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SPLC - Cruel Confinement - Report on Medical and Mental Health Care in AL Prisons, 2014

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Cruel Confinement
Abuse, Discrimination and Death
Within Alabama’s Prisons
A Special Report from the Southern Poverty Law Center
and the Alabama Disabilities Advocacy Program
Montgomery, Alabama
June 2014

Cruel Confinement
Abuse, Discrimination and Death
Within Alabama’s Prisons

Ashley Levett
Southern Poverty Law Center
400 Washington Ave., Montgomery, Ala.
(334) 956-8200

© Southern Poverty Law Center. All rights reserved.

cruel confinement: abuse, discrimination and death within alabama’s prisons

About the Report

This report is the result of an investigation by the Southern Poverty Law Center (SPLC) and the
Alabama Disabilities Advocacy Program (ADAP). It is based on inspections of Alabama’s 15 prisons;
interviews with more than 100 prisoners; a review of thousands of pages of medical records as
well as depositions and media accounts; and the policies, contracts and reports of the Alabama
Department of Corrections (ADOC) and two of its major contractors. The principal writer was
Maria Morris, managing attorney of the SPLC’s Montgomery Legal Office. Contributing writers
were J. Patrick Hackney and William Van Der Pol Jr., both staff attorneys for ADAP. The report was
edited by Jamie Kizzire and designed by Sunny Paulk, both of the SPLC. For further information,
see the SPLC’s letter to the ADOC at
About the Southern Poverty Law Center
The Southern Poverty Law Center is a Montgomery, Alabama-based nonprofit organization
dedicated to fighting hate and bigotry and to seeking justice for the most vulnerable members of
our society. Using litigation, education and other forms of advocacy, the SPLC works toward the
day when the ideals of equal justice and equal opportunity will be a reality.
About the Alabama Disabilities Advocacy Program
The Alabama Disabilities Advocacy Program (ADAP) is part of the nationwide federally
mandated protection and advocacy (P&A) system. ADAP’s mission is to provide quality,
legally-based advocacy services to Alabamians with disabilities in order to protect, promote
and expand their rights. ADAP’s vision is one of a society where persons with disabilities
are valued and exercise self-determination through meaningful choices, and have equality
of opportunity.


cruel confinement: abuse, discrimination and death within alabama’s prisons

Table of Contents
Executive Summary	


Inadequate Medical Staff Leads to Treatment Delays,
Even Death	


Mental Health Care is a Systematic Failure	


Alabama Violates the Rights of Prisoners with Disabilities	 18



cruel confinement: abuse, discrimination and death within alabama’s prisons

Kilby Correctional Facility infirmary

Executive Summary
An investigation by the Southern Poverty Law Center (SPLC) and Alabama Disabilities
Advocacy Program (ADAP) has found that for many people incarcerated in Alabama’s state
prisons, a sentence is more than a loss of freedom. Prisoners, including those with disabilities
and serious physical and mental illnesses, are condemned to penitentiaries where systemic
indifference, discrimination and dangerous – even life-threatening – conditions are the norm.
The Alabama Department of Corrections
(ADOC) is deliberately indifferent to the serious medical needs of the prisoners in its custody.
Inspections of 15 Alabama prisons, interviews with
well over 100 prisoners and a review of thousands
of pages of medical records, depositions and media
accounts – as well as the policies, contracts and
reports of the department and two major contractors – lead to one inescapable conclusion: Alabama’s
prisons violate federal law protecting people with
disabilities and the U.S. Constitution’s ban on “cruel
and unusual punishments.”
This disregard for the law endangers the health
and lives of prisoners. The ADOC’s actions demon-


strate a valuing of cost over human life. The following
are just a few examples of the consequences:
•	 A prisoner who had survived prostate cancer had
a blood test indicating his cancer had probably
returned, but no follow-up test was given until a
year and a half later. By that time, the cancer had
spread to his bones and was terminal. He died less
than a year later, in February 2014.
•	 A prisoner undergoing dialysis died after he was
given an injection of a substance that sent him
into cardiac arrest in January 2014. Although
there was a cart stocked with emergency medical

cruel confinement: abuse, discrimination and death within alabama’s prisons

equipment in the dialysis unit, no one present
knew how to use it to save the man’s life.
•	 A prisoner who had undergone abdominal
surgery died after complaining to the medical staff that he was bleeding from his rectum.
Although the man had requested two new pairs
of pants the day he died because he kept bleeding through his clothes, the medical staff offered
him only an antacid.
•	 A prisoner incarcerated eight years ago after
being shot in the groin had been told at the time
of the shooting that he would have a catheter and
a colostomy bag for six months before having surgery to repair damage from the gunshot. Almost
a decade later, he has not had the surgery. He is
in constant pain, sometimes urinating blood. He
endures frequent infections from the catheter,
often requiring hospitalization.
•	 Numerous prisoners have had toes, feet or
portions of legs amputated as a result of poor
diabetes care. Some diabetic prisoners have
reported that they have not had their blood sugar
measured in months.
Psychiatric medication is often stopped or changed
without any discussion between the psychiatrist and
the patient.
Numerous prisoners have been placed under “Do
Not Resuscitate” or “Allow Natural Death” orders
without their consent or even their knowledge.
Prisoners with disabilities face many forms of
discrimination. People in wheelchairs can’t access
critical areas of facilities. At Kilby Correctional
Facility, a wheelchair-bound prisoner is housed in a
dormitory that has no wheelchair-accessible exits to
the outside. The prisoner had no assistance when the


facility was evacuated twice in May 2014, once for a
fire and again for a gas leak. He had to struggle against
the flow of evacuating prisoners to go farther into the
prison to use a wheelchair-accessible exit.
Prisoners wishing to receive medical care are
expected to complete a written form to request it – a
potential hurdle for those who are blind or have cognitive disabilities. Blind prisoners are routinely asked
to sign documents that they cannot read. The SPLC
and ADAP have learned of two blind prisoners who
unknowingly signed “Do Not Resuscitate” orders.
The state’s legal responsibilities are clear: Alabama
has a constitutional obligation to provide adequate
medical and mental health care to individuals in its
custody. In 2011, the U.S. Supreme Court found in
Brown v. Plata that depriving prisoners of adequate
medical care “is incompatible with the concept of
human dignity and has no place in civilized society.”
Deliberate indifference to these medical needs constitutes “unnecessary and wanton infliction of pain”
barred by the Eighth Amendment.
Alabama also must ensure that its prisons, programs, activities and services are accessible to
prisoners with disabilities under Title II of the
Americans with Disabilities Act and Section 504 of
the Rehabilitation Act of 1973. Instead, the ADOC
systematically violates federal law, leaving people
with disabilities isolated, unable to participate in
prison programs and deprived of the medical care
they need.
Alabama illegally operates a corrections system
that is little more than a network of human warehouses, a place where individuals caught in the
criminal justice system are banished and forgotten.
A conviction does not open the door for the state
to engage in cruelty. Whenever Alabama determines a
person must be incarcerated, it must accept the legal
– and moral – responsibility that comes from imprisoning a human being.

