Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca9-13-16396/USCOURTS-ca9-13-16396-0/pdf.json

Nature of Suit Code: 555
Nature of Suit: Prisoner - Prison Condition
Cause of Action: 

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FOR PUBLICATION

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

VICTOR ANTONIO PARSONS; SHAWN

JENSEN; STEVE SWARTZ; DUSTIN

BRISLAN; SONIA RODRIGUEZ;

CHRISTINA VERDUZCO; JACKIE

THOMAS; JEREMY SMITH; ROBERT

CARRASCO GAMEZ, JR.; MARYANNE

CHISHOLM; DESIREE LICCI; JOSEPH

HEFNER;JOSHUA POLSON;

CHARLOTTE WELLS; ARIZONA

CENTER FOR DISABILITY LAW,

Plaintiffs-Appellees,

v.

CHARLES L. RYAN; RICHARD PRATT,

Defendants-Appellants.

No. 13-16396

D.C. No.

2:12-cv-00601-

NVW

OPINION

Appeal from the United States District Court

for the District of Arizona

Neil V. Wake, District Judge, Presiding

Argued and Submitted 

November 6, 2013—San Francisco, California

Filed June 5, 2014

Before: Stephen Reinhardt, John T. Noonan, and 

Paul J. Watford, Circuit Judges.

Opinion by Judge Reinhardt

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2 PARSONS V. RYAN

SUMMARY*

Prisoner Civil Rights/Class Action

The panel affirmed the district court’s order certifying a

class and a subclass of inmates in Arizona’s prison system

who alleged that they were subjected to systemic Eighth

Amendment violations. 

The panel held that the district court acted well within its

broad discretion in concluding that the putative class of

inmates challenging Arizona Department of Corrections’

health care policies and practices and the subclass of inmates

challenging the isolation unit polices and practices satisfied

the requirements for class certification set forth in Federal

Rule of Civil Procedure 23. 

The panel held that certification of the class and subclass

was appropriate with respect to Rule 23(a)(2)’s requirement

of commonality because plaintiffs’ claims set forth common

contentions whose truth or falsity could be determined in one

stroke: whether the specified statewide policies and practices

exposed them to a substantial risk of harm. 

The panel also held that the district court did not abuse its

discretion in determining that the named plaintiffs, inmates in

Arizona custody who alleged that they were exposed to a

substantial risk of harm by the challenged polices and

practices, satisfied the typicality requirement of Rule

23(a)(3). 

* This summary constitutes no part of the opinion of the court. It has

been prepared by court staff for the convenience of the reader.

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PARSONS V. RYAN 3

The panel held that considering the nature and contours

of the relief sought by the plaintiffs, the district court did not

abuse its discretion in concluding that a single injunction and

declaratory judgment could provide relief to each member of

the proposed class and subclass and therefore that plaintiffs

satisfied Rule 23(b)(2). 

COUNSEL

Nicholas D. Acedo (argued) and Daniel P. Struck, Struck

Wieneke & Love, P.L.C., Chandler, Arizona; Thomas C.

Horne, Arizona Attorney General, and Michael E. Gottfried,

Assistant Attorney General, Phoenix, Arizona, for

Defendants-Appellants.

David C. Fathi (argued), ACLU National Prison Project,

Washington, D.C.; Daniel Pochada, ACLU Foundation of

Arizona, Phoenix, Arizona; Daniel C. Barr, Amelia M.

Gerlicher, Kirstin T. Eidenbach, Perkins Coie LLP, Phoenix,

Arizona; Caroline Mitchell, Jones Day, San Francisco,

California; Donald Specter and Corene Kendrick, Prison Law

Office, Berkeley, California; John Laurens Wilkes, Jones

Day, Houston, Texas; Jennifer K. Messina, Jones Day, New

York, New York, for Plaintiffs-Appellees.

Catherine Weiss, Michael Hahn, Jason Halper, and Monica

Perrette, Lowenstein Sandler LLP, Roseland, New Jersey;

Mark A. Chavez, Chavez & Gertler LLP, Mill Valley,

California, for Amici Curiae American Friends Service

Committee, Center for Children’s Law and Policy, Children’s

Rights, Impact Fund, National Alliance on Mental Illness

(NAMI), NAMI-Arizona, National Center for Youth Law,

National Disability Rights Network, National Immigrant

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4 PARSONS V. RYAN

Justice Center, National Juvenile Defender Center, Pacific

Juvenile Defender Center, The ARC of the United States, and

Youth Law Center.

OPINION

REINHARDT, Circuit Judge:

The defendants, senior officials of the Arizona

Department of Corrections (“ADC”), appeal an order

certifying a class and a subclass of inmates in Arizona’s

prison system who claim that they are subject to systemic

Eighth Amendment violations. The inmates allege that

numerous policies and practices of statewide application

governing medical care, dental care, mental health care, and

conditions of confinement in isolation cells expose them to a

substantial risk of serious harm to which the defendants are

deliberately indifferent. The inmates seek declaratory and

injunctive relief from the alleged constitutional violations. 

After reviewing the substantial record compiled by the

plaintiffs, which includes four expert reports, hundreds of

internal ADC documents, depositions of ADC staff, and

inmate declarations, the district court determined that the

plaintiffs meet the standard for class certification set forth in

Federal Rule of Civil Procedure 23. It therefore certified a

class of inmates challenging ADC health care policies and

practices, and a subclass of inmates challenging ADC

isolation unit policies and practices. We conclude that the

district court did not abuse its discretion in certifying the

class and subclass, and therefore affirm the order of the

district court.

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PARSONS V. RYAN 5

BACKGROUND

I

Arizona law requires the Director of the ADC to “provide

medical and health services” for the approximately 33,000

inmates in ten prison facilities who depend on the state for all

basic needs.1 Ariz. Rev. Stat. Ann. § 31-201.01; see also id.

at § 41-1604 (providing that “the director shall be responsible

for the overall operations and policies for the department”). 

To satisfy the duty imposed by statute on its director, ADC

has promulgated extensive statewide policies governing

health care and conditions of confinement that apply to all of

the inmates in its custody, all of its staff, and all of its

facilities.2

Since July 2012, ADC has contracted with private entities

to provide medical, dental, and mental-health care services to

inmates. Specifically, ADC hired Wexford Health Services

from July 1, 2012 through March 3, 2013, at which point it

replaced Wexford with Corizon, Inc., its current partner. 

ADC’s private contractors are required by the plain terms of

their agreements to follow all ADC policies, and work with

ADC to implement additional policies governing such matters

as health care staffing, access to prescriptions, emergency

care, and dental care. The contractors’ full compliance with

1 Defendant Charles Ryan is the Director of ADC and Defendant

Richard Pratt is ADC’s former Interim Division Director of Health

Services. Ryan and Pratt have both been sued in their official capacities.

2 The ten ADC facilities are Douglas, Eyman, Florence, Lewis,

Perryville, Phoenix, Safford/Ft. Grant, Tucson, Winslow, and Yuma.

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6 PARSONS V. RYAN

statewide ADC policy is constantly monitored by ADC

officials.

The plaintiffs are thirteen inmates in ADC custody and

the Arizona Center for Disability Law, Arizona’s authorized

protection and advocacy agency. See 42 U.S.C. § 10801. 

They filed this suit in March 2012, claiming that ADC’s

policies and practices governing medical care, dental care,

and mental health care expose all inmates “to a substantial

risk of serious harm, including unnecessary pain and

suffering, preventable injury, amputation, disfigurement, and

death.” The plaintiffs support these general allegations with

detailed references to nearly a dozen specific ADC policies

and practices, including inadequate staffing, outright denials

of care, lack of emergency treatment, failure to stock and

provide critical medication, grossly substandard dental care,

and failure to provide therapy and psychiatric medication to

mentally ill inmates.

The plaintiffs also claim that conditions in ADC isolation

units constitute cruel and unusual punishment.3 They allege,

for example, that prisoners in isolation often go months or

years without any meaningful interaction with other persons,

that these inmates are frequently denied adequate nutrition,

that some receive no outdoor exercise at all for months or

years on end, and that most inmates held in isolation are

confined to cells with 24-hour-a-day illumination. The

plaintiffs add that “[t]he predictable outcomes of these cruel

3 The plaintiffs and the district court use the term “isolation cells,” while

the defendants refer to the same cells as “maximum custody cells.” 

Although we adopt the district court’sterminology, that decision does not

amount to an opinion about the substance of the plaintiffs’ conditions of

confinement claims relating to the isolation cells.

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PARSONS V. RYAN 7

conditions of isolation are psychiatric deterioration, selfinjury, and death.”

With respect to both the health care and isolation unit

claims, the plaintiffs allege that ADC is aware of these

constitutionally defective conditions and has deliberately

ignored the resulting risk to which it has exposed inmates. 

For example, the plaintiffs allege that, in 2009, the ADC

Director of Medical Services responded to a prison

physician’s complaint that ADC was failing to provide

adequate care by agreeing that ADC was “probably” violating

inmates’ rights and stating that “I do think that there would be

numerous experts in the field that would opine that deliberate

indifference has occurred.”

The plaintiffs seek declaratory and injunctive relief to

eliminate identified systemic deficiencies in ADC’s statewide

health care system and isolation units.

II

After the district court denied a motion to dismiss, the

plaintiffs moved for class certification. They supported their

motion with the detailed factual allegations in the Complaint,

hundreds of documents that they had obtained from the

defendants in discovery, expert reports by four specialists in

prison medical care and conditions of confinement, and

declarations by the named plaintiffs. The discoverymaterials

included assessments of ADC staffing, reports by contractor

monitors, internal communications between ADC officials,

and letters exchanged between ADC and Wexford. In their

response, the defendants relied on a few declarations by some

ADC officials in which those officials summarized formal

ADC policies—several of which had been modified mere

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8 PARSONS V. RYAN

days before the defendants filed their brief in the district

court. The defendants did not submit rebuttal expert

declarations, nor did they offer evidence that the newly

revised written statements of ADC policy reflected the actual

policy and practice of the ADC facilities. Further, the

defendants did not address the individual policies and

practices complained of by the plaintiffs nor present evidence

meant to deny their existence. Rather, the defendants argued

in a general fashion that ADC written policies are the only

statewide policies and practices.4

A. Factual Allegations in the Complaint

The 74-page complaint in this case contains detailed

factual allegations concerning the existence of uniform,

statewide policies and practices in all ADC facilities. In the

plaintiffs’ view, these policies and practices expose all ADC

inmates to a substantial risk of harm. With respect to their

health care claims, the plaintiffs allege the existence of the

following policies and practices: (1) creation of “lengthy and

dangerous delays in receiving” care and “outright denials of

health care”; (2) failure to “provide prisoners with timely

emergency treatment”; (3) failure to “provide necessary

medication and medical devices to prisoners”; (4) a practice

of “employ[ing] insufficient health care staff”; (5) failure to

“provide prisoners with care for chronic diseases and

protection from infectious diseases”; (6) failure to “provide

timely access to medically necessary specialty care”; (7)

provision of “substandard dental care”; (8) provision of

“substandard mental health care”; (9) denial of “medically

4 Of course, this argument is ineffective as to the several policies and

practices complained of by the plaintiffs that reflect formal ADC written

policy.

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PARSONS V. RYAN 9

necessary mental health treatment,” including “psychotropic

medication, therapy, and inpatient treatment,” to mentally ill

prisoners; and (10) denial of “basic mental health care” to

“suicidal and self-harming prisoners.” With respect to the

isolation units claims, the plaintiffs allege the existence of the

following policies and practices: (1) denial of adequate

recreation; (2) constant cell illumination; (3) extreme social

isolation; (4) denial of adequate nutrition; and (5) failure to

provide adequate mental health care staffing and treatment.

