### In th e



# United States Court of Appeals For the Seventh Circuit

No. 12-3620
J O H N T OWN S E ND, Plaintiff-Appellant,

v.

S AR AH C O OP E R

, et al. , Defen dants-Appellees.
Appe al f ro m the Uni ted S tates Distri ct Co urt fo r the E astern Distri ct o f Wi sconsi n. No. 2: 10 -cv-00 34 7- PJG — Pa trici a J. Gorence , Magistrate J udg e.

A RGU E D M A

Y 31, 2013

— D E C I D E D J ULY 17, 2014

Before F L AUM

, M AN I O N

, and R OVN E R

, Circ uit Judges.

R OVN E R , Cir cui t Judge. John T

ownsend w as a pris oner at the G re e n B ay C or re c ti on a l In s ti tution (“GBCI”), a faci li ty op e ra te d by the Wi scons in Department of Cor rections (“ DO C”). T ownsend sued a numb er o f offi ci als at the Green B ay f aci li ty for violat io ns of hi s ci vil rights under the Ei ghth and Four teenth Amendments. The low er court gr anted sum mary2 No. 12-3620 judgment in fav or of the defendants. W e a ff ir m in part and

v acate and remand in part. I. On a ppeal from a gr ant of sum mary judgment, “[t]he evidenc e of the non-mov ant i s to be beli ev ed, and all justifi able inferences are to be drawn in hi s fav or .” Anderson v
. Liberty Lobby , Inc ., 477 U.S. 242, 255 (1986). W e mus t there fore credi t T ownsend’s versi on of the facts at thi s stage. GBCI has procedures in place for inmates who violate prison rules. See Wi s. Admin. Code (the “Code”) §§ DOC 303.01 et s e q

. (t he “rules governing inmate conduct under thi s chapter describe t he conduc t for whi ch an inmate may be di sci plined and the procedures for the i mposi tion of di scip line.”). The ext ensi v e procedures that follow secti on DOC 303.01 govern how pris on offi ci als may enforce di sci pline in Wi sc onsin pris ons. See e.g. Wi s. Admin. Code. §§ DOC 303.69 & 303.70 (d e scribing procedures for major penalti es inclu ding adjustment segreg ation, prog ra m s e gr e ga ti on a n d d i s c i p l in a ry s e p arat i on). See also R. 63-9 (GBCI Segr egat i on Uni t Handbook). The pris on a lso has procedures for inmates who are mentally i ll and pose a danger to themselv es or other s. See W i s. Admin. Code §§ DOC 311.01 et seq. That chapter prov i des “for
an inv oluntary or v oluntary nonpuni tiv e status to be used for the tempor ary confinement of an inmate to ensure the inmate's safety and the s afety of other s i f the inmate i s mentally i ll and dangero us, [or ] is danger ous t o hi mself or herself[.] ” As with di sci plinary infracti ons, the Code prov i des ext e ns ive procedures for placemen ts for ment a l he alth reasons. See e.g. Wi s. Admin. Code § DOC 311.04 (“Mental health placemen t”).No. 12-3620 3
The non-pun i tiv e status that GBCI employs i s refer red to as “observ ation status,” a v ery restr i cti v e status in whi ch prison staff r emov e any proper ty that t he inmate could us e to injure hi mself or other s. See W i s. Admin. Code § DOC 311.14 (“ C o nditi ons of confinement whi le in observ ation”). For a n inmate bent on self- destructi on, thi s could inclu de almost any proper ty , and some W i scons in inmates hav e proven morbid ly creativ e in their use of common objects to harm themselv es. See e.g. Bowers v

. Pollard, 6 02 F

. Supp. 2d 977, 981 (E.D. W i s. 2009) (behavi or acti on plan appli ed to mentally i ll inmate who repeat edly atte mpted to injure hi mself by ins e r tin g objects
such as the teet h of a comb, fingernails, a pi ece of a mi lk carto n and a pi ece of a mattr ess, into his peni s).
T ownsend presented complex challen ges to t he st aff at GBCI becau se he suffere d fr o m si gni fi cant mental i llness and also engaged in di srupti v e behavi or

. The resulti ng acti ons that pris on staff too k to address hi s behavi or w ere a blend of the tw o approaches. As w e wi ll see, though, the hybri d approach lacked procedural prot ecti ons required by the d ue process claus e and someti mes resulted in li ving condi tions that di d not meet the Ei ghth Amendment’s sta nd a rd for the mini mal ci vili zed me a su r es of li fe’s necess i ties

. Under the hybrid approach, i f an inmate at GBCI engages in “ co nti nual di srupti v e, destructiv e, assau ltive or self-harming behaviors” and “reg ular measu res” have “fai led to corr ect the inmate’s behavi or ,” the pris on’s S e g reg ation Review Commi tte e i mplements a Behavior Acti on Plan (“ B A P”) for the inmate. Accordi ng to the defendants, a BAP i s an indi vidu ali zed plan th at i s desi gned to prov i de incenti v es for appropr i ate beha vi or

. An inmate on a BAP faces restr i cti ons o n his proper ty and4 No. 12-3620 privi leges; goo d behavi or re s u l ts in restorat i on of proper ty and privi leges, a nd “uns table” behavi or i s met wi th more sev ere restr i cti ons. A lthough the pris on characterizes a BA P a s no npuni tiv e, i t also ci tes as the source of authority for the BAP the secti ons of the Wi scons in Ad m ini strat i v e Code that prov i de for “Maj or penalti es: adjustment segreg ation,” and “Maj or penalti es: prog ram segreg ation and d isci plinary separation.” See Wi s. Admin. Code. §§ DOC 303.69 & 303.70. Whether the BAP i s puni tiv e and whether i t requires notic e and an oppor tuni ty to o bj e ct i s o ne of the di sputed is sues in t he case that w e wi ll address b elow

