Opinion ID: 404985
Heading Depth: 1
Heading Rank: 6

Heading: eighth amendment issues

Text: 38 6.1 Cruel and Unusual Punishment: The Constitutional Standard 39 Before reviewing the findings of fact relative to the charge of cruel and unusual punishment, we set out the legal precepts that we must follow. In Rhodes v. Chapman, 452 U.S. 337, 101 S.Ct. 2392, 69 L.Ed.2d 59 (1981), which was decided after the district court had rendered its opinion and its orders in this case, 80 the Supreme Court considered for the first time the limitation that the eighth amendment, which is applicable to the states through the fourteenth amendment, 81 imposes upon the conditions in which a State may confine those convicted of crimes. 82 After reviewing the Eighth Amendment precedents for the general principles that are relevant to a State's authority to impose punishment for criminal conduct, the Court noted that the amendment prohibits punishments which, although not physically barbarous, 'involve the unnecessary and wanton infliction of pain.'  83 Thus the eighth amendment prohibits inflictions of pain that are  'totally without penological justification.'  84 40 No static 'test' can exist by which courts determine whether conditions of confinement are cruel and unusual, for the Eighth Amendment 'must draw its meaning from the evolving standards of decency that mark the progress of a maturing society.'  85 These  'judgments should not be, or appear to be, merely the subjective views of individual (judges).'  86 The judgments instead  'should be informed by objective factors to the maximum possible extent.'  87 41 The same principles apply when the conditions of confinement compose the punishment at issue. 88 (C)onditions that cannot be said to be cruel and unusual under contemporary standards are not unconstitutional. To the extent that such conditions are restrictive and even harsh, they are part of the penalty that criminal offenders pay for their offenses against society. 89 42 Applying these precepts, the Rhodes Court held that confining two inmates to one cell, called double-celling, at an Ohio maximum security prison was not cruel and unusual punishment. Double-celling was made necessary by an unanticipated increase in prison population. It did not lead to deprivations of essential food, medical care, or sanitation. It did not increase violence among inmates or create other conditions intolerable for prison confinement. 90 It diminished job and educational opportunities only marginally. 91 43 The Court had previously noted other facts. The cells measured sixty-three square feet. Each had a cabinet-type night stand and other furnishings. Double-celling had not reduced significantly the availability of space in the day rooms or visitation rooms, nor had it rendered the library or school facilities inadequate. There had been no increase in the rate of violence. 92 The ratio of guards to inmates satisfied the standard of acceptability offered by the inmates' expert witness. 93 44 This review of the opinion makes it evident that Rhodes v. Chapman does not reject the totality of conditions test that we applied in Jones v. Diamond, 636 F.2d 1364, 1368 (5th Cir. 1981) (en banc). 94 Like Justice Brennan in his concurring opinion, 95 we read the majority opinion in Rhodes v. Chapman as adopting that test, just as another panel of this court recently did in Stewart v. Winter, 669 F.2d 328, 335-36 & n.17 (5th Cir. 1982). 96 This interpretation is based not only on the opinion's precise and carefully chosen words but on its factual recitals. Were it necessary to decide only that confining two inmates in a single cell is not cruel and unusual punishment, there would have been no need to describe the general conditions in the prison. Rhodes holds that the confinement of two persons in one cell is not per se cruel and unusual when, all prison conditions having been considered alone or in combination, inmates are not deprived of the minimal civilized measure of life's necessities. 97 This is also the reading that other courts have given to Rhodes. 98 Rhodes does, however, hold that the totality of the conditions of confinement does not offend the Constitution unless prison conditions are cruel and unusual, and not merely harsh or restrictive. 45 These precepts provide the illumination by which we examine those provisions of the district court's decree based on the eighth amendment. 6.2 Findings by the District Court 6.21 Overcrowding 46 At the time of trial, TDC confined over 26,000 inmates. (The inmate population has since increased to over 33,000.) About 1,000 were sleeping on floors. (None are now on floors but many are confined in tents.) In cells measuring forty-five square feet, 99 originally designed for one occupant, TDC confined two to four inmates. The district court found that assault or molestation by fellow inmates was a continual threat. It found that the population density of inmates confined in dormitories was shocking. 