For each of these alleged policies and practices, the

Complaint contains several paragraphs or pages of

particularized factual allegations. For example, with regard

to the alleged policy and practice of failing to provide

necessary medication and medical devices, the Complaint

alleges that the “[d]efendants have a policy and practice of

not providing prisoners with the full course of their

medication, not providing prisoners medication as prescribed

or in a timely fashion, and inappropriately starting and

stopping medication.” The Complaint further alleges that

“psychotropic medications that are to be taken daily regularly

go undelivered, without explanation or warning,” prisoners

“are given expired medication or incorrect dosages of

medication,” the defendants “routinely substitute doctorapproved drug regimens with drugs on the ADC-approved

formulary,” and the defendants fail to provide “medically

necessary devices, thus depriving . . . prisoners of basic

sanitation.” The Complaint also includes factual allegations

that demonstrate the kinds of serious harm to which members

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10 PARSONS V. RYAN

of the proposed class are exposed by ADC policies and

practices.5

To take another example of the medical care claims, the

Complaint alleges the existence of a policy and practice of

“failing to provide prisoners with specialty care, or doing so

only after extensive and unreasonable delays, often resulting

in unnecessary pain and suffering, permanent injuries, and

death.” The Complaint further alleges that, even though

ADC sends prisoners to contracted outside specialists, “[f]or

much of 2009 and 2010, Defendants had no contracts in place

with outside providers, and even today have few outside

specialists under contract to treat ADC prisoners.” The

5 Thus, with respect to the policy and practice of failing to provide

prisoners with necessary medication and medical devices, the Complaint

alleges the following examples, among others:

• “A prisoner at the Tucson complex was given the incorrect

dosage of medication to treat his seizures in September 2011. He

suffered a stroke, and despite pleas for help from his fellow

inmates, waited more than a day before medical staff saw him

and referred him to an outside hospital’s Intensive Care Unit. 

Now, due to the stroke, he slurs his speech, has difficulty

walking and relies on a wheelchair, and is incontinent.”

• “When [a named plaintiff] [suffered an] eye injury, a nurse at the

Safford prison gave him eye medication that had expired more

than three months previously. When he used the medication, his

vision dramatically worsened, and he developed iritis.”

• “[A named plaintiff] and other prisoners who need catheters are

given fewer clean catheters than they need, and thus have to reuse the catheters, putting them at risk of bladder and urinary tract

infections . . . Prisoners who need incontinence briefs or wipes

often go without them, or are told they only are allowed one

diaper per day.”

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PARSONS V. RYAN 11

Complaint elaborates that from FY 2009 to FY 2011,

“spending on specialty services had plummeted by 38% . . .

while there was no corresponding decline in the number of

prisoners in ADC’s custody.” The Complaint quotes ADC

physicians who stated that “the referral system has broken

down” and that specialist referrals are “falling through the

cracks,” and alleges that the defendants “have a policy and

practice of failing to order or approve outside diagnostic

testing, including biopsies of suspicious tumors and

growths.”6

6 The plaintiffs’ examples of the kinds of serious harm to which they are

exposed by this ADC policy and practice include the following:

1. “In late February 2010, [a named plaintiff] was attacked by other

inmates and suffered eye injuries and fractures of his cheek bone,

orbital bone around his eye, and upper jaw bone – fractures that,

if not treated, result in the person’s face caving in, and in

permanent disfigurement. Outside emergency room doctors

advised that he be seen within a week by an ophthalmologist and

plastic surgeon. Prison doctors submitted these referrals to the

review committee, but they were not approved. Instead, [the

named plaintiff] was sent to an oral surgeon, who operated on his

face without an anesthesiologist present. [The named plaintiff]

was over-sedated and had to have an antidote to be revived. His

face was partially paralyzed due to nerve damage from the

botched surgery and over-sedation, and his eyelid drooped,

causing dryness to his cornea.”

2. “[A named plaintiff] waited more than two years to have a

biopsy of [a] mass in his prostate, because contracts with outside

providers were cancelled. By the time he was finally seen and

treated, the cancer was much worse, resulting in more invasive

surgery and the need to permanently use a catheter.”

3. “Beginning in 2010 [a named plaintiff] observedmultiple masses

growing on her breasts, mouth, and arms, and reported

discomfort in her cervix. The masses were observable in

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A third example of the Complaint’s medical care

allegations is the alleged statewide ADC policy and practice

of “not providing prisoners with timely emergency responses

and treatment, and [failing to provide] an adequate system for

responding to health care emergencies.” The Complaint

further alleges that “there is not an adequate number of onduty health care staff to respond to possible emergencies,”

“[d]efendants have not adequately trained security and health

care staff on how to handle health care emergencies,”

“[l]ower level medical staff, who serve as the first line of

response to prisoners’ requests for medical assistance, often

do not recognize when a prisoner is experiencing an

emergency,” and “even when properly responding to an

emergency, medical staff face barriers to providing timely

emergency assistance.”7

physical examinations. She began experiencing frequent

diarrhea, nausea, exhaustion, weight loss, pain, and other

alarming systems. [She] has a family history of cancer and was

treated for cancer in 2001. Starting in December 2010 she

requested testing and a prison doctor ordered a referral to an

oncologist. However, [she] was not sent to an oncologist and did

not receive a CT scan until late September 2011. At that time the

masses were described as ‘lighting [the CT scan] up like a

Christmas tree,’ and the specialist orders biopsies and a

colonoscopy . . . . She still has not seen an oncologist or had

biopsies.”

 

7

 Here, the plaintiffs’ examples include the following:

1. “In July 2010, correctional officers at the Tucson prison stood by

and watched a severely mentally ill prisoner . . . bleed to death

after his second suicide attempt . . . . When an internal

investigator asked one officer, ‘So you guys just stood around for

23 minutes and watched this guy bleed to death?’, the officer

stated that his response was to call [the inmate’s] name and to try

to elicit a reaction.”

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PARSONS V. RYAN 13

Turning to the dental care claims, the Complaint alleges

that the defendants “have a policy and practice of failing to

provide medically necessary dental services.” It further

alleges that “prisoners wait months or years for basic dental

treatment and suffer significant pain and other harm,” “the

primary service provided by Defendants is tooth extraction,

even if a much less invasive procedure . . . is medically

appropriate and necessary,” and “prisoners who are fortunate

enough to get fillings are not given permanent fillings, but

rather temporary fillings that are not designed to last more

than a few months at most.” The Complaint contains

allegations concerning several inmates who have faced “the

horrible dilemma of saving a tooth and suffering pain, or

ending the pain and losing a tooth that otherwise could be

saved.”

2. “In October 2011, a prisoner at the Eyman prison collapsed in his

living unit from a heart attack. Other prisoners yelled for

security staff to contact medical staff. Officers told the prisoners

to ‘wait and see what happens,’ and did not summon help or

provide assistance to the stricken prisoner. In desperation,

another inmate checked the prisoner’s pulse, and finding none,

began to perform CPR. After a few minutes, the prisoner began

breathing again. Only then did officers summon medical staff. 

Three hours later, the prisoner was sent from the medical unit

back to his living unit and told he had a medical appointment in

a few days. The prisoner had another heart attack the next day

and died.”

3. “In May 2011, a prisoner who was four months pregnant began

experiencing painful contractions and spotting blood, and went

to Perryville’s medical unit. The staff person on duty told her it

was nothing serious, that her problems were ‘all in your head,’

and that she could not see a clinician for evaluation or treatment. 

She was sent back to her living unit, and she continued to

experience great pain and cramping for an hour and a half, until

she miscarried.”

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With respect to the mental health care claims, the

Complaint alleges that the defendants systematically “fail[]

to provide prisoners with adequate mental health care.” It

first alleges that the defendants have a policy and practice of

“denying treatment to or providing inadequate treatment to

prisoners with serious mental health needs.” It elaborates that

the defendants lack sufficient staff to treat mentally ill

inmates; that the defendants fail to monitor and provide

follow-up treatment after prescribing psychotropic

medications; that prisoners who are on psychotropic

medications that increase heat sensitivity are exposed to

dangerous levels of heat; and that the defendants rely on

unqualified nurses and medical assistants for ongoing

monitoring of prisoners on psychotropic drugs.8

The Complaint then separately alleges that the defendants

“deprive suicidal and self-harming prisoners of basic mental

health care.” In support of this allegation, it charges that the

 

8

 Here, the plaintiffs’ examples include the following:

• “On two separate occasions when [a named plaintiff] was placed

in suicide watch for engaging in self-harming behavior and

suffering severe side effects from a variety of psychotropic

medications, he did not see a psychiatrist for stretches offive and

seven months.”

• “In June 2008, [a named plaintiff] was prescribed Celexa, but did

not receive it for nearly a year. He was also prescribed lithium;

however, despite the need for close monitoring for side effects

from the lithium, he was not seen by a doctor for three months. 

His lithium was renewed without [the named plaintiff] having

seen a doctor for six months. In November 2009, [he] submitted

a [health needs request] reporting that he was vomiting when

given lithium without food. He was given Tums and was not

seen by a doctor.”

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PARSONS V. RYAN 15

defendants “have a policy and practice of housing prisoners

with serious mental health needs in unsafe conditions that

heighten their risk of suicide,” and reports that ADC prisoners

have a suicide rate double the national average in state

prisons. The Complaint adds that, as a matter of statewide

policy and practice, ADC suicide watch facilities “offer no

meaningful treatment”; “suicide watch cells are often filthy,

with walls and food slots smeared with other prisoners’ blood

and feces, reeking of human waste”; suicide watch cells are

maintained at “very cold temperatures” while prisoners “are

stripped of all clothing and given only a stiff suicide smock

and a thin blanket, making the extreme cold even harder to

tolerate”; the defendants unjustifiably use chemical agents on

suicidal inmates; and the defendants provide inadequate

nutrition to inmates on suicide watch, force them awake every

ten to 30 minutes around the clock, and leave bright lights on

24 hours a day.

9

Finally, the Complaint alleges that the defendants have a

policy and practice “of confining thousands of prisoners in

isolation . . . in conditions of enforced idleness, social

isolation, and sensory deprivation.” It further alleges as

 

9

 Here, the plaintiffs’ examples include the following:

• “[A named plaintiff] did not see a psychitratist for 11 months

despite being placed on suicide watch multiple times.”

• “[Two named plaintiffs] have asthma and rely upon inhalers, and

they have had asthma attacks from the regular use of pepper

spray in the women’s suicide watch unit. On multiple occasions

after she was pepper sprayed in the eyes, nose, and mouth, [one

named plaintiff] was dragged to a shower, stripped naked, and

sprayed with extremely cold water to rinse away the pepper

spray; she was then left naked to wait for a new vest and

blanket.”

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follows: “prisoners in isolation leave their cells no more than

three times a week, for a brief shower and no more than two

hours of ‘exercise’ in the ‘rec pen’ – a barren, windowless

concrete cell with high walls [and] no exercise equipment”;

“some prisoners in isolation receive no outdoor exercise at all

for months or years on end; others receive insufficient

exercise to preserve their physical and mental health”; “most

or all of these prisoners are held in cells with a solid steel

door and no window to the outside”; “cells are often

illuminated 24 hours a day”; “chronic sleep deprivation is

common”; “property is extremely limited”; “prisoners in

isolation often go months or years without any meaningful

human interaction”; and the defendants “deny[] prisoners in

isolation adequate nutrition.” The Complaint adds that the

harm to inmates’ mental and physical health from these

conditions is “exacerbated by the policy and practice of

Defendants of failing to provide adequate mental health care

staffing and treatment.”

In sum, the lengthy and comprehensive complaint in this

case alleges that there exist a number of statewide, uniform

ADC policies and practices concerning health care and

isolation units, and that these policies and practices expose all

members of the proposed class and subclass to a substantial

risk of serious harm.

B. Discovery Material

The plaintiffs also supported their motion for class

certification with documents obtained from the defendants

during discovery. For example, they submitted a letter from

ADC to Wexford dated September 21, 2012 in which ADC

identified serious and systemic deficiencies in Wexford’s

provision of health care to ADC inmates. In this letter, the

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PARSONS V. RYAN 17

ADC Contract Beds Operations Director stated that an ADC

review had revealed that “a significant number of inmates

may not have been receiving their medications as prescribed

[in July and August 2012] due to expired prescription(s) and

inappropriate renewals or refills,” describing these “8,358”

prescriptions as a “critical issue” and “grave concern to the

ADC.” After surveying other compliance concerns, the letter

proceeded to identify a number of “non-compliance issues”

regarding Wexford’s provision of health care in ADC

facilities, such as:

• “Inadequate staffing levels in multiple program areas

at multiple locations,” resulting in “inappropriate

scheduling gaps in on-site medical coverage,

including In-Patient Component” and “[s]taffing

levels forcing existing staff to work excessive hours,

creating fatigue risks”;

• “Incorrect, incomplete, inconsistent medication

administration or documentation of care provided,”

including a “backlog of prescription medication

expiration review,” “incorrect or incomplete

pharmacy prescriptions,” “inappropriate

discontinuation/change of medication,” “inconsistent

or contradictory medication refill and/or return

procedures,” and “inconsistent provision of release,

transfer, and/or renewal medications”; and

• A “quantitative decrease in routine institutional care,”

including a “backlog of provider line appointments,”

“untimely handling of Health Needs Requests,” and

“backlog/cancellation of outside specialty

consultations”

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On October 1, 2012, Wexford replied with a letter in which

it condemned the low qualityof ADC’s preexisting programs. 

