Grubbs v. Bradley

MEMORANDUM

MORTON, Chief Judge.

I. INTRODUCTION

This action pursuant to 42 U.S.C. § 1983 challenges the constitutionality of conditions of confinement in 12 of Tennessee’s adult penal institutions. The case originated as several separate

pro se

prisoner complaints, each of which challenged various related aspects of prison conditions in the state. Having determined that this court’s previous, consistently followed practice of abstention in favor of a pending state court action on the same issues was unjustifiable in light of a recent decision by the United States Court of Appeals for the Sixth Circuit,

Hanna v. Toner,

630 F.2d 442 (6th Cir.1980),

1

the instant cases were consolidated, and because of the seriousness and complexity of the issues raised, attorneys were appointed to represent the plaintiffs. Thereafter, an amended class action complaint was filed, seeking certification as a class of all present and future adult inmates committed to the custody of the Tennessee Department of Correction (TDOC). Pursuant to Fed.R.Civ.P. 23(c), the court entered an order certifying said class.

The amended complaint challenged a wide range of living conditions in Tennessee’s prisons, including,

inter alia,

overcrowding, sanitation, medical care, violence, idleness and the classification system. The plaintiffs have asserted that these and other conditions lead to the wanton infliction of unnecessary pain and suffering, and therefore amount to cruel and unusual punishment, prohibited by the Eighth Amendment to the United States Constitution, as applied to the states through the due process clause of the Fourteenth Amendment.

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See Louisiana ex rel. Francis v. Resweber,

329 U.S. 459 , 67 S.Ct. 374 , 91 L.Ed. 422 (1947) (case wherein Supreme Court first assumed incorporation of the Eighth Amendment into the Fourteenth Amendment), and numerous subsequent cases,

e.g. Furman v. Georgia,

408 U.S. 238 , 92 S.Ct. 2726 , 33 L.Ed.2d 346 (1972). The same conditions are alleged to violate provisions in the Tennessee Constitution as well.

See, infra.

Before proceeding further, the court deems it appropriate to digress a bit in order to clarify the record concerning the manner in which the instant action arose, and the reasons why this court is now faced with deciding issues previously litigated in the state courts of Tennessee.

See Trigg v. Blanton,

No. A-6047 (Dav. Ch. 978),

retired on grounds of state abstention, sub nom., Trigg

v.

Alexander

(Tenn. July 2, 1981).

As is the trend in federal courts throughout the nation, this court in recent years has been inundated with complaints filed by state prisoners incarcerated within this district alleging violations on the part of prison authorities of various rights secured by the constitution and laws of the United States. Such complaints are typically filed

pro se,

and in this court’s experience, have often challenged the constitutionality of conditions of confinement within state prisons. In the past, this court has ruled on individual claims concerning prison conditions on a case by case basis.

See, e.g., Carroll v. Murray,

No. 77-3467, mem. op. (M.D.Tenn.1979).

However, during the pendency of

Trigg, supra,

a class action very similar to the instant case, this court determined that principles of comity justified a policy of abstention in cases challenging prison conditions, pending a full and complete state court review of the situation. The court therefore developed a “retired docket” whereby cases challenging conditions of confinement in TDOC institutions were filed, so as to toll the applicable statutes of limitations, but were retired pending a final decision in

Trigg,

with the possibility of later reactivation upon simple motion in order to determine any issues not precluded by the state court judgment.

See, e.g., McDonald

v.

Henderson,

No. 77-3242, mem. op. (M.D.Tenn.1977).

Then, in September 1980, the Sixth Circuit’s ruling in

Hanna, supra,

to the effect that abstention is improper in cases challenging institutional violations of constitutional rights prompted the court to reconsider its previous policy. While

Hanna

is arguably distinguishable from the instant case because of the presence here of potentially dispositive state constitutional claims, the court concluded that the likelihood of a state court decision that would preclude or alter consideration of the federal constitutional issues was at best slim,

2

and would

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not justify contravention of the clear language of

Hanna. See Dixion v. Bradley,

Nos. 80-3578 et al., mem. op. (M.D.Tenn. June 2, 1981).

3

Nevertheless, the court remained hopeful that there would ultimately be no need for substantial federal court intervention, since the

Trigg

case, dealing with many of the same issues as the case

sub judice,

was then on appeal to the Tennessee Supreme Court, and any final decision by the state courts would be entitled to full faith and credit here. Thus, if the instant action would not have been entirely foreclosed by res judica-ta, certainly many issues would have been subject to collateral estoppel in the event of a final state court decision.

Unfortunately, there has been no final state court decision. On July 2, 1981, the Supreme Court of Tennessee, in a decision that so far as this court is aware is wholly unprecedented in the annals of our federal system, ordered abstention by the state courts pending federal resolution of the present case. Without considering whether such action may have amounted to an abdication of the duties assigned to state courts by the Constitution and laws of Tennessee, the effect of the decision is clear: The task of resolving the serious and politically sensitive constitutional claims raised by inmates incarcerated by the State of Tennessee has been passed to the federal courts. It is a task which this court does not take lightly, in part because of a natural reluctance to interfere with the State’s administration of its own prison system. Yet, to shrink from decision would be in contravention of the clear policy statement in

Hanna

that, where institutional violations of federal constitutional rights are concerned, federal courts must act to hear those claims. 630 F.2d at 444 ,

citing, Procunier v. Martinez,

416 U.S. 396, 405-06 , 94 S.Ct. 1800, 1807-08 , 40 L.Ed.2d 224 (1978). That the state courts have chosen to sit and wait for a federal decision is simply an unfortunate curiosity, a decision which this court assumes will remain an aberration and not evolve into a new policy of state abstention.

Trial of this cause was held on November 23-25 and December 7, 1981. At the conclusion of trial, some 20,000 to 30,000 pages of evidentiary material, including a plethora of detailed documents, reports, responses to discovery, depositions and other material considered by one or both parties to be relevant was filed and submitted for the court’s consideration. Objections to the introduction of particular exhibits were raised by the defendants. Those objections, along with the merits of the case itself, were taken under advisement by the court.

4

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Consideration of the issues properly before the court necessitates a detailed inquiry into specific conditions at each of the individual institutions encompassed by this litigation. In order to place the institutional conditions in their proper perspective, the court will first explore the TDOC system: Its organization of personnel and responsibilities, and the division of functions between the Department and the individual institutions.

II. THE TDOC SYSTEM

A. General Overview

At the head of TDOC is the Commissioner of Correction, a post presently held by defendant Harold B. Bradley, an individual whose competence, dedication and professional credentials are beyond reproach. The department’s number two administrator is Deputy Commissioner Robert Mor-ford, who, along with Commissioner Bradley, oversees all TDOC functions. Reporting directly to the Commissioner or Deputy Commissioner are an assistant commissioner of community relations, the staff attorney, the director of internal affairs and the director of medical services. Those persons administer TDOC functions that, for one reason or another are not assigned to any of the five major divisions of the department.

The Division of Adult Services is headed by Assistant Commissioner Dorothy M. Greer. Administrative staff for this division includes the director of rehabilitative services, the director of offender classification, the director of adult probation and the director of institutional programs. Individual prison wardens report to TDOC through the Division of Adult Services.

The Division of Agri-Industries consists of two sections: Tennessee State Industries and Institutional Farms. Each section is headed by a director, who reports to the Assistant Commissioner for Agri-Industries, Larry Daniels. The Division of Agri-Indus-tries works closely with an independent nine-member Prison Agri-Industries Board, established by the legislature as an advisory body but utilized, according to Mr. Daniels, much like a board of directors for setting divisional policies and providing expertise in areas such as management, finance and marketing. Under the direction of Mr. Daniels, with the assistance of the board, agri-industries within TDOC have expanded considerably over the last few years. However, even now the division employs only about 1,150 inmates out of the total of more than 7,000 in TDOC custody.

5

Two other divisions that are potentially relevant here are the Division of Organization Development and the Division of Administration, both headed by assistant commissioners. The former division has directors in charge of the following areas: Planning and research; internal audit; management information systems; volunteer services; and staff development and training. The Division of Administration has directors in the area of fiscal services, personnel and engineering. The remaining division is Youth Services and is not relevant to the present case.

There are approximately 7,000 adult inmates in those TDOC institutions currently under this court’s review. The largest single facility is the Tennessee State Penitentiary (TSP or “main prison”), a maximum security facility located in Nashville which currently houses approximately 1,930 inmates, in addition to over 300 others administratively assigned there but not physically present. The Nashville Community Service Center (NCSC) which prior to July 1, 1981, was administratively part of TSP, houses approximately 350 minimum security and work release inmates. The Fort Pillow State Farm (FP), located in Lauderdale County, houses over 700 inmates and is a close security prison. The Tennessee Prison for Women (TPW) is the primary institution for housing the State’s female inmates and is also designated close security. Located in Nashville, TPW houses approxi

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mately 300 women. Brushy Mountain Prison (BM), located in Morgan County, is a maximum security prison with a population of about 450. The Turney Center for Youthful Offenders (TC) is a medium security facility housing about 630 inmates, and is located in Hickman County. The Memphis Correctional Center (MCC), also medium security, houses over 400 inmates and is now used as the classification and intake center for some new inmates from West Tennessee. DeBerry Correctional Institute for Special Needs Offenders (DCI) houses approximately 275 inmates assigned there for various types of psychological care and is a maximum security facility. The Nashville Regional Correctional Facility (NRCF), a medium security prison,

6

is the primary intake and classification center for male inmates in the state, houses just under 600 inmates. Three other regional prisons, also medium security, are Bledsoe County Regional Correctional Facility (BCRCF), Morgan County Regional Correction Facility (MCRCF), and Lake County Regional Correctional Facility (LCRCF). They have populations ranging from approximately 400 at LCRCF to approximately 470 at MCRCF. In addition, TDOC operates community service centers in Memphis and Chattanooga, as well as the transitional center in Memphis, none of which are challenged in the present action. An additional 300 or so state prisoners are housed in county jails pursuant to contracts with the State. Conditions in those jails will not be directly reviewed herein.

The current TDOC prisoner population of about 7,000 inmates is almost double the population of 10 years ago. Every indication is that the increase, which for the five years ending in 1979 averaged 454 inmates per year, is likely to continue. Using that figure in a 1980 program evaluation, the State Comptroller of the Treasury projected a total of 8,366 inmates in TDOC institutions by 1985. In fact, the population increase from 1979 to 1980 was over 800 inmates, well above the previous average. And, according to Commissioner Bradley, the rate of increase at the time of trial was about 100 inmates per month. Present TDOC projections place the inmate population at more than 12,000 by mid-1986.

Although the regional prisons were built in response to the problem of overcrowding, the fact that those facilities already house inmates at or above their design capacity of 400 is indicative of the apparently persistent nature of the spiraling prison population. In fact, overcrowding has been a recognized problem in Tennessee’s prisons for many years, dating back at least to 1937. According to the State Comptroller’s 1980 evaluation, the actual prison population is consistently well in excess of nationally accepted minimum standards, a conclusion with which the experts in this action uniformly agree. And although average daily populations are maintained relatively close to the various prisons’ “design capacities,” that is accomplished through the juggling of figures, in which design capacities are routinely raised whenever it appears that the department is no longer able to keep the count at or near the previously designated capacity. In their post-trial brief, the defendants admit that TDOC institutions continue to face a serious problem in regard to crowded conditions. They argue, however, with the vague and conclusory nature of the term “overcrowding,” and contend that current conditions meet constitutional minima.

Just as the prison populations continue to increase, so, too, do costs. The TDOC budget, which was under $15 million in fiscal year 1968-69, had risen to over $76 million in 1978-79. During the same period, the average annual cost per prisoner rose from $2,201 to $6,705. The department’s budget is now in excess of $100 million. In its appropriation request for 1982-83, TDOC indicates that expenditures of almost $127 million will be required to maintain a “base” budget, that is, to simply maintain services at current levels, with no additions of personnel. It now costs the state nearly $10,000 per year to house each inmate committed to TDOC custody.

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Thus, TDOC’s dilemma appears intractable. In the face of constantly rising numbers of prisoners and costs of incarceration, problems over which the department has no effective control, increased appropriations are needed just to maintain the status quo. Yet the political climate is such that the legislature is reluctant to authorize substantial increases in funding for TDOC at a time when other programs are being cut. TDOC’s task is at best a formidable one.

It appears that the present administration, perhaps in response to

Trigg

and the instant litigation, are making some strides toward improvements in spite of the unenviable position in which the department finds itself. Substantial reorganization has occurred over the last few years, including restructuring the TDOC hierarchy with the creation of new assistant commissioners, the hiring of a health professional as director of medical services and the ongoing effort to implement standard department-wide policies and procedures. Just as clearly, the changes that have been made have been neither swift nor entirely effective to correct numerous admitted deficiencies of long standing.

While the determination whether particular conditions amount to violations of the Eighth Amendment must necessarily be made on an institution by institution basis, two areas under dispute are so subject to central TDOC operation as to warrant systemic consideration. The first is classification. The classification function occurs upon the arrival of a new inmate into the system, and determines that inmate’s placement, security status and opportunity to participate in any work or educational programs. Although reclassification at least theoretically occurs at the institutional level from time to time, the initial process is clearly a systemic function and will be considered as such.

The other arguably system-wide function that will be so considered here is the health care delivery system. Although primary health coverage is furnished at each local institution, TDOC at least monitors the level of care through the director of health services. The department also maintains a central hospital at TSP for referrals from throughout the system and funnels all inmates in need of acute mental health care to DCI for treatment. The plaintiffs have argued that various systemic deficiencies in this arrangement negatively affect the level of care actually delivered at the institutional level. Thus, following the classification discussion, but before embarking upon the institution by institution analysis of conditions, which will include individual health care delivery capabilities, the department’s system for assuring the delivery of care will be separately examined.

B. Classification

The function of the classification process is to determine each inmate’s security level, the institution to which he will be assigned, and the employment, educational or vocational program in which he or she should participate. It is essentially undisputed that a competent classification system is very important to the operation of a prison system, and should identify the medical, psychological, vocational and educational needs of inmates, as well as insuring the separation of violence prone prisoners from their potential victims and enabling closer supervision of higher escape risk inmates. The defendants’ classification expert, Mr. Ernest Reimer, described the classification function in his deposition as follows:

[A] System of accumulating pertinent information about an inmate to allow programming and treatment and management of that inmate on an individual basis; to promote the safety and well being of the inmate, other inmates, staff and the public, and to enhance the social, vocational and personal growth of the inmate.

As will be discussed,

infra,

there simply is no distinct constitutional right either to a particular security classification, assignment to a particular institution, or to participation in employment, vocational or educational programs while incarcerated. Thus, much of the proof submitted on classification deficiencies is entirely irrelevant and will not be addressed here. Nonethe

*1061

less, there is substantial evidence that certain deficiencies in the classification system contribute to an unconstitutionally high level of violence in TDOC prisons, and for that reason, the classification process must be examined.

Initial classification occurs at three facilities in the Tennessee prison system. Most male inmates are classified at NRCF, a facility which includes a 16-guild regional facility which opened in 1979 and is sometimes referred to as Cockrell Bend (CB), and a facility some two miles away now known as Guild 17, which was constructed in 1910. Beginning in the summer of 1981, the department began performing the initial classification of some inmates from the Memphis area (those with less than five years to serve) at MCC. All initial classification for women is done at TPW. Classification functions and procedures are substantially the same at each of these locations. Therefore, only the process at NRCF will be presently examined in detail, but because of the similarities, the findings reached will be deemed applicable across the board, unless expressly noted otherwise.

