The opinion of the court was delivered by: COHILL
This civil rights class action under 42 U.S.C. § 1983 was filed in 1976 by inmates of the Allegheny County Jail challenging allegedly unconstitutional conditions at the jail. After a lengthy trial, this Court concluded that many of the deficiencies at the jail arose to the level of constitutional violations. Opinions and orders were entered on January 4, 1978, and October 11, 1978. See Owens-El v. Robinson, 442 F. Supp. 1368 (W.D.Pa.1978) and 457 F. Supp. 984 (W.D.Pa.1978).
On appeal to the United States Court of Appeals for the Third Circuit, the inmates challenged, inter alia, our failure to order psychiatric care for inmates in the jail. Inmates v. Pierce, 612 F.2d 754 (3d Cir. 1979). In the first opinion in this case I wrote:
We cannot, in good conscience, write this Opinion without commenting on the lack of mental health treatment facilities in this community for persons such as the inmates of the jail. There is no suitable arrangement within the jail for dealing with violent, acting-out mentally unstable inmates. Neither are we aware of any mental health facility in the community with the capacity to deal with such unfortunate people.
It became obvious during the trial that there is difficulty, indeed, perhaps tension, between jail personnel and "outside" mental health personnel in handling such persons. While ordering the creation of such a facility in the community would be going beyond the parameters of the case before us, we are compelled to comment that the absence of such facilities is noteworthy, and we strongly suggest that the appropriate authorities at the federal, state and local levels seek to provide such a facility before a tragedy occurs.
The Court of Appeals agreed that conditions at the jail were proved to be "shockingly substandard," but disagreed with this Court's assumption that we lacked authority to order psychiatric facilities be implemented at the jail. Judge Rosenn, recognizing the well-established right of prisoners to access to medical care, wrote that "we perceive no reason why psychological or psychiatric care should not be held to the same standard." 612 F.2d at 763. Remanding the case for further consideration, the Court of Appeals assigned four tasks:
1) to determine whether inmates with serious mental or emotional illnesses or disturbances are provided reasonable access to medical personnel qualified to diagnose and treat such illnesses or disturbances;
2) to determine any change in conditions caused by this Court's prior Order;
3) to make a specific finding as to the adequacy of the present system for psychiatric care at the jail;
4) to determine what changes, if any, are necessary to meet the constitutional standards of care enunciated by the Third Circuit.
We have pursued these tasks during the course of a five-day non-jury trial on the matter, and now enter findings of fact and conclusions of law in accordance with Federal Rule of Civil Procedure Rule 52.
The Allegheny County Jail is a criminal detention facility located in Pittsburgh, Pennsylvania, housing primarily pre-trial detainees. It has an average daily population of 450 to 500 inmates.
Several jail guards, a nurse, and a senior staff psychiatrist doing consultant work for the jail testified from personal knowledge about the conditions within the jail. All agreed, and we find as a fact, that this jail is persistently understaffed, disorganized, and unsafe for employees and inmates alike. The good work that these individuals do is thwarted by the chaotic conditions within the jail. Dr. Herbert Thomas, a psychiatrist with long experience in corrections and years of association with the Allegheny County Behavior Clinic doing evaluations of inmates, rated the jail as a correctional facility at "Z minus" on a scale of A to Z during his testimony before this Court. Several employees testified that a single guard may be working one cell block on the day shifts, despite an earlier order of this Court that two guards be assigned to each cell block. Owens-El v. Robinson, supra, 457 F. Supp. at 988-89.
Several inmates also testified about conditions at the jail; their reports were very similar to those of the jail employees. One articulate and highly credible inmate testified that during the last two months at the jail, he had personally witnessed four separate beatings of inmates by other inmates; the victims in these instances were classified by the witness as "mentally ill." One incident involved a recent admittee to the jail who was filthy and foul-smelling and who was assaulted by a group of inmates in the cafeteria. The witness believed, and we must agree, that there is no place in the jail where inmates unable to defend themselves are safe.
All the employees and inmates described a similar and wide-range of behavior in the jail which points to mental illness of many inmates. One guard testified that there have been about ten suicide attempts in the last six months and two successful suicides in the first three months of 1980. Several episodes were described of inmates obsessed with their own excrement: they decorate themselves, their cells, and others around them with their own wastes or drink their urine. One inmate who is on the clean-up crew testified that these inmates are sometimes hosed down with cold water during the hosing down of the cell block. Other inmates are obviously hallucinating, talking to themselves or non-existent persons. There are frequent incidents of all-night singing, shouting, or "music"-making by inmates who cannot be calmed or quieted. Some inmates appear dazed, incoherent or disoriented to jail employees; others the guards recognize as suffering from delirium tremens. There is a lot of fire-setting, some of it to human hair or clothing. There have been instances of self-mutilation. Some of the "disturbed" inmates become violent; one guard had his hand broken by an inmate in the psychiatric section of the hospital and another was choked by an inmate later admitted to Mayview State Hospital. More often, however, the inmates who act confused or strange are the victims of abuse rather than abusers. According to jail employees, these inmates have been assaulted with fists, broom handles, and even hospital beds. The "normal" inmates throw burning objects into their cells, pour water on them, and generally taunt or tease them. They are vulnerable rape victims. The stipulations of counsel admitted as exhibits provide gruesome case histories of such incidents.
There are three places where inmates with suspected mental problems may be housed in the jail in the hospital, in the selective housing unit ("SHU"), or in the general population. Generally, an inmate with mental problems is not placed in the hospital unless he "has done something to draw attention to himself," in the words of the officer in charge of the hospital, or unless he requires restraints. However, inmates with delirium tremens are placed in the hospital, usually in restraints. (Our prior order of October 11, 1978 directed that any inmate suffering delirium tremens be immediately transferred to a medical facility outside the jail. Owens-El v. Robinson, supra, 457 F. Supp. at 991.)
The term "hospital" is a misnomer as used at the jail. We have personally visited this area on more than one occasion, the most recent being April 14, 1980. The hospital area consists of two rooms, the so-called "square room" and the "round room" connected by a doorway. The round room is, indeed, circular with a diameter of approximately thirty feet. It contains about twenty cots lined up around the circle with feet toward the center and heads to the wall. There are no partitions between the cots. This room is used for prisoners who have medical illnesses of various types. The square room is really rectangular and is used to house inmates with mental illnesses and those requiring restraints. The part occupied by beds is approximately fifteen feet by thirty feet with an aisle down the middle; there are about seven cots on each side. At one end is a glass partition with two more cots behind it. Other than the glass partition at the end, there ...