Case 3:15-Cv-00318-SDD-RLB Document 557 04/17/19 Page 1 of 298

Case 3:15-cv-00318-SDD-RLB Document 557 04/17/19 Page 1 of 298 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’ PROPOSED FINDINGS OF FACT AND CONCLUSIONS OF LAW Case 3:15-cv-00318-SDD-RLB Document 557 04/17/19 Page 2 of 298 TABLE OF CONTENTS PROPOSED FINDINGS OF FACT ............................................................................... 1 BACKGROUND ..................................................................................................................... 1 I. CLASS MEMBERS ..................................................................................................... 1 II. DEFENDANTS ........................................................................................................... 1 III. OVERVIEW OF DISCOVERY .............................................................................. 3 IV. OVERVIEW OF MEDICAL CARE PROVIDED BY DEFENDANTS ... 3 V. THE PARTIES’ WITNESSES ............................................................................... 7 A. Plaintiffs’ Medical Experts ........................................................................................... 7 (1) Credentials and Summary of Findings of Plaintiffs’ Medical Experts ............. 7 (2) Reliability and Credibility of Plaintiffs’ Experts ................................................ 14 a. Plaintiffs’ Experts’ Sampling Methodology Was Reliable ............................... 14 b. Plaintiffs’ Experts’ Chart Reviews Were Reliable ............................................. 19 c. Plaintiffs’ Experts Applied Reliable Standards .................................................. 32 d. Plaintiffs’ Experts Are Qualified in the Areas They Testified ........................ 35 e. Plaintiffs’ Experts Did Not Demonstrate Any Bias ......................................... 37 B. Defendants’ Medical Experts ..................................................................................... 39 (1) David Thomas ........................................................................................................ 39 (2) Dr. Jacqueline Moore ............................................................................................ 45 C. Trial Witnesses ............................................................................................................. 47 EIGHTH AMENDMENT CLAIM ............................................................................... 61 I. DEFENDANTS’ POLICIES AND PRACTICES SUBJECT THE CLASS TO A SUBSTANTIAL RISK OF SERIOUS HARM ..................... 61 A. Defendants’ Medical System Creates a Substantial Risk of Delayed Diagnosis, Delayed Treatment or Mistreatment, Needless Pain and Suffering, and Preventable Death ....................................................................................................... 62 (1) Findings of Plaintiffs’ Medical Experts .............................................................. 62 (2) Corroborating Evidence of a Substantial Risk of Serious Harm ................... 68 a. Testimony from Treating Providers ................................................................... 68 b. Named Plaintiffs’ Medical Records ..................................................................... 70 Case 3:15-cv-00318-SDD-RLB Document 557 04/17/19 Page 3 of 298 c. Class Member Witnesses’ Testimony ................................................................. 72 d. Contemporaneous Documentation of Deficiencies in Medical Care and Harm to Patients .................................................................................................... 74 e. Testimony and Contemporaneous Admissions by Current and Former DOC Employees .................................................................................................... 75 f. Testimony of Defendants’ Experts ..................................................................... 76 g. Mortality Statistics .................................................................................................. 76 B. Specific Practices Contributing to Substantial Risk of Serious Harm ................. 78 (1) Staffing Practices Contributing to the Substantial Risk of Serious Harm .... 80 a. Providers ................................................................................................................. 81 b. Nurses ......................................................................................................................88 c. EMTs ....................................................................................................................... 89 d. Correctional officers .............................................................................................. 94 (2) Clinical Practices Contributing to the Substantial Risk of Serious Harm ..... 94 a. Sick Call and Access to Care ................................................................................ 94 b. Inadequate Treatment of Medical Emergencies ............................................ 104 c. Inadequate Chronic Disease Management Program ..................................... 111 d. Failure to Provide Timely Access to Specialty Care ...................................... 119 e. Inadequate Inpatient Care ................................................................................. 130 f. Inadequate Medication Administration and Pharmacy Services ................. 139 g. Inadequate Diagnostic Services ........................................................................ 149 h. Failure to Create, Maintain, and Use Adequate and Reliable Medical Records ................................................................................................................. 150 i. Inadequate and Unsanitary Facilities ............................................................... 153 (3) Administrative Policies and Practices Contributing to the Substantial Risk of Serious Harm ....................................................................................................... 155 a. Inadequate Leadership ....................................................................................... 155 b. Inadequate Funding and Inappropriate Budget Management ..................... 160 (4) Inadequate Monitoring and Quality Assurance ............................................. 164 a. Inadequate Peer Review ..................................................................................... 164 Case 3:15-cv-00318-SDD-RLB Document 557 04/17/19 Page 4 of 298 b. Inadequate Mortality Review ............................................................................ 167 c. Inadequate Continuous Quality Improvement Program .............................. 170 C. Defendants’ Counterarguments ............................................................................. 172 (1) Refusals of Care .................................................................................................. 173 (2) Examples of Care in the Record ...................................................................... 180 (4) ACA Accreditation ............................................................................................. 184 II. DEFENDANTS HAVE SUBJECTIVE KNOWLEDGE OF THEIR POLICIES AND PRACTICES, THEIR INADEQUACIES, AND THE RISK OF SERIOUS HARM ............................................................................... 185 A. Defendants Received Repeated Warnings About Deficiencies ......................... 186 (1) Warnings from the DOJ .................................................................................... 187 (2) Warnings from Consultants .............................................................................. 190 (3) Warnings from Outside Providers ................................................................... 191 B. Defendants’ Own Documents and Testimony Demonstrate Defendants’ Knowledge ................................................................................................................. 192 C. Defendants Received Thousands of Complaints and Grievances from Class Members ..................................................................................................................... 194 D. Defendants Have Been Willfully Blind to the Deficiencies of Their Policies and the Risk of Serious Harm to Class Members ....................................................... 195 AMERICANS WITH DISABILITIES ACT AND REHABILITATION ACT CLAIM .................................................................................................................................. 197 I. THE DOC’S POLICIES AND PRACTICES DENY PROGRAMMATIC ACCESS TO AND DISCRIMINATE AGAINST INDIVIDUALS WITH DISABILITIES ...................................................................................................... 197 A. The Subclass Consists of Individuals with a Range of Disabilities. .................

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