferentially recommended outpatient treatment during the COVID-19 crisis as telehealth technology and
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social distancing can be more effectively implemented, inpatient psychiatric care will inevitably be required for a number of patients.” Id. at 1. Contrary to Plaintiffs’ position that discharges should be expedited through lowering standards, SAMHSA states:
Discharge planning may be more difficult. As many step down residential facilities and outpatient facilities are limiting intakes, social workers may find it more difficult to plan disposition of patients. This may result in longer lengths of stay. The treatment team as well as utilization review staff should adjust with this expectation. Also, questions may arise about the risk of the patient’s exposure to those at the receiving facility. Id. at 4. Rushing inpatients into temporary housing is not consistent with SAMHSA’s caution regarding the community capacity to accept discharges. Likewise, the American Psychiatric Association (APA) has issued a guidance document addressing admissions and discharge of psychiatric patients during the pandemic. Defs. Ex. W, APA, Guidance on Admittance, Discharge of Psychiatric Patients During COVID-19. It also has no recommendation that inpatients be discharged to secure social distancing. The APA opposes expedited discharges. “Premature discharge of patients from psychiatric hospitals and inpatient psychiatric units is unreasonable as this practice exposes patients, families, and the community at large to the risks of harmful and adverse outcomes irrespective of communicable disease outbreaks.” Id. at 2. Plaintiffs burden in establishing a due process violation is to demonstrate that the treatment teams decision not to wholesale discharge patients to achieve social distancing “is such a substantial departure from accepted professional judgment, practice, or standards as to demonstrate that the person responsible actually did not base the decision on such a judgment.” Soc'y for Good Will to Retarded Children, Inc. v. Cuomo, 737 F.2d at 1248 (quoting Youngberg, 457 U.S. at 323). No violation of due process may be found where a plaintiff only proves a difference of professional opinion as to which practices are appropriate and which are not. Id.; Die v. Gaughan, 617 F.Supp. 1477, 1487 (D.Mass.1985), aff'd, 808 F.2d 871 (1st Cir.1986). In
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this sense, the Court may not “weigh the decisions of treating professionals against the testimony” of plaintiffs' experts to decide which of several acceptable standards should apply. Messier v. Southbury Training Sch., No. 3:94-CV-1706(EBB), 1999 WL 20910, at *6 (D. Conn. Jan. 5, 1999). The CDC, SAMSHA and the APA do not endorse the practice of discharging patients to achieve social distancing and therefore, at best, Plaintiffs merely offer the unique views of their “experts.”
Plaintiffs have not demonstrated that the responsible physician and the treatment teams at the hospitals failed to exercise professional judgment in their discharge decisions. At each monthly treatment team review, there has been a professional judgment by the physician informed by the team as to whether a patient is discharge ready. During the course of the pandemic, the treatment teams continued to address discharge readiness and barriers reflected in the treatment plans including those posed by the COVID-19 pandemic. Defs. Ex. C, Decl. of Dr. Wasser ¶ 41-43; Defs. Ex. D., Decl. of Dr. Carvalho, ¶ 43-45. The physicians and treatment teams had to consider the operational problems resulting from COVID-19 for community providers in making their discharge decisions. Plaintiffs fail to address whether the community residential or service providers could accommodate a massive discharge of patients who require inpatient level of care or whether the community provided a safer environment. Absent an evaluation of these factors which were part of the professional judgment of the patients’ physicians and treatment teams, Plaintiffs have presented an incomplete evaluation of these judgments. Plaintiffs experts state: “Based on the conversations we have had, we are confident that community service providers would be willing to engage with the hospitals on planning and implementing discharges as part of such an effort at CVH and WFH.” Pls. Ex. 2, , Decl. of Canavan & Jones ¶ 24. They fail to identify who they conversed with or provide any other
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analysis of the community’s capacity to receive the expedited discharge patients. In fact, the problems posed by COVID-19 in the community and ignored by the Plaintiffs are substantial.
The necessity that discharged patients must manage and maintain COVID-19 precautions (including reduced social interaction, adhering to cleaning protocols and the wearing of a mask) in the community requires that the discharge candidate be higher functioning in their ability to maintain their own safety and independence than in the absence of a pandemic. Defs. Ex. K, Decl. of Navaretta, ¶ 7.11 Traditionally, inpatient discharges are accomplished with phased transition using day visits, overnight stays and temporary leaves to ease the relocation of the resident to the community provider. Due to the pandemic, this standard has been halted to avoid the potential for exposure of the patient at the community residence and then exposing others upon their return to the hospital. In some cases, community providers have been uncomfortable accepting a placement without this transition period and assurances that the patient has a hospital bed to return to if the transition is not successful. Id. at ¶ 10.
Plaintiffs do not address whether community placement will provide a safer environment than the hospitals. Community residential settings face challenges in maintaining social distance within their home style settings with limited numbers of bathrooms, common space and typically a communal kitchen. Id. ¶ 6. Community residential providers face significant challenges in the ability to maintain social isolation of residents. Community residential providers cannot prevent residents from leaving the home which increases the risks of exposure. Similarly, community providers can be challenged in preventing visitors into the residence. Id. ¶ 8. For community
11 The last page attached to the affidavit of Vincent Ardizzone is a letter from his urologist, Dr. Meyer, who states: “My greatest concern is that if he is discharged into the community, he will not be compliant with social distancing (he has already expressed a desire to return to work), which will paradoxically (sp) increase his risk for acquiring COVID-19.” Pls. Ex. 4, Ardizzone Aff. p. 27.
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residential providers with multiple sites, staff may be working in multiple sites creating risk of transmitting infection among sites. Community providers do not have the purchasing power to secure large scale orders of PPE and infection control supplies. Id. ¶ 9.
Community residential providers face significant challenges in the ability to cohort and isolate residents with COVID-19 exposure, symptomatic COVID-19 or COVID-19 positive diagnosis. In many cases, especially small congregate settings, space is limited without the option to create or open up new space in these residential buildings. The consequence is the necessity to maintain a vacant bedroom for this purpose, if there happened to be a vacancy at the time of the COVID-19 surge in Connecticut, thereby reducing the number of available beds for new residents. Id. ¶ 5.
The extent to which community service providers experienced major scale-backs and cope with barriers to discharge are also detailed in the declaration of Dr. Geller. Defs. Ex. A, Decl. of Dr. Geller, ¶ 6. Dr. Geller also concluded that community options did not provide safer alternatives to CVH or WFH. Id. at ¶ 7. Dr. Geller opined:
To have [accelerated discharges] …would have exposed patients to far greater risks of harm than keeping the patients at CVH and WFH. There were extraordinary limitations on services to discharge patients to. Even naturalistic services like libraries coffee shops, and churches/synagogues/mosques were closed. Even if defendants could have discharged more patients to residences than they did, there are no data that living in a group home in a small house is safer than being in a state hospital. To have accelerated discharges of patients who needed to be in CVH or WFH in the midst of the COVID-19 pandemic would not only have been below the standard of care, it would have been cruel. Id. at ¶10. Plaintiffs falsely claim that “Defendants have failed to take even preliminary steps to identify patients who can safely return to the community, or to granting temporary leave or conditional discharges to those patients for whom such actions would be appropriate. Pls. Mem. at 22. Despite the problems posed by COVID-19’s for community providers, between March 1, 2020 and June 30, 2020, 34 patients from CVH’s General Psychiatric Division and 44 patients
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from Whiting were discharged. Defs. Ex. C, Decl. of Dr. Wasser ¶ 44; Defs. Ex. D. , Decl. of Dr. Carvalho, ¶ 46.
The decisions made by professionals exercising their professional judgment regarding the care and treatment of class members are presumptively valid. Youngberg, 457 U.S. at 323. In determining whether individuals’ rights have been protected, “the Constitution only requires that the courts make certain that professional judgment was in fact exercised.” United States v. Commonwealth of Pennsylvania, 902 F. Supp. 565, 582 (W.D. Pa. 1995), aff’d sub nom., U.S. v. Ridge, 96 F.3d 1436 (3rd Cir. 1996). Plaintiffs have not established that the minimum acceptable professional standard requires discharging psychiatric inpatients in order to maximize social distancing in a psychiatric hospital. Plaintiffs experts have provided an incomplete assessment of the hospital professionals’ judgments by failing to evaluate whether the community setting is a safer environment or the capacity of the community providers to meet the needs of the hospital inpatients.
As Dr. Martinello, a board-certified infectious disease physician observed: Further, it is a challenge to balance the tradeoff of providing potentially lifesaving supervision and care to patients severely impacted by their mental health illness versus decanting the residents from the facility in an effort to minimize those at risk and support social distancing. Although decanting residents from the facility can improve the ability to provide social distance, the residents themselves, their families and friends and potentially the public may bear a heavy burden if the subsequent care received in the community is insufficient for the resident. Defs. Ex. B, Decl. of Dr. Martinello, ¶ 38. “CVH and WFM only discharged patients who could be safely discharged with the limited existent resources, and they did not discharge patients to unsafe conditions simply to increase social distancing in the hospitals. What the plaintiffs ask the court to order Connecticut in terms of the discharge of patients to do would put CVH and Whiting functioning below the standard of care and jeopardize the lives of the same individuals the plaintiffs want to protect.” Defs. Ex. A, Decl. of Dr. Geller, ¶ 35. The physicians and
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treatment teams exercised their professional judgment in determining the tradeoff of social distancing and providing lifesaving supervision and care to their patients.
B. The Plaintiffs Fail to Show They Will Suffer Irreparable Harm "An irreparable injury is one that is not remote or speculative but actual and imminent…and 'for which a monetary award cannot be adequate compensation.'" South Lyme Property Owners Association v. Town of Old Lyme, 121 F.Supp.2d 195,203 D.Conn. 2000). A substantial risk of serious illness or death has often been found to constitute irreparable harm. See, e.g., Innovative Health Systems, Inc. v. City of White Plains, 117 F.3d 37, 43-44 (2d Cir. 1997) (finding irreparable harm where the closure of a treatment program would pose serious risk of harm to plaintiffs, including “death, illness or disability”); Shapiro v. Cadman Towers, Inc., 51 F.3d 328, 332-33 (2d Cir. 1995) (upholding District Court’s irreparable harm finding based on the “risk of injury, infection, and humiliation”). In the prison context, “[c]ourts across the country have concluded that the risk of contracting COVID-19 as a result of unsafe conditions of confinement constitutes irreparable harm.” Martinez-Brooks v. Easter, No. 3:20CV-00569 (MPS), 2020 WL 2405350, at *26–27 (emphasis added). “In the Second Circuit, it is well-settled that an alleged constitutional violation constitutes irreparable harm.” Basank v. Decker, 2020 WL 1481503, at *4 (citing cases); Connecticut Dep't of Envtl. Prot. v. O.S.H.A., 356 F.3d 226, 231 (2d Cir. 2004) (“[W]e have held that the alleged violation of a constitutional right triggers a finding of irreparable injury.” (internal quotation marks and citations omitted)). The Plaintiffs assert that they are at great risk of being infected at CVH and Whiting because these are congregate facilities. Pls. Memo. at p. 2; Pls. Ex 1, Decl. Dr. Manian ¶ 8. They also argue that the Defendants alleged failure to implement all of the guidelines issued by the CDC puts them at increased risk of infection. Pls. Mem. at pp. 3-5, 9. The facts do not support these claims.
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The date that a Whiting patient last tested positive for COVID-19 was April 21, 2020. Defs. Ex. C, Dr. Wasser Decl. ¶ 13; Defs. Ex. B, Dr. Martinello Decl. ¶ 9. Since May 19, 2020, no new Whiting patients have tested positive for COVID-19. Defs. Ex. C, Dr. Wasser Decl. ¶ 14. From June 1, 2020 until July 2, 2020 there have been no patients with COVID-19 at Whiting. From May 13, 2020 until July 2, 2020, there were 41 out of 51 days where there were no patients at Whiting who were COVID-19 positive. 12 Defs. Ex. Z.
The date that a CVH patient last tested positive for COVID-19 was May 16, 2020. Defs. Ex. D, Dr. Carvalho Decl. ¶ 13; Defs. Ex. B, Dr. Martinello Decl. ¶ 36. Since May 16, 2020, no new patients at CVH have tested positive for COVID-19. Defs. Ex. D, Dr. Carvalho Decl. ¶ 14. From June 1, 2020 until July 2, 2020 the daily number of patients with COVID-19 at CVH was one. Defs. Ex. X.
The Plaintiffs’ remedy for reducing this risk is to reduce the patient census. Pls. Mem. at 21. They seek an order implementing a new process for determining discharge readiness and to discharge as many patients as possible. Pls. Mem. at pp. 3, 4; Pls. Ex. 1, Decl. Dr. Manian ¶ 12. Although they provide no supporting evidence, Plaintiffs believe that their risk of infection is less in the community than at the hospitals. A key factor present in prison COVID-19 cases, unsafe conditions of confinement, is not present at Whiting or CVH. The Defendants’ evidence shows that the planning and implementation by CVH, Whiting, and DMHAS has reduced the risk of infection within the facilities and that the risk of harm is not less in the community. Instead the community providers would be severely handicapped by the COVID-19 pandemic to care for these newly discharged inpatients. Defs. Ex. K, Decl. of Nancy Navaretta ¶¶ 5-10; Defs. Ex. A, Decl. of Dr. Geller ¶¶ 6-7.
12 Two patients who tested positive on May 19, 2020 had previously tested positive and did not represent new cases of COVID-19.
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C. Balance of the Equities and the Public Interest “Where the Government is the opposing party, the final two factors in the temporary restraining order analysis—the balance of the equities and the public interest—merge.” Martinez-Brooks v. Easter, No. 3:20-CV-00569 (MPS), 2020 WL 2405350, at *27 (citing Coronel v. Decker, ––– F.Supp.3d ––––, ––––, 2020 WL 1487274, at *7 (S.D.N.Y. Mar. 27, 2020) (citing Planned Parenthood of New York City, Inc. v. U.S. Dep't of Health & Human Servs., 337 F. Supp. 3d 308, 343 (S.D.N.Y. 2018)). “[T]he court must ensure that the ‘public interest would not be disserved’ by the issuance of a preliminary injunction.” Illinois Tool Works Inc. v. J-B Weld Co., LLC, 419 F. Supp. 3d 382, 389 (D. Conn. 2019), modified, No. 3:19-CV01434 (JAM), 2019 WL 7816510)(quoting Salinger v. Colting, 607 F.3d 68, 80 (2d Cir. 2010)). “A preliminary injunction is ‘in the public interest’ if the preliminary injunction would not ‘cause harm to the public interest.’” Local 1159 of Counsel 4 AFSCME, AFL-CIO v. City of Bridgeport, 435 F. Supp. 3d 400 (D. Conn. 2020) (quoting U.S. S.E.C. v. Citigroup Global Mkts. Inc., 673 F. 3d 158, 163 n.1 (2d Cir. 2012)). There is a public interest in having only those patients who have been deemed by the treatment team’s professional judgment to be discharge ready, which includes the patient’s ability to function in the community without risk of harm to themselves and others. See Martinez-Brooks v. Easter, No. 3:20-CV-00569 (MPS), 2020 WL 2405350, at *28. Whiting and CVH continued their assessments of patients’ ability to be discharged in the midst of the COVID-19 pandemic and secured appropriate community placements. There is also a public interest in making certain that all patients admitted to the hospitals, whether via civil commitment, a finding of NGRI, criminal pre-trial placement for restoration for competency, transfer permitted by statute from the DOC, or voluntarily admissions, receive appropriate treatment from the State. As Dr. Martinello observed, “[a]lthough decanting
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residents from the facility can improve the ability to provide social distance, the residents themselves, their families and friends and potentially the public may bear a heavy burden if the subsequent care received in the community is insufficient for the resident.” Defs. Ex. B, Decl. of Dr. Martinello, ¶ 38. An injunction restricting admissions or forcing unwarranted discharges would harm these public interests. IV. CONCLUSION
The Defendants’ response to the pandemic is ongoing due to the changing circumstances of the pandemic and the evolving body of knowledge about the disease. Defendants’ response to Plaintiffs’ Motion necessarily reflects a snapshot in time. Given the challenges of marshalling the Defendants’ voluminous evidence and operating the hospitals in light of evolving practices, prior to argument some evidence may be superseded by changes in protocols. The Defendants respectfully reserve the right to update their submissions accordingly.
For the forgoing reasons, the Defendants urge the Court to deny the Plaintiffs’ Motion for Preliminary Injunction.
DEFENDANTS, NED LAMONT ET AL WILLIAM TONG ATTORNEY GENERAL BY: /s/ Henry A. Salton Henry A. Salton Assistant Attorney General Federal Bar No. ct07763 Henry.Salton@ct.gov Office of the Attorney General 165 Capitol Avenue Hartford, CT 06106 Tel: (860) 808-5210 Fax: (860) 808-5385
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BY: /s/ Ralph E. Urban Ralph E. Urban Assistant Attorney General Federal Bar No. ct00349 Ralph.Urban@ct.gov Office of the Attorney General 165 Capitol Avenue Hartford, CT 06106 Tel: (860) 808-5210 Fax: (860) 808-5385
BY: /s/ Emily V. Melendez Emily V. Melendez Assistant Attorney General Federal Bar No. ct21411 Emily.Melendez@ct.gov Office of the Attorney General 165 Capitol Avenue Hartford, CT 06106 Tel: (860) 808-5210 Fax: (860) 808-5385
BY: /s/ Laura D. Thurston Laura D. Thurston Assistant Attorney General Federal Bar No. ct30612 laura.thurston@ct.gov Office of the Attorney General 165 Capitol Avenue Hartford, CT 06106 Tel: (860) 808-5210 Fax: (860) 808-5385
/s/ Shawn L. Rutchick Shawn L. Rutchick Assistant Attorney General Federal Bar No. ct24866 Shawn.Rutchick@ct.gov 165 Capitol Avenue Hartford, CT 06106 Tel: (860) 808-5210 Fax: (860) 808-5385
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Case 3:20-cv-00594-JCH Document 49 Filed 07/09/20 Page 57 of 57 CERTIFICATION
I hereby certify that on July 9, 2020 a copy of the foregoing Objection to Motion for Preliminary Injunction, along with all attachments and Exhibits, was filed electronically. Notice of this filing will be sent by e-mail to all parties by operation of the Court’s electronic filing system. Parties may access this filing through the Court’s CM/ECF system.
/s/ Henry A. Salton Henry A. Salton Assistant Attorney General
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Wilkes v. Lamont et al. Docket No.: 3:20CV594-JCH Exhibit List to Defendants’ Objection to Plaintiffs’ Motion for Preliminary
Injunction Exhibits: A. Dr. Geller Declaration B. Dr. Martinello Declaration C. Dr. Wasser Declaration D. Dr. Carvalho Declaration E. Mary Mason Declaration F. Paul DiLeo Declaration G. Michele Lizotte Declaration H. Tim Denier Declaration I. Jose Crego Declaration J. Michael Boutin Declaration K. Nancy Navaretta Declaration L. Whiting Guidance on Confirmed and Suspected Covid-19 Cases M. Whiting PPE Inventory as of July 1, 2020 N. CVH PPE Inventory as of July 1, 2020 O. Coronavirus (COVID-19) Fact Sheet P. CVH COVID-19 Response Plan Testing Protocol Q. KaiVac1750 Cleaning System R. CDC Coronavirus Disease 2019 (COVID-19) Healthcare Infection Prevention and Control FAQs for COVID-19 S. SAMHSA Covid19: Interim Considerations for State Psychiatric Hospitals T. CDC Testing Guidelines for Nursing Homes U. CDC Interim Guidance on Testing Healthcare Personnel for SARS-CoV-2 V. Mass Bulletin on Admission Psychiatric Facilities W. APA Guidance Admittance, Discharge of Patients During COVID-19 X. CVH Patient Comparison Chart
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Case 3:20-cv-00594-JCH Document 49-1 Filed 07/09/20 Page 2 of 2 Y. CVH Staff Comparison Chart Z. Whiting Patient Comparison Chart AA. Whiting Staff Comparison Chart BB. Hal Smith Declaration
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EXHIBIT A

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UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

THOMAS WILKES,

:

BARBARA FLOOD,

:

VINCENT ARDIZZONE,

:

GAIL LITSKY,

:

CARSON MUELLER,

:

On behalf of themselves and

:

all other persons similarly

:

situated,

:

Plaintiffs

:

:

v.

:

:

NED LAMONT, Governor

:

MIRIAM E. DELPHIN-RITTMAN,

:

Commissioner of DMHAS,

:

HAL SMITH, CEO of Whiting Forensic :

Hospital,

:

LAKISHA HYATT, CEO Connecticut :

Valley Hospital,

:

In their official capacities,

:

Defendants

:

CIVIL NO. 3:20CV594-JCH JULY 8, 2020

DECLARATION JEFFREY GELLER, MD, MPH The undersigned declarant, Jeffrey Geller, MD,MPH, being duly sworn, hereby deposes and declares under the pains and penalties of perjury, pursuant to 28 USC §1746, that: 1. I am a board certified psychiatrist by the American Board of Psychiatry and Neurology. I received my medical degree from The University of Pennsylvania School of Medicine. I completed my residency in Psychiatry at Beth Israel Hospital and Harvard Medical School, Boston. I received a Masters of Public Health from Harvard University. I have 42 years of experience as an inpatient and outpatient psychiatrist and continue to practice both. My current CV is attached as Attachment 1.

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2. I am currently Professor of Psychiatry at the University of Massachusetts Medical School. I practice and teach at Worcester Recovery Center and Hospital, a facility of the Massachusetts Department of Mental Health.
3. In preparing this declaration, I relied upon the documents and sources of information set forth in the attached list, attached hereto as Attachment 2.
4. I made the following observations and received the following information from a virtual tour of CVH. a. CVH has a total bed capacity of 361 patients. There are two divisions; General Psychiatry and Addiction Services. General Psychiatry is divided into acute, subacute, and chronic patient populations. The General Psychiatry occupancy is 209 patients and it was full. b. Battell Building had signage about COVID-19 precautions at front door and a mask is required for building entry. The elevator capacity is 4 people, one in each corner. c. Battell contains an Isolation room (Room 228) located between two units and thus isolated from all other areas with 1 bed and an adjoining bathroom. Staff is posted outside the room at all times. There is a separate room for donning and doffing PPE just outside isolation room. CDC Guidelines are posted. Battell never exceeded the capacity of its isolation room. d. Battell 2S [General Psych] has 22 patients. CVH repurposed some rooms to increase the number of bedrooms on the unit., e.g., staff breakroom, comfort room. There are some single rooms. Admissions are quarantined to a room for not less than 14 days.
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e. There are two dorms on this unit with up to 2 patients per room. The rooms have ¾ walls. The beds in the dorms are parallel against the same wall with patients’ heads at opposite ends so the patients’ feet are 6 feet apart and their heads are 20 feet apart. There have never been any suspected cases on this unit. The dining area is locked. CVH decreased the number of patients in the dining room from 22 to 8 at any time by staggering each meal. When seated in the dining room patients are 6 feet apart. Some patients eat in their bedrooms.
f. The Woodward building [General Psych] has 4 units with capacity of 15 patients each. Three units are geriatric and one unit is for traumatic brain injury (TBI) patients. Everyone is screened at the building’s front door and there is signage everywhere. The elevators have been limited to 4 maximum since early June; before that staff encouraged patients to limit the number in the elevator and encouraged the use of the stairwell. Staff controlled the number of geriatric patients on the elevator before official limit was set.
g. Woodward 2N is an all male unit of geriatric patients with 2 bathrooms. Bathroom usage was limited to one patient in the bathroom at a time if suspected case in the unit. The unit has an open RN station with its own sink and a treatment room with sink. There are 3 good sized single rooms; 6 double rooms with beds feet to feet as in Battell. The TV room limit is 2 people at a time. A lounge area has seating limited to 2 people at a time
h. The unit has a medication room with a Dutch door and only one patient is served at a time; if the patient is physically sick, medications are brought to the patients’ room. The unit’s dining area has 2 patients seated at opposite corners of a table
3

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48” x 30”. Covid suspicious patients eat in their rooms. The unit is totally cleaned by housekeeping twice a day. i. Patients stay on the unit and only leave for medical appointments that could not be delayed for medical reasons; this began on all units in Woodward 3/17/2020. No patients were ever in the elevator since they never left their units. No congregate groups were held and no patients were allowed outside. j. There were 3 patient deaths on this unit. k. The Merritt building [Substance Abuse Services] had pre-COVID-19, 110 beds, 90 rehab and 20 detox. Since COVID-19, Merritt reduced its total capacity to 32 patients (71% decrease). There is signage at the front door and again on the inside door. Screening takes place immediately on the other side of second door. Masks are given to employees weekly or as needed. Housekeeping occurs 7 days per week 6:45 am – 10:00 pm (one shift works 6:45 am – 2:45 pm and a second shift works 2:45 pm – 10:00 pm). CVH has supplemented regular housekeeping staff with contract employees. l. CVH’s COVID-19 Positive Unit has a 13 patient capacity with surge capacity to 16. Only COVID-19 positive patients reside on this unit. The donning and doffing PPE area is before one enters the unit. An emergency cart is on the unit. The dorms pre-COVID-19 would hold four patients; since COVID-19 this has been reduced to two patients. The bedroom with two patients is really two single rooms with a shared door to the hallway. There are single rooms for female patients. Shower stalls were sanitized by housekeeping after each shower and staff used gowns.
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m. Patients are expected to stay in their bedrooms and wear masks any time they are out of their own room. Patients were provided use of state cell phones. The phones are sanitized between each use [Per-Covid-19 no cell phones]. Phones were provided when visitors were stopped from entering CVH. Signage is everywhere on the unit. The unit changed administration of medication from a patient coming to med window pre-COVID-19 to patients receiving medication in their bedrooms. The last positive patient left this unit 6/15/2020.
5. I made the following observations and received the following information from a virtual tour of Whiting Forensic Hospital (WFH). a. WFH has a total of 11 units made up of (i) maximum security consisting of 5 units, with up to 91 patients total and up to 18 patients per unit; and (ii) enhanced security consisting of 6 units, with up to 138 patients total and 21-24 patients per unit. WFH’s total capacity is 229 patients. The usual census is 210 – 225 patients but since COVID-19 the census has had a 25% reduction with the census on 6/25/2020 at 172 patients. b. Census reduction occurred through both fewer admissions as the court slowed down its activity and the occurrence of expected discharges. c. On 5/19/2020, WFH tested 110 patients, 75 others refused. Of 560 staff, 450 tests took place (200-300 staff; some staff tested more than once); Testing for staff became mandatory as of June 22, 2020. d. WFH has had no COVID-19 deaths. Only one COVID-19 positive case was medically hospitalized and he has returned to WFH.
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e. WFH undertook the following Interventions to decrease the risk of COVID-19 infection: i. Screening included a questionnaire and taking temperatures ii. Vital signs taken of all patients daily; suspected cases or confirmed case taken twice a day iii. Converted rehab space into negative pressure isolation unit iv. Stopped using off unit rehab space v. Suspected cases isolated to bedroom and then when negative pressure unit set up moved suspected cases there but separated from positive cases; never had more than one patient per side. vi. Initially isolated cases for 7 days per CDC recommendations; when CDC recommended 10 days, WFH went to 14 days. vii. Divided very large courtyard so units would not mix when outside (previously all 5 units shared space); each unit has direct access to outdoor space. viii. Legal hearings done electronically ix. Housekeeping: hired additional 4 contract personnel and purchased and placed alcohol mist machines. x. Screening everyone at entrance as of 3/13/2020 xi. Psychiatry staff: Platooning: 50% on unit, 50% satellite office each week xii. Whiting building Unit #1 usually has 8-9 patients and now has 3 females. It has 2 bathrooms with 2 sinks and 2 stalls per bathroom. Mostly single
6

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bedrooms. Areas with 2 beds had at least 6 feet between beds. The dining room provides one patient per table, all facing the same direction xiii. Dutcher building unit D2S has a 24 patient capacity; census today is 8 patients, 4 wearing masks; 4 without; all staff wearing masks. xiv. Courtyard use is limited to one unit at a time (previously multiple units at a time) xv. Dining room use was previously 2 units at a time; since COVID-19 there is one unit at a time and added second room, so space that previous had 52 patients eating now has 12 patients. A patient travels from unit to dining room only with other patients from her unit. xvi. Bedrooms: double rooms have beds 5 feet apart and secured to ground; 2 single bedrooms per unit; xvii. Group spaces on unit are limited to 5 patients at a time (previously 10 patients) xviii. Bathrooms: 2 bathrooms with 3 sinks and 4 stalls per bathroom xix. Shower room: 2 showers, each enclosed by walls on 3 sides xx. New mask are provided weekly and whenever mask becomes soiled or ripped 6. Based upon the information gathered in my review, I conclude that community services experienced major scale-backs and presented the following barriers to discharge: a. Very significant decreased availability of services from residences, LMHA, psychiatrists, Teams, other supports. b. “Push-back” from all sectors against discharges
7

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i. “Anticipatory anxiety”: fear of taking new patients into a residence c. No partial hospital programs operational d. All social rehab programs closed e. Clubhouses closed and services became virtual f. Case managers only worked through telehealth, no face-to-face contacts g. Supported apartment staff only worked through telehealth, no face-to-face
contacts h. Assertive Community Treatment (ACT) teams cut services way back and worked
through phone calls and texting i. Outpatient services available at only a fraction of pre-COVID-19 availability j. Mobile crisis services “mostly stayed active” as demand for crisis services
increased substantially k. Medication appointments were virtual and this proved much harder for new
patients l. Most self- help groups stopped face-to-face meetings m. Support from religious community mostly gone n. Provider transportation “really at a minimum” and public transportation was high
risk o. Significant challenges for community residents to get money from Rep Payees p. All naturalistic community resources were closed. e.g., library, coffee shop q. Referrals possible but extremely difficult, negotiations case by case, took more
time and extra administrative staff
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r. “There is no comparison between the pre-COVID-19 level of community services and the community services during the pandemic”
7. Based upon the information gathered in my review, I conclude that community options did not provide safer alternatives to CVH or WFH for the following reasons: a. Community programs less able to get PPE than is hospital; “poor buying power” in the community b. Groups homes and congregate care usually in converted private homes presenting challenges to social distancing i. Narrow hallways ii. Shared small bathrooms iii. Small kitchen iv. Small dining area v. Little ability to isolate anyone c. Some group residences had to keep a vacant room open to run at decreased capacity to be able to accommodate any semblance of social distancing d. Unable to do any form of gradual transitioning to the community e. Covid-19 positive community residence went through 4 sites rapidly: residencegeneral hospital EDgeneral hospital inpatient unitWFH exposing them to more high risk areas and COVID positive patients than would have been the case if they were CVH or WFH inpatients f. No medical personnel on site at any community program g. Challenges to get discharged patients in a new setting to adhere to residence’s rules like social isolation in the residence, stay in the residence
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h. Suspected cases in the community were sent to the general hospital where they were less able to deal with the psychiatric problems than the patient who stayed in CVH or WFI and was moved to another location in the hospital
i. At this time there are no reliable data on deaths of DMHAS clients in the community
8. The plaintiffs asked the court to order Connecticut to have CVH and WFH 1) conform their testing protocols to CDC standards; 2) take steps to ensure staff consistently wear masks; 3) improve hygiene and decontamination practices; 4) implement social distancing to the maximum extent possible including by reducing census; and 5) undertake a clinical review in order to accelerate discharge.
9. As the data show, defendants have, in fact, done 1-4. The fact plaintiffs are unaware of this is due to the fact their experts made minimal effort to ascertain what was actually taking place at CVH or WFH. Plaintiffs’ experts read some documents. They did not speak to any staff at CVH or WFH, nor did they make any effort to do so. Connecticut received no request from any expert to interview staff. Nor did plaintiffs’ experts make any effort to tour CVH of WFH, which they could have done safely through a virtual tour as defendants’ expert did. Nor did plaintiffs’ experts review any treatment plans or other clinical material of the named plaintiffs to ascertain what risks each patient’s discharge would entail or what plans had been made for their discharges.
10. Defendants did not do #5, accelerate discharges. To have done so would have exposed patients to far greater risks of harm than keeping the patients at CVH and WFH. There were extraordinary limitations on services to discharge patients to. Even naturalistic services like libraries coffee shops, and churches/synagogues/mosques were closed. Even
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if defendants could have discharged more patients to residences than they did, there are no data that living in a group home in a small house is safer than being in a state hospital. To have accelerated discharges of patients who needed to be in CVH or WFH in the midst of the COVID-19 pandemic would not only have been below the standard of care, it would have been cruel. 11. Plaintiff’s expert, Manian, MD, MPH, an expert in medicine and infectious diseases, provides a primer on COVID-19 precautions. Much of what he states, no one would argue with as being relevant guidance; CVH and WFH are actually implementing all the well-founded steps. Dr. Manian states should be implemented. Dr. Manian makes no comparisons between what he believes is the standard of care for a psychiatric hospital during the COVID-19 pandemic and what CVH and WFM are actually doing. 12. Dr.Manian perhaps oversteps when he claims he has any expertise in what state hospitals are doing during the COVID-19 pandemic. He provides no background in this area. He claims some standards that no state hospital in the USA meets, nor for that matter would general hospitals. For example, he states the standard is that every patient should be tested for COVID-19 every week. 13. Dr.Manian opines on decreasing the census through discharge, an area far outside his scope of practice. He does not establish he has experience or expertise in conducting those risk assessments necessary to responsibly discharge a psychiatric patient. 14. Dr.Manian reaches the inaccurate conclusion that because there are no standards for psychiatric hospitals he can blindly apply nursing home standards. While I think that comparison is ill conceived, let’s defer to Dr. Manian for a moment and say that one can
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compare CVH to a nursing home. Let’s look at the COVID-19 outcomes for CVH and for the three nursing homes in Middletown:

Nursing Home Comparison

Facility

Location

Census

Positive Cases

Deaths

CVH

Middletown

239

40

5

Apple Rehab Middletown

70

46

18

Middlesex Middletown

150

63

27

Waters Edge Middletown

150

88

23

15. Based on these findings, CVH should be vastly expanding is admissions and its census,

not contracting them.

16. Had Dr. Manian reviewed the five deaths of patients at CVH related to COVID-19, which

he did not do, he would have found these were older, quite medically ill patients, who

were handled in a clinically sound manner following proper protocols. All but one was

treated for over 3 weeks in a general hospital. The fifth was treated there for one week.

17. Plaintiffs’ experts Canavan and Jones provide a joint Declaration. In the same manner as

Dr. Manian, they have reviewed a remarkably limited number of documents and have

done no more than that. They did not conduct interviews or tours and hence have no

knowledge of what CVH and WFH have actually done during the COVID-19 pandemic.

18. Their first point is they agree with Dr. Manian. However, neither one has any expertise

in medicine nor infectious diseases, so it is difficult to understand how they have standing

to agree or disagree with Dr. Manian.

19. Canavan and Jones depend on information in patients’ affidavits. However, a

comparison between the information in the affidavits and the information I obtained from

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Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 14 of 82
documents, interviews and tours, shows the patients are often ill informed. These experts make no attempt to verify any information contained in patients’ affidavits, nor do they ask to see any clinical material about these patients. 20. Canavan and Jones indicate that the situations the patients describe in their affidavits “could be avoided if there were fewer people on the unit, if there was a scheduled use of bathrooms, if staff reinforced the need for masks while in public areas, and if the bedrooms were consistently cleaned and restocked.” Had these experts asked, they would have found that all these interventions were and are being done. 21. Canavan and Jones’ description of how the Dutcher dining room is being managed also has no relationship to how it is actually being managed. Again, they failed to inquire about the management and set up. 22. Canavan and Jones state at paragraph #13, “Numerous patients indicated that staff has not consistently worn masks….” They do not state what patients they are referring to. They did not report interviewing any patients. They read seven patient affidavits, most of which state nothing about staff and masks. 23. Canavan and Jones make recommendations about space between beds in patients’ rooms, but have no information about what the space between beds is at CVH or WFH. 24. Canavan and Jones recommend census reduction through discharges to “communitybased settings with supports.” As the data in this affidavit indicate, there were very minimal supports. These two experts are disingenuous when they state they have vast experience transitioning patients into the community when, based on their CV’s, they have no such experience during a viral pandemic.
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25. Canavan and Jones’ suggestions for forensic patients would have more patients end up in jail and jails have been shown to be a much greater risk for COVID-19 than state hospitals.
26. Canavan and Jones characterize patients’ returns from leave to the hospital as a major problem, when the total number of people this applies to is two individuals.
27. Canavan and Jones state that DMHAS should make a whole range of services available to prospective patients instead of re-hospitalization when almost none of these services are operational. Agencies closed all these programs because it was unsafe for their staffs to work. Only CVH and WFH stayed fully operational despite the dangers to staff.
28. Canavan and Jones make recommendations about where the named plaintiffs might be discharged to, despite not knowing about these individuals except what the named plaintiffs attest to in their affidavits. Some of the patients have very serious risks; this information is left out of the patients’ affidavits.
29. Canavan and Jones state that based on conversations they had, they are “confident” community providers would engage with the hospital on planning and implementing discharge. It is not clear what conversations Canavan and Jones had or whom they conversed with. Based on my conversations with those in leadership positions in DMHAS, listed in Attachment 2, this is just plain wrong.
30. If CVH or WFH was the most integrated setting appropriate to a patient’s needs before the pandemic, then it is the most integrated setting appropriate to the persons needs during the pandemic. There is no evidence there is increased safety, all things considered, for such patients outside of CVH or WFH, then inside.
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31. The plaintiffs ask Connecticut to fashion all manner of Rube Goldberg-like discharges and then “ensure” that necessary community-based services are provided. It is my professional opinion that the first ask is dangerous; the second ask is impossible.
32. The plaintiffs’ paragraphs about each of the named plaintiffs lack so much significant information that for any psychiatrist to act on such scant data would be malpractice. None of the patients informs the court that he or she has committed arson, attempted murder, murdered his mother, or murdered his father.
33. In the plaintiffs’ Amended Class Action Complaint and Petition for a Writ of Habeas Corpus, paragraphs #53 through # 58 list what the defendants have failed to do. Based on my review of all the materials I have listed in Attachment 2and that I used as the basis for my opinion, the defendants have, in fact, not failed to do these things. The plaintiffs can only have come to these conclusions because their experts had terribly inadequate information and so misinformed plaintiffs’ counsel.
34. In my opinion CVH and WFH have functioned within what has been the standard of care for like faculties in other states during the COVID-19 pandemic. CVH and WFH have screened staff and patients; tested staff and patients; provided masks to staff and patients; set either requirement or expectations about wearing masks; decreased the census; decreased admissions; established and acted on procedures to quarantine known and suspected COVID positive patients; educated staff and patients through signage, training and modeling; restricted visitors; avoided comingling different units; established safer ways to feed patients and to administer medication; avoided to the maximal extent possible moving staff from one unit to another; platooned the psychiatry staff; and obtained repeated consultation from outside experts.
15

Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 17 of 82 35. CVH and WFH only discharged patients who could be safely discharged with the limited
existent resources, and they did not discharge patients to unsafe conditions simply to increase social distancing in the hospitals. What the plaintiffs ask the court to order Connecticut to do, in terms of the discharge of patients, would put CVH and WFH functioning below the standard of care and jeopardize the lives of the same individuals the plaintiffs want to protect. 36. Finally, the evidence that CVH and WFH have been and are acting in a medically sound fashion within the standard of care is in their outcomes. CVH and WFH have had far better outcomes than have facilities in the same city as CVH and WFH that plaintiffs put forward as a fair comparison to CVH and WFH.
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Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 18 of 82 DECLARATION
Pursuant to Conn. Gen. Stat. §§1-24a, 53a-157b, and 28 U.S.C. §1746, I declare under the pains and penalties of perjury that the foregoing statements are true and accurate to the best of my knowledge and belief.
Dated this eighth day of July, 2020. _________________________________ Jeffrey Geller, MD, MPH
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ATTACHMENT 1

Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 20 of 82

NAME: HOME ADDRESS:
BUSINESS ADDRESS:
BIRTH DATE: BIRTH PLACE: CITIZENSHIP:
UNDERGRADUATE September 1966June 1970
January 1969June 1969 GRADUATE September 1970December 1973
September 1976June 1978

CURRICULUM VITAE
Jeffrey L. Geller, M.D., M.P.H.
73 Twinbrooke Drive Holden, MA 01520 (508) 829-0404
73 Twinbrooke Drive Holden, MA 01520 (508-868-9361
April 12, 1948
New York, NY
U.S.A.
EDUCATION AND TRAINING
B.A. 1970 Psychology Williams College Williamstown, MA
Exchange Student Vassar College Poughkeepsie, NY
M.D. 1973 University of Pennsylvania School of Medicine Philadelphia, PA Rotation at the Austen Riggs Center
Stockbridge, MA, June, 1971-August, 1971 Rotation at Kaimosi Friends Hospital,
Kisumu, Kenya, May, 1973-August, 1973
M.P.H. 1978 Harvard School of Public Health Boston, MA

Jeffrey Geller, MD, MPH

Page 1

Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 21 of 82

POST GRADUATE January 1974June 1974 July 1974June 1977 July 1977June 1978
ACADEMIC APPOINTMENTS 1974-1978
1979-1983
1982-1984
1983-1984
1984, 1987, 1989
1984-1986
1986-1991
1991-
Jeffrey Geller, MD, MPH

Internship Philadelphia General Hospital Philadelphia, PA
Psychiatric Residency Beth Israel Hospital Boston, MA
N.I.M.H. Fellowship Psychiatry in Primary Care Medicine Beth Israel Hospital Boston, MA
APPOINTMENTS AND POSITIONS
Fellow Harvard Medical School Boston, MA
Assistant Professor University of Massachusetts Medical School Worcester, MA
Clinical Assistant Professor Smith School for Social Work Northampton, MA
Assistant Professor Harvard Medical School Cambridge, MA
Adjunct Winter Study Faculty Williams College Williamstown, MA
Assistant Professor University of Pittsburgh, School of Medicine Pittsburgh, PA
Associate Professor University of Massachusetts Medical School Worcester, MA
Professor

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Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 22 of 82

University of Massachusetts Medical School Worcester, MA

1993-1994

Robert Wood Johnson Health Policy Fellow

1995-2007

Adjunct Faculty, Professor Smith College School for Social Work Northampton, MA

9/01-12/01

Visiting Professor Psychology Department Williams College Williamstown, MA

2/10/03-2/14/03

Visiting Professor Department of Psychiatry University of Hawaii School of Medicine Honolulu, HI

4/12/10-4/17/10

Visiting Professor Tirana University Tirana, Albania

2/10-2/11/11

Visiting Professor Department of Psychiatry Makerere University College of Health Sciences School of Medicine Kampala, Uganda

ACADEMIC CLINICAL AND ADMINISTRATIVE POSITIONS

1979-1983

Director Psychiatric Regional Resource Unit/Northampton State Hospital Northampton, MA

1983-1984

Medical Director Westfield Community Support Services Westfield, MA

1984-1986

Law and Psychiatry Program Western Psychiatric Institute and Clinic Pittsburgh, PA
Associate Director, 1986

1986-2012
Jeffrey Geller, MD, MPH

Director of Public Sector Psychiatry Department of Psychiatry University of Massachusetts Medical School

Page 3

Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 23 of 82

1986-2016 1988-1989 1990-1992 1990-1998 2012-

Worcester, MA
Westfield Area Mental Health Clinic Westfield, MA
Interim Medical Director, 1987-1988
Interim Director, Continuing Treatment Service Worcester State Hospital Worcester, MA
Director, Open Units Service Worcester State Hospital Worcester, MA
Medical Director Department of Mental Health Central Massachusetts Area Worcester, MA
Medical Director Worcester Recovery Center and Hospital Worcester, MA

CERTIFICATION AND LICENSURE

SPECIALTY CERTIFICATION

1981

Diplomate, American Board of Psychiatry and Neurology

MEDICAL LICENSURE

1974-

Massachusetts, Board of Registration of Medicine

1984(inactive)

Pennsylvania, Bureau of Professional and Occupational Affairs

MEMBERSHIPS IN PROFESSIONAL AND SCIENTIFIC SOCIETIES

1974-

American Psychiatric Association

1974-1984, 1986-

Massachusetts Psychiatric Society

1980-1984

Western Massachusetts Psychiatric Society

1984-1988, 2004-

American Academy of Psychiatry and the Law

1984-1986

Pennsylvania Psychiatric Society

Jeffrey Geller, MD, MPH

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Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 24 of 82

1984-2010 1984198719881988-2000 2011-
1969 1970 1970 1989 1990
1992
1993-1994 1994
1994
1996
1997
1999
2002 2003
Jeffrey Geller, MD, MPH

American Association for the History of Medicine
American Association of Community Psychiatrists
American Association for Social Psychiatry
American Association of Psychiatric Administrators
Group for the Advancement of Psychiatry
World Federation for Mental Health
HONORS
Phi Beta Kappa, Williams College
Summa cum Laude, Williams College
Sigma Xi Science Honor Society
Fellow, American Psychiatric Association
Walter E. Barton Award The American College of Mental Health Administration
Exemplary Psychiatrist Award National Alliance for the Mentally Ill
Robert Wood Johnson Health Policy Fellow
Effective Legislative Fellow Award National Alliance for the Mentally Ill
Board of Directors' Award Community Healthlink Inc.
The Myers Center Award for the Study of Human Rights in North America
Rothstein Award Massachusetts Alliance for the Mentally Ill
President's Award for Public Service University of Massachusetts
Distinguished Fellow, American Psychiatric Association
Arnold L. van Ameringen Award for Psychosocial Rehabilitation
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Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 25 of 82

American Psychiatric Association

2005

Torrey Advocacy Commendation Award Treatment Advocacy Center

2006

Ronald A. Shellow Award APA Assembly

2010

Distinguished Life Fellow, American Psychiatric Association

2010

Outstanding Psychiatrist Award for Public Sector Massachusetts Psychiatric Society

2012

Lifetime Achievement Certificate Pakistan Psychiatric Society

2014

Human Rights Award American Psychiatric Association

SERVICE

NATIONAL AND REGIONAL COMMITTEE ASSIGNMENTS:

1977-1978

Co-chairperson of Professional Advisory Board to Plaintiff's Legal Council, Brewster v. Dukakis

1978

Member, Harvard University Primary Care Delegation to the People's Republic of China

1979-1984

Member, Department of Mental Health Region I Research Review Committee, Commonwealth of Massachusetts

1980-1981

Member, Massachusetts Mental Health Committee, Clinical Committee

1981-1983

Member, City of Northampton Task Force on Deinstitutionalization

1984-1988

American Academy of Law and Psychiatry: Public Service Committee

1985-1996

American Psychiatric Association: Committee on International Abuse of Psychiatry and Psychiatrists Member 1985-1991 Vice Chairman, 1989-1991 Corresponding Member, 1991-1996

1985-1987

American Psychiatric Association: DSM III R Advisory Committee on Impulse Disorders Not Elsewhere Classified

Jeffrey Geller, MD, MPH

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Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 26 of 82

1986-1987 1987-1989, 20101988-1994 1990-1995 1991-2000
1993-1996 1993-2001 1993-1996 1993-2006 1996-1998 1998-2003 1999-2000 2000-2002 2001-2006, 2012-2019
Jeffrey Geller, MD, MPH

American Psychiatric Association: Local Arrangements Committee, 1987 Institute on Hospital and Community Psychiatry

Massachusetts Psychiatric Society: Public Sector Committee

American Psychiatric Association: DSM IV Advisory Committee on Impulse Disorders Not Elsewhere Classified

American Psychiatric Association: Committee on Psychiatric Services Resource Center Vice Chairman, 1991-1995

American Psychiatric Association: Council on International Affairs Consultant, 1991-1995 Assembly Liaison, 1995-1998 Member, 1997-2000 Vice Chairman, 1997-1998 Chairman, 1999-2000

American Psychiatric Association: Task Force on Psychiatry in U.S. Territories
Chairman, 1993-1996

Massachusetts Psychiatric Society: District Branch Assembly Representative Lead Representative, 1996-2001

National Advisory Board of Pew Charitable Trust State Hospital Closing Project

American Psychiatric Association Assembly Committee on Public Psychiatry Chair 2004-2006

American Psychiatric Association History and Library Committee Corresponding Member, 1996-1998

Partners in CARE National Advisory Council National Mental Health Association,

Co-Chair, Scientific Program Committee of the Second Sino-American Conference on Psychiatry, Beijing, China, April 6-10, 2000

American Psychiatric Association: Commission on Global Psychiatry

American Psychiatric Association: Assembly Deputy Area I Rep 2001-2002 Area 1 Rep 2002-2006

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Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 27 of 82

2001-2006 2003-2006 2004-2005 2004-2008 2004200420042006-2011, 2012-
2007-2011 20082008-2009 2008-2019
2008-2009 2011-
Jeffrey Geller, MD, MPH

Assembly Executive Committee 2002-2006, 2018-2019 Assembly Committee on Planning 2003-2006 AOL/ACROSS Rep, American Association of Community Psychiatry, 2012-2019 Assembly ACROSS Rep 2018-2019

American Psychiatric Association: Council on Social Issues and Public Policy

American Psychiatric Association: Intracouncil Workgroup on Inpatient Capacity

CMHS Acute Care Subcommittee

CMHS National Advisory Council Secretary (highest office), 2004-2008

American Psychiatric Association: Medicaid Advisory Group

NAMI Scientific Council

Treatment Advocacy Center, Board

American Psychiatric Association: Board of Trustees Area 1 Trustee, 2006-2009 Vice President, 2009-2011 Area 1 Trustee, 2012-2018 President-Elect 2019-2020 President 2020-

American Psychiatric Association: Council on Advocacy and Public Policy

American Academy of Psychiatry and the Law: Developmentally Disabled Committee

Chair, APA Board Work Group on APA-Pharma Relationship

American Association of Community Psychiatrists: Area 1 Rep, Board of Directors 2008-2014 AOL Rep to APA Assembly 2012-2016, 2018-2019 At-Large Rep, Board of Directors, 2014-2019

American Psychiatric Association: Committee on Psychiatric Diagnosis and Assessment

Geneva Initiative on Psychiatry - USA, Board of Directors

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2011-

World Federation for Mental Health, Vice President. Executive Board, 2016-

2012-

Clubhouse International, Board

2018-

SAMHSA National Advisory Council

2019-2020

APA Joint Reference Committee Chair 2019-2020

2019-2020

American Psychiatric Foundation Board

MEDICAL SCHOOL COMMITTEE ASSIGNMENTS:

University of Massachusetts:

1980-1983

Utilization Review Committee, Northampton State Hospital

1980-1983

Executive Council, Department of Mental Health Region I

1981-1982

Search Committee, Psychiatry Chair of University of Massachusetts Medical Center

1986-

Executive Committee, Department of Psychiatry

1986-1992

Residency Education Committee

1987-1993

Planning Committee, Psychiatric Treatment and Research Center

1987-1993

Planning Committee, Worcester Psychiatric Rehabilitation Center

1990-1994

Review Committee for Public Service Endowment Grants

1990-1991

Search Committee, Psychiatry Chair of the Medical Center of Central Massachusetts

1991-1992

Co-Director, Salute to Science

1991-1993

Medical School Library Committee

1993-1994

Review Committee for James P. Healey Awards

1993-1994

Search Committee, Psychiatry Chair of St. Vincent Hospital, Worcester, Massachusetts

1994-1998

Pappas Commission on Medical Services at Framingham MCI

Jeffrey Geller, MD, MPH

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1999-2001 2010-2013
2012-

Strategic Planning Committee: Community Benefits
Psychiatry Department Grand Rounds Committee Co-Chair, 2010-2011 Chair, 2011- 2013
Onboard Mentor

University of Pittsburgh:

1984-1986

Utilization Review Committee, Western Psychiatric Institute and Clinic

1984-1986

Ethics and Human Rights Committee, Presbyterian University Hospital

HOSPITAL COMMITTEE ASSIGNMENTS

Worcester Recovery Center and Hospital

2012-

Clinical Care: Chair

2012-

Pharmacy and Therapeutics

2012-

Professional Staff Organization Executive Committee

2012-

Planning

2012-

Morbidity and Mortality

2013-

End of Life

2014-

Department Directors, Chair

COMMUNITY BOARDS:

1991-

Genesis Club (Fountainhouse Clubhouse)

2003-2004

Sapling Project

EDITORIAL BOARDS AND JOURNAL REFEREE:

19781986-
1987198819911991-
Jeffrey Geller, MD, MPH

Referee, American Journal of Psychiatry Referee, Psychiatric Services (formerly Hospital and Community
Psychiatry) Referee, Community Mental Health Journal Referee, American Psychiatric Press Referee, Journal of Nervous and Mental Disease Referee, Behavioral Sciences and the Law
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1992-2000 19941995-2016 200120062007200720082008-
200920092010201120122012201220122012
2014201420172018
1976-1977
1976-1978
1977-1978
1979-1983
1979-1983
1979-1983
1981-1983
Jeffrey Geller, MD, MPH

Editorial Board, Psychiatric Services Column Editor, Psychiatric Services Book Review Editor, Psychiatric Services Referee, Lancet Referee, Journal of Behavioral Health Services & Research Referee, Israel Journal of Psychiatry Referee, Psychology, Public Policy & Law Referee, Biomedical Central Psychiatry Special Issue Editor, “Transition to Adulthood Research: Process and
Outcome Findings.” Journal of Behavioral Health Services & Research Referee, African Journal of History and Culture Referee, Clinical Psychology Review Referee, Journal of Psychopharmacology Referee, Aggression and Violent Behavior Referee, Australian and New Zealand Journal of Psychiatry Referee, Health Affairs Referee, Social Psychiatry and Psychiatric Epidemiology Editorial Board, International Journal of Clinical Medicine Special Section Editor, "Navigating the Waters of Digital Technology." Psychiatric Times, December 7, 2012 Referee, Mental Health Review Journal Referee, Comprehensive Psychiatry Book Review Editor, Community Mental Health Journal Referee. Clinical Nursing Studies
TEACHING
Taught Introduction to Clinical Medicine, Harvard Medical School
Supervisor for Medical Students on clinical rotation in psychiatry, Harvard Medical School
Instructed and supervised primary care residents and primary care staff on psychiatric care, Harvard Medical School and Beth Israel Ambulatory Care Center
Directed required psychiatry rotation for third and fourth year medical students of UMass Medical School at Northampton State Hospital
Coordinator of Psychiatric Grand Rounds, U. Mass Medical School, Northampton State Hospital
Developed and taught patient interviewing utilizing video equipment, UMass Medical School at Northampton State Hospital
Co-Developed a Psychology Internship Program at Northampton State Hospital
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1981-1984 1984-1986 1984-1986 1984-1986 1984-1986 1986-1989 1986-
1986-1992 1987-1994 1990-1992 1998-2001 1998-2009 2002-2012 2006-2012 2006-2012 20112013-
Jeffrey Geller, MD, MPH

Supervisor for Smith School for Social Work Students on placement at Northampton State Hospital

Supervision of Psychiatric Residents at Western Psychiatric Institute and Clinic for Psychotherapy and Community Psychiatry

Coordinate Law and Psychiatry rotation for psychiatric residents at Western Psychiatric Institute and Clinic

Coordinate medical student elective in Law and Psychiatry at U. of Pittsburgh School of Medicine

Teach medical students in required rotations and in clinical ethics at U. of Pittsburgh School of Medicine

Teach second year medical student course in Behavioral Science at UMass Medical School

Supervision of psychiatric residents at U. Mass Medical School PGY 2 and PGY 4: Psychotherapy PGY 3: Public Sector Psychiatry

Co-teach with Aaron Lazare, M.D., and Paul Barreira, M.D., seminar for PGY II residents in ongoing psychotherapy

Develop and direct didactic component of Public Sector Community Psychiatry rotation for PGY III & IV residents

Co-developed and supervise, with Paul Barreira, M.D., the "Adopt-AResident" Program

Responsible for Schizophrenia Module in PGY 1/2 Core Didactic Series

Coordinator of Clinical Case Conference Series at Quincy Mental Health Center, Quincy, MA

Responsible for Public Sector Didactic Series in PGY III/IV Core

Direct Continuing Education Seminar for Area Medical Directors

Co-direct, History of Psychiatry Seminar, PGY I/II/III/IV

Project Advisor, Forensic Fellows

Onboard Mentor, New Faculty

CONSULTANT/EXPERT

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1977-1978
1981-1984 1982-1983 1985-1989 1985-2000 1985-1990 1987-1989 19871990-1991 1991-1993 1991-2004 1992-1993
1993-1994 1993-1996
1993-1994, 1996-2003
1995-1997 1995, 2001 1998
1998-2001 2000
2000-2005
Jeffrey Geller, MD, MPH

Expert on behalf of plaintiffs, Brewster v Dukakis (Treatment in the Least Restrictive Setting)

Franklin/Hampshire Community Mental Health Center

Center for Human Resources, Northampton, MA

U.S. Attorney, Western District of Pennsylvania

U.S. Dept. of Justice, Civil Rights Division (CRIPA)

New York State Office of Mental Health (Includes 2 CRIPA Cases)

Buffalo Psychiatric Center

Massachusetts Board of Registration in Medicine

Bliss Mental Health Center

Massachusetts Rehabilitation Commission

Geneva Initiative (International)

Expert on behalf of Milwaukee County, Joan S. v Jon Gudeman/Milwaukee County

Weston State Hospital/William R. Sharpe, Jr. Hospital, Weston, WV

Evaluation, Hawthorne Children’s Psychiatric Hospital (Missouri state facility)

Commonwealth of Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services (Includes 4 CRIPA Cases)

District of Columbia’s Commission on Mental Health Services

District Attorney NYS, Washington County

Expert on behalf of Pennsylvania, Kathleen S. v Pennsylvania, Department of Public Welfare (Olmstead Case)

Vermont Protection and Advocacy

Department of Veterans Affairs, Board of Veterans Appeals, Washington, DC

New Jersey: Greystone Park Psychiatric Center

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2001-2007
2001-2009
2002
2002-2003
2005-2009
2005-2010
2005-2006 2005-2008 2006-2010
2006-2011 2006-2011 2007-2012 2007-2010
2007-2009 2007-2008 2007-2009 2008-2012 2008-2010 2009-2010
Jeffrey Geller, MD, MPH

Tennessee Attorney General/Tennessee Department of Mental Health and Developmental Disabilities (CRIPA)
North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services and Attorney General’s Office (CRIPA)
Expert on behalf of Case Western Reserve, Hunt v University Psychiatrists of Cleveland
Expert on behalf of Pennsylvania, Frederick L. v. Department of Public Welfare of Pennsylvania (Olmstead Case)
New York State Attorney General, Disability Advocates Inc. v. New York State II (Olmstead Case)
Vermont Department of Health/Vermont State Hospital Consultant 2005-2012 Monitor 2006-2012
New Hampshire Department of Health and Human Services
Monitor, U.S. vs. North Carolina (CRIPA)
Connecticut Department of Mental Health and Substance Abuse Services (Includes CRIPA)
Oregon State Hospital and Attorney General’s Office (Includes CRIPA)
World Health Organization (WHO), Albania
New Jersey Division of Mental Health Services (Includes CRIPA)
Georgia State Attorney General’s Office and Division of Mental Health, Developmental Disabilities and Addictive Diseases (CRIPA)
Delaware Department of Health and Human Services (CRIPA)
Oklahoma Department of Mental Health
Washington State Mental Health Division
New York State Office of Mental Health/Kingsboro Psychiatric Center
Williams v. Quinn, Illinois (Olmstead Case)
Streamwood Hospital (Children’s Psychiatric), Illinois
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2009-2011

New York State Attorney General, Disability Advocates Inc. v. New York State III (Olmstead Case)

2011

The Lucas Group, Boston, MA

2013-2016

Massachusetts Attorney General’s Office, Commonwealth v. JRC

2018-

Mississippi Department of Mental Health

PUBLICATIONS

REFEREED ARTICLES

Geller J: "The Development of Behavior Therapy with Autistic Children: A Review." Journal of Chronic Diseases 25:21-31, 1972.

Geller JL: "Treatment of Anorexia Nervosa by the Integration of Behavior Therapy and Psychotherapy." Psychotherapy and Psychosomatics 26:167-177, 1975.

Geller JL, Lister E: "The Process of Criminal Commitment for Pretrial Psychiatric Examination: An Evaluation." American Journal of Psychiatry 135:53-60, 1978.

Geller JL: "The Muddied Path Between the Criminal Court and the State Hospital." Journal of Psychiatry and Law 8:389-411, 1980.

Geller JL: "Sustaining Treatment with the Hospitalized Patient Who Refuses Treatment." American Journal of Psychiatry 139:112-113, 1982.

Geller JL: "State Hospital Patients and Their Medication: Do They Know What They Take?" American Journal of Psychiatry 139:611-615, 1982. Reprinted in Spring RL, Lacoursiere RB, Weissenberger G: Patients, Psychiatrists and Lawyers: Law and the Mental Health System. Anderson, Cincinnati, 1989.

Geller J, Brandzel M: "Addressing the Borderline's Repetitive Misuse of the State Hospital: A Case Report." Psychiatric Quarterly 55:275-278, 1983.

Geller J: "Arson: An Unforeseen Sequela of Deinstitutionalization." American Journal of Psychiatry 141:504508, 1984.

Geller JL, Bertsch G: "Firesetting Behavior in the Histories of a State Hospital Population." American Journal of Psychiatry 142:464-468, 1985.

Geller JL: "Women's Accounts of Psychiatric Illness and Institutionalization." Hospital and Community Psychiatry 36:1056-1062, 1985.

Geller JL: "The Long-Term Outcome of Unresolved Grief: An Example." Psychiatric Quarterly 57:142146, 1985.