cruel confinement: abuse, discrimination and death within alabama’s prisons

Inadequate Medical Staff Leads
to Treatment Delays, Even Death
The Alabama Department of Corrections had 25,055 prisoners in in-house custody as of
March 2014. This means the department is responsible for the health and well-being of
a population comparable to the Birmingham suburb of Homewood (population: 25,262,
according to 2012 U.S. Census estimates).
Yet there are only 15.2 doctors and 12.4 dentists
for this city behind bars.1 A doctor’s average caseload is 1,648 patients and a dentist’s is more than
2,000 patients.
Overall, Corizon Inc., which has the contract to
deliver medical services to these prisoners, provides a
medical staff of 493 people (including doctors, nurses,
administrative and records staff ). The ratio of total
medical staff to prisoners is 1:51. Even at the Kilby
Correctional Facility in Mt. Meigs, which is home
to the ADOC hospital and is where all prisoners go
through an intake assessment, doctors are scarce.
There is just one full-time and one half-time doctor
on staff for more than 2,000 prisoners.
This extraordinary understaffing has led to a
multitude of problems. The vast majority are easily


predictable: delays, failures to diagnose and treat
problems, failure to follow up with patients, errors
and decisions to not treat seriously ill prisoners.
There should be no doubt that this understaffing is a
direct result of the ADOC’s bid process for its medical
services contract, a process that placed far greater
emphasis on cost than any other factor.
Numerous prisoners have complained of symptoms for months without anyone addressing their
concerns, only to be diagnosed with advanced stage
cancer that is terminal by the time it is diagnosed. In
mid-2011, a prisoner who had been treated for prostate cancer in 2006 began showing a dramatic rise
in the levels of a protein that is the main indicator of
prostate cancer – a sign his cancer had returned. He
began vomiting frequently, sometimes even throw-

cruel confinement: abuse, discrimination and death within alabama’s prisons

A room in the infirmary at
Donaldson Correctional Facility
is cluttered with equipment. The
state prison system only has 15.2
doctors and 12.4 dentists for more
than 25,000 prisoners.

ing up blood. He was not
given necessary tests or diagnosed until a year and a half
later: February 2013. By that
time, his prostate cancer had
spread to his bones. He died
in January 2014.
A prisoner incarcerated
eight years ago after being
shot in the groin had been
told at the time of the shooting that he would have the
catheter and colostomy bag
for six months before having surgery to repair damage
from the gunshot. Almost a decade later, he has not
had the surgery. He is in constant pain, sometimes urinating blood. He endures frequent infections from the
catheter that often require hospitalization.
Prisoners have lost toes, feet or portions of legs
as a result of poor diabetes care. One diabetic prisoner had a toe amputated in February 2013 after a
blister on it went untreated for six weeks, despite his
repeated requests for medical assistance. After his
toe was amputated, he did not receive proper care at
the Kilby Correctional Facility infirmary. His surgical wound became infected, resulting in a second toe
being amputated in July 2013.
Another diabetic prisoner estimates that in the
two years he has been in the ADOC’s custody, he has
passed out 15 to 20 times from having low blood sugar.
In the fall of 2013, a new doctor arrived at Kilby and
changed the medications of many of the diabetics
without examining them. Some diabetic prisoners
have reported that they have not had their blood sugar
measured in months.
A September 2012 report from Corizon states that
there were 2,144 prisoners with hepatitis C but only
four of them were receiving treatment. A prisoner
at Holman Correctional Facility in Atmore recently
died from complications from hepatitis C after going
without treatment. Another prisoner at Holman
Correctional Facility reports that he watched several men with hepatitis C become jaundiced as their


disease progressed without treatment and their livers begin to fail.
Staph infections also are rampant. Numerous
prisoners end up being sent to the hospital as their
untreated infections progress and become septic or
develop into cellulitis – both serious complications.
One prisoner reported that he had a staph infection
on his leg, which became swollen. Yet, he was not
approved to have intravenous antibiotics and was
not treated. After his leg turned black, he underwent emergency surgery to remove the infected area.
Another prisoner estimates six men in his dormitory
at St. Clair Correctional Facility had staph infections
in April 2014. A prisoner at Bibb Correctional Facility
sleeps in a bunk next to a man with a hole the size of a
quarter in his cheek that oozes pus and blood.
Slow or nonexistent emergency response
Even prisoners with broken bones, burns or other
emergency conditions have waited hours, days or
months for treatment, the SPLC and ADAP found.
A prisoner who had undergone abdominal surgery
died after complaining to the medical staff that he
was bleeding from his rectum. Although the man had
to ask for two new pairs of pants on the day he died
because he kept bleeding through his clothes, the
medical staff offered him only an antacid.
At Elmore Correctional Facility, a prisoner had an
adverse reaction to some substance on May 16, 2014.

cruel confinement: abuse, discrimination and death within alabama’s prisons

He was taken to the infirmary, where he writhed
around, repeatedly falling off his bed. He was not
given any treatment. Three days later, he was finally
taken to the hospital where he died.
At St. Clair Correctional Facility, nurses in
November 2012 told a doctor that a dialysis patient
was in pain following his treatment. The doctor
instructed the nurses to give the man some water and
return him to his dorm. He also told the nurses they
should not call him again or send the man to the hospital. The prisoner returned to the infirmary several
times during the night, but each time was sent back to
his dorm. He died in the early hours of the morning.
A prisoner with a broken foot was not treated for
nine months, at which point the bones had begun
to heal incorrectly. Another prisoner with a broken
kneecap waited nearly two months for medical care.
By the time he was treated, the kneecap could no longer be fixed. A prisoner who complained of a sore,
swollen testicle was given only ice for five days. It
was then determined that he had gangrene: His testicle had to be removed.
Even prisoners who have suffered strokes say there
was a delay in treatment. One man lay on the floor of
his cell for four days before medical staff saw him following a stroke. He was left partially paralyzed on one
side of his body. Another prisoner had a stroke one
evening while at a work release center. He was sent
to the hospital unit at the Kilby Correctional Facility
rather than a local hospital. There was no doctor on
duty at Kilby, and the medical staff waited until the
doctor came in the following morning to send the
prisoner to the hospital. This meant the prisoner was
not treated for his stroke until more than 12 hours
after it occurred. He is now confined to a wheelchair.
A prisoner at Kilby was forced to wait seven
hours to be taken to the hospital after grill cleaner
splashed in his eyes. A prisoner at Holman who had
a flaming cloth thrown on him in his cell by other
prisoners was not taken to the hospital until more
than a day later.
Failure to manage outbreaks
The ADOC also has no effective system for preventing or managing infectious diseases. The U.S. Supreme
Court has repeatedly recognized that exposing prisoners to infectious diseases can constitute a violation
of the Eighth Amendment.2
Recent years have seen numerous tuberculosis
(TB) outbreaks in Alabama’s prisons. In the fall of
2013, a guard at Tutwiler Prison for Women had active