100 47 This overcrowding exercises a malignant effect on all aspects of inmate life. 101 Day rooms designed for recreational purposes must serve double and even triple the number of inmates for which they were planned. Access to gymnasiums, outdoor playing fields, craft shops, and libraries is even more limited. Dining rooms are nearly always crowded. 102 48 Although TDC contends that, because of TDC's work ethic, inmates spend little of their time in cells or dormitory sleeping areas, in fact inmates spend much of their time in their living quarters. Because of a shortage of civilian guards who can be assigned to supervise inmates working in agricultural programs, the full complement of inmates assigned to work on TDC's farms cannot safely be employed on any given day. Therefore, at many units, the inmates work on a rotating basis. As many as one-half to three-fourths of the inmate agricultural force will remain idle in the living quarters on a specific day. 103 In view of the unprecedented surge in prison population, new facilities being constructed will not eliminate the overcrowding. 104 The district judge emphasized the threat to the inmates' safety, the lack of privacy for inmates, the increase in stress and tension, and the possible spread of disease, all caused by overcrowding. 105 6.22 Security and Supervision 49 TDC's prisons are severely understaffed. During the summer of 1979, TDC employed one guard for every 12.45 inmates, one of the worst guard-inmate ratios in the nation; 106 the average nationally is one guard for every five inmates. 107 TDC's argument that its system requires fewer guards than others was rejected by the district court after a detailed analysis of staffing patterns. 108 50 Overcrowding, combined with the relatively small number of security guards, results in a constant threat to the inmates' personal safety. 109 Escapes are virtually unheard of and homicides are uncommon, but there is excessive nonhomicidal violence. (V)irtually all inmates are exposed to, and many are victimized by, the concomitants of unguarded, overcrowded cells and dormitories-the ever-present risk of assaults, rapes and other violence-for every day of their incarceration at TDC. 110 TDC inmates are routinely subjected to brutality, extortion, and rape by their cellmates. 111 Inmates who live in dormitories are exposed to the same threats of violence endemic to the cells. 112 The threat to inmates in dormitories may be even greater because (p)otentially assaultive inmates are present in great numbers in every dormitory and the dormitories are practically unsupervised. 113 Numerous examples of the inability of TDC staff to protect inmates' personal safety were graphically presented by credible testimony at the trial. 114 51 These conditions result from having too few civilian guards to supervise inmate activities adequately, from inadequate training for new guards, and from a high turnover rate that results in virtually perpetual vacancies in low-level guard positions. 115 6.23 Failure To Ameliorate Overcrowding 52 TDC officials have the power, the district judge found, to reduce TDC's inmate population quickly by increasing good time credit, and restoring forfeited good time. 116 Inmates receive incentive (PIP) points for good performance in work, education, and personal improvement programs. The Board of Pardons and Paroles declines to interview any inmate who has less than a specified number of PIP points, who has suffered a forfeiture of good time that has not been restored, or who is in Class III status. By awarding more PIP points, restoring lost good time, classifying more inmates in Class I status, and preparing favorable institutional adjustment reports, TDC officials could increase the number of inmates likely to receive parole. 117 Moreover, TDC has failed to implement in more than a half-hearted and unimaginative 118 fashion the work release program authorized by Texas law. 119 6.3 Challenges to the Findings 53 The web of conditions is not seamless. The findings of fact concerning various conditions at TDC are discrete. Moreover, the injunctive relief ordered by the district court includes provisions patently and properly directed at specific conditions. We now consider TDC's challenges to those findings that determine the totality of conditions caused by overcrowding in the presence of the other conditions discussed, particularly the size of the security staff. 54 The district judge's conclusion that TDC's prisons are seriously overcrowded is virtually conceded. TDC questions only whether this overcrowding constitutes cruel and unusual punishment, whether the remedies ordered are appropriate, and whether specific provisions of the decree are ill-considered and unwise. TDC challenges the findings concerning the inadequacy of prison security and the existence of staff brutality as being clearly erroneous. 