New inmates going through classification at NRCF are taken first to Guild 17, at which time they are fingerprinted, photographed and asked to provide basic personal information. Soon after the inmate’s arrival, an intake medical screening that has been appropriately characterized as a “quick and dirty” assessment is made in order to isolate those inmates readily identifiable as needing immediate acute care.

Within a day or two of the inmate’s arrival at Guild 17, he is given a “salient factor profile” which is designed to provide general information on that inmate’s security risk. Those inmates whose score on this profile indicates a low security risk remain at Guild 17 only until space is available at the CB facility, where they are transferred for the remainder of the classification process. Those whose score indicates a high security risk, as well as all “Class X” offenders

7

are designated “keepers” and remain at Guild 17 for the entire classification process.

The classification process takes about six weeks to complete. During that time, each inmate is assigned to a classification team that consists of a psychological examiner and a counselor. Those persons are responsible for completing the interviews and obtaining information about the inmates. The counselor also conducts an oral orientation program, providing the inmate with general descriptions of the other institutions in the TDOC system.

During the classification process, each inmate is given a complete medical examination, including a TB skin test,

8

a dental examination and a battery of psychological tests. The psychological tests regularly given include: the Beta II, an intelligence test; the Minnesota Multi-Phastic Personality Inventory (MMPI), designed to give a general idea of a person’s psychological make-up; the Wide Range Achievement Test, which recently replaced the California Achievement Test as the system’s measurement of basic educational skills; and the Wide Range Interest-Opinion Test, which recently replaced the General Aptitude Test Battery as a vocational aptitude test.

Alternative tests are used for retarded or illiterate inmates. These include a taped version of the MMPI for inmates unable to read, and the Wechsler Adult Intelligence Scale for retarded inmates. The Peabody Picture Vocabulary is also used for educationally deficient inmates. However, none of the tests are specifically designed to identify violence-prone inmates.

The major tests are usually administered in groups by a testing diagnostician, and the results are forwarded to the psychological examiner for evaluation. The testing occurs by the end of the inmate’s third week at the classification center. After the scores are tabulated by the testing diagnostician, they are forwarded to the psychological examiner for evaluation.

*1062

During the inmate’s fourth week of incarceration, he or she is interviewed by the psychological examiner, who formulates recommendations based upon his impressions from the interview and his evaluation of the test results.

After the tests and interviews have been completed, usually in the fourth or fifth week, the inmate meets with the classification committee. The committee’s composition is apparently fluid, but always includes a counselor, a security officer, and an “administrative” member, drawn from some other area of the institution. The psychological examiner may attend if he or she desires to, and the warden or associate warden may also be in attendance. It is this committee, acting upon the recommendation of the inmate’s classification team, which actually makes the classification decisions, i.e., the institution to which the inmate will go, his security classification and his job and programming recommendations.

Usually within two weeks of the classification committee’s decision, the inmate is transferred to the designated facility referred to as the “time building” institution. Once, there, the inmate’s classification and programming recommendations are reviewed either by a counselor or the reclassification committee. A determination is then made, subject to approval of the warden, concerning the inmate’s housing and programming assignments. Although the classification recommendations are by policy considered by the receiving institution, they are not always implemented. Further, inmates of differing security classifications are routinely housed together in the same unit and often even within the same cell. Even though housing assignments are not, as a matter of policy, made on a space available basis, in reality space availability is the main determinant in most housing assignments.

9

And, as will appear,

infra,

programs are so scarce that recommendations as to placement in them frequently simply cannot be followed.

The security classification assigned to inmates by the classification committee determines the level of custody required for what is considered to be effective supervision of each inmate. The classifications are maximum, close, medium and minimum.

10

The minimum security classification is further subdivided according to the type of supervision required when the inmate is outside the security perimeter of a facility, into minimum direct (direct supervision by TDOC employee), minimum trusty (supervision by other state employees) and minimum community (work or educational release). An inmate may be classified as maximum or close security because of his violence potential, escape risk or some other factor indicative of a need for a high level of supervision.

It is undisputed that the vast majority of inmates coming into the TDOC system receive initial classification as medium security prisoners. In fact, both of the classification experts who appeared in this case agreed that some inmates are routinely classified as medium security who would be appropriate candidates for minimum security classifications.

The reasons for the phenomenon are to some extent disputed and are of questionable relevance in any event. There is agreement, however, that one primary cause of the initial classification procedure’s failure to accurately classify low risk inmates is the problem of obtaining a verified criminal record in the form of an F.B.I. “rap sheet” prior to the termination of the classification process. According to Warden Stephens of NRCF, only in an extremely low percentage

*1063

of cases does the department receive a rap sheet before an inmate leaves NRCF. Yet, without that rap sheet, the only way for an inmate to be classified below medium security is upon the recommendation of the Director of Offender Classification and the concurrence of the Commissioner, a procedure that is utilized only in rare circumstances.

The problem of this “overclassification” of inmates is that it leads both to increased levels of violence and to the psychological deterioration of non-violent inmates housed with a tougher element of the prison population. The problem was acknowledged by both classification experts, and is most severe in its impact upon young first offenders, whose chances for rehabilitation are lessened by incarceration with the hard core elements of prison society. In fact, the Tennessee Law Enforcement Planning Commission recognized as much in its 1975 report:

The correctional system must be able to screen out those individuals who are dangerous to the community and must be incarcerated. However, the underlying problem is that so often offenders who could better be served in a community based treatment or residential treatment program are incarcerated in a penal institution. It is quite evident that once a person is exposed and indoctrinated into the hardcore elements of a prison society, the lesser his chances are for adjustment or habilitation back into society.

T.L.E.P.C., “Comprehensive Plan for the Improvement of Law Enforcement in the State of Tennessee” (1975) Ex. No. 8922 at 72. Even as early as 1937, a Citizens’ Committee established by the Commissioner of Institutions found that the state’s prisons were “giving a post graduate course in crime .. . that ... will continue as long as boys of tender age are mixed with sex perverts, the venereal diseased and prisoners serving terms for three or four felonies.” Report, “Prisons, Reformatories and Penal Institutions in Tennessee,” (1937), Ex. No. 8914, at 53.

Yet, as the defendants’ classification expert, Mr. Reimer, made clear in his deposition, the adverse impact resulting from ov-erclassification is not restricted either by age or the nature of the offense for which the inmate is incarcerated. The most important consideration appears to be simply the propensity of a given inmate to participate in violence. William G. Nagel, a nationally acclaimed authority on corrections, described the problem in terms of the psychological impact of housing non-violent prisoners together with those who actually require a more restrictive setting. In that situation, Mr. Nagel testified, the non-violent prisoner begins to perceive himself as just “as bad as the next guy,” and starts to behave accordingly. The result is that the system makes “problems out of people who shouldn’t be problems.”

In Tennessee, the overclassification problem is exacerbated by the incarceration of many inmates convicted of non-violent property offenses who would not even go to prison in most states.

11

While currently only 25% of the inmates in TDOC institutions are classified as minimum security, it is readily admitted that many more would qualify for that status.

12

Furthermore, those inmates who are classified as medium security are usually housed in institutions that also contain close or maximum security inmates, and often share individual units or even cells with higher classification inmates.

The proof is clear that an inmate’s potential for violence is simply not, to any appreciable degree, taken into account in the initial decision where in the TDOC system

*1064

he is to be housed. And, to the extent that an inmate’s violent or non-violent nature is considered at all in the classification process, all distinctions are effectively obliterated by the pervasive practice of classifying the overwhelming majority of new arrivals as medium security or higher. Furthermore, particular institutions almost uniformly house inmates of various security classifications, often within the same'units or even cells. The fact that housing assignments within an institution are made largely on a “space available” basis, further reduces the system’s ability to effectively separate those inmates who may somehow have been identified as more or less violent. The conclusion is inescapable that the increased violence and psychological deterioration which the experts uniformly attribute to overclassification occurs to a significant extent in Tennessee’s prisons.

The court views the remainder of the plaintiffs’ complaints about the initial classification process, such as the lack of “objective criteria,” and insufficient participation by inmates in the process, as raising problems of classification theory properly left to the sound discretion of prison administrators. There is no substantive evidence to indicate that those factors, even to the extent that there might be deficiencies in the classification process, negatively impact any constitutionally protected right. Furthermore, to the extent that the plaintiffs would have the court order specific relief in areas such as the alleged deficiencies in numbers and training of staff, such areas represent the sort of minutiae of details with which this court will not interfere.

See

§ IV,

infra.

In contrast to the situation at the time of the Chancery Court decision in

Trigg,

TDOC now has a policy requiring periodic review and reclassification of inmates. That policy requires reclassification of each inmate every six months. However, compliance with the policy has been less than total, and Commissioner Bradley doubts whether it will ever be practicable to reclassify all inmates every six months.

13

In addition to the six-month review policy, the department has a policy that each inmate’s classification recommendation be reviewed within two weeks of his receipt at his “time-building” institution. Other factors that can trigger an early reclassification are a disciplinary action, the lodging or dropping of a detainer, or the arrival of a rap sheet. Both Dr. Fisher and Dr. Reimer criticized the apparently frequent failure to automatically review classification recommendations upon the receipt of the rap sheet. And, while Warden Rose said that such review should occur, neither he nor the Director of Offender Classification, Evans Fine, knew of any policy requiring it. In fact, the court is persuaded that such a review rarely occurs, and that the predominant overclassification of inmates to medium security (in part because of the absence of the rap sheet) is not often corrected in a timely fashion.

Furthermore, it is clear that the six-month reclassification, when it occurs, is not successful in curing much of the initial overclassification. There exists neither a department wide policy setting forth the goals of periodic reclassification, nor any sense of consistency in the way the process is carried out at various institutions. For example, although Commissioner Bradley has identified transfers, job assignments, counseling and special programs as among the decisions that ought to be determined in a reclassification hearing, job and program placements at a number of institutions are apparently determined by a job board

*1065

(which may consist of a single person) without consultation with the reclassification committee. At its worst, the reclassification process is, as found by Mr. David Fo-gel, a corrections expert called by the plaintiffs, little more than a mockery. Such is apparently the case at least part of the time at BCRCF, where inmate participation in the process at times seems limited to “just [signing] the papers,” without even meeting the reclassification Board.

14

Beyond the lack of definition and consistency in the reclassification process, however, the system’s failure to remedy initial overclassification is evident in the department’s admission,

see supra,

that a large number of inmates who could be handled on a minimum security basis continue to be confined as medium security prisoners. Although it has been asserted that the problem is partially attributable to the lack of minimum security programs and bed space, there is a consistent problem of filling spaces in the minimum security community service centers. In fact, each institution has now been assigned a monthly quota for transfers to the CSC’s. Yet, despite the admitted presence of many minimum security candidates, the various reclassification committees have been unable to consistently meet those quotas. Consequently, over-classification often continues throughout an inmate’s stay in TDOC custody, and reclassification has to date not gone far toward alleviating the increased violence and psychological deterioration that result.

C. The Health Care Delivery System

The evidence is convincing that the health care needs of inmates are greater than the needs of the general free world population. A variety of factors seem responsible for that phenomenon, some of which are related to the socio-economic and family backgrounds of the prison population. Other factors equally important, however, stem from the prison environment itself: overcrowded conditions and the concomitant ease with which communicable diseases can spread, and the propensity of prisoners for violent attacks upon one another, to state but two of the most obvious. At the same time as these factors enhance the likelihood of physical disease or injury, many of them also lead to or worsen psychological and emotional problems as well. Thus, the fundamental fact against which the level of health services must be evaluated, is that within a prison system, a variety of serious physical and mental health problems can be anticipated. Sobering but true is the further realization that the physical and mental conditions of many inmates can actually be expected to deteriorate during their stay behind the walls. The health care delivery system must be capable of meeting those needs in at least a minimally adequate fashion, so as to prevent needless pain and suffering.

That deficiencies exist in the delivery of health care to prisoners in the TDOC system is beyond serious cavil. Chancellor Cantrell, in the

Trigg

decision, found that the level of medical care in the system was “inadequate to protect life and limb, ... [causing] needless human suffering.”

Trigg

(Dav.Ch.Op. at 31). That conclusion was supported by extensive factual findings, the accuracy of which has been admitted by the present defendants. Although there have been some changes in the intervening years, deficiencies clearly remain. Even the defendants’ expert witness on health care, Richard A. Kiel, while concluding that the health care delivery system is “adequate” has acknowledged the continued existence of many persistent problems and the resulting need for many additional improvements. The defendants’ Director of Health Services, Jamie S. Brodie, has likewise identified numerous deficiencies in the present level of health care available to inmates in Tennessee. The issue of concern here, therefore, is precisely what and how serious the present deficiencies are.

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The present section will examine the TDOC health care delivery program from a systemic perspective, for indeed, many of the complaints raised by the plaintiffs are systemic in nature. In the following sections, dealing with challenged conditions at the institutional level, the court will address the facilities, staffing and the level of care actually available at each individual prison.

The linchpin in the ostensibly centralized TDOC health care delivery system is the TSP hospital, which is used as a referral center for male inmates throughout the system who require inpatient treatment.

15

Emergency and infirmary type care are provided at each institution, and civilian hospitals are utilized when needed. Inmates in need of extensive mental health care, including treatment for alcohol and drug dependency are referred to DCI, as individual institutions are not equipped to provide such services.

The TDOC health care system is under the supervision of the Director of Health Services, Jamie S. Brodie, a registered nurse who has served in his present capacity since February 1981. Although Mr. Bro-die’s title is “Director,” he actually has no direct authority to control the provision of health services. Rather, his role is merely advisory. Mr. Brodie reviews the department’s health care delivery system, including equipment, facilities and staffing at each institution, and makes such recommendations as he deems necessary. However, Mr. Brodie is able to implement his recommendations only to the extent that he can convince Commissioner Bradley or local wardens to do so. His only real power is to study, recommend, and lobby for his position.

Ultimately, it is individual wardens who retain the power to control the provision of health services at their respective institutions. The wardens are responsible for institutional health care budgets in conjunction with their general operating budgets, and are similarly responsible for hiring health care personnel, and for the requisition of necessary equipment and supplies. In the development of institutional budgets, the wardens are often faced with balancing the needs of the health care delivery system against competing demands upon the scarce fiscal resources allocated to their facilities. And, when the friction is between health care and security needs, health services are frequently the hardest hit and the first to be cut.

16

Both Mr. Brodie and the defendants’ medical expert, Mr. Kiel, are satisfied with the present system wherein Mr. Brodie functions in an advisory “staff” position without direct line authority to implement his recommendations. Mr. Brodie and Mr. Kiel assert that the system allows input and influence by the Director of Health Services, without infringing on the ability of wardens to manage their own institutions. It is their belief that Mr. Brodie can be effective in his supervision of medical services by virtue of his close working relationship with the Commissioner and the wardens who, it is asserted, will usually go along with Mr. Brodie’s recommendations out of respect for his judgment.