TB but was allowed to continue working – even after
officials were aware of the guard’s condition. The
staff was eventually tested for TB, but many prisoners
where the guard was stationed have not been tested.
SPLC investigators have both witnessed and heard
that the dorms where prisoners are found to have
TB are not effectively quarantined. In the summer
of 2012, the SPLC and ADAP visited Donaldson. The
warden stated that one of the dormitories was under
quarantine for TB. The SPLC and ADAP were permitted to enter, and prisoners were wandering in and
out of the dorm and mixing with prisoners from other
dorms. At St. Clair, in January and February 2014, several men were diagnosed with active TB. One worked
in the kitchen until the day he was diagnosed. Another
prisoner at St. Clair reported that during his last physical in the summer of 2013, neither he nor the group
of the 60 to 70 prisoners going through the physical
process with him were given TB tests.

Blind Prisoner
Unknowingly Signs ‘Do
Not Resuscitate’ Order
The blind prisoner believed he was signing a document related to his transfer. His hand was placed
where he needed to sign the form. Prison officials
just needed his signature for this small matter.
The prisoner later discovered the form was a
“Do Not Resuscitate” order.
There is significant evidence that numerous
Alabama prisoners have been placed under “Do
Not Resuscitate” or “Allow Natural Death” orders
without their consent or even their knowledge.
The SPLC has learned of prisoners being placed
under these orders without their consent at the
Kilby, St. Clair, Staton and Hamilton facilities.
In some cases, doctors have discussed
this issue with prisoners, and these prisoners have declined to be placed under a “Do Not
Resuscitate” or “Allow Natural Death” order, only
to be placed under it despite their refusal. One of
the most basic health care decisions is when to
discontinue treatment for a terminally ill patient.
This is a decision that resides with the patient –
even in prison.

cruel confinement: abuse, discrimination and death within alabama’s prisons

The pill window at the St. Clair
Correctional Facility is covered with
prisoner instructions. Prisoners
throughout the prison system have
reported problems receiving medication.

There was also a recent outbreak of scabies, a contagious skin disease, at the Tutwiler, St. Clair and
Ventress correctional facilities. Prisoners report
that, contrary to the statements made by the ADOC
in the media about the outbreak at Ventress, there has
been a scabies infestation there for years. In response
to this outbreak, prisoners were instructed to place
their mattresses over a fence in the yard during the
day to air them out. When they collected the mattresses at night, there was no way to ensure that
each person received the same mattress. The U.S.
Supreme Court has recognized the mingling of mattresses where prisoners had infectious diseases as a
constitutional violation.3
The conditions within the state’s prisons, which
are grossly overcrowded, make spread of disease
nearly inevitable. Prisoners in every facility report
the presence of vermin, especially rats and spiders.
At the Fountain Correctional Facility in Atmore, there
were large amounts of what appeared to be rat droppings on cans of food in the kitchen. At Holman, the
SPLC was informed that a bird had been flying around
in the kitchen for several weeks. What appeared to be
bird droppings were found on a bed in a prison dorm.
Prisoners at several facilities have reported problems with the plumbing. They describe repeated
sewage overflows, including incidents at Ventress
Correctional Facility where prisoners were required
to carry raw sewage away to be dumped on the edges
of the prison grounds. At the Hamilton Aged and
Infirmed Center, there is a footbridge across a canal
of raw sewage.


It is clear from physical
inspections of Alabama’s prisons
that the showers, toilets, sinks
and other physical infrastructure
cannot withstand the challenges
of housing twice as many people
as the prisons were intended to
hold. Such conditions violate the
Eighth Amendment.4 This failure
is not only evident in the stories
told by prisoners but by the very
uniforms they must wear. The
uniforms, like their bedding, are
unclean because the laundry facilities simply cannot
produce water hot enough to adequately clean them.
Medication errors
Several prisoners in various prisons recounted stories to the SPLC and ADAP of people who died
after receiving the wrong medication. One prisoner
received an injection as he underwent a dialysis treatment in January 2014. After the substance, which is
still unknown to the SPLC and ADAP, entered the
prisoner’s bloodstream, he went into cardiac arrest.
The prison’s dialysis unit included a cart stocked with
emergency medical equipment. But no one present
that day knew how to use the equipment. The prisoner died.
Many prisoners are given the wrong medicine.
One prisoner recalled five instances of receiving the wrong medication. Another was given the
wrong medicine and was left unable to walk or talk
for about 10 hours. Nearly all prisoners interviewed
reported that they were not informed of the purpose, side effects and benefits of the medications
prescribed to them.
Numerous prisoners have reported that they have
had problems receiving medication within the prison
system. A prisoner prescribed a medication for mental
health symptoms along with a second medication to
control its side effects reported that she is routinely
denied the medication for the side effects. Other
prisoners report that medications they had been taking for years have been abruptly discontinued even
though they had not seen their doctors.

cruel confinement: abuse, discrimination and death within alabama’s prisons

At Bullock Correctional Facility, a prisoner with
a seizure disorder found his seizure medication discontinued because he slept through his 4 a.m. pill
call a few times. He slept through pill call because his
mental health medications make it difficult for him to
wake up. He has had two seizures since being taken
off the medication.
Interference and indifference
Another obstacle for prisoners seeking medical help
is the corrections officers. The SPLC and ADAP found
many instances where officers delayed or denied
access to medical care. At St. Clair Correctional
Facility a prisoner in segregation suffering from
abdominal pain and constipation asked for help only
to have correctional officers refuse to take him to the
infirmary. Over a period of weeks, the correctional
officers told him the pain was only acid reflux. The
prisoner was eventually taken to a hospital for emergency surgery on a severe bowel obstruction.
At Fountain Correctional Facility in March 2013,
correctional officers refused to let a prisoner with a
large infected wound go to the infirmary, although he
had instructions to return to the infirmary every day
to have the dressing on the wound changed. As result,
the infection became worse.
In December 2013 at Holman Correctional Facility,
a prisoner on suicide watch had a flaming cloth
thrown on him by other prisoners, causing burns on
his legs. The guards put the fire out, but refused to
take him to see medical, saying the burns were “nothing.” It was not until more than 24 hours after the
assault that the man was sent to medical and then
the hospital.
Prisoners also say when they receive medical treatment, corrections officers are present. The officers
sometimes tell the medical staff treating the prisoner
that the prisoner is lying, or at least suggest that the
patient isn’t being truthful.
One prisoner in segregation at St. Clair passed
out five different times in May 2014. Each incident
occurred late in the day, several hours after the prisoners are fed their dinner. There were no guards in
the unit. Each time this prisoner passed out, it wasn’t