. Accordin g to a pris on psychologis t, T ownsend had

“ multiple observ ation placemen ts datin g back to Februar y 2004.” R. 63-11, at 2. These placements w ere based on threat s of self- harm and T

ownsend’s inabi li ty to “contract for safety .” In Februar y 200 4 , for example, whi le housed in the gener al populati on, T

ownsend tr i ed to hang hi mself from a li ght wi th
a bed sheet. Bey ond being p l a ced on observ ation status, the
recor d does not r ev eal how the pris on responded to T ownsend’s Februar y 2004 sui ci de atte mpt. In Mar ch 2005, T ownsend again told pris on staff that he w anted to kill hi mself

. As a result, a pris on psychologis t, Dr . St ev en Schmi dt, pl aced T ownsend on observ ation status on Mar ch 17, 2005. During the
nex t t hr ee months, T

ownsend twi ce tr i ed to kill hi mself and repeat edly expr essed sui ci dal desi res. Pri son psychologis ts Dr

. T odd Hami lton and Dr

. Mar tha Breen-Smith reg ularly vis i ted T ownsend duri ng thi s period and adjusted hi s li ving condi tions to remove from hi s possess i on objects he could use to harm hi mself

. For example, a fter tr yin g to hang hi mself from
a li ght fi xtur e on May 24, 2005, hi s possess i ons w ere li mi ted toNo. 12-3620 5

a blanket, a smock and a book

. O n May 26, he w as released bri efly from observ ation s tatus only to b e placed back on that status later that sa me day after again threat ening to harm hi mself

. On June 2, he w as released from observ ation status but

w as found later wi th a sheet wrapped aro und hi s neck, resulti ng in a ret urn to observ ation that same day

. A few

w eeks later

, when he removed a strip of V elcro from hi s smock and stated an intention to use i t to hang hi mself , he w as giv en
a paper gown instead. At tim es, when staff deemed i t s afe, he

w as allow ed to show er and w as giv en soap, a tow el and show er shoes for that purpose. Other wi se, whi le on observ ation status, T

ownsend’s ac cess to hi s proper ty w as v ery li mi ted. In May 2005, in the mi dst of multi ple placemen ts and releases from obse r v ation status, Dr

. Schmi dt conduc ted a “Review for Mental Health Plac e m e n t” for T own send. R. 63-11, at 1. Dr

. Schmi dt di agnosed T ownsend as sufferin g from PostT raumatic St ress Di sorder (“PT SD”). He noted that T ownsend h a d “ mu l tiple contacts wi th psychologic al services in the p a s t, ” that he w as gener ally cooper ativ e and di d not show si gn s of psychoti c symptoms “except o ne t ime.” He w as at tim es agitated and dysphoric, and he repo rt ed to pris on psychologis ts that ev ents in the gener al populati on someti mes tr i gge red memories that led to hi m acting out. Dr

. Schmi dt 1

Acco rdi ng to the Natio nal Institute of Mental Health, “PTS D develo ps 1 after a terri fyi ng or deal tha t i nv ol v ed physical ha r m or the threat of physical harm .” Co mmon symptoms ofP TSD incl ude re-e xperie ncing the i niti al trauma

, which i s someti mes tri ggered b y word s, objects, or situati ons tha t are remi nders of the event; av oi dance, i nclud i ng bo t h p hy sical l y (co ntinued. ..)6 No. 12-3620

no t e d in hi s repo rt that T ownsend had been placed o n observ ation status twi ce in May 2005 after telling s taff that he

w as depressed and w anted to hurt hi mself

. T ownsend had not been prescribed any psychotro pi c medicati ons. Dr

. Schmi dt conclu ded that T

ownsend w as lo oking for help, w anted to be helped, and w as motiv a t e d to w or k wi th the staff at the Wi scons in Resource Center (“WRC”), a se cure mental health faci li ty for pris oners. On May 18, 2005, Dr

. Schmi dt th e r e fo r e recommended an “urgent tr ansfer” to the WRC for T ownsend.
But T ownsend w as not tr ansferr ed to that faci li ty

. Although the recor d does not rev eal the reason that Dr

. Schmi dt’s urgent

r e quest and recommendati on w as not carried out, at o r a l arg ument, couns el fo r the defendants stated that there w as another inmate at the WRC wi th whom T ownsend could not be placed. Instead, on June 21, 2 0 0 5, just weeks after Dr

.

2 Schmi dt’s urg e nt recommendati on, T ownsend w as released

( ...c onti nued) 1 stay i ng away fro m remi nders and also emoti onal symptoms such as numb ness, guil t and depr essio n; and hyperarousal, i nclud i ng b ei ng easil y startled, fee l i ng tense or “o n edge, ” hav i ng di ffi cul ty sle epi ng, and hav i ng ang ry outbursts. Recogni zed treat me nts fo r PTSD i nclud e psychotherapy and medi catio n. See http://www.ni mh.ni h.gov/health/to pi cs/po st-trau mati c-stress-d i sord er-p tsd/i ndex.sh tml ( l ast v i site d J une 20 , 2 01 4)

.
In respo nse to the cour t’s questio ns, counsel coul d not explain wh y t he 2 presence of a singl e i nma te with whom Townsend had an u ns p e ci fi ed conf l i ct precl uded him entirel y fro m pl acement at the WRC. Acco rdi ng to Townsend, whom we must cred i t on summa ry judgment, i n Februa ry 20 06 , B r e e n- S mith tol d Townsend tha t he woul d nev er go to the WRC b ecau se she b el i eved he was faking his symptoms and tha t there was nothi ng wrong with hi m.No. 12-3620 7
from s egr egat i on s tatus and on J une 22, he w as released from observ ation status and ret urned to the pris on’s gener al populati on. Not su r p r isingly