Jeffrey Geller, MD, MPH

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Geller JL: "In Again, Out Again. A Preliminary Evaluation of a State Hospital's Worst Recidivists." Hospital and Community Psychiatry 37:386-390, 1986.
Geller JL, Erlen J, Pinkus R: "A Historical Appraisal of America's Experience with 'Pyromania'--A Diagnosis in Search of a Disorder." International Journal of Law and Psychiatry 9:201-229, 1986.
Geller JL: "Rights, Wrongs, and the Dilemma of Coerced Community Treatment." American Journal of Psychiatry 143:1259-1264, 1986.
Geller JL, Munetz MR: "The Process of Staff Change: Grappling with the Needs of the High-Management Patient." Hospital and Community Psychiatry 37:1047-1049, 1986.
Geller JL: "The Quandaries of Enforced Community Treatment and Unenforceable Outpatient Commitment Statutes." The Journal of Psychiatry and Law 14:149-158, 1986.
Mulvey EP, Geller JL, Roth LH: "Balancing the Promises and Perils of Involuntary Outpatient Commitment." American Psychologist 42:571-584, 1987.
Geller JL: "Fire-setting in the Adult Psychiatric Population." Hospital and Community Psychiatry, 38:501506, 1987. Abstracted in Psychiatry Digest 1:3-5, 1988.
Geller JL: The "Elixir of Life?" The Journal of Irreproducible Results 33(2):20, 1987.
Geller JL, Lidz CW: "When the Subjects are Hospital Staff, is it Ethical (or Possible) to Get Informed Consent?" IRB 9:4-5, 1987.
McEvoy JP, Apperson LJ, Appelbaum PS, Ortlip P, Brecosky J, Hammill K, Geller JL, Roth L: "Insight in Schizophrenia: Its Relationship to Acute Psychopathology." Journal of Nervous and Mental Disease 177:4347, 1989.
McEvoy JP, Freter S, Everett G, Geller JL, Appelbaum P, Apperson LJ, Roth L: "Insight and the Clinical Outcome of Schizophrenic Patients." Journal of Nervous and Mental Disease 177:48-51, 1989.
McEvoy JP, Appelbaum PS, Apperson LJ, Geller JL, Freter S: "Why Must Some Schizophrenic Patients be Involuntarily Committed? The Role of Insight." Comprehensive Psychiatry 30:13-17, 1989.
Geller JL: "Deinstitutionalization in Nineteenth Century America: A Case Example." Hospital and Community Psychiatry 40:85-86, 1989.
Fisher WH, Geller JL, Costello DJ, Phillips BF: "Demographic Trends and Mental Health Services: State hospitals in the 1990's." Hospital and Community Psychiatry 40:747-749, 1989.
Schmidt MJ, Geller JL: "Involuntary Administration of Medication in the Community - The Judicial Opportunity." Bulletin of the American Academy of Psychiatry and the Law 17:283-292, 1989.
Geller JL: "A Bite of AIDS? Institutional Line Staff and the Fear of HIV Contagion." Psychiatric Quarterly 60:243-251, 1989. Abstracted in Sociological Abstracts.

Jeffrey Geller, MD, MPH

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Geller JL, Erlen J, Kaye NS, Fisher WH: "Feigned Insanity in Nineteenth Century America: Tactics, Trials, and Truth." Behavioral Sciences and the Law 8:3-26, 1990.
Fisher WH, Geller JL, Wirth-Cauchon J: "Empirically Assessing the Impact of Mobile Crisis Capacity on State Hospital Admissions." Community Mental Health Journal 26:245-253, 1990.
Geller JL: "Low Dose Neuroleptic Treatment (case report)." American Journal of Psychiatry 147:672, 1990.
Geller JL, Fisher WH, Wirth-Cauchon JL, Simon LJ: Second Generation Deinstitutionalization I: "The Impact of Brewster v. Dukakis on State Hospital Case Mix." American Journal of Psychiatry 147:982-987, 1990. Abstracted in Sociological Abstracts and in Digest of Neurology and Psychiatry, Nov/Dec 1990, p. 264.
Geller JL, Fisher WH, Simon LJ, Wirth-Cauchon JL: "Second Generation Deinstitutionalization II: The Impact of Brewster v. Dukakis on Correlates of Community and Hospital Utilization." American Journal of Psychiatry 147:988-993, 1990. Abstracted in Sociological Abstracts and in Digest of Neurology and Psychiatry, Nov/Dec 1990, p. 265.
Geller JL: "Clinical Guidelines for the Use of Involuntary Outpatient Treatment." Hospital and Community Psychiatry 41:749-755, 1990. Abstracted in Sociological Abstracts.
Geller JL, Kaye NS: "Smoking in Psychiatric Hospitals: A Historical View of a Hot Topic." Hospital and Community Psychiatry 41:1349-1350, 1990.
Geller JL: "Any Place but the State Hospital. Examining Assumptions about the Benefits of Admission Diversion." Hospital and Community Psychiatry 42:145-152, 1991.
Geller JL: "Operation Desert Storm and Delusions about the War Among Chronic Patients in the Community." Hospital and Community Psychiatry 42:419-420, 1991.
Geller JL, Fisher WH, Kaye NS: "Effect of evaluations of competency to stand trial on the state hospital in an era of increased community services." Hospital and Community Psychiatry 42:818-823, 1991. Abstracted in Psychiatry Digest 5:21-22, 1992.
Geller JL: "Rx: A Tincture of Coercion in Outpatient Treatment." Hospital and Community Psychiatry 42:1068-1070, 1991.
Geller JL, Erlen J, Kaye NS, Fisher WH: "Feigned Insanity in Nineteenth Century America: Experts, Explanations, Evaluations, and Exculpations." Anglo-American Law Review 20:443-481, 1991.
Fisher WH, Geller JL, Pearsall D, Simon L, Wirth-Cauchon J: "A Continuum of Services for the Deinstitutionalized, Chronically Mentally Ill Elderly." Administration and Policy in Mental Health 18:397-410, 1991.
Geller JL: "Communicative Arson." Hospital and Community Psychiatry 43:76-77, 1992.

Jeffrey Geller, MD, MPH

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Tonkonogy JM, Geller JL: "Hypothalamic Lesions and Intermittent Explosive Disorder." Journal of Neuropsychiatry and Clinical Neurosciences 4:45-50, 1992.

Geller JL: "Clinical Encounters with Outpatient Coercion at the CMHC: Questions of Implementation and Efficacy." Community Mental Health Journal 28:81-94, 1992.

Fisher WH, Geller JL, Altaffer F, Bennett MB: "The Relationship Between Community Resources and State Hospital Recidivism." American Journal of Psychiatry 149:385-390, 1992.

Geller JL, White C, Fisher WH, Sorgi P, Jarvey AM: "Operation Desert Storm and a State Hospital Population: What Patients Knew, Thought, and Felt." Hospital and Community Psychiatry 43:833-835, 1992.

Geller JL: "Pathological Firesetting in Adults." International Journal of Law and Psychiatry 15:283-302, 1992.

Geller JL: "A Survey of the "Worst" State Hospital Recidivists in the USA." Hospital and Community Psychiatry 43:904-908, 1992.

Geller JL, Gaulin BD, Barreira PJ: A Practitioner’s Guide to Use of Psychotropic Medication in Liquid Form. Hospital and Community Psychiatry 43:969-971, 1992.

Geller JL: "A Historical Perspective on the Role of State Hospitals Viewed from the Era of the Revolving Door." American Journal of Psychiatry 149:1526-1533, 1992.

Geller JL, Fisher WH, Moynihan K: "Adult Lifetime Prevalence of Fire-setting Behaviors in a State Hospital Population." Psychiatric Quarterly 63:129-142, 1992.

Geller JL, Fisher WH, Bertsch G: "Who Repeats? A Follow-Up Study of State Hospital Patients' Firesetting Behavior." Psychiatric Quarterly 63:143-157, 1992.

Geller JL: "Treating Revolving-Door Patients Who Have 'Hospitalphilia': Compassion, Coercion, and Common Sense." Hospital and Community Psychiatry 44:141-146, 1993.

Nicholson J, Geller JL, Fisher WH, Dion GL: "State Policies and Programs that Address the Needs of Mentally Ill Mothers in the Public Sector." Hospital and Community Psychiatry 44:484-489, 1993.

Geller JL, Fisher WH: "Transitional Residences in the Linear Continuum: Debunking the Myth." American Journal of Psychiatry 150:1070-1076, 1993.

Munetz MR, Geller JL: Least Restrictive Alternative in the Post- institutional Era. Hospital and Community Psychiatry 44:967-973, 1993.

Fisher WH, White C, Geller JL, Altaffer F: Predicting State vs. Private Hospital Referral in Psychiatric Emergencies. Administration and Policy in Mental Health 21:449-461, 1994.

Geller JL: Issues in American Psychiatry Reflected in Remarks of APA Presidents, 1844-1994. Hospital and Community Psychiatry 45:993-1004, 1994.

Jeffrey Geller, MD, MPH

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Fisher WH, Geller JL, White CL, Altaffer F: "'Serving the Seriously Mentally Ill in the Least Restrictive Alternative': Issues from a Federal Court Consent Decree." Administration and Policy in Mental Health 22:423-436, 1995.
Geller JL: A Biopsychosocial Rationale for Coerced Community Treatment in the Management of Schizophrenia. Psychiatric Quarterly, 66:219-235, 1995.
White CL, Bateman A, Fisher WH, Geller JL: Factors Associated with Admission to Public and Private Hospitals from a Psychiatric Emergency Screening Site. Psychiatric Services 46:467-472, 1995.
White CL, Nicholson J, Fisher WH, Geller JL: "Mothers with Severe Mental Illness Caring for Children." Journal of Nervous and Mental Disease 183:398-403, 1995.
Geller JL, Fisher WH, McDermeit M: A National Survey of Mobile Crisis Services and Their Evaluation. Psychiatric Services 46:893-897, 1995.
Fisher WH, Soreff S, Geller JL, McDermeit M, White CL, Hicks L: Inpatient Treatment "Careers" of Persons with Schizophrenia: Public and Private Hospital Utilization. Administration and Policy in Mental Health 23:137-151, 1995.
Fisher WH, Simon L, Geller JL, Penk WB, Irvin EA, White CL: Case mix in the "downsizing" state hospital. Psychiatric Services 47:255-262, 1996.
Nicholson J, Geller JL, Fisher WH: "Sylvia Frumkin" has a baby: A case study for policy makers. Psychiatric Services 47:497-501, 1996.
Geller JL: Mental Health Services in the Future: Managed Care, Unmanaged Care, Mismanaged Care. Smith College Studies in Social Work 66:223-239, 1996.
Geller JL: Self-incineration: A review of the psychopathology of setting oneself afire. International Journal of Law and Psychiatry 29:355-372, 1997.
Geller JL, Grudzinskas AJ, McDermeit M, Fisher WH, Lawlor T: The efficacy of involuntary outpatient psychiatric treatment in Massachusetts. Administration and Policy in Mental Health 25:271-285, 1998.
Geller JL, Brown JM, Fisher WH, Grudzinskas AJ, Manning TD: A National survey of “consumer empowerment” at the state level. Psychiatric Services 49:498-503, 1998.
Geller JL, Fisher WH, McDermeit M, White C: The rights of state hospital patients: From state hospitals to their alternatives. Administration and Policy in Mental Health 25:387-401, 1998.
Nicholson J, Sweeney EM, Geller JL: Mothers with mental illness: I. The competing demands of parenting and living with mental illness. Psychiatric Services 49:635-642, 1998.
Nicholson J, Sweeney EM, Geller JL: Mothers with mental illness: II. Family relationships and the context of parenting. Psychiatric Services 49:643-649, 1998.

Jeffrey Geller, MD, MPH

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Tonkonogy JM, Geller JL: Late-onset paranoid psychosis as a distinct clinicopathological entity. Neuropsychiatry, Neuropsychology and Behavioral Neurology 12:230-235, 1999.

Geller JL: The last half-century of psychiatric services as reflected in Psychiatric Services. Psychiatric Services 51:41-67, 2000.

Geller JL, Fisher WH, McDermeit M, Brown JM: The effects of public sector managed care on patterns of intensive use of inpatient psychiatric services. Psychiatric Services, 49:327-332, 1998. Reprinted in Psychiatric Services 51:1385-1391, 2000.

Geller JL: The use of advance directives by persons with serious mental illness for psychiatric treatment. Psychiatric Quarterly 71:1-13, 2000.

Penk WE, Flannery Jr. RB, Irvin E, Geller J, Fisher W, Hanson MA: Characteristics of substance-abusing persons with schizophrenia: The paradox of the dually diagnosed. Journal of Addictive Diseases 19:2330, 2000.

Geller JL: At the margins of human rights and psychiatric care in North America. Acta Psychiatrica Scandinavica 101 (399):87-92, 2000.

Geller JL: Excluding Institutions for Mental Diseases from federal reimbursement for services: Strategy or tragedy. Psychiatric Services 51:1397-1403, 2000.

Fisher WH, Barreira PJ, Geller JL, White AW, Lincoln AK, Sudders M: Long-stay patients in state psychiatric hospitals at the end of the 20th century. Psychiatric Services 52:1051-1056, 2001.

Geller JL, Sprung S, McCracken SG, Boggio RM, Munetz MR, Zarate CA, Evans NK, Sudders M: The case of Sam: multidisciplinary perspectives. Psychiatric Services 52:1318-1330, 2001.

Stovall J, Hobart M, Geller JL: One strike and you’re out: the impact of an employees’ strike upon a community mental health center. Psychiatric Services, 55:188-191, 2004.

Geller JL, Morrissey JP: Asylum within and without asylums. Psychiatric Services 55:1128-1130, 2004.

Geller JL, Stanley JA: Settling the doubts about the constitutionality of outpatient commitment. New England Journal of Criminal and Civil Confinement, 31:127-138, 2005.

Geller JL, Stanley JA: Response to: New research continues to challenge the need for outpatient commitment. Journal of Criminal and Civil Confinement, 31:123-126, 2005.

Geller JL, Shore H, Grudzinskas AJ, Appelbaum PS: Against the grain? A reasoned argument for not closing a state hospital. Psychiatric Quarterly, 76:177-194, 2005.

Geller JL: A history of private psychiatric hospitals in the USA: From start to almost finished. Psychiatric Quarterly, 77:1-41, 2006.

Geller JL: The evolution of outpatient commitment in the USA: From conundrum to quagmire. International Journal of Law and Psychiatry, 29:234-248, 2006.

Jeffrey Geller, MD, MPH

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Biebel K, Nicholson J, Fisher W, Geller J: A national survey of state mental health authority programs and policies for clients who are parents: A decade later. Psychiatric Quarterly, 77:119-128, 2006.
Geller JL: Avoiding extinction: Successful private psychiatric hospitals in the opening decade of the twenty-first century. Psychiatric Quarterly, 77:189-201, 2006.
Geller JL, Biebel K: The premature demise of public child and adolescent inpatient psychiatric beds. Part I: Overview and current conditions. Psychiatric Quarterly, 77: 251-271, 2006.
Geller JL, Biebel K: The premature demise of public child and adolescent inpatient psychiatric beds. Part II: Challenges and implications. Psychiatric Quarterly, 77:273-291, 2006.
Geller JL, Fisher WH, Grudzinskas AJ, Clayfield JC, Lawlor T: Involuntary outpatient treatment as ‘Deinstitutionalized Coercion’: The net-widening concern. International Journal of Law and Psychiatry, 29(6):551-562, 2006.
Tonkonogy J, Geller J: A neuropsychiatry service in a state hospital. Adolf Meyer’s approach revisited. Psychiatric Quarterly, 78:219-235, 2007.
Lawlor T, Grudzinskas AJ, Geller JL, Genovese M: A competency-based approach to managing violence with involuntary outpatient treatment. Administration and Policy in Mental Health & Mental Health Policy Research 34(3):315-318, 2007.
Geller JL: Back to the nineteenth century is progress. Philosophy, Psychiatry, & Psychology 15:19-21, 2008.
Torrey EF, Esposito R, Geller J: Problems associated with mentally ill individuals in public libraries. Public Libraries 42(2):45-50, 2009.
Fisher WH, Geller JL, Pandiani JA: The changing role of the state psychiatric hospital. Health Affairs 28(3):676-684, 2009.
Webster SL, Sheitman BB, Barboriak PN, Harmon SH, Paesler BT, Gordon PA, Kelly SY, Geller JL: Integrating forensically and civilly committed adult inpatients in a treatment mall program at a state hospital. Psychiatric Services, 60:262-265, 2009.
McLoughlin KA, Geller JL: Interdisciplinary treatment planning in inpatient settings: from myth to model. Psychiatric Quarterly, 81(3):263-277, 2010.
Foti ME, Geller JL, Guy LS, Gunderson JG, Palmer BA, Smith LM: Borderline personality disorder: Considerations for inclusion in the Massachusetts parity list of "biologically-based" disorders. Psychiatric Quarterly, 82:95-112, 2011.
Geller JL: A premature obituary: Edward C. Spitzka and the American Psychiatry of 1878. Journal of Nervous and Mental Disease, 199(9):621-630, 2011.

Jeffrey Geller, MD, MPH

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Geller JL, Glazer WM: Best practices: Visions for best practices in using coercion in mental health care. Psychiatric Services 63:414-414, 2012.
Geller JL: Patient-centered, recovery-oriented psychiatric care and treatment are not always voluntary. Psychiatric Services 63:493-495, 2012.
Geller J, Lee L: United States Department of Justice Findings Letters in Psychiatric Hospital CRIPA Cases: An Aid or a Distraction? Journal of the American Academy of Psychiatry and Law 41:2:174-190, 2013
Stewart RJ, Geller JL: Personal Accounts: Recovery Is Resilience in the Face of Symptoms. Psychiatric Services. 2014; 65(4):563-564. doi: 10.1176/appi.ps.650402
Geller JL: The First Step in Health Reform for those with Serious Mental Illness: Integrating the DisIntegrated Mental Health System. Journal of Nervous and Mental Disease. 203:909-918, 2015.
Fisher WH, Geller JL , McMannus DL Same Problem, Different Century: Issues in Recreating the Functions of Public Psychiatric Hospitals in Community-Based Settings. Advances in Medical Sociology (50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities), 17:3-25, 2016.
Chang BH, Biebel K, Geller JL: The Relationship Between Opportunities to Discuss Spiritual Needs and Mental Health Recovery Outcomes. American Journal of Rehabilitation298-312, 2018.
BOOKS
Geller JL, Harris M: Women of the Asylum. New York, Anchor Books, 1994.
VIDEO
Geller JL: Worcester State Hospital Before the War. An Interview with Walter E. Barton, M.D. Worcester, MA, University of Massachusetts Medical School, 1995.
BOOK CHAPTERS AND MONOGRAPHS
Lister E, Geller J: "Crossing Organizational Boundaries: Pre-Trial Commitment for Psychiatric Evaluation." In JP Morrissey, HH Goldman, LV Klerman (eds.), The Enduring Asylum. New York, Grune and Stratton, 1980.
Geller JL, Munetz MR: "The Iatrogenic Creation of Psychiatric Chronicity in Women." In C Nadelson, LL Bachrach (eds.), Treating Chronically Mentally Ill Women. Washington, DC, American Psychiatric Press, 1988, pp. 141-177.
Geller JL: "We Live in the Community with No Voices of Our Own." In JA Talbott, A Manevitz (eds.), Psychiatric Housecalls. Washington, DC, American Psychiatric Press, 1988, pp. 222-227.
Geller JL: "The Chronic Mentally Ill." In A Lazare (ed): Outpatient Psychiatry. Baltimore, MD, Williams and Wilkins, 1989.

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Geller JL, Fisher WH, Simon LJ, Wirth-Cauchon JL: “The Massachusetts Experience with Funded Deinstitutionalization: A Decade of Promises, Products and Problems Under the Brewster v. Dukakis Consent Decree.” UMMC/DMH Monograph #PS-891, Worcester, MA, 1989.
Hoge SK, Appelbaum PS, Geller JL: “Involuntary Treatment.” In American Psychiatric Press Review of Psychiatry Volume 8. Washington, DC, American Psychiatric Press, 1989, pp. 432-450.
Geller JL: "Arson in Review: From Profit to Pathology." Psychiatric Clinics of North America 15:623-645, 1992.
Geller JL: "The Right to Treatment." In R Rosner (ed), The Comprehensive Textbook of Forensic Psychiatry. New York, Van Nostrand, 1994.
Geller JL: Commentary on Suicide. In P Backlar (ed), The Family Face of Schizophrenia. Los Angeles, CA, Jeremy D. Tarcher, 1994.
Geller JL: Coerced Community Treatment and Psychiatric Hospital Recidivism. In S Soreff (ed): Handbook for the Treatment of the Seriously Mentally Ill, Seattle, Hogrefe & Huber, 1996.
Geller JL, Nicholson J, Traverso A: The Victimization of Women with Mental Illness by Treators: A Historical Perspective. In M Harris (ed): Sexual Abuse in the Lives of Women Diagnosed with Severe Mental Illness. Amsterdam, Harwood, 1997.
Geller JL: Mental Health Services for the Future: Managed Care, Unmanaged Care, Mismanaged Care? In G Schamess, A Lightburn (eds): Humane Managed Care. Washington, DC, NASW Press, 1998.
Geller JL: Psychiatric Health Care Proxies in Massachusetts: Much to do About Nothing, So Far. In P Backlar, DL Cutler (eds): Ethics in Community Mental Health Care. New York, Kluwer Academic/Plenum, 2002.
Biebel K, Geller JL: Challenges for a System of Care. In W Fisher (ed): Research on Community-Based Mental Health Services for Children and Adolescents. Boston, Elsevier, 2007.
Geller JL: Firesetting: A Burning Issue. In R Kocsis (ed): Criminal Profiling and Serial Violent Crimes. Totowa, NJ, Humana Press, 2007.
Geller JL: “History of Hospital Psychiatry and Lessons Learned.” In S Sharfstein (ed): Textbook of Hospital Psychiatry. Arlington, VA, American Psychiatric Publishing, Inc., 2009.
Geller JL, Guzofski S, Lauterbach M: “The Ins and Outs of 200 Years of Psychiatric Hospitals in the USA.” In F Ovsiew, R Munich (eds), Principles of Inpatient Psychiatry. Baltimore, MD, Lippincott Williams & Wilkins, 2009.
Geller JL: “The Role of the Hospital in the Care of the Mentally Ill.” In B Sadock, V Sadock, P Ruiz (eds): Comprehensive Textbook of Psychiatry, ninth edition. New York, NY, Lippincott Williams & Wilkins Publication, 2009.

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Geller JL: Advocacy: The Push and Pull of Psychiatrists. In HL McQuistion, WS Sowers, JM Ranz, JM Feldman (eds). Handbook of Community Psychiatry. New York, N.Y, Springer, 2012.
Fisher, W.H., Geller, J.L. and McMannus, D.L. (2016) ‘Same problem, different century: Issues in recreating the functions of public psychiatric hospitals in community-based settings’, in Brea BL (Ed):50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities. Emerald, pp. 3–25.
INVITED PUBLISHED PAPERS AND OTHER PUBLICATIONS
Geller JL, Lister ED: Reply to a comment (Ltr to edit). American Journal of Psychiatry 135:256, 1978.
Geller JL, Appelbaum PS: Competency to Stand Trial Neuroleptic medication and Demeanor in Court. Hospital and Community Psychiatry, 36:6-7, 1985. Reprinted in Rucker WB, Rucker ME (eds): Drugs, Society and Behavior, Dushkin, Guilford, CT, 1987. Reprinted in Paul Appelbaum on Law and Psychiatry, H & CP Service, 1989, pp. 13-14.
Lister ED, Geller JL: The making of a modern psychiatrist: Cracks in the foundation (Ltr to edit). American Journal of Psychiatry 142:1524-1525, 1985.
Geller JL: "On strike." Psychiatric Annals 16:188, 1986.
Geller JL: Book Review: Premium Non Nocere--Above All, Do No Harm. Contemporary Psychiatry 5:102-105, 1986.
Geller JL: "Can We Talk" evokes praise, objections (Ltr to edit). American Journal of Psychiatry 143:934, 1986.
Geller JL: Involuntary Outpatient Commitment? Psychiatric Times 3:8-9, 1986.
Geller JL: “Psychiatric Health Care Proxies in Massachusetts: Much To Do About Nothing, So Far.” In P. Backlar and D.L. Cutler (Eds): Ethics in Community Health Care. New York, Kluwer, 2002.
Geller JL: Outpatient civil commitment. Dr. Geller responds (Ltr to edit). American Journal of Psychiatry 144:695, 1987.
Geller JL: Coerced outpatient treatment. Dr. Geller replies (Ltr to edit). American Journal of Psychiatry 144:968-969, 1987.
Geller JL, Hoge SK: Voluntary and involuntary patients. (Ltr to edit). American Journal of Psychiatry 144:1112, 1987.
Geller JL: Drug noncompliance. (Ltr to edit). Hospital and Community Psychiatry 40:191, 1989.
Geller JL: Social work's PIE system. (Ltr to edit). Hospital and Community Psychiatry 41:455, 1990.

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Geller JL, Roth LR: Commentary on Monahan J: Prediction Research and the Emergency Commitment of Dangerous Mentally Ill Persons: A Reconsideration. In JE Mezzich, B Zimmer (eds.). Emergency Psychiatry. International University Press, Madison, CT, 1990.
Geller JL, Fisher WH: Psychiatric ward incidents (Ltr to edit). Hospital and Community Psychiatry 41:1024-1025, 1990.
Geller JL: Services for the homeless mentally ill (Ltr to edit). American Journal of Psychiatry 148:272, 1991.
Geller JL: Involuntary Outpatient Commitment: The Debate Continues (tape). Practical Reviews in Psychiatry and the Law, American Academy of Psychiatry and the Law 1991.
Geller JL: Stigmatizing labels (Ltr to edit). Hospital and Community Psychiatry 42:319, 1991.
Geller JL, Fisher WH: Reply to 'Community-based care in western Massachusetts'. (Ltr to edit). American Journal of Psychiatry 148:816, 1991.
Geller JL: Book Review: Schizophrenia: Treatment of Acute Psychotic Episodes. General Hospital Psychiatry 13:281-283, 1991.
Geller JL: Emergence of a Free Romanian Psychiatry. Psychiatric News 26:14, 16, 1991.
Geller JL: “Defining the meaning of ‘in the community’.” Hospital and Community Psychiatry 42:1197, 1991.
Geller JL: To be poor and mentally ill: Looking back to see ahead, Smith College School for Social Work Journal 9:26-32, 1991.
Geller JL: Comment on William H. Wilson, "Psychiatric education in a state hospital: A current approach." Community Mental Health Journal 28:61-67, 1992.
Geller JL: Book Review: "Bedlam: A Year in the Life of a Mental Hospital." Hospital and Community Psychiatry 43:652-653, 1992.
Fisher WH, Altaffer F, White CL, Geller JL: Inpatient Services for the Seriously Mentally Ill: Estimating the State Hospital's "Market Share." Proceedings of the Second Annual Conference on State Mental Health Service System Research. Alexandria VA, National Association of State Mental Health Program Directors Research Institute, 1991, pp. 289-298.
Geller JL: Book Review: "The Private Wars of Mrs. Packard." American Journal of Psychiatry 149:971-972, 1992.
Geller JL: A glimpse of Romanian psychiatry. Documents of the Geneva Initiative on Psychiatry 59:48-57, 1992.
Geller JL: In reply (Ltr to edit). Hospital and Community Psychiatry 44:691, 1993.

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Geller JL: “On being 'committed' to treatment in the community.” Innovations & Research 2:23-27, 1993.

Geller JL: Book Review: The Death of Superman. Hospital and Community Psychiatry 44:290-292, 1993

Geller JL: Book Review: Girl, Interrupted. Hospital and Community Psychiatry 44:1108-1109, 1993.

Nicholson J, Geller JL, Fisher WH, Dion GL: In reply (Ltr to edit). Hospital and Community Psychiatry 44:1107, 1993.

Geller JL: A Hospital by Any Other Name…Hospital and Community Psychiatry 44:1125, 1993.

Geller JL, Harris M: On the usefulness of first-person accounts. Hospital and Community Psychiatry 45:7-8, 1994.

Geller JL, Appelbaum PS: Samuel B. Woodward's remarks on feigned insanity. Hospital and Community Psychiatry 45:318-319, 328, 1994.

Geller JL: A history lesson. Psychiatric News 29(6):10, 1994.

Geller JL: Book Reviews "Crazy All the Time", "Under Observation" and "9 Highland Road." Psychiatric Services 46:733-735, 1995.

Geller JL: First-Person Accounts of Psychiatric Illness and Treatment: Reviews of Recent Books (11 books). Psychiatric Services 46:1080-1087, 1995.

Geller JL: When Less is More: When Less is Less. Psychiatric Services 46:1105, 1995.

Geller JL, Fisher WH: In reply (Ltr to edit). Psychiatric Services 47:91-92, 1996.

Geller JL, Fisher WH, McDermeit M: In reply (Ltr to edit). Psychiatric Services 47:310, 1996.

Geller JL: Disability payments among schizophrenic cocaine abusers (Ltr to edit). New England Journal of Medicine 334:664, 1996.

Geller JL: Book Review: Unbearable Affect: A Guide to the Psychotherapy of Psychosis." Psychiatric Services 47:541, 1996.

Geller JL: Book Review: "Welcome to My Country." Psychiatric Services 47:658-659, 1996.

Geller JL: Book Review: Affective Disorders From Inside Out: Six First-Person Accounts. Psychiatric Services 47:767-771, 1996.

Geller JL: Book Review: Stories by 'Multiples' as told by Themselves (4 books). Psychiatric Services 47:1006-1008, 1996.

Geller JL: Book Review: Patients Talk About Their Treatments: Five First-Person Accounts. Psychiatric Services 47:1135-1138, 1996.

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Geller JL: Make 'em Do It. Psychiatric Services 47:1157, 1996.
Geller JL: Is the Camel’s Nose Under the Tent? Psychiatric News 31(23):18, 34, 1996.
Geller JL: Book Review: Psychological trauma from victims’ view points: five books. Psychiatric Services 48:251-254, 1997.
Geller JL: Book Review: Novel psychiatrists. Review of four novels with psychiatrists as the main character. Psychiatric Services 48:713-716, 1997.
Geller JL, McDermeit M, Grudzinskas AJ, Lawlor T, Fisher WH: A competency-based approach to courtordered outpatient treatment. In MR Munetz (Ed): Can Mandatory Treatment Be Therapeutic? New Directions for Mental Health Services no. 75. San Francisco, Jossey-Bass, 1997, pp. 81-95.
Geller JL: Book Review: First-person accounts with a different slant. Review of seven books. Psychiatric Services 48:1471-1475, 1997.
Geller JL: We still count beds. Psychiatric Services 48:1233, 1997.
Geller JL: Book Review: From the eccentric to the bizarre. Review of five books. Psychiatric Services 49:394-396, 1998.
Geller JL: Book Review: Daughter’s views of their mentally ill mothers. Review of three books. Psychiatric Services 49:702-705, 1998.
Geller JL: Book Review: Is it bogus, is it not? Review of ten books. Psychiatric Services 49:1363-1369, 1998.
Geller JL: Book Review: Women speak about their mental illness. Review of six books. Psychiatric Services 50:708-713, 1999.
Geller JL: Book Review: City of One: A Memoir. Psychiatric Services 50:838-839, 1999.
Geller JL: Book Review: Wasted: Tales of a Gen X Drunk and My Mamma’s Waltz: A Book for Daughters of Alcoholic Mothers. Psychiatric Services 50:1238-1239, 1999.
Geller JL: Reclaiming oneself from the symptoms of mental illness. Review of five books. Psychiatric Services 50:1644-1647, 1999.
Geller JL: Book Review: Girl Interrupted: The book and the film. Psychiatric Services 51:536-537, 2000.
Geller JL: First-person accounts in the Journal’s first quarter-century. Psychiatric Services 51:575-578, 2000.
Geller JL: First-person accounts in the Journal’s second 25 years. Psychiatric Services 51:713-716, 719, 2000.

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Geller JL: Book Review: Losing family: Three first-person accounts. Psychiatric Services 51:1324-1325, 2000.
Munetz MR, Geller JL, Frese FJ: Commentary: Capacity-based involuntary outpatient treatment. Journal of the American Academy of Psychiatry and the Law 28:145-148, 2000.
Geller JL: Book Review: Tourette’s Syndrome in fact and fiction (3 books). Psychiatric Services 51:14551457, 2000.
Geller JL: American “community” psychiatry. The Lancet, supplement, December, 2000.
Geller JL: Book Review: Sexual abuse. Review of three books. Psychiatric Services 52:115-116, 2001.
Geller JL: You must read this. Psychiatric Services 52:265, 2001.
Geller JL: Book Review: Mockingbird Years. Psychiatric Services 52:695-696, 2001.
Geller JL: Ain’t no such thing as a schizophrenic. Psychiatric Services 52:715, 2001.
Geller JL: Book Review: Dates and dictionaries (5 books). Psychiatric Services 52:980-983, 2001.
Geller JL: Book Review: Exiting Nirvana: A Daughter’s Life with Autism. Psychiatric Services 52:12591260, 2001.
Geller JL: Book Review: The Day the Voices Stopped: A Schizophrenic’s Journey from Madness to Hope. Psychiatric Services 52:1400-1401, 2001.
Geller JL: Book Review: One Hundred Days: My Unexpected Journey from Doctor to Patient. Psychiatric Services 52:1403-1404, 2001.
Geller JL: Book Review: A sampling of first-person accounts (7 books). Psychiatric Services 52:15401543, 2001.
Geller JL: Donut shop diversion program. Psychiatric Services 52:1559, 2001.
Geller JL: The Case of Sam: In Reply (Ltr to Edit). Psychiatric Services 53:482, 2002.
Geller JL: Does “in the community” mean anything anymore? Psychiatric Services 53: 1201, 2002.
Geller JL: Book Review: Two personal accounts from Hollywood. Psychiatric Services 53: 1332-1333, 2002.
Geller JL: Book Review: Three women speak again about experiences with illness. Psychiatric Services 53:1338-1339, 2002.
Geller JL: Process, not practice (Ltr to Edit). Psychiatric Services 54:402, 2003.

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Geller JL: Book Review: When mental illness comes and goes (3 books). Psychiatric Services 54:10041046, 2003.

Geller JL: Book Review: Retards, rebels, and slackers. Psychiatric Services 54:1169-1170, 2003.

Geller JL: Medicaid everywhere. Psychiatric Services 55:215, 2004.

Geller JL: Book Review: Sadness, depression and hypomania: Five first person accounts. Psychiatric Services 55:590-593, 2004.

Geller JL: Book Review: How accidents, alcohol and madness affect the family: Three accounts. Psychiatric Services 55:721-723, 2004.

Geller JL: Book Review: Personal accounts by users and providers of mental health services: Seven books. Psychiatric Services 55:837-841, 2004.

Geller JL: Book Review: The Hillside Diary and Other Writings. Psychiatric Services 55:1070-1071, 2004.

Geller JL: Book Review: State Hospitals: Problems and Potentials. Psychiatric Services 55:1185-1186, 2004.

Geller JL, Haynes K: Book Review: Family accounts: Autism Spectrum Disorders (six books). Psychiatric Services 55:1320-1322, 2004.

Haynes K, Geller JL: Book Review: Personal accounts: Asperger’s Syndrome (three books). Psychiatric Services 55:1324-1326, 2004.

Geller JL: Book Review: Two masters stumble. Psychiatric Services 55:1446-1447, 2004.

Geller JL: Book Review: The cock and bull of Augusten Burroughs (three books). Psychiatric Services 56:363-364, 2005.

Geller JL: Book Review: She’s not there: A life in two genders. Psychiatric Services 56:495-496, 2005.

Geller JL: Book Review: Fathers lost, found or looking (five books). Psychiatric Services 56:878-880, 2005.

Geller JL: A view of American psychiatry (Ltr to Edit). American Journal of Psychiatry 162:1758-1759, 2005.

Geller JL: Book Review: Menspeak (four books). Psychiatric Services 56:1026-1027, 2005.

Geller JL: Book Review: The lobotomist and the lobotomized (two books). Psychiatric Services 56:13181319, 2005.

Geller JL: First person accounts: The importance of being honest. Psychiatric Services, 57:607, 2006.

Geller JL: Book Review: Women speak… briefly (five books). Psychiatric Services 57:145-147, 2006.

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Geller JL: Book Review: Women’s search for love through sex (four books). Psychiatric Services 57:729730, 2006.
Geller JL: Book Review: Brief reviews (seven books). Psychiatric Services 57:749-751, 2006.
Geller JL: Book Review: Madhouse: A tragic tale of megalomania and modern medicine. Psychiatric Services 57:1054-1055, 2006.
Geller JL: Book Review: Clinical manual of impulse control disorders. American Journal of Psychiatry 164:352, 2007.
Geller JL: Invisible on judgment day. Psychiatric Services 58:177-178, 2007.
Geller JL: Book Review: Shock: The healing power of electroconvulsive therapy. Psychiatric Services 58:1133, 2007.
Geller JL: Book Review: Freud: Inventor of the modern mind. Psychiatric Services 58:1381-1382, 2007.
Geller JL: Book Review: Godless medicine and the sixth cow. Psychiatric Services 58:1609, 2007.
Geller JL: Commentary: Is CIT today’s lobotomy? Journal of the American Academy of Psychiatry and the Law 36:56-58, 2008.
Geller JL: Book Review: Improving medication adherence: How to talk to patients about their medication. Psychiatric Services 59:940, 2008.
Geller JL: Ltr to Edit: Raise enlistment age. USA Today, July 16, 2008, op-ed page.
Geller JL: Ltr to Edit: Old enough to vote, enlist and marry, but to drink? Wall Street Journal, August 28, 2008, p. A14.
Geller JL: You light my fire: Understanding pathological firesetting. CMHSR Issue Brief 5(2):1-2, 2008.
Geller JL: Consider this… Should it be ok to beat up the nurse? Archives of Psychiatric Nursing, 22:235236, 2008.
Geller JL: Book Review. Impulse Control Disorders: A clinician's guide to understanding and treating behavioral addictions. American Journal of Psychiatry, 165:1362-63, 2008.
Geller JL: If we only had a historiscope. The Action Paper 1(2):4-5, 2009.
Geller JL: The state of mental health. Worcester Telegram & Gazette, June 10, 2009, p. A-10.
Geller JL: Book Review: The lives they left behind. Psychiatric Services 60:1406-1407, 2009.
Geller JL: Book Review: Doctor Olaf van Schuler’s brain. Psychiatric Services 60:1692, 2009.

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Geller JL: Ltr to Edit: A case of neutralized findings? Psychiatric Services 61:529, 2010.
Geller JL: Book Review: Library of dust. Psychiatric Services 61:536, 2010.
Geller JL: Book Review: Boy alone. Psychiatric Services 61:848, 2010.
Geller JL: Book Review: Asylum: inside the closed world of state mental hospitals. Psychiatric Services 61:1048-1049, 2010.
Geller JL: Book Review: Room. Psychiatric Services 61:1266-1267, 2010.
Geller JL: Panacea or Pandora’s Box: Electronic health record in psychiatry. Worcester Medicine 74(5):14-15, 2010.
Geller JL: Book Review: The roots of the recovery movement in psychiatry: Lessons learned. Psychiatric Services 62:225-226, 2011.
Geller JL, Satel S: Time to mandate reporting of mental health concerns. USA Today, January 19, 2011, p. 9A.
Geller JL: Book Review: The ethical way: Challenges and solutions for managed behavioral healthcare. Psychiatric Services 62(1):3, 2011.
Geller JL: Book Review: Unhinged: The trouble with psychiatry—A doctor’s revelations about a profession in crisis. Psychiatric Services 62:1396-1397, 2011.
Geller JL: Book Review: Delirious. Psychiatric Services 62:1517, 2011.
Geller JL: Book Review: Netsuke. Psychiatric Services 62:1518, 2011.
Geller JL: Ltr to Edit: How many authors is too many? Psychiatric Services 63:293, 2012.
Geller JL: Book Review: Oxford Textbook of Community Mental Health. Psychiatric Services 63:329, 2012.
Geller JL: Book Review: Sybil Exposed: The extraordinary story behind the famous multiple personality case. Psychiatric Services 63:513-514, 2012.
Torrey EF, Fuller DA, Geller JL, Jacobs C, Ragosta K: No room at the Inn: trends and consequences of closing public psychiatric hospitals, 2005-2012. Arlington, VA, Treatment Advocacy Center, 2012.
Geller, JL: Ltr to Edit: Use of coercion in recovery-oriented care: Staying vigilant. Psychiatric Services 63:834-835, 2012.
Geller, J: Ltr to Edit: Headline writer shoots from the hip. Worcester Telegram & Gazette. August 20, p. A11, 2012.

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Geller JL: Book Review: Freud’s Revenge. Psychiatric Services Dec 2012; 63 (12); e01-e01. doi: 10.1176/appi.ps.631207

Geller JL: Book Review: Checkmate. Psychiatric Services Dec 2012; 63 (12); e07-e07. doi: 10.1176/appi.ps.631206

Geller JL: Introduction: Navigating the waters of digital technology. Psychiatric Times, December 7, 2012, p. 29.

Geller JL: The Quest for Mental Health: A Tale of Science, Medicine, Scandal, Sorrow, and Mass Society. Psychiatric Services 64: February 1, 2013; doi: 10.1176/appi.ps.640403.

Geller JL: Ltr to Edit: Gender defies definition; let all marry. Worcester Telegram and Gazette, April 6, 2013.

Geller JL: Book Review. Preventing Patient Suicide: Clinical Assessment and Management. Psychiatric Services 64: April 1, 2013; doi: 10.1176/appi.ps.640404.

Geller JL: Book Review. Modern Community Mental Health: An Interdisciplinary Approach Psychiatric Services, May 2013; 64 (5); e01-e01. doi: 10.1176/appi.ps.640508

Geller JL: Ltr to Edit: The Need for Appropriate Use of Involuntary Commitment Psychiatric Services, May 2013; 64 (5); 496-496. doi: 10.1176/appi.ps.640501

Geller JL: Correspondence: Community Treatment Orders for Psychosis. Lancet 382:502, 2013.

Geller J: Ltr to Edit: Asylum Should be Available to All Who Need It. Psychiatric News 48 (18):21, 2013.

Geller J: Depression and Danger to Others. Community Psychiatrist 27 (2):7, 2013.

Geller, JL: Book Review. First Person Accounts of Mental Illness and Recovery. Psychiatric Services 2014; 65(1):e04-e04. doi: 10.1176/appi.ps.650106

Geller, JL. Book Review. The Painted Bridge. Psychiatric Services 2014; 65(3):e13-e13. doi: 10.1176/appi.ps.650309

Geller JL: Refocusing gun policy. Ltr to Edit. Psychiatric Services. 2014; 65(4):563-563. doi: 10.1176/appi.ps.650401

Geller JL: Book Review. Season to Taste. Psychiatric Services .2014, 65(12) pp. e1 - e1. doi:org/10.1176/appi.ps.660101

Geller J: Ltr to Edit. Can there b good mental asylums? New York Times, February 26, 2015, p. A26. http://www.nytimes.com/2015/02/26/opinion/can-there-be-good-mental-asylums.html?_r=0

Geller JL: Listening to patients with an open mind. Psychiatric News. 2015, 50(3):22, March 6, 2015.

Geller JL: What we knew and when we knew it. Community Psychiatry 29 (2): 8, 2015
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Sacco C, Geller J: Mental Illness: Understanding the power of words, labels. Berkshire Eagle, Manchester Journal, Brattleboro Reformer, Bennington Banner, 2/19/16.
Sacco C, Geller J: Myth vs. Fact: Sorting out mental illness, violence relationship Berkshire Eagle, Manchester Journal, Brattleboro Reformer, Bennington Banner, The Sun: San Bernardino, San Valley Gabriel Tribune, The Daily Breeze, 3/18/2016.
Sacco C, Geller J: Myth vs. Fact: Understanding what autism means. Berkshire Eagle, Manchester Journal, Brattleboro Reformer, Bennington Banner, 4/15/16
Geller J, Sacco C: Trauma and health: Connecting the dots. Berkshire Eagle, Manchester Journal, Brattleboro Reformer, Bennington Banner, 5/20/2016 .
Geller J, Sacco C: Myth vs. Fact: Transcending barriers in the work place. Berkshire Eagle, Manchester Journal, Brattleboro Reformer, Bennington Banner, 6/17/16.
Geller J, Sacco C: Myth vs. Fact: Shades of Darkness: Recognizing Depression. Berkshire Eagle, Manchester Journal, Brattleboro Reformer, Bennington Banner 7/15/2016.
Sacco C, Geller J: Myth vs. Fact: Know the difference between grief, major depression. Berkshire Eagle, 8/12/2016.
Geller J: The aftermath of the folie a neuf. American Association of Community Psychiatrists Newsletter 30 (2):11-12, 2016.
Geller J, Sacco C: Myth vs. Fact: Not always a straight path when treating depression. Berkshire Eagle (Pittsfield, MA), Manchester Journal (Manchester, VT), Brattleboro Reformer (Brattleboro, VT), Bennington Banner (Bennington, VT), 9/19/2016.
Sacco C, Geller J: Myth vs. Fact: Nothing ‘natural’ about synthetic substances. Berkshire Eagle (Pittsfield, MA), Manchester Journal (Manchester, VT), Brattleboro Reformer (Brattleboro, VT), Bennington Banner (Bennington, VT), 10/24/2016.
Geller JL (Ltr to Edit): A Revised Debate Over Asylums. New York Times, March 18. 2018.
Geller JL: Twenty-one “Do Nots” in constructing a psychiatric hospital. American Association of Community Psychiatrists Newsletter 32(1):15-19, 2018.
Geller JL: The rise and demise of America’s psychiatric hospitals: A tale of dollars Trumping Decency. Psychiatric News (54 (5): 8-9, March 1, 2019. Published Online:26 Feb 2019https://doi.org/10.1176/appi.pn.2019.3a36
Geller J: The Rise and Demise of America’s Psychiatric Hospitals: a Tale of Dollars Trumping Sense. Psychiatric News 54 (6): 11-12, March15, 2019. Published Online:14 Mar 2019https://doi.org/10.1176/appi.pn.2019.3b29
Geller JL, Daou MBZ: Patients With SMI in the Age of COVID-19: What Psychiatrists Need to Know. Psychiatric News. Published Online:7 Apr 2020 https://doi.org/10.1176/appi.pn.2020.4b39

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Geller J: Ltr to edit. Wherever the peak may be, our caution should not flag. Boston Globe, April 22, 2020, p. A9.
Geller J: COVID-19 and Advocacy—The Good and the Unacceptable. Psychiatric News. Published Online:7 May 2020https://doi.org/10.1176/appi.pn.2020.5b13
Geller JL, Daou MBZ: COVID-19 and People With SMI: New Notes From the Field. Psychiatric News. Published Online:7 May 2020 https://doi.org/10.1176/appi.pn.2020.5b24
Geller J: Emailectomies During the COVID-19 Pandemic and Its Aftermath.
Pyshictaric News. Published Online:28 May 2020https://doi.org/10.1176/appi.pn.2020.6a26
Geller J: COVID-19 and Sensationalizing Inpatient Psychiatric Settings. Psychiatric News. Published Online:9 Jun 2020https://doi.org/10.1176/appi.pn.2020.6b22
SYMPOSIUM AND PANEL PARTICIPATION
Speaker: "Gender and Gender Dysphoria." Grand Rounds, UMass Medical School, Worcester, MA, April 30, 1981.
Speaker: "The Impact of a Consent Decree on Hospital and Community Development." Conference: Planning for Care of the Seriously Mentally Ill in Times of Austerity. UMass Medical School, Worcester, MA, April 30, 1982.
Speaker: "Arson: An Unforeseen Sequela of Deinstitutionalization." Conference: Clinical Challenges in Crisis Intervention, Consortium Emergency Services Network, Springfield, MA, March 15, 1983.
Symposium: The Role of the Attorney and Guardian Ad Litem in Rogers - Type Guardianships. Hampshire County Bar Association, Northampton, MA, March 14, 1984.
Symposium: Mental Health Procedures Act, Commonwealth of Pennsylvania Department of Public Welfare, Pittsburgh, PA, February, April 1985.
Invited Participant: N.I.H. - U.C.S.F. Conference on Ethics Consultation. National Institute of Health, Bethesda, MD, October 7-8, 1985.
Co-Speaker: with Loren H. Roth: "Deinstitutionalization - Reinstitutionalization. Is There a Middle Ground?" ADMIT, Pittsburgh, PA, February 25, 1986.
Speaker: "Fire Setting in the Adult Psychiatric Population." Office of Education and Regional Planning, W.P.I.C., Warren, PA, April 4, 1986.
Speaker: "Iatrogenic Creation of Chronicity in Women." Presidential Symposium: "Issues in Treating Chronically Mentally Ill Women." 139th American Psychiatric Association Meeting, Washington, DC, May 12, 1986.

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Co-Speaker: with Loren H. Roth: "Involuntary Commitment to Outpatient Treatment." Forum: "Reinstitutionalization: The Next Panacea?" 139th American Psychiatric Association Meeting, Washington, DC, May 14, 1986.
Speaker: "Overview of Mental Health Procedures Act in Pennsylvania." Office of Education and Regional Planning, W.P.I.C., Kitanning, PA, June 4, 1986.
Speaker: "Fire Setting in Adult Psychiatric Patients" Grand Rounds, Worcester State Hospital, Worcester, MA, October 9, 1986.
Speaker: "Interpretation and Treatment Implications of Risk Assessment in the System. The Adult Mental Health Committee of the Greater Worcester Area, Worcester, MA, October 23, 1986.
Speaker: "Involuntary Community Treatment and Its Derivatives." 38th Institute on Hospital and Community Psychiatry, San Diego, CA, October 29, 1986.
Speaker: "The Future of Institutional Treatment of the Mentally Ill." Wes-Ros-Park Community Mental Health Center, Boston, MA, November 6, 1986.
Speaker: "Involuntary Community Treatment: Panacea or Problem?" Veterans Administration Northeast Regional Medical Education Center Decentralized On-site Program, Boston, MA, February 25, 1987.
Conference Director: "Family and Community Treatment of Severe Mental Illness." Public Sector Division of University of Massachusetts Department of Psychiatry, Worcester, MA, May 1, 1987.
Speaker: "Diagnosing the Mentally Ill." Western Massachusetts Alliance for Mentally Ill Citizens, Holyoke, MA, June 8, 1987.
Speaker: "Overview of Treatment of the Chronically Mentally Ill." Central Massachusetts Alliance for the Mentally Ill. Worcester, MA, October 13, 1987.
Symposium Director: "The Scope of Public Sector Psychiatry in the 1980's. 39th Institute on Hospital and Community Psychiatry, Boston, MA, October 25, 1987.
Workshop Leader: "When the Federal Court Dictates Deinstitutionalization: The Brewster v. Dukakis Consent Decree 1978-1987. 39th Institute on Hospital and Community Psychiatry, Boston, MA, October 26, 1987.
Co-Speaker: with Paul Appelbaum: "Mandatory Outpatient Treatment: Legal and Clinical Issues." 39th Institute on Hospital and Community Psychiatry, Boston, MA, October 28, 1987.
Speaker: "Involuntary Outpatient Treatment." Community Psychiatry Seminar, Oregon Health Sciences Center, Portland, OR, October 30, 1987.
Speaker: "Involuntary Outpatient Commitment." Mental Health Division, Department of Human Resources, Salem, OR, October 30, 1987.

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Keynote Speaker: "Outpatient Commitment: Trick of Treat." Annual Meeting of the Mental Health Association of Oregon, Portland, OR, October 31, 1987.
Co-Speaker: with Alan R. Kerr: "Intervention with Borderline Patients." Second Annual Western Massachusetts Conference on Human Services: Reaching Populations at Risk, Springfield, MA, November 5, 1987.
Speaker: "The Involuntary Treatment of Mental Illness, Models Old and New." Advances in Psychiatry Series, HLA Portsmouth Pavilion, Portsmouth, NH, February 19, 1988.
Keynote Speaker: "Outpatient Commitment." Nebraska Department of Public Institutions, Omaha, NE, April 11, 1988.
Conference Director: "Meeting the Needs of the Chronic Mentally Ill: Patients, Families, and Practitioners in Partnership." Public Sector Division of the University of Massachusetts Department of Psychiatry, Shrewsbury, MA, April 29, 1988.
Co-Speaker: with Marilyn Schmidt: "Involuntary Community Treatment in Western Massachusetts: Two Models. Public Sector Division of the University of Massachusetts Department of Psychiatry, Shrewsbury, MA, April 29, 1988.
Speaker: "The Massachusetts Experience with Involuntary Community Treatment." Metropolitan State Hospital Grand Rounds, Waltham, MA, May 24, 1988.
Speaker: "Involuntary Community Treatment and Its Benefit to the State Hospital." Westborough State Hospital Grand Rounds, Westborough, MA, October 3, 1988.
Co-Speaker: With Robert M. Factor: "‘Asylum’: Redirection or Misdirection?" 40th Institute on Hospital and Community Psychiatry, New Orleans, LA, October 25, 1988.
Poster Presentation: "The State Hospitals' Worst Recidivists: Who Are They and What's to be Done?" 40th Institute on Hospital and Community Psychiatry, New Orleans, LA, October 25, 1988.
Symposium: "Funded Deinstitutionalization: For Whom Does It Work?" 40th Institute on Hospital and Community Psychiatry, New Orleans, LA, October 27, 1988.
Speaker: "Firesetting in Children and Adults: Distinctions and Common Denominators." Center for Children and Youth, Westfield, MA, November 16, 1988.
Speaker: "Communicative Arson and the Adult Psychiatric Patient." Grand Rounds, Norwich State Hospital, Norwich, CT, November 17, 1988.
Speaker: "Firesetting and Servicing the Mentally Ill in the Community. Mt. Tom Institute, Holyoke, MA, March 6, 1989.
Speaker: "Involuntary Community Treatment and the Families of the Chronic Mentally Ill." National Alliance for the Mentally Ill, Newton-Wellesley Chapter, Newton, MA, March 28, 1989.

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Speaker: "Prescriptions and Proscriptions in the Treatment of the State Hospital Recidivist." Northampton State Hospital Grand Rounds, Northampton, MA, April 6, 1989.
Speaker: "State Hospital Recidivism and the CMHC" Center for Adults and Families, Westfield, MA, April 26, 1989.
Conference Director: "The State Hospital and Its Alternatives: Myths and Realities." Fifth Annual Public Sector Psychiatry Conference, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, April 28, 1989.
Discussant: "Trafficking in Fire. Dangerous Statements, Dangerous Behavior and the Manipulation of Staff." Grand Rounds, University of Massachusetts Medical Center, Worcester, MA, May 25, 1989.
Speaker: "A Clinician's Primer on Involuntary Outpatient Treatment. 41st Institute on Hospital and Community Psychiatry, Philadelphia, PA, October 16, 1989.
Conference Director: "Violence and Mental Illness: Theory and Prevention." Sixth Annual Public Sector Psychiatry Conference, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, April 19, 20, 1990.
Speaker: "Contracting with Violent Patients in Outpatient Treatment." Public Sector Psychiatry Conference, Worcester, MA, April 20, 1990.
Speaker: "Pyromania, Communicative Arson, and Public Sector Psychiatry." Grand Rounds, Northampton State Hospital, Northampton, MA, May 31, 1990.
Conference Director: "The Asylum: Redirection or Misdirection" Public Sector Division, University of Massachusetts Medical School, Department of Psychiatry, Worcester, MA, June 1, 1990.
Co-Speaker: with Robert I. Paulson, D.S.W.: "Blowing Winds of Change into Academia: NAMI Recognizes Excellence in Training." Tenth Annual National Alliance for the Mentally Ill Convention, Chicago, IL, July 21, 1990.
Speaker: "The State and the State Hospital: Old and New Assumptions." Grand Rounds, Worcester State Hospital, Worcester, MA, September 25, 1990.
Speaker: "Revolvingvolvingvolving Door: Recidivism, Recidivism, and Recidivism." 42nd Institute on Hospital and Community Psychiatry, Denver, CO, October 9, 1990.
Speaker: "Firesetters and Treatment." 42nd Institute on Hospital and Community Psychiatry, Denver, CO, October 10, 1990.
Speaker: "'Any Place but the State Hospital.' Examining the Assumptions of Admissions Diversion." Grand Rounds, Northampton State Hospital, Northampton, MA, November 1, 1990.
Speaker: "Pathological Firesetting." Grand Rounds. Worcester State Hospital, Worcester, MA, November 6, 1990.

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Speaker: "The State and Its State Hospitals: What's Been and What Might Be." Commonwealth of Pennsylvania Superintendent and Chief Physician Meeting, Harrisburg, PA, December 12, 1990.
Speaker: "Here Today, Gone Tomorrow, Back the Next Day: State Hospital Recidivism in Perspective." Grand Rounds, Westborough State Hospital, Westborough, MA, January 29, 1991.
Speaker: "Dilemmas of the Revolvingvolvingvolving Door Patient." Grand Rounds, Danvers State Hospital, Hathorne, MA, February 21, 1991.
Symposium: "Community/State Relations." Sixth Annual Pennsylvania Conference on Schizophrenia, Pittsburgh, PA, March 8, 1991.
Visiting Lecturer, Oregon Department of Human Services: "Arson: From Profit to Pathology," Oregon State Hospital, Salem, OR, April 8, 1991; "The Revolvingvolvingvolving Door," Oregon State Hospital, April 9, 1991; "The Revolvingvolvingvolving Door," Dammasch State Hospital, Wilsonville, OR, April 9, 1991; "Arson: From Profit to Pathology" and "Involuntary Outpatient Treatment in the Community" and "The Revolvingvolvingvolving Door," Eastern Oregon Psychiatric Center, Pendleton, OR, April 10, 1991.
Conference Director: "Controversies in Public Psychiatry: Commitment and Coercion." Seventh Annual Public Sector Psychiatry Conference. Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, April 19, 1991.
Speaker: "Coercion in the Community: A Copacetic Contract or a Copout." Seventh Annual Public Sector Psychiatry Conference, University of Massachusetts Medical School, Department of Psychiatry, Worcester, MA, April 19, 1991.
Speaker: "Involuntary Outpatient Treatment: Promise and Peril." Fifth Annual Forensic Psychiatry Conference of the Penetanguishene Mental Health Centre and the Ontario Ministry of Health, Midland, Ontario, June 21, 1991.
Speaker: "From 'Asylum' to 'Loony Bin': American Women's Perspectives on Entering the Psychiatric Institution." 43rd Institute on Hospital and Community Psychiatry, Los Angeles, CA, October 22, 1991.
Speaker: "Assessing the Utilization Patterns of Community Residential Programs." 43rd Institute on Hospital and Community Psychiatry, Los Angeles, CA, October 23, 1991.
Co-Speaker: with Robert Factor: "Models and Applications of Coerced Community Treatment: Yeah! Nay! or Maybe?" 43rd Institute on Hospital and Community Psychiatry, Los Angeles, CA, October 23, 1991.
Speaker: "Psychosis and the Revolvingvolvingvolving Door." Grand Rounds, Newton-Wellesley Hospital, Newton, MA, November 7, 1991.
Speaker: "Public Sector Psychiatry and Worn Out Sneakers." Grand Rounds, Worcester State Hospital, Worcester, MA, January 14, 1992.

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Speaker: "Historical Appraisal of the Demise of the State Hospital and the Rise of General Hospital Psychiatric Units: Maybe a Reason but No Rhyme." Grand Rounds, Wing Memorial Hospital, Palmer, MA, February 5, 1992.
Speaker: "Community Psychiatry in the 1990's: Confusion? Commitment: Choice!" Third Simposio Psiquiatrico de Puerto Rico, La seccion de Psiquiatria dela Asociacion Medica de Puerto Rico, San Juan, PR, April 11, 1992.
Speaker: "Use of Coercion to Keep People Out of Hospital: Paradigm or a Problem." Grand Rounds, Nassau County Medical Center, East Meadow, NY, April 24, 1992.
Symposium paper: "Romanian Psychiatry: Quest for Professional Freedom." 145th Annual Meeting of the American Psychiatric Association, Washington, DC, May 6, 1992.
Conference Director: "Right-Sizing Massachusetts' State Hospitals." Public Sector Division, University of Massachusetts Medical School, Department of Psychiatry, Worcester, MA, May 15, 1992.
Co-Speaker: with Charles Goldman, M.D.: "Model Training Programs in Psychiatry," as part of a conference: "Treating the Seriously Mentally Ill - Educating Professionals for the 21st Century." Medical College of Pennsylvania and National Alliance for the Mentally Ill, Philadelphia, PA, June 5, 1992.
Speaker: "Massachusetts' Experiments in Public Sector Psychiatry in the Nineties and Their Implications for Michigan." Annual Meeting of the Michigan Association of Neuro-Psychiatric Hospitals and Clinics Physicians, Novi, MI, July 17, 1992.
Speaker: "'Clinical coercion' in Post-Totalitarian Romania--Ethical Quagmire?" First International Conference of the Romanian Free Psychiatrists' Association, Bucharest, Romania, October 2, 1992.
Speaker: "A State's Response to Its Seriously Mentally Ill: A Comparison of the Massachusetts Commission Reports of 1855 and 1991." 44th Institute on Hospital and Community Psychiatry, Toronto, October 24, 1992.
Speaker: "A Disability Model of Schizophrenia and Psychosocial Modes of Rehabilitation." Harlem Valley Psychiatric Center Grand Rounds, Wingdale, NY, November 20, 1992.
Discussant: Workshop on Treatment of Violent Mentally Ill Persons in the Community: Issues of Research, Policy, and Services. Violence and Traumatic Stress Research Branch, Division of Epidemiology and Services Research, National Institute of Mental Health, Washington, DC, January 15, 1993.
Speaker: "A Patient with High Service Utilization." George B. Wells Human Service Center Mental Health Education and Training, Southbridge, MA, April 1, 1993.
Conference Director: Affective Disorders as Chronic Mental Illness. Public Sector Division, University of Massachusetts Medical Center, Worcester, MA, April 30, 1993.
Speaker: "Pathological Firesetting and the State Hospital." Norwich State Hospital Grand Rounds, Norwich, CT, May 13, 1993.