until the guards made their rounds the next morning
that they discovered he had passed out.
Prisoners with disabilities face obstacles to
health care
Numerous prisoners have expressed concerns over
Corizon or the ADOC failing to provide medical
supplies, equipment and personal assistance. One
prisoner who contacted the SPLC and ADAP stated
that the ADOC lost his prosthetic leg and refused to
replace it. Where prisoners with disabilities are able
to get assistance from other prisoners, they have to
pay for the assistance with tasks such as going to the
cafeteria, completing medical call slips, going to pill
call and bathing.
Even those who are able to pay are not always
able to get assistance. A wheelchair-bound prisoner
at Kilby, who is paralyzed on one side, has tried to get
people to help him, only to have the guards say that
it is not permitted. He often misses pill call because,
without assistance, it is very difficult for him to get to
the pill call window.
Prisoners with vision or hearing impairments also
encounter numerous obstacles in accessing medical
care. There is no mechanism for assisting prisoners
who cannot see to fill out sick call slips. There also
are no sign language interpreters to assist prisoners
who cannot hear. Frequently, medical personnel have
individuals who cannot see well enough to read their
documents sign forms without explaining what they
are about.
The SPLC and ADAP have spoken with two prisoners who are blind and unknowingly signed “Do Not
Resuscitate” orders. In one case, the prisoner learned
of the Do Not Resuscitate order when the ADOC cited
it as the reason the prisoner could not have the cataract surgery he needed.
The ADOC’s contractual agreement with Corizon
and MHM Correctional Services, the mental health
services contractor, does not include provisions
to ensure effective communication with patients
with impaired hearing or vision. Neither contractor appears to have any policies or staff to address
such needs.

cruel confinement: abuse, discrimination and death within alabama’s prisons

Mental Health Care is
a Systematic Failure
More than 3,000 prisoners in Alabama prisons were receiving some form of mental health
treatment in March 2013, according to an ADOC mental health report. This population was
distributed throughout the prison system’s facilities. Other than the Hamilton Aged and
Infirmed Center, every medium or maximum security facility housed at least 100 prisoners on the mental health caseload.
Despite the fact that every facility housed a sigThis failure by the state to adequately staff its
nificant number of individuals taking psychiatric facilities is even more astonishing when viewed
medication, the level and quality of staffing at Alabama from a historical perspective. In the 1970s, when
Department of Corrections facilities is woefully inad- Alabama prisons were about one-sixth as large as
equate. There are
they are now, the
just 4.7 full-time
level of mental
psychiatrists in the
health staffing
facilities. At many
was found to be
prisons, there is no
l ow. 5 T h e re wa s
The level of
one full-time
staffing is clearly
psychologist in
insufficient. Several
the system at that
prisoners report
time. Remarkably,
that, despite being
the current ratio
prescribed psychiof psychologists to
atric medications,
prisoners is roughly
they do not receive
half of what it was
periodic check-ups
with a psychiatrist.
Even the ADOC
Often, the only condoes not believe
tact they have with A prisoner at Bibb Correctional Facility receives a medical exam.
the current mental
any mental health
health staffing levprofessional is when they are acutely mentally ill and els are adequate. When the ADOC issued a recent
exhibiting suicidal ideations or actions.
request for mental health services contract proposThere are only 5.6 psychologists for the entire als, it cited the minimum staffing need to be 144.95
system. Only Tutwiler Prison for Women has a full- full-time employees. Under the current contract,
time psychologist on staff. Psychologists work at MHM, the mental health services contractor, is not
just six facilities: Donaldson, Bullock, Limestone, providing even this number of mental health staff.
Holman, Kilby and Tutwiler. At all other facilities, The new MHM contract provides for just 126.5 fullno psychologist is available.
time employees.


cruel confinement: abuse, discrimination and death within alabama’s prisons

Failure to identify
mentally ill prisoners
Only 12.2 percent
of the prison population is identified
as having any mental health issue. This
almost certainly indicates that Alabama is
not identifying prisoners with mental health
disorders. A 2006
Department of Justice
study of prison and jail
prisoners throughout
the country found that
about half of the prisoners in state correctional
facilities meet the criteria for a mental illness
found in the Diagnostic
and Statistical Manual
of Mental Disorders
(DSM-IV). It is highly unlikely that Alabama’s prisoners suffer from mental illness at just one-quarter
of the rate of most state prison populations. The failure to identify prisoners in need of mental health care
or to provide them with the level of care needed is a
violation of the Eighth Amendment.
It is evident from the joint SPLC and ADAP investigation that the ADOC under-identifies prisoners with
mental health disorders.
One prisoner at St. Clair cut himself with razor
blades on five separate occasions, but never received
mental health care despite his numerous requests.
Instead, corrections officers mostly expressed their
frustration with the prisoner, even beating him on one
occasion. When the prisoner cut himself so severely
that he cut a tendon in his forearm, a corrections officer asked him why he insisted on mutilating himself
on his shift.
“Why don’t you just go ahead and kill yourself?”
he asked the prisoner.
Shortly thereafter, a nurse came by and the prisoner showed the nurse his arm. The nurse said he
would return when he had time, but did not come
back. The prisoner was taken out of his cell and placed
in a cell outside. He was beaten by two officers in the
cell and left there for another hour before he was
taken to the infirmary.


A prisoner rests in a suicide-watch cell at the Bibb Correctional
Facility. Often, the only contact state prisoners have with a
mental health professional is when they are exhibiting suicidal
thoughts or actions. Even then, the contact is minimal.