, hi s stay in the gener al populati on w as short-liv ed. Wi thi n a day , he got into a fi gh t wi th other inmates, and on June 23, 2005, he w as placed in “tempor ary lock-up status.” On J une 24, he w as placed in “contro l status” and giv en a paper gown. On that same day , t he S e gr egat i on 3 Review Commi tte e placed T ownsend on a BAP

. He w as giv en a memorandum that described the ter ms of hi s fi rst BAP: Y ou hav e r e cent ly made threat s to y ourself and other s. Addi tionally

, y our behavi or has been v ery di srupti v e. Therefore , pursuant to the DOC Admin Cod 303.69 and 303.70, y our proper ty wi ll be kept outs ide of y our cell, due to safety and secu rity
concerns presented by allowing y ou to hav e it in cell. •Y our cell wi ll be searched tw o timesa w eek. •Y ou wi ll be gi v en a bag meal. •Y ou wi ll be take n out of y our cell of [si c] Fr i days to rev i ew mai l, wri te lette r , etc. Y ou wi ll be

Acco rdi ng to the def endants, an i nma te i s pl aced i n “co ntrol statu s” when 3 the i nma te i s b ehav i ng i n a di srupti v e manner. During contro l statu s, the i ns t i t u t i on pro v i des a mattress, l i ght, toi l et, sink, v entil atio n and heati ng, adequa te cl othi ng, ess e nt i al hygiene suppl i es and nutriti onall y adequa te meals, b ut otherwi se maintains cl ose contro l of the i nma te’s pro perty. R. 48 , at 16.8 No. 12-3620
allow ed one hour to perfor m these task s. An offi cer wi ll be present at all time. •Y ou wi ll hav e a paper g own to w ear

. •Upo n request, y ou wi ll be giv en a self- help book by clini cal s erv i ces. •Y ou wi ll be gi v en a segreg ation mattress. •Y ou wi ll be giv en a show e r o n reg ular show er days. As appropr i ate, a tow el and hygiene suppl ie s wi ll be prov i ded to y ou prior to the sh ow er

. Y

ou wi ll be expected to ret urn all i tems after t he show er

. No changes will be made in the plan wi thout Lt. Swi ekat owski, Prog ram Su p erv i sor Coo per , Dr

. Hami lton and/or Dr . Breen’s appro v al. Thi s p l an wi ll be rev i ew ed on an ongo ing and reg ular basi s. Modifi cati ons wi ll be made as appropr i a te, to inclu de giving y ou more privi leges and proper ty as y our behavi or stabi li zes, or taking
more privi leges and proper ty i f y ou become
uns table.
R. 48-8. T w elv e days later

, the BAP w as modi fi ed to change the segreg ation mattr ess to a reg ular mattr ess and to prov i de a “seg blanke t.” Id

. Wi th few changes, future BAP notic es prov i ded for si mi lar condi tions, somet imes allowing more prop e r ty and privi leges and someti mes i mposing stric ter constrain ts. When T

ownsend w as p l a ce d on a BAP in Nov ember 2005, the notic e speci fi ed “Thi s plan wi ll be
rev i ew ed on an ongo ing and reg ular basi s, there i s no set dateNo. 12-3620 9
that thi s wi ll occur .” R. 48 -2 1

. T ownsend clai med that he w as not alw ays give n a ll o f t he proper ty or privi leges speci fi ed in the BAP

. No BAP prov i ded any oppor tuni ty for a hearin g or for T ownsend to object. Other than gener al statements in each BAP that the plan w ould be rev i ew ed “reg ularly ,” and that T ownsend w ould receiv e adjustments to the restr i cti ons based
on stable o r uns table behavi or , there w as no end dat e for any BAP and there w as no speci fi ed w ay for T ownsend to bri ng an end to t he restr i cti ons i mposed un der a BAP

. Betw een June 24, 2005 and Mar ch 31, 2006 (wh en he w as tr ansferr ed to another faci lit y ), T ownsend w as subjected to di fferent BAPs for 259 days. During that tim e, hi s proper ty 4 and privi leges w ere sev erely constrain ed. For at least ninety of those days, he w as e ither naked or i ssu ed only a paper gown
or segreg ation smock. He w as deni ed a reg ular mattr ess for 106 days, and w as not allow ed sheets or a pi llow for almost the entirety of the BAP period. When he di d not hav e a reg ular mattr ess, he slept on ei ther a rubber ma t or a concrete slab. Cold ai r blew into hi s cell from the v e nti lation system and T ownsend w as often v ery cold. He w alked non-stop aro und hi s cell in an atte mpt to keep w arm. He w as allow ed out of hi s cell for one hour per w eek to read hi s mai l and wri te lette rs. He

w as not allow ed acces s to toiletries or a tow el for almost the entirety of hi s confinement under the BAP

. That meant he had
no toilet paper (or at tim es o nly a v ery small amount of to i let

F o r br i ef peri od s of time, Townsend was rel eased fro m the BAP. Thus, 4 although 28 0 d ays el apsed b etween the fi rst i mposi tio n of the BAP and Townsend’s trans fer to another faci l i ty, he was sub jec ted to the BAP, b y his own cal cul atio n, fo r 2 59 days.10 No. 12-3620 paper), no soap to w ash hi s hands, and no too thpaste or too thbrush. For 136 days, he w as deni ed wri tin g materials in hi s ce l l , and hi s acces s to book s and mai l w as sev erely
res t r ict ed. For a lengthy period, he w as given hi s meals in a bag, to eat wi th hi s hands, rat her than a meal tr ay wi th utensi ls that w as prov i ded to other pris oners. For a period of w eeks (he does not speci fy how many), T ownsend w as entir e l y nak ed and prov i ded wi th no clothi ng, bedding, linen, matt r e ss o r shoes. At certain tim e s d uri ng the BAP , he w as also on observ ation sta t us and, during those tim es, he w as v i si ted by Drs. Hami lton and Breen-Smith. A cc o rdin g to T ownsend, he kept hearin g v oic es tellin g hi m to kill hi mself in or der to end the pain and sufferin g he w as exper ie nc ing on the BAP