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Co-Speaker: with Sheldon Benjamin, M.D.: "Post-Communist Psychiatry: Report on a Visit to Psychiatric Hospitals in Romania and Ukraine." Westborough State Hospital Grand Rounds, Westborough, MA, May 18, 1993.
Symposium Discussant: "Chronic Institutionalization: Current Status. 146th Annual Meeting of the American Psychiatric Association, San Francisco, CA, May 24, 1993.
Speaker: "Is Managed Care Changing Administrative Psychiatry?" 146th Annual Meeting of the American Psychiatric Association, San Francisco, CA, May 24, 1993.
Speaker: "Impinging on Community Practice: More Good than Bad." A Symposium co-sponsored by APA and AACP. 146th Annual Meeting of the American Psychiatric Association, San Francisco, CA, May 27, 1993.
Co-Speaker: with Trevor Hadley, Ph.D., Edna Kamis-Gould, Ph.D., and William Fisher, Ph.D.: Unbundling and Privatizing Psychiatric State Hospital Services: Doing the Right Thing and Doing It Right. 45th Institute on Hospital and Community Psychiatry, Baltimore, MD, October 9, 1993.
Symposium Organizer and Moderator: Medicaid Managed Care for Mental Health/Substance Abuse Services. 45th Institute on Hospital and Community Psychiatry, Baltimore, MD, October 10, 1993.
Symposium Presenter: Writing a Paper in Symposium: Writing for Journals. 45th Institute on Hospital and Community Psychiatry, Baltimore, MD, October 11, 1993.
Speaker: The Past and Present of National Health Reform and Mental Health Benefits. Meeting of the Delaware Psychiatric Society, Wilmington, DE, October 28, 1993.
Conference Director: Long-term Treatment of Long-term Patients. Public Sector Division, University of Massachusetts Medical Center, Worcester, MA, April 29, 1994.
Symposium Presenter: Writing for Journals. 46th Institute on Hospital and Community Psychiatry, San Diego, CA, September 30, 1994.
Symposium Presenter: Ethical Issues in Community Psychiatry. 46th Institute on Hospital and Community Psychiatry, San Diego, CA, October 1, 1994.
Symposium Presenter, with Joseph English, Laurie Flynn and Boris Astrachan: Providers and Consumers: Partners in Psychiatric Care. 46th Institute on Hospital and Community Psychiatry, San Diego, CA, October 1, 1994.
Co-Speaker: with Jay Cutler: On the Inside Looking In: The Mental Health/Substance Abuse Benefit in National Health Care Reform. 46th Institute on Hospital and Community Psychiatry, San Diego, CA, October 3, 1994.
Speaker: Health Reform on the Hill: A Capitol Perspective, Grand Rounds, University of Massachusetts Medical School, Worcester, MA, October 13, 1994.

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Speaker: Juvenile and Adolescent Firesetting. Series sponsored by the Northern Berkshire Mental Health Association, North Adams, MA, November 22, 1994.
Speaker: Psychiatrist in Congress. Mid-Hudson (N.Y.) Branch of the American Psychiatric Association. Poughkeepsie, NY, January 12, 1995.
Speaker: From Long-Term Hospitalization to Community: Progress or Pratfall. Grand Rounds at Hudson River Psychiatric Center, Poughkeepsie, NY, January 13, 1995.
Speaker: National Mental Health Reform: To Be Or Not To Be. Grand Rounds at the Institute of Living/Hartford Hospital, Hartford, CT, January 25, 1995.
Co-Speaker: with William Fisher, Ph.D.: Assessing the Efficacy of Outpatient Commitment: A Case Control Study of Service Use by Committed and Non-committed Consumers. Fifth Annual Conference on State Mental Health Agency Services (SMHA) Research, San Antonio, TX, January 31, 1995.
Co-Speaker: with Laurie Flynn. Keynote Address: The Future of Public Psychiatry. The Ohio Institute on Community Psychiatry, Department of Psychiatry CWRU and Ohio Department of Mental Health, Cleveland, OH, March 24, 1995.
Speaker: National Health Reform and Public Sector Psychiatry. Grand Rounds, Westborough State Hospital, Westborough, MA, April 4, 1995.
Speaker: Psychiatric Services Under National Health Reform. Western Massachusetts Psychiatric Society, Springfield, MA, April 19, 1995.
Speaker: Revolution or Revision? Massachusetts' Lessons in Public Managed Care of Mental Illness. The Center for Psychiatric Medicine at St. Francis' Conference: Privatizing Public Mental Health Service Delivery: Promise or Peril, Pittsburgh, PA, April 22, 1995.
Speaker: How Washington Works: And If It Does, What Happens to Us Psychiatrists? Outpatient Psychiatry Annual Series, Massachusetts General Hospital, Boston, MA, April 15, 1995.
Conference Director: In Search of Parity: Mental Illness Care and Mental Illness Coverage. Public Sector Division, University of Massachusetts Medical Center, Worcester, MA, April 28, 1995.
Co-Speaker: with Jay Cutler: Evolving Federal Policy on Mental Illness and the Insurance Coverage. 148th Annual Meeting of the American Psychiatric Association, Miami, FL, May 24, 1995.
Speaker: Interfacephiliacs. 1995 National Conference on Mental Health Statistics. Center for Mental Health Services, Washington, DC, June 1, 1995.
Speaker: Who's committed to Involuntary Outpatient Treatment: The Psychiatrist or the Patient?" Grand Rounds, U. of South Dakota School of Medicine, Sioux Falls, SD, June 9, 1995.
Speaker: Managed Mental Health Care Has Arrived. Semi-Annual Meeting of the South Dakota Psychiatric Society, Sioux Falls, SD, June 10, 1995.

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Speaker: Mental Health Services of the Future: Managed Care, Unmanaged Care, Mis-managed Care. Helen Pinkus Memorial Lecture. Smith College School for Social Work Supervisors' Annual Conference, Northampton, MA, July 21, 1995.
Co-Speaker: with Oleg Nasynnik, M.D. Issues in Compulsory Treatment in Forensic Psychiatry. Third Meeting of Reformers of Psychiatry, Prague, Czech Republic, September 1, 1995.
Speaker: Revolution in American Psychiatry: Managed Mental Health Care. Third Meeting of Reformers in Psychiatry, Prague, Czech Republic, September 2, 1995.
Co-Speaker: with Vladimir Tochilov, M.D. Managing a Psychiatric Facility – Models, Obstacles, Objectives. Third Meeting of Reformers of Psychiatry, Prague, Czech Republic, September 2, 1995.
Moderator and Speaker: Major Mental Illness, Women, and Reproduction: Innovative Programs. 47th Institute on Psychiatric Services, Boston, MA, October 9, 1995.
Conference Director: Pathological Firesetters: Who; Why; What's to be Done? Public Sector Division, University of Massachusetts Medical Center, Springfield, MA, November 13, 1995.
Speaker: Managed and Unmanaged Behavioral Health Care. Marian Health Center Grand Rounds, Sioux City, IA, January 12, 1996.
Speaker: Managed and Unmanaged Behavioral Health Care. University of South Dakota Medical School, Department of Psychiatry Grand Rounds, Sioux Falls, SD, January 12, 1996.
Speaker: History of the Treatment of Women in the Mental Health System. Conference: Women on the Threshold of Change: Issues in the Mental Health and Chemical Abuse Fields, Morris Plains, NJ, February 1, 1996.
Speaker: Compassion and Coercion in the Treatment of Women with Dual Diagnoses. Conference: Women on the Threshold of Change: Issues in the Mental Health and Chemical Dependence Fields, Morris Plains, NJ, February 1, 1996.
Speaker: Involuntary Outpatient Treatment: Who's Committed? ComCare Grand Rounds, Phoenix, AZ, April 16, 1996.
Conference Director: Treating the Dual Disorders: Mental Illness and Substance Abuse. Public Sector Division, University of Massachusetts Medical Center, Worcester, MA, April 27, 1996.
Co-Speaker: with Maureen Slade, R.N., M.S. and Glen Lawrence, M.A. Continuum: Comprehension, Compliance, Coercion. 73rd Annual Meeting of the American Orthopsychiatric Association, Boston, MA, May 1, 1996.
Speaker: Public Sector Psychiatric Services at the End of the Millennium: Repetition Compulsionsionsion. 3rd Annual Conference for Mental Health Policy Services and Clinical Research of the Connecticut MHC and Department of Psychiatry of Yale University School of Medicine, New Haven, CT, May 30, 1996.

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Speaker: Involuntary Outpatient Treatment. Department of Mental Health Western Massachusetts Area, Pittsfield, MA, June 19, 1996.
Co-Speaker: with Maureen Slade, R.N., M.S. and Roland Gibson. Continuum: Comprehension, Compliance, Coercion. NAMI 1996 Annual Convention, Nashville, TN, July 8, 1996.
Co-Speaker: with Jay Cutler. Lobbying Governmental Organizations. IV Meeting of Reformers in Psychiatry, Madrid, Spain. August 29, 1996.
Speaker: Compulsory Outpatient Treatment. IV Meeting of Reformers in Psychiatry, Madrid, Spain. August 30, 1996.
Speaker: Video Workshop: The History of Psychiatry. 48th Institute on Psychiatric Services, Chicago, IL, October 18, 1996.
Speaker: What Does a CRIPA Expert Look For? Association of State Mental Health Attorneys Annual Conference, New Orleans, LA, October 22, 1996.
Speaker: Make ‘em Do It in the Community! The Facts and Fantasies about Involuntary Outpatient Treatment. Special Programs in Community Psychiatry, Northeastern Ohio Universities College of Medicine, Akron, OH, April 17, 1997.
Speaker: Recidivism: Causes and Treatment. 2nd Annual Taunton Psychiatric Conference, Taunton, MA, April 25, 1997.
Conference Director: Clinical Management of Pathological Violence. Public Sector Division, University of Massachusetts Medical Center, Worcester, MA, May 2, 1997.
Speaker: Reflections on Reforms in Psychiatry. Subnetwork Role of Professional Psychiatric Associations. Geneva Initiative, Amsterdam. May 8, 1997.
Speaker: Human Rights and Psychiatric Care --Ideas and Realities in North America. Berzelius Symposium XXXVII, Swedish Society of Medicine and the Hastings Center, Stockholm, Sweden, June 17, 1997.
Speaker: Make ‘Em Do It! Me? Yeah, You! Nineteenth Annual Inservice Training Conference, Association of Ohio Forensic Psychiatric Center Directors, Columbus, OH, June 20, 1997.
Speaker: The Massachusetts Medicaid Experience. 49th Institute on Psychiatric Services, Washington, D.C., October 26, 1997.
Speaker: The Ethics of Compulsory Outpatient Treatment, Geneva Initiative, Woudschoten, Zeist, Netherlands, Geneva, April 2, 1998.
Speaker: Involuntary Outpatient Treatment: Been There, Done That, or Not? Massillon Psychiatric Center and Northeastern Ohio Universities College of Medicine, Canton, OH, May 4, 1998.

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Conference Director: Treatment and Mistreatment of Women with Chronic Mental Illness. Public Sector Division, University of Massachusetts Medical School, Worcester, MA, May 8, 1998.
Discussant: Dealing with Psychopathy: The United States Supreme Court’s Hendricks vs. Kansas Decision and Beyond. 151st Annual Meeting of American Psychiatric Association, Toronto, Ontario, June 2, 1998.
Conference Co-Chair: Long-Term Care. National Alliance for the Mentally Ill, Bethesda, MD, September 15, 1998.
Discussant: Innovations in Trauma Recovery Work. 50th Institute on Psychiatric Services, Los Angeles, CA, October 5, 1998.
Speaker: Competency Evaluations. Fall Judicial Education Conference, Plymouth, MA, October 23, 1998.
Speaker: Written Words by Women with Psychosis. Women and Psychosis Conference, Clarke Institute, Toronto, Ontario. February 25, 1999.
Conference Director: Care and Treatment of “Mentally Ill” Sexual Perpetrators. Public Sector Division, University of Massachusetts Medical School, Worcester, MA, April 30, 1999.
Speaker: The Place of Treatment for Individuals with Chronic, Serious Mental Illness. Grand Rounds, UMDNJ-New Jersey Medical School, Newark, NJ, October 20, 1999.
Speaker: Whither Social Work? Or, Wither Social Work. Social Work Grand Rounds, Beth Israel Deaconess Hospital, Boston, MA, March 23, 2000.
Co-Chair: with Zou Yizhuang, M.D., Scientific Program Committee of the Second Sino-American Conference on Psychiatry, Beijing, China, April 6-10, 2000.
Conference Director: Implications of the Blurring Boundaries Between Mental Health and Criminal Justice Systems: Policies, Plans, and Practices. Public Sector Division, University of Massachusetts Medical School, Worcester, MA, May 5, 2000.
Discussant: Patient Autonomy and Paternalism Across Cultures. 153 APA Annual Meeting, Chicago, IL, May 16, 2000.
Speaker: The Institution for Mental Disorders (IMD) Exclusion: The Federal Government’s Impaired Vision in the Care and Treatment of its Citizens with Chronic Mental Illness. Robert Wood Johnson Health Policy Fellowship Program: Unintended Consequences of Health Policy Programs and Policies, Washington, DC, August 22, 2000.
Speaker: An overview of 50 years of Psychiatric Services. 52nd Institute on Psychiatric Services, Philadelphia, PA, October 26, 2000.

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Debate Participant: Resolved: Outpatient Commitment is Likely to Do More Harm than Good in Facilitating Effective Treatment of Persons with Serious Mental Illness. 52nd Institute on Psychiatric Services, Philadelphia, PA, October 27, 2000.
Speaker: The Sham and Shamefulness of the Least Restrictive Alternative Concept as an Enabler of Empowerment. 8th Annual North Carolina Conference on Innovative Approaches in Psychiatric Rehabilitation, Butner, NC, November 2, 2000.
Conference Director: “Benevolent Coercion” to Facilitate Treatment of Persons with Chronic Mental Illnesses. Public Sector Division, University of Massachusetts Medical School, Worcester, MA, April 27, 2001.
Speaker: From Right to Treatment to Needs Based Discharge Planning. Association of Public Developmental Disabilities Administrators, New Orleans, LA, February 20, 2002.
Speaker: Pathological Firesetting: Etiology and Treatment. Northeastern Ohio U. College of Med., Ohio Community Forensic Association and the Ohio Department of Mental Health, Columbus, OH, March 15, 2002.
Conference Director: Responding to Parasuicidal Behaviors, Suicide Threats, Suicide Attempts and Suicide. Public Sector Division, University of Massachusetts Medical School, Worcester, MA, April 26, 2002.
Speaker: Extinction versus Adaptation: The Future of State Hospital Psychiatry: Building, Unbuilding, and Rebuilding America’s State Hospitals. 155 APA Annual Meeting, Philadelphia, PA, May 20, 2002.
Speaker: The Past, Present and Future of Inpatient Psychiatry. NAMI Kansas, Topeka, KS, September 23, 2002.
Speaker: Advocating for Patients and Psychiatrists. 54th Institute on Psychiatric Services, Chicago, IL, October 11, 2002.
Conference Director: Addressing the Clinical Issues of Persons with Mental Illness and/or Mental Retardation and Co-occurring Disordered Sexual Behaviors. Public Sector Division, University of Massachusetts Medical School, Worcester, MA, May 9, 2003.
Speaker: Treatment: Rights and Wrongs. Grand Rounds, University of Massachusetts Medical School, June 26, 2003.
Speaker: Secrets of the Therapeutic Relationship. Western Massachusetts Psychiatric Society, Springfield, MA, September 17, 2003.
Speaker: Living Together in Communities. NAMI-Western Massachusetts. Northampton, MA, October 14, 2003.
Discussant: Peer Review and Morbidity and Mortality in the Community: A Ten-Year Perspective. Institute on Psychiatric Services, Boston, MA, October 30, 2003.

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Speaker: Forty Years of Neglect: The Federal Role in Caring for the Severely Mentally Ill. American Enterprise Institute for Public Policy Research, Washington, DC, October 31, 2003.
Speaker: Mental Illness Services: 1963 Looking Backwards and Forwards. Carson Center for Human Services Fortieth Anniversary Annual Meeting, West Springfield, MA, November 20, 2003.
Speaker: When Dollars Trump Sense. American Association of Community Psychiatrists Annual Meeting, Honolulu, Hawaii, February 20, 2004.
Speaker: Treatment and Care of Persons with Serious Mental Illness: Are we Winding Up or Winding Down? Grand Rounds, Westborough State Hospital, Westborough, MA, March 2, 2004.
Panelist: Medical Issues Concerning Involuntary Treatment. New England Journal on Criminal and Civil Confinement, Center for Law and Social Responsibility at the New England School of Law, and UMass Medical School, Boston, MA, March 5, 2004.
Panelist: The Civil Context – Involuntary Outpatient Commitment. New England Journal on Criminal and Civil Confinement, Center for Law and Social Responsibility at the New England School of Law, and UMass Medical School, Boston, MA, March 5, 2004.
Speaker: What Can You Advocate for and Why? NAMI of Central MA, Worcester, MA, March 18, 2004.
Speaker: They Live in My Head. A BI Resident Looks Back at his First Psychotherapy Cases. Beth IsraelDeaconess Grand Rounds, Boston, MA, March 30, 2004.
Speaker: State Hospital Psychiatry: Been Down So Long It Looks Like It’s Up To Me. 157th APA Annual Meeting, New York, NY, May 3, 2004.
Panelist: Public Psychiatry: Leading the Way in Transforming Service Delivery in the 21st Century. 157th APA Annual Meeting, New York, NY, May 3, 2004.
Conference Director: Mad or Bad: When is it Psychopathy? Public Sector Division, University of Massachusetts Medical School, Worcester, MA, May 20, 2004.
Speaker: Can’t Get No Respect. How’d the American State Hospital Get Here? First Annual Mental Health Conference, Larned State Hospital, Larned, Kansas, September 29, 2004.
Co-Speaker, with Debra Pinals, M.D. Police and Mental Health Professionals: Learning From Each Other. 56th Institute on Psychiatric Services, Atlanta, GA, October 10, 2004.
Speaker: They Live in My Head. Grand Rounds, University of Massachusetts Medical School, Worcester, MA, November 7, 2004.
Speaker and Panelist: Enhancing Personal Liberty for Persons with Serious Mental Illness: Legal and Clinical Perspectives. University of Vermont Department of Psychiatry and Vermont State Hospital, Montpelier, VT, December 9, 2004.

Jeffrey Geller, MD, MPH

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Speaker: Clinical Criteria for Involuntary, Coercive and Pseudo-Voluntary Treatment. 5th Annual International Association of Forensic Mental Health Services, Melbourne, Australia, April 19, 2005.

Conference Director: Making It in the Community: Best Practices. Public Sector Division, University of Massachusetts Medical School, Worcester, MA, June 28, 2005.

Speaker: Involuntary Outpatient Treatment in the USA: Conundrum or Quagmire. 29th International Congress on Law and Mental Health, Paris, France, July 8, 2005.

Speaker with Fabian Saleh, M.D. and Gina Vincent, Ph.D: Dangerous Ones: Assessing and Treating Psychopaths, Pedophiles and Firesetters. 57th Institute on Psychiatric Services, San Diego, CA, October 7, 2005.

Speaker with Aaron Lazare, M.D. and David Spiegel, M.D.: The Theory and Practice of Apology. 159th Annual Meeting, Toronto, Canada, May 22, 2006.

Conference Director: Creating Sanctuary: Trauma-Informed Treatment and Why It Matters. Public Sector Division, University of Massachusetts Medical School, Worcester, MA, June 9, 2006.

Speaker: Firesetting: A Burning Issue. Sixth Annual International Association of Forensic Mental Health Services, Amsterdam, Netherlands, June 16, 2006.

Speaker: Hearing Their Voices: A Resident’s First Psychotherapy Case Three Decades Later. University of Vermont College of Medicine, Department of Psychiatry Grand Rounds, January 19, 2007.

Speaker: Soft Voices Can Speak Loudly: Listening to Psychiatric Patients to Avoid Adverse and Costly Outcomes. Mental Health in Development, World Psychiatric Association, Nairobi, Kenya, March 21, 2007.

Speaker: Faux Refusal and Pseudo Cooperation: Clinical Quagmires of Addressing Consent, Assent, Cooperation and Refusal. When, When Not and Why. University of Iowa/Carver College of Medicine/Iowa Psychiatric Society, Ames, Iowa, April 21, 2007.

Speaker: Conceptualizing Access to Psychiatric Care: DOD and VA. APA Annual Meeting, San Diego, CA, May 21, 2007.

Conference Director: Understanding and Treating the Dual Diagnoses of Chronic Mental Illness and Substance Abuse. Public Sector Division, University of Massachusetts Medical School, Worcester, MA, June 1, 2007.

Speaker: Assisted Outpatient Treatment: A Psychiatrist’s Perspective. National Alliance on Mental Illness Annual Meeting, San Diego, CA, June 22, 2007.

Speaker: Who Do You Work For? The Ethics of Agency. Grand Rounds, UT Southwestern Medical Center, Dallas, TX, January 30, 2008.

Speaker: The State Mental Health Authority’s Role Before and After a Tragedy Involving Individuals with Mental Illness. What Role Do We Have? 161st APA Annual Meeting, Washington, DC, May 6, 2008.

Jeffrey Geller, MD, MPH

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Speaker: Keynote Address: Pyromania: A Hot Diagnosis Looking for its Fire. 2nd Annual Northeast Juvenile Firesetting Conference. Worcester, MA, May 9, 2008.
Speaker: History of State Hospitals. Midwestern Association of State Mental Health Organizations. Indianapolis, IN, May 22, 2008.
Conference Director: Rehabilitations and Recoveries. Public Sector Division, University of Massachusetts Medical School, Worcester, MA, June 6, 2008.
Discussant: The Insanity Offense: How America’s Failure to Treat the Seriously Mentally Ill Endangers Its Citizens (E. Fuller Torrey, M.D.). American Enterprise Institute for Public Policy Research, Washington, D.C., June 9, 2008.
Speaker: Where Is the State Hospital Today and How Did It Get There? Conference in celebration of the new Greystone Park Hospital: Wellness and Recovery in the New State Hospital: Clinical Challenges & Opportunities. Greystone Park, NJ, June 26, 2008.
Speaker: Worcester State Hospital in the Context of the History of American State Hospitals. American Psychology Association Annual Meeting, Boston, MA, August 16, 2008.
Speaker: Sending Patients to the Community vs. Community Integration – Lessons Learned from the U.S. W.H.O. Meeting: Mental Health Talks, Tirana, Albania, September 19, 2008.
Speaker: When Community Services Replace State Hospitals: Practical Tips and Typical Pitfalls. World Health Organization, Tirana, Albania, September 20, 2008.
Speaker: Pyromania: A Hot Diagnosis Looking for Its Fire. Grand Rounds, SUNY Downstate Medical Center, Brooklyn, NY, September 24, 2008.
Speaker: CRIPA and the Contemporary State Hospital. Northeastern Regional State Psychiatric Hospital Association (includes DE, NJ, NY, PA). Greystone Park, N.J., October 29, 2008.
Speaker, with Batool Kazim, M.D.: Psychological Challenges in New Immigrant Families – Role of Culture and Traditions. Al-Hamra Academy, Shrewsbury, MA, November 16, 2008.
Speaker: How Did So Many People with Mental Illness Get into My ED? South Carolina Hospital Association, Columbia, SC, March 4, 2009.
Panelist: How to Get Persons with Serious Mental Illness in the ED Out of the ED. South Carolina Hospital Association, Columbia, SC, March 4, 2009.
Speaker with Carrie Sacco, RN: The Psychiatrist and Nurse Partnership at the CMHC. All Ohio Conference on Community Mental Health, Cleveland, OH, March 21, 2009.
Speaker: Transitional Age Youth: What’s to be Done? 39th National Council Conference, San Antonio, TX, April 7, 2009.

Jeffrey Geller, MD, MPH

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Speaker: Deinstitutionalization in the Past 40 Years in the U.S.A. 1st International Conference on Organization of Psychiatric Care, Prague, Czech Republic, April 20, 2009.

Conference Director: Health & Wellness for Persons with Serious Mental Illness: Challenges & Opportunities. Public Sector Division, University of Massachusetts Medical School, Worcester, MA, June 17, 2009.

Speaker: Psychiatric Hospitals: Use, Misuse, Overuse. Bite the Bullet, Michigan State Bar, Elder Law Section, Traverse City MI, September 23, 2009.

Speaker: Support and Supervision to the Primary Health Care from the Specialized Services. National Conference by WHO, Albanian Ministry of Health and Tirana University, Tirana, Albania, October 7, 2009.

Speaker: Standards of Mental Health Care. National Conference by WHO, Albanian Ministry of Health and Tirana University, Tirana, Albania, October 8, 2009.

Speaker: Individualized Psychiatric Treatment and Rehabilitation at a Contemporary Psychiatric Hospital. Federal Neuro-Psychiatric Hospital – Yaba, Lagos, Nigeria, October 19, 2009.

Speaker: Are We Losing the Person in the Patient? World Psychiatric Association Regional Meeting, Abuja, Nigeria, October 22, 2009.

Speaker: Do We Need Long-Term Psychiatric Beds? World Psychiatric Association Regional Meeting, Abuja, Nigeria, October 23, 2009.

Course: Inpatient Practice of Psychiatry. World Health Organization and Tirana University. Vlora, Albania. April 12-14 and April 15-17, 2010.

Speaker: A New Era (Not Error) for Mental Health Services: Working Together Now in the Community. NAMI Roanoke Valley. Salem, Virginia, April 29, 2010.

Speaker: Virginia’s Mental Health System: Past, Present, and Future. NAMI Roanoke Valley. Salem, Virginia, April 29, 2010.

Moderator and Discussant: The Tattered Safety Net: The Public Mental Health Crisis in an Economic Recession. American Psychiatric Association Annual Meeting, New Orleans, LA, May 25, 2010.

Conference Director: Young Adults in the Extended Mental Health Systems of Massachusetts in the 21st Century. Public Sector Division, University of Massachusetts Medical School, Worcester, MA, June 16, 2010.

Speaker: Keynote Address: Understanding Long Term Illness. Mental Health and Long Term Illness: The Need for Continued and Integrated Care. Ministry of Health, Tirana, Albania, October 11, 2010.

Speaker: An Integrated System of Mental Health Care: Inpatient and Outpatient Services Towards Continuity of Care. Mental Health and Long Term Illness: The Need for Continued and Integrated Care. Ministry of Health, Tirana, Albania, October 11, 2010.

Jeffrey Geller, MD, MPH

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Speaker: Management of Psychiatric Emergencies. Mental Health and Long Term Illness: The Need for Continued and Integrated Care. Ministry of Health, Tirana, Albania, October 11, 2010.
Speaker: Peer Review Activities in Albania: Feasibility and Prevalence. Mental Health and Long Term Illness: The Need for Continued and Integrated Care. Ministry of Health, Tirana, Albania, October 12, 2010.
Speaker: Integration of psychiatry to achieve awareness and prevention. 18th International Conference of Pakistan Psychiatric Society, Islamabad Pakistan, December 18, 2010.
Workshop with Dr. Batool Kazim: Do You Hear Me? 18th International Conference of Pakistan Psychiatric Society, Islamabad Pakistan, December 19, 2010.
Speaker: Effective Psychiatric Treatment in the Context of Limited Resources. 18th International Conference of Pakistan Psychiatric Society, Islamabad Pakistan, December 19, 2010.
Workshop Leader: For Residents at Makerere College of Health Sciences/School of Medicine, Department of Psychiatry, Kampala, Uganda, February 10, 2011.
Discussant: More Than a Med Check: Making the Most of 15 Minutes. Western Psychiatric Institute and Clinic, WebEx meeting, March 3, 2011.
Conference Director: Using Mindfulness for Improving Care of Patients with Serious Mental Illness and Clinicians’ Self-Care. Public Sector Division, University of Massachusetts Medical School, Worcester, MA, June 15, 2011.
Speaker: Understanding Psychotropic Medication: Uses and Misuses. Changes and Choices, Elder Law & Disability Rights Section, State Bar of Michigan, Crystal Mountain, MI, September 21, 2011.
Panelist: Olmstead: What Does Least Restrictive Setting Really Mean? Changes and Choices, Elder Law & Disability Rights Section, State Bar of Michigan, Crystal Mountain, MI, September 22, 2011.
Speaker: Why Medical Students Interested in Psychiatry Should Understand the Last 200 Years in American Health Policy for Persons with Serious Mental Illness. PsychSIGN California Conference, San Francisco, October 29, 2011.
Chair and Discussant: There Is No Such Thing as a “Med Check.” 63rd Institute of Psychiatric Services, San Francisco, CA, October 30, 2011.
Speaker: Understanding Pathological Firesetting in Community Settings. Center for Human Development, Springfield, MA, February 22, 2012.
Co-Presenter with Hunter McQuistion, Jacqueline Feldman, James Pierce. Person-Centered Planning and Shared Decision Making. American Association of Community Psychiatrists Winter Meeting, Phoenix, AZ, March 2, 2012.

Jeffrey Geller, MD, MPH

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Co- Presenter with Brian Stettin. Assisted Outpatient Treatment. American Association of Community Psychiatrists Winter Meeting, Phoenix, AZ, March 2, 2012.

Speaker: “Challenges in Delivering Mental Health Care: Then and Now. Challenges to Cure and Care, New Jersey Psychiatric Association, Iselin, NJ, March 31, 2012.

Symposium Chair and Discussant: “There Is No Such Thing as a 'Med Check.” 165th APA Annual Meeting, Philadelphia, PA, May 8, 2012.

Speaker: Keynote Address: Southwestern Virginia Mental Health Institute in the Context of the Development of Public Psychiatry in Virginia and the Nation, 1768 to 2012. 125th Anniversary of the founding of Southwestern Virginia Mental Health Institute, Marion VA, May 18, 2012.

Conference Director: Moving to a Recovery-Based, Patient-Centered System of Care. . 28th Annual Public Sector Psychiatry Conference, University of Massachusetts Medical School, Worcester, MA, June 13, 2012.

Speaker: A Brief History of Recovery. Moving to a Recovery-Based, Patient-Centered System of Care. , 28th Annual Public Sector Psychiatry Conference, University of Massachusetts Medical School,
Worcester, MA, June 13, 2012.

Speaker: Shared Decision Making as the Future of Psychiatry. The 21st Century Approach to Mental Health. The Seventh World Congress on the Promotion of Mental Health and the Prevention of Mental and Behavioral Disorders, Perth, Australia, October 18, 2012.

Speaker: Prevention and Persons with Chronic Mental Illness: Are You Listening? The Seventh World Conference for the Promotion of Mental Health and the Prevention of Mental and Behavioral Disorders. The Carter Center, World Federation for Mental Health and Clifford Beers Foundation. Perth, Australia, October 19, 2012.

Speaker: Listening to Preventing Fire-setting by Persons with Mental Illness: The World's Most Dangerous Behavior. The Seventh World Conference for the Promotion of Mental Health and the Prevention of Mental and Behavioral Disorders. The Carter Center, World Federation for Mental Health and Clifford Beers Foundation. Perth, Australia, October 19, 2012.

Speaker: From Worcester Lunatic Asylum to Worcester Recovery Center and Hospital: 178 years and 29 weeks. First Grand Rounds at Worcester Recovery Center and Hospital, Worcester MA, November 13, 2012.

Speaker: Recovery-Based Care. NAMI of Florida Annual Meeting. Sarasota, FL, December 9, 2012.

Plenary Address: Talking to Psychotic Patients – A Necessary Skill for the Practicing Psychiatrist. 19th International Conference of the Pakistan Psychiatric Society with World Psychiatric Association Cosponsorship. Islamabad, Pakistan, December 28, 2012.

Workshop: Improving Psychiatric Treatment in Afghanistan. 19th International Conference of the Pakistan Psychiatric Society with World Psychiatric Association Co-sponsorship. Islamabad, Pakistan, December 30, 2012.

Jeffrey Geller, MD, MPH

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Speaker: Advance Directives. Center Street Health Center, Somerville, MA, March 27, 2013.

Conference Director: Mitigating the Risk of….,. 29th Annual Public Sector Psychiatry Conference, University of Massachusetts Medical School, Worcester, MA, June 19 2013.

Speaker: Mitigating the Risks of Murder-Suicide. Public Sector Division, University of Massachusetts Medical School, Worcester, MA, June 19 2013.

Co-presenter with Brian Stettin, JD: The Medical Model Matters. 2013 NAMI National Conference. San Antonio, TX, June 29, 2013.

Co-presenter with Rita Larranaga: Casa del Parana and the Future of Clubhouses in Argentina. 2013 World Mental Health Congress of the World Federation for Mental Health. Buenos Aires, Argentina, August 27, 2013.

Co-presenter with Carol Caruso and Joseph Rogers: Advocacy: Can We Work Together for Change? 65th Institute on Psychiatric Services, American Psychiatric Association, Philadelphia, PA, October 10, 2013.

Plenary Speaker: Trends in Mental health Services that Can Positively Impact the Scope and Effectiveness of CIT. CIT International Conference, Hartford, CT, October 15, 2013.

Conference Director: Healing Environments. . 30th Annual Public Sector Psychiatry Conference , University of Massachusetts Medical School, Worcester, MA, June 18 2014.

Speaker: What is schizophrenia? International Congress of the World Federation for Mental Health & the Hellenic Psychiatric Association. Athens, Greece, October 10, 2014.

Speaker: What is Chronic about Chronic Mental Illness? Board of Directors of Clubhouse International. New York, New York, October 23, 2014.

Plenary Speaker with Melissa Harris, Randy Loss, Andrew Sperling & Jane Plapinger: Perspectives and Advice from our National Partners. USA National Clubhouse Conference, Silver Spring, MD, November 13, 2014.

Moderator and Speaker: Medicaid and Clubhouse. . USA National Clubhouse Conference, Silver Spring, MD, November 13, 2014.

Co-chair, Scientific Program Committee. . Mental Health for All, Connecting People and Sharing Experience. World Federation for Mental Health. Lille, France, April 28-April 30, 2015.

Co-presenter with Michael Flaum and Ken Thompson: The evolution of psychiatry in the US over the past 50 years: from institutionalization to integration and recovery. Mental Health for All. World Federation for Mental Health. Lille, France, April 29, 2015.

Co-presenter with Esko Hänni, Imran Haider, AAfzal Javed and Wander Reitsma. Activating use of psychosocial rehabilitation innovations. . Mental Health for All. World Federation for Mental Health. Lille, France, April 29, 2015.

Jeffrey Geller, MD, MPH

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Speaker: When is Involuntary Treatment Necessary in an Integrated System of Care?. Mental Health for All. World Federation for Mental Health. Lille, France, April 29, 2015.

Speaker: Mental Health: the American Perspective. Mental Health for All. World Federation for Mental Health. Lille, France, April 30, 2015.

Speaker: When a State Has No County Psychiatric Services. 168 Annual Meeting of the American Psychiatric Association. Toronto, CA. May 17, 2015.

Conference Director: Families’ Roles in Mental Illness: Response & Resilience in Rehabilitation and Recovery. 31st Annual Public Sector Psychiatry Conference, University of Massachusetts Medical School,
Worcester, MA, June 17 2015.

Speaker: World Dignity Project. 31st Annual Public Sector Psychiatry Conference, University of Massachusetts Medical School, Worcester, MA, June 17 2015.

Panelist: Pushing the Boundaries and Healing Hearts: The Shifting Roles of the 21st Century Psychiatrist. Institute on Psychiatric Services, New York, NY, October 10, 2015.
Speaker: The Role of the Hospital in the Care of Persons with Mental Illness in the 21st Century. 20th World Congress of the World Federation for Mental Health. Cairo, Egypt, October 19, 2015.

Conference Director: Where Mental Illness and Violence Intersect. 32nd Annual Public Sector Psychiatry Conference, University of Massachusetts Medical School, Worcester, MA, June 14 2016.

Co-Chair, Scientific Program Committee, Moving Toward a Mentally Healthy Community, World Federation for Mental Health, Cairns, Australia, October 17-19, 2016.

Speaker, with Carolyn Sacco, RN: Writing for the public. World Federation for Mental Health, Cairns, Australia, October 18, 2016.

Speaker: Depression, Suicide and Danger to Others. World Federation for Mental Health, Cairns, Australia, October 18, 2016.

Grand Rounds Speaker: Not Enough Money and Even Less Sense: No One in Psychiatry Is Immune. UT Southwestern, Dallas, TX, January 11, 2017. Grand Rounds Speaker: Mitigating the Risks of Murder-Suicide. Medical University of South Carolina, Charleston, SC, April 21, 2017

Conference Director: Communicating With and About Persons with Mental Illness: The Tried-and-True and the New. . 33rd Annual Public Sector Psychiatry Conference, University of Massachusetts Medical School, Worcester, MA, June 13, 2017.

Speaker: Stigma: A Major Interference in Communication With and Amongst Persons with Serious Mental Illness. 33rd Annual Public Sector Psychiatry Conference, University of Massachusetts Medical School, Worcester, MA, June 13, 2017

Jeffrey Geller, MD, MPH

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Speaker with Dominic Sisti, PhD and Emanuel Trujillo, MD: Bring Back the Asylum? Manhattan Institute, New York City, May 8, 2018.
Speaker: From 19th Century Public Psychiatric Hospital Farms to 21st Clubhouses: Work Works. First Annual Dr. Ron Brown Memorial Grand Rounds, Jewish General Hospital/McGill Medical School, Montreal,
Quebec, October 4, 2018.
Panelist: After Rikers: Course Change for people with Serious Mental Illness. Greenburger Center for Social and Crminal Justice. New York City, March 25, 2019.
Geller JL: Too Few Dollars and Even Less Sense: How the Economic Development of Psychiatry 18441944 Affects Us Now. . American Psychiatric Association Annual Meeting, San Francisco, CA , May 19, 2019.
Geller JL: A Rational, Reliable, Remission-focused, Reasonably Reimbursed, Readily Accessible Mental Health Care System. 8th Annual Psychiatric Society of Delaware Symposium, Newark, DE, September 21, 2019.
Geller JL: Discussant, The Mental Health Crisis in America: Recognizing Problems, Working Toward Solutions. Austen Riggs Center, Stockbridge, MA September 22, 2019.
Geller JL: Fixing a Frankly Feckless Mental Health System . North Dakota Psychiatric Society, Fargo, ND, November 2, 2019.
Geller JL: Hamilton Ford Lecture: The First 100 Years of America’s Psychiatric Hospitals and How We Still Live the Legacy. Titus Harris Society, Galveston TX, January 25, 2020.

Jeffrey Geller, MD, MPH

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Jeffrey Geller, MD, MPH

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ATTACHMENT 2

Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 76 of 82

CVH Documents:

ATTACHMENT 2

• Mask Protocol KN95 Memo

• COVID-19 Cohorting Memo

• COVID-19 Cohort Protocol 05140

• Points to Remember COVID-19

• Staff screening memo 5/12/2020

• COVID-19 Status Update Memo

• Manager Responsibilities for Transferring COVID-19 Patient 050420

• COVID-19 Required Policy Changes 042720

• Protective Mask protocol 042720

• N95 Respirator Replacement Protocol 042520 v1

• Patient Cloth Mask Protocol 042120 v3

• Cloth Masks Memo

• N95 Respirator Fit Testing Protocol Memo 041920 V4

• N95 Respirator Fit Testing Protocol Memo

• Protocol for Ordering of PPE for Units 041620

• DMHAS-CVH Protocols for COVID Q and I 4-12-20

• Patient Testing Protocol 4.14.20

• CVH Staff Screening Protocol.rev 4.13.20

• CVH PPE Protocol V4

Admissions and Discharge:

• Pending litigation admissions, information

Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 77 of 82
• WFH discharges during COVID pandemic Whiting Documents:
• Whiting Treatment Mail EOC Risk Assessment and Preparation for Use as Isolation Area New 4-9-20
• WFH Transfer-Return from Community Hospital and Transfer to Whiting Isolation Area New 4-3-20
• WFH Screening Tool Guide rev 3-29-20
• WFH Screening Protocol rev 3-29-20
• ZIX: FW:ZIX: PT COVID complaints - Email to Deborah Moore o Email Attachment 1 – COVID Sylvia F. Log Email Attachment 2 – 20 08 05 Alleged that a doctor continues to retaliate against him o Email Attachment 3 – 20 09 04 Patient alleged that staff aren’t social distancing and are not wearing PPE o Email Attachment 4 – 20 29 03 Forced to take Elevator BS o Email Attachment 5 – 20 30 03 Eating on Unit o Email Attachment 6 – 20 31 03 Alleged that a Doctor retaliated against him o Email Attachment 7 – 2020.05.11 Gail Litsky MHA not wearing a mask – Copy
• WFH Screening Protocol rev 3-29-20
• WFH Guidance on Management Meeting on Suspected and Confirmed COVID19 in Patients and Staff 5-4-20
• WFH Guidance on Management Meeting on Suspected and Confirmed COVID19 in Patients and Staff 4-13-20
• WFH Guidance on Management Meeting on Suspected and Confirmed COVID19 in Patients and Staff 4-2-20

Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 78 of 82
• WFH Guidance on Management Meeting on Suspected and Confirmed COVID19 in Patients and Staff 4-13-20
• WFH Guidance on Management Meeting on Suspected and Confirmed COVID19 in Patient…
• WFH Front Door Screening rev 4-8-20 • WFH Coronavirus Pandemic Incident Action Plan rev 3-26-20 • Staff Self-Monitoring Guide 3-20-20 • Procedure for N95 Respiratory Fit Test Tracking new 4-3-20 • Isolation Unit Environmental Safety Check 3-30-20 • Instructions for PPE Re-use 4-2-20 • Instructions for PPE Re-use 4-1-20 • HHC Guidelines for Ordering COVID19 Testing 3-26-20 • HHC Testing COVID19 DMHAS 3-26-20 • Gymnasium EOC Risk Assessment 3-30-20 • GymISOlayout • Fit Kit Manual • Donna-Doffing PPE in the Isolation Units Instructions – Poster 4-30-20 • DMHAS Protocol for Patients Exposed to COVID Positive Case 4-10-20 • CT DPH COVID Report Form • COVID-19 Uniform Screening Tool revised 4-9-2020 • Covid19 Patient Use of Face Masks protocol 4-23-20 • Appendix H revised 5-4-20 updated • Appendix H revised 4-15-20 updated

Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 79 of 82
• Appendix H revised 4-9-20 updated • Appendix H revised 4-1-20 updated • Appendix H Patient Isolation protocol revised 4-16-20 • Acknowledgment Re: Use of Personal Masks 3-27-20 FINAL • 2-WFH-COVID-19 ICS 214 Continuation • 1-WFH-COVID-19 ICS-214 • WFH Screening Protocol rev 3-29-20 • WFH Screening Tool Guide rev 3-29-20 • WFH Transfer–Return from Community Hospital and Transfer to Whiting
Isolation Area 4-3-20 • Whiting Treatment Mall EOC Risk Assessment and Preparation for Use as
Isolation Area new 4-9-20 • 1 WFH COVID-19 ICS 214 • Dr. Wasser Notes re injunction • King, Rehab PSRB July 2018 FINAL • Litsky, Gail PSRB OCT 2019 FINAL • Mueller.PSRB.11.19 • Clark, F. CR-JP-3, LH JG Rev 1-30-20 NC-NR • Ardizzone PSRB.December 2019 Other Documents • DMHAS supportive housing list • Resource Guide update 7-13 • COVID Commissioner Order on Visitors Memo to Staff PNP Providers 5-12-20

Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 80 of 82
• WFH Task Force Presentation by Hal Smith and Tobias Wasser June 17, 2019 • 5-26-20 Final Revised WFH Coronavirus Pandemic Incident Action Plan • 17-6019 MDSX Hospital • 17-6019-01 MDSX Hospital executed • 17-6019-02 Executed • Annual Report SFY2019 • Community Integration & Discharge from CVH • CT Valley Hospital & Whiting Forensic Hospital Staff Educational & Training
Presentation November 21, 2019 • CVH & Whiting Forensic Procedure manual, Community Integration & Discharge,
June 11, 2015 • CVH Whiting Task Force presentation by Charles Dike and Vinneth Carvalho
September 16, 2019 • DMHAS Commissioners Policy Statement of DMHAS Client Rights Policy,
January 3, 2019 • DPH COVID-19 Guidance-for-Long-Term-Care-Facilities March 26, 2020 • Evolution of Forensic Services in CT IRCC presentation • WFH Operational Procedural Manual on Community Integration & Discharge
June 18, 2018 • Coronavirus CT: Deaths, Cases For All Elder Care, Nursing Homes.
https://patch.com/connecticut/across-ct/coronavirus-ct-deaths-cases-all-eldercare-nursing-homes-2 (last visited June 20, 2020). Guidance Relied Upon by CVH and Whiting: • CDC and other Guidances CVH/Whiting Using Plaintiff’s Treatment Notes:

Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 81 of 82
• CM Treatment plan • VA Treatment plan • GL Treatment plan • TW Notes • CLRP Suit BF 04-08-20 notes Pleadings: • Wilkes preliminary Injunction memo of law • Wilkes Motion for preliminary injunction • Exhibit 1 – Declaration of Dr. Farrin A. Manian, MD, MPH • Exhibit 2 – Declaration of Dr. Patrick Canavan and Elizabeth Jones • Exhibit 3 – Affidavit of Carson Mueller 052420 • Exhibit 4 – Affidavit of Vincent Ardizzone • Exhibit 5 – Affidavit of Gail Litsky 052320 • Exhibit 6 – Affidavit of Francis Clarke 052320 • Exhibit 7 – Affidavit of Rehab King 052420 • Exhibit 8 – Affidavit of Richard Gudis • Exhibit 9 – COVID-19 Guidance for Long Term Care facilities 32620 • Exhibit 10 – Nursing Home Reopening Recommendations for State and Local
Officials 051820 • Exhibit 11 – How to Protect Yourself and Others • Exhibit 12 – Key Strategies to Prepare COVID 19 in Long-Term-Care Facilities • Exhibit 13 – Preparing COVID19 in Nursing Homes 051920 • Exhibit 14 – Responding to COVID 19 in Nursing Homes 050920

Case 3:20-cv-00594-JCH Document 49-2 Filed 07/09/20 Page 82 of 82
• Exhibit 15 – Testing Guidance for Nursing Homes 051920 • Exhibit 16 – Performing Facility-wide SARS – coV2-Testing in Nursing Homes
05-19-20 • Exhibit 17 – Infection Prevention and Control Assessment Tool for Nursing
Homes Preparing for COVID 19 • Exhibit 18 – Considerations for the Care and Treatment of Mental and Substance
Use Disorders in the COVID-19 Epidemic 032020 Rev 050720 Root Cause Analyses of COVID-Deaths SV 4/29/20 RR 5/14/20 JJ 5/20/2020 TF 5/21/2020 CM 5/27/2020 Interviews Vinneth Carvalho, MD, Medical Director, CVH, 6/23/2020, 12:30 pm – 1:50 pm Tobias Wasser, MD, Medical Director, WFH, 6/25/2020, 2:30pm – 4:00 pm Timothy Denier, Director of Accreditation & Regulatory Compliance, CVH, 6/26/2020 Nancy Navaretta, Deputy Commissioner, DMHAS, 4:00 – 4:45 pm Simie Rosenthal-Whalen, Director of Admissions at DMHAS, 5:00 – 5:25 pm Tours CVH 6/26/2020 1:00 pm – 2:38 pm WFH 6/25/2020 concurrent with interview

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EXHIBIT B

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ATTACHMENT 1

Case 3:20-cv-00594-JCH Document 49-3 Filed 07/09/20 Page 19 of 47
Richard Martinello, M.D.
CURRICULUM VITAE

Date of Revision:

4/2020

Name:

Richard Martinello, M.D.

Term:

Primary Appointment: July 1, 2017 to June 30, 2022 Secondary Appointment: July 1, 2017 to June 30, 2022

School:

Yale School of Medicine

Education: B.S. M.D.

Loyola University Chicago (Biology) 1991 Loyola University Chicago, Stritch School of Medicine 1995

Career/Academic Appointments:

1995-96

Intern, Departments of Internal Medicine and Pediatrics, Indiana University School of

Medicine, Indianapolis, IN

1996-99

Resident, Departments of Internal Medicine and Pediatrics, Indiana University School of

Medicine, Indianapolis, IN

1998-99

Chief Resident, Internal Medicine/Pediatrics training program, Indiana University

School of Medicine, Indianapolis, IN

1999-02

Fellow, Infectious Diseases, Department of Internal Medicine, Yale School of Medicine,

New Haven, CT

2000-03

Fellow, Infectious Diseases, Department of Pediatrics, Yale School of Medicine, New

Haven, CT

2002-03

William Wirt Winchester Fellow in Healthcare Epidemiology, Quality Improvement

Support Services, Yale New Haven Hospital, New Haven, CT

2003-06

Clinical Instructor, Departments of Internal Medicine and Pediatrics, Infectious

Diseases, Yale School of Medicine, New Haven, CT

2003-19

Staff Physician, VA Connecticut Healthcare System, West Haven, CT

2006-12

Assistant Professor, Departments of Internal Medicine and Pediatrics, Infectious

Diseases, Yale School of Medicine, New Haven, CT

2012-present Associate Professor, Departments of Internal Medicine and Pediatrics, Infectious

Diseases, Yale School of Medicine, New Haven, CT

Administrative Positions:

2003-12

Hospital Epidemiologist, VA Connecticut Healthcare System, West Haven, CT

2009-12

Acting Senior Medical Advisor, Office of Public Health and Environmental Hazards,

Veterans Health Administration, Department of Veterans Affairs, Washington, DC

2012-15

Chief Consultant, Clinical Public Health, Office of Public Health, Veterans Health

Administration, Department of Veterans Affairs, Washington, DC

2015-present Medical Director, Infection Prevention, Yale New Haven Hospital, New Haven, CT

2017-present Medical Director, Infection Prevention, Yale New Haven Health System, New Haven,

CT

Board Certification: American Board of Internal Medicine, Internal Medicine, 1999 American Board of Pediatrics, Pediatrics, 1999

1

Case 3:20-cv-00594-JCH Document 49-3 Filed 07/09/20 Page 20 of 47
Richard Martinello, M.D.
American Board of Infectious Diseases, 2002 American Board of Pediatrics, Pediatric Infectious Diseases, 2005 American Board of Pediatrics, recertified, Pediatrics, 2006 American Board of Internal Medicine, recertified, Infectious Diseases, 2012 American Board of Pediatrics, recertified, Pediatric Infectious Diseases, 2015

Professional Honors & Recognition
International/National 2015: Hispanic–Serving Health Professions Schools, Certificate of Appreciation 2013: Department of Veterans Affairs, Service Award 2011: Department of Veterans Affairs, Veterans Health Administration, Under Secretary for Health,
Certificate of Appreciation 2009: Department of Veterans Affairs, Veterans Health Administration, VA Central Office, Special
Contribution Award 2007: Department of Veterans Affairs, Veterans Health Administration, Veterans Integrated Service
Network 1, Special Contribution Award 2006: Department of Veterans Affairs, Veterans Health Administration, Veterans Integrated Service
Network 1, Certificate of Appreciation 2003: Society for Healthcare Epidemiology of America, 13th Annual Meeting Travel Award
Regional 2018: Best abstract/Performance Improvement category, Yale New Haven Health, Safety, Quality
and Experience Conference. “Using Multidisciplinary Teamwork to Reduce Hospital Acquired C. difficile.”

Grants and Clinical Trials:

Submitted Grants

Agency:

Professional Disposables, Inc.

RFA

NA

Title

Prospective, Cross-Over Comparison of Prevantics vs. Isopropyl Alcohol Hub Disinfection

for Preventing Catheter-Associated Bloodstream Infection and Blood Culture Contamination

in Hematology-Oncology Patients

PI

David Pegues, MD and Richard Martinello, MD

Role on Project: Co-PI

Direct Cost:

Total Cost: $206,000

Project Period:2019 - 2021

Current Grants

Agency:

DoD/DARPA

Contract #: N6001-17-2-4023

Title:

Contagious Phenotypes of Acute Respiratory Infection: Identification, Characterization, and

Biomarkers

PI:

Donald K. Milton, MD, DrPH

Role on Project: Consultant

2

Case 3:20-cv-00594-JCH Document 49-3 Filed 07/09/20 Page 21 of 47
Richard Martinello, M.D.
Percent effort: <5% Direct cost: $1,102,749 Total cost: $1,527,351 Project Period:01/01/17 – 12/31/18

Past Grants

Agency: VHA/ORD/HSR&D

ID#:

HIR 08-374

Title: “Consortium for Health Informatics Research”

P.I.:

Matthew Samore, M.D.

Percent effort: 10%

Direct costs per year: $2,750,000

Total costs for project period: $11,000,000

Project period: 01/01/09 – 12/31/14

Agency: VA/OI&T

ID#:

291

Title: “Reducing Health Care Associated Infections: Electronic Methods to Measure Medical Device

Use”

P.I.

Richard Martinello, M.D.

Percent effort: 10%

Direct costs per year: $567,158

Total costs for project period: $567,158

Project period: 10/01/11 – 09/30/12

Agency: VHA/COHIC

ID#:

not-applicable

Title: “Carriage Patterns and Molecular Epidemiology to Optimize MRSA Prevention”

P.I.

Kalpana Gupta, M.D.

Percent effort: 5%

Direct costs per year: $425,000

Total costs for project period: $425,000

Project period: 07/01/11 – 06/30/12

Agency: VHA/HSR&D

ID#:

PPO 10-266

Title: “Ontology-Enhanced Information Retrieval to Improve Clinical Practice”

P.I.

James A. McCart, Ph.D.

Percent effort: 5%

Direct costs per year: $100,000

Total costs for project period: $100,000

Project period: 10/1/11 – 9/30/12

Agency: VHA HSR&D SDR

ID#:

HX-11-022

Title: “Consequences of Notifying Patients After Potentially Harmful Exposures, Large Scale Adverse

Event Communications”

P.I.

Rani Elwy, Ph.D.

Percent effort: 5%

3

Case 3:20-cv-00594-JCH Document 49-3 Filed 07/09/20 Page 22 of 47
Richard Martinello, M.D.
Direct costs per year: $500,000 Total costs for project period: $500,000 Project period: 1/1/12 – 12/31/12

Agency: VHA/COHIC

ID#:

NA

Title: “Aerosol Transmission of Influenza”

P.I.:

Richard Martinello, M.D.

Percent effort: 10%

Direct costs per year: $250,000

Total cost for project period: $250,000

Project period: 10/1/10 – 9/30/11

Agency: VHA/Office of Public Health and Environmental Hazards

ID#:

NA

Title: “VA H1N1 Response After Action Report”

P.I.:

Richard Martinello, M.D.

Percent effort: 5%

Direct costs per year: $32,017

Total cost for project period: $32,017

Project period: 10/1/10 – 1/31/11

Agency: VHA/COHIC

ID#:

NA

Title: “Effectiveness of disinfectants against H1N1 2009 influenza virus”

P.I.:

Richard Martinello, M.D.

Percent effort: 5%

Direct costs per year: $50,000

Total cost for project period: $50,000

Project period: 1/1/09 – 12/31/11

Agency: NIH/NIAID

ID#:

AI52251

Title: “Genetic Virulence Markers in Respiratory Syncytial Virus”

P.I.:

Richard Martinello, M.D.

Percent effort: 75%

Direct costs per year: $122,875

Total cost for project period: $530,820

Project period: 9/1/03 – 8/31/07

Agency: VHA/Office of Public Health and Environmental Hazards

ID#:

NA

Title: “Developing new competencies for pandemic flu response”

P.I.:

Richard Martinello, M.D.

Percent effort: 5%

Direct costs per year: $5,000

Total cost for project period: $5,000

Project period: 7/1/07 – 6/30/08

4

Case 3:20-cv-00594-JCH Document 49-3 Filed 07/09/20 Page 23 of 47
Richard Martinello, M.D.

Agency: VHA/Office of Public Health and Environmental Hazards

ID#:

NA

Title: “Implementation of best practices to reduce ventilator associated pneumonia”

P.I.:

Richard Martinello, M.D.

Percent effort: 5%

Direct costs per year: $5,000

Total cost for project period: $5,000

Project period: 7/1/05 – 6/30/06

Agency: VHA/ Office of Public Health and Environmental Hazards

ID#:

NA

Title: “Improving health care worker hand hygiene performance”

P.I.:

Richard Martinello, M.D.

Percent effort: 5%

Direct costs per year: $1,000

Total cost for project period: $1,000

Project period: 7/1/04 – 6/30/05

Other Support:

Agency: Infectious Diseases Section Research Incentive, Yale School of Medicine

Title: Case-control study of proton pump inhibitor exposure as a risk for healthcare associated

Clostridium difficile

P.I.:

Richard Martinello, M.D.

Percent effort: 5%

Direct costs per year: $10,000

Total cost for project period: $10,000

Project period: 2007

Agency: VHA Health Services Research and Development, Clinical Epidemiology Research Center grant

Title: Human metapneumovirus as a trigger for acute exacerbations of COPD

P.I.:

Richard Martinello, M.D.

Percent effort: 5%

Direct costs per year: $25,000

Total cost for project period: $25,000

Project period: 2007

Invited Speaking Engagements, Presentations, Symposia & Workshops Not Affiliated With Yale:
International/National 2020: “COVID-19” US Embassy. US Department of State. Cairo, Egypt. 2020: “Defining Standards and Metrology Needs for Ultraviolet Disinfection Technologies &
Healthcare Associated Infections through Industry and Federal Collaboration: a summary of the NIST/IUVA workshop”. 2020 International Ultraviolet Association World Congress. Orlando, FL.