It described “long-standing issues, embedded into ADC

health care policy and philosophy,” and noted that ADC’s

health care system was “extremely poor,” “dysfunctional,”

“sub-standard,” and rife with “deficiencies.”

This assessment of ADC policies and practices governing

the provision of health care to inmates is echoed by other

discovery materials. For example, a February 2011 e-mail

from the psychiatrist supervisor at one ADC complex warned

of “abysmal staffing” and cautioned that he was “circling the

drain.” In a similar vein, an August 2012 ADC memo

concluded that psychiatry staffing was “grossly insufficient”

and “so limited that patient safety and orderly operation of

[ADC]facilities maybe significantlycompromised.” Dozens

of other contract monitor reports from August 2012 offered

similar assessments, as did a Wexford staffing review

undertaken in November 2012, five months after Wexford

had taken over the provision of health care services in ADC

facilities. Wexford’s comprehensive review concluded that,

of 762 budgeted full time employee positions, only 567

positions had been filled. It also revealed that, for higherlevel providers, such as physicians, psychiatrists, dentists,

nurse practitioners, and management-level health care staff,

the overall vacancy rate across ADC facilities exceeded 50%.

A survey of the quality of health care provision at ADC

facilities, also completed in November 2012, bristled with

criticism: “Insufficient coverage which only allows for

basically emergency care . . . now reaching a critical state for

both routine visits and chronic care follow-ups . . . no filled

dentist positions at this complex”; “There is no nurses line

being conducted in Central Unit”; “The [Health Needs

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PARSONS V. RYAN 19

Requests for mental health services] are not being triaged by

qualified mental health professionals during the required time

frame . . . [Inmates referred to a psychiatric provider] are not

being seen as required due to limited staffing”; “Staffing

continues to be of primary concern. In nursing alone, the

Lewis complex is 5.9 RN’s below staffing expectations and

8 LPN’s below staffing expectations”; “Nurseline is backlogged out three weeks . . . Provider line is back-logged out

2 months . . . Charts requiring Provider review total roughly

70 charts”; and “At the current level there [are] not enough

providers to serve an inmate population of 4200+.” The rest

of the ADC and Wexford documents submitted by the

plaintiffs paint an equally grim picture of ADC’s operations

from 2009 through the time this case was filed.

C. Expert Reports

The plaintiffs submitted four expert reports, none of

which was rebutted by the defendants. Each of these experts

based his report on an examination of major portions of the

evidentiary record that the parties compiled in the district

court.

Dr. Robert L. Cohen, an expert in prison health care,

court-appointed monitor in several other similar cases, and

member of the New York City Board of Corrections,

concluded that the defendants have placed prisoners “at

serious risk of harm, and in some cases, death” by “failing to

manage, support, supervise, and administer medical care to

prisoners in the ten state facilities.” The defendants, he

stated, “operate a top-down centralized health care system”

and “any local policies developed at the prison level must be

consistent with departmental policies.” Cohen noted that this

centralized system is nonetheless “highly dysfunctional,”

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adding that “there is a system-wide practice of not following

the [ADC’s formal] policies and procedures because, among

other things, [the] defendants have failed to provide adequate

staffing, supervision and resources to promote compliance.” 

He elaborated that “written policies and procedures are often

viewed by providers and their supervisors as setting

unrealistic requirements, and therefore are ignored.”

Cohen reported that, instead of following their formal

procedures, ADC’s prison facilities maintain “a policy and

practice of not providing adequate medical professional

staffing,” “a practice of not complying with [ADC’s]

requirement that health care records be reviewed within 12

hours of an inmate’s arrival,” “a practice and unwritten policy

of delaying and/or denying prisoners access to necessary care

for serious medical needs,” “a practice and unwritten policy

of not providing sufficient, trained staff to competently

respond to emergencies,” a “practice and unwritten policy of

failing to supervise, manage and support medication

distribution,” and a “practice of keeping chaotic, inaccurate,

and disorganized records throughout the state.” These

“extensive problems,” he opined, “are systemic, and are

similar to problems [he has] encountered in other prison class

action lawsuits where [he has] been an expert.” As a result of

these statewide policies and practices, Cohen concluded,

“medical care delivery in [ADC] poses a substantial risk of

serious harm to prisoners who require medical care.”

Dr. Jay D. Shulman, a dentist with extensive experience

practicing in and examining military, educational, and

correctional dentistry programs, reviewed the ADC’s dental

system and offered a highly critical assessment: “[T]he

consistently inadequate care documented in the records I

reviewed is attributable to systemic problems caused by

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inadequate and poorly monitored policies and procedures in

the ADC’s Dental Department.” Shulman carefully

summarized and then broadly criticized ADC’s policies and

practices “with regard to staffing, inmate health requests, pain

management, dental appliances, tooth extraction, and

informed consent,” explaining that they “combine into a

system that fails to adequately identify, or properly and

timely treat, dental issues experienced by inmates.” These

failures, he remarked, “place all inmates at risk not only of

preventable pain, but also of tooth decayand unnecessaryloss

of teeth.” Shulman added that ADC policies “themselves

[fall] below the standard of care” and that “regular practices

often fall even further short.”

In his report, Shulman singled out for particularly strong

criticism ADC’s “de facto [tooth] extraction only policy,” its

“policy or practice of failing to employ sufficient dental

staffing,”

10

its failure to “ensure appropriate classification and

treatment of patients reporting dental issues,” its absence of

“timelines for routine treatment,”11and its failure adequately

to treat “chewing difficulty” that can cause pain and

nutritional problems. These and the other issues he

identified, Schulman concluded, are “attributable to systemic

problems, primarily, inadequate staffing and inadequate and

poorly monitored policies and procedures.”

10 Shulman noted that the systemwide ADC ratio as of October 2012 was

1,384 inmates per dentist. He explained that the recommended ratio is

1,000:1, assuming that dental hygienist support is provided. ADC does

not employ any dental hygienists.

11 Shulman expressed grave concern that the treatment time to fill a

cavity in ADC facilities ranges from 85 to 292 days, with an average of

225 days.

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Dr. Pablo Stewart, a professor of psychiatry with

extensive experience in correctional mental health care,

offered his “preliminary opinion” that “mental health care

services at ADC are in a state of disarray, and have been for

some time.” Observing that “all relevant policies and

procedures . . . are centralized with statewide application,”

Stewart opined that ADC’s “lack of a functioning mental

health program poses a substantial risk of serious harm to

prisoners with mental health needs.” He described a

“shortage of mental health staff, delays in providing or

outright failure to provide mental health treatment, and []

gross inadequacies in the provision of psychiatric

medications” as “statewide systemic problems,” noting that

“prisoners who need mental health care have already

experienced, or will experience, a serious risk of injury to

their health if these problems are not addressed.” Stewart

offered detailed analysis of these issues, as well as of

statewide problems involving policies and practices of

medication management, continuity of care, and protection of

prisoners on psychotropic medication from heat injury.

12

Stewart also addressed the issues of isolated confinement

and care for suicidal inmates. With respect to isolation, he

noted that ADC regularly houses mentally ill inmates in

12 Stewart noted that “there have been and continue to be severe

systemwide shortages of mental health staff in ADC,” that ADC “lacks a

reliable system for ensuring the delivery of prescribed medications,” that

“ADC does not have a reliable means for prisoners to make their mental

health needs known in a timely manner to qualified staff,” and that “ADC

lacks a reliable system to ensure that prisoners needing a higher level of

mental health care are transferred in a timely fashion to appropriate

facilities.” He supported each of these observations with references to the

voluminous evidentiary record—including, in many cases, references to

statements by ADC staff, officials, and contractors.

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isolation units—in accordance with ADC policy—even

though isolated confinement can be “devastating” to inmates

with “mental illness, such as psychotic disorders and major

mood disorders,” and can cause “severe deterioration in

mental health, self-harm, or suicide.” Turning to suicide

prevention, Stewart agreed with a senior ADC official who

admitted in his deposition that ADC maintains “a serious gap

in [its] ability to provide suicide prevention.” Stewart then

discussed what he characterized as serious flaws in ADC’s

policies and practices governing suicide watch, including the

absence of a requirement that inmates on suicide watch be

evaluated face-to-face by a psychiatrist and the policy of

allowing inmates to be removed from suicide watch by

unlicensed mental health staff members. He added that ADC

policies permitting the use of chemical agents on suicidal

inmates, and its practice of failing to ensure that its

correctional staff conducts regular security checks on

inmates, exacerbate the risk to which mentally ill inmates are

exposed in ADC facilities. Stewart ultimately concluded that

“the current state of mental health care services in [ADC]

poses a substantial risk of serious harm to prisoners who

require mental health care.” He explained that, although “not

all ADC prisoners will be harmed by these deficiencies in

exactly the same way—some will die, some will suffer injury

short of death, and some will be lucky enough to escape

permanent injury altogether,” the problems that he had

discovered in ADC’s “highly centralized” mental health care

system “are systemic in nature, and require systemic

solutions.”

Dr. Craig Haney, a professor of social psychology with

extensive experience studying the psychological effects of

imprisonment and the consequences of solitary confinement,

assessed ADC’s isolation units. He first described, in detail,

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24 PARSONS V. RYAN

“a reasonably large and growing literature on the many ways

that solitary or so-called ‘supermax’ confinement can very

seriously damage the overall mental health of prisoners.” He

also emphasized that “mentally ill prisoners are particularly

at risk in these environments,” and that, as a result, “mental

health staff in most prison systems with which [he is] familiar

are charged with the responsibility not only of screening

prisoners in advance of their possibly being placed in

isolation (so that the mentally ill can be excluded) but also of

monitoring prisoners who are currently housed in solitary

confinement for signs of emerging mental illness (so that

they, too, can be removed).”

Turning to ADC’s policies and practices, Haney opined

that “the failure of [ADC] to exclude categorically prisoners

who suffer from [severe mental illness] from its isolation

units is inconsistent with sound corrections and mental health

practice and places all such prisoners at substantial risk of

harm.” He added: “[T]he policies, practices and admissions

of ADC regarding conditions of confinement in its isolation

units . . . reflect the type of conditions that my own

experience and research—which is also supported by decades

of scientific research and study by others—have found to be

potentially detrimental to all human beings, regardless of preexisting mental illness. As such, all ADC prisoners are at risk

of substantial psychological harm under ADC’s current

isolation policy and practice.” Haney described the “stark

conditions of isolation” imposed by ADC as “harsh and

severe and precisely the kind that create a risk of substantial

harm for all the prisoners who are subjected to them.”13 He

13 Here, Haney emphasized ADC “policies that allow for 24 hour

illumination in some isolation cells; limited property, including lack of

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PARSONS V. RYAN 25

voiced particular alarm concerning ADC policies that allow

seriously mentally ill inmates to be housed in isolation,

ADC’s practice of inadequatelymonitoring those inmates due

to “policyshortfalls and chronic mental health understaffing,”

and ADC policies authorizing the use of chemical agents

against seriously mentally ill inmates (including those who

are on psychotropic medications). Haney concluded by

opining that “ADC’s apparent failure to put in place careful

mental health monitoring policies for all prisoners subject to

the extremely isolated conditions in their [isolation units]

places all prisoners subject to such conditions at an

unreasonable risk of harm.” “These harms,” he warned, “are

extremely serious and sometimes irreversible, including loss

of psychological stability, impaired mental functioning, selfmutilation, and even death.”

D. Declarations by the Named Plaintiffs

In addition to the allegations in their complaint, the

documents obtained from ADC and Wexford in discovery,

and the expert reports, the plaintiffs also submitted

declarations describing their experienceswithADC’s policies

and practices governing health care and conditions of

confinement. These declarations by the named plaintiffs

were not submitted to support individual Eighth Amendment

claims; rather, the plaintiffs submitted these declarations as

evidence of the defendants’ unlawful policies and practices,

and as examples of the serious harm to which all inmates in

ADC custody are allegedly exposed. For example, Plaintiffs

Swartz, Licci, Jensen, Hefner, Wells, and Polson described

significant delays in receiving vital medical care, including

access to TVs or radios; infrequent, reduced calorie meals; and the years

and years that many prisoners spend in such conditions.”