Yet, in reality, those recommendations are often not followed. As an example, a number of health staff positions that Mr. Brodie deemed essential were subsequently abolished by the wardens, who considered them expendable. The clearest example of Mr. Brodie’s inability to effect meaningful changes can be found in the way his recommendations for the TSP hospital have apparently fallen on the deaf ears of Warden Rose. Easily correctable problems cited in his September 1981 report, including the

*1067

presence of outdated I.V. solutions and pharmaceuticals in the emergency room, and the use of open cupcake tins for bulk storage and dispensing of medications, have not been corrected. Warden Rose has simply not responded to numerous other recommendations. These include:

(1) replacing the present hospital administrator, Harley Seimer, with a professionally qualified administrator (a move which Mr. Brodie deems “essential”);

(2) restructuring the delivery of patient care according to the principles of levels of care;

(3) freezing the opening of the West 100 psychiatric unit at TSP hospital;

(4) use of the hospital’s third floor for a therapeutic community;

(5) removing hospital beds from institutional capacity and restricting their use to medical patients only;

(6) achievement of licensure for the hospital;

(7) reform of the budget process;

(8) developing a master staffing plan with criteria for measuring performance and planning changes;

(9) developing a central pharmacy; and

(10) instituting quality assurance mechanisms.

Another proposal, to establish a permanent cadre of security staff assigned full time to the hospital, was acknowledged and rejected. It thus appears that Mr. Brodie is often simply ineffective in persuading the wardens to adopt his proposals, at least at budget time, when health services compete with security needs for scarce dollars.

With the wardens thus firmly in charge of the TDOC health care delivery system, and in light of the glaring absence of any effective centralized authority to mandate changes, it is not surprising that the level and quality.of care varies widely from one institution to another. For example, annual expenditures for health care services recently ranged from $297 per inmate at FP, to $1,152 per inmate at TPW. At the same time, TPW needed emergency equipment that would have cost less than $100, in contrast to the expenditure of over $50,000 at TSP to purchase three new x-ray machines, when only one machine was needed. Centralized health care planning and budgeting would surely eliminate some of the irrationality that is apparent in the present system.

The problem, however, is exacerbated by the absence of comprehensive system-wide health care policies and treatment protocols. This dearth of policies and protocols is a widely recognized problem of long standing which has impacted areas ranging from hiring practices and the proper qualifications for health care providers,

17

to the level of emergency care that is available at each institution. And, while there is evidence that comprehensive policies are now being developed, the project is proceeding at a snail’s pace, and at the time of the submission of the record in this case, only two health care policies had been adopted and inserted into the policy manual.

18

In addi

*1068

tion, the absence of treatment protocols continues unabated, leaving the health care staff at each institution to respond ad hoc to emergency situations that may arise at times when the personnel on duty may be unqualified to develop a proper response. Indeed, the department has failed to develop any sort of comprehensive plan for the organization of either personnel or equipment to properly handle emergency situations.

Similarly, there is no functioning program or device to assure the maintenance of quality control in the delivery of health care to inmates. Recommendations for quality assurance mechanisms have come from several sources over the years, and Mr. Brodie himself views quality assurance as “absolutely essential.” Yet, in the absence of a quality assurance program, the evidence indicates that nurses routinely perform functions beyond the level of their license or certification, former military medics are used interchangeably with nurses without apparent regard to the individual’s actual qualifications, and staff remain largely unaccountable for the level or quality of care actually delivered. This lack of accountability extends beyond the quality of services, and has produced a situation in which staff idleness is a common problem,

19

and which in one case revealed extensive falsification of time records by a staff dentist.

Perhaps the single most serious systemic defect that results from lack of the central administration of the TDOC health system is the failure to follow up on patient treatment. One common manifestation of the lack of follow up is the transfer of inmates among institutions for treatment, unaccompanied by their medical records. As a result, the experience of the BM health staff is not exceptional, when they stated that approximately 60% of Brushy inmates transferred to TSP for hospital care never receive the needed treatment. Even within a particular institution, continuity of care is often woefully lacking. There is no system for regular periodic physical examinations even for certain high risk inmates for whom close monitoring is indicated. Furthermore, even when treatment is provided and particular followup ordered, such followup often never occurs.

The defendants contend that the full implementation of a new “problem oriented” medical records system will help to remedy many of the problems related to continuity of care and assurance of adequate followups. The new system has been two years in the making, and if the schedule goals set by Mr. Brodie have been met, should be fully effective at the present time.

The system consists of three components: A health records manual, containing forms and detailed descriptions of procedures to be followed; a newly designed problem-oriented record folder; and 40 or 50 standardized forms. One of the main features of the folder is the supposed ease with which an accurate summary of an inmate’s medical condition and required treatment can be obtained. A standard form has been developed to accompany an inmate on transfer among institutions which is to describe pre

*1069

cisely the type of care, testing or followup needed by the inmate upon transfer.

Evidence also shows that the TDOC health care system has been unable to provide adequate safeguards against the possible outbreak of communicable disease, particularly hepatitis. The need for such safeguards is clear. Overcrowding and the attending poor sanitation are major factors contributing to the outbreak of the disease, which is highly communicable and sometimes fatal. Several major hepatitis outbreaks have been identified in TDOC institutions in recent years, and have risen to epidemic levels at FP and TSP in 1976, and again at TSP in 1977 and 1979. The incidence of the disease at TSP continued to be high in 1980, and has also been identified as high at MCC. Reports prepared by epidemiologists at both the National Center for Disease Control in Atlanta and the Tennessee Department of Public Health have criticized TDOC’s failure to institute a mechanism for monitoring the incidence of hepatitis. Yet, despite the studies and recommendations, no action has been taken to either monitor occurrence of the disease or reduce the likelihood of an outbreak. Furthermore, the wardens at the institutions most affected persist in maintaining that no problem exists.

Similar deficiencies exist in the monitoring and control of both tuberculosis and venereal disease, both of which present serious problems in the institutional setting. Evidence was presented that policy memo-randa establishing a mechanism for monitoring and reporting TB cases, and for requiring routine pre-employment screenings and mandatory followup for prison staff, have been largely ignored. Indeed, Mr. Brodie’s 1981 evaluation of health services at TSP included the observation that cases of communicable diseases at the prison are apparently not even being reported to the local health department, as required by state law. And while Mr. Brodie believes that effective screening for VD is essential in the prison setting, Dr. Lambert King found that the health staff at MCC, one of the two intake and classification centers for male prisoners, did not even know how to screen for gonorrhea. Clearly, the department has not been effective in taking measures to control the outbreak of communicable diseases.

Further illustrations of the problems generated by the lack of a central administrative leadership for TDOC’s health care system include: Inefficient and poorly organized pharmacy services, in the face of repeated recommendations that the system would be better served by a single centralized pharmacy; the absence of even a titular director of dental services, with the attendant lack of coordination among facilities and widely variable levels of care; and the lack of coordination of mental health services, including an almost total absence of any meaningful correlation of mental health and physical treatment. With respect to both dental care and mental health care, Mr. Brodie is unqualified to provide informed professional leadership even if his role allowed him an effective voice, and even if the other duties required of him allowed adequate time to devote to those areas. Neither condition is present in the existing administrative scheme.

20

The presence of the systemic problems noted above, as well as others perhaps as serious, has been evident for a number of years. Indeed, as noted,

supra,

Chancellor Cantrell in the

Trigg

decision included specific findings regarding the same deficiencies. Studies conducted by independent sources in both 1977 and 1979 also identified many of the same problem areas. Although some steps toward reform have been taken, and although Mr. Brodie appears determined to do his best to steer the department in the right direction, the overall improvement has been slow. The departmen

*1070

tal system for assuring the delivery of minimally adequate health care to inmates remains beset by numerous problems that clearly have an adverse impact upon the level of care available in the TDOC system.

It is, of course, the level of care actually provided at each institution by which the constitutionality of the system as a whole must ultimately be judged. The discussion to follow will therefore include an examination of health care delivery at each TDOC facility as part of the broader analysis of conditions of confinement within the individual prisons.

III. CONDITIONS OF CONFINEMENT

A. Introduction

A leviathan body of evidence (much of which is of questionable relevance) was introduced concerning what are broadly referred to as conditions of confinement within TDOC prisons. Of concern are only those conditions which, either alone or in combination, so affect the quality of life that the incarceration of inmates under such conditions may amount to cruel and unusual punishment in violation of both the federal and state constitutions. The evidence took many forms, including the reports and testimony of expert witnesses who offered factual testimony as well as conclusions and opinions regarding the impact (and at times, even the constitutionality) of particular conditions.

The plaintiffs presented the testimony of three expert witnesses with regard to housing conditions. Samuel W. Hoover, an expert in the field of environmental health and sanitation, inspected conditions in four Tennessee prisons, TSP, TPW, FP and BMP. William G. Nagel, a nationally acclaimed corrections and criminal justice authority, examined TSP, FP, BMP and MCC with regard primarily to housing and idleness, two areas that he believes are of paramount importance. Mr. David Fogel, another nationally recognized corrections expert (and a former commissioner of corrections in Minnesota), inspected six TDOC facilities, TSP, BMP, FP, TC, TPW and MCRCF. Mr. Fogel’s examinations also included housing and idleness, but were much more wide ranging, touching upon,

inter alia,

security coverage and the existence

vel non

of standard departmental policies and procedures for various aspects of prison operations. Accordingly, his opinions include systemic conclusions as well as conclusions regarding the particular institutions inspected. The sole expert witness for the defendants with respect to most issues raised by Messrs. Hoover, Nagel and Fogel, was Commissioner Bradley, who, as stated previously, is himself well respected in the correctional field. No challenges have been raised to the qualifications of any of these individuals as expert witnesses.

Other evidence concerning conditions in TDOC prisons was offered in a variety of forms. The findings which follow reflect the court’s review of the entire record, including trial and deposition testimony and the thousands of pages of documents introduced at the conclusion of trial. Conditions at each institution will be examined separately. .

B. Tennessee State Penitentiary

1. Housing Facilities

Built in 1898 in the then classic “fortress” design, the Tennessee State Penitentiary is the largest of the state’s adult penal institutions. Originally constructed to house a maximum of 1,600 inmates, TSP now regularly contains in excess of 1,900 prisoners. An additional 300-350 are assigned to the facility administratively, but are not actually housed there.

21

The current population is down from an apparent high of approximately 2,300 in the months preceding the Chancery Court opinion in

Trigg, supra.

22

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The facility is classified as a maximum security institution, but approximately 98% of the men there are medium security prisoners.

Of the 21 buildings in the TSP compound, 4 are actually used for housing prisoners in 7 separate cellbloeks or units. The largest of these housing units is a long and narrow structure extending both to the left and right directly behind the administration building. These buildings comprise the entire front side of the rectangular principal compound at TSP and combine to impress observers with the imposing image of a seemingly impenetrable, if aging, fortress. This main housing building is divided into four cellbloeks, Units I-IV, which together house nearly 80% of the total population at TSP.

23

Units I-IV are similar in design, although there are some minor variations. Each unit has five levels of cells extending down the center of the unit, with two rows or “walks” of cells positioned back-to-back on each level. The hall in front of each upper level walk is essentially a narrow catwalk, suspended in the air, which faces the building’s outside wall and the vertical, arched windows that provide the cells with at least some fresh air and natural light, albeit from a number of feet away.

Units I and III each consist of 109 38-square foot cells and 80 53-square foot cells. Units II and IV each contain 189 45-square foot cells. All or virtually all of the cells in Units I-IV are “double bunked,” that is, they house two inmates per cell. Thus, when fully occupied, Units I and III each confine 218 inmates in cells that afford 19 square feet per inmate and 160 men in cells providing 26.5 square feet per inmate. Units II and IV house, when full, 378 inmates each in cells providing 22.5 square feet per inmate.

Units I-IV at TSP are maintained regularly at population levels very near these capacities. For example, on July 24, 1981, Unit I housed 369 inmates, Units II and III each contained a full house of 378 inmates, and Unit IV housed 374. Unit I houses inmates in protective custody or “check-ins” (so called because they voluntarily check in for their own protection) and general population inmates. Units II-IV are general population cellbloeks. In July 1981, 18 of the prisoners in these 4 units were classified as close security and the remainder were medium security inmates.

Immediately behind Units III and IV is a building containing the prison gymnasium/auditorium, dining room and, on the floor above the dining room, housing Unit V. Unit V is a single level cellblock containing 54 cells on 6 parallel corridors. Of these, 48 cells have 100 square feet and house 4 inmates each. The remaining 6 cells have approximately 50 square feet each and are double occupancy. As of July 24, 1981, the unit was fully occupied with 204 general population inmates, 2 of whom were close security, with the remaining 202 classified as medium security.

A separate single-story structure situated behind Units I and II contains the prison’s maximum security cellblock, Unit VI. Unit VI consists of 48 cells ranging in size from 35 square feet to 44 square feet, which, except for those inmates on “death row,”

24

are double occupancy cells. In addition to death row inmates, Unit VI houses inmates on administrative and disciplinary segregation, and at times some check-ins.

The remaining housing unit is the Self Determination Center (SDC), located near the extreme opposite end of the TSP compound from Units I-VI, and used to house

*1072

inmates on “honor” status. The SDC is a three-story structure which contains, on the ground floor, its own kitchen, laundry area and activity rooms. The second floor consists of 22 rooms, 2 of which house 4 inmates each in areas of 200 square feet and 150 square feet. The other 20 rooms are approximately 100 square feet each and are all double occupancy. On the third floor, 21 rooms of approximately 95 square feet (actually partitioned cubicles of a former dormitory area) house 2 inmates each. Four rooms on the third floor are single occupancy rooms of about 60 square feet.

Finally, some additional prisoners are housed temporarily at the TSP hospital, although at any given time, some or all of those may be inmates on administrative transfer from another TDOC institution. However, primarily because of the shortage of cell space at TSP, inmates who enter the prison hospital lose their cells and must often remain in the hospital after the need for treatment has passed, awaiting an available cell.

There is no dispute about the fact that TSP housing facilities are seriously overtaxed. Ninety percent or more of the prison’s 1,900 plus inmates are double bunked in cells ranging from 38 square feet to 53 square feet in size. Over 1,400 inmates at TSP are housed, 2 to a cell, in areas about the size of a ping pong table, 45 square feet, or less. Each of those cells contains two bunks, a sink and a toilet, as well as any personal belongings that the inmates are allowed to keep.

Little imagination is required to realize that considerable anguish and inconvenience necessarily accompany the confinement of two individuals in such close quarters. The burdens include the lack of room for two men to do more than simply stand up at the same time and the difficulty a relatively tall inmate has in fully extending either his arms or his legs inside the cell. Further, the close proximity of the shared toilet facilities, which are often old and in serious need of repair, is a condition that is repugnant to civilized sensibilities.

Yet, overcrowding is but part of the story and must be evaluated in light of other factors that affect the quality of life behind the walls. Those factors include: environmental conditions such as sanitation, lighting, heating, ventilation and the level of noise; the availability and accessibility of space outside the cells and the amount of time typically spent in the cells; and finally, the level of violence and the fear thereof which are present within the prison.