5

Case 3:20-cv-00594-JCH Document 49-3 Filed 07/09/20 Page 24 of 47
Richard Martinello, M.D.
2020: Multiple Presentations. Workshop on Ultraviolet Disinfection Technologies & Healthcare Associated Infections: Defining Standards and Metrology Needs. Gaithersburg, MD. (Conference Organizing Committee)
2019: “Seasonal Influenza: When, Who, and How to Manage”. Pri-Med East Conference. Boston, MA.
2019: “Cases in Infectious Disease: How the Recent Medical Literature Might Influence Your Clinical Practice”. Pri-Med New York 2019 Conference. New York City, NY. (~1,300 attendees)
2019: “Cases in Infectious Disease: How the Recent Medical Literature Might Influence Your Clinical Practice”. Pri-Med Midwest 2019 Conference. Rosemont, IL. (~800 attendees)
2019: “Cases in Infectious Disease: How the Recent Medical Literature Might Influence Your Clinical Practice”. Pri-Med South 2019 Conference. Tampa, FL. (~600 attendees)
2019: “Cases in Infectious Disease: How the Recent Medical Literature Might Influence Your Clinical Practice”. Pri-Med Atlanta 2019 Conference. Atlanta, GA. [>500 attendees]
2019: “Cases in Infectious Disease: How the Recent Medical Literature Might Influence Your Clinical Practice”. Pri-Med Irving Conference. Irving, TX. [>600 attendees]
2019: “How UV-C Technologies and Standards Fit in the Fight Against HAIs”. ASHRAE 2019 Annual Conference, Technical Conference 2.9 Ultraviolet Air and Surface Treatment. Kansas City, MO.
2019: “How UV-C Technologies and Standards Fit in the Fight Against HAIs”. ASHRAE 2019 Annual Conference, Technical Conference 9.6 Healthcare. Kansas City, MO.
2019: “Seasonal Influenza: When, Who, and How to Manage”. Pri-Med Southwest Conference. Houston, TX. [>1,800 attendees]
2019: “Minimizing Healthcare-Associated Infections in the United States through the Collaborative Development of Standards, Metrology and Technology” 2019 International Ultraviolet Association World Congress. Sydney, Australia.
2019: “Heterogeneity in the Reporting of UVC Surface Disinfection Interventions in the Medical Literature- A Potential Barrier to Implementation” 2019 International Ultraviolet Association World Congress. Sydney, Australia.
2018: “Current Concepts in the Management of Influenza”. Pri-Med Conference. Atlanta, GA. [>900 attendees]
2018: “Current Concepts in the Management of Influenza”. Pri-Med Conference. Los Angeles, CA. [>800 attendees]
2018: “Identifying Opportunities and Implementing Best Practices for Immunization Against Pneumococcal Disease in Adults”. Virtual Expert Roundtable teleconference. Pri-Med.
2018: “How UV-C Technologies and Standards Fit in the Fight Against Hospital-Acquired Infections”. International Ultraviolet Association Americas Meeting. Redondo Beach, CA.
2018: “Identification of barriers and research opportunities to improve the effective and efficient application of adjunct UVC surface disinfection in healthcare”. SPIE Photonics West. San Francisco, CA.
2017: “Fighting Healthcare Associated Infections and Multi-Drug Resistant Organisms with UV-C Using Industry, Healthcare and Federal Collaboration”. International Ultraviolet Association 2017 Americas Conference. Austin, TX.
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Case 3:20-cv-00594-JCH Document 49-3 Filed 07/09/20 Page 25 of 47
Richard Martinello, M.D.
2015: “Protecting Pregnant Women and Their Babies from Influenza”. Moderator (Speaker, Dr. Sonja Rasmussen); Veterans Health Administration, National Public Health Teleconference. Washington, DC.
2014: “Ebola”. Department of Veterans Affairs, National Partnership Council National Teleconference. Washington, DC.
2014: “Influenza Vaccination and Prevention”. Veterans Health Administration, National Public Health Teleconference. Washington, DC.
2014: “MERS Coronavirus”. Moderator (Speakers, Drs. Connie Savor-Price and Mary Bessesen), Veterans Health Administration, National Public Health Teleconference.
2014: “Water and high-risk populations”. Water Safety in Healthcare Workshop. Department of Veterans Affairs, Veterans Health Administration. Cincinnati, OH.
2014: “Access to Vaccinations in the Department of Veterans Affairs”. National Adult Immunization and Influenza Summit. Atlanta, GA. (Session moderator and presenter).
2014: “Healthcare Personnel Immunizations”. Department of Veterans Affairs, National Occupational Health Grand Rounds. Washington, DC.
2013: “Reduction of Healthcare Associated Infections through Informatics”. Department of Veterans Affairs, Veterans Affairs Innovation Program. Washington, DC.
2013: “Outbreak and Exposure Investigation Fundamentals”, Veterans Health Administration, Mental Health and Psychology Fellows National Teleconference. Washington, DC.
2013: “Vaccinations and Pregnancy”, Veterans Health Administration, joint VA Public Health and Women’s Health National Teleconference. Washington, DC.
2012: “Hand Hygiene: Power, trust and obligation”, Veterans Health Administration Hand Hygiene Summit, Chicago, IL.
2012: “Infection Control in the 21st Century”, planning committee, Veterans Health Administration.
2012: “Influenza Transmission”, Pandemic Sub-Interagency Policy Committee, National Security Staff, Executive Office of the President, The White House. Washington, DC.
2012: “Health care providers and influenza vaccination”, Veterans Health Administration, Infectious Diseases National Teleconference. Washington, DC.
2012: “Influenza Vaccination and Health Care Providers: Attitudes and Challenges” Veterans Health Administration, 2012 VHA Influenza Summit. Washington, DC.
2012: “Decreasing the Impact of Influenza: Opportunities for Change”. Department of Veterans Affairs, Joint Semi-Annual Labor Management Relations Meeting. Washington, DC.
2011: “Do masks work against influenza?” Veterans Health Administration, Sixth Annual VISN 23 Pandemic Influenza Conference. Bloomfield, MN.
2011: “Mitigating the impact of influenza in the future: Vaccine advances”, Veterans Health Administration, Sixth Annual VISN 23 Pandemic Influenza Conference. Bloomfield, MN.
7

Case 3:20-cv-00594-JCH Document 49-3 Filed 07/09/20 Page 26 of 47
Richard Martinello, M.D.
2011: “Seasonal Influenza Update”. Veterans Health Administration, Office of Public Health National Teleconference. Washington, DC.
2011: “Influenza vaccine safety and efficacy” Veterans Health Administration, Office of Public Health National Teleconference. Washington, DC.
2011: “Promoting Influenza Vaccination: Reducing disparities and expanding use”, Veterans Health Administration, Office of Public Health National Teleconference.
2011: “Climate Change and Health: Vulnerabilities and Actions”. The White House Council on Environmental Quality, Inter-Agency Meeting, Executive Office of the President. Washington, DC.
2011: “VA Health Care Personnel Influenza Vaccination”. Department of Health and Human Services, National Vaccine Advisory Committee, HCP Influenza Vaccination Subgroup. Washington, DC.
2011: “Expanding Access to Adult Vaccines”. Department of Health and Human Services, National Vaccine Advisory Committee, Adult Immunization Stakeholders Meeting. Chicago, IL.
2011: “Health Care Providers and Influenza Vaccination: Considerations for Mandatory Vaccination Programs”. Veterans Health Administration, Infection: Don’t Pass It On conference. Biloxi, MS.
2011: “High Dose Influenza Vaccine: Barriers to Implementation”. Veterans Health Administration, Infection: Don’t Pass It On conference. Biloxi, MS.
2011: “Identifying and Prioritizing New Vaccines for Development”. Institute of Medicine, Committee on Identifying and Prioritizing New Vaccines for Development. The National Academy of Sciences, Keck Center, Washington, DC.
2010: “Using evaluation to improve our work: A resource guide for After Action Reports”. Veterans Health Administration, Health Services Research & Development National Cyberseminars. Washington, DC.
2010: “Respiratory Protection and Prevention of Influenza Infection”. Veterans Health Administration, National Safety and Health Teleconference. Washington, DC.
2010: “Influenza Vaccination Update: Expanded Recommendations and an Introduction to the High Dose Influenza Vaccine”. Veterans Health Administration, National Public Health Teleconference.
2010: “Preparedness in an Integrated Health Care Delivery System”. Institute of Medicine, Forum on Medical and Public Health Preparedness for Catastrophic Events. Woods Hole, MA.
2010: “Medical and Public Health Preparedness: Efforts and Gaps”. Institute of Medicine, Forum on Medical and Public Health Preparedness for Catastrophic Events. Woods Hole, MA, June 7, 2010.
2010: “Influenza Vaccine Efficacy, Effectiveness and Controversy”. Influenza Summit, Veterans Health Administration. Washington, DC.
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Richard Martinello, M.D.
2010: “Pandemic Response”, Emergency Management Leadership Conference. Department of the Interior. Shepardstown, WV.
2009: “Preventative measures: vaccination, infection control practices and personal protective equipment”. National Pandemic Influenza Training. Veterans Health Administration. Washington, DC.
2009: “Wound Infections: Antimicrobial Therapy”. Symposium on Advanced Wound Care. Association for the Advancement of Wound Care. Washington, DC.
2009: “New antibiotics for MRSA and Clostridium difficile”. 8th Annual Needham Life Sciences Conference. New York City, NY.
2009: “Preventative measures: vaccination, infection control practices and personal protective equipment”. National Pandemic Influenza Training, Veterans Health Administration. Washington, DC.
2009: “Seasonal and Pandemic Influenza”. Veterans Health Administration, National Safety Conference, Department of Veterans Affairs. Las Vegas, NV.
2009: “Preparing for Pandemic Influenza”. Veterans Health Administration, National Safety Conference, Department of Veterans Affairs. Las Vegas, NV.
2009: “Bloodborne Pathogens”. Veterans Health Administration Occupational Health National Grand Rounds, Department of Veterans Affairs. Washington, DC.
2008: “Bloodborne pathogens, post-exposure prophylaxis and infection control for occupational health”. National VA Safety Training Conference, Department of Veterans Affairs. Las Vegas, NV.
2008: “Methicillin resistant Staphylococcus aureus”National VA Safety Training Conference, Department of Veterans Affairs. Las Vegas, NV.
2008: “Legionella and Legionella Prevention”. National VA Safety Training Conference, Department of Veterans Affairs. Las Vegas, NV.
2008: “Best Practices for Minimizing Exposure to Bloodborne Pathogens”. National VA Safety Training Conference, Department of Veterans Affairs. Las Vegas, NV.
2008: “Bloodborne pathogens, post-exposure prophylaxis and infection control for occupational health”. National VA Safety Training Conference, Department of Veterans Affairs. Las Vegas, NV.
2007: “Bloodborne Pathogens: HIV, Hepatitis B and Hepatitis C”. National VA Safety Training Conference, Department of Veterans Affairs. Las Vegas, NV.
2007: “Infection Control for Occupational Safety and Health”. National VA Safety Training Conference, Department of Veterans Affairs. Las Vegas, NV.
Regional 2018: “Hospital and Environmental Infections: An Interdisciplinary Approach”. Connecticut Infectious
Diseases Society Annual Meeting. Orange, CT.
2016: “Zika: An introduction and update”. VA Boston Healthcare System, Medical Grand Rounds. West Roxbury, MA.
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Richard Martinello, M.D.
2014: “Emerging Viral Infections: Chikungunya, MERS & Ebola”. Veterans Health Administration, VISN 1 Primary Care Teleconference. Bedford, MA.
2014: “Influenza”. Veterans Health Administration, VISN 1 Primary Care Teleconference. Bedford, MA.
2012: “Influenza: impact, prevention and patient safety”. Veterans Health Administration, VISN 3 Influenza Colloquium. New York City, NY.
2012: “Influenza Vaccination among health care providers: Opportunities for change”. Veterans Health Administration, VISN 3 Influenza Colloquium. New York City, NY.
2012: “Ontology development and text processing for MRSA”. Veterans Health Administration Consortium for Health Informatics Research conference. Salt Lake City, UT.
2011: “Influenza and its prevention”. Veterans Health Administration, VISN 3 Influenza Conference. New York City, NY.
2010: “2009 Influenza Pandemic: Lessons Learned”. Veterans Health Administration, VISN 23 Pandemic Influenza Summit. Minneapolis, MN.
2010: “Influenza 2010-11”. Veterans Health Administration, VISN 1 Primary Care Grand Rounds. Bedford, MA.
2010: “Developing the MRSA Working Use Case”. Consortium for Healthcare Informatics Research. Veterans Health Administration. Salt Lake City, UT.
2010: “Pandemic Response” Southern VISN Emergency Management Leadership Training. Veterans Health Administration. Atlanta, GA.
2009: “Influenza and HIV”. Infectious Diseases Conference. Department of Internal Medicine, Brown University. Providence, RI.
2009: “Seasonal and Pandemic Influenza”. State of Connecticut, Department of Mental Health and Addiction Services. Bridgeport, CT.
2009: “Influenza: Transmission, Prevention and Treatment”. VA Boston Healthcare System, Department of Internal Medicine Grand Rounds. West Roxbury, MA.
2009: “MRSA”. State of Connecticut, Department of Mental Health and Addiction Services. Bridgeport, CT.
2009: “Infection Control”. State of Connecticut, Department of Mental Health and Addiction Services. Bridgeport, CT.
2009: “Seasonal and Pandemic Influenza”. State of Connecticut, Department of Mental Health and Addiction Services. Bridgeport, CT.
2009: “Respiratory Virus Infections”. State of Connecticut, Department of Mental Health and Addiction Services. Bridgeport, CT.
10

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Richard Martinello, M.D.
2009: “Avian Influenza and Influenza Pandemics”. Togus VA Medical Center, Medical Center Grand Rounds. Togus, ME.
2006: “Avian influenza and influenza pandemics”. Togus VA Medical Center Grand Rounds. Togus, ME.
Peer-Reviewed Presentations & Symposia Given at Meetings Not Affiliated With Yale
International/National 2020 SHEA abstracts 2020 APIC abstracts 2019 IDWeek 2019. Rathod SN, McManus D, Rivera-Vinas J, Topal JE, Martinello RA. Evaluating
the Antibiotic Risk for Clostridioides difficile Infection (CDI): Comparing Piperacillin/Tazobactam to Cefepime and Ceftazidime. 2019 SHEA Spring 2019 Conference. Rathod S, Sussman LS, Peaper DR, Azar MM, Topal JE, Kashyap N, Tichy EM, McManus D, Martinello RA. Examining Clinicians’ Rationale for Ordering Clostridioides difficile Testing in Patients Receiving Laxatives. 2019 American Academy of Orthopaedic Surgeons. Tyagi V, Kahan J, Rubin LE, Moore A, Whitbread M, Wysocki D, Fairweather I, Oliver P, Ruskis A, Golden M, Martinello RA, Topal JE, Spadaccino B, Novella L, Serra J, Morris J, O’Connor MI. Reducing Surgical Site Infection for Fragility Hip Fracture Patients at the Center for Musculoskeletal Care at Yale New Haven Hospital. 2018 Institute for Healthcare Improvement National Forum. Fillion S, Fischer A, Advani S, Barna J, Smith C, Walka C, Hittleman A, Leapman M, Martinello RA, Wagner J. Champions Changing Practice, Changing Culture: Cultivating Use of the CAUTI Prevention Bundle at Yale New Haven Hospital. 2018 International Ultraviolet Association Healthcare Workshop. Healthcare Associated Infections; Overview and Issues (panel facilitator). 2018 International Ultraviolet Association Healthcare Workshop. Healthcare Associated Infections Mitigation Programs (panel facilitator). 2018 International Ultraviolet Association Healthcare Workshop. Martinello RA. The burden of HAI, HAI surveillance, and HAI public reporting. 2018 SPIE Optics & Photonics. Poster DL, Miller CC, Obeng Y, Postek MT, Cowan TE, Martinello RA. Innovative Approaches to Combat Healthcare-Associated Infections Using Efficacy Standards Developed Through Industry and Federal Collaboration. 2018 Council for Optical Radiation Measurements, National Institute for Standards and Technology. Miller CC, Poster DL, Obeng Y, Postek MT, Cowan TE, Martinello RA. Innovative approaches to combat healthcare associated infections using efficacy standards developed through industry and federal collaboration. 2018 Annual Meeting of the Infectious Disease Society of America (IDSA) IDWeek 2018. Gao CA, Datta R, Smith C, Martinello RA, Dembry LM, Advani SD. The culture of culturing in catheterized patients: A Multi-Hospital Survey of Nurses and Physicians. 2018 Annual Meeting of the Infectious Disease Society of America (IDSA) IDWeek 2018. Pepe DE, Aniskiewicz A, Paci G, Sullivan L, Dembry LM, Martinello RA, Advani S. A Risk-Stratified Approach to Healthcare-Associated Tuberculosis Exposures Following the "Stone in the Pond" Principle. 2018 Annual Meeting of the Infectious Disease Society of America (IDSA) IDWeek 2018. Gao CA, Datta R, Smith C, Dembry LM, Dunne D, Martinello RA, Juthani-Mehta M, Advani S. Educational interventions improve trainee approach to obtaining urine cultures in catheterized patients.
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2018 2018 2018 2018 2017 2017 2017 2017 2017 2017 2016 2016 2015
2015
2015 2015

SHEA Spring 2018 Conference. Glanternik JR, Advani S, Aniskiewicz M, Murdzek C, Bizzarro M, Baltimore RS, Martinello RA. Impact of Active Surveillance for Vancomycin Resistant Enterococcus in the Neonatal Intensive Care Unit. SHEA Spring 2018 Conference. Pepe D, Advani S, Aniskiewicz M, Paci G, Macone E, Sullivan L, Martinello RA. Analysis of healthcare associated tuberculosis exposures at an academic medical center. SHEA Spring 2018 Conference. Advani S, Sann L, Smith C, Datta R, Leapman M, Hittelman A, Gao C, Sullivan L, Juthani-Mehta M, Martinello RA. Impact of Reflex Urine Cultures on Catheter-associated Urinary Tract Infections at an Academic Medical Center. SPIE-Photonics West, BioS. Martinello RA, Miller SL, Fabian MP, Peccia J. Identification of barriers and research opportunities to improve the effective and efficient application of adjunct UVC surface disinfection in healthcare. IDWeek 2017. Datta R, John B, Hellou E. Martinello RA, Malinis M. Evaluating the Risk of Viral Myocarditis following Influenza Infection among Hospitalized Patients during 2014- 2015 and 2015-2016 Influenza Seasons. IDWeek 2017. John B, Malinis M, Baltimore RS, Fairweather I, Rivera-Vinas J, Martinello RA. Improved Survival of Candida CLABSI by Adherence to Standard of Care and Involvement of Infectious Diseases Consultant: A 5-year Experience in a Single Academic Center. VHA HSR&D 2017, Crystal City, VA. Elwy AR, Maguire EM, Bokhour BG, Wagner TH, Asch SM, Gifford AL, Gallagher TH, Durfee JM, Martinello RA, Taylor TJ. Risk Communication in VA Healthcare: Preventing Unintended Consequences. APIC 2017 Conference, Portland, OR. Smith C, Fillion S, Williams E, Martinello RA. Using Data to Drive and Sustain Practice Changes in conquering Catheter-Associated Urinary Tract Infections. SHEA Spring 2017 Conference, St. Louis, MO. Acquarulo B, Sullivan L, Gentile AL, Boyce JM, Martinello RA. Mixed-Methods Analysis of Glove Use as a Barrier to Hand Hygiene. SHEA Spring 2017 Conference, St. Louis, MO. Martinello RA, Arbogast JW, Parker AE, Boyce JM. Nurse Preference for Alcohol-Based Hand Rub Volume. SHEA Spring 2016 Conference. Atlanta, GA. Boyce JM, Rillstone H, Colandrea N, Stout RW, Topal J, Ruskis A, Martinello RA, Davis KA. Reducing Colon Surgery-Related Surgical Site Infection (SSI) Rates Using a Bundle. SHEA Spring 2016 Conference, Atlanta, GA. St. Pierre C, McDevitt JJ, Milton DK, Martinello RA. Implementation of Upper Room Germicidal Irradiation in a Closed Dementia Long-Term Care Unit. NIH/AcademyHealth Dissemination & Implementation Conference. Washington, DC. McCullough MB, Maguire EM, George J, Bokhour BG, Asch SM, Gifford AL, Wagner TH, Durfee JM, Martinello RA, Elwy AR. Stakeholders’ perspectives on disclosing large scale adverse events: A toolkit built on lessons from implementing a national policy. International Conference on Communication in Healthcare. New Orleans, LA. Maguire EM, Taylor TT, Gallagher TH, Bokhour BG, Asch SM, Gifford AL, Wagner TH, Durfee JM, Martinello RA, Elwy AR. Testing large-scale disclosure language and communication methods through an experimental online vignette survey. American Public Health Association Annual Meeting. Chicago, IL. Finley P, Beyeler W, Mitchell M, Kaslow RA, Martinello RA, Davey VJ. Evaluating Ebola Response Alternatives in the VA Healthcare System using a Computational Epidemiological Control Model. Council of State and Territorial Epidemiologists Annual Conference. Boston, MA. Brown PL, Akaka LK, Oda G, Ross DB, Durfee JM, Kotar T, Martinello RA. Survey of Veterans Health Administration (VHA) Infectious Disease Reporting to State, Local, and Territorial Public Health Authorities (PHA).

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2015 2015 2015 2014 2014 2013 2013 2013 2013 2013 2012 2012 2012 2012

Council of State and Territorial Epidemiologists Annual Conference. Boston, MA. MedinaMartinez G, Rivera-Colon A, Wu M, Akaka LK, Oda G, McFarland L, Martinello RA. Reducing the Complexity of Veterans Health Administration (VHA) Infectious Diseases Reporting to State, Local and Territory Public Health Departments. NIH/AcademyHealth Dissemination & Implementation Conference. Bethesda, MD. Elwy AR, Maguire EM, Bokhour BG, Asch SM, Gifford AL, Wagner TH, Gallagher TH, Durfee JM, Martinello RA, Jesse RL. Stakeholders’ perspectives on disclosing large scale adverse events: A toolkit built on lessons from implementing a national policy. American Academy on Communications in Healthcare Research and Teaching Forum. Orlando, FL. Maguire EM, Bokhour BG, Durfee JM, Martinello RA, Asch SM, Gifford AL, Wagner TH, Gallagher TH, Elwy AR. Exploring Patient, Staff, and Leader Perceptions of Large Scale Adverse Event Notification Communication. IDWeek 2014. Philadelphia, PA. Schirmer P, Winters M, Lucero-Obusan C, Oda G, Martinello RA, Davey V, Holodniy M. Improperly Used Insulin Pen Lookback Investigation in Veterans Affairs (VA) Medical Center. IDWeek 2014. Philadelphia, PA. Schirmer P, Winters M, Lucero-Obusan C, Oda G, Martinello RA, Davey V, Holodniy M. Influenza Infection in the Department of Veterans Affairs (VA): 2013-2014. 141st American Public Health Association Annual Meeting. Boston, MA. Goulet JL, Martinello RA, Bathulapalli H, Higgins D, Driscoll MA, Brandt CA, Womack JA. High STI rates among returning Veterans, but low rates of HIV testing. International Society for Diseases Surveillance 2013 Conference. New Orleans, LA. LuceroObusan CA, Winters M, Schirmer P, Oda G, Martinello RA, Davey VJ, Holodniy M. Influenza Surveillance in the Department of Veterans Affairs (VA): 2012-2013 Influenza Season. American Medical Informatics Association 2013 Annual Symposium. Washington, DC. Martins SB, Tu SW, Martinello RA, Rubin MA, Foulis PR, Luther SL, Forbush TB, Scotch M, Doebbeling BN, Goldstein MK, for the VA CHIR MRSA Project. Creating a MRSA Ontology to Support Categorization of MRSA Infections. Institute for Operations Research and the Management Sciences Conference. Minneapolis, MN. Finley PD, Lambert GJ, Huff AG, Martinello RA, Evans L, Moore T, Glass R, Mecher C, Davey VJ. Ranking Pandemic interventions via Multilevel Sensitivity Analysis of Model Results (No. SAND2013-8521C). NIH/Academy Health, Translation and Communications Interest Group. San Diego, CA. Maguire, E., Elwy AR, Bokhour BG, Gifford AL, Asch SM, Wagner TH, Gallagher TH, Durfee JM, Martinello RA. Communicating large scale adverse events: Lessons from media reactions to risk. IDWeek 2012. San Diego, CA. Sellick J, Lesse A, Martinello RA, Kralovic S, Watson E, McCabe L, Schoenhals K. An Outbreak of Invasive Group A Streptococcus Infections in Veterans Treated with Skin Substitute Grafts at a Podiatry Clinic. IDWeek 2012. San Diego, CA. Mortensen E, Schirmer P, Lucero C, Oda G, Winters MA, Durfee J, Martinello RA, Davey VJ, Holodniy M. Are Current Screening Protocols for Chronic HBV Infection Adequate? Institute for Operations Research and the Management Sciences Conference. INFORMS 2012: Informatics Rising. Phoenix, AZ. Moore T, Finley P, Jones K, Martinello RA, Mecher C, Davey V. Mitigating infectious disease outbreaks in medical facilities with incomplete vaccination. American Academy on Communication in Healthcare Research & Teaching Forum. Providence, RI. Maguire E, Elwy AR, Bokhour BG, Gifford AL, Asch S, Wagner T, Gallagher T, Burgess J, Martinello RA. Communicating Large Scale Adverse Events: Lessons from Media Reactions to Risk.

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Richard Martinello, M.D.

2011 2011 2011 2010 2010 2010 2010 2010 2010 2008 2008 2008 2008 2008

American Medical Informatics Association 2011 Annual Symposium. Washington, DC. Garvin J, Doebbling B, Merchant M, Martinello RA, Mutalik P, Goldstein M, Luther S, Samore M, South B. An Informatics Approach to Methicillin Resistant Staphylococcus Aureus Surveillance in the Department of Veterans Affairs. Infectious Diseases Society of America Annual Meeting. Boston, MA. Gupta K, Young M, Strymish J, Martinello RA, Sokolovskaya G, Cho K, Lawler E. Long term persistence of the non-colonized with nasal MRSA state among hospitalized Veterans. Society for Healthcare Epidemiology of America 2011 Annual Scientific Meeting. Dallas, TX. Martinello RA, Cavaiuolo M, Johansen S, Campbell S. Use of common disinfectants to remove influenza virus from elastomeric respirators. International Society for Disease Surveillance 9th Annual Conference. Park City, UT. Rangel MC, Martinello RA, Lucero C, Oda G, Holodniy M, Peterson M, Davey VJ and the VA Gulf Coast Oil Spill Task Force. Adapting a Syndromic BioSurveillance System to Monitor Veterans’ Health Impact Associated with the Gulf Coast Oil Spill. American Medical Informatics Association 2010 Annual Symposium. Washington, DC. Martins SB, Tu SW, Yeh GS, Garvin JH, Martinello RA, Rubin MA, Foulis PR, Friedlin J, Doebbeling BN, and Goldstein MK for the VA CHIR MRSA Project. Creating an MRSA Ontology to Support Natural Language Processing. American Medical Informatics Association 2010 Annual Symposium. Washington, DC. Scotch M, Martinello RA, Mutalik P, Brandt C. Use of Natural Language Processing and Machine Learning for Surveillance of MRSA at the VA. American Medical Informatics Association 2010 Annual Symposium. Washington, DC. Merchant M, Rubin MA, Martinello RA, Goldstein MK, Foulis PR, Samore M, Martins SB, Garvin JH, Friedlin J, South B, Gullans SK, Doebbeling BN. An Interdisciplinary Research & Development Collaborative for Enhancing MRSA Surveillance and Decision Support. Fifth Decennial International Conference on Healthcare-Associated Infections. Atlanta, GA. Schult T, Awosika E, Hodgson M, Martinello RA. VHA Clinical and Non-Clinical Staff Differences in Sick Leave Usage: A Flu Effect? Fifth Decennial International Conference on Healthcare-Associated Infections. Atlanta, GA. Hirsch P, Martinello RA, Davey VJ, Hodgson M. Seasonal Influenza Vaccination: Results of a Four-Year Campaign. 48th Annual ICAAC/IDSA 46th Annual Meeting. Washington, DC. Martinello RA, Wattier RL, Rubino J, Mayo DR, Griffith B, Radonovich L, Milton DK. Investigation of a nursing home outbreak of H3N2 influenza using HA gene nucleotide sequences. 48th Annual ICAAC/IDSA 46th Annual Meeting. Washington, DC. Saharia K, Mayo DR, Griffith B, Martinello RA. Identification of norovirus gastroenteritis among hospitalized veterans in the absence of an outbreak. 48th Annual ICAAC/IDSA 46th Annual Meeting. Washington, DC. Miller H, Campbell S, Martinello RA, Towle D. Validation of NucliSENS® easyMAG™ Automated Nucleic Acid Extraction for Use with DiversiLab™ Microbial Strain-Typing System for Methicillin Resistant S. aureus. Seasonal and Pandemic Influenza 2008. Arlington, VA. Martinello RA, Wattier RL, Rubino J, Mayo DR, Griffith B, Radonovich L, Milton DK. Investigation of a nursing home outbreak of H3N2 influenza using HA gene nucleotide sequences. Society for Healthcare Epidemiology of America 18th Annual Scientific Meeting. Orlando, FL. Martinello RA, O’Neil K, Kotansky B, Concato JC. Proton Pump Inhibitor Use is Not a Risk for Healthcare Associated Clostridium difficile Associated Diarrhea.

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Richard Martinello, M.D.

2007 2007
2007 2006 2005 2004 2004 2004 2003 2003 2003 2001 2001 2001

Pediatric Academic Societies Annual Scientific Meeting. Toronto, ON. Lazar I, Kanungo N, Weibel C, Martinello RA, Kahn JS. The Magnitude of Induction of IL-6 by Clinical Isolates of Respiratory Syncytial Virus is Strain Specific. Pediatric Academic Societies Annual Scientific Meeting. Toronto, ON. Meyers R, Alvarez R, Tripp R, Hadwiger P, Roehl I, Elbashir S, Nechev L, Toudjarska I, Martinello RA, Kahn JS, DeVincenzo J. ALN-RSV01, an RNAi Therapeutic for the treatment of Respiratory Syncytial Virus (RSV) infection. Society for Healthcare Epidemiology of America 17th Annual Scientific Meeting. Baltimore, MD. Perkal K, Welch B, Rubino MJ, Swan K, Levey M, Cain H, Martinello RA. Use of Goal Sheets Reduces the Incidence of VAP. Society for Healthcare Epidemiology of America 16th Annual Scientific Meeting. Chicago, IL. Benin AL, Learsy-Cahill D, Das R, Kancir S, Welch B, Martinello RA. Veterans’ perception of urgency due to influenza vaccine shortage and its impact on vaccination, 2004-2005. RSV Symposium 2005. Keble College, Oxford University, United Kingdom. Martinello RA, Weibel C, Lazar I, Shapiro ED, Kahn JS. Association between RSV genotype and severity of disease in children. Society for Healthcare Epidemiology of America Annual Meeting. Philadelphia, PA. Martinello RA, Benin AL, Welch B, Cooper T, Ehrenkranz RA, Baltimore RS, Dembry LM. Risk Factors Associated with MRSA Colonization in Patients in a Neonatal Intensive Care Unit. Society for Healthcare Epidemiology of America Annual Meeting. Philadelphia, PA. Martinello RA, Reagan-Cirincione P, Dembry LM Risk Factors associated with the Identification of Methicillin Resistant Staphylococcus aureus in Hospitalized Patients. 42nd Annual Meeting of the Infectious Diseases Society of America. Boston, MA. Martinello RA, Esper F, Weibel C, Ferguson D, Landry ML, Kahn JS. Human metapneumovirus and exacerbations of chronic obstructive pulmonary disease. Society for Healthcare Epidemiology of America Annual Meeting. Martinello RA, Topal JE, Cooper T, Dembry LM, Kahn JS. Molecular Epidemiology of a Nosocomial Parainfluenza Virus Outbreak. Society for Healthcare Epidemiology of America Annual Meeting. Martinello RA, Esper F, Boucher D, Weibel C, Kahn JS. Nosocomial Transmission of the Human Metapneumovirus. Society for Healthcare Epidemiology of America Annual Meeting. Martinello RA, Welch BA, King S, Topal JE, Dembry LM. An Outbreak of Norwalk-like Virus (NLV) in a Psychiatric Hospital. Society for Healthcare Epidemiology of America Annual Meeting. April, 2003. Infectious Disease Society of America Annual Meeting. San Francisco, CA. Martinello RA, Cooney EL. Cerebellar brain abscess associated with tongue piercing. Infectious Disease Society of America Annual Meeting. San Francisco, CA. Martinello RA, Chen MD, Weibel C, Kahn JS. Correlation between respiratory syncytial virus genotype and illness severity. Society for Healthcare Epidemiology of America Annual Meeting. Toronto, ON. Martinello RA, Jones L, Topal JE. Assessment of healthcare worker attitudes toward influenza vaccination.

Regional 2019 Yale New Haven Health Safety, Quality, and Experience Conference, Wallingford, CT. Clemons
C, Advani S, Aniskiewicz M, Brien P, Brophy C, Dahlberg S, DeWitt M, Fairweather I, Figoras AM, Hall A, Katz J, Landry M, Martinello R, Malone R, Owen M, Parwani V, Peaper D, Saxa T, Scarpetti E, Sevilla M, Shapiro M, Sullivan S, Ulrich A. MRSA Optimization: Reducing Unnecessary MRSA Precautions for 11,000 patients improves Patient Care and Value.

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Richard Martinello, M.D.

2019 2018
2018 2018 2018 2018 2017 2007

Yale New Haven Health Safety, Quality, and Experience Conference, Wallingford, CT. Rathod S, Sussman LS, Azar MM, Tichy EM, Topal JE, Murdzek C, Kashyup N, McManus D, Peaper DR, Martinello RA. Examining Clinicians’ Rationale for Ordering Clostridioides difficile Testing in Patients Receiving Laxatives. Yale New Haven Health Safety, Quality, and Experience Conference, Wallingford, CT. Advani S, Aniskiewicz M, Branson B, Brien P, Brophy C, Clemons C, Dahlberg S, Dewitt M, Fairweather I, Figoras AM, Hall A, Katz J, Landry ML, Martinello RA, Malone R, Owen M, Parwani V, Peaper DR, Saxa T, Scarpetti E, Sevilla M, Shapiro M, Sullivan L, Ulrich A. Emergency Department implementation of rapid influenza PCR provides more accurate, timely care. Yale New Haven Health Safety, Quality, and Experience Conference, Wallingford, CT. Susman LS, Williams J, Kozakiewicz J, Peaper D, Martinello RA, Holmes M, Murdzek C, Topal JE, et al. Using multidisciplinary teamwork to reduce hospital acquired C. difficile. Yale New Haven Health Safety, Quality, and Experience Conference, Wallingford, CT. Fischer A, Advani S, Amell N, Ashman A, Barna J, Carroll L, Costa S, Depukat D, Edwards L, Fillion S, Gowisnock S, Hittleman A, Leapman M, Martinello RA, Rossetti RM, Smith C, Strouse MR, Whitbread M, Walka C, Wagner J. Champions changing practice changing culture: Cultivating use of the CAUTI prevention bundle. Yale New Haven Health Safety, Quality, and Experience Conference, Wallingford, CT. Gao CA, Datta R, Smith C, Martinello RA, Dembry LM, Advani SD. The culture of culturing in catheterized patients: A Multi-Hospital Survey of Nurses and Physicians. Yale New Haven Health Safety, Quality, and Experience Conference, Wallingford, CT. Implementation of a bundle protocol to reduce surgical site infection for hip fracture patients at YNHH Center for Musculoskeletal Care. Tyagi V, Kahan J, Moore A, Whitbread M, Wysocki D, Oliver P, Ruskis A, Golden M, Martinello R, Topal J, Spadaccino B, Novella L, Serra J, Morris J, O’Connor MI, Rubin LE. 35th Annual Conference of the Connecticut Infectious Disease Society, West Haven, CT. Laurent-Rolle M, Poonawala H, Montero N, Golden M, Martinello R, Aoun-Barakat L. Mycobacterium abscessus Skin and Soft-Tissue Infections Following Plastic Surgery Procedures in the Dominican Republic. Veterans Integrated Service Network 1 Emergency Preparedness Forum. Nashua, NH. Martinello RA. The Canadian SARS Experience: Lessons Learned.

Professional Service

Peer Review Groups/Grant Study Sections:

2018

Ad hoc reviewer, Kuwait Foundation for the Advancement of Sciences.

2011-15 Review Panel. QUERI Service Directed Projects. Health Services Research and

Development, Office of Research and Development, Veterans Health Administration,

Department of Veterans Affairs.

2011-15 Review Committee. QUERI Research and Methodology Committee. Health Services

Research and Development, Office of Research and Development, Veterans Health

Administration, Department of Veterans Affairs.

2015

Member, Review Panel, CHIKV Challenge, Defense Advanced Research Projects

Agency, Department of Defense.

2009

Review Committee, Pandemic Influenza Grants, Public Health Strategic Health Care

Group, Veterans Health Administration, Department of Veterans Affairs.

2008

Ad hoc member, Microbiology & Infectious Diseases study section, NIAID, NIH.

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Richard Martinello, M.D.
Ad hoc member, Microbiology and Infectious Diseases B Research Review Committee, NIAID, NIH.

Journal Service: Reviewer
Reviewer for; JAMA, Pediatrics, Clinical Infectious Diseases, American Journal of Managed Care, Journal of Infection, Pediatric Infectious Diseases Journal, American Journal of Tropical Medicine and Hygiene, American Journal of Respiratory and Critical Care Medicine, Vaccine, American Journal of Infection Control, Archives of Medical Research, Infection Control and Hospital Epidemiology, Influenza Drug Discovery Today, Yale Journal of Biology and Medicine, Pediatric Research, The Lancet, American Journal of Public Health, BMC Research Notes, Evolution Medicine and Public Health, Infection Genetics and Evolution, and Journal of Infection.

Professional Service for Professional Organizations:
Federal Government 2009-15 Member, Pandemic Sub-Interagency Policy Committee, National Security Staff,
Executive Office of the President 2010-15 Ex Officio Member, National Vaccine Advisory Committee
Department of Health and Human Services 2010-12 Member, Health Care Provider Immunization Work Group, National Vaccine Advisory
Committee, Department of Health and Human Services 2010-12 Member, Adult Immunization Work Group, National Vaccine Advisory Committee,
Department of Health and Human Services 2011-12 Member, Anthrax Vaccine Working Group, National Biodefense Science Board,
Department of Health and Human Services 2011-12 Member, Anthrax Vaccine Distribution Federal Interagency Working Group,
Departments of Homeland Security and Health and Human Services 2012-15 Member, National Vaccine Advisory Committee, Global Immunization Working
Group, Department of Health and Human Services 2012-15 Ex Officio Member, National Biodefense Science Board, Department of Health and
Human Services 2012-15 Member, National Vaccine Advisory Committee, Maternal Immunization Working
Group, Department of Health and Human Services 2013-14 Member, HIV Care Continuum Initiative Working Group, Recommendations
Sub-Committee, Office of National AIDS Policy, Executive Office of the President and the Department of Health and Human Services 2013-15 Combatting Antimicrobial Resistant Bacteria Interagency Policy Committee, National Security Staff, Executive Office of the President
State Government 2015-current Healthcare Associated Infections Advisory Group, Connecticut Department of Public
Health 2015-current Member, Antimicrobial Resistance/Antimicrobial Stewardship Multidisciplinary
Advisory Group, Connecticut Department of Public Health

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Richard Martinello, M.D.
Yale University Service: 2015-present Biosafety Committee 2017-2018 Quality Committee, Yale Medicine 2018-present Quality Committee, Yale Medicine/Yale New Haven Health 2020-present COVID-19 Advisory Board 2020-present COVID-19 Public Health Committee

Departmental Committees

2003-14 Member, Internal Medicine/Pediatrics Residency Selection Committee

2006-09 Member, Internal Medicine Residency Selection Committee

2015

Ad hoc interviewer, Internal Medicine/Primary Care Program Residency Selection

Committee

Hospital Boards & Committees
Local 2003-12 Chair, Infection Control Committee, VA Connecticut Healthcare System 2003-12 Member, Emergency Management Council, VA Connecticut Healthcare System
Chair, Patient Surveillance & Tracking Sub-Committee 2007-15 Member, Research & Development Committee, VA Connecticut Healthcare System 2007-12 Member, Medication Management Committee, VA Connecticut Healthcare System 2008-12 Member, Peer Review Committee, VA Connecticut Healthcare System 2015-present Chair, Infection Control Committee, Yale New Haven Hospital 2016-2019 Infection Prevention Sponsor, Central Line Associated Blood Stream Infection
Performance Improvement Team, Yale New Haven Hospital 2016-2019 Infection Prevention Sponsor, Catheter Associated Urinary Tract Infection Performance
Improvement Team, Yale New Haven Hospital 2016-present Infection Prevention Sponsor, Hand Hygiene Performance Improvement Team, Yale
New Haven Hospital 2016-present Infection Prevention Sponsor, Trans-Abdominal Surgery Performance Improvement
Team, Yale New Haven Hospital 2016-2019 Infection Prevention Sponsor, Orthopedic Surgery Surgical Site Infection Performance
Improvement Team, Yale New Haven Hospital 2016-2019 Infection Prevention Sponsor, C. difficile Performance Improvement Team, Yale New
Haven Hospital 2016-present Co-Chair, System Infection Prevention Committee, Yale New Haven Health 2017-present Member, System Quality Council, Yale New Haven Health 2017-present Member, Clinical Governance Committee, Yale New Haven Health 2017-present Member, Quality Committee, Yale Medicine 2018-present Member, Executive Leadership Group, Yale Medicine-United Health Care 2018-present Member, Readmissions committee, Yale New Haven Health 2019-present Member, Serious Event Review Committee, Yale New Haven Hospital 2019-present Member, Sepsis Working Group, Yale New Haven Health, Clinical Redesign 2019-present Co-Sponsor, Central Line Associated Blood Stream Infection-Catheter Associated
Urinary Tract Infection Performance Improvement Team, Yale New Haven Health 2019-present Co-Sponsor, C. difficile Performance Improvement Team, Yale New Haven Health 2019-present Sponsor, Arthroplasty and Spine Surgery Surgical Site Infection Prevention
Performance Improvement Team, Yale New Haven Hospital

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Richard Martinello, M.D.
2020-present Executive Team, Medical Technical Specialist, COVID-19 System Incident Management Team, Yale New Haven Health System.
Regional 2003-10 Chair, VISN 1 Infection Control Council; Veterans Health Administration, Veterans
Integrated Service Network 1 2003-12 Member, Emergency Preparedness Sub-Council; Veterans Health Administration,
Veterans Integrated Service Network 1, 2003-12 Chair, Biologics Subcommittee; Veterans Health Administration, Veterans Integrated
Service Network 1, Emergency Preparedness Sub-Council 2004-09 Member, VISN 1 Network Safety Leadership Sub-Council; Veterans Health
Administration, Veterans Integrated Service Network 1 2005-06 Member, Network Safety Task Force; Veterans Health Administration, Veterans
Integrated Service Network 1
National 2008-10 Member, Emergency Medical Management and Public Health Advisory Sub-Committee;
Department of Veterans Affairs, Veterans Health Administration 2009-12 Co-Director, Public Health Medical Operations Group, Department of Veterans Affairs 2010-15 Member, Infectious Diseases Field Advisory Committee, Veterans Health
Administration, Department of Veterans Affairs 2012-15 All-Hazards Emergency Cache Committee, Veterans Health Administration, Department
of Veterans Affairs 2014-15 Water Safety Oversight Committee, Veterans Health Administration, Department of
Veterans Affairs 2019-presentMember, Public Policy and Government Affairs Committee, Society for Healthcare
Epidemiology of America 2019-presentMember, Council for Outbreak Response: Healthcare Associated Infections and
Antimicrobial Resistant Pathogens. Council of State and Territorial Epidemiologists
Board of Directors 2015-present Member, Quinnipiack Valley Health District, North Haven, CT 2015-present Member, Board of Directors Executive Committee, Quinnipiack Valley Health District, North Haven, CT 2019-present Member, Board of Directors, Appointments sub-committee, Quinnipiack Valley Health District, North Haven, CT 2019-present Member, International Ultraviolet Association, Chevy Chase, MD
Bibliography:
Peer-Reviewed Original Research 1. Martinello RA, Chen MD, Weibel C, Kahn JS. Correlation between respiratory syncytial
virus genotype and illness severity. Journal of Infectious Diseases 2002;186:839-42. 2. Martinello RA, Cooney EL. Cerebellar brain abscess associated with tongue piercing. Clinical
Infectious Diseases 2003;36(2) e-32-4. 3. Esper F, Boucher D, Weibel C, Martinello RA, Kahn JS. Human matapneumovirus infection in
the United States: clinical manifestations of a newly emerging respiratory disease in children. Pediatrics 2003;111(6):1407-1410.
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Richard Martinello, M.D.
4. Martinello RA, Jones L, Topal JE. Assessment of healthcare worker attitudes toward influenza vaccination. Infection Control and Hospital Epidemiology 2003;24(11):845-847.
5. Martinello RA, Teitelbaum J, Young E, Hostetter MK. Non-typable Haemophilus influenza meningitis in an 11 year-old. Pediatric Infectious Disease Journal 2004;23:281, 285-6.
6. Esper F, Martinello RA, Boucher D, Weibel C, Ferguson D, Landry M, Kahn JS. A 1-year experience with human metapneumovirus in children less than five years-old. Journal of Infectious Diseases 2004;189:1388-96.
7. Held MR, Begier EM, Beardsley DS, Browne FA, Martinello RA, Baltimore RS, McDonald LC, Jensen B, Hadler JL, Dembry LM. Life-threatening Sepsis due to Burkholderia cepacia from contaminated intravenous flush solutions prepared by a compounding pharmacy in another state. Pediatrics 2006; 118:e212-e215.
8. Martinello RA, Esper F, Weibel C, Ferguson D, Landry ML, Kahn JS. Human metapneumovirus and exacerbations of chronic obstructive pulmonary disease. Journal of Infection 2006;53:248-25.
9. Martinello RA. Preparing for avian influenza. Current Opinion in Pediatrics 2007:64-70. 10. Benin AL, Learsy-Cahill D, Das R, Kancir S, Welch B, Martinello RA. Veterans’ perceptions
of urgency due to influenza vaccine shortage and its impact on vaccination, 2004-2005. Human Vaccines 2009;5(4):237-41. 11. Alvarez R, Elbashir S, Borland T, Toudjarska I, Hadwiger P, John M, Roehl I, Shulga-Morskaya S, Martinello RA, Kahn JS, Van Ranst M, Tripp RA, Pandey R, Maier M, Nechiv L, Manoharan M, Koteliansky V, and Meyers R. RNAi-mediated silencing of the respiratory syncytial virus nucleocapsid defines a potent anti-viral strategy. Antimicrobial Agents and Chemotherapy 2009;53:3952-3962. 12. Schult T, Awosika E, Hodgson M, Martinello RA. 2009 Influenza pandemic impact on sick leave use in the Veterans Health Administration: Framework for a health care provider-based national syndromic surveillance system. Disaster Medicine and Public Health Preparedness 2011;5:S235-241. 13. Fink S, Martinello RA, Campbell S, Murray TS. Low prevalence of heterogeneous vancomycin intermediate Staphylococcus aureus among Connecticut veterans. Antimicrobial Agents and Chemotherapy 2012:56(1):582-3. 14. Gunderson CG, Martinello RA. A systematic review of bacteremia in cellulitis and erysipelas. Journal of Infection 2012:64(2):148-55. 15. Gupta K, Martinello RA, Young M, Strymish J, Cho K, Lawler E. MRSA nasal carriage patterns and subsequent risk of conversion between patterns, infections and death. PLoS ONE 2013;8(1):e53674. 16. Schacht-Reisinger H, Yin J, Radonovich L, Knighton VT, Martinello RA, Hodgson MJ, Perencevich E. Comprehensive survey of hand hygiene measurement and improvement practices in the Veterans Health Administration. American Journal of Infection Control 2013:41:989-993. 17. Czarnogorski M, Halloran J, Pedati C, Dursa EK, Durfee J, Martinello RA, Davey VJ, Ross D. Expanded HIV testing in the US Department of Veterans Affairs, 2009-2011. American Journal of Public Health 2013; 203(12):e-40-e45. 18. Subhash SS, Cavaluolo M, Radonovich LJ jr., Eagan A, Lee ML, Campbell S, Martinello RA. Effectiveness of common healthcare disinfectants against H1N1 influenza virus on reusable elastomeric respirators. Infection Control and Hospital Epidemiology 2014;35(7):894-897. 19. Goulet JL, Martinello RA, Bathulapalli H, Higgins D, Driscoll MA, Brandt CA, Womack JA. STI diagnosis and HIV testing among OEF/OIF/OND Veterans. Medical Care 2014;52(12): 1064-1067. 20. Midboe AM, Elwy AR, Durfee JM, Gifford AL, Yakovchenko V, Martinello RA, Ross D, Czarnogorski M, Goetz MB, Asch SM. Building Strong Research Partnerships Between Public
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Health and Researchers: A VA Case Study. Journal of General Internal Medicine 2014:29(4):831-834. 21. Elwy AR, Bokhour BG, Maguire EM, Wagner TH, Asch SM, Gifford AL, Gallagher TH, Durfee JM, Martinello RA, Schiffner S, Jesse RL. Improving healthcare systems’ large scale adverse event disclosures: A Department of Veterans Affairs leadership, research, operations and stakeholder partnership. Journal of General Internal Medicine 2014:29 (4):895-903. 22. LaVela SL, Hill JN, Smith BM, Evans CT, Goldstein B, Martinello RA. Healthcare worker influenza declination form program. American Journal of Infection Control 2015:43(6):624-8. 23. Wagner TH, Taylor TT, Cowgill E, Asch SM, Su P, Bokhour BG, Dufee JM, Martinello RA, Maguire EM, Elwy AR. The intended and unintended effects of large-scale adverse event notifications. British Medical Journal Quality & Safety 2015;24:295-302. 24. Schimer P, Winston C, Lucero-Obusan C, Winters M, Lesse A, deComarmond C, Oda G, Martinello RA, Holodniy M. Reuse of insulin pens among multiple patients at two Veterans Affairs medical centers. Infection Control and Hospital Epidemiology 2015;36(10): 1121-1129. 25. Ibrahim L, Sellick JA, Watson E, McCabe L, Schoenhais K, Martinello RA, Lesse AJ. An outbreak of severe group A Streptococcus infections associated with podiatric application of a biological dermal substitute. Infection Control and Hospital Epidemiology 2016;37(3) 306-312. 26. Mortensen E, Kamali A, Schirmer PL, Lucero-Obusan C, Winston CA, Oda G, Winters MA, Durfee J, Martinello RA, Davey VJ, Holodniy M. Are current screening protocols for chronic hepatitis B virus infection adequate? Diagnostic Microbiology and Infectious Disease 2016;85(2), 159-167. 27. Maguire EM, Bokhour BG, Asch SM, Wagner TH, Gifford AL, Gallagher TH, Durfee JR, Martinello RA, Elwy AR. Disclosing large scale adverse events in the US Veterans Health Administration: Lessons from media responses. Public Health 2016; 135:75-82. 28. Razouki Z, Knighton VT, Martinello RA, Hirsch PR, McPhaul KM, Rose AJ, McCullough M, Organizational factors impacting health care provider (HCP) influenza campaigns in the veterans health care system: A qualitative study. BMC Health Services 2016;16(211):1-10. 29. Maguire EM, Bokhour BG, Wagner TH, Asch SM, Gifford AL, Gallagher TH, Durfee JM, Martinello RA, Elwy AR. Evaluating the implementation of a national disclosure policy for large-scale adverse events in an integrated health care system: identification of gaps and successes. BMC Health Services Research 2016;16(1):648. 30. Hauser RG, Brandt CA, Martinello RA. Criteria to screen molecular tests for the diagnosis of herpes simplex virus in the central nervous system have no propensity to harm. Journal of Pathology Informatics 2017;8:4. 31. Lipkowitz-Eaton J, Mohr DC, McPhaul KM, Kaslow RA, Martinello RA. Access, Education and Policy Awareness: Predictors of Influenza Vaccine Acceptance Among VHA Healthcare Workers. Infection Control and Hospital Epidemiology 2017;38(8):970-975. 32. Martinello RA, Miller SL, Fabian MP, Peccia J. Identification of barriers and research opportunities to improve the effective and efficient application of adjunct UVC surface disinfection in healthcare. Proc. SPIE 10479, Light-Based Diagnosis and Treatment of Infectious Diseases 2018;104791B:1-8. 33. Poster DL, Miller CC, Obeng Y, Postek MT, Cowan TE, Martinello RA. Innovative Approaches to Combat Healthcare-Associated Infections Using Efficacy Standards Developed Through Industry and Federal Collaboration. Proc. SPIE 2018;10730. 34. Datta R, Hellou E, Tucker M, John B, Martinello RA, Malinis M. Detection of influenza myocarditis using National Healthcare Safety Network definitions accounting for fever in older adults. Infection Control and Hospital Epidemiology 2018;39(9):1145-1147.
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35. Acquarulo BA, Sullivan L, Gentile AL, Boyce JM, Martinello RA. Mixed-methods analysis of glove use as a barrier to hand hygiene. Infection Control and Hospital Epidemiology 2019;40(1):103-105.
36. Rathod SN, Beauvais K, Sullivan L, Sudikoff S, Peaper DR, Martinello RA. The Effectiveness of a Novel Colorant Additive in the Daily Cleaning of Patient Rooms. Infection Control and Hospital Epidemiology 2019;40(6):721-723.
37. Fogerty RL, Cabie M, Doyle D, Brien P, Beley P, Jansen L, Stump L, Gaffney J, Ferencz KW, Lourenco C, Cushing W, Williams E, Marseglia J, Martinello RA, Morris V. Conversion of a conference room into low-acuity inpatient medical unit: A creative response to influenza related surge. Joint Commission Journal on Quality and Patient Safety 2019;45(7):524-529.
38. Advani S, Gao C, Datta R, Sann L, Smith C, Leapman MS, Hittelman A, Sabetta J, Dembry LM, Martinello RA, Juthani-Mehta M. Knowledge and Practices of Physicians and Nurses related to Urine Cultures in Catheterized Patients: An Assessment of Adherence to IDSA Guidelines. Open Forum Infectious Diseases 2019;6(8):1-8.
39. Martinello RA, Arbogast JW, Guercia K, Parker AE, Boyce JM. Nursing Preference for Alcohol-Based Hand Rub Volume. Infection Control and Hospital Epidemiology 2019;40(11):1248-1252.
40. Pepe D, Martinello RA, Juthani-Mehta M. Involving Physicians-in-Training in the Care of Patients During Epidemics. Journal of Graduate Medical Education 2019;11(6):632-634.
41. Colandrea NA, Cleary ML, Peaper DR, Sullivan LK, Martinello RA, Murray TS. Oxygen Nipple and Nut (Christmas Tree) Adaptor Contamination Rates and Decontamination with Disinfecting Wipes. Infection Control and Hospital Epidemiology 2020;41(4):396-399.
42. Fauver JR, Petrone ME, Hodcroft EB, Shioda K, Ehrlich HY, Watts AG, Vogels CBF, Brito AF, Alpert T, Muyombwe A, Razeq J, Downing R, Cheemarla NR, Wyllie AL, Kalinich CC, Ott I, Quick J, Loman NJ, Neugebauer KM, Greninger AL, Jerome AR, Roychoundhury P, Xie H, Shrestha L, Huang ML, Pitzer VE, Iwasaki A, Omer SB, Khan K, Bogoch I, Martinello RA, Foxman EF, Landry ML, Neher RA, Ko AI, Grubaugh ND. Coast-to-Coast Spread of SARSCoV-2 in the United States revealed by genomic epidemiology. Cell 2020 (in press)
43. Jamieson DJ, Steinberg JP, Martinello RA, Perl TM, Rasmussen SA. Obstetricians on the COVID-19 front lines and the confusing world of personal protective equipment (PPE). Obstetrics & Gynecology 2020. (in press)
Chapters, Books, and Reviews 1. Martinello RA, Dembry LM. Educational needs and opportunities for the hospital
epidemiologist. In A Practical Handbook for Hospital Epidemiologists, 2nd edition, eds. K. Wojetle and E. Lautenbach, SLACK Incorporated, Thorofare, NJ, 2004. 2. Martinello RA, Cappello M. Acute Pericarditis. In Clinical Infectious Diseases, 1st edition, ed. D. Schlossberg, Cambridge University Press, New York, NY, 2008. 3. Women’s Health: A Guide to Preventing Infections, eds. P. Hayes and R. Martinello, Veterans Health Administration, Department of Veterans Affairs, Washington, DC, 2012. 4. Bullis E, Martinello RA. Antibiotic Use in Primary Care. In: Talwalkar JS, Fenick AM, eds. Yale Primary Care Pediatrics Curriculum, 8th Edition, 2014. 5. VHA Seasonal Influenza Manual, eds. V.T. Knighton and R. Martinello, Veterans Health Administration, Department of Veterans Affairs, Washington, DC, 2014. http://www.publichealth.va.gov/docs/flu/va-flu-manual.pdf 6. Disaster Preparedness Manual. Eds. K. Etminani, M. Gosch, J. Lopez, C. Lucero-Obusan, R. Martinello, K. Ricci, C. Raab, P. Schirmer, and B. O’Hanley-Selzer. Veterans Health Administration, Department of Veterans Affairs, Washington, DC, 2015.
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7. Bullis E, Martinello RA. Antibiotic Use in Primary Care. In: Talwalkar JS, Fenick AM, eds. Yale Primary Care Pediatrics Curriculum, 9th Edition, 2015.
8. Martinello RA, Cappello M. Acute Pericarditis. In Clinical Infectious Diseases, 2nd edition, ed. D. Schlossberg. Cambridge University Press, New York, NY, 2015, pp. 254-259.
9. Bullis E, Martinello RA. Antibiotic Use in Primary Care. In: Talwalkar JS, Fenick AM, eds. Yale Primary Care Pediatrics Curriculum, 10th Edition, 2016.
10. Gupta S, Martinello RA. Zika Virus Epidemic Through the Americas: Epidemiology, Clinical Guidelines, and Review of New Developments. Connecticut Medicine 2017;81(8):487-497.
11. Bullis E, Martinello RA. Antibiotic Use in Primary Care. In: Talwalkar JS, Fenick AM, eds. Yale Primary Care Pediatrics Curriculum, 11th Edition, 2017.
12. Bullis E, Martinello RA. Antibiotic Use in Primary Care. In: Talwalkar JS, Fenick AM, eds. Yale Primary Care Pediatrics Curriculum, 12th Edition, 2018. Available from http://pcpc.yale.edu
13. Bullis E, Martinello RA. Antibiotic Use in Primary Care. In: Talwalkar JS, Fenick AM, eds. Yale Primary Care Pediatrics Curriculum, 13th Edition, 2019. Available from http://pcpc.yale.edu
14. Martinello RA. Outbreak Investigations. In: Friedland G, Golden M, Obuagu O, eds. Current Diagnosis and Treatment – Infectious Diseases. McGraw-Hill; (submitted).
15. Martinello RA, Davis K. Prevention of Surgical Site Infections. In: Friedland G, Golden M, Obuagu O, eds. Current Diagnosis and Treatment – Infectious Diseases. McGraw-Hill; (submitted).
16. Martinello RA, Cappello M. Acute Pericarditis. In Clinical Infectious Diseases, 3rd edition, ed. D. Schlossberg, B. Cunha. Cambridge University Press, New York, NY (submitted).
Peer-Reviewed Educational Materials 17. Maguire E, Martinello RA, Durfee J, Elwy R. Large Scale Disclosure Toolkit. Veterans Health
Administration, Office of Research and Development, Health Services Research and Development, 2014.
Peer-Reviewed Publications 18. Martinello RA. Acute Exacerbations of Chronic Bronchitis. British Medical Journal, Epocrates
2008. 19. Martinello RA. Acute Exacerbations of Chronic Bronchitis. British Medical Journal, Epocrates
2010. 20. Martinello RA, Rochester C. Acute Exacerbations of Chronic Bronchitis. British Medical
Journal, Epocrates 2011. 21. Martinello RA, Rochester C. Acute Exacerbations of Chronic Bronchitis. British Medical
Journal, Epocrates 2012. 22. Martinello RA, Rochester C. Acute Exacerbations of Chronic Bronchitis. British Medical
Journal, Epocrates 2014. 23. Martinello RA, Rochester C. Acute Exacerbations of Chronic Bronchitis. British Medical
Journal, Epocrates 2015. 24. Martinello RA, Rochester C. Acute Exacerbations of Chronic Bronchitis. British Medical
Journal, Epocrates 2016. 25. Martinello RA, Rochester C. Acute Exacerbations of Chronic Bronchitis. British Medical
Journal, Epocrates 2018. http://bestpractice.bmj.com/topics/en-us/8 (published January 2018)
Invited Editorials and Commentaries
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Richard Martinello, M.D.
26. Cowan TE, Martinello RA. Fighting HAIs and MDROs with UV-C Using Industry, Health Care and Federal Collaboration. IUVA News 2017;19(2):26-27.
27. Martinello RA. Testing for UV-C Antimicrobial Efficacy in the Healthcare Setting. IUVA News 2018;20(4):12-16.
28. DiMartino L, Martinello RA. Mobile Device Use in Healthcare: New Opportunities for UV Disinfection. UV Solutions 2020;2(1):18-21.
Practice Guidelines, Standards and Consensus Statements 29. National Biodefense Science Board. Challenges in the use of anthrax vaccine adsorbed (AVA) in
the pediatric population as a component of post-exposure prophylaxis (PEP). A Report of the National Biodefense Science Board. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. October, 2011. 30. National Vaccine Advisory Committee. A Pathway to Leadership for Adult Immunization: Recommendations of the National Vaccine Advisory Committee. Public Health Reports 2012;127(S1):1-42. 31. National Vaccine Advisory Committee. Strategies to achieve the healthy people 2020 annual influenza vaccine coverage goal for health-care personnel: recommendations from the national vaccine advisory committee. Public Health Reports 2013;128:7-25. 32. National Vaccine Advisory Committee. Protecting the Public’s Health: Critical Functions of the Section 317 Immunization Program—A Report of the National Vaccine Advisory Committee. Public Health Reports 2013;128(1):78-95. 33. National Vaccine Advisory Committee. Enhancing the Work of the Department of Health and Human Services National Vaccine Program in Global Immunization: Recommendations of the National Vaccine Advisory Committee. Public Health Reports 2014;129(S3):12-20. 34. National Vaccine Advisory Committee. Recommendations from the National Vaccine Advisory Committee: Standards for Adult Immunization Practice. Public Health Reports 2014;129:115123.
Case Reports, Technical Notes, Letters 35. Radonovich LJ, Martinello RA, Hodgson M, Milton DK, Nardell EA. Influenza and Ultraviolet
Germicidal Irradiation. Virology Journal 2008;5:149. 36. Gosch M, Martinello RA, Meyer E, Post LA, Radonovich L. VHA response to
the 2009 H1N1 pandemic: Final after-action report. 2012. 37. Hamlett-Berry K, Christofferson DE, Martinello RA. Smoking and tobacco use within the
Department of Veterans Affairs. American Journal of Public Health 2013;103(7):e3.
Scholarship in Press and Submitted 38. Taylor TJ, Maguire EM, Gallagher TH, Bokhour BG, Asch SM, Gifford AL, Wagner TH, Durfee
JM, Martinello RA, Elwy AR. Communicating High-Risk Information about Potentially LowRisk Healthcare Events: A Randomized Survey. (submitted) 39. Gao CA, Datta D, Dunne D, Dembry LM, Martinello RA, Juthani-Mehta M, Advani S. Comparison of Traditional Instruction versus Non-Traditional Learning to improve Trainee Knowledge of Urine Culture Practices in Catheterized Patients. (submitted) 40. Elwy AR, Maguire EM, McCullough M, George J, Bokhour BG, Durfee JM, Martinello RA, Walker Y, Sharpe VA, Geppert C, Holodniy M, West G, SCALE and CERT teams. From implementation to operational sustainment: A large-scale adverse event disclosure toolkit and support program generated through embedded research in the Veterans Health Administration. (submitted)
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41. Kenney P, Chan BK, Kortright K, Cintron M, Havill N, Russi M, Epright J, Lee L, Balcezak T, Martinello RA. Hydrogen Peroxide Vapor Sterilization of N95 Respirators for Reuse. (submitted)
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ATTACHMENT 2

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Wilkes v Lamont
Documents Reviewed Richard Martinello, MD July 7, 2020
1. First Amended Complaint 5-7-2020 2. Wilkes prelim injunction memo 6-8-2020 3. Wilkes Dr. Manian Affidavit 6-8-2020 4. CDC LTC guidance 3-26-20 [Ex 9] 5. CMS guidance relax restrictions LTC 5-18 [10] 6. CDC COVID protect yourself [Ex 11] 7. CDC LTC key strategies [Ex 12] 8. CDC preparing COVID NH [Ex 13] 9. CDC responding COVID in NH 4-30 [Ex 14] 10. CDC COVID testing NH 5-18-20 [Ex 15] 11. CDC guidance fac wide testing NH 5-19 [Ex 16] 12. CDC IC assessment tool [Ex 17] 13. SAMSHA COVID psych hosp guide [Ex 18] 14. Ardizzone affidavit 15. Wilkes Atty Gudis Affidavit 16. Wilkes canavan jones affidavit 17. Wilkes mueller affidavit 18. Wilkes King affidavit 19. Wilkes Clark affidavit 20. Wilkes Litsky affidavit 21. COVID-19 uniform screening tool 22. DMHAS Protocols for COVID Q/I 5-17/20 23. DMHAS Employee FAQs 24. CVH Environmental Services Protocol 25. WFH Housekeeping 26. WFH Biospray 27. CVH Inf Prevention Containment 28. WFH Coronavirus Pandemic Incident Action Plan 29. Testing Protocol 6.29.20 [CVH] 30. Revised Testing Protocol Memo 6.29.20 31. COVID-19 Uniform Screening Tool 5-17 32. COVID-19 Required Policy Changes 4-27 33. CVH IP Manual 34. CVH Staff-Patient Testing Response 6.18.20 35. Declaration of Vinneth Carvalho 36. Exhibit 2 of Defendants’ Motion to Dismiss, Declaration Charles Dike 37. WFH Sanitizing Agents 38. WFH KaiVac1750 39. Telephone discussion with Dr. Tobias Wasser (June 26, 2020) 40. Tour of WFH (June 26, 2020)

Case 3:20-cv-00594-JCH Document 49-3 Filed 07/09/20 Page 46 of 47
41. New York Times. “43% of U.S. Coronavirus Deaths Are Linked to Nursing Homes” https://www.nytimes.com/interactive/2020/us/coronavirus-nursing-homes.html
42. CT Data. Nursing Home Residents Positive for COVID-19. https://data.ct.gov/Health-andHuman-Services/Nursing-Homes-with-Residents-Positive-for-COVID-19/wyn3-qphu
43. Ramgopal K. Coronavirus in a Psychiatric Hospital: ‘It’s the worst of all worlds’. NBC News. April 17, 2020.
44. NPR. “'Shocking, Heartbreaking' Coronavirus Outbreak In Calif. Prison Alarms Health Experts” https://www.npr.org/2020/06/27/884149444/shocking-heartbreaking-coronavirusoutbreak-in-ca-prison-alarms-health-officials
45. Johnson GR, Morawska L. The mechanism of breath aerosol formation. Journal of Aerosol Medicine and Pulmonary Drug Delivery 2009;22(3). https://www.liebertpub.com/doi/abs/10.1089/jamp.2008.0720
46. Hamner L, Dubbel P, Capron I, et al. High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice — Skagit County, Washington, March 2020. MMWR Morb Mortal Wkly Rep 2020;69:606–610.
47. Zhang S, et al. Estimation of the reproductive number of novel coronavirus (COVID-19) and the probable outbreak size on the Diamond Princess cruise ship: A data-driven analysis. International Journal of Infectious Diseases 2020;93:201-204. https://doi.org/10.1016/j.ijid.2020.02.033
48. CT Data. COVID-19 Data Resources. https://data.ct.gov/stories/s/COVID-19-data/wa3gtfvc/
49. Arons MM, et al. Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility. New England Journal of Medicine 2020;382:2081-2090. https://www.nejm.org/doi/full/10.1056/NEJMoa2008457
50. Wolfel R, et al. Virological assessment of hospitalized patients with COVID-2019. Nature 2020;581:465-469. https://www.nature.com/articles/s41586-020-2196-x
51. Bullard J, et al. Predicting infectious SARS-CoV-2 from diagnostic samples. Clinical Infectious Diseases 2020. https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa638/5842165
52. Korea Centers for Disease Control. Findings from investigation and analysis of re-positive cases. May 19, 2020. https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=0030&act=view&list_no=3 67267&nPage=1
53. van Doremalen N, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. New England Journal of Medicine 2020;382: 1564-1567. https://www.nejm.org/doi/full/10.1056/nejmc2004973
54. Chin AWH, et al. Stability of SARS-CoV-2 in different environmental conditions. Lancet 2020. https://www.thelancet.com/action/showPdf?pii=S2666-5247%2820%2930003-3
55. CDC. Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
56. EPA. List N: Disinfectants for Use Against SARS-CoV-2 (COVID-19). https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid19
57. Chu DK, et al. Physical distancing, face masks, and eye protection to prevent person-toperson transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis.