55 The district judge's findings concerning the specific episodes mentioned in his opinion turn entirely on the credibility of witnesses. On this, as on virtually every other aspect of the case, there was conflicting testimony. There was substantial evidence on the record to support the district judge's findings, and we have been given no reason to overturn them, save the inadequate reason that the testimony of others conflicts. We do not sit to reassess that testimony. This is neither our function as appellate judges nor within our power. 120 56 Based on these specific findings, the district judge made other, more general factual findings. He found that the life of the typical inmate within TDC is characterized by a constant threat of violence and that TDC staff members engage in widespread brutality of inmates. These findings necessarily are partly conclusory; their accuracy depends on inferences from the specific facts established. 57 Considering that TDC houses more than 33,000 inmates, it is proper to ask the question that this court put to counsel before oral argument: how many episodes of inmate assault must be shown to warrant the conclusion that there is a constant threat of violence? Patently the trial should not and cannot consist of a review either of every assault over a five-year period or of a day in the life of each of the inmates. The statistics presented are inconclusive. The homicide rate at TDC is less than in many cities. The assault rate is less than the rate reported in other prison cases, 121 but this means only that other prisons are worse. The guard-inmate ratio is among the lowest in the nation. Considering the record as a whole, we are not left with that impression requisite to rejecting the district judge's findings, the definite and firm conviction that he was mistaken. 122 6.4 Relief Ordered by the District Court 58 This relief is set forth in full in the Appendix to our opinion in Ruiz VI, 666 F.2d at 862-73, and summarized in Ruiz V, 650 F.2d at 559-64. However, we here again outline its principal features, as they relate to overcrowding 123 and security. 6.41 Overcrowding 59 a. Maximum Population: Effective November 1, 1981. 60 By November 1, 1981, TDC had to reduce its overall inmate population to a figure equal to twice the number of general population cells, plus the number of inmates who could be housed in dormitories that afford forty square feet (excluding bathing, toilet, and activity areas) per inmate. TDC may not thereafter, until further order of the court, accept any inmate whose confinement would cause the inmate population to exceed that figure. 124 61 b. Maximum Population: Effective November 1, 1982. 62 By November 1, 1982, TDC must reduce its overall inmate population to a figure equal to 1.5 times the number of general population cells, plus the number of inmates who can be housed in dormitories that afford sixty square feet (excluding bathing, toilet, and activity areas) per inmate. TDC may not thereafter, until further order of the court, accept any inmate whose confinement would cause the inmate population to exceed that figure. 125 63 c. Maximum Population: Effective November 1, 1983. 64 By November 1, 1983, TDC must reduce its overall inmate population to a number equal to the number of general population cells, plus the number of inmates who can be housed in dormitories that afford sixty square feet (excluding bathing, toilet, and activity areas) per inmate. TDC may not thereafter, until further order of the court, accept any inmate whose confinement would cause the inmate population to exceed that figure. 126 65 d. Double-Celling. 66 By August 1, 1982, no more than 50% of TDC's inmate population housed in cells may be assigned to cells of sixty square feet or less holding two inmates. By August 1, 1983, no inmate may be assigned with another inmate to a cell containing sixty square feet or less. 127 67 e. Dormitories. 68 Beginning November 1, 1981, TDC could not confine any inmate to a dormitory providing less than forty square feet (excluding bathing, toilet, and activity areas) per inmate. By November 1, 1982, TDC may not confine any inmate to a dormitory providing less than sixty square feet (excluding bathing, toilet, and activity areas) per inmate. 128 69 f. Work Furlough. 70 To alleviate overcrowding, TDC is required to make maximum use of its authority to house inmates outside of TDC units on the work furlough program as authorized by Tex.Rev.Civ.Stat.Ann. art. 6166x-3 (Vernon 1970 & Cum.Supp.1982). By November 1, 1981, TDC was to have at least 300 inmates on work furlough; by May 1, 1982, TDC was to have at least 1,200 inmates on work furlough; and by November 1, 1982, and thereafter until further order of the court, TDC must at all times have at least 2,500 inmates on work furlough. 129 71 g. Temporary Furlough. 72 TDC must expand its temporary inmate furlough program as authorized by Tex.Rev.Civ.Stat.Ann. art. 6184n(2) (Vernon Cum.Supp.1982). By November 1, 1981, TDC was to have at least 300 inmates on this furlough program; by May 1, 1982, TDC was to have at least 600 inmates on furlough; and by November 1, 1982, and thereafter until further order of the court, TDC must at all times have at least 1,000 inmates on furlough. 