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emergency and specialist care, as well as experiences in

which they were treated by nurses rather than doctors for

serious conditions, forced to wait months or years for

diagnostic tests, and denied timely access to medication. 

Each of these plaintiffs reported suffering terrible pain—and

some also declared that these lengthy delays in and denials of

care led to permanent disfigurement or a need for more

radical, high-risk treatments. Each of the other named

plaintiffs submitted a sworn declaration attesting to his or her

experiences with ADC dental care, mental health care, or

isolation units.

III

In a careful, thorough, and rigorous opinion, the district

court, considering all of this evidence, granted the plaintiffs’

motion for certification of a class and subclass. It then denied

a motion for reconsideration. It certified a class consisting of

“[a]ll prisoners who are now, or will in the future be,

subjected to the medical, mental health, and dental care

policies and practices of the ADC.” It also certified a

subclass consisting of “[a]ll prisoners who are now, or will in

the future be, subjected by the ADC to isolation, defined as

confinement in a cell for 22 hours or more each day or

confinement in [certain housing units].”

In the district court, as in this court, the parties’ main

dispute concerned the requirement of commonality. The

district court determined that the plaintiffs could show

commonality, explaining that “the question common to all

members of the Class and the Subclass is whether

Defendants’ practices are deliberately indifferent to inmates’

health and safety in violation of the Eighth Amendment and

subjection to unconstitutional conditions of confinement in

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PARSONS V. RYAN 27

isolation units.” The district court emphasized that “the

problems identified in the provision of health care are not

merely isolated instances but, rather, examples of systemic

deficiencies that expose all inmates to a substantial risk of

serious harm.” In other words, it found that “the evidence

here suggests that the root cause of the injuries and threats of

injuries suffered by Plaintiffs is the systemic failures in the

provision of health care generally.” The district court deemed

this evidence to be “‘significant proof’ that ADC is operating

under a policy of providing deficient health care,” and

concluded that “the allegations of systemic deficiencies in

ADC’s provision of health care are sufficient to establish ‘a

system-wide practice or policy that affects all of the putative

class members.’” The district court then identified ten

specific ADC health care practices that allegedly expose all

members of the certified class to a substantial risk of harm to

which the defendants are deliberately indifferent, and seven

specific ADC isolation unit practices that allegedly do so the

same. These 17 statewide ADC practices, it concluded,

create the commonality required for the plaintiffs to proceed

by class and subclass form.

After the district court denied a motion for

reconsideration, the defendants filed a Rule 23(f) petition

seeking interlocutory review of the district court’s class

certification order. See Chamberlan v. Ford Motor Co.,

402 F.3d 952, 959 (9th Cir. 2005) (per curiam) (describing

the legal standard applicable to discretionary authorization of

appeals under Rule 23(f)). This court granted that petition on

July 10, 2013 and the defendants perfected their appeal in a

timely manner.14

14 Both the district court and this court have denied motions filed by the

defendants to stay proceedings pending the outcome of this appeal.

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STANDARD OF REVIEW

We review a district court’s decision to certify a class

under Rule 23 for abuse of discretion and we review for clear

error any findings of fact upon which the district court relied

in its certification order. Hester v. Vision Airlines, Inc.,

687 F.3d 1162, 1171–72 (9th Cir. 2012). “When reviewing

a grant of class certification, we accord the district court

noticeably more deference than when we review a denial of

class certification.” Abdullah v. U.S. Sec. Associates, Inc.,

731 F.3d 952, 956 (9th Cir. 2013) (citing Wolin v. Jaguar

Land Rover N. Am., LLC, 617 F.3d 1168, 1171 (9th Cir.

2010)). “An abuse of discretion occurs when the district

court, in making a discretionary ruling, relies upon an

improper factor, omits consideration of a factor entitled to

substantial weight, or mulls the correct mix of factors but

makes a clear error of judgment in assaying them.” Stearns

v. Ticketmaster Corp., 655 F.3d 1013, 1018 (9th Cir. 2011)

(citing Wolin, 617 F.3d at 1171). Under the applicable

clearly erroneous standard of review, we reverse the district

court’s findings of fact only if they are “(1) illogical,

(2) implausible, or (3) without ‘support in inferences that may

be drawn from the record.’” Abdullah, 731 F.3d at 956

(quoting United States v. Hinkson, 585 F.3d 1247, 1262 (9th

Cir. 2009)). “Where there are two permissible views of the

evidence, the factfinder’s choice between them cannot be

clearly erroneous.” United States v. Working, 224 F.3d 1093,

1102 (9th Cir. 2000) (en banc) (citations and quotation marks

omitted).

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PARSONS V. RYAN 29

DISCUSSION

I

Class certification is governed by Federal Rule of Civil

Procedure 23. Under Rule 23(a), a party seeking certification

of a class or subclass must satisfy four requirements:

(1) numerosity; (2) commonality; (3) typicality; and

(4) adequacy of representation.15

“Class certification is

proper only if the trial court has concluded, after a ‘rigorous

analysis,’ that Rule 23(a) has been satisfied.” Wang v.

Chinese Daily News, Inc., 737 F.3d 538, 542–43 (9th Cir.

2013) (quoting Wal-Mart Stores, Inc, v. Dukes, 131 S. Ct.

2541, 2551 (2011)). The proposed class or subclass must also

satisfy the requirements of one of the sub-sections of Rule

23(b), “which defines three different types of classes.” Leyva

 

15 The full text of the subsection is as follows:

(a) Prerequisites. One or more members of a class may

sue or be sued as representative parties on behalf of all

members only if:

(1) the class is so numerous that joinder of all

members is impracticable;

(2) there are questions of law or fact common to

the class;

(3) the claims or defenses of the representative

parties are typical of the claims or defenses of the

class; and

(4) the representative parties will fairly and

adequately protect the interests of the class.

Fed. R. Civ. P. 23(a).

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v. Medline Industries, Inc., 716 F.3d 510, 512 (9th Cir. 2013). 

In this case, the plaintiffs contend that their proposed class

and subclass meet the requirements of Rule 23(b)(2), which

requires that “the party opposing the class has acted or

refused to act on grounds that apply generally to the class, so

that final injunctive relief or corresponding declaratory relief

is appropriate respecting the class as a whole.”

In evaluating whether a party has met the requirements of

Rule 23, we recognize that “Rule 23 does not set forth a mere

pleading standard.” Wal-Mart, 131 S. Ct. at 2551. We

therefore require a party seeking class certification to

“affirmatively demonstrate his compliance with the

Rule—that is, he must be prepared to prove that there are in

fact sufficiently numerous parties, common questions of law

or fact, etc.” Id. Similarly a party must affirmatively prove

that he complies with one of the three subsections of Rule

23(b).

The defendants do not dispute that the plaintiffs meet the

requirements of numerosity and adequacy of representation

under Rule 23(a). They argue only that the district court

abused its discretion in concluding that the plaintiffs have

demonstrated commonality and typicality. The defendants

also contend that the plaintiffs have not met the requirements

of Rule 23(b)(2). They argue that the district court abused its

discretion in concluding that, assuming the plaintiffs prevail

on the merits, injunctive relief will be appropriate for the

whole class and subclass. We address each of these

arguments in turn and conclude that the district court did not

err in certifying the plaintiffs’ proposed class and subclass.

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PARSONS V. RYAN 31

II

Rule 23(a)(2) requires “questions of law or fact common

to the class.” In Wal-Mart v. Dukes, the Supreme Court

announced that this provision requires plaintiffs to

“demonstrate that the class members ‘have suffered the same

injury,’” not merely violations of “the same provision of

law.” 131 S. Ct. at 2551 (quoting Gen. Tel. Co. of Sw. v.

Falcon, 457 U.S. 147,157 (1982)). Accordingly, plaintiffs’

claims “must depend upon a common contention” such that

“determination of [their] truth or falsity will resolve an issue

that is central to the validity of each one of the claims in one

stroke.” Id. at 2551. “What matters to class certification . . .

is not the raising of common ‘questions’—even in droves—

but, rather the capacity of a classwide proceeding to generate

common answers apt to drive the resolution of the litigation.” 

Id. (quoting Richard A. Nagareda, Class Certification in the

Age of Aggregate Proof, 84 N.Y.U. L. Rev. 97, 132 (2009)).

Plaintiffs need not show, however, that “every question in

the case, or even a preponderance of questions, is capable of

class wide resolution. So long as there is ‘even a single

common question,’ a would-be class can satisfy the

commonality requirement of Rule 23(a)(2).” Wang, 737 F.3d

at 544 (quoting Wal-Mart, 131 S. Ct. at 2556); see also

Mazza v. Am. Honda Motor Co., Inc., 666 F.3d 581, 589 (9th

Cir. 2012) (noting that “commonality only requires a single

significant question of law or fact”). Thus, “[w]here the

circumstances of each particular class member vary but retain

a common core of factual or legal issues with the rest of the

class, commonality exists.” Evon v. Law Offices of Sidney

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32 PARSONS V. RYAN

Mickell, 688 F.3d 1015, 1029 (9th Cir. 2012) (quotation

marks and citation omitted).16

Here, the defendants argue that the district court erred in

concluding that the plaintiffs satisfied Rule 23(a)(2). Their

principal argument is that the district court abused its

discretion in concluding that the plaintiffs have identified

questions of law or fact common to the class. In their view,

“Eighth Amendment healthcare and conditions-ofconfinement claims are inherently case specific and turn on

many individual inquiries. That fact is an insurmountable

hurdle for a commonality finding because Wal-Mart instructs

that dissimilarities between class members ‘impede the

generation of common answers.’” Reply Br. at 4 (quoting

Wal-Mart, 131 S. Ct. at 2551, 2556). In other words—also

from the defendants—the plaintiffs fail Rule 23(a)(2)’s

commonalitytest because “a systemic constitutional violation

[of the sort alleged here] is a collection of individual

constitutional violations,” each of which hinges on “the

16 The defendants assert that the district court applied an incorrect, preWal-Mart legal standard to the class certification issue. That assertion is

incorrect. Although the district court did, at one point, cite a pre-WalMart case that no longer states the law, see Walsh v. Ford Motor Co., 130

F.R.D. 260, 268 (D.D.C. 1990), its analysis otherwise fully recognized

and addressed Wal-Mart and post-Wal-Mart cases. Its conclusion,

moreover, reflects a proper application of current law. Cf. D.G. ex rel.

Stricklin v. Devaughn, 594 F.3d 1188, 1200 (10th Cir. 2010) (“We refuse

to find an abuse of discretion where the district court is accused of not

talismanically reciting [Rule 23’s] exact language in applying the law to

the facts when it clearly understood the law it was required to apply and

accurately applied it.”).

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PARSONS V. RYAN 33

particular facts and circumstances of each case.”17Id. at

9–10. This position amounts to a sweeping assertion that,

after Wal-Mart, Eighth Amendment claims can never be

brought in the form of a class action.18 The defendants’ view

rests, however, on a fundamental misunderstanding of WalMart, Eighth Amendment doctrine, and the plaintiffs’

constitutional claims.

In this case, as in all class actions, commonality cannot be

determined without a precise understanding of the nature of

the underlying claims. See Amgen Inc. v. Connecticut Ret.

Plans & Trust Funds, 133 S. Ct. 1184, 1194–95 (2013)

(“Merits questions may be considered to the extent—but only

to the extent—that they are relevant to determining whether

the Rule 23 prerequisites for class certification are satisfied.”

(citation omitted)); Ellis v. Costco Wholesale Corp., 657 F.3d

970, 981 (9th Cir. 2011) (“[T]he merits of the class members’

substantive claims are often highly relevant when

determining whether to certify a class.”).19 As we recently

17 The cases cited in the defendants’ briefs, many of which involve

individuals challenging particular instances of medical treatment or

conditions of confinement, confirm that they (erroneously) view the

plaintiffs’ claims as ultimately little more than a conglomeration of many

such individual claims, rather than as a claim that central policies expose

all inmates to a risk of harm.