. But wh en he shared these thought s wi th the psychologis ts, t he y told hi m that, becau se he w as already naked an d had nothin g in hi s cellwi th whi ch to harm hi mself , they w ere no t w or ried about hi s sui ci dal thought s. So meti mes the psycholo g ist s
w o ul d l augh at T

ownsend and tell hi m that he w as making thi ngs up so that he w ould be removed from the BAP

. On Mar ch 31, 2006, T

ownsend w as tr ansferr ed to Columbi a Cor rectional Insti tution.
T ownsend then fi led sui t again st a numb er of GBCI pris on offi ci als under 42 U.S.C. § 1983. He alleged that the defendants (1) violated hi s rights unde r t he Fifth and Four teenth Amendments by subjecting hi m to t he BAP wi thout due process; (2) depriv ed hi m of the mini mal ci vili zed measu re of li fe’s ne ce ss ities whi le he w as subject to the BAP , contrar y to the Ei ghth Am e nd ment ; and (3) w ere deliberately indi fferent to hi s seri ous medi cal needs, also in violati on o f the Ei ghthNo. 12-3620 11
Amendment. The di stric t court gr anted sum mary judgment in fav or of the defendants o n a l l three counts. The court found that the BAP w as not pun i tiv e but rat her w as i mplemented to prot ect T

ownsend from harming hi mself or other s, and there fore no notic e w as required under the due process claus e. The court also conclud e d that T ownsend’s condi tions -ofconfinement clai m fai led becau se the condi tions w ere i mposed for safety reasons and becau se T ownsend could hav e ended the harsh condi tions by si mply behavi ng appropr i ate l y

. Fin ally , the cour t d e t ermin ed that pris on offi ci als w ere not deliberately indi ffere n t to T ownsend’s mental health i ssu es but tr eated himappropr i ately . T ownsend ap peals. II. On appeal, T

ownsend contends that the BAP w as puni tiv e and that due process required notic e and an op port uni ty to object. He also asserts that the condi tions to whi ch he w as subject under the BAP violated the Ei ghth Amendment prohibi tion again st cruel and unus ual puni shm ent. Fin ally , he maintai ns that pri son offi ci als w ere deli berately indi fferent to hi s seri ous medi cal needs when they fai led to appropr i ately tr eat hi m and actually w or se ne d hi s mental i llness by subjecting hi m to condi tions that they knew w ould exacerbate hi s d e p re s s i on a n d s u i ci dal urges. Although T ownsend ini ti a l l y sued a much large r gr oup of employ ees of the DOC, he appeals only that part of th e d ist ric t court’s deci si on that relat es to Sar ah Coo per (the Prog rams Superv i sor of GBCI’s Seg reg ation Uni t); Wi lli am Swi ekat ow s ki ( a s u p e rv i s in g offi cer and li eutenant); Mar k Zim oni ck (a Seg reg ation So ci al W or ker ); Mar tha Breen-Smith (a psychologis t); T odd Hami lton (another psychologis t); and Wi lli am Pollard (the w arden of GBCI). He12 No. 12-3620
does not appeal the di stric t court’s conclu si on that other pris on employ ees who w ere not personally inv olv ed in the harms he alleges may not be held li able under secti on 1983. See Ashcroft

v
. Iqb al , 556 U.S. 662, 677 (2009) (in a secti on 1 983 sui t, each government o ff i ci al i s li able only for hi s or her own mi scondu ct). The defendants do not deny that these remain ing pris on offi ci als w ere personally inv olve d in the deci si on to i mpose th e BAP and i mplement i ts ter ms, but they do deny that the BAP condi tions violated consti tutional standards. W e
rev i ew the di stric t court's gr ant of sum mary judgment de novo , exami ning the recor d in the li ght most fav or able to T ownsend and cons tr uing all reasonable inferences from the evidenc e in hi s fav or

. Anderson , 477 U.S. at 255; Nafi cy v
. Il l inois Dep't of H u m a n S e r v s

. , 6 9 7 F

. 3 d 5 0 4 , 5 0 9 (7 t h C i r

. 2 0 1 2 ) ; Norman–Nun nery v
. Madiso n Area T echni cal Coll ., 625 F .3d 422, 428 (7th Ci r

. 2010). Summary judgment i s appropr i ate when there are no genuine di sputes of material fact and the mov ant i s entitled to judgment as a matter of law

. Fed.R.Civ

.P

. 56(a); Naficy, 697 F .3d at 509. A.
W e begi n wi th the questi on of whether the imp o si tion of the BAPwi thout no tic e and an opport uni ty t o obj ect violated T ownsend’s due process rights, and the closely relat ed questi on of whether the cond i ti on s of T ownsend’s confinement under the BAP violated hi s right s under the Ei ghth Amendment. There i s a certain di sconnec t betw een the parties in their bri efing of the legal i ssu es r elated to the BAP

. T ownsend characterizes the pro gr am as enti rely puni tiv e; the defendants contend i t w as i mplemented for safety reasons. AsNo. 12-3620 13

a fact ua l matter

, how ev er

, i t appears that the BAP w as i mplemented in response to both sa fet y concerns and infracti ons of pris on rules; at the very least, ther e are genuine i ssu es of material fact reg ardin g the reasons for i mplementing t he BAP

