population's needs. Plaintiffs' Exhibit 19 at 13-14, 30-31, 41-42, 47. Dr. Allen and others note that the current population level at Occoquan is having a negative impact on dental care. Tr. at 214-15, 1064-65; Plaintiffs' Exhibit 19 at 25-26. That lengthy delays in obtaining dental care are common is buttressed by the numerous administrative complaints filed by inmates complaining of the pain they are suffering due to these delays. Plaintiffs' Exhibits 11; 22 at 6, 8.
D. Mental Health Services
Mental health screening of all inmates should be performed by a trained mental health professional and appropriate psychological tests administered in order to identify those in need of psychological care. Tr. 363-64. The experts agreed that the screening process conducted at the D.C. Jail is not successful in identifying all those suffering with serious mental disturbances. This is not surprising given that no formal mental health screening performed by trained mental health professionals is conducted there. Tr. at 341, 916; see also Campbell v. McGruder, No. 1462-71, slip. op. at 27 (D.D.C. July 15, 1985). At the same time, in place at Occoquan is only an informal system for screening inmates for psychological problems. Tr. at 353; Plaintiffs' Exhibit 6 at 1. This system, or lack thereof, is entirely inadequate. Tr. at 294-96, 363, 372.
2. Mental Health Staff
There are widely acknowledged deficiencies among the mental health staff at Occoquan. Tr. at 284, 301, 366, 380. These deficiencies are evidenced by a "burned-out" staff, overwhelmed by their work load. Tr. at 301, 366.
Such an impaired staff has an adverse impact on the quality of care. Tr. at 370. The psychiatrist is available only two hours per week. This limits each patient to about seven minutes with the psychiatrist, an amount of time within which it is "simply impossible" to evaluate one's mental state. Tr. at 36, 352. There is a pressing need for additional mental health personnel, particularly given the numbers of inmates who are mentally disturbed. Tr. at 301, 303, 346, 356, 361.
3. Q Block
In addition to housing inmates on administrative and punitive segregation, Q block is used also to house mentally ill inmates until they can be examined by a psychiatrist and transferred to a proper treatment facility. Tr. at 298-99, 345. Both mental health experts agreed that Q block is an inappropriate place to house inmates suffering from serious mental health problems. Tr. at 299, 370. Indeed, placing such inmates in Q block will surely aggravate their condition. Tr. at 299.
Inmates in need of hospitalization for treatment of mental health conditions are not being transferred to St. Elizabeths Hospital (the District of Columbia's mental health institution) in some cases within 48 hours. While this is the reality, defendants' mental health expert testified that in no case should an inmate with a psychiatric problem be confined in Q block for more than 24 hours. Tr. at 370. There are also delays in nonemergency transferring of mentally disturbed inmates out of Q block. It may take more than one month for transfer to St. Elizabeths Hospital in such instances. Tr. at 353, 375.
4. Medications and Records
Certain mentally ill inmates at Occoquan are not receiving their prescribed medications. Tr. at 297. This represents a significant problem in that failure to maintain prescribed medication levels may aggravate dangerously the patient's psychotic state. Tr. at 298, 367. The effectiveness of the already stretched Occoquan mental health services is further taxed by the unavailability of various medical records, similar to the problem noted supra at 28-29.
E. Cumulative Impact
The conditions at Occoquan, not to mention the experts on both sides and the Occoquan administrators, cry out for a population limit. PT at 29; Tr. at 91, 838, 841, 1200-01; Plaintiffs' Exhibits 17 at 36-37; 18 at 4-5, 75, 80-81. In June 1986, the District of Columbia's special consultant for correctional affairs, Ms. Kathryn Monaco, observed that:
The serious overcrowding the District now faces in those facilities not covered by court order poses a much more dangerous threat. In Occoquan I and II, inmates are crowded into dormitories with little or no chance for privacy, causing a great deal of tension with the result that normal prison management difficulties are compounded. . . . Experiences in prisons across the country demonstrates [sic] that overcrowding like that now existing at Occoquan I and II, which so sever[ely] inhibits any quality of life, results in violence. Unless remedied, this situation will result in a disturbance that will be costly in terms of human life and property.
Plaintiffs' Exhibit 6 at 3-4. Unfortunately, the July 1986 riot at Occoquan proved Ms. Monaco all too correct.
As indicated supra at 3, the Occoquan population is again approaching the level that existed at the time of the July 1986 riot. As demonstrated supra, passim, virtually every facet of the Occoquan system is at or beyond the breaking point. It is apparent that even with significantly fewer inmates, the physical plant and the various services and programs at Occoquan are, at best, substandard. This situation, taken cumulatively, presents a clear and present danger to the health and safety of plaintiffs. See, e.g., Tr. at 292-94, 301, 312, 322-30, 357, 380-81, 1223-26.
II. Conclusions of Law
A. Equitable Relief Is Appropriate
Defendants suggest that recently implemented plans designed to alleviate many of the above-noted conditions should render the Court's intervention unnecessary. The Court wishes sincerely that were the case. The Court's experiences with the Department of Corrections, however, make "skeptical" the operative word.
First, the Court should only refrain from issuing a remedy where defendants satisfy the "heavy burden" of demonstrating that (1) the alleged improvements have "completely and irrevocably eradicated the effects of the alleged violation," County of Los Angeles v. Davis, 440 U.S. 625, 631, 59 L. Ed. 2d 642, 99 S. Ct. 1379 (1979), and that (2) it is "absolutely clear" absent an injunction "that the allegedly wrongful behavior could not reasonably be expected to recur." Vitek v. Jones, 445 U.S. 480, 487, 63 L. Ed. 2d 552, 100 S. Ct. 1254 (1980). The Supreme Court explained the rationale of this stringent test in City of Mesquite v. Aladdin's Castle, Inc., 455 U.S. 283, 288-89 and n. 10, 71 L. Ed. 2d 152, 102 S. Ct. 1070 (1982):
It is well settled that a defendant's voluntary cessation of a challenged practice does not deprive a federal court of its power to determine the legality of the practice.