130 73 h. Expanding Community Corrections. 74 TDC must expand its role in community corrections and establish minimum security institutions, honor farms, halfway houses, urban work or educational release centers, community treatment centers, and the like. These facilities must be located in areas near population centers of sufficient size to provide the services needed by inmates at the facilities. By November 1, 1981, TDC was to have filed with the court a plan for the establishment of such facilities with or without the participation of other state or local agencies. 131 6.42 New Facilities 75 a. Construction of New Units. 76 TDC must not make a final selection of a site for, or undertake the construction of, any new units for housing inmates unless it has filed a report with the court demonstrating that specified conditions are met. These conditions require, inter alia, that the population of each new TDC unit or subunit 132 not exceed 500 inmates, and each new TDC unit must be located within fifty miles of a Standard Metropolitan Statistical Area with a population exceeding 200,000 people. 133 77 b. New Facilities at Existing Units. 78 TDC is prohibited from undertaking construction of any new facilities for the housing of inmates at existing correctional units unless it has filed a report with the court demonstrating, inter alia, that the space requirements in Part I of the decree will be met, and that it will be able to recruit and maintain adequate numbers of the employees needed to run the facilities. 134 6.43 Reorganization of TDC 79 TDC must submit a plan providing for the reorganization and decentralization of the management of each TDC unit housing more than 500 inmates, and ensuring that the affected units will be subdivided into units of no more than 500 inmates each. 135 6.44 Security and Safety 80 a. Staff Training. 81 By August 1, 1981, TDC was required to file with the court a plan and timetable for the training of new security officers and the retraining of existing security officers. 136 82 b. Classification of Inmates. 83 So long as TDC confines more than one inmate to a cell of sixty square feet or less, or to a dormitory, TDC must maintain a classification system that ensures that abuses of inmates by those with whom they live will be minimized. TDC was required, by August 1, 1981, to file with the court a plan setting forth an adequate classification system and a timetable for its implementation. 137 84 6.5 Application of the Constitutional Standard to the Relief Ordered by the District Court 85 Although a district court has wide discretion in tailoring a remedial injunction, 138 that discretion is not unconfined. As we have pointed out, the constitutional mandate against cruel and unusual punishment is not a warranty of pleasant prison conditions. Reparative injunctive relief must be targeted at elimination of the unconstitutional conditions. (T)he nature of the violation determines the scope of the remedy. 139 Therefore, a court can order only relief sufficient to correct the violation found. 140 We have neither commission nor competence to prescribe the purposes of confinement. 86 As a matter of respect for the state's role and for the allocation of functions in our federal system, as well as comity toward the state, the relief ordered by federal courts must be consistent with the policy of minimum intrusion into the affairs of state prison administration that the Supreme Court has articulated for the federal courts. Ruiz V, 650 F.2d at 571. 141 (T)he principles of federalism which play such an important part in governing the relationship between federal courts and state governments are applicable where injunctive relief is sought ... against those in charge of an executive branch of an agency of state government. 142 We should, therefore, fashion the least intrusive remedy that will still be effective. 143 In shaping that remedy, we must also, as a matter of judicial administration, regard the essential nature of federal courts in an adversary system. Our remedial powers are inherently judicial, not administrative. 144 87 The experienced district judge gave lengthy and careful attention both to the trial of this case and to the fashioning of the reparative injunction. In many respects the decree he shaped is focused directly on steps to remedy the aspects of confinement that together make it cruel and unusual. In other respects the decree is, as the district court's order of reference to the special master recites, infinitely broader than that encountered in any other example of correctional litigation. Considering both the constitutional violations to be excised and the scope of the therapy directed, we are left with the conviction that, without the guidance now provided by Rhodes v. Chapman, the district court adopted some remedies that are not essential for the elimination of unconstitutional prison conditions. Taken as a whole, the district court's decree administers a massive curative dose when it is not yet demonstrable that a lesser therapeutic measure would not suffice. Conservative treatment is essential because it is more readily administered, less costly to the state, and not irreversible. Therefore, the remedy should begin with what is absolutely necessary. If these measures later prove ineffective, more stringent ones should be considered. We turn now to the specifics. 