2. Environmental Conditions and Sanitation

Extensive testimony concerning environmental conditions at TSP (as well as FP, BM and TPW,

see, infra)

was presented by Samuel W. Hoover, a registered sanitarian with the United States Public Health Service from 1962 until his retirement in 1979, who is now engaged in environmental health consulting work, including a contract with the U.S. Bureau of Prisons. Mr. Hoover’s specific factual findings are credible and to a large extent undisputed. They will be relied upon extensively herein.

(a)

General Maintenance

The court is not surprised to find that an institution as old and as crowded as TSP, and inhabited as it is by persons who are hardly models of social responsibility, has fallen into a state of some disrepair. The problems identified by Mr. Hoover ranged from relatively minor items like broken windows and missing screens to leaky ceilings, deteriorated floors, rust-covered cell doors, exposed electrical wiring and seriously deteriorated plumbing. The broken windows, leaky ceilings, deteriorated floors and rusty cell doors were relatively isolated occurrences and need no further explanation here. The problems with the prison’s electrical wiring and plumbing, however, were found to be extensive and will be discussed in more detail.

Mr. Hoover found exposed electric wires, jerry-rigged connections and make-shift extension cords throughout TSP’s living units. Exposed wiring existed to some extent in every eellblock, and on occasion in the shower facilities as well. Electrical

*1073

switches and outlets were found on numerous occasions to be without covers, and many cells contained homemade extension cords and plugs. The conditions were found to present serious risks of both electrical shock and fire. Mr. Hoover acknowledged that many of the problems were attributable to unauthorized actions of the inmates themselves.

Mr. Hoover’s inspection of TSP uncovered extensive problems with the institution’s plumbing. Those problems generally fit into two categories. The first involves what may be described as plumbing design defects, and the second consists of inadequate or improper maintenance and repairs. In combined effect, these defects present real as well as potential hazards to the health of the prison population, and surely contribute to the misery that accompanies life at TSP, through, for example, the emission of noxious odors.

Mr. Hoover identified instance after instance of what are described as cross-connections between toilets and the drinking water supply. Such a condition can lead to the contamination of drinking water with raw sewage. Cross-connections were found in all TSP living units and were so extensive that Mr. Hoover estimated that at least 151 of the 189 cells in each of Units I-IV contain toilets that are directly cross-connected with the drinking water.

With the exception of the absence of anti-siphon devices on hoses attached to water faucets in the TSP kitchen, the remaining plumbing problems identified by Mr. Hoover at TSP concern the need for or inadequacy of repairs to the plumbing system. They included leaks in the sewer lines, stools or water lines in virtually every living unit, the use of inappropriate or ineffective patches on existing leaks, the resulting accumulations of pooled sewage (and in one instance identifiable human feces), missing drain covers, and other miscellaneous examples of faulty plumbing facilities. In the SDC, an additional plumbing problem was evidenced by the fact that whenever certain toilets were flushed, other toilets were immediately filled with raw sewage.

It should be noted, however, that Mr. Hoover did not find evidence that sewage at TSP overflowed directly into any living units. Rather, the pooled sewage found was in pipe chase areas. In addition, the record indicates that the defendants responded to Mr. Hoover’s findings and have already remedied some of the defects found. Other more extensive problems such as the faulty plumbing are apparently being corrected on an ongoing basis.

(b)

Lighting, Ventilation and Noise

In his inspection of TSP, Mr. Hoover found that lighting throughout the housing units was substantially less than that considered necessary for reading, writing and the maintenance of proper personal hygiene. While stating that a minimum of 30 footcandles is considered necessary, the lighting in many cells was measured at less than 5 footcandles. Indeed, of the 57 readings taken by Mr. Hoover in TSP living units, only three met or exceeded the 30-fo-otcandle minimum standard. The lighting level on some lower bunks was as low as 0.2 footcandles. Even on top bunks and in the middle of cells, the readings often revealed lighting levels of less than 5 footcandles. Although Mr. Hoover’s lighting measurements were taken in only a small percentage of the total cells, the figures do appear fairly representative and reflect lighting levels in some cells within each of TSP’s living units.

Lighting at TSP was also criticized by another plaintiffs’ expert, William Nagel, who testified that the near exclusive reliance upon artificial light can in and of itself have a deleterious effect upon inmates.

25

Mr. Nagel noted that even in Units I-IV, the cells of which face outside

*1074

windows, the natural light is muted because of the distance from the windows to the cells. In Unit V, only two walks face windows at all, and they have been painted over. Two of the four walks in Unit VI do face windows that provide some natural light.

On the dates of Mr. Hoover’s inspection of TSP, in early September 1981, he recorded “effective temperatures”

26

ranging from 74 °F in some cells to 80.5 °F in others. Except for Unit VI, where a fan was not working on the day of his inspection, Mr. Hoover reported no serious problems with ventilation at TSP. In addition, Mr. Nagel found that on the day of his inspection, August 18, 1981, the temperature in the TSP living units was not excessive.

Mr. Nagel did find that the level of noise inside TSP cellblocks was extremely high, and at times becomes “intolerable,” He explained in his trial testimony that the excessive noise level results from constant activity within the cells, including the frequently simultaneous use of radios and televisions, as well as constant talking (sometimes shouting to be heard above the noise), the flushing of toilets and the clanging of cell doors. Particularly in the case of the multi-tiered Units I-IV, the noise travels from level to level and tends to reverberate off the steel and masonry from which the cell-blocks are constructed. Mr. Nagel’s testimony was confirmed by inmate Jerry Brazen, who testified that the noise was often “enough to literally set your teeth on edge,” and that a person could sit in his cell and become irritable just because of the noise.

(c)

Sanitation

Issues concerning poor sanitation at TSP have been raised with respect to both the living units and the kitchen area. To some extent, the problems in the living units have been discussed in relation to faulty plumbing. Those findings will not be repeated, except to say that many of the plumbing deficiencies give rise to unsanitary as well as noxious conditions, and are conducive to the spread of communicable diseases.

Beyond dilapidated plumbing, however, Mr. Hoover found that the living units at TSP were frequently unclean both inside the cells and out. For example, he found that the living areas were heavily littered, including in some instances the presence of food garbage, and that there was extensive evidence of cockroach infestation. Filthy pipe chases were found to be prime harbor-age areas for roaches and other vermin. Inside the cells themselves, Mr. Hoover found that toilets were not only dirty, but that a great many of them are so old and deteriorated as to be uncleanable. These conclusions are well-supported by photographic evidence in the record, which shows toilets in such a state of deterioration that they appear virtually unfit for human use. Although inmates are supposedly provided with materials with which to clean and maintain their own cells, testimony indicated that those materials are sometimes difficult to obtain, particularly for inmates on check-in status.

Mr. Hoover concluded from his inspection that the food service area at TSP failed to meet basic sanitation standards. His specific findings included: poor sanitation in the garbage area, which may attract disease-carrying vermin; improper storage and handling of foods in both cold storage and dry storage areas; food residues and poor sanitation generally in the kitchen, including standing water; a leaky ceiling in the food storage area; insufficient temperatures in utensil and dishwashing facilities; and improper maintenance of temperature on food served to segregation inmates. Using an evaluation form provided by the Public Health Service of the Food and Drug Administration, Mr. Hoover found deficiencies in 25 of 44 inspection areas, including eight areas characterized as “critical.” Using that form, Mr. Hoover rated the TSP food service area at 45 out of a possible 100.

*1075

It should be noted that a public health environmentalist with the Metropolitan Davidson County Public Health Department routinely inspects the TSP kitchen and food service facilities at least every six months. Although his reports consistently reveal some sanitation problems, they are generally more favorable than Mr. Hoover’s report. On the other hand, the defendants admit that TSP’s large population places a strain on kitchen facilities and that improved monitoring of conditions there is needed.

(d)

Personal Hygiene and Facilities

As previously noted, the vast majority of TSP inmates have toilets and lavatories located within their cells. The single exception to this rule is the SDC, where toilet facilities are located in common areas. And, as stated,

supra,

many of the toilets are in such a deteriorated condition or are constructed of such materials that effective cleaning of the stools is virtually impossible. The significance of this condition is certainly magnified by the proximity of the toilets to the space in which the inmates live, sleep and sometimes eat.

Showers in each of the living units are located in common areas, in ratios ranging from 4.6 inmates per shower head for death row inmates to 11 — 21 inmates per shower head for inmates in the other units. Like the other areas in the TSP housing units, the shower areas are showing the effects of time, are deteriorated and in poor repair. Nevertheless, the showers are more or less functional and serve their essential purpose of allowing inmates to bathe. No substantial issue has been raised concerning the frequency of which inmates are permitted to take showers.

27

Facilities for the laundering of prisoners’ clothing are provided at TSP. However, it appears that many inmates choose to wash their own clothes in their cells, because of fees charged by inmates who work in the laundry and because of incidents of clothes not being returned to their owner after being laundered. On the whole, however, it should be noted that Mr. Hoover could find “no severe problems” with the laundry facilities at TSP.

The only other problem identified in the TSP housing units relative to personal hygiene or environmental health which the court finds even arguably relevant is the indication that there are no facilities or procedure for the routine sanitizing of bedding prior to its reissue to other inmates. This fact may be made more significant because of the apparent frequency with which cell changes are made, although nothing in the record suggests whether or not bedding might follow a particular inmate from cell to cell within the facility.

3. Fire Safety

Several issues have been raised with respect to fire safety precautions at TSP. While as explained,

infra,

the court does not believe that the evidence establishes any constitutional violation arising out of inadequate fire safety, in the interest of a complete record, the allegations will be briefly discussed.

In the view of the plaintiffs, the “most startling” fire safety deficiency at TSP is the prison’s continual extensive use of pillows and mattresses made of polyurethane foam. That material has been known for years to emit deadly fumes when burned, and TDOC policy has for several years prohibited its use. Although Commissioner Bradley had thought that all polyurethane mattresses and pillows had been replaced, Mr. Hoover discovered otherwise. Of the 15 TSP cells that he checked, there were 20 polyurethane pillows and 4 polyurethane mattresses in use.

Another problem cited was the absence of a second means of exit from housing units I — VI. Such exits were recommended by a 1977 TDOC report and are thought by the department’s chief engineer, Ed Hardy, to

*1076

be absolutely necessary to save lives in the event of a serious fire. The plaintiffs further complain that even where such exits exist, they are ineffective because of the prison’s lack of a fire evacuation plan and failure to prepare for a fire by conducting fire drills. The defendants, by contrast, presented evidence that second exits are being installed and that a fire evacuation plan does indeed exist, although they do admit that fire drills are not conducted.

Finally, the plaintiffs point to two alleged impediments which it is asserted will hinder prompt evacuation of inmates in the event of a fire. First, it is noted that TSP guards are not furnished with breathing masks to enable them to endure heavy smoke during the evacuation process, in spite of two 1977 reports recommending their acquisition. Second, Mr. Hoover noted the danger inherent in the present system whereby individual cells must be separately unlocked to release inmates and recommended a centrally controlled electronic locking system.

4. Idleness

Idleness of inmates is recognized, even by TDOC officials, as one of the most serious problems currently faced by the department. Commissioner Bradley has characterized the situation as both “serious [and] ... intractable.” Similarly, there is little dispute about the effect of overpopulation on the dearth of meaningful activities. In the absence of increased expenditures, idleness grows with population. Of course, the level of idleness is directly governed by the availability of employment opportunities or other programs to occupy inmates’ waking hours. At TSP a large number of inmates appear not to be engaged in any form of constructive work or rehabilitative activities.

For present purposes, inmates will be considered idle whenever their available daytime hours are not spent either working or attending educational or vocational training classes. Inmates who are not engaged in such activity are left largely to their own devices to determine how to spend their days behind the prison walls, with the result that large numbers of inmates spend substantial portions of each day in their cells.

In reality, there are two distinct classes of idle inmates at TSP. First, and most conspicuously, are the inmates who are neither employed nor enrolled in any daytime training program. At the time of Warden Rose’s deposition in this case, there were about 600 inmates in the first group. The second group is more difficult to quantify and consists of inmates who on paper are assigned to work or training programs, but for whom these activities require only a portion of their available time. The most glaring examples of this kind of hidden idleness can be found among those inmates assigned to institutional support jobs (e.g., the prison laundry, kitchen or maintenance positions), where a practice known as “featherbedding” results in the assignment of too many inmates to too few bona fide jobs.

Although ascertaining the precise extent of idleness due to job featherbedding is inherently difficult, and is perhaps on the present record impossible, it is absolutely clear that the practice of featherbedding at TSP is a substantial contributing factor to the overall idleness extant within the prison. Of 1,312 inmates employed at TSP on September 30, 1979,

28

729 were assigned to institutional jobs. At the time of Mr. Fo-gel’s inspection on August 26-27, 1981, he concluded that out of a total population of 1,915, only 369 were employed in Tennessee State Industries. An estimated 653 inmates were “without real work assignments,” and the remainder were assigned to institutional jobs, many of which Mr. Fogel found to be suspect. In Mr. Fogel’s opinion, which the court credits, “legitimate institutional .. . needs cannot gainfully occupy more than a fraction of the ... men who would have to look to such jobs for employment.”

*1077

While featherbedding is apparently more serious with respect to some institutional jobs than others, it is a pervasive practice throughout the system. For example, Mr. Fogel reported Warden Rose’s inability to explain the duties of the 293 men assigned to “operations” jobs and questioned the 35 men in “clothing,” the 25 in “laundry,” and the 30 assigned to “farms.”

29

In addition, a former TSP guard, Sammy Ray Mathis, stated that of the 10-20 men usually assigned to a “yard crew,” the work would be done by three or four and the rest would sit around doing nothing. Featherbedding has also made its way into the TSP hospital. In September 1981, the TDOC director of medical services, Jamie S. Brodie, conducted an evaluation of health services which found that the TSP hospital employed twice as many inmate workers as were necessary.

30

Mr. Brodie accordingly recommended a reduction, having found that the overstaffing resulted in widespread idleness among inmate workers, many of whom actually worked only about 2 hours per day and spent the rest of their time standing around the hallways and visiting with each other. Warden Rose, without directly acknowledging the existence of featherbedding in institutional jobs, has admitted that it would not be practical to add any more inmates to the institutional payroll because the need for that type work is “pretty well covered.” In light of the evidence, the understatement of the warden’s assessment is obvious.

Thus, with its current population level, TSP is unable to occupy a large number of its residents with any sort of gainful employment. And of those who are employed, a large number are not kept busy during a full work day. At least for those inmates with no job assignment at all, the only presently available effective antidote to idleness would be enrollment in some educational or vocational training program. Yet, as is the case with job opportunities, the number of available training programs are inadequate to meet the current needs of the TSP population.

The defendants have admitted that as of January 1978, vocational and educational programs at TSP (as well as most other institutions) were inadequate to meet needs. As of July 10, 1981, daytime academic and vocational classes at the prison had a total capacity of 367 students, and an additional 50 could be accommodated at night. Even if the vocational and educational programs were operated at full capacity, and it appears they are not, a substantial number of inmates would be left without either work or training assignments to occupy their time. And, in view of the widespread idleness among even those inmates assigned to jobs, the absence of more extensive academic and vocational programs further exacerbates the problem of inmate idleness at TSP. It should be recalled that Warden Rose’s estimate of 600 idle inmates,

supra,

referred to those neither working nor in a training program.