. Each party ’s characterizati on of the BAP he a v ily influ enced how th e y br i efed the i ssu es. For example, the defendants contend that, becau se t he B AP w as not puni tiv e, and becau se the BAP di d not i mpose an a t y p ica l and si gni fi cant ha r dshi p on T ownsend, no oppor tuni ty to object

w as required before applyi ng the prog ram to T ownsend. They also arg ue that T

ownsend di d re ce ive a notic e of sort s; each tim e he w as placed on the BAP or the ter ms w ere changed, he

w as giv en a descri ption of the condi tions t ha t w ere to be i mposed. The defendants appear to concede that the prog ram
w as i mposed wi thout any oppor tuni ty to object. T ownsend, in turn, arg ues that the BAP w as entirely pun itiv e and w as i mplemented wi thout due process. He d o e s not address the conundrum that pris on offi ci als faced in dealing wi th a pris oner who w as both me ntally i ll and wi llful ly di srupti v e. Our analysi s mus t necess arily accoun t for the factua l r e a li ty: T ownsend w as both mentally i ll and repeat edly in violati on of pris on reg ulati ons. T o suc ceed on hi s Four teenth Amendment due proces s clai m, T ownsend “m ust establi sh that he has a liberty intere st in not being placed in the [BAP] —as i t w as admini stered to hi m—wi thout procedural prot ecti ons. It i s undi sputed that he receiv ed no procedural due pr o ce ss, so the clai m turns on whether he can establi sh a liberty intere st.” Gillis v
. Litscher, 468 F .3d 488, 491-92 (7th Ci r

. 2006 ). I n Sandin v
. Conner, 515 U.S. 472 (1995), “the Court explain ed that t he Four teenth14 No. 12-3620
Amendment prov i des to inmates a liberty intere st in av oiding tr ansfer to more restr i cti v e pris on co ndi tions i f those condi tions result in an ‘aty pi cal and s i gni fi cant hardshi p’ when compared to ‘the ordi nary inci dents of pris on l i fe.’” T ownsend

v
. Fuc hs , 522 F .3d 765, 768 (7th Ci r

. 2008) (quot ing Sa n d i n , 5 1 5 U.S. at 484-86). When a t r a nsfer to condi tions meetin g thi s
s tan d a rd oc curs, the “pris on mus t afford the inma te p ro c e d u ra l prot ecti ons before the tr ansfer occurs.” T ownsend, 522 F .3d at 768 (ci ting S an din , 515 U.S. at 487). T ownsend there fore mus t demonstrate that t he BAP i mposed condi tions resulti ng i n an atypical and si gni fi cant hardshi p compared to or dinary pris on li fe. He easi ly meets this standard. 5

Due pro cess appli es when an i nma te i s sub jec t to condi tio ns tha t pose an 5 atypical and signi fi cant hardship when compared to the or di nary i ncid ents ofpriso n l i fe, and also when the condi tio ns “exceed [] the sentence in such
an unex pected manne r as to give ri se to pro tecti on b y the Due Proc ess Cl ause of i ts ow n fo rce. ” Sandin , 51 5 U.S

. at 48 4 (ci ting Vitek v. Jones , 44 5 U.S

. 48 0, 49 4 (1 98 0) (hol di ng t ha t an i nv ol unta ry trans fer to a menta l ho sp i t al fo r the purpo se of psychiatri c treatment i mpli cated a l i b erty i nterest pro tected b y the due pro cess cl ause); and Washington v. Harper, 49 4 U.S

. 21 0, 22 1- 22 (1 99 0) (hol di ng tha t a pri soner possesses a signi fi can t l i b erty i nterest i n av oi di ng the u nw an ted admini stratio n of anti psychoti c drugs under the Due Proc ess Cl ause of the Fourte enth A me nd ment)). In Vitek , fo r exa mple , the C ou rt c on c lu de d th a t the “sti gma tizi ng consequences
o f a trans fer to a menta l hospi tal fo r i nv ol unta ry psychiatri c treatment, coup l ed with the sub jec tio n of the pri soner to man dato ry b ehav i or modi fi catio n as a treatment fo r menta l i l l ness, c o ns t i t u te the kind of depr i v atio ns of l i b erty tha t r equire s pro cedur al pro tecti ons.” 44 5 U.S

. at 49 4. Under Vitek and Washing t o n , an i nma te sub jec ted to condi tio ns i mpingi ng a l i b erty i nterest fo r menta l health reasons must stil l b e affo rded due p ro cess.No. 12-3620 15
The condi tions i mposed in Gillis w ere remark ably si mi lar to those T

ownsend exper i enced. In Gillis , a di fferent W i scons in pris on i mplemented a “Behavioral Modifi cati on Prog ram,” or
a “BMP ,” for certai n inmate infracti ons. Gi lli s w as placed on a tw o-stage BMP for violati ng a rule that required him to sleep wi th hi s head at the back of hi s cell so that he w ould be vis ible to g uards ch ecki ng hi m throug h a sm all window on hi s door

. I n S t a ge One, “all proper ty” w as removed from hi s cell fo r three d a y s a nd he w as fed nutri- loaf for hi s meals. St age One

w as ext ended tw o days for Gi lli s based on certain behavi or s he exhib i ted duri ng the fi rst three days. In St age T w o , which gener ally lasted a mini mum of sev en days but could hav e been ext ended based on Gi llis’ s be havior , he w as allow ed a segreg ation smock, hygiene i tems twi ce a day and show ers on reg ular show er days. When pris on offi ci als sai d “all proper ty”

w ould be removed in St age One, apparently they me a nt t hat all of hi s clothing, bedding and ev en basi c hygiene i tems w ere removed. Gi lli s w as left naked in hi s cell wi th a concrete slab for a bed, wi thout soap or ev en toilet paper for all of St age One and most of St age T

w o on the BMP

, for a t otal o f tw elv e days. He w as deni ed mai l, vis i tor s, phone privi leges, canteen i tems, wri tin g materials and acces s to the law library