The nurse at the infirmary attempted to staunch
the blood flow from his arm, but was unable to do so.
An hour later, he was taken to Brookwood Medical
Center in Birmingham, where several staples were
put into his arm to hold the wound closed – approximately five hours after he mutilated his forearm.
One prisoner reported hearing voices and engaging in self-harm thousands of times over a period of
about eight years before finally being identified as
needing mental health care. Another prisoner was
placed on suicide watch three times within four
months and asked for mental health treatment, but
has not been given any treatment. A prisoner who
repeatedly mutilated himself was threatened with
forced medication by staff. Just two weeks later, he
asked to be placed on the mental health caseload
only to have the request refused.
There is also evidence that the ADOC is dramatically under-identifying the level of acuity of those
who are mentally ill.
According to ADOC mental health codes, MH-1 and
MH-2 are used for prisoners with “mild impairment
in mental functioning, such as depressed mood or

cruel confinement: abuse, discrimination and death within alabama’s prisons

insomnia.” MH-3 is for moderate impairments “such
as difficulty in social situations and/or poor behavior
control.” MH-4 is for severe impairments “such as
suicidal ideation and/or poor reality testing.” MH-5
is used for severe impairments “such as delusions,
hallucinations, or inability to function in most areas
of daily living.” MH-6 – the code for the most acutely
mentally ill – is reserved for prisoners who have been
committed to a mental hospital.
As of March 2013, just 234 prisoners in ADOC custody – less than 1 percent – were classified at greater
than MH-2. In contrast, the Department of Justice
study cited above found that, nationally, some 43
percent of state prisoners met the DSM-IV criteria
for mania and 15 percent met the criteria for psychotic disorders. It is extremely likely that far more
of ADOC’s prisoners should have a higher mental
health code.
The SPLC and ADAP have spoken with a number
of prisoners who report hallucinations but are either
not on the mental health caseload at all or are classified as either MH-1 or MH-2. The SPLC and ADAP
have heard of numerous severely mentally ill prisoners who are housed in general population where they
are victimized by other prisoners and, in some cases,
are dangerous to other prisoners as well as to themselves. The SPLC and ADAP have met with mentally
ill prisoners unable to carry on even the most basic
coherent conversation. These prisoners are, in some
instances, at facilities that house no one with a mental health code higher than MH-2.
Even the ADOC’s own documents show the
acuity of prisoners’ mental illness is understated.
According to the March 2013 report, only 222 people were categorized as MH-3, and just 12 people
were classified at higher mental health codes. Yet,
853 people were, at that time, diagnosed with psychotic disorders – disorders that would clearly, per
the ADOC description of mental health classifications, classify a person as MH-5.
Medication denied
The ADOC barely spends $1 per patient, per day on
psychiatric medication. Even more astounding is that
the ADOC’s annual expenditure for psychiatric medication actually decreased by 26 percent from March
2010 through March 2012, despite the relative stability of the state’s prison population.
The investigation by the SPLC and ADAP uncovered instances of mentally ill prisoners being denied
access to necessary psychiatric medication as well as


issues with medication management. These failures
by the ADOC to provide, prescribe and manage necessary psychiatric medications to its prisoners violate
the Eighth Amendment.
There are numerous, credible reports that psychiatric medication is improperly decreased, ended or
changed to less effective forms. Some prisoners report
being on psychiatric medications for years and then
being taken off their medications – and the mental
health caseload – despite needing treatment. This
includes prisoners exhibiting suicidal thoughts and
actions. Even after numerous suicide attempts, prisoners’ medications are not reinstated nor are they
returned to the mental health caseload.
Prisoners entering the prison system or transferred
within it often face lengthy periods where they are
denied psychiatric medications and are not properly
monitored until seen by the staff at the new facility.
The SPLC and ADAP found numerous instances of
medication being denied to prisoners when they are
transferred into a new facility. There is also little or
no follow-up to ensure the efficacy of the medication. The lack of staff experienced in monitoring the
medication ensures that it is practically impossible
for necessary monitoring to occur.
The SPLC and ADAP have received numerous
reports from prisoners who have never received any
form of regular, face-to-face consultations with a psychiatrist despite being on the mental health caseload
for years. Many report that the only time that they
have ever had a face-to-face consultation with a psychiatrist is during an acute mental health crisis. In
most instances, this contact is limited to someone
with less experience than a psychiatrist, such as a
nurse practitioner or a mental health counselor.
When prisoners receive psychiatric medication
that increases their heat sensitivity, care must be
taken because they are more prone to heat stroke
and heat-related illnesses. Other than the residential treatment units, none of the ADOC facilities that
routinely house prisoners on psychiatric medications
have air conditioning. And as of May 2014, the air conditioning in three of the seven dormitories in Bullock’s
residential treatment unit is not working.
The SPLC and ADAP found a prisoner on psychiatric medication that increases heat sensitivity in a
dormitory where the air conditioning is not working. In May 2014, the prisoner endured temperatures
in the 90s. This prisoner, who has difficulty carrying on a coherent conversation and does not read
well, was asked by prison officials to sign a paper

cruel confinement: abuse, discrimination and death within alabama’s prisons

Prisoners fill an open-air
dormitory at Kilby Correctional
Facility in Mt. Meigs.

promising to tell the correctional officers if he was
getting too hot.
Prisoners medicated against their will
Numerous prisoners report being forced to take medication under circumstances that do not comport with
due process requirements. Two prisoners reported
being forcibly medicated for years but had no recollection of any proceeding that determined that they
could be medicated against their will.
When one of these prisoners told a nurse that he
did not want to continue taking medication, he was
threatened with segregation. Several prisoners report
being sent to segregation until they agree to take the
medication. One man was kept in segregation for 15
days for refusing his medication.
One prisoner was forcibly medicated even as he
awaited a determination of whether he was seriously
mentally ill and could be forced to take medications. In the end, it was determined that he was not
seriously mentally ill and could not be medicated
against his will. Prisoners at the Bullock Correctional
Facility, which maintains a specialized unit for the
most severely mentally ill known as the Intensive
Stabilization Unit, have reported being forcibly medicated for talking back and other behavior that met
with the staff’s disapproval. Prisoners reported that
this occurs at other facilities as well.


Another prisoner
reports that he refused
his medication, Prolixin,
because it made him shake
– a well-known side effect.
This resulted in an officer
slapping him and wrestling him to the ground.
The officers told him that
they were going to put him
in segregation for refusing
his medication. He was
able to explain to them
that he needed to see the
psychiatrist because he
was suffering from the
medication’s side effects.
The officers offered a deal:
If the prisoner took his medicine, they would tell the
psychiatrist to see him. They also would not put him
in segregation. The prisoner agreed, but it took 30
days for him to see the psychiatrist.
This prisoner has refused his medication on a
number of occasions. When he refuses, officers tell
him that he will be forcibly held down and given
his medication. This prisoner has never had a hearing to determine whether he should be permitted
to refuse his medication.
He has witnessed other prisoners refuse to take
their medication as well. Sometimes they are held
down and forced to take it. Other times, the threat of
forced medication is enough to change their mind.
They are even taken to segregation until they start
taking the medication.
Seriously mentally ill in poorly equipped facilities
On paper, the Bullock Correctional Facility’s unit
for severely mentally ill prisoners had plenty of
space to care for such prisoners in early 2013. A
March 2013 ADOC report showed seven people
were housed in the Intensive Stabilization Unit,
which was listed as having beds for 30 people.
Only two people had been there for more than 30
days. The report painted a picture of a unit ready to
accommodate prisoners with the most serious need
for mental health care.