6.51 Overcrowding: Space Requirements 88 Neither the number of inmates in one cell nor the amount of space provided for an inmate in a dormitory alone determines whether confinement is cruel and unusual. See Ruiz VI, 666 F.2d at 858. If an inmate uses his living quarters only for sleeping, and is not threatened with violence, a single bunk space, eighteen or twenty square feet, may be adequate. 145 The district judge found that the crowding of persons, the consequent effect on prison services and facilities, and the lack of security are specific conditions that combine to make confinement at TDC uncivilized and inhumane. However, we cannot know whether the provision of additional guards and the consequent increase both in inmate security and in work opportunities, the diminished role of building tenders, and the various other remedial measures either incorporated in the consent decrees or approved by us elsewhere in this opinion will sufficiently relieve the conditions that combined to make double-celling cruel and unusual, with the result that confinement of two inmates to one forty-five-foot cell will be only the harshness sanctioned by Rhodes, or whether it will still be cruel and unusual. Current estimates for maximum security prison cells suggest that their cost ranges from $30,000 to $60,000 apiece. 146 Approximately 10,000 additional cells would be required to house in a single cell every person now in a double cell less than sixty square feet in area. These additional cells, therefore, could cost at least $300,000,000 and require three to four years or more to build. Prisons once built cannot be readily adapted to other governmental uses. 89 Constitutional rights are not, of course, confined to those available at modest cost. 147 The very concept of federalism, the division of powers among the branches of the federal government, and the nature of the safeguards imposed by the Bill of Rights and the fourteenth amendment levy costs impossible for an accountant to calculate, but esteemed by us because they are literally priceless. 90 Yet in considering remedies for unconstitutional deprivation, the cost of one proposed remedy in comparison with the cost of others and the demonstrable need for the remedy should both be considered. 148 A remedy imposing great cost on a state should not be ordered unless its constitutional need has been demonstrated. Although we recognize the great discretion accorded a trial judge in fashioning remedies, 149 the district judge here lacked the guidance of Rhodes v. Chapman and failed to consider the cost of the remedial measures ordered as well as the possibility of achieving constitutional conditions without requiring single-celling. 91 We turn to the dormitory space limitation. Neither sixty square feet, nor forty square feet, nor any other measure is constitutionally ordained. Yet the facts found serve as adequate basis to require more space for inmates confined in dormitories, not only to ameliorate living conditions but, more important, to enhance security and reduce violence. An inmate in a cell with one other person is exposed to assault only by that person; an inmate in an overcrowded dormitory having an inadequate security staff may be victimized by many. Moreover, a forty-square-feet-per-inmate dormitory space requirement will not occasion vast expense. At present, TDC is, by use of tents, providing forty square feet for most dormitory inmates. 150 Only 128 inmates are confined in dormitories that house more than they would if there were forty square feet per inmate. 92 The requirement of sixty square feet per inmate, however, would necessitate the construction of facilities for 2,831 additional inmates. If it costs only $10,000 per inmate to construct a dormitory instead of the $30,000 amount used to estimate the cost of constructing cells, the construction of dormitories for these additional inmates would cost almost $30,000,000. 93 It has not been demonstrated that provision of additional security guards and the other measures required by the district court's decree and the two consent decrees will not remedy the constitutional deficiency. It appears desirable, therefore, first to undertake measures that will not be both costly and irreversible. If these measures do not work, then additional ones may be necessary. This wait and see approach ensures that the intrusion into state processes will be no greater than that required to achieve compliance with the Constitution. 94 Accordingly, we affirm the provisions of the district court's decree that restrict TDC's acceptance of inmates to be housed in dormitories to those inmates who can be accommodated with a space of at least forty square feet. 151 We vacate the provisions of the decree that require (1) single-celling and (2) sixty square feet per inmate in dormitories. 