Inmates without work or classes to attend are left with few choices. For most, the majority of time is apparently spent in the cells. The prison gymnasium, when open, is available for basketball, weightlifting and boxing. However, the total capacity for all of these activities is about 20 inmates at any one time. Mr. Nagel stated that in his experience with prisons around the nation, unsupervised gymns, including the one at TSP, lend themselves to domination by a relatively few of the more athletic inmates, further reducing the gym’s availability as an alternative to time in the cell for the majority of idle inmates. In addition to the gym, inmates have access to the exercise yard for about 2V2 hours per day in good weather.

Another choice for idle inmates is to read or study in the prison library or law library, subject to the hours of operation and the number of inmates the libraries will accommodate at one time. The main prison does not have any “dayroom” space in which inmates can congregate and visit outside

*1078

the strict confines of their cells.

31

The compound does include both indoor and outdoor visiting areas. But these, of course, can be used only when an inmate is visited by free-world persons.

Doors to the cells at TSP remain locked throughout the day and are opened once each hour when inmates wishing to pass between their cells and other parts of the prison may do so. As a result of the widespread idleness and the limited access to activities outside the cells, a large number of inmates spend the vast majority of their time inside their cells. Mr. Nagel estimated that it would not be uncommon for a prisoner at TSP to remain in his cell 16 hours or more per day. And while there is no evidence what percentage of those incarcerated at the prison actually remain in their cells for such extended periods, the court credits Mr. Nagel’s estimate and finds that a substantial number of TSP inmates spend most of each day in their cells. That factor must be considered in evaluating the overcrowded condition.

32

5.

Violence

Violence behind the TSP walls takes a variety of forms, from strong arm robbery to stabbing, homosexual rape and even murder. While most episodes of prison violence are inmate upon inmate, on occasion there are instances of inmate-upon-guard or guard-upon-inmate violence. The resulting atmosphere of fear, intimidation, threats and coercion is simply a way of life for TSP inmates.

Quantifying the level of prison violence is difficult at best. Official incident reports, upon which the defendants base their opinion that the level of violence is not excessive, are so underinclusive as to be almost wholly devoid of meaning. Somewhat more helpful are records of disciplinary convictions of inmates for violent rules infractions, although they too present only a partial picture. The TSP hospital emergency room log is instructive for comparison, but in light of the often unsatisfactory explanations given by prisoners for their injuries, those records also do not provide a precise measure of violent episodes.

In fact, it is clear that none of the existing records, either alone or in combination, reflect the actual frequency with which violent acts occur at TSP and that, indeed, no system of recordkeeping could ever be equal to the task. The simple reason for this inherent deficiency is that many of the episodes of actual or threatened violence are never reported to prison officials and thus are not subject to any form of recordation. Life behind TSP’s walls is to a large extent governed by the “inmate code,” one tenet of which strictly prohibits prisoners from “snitching” on fellow inmates. The consequences of becoming a snitch may include physical retaliation, including threats of death,

33

the fear of which helps to persuade even well intending inmates to abide by the code. Thus even violent incidents that are witnessed by a large number of inmates are never reported by either the victim or the witnesses. Furthermore, there is evidence that the reach of the inmate code extends beyond the prisoners to affect, at times, the conduct of the correctional staff as well. In any event, the evidence is absolutely clear that the inmate code exists and that it prevents the reporting of a great many episodes of actual or threatened violence.

An examination of just the violence that is reported, however, compels the conclusion that TSP is an extremely violent institution. In 1979, 170 prisoners were convicted

*1079

in prison disciplinary proceedings of violent offenses: 56 for assault, 7 for sexual malpractice or rape, 83 for fighting and 24 for strong arm robbery. Another 77 inmates were disciplined that year for possession of a deadly weapon. In 1980, 57 inmates were convicted of assault, 22 for sexual malpractice or rape, 95 for fighting and 17 for strong arm robbery, a total of 191 disciplinary convictions for violent infractions. An additional 57 inmates were convicted in 1980 for possession of a deadly weapon.

34

During the first eight months of 1981, the last period for which figures have been provided, there were 137 disciplinary convictions at TSP for violent offenses: 55 for assault, 9 for sexual malpractice or rape, 55 for fighting and 18 for strong arm robbery. During the same eight months, there were also 54 convictions for possession of a deadly weapon.

Perhaps more telling than sheer numbers, which in any event underestimate the magnitude of violence, are descriptions which have been offered of the nature of the violence that occurs behind the walls. Both rapes and robberies are often accomplished with the aid of knives or other deadly weapons, and victims who do not give in are subject to being stabbed, viciously beaten or even killed. Most stabbings that occur involve multiple wounds, as evidenced by the hospital emergency room logs. One inmate testified that he was stabbed three times over a 15-minute period.

Another inmate, Ralph Janou, was stabbed nine times in what Mr. Janou thinks was a simple misunderstanding concerning his identity. Although Mr. Janou apparently passed out soon after the attack began, the perpetrator continued to stab him about the chest, back and throat. His injuries included a punctured heart sac and punctured lung, requiring treatment at an outside hospital for nine days.

The record is replete with other examples of violence among inmates at TSP. The most commonly related stories are of stabbings and rapes. The episodes have on occasion led directly to the death of the victim. For example, inmate Eddie Pitman described a murder by stabbing that occurred in the prison dining room. The same inmate described a fight between two men on the ballfield in which one was armed with a knife and the other defended himself with a baseball bat. These and numerous other instances, both reported and unreported, lend credence to Warden Rose’s belief that all TSP inmates live in constant danger of violent attack.

Furthermore, it is evident that the violence is so pervasive that no area of the prison can be considered safe. Evidence has been presented of violent attacks occurring in housing units, including locked cells, in the showers, hallways, hospital, dining room, ballfield, and virtually every other area of the prison compound. Even those prisoners who check in for their own protection cannot assume that they are in fact safe from attack, since the record includes numerous instances of rapes, stabbings and other violent attacks on check-ins at TSP.

The ability of the prison staff to protect the inmates from violent attack is, under present circumstances, severely limited. Oftentimes, guards are simply nowhere to be found when an attack occurs. Other examples indicate that even when guards are present they are sometimes unable or unwilling to protect inmates from attack. To the extent that the inmate code is followed by staff members,

see supra,

such a result is not surprising.

The problem of inadequate protection of inmates, however, is not limited to isolated instances of particular guards failing to act. Rather, the deficiencies appear to be endemic to the system, and to have roots much deeper than the conduct of individual officers. Furthermore, the beast has many heads, all of which must shoulder a share of the blame.

*1080

One aspect of the problem at TSP is attributable to the architecture and design of the complex itself. Many areas of the prison compound simply are not designed for proper surveillance, but are, instead, virtual blind spots that render consistent surveillance impossible. These areas are obviously prime candidates for violent episodes, and in fact provide the loci of a number of incidents identified in the record.

Beyond problems inherent in the design of TSP, the guards there are, in large measure, substantially undertrained. Although a state statute requires that correctional officers receive two weeks’ inservice training within six months of their entry on duty, past compliance with that law has not been exemplary. Even when training is provided, the evidence strongly suggests that the sessions are woefully short, both in terms of hours of training and in the topics on which instruction is offered. Without question, the training provided to guards at TSP is inadequate preparation for dealing with the security needs of the institution, including the right of inmates to be kept reasonably safe from violent attacks.

In addition to a general lack of adequately trained guards, TSP experiences a problem in retaining experienced guards as well. Warden Rose estimates that there is a 20%-35% turnover rate among TSP correctional staff, and that a single position could change hands as often as three or four times per year. Inmate testimony in this case has made clear the serious abuses that can result from the use of untrained and inexperienced guards. These include the repeated housing of weaker inmates with a known sexual predator whom one inmate described as apparently “unstable.”

35

John Doe No. 15 told of instances in which he had observed “inmates pay guards to let [an] inmate into a cell to rape another inmate.” He had also observed payment by inmates to guards for bringing drugs into the prison. Doe said that he had seen the same guard who sold the drugs instruct another guard to “bust” the inmate who had made the purchase so that the drugs could be confiscated for sale to another inmate.

36

Yet another shortcoming of the main prison security force is that the number of guards is simply insufficient to properly control a population of nearly 2,000 inmates. Indeed, there are times when one guard is expected to patrol as many as four separate walks, each housing 30-39 men. This, combined with the difficulty of observing activity within individual cells without actually passing in front of the cell, makes controlling violent acts committed in the cells themselves extremely difficult. The evidence is clear that, despite Commissioner Bradley’s opinion to the contrary, a substantial amount of the violence at TSP does occur in the cells. And such violence is not limited to the acts of cellmates against one another, but includes acts perpetrated by persons outside the cell upon occupants inside. For example, reported incidents include the thrusting of a knife between the bars, throwing scalding water on a man in a cell, and even dousing an inmate with a cleaning mixture resulting in burns to the inmate’s eyes.

The ability to adequately protect inmates is further hampered by a classification system that permits mixed housing of inmates with different security classifications and that in fact does not attempt to fully evaluate a prisoner’s propensity for violence prior to assignment to a particular prison or unit.

See supra.

In addition, cell changes are made by correctional officers without any apparent regard to an inmate’s violent nature. These changes occur with such frequency that, when coupled with the fact

*1081

that guards also are assigned to different units from time to time, the officers on duty simply do not know which inmates are assigned to what units. As a result of that confusion, inmates who wish to harm their fellow prisoners can gain relatively easy access to the cells of their intended victims.

One final factor that makes the protection of inmates difficult is the ready availability of weapons behind the walls. Some indication of this availability can be seen in the number of disciplinary convictions for possession of a deadly weapon: 77 in 1979; 57 in 1980; and 54 through August of 1981. According to inmate testimony, weapons may be purchased within TSP, and at the time of trial the going price for a knife on the prison black market was about $30. While it appears that knives or homemade shanks are the most common weapons in use at the prison, guns and other weapons are also available. For example, on February 11, 1981, officials found a .32 caliber automatic pistol and 12 rounds of ammunition inside a cell.

The conclusion is inescapable that, as acknowledged by Warden Rose, TSP’s inmates do live in constant danger of violent attack. Equally clear and disturbing is that the correctional staff is insufficient and ineffective to prevent many such attacks from taking place.

6. Health Services

(a)

Medical Care

As noted,

supra,

the main prison hospital serves as the central referral center for all of the adult prisons in the state. The facility also provides some primary and emergency care for inmates assigned to NCSC as well as those confined at TSP itself. The recently renovated and expanded hospital (at an estimated cost of $2.5 million) has produced an impressive physical plant, including three elaborate new surgical suites, sophisticated x-ray equipment (three new machines were purchased at a cost of over $50,000), and a modern new intensive care unit.

Some confusion exists, even among the defendants themselves, concerning the role of the main prison hospital, and the level of care to be provided there. For most purposes, the facility is referred to and treated as a hospital, but in defense of claims in this action, it is asserted that the hospital is really just a high level infirmary, providing emergency and intermediate care. Even Mr. Brodie seems confused (or at least ambiguous) about the hospital’s role, when he refers to the recent renovation as supporting the department’s goal of developing a licensable hospital, yet immediately defends TDOC’s refusal to comply with hospital accreditation standards by asserting that those standards are not applicable to the kinds of “intermediate functions now occurring and planned for the TSP Hospital.”

In fact, the TSP facility has been used to provide acute hospital care for many years. In the

Trigg

decision, Chancellor Cantrell ordered the state to either meet hospital accreditation standards or cease using the facility for acute hospital treatment. At about the same time as the Chancellor’s order, a University of Michigan Correctional Health Care Program evaluation of health services in Tennessee prisons urged that the hospital be immediately downgraded to an infirmary, citing many of the same deficiencies found by the Chancery Court. However, instead of downgrading, the state embarked on its ambitious renovation and expansion program, apparently intent upon providing even more acute care services, but still without any plans to seek hospital accreditation.

That the facility continues to provide acute hospital care is abundantly clear. Although many major surgical procedures are farmed out to civilian hospitals, others are performed on site. In 1980, 61 major surgeries were performed at the TSP hospital in addition to 138 operations classified as minor, 42 cases of orthopedic surgery and 112 cases of plastic surgery. In the same year, 961 inmates were admitted to the TSP hospital, as opposed to a total of 265 admitted to outside hospitals. Similar patterns are evident for the first nine months of 1981, the last period for which figures were provided, when over 40 major surgical oper

*1082

ations were performed on site. Many if not all of the major surgical procedures require the use of spinal or general anesthetics. In addition, the TSP hospital continues to treat critically ill patients requiring around-the-clock care, including heart patients and others with chronic disorders.

37

The contention that the main prison hospital is presently used to provide only infirmary-level care is simply not supported by any substantial evidence. To the contrary, the contention is inconsistent with,

inter alia,

Mr. Brodie’s assessment (n. 37,

supra),

with the sophisticated design of the renovated facility, with other evidence of the level of care currently provided, and with the defendants’ clearly established plans to further expand the level of services being furnished on site. The contention, in short, is inconsistent with the overwhelming weight of the evidence that the state is currently attempting to furnish, at the main prison hospital, a wide range of acute hospital services.

Yet the evidence is also clear that the TSP hospital staff are insufficient in terms of numbers, training and experience to adequately provide acute hospital care. Likewise, it is clear that the provision of adequate medical care is severely hampered by administrative problems that plague the hospital’s organization and operation. The court will first examine the TSP hospital administration and related problems and then will review the medical staff whose duty it is to actually deliver health care.

The main prison hospital is administered by Mr. Harley Seimer, a registered nurse who serves as hospital superintendent. Mr. Seimer is directly accountable to Warden Rose, with no direct accountability to Mr. Brodie or any other central TDOC official. While this structure is typical of the health systems and organization departmentwide, described

supra,

the results are particularly anomalous at TSP, where the hospital is relied upon to care for inmates from throughout the system. In such a situation, it would appear especially important that the hospital management remain primarily sensitive to patient health needs as opposed to prison security.

Unfortunately, however, that is not the case with Mr. Seimer, who has a close and well-established relationship with Warden Rose. For example, Mr. Seimer has vocally resisted efforts of health staff to assign security personnel to the hospital on a permanent basis, a move urged by Mr. Brodie but which would somewhat restrict the Warden’s flexibility in day-to-day guard assignments. In another instance, Mr. Seimer was apparently willing to risk a patient’s safety because of the institution’s tight fiscal situation. In that case, a licensed practical nurse (LPN) on duty alone at night discovered that a patient who was recovering from abdominal surgery was hemorrhaging. When he phoned Mr. Seimer for instructions, he was told to open the patient’s abdomen and tie the blood vessel off, a procedure which the LPN was neither trained nor qualified to perform. Mr. Seimer argued that the nurse should perform the procedure despite his lack of qualification, on the grounds that the hospital’s yearly budget to finance treatment at outside facilities had already been spent. Fortunately for the patient, the nurse adamantly refused Mr. Seimer’s order, and Mr. Seimer finally agreed to outside treatment.

In his September 1981 evaluation, Mr. Brodie found that Mr. Seimer ran at best a loose ship. Mr. Brodie found that the hospital was “administratively unhealthy,” and that Mr. Seimer’s approach to management “has contributed to a chronic morale problem and high turnover rate among employ

*1083

ees.” The report concluded that Mr. Seimer has failed to demonstrate the “ability to successfully administer” the TSP hospital and recommended his transfer to a smaller prison and his replacement by a professionally trained hospital administrator. In Mr. Brodie’s opinion, “the main prison hospital is stagnant and in desperate need of fresh administration.” Such a change is essential, said the report, “to the future development of a quality health care program.”