cruel confinement: abuse, discrimination and death within alabama’s prisons

The reality was much different.
During an SPLC and ADAP inspection, the unit
was full, which is almost always the case, according
to ADOC staff at the inspection. Half the unit was
used for segregation of individuals not on the mental
health caseload. This means that if a prisoner became
acutely mentally ill, there would not be a cell available
in this unit unless someone is removed.
The SPLC and ADAP interviewed numerous prisoners who said when they become acutely psychotic
and a danger to themselves, they are placed in a “suicide cell” because there’s no other place for them.
Treatment for prisoners in suicide cells consists of
mental health staff making a once-a-day pass where
they ask – through the door – whether the person is
still suicidal. The staff member usually spends less
than five minutes with the patient. One prisoner said
this pass often occurs in the early morning hours
when prisoners are likely to be asleep.
One prisoner with a mental health code of MH-5
(severe impairment) was housed at Easterling
Correctional Facility, which lacks any psychiatric
staffing. Three prisoners with a mental health code of
MH-3 (moderate impairment) were housed at ADOC
facilities not designed to care for MH-3 prisoners.
Some mentally ill prisoners are housed for years on
end in segregation units throughout ADOC facilities
because of their acute mental illness. These prisoners are referred to as being “on the circuit” and are
moved between the segregation units at Holman,
Donaldson and St. Clair. One man, currently in segregation at Donaldson, has been on the circuit for five
years. They receive little or no mental health care in
the segregation units.
Even when prisoners are in a Residential Treatment
Unit (RTU), they still may not receive the care they
need. By the end of March 2013, there were 270 individuals in the RTUs. Yet there were only 243 individual
contacts by psychiatrists with the RTU patients over
the course of the month. There were 42 contacts with
a psychologist and 76 contacts with a nurse practitioner. Prisoners report that these contacts last just
minutes, often at the cell door or in settings that are
not confidential and offer little therapeutic value.
Abuse by guards also appears to be much worse
in the mental health units than elsewhere in the
prison system. Numerous prisoners have reported an
extraordinary level of violence and abuse by guards in
the Bullock mental health units. They describe guards
knocking over bunks if prisoners are not quick enough


to get up in the morning, although many are under the
influence of medications to help them sleep.
One prisoner in the mental health unit at Bullock
describes having to clean up the blood of another
prisoner who had been beaten by guards. In another
incident, when a prisoner tried to change the television channel, the guard told him to get away from the
TV set. He then spit in the prisoner’s face before beating him with a baton. After the beating, the prisoner
was sent to the infirmary where his head was stitched
up. The prisoner was then placed in segregation.
Years earlier, the same prisoner was beaten because
he was loudly responding to auditory hallucinations.
The guards became agitated and beat him, breaking
his jaw and a rib. He was not taken to medical at all.
He was placed in segregation. Six months later, X-rays
revealed his broken bones.
Prisoners also report that guards often use pepper
spray in the mental health units and on the mentally
ill. Several prisoners described an incident where a
guard used pepper spray on a prisoner after a fight,
despite the fight being long over by the time the guard
doused the prisoner. The guard held out his pepper
spray can after the fight ended, causing the prisoner to
put his hands in front of his face. The guard told him
to put his hands down. He even went as far as telling
the prisoner that he would spray him a second time if
he put his hands in front of his face or closed his eyes.
He then sprayed the prisoner, despite the fight being
long over by that time. The mentally ill prisoner did
not put his hands in front of his face.
A failure to protect
The ADOC also fails to protect prisoners in the most
elementary way: Keeping razor blades out of the
hands of suicidal prisoners. The department provides prisoners with disposable razors in their cells
for shaving, but they are never collected or accounted
for by prison authorities after use. This is true in
Residential Treatment Units as well. Even individuals with a documented history of using a razor in
recent suicide attempts are given razors.
Prisoners have the right “to receive medical treatment for illness and injuries, which encompasses a
right to psychiatric and mental health care, and a right
to be protected from self-inflicted injuries, including
suicide.”6 The ADOC does protect prisoners from selfharm. The results are predictable and potentially lethal.
One individual, on two separate occasions in two
separate facilities, used a razor to attempt suicide

cruel confinement: abuse, discrimination and death within alabama’s prisons

Segregation cells at Easterling Correctional Facility

while in a suicide watch cell. He used the same razor
blade he had used in the initial attempts in his cell
and brought it with him to the suicide watch cell.
The guards failed to appropriately search the prisoner before placing him in the suicide cell.
Another prisoner, who has a long history of
self-mutilation with sharp objects, was housed in
segregation at Fountain in March 2014. After intentionally cutting himself with a razor, he did not receive
any mental health counseling. Instead, the episode


marked the beginning of a series of incidents where
the prisoner cut himself – even when he was confined
to a suicide-watch cell. After one cutting incident in
the suicide-watch cell, the guards failed to remove the
razor, which the prisoner turned on himself once he
was returned to it. The guards simply did not believe
the prisoner when he reported there was a razor in
his suicide-watch cell. Instead, the guards assumed
the prisoner was cutting himself on a rusty air vent,
which resulted in him getting a tetanus shot.

cruel confinement: abuse, discrimination and death within alabama’s prisons

Alabama Violates the Rights of
Prisoners with Disabilities
People with disabilities often encounter discrimination throughout the prison system.
They are segregated from other prisoners. They are excluded from work release programs
solely for their disabilities. Prisoners in wheelchairs can’t access parts of the prisons even
when these barriers could be removed with relative ease and limited expense. A hearingimpaired prisoner reports being hit by a corrections officer for not responding to an order
he couldn’t hear.
Quite simply, the ADOC systematically violates
federal law, including Title II of the Americans with
Disabilities Act and
Section 504 of the
Rehabilitation Act
of 1973, which prohibit discrimination
against people with
disabilities, including
those in prisons.
Guards at some
facilities have
informed prisoners in
wheelchairs that they
cannot be pushed
by other prisoners.
Several of the prisoners who have reported
this issue to the SPLC
have had strokes and
have limited use of one hand, making it nearly impossible to push their own wheelchairs. This policy
excludes wheelchair-bound prisoners from the most
basic services of the prison system, including medical care, food and even access to bathroom facilities.
When a prisoner needs medical care, he or she
must complete a written form requesting it. Every
ADOC facility has boxes to submit the medical slips.
It may seem like a simple process, but for a prisoner
with an intellectual disability or vision impairment,
filling out a form can be a major obstacle.
Prisoners with disabilities also have reported that
they are excluded from work release programs due
solely to their disabilities. One prisoner was sent to