. He w as allow ed toilet paper on five o ccas i ons in those tw elv e days, four squares at a tim e. The segregat i on smock that he w as allotted in St age T

w o w as a sleev eless p oncho that cov ered hi s ches t and gr oin

. He w as no t issued underw ear

. At some point, he began to receiv e reg ular meals in St yr ofoam contai ners and

w as allow ed the use o f t o o thpaste and a too thbrush, but w as not giv en soap, bedding or a mattr ess. Whi le on the BMP , Gi lli s began to hear v oic es tellin g hi m that people w ere tr yin g to kill16 No. 12-3620
hi m. He suffered pani c attacks, palpi tatio ns , shortness of breath and a fear that he w as about to di e. He becam e sui ci dal and wrot e the w or ds “help me” in hi s own blood on the w alls of hi s cell. At that poin t, he w a s placed on observ ation status but the condi tions of the BMP di d not change. 468 F .3d at 490- 91. As i s the case wi th T ownsend, in addi tion to a due process clai m, Gi lli s also sued pris on offi ci als under t he Ei ghth Amendment for condi tio ns of confinement that consti tuted cruel and unus ual puni shm ent. That clai m required a showing that the BMP i mposed condi tions that d e nie d hi m “the mini mal ci vili zed measu re of li fe’s necess i ties .” Gillis , 468 F .3d at 491 (quoti ng Rhodes v
. Chapman , 452 U.S. 3 3 7, 347 (1981))

. Gi lli s also w as require d to demonstrate that the defendants acted wi th knowledge that he faced a sub stanti al ris k of seri ous harm and di sregar ded that ris k by fa ilin g to take reasonable
measu res to abate i t. Farmer v
. Brenn an , 511 U.S. 825, 847 (1994); Gillis , 468 F .3d at 491. In Gillis , w e noted that li fe’s necess i ties inclu de shelter , heat, hyg i ene i tems and c lothing. W e ci ted cases where a lack of heat, clothing, sani tation, and bedding, alone o r in
c om b in a ti on , we re found to violate the Ei ghth Amendment. Se e Gillis 468 F .3d at 493 (collecting cases ). See also Ri ce ex rel. Ric e
v
. Correctional Med. S e r v s. , 675 F .3d 650, 664 (7th Ci r

. 2012) (incarcerated persons are entitled to confinement under hu m a n e c on d i tions whi ch prov i de for their basi c human nee d s, inclu ding adequate sani tation and hygienic materials ). Although the defendants here deny that they subjected Townsend to these sort s o f co nd itions, T ownsend has created aNo. 12-3620 17 genuine i ssu e of material fact reg ardin g the condi tions under whi ch he w as held wi th hi s own sw or n statements. In addi tion to the condi tions w e described abov e, T ownsend av err ed that he spent a period of w eeks completely naked, wi th no clothi ng, shoes, bedding, linens, mattr ess, mai l or legal materials

. W e found Gi lli s’s clai m suffi ci ent to proceed to tr i al on both an E i ghth Am e n d m e nt c ond i tions -of-c onf in e m e n t c l a i m a n d a d u e process clai m when he suffered si mi lar condi tions fo r t welv e days, inclu ding fi v e days in St age One and sev en days in St age T w o. T ownsend endured these condi tions in v ary ing degr ees for 259 days. W

e hav e held that “both the durat io n a nd the condi tions of the segreg ation mus t be consi dered in th e d ue process analysi s; i f the co ndi tions of segreg ation w ere si gni fi cantly harsher than those in the normal p r iso n environment, ‘then a y ear of [segregat i on] mig ht co unt as a d e p r iv ation o f liberty where a few days or ev en w eeks mi ght not.’” Mario n v
. Columbia Correction Inst ., 559 F .3d 693, 698 (7th Ci r

. 2009). In Mario n , w e conclu ded that a ter m of segreg ation lasting 240 days required scrutiny of the act ua l co nditi ons of segreg ation, especi ally in li ght of the deci si ons of other courts of appeals holding that periods of confinement that approach
or exceed o ne year may tr i gge r a cogni zable liberty intere st wi thout any refer ence to condi tions

. 559 F .3d at 698-99 n.4 (collecting cases ). In T

ownsend’s case, both the duration of the BAP and the c on d i ti on s i m p os ed i mpli cate liberty intere sts that require procedural prot ecti ons. At a minimum, those prot ecti ons should hav e inclu ded notic e and an oppor tuni ty to object in s ome fashi on. As w e noted abov e, to av oid su mmar y judgment on hi s condi tions -o f- co nf ine ment clai m, T ownsend mus t also18 No. 12-3620
demonstrate t ha t the defendants acted in di sregar d of a sub stanti al ris k of seri ous har m t o hi m. “O ur rev i ew , though, convin ces u s that, on thi s i ssu e as w ell, he mus t be allow ed to proceed to tr i al.” Gil li s , 468 F .3d at 494

. T

ownsend’ s BAPs did not provide end dates, and li ke Gil li s’s BMP , T ownsend’ s BA P s did not spec ify how T ownsend could bring an end to t he obvi ously harsh cond iti ons. Gil li s, 468 F .3d at 493 –9 4