Some of the manifestations of ineffective management of the TSP hospital were also contained in Mr. Brodie’s report. These include the absence of comprehensive hospital policies, the need for a separate medical protocol manual, and for official organizational, functional and supervisory plans. Mr. Brodie found that the present administrative system is so devoid of policies or clear planning that the resulting “lack of supervision of either free world or inmate workers ... at times defies imagination.” Despite such serious criticism from the department’s own Director of Medical Services, Mr. Seimer remains on as superintendent of the TSP hospital, and there is no evidence that substantial changes are in the offing.

Yet another problem that flows, not from ineffective management but from the administrative system itself, is the inclusion of the hospital beds in the prison’s institutional capacity. Mr. Brodie’s report recommended that this practice be abandoned, so that complete control of the hospital beds could be put in the hands of the health care staff. Under the present system, security personnel have the authority to move inmates into hospital beds for security or space reasons on nights and weekends without the approval of any medical personnel. Further, inmates who are hospitalized for legitimate reasons almost always lose their cells because of the shortage of space and following medical discharge must remain in the hospital until other cell space becomes available, often as long as several weeks. Mr. Brodie’s report notes that at any given time as many as 15-20% of the hospital population is designated “discharge pending cell.” In any case, inmates housed in the hospital with no medical reason tend to be disruptive as well as occupying hospital bed space, at times resulting in the cancellation of needed surgery. Testimony at the trial by a former nurse at TSP concerning incidents of violence within the hospital supports Mr. Brodie’s position that housing healthy inmates in hospital beds is a disruptive and dangerous practice.

Clearly the most serious deficiencies in the provision of health care at the TSP hospital are related to the insufficient number and qualifications of the medical staff. In addition, Mr. Brodie’s audit found that the staffing practices at the TSP hospital were irrational and characterized by inappropriate utilization of job classifications, inequitable distribution of workloads and hours of duty, and by a lack of supervision. As a result, Mr. Brodie found that despite a serious shortage of qualified personnel the main prison hospital is beset by staff idleness, improper shifting of duties to inmate workers and some consistently vacant positions.

Medical practitioners authorized at TSP include three physicians, six physician’s assistants (PA’s) and ten registered nurses (RN’s). At the time of Mr. Brodie’s report, one MD position was vacant, as were one PA position and four RN slots. In addition, of ten authorized LPN positions, nine were vacant at the time of Mr. Brodie’s report. Likewise, the single authorized nurse specialist position was unfilled. Overall, of 70 positions authorized for the TSP health care staff, only 49 were filled in September 1981.

As the Brodie report stated, prior to renovation “it was generally acknowledged .. . that the positions authorized were not adequate to the work load or patient care needs.” Mr. Brodie found that during the renovation process, when the hospital bed capacity was cut in half with the consequent increase in the staff-patient ratio, there was a noticeable improvement in the quality of care and a more acceptable degree of patient supervision.

The general absence of adequate patient supervision is exemplified by the fact that

*1084

even when nurses refer inmates for further treatment, the followup is likely to be done by a PA since physicians see only one-fourth to one-third of the inmates seeking care. Indeed, inmates may go through their entire period of hospitalization without an attending physician, leaving decisions such as diagnosis, treatment (including prescription medicines) and even discharge to a PA, who may have little or no relevant training (see,

infra).

Mr. Brodie’s report found that the head physician, Dr. Paul Frishkorn was, under present circumstances, simply unable to adequately safeguard patient needs. In point of fact, it is clear to the court that there is grossly inadequate physician coverage at the TSP hospital to adequately care for the patients hospitalized there.

Inadequate in-house physician coverage is mitigated somewhat by TSP’s fairly extensive use of outside consultants on a contract basis. Specialty services provided on this basis include anesthesia, dermatology, gas-troendoscopy, neurology, opthalmology, optical services, orthopedics, otology, urology and oral surgery. Most of the contract physicians provide their services on site at the TSP hospital, while for others, inmates must be transported to the doctor’s office. Mr. Brodie described the role of contract consultants as being to provide “secondary and tertiary care to the entire adult population of the department.” Thus the consultants do not serve to relieve the shortage of physicians in the provision of primary care.

The staffing shortage does not end with physicians. Mr. Brodie has indicated that minimal staffing for an acute care facility (which the main prison hospital is) would require an extra 27 nursing positions, bringing the total authorized nursing positions to 57 (including Med Tech/Corrections positions).

38

Moreover, considering the difficulty of recruiting and retaining qualified medical staff (in fact, only 17 of the authorized nursing positions were filled at the time of Mr. Brodie’s report), the current deficiency is even more alarming. The defendants’ own medical director states that 57 nurses are needed to provide quality acute care, yet the defendants are presently attempting to provide acute care with a working staff of 17 nurses.

39

Other defense witnesses, including their medical expert, Mr. Kiel, and Superintendent Seimer, agree that the present level of staffing is inadequate for an acute care facility, and Mr. Kiel’s opinion that the present staff is sufficient for even infirmary type care is based upon an assumption that all authorized positions would be filled.

With staff spread so thin, it is not surprising that services must often be provided that are beyond the training and skill of the persons called upon to perform them. As previously mentioned, PA’s make many of the treatment decisions during the course of inmates’ stays in the hospital. Further, it is common for decisions regarding triage and appropriate referral of patients upon their initial complaints to be made by persons without even the training of an LPN. Even where such diagnosis is made by licensed nursing personnel, the evidence indicates that they are often lacking in the specific skills necessary for the job. The absence of clear guidelines or policies for personnel qualifications has helped to produce a situation where unlicensed staff members often function as fully licensed professionals, and where even those who are licensed frequently perform functions beyond their training and expertise.

The most shocking and perhaps the most pervasive example of the provision of medical care by unqualified personnel is seen in the extensive reliance of the TSP hospital upon inmate staff. At the time of Mr. Brodie’s report, 70 inmates were employed

*1085

in the main prison hospital, and while 24 were in non-medical positions such as custodial or clerical jobs, the remainder were involved in the direct delivery of health care. These inmate workers are completely exempt from any requirements of certification, licensure, or even of relevant work experience or training. Most of the inmate workers, in fact, have no such training, and TDOC provides none. Nevertheless, inmates are utilized in tasks which include assisting free world personnel in the observation of examinations, assisting in surgery, cleaning equipment, taking x-rays without direct supervision, and providing emergency treatment, as well as working in other positions providing direct access to patient medical records. As Mr. Brodie found in his report, this extensive use of inmate workers inevitably results in a breach of the confidentiality of the doctor-patient relationship, as well as violating a number of state health codes. Mr. Brodie recommended that the number of inmate health care workers at TSP be immediately cut in half, but while he believes any reliance upon inmate workers in the direct delivery of health care is undesirable, he also believes that with the current staffing shortages and fiscal constraints, some level of reliance upon inmates continues to be necessary.

The foregoing discussion has largely concerned deficiencies that impact rather broadly upon the whole panoply of health services provided at the main prison. Other problems, however, are more narrowly focused upon particular facets of the health care delivery system. While the existence of most of the problems is supported by multiple items of evidence, primary reliance herein will be upon Mr. Brodie’s September 1981 report. For indeed, it is he who has conducted the most extensive recent review of the subject. And, although his ultimate conclusions may be different from those of either the plaintiffs’ experts or the court, Mr. Brodie has nevertheless candidly identified a wide range of deficiencies which are worthy of mention.

In the outpatient department, Mr. Brodie noted various problems mostly related to poor organization, crowded conditions and reliance upon inmate workers. This department is responsible for initial processing of all ambulatory care patients, including triage of complaints, documentation of vital signs, and referral to medical practitioners, as well as supervision of the emergency room and administration of noncontrolled medications, among other functions. Particular problems identified include improper storage of medications such that they are accessible to inmates, and the use of inmate workers to take vital signs and decide which physician or PA is to see a particular patient. Mr. Brodie found that this department, like the hospital as a whole is understaffed by qualified free world personnel and specifically recommended additional nurses.

At the time of Mr. Brodie’s evaluation, the emergency room at TSP was staffed by two inmate workers only, but by the time of his report, a registered nurse had been added. The inmate workers were further found to have access to drugs and needles and to be unsupervised in their work. He found this use of inmate workers to be inappropriate and recommended that the practice be discontinued.

While Mr. Brodie found that the emergency room was reasonably well equipped, he noted an absence of adequate control over stock and the presence of outdated pharmaceuticals and IV solutions. Similarly, many of the prepackaged sterile kits were out of date, and unsanitary conditions were found to be prevalent. One “serious deficiency” which he noted was the unavailability of emergency supplies throughout the other areas of the hospital, including the operating rooms.

Finally, Mr. Brodie criticized the lack of training of hospital personnel in emergency procedures such as cardiopulmonary resuscitation (CPR). Such training, including annual recertification, seems especially important where the emergency room is not staffed by professionally trained and qualified personnel on a 24-hour basis.

*1086

X-ray services at TSP seem adequate to the point of overkill, except for the problem mentioned above of using unsupervised inmate workers to operate the x-ray equipment. However, it does appear that the films are ultimately read by a professional radiologist working under contract.

Laboratory and diagnostic services were also found to utilize inmates in the performance of tasks which should be done by professional technicians. On the other hand, Mr. Brodie found that the free world laboratory personnel, all but one of whom are well qualified, adequately supervise the inmates in their lab work. The report also found, however, that the laboratory was “extremely dirty” and generally disorganized, and recommended improvements in those areas in addition to reducing the amount of reliance upon inmate workers.

Some of the problems found to exist in the operating room department (OR) have been previously mentioned, such as the absence of adequate emergency equipment and the reliance upon inmate workers in the preparation for and performance of surgical procedures. With respect to the latter, Mr. Brodie recommends that the number of inmate workers be reduced immediately and additional free world staff hired, with the goal of eliminating inmate workers altogether. Other problems noted include the use of an unsterile dressing cart in the OR, a practice so risky that “such carts are virtually unknown in modern hospitals,” and improper safeguarding of supplies of nitrous oxide, an anesthetic commonly known as “laughing gas” and a popular street drug among substance abusers. Mr. Brodie also noted that the renovated physical facilities are far more extensive than presently needed, and thus recommended undertaking a study to determine the feasibility of expanding the surgical service.

A number of problems have been identified in the area of pharmacy services, both by Mr. Brodie and others. There seems to be a general consensus, for example, that TDOC could more efficiently operate and control a central pharmacy than its present diversified institutional system. Other problems were identified within the TSP pharmacy that for present purposes are more significant, because of their more direct impact upon patient care. One of these was inadequate inventory control methods, such as the use of large cupcake tins to hold medications with little or no control, a practice that Mr. Brodie described as bordering on the archaic. Another serious problem is the presence of bureaucratic hurdles to the rapid processing of emergency drug orders. One other major problem noted by Mr. Brodie was the poor supervision of staff, with the result that there were persistent reports of a pharmacist regularly sleeping on duty.

(b)

Mental Health Care

With the departmental consolidation of mental health services at DCI, there has been a corresponding decrease in what were, even before, pitifully scarce staff and resources for mental health treatment at the main prison. A staff that used to consist of a full-time clinical psychologist, four counselors, two psychological social workers and a psychological examiner (which Mr. Brodie sees as “more in line with the [present] treatment needs” of TSP), has been effectively reduced to one psychological examiner, a position that was vacant at the time of the report, and one counselor. In addition, the prison contracts with one psychiatrist and one psychologist, each of whom is available four hours per week. The former Division of Psychological Services has been abolished, with such meager services as are still offered being under the auspices of the counseling staff.

Prior to renovation the TSP hospital contained two units that were used for mental health purposes. One of these, West-300, was an open ward containing a therapeutic community. The other, West-100, was used as a short-term observation or holding area for psychiatric patients prior to transfer to DCI. The therapeutic community concept formerly embodied in West-300 has apparently died in the renovation. West-100, however, has been reopened, apparently to serve largely the same function as before;

*1087

its designation is now “medical security ward.”

As Mr. Brodie acknowledged in his report (in which he recommends placing substantial restrictions on the use of West-100 for housing psychiatric patients), that unit has been criticized as a major deficiency in virtually every study that has been conducted of the TSP hospital. Chancellor Cantrell in the

Trigg

decision provided a graphic as well as grim appraisal of conditions in West-100:

This area cannot accurately be described as a hospital ward since it is no more than a row of segregation cells enclosed by heavy steel grid doors. These cells are inadequately lit and improperly ventilated. Although self-mutilators and suicidal patients are caged in this area, it is physically impossible to maintain them under observation .... Recently a medical review committee appointed by a former Commissioner of Correction to investigate conditions at Tennessee State Prison, described West 100 as “not much more than a medieval dungeon out of the dark ages, where a man can only deteriorate further, emotionally, mentally, and physically.” The overwhelming weight of the evidence leads the court to concur in that appraisal.

Trigg, supra,

(Dav.Ch.Op. at 43-44).

Although the renovation resulted in some physical improvements to West-100, including enlargement of cells and improved lighting, its primary purpose remains a segregation unit, used for overflow from punitive and administrative segregation units, as well as some check-ins, in addition to psychiatric “patients.” And, with the drastic reduction in psychiatric and mental health staff, the little treatment that patients caged in West-100 could formerly have hoped to obtain is no longer available. Further, the ability to keep inmates in West-100 cells under observation has not improved in the renovated design, and, in fact, the remaining psychological counselor at TSP warned Warden Rose in an August 13,1981, memorandum that certain changes that had been made themselves rendered the unit dangerous and unfit for housing mentally disturbed inmates. In Mr. Bro-die’s view, the use of the new West-100 “as an inpatient psychiatric ‘lockup’ unit without providing adequate treatment or staffing borders on the inhumane.” Yet, in accordance with Mr. Seimer’s belief that West-100 is necessary to provide “intensive treatment of acutely disturbed patients, and with the blessings of Warden Rose and the concurrence of the security staff, the West-100 dungeon has been reopened, albeit with a fresh coat of paint.

In addition to those inmates in need of acute psychiatric care, there are others in need of outpatient treatment. Despite the fact that the demand for outpatient psychological care is high, the main prison offers little in the way of services. In fact, the sole remaining counselor, Mr. Ernest Bur-son, shoulders virtually the entire load, by holding a “psychological clinic” during morning sick call several days per week. The prison offers no treatment programs for drug or alcohol abuse,

40

and no group therapy. As Mr. Brodie’s report notes, “the present staffing is inadequate for the provision of mental health services with the exception of crisis intervention,” and that is virtually the only mental health service now provided there. Indeed, Mr. Brodie seems to have identified the “bottom line” in this area when he found in his report that “[tjhere is no organized program for the provision of mental health services at the Main Prison.”

C. Fort Pillow State Farm

1. Housing Facilities

Fort Pillow State Farm is a close security facility built in the late 1930’s in a rural area of Lauderdale County. At the time of the trial, FP housed approximately 750 inmates, of whom about 35 were close security, about 125 were minimum security, with

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the remainder classified as medium security. Over the last few years, the housing areas at FP have undergone renovation, the final stages of which were in progress during the instant trial. Although the court has not been advised whether the project was completed on schedule, the renovation was supposed to have been finished in the early part of 1982.

