Document ID: ./input/supremecourt_opinions/opinions/10pdf/09-1233.pdf
Page Number: 29

Cite as:  563 U. S. ____ (2011) 

23 

Opinion of the Court 

care.  Two  prisoners  committed  suicide  by  hanging  after
being placed in cells that had been identified as requiring
a  simple  fix  to  remove  attachment  points  that  could  sup-
port  a  noose.    The  repair  was  not  made  because  doing  so
would involve removing prisoners from the cells, and there 
was  no  place  to  put  them.  Id.,  at  769–777.  More  gen-
erally,  Jeanne  Woodford,  the  former  acting  secretary  of 
California’s  prisons,  testified  that  there  “ ‘are  simply  too 
many  issues  that  arise  from  such  a  large  number  of  pris-
oners,’ ” and that, as a result, “ ‘management spends virtu-
ally  all  of  its  time  fighting  fires  instead  of  engaging  in
thoughtful  decision-making  and  planning’ ”  of  the  sort 
needed  to  fashion  an  effective  remedy  for  these  constitu-
tional violations.  Juris. App. 82a. 

Increased  violence  also  requires  increased  reliance  on
lockdowns  to  keep  order,  and  lockdowns  further  impede
In  2006,  prison  officials
the  effective  delivery  of  care. 
instituted 449 lockdowns.  Id., at 116a.  The average lock-
down  lasted  12  days,  and  20  lockdowns  lasted  60  days  or
longer.  Ibid.    During  lockdowns,  staff  must  either  escort
prisoners to medical facilities or bring medical staff to the
prisoners.  Either  procedure  puts  additional  strain  on
already  overburdened  medical  and  custodial  staff.    Some 
programming  for  the  mentally  ill  even  may  be  canceled
altogether  during  lockdowns,  and  staff  may  be  unable  to
supervise the delivery of psychotropic medications. 

The  effects  of  overcrowding  are  particularly  acute  in
the  prisons’  reception  centers,  intake  areas  that  process 
140,000  new  or  returning  prisoners  every  year.  Id.,  at 
85a.  Crowding  in  these  areas  runs  as  high  as  300%  of 
design  capacity. 
Id.,  at  86a.  Living  conditions  are
“ ‘toxic,’ ”  and  a  lack  of treatment  space  impedes  efforts  to 
identify  inmate  medical  or  mental  health  needs  and  pro-
vide  even  rudimentary  care.    Id.,  at  92a.    The  former 
warden  of  San  Quentin  reported  that  doctors  in  that
prison’s  reception  center  “ ‘were  unable  to  keep  up  with