18 As the defendants put it, “[t]he very individualized nature of

inadequate health care and conditions-of-confinement claims makes it

very difficult, if not impossible, to satisfy Wal-Mart’s ‘one stroke’

standard.” Opening Br. at 25.

19 Of course, this does not mean that the plaintiffs must show at the class

certification stage that they will prevail on the merits. See, e.g., Amgen,

133 S. Ct. at 1194–95 (“Although we have cautioned that a court’s classcertification analysis must be ‘rigorous’ and may ‘entail some overlap

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34 PARSONS V. RYAN

observed, “[t]o assess whether the putative class members

share a common question, the answer to which ‘will resolve

an issue that is central to the validity of each one of the [class

members’s] claims,’ we must identify the elements of the

class members’s case-in-chief.” Stockwell, 2014 WL

1623736, at *6 (quoting Wal-Mart, 131 S. Ct. at 2551). Here,

the defendants describe the plaintiffs’ claims as little more

than an aggregation of many claims of individual

mistreatment. See, e.g., Jett v. Penner, 439 F.3d 1091, 1096

(9th Cir. 2006). That description, however, rests upon a

misunderstanding of the plaintiffs’ allegations. The

Complaint does not allege that the care provided on any

particular occasion to any particular inmate (or group of

inmates) was insufficient, see, e.g., Estelle v. Gamble,

429 U.S. 97, 104–05 (1976), but rather that ADC policies and

practices of statewide and systemic application expose all

inmates in ADC custody to a substantial risk of serious harm.

This kind of claim is firmly established in our

constitutional law. As the Supreme Court recognized in

1993, “[t]hat the Eighth Amendment protects against future

harm to inmates is not a novel proposition.” Helling v.

with the merits of the plaintiff’s underlying claim,’ Rule 23 grants courts

no license to engage in free-ranging merits inquiries at the certification

stage.” (quoting Wal-Mart, 131 S. Ct. at 2551); Stockwell v. City & Cnty.

of San Francisco, No. 12-15070, 2014 WL 1623736, at *4 (9th Cir. Apr.

24, 2014) (“[D]emonstrating commonality does not require proof that the

putative class will prevail on whatever common questions it identifies.”);

Messner v. Northshore Univ. HealthSystem, 669 F.3d 802, 811 (7th Cir.

2012) (“[T]he court should not turn the class certification proceedings into

a dress rehearsal for the trial on the merits.”); Ellis, 657 F.3d at 983 n.8

(emphasizing that “whether class members could actually prevail on the

merits of their claims” is not a proper inquiry in determining “whether

common questions exist.”).

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McKinney, 509 U.S. 25, 33 (1993). Noting that it “would be

odd to deny an injunction to inmates who plainly proved an

unsafe, life-threatening condition in their prison on the

ground that nothing yet had happened to them,” Helling

squarely rejected the proposition, hinted at by the defendants

here, that “only deliberate indifference to current serious

health problems of inmates is actionable under the Eighth

Amendment.” Id. at 33, 34; see also id. at 33 (“We have

great difficulty agreeing that prison authorities may not be

deliberatelyindifferent to an inmate’s current health problems

but may ignore a condition of confinement that is sure or very

likely to cause serious illness and needless suffering the next

week or month or year.”). The Court then emphasized that

“[w]e would think that a prison inmate also could

successfully complain about demonstrably unsafe drinking

water without waiting for an attack of dysentery,” and that

prison officials may not be “deliberately indifferent to the

exposure of inmates to a serious, communicable disease on

the ground that the complaining inmate shows no serious

current symptoms.” Id. In Farmer v. Brennan, the Court

elaborated on Helling’s recognition that a “remedy for unsafe

conditions need not await a tragic event,” id., by holding that

“[a] prison official’s ‘deliberate indifference’ to a substantial

risk of serious harm to an inmate violates the Eighth

Amendment,” 511 U.S. 825, 828 (1994).

Since Helling and Farmer, we have repeatedlyrecognized

that prison officials are constitutionally prohibited from being

deliberately indifferent to policies and practices that expose

inmates to a substantial risk of serious harm. See, e.g.,

Graves v. Arpaio, 623 F.3d 1043, 1049 (9th Cir. 2010)

(substantial risk of harm from exposure of pre-trial detainees

on psychotropic medication to extreme heat); Wallis v.

Baldwin, 70 F.3d 1074, 1076 (9th Cir. 1995) (substantial risk

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36 PARSONS V. RYAN

of harm from sustained exposure to asbestos). In fact, we

have recently reminded a district court of the difference

between a claim that an inmate has already suffered harm and

a claim that he has been exposed to a substantial risk of

serious harm. See Thomas v. Ponder, 611 F.3d 1144, 1151

n.5 (9th Cir. 2010) (“In its order, the district court

erroneouslyconsiders whether the prison officials were aware

that Thomas was ‘suffering serious harm from the

deprivation’ of exercise. The correct issue for consideration

is, however, whether the prison officials were subjectively

aware of a ‘serious risk of substantial harm.’” (citing Farmer,

511 U.S. at 837; Helling, 509 U.S. at 32)).

In Brown v. Plata, the Supreme Court distinguished the

kind of systemic, future-oriented Eighth Amendment claim at

issue here from claims in which a past instance of

mistreatment is alleged to have violated the Constitution:

Because plaintiffs do not base their case on

deficiencies in care provided on any one

occasion, this Court has no occasion to

consider whether these instances of delay—or

any other particular deficiency in medical care

complained of by the plaintiffs—would

violate the Constitution under Estelle v.

Gamble, 429 U.S. 97, 104–105 (1976), if

considered in isolation. Plaintiffs rely on

systemwide deficiencies in the provision of

medical and mental health care that, taken as

a whole, subject sick and mentally ill

prisoners in California to “substantial risk of

serious harm” and cause the delivery of care

in the prisons to fall below the evolving

standards of decencythat mark the progress of

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a maturing society. Farmer v. Brennan,

511 U.S. 825, 834 (1994).

Brown v. Plata, 131 S. Ct. 1910, 1925 n.3 (2011). Since

Plata, we have relied on this fundamental distinction to hold

that “where aCalifornia prisoner brings an independent claim

for injunctive relief solely on his own behalf for specific

medical treatment denied to him, Plata does not bar the

prisoner’s claim for injunctive relief.” Pride v. Correa,

719 F.3d 1130, 1137 (9th Cir. 2013). As we explained,

“[i]ndividual claims for injunctive relief related to medical

treatment are discrete from the claims for systemic reform

addressed in Plata.” Id.

As the district court correctly recognized, the Eighth

Amendment claims in this case are of the same basic kind as

the claims in Helling, Farmer, Plata, and several of our own

precedents, including Graves and Wallis. In those cases,

courts have asked only whether the plaintiffs were exposed to

a substantial risk of harm to which prison officials were

deliberately indifferent—and have recognized that many

inmates can simultaneously be endangered by a single policy. 

See Helling, 509 U.S. at 33 (unsafe drinking water); Graves,

623 F.3d at 1049 (heat exposure); Wallis, 70 F.3d at 1076

(asbestos); Hoptowit v. Spellman, 753 F.2d 779, 783–84 (9th

Cir. 1985) (substandard fire prevention).

Here, a proper understanding of the nature of the

plaintiffs’ claims clarifies the issue of commonality. What all

members of the putative class and subclass have in common

is their alleged exposure, as a result of specified statewide

ADC policies and practices that govern the overall conditions

of health care services and confinement, to a substantial risk

of serious future harm to which the defendants are allegedly

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deliberately indifferent. As the district court recognized,

although a presently existing risk may ultimately result in

different future harm for different inmates—ranging from no

harm at all to death—every inmate suffers exactly the same

constitutional injury when he is exposed to a single statewide

ADC policy or practice that creates a substantial risk of

serious harm. See, e.g., Farmer, 511 U.S. at 834; Helling,

509 U.S. at 33; cf. Plata, 131 S. Ct. at 1923 (“For years the

medical and mental health care provided by California’s

prisons has fallen short of minimum constitutional

requirements and has failed to meet prisoners’ basic health

needs. Needless suffering and death have been the welldocumented result.”).

The putative class and subclass members thus all set forth

numerous common contentions whose truth or falsity can be

determined in one stroke: whether the specified statewide

policies and practices to which they are all subjected by ADC

expose them to a substantial risk of harm. See Dukes, 131 S.

Ct. at 2551. The district court identified 10 statewide ADC

policies and practices to which all members of the class are

subjected, and seven statewide ADC policies and practices

which affect all members of the subclass. These policies and

practices are the “glue” that holds together the putative class

and the putative subclass; either each of the policies and

practices is unlawful as to every inmate or it is not. That

inquiry does not require us to determine the effect of those

policies and practices upon any individual class member (or

class members) or to undertake any other kind of

individualized determination.

The district court thus did not abuse its discretion in

deciding to structure the litigation in the form of a class of 

“all prisoners who are now, or will in the future be, subjected

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to the medical, mental health, and dental care policies and

practices of the ADC.” After all, every inmate in ADC

custody is necessarily subject to the same medical, mental

health, and dental care policies and practices of ADC. And

any one of them could easily fall ill, be injured, need to fill a

prescription, require emergency or specialist care, crack a

tooth, or require mental health treatment. It would indeed be

surprising if any given inmate did not experience such a

health care need while serving his sentence. Thus, every

single ADC inmate faces a substantial risk of serious harm if

ADC policies and practices provide constitutionally deficient

care for treatment of medical, dental, and mental health

needs.20 As Justice Kennedy explained in Plata, inadequate

health care in a prison system endangers every inmate: “Even

prisoners with no present physical or mental illness may

become afflicted, and all prisoners in California are at risk so

long as the State continues to provide inadequate care . . . .

[P]risoners who are not sick or mentally ill . . . [are] in no

sense [] remote bystanders in California’s medical care

system. They are that system’s next potential victims.” 

131 S. Ct. at 1940.

Critically, the district court also identified 10 policies and

practices to which all members of the certified class are

exposed. In so doing, it confirmed that the class members are

as one in their exposure to a particular and sufficiently welldefined set of allegedly illegal policies and practices, rather

than only in their advancement of a general Eighth

20 The same analysis applies to the part of the district court’s order

certifying the isolation subclass, which it defined with respect to seven

policies and practices.

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Amendment legal theory.

21 Each of these 10 policies and

practices affords a distinct basis for concluding that members

of the putative class satisfy commonality, as all members of

the class are subject identically to those same policies and

practices, and the constitutionality of any given policy and

practice with respect to creating a systemic, substantial risk

of harm to which the defendants are deliberately indifferent

can be answered in a single stroke.22

For example, with respect to the putative class, the

plaintiffs allege that they are placed at risk of serious harm by

a policy and practice of severe under-staffing across all ADC

medical care facilities. As a result of this statewide policy

and practice, they allege, the quality and availability of care

across all ADC facilities is constitutionally deficient. This

allegation presents questions of law and fact common to all

members of the putative class. While no inmate can know in

21 Of course, district courts must be wary of framing common questions

so generally that they encompass myriad, distinct claims. Here, the

district court complied with that requirement: there is a single claim—

exposure to substantial risk of serious harm due to systemic policies and

practices—that can be proven (or not) in a single stroke with respect to

any or all of the certified policies. The district court might also, in the

alternative, have certified numerous separate classes or subclasses,

separating out groups of policies and practices, but we cannot say that it

abused its discretion in deciding that a single class and a single subclass

would be the most efficacious and appropriate structure for this litigation.

22 The defendants devote little effort to challenging the policies and

practices one at a time. They devote nearly all of their argument to a

broad attack on the certification of any class in this case, saying relatively

little about the propriety of certifying a class as to any particular policy

and practice. In any event, we have reviewed each of the 17 policies and

practices and conclude that certification is appropriate as to each of them

with respect to commonality.