The main compound at FP is shaped like a cross, with the long and narrow, three-tiered housing blocks A and B extending to the left and right behind the administration building. The fourth prong of the cross, opposite the administration building (which also houses the infirmary) is formed by the gymnasium.

A and B blocks are identical in size and construction, although at the time of trial Unit B-l was still undergoing renovation. The top two units of each block contain 50 cells each, about 110 square feet in size, and are all or virtually all double occupancy. The renovated Unit A-l likewise contains 50 cells the same size, as will B-l when renovation is complete, if it is not already. Thus, A and B blocks, when full, will house 600 inmates in 300 cells. Blocks A and B contain all of the close security inmates as well as medium security prisoners. Unit B-l is the segregation unit, used for housing inmates on punitive or administrative segregation as well as check-ins. As at TSP, the cells in A and B blocks at FP contain two bunks, a toilet and lavatory. Because of the larger size, however, there is also room for a small desk, upright lockers and desk chairs in the FP cells.

C block at FP is an open dormitory originally built after the

Trigg

litigation for use as an industrial building. The building is divided into two 90-man dormitories of approximately 7,000 square feet each. A control point separates the two units, which are designated C-l and C-2. The bunks in both dormitories are all on one level and are positioned side by side in long rows. C block dormitories contain medium security prisoners.

Outside the fence of the main FP compound are two trailer complexes, each consisting of three trailers in “T” configurations, and each housing 29 minimum security inmates. A guard post is located at the head of each “T.” The trailers provide 44.7 square feet of space for each inmate housed there.

Also outside the main compound is a “farm dormitory” housing 30 minimum security inmates assigned to farm work. The building was formerly used for housing guards and was described by Mr. Fogel as a “shabby” structure. While Mr. Hoover stated that the 35 square feet of space per inmate in the farm dorm was below acceptable standards, he viewed the building as being overall the best and most desirable housing at FP.

2. Environmental Conditions and Sanitation

Mr. Hoover conducted his evaluation of environmental health conditions and practices at FP on August 30 and 31, 1981. The problems which he identified are generally minor in comparison with those cited at TSP. The court has mostly excluded from present consideration the wholly deplorable conditions found to exist in B-l, which was the last of FP’s units to be renovated. At the time of trial, the unit had been closed for renovation. Based upon the defendants’ representations that the renovated B-l was to be identical to the other units in A and B blocks (although it will still be used for segregation), the court deems it unnecessary to consider in detail the previous condition of the unit. Suffice it to say that the evidence overwhelmingly supports Mr. Fo-gel’s assessment that the old B-l was “shocking” and fell “below any standard of decency,” as well as Mr. Hoover’s specific findings of environmental deficiencies in the unit.

In terms of general maintenance of the physical plant, the most extensive deficiencies identified by Mr. Hoover were the presence of a number of broken windows, the lack of screens to prevent the entry of flies, mosquitoes and other insects, and several leaky ceilings. In some instances, the leaks resulted in pooled water around beds, and in one case the leak was found to have resulted in wet clothing.

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The only cross-connected plumbing of the type found at TSP was in the kitchen restroom and the old Unit B — 1. The latter, presumably, has now been remedied as part of the B-l renovation. In addition, however, the absence of an air relief valve on the water washing attachment in the outside garbage area was cited as a possible source of back siphonage of contaminated water into the drinking water system.

The level of lighting in the FP living units appears generally a little better than at TSP, although Mr. Hoover still believes that many FP inmates are not provided adequate lighting for daily living activities. Mr. Hoover’s readings in blocks A and B revealed light on top bunks in excess of the 30 footcandles he deems necessary, while readings taken at other points in the cells were generally below that level. Light readings in the dormitories were widely variant, ranging from a high of 125 foot-candles at one C-2 bed to 12 footcandles at another bed in the same unit. The farm dorm had overall probably the worst lighting of any FP housing units, while the one trailer unit examined appeared generally better than average. The findings support Mr. Hoover’s conclusion that lighting is poor in FP housing units.

The “effective” temperature in the FP housing units on the days of Mr. Hoover’s inspection (late August 1981) ranged from 74 °F in one cell at 9:30 in the morning to 81.5 °F in another at 5 p.m. No substantial evidence has been introduced that would indicate either that the temperature was excessive or that ventilation in the cells was less than adequate.

Mr. Hoover found evidence of some unsanitary conditions in both the housing areas and kitchen area at FP. In the housing areas, conditions noted included the use of improper and dirty containers for the collection of trash and garbage, and accumulated water from leaks in the ceiling and plumbing. In one of the showers, Mr. Hoover noted the absence of disinfectants in the foot bath, and in C-2 dormitory’s toilet area, a number of broken fixtures were found, including one dysfunctional toilet that was full of fecal matter. In the same area, pooled water was present on the floor, and Mr. Hoover found “no evidence of cleaning or maintenance.”

Unsanitary conditions found in the food service area included improper cold storage of foods in such a way that they “provide fertile areas for the growth of disease producing bacteria.” The dry storage area was characterized by evidence of roach and rodent infestation, “general debris,” and an open sewer line running through the area. The restrooms off the kitchen were found to be filthy. In one of them, there were no towels for handwashing; also one toilet was found to be cross-connected to the drinking, water supply.

In the kitchen itself, Mr. Hoover discovered old, dirty and uncleanable utensils and such poor basic sanitation that he said the area showed no evidence of recent thorough cleaning. The washing of pots and pans was found to be improper and unsanitary. He found a severe roach infestation in the kitchen, and flour and cornmeal that were also infested by bugs. Utensils that were stored for use as though clean were found to contain old food residue or to be otherwise soiled. Mr. Hoover identified a variety of other unsanitary and improper conditions in the kitchen, including the failure to maintain foods at safe temperatures during serving. On the whole it is clear that the FP kitchen is an unsanitary disaster area, where any one of a number of conditions could well lead to the outbreak of disease among inmates and staff alike.

The most serious condition found by Mr. Hoover with respect to toilet and bathing facilities would appear to be the plumbing deficiencies and unclean conditions already noted. Inmates in A and B blocks have a toilet and lavatory in each cell, and common shower areas with fixtures in a ratio to the number of inmates well within the range identified by Mr. Hoover as minimally adequate. The dormitories and minimum security units provide both showers and toilet facilities in common areas, and except for the farm dorm, are sufficient in number to comply with Mr. Hoover’s recommended

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minimum. In the farm dorm, there is one toilet and lavatory for each 13 inmates, compared to the 1 to 8 ratio recommended, and one shower to each 20 inmates rather than the 1 to 15 recommended.

Some deficiencies were cited by Mr. Hoover in the bedding materials in use by a number of inmates. The most serious is probably the fairly extensive use found of polyurethane foam mattresses and pillows. That material emits a noxious and potentially deadly fume in the event of fire, and TDOC officials had, sometime before Mr. Hoover’s inspection, directed that its use be discontinued. A number of dirty and torn mattresses and pillows were also found, some of which the inmates claimed to have been issued in such conditions. Mr. Hoover found no evidence of any arrangement for sanitizing used mattresses and pillows before they are reissued.

Inmates at FP apparently regularly wash their own clothes in their cells, a practice criticized by Mr. Hoover as inconsistent with basic sanitation principles. Several inmates stated that the reason for this practice is that in order to get one’s personal clothes returned from the prison laundry, it is necessary to pay an inmate laundry worker $5.00 per month. Mr. Hoover also observed dirty and laundered clothes being transported in the same cart, a practice that can lead to contamination of clean items and the spread of disease.

3. Idleness

FP is the site of TDOC’s main farming operation, with about 3,000 acres presently under cultivation. Most of the farm work is performed by inmates assigned to “long lines,” crews of 25-50 who work under armed supervision. Farm work is, of course, seasonal and does not provide year-round employment. However, the long lines are used throughout the year as weather permits (they apparently do not go out when the temperature is below freezing) for various maintenance and land reclamation jobs.

The long lines at FP were criticized by plaintiffs’ experts for several reasons, including the lack of relevance of the kinds of work performed to free world job opportunities. It was noted that the FP population are predominantly of urban background and that in any event the types of farm work performed manually by the long lines are usually done by machines in a free world setting. Mr. Nagel was especially critical, calling the long line activities “make work” and possibly leading to built up hostilities and confrontations. Nevertheless, to the extent that the long line inmates are at least kept busy, most of those who testified agreed that some work was preferable to none at all.

The sole industrial operation at FP is a license plate factory, which employs 30-40 inmates. The only criticism of the “tag plant” that has been raised in the present proceedings is that substantially more inmates could be employed in the same size factory in some other industrial pursuit, and that therefore the plant is not an “optimum” use of the space.

It appears that, despite the presence of both farming and industrial operations at FP, the majority of working inmates are employed in institutional support jobs. As at TSP, there is a substantial amount of featherbedding in those institutional job assignments. For instance, Mr. Nagel found that while 121 inmates were assigned to food services, no more than 40 were needed for those jobs. Mr. Fogel also stated that in his opinion various other institutional job classifications at FP were suspect, in that although listed as full time positions, they could be accomplished in a short time, or were, like food services, supply overas-signed.

The availability of educational programs at FP has changed considerably in recent months. In July 1981, the school program was abolished, only to be reinstituted later in the year. As of December 3, 1981, classes were offered through Dyersburg State Community College in English, art, history, business, health, and development studies, in addition to two adult basic edu

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cation classes and a GED program, with a combined enrollment of 416.

41

Aside from a small locally operated course in auto mechanics, which accommodates five or six inmates at a time, there is no vocational training program at FP.

Other opportunities to engage in meaningful activity at FP include a gym which is open during the evenings but not during the day, an exercise yard that includes a ball field, and a law library that is open each day. In addition, movies are shown every Saturday night.

On the whole, it appears that the problem of idle inmates at FP is less severe and less pervasive than at TSP. Nonetheless, the experts who testified agreed that a significant amount of idleness does exist there. For example, Mr. Nagel estimated that on his inspection tour, he observed one-third to one-half of the inmates in their cells at 11:00 a.m., although he noted that two of the long line supervisors were on vacation that day and that his estimate was consequently inflated. Whatever the correct figure, some idleness, primarily due to overas-signment of FP inmates to institutional jobs, is a reality at the facility. Mr. Fogel’s characterization of the prison as a “correctional slum” due to lack of programming appears related as much to his assessment of the lack of rehabilitative value in existing programs as to the fact of substantial idleness.

4. Violence

As noted,

supra,

quantifying the level of violence in a penal institution is practically impossible. With reference to the record before the court, precisely quantifying the level of violence at FP is completely impossible. Nevertheless, on the basis of the record as a whole, the court is left with a clear impression that FP is in fact a very violent institution, where inmates are constantly in substantial danger of attack by other prisoners.

As at other facilities, the inmate code is a factor that severely inhibits the reporting of violent episodes at FP. The existence of the code was expressly acknowledged by Warden Harrison, along with the fear of violent reprisals for its violation.

However, even reported violence at FP is substantial, despite the warden’s apparent lack of knowledge. For example, while the warden said that the facility averages about one fight per month, 111 FP inmates were found guilty of fighting in 1980 alone. Likewise, while the warden was unable to recall any homosexual rapes in the recent past, there were 11 inmates convicted of that offense during 1980. In addition, a murder that occurred at the facility in March 1981 was, as the warden acknowledged, related to attempted homosexual advances.

Inmate testimony established that “all kinds” of weapons are readily obtainable and frequently possessed behind the FP walls. The same prisoner testified that he had observed guards carrying knives inside the prison, although he had never seen a guard use a knife against an inmate, except “playing around.” Testimony also provided examples of various forms of violence at FP, including a stabbing for something so innocent as a request that a radio be turned down.

Evidence in the record strongly suggests that violence is particularly pervasive in the FP dormitories, despite Commissioner Bradley’s opinion to the contrary. Inmates have described frequent instances of stabbings, assaults and rapes within the dormitories. Both Mr. Fogel and Mr. Nagel agree that dormitory housing is dangerous and inappropriate except in highly controlled circumstances. Deputy Commissioner Mor-ford concurs that dormitories housing 50 inmates or more “can be a highly dangerous housing situation, if . .. the .. . men are simply dumped in the dormitory willy-nilly and are crowded up and so forth.”

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Yet despite that recognition and contrary to the advice of the defendants’ own classification expert, such “willy-nilly” dumping is precisely how the dormitory spaces are filled. While Mr. Reimer testified that medium or higher security inmates should not be housed in dormitories, C-block at FP not only includes such inmates, but in fact mixes them with minimum security prisoners. Both Mr. Nagel and Mr. Fogel have noted a further danger whenever new arrivals are placed in a prison’s dormitory unit, as is done at FP. Such inmates are both easy prey for violence prone veterans of the facility, and also are themselves of an unknown quality with respect to their own propensity for violence.

One additional problem with respect to the FP dormitories is inadequate security coverage. Because of the design of the units it is impossible for a single guard to have a view of more than a fraction of the beds within a particular unit. Yet guard coverage at C-l and C-2 is one guard in each unit per shift. It should be noted here that neither Mr. Fogel nor, apparently, Deputy Commissioner Morford believes that the addition of more guards to the dormitory units would make the areas substantially safer. In fact, Mr. Fogel concluded that the FP dormitories were “too dangerous ... [and] even with more staff [could not] be made safe.”

Indeed, Mr. Fogel also found security coverage throughout the FP facility to be “haphazardly low.” Coverage, except for Unit B-l, is generally one guard per shift per unit. He stated that the situation was made worse by inadequate communications capabilities, which consist of a single telephone system with no backup system.

Like at TSP, guards at FP are often inadequately trained and inexperienced.

42

Inmate testimony indicated that FP guards have on more than one occasion assaulted inmates, and have even attempted to provoke a fight between inmates. In any event, it is clear that the FP correctional staff fail to prevent many episodes of violence.

5. Health Services

Medical care at FP is furnished primarily through an infirmary which, like the TSP hospital, was recently renovated. The infirmary now has 13 beds, a number that is generally conceded to be in excess of what is required for a prison the size of FP. Overall, the remodeled FP infirmary is, as found by Mr. Kiel, “an excellent ... facility [that is] neat, very clean, well-lit and spacious.” One serious flaw in the infirmary’s design, however, is its location on the third floor of a building without elevators or ramps, thereby rendering the facility largely inaccessible to handicapped or seriously ill or injured patients. Beyond that nearly incomprehensible design defect, there is convincing evidence of other deficiencies that render the FP health care delivery system, despite the otherwise impressive physical facility, inadequate to furnish much necessary primary and emergency care. Indeed, the problems are so severe that Dr. King characterized FP health services as “a disaster area.”

One problem that has been discussed as endemic throughout the TDOC system, but that is particularly acute at FP, is the health care management structure, which places the warden in control of the delivery of health services. Not only is Warden Harrison untrained in medical care (as are most other TDOC wardens) but he has also displayed a remarkable ignorance of his own institution’s health care program. He is unaware what qualifications health care staff should have or what qualifications his present employees have in fact. Similarly he is unaware whether equipment in the infirmary is sufficient for either present or future needs. Neither he nor the associate warden for treatment is apparently in any position to assess the quality of the hospital superintendent’s work. Warden Harrison appears, in essence, out of touch with the health care delivery system that is under his control.