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Lancet 2020. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)311429/fulltext

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EXHIBIT C

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2. I make this Declaration based upon personal knowledge, and I understand that it will be submitted to this Comi in connection with the above-captioned case in support of the Defendants' Opposition to the Plaintiffs' Motion for Preliminary Injunction.
3. WFH is a state-operated inpatient facility providing services to individuals involved in the criminal justice system as well as through the civil commitment process.
4. WFH employs on site medical doctors ("MDs"), advanced practice registered nurses ("APRNs") and nurses and on every shift who address medical needs of patients.
5. As part ofmy job duties, I am responsible for the management and oversight ofthe daily clinical operations and patient care at WFH.
6. WFH has protocols in place with regard to testing in response to the COVID-19 pandemic. The most recent update to these protocols was May 19, 2020. See Defs. Ex. L, Whiting Guidance on Management ofSuspected and Confirmed Cases in Patients and Staff.
7. From March 17, 2020 to June 30, 2020, there was a prohibition ofvisitors at WFH. As of July 1, 2020, visitation has resumed subject to requirements and guidance from the Connecticut Department ofPublic Health and the Center for Disease Control.
8. WFH conducts COVID-19 screening of all those entering the hospital, including staff, by checking temperatures and asking a detailed series of questions about possible COVID symptoms, potential COVID -19 exposures and recent travel. The questionnaire is frequently updated to reflect evolving CDC guidance.
9. WFH conducts daily screening of patients for COVID-19 by checking temperatures and monitors patients for COVID-19 symptoms.
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10. New patients coming from the Department of Corrections or another hospital are tested for COVID-19 prior to admission. New patients from the community are offered a test for COVID-19 immediately upon admission.
1 L All patients who are symptomatic for COVID-19 are tested. Testing of symptomatic patients began on March 16, 2020.
12. Baseline testing of patients at WFH was completed on May 19, 2020. 13. The date that a patient at WFH last tested positive for COVID-19 was on April 21, 2020.
Two patients who tested positive on May 19, 2020 had previously tested positive and did not represent new cases of COVID-19. 14. Since May 19, 2020, no new patients at WFH have tested positive for COVID-19. 15. As of July I, 2020, a total of 10 patients out of 169 patients at WFH tested positive for COVID-19 since the pandemic began. 16. As of July 1, 2020, a total of 10 patients who tested positive for COVID-19 have reeovered from COVID-19 since the beginning of the pandemic. 17. As of July l, 2020, 135 cumulative patients at WFH have been tested for COVID-19 since the pandemic began. The current WFH census is 169 patients. 18. Baseline testing of staff at WFH was completed on June 4, 2020. 19. On June 15, 2020, WFH began repeat testing of staff. 20. The date that a direct care staff member at WFH last tested positive for COVID-19 was on May 7, 2020. 21. The date that a non-direct care staff member at WFH last tested positive for COVID-19 was on June 15, 2020. 22. As of July 1, 2020, a total of22 staff members out of522 staff members at WFH tested
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positive for COVID-19 since the beginning ofthe pandemic. 23. As ofJuly!, 2020, a total of22 staff members who tested positive for COVID-19 have
recovered from COVID-19. 24. As ofJuly 1, 2020, 333 staffmembers out of 522 staffmembers at WFH have been tested
for COVID-19 since the pandemic began. 25. Ifa patient tests positive for COVID-19, WFH conducts contact tracing and recommends
testing of staff and residents who may have been exposed to the patient. 26. WFH cannot mandate patient testing ofCOVID-19. 27. Ifa patient who displays COVID-19 symptoms refuses COVID-19 testing, WFH treats
the patient as ifhe or she has COVID-19 and follows the hospital's protocol for treating COVID-19 positive patients. 28. Ifa new admission refuses COVID-19 testing, WFH treats the patient as ifhe or she has COVID-19 and follows the hospital's protocol for COVID-19 positive patients. 29. Ifa staff member tests positive for COVID-19, WFH conducts contract tracing and recommends testing of staff and residents who may have been exposed to the patient. 30. The use ofpersonal protective equipment at WFH has evolved in conformity with CDC guidelines. 31. WFH staffhave available for their use all appropriate PPE, including but not limited to: surgical masks, face shields, N95 masks, eye protection, gowns, gloves and probe covers, in addition to hand sanitizer. 32. All staff have received web-based training on proper PPE use, including donning and doffing protocols. Live tutorials have also been provided. Training is ongoing.
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33. Staff are required to wear surgical masks in all patient areas and higher levels ofPPE based upon staff activities or medical procedures. Staffwho violate this requirement have undergone reeducation and counseling.
34. WFH patients are provided masks at least weekly, and more often ifthey become soiled or damaged, consistent with assessments to ensure no unwarranted medical risk or risk of self -injury is present.
35. Patients have been provided clear educational materials on COVID-19 precautions; posters and unit-based meetings also encourage the practice of appropriate preeautions, including proper mask use. Educational efforts are ongoing.
36. All patients at WFH are cared for by a treatment team made up of clinicians that collaboratively plan and provide care to the patient. The team consists of a psychiatrist, medical doctor, psychologist, social worker, rehabilitation therapist, nurses, and mental health assistants (who assist in therapeutic engagements).
37. Taking into account the limits of court-imposed confinement and in accord with governing policies, WFH actively pursues the appropriate discharge of every patient deemed discharge ready by his or her treatment team.
38. Planning for discharge to the most integrated community setting begins upon admission to the inpatient service and treatment planning by the team addresses the particular considerations for each patient bearing on discharge and identifies and attempts to overcome barriers to discharge.
39. At every treatment plan review (which occur at least monthly), the treating physician will document in the chart and discuss with the patient the specific factors that the physician is considering to dete1mine the patient's current clinical need for hospital level ofcare and
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the patient's readiness for discharge. Such factors should include the patient's physical and mental status, results ofmedical/psychological tests, the patient's cognitive and behavioral status, the patient's functional capacities, and evaluative tools or treatment protocols yet to be completed. 40. The physician will also document in the patient's chart the treatment interventions the hospital will provide to address each factor in order to discharge the patient from the hospital in a timely manner once the patient is deemed discharge ready by the treatment team. Extrinsic factors which present barriers to discharge, such as the patient's willingness to leave the hospital or the availability of a residential placement must be documented in the chart. 41. On each team is a clinical social worker who maintain a knowledge base ofcommunity suppmi services and provides oversight to the discharge planning process. Typically, the clinical social worker will be communicating with community providers regarding a patient's discharge in advance of the patient being determined as ready for discharge. 42. This process ensures that each month, there has been a professional judgment by the physician and informed by the team as to whether a patient is discharge ready. 43. During the course of the pandemic, the treatment teams continue to address discharge readiness and barriers to discharge (reflected in the treatment plans) including those posed by COVID 19 pandemic. 44. From March 30, 2020 until June 30, 2020, 43 patients were discharged from WFH. 45. From March I, 2020 until June 30, 2020, 21 patients were admitted to WFH. 46. Beginning in March 2020, PSRB patients who had been granted temporary leaves of7 nights in the community were allowed to remain in community placement except for
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56. The isolation unit has its own bathroom and dining room. 57. To fiuiher combat COVID-19, WFH provides patients and staff with training regarding
social distancing and has enacted several measures to promote social distancing at WFH. 58. In accordance with social distancing, WFH enabled patients to continue to have
meaningful visitor contact through viliual visitation in addition to in person visitation. 59. WFH did an analysis for each therapeutic group to assess whether the risk ofconducting
group therapy outweighed the risk associated with transmission ofCOVID-19. Ifa group was not closed, when therapeutically appropriate, WFH modified the group to increase social distancing, including limiting the group size to five participants, prohibiting cross unit participants, and altering the frequency and duration ofgroup meetings. 60. In buildings where multiple units previously dined together, WFH has organized the provision of meals into two separate dining spaces (dining room and the activity room) so that each unit dines separately and arranged the physical layout in each room to maximize social distancing. 61. WFH has examined the risk and benefits ofother facility use practices. For example, WFH opted to continue using the elevator, and modifying use ofit to create as much social distance as possible and has enacted a process for maximizing stairwell use under staff supervision to account for reduced elevator occupancy due to social distancing requirements. 62. WFH weighed the therapeutic benefits and the risks associated with COVID-19 and modified its patient grounds privileges as follows:
a. The common areas in the combined campus used by CVH and WFH patients
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who have grounds privileges has been separated so that only WFH patients use designated WFH space; b. WFH patients with passes can no longer go and mingle with CVH patients; c. The courtyard used for WFH patients without ground privileges has been changed so that only one unit can go to the building courtyard at a time; and d. In addition, the large Whiting Max courtyard, which used to accommodate all five inpatient units, pre-COVID-19, has been modified. WFH separated it in half with cones and only permits two units to go there at a time: one unit on each side and patients are prohibited from mingling with patients from other units. 63. WFH has amended the time, place and frequency of Probate Court Proceedings to allow staggered times for the proceedings. WFH and CVH previously held Probate Court in a single location (pre-COVID) but have now separated into a WFH-specific and a CVH­ specific location. Probate court hearings are conducted via videoconferencing to limit exposure from Probate Court staff to WFH patients. 64. WFH instituted teleworking arrangements for as many staff as possible and utilizes telemedicine to fwiher reduce the number of people working on-site at WFH. 65. In addition, WFH provides staff with significant, ongoing social distancing training. WFH staffreceived several on-line trainings regarding social distancing and other measures to protect patients and staff from COVID-19. For example, WFH distributed the "COVID-19 Pandemic Response" electronically. Additionally, as CDC, the State of Connecticut Department of Public Health ("DPH") and DMHAS distributed new information, WFH assimilated the new information into the WFH plan and disseminated
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ATTACHMENT 1

Case 3:20-cv-00594-JCH Document 49-4 Filed 07/09/20 Page 15 of 27 Date of Revision: 6/18/20

Tobias Wasser, M.D.
70 O’Brien Drive, Middletown, CT 06457 Phone: (860) 255-8399 Fax: (860) 262-5485
tobias.wasser@gmail.com

Education: B.A. M.D.

Wesleyan University (Psychology) 2006 University of Connecticut School of Medicine 2010

Career/Academic Appointments:

2010-13

Resident, Psychiatry, Yale School of Medicine, New Haven, CT

2013-14

Program-Wide Chief Resident and Chief Resident for Medical Education, Psychiatry,

Yale School of Medicine, New Haven, CT

2014-15

Fellow, Forensic Psychiatry, Yale School of Medicine, New Haven, CT

2015-16

Fellow, Public Psychiatry, Yale School of Medicine, New Haven, CT

2016-present Assistant Professor, Psychiatry, Yale School of Medicine, New Haven, CT

2016-present Assistant Clinical Professor, Yale School of Nursing, New Haven, CT

Administrative Positions:

Clinical 2018-present 2017-18

Chief Medical Officer, Whiting Forensic Hospital, Middletown, CT Division Medical Director, Whiting Forensic Division of Connecticut Valley Hospital, Middletown, CT

Educational 2020-present 2018-20 2016-20 2016-20 2016-17

Associate Program Director, Psychiatry Residency Program, Yale School of Medicine, New Haven, CT Director of Forensic Clinical Curriculum, Psychiatry Residency Program, Yale School of Medicine, New Haven, CT Associate Program Director, Fellowship in Public Psychiatry, Yale School of Medicine, New Haven, CT Director of Quality Improvement and Patient Safety Education, Psychiatry Residency Program, Yale School of Medicine, New Haven, CT Director of Education for Inpatient Services, Connecticut Mental Health Center, New Haven, CT

Other Employment:

2016-17

Inpatient Attending Psychiatrist, Connecticut Mental Health Center, New Haven, CT

2015-present Forensic Psychiatry Private Practice, New Haven, CT

2015-17

Per Diem Forensic Psychiatrist, Connecticut Department of Mental Health and

Addiction Services, Middletown, CT

2013-present Psychiatrist on Duty, VA Connecticut Healthcare System, West Haven, CT

Board Certification: American Board of Psychiatry and Neurology, Psychiatry, 2014 American Board of Psychiatry and Neurology, Forensic Psychiatry, 2015 American Association of Community Psychiatrists, Community and Public Psychiatry, 2016

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Professional Honors & Recognition:
International/National/Regional 2018: Visiting Scholar, Eastern Virginia Medical School, Norfolk, VA 2018: American Psychiatric Association Assembly Resident-Fellow Member Mentor Award 2016: Best Resident/Fellow Paper, American Association of Psychiatric Administrators 2015: SAMHSA Behavioral Health Leadership Development Program 2014: Laughlin Foundation Merit Award
University 2015: Medical Education Fellowship, Yale School of Medicine 2014: Poster Award for Excellence in Medical Education Research, Yale School of
Medicine 2014: Howard Zonana Award, Yale School of Medicine 2013: Benjamin S. Bunney Award, Yale School of Medicine
Grant/Clinical Trials History:
Past Grants Agency: American Academy of Psychiatry and the Law Institute for Education and Research (AIER) Title: “Introduction to Forensic Psychiatry – A National Model for an Interactive Module-Based Curriculum” P.I.: Tobias Wasser, M.D. Percent effort: 5% Direct costs per year: $5,000 Total costs for project period: $15,000 Project period: 02/01/2016 – 01/31/2019
Invited Speaking Engagements, Presentations, Symposia & Workshops:
International/National 2020: The University of Oklahoma-Tulsa (Tulsa, OK), Psychiatry Residency Program,
“Confidentiality and Duties to Third Parties”
2020: American Psychiatric Association (Washington, DC), 2020 APA On Demand, “Television and Podcast Series: Teaching Forensic Psychiatry and Using Narrative Medicine Through TrueCrime and Fiction”
2020: Veterans Health Administration Emergency Medicine Mental Health Leads (Washington, DC), Monthly National Teleconference, “Emergency Holds and Commitments”
2019: CME Outfitters (Washington, DC), Initiating Medication-Assisted Therapy for OUD in Diverse Settings: Clinical Pearls for Navigating the Process, “Correctional Settings”
2018: CME Outfitters (Washington, DC), Opioid Use Disorder in Special Populations: Making Recovery a Goal, “Forensic Populations”
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2018: Eastern Virginia Medical School (Norfolk, VA), Department of Psychiatry Grand Rounds, “Tarasoff Warnings and Duties to Third Parties”
2018: Kawea District Healthcare (Visalia, CA), Psychiatry Residency Program, “Confidentiality and Duties to Third Parties”
2018: Duke University (Durham, NC), Psychiatry and Law Podcast Series, “Duties to Third Parties”
2018: Duke University (Durham, NC), Psychiatry and Law Podcast Series, “Confidentiality”
2016: National Public Radio (NPR), interviewed on All Things Considered: “Insanity Acquittee Recidivism in Connecticut” (http://wnpr.org/post/study-looks-recidivism-among-insanityacquittees-connecticut)
Regional 2020: Western Connecticut Mental Health Network (Waterbury, CT), Invited Lecture,
“Understanding Psychiatry and the Law in the Outpatient Setting”
2018: Western Connecticut Mental Health Network (Waterbury, CT), 3rd Annual Innovations in Behavioral Health Symposium on Violence, “Violence Risk Assessment and Management”
2018: Institute of Living (Hartford, CT), Department of Psychiatry Grand Rounds, “Confidentiality and Duties to Third Parties”
2018: Middlesex Hospital (Middletown, CT), Department of Psychiatry Medical Staff Seminar Series, “Risk Assessment and Management”
2018: Middlesex Hospital (Middletown, CT), Department of Psychiatry Grand Rounds, “Tarasoff Warnings and Duties to Third Parties”
2018: Jersey Shore University Medical Center (Neptune, NJ), Forensic Psychiatry Symposium, “Confidentiality and Duties to Third Parties”
2018: Berkshire Medical Center (Pittsfield, MA), Psychiatry Residency Program, “Confidentiality and Duties to Third Parties”
2016: Western Connecticut Mental Health Network Monthly Staff Meeting (Waterbury, CT): “A Novel Approach to Morbidity and Mortality Analysis”
2016: VA Connecticut Healthcare Services Monthly Staff Meeting: “Graduate Medical Education in Quality Improvement”
2016: Yale Program Directors’ Annual Retreat: “Evaluating Adverse Events and Near Misses Using Root Cause Analysis”
2016: New Haven Community Services Network Quarterly Leadership Meeting: “Planning for Community Safety”
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2016: VA Connecticut Healthcare System Mental Health Service Line Monthly Meeting: “Redesigning Quality Improvement Education”
2015: New Haven Community Services Network Leadership Meeting: “Understanding Violence Risk”
2015: Yale Psychiatry and Cinema: “The Stanford Prison Experiment”
Peer-Reviewed Presentations & Symposia:
International/National 2020: 2020 American Psychology-Law Society Annual Conference, New Orleans, LA, “The
Inventory of Legal Knowledge (ILK): What Does the Research Say”
2019: 50th Annual Meeting of the American Academy of Psychiatry and the Law, Baltimore, MD, “Using Technology to Improve Residents’ Forensic Education”
2019: 50th Annual Meeting of the American Academy of Psychiatry and the Law, Baltimore, MD, “Entertainment Media Reviews: Fluff or Forensic Teaching Tool?”
2019: 50th Annual Meeting of the American Academy of Psychiatry and the Law, Baltimore, MD, “Should Forensic Patients Have Access to Violent Video Games?”
2019: 50th Annual Meeting of the American Academy of Psychiatry and the Law, Baltimore, MD, “A Fifty-State Survey of Insanity Acquittals”
2019: American Psychiatric Association 2019 Annual Meeting, San Francisco, CA, “Crossing the Psychiatric Quality Chasm From Different Angles: Perspectives for Administration, Education, and Clinical Practice”
2019: American Psychiatric Association 2019 Annual Meeting, San Francisco, CA, “Diverse Career Pathways in Psychiatry: A Career Panel for Students and Residents”
2019: American Psychiatric Association 2019 Annual Meeting, San Francisco, CA, “Assessing Leadership Opportunities: A Workshop for Residents, Fellows, and Early Career Psychiatrists”
2019: American Psychiatric Association 2019 Annual Meeting, San Francisco, CA, “Clinically Relevant Forensic Psychiatry: A Practical Review”
2018: 49th Annual Meeting of the American Academy of Psychiatry and the Law, Austin, TX, “Forensic Mental Health Legislation: A Primer and Update”
2018: Annual Convention of the American Psychological Association 2018, San Francisco, CA, “Improving Competency Restoration Through Placement Decisions: A Critical Review”
2018: American Psychiatric Association 2018 Annual Meeting, New York, NY, “Understanding Tarasoff Duties”
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2018: American Psychiatric Association 2018 Annual Meeting, New York, NY, “Assessing Career Opportunities: A Workshop for Residents and Fellows”
2018: American Psychiatric Association 2018 Annual Meeting, New York, NY, “Systems Change Innovations in Psychiatry: Using Technology and Stakeholder Engagement for Meaningful Quality Improvement”
2018: American Psychiatric Association 2018 Annual Meeting, New York, NY, “Diverse Career Pathways to Leadership in Psychiatry”
2018: American Psychology Law Society - AP-LS Conference 2018, Memphis, TN, “Competency Restoration for Adult Defendants in Different Treatment Environments A Future Direction for Research and Policy”
2017: Association for Academic Psychiatry 2017 Annual Meeting, Denver, CO, “Disability Evaluations in Residency Education”
2017: 48th Annual Meeting of the American Academy of Psychiatry and the Law, Denver, CO, “So You're All Grown Up? Transitioning from Trainee to Expert”
2017: 48th Annual Meeting of the American Academy of Psychiatry and the Law, Denver, CO, “Corrections: An Early Intervention Opportunity in Psychosis”
2017: American Psychiatric Association 2017 Annual Meeting, San Diego, CA, “Decriminalizing Mental Illness Using the Sequential Intercept Model: An Overview and Update on Recent Trends”
2017: American Psychiatric Association 2017 Annual Meeting, San Diego, CA, “Confidentiality: What Every Resident Needs to Know”
2017: American Psychiatric Association 2017 Annual Meeting, San Diego, CA, “Innovation and Progress in Public Psychiatry”
2017: American Psychiatric Association 2017 Annual Meeting, San Diego, CA, “Engaging in Meaningful Quality Improvement Using Root Cause Analysis as a Novel Approach to M&M Conferences in Psychiatric Training”
2016: 47th Annual Meeting of the American Academy of Psychiatry and the Law, Portland, OR, “A Tale of Two PSRBs: Thirty Years of Outcome Data Explored”
2016: 47th Annual Meeting of the American Academy of Psychiatry and the Law, Portland, OR, “Forensic Rotations for Residents: Navigating the Challenges”
2016: Institute for Psychiatric Services: The Mental Health Services Conference, Washington, D.C., “Designing Effective Jail Diversion Programs and Identifying Relevant Outcome Measures”
2016: American Psychiatric Association 169th Annual Meeting, Atlanta, GA, “Disentangling Guns and Mental Illness: The Sandy Hook Effect”
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2016: American Psychiatric Association 169th Annual Meeting, Atlanta, GA, “Managing Violence Risk and Interview Safety: A Primer for Residents”

2015: 46th Annual Meeting of the American Academy of Psychiatry and the Law, Fort Lauderdale, FL, “Is Jail Diversion Effective? And for Whom?”

2015: 46th Annual Meeting of the American Academy of Psychiatry and the Law, Fort Lauderdale, FL, “Novel Approach to Teaching Residents About Violence and Safety”

2015: Institute for Psychiatric Services: The Mental Health Services Conference, New York, NY, “A Novel Approach to Morbidity and Mortality Analysis in Psychiatric Training”

2015: Association for Academic Psychiatry Annual Meeting, San Antonio, TX, “A Novel Approach to Morbidity and Mortality Analysis in Psychiatric Training”

2015: American Psychiatric Association 168th Annual Meeting, Toronto, Canada, “The American Journal of Psychiatry Residents’ Journal: How to Get Involved”

2015: 24th Annual Conference of the International Association for Forensic Psychotherapy, New Haven, CT, “The Impact of Violence on Trainees: An Educational Intervention”

Regional 2015: Yale-New Haven Hospital Quality and Safety Series, New Haven, CT, "When "Whose fault is
it?" doesn't get to the root of the problem. Using RCA to improve systems"

Professional Service

Journal Service:

Editorial Board 2018-present Associate Editor, World Journal of Psychiatry 2017-20 Deputy Editor, Journal of Psychiatric Administration and Management 2017-present Book Review Editor, Journal of the American Academy of Psychiatry and the Law 2014-15 Deputy Editor, American Journal of Psychiatry Residents’ Journal

Ad Hoc Reviewer 2019-present Cambridge University Press 2018-present Oxford University Press, World Journal of Psychiatry 2017-present Advances in Medical Education and Practice, BMJ Open, Psychiatric Services,
Journal of Psychiatric Administration and Management 2016-present Journal of Gerontological Social Work 2015-present Academic Psychiatry, Journal of the American Academy of Psychiatry and the Law

Professional Service for Professional Organizations:

American Academy of Psychiatry and the Law (AAPL)

2019-present Co-Chair, Forensic Training of Psychiatry Residents

2019

Member, Task Force on Committee Reform

2018-present Co-Chair, Government Affairs Committee

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2017-19

Member, Forensic Recovery Committee

2017-present Member, Forensic Hospital Services Committee

2015-20

AAPL Young Physician Delegate to the AMA House of Delegates

2015-19

Member, Forensic Training of Psychiatry Residents Committee

2015-17

Member, Community Forensics Committee

American Association of Psychiatric Administration and Leadership

2020-present President-Elect, Executive Council

2019-20

Secretary, Executive Council

2018-19

Treasurer/Secretary, Executive Council

2017-20

Chair, Early Career Psychiatrists Committee

2017-18

Councilor-at-Large, Executive Council

American Medical Association

2016-19

Member, Academic Physicians Section

2016-17

Member, Young Physician Section Committee on Maintenance of

Certification/Licensure

American Psychiatric Association (APA)

2020-present Corresponding Member, Ethics Committee

2020-present Program Director, APA/APAF Leadership Fellow’s Project

2019

Member, Ethics Committee Task Force on Extrinsic Evidence

2019-present Early Career Psychiatrist Representative for Area 1, APA Assembly

2018-19

Early Career Psychiatrist Member, Committee on Voter Turnout of the APA Assembly

2018-19

Early Career Psychiatrist Member, Committee on Education of the APA Assembly

2018-19

Consultant, Committee on Judicial Action

2018-20

Consultant, Ethics Committee

2017-19

Early Career Psychiatrist Deputy Representative for Area 1, APA Assembly

2017-present Early Career Psychiatrist Member, Awards Committee of the APA Assembly

2017-present Member, State Hospital Psychiatrists Caucus

2016-present Fellow of the APA

Association for Academic Psychiatry

2015-19

Member, Fellow and Resident Training Committee

Connecticut Psychiatric Society

2020-present President-Elect, Executive Council

2019-20

Treasurer, Executive Council

2016-19

Councilor-at-Large, Executive Council

Group for the Advancement of Psychiatry (GAP)

2019-present Member, Administration and Leadership Committee

2018-19

Invited Guest, Administration and Leadership Committee

National Association of State Mental Health Program Directors (NASMHPD) 2018-present Northeast Representative, Forensic Division Executive Committee 2017-present Member, Forensic Division

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Physicians for Criminal Justice Reform

2020-present Director, Mental Health Task Force

2016-20

Member, Research Committee

Yale University Service:

Medical School Committees 2017-present Reviewer, Teaching and Learning Center Medical Education Day abstract submissions

Departmental Committees

2016-18

Chair, Quality Improvement Collaborative, Dept. of Psychiatry, School of Medicine

2016-17

Council Member, Yale Psychiatry Global Mental Health Program, Dept. of Psychiatry,

School of Medicine

2016-17

CMHC Representative, Medical Student Education Committee, Dept. of Psychiatry,

School of Medicine

2016-present Member, Quality Improvement Educational Task Force, Dept. of Psychiatry, School of

Medicine

2016-present Member, Resident Interview Committee, Dept. of Psychiatry, School of Medicine

2015-present Member, Forensic Fellowship Interview Committee, Dept. of Psychiatry, School of

Medicine

2013-14

Member, Graduate Education Committee, Dept. of Psychiatry, School of Medicine

2013-14

Co-Director, Resident Grand Rounds Series, Dept. of Psychiatry, School of Medicine

2012-14

Member, Resident Selection Committee, Dept. of Psychiatry, School of Medicine

2011-12

Co-President, Psychiatry Residents Association, Dept. of Psychiatry, School of

Medicine

Hospital Committees

2018-present Chair, Ethics Committee, Whiting Forensic Hospital

2018-present Chair, Grand Rounds Committee, Whiting Forensic Hospital

2018-present Member, Governing Body, Whiting Forensic Hospital

2018-present Member, Forensic Review Committee, Whiting Forensic Hospital

2017-18

Member, Whiting Forensic Hospital Implementation Committee, Connecticut

Department of Mental Health and Addiction Services

2017-18

Member, Forensic Review Committee, Connecticut Valley Hospital

2017-18

Member, Division Review Committee, Connecticut Valley Hospital

2017-18

Member, Hospital Review Committee, Connecticut Valley Hospital

2017-18

Member, Critical Incident Review Committee, Connecticut Valley Hospital

2017-18

Member, Quality Risk and Safety Committee, Connecticut Valley Hospital

2017-18

Member, Whiting Forensic Division Executive Council, Connecticut Valley Hospital

2016-17

Co-Chair, Medication Safety Committee, Connecticut Mental Health Center

2016-17

Co-Chair, Education and Training Committee, Connecticut Mental Health Center

2016-17

Facility Lead, DMHAS Electronic Health Record Workgroup, Connecticut Mental

Health Center

2016-17

Member, Peer Review and Privileging Committee, Connecticut Mental Health Center

2016-17

Member, Ethics Committee, Connecticut Mental Health Center

2016-17

Member, Graduate Education Committee, Connecticut Mental Health Center

Professional Consultation: 2019-present Forensic Psychiatry Inpatient Services Consultant, Brattleboro Retreat, Brattleboro, VT

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2018-present Forensic Education Consultant, Mental Health Technology Transfer Center Grant for Northwest Region, Seattle, WA
2018-present Consultant on Forensic Service Development, Vermont Department of Mental Health 2018-present Forensic Psychiatry Consultant, Middlesex Hospital, Middletown, CT

Educational Activities:

Educational Program Development

2017-present Co-Director, Public Psychiatry Seminar, Forensic Psychiatry Fellowship, School of

Medicine

2016-present Co-Director, Introduction to Public Sector Mental Health and Administration, Yale

Fellowship in Public Psychiatry, School of Medicine

2016-present Co-Director, PGY4 Leadership Course, Dept. of Psychiatry, School of Medicine

2016-17

Director, Inpatient Interdisciplinary Seminar, Connecticut Mental Health Center

2014-16

Mental Health System Improvement Series, VA Connecticut Healthcare System and

Connecticut Mental Health Center

2014

Clinical Rotation in Forensic Psychiatry, Dept. of Psychiatry, School of Medicine

2014

Social Security Disability Evaluations, Dept. of Psychiatry, School of Medicine

2013-present Understanding Violence Risk, Dept. of Psychiatry, School of Medicine

2013-14

Psych 101 “Cheat Sheets”, Dept. of Psychiatry, School of Medicine

Supervision and Mentorship

2015-19

Supervisor of PGY3 resident and MS4 medical student in developing modules for

AIER grant, Dept. of Psychiatry, School of Medicine

2015-present Forensic evaluation supervisor for residents and forensic fellows, Dept. of Psychiatry,

School of Medicine

2012-17

Medical student interview tutor, Dept. of Psychiatry, School of Medicine

Teaching Experience

2017-present Sequential Intercept Model, Forensic psychiatry fellows

2017-19

Criminal Law, Forensic psychiatry fellows

2016-present Quality Improvement Seminar, PGY1-4 psychiatry residents

2016-19

“A New Take on M&Ms” –Quality Improvement Workshop, MS3 medical students

2015-19

Recovery Movement Workshop, PGY2 psychiatry residents

2015-17

Evaluation of Psychosis, MS3 medical students

2015-17

Violence and Suicide Risk Assessment, MS3 medical students

2015-16

Introduction to Forensic Psychiatry, PGY1 psychiatry residents

2015

Forensic Psychiatry Case Conference, PGY2 psychiatry residents

2015

Quality Improvement Workshop, PGY4 psychiatry residents

2014-present Suicide Prevention Workshop, PGY2 psychiatry residents

2014

Assessment and Treatment of Bipolar Disorder, PGY2 psychiatry residents

2013

Ethics Workshop, PGY2 psychiatry residents

2013

The One-Minute Preceptor Workshop, PGY2 psychiatry residents

2013-14

Therapeutic Communication: Termination, PGY1 psychiatry residents

2013-14

Suicide and Violence Risk Assessment, PGY1 psychiatry residents

Professional Memberships

2010-present American Medical Association

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2012-present 2012-present 2014-present 2015-present 2015-present 2015-present 2018-present

American Psychiatric Association Connecticut Psychiatric Society American Academy of Psychiatry and the Law American Association of Psychiatric Administrators American Association of Community Psychiatrists Physicians for Criminal Justice Reform International Initiative for Mental Health Leadership

Other Licensure and Certification:

Connecticut State Medical License, 2012 Buprenorphine DEA Waiver Registration, 2014

Bibliography:

Peer-Reviewed Original Research 1. Ford J.D., Wasser T., Connor D. Identifying and determining the symptom severity associated
with polyvictimization among psychiatrically impaired children in the outpatient setting. Child Maltreat 2011, 16:216-226. 2. Wasser T., Fox P.K.. For whom the bell tolls: Silver Alerts raise concerns regarding individual rights and governmental interests. J Am Acad Psychiatry Law 2013, 41:421-429. 3. Wasser T. How do we keep our residents safe? An educational intervention. Acad Psychiatry 2015, 39:94-98. 4. Wasser T., Richards M., Radhakrishnan R., Freedman R. The American Journal of Psychiatry Residents’ Journal: Training the Next Generation of Academic Psychiatrists. Am J Psychiatry 2016, 173:461-464. 5. Wasser T., Grunschel B.D., Stevens A., Capurso N.A., Ralevski E., Barkil-Oteo A., Trevisan L. Transforming systems of care through a novel resident-led approach to morbidity and mortality conferences. Acad Psychiatry 2016, 40:893-897. 6. Wasser T., Ross D.A. Another step forward: A novel approach to the clinician-educator track for residents. Acad Psychiatry 2016, 40:937-943. 7. Wasser T. Gaining administrative experience during residency – identifying and exploring opportunities. Journal of Psychiatric Administration and Management 2016, 5:9-12. 8. Norko M., Wasser T., Magro H., Leavitt-Smith E., Morton F., Hollis T. Assessing insanity acquittee recidivism in Connecticut. Behav Sci Law 2016, 34:423-443. 9. Radhakrishnan R., Wasser T., Picon F., Puspanathan P., da Costa MP., Nakamae T., Elkholy H. Editorial training models for early-career psychiatrists. Lancet Psychiatry 2017, 4:515-516. 10. Wasser T., Pollard J., Fisk D., Srihari V. First-episode psychosis and the criminal justice system: Using a sequential intercept framework to highlight risks and opportunities. Psychiatr Serv 2017, 68:994-996. 11. Michaelsen K., Lewis A., Morgan P., McKee S., Wasser T. The barriers and benefits to developing forensic rotations for psychiatry residents. J Am Acad Psychiatry Law 2018, 46:322– 328. 12. de Similien R., Dooley E., Wasser T. Public service psychiatry in the age of social determinants: Why psychiatry trainees should join in. Journal of Psychiatric Administration and Management 2018, 6:39-44. 13. de Similien R., Hairston D., Kumari S., Matthews G., Wasser T., Malik M., Manalai P. Sociodemographic and clinical correlates of the frequently hospitalized African American patients with severe persistent mental illness. Ann Clin Psychiatry 2018, 30:305-310.

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14. Wasser T., Sun A., Chandra S., Michaelsen K. The benefits of required forensic clinical experiences in residency. Academic Psychiatry 2019, 43:76-81.
15. Danzer G., Wheeler E., Alexander A., Wasser T. Competency restoration for adult defendants in different treatment environments: A future direction for research. J Am Acad Psychiatry Law 2019, 47:68-81.
16. Li L., Gupta N., Wasser T. A novel initiative contextualizing quality improvement and systems based practice in psychiatric clinical teaching settings, Journal of Mental Health Training, Education and Practice 2019, 14:156-163.
17. Cerny-Suelzer C.A., Ferranti J., Wasser T., Janofsky J.S., Michaelsen K., Alonso-Katzowitz J.S., Cardasis W., Noffsinger S., Martinez R., Spanggaard M. Practice resource for forensic training in general psychiatry residency programs. J Am Acad Psychiatry Law 2019, 47:266, S1S14.
18. Wasser T., Chandra S., Michaelsen K. Enhancing forensic exposures in residency training. Journal of Mental Health Training, Education and Practice 2019, 15:13-19.
19. Wasser T., Hu J., Danzig A., Yarnell-Mac Grory S., Rodriguez-Guzman J., Michaelsen K. Teaching forensic concepts to residents using interactive online modules. J Am Acad Psychiatry Law 2020, 48:77-83.
20. Chaffkin J., Wasser T. The impact of teaching internal medicine residents about decisionmaking capacity. Academic Psychiatry 2020, [Epub ahead of print]. doi: 10.1007/s40596-02001219-8.
21. Pollard J.M., Ferrara M., Lin I.H., Kucukgoncu S., Wasser T., Li F., Srihari V. Analysis of early intervention services on adult judicial outcomes. JAMA Psychiatry 2020, [Epub ahead of print]. doi: 10.1001/jamapsychiatry.2020.0448.
Books 22. Psychiatry and the Law: Basic Principles, 1st edition, ed. T. Wasser, Springer, NY, NY, 2017.
Chapters and Reviews 23. Wasser T. A relevant review of violence risk for the psychiatric trainee. Am J Psychiatry
Residents’ Journal 2014, 9:5-7. 24. Wasser T. Attending to safety in the psychiatric interview. Am J Psychiatry Residents’ Journal
2014, 9:3-5. 25. Wasser T. Chapter 9: Recognizing and managing the agitated patient, in A Resident’s Guide to
Surviving Psychiatric Training, 3rd Edition. Edited by Foreman T, Dickstein LJ, Garakani A, Jordan AM, Richards M. American Psychiatric Association Publishing, Arlington, VA, 2015, pp. 53-62. 26. Wasser T. Chapter 36: Ethics (Capacity Evaluation), in Essential Psychiatry Board Review. Edited by Tampi R, Zdanys K, Oldham M. Oxford University Press, NY, NY, 2017, pp. 335338. 27. Wasser T., Michaelsen K. Introduction: Why Understanding the Law Matters. In Psychiatry and the Law: Basic Principles, 1st edition, ed. T. Wasser, Springer, NY, NY, 2017, pp. 1-8. 28. Sun A., Wasser T. Confidentiality and Privilege. In Psychiatry and the Law: Basic Principles, 1st edition, ed. T. Wasser, Springer, NY, NY, 2017, pp. 21-34. 29. Wasser T. Conclusion: How to Learn More About Forensic Psychiatry. In Psychiatry and the Law: Basic Principles, 1st edition, ed. T. Wasser, Springer, NY, NY, 2017, pp. 183-188. 30. Sun A., Wasser T. Chapter 1: Cognitive-Behavioral Therapy, Imipramine, or Their Combination for Panic Disorder. In 50 Studies Every Psychiatrist Should Know, 1st edition, eds. I. Bhalla, R. Tampi, V. Srihari, Oxford University Press, NY, NY, 2018, pp. 1-6.
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31. Habecker E., Wasser T. Chapter 2: Fluoxetine, Comprehensive Cognitive-Behavioral Therapy, and Placebo for Generalized Social Phobia. In 50 Studies Every Psychiatrist Should Know, 1st edition, eds. I. Bhalla, R. Tampi, V. Srihari, Oxford University Press, NY, NY, 2018, pp. 7-13.
32. Wasser T., Papapietro D., Kapoor R. Chapter 22: Self-disclosure in forensic settings: Therapeutic intervention vs. boundary violation. In Therapeutic Self-Disclosure, 1st edition, ed. Danzer G., Brunner-Routledge, NY, NY, 2018, pp. 168-177.
Peer-Reviewed Educational Materials 33. Wasser T., Ross D. Recognizing and Managing Safety in the Psychiatric Interview: A Brief
Intervention. Peer-reviewed and selected by the American Association of Directors of Psychiatric Residency Training as a Milestones Toolkit; August 2014. 34. Kopelovich S., Michaelsen K., Wasser T. Violence Risk Assessment & Management in Community Mental Health Settings. Published by the Mental Health Technology Transfer Center Network; June 2019. Available at https://mhttcnetwork.org/centers/northwest-mhttc/traininglaunch-violence-risk-assessment-management-community-mental-health. 35. Wasser T., Yarnell-Mac Grory S., Michaelsen K. Understanding Confidentiality: Protecting Your Patient, Third Parties and Yourself. Peer-reviewed and selected by the American Association of Directors of Psychiatric Residency Training as a Model Curriculum; 2020.
Invited Editorials and Commentaries 36. Wasser T. A day in the life of a resident: Yale psychiatry. Psychiatric Times 2013,
http://www.psychiatrictimes.com/blogs/residents-blog/day-life-resident-yale-psychiatry. 37. Wasser T, Grunschel B. A novel approach to morbidity and mortality analysis in psychiatry
residency. Psychiatric Times 2014, http://www.psychiatrictimes.com/residents-corner/novelapproach-morbidity-and-mortality-analysis-psychiatry-residency 38. Richards M., Wasser T., Radhakrishnan R. Residents’ Journal: An Opportunity to Get Involved. Psychiatric News 2014, http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1901733. doi: 10.1176/appi.pn.2014.8b1. 39. Wasser T. One head, multiple hats. AAPL Newsletter 2015; 40 (2):10, 25. 40. Wasser T. The ripple effect – psychiatric admissions and gun ownership following sandy hook. Connecticut Psychiatrist. Spring 2015; 54 (1): 1, 4-5. 41. Wasser T., Michaelsen K., Ferranti J. Developing forensic clinical experiences for general psychiatry residents: Navigating the obstacles. AAPL Newsletter 2016; 41(1): 21, 26, 28. 42. Wasser T. 2015 AAPL presidential address – Graham Glancy, MBChB, FRCPsych, FRCP(C):: Witness protection program: A matter of training. AAPL Newsletter 2016; 41(1): 1-2. 43. Wall B., Gruenberg L., Piel J., Wasser T. American Medical Association 2015 interim meeting highlights. AAPL Newsletter 2016; 41(1): 14. 44. Wall B., Gruenberg L., Piel J., Wasser T. American Medical Association 2016 annual meeting highlights. AAPL Newsletter 2016; 41(3): 19, 31. 45. Wall B., Gruenberg L., Piel J., Wasser T. American Medical Association 2016 interim meeting highlights. AAPL Newsletter 2017; 42(1): 17, 34. 46. Wall B., Gruenberg L., Piel J., Wasser T. American Medical Association 2017 interim meeting highlights. AAPL Newsletter 2018; 43(1): 22. 47. Wall B., Gruenberg L., Piel J., Wasser T. American Medical Association 2018 annual meeting highlights. AAPL Newsletter 2018; 43(3): 15. 48. Wasser T. Becoming the medical director of a forensic hospital. AAPL Newsletter 2018; 43(2): 25-26. 49. Wasser T., Thompson, C. Expanding AAPL’s scope. AAPL Newsletter 2018; 43(3): 19, 35.
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Case 3:20-cv-00594-JCH Document 49-4 Filed 07/09/20 Page 27 of 27
Date of Revision: 6/18/20
50. Wall B., Piel J., Wasser T. American Medical Association 2018 interim meeting highlights. AAPL Newsletter 2019; 44(1): 25, 31.
51. Wasser T., Michaelsen K. Engaging general psychiatry residents: Forensic educators as storytellers. AAPL Newsletter 2019; 44(1): 24, 31.
52. Wall B., Piel J., Wasser T. American Medical Association 2019 annual meeting highlights. AAPL Newsletter 2019; 44(3): 1-2.
53. Rosenbaum K., Friedman SH., Cerny-Suelzer C., Weiss K., Wasser T. Entertainment media reviews: Fluff or forensic teaching tool? AAPL Newsletter 2020; 45(1): 19. 26.
Case Reports, Technical Notes, Letters 54. Wasser T., Edwards L. Mentally ill in police custody: subjective standard denied. J Am Acad
Psychiatry Law 2013, 41:121-123. 55. Wasser T., Trueblood K. Forced meds to restore competency. J Am Acad Psychiatry Law 2015,
43:9-11. 56. Charoensook J., Sidaros R., Pier K., Millard H., Wasser T., Richards M., Radhakrishnan R.:
Reflections on an innovation: The first trainee-led academic psychiatry journal. Acad Psychiatry 2016, 40:564-565. 57. Wasser T., Ross D.A.: Resident grand rounds. Med Educ 2016, 50:1157-1158. 58. Yarnell S., Wasser T. Is “some” enough in special education? J Am Acad Psychiatry Law 2018, 46:119-121. 59. Abellard J., Wasser T. Parens patriae liability prevented by governmental immunity. J Am Acad Psychiatry Law 2019, 47:109-111. 60. Mathew M., Wasser T. Religious rights in the criminal justice system. J Am Acad Psychiatry Law 2020, 48:119-121.
In Press 61. Wasser T., Zhong R., Mufson J., Danzig A., Koka L., Kapoor, R. Violent video games in
forensic psychiatric hospitals. J Am Acad Psychiatry Law 2020, In press. 62. Danzer G., Wasser T. The Inventory of Legal Knowledge (ILK): A literature review. J Am Acad
Psychiatry Law 2020, In press. 63. Sapra M., Alvarado G., Wasser T. Chapter 5: Organized psychiatric healthcare systems: Private
practices, community-based clinics, hospitals, and health Systems. In Textbook of Psychiatric Administration and Leadership, 3rd edition, ed. Saeed S., Lauriello J. & Roberts L., APA Publishing, Washington, D.C., In press. 64. Wasser T., Dike C., Norko M. Chapter 12: The forensic unit. In Textbook of Hospital Psychiatry, 2nd edition, ed. Travedi H. & Sharfstein S., APA Publishing, Washington, D.C., In press. 65. Wasser T., Hauser L., Kapoor R. The management of COVID-19 in forensic psychiatric institutions. Psychiatr Serv 2020, In press.
13

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EXHIBIT D

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UNITED STATES DISTlUCT COURT DISTIUCT OF CONNECTICUT

THOMAS WILKES, BARBARA FLOOD, VINCENT ARDIZZONE, GAIL LITSKY, CARSON MUELLER,
On behalf of themselves and all other persons similarly situated, Plaintiffs
v.
NED LAMONT, Governor MIRIAM E. DELPHIN-RITTMAN, Commissioner ofDMHAS, HAL SMITH, CEO of Whiting Forensic
Hospital, LAKISHA HYATT, CEO Connecticut
Valley Hospital, In their official capacities,
Defendants

CIVIL NO. 3:20CV594-JCH JULY 6, 2020

DECLARATION OF VINNETH CARVALHO, MD The undersigned declarant, Vinneth Carvalho, MD, being duly sworn, hereby deposes and declares under the pains and penalties of pe1jury, pursuant to 28 USC §1746, that: 1. I am employed by the State of Connecticut Department of Mental Health and Addiction Services as the Chief Medical Officer at Connecticut Valley Hospital ("CVH") in Middletown, CT. I have held this position since April 22, 2019. A copy ofmy CV is attached as Attachment 1 hereto.
2. I make this Declaration based upon personal knowledge, and I understand that it will be submitted to this Court in connection with the above-captioned case in support of the

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 3 of 25
Defendants' Opposition to the Plaintiffs' Motion for Preliminary Injunction. 3. CVH is a state-operated psychiatric inpatient facility providing mental health services to
individuals. 4. CVH employs on site medical doctors ("MDs"), advance practice registered nurses
("APRNs"), Physician Assistant and nurses on every shift who address medical needs of patients. 5. As part of my job duties, I am responsible for the management and oversight of the daily clinical operations and patient care at CVH. 6. CVH has protocols in place with regard to testing in response to the COVID-19 pandemic. The most recent update to these protocols was on June 29, 2020. See Exhibit P, CVH COVID-19 Response Plan Testing Protocol. 7. From March 17, 2020 to June 30, 2020, there was a prohibition of visitors at CVH. As of July 1, 2020, visitation has resumed subject to requirements and guidance from the Connecticut Department of Public Health ("DPH") and the Center for Disease Control. ("CDC"). 8. CVH conducts daily COVID-19 screening of those entering the hospital, including staff, by checking temperatures and asking series of questions about current COVID-19 symptoms, potential COVID-19 exposures and recent travel. The questionnaire is frequently updated to reflect evolving CDC guidance. 9. CVH conducts daily COVID-19 screening of patients by checking temperatures, monitoring their breathing and oxygen saturation level with the use of pulse oximeters
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and asking series of questions about current COVID-19 symptoms. The questionnaire is frequently updated to reflect evolving CDC guidance. 10. All new patients are tested prior to or upon entry to CVI-1 and are quarantined for 14 days. 11. On March 19, 2020, CVI-1 began monitoring all patients for COVID-19. All patients who are suspected for COVID-19 arc tested. On March 21, 2020, CVI-l tested its first suspected case of COVID-19. 12. Baseline testing of patients at CVI-1 was completed on May 6, 2020. 13. The date that a patient at CVH last tested positive for COVID-19 was on May 16, 2020. 14. Since May 16, 2020, no new patients at CVI-1 have tested positive for COVID-19. 15. As of July I, 2020, a total of63 patients out of243 patients at CVI-1 tested positive for COVID-19 since the pandemic began. 16. As of July I, 2020, a total of 57 patients who tested positive for COVID-19 have recovered from COVID-19 since the begim1ing of the pandemic. 17. As of July I, 2020, 239 CVI-1 patients in total have been tested for COVID-19 since the pandemic began. The current CVI-1 census is 217 patients. 18. Baseline testing of staff al CVI-1 was completed on May 28, 2020. 19. On July 6, 2020, CVI-1 began repeat testing of staff. 20. The date that a direct care staff member at CVI-1 last tested positive for COVID-19 was on May 19, 2020. 21. The date that a non-direct care staff member at CVI-1 last tested positive for COVID-19 was on May 21, 2020. 22. As of July I, 2020, a total of 45 staff members out of 1095 staff members at CVI-1
3

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 5 of 25
tested positive for COVID-19 since the beginning of the pandemic. 23. As of July 1, 2020, a total of44 staff members who tested positive for COVID-19 have
recovered from COVID-19. 24. As of July I, 2020, 541 staff members out of 1095 staff members at CVI-1 have been
tested for COVID-19 since the pandemic began. 25. As of July I, 2020, 504 staff members of the 541 staff members at CVH who have been
tested for COVID-19 since the pandemic began are direct care staff. 26. If a patient tests positive for COVID-19, CVH conducts contract tracing and testing of
staff and residents who may have been exposed to the patient. 27. CVH cannot mandate patient testing for COVID-19. 28. If a patient who displays COVID-19 symptoms refuses COVID-19 testing, CVH treats
the patient as ifhe or she has COVID-19 and follows the hospital's protocol for treating COVID-19 positive patients. 29. If a new admission refuses COVID testing, CVH treats the patient as ifhe or she has COVID-19 and follows the hospital's protocol for COVID-19 positive patients. 30. If a staff member tests positive for COVID-19, CVH conducts contract tracing and testing of staff and residents who may have been exposed to the patient. 31. As of July 6, 2020, testing for COVID-19 is mandatory for direct care staff and those who regularly interact with patients. 32. The use of personal protective equipment ("PPE") at CVH has evolved consistent with CDC guidelines.
4

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 6 of 25
33. In particular, as early as March 10, 2020, CVH issued guidance on PPE use, including the requirement of mask use at the point of presentation of any COVID-19 like symptoms.
34. CVH staff have available to them all necessary PPE, including, but not limited to: surgical masks, face shields, N95 masks, eye protection, gowns, gloves and probe covers, in addition to hand sanitizer.
35. Direct care staff have received web-based training on PPE use including proper donning and doffing protocols. Live tutorials have also been offered. Training for staff on these i.ssues 1.s ongom. g.
36. Staff arc required to wear surgical masks in all patient areas. CVH patients are provided face masks at least weekly, and more often if they become soiled or damaged, consistent with individual medical assessments to ensure no unwarranted medical risk or risk of self-injury is present.
37. Patients have also been provided education on proper mask use through handouts, posters and unit-based meetings. Educational efforts are ongoing. There is documentation regarding the education on the proper use of mask, hand hygiene and social distancing in each patient's medical chart.
38. All patients at CVH are part of a treatment team made up of clinicians that collaboratively plan and provide care to the patient. The team consists of a psychiatrist, medical doctor, psychologist, social worker, rehabilitation therapist, nurses, and mental health assistants (who assist in therapeutic engagements).
5

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39. Taking into account the limits of court-imposed confinement and in accord with governing policies, CVH actively pursues the appropriate discharge of every patient deemed discharge ready by their treatment team.
40. Planning for discharge to the most integrated community setting begins upon admission to the inpatient service and treatment planning by the team addresses the particular considerations for each patient bearing on discharge and identifies barriers to discharge.
41. At every monthly treatment plan review the treating physician will document in the patient's chart and discuss with the patient the specific factors that the physician is considering to determine the patient's current clinical need for hospital level of care and the patient's readiness for discharge. Such factors should include the patient's physical and mental status, results of medical/psychological tests, the patient's cognitive and behavioral status, the patient's functional capacities, and evaluative explorations or treatment protocols yet to be completed.
42. The physician will also document in the patient's chmi the treatment interventions the hospital will provide to address each factor in order to discharge the patient from the hospital in a timely manner once the patient is deemed discharge ready by the treatment team. Extrinsic factors which present bmTiers lo discharge, such as the patient's willingness to leave the hospital or the availability of a residential placement must be documented in the chart.
43. On each temn is a clinical social worker who maintains a knowledge base of community support services and provides oversight to the discharge planning process. Typically, the clinical social worker will be communicating with community providers regm·ding a patient's discharge in advance of the patient being determined as ready for discharge.
6

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 8 of 25
44. As a result of this process, each month, there has been a professional judgment by the physician informed by the team as to whether a patient is discharge ready.
45. During the course of the pandemic, the treatment teams continue to address discharge readiness and barriers (reflected in the treatment plans) including those posed by COVID 19 pandemic.
46. From March l, 2020 until June 30, 2020, 34 patients were discharged from the CVH General Psychiatric Division.
47. From March l, 2020 until June 30, 2020, 23 patients were admitted to the CVH General Psychiatric Division.
48. CVH is comprised of two campuses with four clinical buildings: two (2) addiction services buildings, a geriatric building and a general psychiatric building.
49. The physical space as well as the reduction in census of the two addiction services buildings has allowed for appropriate social distancing throughout the pandemic.
50. Social distancing is more of a challenge in the General Psychiatric and Geriatric Services buildings; however, CVH has taken numerous steps to work with the challenges to achieve the goals of social distancing.
51. CVH, in consultation with the State of Connecticut Department of Public Health ("DPH") and a Middlesex Hospital Epidemiologist, established three patient cohorts: (1) Patients who tests positive for COVID 19; (2) Patients who test negative for COVID-19 but were exposed to others who tested positive for COVID-19; and (3) Patients that test negative for COVID-19 who were not exposed to a person who tested positive for COVID-19.
7

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 9 of 25
52. CVH assigns COVID-19 positive patients lo one of the two isolation units that CVH established to treat COVID-19 positive patients, one of which has a surge capacity and each of which is equipped with negative pressure rooms and enough space to allow for social distancing.
53. CVH places people suspected of having COVID-19 ("PUis") based on CDC guidelines in an isolation room with floor-to-ceiling walls and a separate bathroom.
54. In addition, patients exposed to a COVID-19 positive person who test negative for COVID-19 are cohorted and quarantined for fourteen (14) days.
55. CVH utilizes a more conservative adaptation of the Center for Disease Control's symptom-based criteria for discontinuing isolation precautions: No fever for seventy-two (72) hours without the use of fever reducing medications; resolution of symptoms; and fourteen (14) days since the onset of symptoms. The CDC reconnnends ten (10) days but out of abundance of caution, CVH uses fourteen ( 14) days. CVH also requires resolution of, rather than diminution of symptoms as the guidepost. Also, older CVH patients who experience complicated recoveries are tested twice, twenty-four hours apart. This protocol is in addition to the resolution of symptoms and the fourteen (14) day period.
56. Based on CDC and DPH recommendations, CVH consistently deploys staff to the same unit or, if not possible, to the same cohort. CVH makes every attempt to avoid deploying staff from a positive cohort unit to a negative cohort tmit.
57. To fmiher suppmi social distancing, the beds in donble-occupant rooms at CVH are placed so that the head of one bed faces the foot of the other bed thereby creating more than six (6) feet of distance between the heads of the patients.
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58. Instead of congregate dining, CVH employs unit-based dining. CVH patients eat meals in their bedrooms or other rooms within patient units and, to the extent possible, staggers bathroom use and showering activity.
59. CVI-I has an enhanced protocol for patients who are exhibiting lack of behavior control, which includes: (a) onsite staff management; (b) assigning these patients to single occupant rooms when possible; and (c) for COVID-19 positive patients, conducting patient observation through a window or if there is no window, placement of a staff in proximity with appropriate PPE donned to permit timely intervention, if necessary.
60. In accordance with social distancing, CVI-1 has continued to have meaningful visitor contact through virtual visitation.
61. To further support social distancing, from the end of March through mid-May, CVH ceased group therapeutic sessions and, instead, provided patients with individual therapy sessions via unit-based therapists. Since mid-May, CVH has performed risk benefit analyses for the previously available therapy groups to determine whether the benefits of a therapeutic group outweigh the risks associated with the pandemic if groups are limited to participants within a unit and group size is limited to three (3) to five (5) patients. This process has resulted in resuming some unit-based therapeutic groups of three (3) to five (5) patients.
62. CVI-I has altered CVI-1 patient movement privileges. CVH limits comiyard use to members of a unit and limits the number of patients using it at any given time. CVI-1 also prevents patients from congregating in other areas and mingling with patients from other units at CVI-I and prevents patients from accessing other areas at CVH and Whiting Forensic Hospital ("WFH").
9

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63. CVH has instituted staff teleworking mwngements, to the extent possible, postponed
non-critical staff training, and continues to utilize tclemedicine to further reduce the
number of people at CVH and maximize social distancing.
64. CVII has provided and continues to provide staff and patients with meaningful, ongoing
education regarding COVID-19 prevention strategies, included social distancing.
65. CVH has provided and continues to provide patients with COVID-19 education in
individual and small, unit-based group sessions. CVH uses the Coronavirus (COVID-19)
I'ACT SHEET, See Exhibit 0, as the basis for patient education. CVH also posts
COVID-19 patient education posters in the bathroom (male and female) and hallways
walls within patient care units.
66. CVH's "Talking Points Regarding Masks and PPE," guides staff communications with
patients, in very simple terms. The guideline provides talking points for staff to use as
follows:
• If you are wearing PPE that has been issued to you by DMI-IAS and is clinically indicated, please inform patients and other staff that you m·e wearing PPE because a risk has been identified and the PPE has been issued to you by DMHAS to protect you from exposure.
• We ask that if you choose to wem your own PPE, please convey to clients and other staff that your use of your personal PPE is not required and is a personal choice.
• Reassnre clients that DMI-IAS and staff are doing everything they can to ensnre the safety and health for all clients and staff on the unit.
• Reinforce social distancing and hand hygiene • Remind patients that CVH will be sure to provide a mask to patients
whenever they are needed • Achieving Excellence & Conquering COVID TOGETHER!!
67. In addition, over a two-day period, CVI-I provided patients with enhanced COVID-19
reeducation in the following areas:
a. How is COVID-19 spread? Person-to-person through respiratory droplets; b. COVID-19 may be spread by people who are not showing symptoms;
10

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 12 of 25 c. Clean your hands often by washing for at least 20 seconds or using hand
sanitizer; d. Cover your mouth and nose with a cloth face mask when around others; and e. Avoid close contact- stay six feet (about two arm's length) away from others 68. All CVH staff have received frequent communications about the importance of providing patient COVID-19 prevention education and modelling COVID-19 preventive measures for the patients. 69. To further reinforce the CYB-provided patient education, CVH is also implementing a CVI-I developed, nine (9) session patient education program. 70. CVH staff and patients are instructed to maximize social distancing opportunities and maintain social distancing to the greatest extent possible.
11