. Thus, the defend ants’ relia nce o n t he Second Circuit’s decision in T

rammel v

. Keane , 338 F

.3d 15 5 (2d Cir

. 200 3), is unper suasive for virtual ly the same reasons we explai ned in Gil li s
. See Gi ll is , 46 8 F .3d at 49 3–9 4. T ownsend ha s also rais ed a genuine i ssu e of material fact reg ardin g whether the BAP w as i mposed for safety reasons or
as a di sci plinary meas ure. Of course, safety and di sci pline are not mutually exclusi v e concerns. T ownsend seems to concede
as much by characterizing the BAP as a hybrid prog ram. And T ownsen d, b y hi s own admi ssi ons, presented both di sci plinary problems and mental health i ssu es to pris on offi ci als. Nothing precludes pris on offi ci als from addressing both concerns, ev en si multaneously

. But as support for the i mposi tion o f the BAP , GBCI ci ted Wi scons in Admini strat i v e Code §§ 303.69 (“Majo r penalti es: adjustment segreg ation”), 303.70 (“Majo r penalti es: prog ram segreg ation and di sci plinary separation”) and 303.71 (“Contr olled segreg at ion”). Sections 303.69 and 303.70 each speci fy that the penalty may not exceed the period speci fi ed in secti on 303.84 (“S e ntencing procedure and sch edule of penalti es”). That secti on, as i ts title suggests, speci fi es penalti es (inclu ding durations) “where an inmate i s found gui lty of one
or more violati ons of the di sci plinary rules.” W i s. Adm in

. C od e DOC § 303

. 8 4

. The defendants concede that the BAP “has elements desi gn ed to enforce di sci pline,” (Bri ef at 23) andNo. 12-3620 19
noted sev eral tim es that the BAP w as acti v ated by T ownsend’s

v iolations of pris on rules. For example, the BAP w as ini t ia l l y act i v ated becau se T

ownsend got into a fi ght wi th other inmates, and then r efus ed to enter hi s cellbecau se he w anted to be housed closer to hi s brot her

. Hi s second placement on the BAP follow ed sev eral conduc t repo rt s for infracti ons such as refusing to ret urn hi s lunch bag, refusin g hi s meal tr ay , and
cov ering hi s cell window

. When he engaged in behavi or s that

w ere harmful t o hi mself , the pris on also used “observ ation status” to ensu re hi s safety

. Observ ation status, as w e noted earlier , i s governed by secti on DOC 311.14, “Co nd itions of confinement whi le in observ ation,” and accompa ny ing reg ulati ons. But when T ownsend engaged in rules infracti ons
u nacc ompani ed by threat s of self- harm, he w as subjecte d to the BAP and endured sev ere proper ty restr i cti ons unrelated to hi s personal safety

. Thus, T ownsend has rais ed a genuine i ssu e of fact reg ardin g whether the BAP w as i mposed as di sci pline for violati ons of pris on rules.
W e note tha t, at tim es when T ownsend w as on the BAP , pris on offi ci als used observ ation status and the relat ed proce d ures becau se T

ownsend posed a danger to hi mself or other s. They also employ ed certain di sci plinary procedures whi le T own send w as on the BAP for particu lar rules violati ons. In th o se instances where pris on offi ci als indi sputably employ ed establi shed procedures to address particu lar safety i ssu es or di sci plinary concerns, due process w as sati sfi ed. But they e mp l o y ed no due process for the addi tional restr i cti ons occasi o ne d by the BAP i tself when i t w as arg uably used as a puni tiv e measu re. In li ght of the re m a rk able si mi larity betw een the condi tions i mposed in Gillis under the BMP and T own-20 No. 12-3620
send’s BAP

, w e there fore concl ud e that the court err ed in g r a nt ing judgment in fav or of the defendants on T ownsend’s due process cl a im and hi s Ei ghth Amendment condi tions -ofconfinement clai m. B. All that remain s i s T

ownsend’s clai m again st Drs. Hami lton and Breen-Smith for deliberate indi fference to hi s seri ous medi cal needs. The Ei ghth Amendment i mposes a duty on government offi ci als to prov i de medi cal care to pris on e r s. Estelle v
. Gamble, 429 U.S. 97, 104-05 (1976); see also Gil v
. Reed, 535 F .3d 551, 556 (7th Ci r

. 2008); W illiams v
. Lief

er, 491 F .3d 710, 714 (7th Ci r

. 2007). Pri son of fici als violate the Ei ghth Amendment when the y are deliberately indi fferent to a pris oner' s seri ous me d ica l needs. Estelle, 429 U.S. at 104, Gil , 535 F .3d at 556; W

illiams , 491 F .3d at 714. “A clai m of deliberate indi fference to a seri ous medi cal need contai ns both an objectiv e and a subjectiv e component. T o sati sfy t he objectiv e component, a pris oner mus t demonst r a te that hi s medi cal condi tion i s ‘obj ecti v ely , suffi ci ently seri ous.’” Greeno v

