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Lewis V. Cain Case 3:15-cv-00318-SDD-RLB Document 498 10/03/18 Page 1 of 137 UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF LOUISIANA JOSEPH LEWIS, JR., KENTRELL PARKER, FARRELL SAMPIER, REGINALD GEORGE, JOHN TONUBBEE, OTTO BARRERA, CLYDE CARTER, CEDRIC EVANS, EDWARD GIOVANNI, RICKY D. DAVIS, LIONEL TOLBERT, and CIVIL ACTION NO. 3:15-cv-00318 RUFUS WHITE, on behalf of themselves and all others similarly situated, CHIEF JUDGE: Hon. Shelly D. Dick Plaintiffs, MAGISTRATE JUDGE: Richard L. Bourgeois, Jr. v. BURL CAIN, Warden of the Louisiana State Penitentiary, in his official capacity; STEPHANIE LAMARTINIERE, Assistant Warden for Health Services, in her official capacity; JAMES M. LEBLANC, Secretary of the Louisiana Department of Public Safety and Corrections, in his official capacity; and THE LOUISIANA DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONS, Defendants. PLAINTIFFS’ FINDINGS OF FACT AND CONCLUSIONS OF LAW Case 3:15-cv-00318-SDD-RLB Document 498 10/03/18 Page 2 of 137 TABLE OF CONTENTS I. CLASS MEMBERS ........................................................................................................... 1 II. DEFENDANTS ................................................................................................................ 1 III. OVERVIEW OF MEDICAL CARE PROVIDED BY DEFENDANTS ......... 2 IV. THE PARTIES’ EXPERTS ......................................................................................... 6 A. Plaintiffs’ Experts ........................................................................................................... 6 B. Defendants’ Experts ....................................................................................................... 8 I. DEFENDANTS’ POLICIES AND PRACTICES SUBJECT THE CLASS TO A SUBSTANTIAL RISK OF SERIOUS HARM ................................................................... 9 A. Defendants’ Medical System Creates a Substantial Risk of Delayed Diagnosis, Delayed Treatment or Mistreatment, Needless Pain and Suffering, and Preventable Death ..................................................................................................................................... 10 (1) Findings of Plaintiffs’ Medical Experts .............................................................. 10 (2) Corroborating Evidence of a Substantial Risk of Serious Harm ................... 16 a. Testimony from Treating Providers ................................................................... 17 b. Named Plaintiffs’ Medical Records .................................................................... 17 c. Class Member Witnesses’ Testimony ................................................................. 19 d. Contemporaneous Documentation of Deficiencies in Medical Care and Harm to Patients ........................................................................................................... 20 e. Testimony and Contemporaneous Admissions by Current and Former DOC Employees .......................................................................................................... 21 f. Mortality Statistics ................................................................................................. 21 B. Specific Practices Contributing to Substantial Risk of Serious Harm .................. 23 (1) Administrative Policies and Practices Contributing to the Substantial Risk of Serious Harm ............................................................................................................... 24 a. Inadequate Funding and Inappropriate Budget Management ....................... 24 b. Inadequate and Inappropriate Staffing .............................................................. 26 c. Inadequate Leadership .......................................................................................... 35 d. Sick Call and Access to Care ................................................................................ 38 e. Inadequate Treatment of Medical Emergencies ............................................... 44 f. Inadequate Chronic Disease Management Program ........................................ 47 Case 3:15-cv-00318-SDD-RLB Document 498 10/03/18 Page 3 of 137 g. Failure to Provide Timely Access to Specialty Care ........................................ 50 h. Inadequate Inpatient Care .................................................................................... 55 i. Inadequate Pharmacy Services and Medication Administration .................... 59 j. Inadequate Diagnostic Services ........................................................................... 64 k. Failure to Create, Maintain, and Use Adequate and Reliable Medical Records ........................................................................................................................... 66 l. Inadequate and Unsanitary Facilities .................................................................. 67 m. Inadequate Peer Review .................................................................................... 69 n. Inadequate Mortality Review ............................................................................... 70 o. Inadequate Continuous Quality Improvement Program ................................ 70 II. DEFENDANTS HAVE SUBJECTIVE KNOWLEDGE OF THEIR POLICIES AND PRACTICES, THEIR INADEQUACIES, AND THE RISK OF SERIOUS HARM ................................................................................................................... 72 A. Defendants Received Repeated Warnings About Deficiencies ............................. 73 (1) Warnings from the DOJ ....................................................................................... 73 (2) Warnings from Consultants ................................................................................. 76 (3) Warnings from Outside Providers ...................................................................... 77 B. Defendants’ Own Documents and Testimony Demonstrate Defendants’ Knowledge ............................................................................................................................ 77 C. Defendants Received Thousands of Complaints and Grievances from Class Members ................................................................................................................................ 79 D. Defendants Have Been Willfully Blind to the Deficiencies of Their Policies and the Risk of Serious Harm to Class Members .................................................................. 80 III. Americans with Disabilities Act and Rehabilitation Act Claim ............................. 81 A. The subclass consists of qualified individuals with disabilities. ............................. 81 B. Angola Denies Programmatic Access to and Discriminates Against Individuals with Disabilities .................................................................................................................... 82 (1) Architectural Barriers to Angola’s Programs, Services, and Activities .......... 82 (2) Failure to Integrate Individuals with Disabilities .............................................. 89 (3) Failure to Provide Reasonable Accommodations or Modifications ............. 90 a. Denial of Assistive Devices and Auxiliary Aids ............................................... 90 Case 3:15-cv-00318-SDD-RLB Document 498 10/03/18 Page 4 of 137 b. Denial of Assistance with Insulin Administration ........................................... 92 c. Failure to Accommodate Disabilities in Work Assignments .......................... 92 d. Failure to Accommodate Dietary Needs ........................................................... 93 e. Failure to Accommodate Disabilities When Transporting Patients .............. 93 f. Lack of Accommodations in Prison Procedures .............................................. 94 g. Lack of Accommodations in Discipline ............................................................ 94 (4) Discriminatory Methods of Administration ...................................................... 95 a. Failure to inform individuals of rights and procedures ................................... 95 b. Inadequate procedures for requesting accommodations ................................ 96 c. Failure to identify and track disabilities .............................................................. 99 d. Charging copays to request accommodations ................................................ 100 e. Inadequate staff training .................................................................................... 100 f. Failure to maintain a qualified ADA Coordinator ........................................ 100 g. Failure to maintain an advisory committee .................................................... 102 (5) Overt Discrimination ......................................................................................... 102 IV. CONCLUSIONS OF LAW .................................................................................... 102 A. Eighth Amendment Claim ....................................................................................... 102 (1) LEGAL STANDARD ...................................................................................... 102 (2) The Objective Test ............................................................................................. 103 (3) The Subjective Test ............................................................................................ 105 B. Individual Practices That Can Violate the Eighth Amendment ......................... 107 C. DEFENDANTS’ POLICIES AND PRACTICES VIOLATE THE
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