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advance whether he will receive adequate and timely care in

the event that he falls ill or is injured, or know exactly what

form of harm he will suffer from the absence of such care,

every single inmate has allegedly been placed at substantial

risk of future harm due to the general unavailability of

constitutionally adequate care. The question whether ADC’s

staffing policies pose a risk of serious harm to all ADC

prisoners can thus be answered as to the entire class “in one

stroke.” Wal-Mart, 131 S. Ct. at 2551. Either ADC employs

enough nurses and doctors to provide adequate care to all of

its inmates or it does not do so; there is no need for an

inmate-by-inmate inquiry to determine whether all inmates in

ADC custody are exposed to a substantial risk of serious

harm by ADC staffing policies. See M.D. v. Perry, 294

F.R.D. 7, 45 (S.D. Tex. 2013) (holding, in a prisoner class

action suit, that “[t]he fact of whether [prison] policies

subject class members to an unreasonable risk of harm, and

whether that risk is so unreasonable as to rise to a

constitutional violation, can be proven on the basis of

classwide evidence without individualized inquiries.”). As

exemplified by Plata, claims of this kind, involving detailed

factual and legal allegations of specified systemic

deficiencies in prison conditions giving rise to a substantial

risk of serious harm, have long been brought in the form of

class actions lawsuits.23See also, e.g., Armstrong v. Davis,

23 The defendants’ insistence that commonality is defeated by individual

variations in preexisting conditions, demand for medical care, and

response to treatment is incorrect. Even if some inmates are exposed to

a greater or idiosyncratic risk of harm by the policy and practice of not

hiring enough staff to provide adequate medical care to all inmates, that

single policy and practice allegedly exposes every single inmate to a

serious risk of the same basic kind of harm. Thus, while Wal-Mart

instructs that “[d]issimilarities within the proposed class . . . have the

potential to impede the generation of common answers,” 131 S. Ct. at

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275 F.3d 849 (9th Cir. 2001). In fact, without such a means

of challenging unconstitutional prison conditions, it is

unlikely that a state’s maintenance of prison conditions that

violate the Eighth Amendment could ever be corrected by

legal action.

The same is true of the plaintiffs’ allegations concerning

conditions of confinement in the isolation units. For

example, the plaintiffs allege that it is the policy and practice

of ADC to provide inmates in isolation with constitutionally

deficient food and nutrition. See Foster v. Runnels, 554 F.3d

807, 814 (9th Cir. 2009) (“The sustained deprivation of food

can be cruel and unusual punishment when it results in pain

without any penological purpose.” (citation omitted)). They

support that claim with references to formal ADC policies,

admissions by ADC officials in discovery documents,

declarations by the named plaintiffs, allegations in the

Complaint, and Dr. Haney’s expert report. This claim will

not stand or fall based on variations in how hungry each

member of the putative subclass is, or on each individual’s

particular dietary needs (e.g., some may be kosher, others

may be vegetarians). While those variations undoubtedly

exist and affect how particular inmates experience and

respond to ADC policies and practice, they do not defeat

commonality because the plaintiffs’ claim is that ADC, as a

matter of formal policy and systemic practice, regularly

provides a level of nutrition that is so inadequate that it

2551, the acknowledged dissimilarities here between members of the

proposed class do not in any way bear on or disrupt what they allegedly

have in common, and it is that common exposure to ADC policies that

constitutes the core factual predicate of their shared legal claim. In other

words, ADC staffing policies for all of its facilities are either

constitutional or unconstitutional as to all inmates—that legal contention

can be answered in one stroke.

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exposes any inmate who is presently in ADC isolation or will

in the future be placed in isolation to a substantial risk of

serious harm. Some inmates may not actually be harmed, but

they are all allegedly exposed to a risk of harm that is, in its

own right, a constitutional injury amenable to resolution in a

class action.24

Wal-Mart, decided shortly after Plata, clarified that class

certification is appropriate only where the plaintiffs’ claims

rest on a “common contention” whose “truth or falsity will

resolve an issue that is central to the validity of each one of

the claims in one stroke.” Wal-Mart, 131 S. Ct. at 2551. 

Although the defendants assert that Wal-Mart prohibits class

certification here, a comparison of Wal-Mart and this case

strongly supports affirmance. Wal-Mart concluded that a

proposed Title VII class of 1.5 million female employees,

challenging discretionary decisions made by managers in

3,400 stores across the country, failed Rule 23(a)(2). Id. at

2551–57. It reasoned that the plaintiffs, who alleged a

general corporate policy of allowing discretion by local

managers, lacked “a common answer to the crucial question

24 To take another example from the isolation subclass, the plaintiffs

allege that they are exposed to a substantial risk of harm by inadequate

psychiatric monitoring due to chronic understaffing. They support this

claimwith detailed allegations in the Complaint; declarations fromseveral

named plaintiffs; internal ADC documents in which ADC staff

psychiatrists warn of dangerous understaffing and ADC accuses Wexford

of failing properly to provide mental health care staff; Wexford reports

that reveal gross understaffing of psychiatric positions; and the expert

reports of Dr. Haney and Dr. Stewart. For this claim, too, the question is

whether all inmates in isolation units—all of whom are at high risk of

mental health issues by the very fact oftheir confinement in isolation—are

placed at risk of harm by the absence of enough mental health care

providers to treat them. This question can be answered as to every

member of the subclass in one stroke.

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why was I disfavored.” Id. at 2552. It ultimately concluded

that the plaintiffs’ effort to “sue about literally millions of

employment decisions at once” thwarted commonality

because “demonstrating the invalidity of one manager’s use

of discretion will do nothing to demonstrate the invalidity of

another’s.” Id. at 2252, 2254. This case is different than

Wal-Mart in every respect that matters. It involves uniform

statewide practices created and overseen by two individuals

who are charged by law with ultimate responsibility for

health care and other conditions of confinement in all ADC

facilities, not a grant of discretion to thousands of managers. 

It involves 33,000 inmates in the custody of a single state

agency, not millions of employees scattered throughout the

United States. It looks to whether current conditions in ADC

facilities create a risk of future harm, not to the varied reasons

for millions of decisions made in the past. Whereas there

may have been many answers in Wal-Mart to the question

“why was I disfavored?,” here there is only a single answer

to questions such as “do ADC staffing policies and practices

place inmates at a risk of serious harm?”

It is therefore not surprising that, in deciding analogous

class certification motions since Wal-Mart, numerous courts

have concluded that the commonality requirement can be

satisfied by proof of the existence of systemic policies and

practices that allegedly expose inmates to a substantial risk of

harm. See, e.g., Chief Goes Out v. Missoula Cnty., No. 12

Civ. 155, 2013 WL 139938, at *5 (D. Mont. Jan. 10, 2013)

(“[C]ourts have long recognized that, in prison condition

cases like this one, the injury is the [deprivation] itself, not

just the negative effects resulting from the [deprivation] . . . .

[O]ther courts have certified classes of inmates claiming

unconstitutional deprivation of outdoor exercise, and scores

of courts have certified classes of prisoners claiming other

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unconstitutional prison conditions.”); Butler v. Suffolk Cnty.,

289 F.R.D. 80, 98 (E.D.N.Y. 2013) (“Whether the County

was aware of and deliberately indifferent to the conditions at

the [prison] is a common question subject to class-wide

resolution.”); Hughes v. Judd, No. 12 Civ. 568, 2013 WL

1821077, at *23 (M.D. Fla. Mar. 27, 2013) report and

recommendation adopted as modified, No. 12 Civ. 568, 2013

WL 1810806 (M.D. Fla. Apr. 30, 2013) (“Plaintiffs’ claims

related to these [prison] conditions are capable of class-wide

resolution: Plaintiffs seek permanent injunctive and

declaratoryrelief that would enjoin allegedlyunconstitutional

behavior as applied to the entire class. Importantly, the

questions of law are applicable in the same manner to each

potential class member . . . . Each class member, if

proceeding separately against Defendants, would need to

meet the same test under the Eighth and Fourteenth

Amendments to prevail.”); Rosas v. Baca, No. 12 Civ. 428,

2012 WL2061694, at *3 (C.D. Cal. June 7, 2012) (Pregerson,

J.) (“In a civil rights suit such as this one . . . commonality is

satisfied where the lawsuit challenges a system-wide practice

or policy that affects all of the putative class members. 

Under such circumstances, individual factual differences

among class members pose no obstacle to commonality.”);

Indiana Prot. & Advocacy Servs. Comm’n v. Comm’r,

Indiana Dep’t of Correction, No. 08 Civ. 1317, 2012 WL

6738517, at *18 (S.D. Ind. Dec. 31, 2012) (“The mentally ill

prisoners here, have demonstrated through a wealth of

evidence, that the class is united by the common question of

whether the lack of treatment and isolated living conditions

in IDOC facilities violate the Eighth Amendment.”); see also

Armstrong, 275 F.3d at 868.

In the related context of suits challenging a state’s

provision of social services to children in its protection,

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courts have employed similar logic while concluding that

Rule 23(a)(2) is satisfied. As the Tenth Circuit explained

while affirming certification of a class challenging

Oklahoma’s foster care system:

Named Plaintiffs presented more than

conclusory statements that OKDHS’s agencywide monitoring policies and practices, or

lack thereof, create a risk of harm shared by

the entire class. All class members, by virtue

of being in OKDHS’s foster care, are subject

to the purportedly faulty monitoring policies

of OKDHS, regardless of their individual

differences; therefore, all members of the

class are allegedly exposed to the same

unreasonable risk of harm as a result of

Defendants’ unlawful practices. Though each

class member may not have actually suffered

abuse, neglect, or the risk of such harm,

Defendants’ conduct allegedly poses a risk of

impermissible harm to all children in OKDHS

custody.

DG ex rel. Stricklin v. Devaughn, 594 F.3d 1188, 1196 (10th

Cir. 2010); see also, e.g., M.D., 294 F.R.D. at 44 (“To what

extent caseworkers are overworked, whether this overwork is

significant enough to subject the members of the General

Class to an unconstitutionally unreasonable risk of harm, and

whether the State has sufficient mechanisms in place to

mitigate those risks are the issues central to the Plaintiffs’

claim. Resolving them will determine the validity of the

common General Class Fourteenth Amendment claim in ‘one

stroke.’ If, for example, it is proven at trial that caseworkers

are not so overworked that they fail to provide

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constitutionally adequate care, then that will resolve all of the

class members’ claims at once; the State’s policies regarding

caseworker workloads would be found not to violate the

Fourteenth Amendment.”); D.G. ex rel. Strickland v.

Yarbrough, 278 F.R.D. 635, 644 (N.D. Okla. 2011)

(“[P]laintiffs have presented ‘significant proof’ that DHS has

a policy or practice of failing to adequatelymonitor the safety

of plaintiff children causing significant harm and risk of harm

to their safety.”); Connor B., ex rel. Vigurs v. Patrick, 278

F.R.D. 30, 34 (D. Mass. 2011) (“Plaintiffs have alleged

specific and overarching systemic deficiencies . . . that place

children at risk of harm. These deficiencies, rather than the

discretion exercised by individual case workers, are the

alleged causes of class members’ injuries, because they

undermine [the Department of Children and Family’s] ability

to timely and effectively implement case workers’ decisions. 

These systemic shortcomings provide the ‘glue’ that unites

Plaintiffs’ claims.”).25

25 One court has used similar logic to conclude that a putative class of

mentally ill individuals who are unnecessarily institutionalized in state

hospitals or who are at serious risk of unnecessary institutionalization in

those facilities satisfied Rule 23(a)(2)’s commonality requirement. See

Kenneth R. ex rel. Tri-Cnty. CAP, Inc./GS v. Hassan, 293 F.R.D. 254, 267

(D.N.H. 2013), appeal dismissed (Mar. 14, 2014) (“The plaintiffs have

also shown that common questions susceptible to common answers are

present. For instance, whether there is a systemic deficiency in the

availability of community-based services, and whether that deficiency

follows from the State’s policies and practices, are questions central to

plaintiffs’ theory of the case. These questions will, necessarily, be

answered similarly for every class member. And, whether the systemic

conditions, if shown to exist, expose all class members to a serious risk of

unnecessary institutionalization, including continued unnecessary

institutionalization, is a central and common contention whose resolution

will defeat or advance the claims of all class members, whether

institutionalized or not. In short, these common questions can be answered

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To be sure, this line of precedent does not hold that utterly

threadbare allegations that a group is exposed to illegal

policies and practices are enough to confer commonality. As

Wal-Mart made clear, Rule 23(a) is not a pleading standard;

rather, it requires proof that there are “in fact . . . common

questions of law or fact.” 131 S. Ct. at 2551; see also

Comcast Corp. v. Behrend, 133 S. Ct. 1426, 1432 (2013)

(noting that “it may be necessary for the court to probe

behind the pleadings before coming to rest on the certification

question” (quotation marks and citations omitted)); DL v.