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 13 of 25 DECLARATION
Pursuant to Conn. Gen. Stat. §§ l-24a, 53a-l 57b, and 28 U.S.C. §1746, I declare under the pains and penalties of perjury that the foregoing statements are true and accurate to the best ofmy knowledge and belief
·i, Dated this ~ day of July, 2020.
Vinneth Carvalho, MD
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ATTACHMENT 1

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 15 of 25
1
6/28/20
VINNETH V. CARVALHO, M.D. Connecticut Valley Hospital Middletown, CT. 06457 Telephone :( 860) 262-7030 Email: vinneth.carvaho@ct.gov
_______________________________________________________
LICENSURE/CERTIFICATION
Medical Licensure: Connecticut (2006-current) #043469
Certification: Board Certified in Psychiatry and Neurology (05/2007-current) Board Certified in Forensic Psychiatry (06/2009-current)
EMPLOYMENT HISTORY
4/22/2019-current Chief Medical Officer Connecticut Valley Hospital 1000 Silver Street Middletown, Connecticut 06457
01/05/2018-04/21/2019 Service Medical Director Whiting Forensic Hospital 70 Obrien Drive Middletown, Connecticut 06457
10/05/2012-01/04/2018 Assistant Chief of Psychiatry University of Connecticut Health Center-CMHC 263 Farmington Avenue Farmington, Connecticut 06030
12/31/2010-10/05/2012 Principal Psychiatrist Whiting Forensic Division Connecticut Valley Hospital 70 Obrien Drive
Vinneth Carvalho M.D

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 16 of 25
2
Middletown, Connecticut 06457
11/15/2006 – 12/30/2010 Principal Psychiatrist University of Connecticut Health Center York Correctional Institution 201 West Main Street Niantic, Connecticut 06357
ACADEMIC APPOINTMENT
07/01/2006-current Clinical Instructor in Psychiatry Yale Law and Psychiatry Division Yale University 34 Park Street New Haven CT 06519
10/2012-01/2018 Clinical Instructor in Psychiatry University of Connecticut School of Medicine Farmington, CT 06030
POST GRADUATE TRAINING
07/01/2005 - 06/30/2006 Forensic Psychiatry Fellowship PGY V Yale University - Law and Psychiatry Division 34 Park Street New Haven CT 06519
07/01/2001 – 06/30/2005, Psychiatry Resident PGY I-IV Mount Sinai School of Medicine – Elmhurst Hospital Center 79-01 Broadway, Elmhurst, NY 11373
MEDICAL EDUCATION
08/01/1991 – 07/19/1997 Doctor of Medicine Diploma (M.D.) Institution of Higher Education of Medical Sciences of Havana Hospital Salvador Allende University of Havana Havana, Cuba
Vinneth Carvalho M.D

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 17 of 25
3
09//01/1997 – 06/30/1999 Locum Physician-Internship Cornwall Regional Hospital Montego Bay, Jamaica.
PROFESSIONAL MEMBERSHIP
American Psychiatric Association American Association of Psychiatry and Law National Commission on Correctional Health Care
PROFESSIONAL ACTIVITIES
O4/22/2019-current: Chair QRS subcommittee (Critical Incident Review), Connecticut Valley Hospital
04/22/2019-current; Co-Chair Clinical Management Committee, Connecticut Valley Hospital
05/2018-current: Co-Chair Pharmacy, Therapeutics and Nutrition CommitteeWhiting Forensic Hospital
2012-2017: Chair, Staff Development Workshop, York Correctional Institution
2012-2017: Policy and Procedures Executive Committee UConn Health-Correctional Managed Health Care
2012-2017: Pharmacy and Therapeutics Committee UConn Health Correctional Managed Health Care
July 2003-June 2005 Chief Resident in Psychiatry, Mt. Sinai School of Medicine, Elmhurst Hospital, NY.
TEACHING/ACADEMIC SUPERVISION EXPERIENCE
2018-current Forensic Psychiatry Fellows Yale University-Law and Psychiatry Division New Haven, CT
2012-2018 Psychiatric APRNs, Medical Students, Forensic Psychiatry Fellows
Vinneth Carvalho M.D

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 18 of 25
4
Yale University New Haven CT
2012-2018 Medical Students, Psychiatry Residents University of Connecticut School of Medicine Farmington, CT
2006-2010 Medical Students Yale School of Medicine New Haven, CT
PRESENTATIONS/PUBLICATIONS
Carvalho, Vinneth MD,: The Fine Art of Court Testimony, Connecticut Valley Hospital Grand Rounds, February 5, 2020 .
Carvalho, Vinneth MD, Smoyer, Amy PhD: Why Food Matters: Impact of Food on the Physical and Psychosocial Health of Incarcerated Females. National Conference on Correctional Health Care, Las Vegas NV: October 24, 2016.
Carvalho, Vinneth MD, Amy Smoyer PhD: Eating in: Food and Nutrition in Women’s Prison. Adult and Juvenile Female Offender’s (AJFO) Conference, Hartford, CT. October 15, 2015.
Carvalho, Vinneth MD: Impact of Metabolic Syndrome in the Correctional System, UConn Statewide Mental Health Conference, Farmington, CT: October 13, 2014.
Kapoor, Reena MD, Dike, Charles MD, Burns, Craig MD, Carvalho, Vinneth MD, Ezra Griffith MD: Cultural Competence in Correctional Mental Health. International Journal of Law and Psychiatry, September 2013, Vol 36 (3) pp 273280.
Baranoski, Madelon PhD, Carvalho, Vinneth MD, Singh, Bobby MD, Darani, Shaheen MD: Teaching Performance in Forensic Education, AAPL Conference, 2006.
Carvalho, Vinneth, MD: Competence for Waiver of Appeals in Death Penalty: Timing, Standard and Standing. J Am Acad. Psychiatry Law 2006, Vol. 34, pp 120-122.
Carvalho, Vinneth, MD: Absinthe, Art and Agony; The Case of Vincent Van Gogh, Elmhurst Hospital Center Grand Rounds 12/03/2003.
Vinneth Carvalho M.D

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 19 of 25
5
FORENSIC PSYCHIATRY CONSULTATIONS/TESTIMONIES: Performed over 200 forensic evaluations including Competency to Stand Trial Evaluations (CST), Not Guilty by Reason of Insanity (NGRI), Competency to Make a Will, Pre-sentence Evaluations, Risk Management Assessments of Youths for Community Placement, and Psychiatric Evaluation of Adults in child custody cases. Performed over 130 Competency to Stand Trial evaluations and testified in approximately 42 cases (36 were competency evaluations). Testified on September 16, 2019 before the CVH/WFH Task Force at the Legislative Office in Hartford on behalf of CVH LANGUAGES English, Spanish
Vinneth Carvalho M.D

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 20 of 25
ATTACHMENT 1

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 21 of 25
1
6/28/20
VINNETH V. CARVALHO, M.D. Connecticut Valley Hospital Middletown, CT. 06457 Telephone :( 860) 262-7030 Email: vinneth.carvaho@ct.gov
_______________________________________________________
LICENSURE/CERTIFICATION
Medical Licensure: Connecticut (2006-current) #043469
Certification: Board Certified in Psychiatry and Neurology (05/2007-current) Board Certified in Forensic Psychiatry (06/2009-current)
EMPLOYMENT HISTORY
4/22/2019-current Chief Medical Officer Connecticut Valley Hospital 1000 Silver Street Middletown, Connecticut 06457
01/05/2018-04/21/2019 Service Medical Director Whiting Forensic Hospital 70 Obrien Drive Middletown, Connecticut 06457
10/05/2012-01/04/2018 Assistant Chief of Psychiatry University of Connecticut Health Center-CMHC 263 Farmington Avenue Farmington, Connecticut 06030
12/31/2010-10/05/2012 Principal Psychiatrist Whiting Forensic Division Connecticut Valley Hospital 70 Obrien Drive
Vinneth Carvalho M.D

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 22 of 25
2
Middletown, Connecticut 06457
11/15/2006 – 12/30/2010 Principal Psychiatrist University of Connecticut Health Center York Correctional Institution 201 West Main Street Niantic, Connecticut 06357
ACADEMIC APPOINTMENT
07/01/2006-current Clinical Instructor in Psychiatry Yale Law and Psychiatry Division Yale University 34 Park Street New Haven CT 06519
10/2012-01/2018 Clinical Instructor in Psychiatry University of Connecticut School of Medicine Farmington, CT 06030
POST GRADUATE TRAINING
07/01/2005 - 06/30/2006 Forensic Psychiatry Fellowship PGY V Yale University - Law and Psychiatry Division 34 Park Street New Haven CT 06519
07/01/2001 – 06/30/2005, Psychiatry Resident PGY I-IV Mount Sinai School of Medicine – Elmhurst Hospital Center 79-01 Broadway, Elmhurst, NY 11373
MEDICAL EDUCATION
08/01/1991 – 07/19/1997 Doctor of Medicine Diploma (M.D.) Institution of Higher Education of Medical Sciences of Havana Hospital Salvador Allende University of Havana Havana, Cuba
Vinneth Carvalho M.D

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 23 of 25
3
09//01/1997 – 06/30/1999 Locum Physician-Internship Cornwall Regional Hospital Montego Bay, Jamaica.
PROFESSIONAL MEMBERSHIP
American Psychiatric Association American Association of Psychiatry and Law National Commission on Correctional Health Care
PROFESSIONAL ACTIVITIES
O4/22/2019-current: Chair QRS subcommittee (Critical Incident Review), Connecticut Valley Hospital
04/22/2019-current; Co-Chair Clinical Management Committee, Connecticut Valley Hospital
05/2018-current: Co-Chair Pharmacy, Therapeutics and Nutrition CommitteeWhiting Forensic Hospital
2012-2017: Chair, Staff Development Workshop, York Correctional Institution
2012-2017: Policy and Procedures Executive Committee UConn Health-Correctional Managed Health Care
2012-2017: Pharmacy and Therapeutics Committee UConn Health Correctional Managed Health Care
July 2003-June 2005 Chief Resident in Psychiatry, Mt. Sinai School of Medicine, Elmhurst Hospital, NY.
TEACHING/ACADEMIC SUPERVISION EXPERIENCE
2018-current Forensic Psychiatry Fellows Yale University-Law and Psychiatry Division New Haven, CT
2012-2018 Psychiatric APRNs, Medical Students, Forensic Psychiatry Fellows
Vinneth Carvalho M.D

Case 3:20-cv-00594-JCH Document 49-5 Filed 07/09/20 Page 24 of 25
4
Yale University New Haven CT
2012-2018 Medical Students, Psychiatry Residents University of Connecticut School of Medicine Farmington, CT
2006-2010 Medical Students Yale School of Medicine New Haven, CT
PRESENTATIONS/PUBLICATIONS
Carvalho, Vinneth MD,: The Fine Art of Court Testimony, Connecticut Valley Hospital Grand Rounds, February 5, 2020 .
Carvalho, Vinneth MD, Smoyer, Amy PhD: Why Food Matters: Impact of Food on the Physical and Psychosocial Health of Incarcerated Females. National Conference on Correctional Health Care, Las Vegas NV: October 24, 2016.
Carvalho, Vinneth MD, Amy Smoyer PhD: Eating in: Food and Nutrition in Women’s Prison. Adult and Juvenile Female Offender’s (AJFO) Conference, Hartford, CT. October 15, 2015.
Carvalho, Vinneth MD: Impact of Metabolic Syndrome in the Correctional System, UConn Statewide Mental Health Conference, Farmington, CT: October 13, 2014.
Kapoor, Reena MD, Dike, Charles MD, Burns, Craig MD, Carvalho, Vinneth MD, Ezra Griffith MD: Cultural Competence in Correctional Mental Health. International Journal of Law and Psychiatry, September 2013, Vol 36 (3) pp 273280.
Baranoski, Madelon PhD, Carvalho, Vinneth MD, Singh, Bobby MD, Darani, Shaheen MD: Teaching Performance in Forensic Education, AAPL Conference, 2006.
Carvalho, Vinneth, MD: Competence for Waiver of Appeals in Death Penalty: Timing, Standard and Standing. J Am Acad. Psychiatry Law 2006, Vol. 34, pp 120-122.
Carvalho, Vinneth, MD: Absinthe, Art and Agony; The Case of Vincent Van Gogh, Elmhurst Hospital Center Grand Rounds 12/03/2003.
Vinneth Carvalho M.D

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5
FORENSIC PSYCHIATRY CONSULTATIONS/TESTIMONIES: Performed over 200 forensic evaluations including Competency to Stand Trial Evaluations (CST), Not Guilty by Reason of Insanity (NGRI), Competency to Make a Will, Pre-sentence Evaluations, Risk Management Assessments of Youths for Community Placement, and Psychiatric Evaluation of Adults in child custody cases. Performed over 130 Competency to Stand Trial evaluations and testified in approximately 42 cases (36 were competency evaluations). Testified on September 16, 2019 before the CVH/WFH Task Force at the Legislative Office in Hartford on behalf of CVH LANGUAGES English, Spanish
Vinneth Carvalho M.D

Case 3:20-cv-00594-JCH Document 49-6 Filed 07/09/20 Page 1 of 4
EXHIBIT E

Case 3:20-cv-00594-JCH Document 49-6 Filed 07/09/20 Page 2 of 4

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

THOMAS WILKES, BARBARA FLOOD, VINCENT ARDIZZONE, GAIL LITSKY, CARSON MUELLER,
On behalf of themselves and all other persons similarly situated, Plaintiffs
v.
NED LAMONT, Governor MIRIAM E. DELPHIN-RITTMAN, Commissioner ofDMHAS, HAL SMITH, CEO of Whiting Forensic
Hospital, LAKISHA HYATT, CEO Connecticut
Valley Hospital, In their official capacities,
Defendants

CIVIL NO. 3:20CV594-JCH mLY7,2020

DECLARATION OF MARY MASON The undersigned declarant, Mary C. Mason, being duly sworn, hereby deposes and declares under the pains and penalties of perjury, pursuant to 28 USC §1746, that: 1. I am employed by the State of Connecticut Department of Mental Health and Addiction
Services ("DMHAS") as an Executive Assistant. I have held this position since 2015. 2. I make this Declaration based upon personal knowledge, and I understand that it will be
submitted to this Court in connection with the above-captioned case in support of the Defendants' Opposition to the Plaintiffs' Motion for Preliminary Injunction. 3. As part of my duties, I am responsible for managing public information, media relations, issues management and public affairs, and internal communications.

Case 3:20-cv-00594-JCH Document 49-6 Filed 07/09/20 Page 3 of 4
4. As part ofmy job duties, I was assigned to the DMHAS Incident Command Team in response to the COVID-19 pandemic.
5. As part of a member of the Incident Command Team, I tracked and compiled data reflecting the COVID-19 testing of DMHAS staff and patients as well as the COVID19 testing results ofDMHAS staff and patients.
6. The data is constantly tracked and updated in response to the receipt of new information and new testing results ofDMHAS staff and patients.
7. I directed staff to compile the data into a table and/or chart. 8. I have reviewed the table and/or chart and represent that the data depicted in this table
and/or chart is true, complete, and accurate.

Case 3:20-cv-00594-JCH Document 49-6 Filed 07/09/20 Page 4 of 4
DECLARATION Pursuant to Conn. Gen. Stat. §§1-24a, 53a-157b, and 28 U.S.C. §1746, I declare under the pains and penalties of perjury that the foregoing statements are true and accurate to the best of my knowledge and belief.
1 Dated this day of July, 2020.

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EXHIBIT F

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UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

THOMAS WILKES,

:

BARBARA FLOOD,

:

VINCENT ARDIZZONE,

:

GAIL LITSKY,

:

CARSON MUELLER,

:

On behalf of themselves and

:

all other persons similarly

:

situated,

:

Plaintiffs

:

:

v.

:

:

NED LAMONT, Governor

:

MIRIAM E. DELPHIN-RITTMAN,

:

Commissioner of DMHAS,

:

HAL SMITH, CEO of Whiting Forensic :

Hospital,

:

LAKISHA HYATT, CEO Connecticut :

Valley Hospital,

:

Defendants

:

CIVIL NO. 3:20CV594-JCH July 2, 2020

DECLARATION OF PAUL DILEO

The undersigned declarant, Paul DiLeo, hereby deposes and declares under the pains and penalties of perjury, pursuant to 28 USC §1746, that:

1. I am employed by the State of Connecticut Department of Mental Health and Addiction Services and currently serve as the Chief Operating Officer and have held this position since February 20, 2004. I also served as Deputy Commissioner for DMHAS for part of the first term of the Malloy Administration. A copy of my current CV is attached as Attachment 1 hereto.

1

Case 3:20-cv-00594-JCH Document 49-7 Filed 07/09/20 Page 3 of 9
2. I make this Declaration based upon personal knowledge, and I understand that it will be submitted to this Court in connection with the above-captioned case in support of the Defendants’ Opposition to the Plaintiffs’ Motion for Preliminary Injunction.
3. As the Chief Operating Officer, I am responsible for assisting DMHAS to plan and to respond to incidents that can affect DMHAS operations.
4. In 2006, the Department of Administrative Services required state agencies to be trained in Incident Command. State agencies such as DMHAS have created an Incident Command Team to respond to and manage disasters or community incidents through a coordinated structure.
5. When an emergency occurs or is anticipated, the DMHAS Commissioner or her designee activates the Incident Command Team (“ICT”).
6. The composition of DMHAS’ ICT corresponds to the structure used in the National Incident Management System (NIMS).
7. DMHAS’ command structure includes the Commissioner’s Executive Group, Senior Managers, and the Chief Executive Officers (CEO’s) of each DMHAS facility.
8. The purpose of the ICT is to: respond to the mental health needs of Connecticut citizens following disasters; prepare and train DMHAS facilities to maintain business operations following a disaster; manage DMHAS’ disaster response to ensure that DMHAS agency functions and operations continue after a disaster; link to state’s emergency response framework in order to provide behavioral health support to the state response and to link to the state’s emergency response framework to obtain assets and supplies from the state necessary to maintain operations.
2

Case 3:20-cv-00594-JCH Document 49-7 Filed 07/09/20 Page 4 of 9
9. I currently serve as the Incident Commander of the ICT.
10. The ICT was activated in response to the threat of the COVID-19 pandemic in the first
week of March 2020. 11. Since the start of the COVID-19 pandemic, the ICT has had frequent meetings, including
daily meetings and meetings on the weekends, from March 16, 2020 to May 22, 2020. Since May 23, 2020, the ICT continued to meet several times a week. As of June 8, 2020, the ICT has weekly meetings. Additional meetings may be scheduled subject to the status of the COVID-19 pandemic and DMHAS’ response to the COVID-19 pandemic. 12. The ICT has addressed and continues to address the management of issues related to COVID-19, including, but not limited to: management of quarantine and isolation in inpatient and residential Programs; safety procedures for staff and patients; work-at-home protocols; state-operated service delivery in the community and in inpatient and residential facilities; service delivery related to private-not-for profit providers (“PNPs”); Acquisition of supplies and Personal Protective Equipment (“PPE”) for state-operated facilities and PNPs; Staff and Provider Communications; Staffing and Human Resources; Information Technology; Staff Training necessitated by COVID; and Preparation for reopening. 13. The ICT has worked with DMHAS facilities to implement policies and procedures in response to COVID-19 including, but not limited to, quarantine and isolation; social distancing; cleaning and decontamination; hygiene, patient and staff testing for COVID-19; and use of PPE, including education to staff and patients as to the use of PPE.
3

Case 3:20-cv-00594-JCH Document 49-7 Filed 07/09/20 Page 5 of 9 14. The response plans are constantly updated and revised in response to events and guidance
from agencies including but not limited to the Office of the Governor, the Connecticut Department of Public Health (“DPH”) and the Centers for Disease Control (“CDC”).
4

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ATTACHMENT 1

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PAUL J. DI LEO, MS, FACHE
CHIEF OPERATING OFFICER
Mr. Di Leo is a Fellow of the American College of Healthcare Executives and a Board Certified Healthcare Executive. He is a volunteer faculty member of Yale University’s School of Medicine, Department of Psychiatry. He is a highenergy, results-oriented leader with proven success in managing a multimillion-dollar healthcare system and has an outstanding background of leadership within government, corporate and community organizations. Mr. Di Leo’s expertise includes crisis management, strategic and structural contributions related to healthcare reform and managed care environments as well as initiation and control of organizational change, managing systems operations and facilities, creation of healthcare alliances, and negotiation of contracts. He has full budget and business planning experience with cost effective direction of resources and has extensive new business initiative and development background. He’s an accomplished and dynamic speaker, lecturer and trainer on healthcare management issues within academic, business and medical communities.
PROFESSIONAL EXPERIENCE
STATE OF CONNECTICUT DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES (1997- present) A statewide behavioral healthcare system incorporating hospitals and ambulatory care Chief Operating Officer
(Direct Reports: Chief Financial Officer until 3/1/20, Director of Human Resources 4/1/20, Director of Information Systems, Chief of Safety Services, Director of Forensic Services until 6/1/20, Director of Legal Services until 5/1/20, Director of Auditing until 7/1/20, Director of Healthcare Information Technologies (vacant))
• Directly managed statewide clinical/recovery healthcare operations and programs in a cost effective manner while achieving the agency mission of delivering quality healthcare to a diverse patient population in a politically and fiscally challenging environment.
• Directs a $700 million annual budget, oversees the Fiscal Division including, healthcare financing, budgeting, engineering, plant operations (until 3/1/20) and auditing (until 7/1/20).
• Responsible for the Agency Human Resources Division including, recruitment, retention, labor relations (seven labor unions) and payroll. Dramatically increased nursing and doctor recruitment and retention and determines appropriate staffing levels (until 4/1/20).
• Managed provider networks, implemented healthcare financing mechanisms and quality improvement measures in a managed care environment.
• Oversees Agency Information Systems Division including management information systems, electronic medical record system, and all hardware and software packages.
• Responsible for DMHAS Safety Services Division (agency police force). • Manages the Legal Unit, which coordinates the successful resolution of pending and active litigation with
CT Attorney General’s Office (until 5/1/20). • Manages and creatively advances the State/Academic Partnership with Yale University (until 3/1/20). • Responsible for the Division of Forensic Services which implements and coordinates specially-skilled
evaluation and treatment services for individuals with serious mental illness and/or substance use disorders who become involved in the criminal justice system (until 6/1/20). • Incident Commander since 1997. Designed, directed and coordinated the State of Connecticut’s Behavioral Health response to the Lottery Shooting, 9/11, Hurricane Sandy, Sandy Hook and COVID19 crises.

Case 3:20-cv-00594-JCH Document 49-7 Filed 07/09/20 Page 9 of 9

DiLeo

Page 2

• Previously provided testimony to CT Legislative Committees. Propose and analyze impact of pending political/legislative initiatives. Provides testimony on budgetary and policy matters.
• Previously oversaw DMHAS’ community clinical and recovery service contracts. • Previously chaired the International Recovery Council, designed and facilitated the annual international
recovery conference in Connecticut in partnership with Quebec Province and other international partners. • Previously oversaw the Agencies HealthCare Reform initiatives including the CT Behavioral Health
Partnership (in collaboration with the State’s Medicaid Authority). • Directed closure of Cedarcrest Hospital placed of over fifty clients in community settings. • Previously supervised 3 hospitals (over 800 beds). • Provided quality care for over 80,000 individuals annually and manage a staff of 3,600 individuals annually
Managed over 300 contracts, 7 regional systems of care.

Previous Experience • BENOVA\HEALTHCHOICE, Portland, Oregon (1995-1997)
Acting Vice President, Eastern United States • HILL HEALTH CENTER/SOUTH CENTRAL REHABILITATION CENTER, New Haven, CT (1992-1995)
Director of Counseling and Clinical Support Services • ETP, INC., East Hartford, CT (1990-1992), Behavioral Healthcare Manager

EDUCATION • Master of Sciences, Counseling, Western Connecticut State University, Danbury, CT • Bachelor of Arts, Communications, Western Connecticut State University, Danbury, CT

Publications • The 2012 Sandy Hook Elementary School Shooting: Connecticut’s Department of Mental Health Crisis
Response, Paul DiLeo, Michael Rowe, Barbara Bugella, Lauren Siembab, James Siemianowski, Jennifer Black, Patricia Rehmer, Frank Baker, Christa Morris, Miriam Delphin- Rittmon & Thomas Styron, Journal of School Violence, DOI: 10.1080/15388220.2017.1387129, 2017 • Bearing Witness to Change: Forensic Psychiatry & Psychology Practice, Chapter 5, Politics & Money as Change-Agents in Forensic Systems, Paul Di Leo & Larry Davidson, CRC Press 2016 • The CT Mental Health Center: Celebrating 50 Years of a Successful Partnership Between the State and Yale University, Steiner, Di Leo, Jacobs et al, Psychiatric Services A Journal of the American Psychiatric Association, 10.1176/appi.ps.201600373, October 3rd 2016 • Yale Textbook of Public Psychiatry, Chapter 2, The Service System of Public Psychiatry, Jacobs, Barkil-Oteo, Di Leo, Rehmer, & Davidson. Oxford University Press 2016 • Yale Textbook of Public Psychiatry, Chapter 3, Recovery & Recovery-Oriented Practice, Davidson, Tondora, O’Connell, Bellamy, Pelletier, Di Leo, & Rehmer. Oxford University Press 2016 • The Global Model of Public Mental Health through the WHO Quality Rights Project, Pelletier, Fortin, Laporta, Pomey, Roelandt, Guézennec, Murray, Di Leo, Davidson, Rowe, Journal of Public Mental Health, Vol. 12 Issue: 4, pp.212 – 223, 2013 • Case and Care Management Improves Outcomes while Reducing Costs and Service Demand, Kirk, Di Leo, Rehmer, Moy and Davidson. Psychiatric Services Journal May 2013 Vol. 64 No.5 • Hebergement Lodgement et Retablissement en SanteMentale (Housing and Recovery in Mental Health), Part 1, Chapter 2, Creation of a System Centered on Recovery, Thomas A. Kirk and Paul J. Di Leo. Presses De L’Universite Du Quebec 2009 • Forty Years of Academic Public Psychiatry, Chapter 7, A Public-Academic Partnership at the CT Mental Health Center, Dailey, Kirk, Cole & Di Leo. John Wiley & Sons LTD 2007

Case 3:20-cv-00594-JCH Document 49-8 Filed 07/09/20 Page 1 of 5
EXHIBIT G

Case 3:20-cv-00594-JCH Document 49-8 Filed 07/09/20 Page 2 of 5

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

THOMAS WILKES, BARBARA FLOOD, VINCENT ARDIZZONE, GAIL LITSKY, CARSON MUELLER,
On behalf of themselves and all other persons similarly situated, Plaintiffs
v.
NED LAMONT, Governor MIRIAM E. DELPHIN-RITTMAN, Commissioner ofDMHAS, HAL SMITH, CEO of Whiting Forensic Hospital, LAKISHA HYATT, CEO Connecticut Valley Hospital, In their official capacities,
Defendants

CIVIL NO. 3:20CV594-JCH JULY 8, 2020

DECLARATION OF MICHELE LIZOTTE The undersigned declarant, Michele Lizotte, being duly sworn, hereby deposes and declares under the pains and penalties of perjury, pursuant to 28 USC§ 1746, that: 1. I am employed by the State of Connecticut Department of Mental Health and Addiction Services as the Building Superintendent 3 at Connecticut Valley Hospital ("CVH") in Middletown, CT. I have held this position since January of 2017. 2. The custodial staff at CVH consists of 60 individuals, including supervisors with some individuals assigned to Battell Hall, Merritt Hall, Page Hall, Shew/Beers Hall, Transitional Cottage, Woodward Hall, the Cottages, Dutton Home (River Valley Services), and Leak Hall (River Valley Services). Twenty-five ofthese individuals are outside contractors.

Case 3:20-cv-00594-JCH Document 49-8 Filed 07/09/20 Page 3 of 5
3. The custodial staff work hours are from 6:45am through 10:00 pm Monday through Friday. 4. On Saturday and Sunday, the hours of coverage are 6:00 A.M. -2:00P.M. 5. Emergent issues that occur at any time are covered by myself, or "E-Man" which is a group ofCVH's custodial staff who volunteer on a monthly basis to accept emergency calls after hours. 6. CVH has Environmental Services Protocols in place in response to the COVID-19 pandemic. The most recent update to these protocols was April 24, 2020. 7. CVH utilizes seven primary cleaning agents and sanitizers:
a. BioSpray D2 Surface Sanitizer (EPA Registered) b. Virex II 256 (EPA Registered).; c. Super Sani-Cloth Germicidal Disposable Wipes (EPA Registered); d. MP-32 All Purpose Cleaner; e. AP-64 All Neutral Cleaner; f. Window Cleaner; and g. Clorox Healthcare Fuzion Bleach (EPA Registered). 8. All bathrooms are cleaned thoroughly once daily or twice depending on the situations that arise. To clean the bathrooms, the custodial staff utilizes a pre-mixed solution of Fuzion Bleach or Virex. There are specific procedures for cleaning sinks, commodes, urinals, showers and tubs.
2

Case 3:20-cv-00594-JCH Document 49-8 Filed 07/09/20 Page 4 of 5
9. The standard occupied patient rooms are cleaned on a daily basis utilizing Fuzion Bleach or Virex; including damp dusting bed tables, telephones, chairs, ledges, light switches, lamps, and damp mopping the bathroom floor. 10. All common areas are cleaned daily and high touch areas are sanitized twice daily using the BioSpray D2 surface sanitizer including patient phones. 11. Disinfecting wipes are available to patients. Patients can ask that staff wipe a phone. 12. Patient phones are cleaned daily Monday- Friday. 13. Hand soap and paper towels are always available on units at all times. 14. The custodial staff are to check the soap dispensers twice a day once in the morning and then once before the end of their shift. They will refill the soap dispenser if it is getting low or empty. 15. When the custodial staff are not on duty and a soap dispenser rnns out of product E-Man is called and they will refill the soap dispenser if necessary. 16. Specific cleaning procedures are utilized in those areas where patients are quarantined or are in isolation. 17. The custodial staff don all PPE prior to the entry into the isolation unit. After cleaning is complete staff remove all PPE except gloves, all supplies and equipment are washed with an approved gennicidal solution. Mop heads and linens are placed in a bag along with the gloves. The bag is tied off and labeled as biohazardous and is disposed of as such.
3

Case 3:20-cv-00594-JCH Document 49-8 Filed 07/09/20 Page 5 of 5

DECLARATION Pursuant to Conu. Gen. Stat. §§l-24a, 53a-157b, and 28 U.S.C. §1746, I declare under the pains and penalties of pe1jury that the foregoing statements are true and accurate to the best of my knowledge and belief.

Dated

this

'l

rH
day

of July,2020.

Building Superintendent 3 Connecticut Valley Hospital

4

Case 3:20-cv-00594-JCH Document 49-9 Filed 07/09/20 Page 1 of 4
EXHIBIT H

Case 3:20-cv-00594-JCH Document 49-9 Filed 07/09/20 Page 2 of 4
UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

THOMAS WILKES, BARBARA FLOOD, VINCENT ARDIZZONE, GAIL LITSKY, CARSON MUELLER,
On behalf of themselves and all other persons similarly situated, Plaintiffs
V.
NED LAMONT, Governor MIRIAM E. DELPHIN-RITTMAN, Commissioner ofDMHAS, HAL SMITH, CEO of Whiting Forensic Hospital, LAKISHA HYATT, CEO Connecticut Valley Hospital, In their official capacities,
Defendants

CIVIL NO. 3:20CV594-JCH JULY2, 2020

DECLARATION OF TIMOTHY DENIER The undersigned declarant, Timothy Denier, being duly sworn, hereby deposes and declares under the pains and penalties of perjury, pursuant to 28 USC §1746, that: 1. I am employed by the State of Connecticut Department of Mental Health and Addiction Services("DMHAS") as the Director of Accreditation and Regulatory Compliance at Connecticut Valley Hospital ("CVH") in Middletown, CT. I have held this position since August, 2008.
2. As part of my duties, I am responsible for assisting CVH plan and respond to incidents that can affect CVH operations.

Case 3:20-cv-00594-JCH Document 49-9 Filed 07/09/20 Page 3 of 4

3. CVH utilizes a planning tool, the National Incident Management System ("NIMS"), issued/developed by the Federal Emergency Management Agency ("FEMA") to develop responses to all types of incidents that can affect CVH operations such as weather related emergencies, water or power systems failure, and health emergencies. I have received formal training in the use of this tool from FEMA and the Connecticut Department of Emergency Management and Homeland Security.

4. When an emergency occurs or is anticipated CVH activates the Hospital Incident Command System ("HICS"). HICS was developed by the Emergency Medical Services Authority (EMSA) of California and is consistent with NIMS principles.

5. HICS assigns specific responsibilities to specific CVH staff for the duration of the emergency.

6. Hyatt.

The Incident Command Leader is the Chief Executive Officer of CVH Lakisha

7. HICS was activated in response to the threat of COVID-19 in the first week of March 2020. As part of my duties, I have taken a lead role in utilizing the NIMS tool to assist in CVH's planning for the impact(s) of COVID-19 on CVH operations.

8. The response plans are constantly updated and revised in response to events and guidance from agencies including but not limited to, the Office of the Governor, the Connecticut Department of Public Health ("DPH") and the Centers for Disease Control ("CDC")

Case 3:20-cv-00594-JCH Document 49-9 Filed 07/09/20 Page 4 of 4 DECLARATION
Pursuant to Conn. Gen. Stat. §§1-24a, 53a-157b, and 28 U.S.C. §1746, I declare under the pains and penalties of perjury that the foregoing statements are true and accurate to the best of my knowledge and belief.
Dated this ';)_ "'-ds day of July, 2020.
Timothy Denier

Case 3:20-cv-00594-JCH Document 49-10 Filed 07/09/20 Page 1 of 5
EXHIBIT I

Case 3:20-cv-00594-JCH Document 49-10 Filed 07/09/20 Page 2 of 5

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

THOMAS WILKES, BARBARA FLOOD, VINCENT ARDIZZONE, GAIL LITSKY, CARSON MUELLER,
On behalf of themselves and all other persons similarly situated,
Plaintiffe

CIVIL NO. 3:20CV594-JCH

V.

NED LAMONT, Governor MIRIAM E. DELPHIN-RITTMAN, Commissioner ofDMHAS, HAL SMITH, CEO of Whiting Forensic Hospital, LAKISHA HYATT, CEO Connecticut
Valley Hospital, Defendants

July 1, 2020

DECLARATION OF JOSE CREGO The undersigned declarant, Jose Crego, being duly sworn, hereby deposes and declares

under the pains and penalties of pe1jury, pursuant to 28 USC §1746, that:

1. I am a Connecticut licensed clinical social worker and alcohol and drug counselor.

I serve as the Chief Operating Officer of Whiting Forensic Hospital ("WFH") and have held this position for approximately one- and one-half years.

2. My responsibilities in this position include but are not limited to programming and

the environment of care at WFH, which encompasses WFH's supply of personal protective

equipment ("PPE") and oversight of the Environmental Services Department which performs custodial functions at WFH.

Case 3:20-cv-00594-JCH Document 49-10 Filed 07/09/20 Page 3 of 5
3. During the current Covid-19 pandemic WFH has put in place several measures to ensure responsible usage of PPE. While during this pandemic WFH has experienced some challenges in obtaining stock of various PPE due to market conditions, at no time has WFH ever reached the point where any type of PPE was either depleted or unavailable.
4. As of the date of this declaration, WFH's supplies of PPE, including how many days of supply for each item are available based on WFH's "bum rate," are set fmih in Exhibit M. The bum rate for each item of PPE is calculated using the following factors: i) current inventory divided by average daily use; ii) units required for a thirty (30) day supply, which is average daily use times 30; and iii) units required to meet 30-day need, which is units required for a 30-day supply subtracted from current inventory.
5. The custodial staff at WFH consists of 16 individuals, including one supervisor with some assigned to Whiting Service and others to Dutcher Service. Four of these individuals are outside contractors.
6. The custodial staff works from 4:45 am through 7:45 pm Monday through Friday. 7. On Saturday and Sunday, the hours of coverage are 4:45 am through 7:45 pm with 3 staff available for all units at WFH. 8. Emergent issues that occur at any time are covered by the custodial manager who will respond or send a staff member to respond. 9. WFH utilizes four primary cleaning agents and sanitizers:
a. BioSpray D2 Surface Sanitizer (EPA Reg. No. 73232-1-83022 ); b. Virex II 256 (EPA Reg. No. 70627-24); c. Super Sani-cloth germicidal disposable wipes (EPA Reg. No. 61178-4-
9480); and
2

Case 3:20-cv-00594-JCH Document 49-10 Filed 07/09/20 Page 4 of 5
d. Clorox Fuzion Bleach (EPA. Reg. No. 67619-30) 10. To clean the bathrooms, the custodial staff utilizes the KaiVac 1750 touchless cleaning system and the procedures associated with its use. All staff have been trained in the use of the equipment. This is a high temperature water-based cleaning system. 11. The custodial staff are able and in fact do more cleaning as may be required by specific need using appropriate disinfecting products. 12. The floors and walls of bathrooms are tiled and are cleaned between 4:45 am and 6:45 am every day. 13. The standard occupied patient rooms are cleaned on a daily basis utilizing Fuzion Bleach or Virex including damp mopping the floor. 14. All common and high touch areas are sanitized twice daily using the BioSpray D2 surface sanitizer including patient phones. 15. Disinfecting wipes are available to patients. Patients can ask that staff wipe a phone, or depending on the status of the patient, staff may be able to give them a wipe to do it themselves. 16. The standard process ensures that the soap dispensers which contain liquid soap are checked on a daily basis by the custodian assigned to the respective unit. The custodial staff will replace it if the product is low and feels it will not last through the next interval. 17. However, ifa patient or a staff member finds that the dispenser is empty, then the unit director or the nurse supervisor will contact the custodial staff or the nurse supervisor's office in the off hours to ensure a quick resolution is afforded. 18. Hand soap and paper towels are always available on units at all times.
3

Case 3:20-cv-00594-JCH Document 49-10 Filed 07/09/20 Page 5 of 5 19. Specific cleaning procedures are utilized in those areas where patients are quarantined or are in isolation. 20. The custodial staff don all PPE prior to the entry into the isolation unit. After cleaning is complete staff remove all PPE except gloves, all supplies and equipment are washed with an approved germicidal solution. Mop heads and linens are placed in a bag along with the gloves. The bag is tied off and labeled as biohazardous and is disposed of as such.
DECLARATION Pursuant to Conn. Gen. Stat. §§ 1-24a, 53a-157b, and 28 U.S.C. §1746, I declare under the pains and penalties of perjury that the foregoing statements are true and accurate to the best of my knowledge and belief. Dated this 1st day of July, 2020.
Jose Crego
4

Case 3:20-cv-00594-JCH Document 49-11 Filed 07/09/20 Page 1 of 3
EXHIBIT J

Case 3:20-cv-00594-JCH Document 49-11 Filed 07/09/20 Page 2 of 3
UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

THOMAS WILKES, BARBARA FLOOD, VINCENT ARDIZZONE, GAIL LITSKY, CARSON MUELLER,
On behalf of themselves and all other persons similarly situated,
Plaintiffs

CIVIL NO. 3:20CV594-JCH

V.

NED LAMONT, Governor MIRIAM E. DELPHIN-RITTMAN, Commissioner ofDMHAS, HAL SMITH, CEO of Whiting Forensic Hospital, LAKISHA HYATT, CEO Connecticut
Valley Hospital, Defendants

July 1, 2020

DECLARATION OF MICHAEL BOUTIN The undersigned declarant, Michael Boutin, being duly sworn, hereby deposes and declares

under the pains and penalties of perjury, pursuant to 28 USC§ 1746, that:

1. I am a nurse by professional training and I currently serve as a Compliance Officer

and Performance Improvement Manager for Connecticut Valley Hospital ("CVH"). My duties

involve all areas ofPerformance Improvement at CVH. My responsibilities in this position include

but are not limited to overseeing and reporting on CVH's supply of personal protective equipment

("PPE").

2. During the current Covid-19 pandemic CVH has put in place several measures to

ensure responsible usage of PPE. While during this pandemic CVH has experienced some

Case 3:20-cv-00594-JCH Document 49-11 Filed 07/09/20 Page 3 of 3 challenges in obtaining stock of various PPE due to market conditions, at no time has CVH ever reached the point where any type of PPE was either depleted or unavailable.
3. As of the date of this declaration, CVH has in stock the PPE supplies set forth in Exhibit N, which reflects the number of days' supply for each item based on the historic "bum rate." The bum rate for each item of PPE is calculated using the following factors: i) current inventory divided by average daily use; ii) units required for a thirty (30) day supply, which is average daily use times 30; and iii) units required to meet 30 day need, which is units required for a 30 day supply subtracted from current inventory.
DECLARATION Pursuant to Conn. Gen. Stat. §§ l-24a, 53a-l 57b, and 28 U.S.C. §1746, I declare under the pains and penalties of pe1jury that the foregoing statements are true and accurate to the best of my knowledge and belief. Dated this 1st day of July 2020.
Michael Boutin
2

Case 3:20-cv-00594-JCH Document 49-12 Filed 07/09/20 Page 1 of 9
EXHIBIT K

Case 3:20-cv-00594-JCH Document 49-12 Filed 07/09/20 Page 2 of 9
UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

THOMAS WILKES, BARBARA FLOOD, VINCENT ARDIZZONE, GAIL LITSKY, CARSON MUELLER,
On behalfofthemselves and all other persons similarly situated,
Plaintiffs

CIVIL NO. 3:20CV594-JCH

V.

NED LAMONT, Governor MIRIAM E. DELPHIN-RITTMAN, Commissioner ofDMHAS, HAL SMITH, CEO ofWhiting Forensic Hospital, LAKISHA HYATT, CEO Connecticut
Valley Hospital, Defendants

July 7, 2020

DECLARATION OF NANCY NAVARRETTA

The undersigned declarant, Nancy Navarretta, being duly sworn, hereby deposes and declares under the pains and penalties ofperjury, pursuant to 28 USC § 1746, that:

1. I am a Connecticut licensed professional counselor and serve as the Deputy Commissioner ofthe Department ofMental Health and Addiction Services (DMHAS) and have held this position for approximately five years. A copy ofmy current CV is attached as Attachment 1 hereto.
2. I make this Affidavit based upon personal knowledge, and I understand that it will be submitted to this Court in connection with the above-captioned case in support ofthe Defendants' Opposition to the Plaintiffs' Motion for Preliminary Injunction.

Case 3:20-cv-00594-JCH Document 49-12 Filed 07/09/20 Page 3 of 9
3. As Deputy Commissioner, my responsibilities in this position include but are not limited to serving as the liaison to DMHAS funded private non-profit providers (160+ providers) and for oversight of several Divisions, including the Community Services Division, which implement and monitor contracted behavioral health services and initiatives statewide.
4. As a result of these responsibilities, I am knowledgeable of the impact of the COVID 19 pandemic on the operations of community-based service and residential providers that serve DMHAS clients including patients eligible for discharge from Connecticut Valley Hospital and Whiting Forensic Hospital.
5. Community residential providers face significant challenges in the ability to cohort and isolate residents with COVID 19 exposure, symptomatic COVID 19 or COVID 19 positive diagnosis. In many cases, especially small congregate settings, space is limited without option to create or open up new space in these residential buildings. The consequence is the necessity to maintain a vacant bedroom for this purpose, if there happened to be a vacancy at the time of the COVID surge in Connecticut, reducing the number of available beds for new residents.
6. Community residential settings face challenges in maintaining social distance within their home style settings with limited numbers of bathrooms, common space and typically a communal kitchen.
7. The necessity that discharged patients must manage and maintain COVID 19 precautions (including reduced social interaction, adhering to cleaning protocols and the wearing of a mask in public spaces) in the community requires that the discharge candidate be higher

Case 3:20-cv-00594-JCH Document 49-12 Filed 07/09/20 Page 4 of 9
functioning in their ability to maintain their own safety and independence than in the absence of a pandemic. 8. Community residential providers face significant challenges in the ability to maintain social isolation of residents. COVID 19 closed or severely modified social rehabilitation programs which previously provided opportunities for residents to have social interactions and support. Community residential providers cannot prevent residents from leaving the home which increases the risks of exposure. Similarly, community providers can be challenged in preventing visitors into the residence. 9. For community residential providers with multiple sites, staff may be working in multiple sites creating risk of transmitting infection among sites. Community providers do not have the purchasing power to secure large scale orders of PPE and infection control supplies. The State has had to extend PPE support to the providers. 10. Traditionally, inpatient discharges are accomplished with phased transition using day visits, overnight stays and temporary leaves to ease the relocation of the resident to the community provider. Due to the pandemic, this standard has been halted to avoid the potential for exposure of the patient at the community residence and then exposing others upon their return to the hospital. In some cases, community providers have been uncomfortable accepting a placement without this transition period and assurances that the patient has a hospital bed to return to if the transition is not successful. 11 . On July 6, 2020, the Governor of Connecticut using his emergency powers issued an executive order that modified the statutory minimum number of hours of rehabilitation services required to be provided by certain group homes that serve DMHAS clients in order for the provider to receive Medicaid reimbursement by more than 35%. This

Case 3:20-cv-00594-JCH Document 49-12 Filed 07/09/20 Page 5 of 9
reduction is an accommodation allowed providers due to the challenges of the group homes in providing the minimum monthly service hours for reasons, including, but not limited to: isolation and quarantine of residents due to COVID 19, social distancing requirements restricting the ability to run group programs, residents who may chose not to participate in certain programs due concerns about COVID-19, and staffing which was limited due to reallocations in workforce to monitoring and other tasks, as well as staff sicknesses and absences. This modification was made retroactive to the beginning of the COVID~19 public health emergency in Connecticut.
DECLARATION Pursuant to Conn. Gen. Stat. §§1-24a, 53a-157b, and 28 U.S.C. §1746, I declare under the pains and penalties of perjury that the foregoing statements are true and accurate to the best of my knowledge and belief. Dated this 7th day of July 2020.
Na cy Navarretta

Case 3:20-cv-00594-JCH Document 49-12 Filed 07/09/20 Page 6 of 9
ATTACHMENT 1

Case 3:20-cv-00594-JCH Document 49-12 Filed 07/09/20 Page 7 of 9
Nancy Navarretta, M.A., LPC, NCC Hamden, CT 06518
navarretta@comcast.net nancy.navarretta@ct.gov
(203) 671-0170 cell
Summary of Qualifications Extensive experience in public and private program development, strategic planning, leadership, process improvement and analysis of revenue cycles, resulting in the delivery of effective, recovery-oriented, and integrated community healthcare systems. National Certified Counselor: #51610 CT Licensed Professional Counselor: #000026
Professional Experience 7/15-present Connecticut Department of Mental Health and Addiction Services (DMHAS)
Deputy Commissioner • Direct report to the Commissioner of DMHAS • Responsible for active participation and project management related to the Commissioner’s Executive
Group, Commissioner’s Budget Group and Departmental Strategic Planning • Responsible for leadership of the Opioid Response, Community Services (Contracted Community
Providers), Managed Services (ASO Contract Management, Behavioral Health Homes), Research Division (Program Evaluation), Statewide Services (Housing Supports, Long Term Services and Supports, Women and Children’s Programs, Problem Gambling), Evidenced Based Practices and Grants Unit (Application and Implementation) and the Legal Division within the Office of the Commissioner • Responsive liaison to state funded private non-profit providers (160+ providers) • Participate in partnerships with other State agencies, consumers and providers in the delivery of evidenced-based, recovery-oriented behavioral healthcare
7/13- 7/15 Connecticut Department of Mental Health and Addiction Services (DMHAS) Director of Behavioral Health Services
• Direct report to the Chief Operating Officer of DMHAS • Responsible for leadership of the Community Services, Managed Services and Veteran’s Services,
Research Division and Statewide Services within the Office of the Commissioner • Participate in partnerships with other State agencies, consumers and providers in the delivery of
evidenced-based, recovery-oriented behavioral healthcare
4/12-6/13 Liberation Programs, Inc., Norwalk CT Chief Operating Officer
• Direct report to CEO of a private, non-profit, behavioral health system of care • Responsible for leadership of all clinical business units and quality department • Strategic development of behavioral solutions to achieve agency mission and revenue maximization of
all lines of business • Lead in developing community partnerships in healthcare (integrating behavioral health and primary
care) • Manage all aspects of healthcare service delivery systems and CARF accreditation cycle
5/00-3/12 Cornell Scott-Hill Health Corporation (CS-HHC), New Haven, CT Chief of Behavioral Health Services
• Direct report to CEO of a private, non-profit, Federally Qualified Health Center with an annual budget of $50M
Navarretta 2020 Page 1 of 3

Case 3:20-cv-00594-JCH Document 49-12 Filed 07/09/20 Page 8 of 9

• Responsible for approximately 30 cost centers (200+ employees) with a net revenue of $22M providing a full continuum of behavioral healthcare services
• Strategic development of co-located and integrated services (MH, SA, Primary care) • Led Joint Commission compliance efforts in behavioral health through four successful cycles of accreditation • Responsible for improved clinical standards of care, operational efficiencies, increased productivity (30,000
encounters to 80,000 encounters), and collection rates
• Led program development through focused growth and recruitment of strong program specific leadership to become the strongest profit center in the organization

7/99-5/00 Cornell Scott-Hill Health Corporation (CS-HHC), New Haven, CT Clinical Coordinator Grant Street Partnership
• Program Director of a CS-HHC Mental Health and Substance Abuse Facility providing Intensive Day Treatment and Transitional Housing
• Supervision and recruitment of all staff (clinical, case management, paraprofessional, facilities, food service and support staff)
• Administrative management, utilization review, funding/accreditation compliance and provision of direct services

1/96-present Private Practitioner, Hamden, CT • Licensed Professional Counselor trained in mental health and addiction, specializing in the treatment of addictions and trauma related disorders • Manage all clinical and business requirements of practice.

3/94-7/99 Fairfield Community Services, Fairfield, CT Clinical Director of Mental Health and Substance Abuse Programs
• Responsible for clinical operation of outpatient mental health and substance use facility • Maintained full caseload • Internally promoted from position of Coordinator of Substance Abuse Programs/Staff
Psychotherapist • Served as Acting Director of agency responsible for all clinical and administrative operations

5/93-3/94 The Center for Family Development, Beverly, MA Staff Psychotherapist
• Part-time member of Outpatient and Trauma Teams

10/89-3/94 The Psychological Center, Lawrence and Andover, MA Staff Psychotherapist
• Full-time outpatient therapist • Initiated trauma sensitive treatment and program development

6/88-9/88

Upward Bound, Fordham University, Bronx, NY Instructor/Counselor

6/87-6/88

New York Hospital/Cornell Medical Center, Westchester Division, White Plains, NY Project Coordinator/Research Assistant

Supervised Professional Experience 10/88-10/89 APA Accredited Internship in Clinical Psychology
Franklin Delano Roosevelt Veterans Administration Hospital, Montrose, NY 9/86-5/87 Practicum in Counseling and Psychotherapy
Navarretta 2020 Page 2 of 3

Case 3:20-cv-00594-JCH Document 49-12 Filed 07/09/20 Page 9 of 9

9/85-5/86

Counseling Center, Fordham University, Bronx, NY Clerkship in Clinical Psychology/Psychological Testing Goldwater Memorial Hospital, Roosevelt Island, NY

Graduate Assistantships/Fellowships 9/86-5/87 Graduate Teaching Fellow
Fordham University, Bronx, NY 9/84-5/86 Graduate Assistant
Fordham University, Bronx, NY

Current Professional Affiliations 1996-2020 American Counseling Association 1996-2020 Connecticut Counseling Association 1986-2020 Kappa Phi Honor Society Member

Awards, Presentations and Publications

9/18

Community of Caring Award

Cornell Scott Hill Health Center

5/17

A Symposium of the International Recovery and Citizen Council

Treatment of Substance Use Disorders: Current Policy and Practice & Emerging Trends

6/11

FQHCs and Health Care Reform: Models for Collaboration CHCACT Forum

Collaborating to Integrate Behavioral Health and Primary Care

1/11

The Joint Commission BHC News Issue One 2011

Behavioral healthcare organizations get ‘physical’

Education 1986 1984
1980

Fordham University, Bronx, NY M.A. in Clinical Psychology/PhD. Program Clinical Psychology (ABD) Graduate Academic Record: Overall Index 3.94/4.0 Boston College, Chestnut Hill, MA B.A. in Psychology, Summa Cum Laude Concentration in Speech-Language Pathology Undergraduate Academic Record: Overall Index 3.7/4.0 Major Index 3.94/4.0 Sacred Heart Academy, Hamden, CT Valedictorian

Navarretta 2020 Page 3 of 3

Case 3:20-cv-00594-JCH Document 49-13 Filed 07/09/20 Page 1 of 14
EXHIBIT L

Case 3:20-cv-00594-JCH Document 49-13 Filed 07/09/20 Page 2 of 14

STATE OF CONNECTICUT
DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES WHITING FORENSIC HOSPITAL
70 O’Brien Street Middletown, Connecticut 06457

MEMORANDUM

TO:

All WFH employees and contracted staff

FROM:

Hal Smith, Chief Executive Officer Tobias Wasser, Chief Medical Officer Jan Bergin, Chief Nursing Officer Elizabeth Tillman, ACS Service Medical Director

DATE:

May 19, 2020 (updated)

SUBJECT:

Instructions for managing WFH patients and staff suspected or confirmed positive for COVID-19.

Please follow these instructions when managing patients and staff suspected or confirmed positive for COVID-19. These instructions are based on CDC guidelines and DMHAS protocols that were reviewed and approved by CT DPH and adapted to our setting.

Infection Control General Recommendations:  All staff will be continuously reminded to follow CDC guidelines for transmission- based precautions. See: https://www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html.  WFH leadership will post materials to remind staff to perform basic hygiene, social distancing, and proper use of personal protective equipment (PPE). These materials can be found on the T drive at: T:\COVID19.

Additionally, WFH will: 1. Obtain vital signs, including temperature, of all patients at least daily. 2. Limit the use of “floating” staff who move between inpatient units and buildings. 3. Evaluate unit programming with a focus on limiting group activities where possible to support social distancing. 4. Confine programming to each unit and limit mixing of patients from other units. 5. If there are no exposures, communal dining can continue but patients from different units should not mix. 6. Close contact is defined as being within 6 feet of another person, in a closed room for more than 10 minutes. This is important as we consider patient movement during these limiting situations. We should continue to encourage patients to get fresh air on the campus within the guidelines of their respective privilege level.

1

Case 3:20-cv-00594-JCH Document 49-13 Filed 07/09/20 Page 3 of 14
STATE OF CONNECTICUT
DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES WHITING FORENSIC HOSPITAL
70 O’Brien Street Middletown, Connecticut 06457
PPE Use: General Guidelines for Use of Face Masks Masks must be worn in combination with good hand hygiene and keeping social distance. When interacting directly with a patient with suspected or confirmed COVID-19, masks, gloves, gown, and face mask are required as noted below.
It is expected that staff will use surgical masks when: - Working in patient care areas. For WFH, we are defining patient care areas as anywhere past the sally port in Whiting and anywhere in the Dutcher building. Exceptions to this include private offices, chart rooms, nursing stations, break rooms and bathrooms. - Screening individuals for COVID-19, including during intake of new admissions. - Asymptomatic staff directly (within 3-6 feet) exposed to a suspected or confirmed case of COVID-19, who continue to work should wear a mask, maintain social distance of 6ft and perform hand hygiene frequently. - Person is persistently coughing or sneezing - Housekeeping staff cleaning and disinfecting room or area previously occupied by an individual with suspected or confirmed COVID-19*
Guidance for Face Mask Re-Use (Surgical and N95): a. Never touch the front of the mask with ungloved hands. The front is contaminated. b. Remove mask last (after removal of all other PPE). c. On typical inpatient psychiatric units (surgical masks) a. Remove mask carefully by handling the straps only. Place mask in a paper bag with the outer surface facing the bottom of the bag. (That way, when you reach in to retrieve your mask, you don’t risk touching the outer surface.) Fold the straps into the mask so that they can’t touch the outer surface. b. Label the bag with your name and date mask was issued. c. Masks may be re-used for up to one week or until visibly soiled or damaged. i. After one week, please request new mask and paper bag and re-label d. On Isolation Unit (N95) a. Never touch the front of the mask with ungloved hands. The front is contaminated. b. Remove mask last (after removal of all other PPE). c. The maximum duration of use for N95 masks is 8 hours. Thus, if a staff member wears the mask for an entire 8 hour shift, the mask must be disposed of at the end of the shift. If a staff member wears it for fewer than 8 hours, please keep track of the amount of time used, re-use it per instructions below, and discard at the 8 hour mark. d. If re-using the mask, remove carefully by handling the straps only. Place mask in a paper bag with the outer surface facing the bottom of the bag. (That way,
2

Case 3:20-cv-00594-JCH Document 49-13 Filed 07/09/20 Page 4 of 14

STATE OF CONNECTICUT
DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES WHITING FORENSIC HOSPITAL
70 O’Brien Street Middletown, Connecticut 06457

when you reach in to retrieve your mask, you don’t risk touching the outer surface.) Fold the straps into the mask so that they can’t touch outer surface. e. Label the bag with your name and number of hours used. f. Any damaged or soiled masks must be discarded. g. Dispose of N95 mask upon exiting the isolation unit in the appropriately marked N95 recycling receptacle so that they may be saved for sterilization and repurposing.
For patients with suspected or confirmed COVID-19: According to CDC and DPH guidelines: when caring for patients with confirmed COVID19 infection and for housekeeping staff performing a cleaning and disinfection of a room of a confirmed COVID-19 patient, use facemask (procedure or surgical mask or N95) AND gown AND gloves AND eye protection (goggles or face shield). N95 respirators should be conserved for colleagues who perform aerosol-generating procedures, including intubation, open suction, and administration of nebulizer treatments.

CDC Stratification of risks following exposure to COVID-19

-

Low risk: walking by an asymptomatic person who tested positive for COVID

-

Mild risk: Being in the same room and within 6 ft of a symptomatic COVID+ person but

exposure time less than 10 minutes.

-

Medium risk: Prolonged exposure (10 minutes or longer) within 6 ft of a symptomatic

COVID+ person.

