by Derek Gilna

Louisiana State Prison (LSP) in Angola, Louisiana, was found “deliberately indifferent” to the Eighth Amendment rights of its nearly 6,400 prisoners to receive competent medical care, according to an opinion issued by a federal district court judge, which she refused to reconsider in a ruling handed down on October 8, 2021.

As PLN has reported, the state Department of Public Safety and Corrections (DOC) has also agreed to settlements in suits filed by men held on death row at the prison over excessive heat and time spent in solitary confinement. [See: PLN, April 2022, p.60.]

The latest ruling from Chief Judge Shelly D. Dick of the U.S. District Court for the Middle District of Louisiana lets stand her earlier ruling on March 31, 2021, in a long-running class action filed by Angola prisoners in 2015.

After hearing evidence from hundreds of prisoners, as well as medical and disability experts from both sides during an 11-day bench trial, the judge also toured the prison before issuing a sweeping order requiring major changes to the prison’s medical care.

The Court noted that “[p]laintiffs have satisfied their burden of proving that Defendants have been deliberately indifferent to the inmates’ serious medical needs in the means and manner of the delivery of health care, in violation of the Eighth Amendment to the United States Constitution.”

The Court also found that “[p]laintiffs have met their burden of establishing” that DOC “violated the Americans with Disabilities Act” (ADA), as modified by the Americans with Disabilities Act Amendment Act, and “Section 504 of the Rehabilitation Act of 1973” (RA).

Angola is no stranger to litigation alleging shoddy medical care, the Court noted, dating back over 30 years to an investigation begun by the federal Department of Justice (DOJ) on August 8, 1989, under the Civil Rights of Institutionalized Persons Act, 42 U.S.C. § 1997.169 134.

DOJ then issued its findings on May 13, 1991, concluding “that several conditions at LSP deprived inmates of their constitutional rights, including the failure to provide adequate medical and psychiatric care.”

“[S]erious flaws in the provision of medical care exist system-wide at LSP,” the DOJ report continued, such that “inmates who need medical care and attention are not receiving it,” and “deficiencies regarding...staffing, sick call procedures, delays in treatment, and safeguards to ensure receipt of proper medication and treatment” were also found.

A class action lawsuit followed in 1992, with a settlement agreement reached in 1998 that required various corrective measures be taken regarding medical care. Thus the Court said that DOC has been on notice for many years that medical care at Angola is substandard, specifically with regard to the terms of the 1998 settlement requiring improvements in:

• sick call reviews;

• implementing “contemporary standards of care;”

• establishing mortality review and “an effective quality assurance program;”

• “automatic referrals” to external physicians;

• “documentation of deviations” from outside provider orders and “communication of those deviations to the outside provider;”

• removing “discipline of inmates for malingering without an evaluation by an outside physician;” and

• the “provision of adequate medical leadership.”

Unfortunately, the Court continued, serious problems persist.

“Plaintiffs have demonstrated organizational and structural deficiencies in the…health care system which underpin and contribute to Eighth Amendment violations,” the Court said, adding that “the cumulative effect of leadership and organizational deficiencies demonstrate the subjective component of deliberate indifference.”

Finding Failures,
Court Issues Injunction

The Court zeroed in on the failure of medical leadership at the prison to ensure “meaningful mortality review.” Rather than cataloguing problems that lead to a prisoner’s death in order to make necessary corrections in patient care to prevent more deaths in the future, the Court found that Angola “does not conduct mortality reviews; rather, the physician who cared for the patient provides a short narrative summary of the circumstances surrounding the death. There is no critical review of the death or the care which preceded the death.”

The Court also noted that a “malingering” policy is still on the books at Angola, though rarely enforced, which requires a prisoner making a sick call to acknowledge he may be subject to discipline if no medical justification for the call is found. The policy is not unconstitutional, the Court said, but the situation it reveals is, namely that “the medical department at LSP is controlled by LSP security rather than medical care providers.”

After reviewing the evidence and testimony, the Court made its findings of fact and ordered injunctive relief regarding the following deficiencies:

1. Failing to provide “constitutionally adequate clinical care” with sufficient “privacy in examinations” and “routine medical equipment in exam rooms,” as well as “adequate medical records management,” “clinical hygiene and spacing” and “episodic treatment of complaints;”

2. Failing to provide “adequate medical care with qualified providers at sick call;”

3. Failing to provide “access to medically necessary specialty care in a timely manner” by not “schedule[ing] and track[ing] specialty appointments,” not “comply[ing] with testing and diagnostic requirements,” failing “to execute appropriate follow-up care ordered by specialty care providers” and “fail[ing] to coordinate care;”

4. Failing to provide “constitutionally adequate emergency care” in the “evaluation and assessment of emergencies by qualified providers” and “failing to timely treat and/or transport to hospital for emergent care;”

5. Failing to provide “adequate, qualified staff in infirmary/inpatient care;”

6. Failing to provide “medical leadership and organization in the following particulars:”

a. “lack of meaningful mortality review;”

b. “use of correctional personnel [guards] to manage medical decisions;”

c. “lack of peer review;”

d. “lack of medical staff involvement in budgeting;”

e. “lack of medical supervision;” and

f. failure to maintain proper credentialing records; and

g. Failing “to comply with the ADA and RA in providing disabled inmates access to programs and services due to physical and architectural barriers;”

h. Failing to provide “adequately trained, staffed, and safe orderly assistance” whenever “physical modifications have not been made to provide access” to handicapped prisoners, as well as a “failure to provide proper oversight of health care orderlies;”

i. Failing “to comply with LSP’s own ADA Directives in maintaining a qualified ADA Coordinator and advisory committee to handle ADA issues;”

j. Failing to “make efforts to integrate disabled inmates within the spirit of the ADA implementing regulations;”

k. Failing to “adequately train medical staff regarding ADA compliance;”

l. Failing to “appropriately evaluate and address ADA accommodation requests and disability-related grievances;”

m. Failing to “identify and track disabilities and accommodation requests in a meaningful way;”

n. Failing to “accommodate disabled inmates in applying discipline;” and

o. Maintaining “blanket exclusionary policies for disabled inmates regarding access to various services, activities, and programs in violation of the ADA.”

The Court also said that it would retain jurisdiction over the parties to ensure compliance with the injunctive relief contained in the order. See: Lewis v. Cain, 2021 U.S. Dist. LEXIS 63293 (M.D. La.).

Defendants then asked the Court to reconsider, or, failing that, to certify the ruling for interlocutory appeal. The Court denied that motion and ordered the parties to proceed to the remedy phase of the litigation. See: Lewis v. Cain, 2021 U.S. Dist. LEXIS 195313 (M.D. La.).

On November 29, 2021, the U.S. Court of Appeals for the Fifth Circuit denied the Defendant’s Writ of Mandamus. See: In re: Vannoy, USCA (5^th Cir.), Case No. 21-30671.

Plaintiffs are represented in their suit by attorneys Mercedes H. Montagnes and Nishi Lal Kumar of the Promise of Justice Initiative, Ronald K. Lospenatto of the Advocacy Center, Bruce W. Hamilton of the American Civil Liberties Union’s Louisiana Chapter, and Erica L. Navalance of the Capital Appeals Project, all in New Orleans; as well as Daniel A. Small and Jeffrey Dubner of Cohen Milstein Sellers & Toll PLLC in Washington, D.C. 

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