a work release program, and then told that he could
not participate because he is blind. The same thing
happened to another
prisoner who is deaf.
Another prisoner has
been excluded from
work release solely
because of his medical code, a code that
is based not on any
medical condition
but on his disability.
Work release is a critical benefit, allowing
prisoners to develop
skills, reintegrate into
society, earn money
and demonstrate
p a ro l e re a d i n e s s.
A policy of excluding prisoners with disabilities clearly violates the
Americans with Disabilities Act and Section 504 of
the Rehabilitation Act of 1973.
The ADOC also must provide auxiliary aids and
services necessary for effective communication with
prisoners with disabilities.7 These aids and services
may include large print materials for prisoners with
low vision or a sign language interpreter for prisoners with deafness. But prisoner accounts show that
the ADOC has failed to provide them.
One deaf prisoner, who has been in the prison
system for several years, has never been offered a
sign language interpreter, though he requested one
on numerous occasions. This prisoner states that

cruel confinement: abuse, discrimination and death within alabama’s prisons

he does not understand certain
ADOC policies and cannot participate in any programs offered
by the prison due to this inability
to communicate.
To make matters worse, staffers often rely on other prisoners
to “communicate” with the prisoner with deafness. On at least
one occasion, the prisoner was
denied a sign language interpreter
for a disciplinary hearing. He did
not understand the proceedings
and was sentenced to a 30-day
segregation term.
A prisoner who had two hearing aids because he is mostly deaf
in both ears ended up with only
one functioning hearing aid after
personnel from the ADOC and
Corizon, the medical services
contractor, told him that he would only be provided
with one. He now frequently loses his balance because
he has only one functioning hearing aid. He often has
to wait a long time for a replacement battery for it,
during which he can hear very little. On one occasion,
he was assaulted by a correctional officer for failing
to obey an order that he could not hear.
Several other prisoners have also described
incidents where they were verbally or physically
mistreated due to their disabilities. At the Kilby
Correctional Facility A Dorm, where prisoners who
are blind or in wheelchairs are concentrated, guards
have taunted prisoners about their disabilities. A
blind prisoner reported that guards wave their hands
in front of his face, refer to him as “blind man,” and
make jokes about the “blind train” – the line formed
when blind prisoners lead each other to the dining
room or to pill call. A prisoner also reports that when
prisoners in wheelchairs complain about an issue the
guards respond by asking, “What are you going to do
about it? You can’t get up.”
A blind prisoner also reported being assaulted by
a guard during prisoner count. The prisoner sat up
in bed as he usually does during the count when the
guard yelled at a prisoner to stand up. The guard kept
yelling, identifying the person only as “you.” The prisoner did not know that he was the person being told
to stand up. The guard threw the blind prisoner to the
floor for disobeying. He then wrote the prisoner up
for disobedience. Disciplinary hearing records show


Everyday tasks, such as showering, can be difficult for prisoners
with disabilities in Alabama prisons.

the prisoner pleaded guilty at the hearing, but the
prisoner says he did not plead guilty and no one even
told him that the record indicates such a plea.
Architectural barriers
Under the Americans with Disabilities Act, the ADOC
is generally not required to undertake architectural
renovations to improve accessibility for facilities built
before 1992, but it must remove architectural barriers
when it can be done with relative ease and at limited
expense. It also must ensure that it operates “each
service, program, or activity so that the service, program, or activity, when viewed in its entirety, is readily
accessible to and usable by [prisoners] with disabilities.”8 It is also discriminatory to deny a prisoner
access to and participation in services, programs and
activities because the facility is not accessible.9
Yet the ADOC consistently houses prisoners with
mobility impairments in facilities that are not accessible. With the exception of the Hamilton Aged and
Infirmed Center, every facility contains architectural
barriers for prisoners with mobility impairments.
These failures turn everyday life for prisoners with
disabilities into an obstacle course.
At Ventress Correctional Facility, a prisoner with
limited mobility due to severe scoliosis needed to use
a shower with a grab bar. He was told he could use
the shower in the infirmary, two buildings away from

cruel confinement: abuse, discrimination and death within alabama’s prisons

The infirmary at the St. Clair Correctional Facility uses a
folding chair in the shower to accommodate individuals
with disabilities.

where he was then housed. But the prisoner was
later moved to the dormitory the farthest distance
from the infirmary.
He was permitted to use the shower only late
at night. This required him to make a painful
15-minute trek across the facility well past midnight to reach the shower. The prisoner asked to
be housed near an appropriate shower, but was
left in the distant dormitory for months. It was
not until the SPLC and ADAP intervened on his
behalf that he was moved to a location closer to
an accessible shower.
At Kilby Correctional Facility a prisoner who
is paralyzed on one side of his body and confined
to a wheelchair is currently housed in B Dorm.
The exit from B Dorm to the yard has steps, not
a ramp. This dorm has no wheelchair-accessible
bathroom facilities. The wheelchair-bound prisoner had no assistance when Kilby was recently
evacuated for a fire. He also found no assistance
when Kilby was evacuated for a gas leak. The
prisoner struggled against the flow of evacuating prisoners to reach A Dorm, which is deeper
within the prison but has a wheelchair-accessible exit.
At other ADOC facilities, prisoners with disabilities also find taking a shower or using the bathroom
can be a needlessly difficult task. Restrooms throughout the system are not accessible. Toilets at several
facilities are on raised platforms.
At Staton Correctional Facility, the only “accessible” shower is in the infirmary. The administrators
at Staton claim that all persons with mobility impairments in the facility are housed in the infirmary to
provide access to the shower. The shower in the infirmary is a raised metal shower stall with a plastic lawn
chair in the middle and a hose for bathing. A prisoner
must climb up a high step to enter. It is extremely difficult – if not physically impossible – for a prisoner
who cannot walk or has limited mobility to independently enter this shower and use it. Moreover, there
are several people with mobility impairments housed
in other dormitories that do not have any form of
accommodation for people with disabilities.
At Kilby’s A Dorm (the dormitory where prisoners
with mobility and vision impairments are concentrated), the shower has an unstable chair. Several


prisoners have reported falling while trying to get in
and out of the shower chair.
Also at Kilby, there are currently nine wheelchairbound prisoners in A Dorm. In recent years, there
have been as many as 17 wheelchair users in A Dorm.
The beds are so close that some of the wheelchairs
cannot maneuver between the beds. The sole toilet
accessible to these prisoners was not functioning for
several months recently.
At the Kilby infirmary, there are a number of
individual cells where the sink sits directly above
the toilet, in the corner of the cell. A blind and
wheelchair-bound prisoner was moved into one of
these cells for several months. Because of his disability and the configuration of the toilet and sink,
he had no access to the sink and had great difficulty
getting to the toilet.
While ADOC need not ensure that all its facilities
are accessible to persons with mobility impairments,
it is impermissible to house those prisoners in locations that are not accessible. During the joint SPLC
and ADAP inspections, wardens indicated that individuals were not housed in dormitories that were not