-

High risk: Close household contact of person suspected or confirmed COVID+

Note: In all situations, risk is reduced if one or both parties have face mask on during the exposure A contact with a contact of someone who is suspected or confirmed COVID positive (i.e. a person twice removed from the COVID case) is at low risk, and does not require additional monitoring or restrictions

Use of Decontaminated N95 Respirator Masks  There is an international shortage of N95 respirator masks, making critical supplies
extremely limited during the COVID pandemic. To address our supply need, DHMAS has partnered with Battelle Memorial Institute to decontaminate used, unsoiled, undamaged N95 respirator masks.  The State of Connecticut and DMHAS have partnered with BATTELLE to take advantage of the BATTELLE Critical Care Decontamination System (CCDS) to sterilize non-cellulous N95 respirator masks. The BATTELLE system for the decontamination of the N95 masks has been FDA approved. The BATTELLE system utilizes a mobile CONEX box based Vapor Phase Hydrogen Peroxide (VPHP) generator to decontaminate and sterilize over 20,000 N95 masks

3

Case 3:20-cv-00594-JCH Document 49-13 Filed 07/09/20 Page 5 of 14
STATE OF CONNECTICUT
DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES WHITING FORENSIC HOSPITAL
70 O’Brien Street Middletown, Connecticut 06457 daily. Using this system, N95 masks can be decontaminated up to 20 times. Battelle tracks and notes on the mask the number of times a mask has been recycled.  Decontaminated N95 masks are effective and safe. Staff using these masks should note the following: Clean hands with soap and water or an alcohol-based hand sanitizer with at least 60% alcohol before and after touching or adjusting the N95 mask.
o Avoid touching the inside of the mask. o Use a pair of clean (non-sterile) gloves when donning the mask and performing a
user seal check. o Visually inspect the mask to determine if its integrity has been compromised. o Check that mask components such as the straps, nose bridge, and nose foam
material did not degrade, which can affect the quality of the fit, and seal. o If the integrity of any part of the mask is compromised, or if a successful user seal
check cannot be performed, discard the mask and try another mask. o Users should perform a user seal check immediately after they don each mask and
should not use an N95 mask on which they cannot perform a successful user seal check.  Please refer to DMHAS “Decontamination N95 Respirator Fact Sheet” for additional information and details on this process
4

Case 3:20-cv-00594-JCH Document 49-13 Filed 07/09/20 Page 6 of 14
STATE OF CONNECTICUT
DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES WHITING FORENSIC HOSPITAL
70 O’Brien Street Middletown, Connecticut 06457
GUIDANCE REGARDING PATIENTS:
Patient with Confirmed Close Contact to asymptomatic person who subsequently develops symptoms and test positive for COVID-19 (or direct contact with potential secretions of such a person), but initial patient remains asymptomatic
 Continue treatment as usual  No need to mask patient  Monitor temperature and respiration at least daily  Monitor at least daily for signs of infection, fever, cough, shortness of breath, sore
throat or GI symptoms  No need to test for COVID-19 unless patient becomes symptomatic  If patient becomes symptomatic, please proceed as described below for symptomatic
patients
Individual Patient with Confirmed Close Contact to a COVID-19-Positive Person, but Initial Patient Remains Asymptomatic:
NOTE: Patients who have been in close contact with another individual who him/herself has been in close contact (“two degrees of separation”) with a COVID-19-positive person DO NOT have to follow the below precautions.
The following apply only to a patient who has close contact directly (e.g. was within 3- 6 feet of the individual continuously for greater than 10 minutes, rode in a car with a COVID-19-positive individual) with another person who has tested positive for COVID- 19 (a CONFIRMED case, not just suspected):
1. Quarantine the patient for up to 14 days per the WFH Medical Isolation Protocol (attached) in a single room (with own bathroom if available) and close door.
2. Monitor the patient’s vital signs at least two times per day and monitor for signs of infection, fever, cough, shortness of breath, sore throat or GI symptoms .
3. Immediately inform the CNO, CMO and Infection Prevention Physician. 4. Place mask on patient when outside the room. Encourage hand hygiene 5. Maintain droplet and standard precautions: Staff wears mask, gloves, gown and face
shield or goggles to enter room, plus frequent hand hygiene and social distance 6. Patient may have fresh air break, coordinated with staff so no contact with others.
5

Case 3:20-cv-00594-JCH Document 49-13 Filed 07/09/20 Page 7 of 14
STATE OF CONNECTICUT
DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES WHITING FORENSIC HOSPITAL
70 O’Brien Street Middletown, Connecticut 06457
7. Housekeeping staff clean and disinfect areas patient went or touched. 8. If patient becomes symptomatic or patient has confirmed COVID-19, please proceed as
described below in each relevant section.
Patient with Suspected COVID-19: 1. Isolate the patient per the WFH Medical Isolation Protocol (with own bathroom if available). Do not cluster patients with similar symptoms because they may ultimately have different diagnosis. 2. Staff in direct contact with the patient should wear gloves, surgical masks, face shields, and gowns. 3. Test the patient for COVID-19. 4. Immediately inform the CNO, CMO and Infection Prevention Physician. 5. Place mask on patient whenever outside the room. Encourage frequent hand hygiene 6. Monitor the patient’s vital signs every shift, including pulse oximeter, encourage fluids, discontinue NSAIDS, and avoid introduction of new corticosteroids. 7. If the patient requires nebulizer treatments, staff should don N95 masks instead of surgical masks (as well as gloves, gown, and eye protection (either goggles or face mask)). 8. Limit the number of staff treating infected patient to mitigate spread. Ensure sufficient PPE for designated staff. 9. Patient may have fresh air break, coordinated with staff so no contact with others 10. Minimize travel outside of isolation room 11. Designated housekeeping staff to clean and disinfect patient’s room, areas patient visited or things touched 12. Serve the patient’s meals in the medical isolation room. While serving the food leave the hard plastic tray which holds the individual food serving plates outside of the isolation room. Open the tray and serve the patient in his/her room using the individually wrapped plates. This will ensure the tray remains unexposed and can safely
6

Case 3:20-cv-00594-JCH Document 49-13 Filed 07/09/20 Page 8 of 14
STATE OF CONNECTICUT
DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES WHITING FORENSIC HOSPITAL
70 O’Brien Street Middletown, Connecticut 06457
be moved through the building. 13. Restrict all patient movement off the unit and monitor vital signs and pulse oximeter of
all other patients on the unit at least twice daily 14. ACS medical personnel to monitor patient daily. ACS clinicians and psychiatrists should
consult with the Infection Prevention Physician and CMO to determine when a patient with COVID-19 should be transferred to a medical hospital for treatment when treatment needs exceed the capacity of inpatient psychiatric hospital. NOTE: Elderly and medically frail patients are at higher risk for more severe forms of COVID-19. Physicians and APRNs should have a lower threshold for sending these patients to a medical hospital. 15. If the patient tests negative for COVID-19, he/she may resume usual activity and isolation protocol and unit restricted movement status can be discontinued. 16. If the patient tests positive for COVID-19, see below for additional instructions. 17. If the patient refuses to comply with tests, Connecticut General Statute Sec. 19a-131c. Enforcement of order of quarantine or isolation, empowers the DMHAS facility to obtain tests over the patient’s objection. However, consider the risks and benefits of forcing patient to have test done. Attempting to engage the patient in physical methods to obtain test could be risky; in such instances, it would be better to assume patient has COVID-19 and proceed accordingly. 18. If the patient refuses to comply with quarantine/isolation, inform the Service Medical Director and CMO. For patients refusing isolation, the unit psychiatrist and the Service Medical Director will evaluate the patient to determine if acute symptoms of mental illness have impaired the patient’s ability to adhere to requests to stay in isolation, and immediately institute appropriate treatment. If the patient remains unable or unwilling to stay in isolation despite treatment, immediately inform the CMO. The CMO will then contact the regional public health director for Middletown. Isolation can be enforced by order of the regional public health director pursuant to Sec. 19a-131c of CT general
7

Case 3:20-cv-00594-JCH Document 49-13 Filed 07/09/20 Page 9 of 14
STATE OF CONNECTICUT
DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES WHITING FORENSIC HOSPITAL
70 O’Brien Street Middletown, Connecticut 06457
statutes. This request would be made to the regional health director for Middletown through the CMO.
Patient with a Confirmed Positive COVID-19 Test: 1. Isolate the patient per the WFH Medical Isolation Protocol. May cluster patients with similar documented diagnosis 2. Inform the WFH Infection Prevention Physician, CMO and CNO immediately, who will then inform and consult with DPH for additional guidance. 3. Staff in direct contact with the patient should wear gloves, surgical masks or N95 (if available and fit testing has been completed by individual staff member utilizing N95), face shields, and gowns. 4. Monitor the patient’s vital signs every shift, including pulse oximeter, encourage fluids, discontinue NSAIDS, and avoid introduction of new corticosteroids. 5. If the patient requires nebulizer treatments, staff should don N95 masks instead of surgical masks (as well as gloves, gown, and face mask). 6. Patient should be masked whenever someone is coming into the room. For patients who cannot do so for themselves, patient’s mask should be placed in a paper bag in the room. Staff will put on PPE at the door, enter the room and then place the mask on the patient. 7. All staff working on the unit will wear a surgical mask while working on the unit (utilizing 1 mask per week unless it becomes visibly soiled) until the period of isolation has ended 8. All patients on the unit will wear a surgical mask (utilizing 1 mask per week unless it becomes visibly soiled) until the period of isolation has ended. 9. Limit the number of staff treating infected patient to mitigate spread. Ensure sufficient PPE for designated staff. Minimize/ limit use of float staff as much as possible. 10. Monitor all staff for temp twice/day 11. Monitor all patients’ temperature on the unit at least twice a day
8

Case 3:20-cv-00594-JCH Document 49-13 Filed 07/09/20 Page 10 of 14
STATE OF CONNECTICUT
DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES WHITING FORENSIC HOSPITAL
70 O’Brien Street Middletown, Connecticut 06457 12. Minimize entry into patient’s room 13. Minimize movement of other patients outside the room. 14. Serve the patient’s meals in the medical isolation room. While serving the food leave
the hard plastic tray which holds the individual food serving plates outside of the isolation room. Open the tray and serve the patient in his/her room using the individually wrapped plates. This will ensure the tray remains unexposed and can safely be moved through the building. 15. Restrict all patient movement off the unit. 16. ACS medical personnel to monitor patient daily. ACS clinicians and psychiatrists should consult with the Infection Prevention Physician and CMO to determine when a patient with COVID-19 should be transferred to a medical hospital for treatment when treatment needs exceed the capacity of inpatient psychiatric hospital. NOTE: Elderly and medically frail patients are at higher risk for more severe forms of COVID-19. Physicians and APRNs should have a lower threshold for sending these patients to a medical hospital.
9

Case 3:20-cv-00594-JCH Document 49-13 Filed 07/09/20 Page 11 of 14
STATE OF CONNECTICUT
DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES WHITING FORENSIC HOSPITAL
70 O’Brien Street Middletown, Connecticut 06457
GUIDANCE REGARDING STAFF:
A. Staff with direct exposure to (or direct contact with potential infectious secretions of) an asymptomatic person who subsequently (at a later time/date after the exposure) develops symptoms and tests positive for COVID; Staff remains asymptomatic
 If exposure occurred 48 hours or less before onset of symptoms, proceed directly to B (below)
 If exposure occurred greater than 48 hours before onset of symptoms, return to work as usual
 Monitor temperature daily  Maintain social distance and frequent hand hygiene  If temperature is 100F or higher, or if respiratory symptoms develop, do not come to
work  Call your supervisor  Call your Primary Care Physician (PCP)  Report Doctor’s recommendation to your supervisor
B. Staff with direct exposure to (or direct contact with potential infectious secretions of) a suspected or confirmed case of COVID; staff is asymptomatic
 For high risk exposure - Self-quarantine for 14 days  For mild or medium risk exposure, return to work wearing a facemask and monitor
temperature twice a day for 14 days from time of the last exposure  Schedule staff for COVID-19 testing if available  Maintain social distance as much as possible and frequent hand hygiene  Be alert to development of respiratory or gastrointestinal symptoms, fatigue, chills
or sore throat. If any of them develops, stay home or leave work immediately if at work.  Call your PCP or 911 for severe symptoms  Call your supervisor  Follow additional steps as stated in c (below)
C. Staff with suspected COVID-19 infection  Stay home or if at work, inform supervisor and leave immediately with face mask on  The Infection Prevention Physician should be notified by the person in receipt of this
information (860/262-1274). If the symptoms are consistent with possible COVID,
10

Case 3:20-cv-00594-JCH Document 49-13 Filed 07/09/20 Page 12 of 14
STATE OF CONNECTICUT
DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES WHITING FORENSIC HOSPITAL
70 O’Brien Street Middletown, Connecticut 06457
the reporting individual will be directed to speak with the CMO (860/706-4399), who
will make the final decision regarding the staff member’s quarantine status versus
continued work within the facility.
 The employee will be directed to seek COVID-19 testing from their PCP or schedule
themselves for rapid testing at a Rapid Testing Center. The employee should inform
his/her supervisor of the results as soon as finalized.
 Housekeeping staff will complete terminal disinfection and cleaning of staff’s work space, including desks, chairs and computer, following CDC/DPH protocol
 Supervisor or designee will identify close contacts of staff and proceed according to B above. Supervisor will call staff to get list of close contacts in last 48 hours
 Supervisor or designee will inform the staff’s colleagues and patients from the staff’s unit (through community meeting)
 Monitor patients twice daily for fever or respiratory symptoms  If the staff’s tests come back positive, staff will stay at home and staff’s close
contacts will maintain self-quarantine at home for the remainder of the 14 days. If staff’s contacts develop symptoms anytime during that period, they should call their PCP and ask to be tested.  If the tests are negative, staff’s contacts will return to work immediately, and staff will return when recovered enough to work.
D. Return to Work: For staff with confirmed COVID+ test
- Staff will call supervisor to give updates of symptoms at mutually agreed frequency - Staff will return to work if:
o No fever for 72 hours without the use of fever reducing medications; and o Respiratory symptoms have improved; and o 14 days have passed since symptoms first appeared - For staff with access to repeated testing, two consecutive tests conducted 24 hours apart at minimum, should be negative. Staff who choose to get repeated tests cannot return to work until both test results are obtained. However, if staff have met the above clinically based return to work guidelines, repeated testing is not necessary to be cleared to return to work. - Supervisor will contact CNO and CMO prior to staff member returning to work to ensure compliance with our COVID-19 guidelines for return to work.
11

Case 3:20-cv-00594-JCH Document 49-13 Filed 07/09/20 Page 13 of 14
STATE OF CONNECTICUT
DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES WHITING FORENSIC HOSPITAL
70 O’Brien Street Middletown, Connecticut 06457
Homemade Facemasks
*According to CDC: In settings where facemasks are not available, Healthcare Providers (HCP) might use homemade masks (e.g., bandana, scarf, cloth) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face when used in the care of COVID-19 patients.
Guidelines:
- Staff will use approved facemasks (N95 or surgical as appropriate and available) when in patient care areas
- When there is shortage of surgical masks, homemade masks could be used in patient care areas to be placed on top of N95 (or the scarce surgical) masks to protect them and to extend their period of usefulness
- Staff in non-patient care areas working in close proximity with other staff should wear surgical masks. Homemade masks may be worn if surgical masks are not available, and should be combined with as much social distancing as possible, along with frequent hand hygiene
- Staff in non-patient care areas working mostly at a distance with other staff (6 ft or greater) may wear cloth masks. However, cloth masks may be appropriate during brief exposures to other staff at distances less than 6 ft.
- Staff working in the community may wear homemade masks. However, if the work includes close contact with patients or staff, they should wear approved facemasks
- Staff should always observe social distance and hand hygiene as appropriate.
12

Case 3:20-cv-00594-JCH Document 49-13 Filed 07/09/20 Page 14 of 14
STATE OF CONNECTICUT
DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES WHITING FORENSIC HOSPITAL
70 O’Brien Street Middletown, Connecticut 06457
Emergency Situations
Behavioral Codes (including Restraint/Seclusion) or Cardiopulmonary Respiration (CPR)  To protect patients and colleagues during restraint and seclusion or CPR involving a patient with suspected/confirmed COVID19, staff should wear the following:  Behavioral Code/Restraint/Seclusion: Surgical mask, gloves, and eye protection (face shields/goggles)  Cardiopulmonary Respiration: N95 mask (or surgical mask if not available), face shield, gloves and gown  Emergency cart should include PPEs such as facemasks (N95 and surgical), face shields, gowns and gloves
All staff working in a suspected or confirmed COVID-19 unit should wear appropriate PPE (including N95 or surgical masks if N95 not available) when engaged in the procedures described above
For more detailed exposure risk guidelines for healthcare workers, see: https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html
13

Case 3:20-cv-00594-JCH Document 49-14 Filed 07/09/20 Page 1 of 2
EXHIBIT M

Case 3:20-cv-00594-JCH Document 49-14 Filed 07/09/20 Page 2 of 2

WFH PPE Inventory as of July 1, 2020

Current

Item

Inventory

Face Shield

3000

ISOLATION GOWNS- Yellow-Single Use-BEESANA

870

TOTAL ALL GOWNS-ALL SIZES

870

TOTAL ALL GLOVES, SMALL

20400

TOTAL ALL GLOVES, MEDIUM

31600

TOTAL ALL GLOVES, LARGE

32800

TOTAL ALL GLOVES, X-LARGE

37600

PDI Wipes, tub

99

*Hand Sanitizer, 2 liter bottle

78

Probe Covers - Braun Therm

3400

Masks, procedure Staff/Patient

1850

Masks, molded surgical Staff/ Patient

95700

Mask, N95 - 8000

230

Mask, N95 - KN95, ZYB11,

580

*Mask, N95 - 3 NMF4 (FDA) Battelle

900

*Mask, N95-1860, Regular (FDA) Battelle

500

Mask, N95-1860s, small (FDA) Battelle

180

Estimated days Supply 2900 78 545 123 58 52 51 32 47 64 67 1285 363 65 123 63 97

Case 3:20-cv-00594-JCH Document 49-15 Filed 07/09/20 Page 1 of 2
EXHIBIT N

Case 3:20-cv-00594-JCH Document 49-15 Filed 07/09/20 Page 2 of 2

CVH Inventory as of July 1, 2020

Item

Current estimated Inventory days' supply

Face Shield Gowns GLOVES, SMALL GLOVES, MEDIUM GLOVES, LARGE GLOVES, EXTRA LARGE PDI Wipes Hand Sanitizer TYMPANIC PROBE COVERS Masks, procedure Masks, molded surgical Mask, Orich KN95 Mask, N95 - 8000 Mask, N95 - 9010 Mask, N95 - 8210 Mask, N95-1860, Regular Mask, N95-1860s, small

4,280 1,386 24,700 44,500 58,900 55,100 176 145 26,400 6,700 22,420 9,085 1,314
75 4,420
60 840

779.0 49.1 40.8 37.7 50.4 43.1 26.3 78.5 34.7 46.2
149.2
43.7
452.2
378.6

Michael Boutin

Case 3:20-cv-00594-JCH Document 49-16 Filed 07/09/20 Page 1 of 3
EXHIBIT O

Case 3:20-cv-00594-JCH Document 49-16 Filed 07/09/20 Page 2 of 3
Coronavirus (COVID-19)
FACT SHEET
Watch for symptoms
These symptoms may appear 2-14 days after exposure (based on the incubation period of MERS-CoV viruses).  Fever  Cough  Shortness of breath
If you develop emergency warning signs for COVID-19 get medical attention immediately. Emergency warning signs include*:  Trouble breathing  Persistent pain or pressure in the chest  New confusion or inability to arouse  Bluish lips or face *This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.
Take steps to protect yourself
Clean your hands often  Wash your hands often with soap and water for at least 20 seconds especially after you have
been in a public place or after blowing your nose, coughing, or sneezing.  If soap and water are not readily available, use a hand sanitizer that contains at least 60%
alcohol. Cover all surfaces of your hands and rub them together until they feel dry.  Avoid touching your eyes, nose, and mouth with unwashed hands.
Avoid close contact  Avoid close contact with people who are sick  Put distance between yourself and other people if COVID-19 is spreading in your community.
This is especially important for people who are at higher risk of getting very sick.
Take steps to protect others
Stay home if you’re sick  Stay home if you are sick, except to get medical care.
Cover coughs and sneezes  Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your
elbow.  Throw used tissues in the trash.  Immediately wash your hands with soap and water for at least 20 seconds. If soap and water
are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol.

Case 3:20-cv-00594-JCH Document 49-16 Filed 07/09/20 Page 3 of 3
Recommendations for Healthcare Professionals
How COVID-19 Spreads There is much to learn about the newly emerged COVID-19, including how easily it spreads. Based on what is currently known about COVID-19 and what is known about other coronaviruses, spread is thought to occur mostly from person-to-person via respiratory droplets among close contacts. Close contact can occur while caring for a patient, including:
 Being within approximately 6 feet (2 meters) of a patient with COVID-19 for a prolonged period of time.
 Having direct contact with infectious secretions from a patient with COVID-19. Infectious secretions may include sputum, serum, blood, and respiratory droplets.
If close contact occurs while not wearing all recommended PPE, healthcare personnel may be at risk of infection.
How should healthcare personnel protect themselves when evaluating a patient who may have COVID-19? Although the transmission dynamics have yet to be determined, CDC currently recommends a cautious approach to persons under investigation (PUI) for COVID-19. Healthcare personnel evaluating PUI or providing care for patients with confirmed COVID-19 should use, Standard Transmission-based Precautions.
Strategies for social distancing in an inpatient psychiatric hospital
Social distancing means remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others when possible.
Someone who has completed quarantine or has been released from isolation does not pose a risk of infection to other people.
Perform hand hygiene with alcohol-based hand rub before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Use soap and water if hands are visibly soiled.
Practice how to properly don, use, and doff PPE in a manner to prevent self-contamination.
There is a current Web Based Training on: Donning Doffing PPE and Hand Hygiene on LMS. Class #: 0000105979

Who to call on campus if you have questions or concerns

IP Nurse: Raeann Paparello Medical Director: Dr. Vinneth Carvalho Asst. Medical Director: Dr. Lynne Manning

(860) 262-6046 (860) 262-7030 (860) 262-5104

Anne Dana

Name and number of our HR affiliate
(860) 262-7190

Case 3:20-cv-00594-JCH Document 49-17 Filed 07/09/20 Page 1 of 4
EXHIBIT P

Case 3:20-cv-00594-JCH Document 49-17 Filed 07/09/20 Page 2 of 4

STATE OF CONNECTICUT
DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES

~
dmhas

PROTOCOL: REVISED:

CONNECTICUT VALLEY HOSPITAL COVID-19 Response Plan Patient Testing 4/14/20, 5/11/20, 6/18/20, 6/29/20

The testing information gathered from existing and newly admitted patients at CVH will be used to cohort similar patient populations (i.e. positive, negative, PUI). The Quarantine and Isolation process will be implemented as described in the protocol in an attempt to limit the spread of the disease.
Even after the total population testing is completed all patients will be assessed on a daily basis using the patient screening record, which is based on the current CDC symptom guidance:
 Temp. > 100.0°  New cough  Difficulty Breathing/SOB  Chills/Shaking  Muscle Pain  Headache  Sore Throat  Loss of Taste/Smell).
For the duration of the pandemic response plan the unit RN will call the ACS provider (during regular business hours), or on-call physician (during off hours, holidays, and weekends) to have any newly symptomatic patient evaluated for treatment and potential re-testing.
A single new case of COVID-19 is considered an outbreak. When one case is detected, there are often already other patients or staff infected who can potentially spread the virus.
Therefore, whenever a symptomatic patient or a staff member who has worked on a unit within the last 48 hours tests positive for COVID-19 a cohort unit will be changed to exposed status. All patients residing on the unit and staff who worked on the unit within the last 48 hours will be tested. The need for testing on additional units or building wide will be determined by the Infection Control team based on the results of contact tracing.
Repeat testing of the cohort of patients and staff identified above who initially tested COVID-19 negative will be conducted weekly, until a period of fourteen days has passed since the last detection of a COVID-19 positive patient or staff member.

Case 3:20-cv-00594-JCH Document 49-17 Filed 07/09/20 Page 3 of 4
SYMPTOM POSITIVE PATIENT RESPONSE PROTOCOL
1. The provider will write an order for isolation 2. The nurse will contact IP for patient placement into one of the pre-identified precaution room 3. The Person under Investigation (PUI) will be restricted to their room with the door closed unless
clinically contraindicated. 4. The PUI must don a mask whenever they are outside of the bedroom. 5. Staff working directly with the PUI will wear a mask, gown, gloves and face shield or goggles to enter
room, plus conduct frequent hand hygiene.
TESTING PROCEDURE
Specimens collected at CVH will be sent to the Hartford Healthcare Lab (HHC) for testing.
During regular business hours (Monday-Friday dayshift) the unit RN calls the assigned ACS physician to report the case. A Provider/RN will obtain the sample. The unit will then call the lab office in Haviland Hall who will arrange for courier pick-up of the sample.
During off hours (Evenings, Nights and Weekends) the unit RN calls the assigned on–call physician to report the case. A Provider/RN will obtain the sample. the unit RN calls HHC Client services line at 1-800-286-9800 and enters Option 2. They then notify the lab person handling the call of the stat lab sample that needs to be picked up. A courier will be dispatched by HHC Lab to pick up the specimen and deliver it to the lab for processing:
1. Symptomatic patients should be tested for COVID 19 using E-Swabs we currently have in house, which are the 220245 BD Swab Regular Collection Kit (White) swabs. These are most suitable for collecting Oropharyngeal specimen.
2. The E Swabs Oropharyngeal Specimen Collection Process: A. Provider/RN collects specimen using all recommended PPE (i.e. Goggles OR Safety glasses plus face shield, N95 Mask, Gloves, Gown). B. Take a dry polyester swab; use a tongue depressor to keep the tongue from interfering with specimen collection. C. Insert swab into mouth, and swab the posterior pharynx and tonsillar areas. (Avoid the tongue and teeth.) D. After collection, place the tip of swab into sterile viral transport media tube and snap/cut off the applicator stick. E. Close the cap tightly and place the closed specimen container inside of the biohazard specimen transport bag.
3. The Nasopharyngeal swabs #220532 (Blue) and 220246 (Green) collection kit can also be used when available.
4. Nasopharyngeal Specimen Collection Process: A. Ask the patient to blow their nose to clear nasal passage of excessive mucus – have the patient dispose of the used tissue in a waste receptacle. B. Tilt the patient’s head back 70 degrees. It may be helpful to have the pt. rest their head against a wall or hard surface during specimen collection.
CVH COVID-19 Testing Protocol – 5/4/2020, 6/29/20 S:COVID 19/CVH Communications

Case 3:20-cv-00594-JCH Document 49-17 Filed 07/09/20 Page 4 of 4 C. Insert swab into the nostril. (Swab should reach depth equal to the distance from nostril to
outer opening of the ear). D. Leave swab in place for 5-10 seconds to absorb secretions. E. Slowly remove swab while rotating it. F. Place the tip of swab into sterile viral transport media tube and snap/cut off the applicator
stick. Ensure lid is tightly closed. G. Place specimen container in a biohazard transport bag. ADDITIONAL INSTRUCTIONS:  On your Lab requisition: write in COVID 19 (actual test codes not necessary).  These additional labs should be ordered as stat: CBC w/Diff, CMP, CRP, UA w/Reflux Culture  Label specimen and lab requisition as STAT  The Courier delivers the specimens to HHC (order is entered into their system & testing
performed at HHC Lab in Newington)  Results reported within 48 hours (subject to change as case volume increases) PATIENT REFUSAL: Whenever a patient refuses to participate in testing the following process should be followed:  Staff should continue to explain the importance of the test and encourage patient to participate  The treatment team will consult with the IP team to determine if an alternative testing method
should be offered and employed.  If the patient continues to refuse testing they will be placed on an appropriate cohort unit
based on their current medical condition and potential exposure history.
CVH COVID-19 Testing Protocol – 5/4/2020, 6/29/20 S:COVID 19/CVH Communications

 
 Case 3:20-cv-00594-JCH Document 49-18 Filed 07/09/20 Page 1 of 2
EXHIBIT Q

Case 3:20-cv-00594-JCH Document 49-18 Filed 07/09/20 Page 2 of 2
KaiVac® 1750
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• 500 psi pump • HEPA ltration •• Small footprint and height for easy
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capability
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© 2008-2017 Kaivac, Inc. All Rights Reserved

Case 3:20-cv-00594-JCH Document 49-19 Filed 07/09/20 Page 1 of 12
EXHIBIT R

Case 3:20-cv-00594-JCH Document 49-19 Filed 07/09/20 Page 2 of 12
r;.;,a•I"~ Centers for Disease
t,,,D,.A_control and Prevention
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other behavioral health facilities?

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Potential Solutions[ÿ]8(,ÿ$<::9X>(.ÿ+:(ÿ@95'+&>ÿ4('8<%:.ÿ<5ÿ%(C5(&:(ÿ25<+$ÿ:9Y(ÿ:<ÿ:<C9&>ÿ%9:'&,C9,2ÿC&,ÿX( 4&9,'&9,(%PÿA,ÿ'8(ÿ(@(,'ÿ'8&'ÿDKLAGMHIÿ9:ÿ'5&,:49''(%ÿ9,ÿ'8(ÿB&C9>9'6.ÿ:(::9<,:ÿ:8<+>%ÿ:'<$ÿ<5ÿ4<@(ÿ'<ÿ&ÿ@9%(<

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0100

Case 3:20-cv-00594-JCH Document 49-19 Filed 07/09/20 Page 3 of 12

•

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6ÿ
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If a long-term care facility has a resident or staff member with suspected or confirmed COVID-19, how and to whom +
should this be communicated?
9
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0122

Case 3:20-cv-00594-JCH Document 49-19 Filed 07/09/20 Page 4 of 12

345675489
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Is a negative test for SARS-CoV-2, the virus that causes COVID-19, required before a hospitalized patient can be

+

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During the COVID-19 pandemic, are there special considerations for surgical and other procedural care settings,

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including performance of aerosol-generating procedures (AGPs)?

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Why does CDC continue to recommend respiratory protection equivalent or higher to the level provided by an N95 +
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What personal protective equipment (PPE) should be worn by individuals transporting patients who are confirmed

with or under investigation for COVID-19 within a healthcare facility? For example, what PPE should be worn when

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Given the potential for asymptomatic transmission of SARS-CoV-2, what personal protective equipment (PPE) should +
be worn by healthcare personnel (HCP) providing care to patients who are not suspected to have COVID-19?

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0122

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What personal protective equipment (PPE) should be worn by environmental services (EVS) personnel who clean and +
disinfect rooms of hospitalized patients with COVID-19?
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,-.+&/$!ÿ97ÿÿ6 67ÿ33ÿÿ3ÿÿ6ÿ6ÿ3&6ÿ7ÿ6ÿ73ÿ476ÿ6ÿÿ7ÿÿÿ 7660ÿÿ476ÿÿ3ÿÿ7676ÿ6!ÿÿ0ÿÿ46ÿ!ÿ.ÿÿ7ÿ7646ÿ46ÿÿÿ3ÿ3ÿ76ÿ66ÿ0ÿ-'ÿ476ÿÿ66ÿ6ÿÿ4ÿ7677ÿÿ76ÿ6ÿ 3! 77ÿ73ÿ7ÿ3ÿÿÿ4767ÿÿ0-'ÿ476!ÿ(ÿ6ÿÿ7ÿ6ÿÿ766ÿ ÿ8ÿÿÿ4ÿ67ÿ63ÿ7ÿ3ÿ6ÿ76ÿ46ÿ6ÿ47!ÿ9ÿ6ÿ6ÿÿ6ÿ6 63ÿÿ'78:'&
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Which procedures are considered aerosol generating procedures in healthcare settings?

+

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+64ÿ6ÿÿ647ÿÿ6ÿ7?ÿ67ÿ7ÿ3ÿÿ6ÿÿ46ÿÿ6ÿ6ÿÿ ÿ6ÿÿ4767ÿÿ37ÿ46ÿ6ÿ766ÿÿÿ3ÿÿ73ÿÿ7467 76ÿ73ÿ7?ÿ7ÿÿ6ÿ766ÿ67ÿ67ÿ5467!

(7ÿÿ7ÿ547ÿ6ÿ67ÿ8ÿ44673ÿÿ6ÿ7ÿÿ2ÿÿ647ÿÿ6 ÿ7? 67ÿ7ÿ3!


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0122

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Where should nasopharyngeal swabs be performed on a known or suspected COVID-19 patient, and with what PPE? +
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Do all patients with confirmed or suspected COVID-19 need to be placed in airborne infection isolation rooms?

+

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How long does an examination room need to remain vacant after being occupied by a patient with confirmed or

+

suspected COVID-19?

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My hospital is experiencing a shortage of isolation gowns. To preserve our supply, can we stop using gowns for the

care of patients with methicillin-resistant Staphylococcus aureus (MRSA) and other endemic multidrug-resistant

+

organisms (MDROs), and Clostridioides difficile?

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• a7Cnadrinogÿt6hf4oe9rr7MpÿaD9tRie6Onÿsts(ew.gh3.o,5ÿha64vÿ5e765hi6gÿ7h$3l6y75rÿe)st7ihsÿ3atatn6atÿrGeÿrnaom7t-9cnÿoengÿ1sai9tdiev4er5eod7r5geÿan!nd7ie6smmis3c:9(e/.4g.9,ÿc6a47r5ÿb9ÿap4eÿnÿe7m8-47re9ÿs+i66s5t4aÿnÿt57ÿEn4t4e6ro5bÿa4c97tÿe6r$9i6a7cae) 9649ÿ76ÿ9$96ÿ99ÿ6ÿ69ÿ7ÿ7ÿ97467ÿÿ964ÿ7ÿ96ÿ9649ÿ9ÿ !ÿ"-6ÿÿ3ÿ 499ÿ76ÿ9$96ÿ4356ÿ5764ÿ9468674ÿ9746774ÿ7$54ÿ646ÿ44ÿ464ÿ44 76ÿ7ÿ94ÿ89ÿ9694ÿ56$6ÿ76ÿ7ÿ36ÿ6497ÿ46ÿ3747ÿ96967ÿ6654ÿ936 97696$64997ÿ45ÿ8345ÿ76ÿ,ÿ37967ÿ7667$6ÿ84ÿ !ÿ76ÿ7664565ÿ9ÿ3456ÿ499 76ÿ9$96ÿÿ79ÿÿ45$53ÿ76ÿ6434967ÿÿ/6756ÿÿ96ÿ36ÿÿ84ÿ !ÿ9ÿ96ÿ35ÿ49436 9ÿ867ÿ$6ÿ7ÿ499ÿ89ÿ966ÿ9649ÿ45ÿ967ÿ64$74649ÿ45ÿ646ÿ35ÿ49436ÿ9ÿ6 6+65ÿ96ÿ35ÿÿ9969ÿ9ÿ6ÿ9649ÿ4+65ÿ7ÿ46965ÿ89ÿ4ÿ.*/0ÿ4ÿÿ7$96ÿ7ÿ $6
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A healthcare provider at our facility was recently diagnosed with COVID-19. What time period and criteria do we use

to determine the patients, visitors, and other healthcare personnel (HCP) who might have been exposed to this

+

individual whi le he/she was potentially infectious?

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(94

0122

Case 3:20-cv-00594-JCH Document 49-19 Filed 07/09/20 Page 10 of 12

• If the provider did not have symptomsÿÿ!ÿ"#ÿ$%ÿ%ÿ&'(ÿ!)ÿ%'ÿ"ÿ*&(ÿ#( %&ÿ !ÿ%ÿ& (ÿ$%ÿ%)ÿ$ ÿ#

o

If an exposure is identifiedÿ+%ÿ&'(ÿ%#(ÿ"ÿ((ÿ&)ÿ#ÿ"ÿ,ÿ()ÿÿ% *&#ÿ#ÿÿÿ(#ÿ+!-.(ÿ/#ÿÿ0!ÿÿÿ!

o

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Case 3:20-cv-00594-JCH Document 49-19 Filed 07/09/20 Page 12 of 12
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How long should facilities continue serial testing of HCP?

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How can public health jurisdictions prioritize testing across nursing homes?

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Should asymptomatic HCP who are tested as part of facility-wide testing be excluded from work while waiting for

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Case 3:20-cv-00594-JCH Document 49-20 Filed 07/09/20 Page 1 of 6
EXHIBIT S

Case 3:20-cv-00594-JCH Document 49-20 Filed 07/09/20 Page 2 of 6
SAMHSA Substance Abuse and Mental Health Services Administration
Covid19: Interim Considerations for State Psychiatric Hospitals
Updated: May 8, 2020
Individuals with serious mental illness, particularly those who are older or who have chronic medical conditions, can be at higher risk for illness with Covid-19. It is important that mental health facilities be prepared for Covid-19 to keep both patients as well as healthcare staff safe, and this may include proactive measures to reduce the psychiatric disease burden caused by the COVID-19 pandemic. While SAMHSA has preferentially recommended outpatient treatment during the COVID-19 crisis as telehealth technology and social distancing can be more effectively implemented, inpatient psychiatric care will inevitably be required for a number of patients. Psychiatric care on an inpatient service is typically reserved for the most severe conditions, and inpatient care at state psychiatric hospitals is typically reserved for the most refractory cases.
State psychiatric hospitals have typically developed Disaster Plans that require the establishment of protocols and relationships with other local government and healthcare entities. Each accredited facility should have existing infection control plans that are designed to address scenarios such as for MRSA, HIV, Hepatitis, and infectious diseases. Plans to manage COVID-19 at the facility should now be in place at all of these sites. However, in contrast to general healthcare settings, psychiatric facilities may experience unique challenges in prevention and infection control.
In addition to consideration of infection control guidelines with the goal of minimizing spread, described below, it is also important to be aware of the psychological impact of quarantine and major disruptions to everyday life. Healthcare workers already support the mental health of their patients, but they also need to attend to their own needs and those of their families. i It is important to provide access to accurate information sources such as the Centers for Disease Control and Prevention (CDC). ii The American Psychiatric Association has resources on the mental health impacts of Covid-19.iii Others also have studied and reported on the adverse effects of quarantine on individuals.iv Patients at mental health facilities are vulnerable both to the infection itself, but also to worsening anxiety, mood, or psychosis during this time. Given the uncertainty and rapid change associated with the virus, anxiety and distress should be anticipated.v
In response to the CDC recommendations for all healthcare facilities, SAMHSA offers further considerations specific to psychiatric hospitals.
1) Reduce morbidity and mortality: a. Many patients admitted to state psychiatric facilities have a number of health comorbidities that increase their risk of developing severe symptoms from COVID-19 infection. These include the very high incidence of tobacco use with resultant COPD and lung disease or metabolic syndrome with diabetes, hypertension, and heart disease. In addition to intake screening and testing when appropriate, these patients should be informed of their elevated risk and frequent follow up COVID-19 screening should be performed. These patients should be segregated from new or symptomatic patients due to their higher stratified risk. b. SAMHSA recommends that when possible all new admissions be segregated until COVID-19 testing results are available for review. For new and existing patients, all suspected and

Case 3:20-cv-00594-JCH Document 49-20 Filed 07/09/20 Page 3 of 6
symptomatic cases should be immediately segregated and transferred, if necessary, to appropriate healthcare facilities with capabilities of treating more severely ill patients. Advanced directives should be updated on all existing patients and should be completed for new patients upon admission. Psychiatric hospitals may not have the capacity to respond to severe respiratory infections. c. Symptoms associated with psychotic illness, such as paranoia or anxiety disorders such as OCD may worsen during the COVID-19 crisis, and patients with these conditions may require additional redirection as they are exposed to more negative news about the pandemic. 2) Considerations when attempting to minimize disease transmission: a. Limit the movement of COVID-19 patients (e.g., have them remain in their room) 1. Capacity of informed consent may be lacking for those admitted involuntarily. Individuals
with serious mental illnesses may have varying degrees of capacity to follow appropriate infection control procedures, therefore it is important to establish the patient’s capacity or lack of capacity when developing the modified COVID-19 treatment plan. Those who lack capacity may not fully appreciate the dangers of exposure. The nature of the therapeutic milieu may make minimal contact rules more challenging. Patients without capacity may require more frequent reorientation to the rules, more activities one on one with staff, and an individual room. While restrictions of movement outside of their room will be implemented for some patients, the presence of mental illness does not mean an individual is incapable of practicing safe hygiene and social distancing practices. Staff should make the assessment based on the patient’s capacity and behavior and carefully avoid stigmatizing those with mental illness.
2. Take steps to prevent known or suspected COVID-19 patients from exposing other patients. a. It is advisable when possible to segregate the areas or individual floors as nonCOVID-19 and COVID-19. This may require further restrictions in movement and accommodations should be explored. For instance, the dayroom is often the location where patients congregate and receive the therapeutic benefits of the milieu. Having an alternate dayroom location, when possible, could help to reduce a patient’s anxiety about exposure and maintain continuity. Also, those patients with severe anxiety disorder or paranoia may feel some relief in segregation as their risk of exposure is reduced. b. Identify dedicated staff to care for COVID-19 patients. c. Psychosocial group treatment sessions may have to be suspended if these sessions cannot be safely modified with fewer individuals reliably practicing social distancing or with video technology available. One on one psychosocial counseling sessions with social distancing can be considered.
b. Another important consideration is that most psychiatric facilities have restricted access with limited visitation. This is stigmatizing in itself as these units are locked for the security of the patients and staff. During the COVID-19 crisis, visitation by friends, family, and various stakeholders may be curtailed. This necessary step to reduce exposure risk can leave the patients feeling more isolated. When visitation is restricted staff of all levels should be aware of this and take steps to reach out and check on patients more often.

Case 3:20-cv-00594-JCH Document 49-20 Filed 07/09/20 Page 4 of 6
c. Often family members and community support are vital components of the patients’ recovery. These individuals are heavily involved in the patient’s lives and have traditionally participated in family meetings and therapy. When safely implemented, this important part of treatment should continue. Continuing these meetings by confirmed appointment in designated area, frequently sanitized between visits, can facilitate disposition planning, reduce recidivism rates, and improve patient satisfaction. Such dedicated spaces could also be used for visitation with a schedule and protocol for safe interaction including social distancing and sanitizing after each use. Alternative steps depending on resources could include setting up a computer with a webcam and microphone in another area within the facility that can be cleaned between uses. This would allow patients and family members to communicate visually as well as via audio.
d. Post visual alerts (signs, posters) at entrances and in strategic places providing instruction on hand hygiene, respiratory hygiene, and cough etiquette. For patients with limited capacity frequent reorientation to these is required.
e. Observe newly arriving patients/residents for development of respiratory symptoms in an area designated for new patient evaluation.
f. Confirm or obtain psychiatric advance directives to facilitate medication and treatment compliance in the event of change of capacity for informed consent.
3) Protect healthcare personnel a. Ensure that staff are aware of sick leave policies, and staff should be encouraged to stay home if they are not feeling well. b. Limit visitors to the facility and perform screening on all who enter the facility. c. Ensure cleaning and disinfectant supplies are available as well as tissues, waste receptacles, and alcohol-based hand sanitizer. d. Ensure housekeeping and dietary personnel frequently sanitize and disinfect all areas where staff and patients can be found. e. Healthcare workers may also develop symptoms of anxiety during this crisis, therefore supervisors and managers should perform more frequent meetings and checks with frontline staff. Flexibilities when possible should be accommodated. Occupational health departments should now be actively engaging staff and implementing plans for staff that are experiencing greater stress and anxiety. Resources should be made available for staff experiencing increased stress, depression, or substance use disorder relapse.
4) Preserve healthcare system functioning a. As staffing shortages may become more common as healthcare workers also become infected and are quarantined, it is important that supervisors and managers establish contact with outside staffing sources to ensure continuity of care. More flexibility in task assignment may be an option, for instance, the ability to “buddy team” with paraprofessional staff if regular staff ratios are limited due to staff illness. b. As the anxiety and fear from COVID-19 can preclude improvement in the patient’s psychiatric condition, providers should instruct staff to engage patients in more one to one activities and

Case 3:20-cv-00594-JCH Document 49-20 Filed 07/09/20 Page 5 of 6
should be mindful of this consideration when ordering prn medications to keep the patient as comfortable as possible. It is important to note that these measures should be implemented in conjunction with the utilization of clear clinical indications and, when applicable, validated psychiatric screening instruments. For example increased screening for worsening symptoms may prompt detection earlier and inform changes to the treatment plan. These measures may prevent escalation of symptoms of agitation, psychosis, or loss of control and thereby avoid seclusion and restraints. Additionally staff should be mindful that overcrowding and restrictions can be potential triggers for behavioral instability. These seclusion events are stressful for staff and traumatic for both the patients and to those patients who observe such incidents. The significant negativity following such events can, in some instances, temporarily transform the nature of the psychiatric unit. Therefore, identifying and addressing issues prior to the outburst should be the goal. c. Discharge planning may be more difficult. As many step down residential facilities and outpatient facilities are limiting intakes, social workers may find it more difficult to plan disposition of patients. This may result in longer lengths of stay. The treatment team as well as utilization review staff should adjust with this expectation. Also, questions may arise about the risk of the patient’s exposure to those at the receiving facility. Repeat testing for COVID19 should ideally be completed prior to discharge as further reassurance for receiving facilities. More resources from varied sources should be mobilized such as family, friends, assisted living, county resources, and local charity.
There are a number of steps that healthcare facilities can take to be prepared should an individual become infected with Covid-19.vi Psychiatric hospitals should follow all infection control guidelines as stipulated by the CDC. For general infection control guidelines, see https://www.cdc.gov/coronavirus/2019-ncov/infection-control/index.html. vii
During this rapidly changing situation, mental health providers should refer to the CDC website for the most updated information. Individuals with serious mental illness are at particular risk related to cooccurring medical conditions as well as challenges with accessing healthcare. Attention to proper prevention and infection control procedures as well as attention to the psychological impacts of the virus are important in reducing morbidity and mortality for this vulnerable population.
i Sustaining the Well-Being of Healthcare Personnel during Coronavirus and other Infectious Disease Outbreaks https://www.cstsonline.org/assets/media/documents/CSTS_FS_Sustaining_Well_Being_Healthcare_Pe rsonnel_du ring.pdf.pdf Accessed March 17, 2020 ii Centers for Disease Control, Coronavirus https://www.cdc.gov/coronavirus/2019ncov/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2Findex.html Accessed March 17, 2020 iii Covid-19 Mental Health Impacts Resources for Psychiatrist https://www.psychiatry.org/newsroom/apablogs/apa-blog/2020/03/covid-19-mental-health-impacts-resources-for-psychiatrists Accessed March 17, 2020 iv The Psychological Impact of Quarantine and How to Reduce It: Rapid Review of the Evidence. Lancet 2020; 395: pgs. 912-20. Brooks, Samantha K. and Webster, Rebecca K. and Smith, Louise E. and Woodland, Lisa and Wessely, Simon and Greenberg, Neil and Rubin, G. James

Case 3:20-cv-00594-JCH Document 49-20 Filed 07/09/20 Page 6 of 6
v Caring for patient mental well-being during coronavirus https://www.cstsonline.org/assets/media/documents/CSTS_FS_Caring_for_Patients_Mental_WellBeing _during_C oronavirus.pdf.pdf Accessed March 17, 2020 vi Ibid vii Infection control guidelines https://www.cdc.gov/coronavirus/2019-ncov/infectioncontrol/index.html. Accessed March 17, 2020

Case 3:20-cv-00594-JCH Document 49-21 Filed 07/09/20 Page 1 of 4
EXHIBIT T

7/6/2020

Case 3:20-cv-00594-JCH DTeostcinugmGueidneltin4es9f-o2r N1ursiFngilHeodme0s7|/C0D9C/20 Page 2 of 4

Coronavirus Disease 2019 (COVID-19)

Testing Guidelines for Nursing Homes

Interim SARS-CoV-2 Testing Guidelines for Nursing Home Residents and Healthcare Personnel

Updated July 2, 2020

Print

Summary of Changes:
Revisions were made on June 1, 2020, to re ect the following:
Focus on testing recommendations for nursing home residents only. Create separate guidance for testing healthcare personnel (HCP), which is available in the Interim Guidance on Testing Healthcare Personnel for SARS-CoV-2.

Note: This document is intended to provide guidance on the appropriate use of testing among nursing home residents and does not dictate the determination of payment decisions or insurance coverage of such testing, except as may be otherwise referenced (or prescribed) by another entity or federal or state agency.
Nursing home residents are at high risk for infection, serious illness, and death from COVID-19. Testing for SARS-CoV-2, the virus that causes COVID-19, in respiratory specimens can detect current infections (referred to here as viral testing) among residents in nursing homes. Viral testing of residents in nursing homes, with authorized nucleic acid or antigen detection assays, is an important addition to other infection prevention and control (IPC) recommendations aimed at preventing SARSCoV-2 from entering nursing homes, detecting cases quickly, and stopping transmission. This guideline is based on currently available information about COVID-19 and will be re ned and updated as more information becomes available.
Testing conducted at nursing homes should be implemented in addition to recommended IPC measures. Facilities should have a plan for testing residents for SARS-CoV-2. Additional information about the components of the testing plan are available in the CDC guidance titled Preparing for COVID-19 in Nursing Homes.
Testing practices should aim for rapid turnaround times (e.g., less than 24 hours) in order to facilitate e ective interventions. Testing the same resident more than once in a 24-hour period is not recommended. Antibody (serologic) test results generally should not be used as the sole basis to diagnose an active SARS-CoV-2 infection and should not be used to inform IPC actions.
While this guidance focuses on testing in nursing homes, several of the recommendations such as testing residents with signs or symptoms of COVID-19 and testing asymptomatic close contacts should also be applied to other long-term care facilities (e.g., assisted living facilities, intermediate care facilities for individuals with intellectual disabilities, institutions for mental disease, and psychiatric residential treatment facilities).
For additional guidance addressing other non-healthcare settings, refer to the CDC guidance addressing Communities, Schools, Workplaces and Events. Guidance for testing healthcare personnel (HCP) is available in the Interim Guidance on Testing Healthcare Personnel for SARS-CoV-2.

Diagnostic Testing

Testing residents with signs or symptoms of COVID-19.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-homes-testing.html

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Case 3:20-cv-00594-JCH DTeostcinugmGueidneltin4es9f-o2r N1ursiFngilHeodme0s7|/C0D9C/20 Page 3 of 4

At least daily, take the temperature of all residents and ask them if they have any COVID-19 symptoms. Perform viral testing of any resident who has signs or symptoms of COVID-19.
Clinicians should use their judgment to determine if a resident has signs or symptoms consistent with COVID-19 and whether the resident should be tested. Individuals with COVID-19 may not show common symptoms such as fever or respiratory symptoms. Some may present with only mild symptoms or other less common symptoms.
Clinicians are encouraged to consider testing for other causes of respiratory illness, such as in uenza, in addition to testing for SARS-CoV-2.

Testing asymptomatic residents with known or suspected exposure to an individual infected with SARS-CoV-2, including close and expanded contacts (e.g., there is an outbreak in the facility).
Perform expanded viral testing of all residents in the nursing home if there is an outbreak in the facility (i.e., a new SARSCoV-2 infection in any HCP or any nursing home-onset SARS-CoV-2 infection in a resident).
A single new case of SARS-CoV-2 infection in any HCP or a nursing home-onset SARS-CoV-2 infection in a resident should be considered an outbreak. When one case is detected in a nursing home, there are often other residents and HCP who are infected with SARS-CoV-2 who can continue to spread the infection, even if they are asymptomatic. Performing viral testing of all residents as soon as there is a new con rmed case in the facility will identify infected residents quickly, in order to assist in their clinical management and allow rapid implementation of IPC interventions (e.g., isolation, cohorting, use of personal protective equipment) to prevent SARS-CoV-2 transmission.
When undertaking facility-wide viral testing, facility leadership should expect to identify multiple asymptomatic and pre-symptomatic residents with SARS-CoV-2 infection and be prepared to cohort residents. See Public Health Response to COVID-19 in Nursing Homes for more details.
If viral testing capacity is limited, CDC suggests rst directing testing to residents who are close contacts (e.g., on the same unit or oor of a new con rmed case or cared for by infected HCP).
See Considerations for Performing Facility-wide SARS-CoV-2 Testing in Nursing Homes for additional details.

Initial (baseline) testing of asymptomatic residents without known or suspected exposure to an individual infected with SARS-CoV-2 is part of the recommended reopening process.
Perform initial viral testing of each resident in a nursing home as part of the recommended reopening process   . nitial viral testing of each resident (who is not known to have previously been diagnosed with COVID-19) is recommended because of the high likelihood of exposure during a pandemic, transmissibility of SARS-CoV-2, and the risk of complications among residents following infection.
The results of viral testing inform care decisions, infection control interventions, and placement decisions (e.g., cohorting decisions) relevant to that resident.

Testing to determine resolution of infection.
A test-based strategy, which requires serial tests and improvement of symptoms, can be used as an alternative to a symptom-based or time-based strategy, to determine when a resident with SARS-CoV-2 infection no longer requires Transmission-Based Precautions.

Repeat Testing in Coordination with the Health Department

Non-diagnostic testing of asymptomatic residents without known or suspected exposure to an individual infected with SARS-CoV-2 (apart from the initial testing referenced above).

https://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-homes-testing.html

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Case 3:20-cv-00594-JCH DTeostcinugmGueidneltin4es9f-o2r N1ursiFngilHeodme0s7|/C0D9C/20 Page 4 of 4

After initially performing viral testing of all residents in response to an outbreak, CDC recommends repeat testing to ensure there are no new infections among residents and HCP and that transmission has been terminated as described below. Repeat testing should be coordinated with the local, territorial, or state health department.
Continue repeat viral testing of all previously negative residents, generally every 3 days to 7 days, until the testing identi es no new cases of SARS-CoV-2 infection among residents or HCP for a period of at least 14 days since the most recent positive result. This follow-up viral testing can assist in the clinical management of infected residents and in the implementation of infection control interventions to prevent SARS-CoV-2 transmission.
If viral test capacity is limited, CDC suggests directing repeat rounds of testing to residents who leave and return to the facility (e.g., for outpatient dialysis) or have known exposure to a case (e.g., roommates of cases or those cared for by a HCP with con rmed SARS-CoV-2 infection). For large facilities with limited viral test capacity, testing only residents on a ected units could be considered, especially if facility-wide repeat viral testing demonstrates no transmission beyond a limited number of units.

De nitions
Healthcare personnel (HCP): HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, feeding assistants, students and trainees, contractual HCP not employed by the healthcare facility, and persons not directly involved in patient care but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel). For this guidance, HCP does not include clinical laboratory personnel.
Nursing home-onset SARS-CoV-2 infections refers to SARS-CoV-2 infections that originated in the nursing home. It does not refer to the following:
Residents who were known to have COVID-19 on admission to the facility and were placed into appropriate Transmission-Based Precautions to prevent transmission to others in the facility. Residents who were placed into Transmission-Based Precautions on admission and developed SARS-CoV-2 infection within 14 days after admission.

COVID-2019 Menu
 Coronavirus Home  Your Health  Community, Work & School  Healthcare Workers  Laboratories  Health Departments  Cases, Data & Surveillance  More Resources

Page last reviewed: July 2, 2020

https://www.cdc.gov/coronavirus/2019-ncov/hcp/nursing-homes-testing.html

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Case 3:20-cv-00594-JCH Document 49-22 Filed 07/09/20 Page 1 of 4
EXHIBIT U

7/6/2020

Case 3:20-cv-0059In4te-riJmCGHuidanDceoocnuTemsteingnHt e4a9lth-c2a2re PeFrsiloenndel0fo7r /S0A9R/S2-C0oV-2P|aCgDeC 2 of 4

Coronavirus Disease 2019 (COVID-19)

Interim Guidance on Testing Healthcare Personnel for SARS-CoV-2

Updated July 2, 2020

Print

Note: This document is intended to provide guidance on the appropriate use of testing among healthcare personnel and does not dictate the determination of payment decisions or insurance coverage of such testing, except as may be otherwise referenced (or prescribed) by another entity or federal or state agency.

This document provides a summary of considerations and current Centers for Disease Control and Prevention (CDC) recommendations regarding testing healthcare personnel (HCP) for SARS-CoV-2. This document does not apply to individuals who do not meet the de nition of HCP as de ned below. The CDC recommendations for SARS-CoV-2 testing have been developed based on what is currently known about COVID-19 and are subject to change as additional information becomes available.
Testing of HCP can be considered in four situations:
1. Testing HCP with signs or symptoms consistent with COVID-19 2. Testing asymptomatic HCP with known or suspected exposure to SARS-CoV-2 3. Testing asymptomatic HCP without known or suspected exposure to SARS-CoV-2 for early identi cation in special
settings (e.g., nursing homes) 4. Testing HCP who have been diagnosed with SARS-CoV-2 infection to determine when they are no longer infectious
Viral tests (authorized nucleic acid or antigen detection assays) are recommended to diagnose acute infection. Testing practices should aim for rapid turnaround times (i.e., less than 24 hours) in order to facilitate e ective interventions. Testing the same individual more than once in a 24-hour period is not recommended.
HCP undergoing testing should receive clear information on:
the purpose of the test the reliability of the test and any limitations associated with the test who will pay for the test and how the test will be performed how to interpret results and any next steps related to the results who will receive the results how the results may be used any consequences for declining testing
Recommended practices to prevent occupational exposure to SARS-CoV-2 are described in the Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic. Guidance for assessing HCP exposure risk and determining the need for work restrictions is available in the Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19

Testing HCP with signs or symptoms consistent with COVID-19

HCP with signs or symptoms of COVID-19 should be prioritized for SARS-CoV-2 testing. Because HCP often have extensive

and close contact to vulnerable populations, even mild signs or symptoms (e.g., sore throat) of possible COVID-19 should

prompt consideration for testing. Clinicians should use their judgment to determine if HCP have signs or symptoms

compatible with COVID-19 and whether HCP should be tested.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-healthcare-personnel.html

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compatible with COVID 19 and whether HCP should be tested.

CDC recommends using authorized nucleic acid or antigen detection assays  that have received an FDA Emergency Use Authorization to test persons with symptoms when there is a concern of potential COVID-19. Tests should be used in accordance with the authorized labeling. Providers should be familiar with the tests’ performance characteristics and limitations.

Testing asymptomatic HCP with known or suspected exposure to SARS-CoV-2
As part of community contact tracing  e orts, viral testing is recommended for everyone, including HCP, who have had close contact  with persons with SARS-CoV-2 infection in the community (including household contacts).
Exposures encountered by HCP are unlike those that might occur the community, and trained HCP generally use personal protective equipment (PPE) to reduce the risk of transmission. Because of this, assessment of HCP exposures should be performed as described in the Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19. Due to their often extensive and close contact with vulnerable individuals, this guidance recommends managing occupationally exposed HCP conservatively:
For certain exposures believed to pose a higher risk for transmission, CDC recommends that exposed HCP be excluded from work for 14 days following the exposure. For other, lower risk exposures, HCP may continue to work; however, CDC recommends screening for symptoms prior to starting work each day and using source control measures as described in CDC’s infection control recommendations.
Should facilities have sta ng shortages, they can refer to CDC’s sta ng mitigation guidance, which includes allowing HCP with higher risk exposures to continue to work during their 14-day post-exposure period. When testing is readily available, performing testing during the 14-day post-exposure period can be considered to more quickly identify pre-symptomatic or asymptomatic HCP who could contribute to SARS-CoV-2 transmission. For HCP with lower risk exposures, CDC continues to recommend symptom screening and source control measures while at work; regular testing, as described below, could also be considered to more rapidly identify infected HCP.
Facilities that elect to perform post-exposure testing of HCP should be aware that testing is logistically challenging and has limitations. For example, testing only identi es the presence of virus at the time of the test. It is possible that HCP can test negative because they are very early in their infection when their sample is collected. In such situations, they could test positive later and transmit the virus to others; for this reason, repeat testing could be considered. Also, when there is SARSCoV-2 transmission occurring in the community, positive tests in HCP do not necessarily indicate transmission due to exposures in the workplace.
If testing of exposed HCP is instituted, test results should be available rapidly (i.e., within 24 hours), and there should be a clear plan to respond to results. The Occupational Safety and Health Administration’s rules for Recording and Reporting Occupational Injuries and Illness (29 CFR part 1904  ) should be consulted regarding requirements for certain employers to make and keep records of work-  related cases of COVID-19.
In nursing homes, expanded viral testing of all HCP is recommended in response to an outbreak in the facility. Testing of all residents is also recommended in this situation. See the Interim SARS-CoV-2 Testing Guidelines for Nursing Home Residents for more information. An outbreak is de ned as a new SARS-CoV-2 infection in any HCP or any nursing home-onset SARSCoV-2 infection in a resident. Expanded viral testing includes initial testing of all HCP followed by repeat testing of all previously negative HCP, generally between every 3 days to 7 days, until the testing identi es no new cases of SARS-CoV-2 infection among residents or HCP for a period of at least 14 days since the most recent positive result. Expanded viral testing of HCP could also be considered in other healthcare settings in some situations (e.g., when multiple instances of SARS-CoV-2 transmission are identi ed among patients or HCP).

Testing asymptomatic HCP without known or suspected exposure to SARS-CoV-2 for early identi cation in special settings

Currently, testing asymptomatic HCP without known or suspected exposure to SARS-CoV-2 is recommended for HCP working

in nursing homes   as part of the recommended reopening process

https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-healthcare-personnel.html

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in nursing homes   as part of the recommended reopening process.

In this situation, initial viral testing of all HCP in nursing homes, along with weekly viral testing thereafter is recommended. State and local o cials may adjust the recommendation for weekly viral testing of HCP based on the prevalence of the virus in their community; for example, performing weekly testing in areas with moderate-to-substantial community transmission and less frequent testing in areas with minimal-to-no community transmission.

Testing to determine when HCP with SARS-CoV-2 infection are no longer infectious
A test-based strategy, which requires serial tests and improvement of symptoms, can be used as an alternative to a symptombased or time-based strategy, to determine when HCP with SARS-CoV-2 infection may return to work.

De nitions
Healthcare personnel (HCP): HCP refers to all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body substances (e.g., blood, tissue, and speci c body uids); contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air. HCP include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual sta not employed by the healthcare facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the healthcare setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel). For this guidance, HCP does not include clinical laboratory personnel.

Substantial community transmission: Large-scale community transmission, including in communal settings (e.g., schools, workplaces).

Minimal-to-moderate community transmission: Sustained transmission with high likelihood or con rmed exposure within communal settings and potential for rapid increase in cases.

No-to-minimal community transmission: Evidence of isolated cases or limited community transmission; case investigations under way; no evidence of exposure in large communal setting.

COVID-2019 Menu

Page last reviewed: July 2, 2020

 Coronavirus Home  Your Health  Community, Work & School  Healthcare Workers  Laboratories  Health Departments  Cases, Data & Surveillance  More Resources

https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-healthcare-personnel.html

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EXHIBIT V

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CHARLES D. BAKER Governor
KARYN E. POLITO Lieutenant Governor
MARYLOU SUDDERS Secretary
JOAN MIKULA Commissioner

The Commonwealth of Massachusetts
Executive Office of Health and Human Services Department of Mental Health 25 Staniford Street
Boston, Massachusetts 02114-2575
(617) 626-8000 www.mass.gov/dmh
DEPARTMENT OF MENTAL HEALTH DIVISION OF CLINICAL AND PROFESSIONAL SERVICES
LICENSING DIVISION – BULLETIN #20-04R June 8, 2020

COVID-19 EMERGENCY GUIDANCE Admission, COVID-19 Testing, and EPIA

In light of the current COVID-19 pandemic, this bulletin highlights current regulations and policies that support behavioral health patients leaving Emergency Departments as soon as possible once it is determined that a psychiatric inpatient level of care is required. In recognition of the vital role of acute psychiatric facilities in providing safe appropriate care for individuals in psychiatric crisis, DMH is highlighting licensed facilities’ obligations to admit and treat patients meeting admission criteria within their license class. The Department of Mental Health (DMH) is also enhancing its capacity to provide assistance through the Expedited Psychiatric Inpatient Admission process (EPIA), so we may all play our role in keeping patients and health care workers safe.
1. No Reject Policy interpreted for COVID-19 Pandemic:
a. If a facility has been identified as accepting admissions and a patient has been medically cleared, requires inpatient psychiatric treatment, and otherwise meets admission criteria, they must admit that patient for care. A facility may deny admission to a patient only if such admission would result in a census exceeding the facility’s operational capacity or if the admission has been determined by the facility medical director to exceed the facility’s capability at the time admission is sought. This determination must be recorded in writing as an admission denial Bulletin 18-01and shall be subject to review by the Department of Mental Health.
b. It is expected that patients will be preferentially re-admitted to the most recent facility where they had been hospitalized. A facility may not deny admission based on circumstances of a patient’s previous admission, including those who were discharged to another facility for treatment and are returning to that inpatient psychiatric facility.
c. Facilities should make every effort to admit patients who are in EDs that are within the Facility's healthcare system.
d. At this time, inpatient psychiatric facilities, identified to DMH as

Case 3:20-cv-00594-JCH Document 49-23 Filed 07/09/20 Page 3 of 3
DEPARTMENT OF MENTAL HEALTH Licensing Bulletin #20-04R June 8, 2020 Page 2
accepting patients who are confirmed to be infected with COVID-19, must be prepared to admit patients who have tested positive or are suspect for COVID-19 and who do not need medical hospital treatment for COVID19.
2. Enhanced Expedited Psychiatric Inpatient Admission (EPIA):
a. All individuals who have been screened appropriate for inpatient psychiatric level of care and are in an ED, ESP, home or other boarding setting awaiting placement must be entered into MABHA no later than 24 hours of such screening and before referring to DMH for assistance under EPIA, to initiate a coordinated advocacy response from the State Agencies involved (MassHealth, DMH, DDS, DCF, DYS, etc.).
b. The insurance carrier must be notified and involved with the ED and/or ESP as soon as hospital level of care is determined for the individual, as provided in current EPIA escalation protocols.
c. EPIA referral to DMH may be made at 24 hours. Documentation of ED/ESP and insurance carrier advocacy efforts are required.
d. Should the above steps not be taken at the time of escalation to DMH, there will be a delay in accepting the referral until they are completed.
Any questions regarding this bulletin should be directed to the DMH Licensing Division at 617-626- 8117 or by email to Teresa.J.Reynolds@massmail.state.ma.us

Case 3:20-cv-00594-JCH Document 49-24 Filed 07/09/20 Page 1 of 3
EXHIBIT W

Case 3:20-cv-00594-JCH Document 49-24 Filed 07/09/20 Page 2 of 3
AMERICAN @
PSYCHIATRIC
ASSOCIATION TM
COVID-19 Pandemic Guidance Document
Guidance on Admittance, Discharge of Psychiatric Patients During COVID-19
The findings, opinions, and conclusions of this guidance document do not necessarily represent the views of the officers, trustees, or all members of the American Psychiatric Association.
© Copyright 2020, American Psychiatric Association, all rights reserved.

