Case: USA v. Doyle

The U.S. Department of Justice's Civil Rights Division conducted a review in 2005, pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA), of the Taycheedah Correctional Institution for women prisoners in Wisconsin. The CRIPA review resulted in a May 1, 2006, letter to the state's governor. The letter set out the results of the review and commended the institution for its procedures to minimize sexual misconduct; however, the letter stated that the review found the facility violated constitutional rights of prisoners by failing to adequately provide mental health care services for prisoners' serious mental health needs.

According to the Civil Rights Division review, Taycheedah: 1) failed to timely and appropriately provide psychiatric treatment, including monitoring of psychotropic medications and performing laboratory tests; 2) failed to provide an adequate array of mental health services to treat its inmates' serious mental health needs; 3) failed to ensure that administrative segregation and observation status were used appropriately; 4) failed to ensure that mental health records were accessible, complete, and accurate; 5) failed to respond to medical and laboratory orders in a timely manner; and 6) failed to ensure that an adequate quality assurance system was in place. According to the review, these practices constituted prison officials' deliberate indifference to mental health needs of prisoners, in that the quality of care provided was such a substantial departure from accepted professional judgment, practice, or standards that deliberate indifference could be inferred.

The letter contained examples to support each of the listed shortcomings and made recommendations to remedy the deficiencies, noting that failure to satisfactorily and promptly address these concerns could result in a federal CRIPA lawsuit against the state to force corrective action.

The recommendations were that Taycheedah should implement, at a minimum, these mental health care measures:

A. Psychiatric Treatment 1. Provide adequate on-site psychiatry coverage for inmates' serious mental health needs. Ensure that psychiatrists see inmates in a timely manner and that psychotropic medication orders are reviewed by a psychiatrist on a regular, timely basis. 2. Ensure that medications are provided to inmates in a timely manner and that they are properly monitored. 3. Provide nurse staffing adequate for inmates' serious mental health needs. Ensure that nursing functions, such as distribution of medications, are performed by nurses or other properly trained staff.

B. Mental Health Services 1. Provide adequate on-site psychology coverage to ensure that psychologists see inmates in a systematic and timely manner to evaluate inmates for their serious mental health needs. Provide adequate staffing to ensure timely and appropriate mental health screening and referrals. 2. Provide an adequate array of mental health programming, including individual and group therapy, to meet inmates' serious mental health needs and prevent de-compensation and mental health crises. 3. Ensure that adequate crisis services are available to address the psychiatric emergencies of inmates. 4. Provide adequate programming in the Monarch Unit (which, as of the review, merely warehoused and medicated prisoners with the most acute mental illnesses) to meet inmates' critical mental health needs.

C. Segregation and Observation Status 1. Ensure that administrative segregation and observation status are not used to punish inmates for symptoms of mental illness and behaviors that are, because of mental illness, beyond their control.

D. Mental Health Records 1. Ensure that Taycheedah's mental health records are centralized, complete, and accurate.

E. Medication and Laboratory Delays 1. Ensure timely responses to orders for medication and laboratory tests and prompt documentation thereof in inmates' charts.

F. Quality Assurance 1. Ensure that Taycheedah's quality assurance system is adequate to identify and correct serious deficiencies with the mental health system.

On September 4, 2008, the Department of Justice filed a complaint in the U.S. District Court for the Eastern District of Wisconsin, detailing the findings of the CRIPA investigation. On the same day, the parties filed a settlement agreement and stipulation of dismissal. Under the terms of the agreement, the defendants agreed to make the changes that had been recommended in the findings letter that followed the initial CRIPA investigation.

On September 15, 2008, the District Court approved the settlement agreement and dismissed the case.