152 This is without prejudice to the right of plaintiffs and plaintiff-intervenor to move for a further hearing, to be held one year after our order becomes effective, to determine whether, despite changes in prison conditions wrought as a result of it, compliance with constitutional requirements requires additional restrictions on inmate capacity. This is also without prejudice to the correlative right of TDC to seek a relaxation of the decree if TDC can demonstrate that the Constitution does not compel continuance of the decree. 6.52 Other Measures To Relieve Overcrowding 95 The mandate that TDC must use good time, parole, and furlough programs to relieve overcrowding unnecessarily invades the management responsibility of state officials. Moreover, it requires detailed supervision of programs that relate only indirectly to the conditions of confinement. Directing state officials to achieve specific results should suffice; how they will achieve those results must be left to them unless and until it can be demonstrated judicial intervention is necessary. They may elect to balance prison population and physical facilities by parole, furloughs, pardons, confinement in county institutions, use of minimum security institutions for some inmates, changes in sentencing policies, or in other ways. 96 However inefficient the management of large prisons may be when compared with the administration of smaller ones, and however desirable it may be to locate prisons near large communities, the failure to do either does not cause confinement to be cruel and unusual. Palaces may be erected in the wilderness. Large prisons may be impersonal but they are not necessarily inhumane. There is of course some relationship between the new-facilities provisions of the district court's decree and the amelioration of prison conditions, but the measure of therapeutic effect is patently small. The effect of these remedial measures does not appear to us sufficient to warrant their economic cost, their intrusion on state decisionmaking, or the supervisory burden that their administration would impose on a federal court. Therefore, we vacate Parts I(A)(1), I(A)(3)-(6), VII, and VIII of the district court's decree. 6.53 Staff Training 97 The decree specifies how correctional officers will be schooled. If correctional officers are hired and trained, we must assume, until the contrary is shown, that they will be both trained and utilized with some minimal degree of wisdom. If, after they are employed, it is demonstrated that TDC officials are still violating inmates' constitutional rights, additional steps can then be taken. Here again, we deem the wait and see policy, rather than radical surgery, more in keeping with the constitutionally reparative function of the injunction. 98 Accordingly, we vacate Part II(B) of the district court's decree. This is without prejudice to the right of plaintiffs and plaintiff-intervenor to move for a further hearing, to be held one year from the date our order becomes effective, seeking further relief, or the correlative right of TDC to seek relaxation of the decree. 6.54 Classification of Inmates 99 The decree requires only the filing of a plan. We affirm this provision of the decree without prejudice to the right of any party to object to the plan or to any court order adopted after the plan is submitted. 153 100 6.6 The Constitutional Standard for Medical Care: Huntsville Unit Hospital 101 The first consent decree disposes of all issues pertaining to medical care except the provision in the district court's decree restricting the use of Huntsville Unit Hospital (HUH) to infirmary purposes, prohibiting treatment at HUH of inmates from any unit other than Huntsville, and requiring TDC to provide inmates with adequate hospital facilities meeting the Standards of the Texas Hospital Association (THA) or the Joint Commission on Accreditation of Hospitals (JCAH). 154 We, therefore, consider only conditions at HUH. 102 The state has an obligation to provide medical care for those whom it is punishing by incarceration. 155 (A)cts or omissions sufficiently harmful to evidence deliberate indifference to serious medical needs of inmates constitute cruel and unusual punishment. 156 Neither inadvertent failure to provide adequate medical care, 157 nor carelessness, 158 nor even deliberate failure to conform to the standards suggested by experts is cruel and unusual punishment. The Constitution does not command that inmates be given the kind of medical attention that judges would wish to have for themselves, nor the therapy that Medicare and Medicaid provide for the aged or the needy. 159 It prohibits only deliberate indifference to serious medical needs. 160 103 HUH is not an accredited hospital. It is outmoded and inadequate. 