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Although there is overwhelming evidence that the former FP hospital superintendent was incompetent both as a manager and as a health care provider and that under his leadership the infirmary was plagued by persistent problems including continuing violations of state laws, he has now been replaced by a qualified and experienced master’s level RN. That is certainly a hopeful sign and in fact was one of two positive aspects of health care at FP noted by Dr. King. (The other was a well organized and thorough tuberculosis skin testing program at the facility.) However, to the extent that administrative problems are beyond the hospital superintendent’s control, they may be expected to continue. Such is the case, for example, with the regular placement by security staff of general population inmates in infirmary beds for no medical reason.

Such is also apparently the case with the consistently inadequate health care budget at FP, a problem about which witnesses in this case generally agreed. Dr. King characterized the funding as “absurdly low,” and both Mr. Brodie and Mr. Kiel admit that the prison’s medical component is seriously underfunded. Yet, in spite of a consistently growing prison population, the health care budget for FP in fiscal 1982 remains at approximately the same level as in previous years.

The most glaring manifestation of the low level of funding is seen in staff shortages at virtually all levels and positions. Permanent health care staff at FP consists of the hospital superintendent (now an RN), an additional RN, three medical technicians, one of whom is an LPN, and a medical records technician. A physician’s assistant position and additional RN position were abolished in July 1981 because of an apparent difficulty in recruiting.

43

Physician services at FP are provided on a contract basis, with mixed reviews as to their adequacy. In any event, it is evident that the frequent absence of a physician on site, combined with the absence of mid-level practitioners, has resulted in the routine delegation to nursing staff of diagnostic decisions and other critical medical judgments that are beyond their level of training and expertise.

Further evidence of the staffing shortage at FP is provided by the facility’s extensive reliance upon inmates in the direct delivery of patient care, including emergency surgery and minor suturing procedures. While there is evidence that the use of inmate health care workers at FP has been substantially curtailed as a result of Mr. Bro-die’s February 1981 audit, at least one inmate continued to provide triage and emergency care when free world staff were not available, at least up to the eve of trial.

Indeed, it is clear that FP operates many hours during nights and weekends without any medically trained personnel on site to respond to an emergency.

44

This situation, combined with the prison’s remote location (where the 15-minute civilian ambulance response time suggested by the defendants may be overly optimistic) convinced Mr. Brodie to strongly urge the training of some staff members from each shift in basic first aid and CPR. The presence of some such trained staff members is, in Mr. Brodie’s opinion, “imperative” for adequate emergency care. Yet, no such training is offered, and FP is left without emergency trained personnel on nights and weekends.

Thus, primarily because of insufficient funding and inadequate staffing, the FP infirmary is unable to meet many serious medical needs of inmates housed in this remote facility. In fact, under present circumstances, the word “infirmary” as ap

*1094

plied to the facility is a misnomer. The facility, in the absence of 24-hour coverage by health trained personnel cannot be used for inpatient care but can operate only as an outpatient clinic. Even for the provision of those outpatient services and especially for the assurance of proper emergency care, the present level of staffing is clearly inadequate to meet existing needs.

Inmate access to primary care at FP (such as it is) is provided through an open sick call performed by an RN or medical technician each morning, including weekends and holidays. While some inmates testified that security staff at times are indifferent to their requests for care, or even take actions to interfere with the provision of care, any such actions are at most isolated instances and do not reveal a consistently followed policy or practice.

One additional aspect of health care at FP deserving of mention here is the prison’s pharmacy service. The FP pharmacy functions on a budget of less than $2,000 per year and has a pharmacist on site only two to four hours per week. When necessary, prescriptions can be filled at a community drugstore as well. Daily dosages of prescribed medications are dispensed once each morning by an RN or medical technician. DEA and psychotropic drugs are dispensed on a dose-by-dose basis only, and a member of the medical staff observes each inmate receiving such medication ingest the prescribed dose. Some outdated medications were found in the inspection of the FP pharmacy.

Otherwise, there is little in the way of medical care currently available at FP. Most lab work is conducted at outside laboratories, and although the prison does have x-ray equipment, there is currently no staff member trained in its usage. There is no substantial evidence that therapeutic diets ordered by physicians or RN’s are not always prepared and served in accordance with instructions.

The level of mental health care available at FP is minimal and consists of the services of one unlicensed counselor and minimal contract services. The contract services are with the Covington Mental Health Center and consist of the availability of a psychiatrist and a psychological examiner, for two hours each per week. As with other TDOC facilities, inmates from FP may be referred to DCI when deemed appropriate. There is general agreement that FP needs additional mental health staff, at least psychological examiners, in order to provide more adequate care for its present population.

D.

Tennessee Prison for Women

1. Housing and Environmental Conditions

The Tennessee Prison for Women was opened in 1966 with a designated capacity of 115. Additional housing areas have since been added, the last being the “annex,” the former NCSC, which in November 1981 housed 65 women. Conditions in the annex have not been challenged in this suit. TPW proper is a close security facility consisting of an administration and infirmary building, a school and gymnasium/auditorium building, two main housing units and a small “honor” dormitory. The main housing units, also referred to as dormitories, are actually divided into rooms of 120 square feet, almost all of which are double occupancy. Dorm I consists of two wings containing 50 rooms, and Dorm II consists of three wings with 74 rooms. The honor dorm is an open bay unit with 30 beds. In August 1981, the population of TPW was 275, exclusive of the annex.

45

The cells in Dorms I and II line corridors of 25 rooms each that project out from a central dayroom and security office, or “control” area. Thus, the dayroom in Dorm I serves the two wings in that unit, while in Dorm II a similar dayroom is shared by all three wings. Each of the cells in these two

*1095

units is equipped with a sink and a toilet in addition to beds, dresser, desk and chair. The construction of the cells is solid block, with wooden doors which allow for observation only through a small window. Located behind the control point in each unit is a so-called “dry cell,” which actually is equipped with both a sink and a toilet, that is used for short-term isolation and observation of problem inmates.

46

The only issues that have been raised concerning alleged overcrowding at TPW concerned celling of up to four women in some intake and segregation cells. However, since these areas are now single-celled, there would appear to be no substantial claim remaining that TPW is unconstitutionally overcrowded.

47

In addition, very few issues have been raised concerning environmental conditions at TPW. Mr. Hoover’s inspection did reveal lighting and ventilation in TPW living units below what he considered adequate. On the other hand, the “effective temperature” in the living units was found to range from 74.5 °P to 78 °F in the cells for which readings were recorded. (The highest temperature recorded was actually 80.5 °F in the showers of Dorm II.) All readings were taken on September 4, 1981, between 11:00 a.m. and 2:30 p.m.

Some deficiencies were also noted in the level of sanitation maintained in the TPW food service facilities, although Mr. Hoover concluded that this area, like others at TPW, was generally better than at the men’s facilities that he inspected. The problems identified included improper disposal of garbage, the use of “nonfood grade plastic” to store some food, a weevil infestation in cornmeal, improper use and cleaning of some utensils, and the failure to maintain a sufficiently high temperature in the final rinse of the dishwashing process. Mr. Hoover also found that “some improvements are necessary in basic sanitation, as reflected by the presence of mold, meat residue, and roaches.”

The only other environmental condition complained of at TPW relates to alleged inadequate fire safety precautions. In particular, the plaintiffs cite the existence of air space above and below each cell door in Dorms I and II, and the likelihood that air pulled through those spaces by the smoke ventilation system would be likely to fan any fire and inhibit evacuation. Mr. Hoover also found a small number of polyurethane pillows in use at the facility, despite the recognized danger posed by the material in the event of fire, referred to

supra.

On the whole, while TPW inmates could benefit from some improvements with respect to fire safety, food service sanitation and lighting and ventilation in the housing units, the court is convinced that the prison is a spacious, modern, clean and generally well kept facility. Housing conditions there do not seem unduly oppressive or even particularly uncomfortable.

2. Idleness

The defendants have readily admitted that idleness at TPW is a serious problem, and that the level of programming is so low that there just are not opportunities for many women prisoners to engage in meaningful activity. As a result, Mr. Nagel discovered a large number of TPW inmates just sitting around the dayroom doing nothing on the day of his inspection.

In fact, virtually the only, form of employment available to TPW inmates is in institutional jobs. As of October 1980, a total of 117 inmates were working in kitchen maintenance, as dorm aides, staff aides, laundry aides or on the “work crew.” These women apparently average six hours of work per day. A few additional TPW inmates work outside the prison at Spencer

*1096

Youth Center or for the State Department of General Services. There is currently no agri-industries employment available at TPW, although there is apparently a plan to begin an industrial sewing operation to make such items as uniforms for TDOC guards and clothing for inmates.

There is currently a vocational type sewing program, as well as courses in cosmetology, business (or typing), cashier/checker, culinary arts, data processing and arts and crafts. Educational programs include ABE and GED courses, as well as college level instruction through a contract with Tennessee State University. As of October 1980, there were approximately 190 TPW inmates involved in the vocational and educational programs. Former Acting Warden Farrar testified in his deposition that there are generally waiting lists for vocational courses at TPW, but not for educational programs. Mr. Farrar also testified that there were a total of 430 TPW inmates enrolled in vocational and educational classes at the time of his deposition. The figures used by the court were compiled in a department-wide survey that was distributed in February 1981 and comprise the only empirical data that is available to the court. Regardless of which figures are more accurate, TDOC officials readily admit substantial idleness and the need for increased programming at TPW.

The most serious allegation concerning lack of meaningful activity at TPW (and perhaps the most serious allegation concerning any condition of confinement there) concerns the denial of exercise to inmates in punitive or administrative segregation. Those inmates are apparently confined in their cells for 23 hours per day. According to Mr. Farrar, segregated prisoners receive no exercise at all for the first 30 days of their confinement and 30 minutes per day for each day thereafter. To the extent that description is accurate, it appears to be in violation of TDOC policy and is unconscionable.

3.The “Point-Grading System”

Programming at TPW has been attacked by the plaintiffs because of a feature that is unique in the TDOC system. The prison employs a behavior management system that Mr. Fogel has characterized as “a bewildering point and four level system,” in which monthly points are amassed by inmates in four separate areas of prison life to determine what level of privileges the inmate is entitled to receive. The point-grading system has been criticized as being confusing, arbitrary and inconsistently applied.

In Mr. Fogel’s opinion, the effects of the system are to foster dependence on the part of inmates, to encourage manipulative behavior and to “juvenilize the women, weakening whatever self-confidence or free-world coping skills they may have.” Mr. Fogel also believes that the educational programs and the emphasis upon traditionally “female” occupations also foster a similar feeling of dependence. These programs, in Mr. Fogel’s opinion, represent “violence against the spirit.”

4. Violence

In contrast to the “violence against the spirit” that Mr. Fogel found as a result of TPW programming, he concluded that “one does not sense [at TPW] a raw fear and physical violence prevalent in the men’s prisons.” Indeed, there is little in the record that would suggest a contrary conclusion, although certainly there are violent episodes at the facility from time to time. The evidence simply does not convince the court that violence at TPW is pervasive or that security coverage is, under present circumstances, inadequate.

5. Health Services

In contrast to some other TDOC prisons, TPW receives funding for medical services that is uniformly accepted as adequate for the provision of necessary care. Nevertheless, certain problems have been identified both by the plaintiffs and by witnesses for the defendants, making it clear that in spite of adequate funding, the level of care at TPW is not as good as it should be. For example, the TPW clinic provides only outpatient treatment, including emergency and dental care. Dr. King criticized the lack of any beds on site for infirmary type care,

*1097

and TDOC officials largely agree that such services would be a desirable addition.

Health services at TPW are the victim of what Mr. Brodie has termed “sloppy management,” resulting in the prison’s inability to retain a sufficient qualified professional staff. Mr. Brodie attributed the high staff turnover to “poor clinic organization, frustration over perceived bureaucratic limitations, lack of appropriate orientation for new employees, and a lack of leadership within the clinic.” Former Acting Warden Farrar, on the other hand, believes the problem is attributable to a general unwillingness of qualified personnel to long endure the immature and “psychopathic” tendencies of the TPW inmates. For whatever reason, staffing problems persist at the women’s prison.

As of June 1981 TPW employed two RN’s, one LPN, one medical technician and one medical records secretary, in addition to a pharmacist. Other funded, but vacant, positions included a PA, a second pharmacist and an additional LPN. General physician coverage is available nine hours per week, on a contract basis. Specialized physician care may be obtained on an outpatient basis at the TSP hospital, and inpatient care is available at area civilian hospitals.

While Mr. Brodie views 24-hour nursing coverage at TPW as an ultimate goal that could be achieved with two additional funded positions and the filling of all presently funded positions, he has recommended a plan for interim coverage on two shifts, seven days per week, utilizing existing staff. Yet, the prison administration has not moved in that direction, and health care staff remain assigned exclusively to the day shift. Thus not only is the TPW clinic understaffed, but such medical staff as there are apparently are not utilized in optimum fashion.

Sick call at TPW, when women in need of care must sign up for clinic treatment, is conducted three days per week, a situation that Mr. Brodie criticized in 1980 as inadequate for the provision of the basic health care needs of inmates. While sick call is conducted by a member of the health care staff, it appears that that correctional staff are in the position of prescreening requests for care and, despite their lack of medical training, determining whether a particular case is urgent enough to require immediate treatment. In the absence of such a determination that a complaint is urgent, inmates may have to wait a week or more to obtain treatment. There is a marked absence of written treatment protocols or policy to guide either correctional or health staff in the triage and screening of medical complaints.

Some deficiencies have been noted in the area of emergency care at TPW. Specifically, some emergency equipment, training and procedures recommended as necessary as long as four years ago are still not available at TPW. Mr. Brodie has noted that even the emergency equipment that is available at the prison is often not readily accessible. He has also recommended the development of policies to guide security staff in the event of an emergency and has urged that a supply of emergency drugs be maintained and regularly checked. At present, CPR-trained staff are apparently on duty at TPW for two shifts each day, but the prison does not offer first aid or CPR training for security personnel.

One final problem identified in the provision of medical care at TPW is the frequent failure of patients to receive followup care as needed. This includes patients on long term drug therapy without proper monitoring, the apparent failure of the TPW kitchen to provide therapeutic diets as prescribed by physicians, and the absence of periodic physical examinations for inmates identified as requiring regular monitoring.

Mental health services at TPW are more extensive than at any TDOC institution except DCI. The staff includes two licensed psychological examiners as well as counselors. In addition, a contract provides for three hours per week of on-site psychiatric care. In fact, TPW is the only institution aside from DCI where, in the view of the defendants’ expert, Dr. Lawrence Bennett, psychological services were sufficient to

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permit all inmates in need to receive treatment. As with other institutions, TPW inmates may be referred to DCI when additional care is needed. The plaintiffs did offer expert testimony of some inappropriate use of the observation cell known as the “dry cell.”

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In addition, the absence of a drug treatment program at TPW has been criticized.

E. Brushy Mountain Prison

1. Housing Facilities

Located in a remote mountainous area of Morgan County, the main BMP compound is a maximum security facility. It is enclosed by a wall on all sides except on one rear corner where the wall is anchored to the sheer face of a mountain. The main building, which is shaped like a cross, was built in 1934. This building houses the bulk of BMP’s population in Blocks A, B and C. Additional inmates are housed in D-block, a separate

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