Document ID: ./input/supremecourt_opinions/opinions/10pdf/09-1233.pdf
Page Number: 28

22 

BROWN v. PLATA 

Opinion of the Court 

Prisons have backlogs of up to 700 prisoners waiting to see 
a  doctor.  Doc.  3231–13,  at 18.    A  review  of  referrals  for 
urgent specialty care at one prison revealed that only 105
of  316  pending  referrals  had  a  scheduled  appointment,
and only 2 had an appointment scheduled to occur within
14  days.  Id.,  at  22–23.    Urgent  specialty  referrals  at  one
prison  had  been  pending  for  six  months  to  a  year.    Id., 
at 27. 

Crowding  also  creates  unsafe  and  unsanitary  living 
conditions  that  hamper  effective  delivery  of  medical  and 
mental  health  care.    A  medical  expert  described  living
quarters  in  converted  gymnasiums  or  dayrooms,  where 
large  numbers  of  prisoners  may  share  just  a  few  toilets
and  showers,  as  “ ‘breeding  grounds  for  disease.’ ”7   Juris. 
App.  102a.  Cramped  conditions  promote  unrest  and  vio-
lence, making it difficult for prison officials to monitor and
control the prison population.  On any given day, prisoners 
in  the  general  prison  population  may  become  ill,  thus 
entering the plaintiff class; and overcrowding may prevent
immediate medical attention necessary to avoid suffering,
death,  or  spread  of  disease.    After  one  prisoner  was  as-
saulted in a crowded gymnasium, prison staff did not even 
learn  of  the  injury  until  the  prisoner  had  been  dead  for 
several  hours.    Tr.  382.  Living  in  crowded,  unsafe,  and 
unsanitary  conditions  can  cause  prisoners  with  latent 
mental  illnesses  to  worsen  and  develop  overt  symptoms. 
Crowding  may  also  impede  efforts  to  improve  delivery  of 

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7 Correctional officials at trial described several outbreaks of disease. 
One  officer  testified  that  antibiotic-resistant  staph  infections  spread
widely among the prison population and described prisoners “bleeding,
oozing  with  pus  that  is  soaking  through  their  clothes  when  they  come
in  to  get  the wound covered  and  treated.”    Tr.  601,  604–605.    Another 
witness  testified  that  inmates  with  influenza  were  sent  back  from  the 
infirmary  due  to  a  lack  of  beds  and  that  the  disease  quickly  spread  to
“more than half ” the 340 prisoners in the housing unit, with the result
that the unit was placed on lockdown for a week.  Id., at 720–721.