161 There was testimony that the effects of inadequate physical facilities are aggravated by deficiencies in sanitation and infection control; the number of physicians is inadequate; and TDC improperly relies on inmate medical assistants, who lack adequate training, for medical care. Inmate assistants have amputated fingers, set bones, applied casts, sutured wounds, repaired Achilles' tendons, given injections, administered medications, and kept records. Inmates, in many instances lacking adequate training, also serve as laboratory technicians, X-ray technicians, physical therapists, respiratory therapists, first aid attendants, and medical records clerks. Many of the inmates assigned to these tasks are uneducated and some are illiterate. The district court found numerous instances of (g)rievous neglect of the personal care of patients at the HUH, 162 but nothing in the findings indicates either that these are imminent in the hospital or that they are not remediable by a larger and better-trained staff. 104 JCAH standards are applied to hospitals in Texas by THA. Although HUH does not meet these standards, the record establishes that no prison hospital in any other state does. Some Federal Bureau of Prisons hospitals meet them but others do not. Of the 7,000 private hospitals in the United States, only 3,000 meet JCAH standards adequately for full accreditation and an additional 1,000 are on probation or one-year accreditation; the other 3,000 are not accredited because they do not meet the standards. Literally millions of persons receiving private medical care are being treated in hospitals that do not meet the requirements imposed by the district court's decree. 105 Expert standards are a useful guide but they are not a constitutional measure. 163 Restricting use of HUH to Huntsville inmates and permitting it to render only infirmary care do not solve the medical care problem. Moreover, there have been additional developments since the district court issued its decree. By orders dated October 19, 1981, and November 5, 1981, the district court stayed the provision of its decree pertaining to HUH. In its October 19 order, the district court directed TDC to file a formal response to particular suggestions made by the plaintiffs concerning HUH. TDC filed this response. In the court's November 5 order, TDC's response is described as exhibiting a commendable air of conciliation. That order further directs the parties to meet and discuss possible agreement on continued operation of HUH. 106 Accordingly, we vacate the provision of the district court's decree pertaining to the HUH and remand that issue to the district court for further proceedings consistent with this opinion after the district court has received a report concerning the results of the discussion it has ordered. Should the district court consider injunctive relief still necessary, its order shall not command the closing of HUH or restrict its use solely to Huntsville inmates. The order should instead be limited to requiring that TDC provide the minimum level of hospital care required by the Constitution. 107 6.7 Double-Celling and Exercise for Inmates in Administrative Segregation 108 Some inmates are confined to cells in a separate part of each unit for a variety of nonpunitive reasons. Some are confined pending investigation of potential disciplinary charges; others are confined awaiting a hearing after charges are filed; still others are confined because they need protective custody, because they are security risks, or because, after being punished, they cannot safely be returned to the regular prison population. 164 109 In the past, inmates sometimes were confined in administrative segregation for lengthy periods without any evaluation by prison officials of the reasons for the confinement; however, TDC policy now requires periodic review of the reasons for this confinement after the inmate has been in administrative segregation thirty to forty-five days. The review is repeated every ninety days thereafter. 165 In addition, the first consent decree requires TDC to file with the district court a plan setting forth (1) the circumstances under which inmates may be confined in administrative segregation; (2) confinement procedures conforming to the requirements of Wolff v. McDonnell, 418 U.S. 539, 94 S.Ct. 2963, 41 L.Ed.2d 935 (1974) and Wright v. Enomoto, 462 F.Supp. 397 (N.D.Cal.1976) (three-judge court), aff'd mem., 434 U.S. 1052, 98 S.Ct. 1223, 55 L.Ed.2d 756 (1978); and (3) procedures for regular and frequent review of the status of each inmate so confined as well as the standards for such review. 110 Aside from matters disposed of by the first consent decree, the district court's decree requires two special relief measures for inmates in administrative segregation: not more than one inmate may be confined in a cell containing sixty square feet or less, Part IV(C)(3), and each inmate must be afforded the opportunity for at least one hour of exercise a day if he is in administrative segregation for more than three consecutive days, Part IV(C)(1). 