Case 3:20-cv-00594-JCH Document 49-24 Filed 07/09/20 Page 3 of 3
The findings, opinions, and conclusions of this guidance document do not necessarily represent the views of the officers, trustees, or all members of the American Psychiatric Association.
APA provides the following guidance for psychiatric care during outbreaks of communicable disease:
1. Premature discharge of patients from psychiatric hospitals and inpatient psychiatric units is unreasonable as this practice exposes patients, families, and the community at large to the risks of harmful and adverse outcomes irrespective of communicable disease outbreaks.
2. During communicable disease outbreaks, referral of patients to any psychiatric setting should balance efforts to match patients’ mental health needs with the appropriate level of care while considering the potential risks of the communicable disease at each level of care.
3. Each level of psychiatric care during such outbreaks should provide safe and appropriate treatment, including adequate protection from the risk of infection from the communicable disease.

© Copyright 2020, American Psychiatric Association, all rights reserved.

2

Case 3:20-cv-00594-JCH Document 49-25 Filed 07/09/20 Page 1 of 5
EXHIBIT X

Case 3:20-cv-00594-JCH Document 49-25 Filed 07/09/20 Page 2 of 5

DATE 3/27/2020 3/28/2020 3/29/2020 3/30/2020 3/31/2020 4/1/2020 4/2/2020 4/3/2020 4/4/2020 4/5/2020 4/6/2020 4/7/2020 4/8/2020 4/9/2020 4/10/2020 4/11/2020 4/12/2020 4/13/2020 4/14/2020 4/15/2020 4/16/2020 4/17/2020 4/18/2020 4/19/2020 4/20/2020 4/21/2020 4/22/2020 4/23/2020 4/24/2020 4/25/2020 4/26/2020 4/27/2020 4/28/2020 4/29/2020 4/30/2020 5/1/2020 5/2/2020 5/3/2020 5/4/2020 5/5/2020 5/6/2020 5/7/2020 5/8/2020 5/9/2020 5/10/2020

CVH - Total No. of Patients to Total No. of Patients Currently Positive

CVH - Total No. of Patients

CVH - Total No. of Patients Currently Positive

333

3

333

1

333

4

301

4

301

4

301

3

301

3

301

3

301

3

301

3

286

3

286

4

286

2

286

2

286

3

286

5

286

4

288

4

288

4

288

2

288

1

288

3

288

3

288

3

288

5

288

7

288

7

288

7

288

7

288

9

288

11

290

12

290

18

290

26

290

25

290

25

290

25

290

25

272

29

272

28

272

28

272

36

272

33

272

35

272

35

Case 3:20-cv-00594-JCH Document 49-25 Filed 07/09/20 Page 3 of 5

5/11/2020

269

33

5/12/2020

269

34

5/13/2020

269

35

5/14/2020

269

35

5/15/2020

269

26

5/16/2020

269

24

5/17/2020

269

24

5/18/2020

251

18

5/19/2020

251

17

5/20/2020

251

12

5/21/2020

251

8

5/22/2020

251

8

5/23/2020

251

6

5/24/2020

251

6

5/25/2020

245

6

5/26/2020

245

5

5/27/2020

245

5

5/28/2020

245

4

5/29/2020

245

4

5/30/2020

245

4

5/31/2020

245

4

6/1/2020

242

1

6/2/2020

242

1

6/3/2020

242

1

6/4/2020

242

1

6/5/2020

242

1

6/6/2020

242

1

6/7/2020

242

1

6/8/2020

234

1

6/9/2020

234

1

6/10/2020

234

1

6/11/2020

234

1

6/12/2020

234

1

6/13/2020

234

1

6/14/2020

234

1

6/15/2020

232

1

6/16/2020

232

1

6/17/2020

232

1

6/18/2020

232

1

6/19/2020

232

1

6/20/2020

232

1

6/21/2020

232

1

6/22/2020

233

1

6/23/2020

233

1

6/24/2020

233

1

6/25/2020

233

1

6/26/2020

233

1

Case 3:20-cv-00594-JCH Document 49-25 Filed 07/09/20 Page 4 of 5

6/27/2020

233

1

6/28/2020

233

1

6/29/2020

229

1

6/30/2020

229

1

7/1/2020

229

1

7/2/2020

229

1

Dates
•CVH - Total No. of Patients Currently Positive

•CVH - Total No. of Patients

DMHAS COVID-19 Daily Synopsis - CVH - Total No. of Patients to Total No. of Patients Currently Positive
365 315 265 215 165 115
65 15 -35

4/2/2020 4/3/2020 4/4/2020 4/5/2020 4/6/2020 4/7/2020 4/8/2020 4/9/2020 4/10/2020 4/11/2020 4/12/2020 4/13/2020 4/14/2020 4/15/2020 4/16/2020 4/17/2020 4/18/2020 4/19/2020 4/20/2020 4/21/2020 4/22/2020 4/23/2020 4/24/2020 4/25/2020 4/26/2020 4/27/2020 4/28/2020 4/29/2020 4/30/2020 5/1/2020 5/2/2020 5/3/2020 5/4/2020 5/5/2020 5/6/2020 5/7/2020 5/8/2020 5/9/2020 5/10/2020 5/11/2020 5/12/2020 5/13/2020 5/14/2020 5/15/2020 5/16/2020 5/17/2020 5/18/2020 5/19/2020 5/20/2020 5/21/2020 5/22/2020 5/23/2020 5/24/2020 5/25/2020 5/26/2020 5/27/2020 5/28/2020 5/29/2020 5/30/2020 5/31/2020 6/1/2020 6/2/2020 6/3/2020 6/4/2020 6/5/2020 6/6/2020 6/7/2020 6/8/2020 6/9/2020 6/10/2020 6/11/2020 6/12/2020 6/13/2020 6/14/2020 6/15/2020 6/16/2020 6/17/2020 6/18/2020 6/19/2020 6/20/2020 6/21/2020 6/22/2020 6/23/2020 6/24/2020 6/25/2020 6/26/2020 6/27/2020 6/28/2020 6/29/2020 6/30/2020 7/1/2020 7/2/2020

Total No. of Patients

Case 3:20-cv-00594-JCH Document 49-25 Filed 07/09/20 Page 5 of 5

Case 3:20-cv-00594-JCH Document 49-26 Filed 07/09/20 Page 1 of 5
EXHIBIT Y

Case 3:20-cv-00594-JCH Document 49-26 Filed 07/09/20 Page 2 of 5

DATE 3/27/2020 3/28/2020 3/29/2020 3/30/2020 3/31/2020 4/1/2020 4/2/2020 4/3/2020 4/4/2020 4/5/2020 4/6/2020 4/7/2020 4/8/2020 4/9/2020 4/10/2020 4/11/2020 4/12/2020 4/13/2020 4/14/2020 4/15/2020 4/16/2020 4/17/2020 4/18/2020 4/19/2020 4/20/2020 4/21/2020 4/22/2020 4/23/2020 4/24/2020 4/25/2020 4/26/2020 4/27/2020 4/28/2020 4/29/2020 4/30/2020 5/1/2020 5/2/2020 5/3/2020 5/4/2020 5/5/2020 5/6/2020 5/7/2020 5/8/2020 5/9/2020 5/10/2020

Total All CVH Staff Currently Positive

Total CVH Staff

Total CVH Staff Currently Positive

1101

3

1101

1

1101

4

1101

4

1101

4

1101

3

1101

3

1101

3

1101

3

1101

3

1101

3

1101

4

1101

2

1101

2

1101

3

1101

5

1101

4

1101

4

1101

4

1101

2

1101

2

1101

4

1101

4

1101

4

1101

6

1101

8

1101

8

1101

8

1101

8

1101

10

1101

12

1101

13

1101

20

1101

29

1101

28

1086

28

1086

28

1086

28

1086

32

1086

31

1086

31

1086

39

1086

36

1086

38

1086

38

Case 3:20-cv-00594-JCH Document 49-26 Filed 07/09/20 Page 3 of 5

5/11/2020

1086

36

5/12/2020

1086

36

5/13/2020

1086

37

5/14/2020

1086

36

5/15/2020

1086

27

5/16/2020

1086

25

5/17/2020

1086

25

5/18/2020

1086

19

5/19/2020

1086

17

5/20/2020

1086

14

5/21/2020

1086

10

5/22/2020

1086

10

5/23/2020

1086

8

5/24/2020

1086

8

5/25/2020

1086

8

5/26/2020

1086

7

5/27/2020

1086

7

5/28/2020

1086

6

5/29/2020

1086

4

5/30/2020

1086

4

5/31/2020

1086

4

6/1/2020

1098

1

6/2/2020

1098

1

6/3/2020

1098

1

6/4/2020

1098

1

6/5/2020

1098

1

6/6/2020

1098

1

6/7/2020

1098

1

6/8/2020

1098

1

6/9/2020

1098

1

6/10/2020

1098

1

6/11/2020

1098

1

6/12/2020

1098

1

6/13/2020

1098

1

6/14/2020

1098

1

6/15/2020

1098

1

6/16/2020

1098

1

6/17/2020

1098

1

6/18/2020

1098

1

6/19/2020

1098

1

6/20/2020

1098

1

6/21/2020

1098

1

6/22/2020

1098

1

6/23/2020

1098

1

6/24/2020

1098

1

6/25/2020

1098

1

6/26/2020

1098

1

Case 3:20-cv-00594-JCH Document 49-26 Filed 07/09/20 Page 4 of 5

6/27/2020

1098

1

6/28/2020

1098

1

6/29/2020

1098

1

6/30/2020

1098

1

7/1/2020

1098

1

7/2/2020

1098

1

Dates • Total CVH Staff Currently Positive

• Total CVH Staff

3/27/2020 3/28/2020 3/29/2020 3/30/2020 3/31/2020
4/1/2020 4/2/2020 4/3/2020 4/4/2020 4/5/2020 4/6/2020 4/7/2020 4/8/2020 4/9/2020 4/10/2020 4/11/2020 4/12/2020 4/13/2020 4/14/2020 4/15/2020 4/16/2020 4/17/2020 4/18/2020 4/19/2020 4/20/2020 4/21/2020 4/22/2020 4/23/2020 4/24/2020 4/25/2020 4/26/2020 4/27/2020 4/28/2020 4/29/2020 4/30/2020 5/1/2020 5/2/2020 5/3/2020 5/4/2020 5/5/2020 5/6/2020 5/7/2020 5/8/2020 5/9/2020 5/10/2020 5/11/2020 5/12/2020 5/13/2020 5/14/2020 5/15/2020 5/16/2020 5/17/2020 5/18/2020 5/19/2020 5/20/2020 5/21/2020 5/22/2020 5/23/2020 5/24/2020 5/25/2020 5/26/2020 5/27/2020 5/28/2020 5/29/2020 5/30/2020 5/31/2020 6/1/2020 6/2/2020 6/3/2020 6/4/2020 6/5/2020 6/6/2020 6/7/2020 6/8/2020 6/9/2020 6/10/2020 6/11/2020 6/12/2020 6/13/2020 6/14/2020 6/15/2020 6/16/2020 6/17/2020 6/18/2020 6/19/2020 6/20/2020 6/21/2020 6/22/2020 6/23/2020 6/24/2020 6/25/2020 6/26/2020 6/27/2020 6/28/2020 6/29/2020 6/30/2020 7/1/2020 7/2/2020

I I I I I I I I I , I •, • •, • ., • .,

- - - - - - - - - • • • IT I, I I , I I I I

- -T - - r - -r - -r - -

1100 1000 900 800 700 600 500 400 300 200 100
0

Total No. of Staff

Case 3:20-cv-00594-JCH Document 49-26 Filed 07/09/20 Page 5 of 5
DMHAS COVID-19 Daily Synopsis - Total Comparison of All CVH Staff Currently Positive

Case 3:20-cv-00594-JCH Document 49-27 Filed 07/09/20 Page 1 of 5
EXHIBIT 

Case 3:20-cv-00594-JCH Document 49-27 Filed 07/09/20 Page 2 of 5

DATE 3/27/2020 3/28/2020 3/29/2020 3/30/2020 3/31/2020 4/1/2020 4/2/2020 4/3/2020 4/4/2020 4/5/2020 4/6/2020 4/7/2020 4/8/2020 4/9/2020 4/10/2020 4/11/2020 4/12/2020 4/13/2020 4/14/2020 4/15/2020 4/16/2020 4/17/2020 4/18/2020 4/19/2020 4/20/2020 4/21/2020 4/22/2020 4/23/2020 4/24/2020 4/25/2020 4/26/2020 4/27/2020 4/28/2020 4/29/2020 4/30/2020 5/1/2020 5/2/2020 5/3/2020 5/4/2020 5/5/2020 5/6/2020 5/7/2020 5/8/2020 5/9/2020

WFH Total No. of Patients to Total No. of Patients Currently Positive

Total No. of Patients

WFH Positive Patients

213

0

213

0

213

2

212

4

212

5

211

5

211

6

210

6

210

6

210

6

210

4

210

2

209

1

209

1

209

1

209

1

209

1

208

0

208

0

207

0

207

0

206

1

206

1

206

1

204

1

204

1

202

1

202

2

199

3

199

3

199

3

197

3

197

2

197

2

197

1

195

1

195

1

195

1

194

1

194

1

193

1

193

1

192

1

192

1

Case 3:20-cv-00594-JCH Document 49-27 Filed 07/09/20 Page 3 of 5

5/10/2020

192

1

5/11/2020

188

1

5/12/2020

188

1

5/13/2020

187

0

5/14/2020

187

0

5/15/2020

187

0

5/16/2020

187

0

5/17/2020

187

0

5/18/2020

186

0

5/19/2020

185

0

5/20/2020

184

0

5/21/2020

184

0

5/22/2020

183

1

5/23/2020

183

2

5/24/2020

183

2

5/25/2020

183

2

5/26/2020

182

2

5/27/2020

181

2

5/28/2020

181

2

5/29/2020

178

2

5/30/2020

178

2

5/31/2020

178

2

6/1/2020

177

0

6/2/2020

177

0

6/3/2020

177

0

6/4/2020

175

0

6/5/2020

176

0

6/6/2020

176

0

6/7/2020

176

0

6/8/2020

176

0

6/9/2020

176

0

6/10/2020

175

0

6/11/2020

175

0

6/12/2020

175

0

6/13/2020

175

0

6/14/2020

175

0

6/15/2020

175

0

6/16/2020

175

0

6/17/2020

174

0

6/18/2020

174

0

6/19/2020

173

0

6/20/2020

173

0

6/21/2020

173

0

6/22/2020

173

0

6/23/2020

172

0

6/24/2020

172

0

6/25/2020

172

0

Case 3:20-cv-00594-JCH Document 49-27 Filed 07/09/20 Page 4 of 5

6/26/2020

170

0

6/27/2020

170

0

6/28/2020

170

0

6/29/2020

170

0

6/30/2020

169

0

7/1/2020

168

0

7/2/2020

168

0

Case 3:20-cv-00594-JCH Document 49-27 Filed 07/09/20 Page 5 of 5
DMHAS COVID-19 Daily Synopsis - WFH Total No. of Patients to Total No. of Patients Currently Positive
• • • • • •T • • • •
Dates • Total No. of Patients • WFH Positive Patients

3/27/2020 3/28/2020 3/29/2020 3/30/2020 3/31/2020
4/1/2020 4/2/2020 4/3/2020 4/4/2020 4/5/2020 4/6/2020 4/7/2020 4/8/2020 4/9/2020 4/10/2020 4/11/2020 4/12/2020 4/13/2020 4/14/2020 4/15/2020 4/16/2020 4/17/2020 4/18/2020 4/19/2020 4/20/2020 4/21/2020 4/22/2020 4/23/2020 4/24/2020 4/25/2020 4/26/2020 4/27/2020 4/28/2020 4/29/2020 4/30/2020 5/1/2020 5/2/2020 5/3/2020 5/4/2020 5/5/2020 5/6/2020 5/7/2020 5/8/2020 5/9/2020 5/10/2020 5/11/2020 5/12/2020 5/13/2020 5/14/2020 5/15/2020 5/16/2020 5/17/2020 5/18/2020 5/19/2020 5/20/2020 5/21/2020 5/22/2020 5/23/2020 5/24/2020 5/25/2020 5/26/2020 5/27/2020 5/28/2020 5/29/2020 5/30/2020 5/31/2020 6/1/2020 6/2/2020 6/3/2020 6/4/2020 6/5/2020 6/6/2020 6/7/2020 6/8/2020 6/9/2020 6/10/2020 6/11/2020 6/12/2020 6/13/2020 6/14/2020 6/15/2020 6/16/2020 6/17/2020 6/18/2020 6/19/2020 6/20/2020 6/21/2020 6/22/2020 6/23/2020 6/24/2020 6/25/2020 6/26/2020 6/27/2020 6/28/2020 6/29/2020 6/30/2020 7/1/2020 7/2/2020

, • 1, I I I I I I 1 • • • • • •

0

50

100

Toatl No. of Patients

150

200

Case 3:20-cv-00594-JCH Document 49-28 Filed 07/09/20 Page 1 of 5
EXHIBIT 

Case 3:20-cv-00594-JCH Document 49-28 Filed 07/09/20 Page 2 of 5

Date 3/27/2020 3/28/2020 3/29/2020 3/30/2020 3/31/2020 4/1/2020 4/2/2020 4/3/2020 4/4/2020 4/5/2020 4/6/2020 4/7/2020 4/8/2020 4/9/2020 4/10/2020 4/11/2020 4/12/2020 4/13/2020 4/14/2020 4/15/2020 4/16/2020 4/17/2020 4/18/2020 4/19/2020 4/20/2020 4/21/2020 4/22/2020 4/23/2020 4/24/2020 4/25/2020 4/26/2020 4/27/2020 4/28/2020 4/29/2020 4/30/2020 5/1/2020 5/2/2020 5/3/2020 5/4/2020 5/5/2020 5/6/2020 5/7/2020 5/8/2020 5/9/2020 5/10/2020

WFH Staff - COVID-19 Daily Synopsis

Total No. of Staff(Cumulative)

Total No. of Staff Currently Positive

580

0

580

0

580

0

580

0

580

0

580

0

580

4

580

1

580

1

580

2

580

7

580

8

580

8

580

9

580

9

580

10

580

11

580

12

580

9

580

6

580

6

580

6

580

6

580

6

580

10

580

10

580

10

580

11

580

11

580

11

580

11

580

13

580

5

580

5

580

5

580

5

580

5

580

5

580

3

580

3

580

2

580

2

580

2

580

2

580

2

Case 3:20-cv-00594-JCH Document 49-28 Filed 07/09/20 Page 3 of 5

5/11/2020

580

3

5/12/2020

580

2

5/13/2020

580

2

5/14/2020

580

1

5/15/2020

580

1

5/16/2020

580

1

5/17/2020

580

1

5/18/2020

580

1

5/19/2020

580

1

5/20/2020

580

1

5/21/2020

580

1

5/22/2020

580

1

5/23/2020

580

1

5/24/2020

580

1

5/25/2020

580

1

5/26/2020

580

0

5/27/2020

580

0

5/28/2020

580

0

5/29/2020

580

0

5/30/2020

580

2

5/31/2020

580

2

6/1/2020

580

0

6/2/2020

580

0

6/3/2020

580

0

6/4/2020

580

1

6/5/2020

580

1

6/6/2020

580

1

6/7/2020

580

1

6/8/2020

580

1

6/9/2020

580

2

6/10/2020

580

3

6/11/2020

580

2

6/12/2020

580

2

6/13/2020

580

2

6/14/2020

580

2

6/15/2020

580

2

6/16/2020

580

2

6/17/2020

580

3

6/18/2020

580

2

6/19/2020

580

2

6/20/2020

580

2

6/21/2020

580

2

6/22/2020

580

2

6/23/2020

580

2

6/24/2020

580

2

6/25/2020

580

2

6/26/2020

580

2

Case 3:20-cv-00594-JCH Document 49-28 Filed 07/09/20 Page 4 of 5

6/27/2020

580

0

6/28/2020

580

0

6/29/2020

580

0

6/30/2020

580

0

7/1/2020

580

0

7/2/2020

580

0

Dates
•Total No. of Staff Currently Positive

•Total No. of Staff(Cumulative)

3/27/2020 3/28/2020 3/29/2020 3/30/2020 3/31/2020
4/1/2020 4/2/2020 4/3/2020 4/4/2020 4/5/2020 4/6/2020 4/7/2020 4/8/2020 4/9/2020 4/10/2020 4/11/2020 4/12/2020 4/13/2020 4/14/2020 4/15/2020 4/16/2020 4/17/2020 4/18/2020 4/19/2020 4/20/2020 4/21/2020 4/22/2020 4/23/2020 4/24/2020 4/25/2020 4/26/2020 4/27/2020 4/28/2020 4/29/2020 4/30/2020 5/1/2020 5/2/2020 5/3/2020 5/4/2020 5/5/2020 5/6/2020 5/7/2020 5/8/2020 5/9/2020 5/10/2020 5/11/2020 5/12/2020 5/13/2020 5/14/2020 5/15/2020 5/16/2020 5/17/2020 5/18/2020 5/19/2020 5/20/2020 5/21/2020 5/22/2020 5/23/2020 5/24/2020 5/25/2020 5/26/2020 5/27/2020 5/28/2020 5/29/2020 5/30/2020 5/31/2020 6/1/2020 6/2/2020 6/3/2020 6/4/2020 6/5/2020 6/6/2020 6/7/2020 6/8/2020 6/9/2020 6/10/2020 6/11/2020 6/12/2020 6/13/2020 6/14/2020 6/15/2020 6/16/2020 6/17/2020 6/18/2020 6/19/2020 6/20/2020 6/21/2020 6/22/2020 6/23/2020 6/24/2020 6/25/2020 6/26/2020 6/27/2020 6/28/2020 6/29/2020 6/30/2020 7/1/2020 7/2/2020

T - ---, - ---, - - • - - - -

- - - - • I I I I I I I I • • . T • . T I I I I I I I T • T • • • • • • • - - - - T - • - - - T - ---r - ---r - - - - - - - T

0

100

200

300

Total No. of Staff

400

500

DMHAS COVID-19 Daily Synopsis - WFH Staff Comparison
600

Case 3:20-cv-00594-JCH Document 49-28 Filed 07/09/20 Page 5 of 5

Case 3:20-cv-00594-JCH Document 49-29 Filed 07/09/20 Page 1 of 4
EXHIBIT BB

Case 3:20-cv-00594-JCH Document 49-29 Filed 07/09/20 Page 2 of 4

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

THOMAS WILKES, BARBARA FLOOD, VINCENT ARDIZZONE, GAIL LITSKY, CARSON MUELLER,
On behalf of themselves and all other persons similarly situated, Plaintiffs
V.
NED LAMONT, Governor MIRIAM E. DELPHIN-RITTMAN, Commissioner ofDMHAS, HAL SMITH, CEO of Whiting Forensic Hospital, LAKISHA HYATT, CEO Connecticut Valley Hospital, In their official capacities,
Defendants

CIVIL NO. 3:20CV594-JCH JULY 8, 2020

DECLARATION OF HAL SMITH The undersigned declarant, Hal Smith, being duly sworn, hereby deposes and declares under the pains and penalties of perjury, pursuant to 28 USC §1746, that: 1. I am employed by the State of Connecticut Department of Mental Health and Addiction Services as the Chief Executive Officer at Whiting Forensic Hospital ("WFH") in Middletown, CT. I have held this position since June 1, 2018. 2. I make this Declaration based upon personal knowledge, and I understand that it will be submitted to this Court in connection with the above-captioned case in support of the Defendants' Opposition to the Plaintiffs' Motion for Preliminary Injunction.

Case 3:20-cv-00594-JCH Document 49-29 Filed 07/09/20 Page 3 of 4 3. WFH is a state-operated inpatient facility providing services to individuals involved in
the criminal justice system as well as through the civil commitment process. 4. As part ofmy job duties, I am responsible for the management and oversight of the daily
clinical operations and patient earn at WFH. 5. WFH has protocols in place with regard to the testing of staff in response to the COVID-
19 pandemic. 6. As of June 22, 2020, testing for COVID-19 is mandatory at for direct care staff and those
who regularly interact with patients at WFH.
2

Case 3:20-cv-00594-JCH Document 49-29 Filed 07/09/20 Page 4 of 4 DECLARATION
Pursuant to Conn. Gen. Stat. §§ 1-24a, 53a-157b, and 28 U.S.C. §1746, I declare under the pains and penalties of pe1jury that the foregoing statements are true and accurate to the best of my knowledge and belief.
Dated this ,,.D day of July, 2020. Hal Smith, CE Whiting Forens1
3

 
 Case 3:20-cv-00594-JCH Document 92 Filed 12/18/20 Page 1 of 21

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

THOMAS WILKES, et al.,

:

on behalf of themselves and all other :

persons similarly situated,

:

Plaintiffs,

:

:

v.

:

:

NED LAMONT, GOVERNOR, et al. :

Defendants.

:

CIVIL CASE NO. 3:20-cv-594 (JCH)
DECEMBER 18, 2020

RULING ON MOTION TO DISMISS (DOC. NO. 32) I. INTRODUCTION
Plaintiffs, five people confined in psychiatric hospitals in Connecticut, bring this action under the Americans with Disabilities Act (the “ADA”), section 504 of the Rehabilitation Act, section 1983 of title 42 of the U.S. Code, and section 2241 of title 28 of the U.S. Code. See Am. Compl. (Doc. No. 10). They seek, on behalf of themselves and all similarly situated individuals, various forms of declaratory and injunctive relief, as well as a writ of habeas corpus. See id. at 25-27 (Prayer for Relief). Plaintiffs allege in their Amended Class Action Complaint and Petition for a Writ of Habeas Corpus (the “Amended Complaint”) that the defendants, various state officials with authority over the operation of Connecticut’s inpatient psychiatric facilities, have not adopted adequate measures to protect plaintiffs and similarly situated persons from the COVID-19 pandemic. See id. ¶¶ 10-14, 66-88.
Before the court is the defendants’ Motion to Dismiss the Amended Complaint. See Mot. to Dismiss (Doc. No. 32). The defendants ask the court to decline to hear the plaintiffs’ claims on account of the primary jurisdiction doctrine, to abstain from

Case 3:20-cv-00594-JCH Document 92 Filed 12/18/20 Page 2 of 21
exercising jurisdiction over certain of the plaintiffs’ claims under the doctrine announced in Colorado River Water Conservation District v. United States, 424 U.S. 800 (1976) (“Colorado River”), and to dismiss the portion of the Amended Complaint seeking a writ of habeas corpus for failure to exhaust state remedies. Id. at 1.
For the reasons below, the Motion to Dismiss is denied in part and granted in part. The portion of the Amended Complaint petitioning for a writ of habeas corpus is dismissed. II. BACKGROUND
The plaintiffs in this case are five individuals confined at Connecticut Valley Hospital (“CVH”) and Whiting Forensic Hospital (“WFH”), two state-operated inpatient psychiatric facilities in Connecticut. Am. Compl. ¶¶ 1-2, 5-9. Thomas Wilkes, 67 years old, is civilly committed in the Battell Hall 3 South area of CVH. Id. ¶ 5. As of the filing of the Amended Complaint, Mr. Wilkes was in quarantine after experiencing symptoms consistent with COVID-19, and after his roommate tested positive for COVID-19. Id. Barbara Flood, 64 years old, suffers from kidney failure and is civilly committed in the Woodward Hall area of CVH, despite having been assessed as “discharge-ready,” because of difficulties in securing dialysis treatment outside CVH. Id. ¶ 6. Vincent Ardizzone, 58 years old, suffers from emphysema and Stage IV prostate cancer and is committed as an acquittee in the Dutcher North 3 area of WFH under section 17a-582 of the Connecticut General Statutes, despite having been approved for temporary leave. Id. 7. Gail Litsky, 53 years old, experiences unspecified health conditions that put her at high-risk for contracting COVID-19 and is committed as an acquittee in the Dutcher North 2 area of WFH under section 17a-582. Id. ¶ 8. Carson Mueller, 45 years old, is
2

Case 3:20-cv-00594-JCH Document 92 Filed 12/18/20 Page 3 of 21
committed as an acquittee in the Dutcher South 3 area of WFH under section 17 pro se582, despite having “been in psychiatric remission for many years.” Id. ¶ 9.
Certain features of CVH and WFH present obstacles to implementing precautions for curbing the spread of COVID-19. See id. ¶¶ 18, 20, 43. According to plaintiffs, “[a]lmost all patients on every unit in both CVH and WFH live in close contact with 15-20 other patients and 5-10 staff at any one time.” Id. ¶ 43. As of the filing of the Amended Complaint, approximately 209 patients resided in the general psychiatry division of CVH; the Amended Complaint does not report or estimate the total populations of CVH and WFH. See id. ¶ 16.
On March 24, 2020, the Connecticut Department of Mental Health and Addiction Services (“DMHAS”) announced that a staff member at CVH had tested positive for COVID-19. Id. ¶ 33. Two days later, DMHAS announced that a patient at CVH also tested positive. Id. ¶ 34. In the ensuing weeks, COVID-19 spread throughout CVH and WFH. Id. ¶¶ 37-40. By April 28, 2020, there were confirmed COVID-19 cases for patients or staff in every building within CVH and WFH. Id. ¶ 40. Several patients were transferred to Middlesex Hospital on account of the severity of their symptoms. Id.
On April 30, 2020, the outbreak within the hospitals turned lethal when a patient at CVH died from COVID-19. Id. ¶ 41. That same day, plaintiffs commenced this case by filing their initial Complaint. See Compl. (Doc. No. 1). Plaintiffs subsequently filed their Amended Complaint on May 7, 2020.1 See Am. Compl.
1 Plaintiffs moved for a Preliminary Injunction on June 8, 2020, but later withdrew that Motion. See Mot. for Prelim. Inj. (Doc. No. 24); Order (Doc. No. 58) (granting plaintiffs' oral Motion to withdraw their Motion for a Preliminary Injunction).
3

Case 3:20-cv-00594-JCH Document 92 Filed 12/18/20 Page 4 of 21
In the Amended Complaint, plaintiffs name as defendants Connecticut Governor Ned Lamont, DMHAS Commissioner Miriam E. Delphin-Rittmon, WFH CEO Hal Smith, and CVH CEO Lakisha Hyatt, in their official capacities only. Id. ¶¶ 10-13. Plaintiffs allege that the defendants owe a duty to provide safe conditions at CVH and WFH, and that they have violated this duty by failing to take sufficient measures to protect plaintiffs and other patients from COVID-19. Id. ¶ 64.
Count One asserts a claim under the substantive component of the Due Process Clause of the Fourteenth Amendment for failure to ensure safe conditions at psychiatric facilities. Id. ¶¶ 65-74 (citing Youngberg v. Romeo, 457 U.S. 307, 314-25 (1982)). Counts Two and Three asserted claims for discrimination on the basis of physical or mental impairments under Title II of the ADA and section 504 of the Rehabilitation Act. Id. ¶¶ 75-88.
In their Prayer for Relief, plaintiffs seek declarations that defendants have violated plaintiffs’ rights, as well as various forms of injunctive relief. See id. at 25-27 (Prayer for Relief). The types of injunctive relief sought by plaintiffs range from orders directing regular testing of patients and cleaning of facilities, to orders “suspending all commitments for civil patients, competency restoration patients, [Department of Correction] transfers and acquittees” and directing the “[i]mmediate[ ] discharge [of] patients to the most integrated setting wherever possible, and where not possible to do so immediately, [the provision of] temporary placements.” Id. Plaintiffs also petition for a writ of habeas corpus ordering the defendants to “release a sufficient number of patients to enable the remaining patients to practice safe social distancing and to
4

Case 3:20-cv-00594-JCH Document 92 Filed 12/18/20 Page 5 of 21
enable staff to maintain the hospital[s] in constitutionally safe conditions of confinement.” Id.
On June 11, 2020, the defendants moved to dismiss the Amended Complaint. See Mot. to Dismiss. The defendants argue that plaintiffs’ request for relief via a writ of habeas corpus should be dismissed for failure to exhaust state remedies, that the court should decline to address plaintiffs’ claims at this time on account of the primary jurisdiction doctrine, and that the court should abstain under Colorado River from plaintiffs’ claims pertaining to assessment and discharge. See Mem. in Supp. of Mot. to Dismiss (“Defs.’ Mem.”) (Doc. No. 33) at 8, 13, 17. Plaintiffs filed their Opposition to defendants’ Motion on July 2, 2020. See Mem. of Law in Supp. of Pls.’ Opp’n to Defs.’ Mot. to Dismiss (“Pls.’ Opp’n”) (Doc. No. 47). Subsequently, on July 20, 2020, plaintiffs filed a Supplemental Brief addressing defendants’ arguments concerning exhaustion of state remedies. See Suppl. Br. in Supp. of Pls.’ Opp’n to Defs.’ Mot. to Dismiss (“Pls.’ Suppl. Br.”) (Doc. No. 62); Order (Doc. No. 61) (granting leave to file). The defendants filed a Reply on July 30, 2020. See Defs.’ Reply to Pls.’ Suppl. Br. Regarding Defs.’ Mot. to Dismiss (“Defs.’ Reply”). III. STANDARD OF REVIEW
Under Federal Rule of Civil Procedure 12(b)(1), “[a] case is properly dismissed for lack of subject matter jurisdiction . . . when the district court lacks the statutory or constitutional power to adjudicate it.” Makarova v. United States, 201 F.3d 110, 113 (2d Cir. 2000) (citing Fed. R. Civ. P. 12(b)(1)). A plaintiff bears the burden of proving the existence of subject matter jurisdiction by a preponderance of the evidence. Id. When determining whether to dismiss for lack of subject matter jurisdiction, a court may
5

Case 3:20-cv-00594-JCH Document 92 Filed 12/18/20 Page 6 of 21
consider affidavits. All. for Envtl. Renewal, Inc. v. Pyramid Crossgates Co., 436 F.3d 82, 88 (2d Cir. 2006). A court also “has discretion to hold a hearing to resolve factual disputes that bear on the court’s jurisdiction.” Saleh v. Sulka Trading, 957 F.3d 348, 353 (2d Cir. 2020). However, a court must otherwise “accept as true all material facts alleged in the complaint and draw all reasonable inferences in the plaintiff’s favor.” Id.
To withstand a motion to dismiss under Federal Rule of Civil Procedure 12(b)(6), “a complaint must contain sufficient factual matter, accepted as true, to ‘state a claim to relief that is plausible on its face.’” Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009) (quoting Bell Atl. Corp. v. Twombly, 550 U.S. 544, 570 (2007)). “The plausibility standard is not akin to a ‘probability requirement,’ but it asks for more than a sheer possibility that a defendant has acted unlawfully.” Id. Reviewing a motion to dismiss under Rule 12(b)(6), the court liberally construes the claims, accepts the factual allegations in a complaint as true, and draws all reasonable inferences in the non-movant’s favor. See La Liberte v. Reid, 966 F.3d 79, 85 (2d Cir. 2020). However, the court does not credit legal conclusions or “[t]hreadbare recitals of the elements of a cause of action.” Iqbal, 556 U.S. at 678. IV. DISCUSSION
A. Primary Jurisdiction Under the doctrine of primary jurisdiction, if a “claim requires the resolution of issues which, under a regulatory scheme, have been placed within the special competence of an administrative body,” a court may “suspend[ ]” the “judicial process . . . pending referral of such issues to the administrative body for its views.” Tassy v. Brunswick Hosp Ctr., Inc., 296 F.3d 65, 73 (2d Cir. 2002) (quoting United States v. W.
6

Case 3:20-cv-00594-JCH Document 92 Filed 12/18/20 Page 7 of 21
Pac. R.R. Co., 352 U.S. 59, 63-64 (1956)). The doctrine “is concerned with promoting proper relationships between the courts and administrative agencies charged with particular regulatory duties” and “aim[s] to allocate initial decision-making responsibility between courts and agencies and to ensure that they do not work at cross-purposes.” Ellis v. Tribune Television Co., 443 F.3d 71, 81 (2d Cir. 2006).
“No fixed formula exists for applying the doctrine of primary jurisdiction.” Id. (quoting W. Pac. R.R. Co., 352 U.S. at 64). The Second Circuit has “emphasize[d] that primary jurisdiction is a discretionary doctrine,” Tassy, 296 F.3d at 72, and has identified four factors bearing on the application of the doctrine: (1) “whether the question at issue is within the conventional experience of judges or whether it involves technical or policy considerations within the agency’s particular field of expertise”; (2) “whether the question at issue is particularly within the agency’s discretion”; (3) “whether there exists a substantial danger of inconsistent rulings”; and (4) “whether a prior application to the agency has been made,” Ellis, 443 F.3d at 81 (citation omitted).
Courts usually--if not exclusively--invoke the doctrine when economic or financial regulations are at issue. See, e.g., id. at 89-90 (involving the Federal Communications Commission’s power to grant waivers to its licensing rules); MFS Sec. Corp. v. N.Y. Stock Exch., 277 F.3d 613, 621-22 (2d Cir. 2002) (involving the power of the Securities & Exchange Commission to adjudicate challenges to disciplinary actions imposed by the New York Stock Exchange); see also Nw. Airlines, Inc. v. Cty. of Kent, Mich., 510 U.S. 355, 366 n.10 (1994) (suggesting that “[t]he reasonableness of the Airport’s rates might have been referred, prior to any court’s consideration, to the Department of Transportation under the primary jurisdiction doctrine”). Indeed, the recent Order on
7

Case 3:20-cv-00594-JCH Document 92 Filed 12/18/20 Page 8 of 21
which the defendants place heavy emphasis in their Memorandum applies the primary jurisdiction doctrine to claims of unsafe working conditions at meat processing plants. Rural Cmty. Workers All. v. Smithfield Foods, Inc., No 5:20-CV-6063 (DGK), 2020 WL 2145350, at *1 (W.D. Mo. May 5, 2020).
In this case, the defendants urge the court to refrain from addressing the plaintiffs’ claims of unsafe conditions of confinement under the Fourteenth Amendment, the ADA, and the Rehabilitation Act until the court “has available to it the considered judgement” of the CDC, DPH, and DMHAS. See Defs.’ Mem. at 12-13. The defendants suggest that that the court may refer the case to the CDC or DPH, and that the plaintiffs may file complaints with these agencies or an administrative grievance with DMHAS. See id.
The first two primary jurisdiction factors--“whether the question at issue is within the conventional experience of judges or whether it involves technical or policy considerations within the agency’s particular field of expertise” and “whether the question at issue is particularly within the agency’s discretion”--weigh heavily against invoking the doctrine. At issue in this case is whether there has been “a substantial departure from accepted professional judgment, practice, or standards,” such that the conditions at Connecticut’s inpatient psychiatric hospitals violate the plaintiffs’ rights under the Due Process Clause of the Fourteenth Amendment. Youngberg, 457 U.S. at 323.
The court has no doubt that the CDC, DPH, and DMHAS possess expertise concerning what constitutes “accepted professional judgment, practice, or standards” relevant to the parties and issues in this case. However, the task of assessing plaintiffs’
8

Case 3:20-cv-00594-JCH Document 92 Filed 12/18/20 Page 9 of 21
claims requires determining whether their fundamental rights under the Constitution have been violated. This question can only be answered through consideration of both case law interpreting the Constitution and facts relevant to what constitutes “accepted professional judgment, practice, or standards.” The former component of this inquiry involves the very core of “the conventional experience of judges” and is not “particularly within [any] agency’s discretion.”
In this respect, the court finds it notable that the defendants have not identified a single case invoking the doctrine of primary jurisdiction in connection with claims alleging violations of individual rights under the Due Process Clause of the Fourteenth Amendment, let alone under any other constitutional provision. The defendants make much of a recent Order of the U.S. District Court for the Western District of Missouri applying the primary jurisdiction doctrine in the context of the COVID-19 pandemic. Defs.’ Mem. at 10-11. However, as explained above, that Order involves claims of unsafe working conditions at meat processing plants. Rural Cmty. Workers All., 2020 WL 2145350, at *1. It falls firmly within the line of cases applying the doctrine of primary jurisdiction in cases involving economic regulations.
The defendants’ position, if accepted, would effectively erect an exhaustion requirement for all claims involving complex or technical facts, regardless as to whether such claims involve questions of individual rights protected by the Constitution. The primary jurisdiction doctrine exists because an ad hoc quasi-exhaustion requirement may sometimes be desirable and tolerable when issues involving complex or technical factual issues have been committed to the discretion of an agency, but the court doubts
9

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whether such an arrangement would ever be acceptable in a case involving alleged violations of constitutional rights.
The third and fourth primary jurisdiction factors--“whether there exists a substantial danger of inconsistent rulings” and “whether a prior application to the agency has been made”--offer little guidance in this case. The defendants assert that “ferreting through these complicated, technical and evolving factual issues, and electing to, in effect, choose winners and losers amongst the options presented for those charged with operating [the] facilities” creates a substantial danger of inconsistent rulings, but they provide no further reasoning or citations in support of this statement. See Defs.’ Mem. at 12. With respect to whether a prior application has been made to any of the agencies, the defendants acknowledge that “it appears no formal complaints have been filed”, but suggest that this factor should not weigh heavily in the court’s analysis, because “federal courts themselves may initiate such referrals.” See id. at 12-13.
Even assuming that the third and fourth factors were to favor the defendants’ position, the court finds that the first and second factors outweigh these considerations for the reasons discussed above. Therefore, the court denies the defendants’ Motion to Dismiss as to this issue and declines to exercise its discretion to apply the doctrine of primary jurisdiction.
B. Colorado River Abstention The abstention doctrines recognize “a few extraordinary and narrow exceptions to a federal court’s duty to exercise its jurisdiction.” Niagara Mohawk Power Corp. v. Hudson River-Black River Regulating Dist., 673 F.3d 84, 100 (2d Cir. 2012) (quoting Woodford v. Cmty. Action Agency of Greene Cty., Inc., 239 F.3d 517, 522 (2d Cir.
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2001)). “Under the Colorado River exception the court may abstain in order to conserve federal judicial resources only in ‘exceptional circumstances,’ where the resolution of existing concurrent state-court litigation could result in ‘comprehensive disposition of litigation.’” Woodford, 239 F.3d at 522 (quoting Colorado River, 424 U.S. at 813).
Courts consider six factors when determining whether to abstain under Colorado River: (1) “whether the controversy involves a res over which one of the courts has assumed jurisdiction”; (2) “whether the federal forum is less inconvenient than the other for the parties”; (3) “whether staying or dismissing the federal action will avoid piecemeal litigation”; (4) “the order in which the actions were filed, and whether proceedings have advanced more in one forum than in the other”; (5) “whether federal law provides the rule of decision”; and (6) “whether the state procedures are adequate to protect the plaintiff’s federal rights.” Id. (citations omitted). “No one factor is necessarily determinative; a carefully considered judgment taking into account both the obligation to exercise jurisdiction and the combination of factors counseling against the exercise is required.” Id. (quoting Moses H. Cone Mem’l Hosp. v. Mercury Constr. Corp., 460 U.S. 1, 15-16 (1983)).
The Second Circuit has indicated that abstention under Colorado River is disfavored, emphasizing that “the balance [is] heavily weighted in favor of the exercise of jurisdiction,” and that “[o]nly the clearest of justifications will warrant dismissal.” Id. (quoting Moses H. Cone Mem’l Hosp., 460 U.S. at 15-16). Consistent with this approach, the Second Circuit has instructed that “the facial neutrality of a factor is a basis for retaining jurisdiction, not for yielding it.” Id.
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Here, the defendants ask the court to abstain from addressing the plaintiffs’ claims for relief related to assessment and discharge, in light of Drummer v. State of Connecticut, et al., MMX-CV-18-5010661-S.2 Defs.’ Mem. at 15. According to the defendants, that case, which was filed in Connecticut Superior Court on January 25, 2018, seeks forms of relief that are “directly comparable” to those sought in the instant case. See id. In fact, the defendants charge that “[a]n honest assessment of the juxtaposition of the two sets of claims and prayers for relief in these lawsuits legitimately raises the concern that the Covid-19 pandemic may be being exploited in the second lawsuit as a convenient basis for pursuing a deinstitutionalization agenda.” Id.
In Drummer, a person confined at CVH filed a putative class action alleging that she and others are unnecessarily being kept in psychiatric inpatient facilities, in violation of Connecticut law. Ex. A, Pls.’ Opp’n (“Drummer Compl.”) (Doc. No. 47-1) ¶¶ 1-9. The Complaint in Drummer asserts claims on behalf of two classes: (1) “[a]ll psychiatric inpatients involuntarily civilly committed to a state-operated psychiatric facility who within a reasonable degree of medical certainty, are likely to not meet commitment standards before their annual or biannual review,” but who have not received periodic reviews of their status; and (2) “[a]ll psychiatric inpatients involuntarily civilly committed to a state-operated psychiatric facility, who have been declared discharge ready by their
2 The plaintiffs and defendants both attached copies of materials filed in Drummer to their memoranda opposing and supporting the defendants' Motion to Dismiss, which the court may consider in determining whether to dismiss under Federal Rule of Civil Procedure 12(b)(1). See All. for Envtl. Renewal, Inc., 436 F.3d at 88 (recognizing that courts may consider certain materials outside a complaint when deciding a motion under Rule 12(b)(1). Additionally, the court may take judicial notice of materials filed in Drummer because they are matters of public record. See Giraldo v. Kessler, 694 F.3d 161, 164 (2d Cir. 2012).
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treatment teams or not meeting commitment standards by the probate court, but who remain in the facility . . . because of a lack of appropriate placements, supports and services in the community.” Id. ¶ 9. The forms of relief requested include “declaratory judgment that the state’s failure to establish and maintain a mental health system that provides adequate community supports and services . . . violates the Connecticut Patients’ Bill of Rights”, and an injunction ordering periodic reviews aimed at facilitating discharge of individuals involuntarily civilly committed in Connecticut’s inpatient psychiatric facilities. Id. at 19-22 (Request for Relief).
On July 12, 2019, the Connecticut Superior Court denied the Drummer plaintiff’s Motion for Class Certification, as well as the defendants’ Motion to Dismiss the Complaint as moot. Ex. B., Pls.’ Opp’n (Doc. No. 47-2) at 2. The defendants’ Motion to Dismiss the Complaint in Drummer for failure to state a claim, which was filed on February 6, 2020, remains pending. See Superior Court Case Look-up: Docket Number Search, State of Conn. Judicial Branch, http://civilinquiry.jud.ct.gov/GetDocket.aspx (search full docket number field for “MMX-CV-18-5010661-S”).
With respect to the first two Colorado River factors, the defendants readily acknowledge that “[t]here is no ‘res’ at issue here,” and, though the defendants complain that it is inconvenient for them to “defend[ ] their current discharge practices in two forums at the same time,” they do not argue that the District of Connecticut is an inconvenient forum in and of itself. See Defs.’ Mem. at 16. The Second Circuit has held that “the absence of a res and the equivalent convenience of the federal forum are factors that favor retention of jurisdiction.” Woodford, 239 F.3d at 523.
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The third and fifth factors--the risk of piecemeal litigation and duplicative proceedings, and whether federal law provides the rule decision--also weigh against abstention. There is no doubt that federal law provides the rule of decision in the current case, regardless as to whether Connecticut law parallels federal law concerning the rights of individuals confined in inpatient psychiatric hospitals. Further, while it is true that there is substantial overlap between the relief sought in both cases, it is not clear that abstaining in the instant case would avoid piecemeal litigation. Even assuming for the sake of argument that the Drummer plaintiff might successfully file a second motion for class certification, the plaintiffs in the current case seek relief that they argue has become necessary in light of the COVID-19 pandemic. See Am. Compl. ¶¶ 2, 60, 64, 81, 88. In contrast, Drummer was filed prior to the outbreak of COVID-19. See Drummer Compl.
Even assuming that the two remaining factors--the order in which the cases were filed, and whether state procedures are adequate to protect the plaintiffs’ federal rights-favor the defendants, this is not enough to justify abstention in this case. Given the Second Circuit’s clear indications that Colorado River abstention is disfavored, and that “[o]nly the clearest of justifications will warrant dismissal,” the court concludes that abstention is not warranted here. See Woodford, 239 F.3d at 522(quoting Moses H. Cone Mem’l Hosp., 460 U.S. at 15-16). Particularly given that it is not clear that there is a risk of piecemeal litigation, and given that federal law--including interpretations of the Fourteenth Amendment--provides the rule of decision, the “exceptional circumstances” needed for application of Colorado River abstention are absent in this case. Id. (citing Colorado River, 424 U.S. at 813). Therefore, the court denies the
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defendants’ Motion to Dismiss as to the defendants’ argument that the court should abstain from exercising jurisdiction under Colorado River.
C. Habeas Corpus Section 2241 of title 28 of the U.S. Code provides that “[w]rits of habeas corpus may be granted by . . . the district courts.” 28 U.S.C. § 2241(a). In the Second Circuit, individuals in custody under federal authority may petition for writs of habeas corpus under section 2241 challenging the conditions of their confinement, as opposed to the underlying reason for their confinement. See Thompson v. Choinski, 525 F.3d 205, 209 (2d Cir. 2008). At least one judge in this District has recently held that individuals confined pursuant to state authority may petition under section 2241 to challenge conditions of confinement. 3 McPherson v. Lamont, 457 F. Supp. 3d 67, 75-76 (D. Conn. 2020). In James v. Walsh, 308 F.3d 162 (2d Cir. 2002), however, the Second Circuit held that state prisoners must file both challenges to the imposition and execution of sentences under section 2254 of title 28 of the U.S. Code.4 Id. at 166-67. Although James addressed a claim that an individual’s release date had been improperly calculated, as opposed to a challenge to conditions of confinement, and although
3 Although petitions for writs of habeas corpus are usually filed by individuals in custody pursuant to criminal judgments, i.e., prisoners, it is well settled that "there are other types of state court judgments pursuant to which a person may be held in custody within the meaning of the federal habeas statute," including judgment ordering the confinement of individuals in psychiatric facilities. See Duncan v. Walker, 533 U.S. 167, 176 (2001).
4 The Second Circuit has characterized challenges to conditions of confinement filed by prisoners as challenges to the "execution" of their sentences, as opposed to the "imposition" of their sentences. See Thompson, 525 F.3d at 209 (citations omitted).
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James did not involve a petitioner confined in a psychiatric facility, the Circuit’s opinion includes language strongly suggesting that all habeas petitions submitted by individuals in state custody must be filed under section 2254. See id. In support of its holding that the petitioner’s challenge to the duration of his sentence needed to be brought under section 2254, rather than section 2241, the Circuit reasoned that “[h]ad Congress intended to make Section 2241 available to state prisoners, it would likely have required, in the interests of comity, that state prisoners challenging the execution of their state-imposed sentences first exhaust their remedies in the state courts.” Id. at 167.
Whether a habeas petition must be brought under section 2241 or 2254 determines whether exhaustion of state remedies is jurisdictional or discretionary. Subsection (b)(1) of section 2254 prohibits courts from granting habeas petitions “unless it appears that [ ] the applicant has exhausted the remedies available in the courts of the State; or [ ] there is an absence of available State corrective process; or [ ] circumstances exist that render such process ineffective to protect the rights of the applicant.” 28 U.S.C. § 2254(b)(1). Although section 2241 does not include a statutory exhaustion requirement, see 28 U.S.C. § 2241, petitions filed under section 2241 are nevertheless subject to a judicially created discretionary exhaustion requirement, see McPherson, 457 F. Supp. 3d at 75-76 (collecting cases); see also Carmona v. U.S Bureau of Prisons, 243 F.3d 629, 633-34 (2d Cir. 2001) (recognizing exhaustion requirement for federal prisoner proceeding under section 2241 who had not exhausted federal administrative remedies). Failure to exhaust state remedies may be excused under section 2241 if doing so would be futile, if state remedies are inadequate, or if
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pursuing state remedies would cause plaintiffs undue prejudice. See McPherson, 457 F. Supp. 3d at 76.
Here, plaintiffs initially suggested that “there is no need for the Court to reach this issue” because--according to the plaintiffs--whether their petition for writ of habeas corpus is properly before the court “is mostly academic for purposes of this case.” Pls.’ Opp’n at 14. Perhaps realizing that a writ of habeas corpus might be necessary for certain forms of relief, plaintiffs subsequently filed a Supplemental Brief arguing that “[e]xhaustion in state court or with DMHAS would be futile and inadequate due to both limitation of remedies and delay, and would cause Plaintiff’s [sic] undue prejudice.” Pls.’ Suppl. Br. at 5.
In their Supplemental Brief, plaintiffs acknowledge that individuals confined in inpatient psychiatric facilities in Connecticut may challenge the conditions of their confinement under the Connecticut Patients’ Bill of Rights, which is codified at sections 17a-540 through 17a-550 of the Connecticut General Statutes. Id. at 6. Section 17a550 provides that “[a]ny person aggrieved by a violation of sections 17a-540 to 17a-549, inclusive, may petition . . . for appropriate relief, including temporary and permanent injunctions, or may bring a civil action for damages.” Conn. Gen. Stat. § 17a-550. Plaintiffs do not address whether “appropriate relief” under section 17a-550 could encompass the relief sought in this case. See Pls.’ Suppl. Br. at 6.
Instead, plaintiffs focus their attention on whether the text of two Connecticut habeas statutes, sections 52-466(a)(1) and 17a-524 of the Connecticut General Statutes, permit them to petition for writs of habeas corpus without challenging their
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commitment orders.5 Section 52-466(a)(1) applies to a “person whose custody is in question [who] is claimed to be illegally confined or deprived of such person’s liberty.” Conn. Gen. § 52-466(a)(1). Section 17a-524 applies to a “person confined in a hospital for psychiatric disabilities” challenging the “illegality or invalidity of the [person’s] commitment.” Conn. Gen. § 17a-524.
While the court understands how the plaintiffs can interpret the text of these provisions, without additional context, as “requir[ing] a challenge to the legality of confinement as a prerequisite,” Pls.’ Suppl. Br. at 8, such an interpretation is not necessarily compelled by the language of these statutes. To begin with, the Second Circuit in James interpreted analogous language in section 2254 permitting the filing of a habeas petition “on the ground that [a petitioner] is in custody in violation of the Constitution or laws or treaties of the United States” as authorizing petitions challenging both the imposition and execution of state sentences. 308 F.3d at 166-67. More importantly, the Connecticut Supreme Court has addressed a challenge to conditions of confinement raised via habeas petition, albeit without stating whether a challenge to the reason for confinement was a prerequisite, and without identifying the specific statutory authority for the petition. See Faraday v. Comm’r of Corr., 288 Conn. 326, 328-29 (2008). Further, the Connecticut Appellate Court has specifically identified section 52466(a)(2) as authorizing habeas petitions challenging conditions of confinement. State v. Carney, 184 Conn. App. 456, 466-67 (2018). Section 52-466(a)(2) states that
5 Plaintiffs quote the text of these statutes but do not cite any cases in support of their argument that they cannot petition for writs of habeas corpus in state court without challenging their commitment orders. See Pls.' Suppl. Br. at 6-8.
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prisoners may file habeas petitions “claiming illegal confinement or deprivation of liberty”--the same language used in section 52-466(a)(1), which plaintiffs acknowledge applies to individuals confined in psychiatric facilities. Conn. Gen. Stat. § 52-466(a); see Pls.’ Suppl. Br. at 6. The court has not identified any cases limiting the use of habeas petitions in Connecticut only to circumstances where the reason for confinement is challenged. Therefore, the court concludes that plaintiffs have failed to show that Connecticut statutes leave them without an adequate remedy.
Plaintiffs also argue that their failure to exhaust state remedies should be excused because of the reduced capacity of Connecticut courts during the COVID-19 pandemic. See Pls.’ Suppl. Br. at 10-11. However, the defendants included as an exhibit to their Reply to the plaintiffs’ Supplemental Brief a Declaration from the Chief Clerk for the Superior Court for the Judicial District of Middlesex stating that any “party seeking to bring a habeas action . . . or challenge his or her conditions of confinement at a psychiatric hospital . . . during any time the Middlesex Judicial District courthouse was closed to the public as a result of the [COVID-19] pandemic could have mailed in his or her summons and complaint” or filed documents electronically. Ex. to Defs.’ Reply to Suppl. Br. (Doc. No. 65-1) ¶ 3. Further, the Chief Clerk stated that any filings deemed “non-Priority 1 matters could have been brought to a judge’s attention by the filing of a caseflow request”, at which point “[a] judge would have reviewed the pleading to determine if immediate action is required.” Id. ¶ 4. Thus, although plaintiffs’ fears of delays while pursuing state remedies during the COVID-19 pandemic are not unreasonable given the unprecedented nature of the current crisis in recent history,
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their arguments with respect to the delays they allege their particular claims would face amount to little more than speculation.
Therefore, the court concludes that the plaintiffs’ failure to exhaust state remedies should not be excused. On account of this conclusion, the court need not address whether plaintiffs’ petition must be brought under section 2241 or 2254. The defendants’ Motion to Dismiss is granted as the plaintiffs’ petition for a writ of habeas corpus, and the portion of the Amended Complaint petitioning for a writ of habeas corpus is dismissed without prejudice to repleading if changed circumstances during the pandemic give rise to a good faith basis for arguing that exhaustion of state remedies should not be required in this case. The court does not believe that this aspect of this Ruling is appealable at this juncture in the case, but the court notes its determination that it will not issue a certificate of appealability once a final judgment is entered in the case, because the plaintiffs have not “made a substantial showing of the denial of a constitutional right.” See 28 U.S.C. § 2253(c)(2). V. CONCLUSION
For the reasons discussed above, the defendants’ Motion to Dismiss (Doc. No. 32) is denied in part as to the defendants’ arguments concerning primary jurisdiction doctrine and Colorado River abstention and granted in part as to the defendants’ arguments concerning habeas corpus. The portion of the Amended Complaint petitioning for a writ of habeas corpus is dismissed.
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Case 3:20-cv-00594-JCH Document 92 Filed 12/18/20 Page 21 of 21 SO ORDERED.
Dated this 18th day of December 2020, at New Haven, Connecticut. /s/ Janet C. Hall _ Janet C. Hall U.S. District Judge
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 Case 3:20-cv-00594-JCH Document 103 Filed 01/13/21 Page 1 of 2

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT

Thomas Wilkes, et al.,

)

On behalf of themselves and )

all other persons similarly )

situated,

)

Plaintiffs,

)

v.

)

)

Ned Lamont, Governor, et al., )

Defendants. )

Civil No.: 3:20cv594 (JCH) January 13, 2021

Joint Stipulation of All Parties

Plaintiffs Thomas Wilkes, Barbara Flood, Vincent Ardizzone, Carson Mueller and Gail Litsky and Defendants Governor Ned Lamont, Miriam Delphin-Rittmon, Lakisha Hyatt and Hal Smith in their official capacity stipulate pursuant to Federal Rule of Civil Procedure 41(a)(1)(A)(ii) that this action be dismissed without prejudice as to all claims, causes of action, and parties, with each party bearing that party’s own attorney’s fees and costs.

Dated: January 13, 2021

The Plaintiffs, By:

s/Kirk W. Lowry Kirk W. Lowry, ct#27850 Karyl Lee Hall, ct#19320 Virginia Teixeira, ct#29213 Connecticut Legal Rights Project CVH – Beers Hall 2nd Floor P.O. Box 351 – Silver Street Middletown, CT 06457 (860) 262-5017 Fax (860) 262-5035 klowry@clrp.org

s/Ira A. Burnim Ira A. Burnim, phv ct#10689 Jennifer Mathis, phv ct#10718 Judge David L. Bazelon Center for Mental Health Law 1090 Vermont Avenue, N.W. Suite 220 Washington, D.C. 20005 (202) 467-5730 Fax (202) 223-0409 irab@bazelon.org jenniferm@bazelon.org

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s/Steven J, Schwartz Steven J. Schwartz, phv ct#23604 Mark J. Murphy, phv ct#01126 22 Green Street Northampton, MA 01060 (413) 586-6024 Fax (413) 586-5711 sschwartz@cpr-ma.org mmurphy@cpr-ma.org
DEFENDANTS
NED LAMONT, et al.
WILLIAM TONG ATTORNEY GENERAL BY: /s/Emily V. Melendez Assistant Attorney General Federal Bar No. ct21411 165 Capitol Avenue Hartford, CT 06106 Tel: (860) 808-5210 Fax: (860) 808-5385 Emily.Melendez@ct.gov /s/Laura Thurston Assistant Attorney General Federal Bar No. ct30612 165 Capitol Avenue Hartford, CT 06106 Tel: (860) 808-5210 Fax: (860) 808-5385 Laura.Thurston@ct.gov /s/Shawn L. Rutchick Assistant Attorney General Federal Bar No. ct24866 165 Capitol Avenue Hartford, CT 06106 Tel: (860) 808-5210 Fax: (860) 808-5385 Shawn.Rutchick@ct.gov
2