District of Columbia, 713 F.3d 120, 126 (D.C. Cir. 2013)

(concluding that commonality had not been shown where the

plaintiffs in a putative IDEA class action had not identified a

“single or uniform policy or practice that bridges all their

claims”); M.D. v. Perry, 675 F.3d 832, 844 (5th Cir. 2012)

(cautioning that “mere allegations of systemic violations of

the law . . . will not automatically satisfy Rule 23(a)’s

commonality requirement” (quotation marks and citations

omitted)).

Here, however, the plaintiffs have met, and indeed far

exceeded, that requirement.26 The materials that they

submitted to the district court—which included four thorough

and unrebutted expert reports, the detailed allegations in the

74-page complaint, hundreds of internal ADC documents,

and declarations by the named plaintiffs—constituted more

either ‘yes’ or ‘no’ for the entire class, and the answers will not vary by

individual class members.” (quotation marks and citations omitted)).

26 We emphasize that our conclusions concerning the adequacy of the

plaintiffs’ evidence and arguments at this early stage in the litigation do

not constitute judgments concerning the ultimate merits of the plaintiffs’

allegations. See Amgen, 133 S. Ct. at 1194–95; Messner, 669 F.3d at 811.

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than sufficient evidence at this stage in the litigation of the

existence of the statewide ADC policies and practices that

allegedly expose all members of the putative class to a

substantial risk of serious harm.27 Those policies and

practices, moreover, are defined with sufficient precision and

specificity; they involve particular and readily identifiable

conduct on the part of the defendants, such as failing to hire

enough medical staff, failing to fill prescriptions, denying

inmates access to medical specialists, adopting a de facto

“extraction only” policy for dental issues, and depriving

suicidal and mentally ill inmates access to basic mental health

care.28 Compare M.D., 675 F.3d at 844 (noting that

commonality is not shown when plaintiffs allege an

amorphous claim of undefined and unspecified systemic

misconduct). Accordingly, the district court did not abuse its

27 As the district court observed, many of these documents, including the

expert reports and the internal ADC and Wexford memos and staffing

reviews, demonstrate that the challenged ADC policies and practices are

uniform across facilities and statewide in their scope.

28 The defendants argue that a few of the “practices” identified by the

district court are not defined with sufficient precision. The district court

carefully considered this argument and firmly rejected it, reasoning that,

unlike in cases where “there was simply insufficient evidence propelling

the plaintiffs’ isolated allegations of mistreatment into a plausible claim

of systemic deficiencies,” “the evidence here suggests that the root cause

of the injuries and threats of injuries suffered by Plaintiffs is the systemic

failures in the provision of health care generally.” The district court added

that “Plaintiffs’ expert declarations, largely unrebutted at this juncture, are

sufficient to establish that ADC’s practices or customs in the provision of

health care rise to the level of deliberate indifference that places inmates

at a substantial risk of serious harm.” We conclude that the district court

did not clearly err in making these factual findings concerning practices

across all ADC facilities, nor did it abuse its discretion in concluding that

those factual findings are sufficient under Rule 23(a)(2) to establish the

existence of the complained of ADC-wide policies and practices.

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considerable discretion in finding that, for purposes of Rule

23(a)(2), the evidence submitted by the plaintiffs adequately

demonstrated the existence of the challenged statewide

policies and practices.29

In sum, we conclude that the district court did not abuse

its discretion in determining that the plaintiffs’ claims depend

upon common questions of law or fact that are answerable in

one stroke. A clear line of precedent, stretching back long

before Wal-Mart and unquestionably continuing past it,

firmly establishes that when inmates provide sufficient

evidence of systemic and centralized policies or practices in

a prison system that allegedly expose all inmates in that

system to a substantial risk of serious future harm, Rule

23(a)(2) is satisfied. Here, the plaintiffs’ Eighth Amendment

claims satisfy all of those criteria. The factual and legal

29The parties dispute whether the “significant proof” standard, described

in Wal-Mart as the standard applicable to one means of bridging a “gap”

in evidence ofsystemic discrimination, applies to the plaintiffs’ arguments

here that the alleged uniform ADC policies and practices exist. Courts

have taken different views of whether Wal-Mart’s significant proof

standard applies to all class certification decisions or only to claims

alleging systemic discrimination. Compare Jamie S. v. Milwaukee Pub.

Sch., 668 F.3d 481, 498 (7th Cir. 2012) (applying “significant proof”

requirement to an alleged policy of violating the requirements of the

IDEA) with Jermyn v. Best Buy Stores, L.P., 276 F.R.D. 167, 172

(S.D.N.Y. 2011) (holding that “these additional requirements are designed

for and unique to the context of employment discrimination”). We need

not resolve that dispute, however, because under either a “significant

proof” standard or any lesser evidentiary standard, we would conclude that

“the breadth and consistency of class counsel’s initial evidence places the

district court’sfinding of commonalitywell within that court’s discretion.” 

Staton v. Boeing Co., 327 F.3d 938, 954 (9th Cir. 2003). That conclusion

is required both by the strength of the plaintiffs’ evidence and by the

defendants’ near-utter failure to respond to it with evidence of their own,

such as expert reports or internal studies.

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questions that they present can be answered “yes” or “no” in

one stroke as to the entire class, dissimilarities among class

members do not impede the generation of common answers

to those questions, and the capacity of classwide proceedings

to drive the resolution of this litigation cannot be doubted. 

See Wal-Mart, 131 S. Ct. at 2551–52. The claims, defenses,

relevant facts, and substantive law are all common across the

class. Accordingly, certification of the class and subclass was

appropriate with respect to Rule 23(a)(2)’s requirement of

commonality.

III

Rule 23(a)(3) requires that “the claims or defenses of the

representative parties are typical of the claims or defenses of

the class.” “Under the rule’s permissive standards,

representative claims are ‘typical’ if they are reasonably coextensive with those of absent class members; they need not

be substantially identical.” Hanlon v. Chrysler Corp.,

150 F.3d 1011, 1020 (9th Cir. 1998). The test of typicality is

“whether other members have the same or similar injury,

whether the action is based on conduct which is not unique to

the named plaintiffs, and whether other class members have

been injured by the same course of conduct.” Hanon v.

Dataproducts Corp., 976 F.2d 497, 508 (9th Cir. 1992). 

Thus, “[t]ypicality refers to the nature of the claim or defense

of the class representative, and not to the specific facts from

which it arose or the relief sought.” Id.

As the Supreme Court recognized in Wal-Mart, Rule

23(a)’s commonalityand typicalityrequirements occasionally

merge: “Both serve as guideposts for determining whether

under the particular circumstances maintenance of a class

action is economical and whether the named plaintiff’s claim

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52 PARSONS V. RYAN

and the class claims are so interrelated that the interests of the

class members will be fairly and adequately protected in their

absence.” 131 S. Ct. at 2551 n.5. We expressed a similar

point over a decade earlier in Armstrong v. Davis, a case in

which we also clarified how to analyze typicality in cases like

this one:

Where the challenged conduct is a policy or

practice that affects all class members, the

underlying issue presented with respect to

typicality is similar to that presented with

respect to commonality, although the

emphasis may be different. In such a case,

because the cause of the injury is the

same—here, the [Board of Prison Term’s]

discriminatory policy and practice—the

typicality inquiry involves comparing the

injury asserted in the claims raised by the

named plaintiffs with those of the rest of the

class. We do not insist that the named

plaintiffs’ injuries be identical with those of

the other class members, only that the

unnamed class members have injuries similar

to those of the named plaintiffs and that the

injuries result from the same, injurious course

of conduct.

275 F.3d at 868–69.

Here, the named plaintiffs are all inmates in ADC

custody. Each declares that he or she is being exposed, like

all other members of the putative class, to a substantial risk of

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PARSONS V. RYAN 53

serious harm by the challenged ADC policies and practices.30

See Hanon, 976 F.2d at 508. The named plaintiffs thus allege

“the same or [a] similar injury” as the rest of the putative

class; they allege that this injury is a result of a course of

conduct that is not unique to any of them; and they allege that

the injury follows from the course of conduct at the center of

the class claims.31

See id. Further, given that every inmate in

ADC custody is highly likely to require medical, mental

health, and dental care, each of the named plaintiffs is

similarly positioned to all other ADC inmates with respect to

a substantial risk of serious harm resulting from exposure to

the defendants’ policies and practices governing health care. 

Cf. Hanlon, 150 F.3d at 1020 (holding that “the broad

composition of the representative parties” can “vitiate[] any

challenge founded on atypicality”). It does not matter that the

named plaintiffs may have in the past suffered varying

injuries or that they may currently have different health care

needs; Rule 23(a)(3) requires only that their claims be

“typical” of the class, not that they be identically positioned

to each tother or to every class member. See Ellis, 657 F.3d

at 985 n.9 (“Differing factual scenarios resulting in a claim of

the same nature as other class members does not defeat

30 With respect to the subclass, several of the named plaintiffs have been

held in the isolation units whose conditions, as a matter of policy and

practice, allegedly violate the Eighth Amendment. The analysis of

typicality for the class in this paragraph is equally applicable to typicality

for the subclass.

31 The defendants’ argument that each named plaintiffs’ description of

past injuries must be treated as its own claim for Eighth Amendment

relief, potentially subject to unique defenses, rests on the same

misunderstanding of the nature of the plaintiffs’ claims that infected their

objections to commonality. The named plaintiffs allege that they are all

exposed to a substantial risk of serious harm, not that their particular

experiences in the past violated the Eighth Amendment.

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54 PARSONS V. RYAN

typicality.”). Accordingly, we conclude that the district court

did not abuse its discretion in determining that the plaintiffs

have satisfied the typicality requirement of Rule 23(a).

IV

Rule 23(b)(2) requires that “the party opposing the class

has acted or refused to act on grounds that apply generally to

the class, so that final injunctive relief or corresponding

declaratory relief is appropriate respecting the class as a

whole.” Although we have certified many different kinds of

Rule 23(b)(2) classes, the primary role of this provision has

always been the certification of civil rights class actions. See

Amchem Products, Inc. v. Windsor, 521 U.S. 591, 614 (1997)

(“Rule 23(b)(2) permits class actions for declaratory or

injunctive relief where ‘the party opposing the class has acted

or refused to act on grounds generally applicable to the class.’ 

Civil rights cases against parties charged with unlawful,

class-based discrimination are prime examples.” (citations

omitted)); Walters v. Reno, 145 F.3d 1032, 1047 (9th Cir.

1998) (“Rule 23(b)(2) was adopted in order to permit the

prosecution of civil rights actions.”); Baby Neal for & by

Kanter v. Casey, 43 F.3d 48, 63 (3d Cir. 1994) (“The writers

of Rule 23 intended that subsection (b)(2) foster institutional

reform by facilitating suits that challenge widespread rights

violations of people who are individually unable to vindicate

their own rights.” (citations omitted)). As Wright and Miller

have explained:

[S]ubdivision (b)(2) was added to Rule 23 in

1966 in part to make it clear that civil-rights

suits for injunctive or declaratory relief can be

brought as class actions . . . [T]he class suit is

a uniquely appropriate procedure in civil-

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PARSONS V. RYAN 55

rights cases, which generally involve an

allegation of discrimination against a group as

well as the violation of rights of particular

individuals. By their very nature, civil-rights

class actions almost invariably involve a

plaintiff class, although they may also be

brought against a defendant class . . .

Wright & Miller, 7AA Fed. Prac. & Proc. Civ. § 1776 (3d

ed.). Of course, we do not interpret Rule 23(b)(2) in a

manner that would prevent certification of the kinds of civil

rights class action suits that it was intended to authorize.

Thus, following Rule 23(b)(2)’s text and purpose, courts

have repeatedly invoked it to certify classes of inmates

seeking declaratory and injunctive relief for alleged

widespread Eighth Amendment violations in prison systems:

[I]t should be noted that a common use of

Rule 23(b)(2) is in prisoner actions brought to

challenge various practices or rules in the

prisons on the ground that they violate the

constitution. For example, Rule 23(b)(2) class

actions have been utilized to challenge prison

policies or procedures alleged to . . . violate

the prisoners’ Eighth Amendment rights to be

free from cruel and unusual punishment.