cruel confinement: abuse, discrimination and death within alabama’s prisons

accessible. These assertions were repeatedly contradicted by the presence of prisoners with disabilities
in such dormitories and confirmation that they did
indeed live there. Also, access to the outside in many
facilities involves going down stairs.
Prisoners with disabilities improperly segregated
The ADOC has a long history of segregating prisoners with disabilities. This practice contradicts Title II
of the Americans with Disabilities Act and its implementing regulations, which specifically require the
ADOC to “administer services, programs, and activities in the most integrated setting appropriate to the
needs of [prisoners] with disabilities.”10
At least two blind prisoners were recently housed
at Kilby Correctional Facility in A Dorm. This dorm
is for persons with a Level 4 security classification,
generally violent offenders. Neither prisoner had a
history or conviction that warranted being housed in
a Level 4 dorm. The justification for housing the prisoners in this dorm was “that’s where we put the blind
people.” The same dorm also houses numerous people
in wheelchairs, including those whose recommended
security level is less than Level 4.
These prisoners are excluded from programming
because the dormitory is part of the reception center,
not a dormitory for those housed at Kilby. Also, it is
often on lockdown because there is a high degree of
violence, as is common in high-security, understaffed
dormitories. Placing people in A Dorm because they
are blind or wheelchair-bound is discriminatory and
dangerous. Also, Title II’s implementing regulations
specifically prohibit placing prisoners with “disabilities in inappropriate security classifications because
no accessible cells or beds are available.”11
Some facilities have the problematic policy of
housing all persons with mobility impairments in
infirmaries. Confining these prisoners to the infir-


mary deprives them of benefits, programs and
services available to other prisoners. At Staton
Correctional Facility, for example, mobility-impaired
prisoners are housed in the infirmary. But the infirmary yard is extremely small and lacks the recreation
equipment found in the regular yard used by the
other prisoners.
No clear transition plan
These failures should not be surprising given the
sparse evidence of planning by the ADOC to protect prisoners with disabilities from discrimination.
The Americans with Disabilities Act and Section 504
of the Rehabilitation Act of 1973 require the ADOC
to develop a transition plan to ensure all programs,
services and activities offered at its facilities are
accessible to and usable by prisoners with disabilities.12 By no later than July 26, 1992, the ADOC should
have developed a transition plan. But nearly 22 years
after the deadline, it has not implemented a transition plan, and does not appear to have even developed
such a plan.
If the ADOC indeed chose to make the structural
changes necessary to comply with Title II of the
Americans with Disabilities Act, such changes should
have been completed by Jan. 26, 1995.13 Yet, the ADOC
continues to operate inaccessible facilities and programs nearly 22 years after federal law mandated it
make its programs accessible.
Even worse, few prisoners have the opportunity to
voice complaints that could remedy violations of the
Americans with Disabilities Act. Each ADOC facility
should have at least one Americans with Disabilities
Act coordinator to investigate a prisoner complaint of
an ADA violation.14 Based on the investigation by the
SPLC and ADAP, the Hamilton Aged and Infirmed
Center appears to be the only facility with a coordinator and grievance procedure.

cruel confinement: abuse, discrimination and death within alabama’s prisons

Federal law and the U.S. Constitution are clear about the treatment of prisoners. The
conditions the Southern Poverty Law Center and the Alabama Disabilities Advocacy
Program found within ADOC facilities demonstrate a disregard for the law that leaves
prisoners confined to dangerous and discriminatory facilities that put their health and
lives at risk.
These prisoners were not sentenced to abuse.
They were not sentenced to suffering from an
infectious disease in a filthy prison. They were not
sentenced to daily humiliation and hardship simply
because they have a disability. But this is the reality
for individuals in Alabama’s prisons. It is a prison
system that not only punishes people, but denies
their humanity.
No “tough on crime” slogan can justify these conditions and the lives they have already destroyed.
Alabama has an obligation to ensure its prison system
does not violate the rights of prisoners with disabilities. It must ensure prisoners receive constitutionally
adequate medical and mental health care. And it must
ensure that no prisoner is involuntarily medicated
without due process.
The state of Alabama must develop and implement
a plan to meet its constitutional, statutory and moral
obligations. This plan must at least include:
•	 Increasing medical and mental health staffing levels to ensure that prisoners can receive the care
they need in a timely manner.
•	 Increasing custody staff to ensure that there are
sufficient officers to monitor segregation and
escort prisoners to medical when necessary.


•	 Maintaining control of razor blades.
•	 Eliminating architectural barriers in all buildings
where prisoners with disabilities are housed.
•	 Ensuring the provision of appropriate assistance devices and services for prisoners with
•	 Eliminating policies that discriminate against
prisoners with disabilities.
•	 Establishing an Americans with Disabilities Act
grievance procedure at each facility that is similar
to the current grievance procedure at Hamilton
Aged and Infirmed Center and appointing an
ADA coordinator at every facility.
If the state is truly dedicated to justice, it will not
rationalize the injustices behind its prison walls. It
will not be slow to act because it’s an issue that garners little sympathy – or votes – from the public. The
time for state officials to uphold their legal obligation
and address these failures is long overdue.

cruel confinement: abuse, discrimination and death within alabama’s prisons

1 Some facilities do not have full-time doctors or

7 28 C.F.R. §§ 35.160-164
8 28 C.F.R. § 35.150(a)

2 See Brown, 131 S. Ct. at 1933; Helling v. McKinney,
509 U.S. 25, 33 (1993); Hutto v. Finney, 437 U.S. 678,
683 (1978)

9 28 C.F.R. § 35.152(b)(1)
10 28 C.F.R. § 35.130(d)

3 Hutto v. Finney, 437 U.S. 678, 683 (1978)
11 28 C.F.R. § 35.152(b)(2)(i)
4 Gates v. Cook, 376 F.3d 323, 341 (5th Cir. 2004)
12 28 C.F.R. §§ 35.150(d)
5 Newman v. State of Ala., 503 F.2d at 1322, 1330 (5th
Cir. 1974)
6 Cook ex rel. Estate of Tessier v. Sheriff of Monroe
County, Fla., 402 F.3d 1092, 1115 (11th Cir.2005)


13 28 C.F.R. § 35.150(c)
14 See 28 C.F.R. § 35.107(a)

Ashley Levett
Southern Poverty Law Center
400 Washington Ave., Montgomery, Ala.
(334) 956-8200
The SPLC is supported entirely by private donations. No government funds are involved.
© Southern Poverty Law Center. All rights reserved