. Daley, 414 F .3d 645, 653 (7th Ci r

. 2005) (quotin g F arm er , 511 U.S. at 834). The de fe ndant s concede that T ownsend had a seri ous medi cal need b ased on hi s severe mental illn ess. T o sati sfy the subjectiv e component, a pris oner mus t demonstrate that pris on offi ci als acted wi th a “suffi ci ently culp able state of mind.” Farmer, 511 U.S. at 834; Greeno , 414 F .3d at 653. In part i cular: The offic ia l s mus t know of and di sregar d an excessi v e ris k to inmate health; indeed they must “both be aw are of facts fro m whi ch the inferenceNo. 12-3620 21
could be drawn that a sub stanti al r isk of seri ous harm exis ts” and “mus t also draw t he inference.” Farmer, 511 U.S. at 837, 114 S. Ct. 1970. Thi s i s not to
sa y that a pris oner mus t establi sh that offi cial s intended or desi red the harm that tr ansp i red. W al ker , 293 F .3d at 1037. Instead, i t i s enough to show that the defendants knew of a sub stanti al ris k of harm to the inmate and di sregar ded the risk.
Greeno , 414 F .3d at 653. The defendants acknowledge that Drs. Hami lton and Breen-Smith w ere aw are of T ow nsend’s condi tion and the ris k to his he a l th. They contend, how ev er , that T ownsend has fai led to rais e a genuine i ssu e of material fact reg a r d ing whether the pris on psychologis ts di sregar ded the ris k to T

ownsend’s health. Instead, they poin t out that Drs. Hami lton and Breen-Smit h re p e a tedly vis i ted T

ownsend when he expr essed any desi re for self- harm. They reg ularly asses sed and adjusted h i s acces s to pro pert y thathe could u se to harm hi mself , and they repeat edly placed hi m on observ ation status to e nsu re his safety when he w as su i ci dal.
T ownsend counters that the vis i ts by Drs. Breen-Smith and Hami lton di d not consti tute tr eatment a nd that the p s ycholog i sts actually aggr av ated hi s condi tion by pl a c in g hi m on the BAP

. Speci fi cal l y

, he charges that they should hav e known about a January 2005 repo rt produced by the W i scons in Department of Cor rections on “T reat ing Mentally Ill Inmates in Seg re g a t e d Set tin gs: A Repor t of the Seg reg ation W or kgr oup” (hereafter “Repor t”). Accordi ng to T ownsend, the Repor t conclu des that segreg ation and remov al of p ro pert y “aggr av ates the condi tion of mentally i ll patien ts.” T ownsend contends that Drs. Hami lton and Breen-Smith “infli cted” those22 No. 12-3620
condi tions on T

ownsend “despi te clear contraindi cati on from” the Repo rt

. There are numerous problems wi th T ownsend’s a na l ysi s. First, as a factual matter , the Repor t does not state conclu si v ely that s e gr egat i on and the remov al of proper ty aggr av ate mental i llnes s. Instead, the Repor t notes that the “sci entifi c literatur e
on the mental health effects of p r olong ed segreg ation i s sti ll incomplete and confli cting,” but that “there i s a g ro wing consens us that inmates wi th psychologic al vulnerabi li ties can d e ter i or ate i f placed in settings that hav e si gni fi cant soci al i solation and inacti vity .” R. 63-8, at 6. Se cond, the Repor t pre

dates T ownsend’s placemen t on the BAP by few er tha n six months, and T

ownsend has ci ted no evidenc e that Drs. BreenSmi th and Hami lton w ere ev en aw are of the R epor t’s conclu si ons, much less that they intentionally i gnor ed them. Nor i s there evidenc e that the pris on psychologis ts w ould hav e been able, by themselv es, to cha ng e p r i son poli ci es in the months betw een the i ssu ance of the Repor t and the i mposi tion of the BAP

. Thi rd, and perhaps most i mport antly , T ownsend has ci ted
no evidenc e that Drs. Br een-Smi th and Ha milton di splayed a
consc i ous di sregar d o f hi s needs. Any di fference of opin i on betw een Drs. Breen-Smith and Hami lton wi th Dr

. Schmi dt reg ardin g the need to tr ansfer T ownsend to the WRC does not i tself supp or t a clai m of deliberate indi fference. See S h i elds v
. Illinois Dep’t of Corrections , 746 F .3d 782, 797 (7th Ci r

. 2014). Nor does Dr

. Breen-Smith’s remark thatT ownsend w as faking his symptoms in or der to be released from the BAP sup p o r t a conclu si on that she w as deliberately indi fferent. Rice , 675 F .3d at 684 (sincere beli ef that inmate w as malingering does notNo. 12-3620 23

supp or t a conclu si on that a nurse w as deliberately indi fferent to an inmate’s medi cal needs). W e recently noted that “prolo ng ed confinement in admini strat i v e segreg ation may consti tute a violati on of the Ei ghth Amendment (and there fore the Four teenth), depending on the du rat i on an d nature of the segreg ation and wh e t her there w ere feasi ble alter nati v es to that confinement.” Rice , 675 F .3d at 6 6 6. See also W alker v
. Shansky, 2 8 F

. 3 d 666, 673 (7th Ci r

. 1994). But as in Rice, Townsend has fai led to i denti fy any alter nati v es open to the psychologis ts for keeping hi m safe during periods when he expr essed sui ci dal wi shes

. Becaus e T ownsend presented no
e v ide nce that Drs. Hami lton and Breen-Smith w ere deliberately indi fferent to hi s seri ous mental health needs, the di stric t court di d not err in gr anti ng sum mary j ud g me nt in fav or of the defendants on that clai m. III. In sum, T ownsend has rais ed genuine i ssu es of material fact

r egar ding whether (1) the i mposi tion of the BAP violat e d his due pr o ce ss rights by i mposing an atypical and si gni fi cant hardshi p compared to the or dinary inci dents of priso n li fe, wi thout appropr i ate notic e and an oppor tuni ty to be heard; and (2) t he BAP i mposed condi tions of confinement that deni ed T

ownsend the mini mal ci vili zed measu res o f l ife’ s necess i ties

. W

e there fore v acate the j udg ment on those tw o clai ms and remand for further procee d ings. On T ownsend’s Ei ghth A mendmen t clai m for deliberate indi fference to hi s seri ous medi cal needs, w e affi rm the di stric t court’s gr ant of
sum mary j udgment in fav or of the defendants. AFF IRM ED IN P

ART ; V ACA TED AND REMANDED IN P ART

.