Id. at § 1776.1; see also, e.g., Butler, 289 F.R.D. at 101

(certifying Rule 23(b)(2) class of prisoners alleging systemic

Eighth Amendment violations); Hughes, 2013 WL 1821077,

at *20 (same); Rosas, 2012 WL 2061694, at *5 (same);

Indiana Prot. & Advocacy Servs. Comm’n, 2012 WL

6738517 at *18 (same).

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56 PARSONS V. RYAN

Here, the plaintiffs seek declaratory and injunctive

remedies. In their prayer for relief, the plaintiffs request that

the defendants be ordered “to develop and implement, as soon

as practical, a plan to eliminate the substantial risk of serious

harm that prisoner Plaintiffs and members of the Plaintiff

Class suffer due to Defendants’ inadequate medical, mental

health, and dental care, and due to Defendants’ isolation

policies.” The plaintiffs then specify 10 separate issues that

the defendants should be required to address in any courtenforced plan designed to satisfy their alleged remedial

obligations. These issues include staffing, screening, chronic

care, emergency response, and medication and supplies.32

The plaintiffs’ expert reports also include descriptions of the

kinds of court-ordered changes in ADC policy and practice

that could alleviate the alleged systemic Eighth Amendment

violations, as well as affirmations by all four experts that, in

their experience, court-ordered injunctive relief could

effectively alleviate the deficiencies in ADC policies and

practices identified in their reports.

The district court concluded that the plaintiffs’ claims

“for injunctive relief stemming from allegedly

unconstitutional conditions of confinement are the

quintessential type of claims that Rule 23(b)(2) was meant to

address.” It explained that “the claims of systemic

deficiencies in ADC’s health care system and

unconstitutional conditions of confinement in isolation units

apply to all proposed class members,” and firmly rejected the

32 Under “Staffing,” for example, the plaintiffs request that the

defendants be required to ensure that “Staffing shall be sufficient to

provide prisoner Plaintiffs and the Plaintiff Class with timely access to

qualified and competent clinicians who can provide routine, urgent,

emergent, and specialty health care.”

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PARSONS V. RYAN 57

defendants’ contention that “any proposed injunction here

would be crafted at a stratospheric level of abstraction.” It

added that “the remedy in this case would not lie in providing

specific care to specific inmates,” but rather “the level of care

and resources would be raised for all inmates.” “Thus,” it

concluded, “if successful, a proposed injunction addressing

those [policies and] practices would . . . prescribe a standard

of conduct applicable to all class members.” In other words,

“relief for some inmates would necessarily result in

injunctive relief for all inmates.”

The district court did not abuse its broad discretion in

determining that the plaintiffs have satisfied Rule 23(b)(2). 

In Wal-Mart, the Supreme Court summarized Rule 23(b)(2)’s

requirements as follows:

The key to the (b)(2) class is “the indivisible

nature of the injunctive or declaratory remedy

warranted—the notion that the conduct is such

that it can be enjoined or declared unlawful

only as to all of the class members or as to

none of them.” In other words, Rule 23(b)(2)

applies only when a single injunction or

declaratory judgment would provide relief to

each member of the class. It does not

authorize class certification when each

individual class member would be entitled to

a different injunction or declaratory judgment

against the defendant . . . .

131 S. Ct. at 2557 (citation omitted). These requirements are

unquestionably satisfied when members of a putative class

seek uniform injunctive or declaratory relief from policies or

practices that are generally applicable to the class as a whole. 

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See Rodriguez v. Hayes, 591 F.3d 1105, 1125 (9th Cir. 2010). 

That inquiry does not require an examination of the viability

or bases of the class members’ claims for relief, does not

require that the issues common to the class satisfy a Rule

23(b)(3)-like predominance test, and does not require a

finding that all members of the class have suffered identical

injuries.33

See id.; Walters v. Reno, 145 F.3d 1032, 1047 (9th

 

33 As Wright & Miller observe:

The term ‘generally applicable’ has been said to signify

that the party opposing the class does not have to act

directly against each member of the class. The key is

whether the party’s actions would affect all persons

similarly situated so that those acts apply generally to

the whole class . . . .

[C]ourts have interpreted this requirement to mean that

the party opposing the class either has acted in a

consistent manner toward members of the class so that

the opposing party’s actions may be viewed as part of

a pattern of activity, or has established or acted

pursuant to a regulatory scheme common to all class

members. This is consistent with the intention of the

Advisory Committee, which stated in its Note to the

1966 amendment of Rule 23 that: “Action or inaction is

directed to a class within the meaning of this

subdivision even if it has taken effect or is threatened

only as to one or a few members of the class, provided

it is based on grounds which have general application

to the class.” All the class members need not be

aggrieved by or desire to challenge defendant’s conduct

in order for some of them to seek relief under Rule

23(b)(2). What is necessary is that the challenged

conduct or lack of conduct be premised on a ground

that is applicable to the entire class.

Fed. Prac. & Proc. Civ. at § 1775 (quotation marks and footnotes

omitted).

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Cir. 1998). Rather, as the text of the rule makes clear, this

inquiry asks only whether “the party opposing the class has

acted or refused to act on grounds that apply generally to the

class.” Rule 23(b)(2).

In this case, all members of the putative class and

subclass are allegedly exposed to a substantial risk of serious

harm by a specified set of centralized ADC policies and

practices of uniform and statewide application. While each

of the certified ADC policies and practices may not affect

every member of the proposed class and subclass in exactly

the same way, they constitute shared grounds for all inmates

in the proposed class and subclass. See Rodriguez, 591 F.3d

at 1125–26; Walters, 145 F.3d at 1047.34In sum, by allegedly

34 See also, e.g., M.D. ex rel. Stukenberg v. Perry, 675 F.3d 832, 847–48

(5th Cir. 2012) (“[T]he [Rule (b)(2)] class claims could conceivably be

based on an allegation that the State engages in a pattern or practice of

agency action or inaction—including a failure to correct a structural

deficiency within the [child protective services] agency, such as

insufficient staffing—“with respect to the class,” so long as declaratory or

injunctive relief settling the legality of the [State’s] behavior with respect

to the class as a whole is appropriate.” (citations omitted)); D.G., 594 F.3d

at 1201 (“Here the ‘grounds’ that have general application to the class are

that all class members have been placed in [the Oklahoma Department of

Human Services’s] foster care program and, as such, caseworkers monitor

all class members in a system that allegedly fails to ensure they do not

carry caseloads so demanding that they cannot monitor class members

adequately.”); Baby Neal, 43 F.3d at 64 (“Plaintiffs have alleged that

systemic failure causes the DHS to violate various mandates under federal

statutory and constitutional provisions. Because the children in the system

are comparably subject to the injuries caused by this systemic failure, even

if the extent of their individual injuries may be affected by their own

individual circumstances, the challenge to the system constitutes a legal

claim applicable to the class as a whole. An order forcing the

[Department of Human Services] to comply with their statutory and

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establishing systemic policies and practices that place every

inmate in ADC custody in peril, and by allegedly doing so

with deliberate indifference to the resulting risk of serious

harm to them, the defendants have acted on grounds that

apply generally to the proposed class and subclass, rendering

certification under Rule 23(b)(2) appropriate.

The relief requested by the plaintiffs also conforms with

Rule 23(b)(2)’s requirement that “final injunctive relief or

corresponding declaratory relief is appropriate respecting the

class as a whole.” See Wal-Mart, 131 S. Ct. at 2557 (stating

that Rule 23(b)(2) “does not authorize class certification

when each individual class member would be entitled to a

different injunction or declaratory judgment against the

defendant”). Contrary to the defendants’ assertion that each

inmate’s alleged injury is amenable only to individualized

remedy, every inmate in the proposed class is allegedly

suffering the same (or at least a similar) injury and that injury

can be alleviated for every class member by uniform changes

in statewide ADC policy and practice. See, e.g., D.G.,

594 F.3d at 1201 (“Named Plaintiffs allege the same injury

on behalf of all class members as a result of excessive

caseloads—exposure to an impermissible risk of harm . . . . 

To remedy this alleged harm, Named Plaintiffs propose an

injunction requiring OKDHS assign no more than 15 foster

children to each caseworker . . . . As the district court noted,

such an injunction applies to the proposed class as a whole

without requiring differentiation between class members.”);

Marisol A. v. Giuliani, 126 F.3d 372, 378 (2d Cir. 1997)

(“Defendants argue that because the plaintiffs have alleged

differing harms requiring individual remedies, no injunction

constitutional mandates would constitute relief generally applicable to the

entire putative class.”).

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will be appropriate for the entire class . . . . We disagree. 

Insofar as the deficiencies of the child welfare system stem

from central and systemic failures, the district court did not

abuse its discretion in certifying a 23(b)(2) class at this stage

of the litigation.” (citations omitted)). For example, every

inmate in ADC custody is allegedly placed at risk of harm by

ADC’s policy and practice of failing to employ enough

doctors—an injury that can be remedied on a class-wide basis

by an injunction that requires ADC to hire more doctors, with

the exact number of necessary additional hires to be

determined by the district court if, after a trial, it ultimately

concludes that the defendants engaged in unlawful conduct. 

Thus, considering the nature and contours of the relief sought

by the plaintiffs, the district court did not abuse its discretion

in concluding that a single injunction and declaratory

judgment could provide relief to each member of the

proposed class and subclass.35

 

35 Remarkably, the defendants do not cite a single Ninth Circuit

case in support of their argument that the district court erred in certifying

the class and subclass under Rule 23(b)(2). Instead, they rely on a Tenth

Circuit case suggesting that, at the class certification stage, plaintiffs

seeking certification under Rule 23(b)(2) might be required to offer a

fairly detailed description of the injunctive relief that they seek. See

Shook v. Board of County Commissioners of County of El Paso, 543 F.3d

597 (10th Cir. 2008) (“Shook II”). In that case, while noting that “we very

well may have made a different decision had the issue been presented to

us as an initial matter,” and that the plaintiffs had “eschewed any effort to

give content” to the terms of their proposed injunction, the court held that

a district court had not abused its discretion in declining to certify a Rule

23(b)(2) class where the proposed injunction had been formulated at “a

stratospheric level of abstraction” and required inmate-by-inmate

assessments. Id. at 603, 604, 606. The court also noted a few reasons

whydistrict courts, exercising their discretion, might require more detailed

descriptions of systemic reform injunctions. See id. at 604–07.

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CONCLUSION

The district court acted well within its broad discretion in

concluding that the putative class and subclass satisfy the

The defendants’ reliance on that case here is ill-founded. First, we

seriously doubt that the degree ofspecificity suggested in Shook II’s wideranging dicta is properly required at the class certification stage for a Rule

23(b)(2) class. That is particularly true in prison cases, given that an

injunction in any such case must closely track the violations established

by the evidence at trial, that any such relief must comply with the PLRA’s

extensive requirements, that prison officials must play a role in shaping

injunctions, that ultimate proof of some violations but not others might

easily change the structure of a remedial plan, that conditions in prisons

might change over the course of litigation, and that the class certification

hearing is not a dress rehearsal of the trial on the merits (let alone a dress

rehearsal of the remedy proceedings). The better approach in a prison

conditions case is for the district court, exercising its discretion and

following Rule 23, to ask whether the plaintiffs’ proposed relief “is

appropriate respecting the class as a whole.” That requirement ordinarily

will be satisfied when plaintiffs have described the general contours of an

injunction that would provide relief to the whole class, that is more

specific than a bare injunction to follow the law, and that can be given

greater substance and specificity at an appropriate stage in the litigation

through fact-finding, negotiations, and expert testimony. Second, since

Shook II, several courts, including the Tenth Circuit, have observed that

certification of a Rule 23(b)(2) class is warranted under circumstances

highly analogous to those present here. See, e.g., M.D., 675 F.3d at 847

(FifthCircuit); D.G., 594 F.3d at 1188 (TenthCircuit). Finally, even if we

were to apply Shook II and all of its dicta, we would still affirm. After all,

we are reviewing for abuse of discretion a grant of class certification—

unlike the Shook II court, which took pains to emphasize that it might well

have certified the class before it on de novo review and that the level of

detail that it described merely explained why the lower court opinion was

not “beyond the pale.” 543 F.3d at 604. Further, here the plaintiffs have

described their injunction in more specific terms than did the plaintiffs in

Shook II, and they have fleshed out that description by introducing four

expert reports that explain which policies are deficient and what sorts of

policy remedies could alleviate the alleged violations.

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requirements of Rule 23. We therefore affirm the district

court’s certification order.

AFFIRMED.

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