111 In Rhodes v. Chapman, the Court declined to find cruel and unusual punishment in the practice of confining two inmates on restrictive classification to a cell. 166 The inmates so confined in Rhodes had been found guilty of rule infractions after a hearing or were  'there by choice at least to some degree.'  167 Although most of the TDC inmates in administrative segregation have not yet been found responsible for rule violations, we are unable to perceive that punishment that is not cruel and unusual for an established rule infraction is so harsh as to be condemned if imposed only after compliance with the procedures now in force or soon to be in force at TDC. Accordingly, we vacate Part IV(C)(3) of the district court's decree. 112 Whether the failure to afford inmates the opportunity to exercise is cruel and unusual punishment was considered by us in Jones v. Diamond, supra, in which, equally divided, we affirmed the district judge's denial of relief. 168 That case, however, involved a county jail in which most of the inmates were confined for relatively brief periods. 169 We deal here with a maximum security prison in which, under our disposition of this case, two persons could be confined in a forty-five-square-foot cell too small to permit any real exercise, for almost twenty-four hours a day. This confinement is continual, unbroken by work assignment, school, or other outside activity. Moreover, although a confined inmate's status is subject to regular review to determine whether the necessity for administrative segregation still exists, this review is no guarantee that the inmate will be released from segregation at an early date. 170 113 Other courts have held that inmates need regular exercise to maintain reasonably good physical and psychological health. 171 Although deprivation of exercise is not per se cruel and unusual punishment, in particular circumstances a deprivation may constitute an impairment of health forbidden under the eighth amendment. 172 Courts have frequently stated that confinement of inmates for long periods of time without opportunity for regular physical exercise constitutes cruel and unusual punishment. 173 114 Of particular importance in determining an inmate's need for regular exercise are the size of his cell, 174 the amount of time the inmate spends locked in his cell each day, 175 and the overall duration of his confinement. 176 These together with the inmate's physical and other needs must be determined on the facts of each case and the evidence in each case should support the existence of any health hazard under the specific circumstances involved. Such specific testimony was lacking in this case. 115 Examining the decree, however, in the light of the facts we have summarized, we conclude that the district court acted within its discretion in prescribing the exercise requirement. 177 In doing so, we do not intimate that, upon a proper evidentiary showing, the decree may not be modified in such details as the amount of time daily or the number of days each week that inmates must have the opportunity to exercise. 116 For these reasons, we affirm Part IV(C)(1) of the district court's decree. 6.8 Fire Safety 117 The district court found the TDC prisons woefully deficient in the number of fire exits .... The few available exits in the housing areas are too small and inadequately constructed to serve effectively during an actual fire. 178 A similar problem in work areas creates a potential for serious injury in the face of a disaster. 179 Concluding that these conditions violate the eighth amendment, the district court ordered TDC to comply with the current edition of the Life Safety Code of the National Fire Protection Association. 180 118 The record contains no evidence either of a single fatality or a serious injury at TDC caused by fire or smoke inhalation in the recent past. Although there is danger from inflammable materials used inside the buildings, the buildings themselves are built of materials that do not burn easily. 119 TDC unquestionably has a duty to provide adequate fire safety for its inmates. 181 The deficiencies in fire safety found at TDC, however, do not constitute cruel and unusual punishment, either alone or in combination with the other conditions in its prisons. Indeed, the fire safety problems have little connection with the other conditions found to violate the eighth amendment. Moreover, although the standards set by private organizations' safety codes may be instructive in certain cases, they simply do not establish the constitutional minima; rather, they establish goals recommended by the organization in question. 182 120 The totality of the circumstances test does not authorize us to reform all deficient prison conditions. The remedy must be confined to the elimination of those conditions that together violate the Constitution. If the cruelty of confinement is thus eliminated, we have no mandate to go further in an effort to require the state to ameliorate the prison environment. 121 For these reasons, we vacate the provision of the decree relating to fire safety.