The opinion of the court was delivered by: J. Andrew Smyser Magistrate Judge
(Magistrate Judge Smyser)
I. Background and Procedural History
On June 23, 2004, the plaintiff, a prisoner, commenced this action by filing a complaint. At the time he commended this action that plaintiff was proceeding pro se. However, counsel subsequently entered an appearance on behalf of the plaintiff.
On April 28, 2006, the plaintiff filed a fifth amended complaint.
The plaintiff voluntarily dismissed a number of his claims. The only remaining claim is an Eighth Amendment claim against defendants Jeffrey Beard, the Secretary of the Pennsylvania Department of Corrections, and Teresa Law, the Chief Health Care Administrator for the State Correctional Institution at Camp Hill (SCI-Camp Hill). The claim is based on an alleged denial of mental health treatment for the plaintiff while he has been housed in the Special Management Unit (SMU) at SCI-Camp Hill. The claim is brought against defendants Beard and Law in their official capacities for declaratory and injunctive relief. The plaintiff seeks a declaration that he has a mental health condition that is a serious medical need, that he has not received adequate treatment of his medical need, that his placement in the SMU makes his mental health condition worse, and that as long as he is in the SMU he will not be able to receive appropriate treatment for his serious medical need. The plaintiff also seeks an injunction ordering the defendants to transfer him to a correctional institution or other SCI-Camp Hill unit appropriate for his mental health needs. In addition, the plaintiff seeks attorney's fees and costs and any additional relief that the court deems just, proper and equitable.
The parties consented to proceed before a magistrate judge pursuant to 28 U.S.C. § 636(c). By Order of October 17, 2006, the defendants' motion for a summary judgment was denied and a trial was scheduled on the plaintiff's claims for declaratory and injunctive relief. The trial was held on November 8, 2006. A summary of the trial testimony follows.
The plaintiff called two witnesses. Dr. John Hume stated that he is a physician and a psychiatrist and has practiced psychiatry for over forty years. He examined Sides' medical records and personally examined Sides and concluded that Sides has bipolar disorder, a mental disorder. He based his opinion upon Sides' history of periods of reasonable control separated by episodes of bizarre, aggressive, acting out, self-destructive behavior, sometimes involving hallucinations. He referred to multiple suicide attempts, self-mutilation and smearing of feces. Sides' relative normalcy during lengthier periods interrupted by short either manic or depressive episodes is symptomatic of bipolar disorder.
Dr. Hume also has the opinion that Sides has not received treatment for his bipolar disorder while in the SMU at Camp Hill. The ideal treatment for bipolar disorder is a combination of medication and therapy.
Dr. Hume also stated the opinion that Sides has antisocial personality disorder and has not received medication and other appropriate treatment for that disorder in the SMU.
Dr. Hume stated that, in his opinion, Sides' confinement in the SMU exacerbates his mental health conditions. Dr. Hume testified that the lack of medication to control his hallucinations and his paranoia increases his problems, causing him to get in more trouble and to get more disciplinary time.
Dr. Hume stated that the conditions in the SMU may aggravate an organic brain syndrome in the plaintiff. Dr. Hume testified that 23 of 24 hours in his cell, the absence of television or reading materials, noise, and a lack of an opportunity for confidential communications to staff, all can contribute to psychotic symptoms.
Dr. Hume stated that although Sides was diagnosed with Axis I disorders in other correctional facilities, he has not been so diagnosed at Camp Hill. He acknowledged that a bipolar disorder diagnosis is problematic and that a person with bipolar disorder may not be correctly diagnosed for a long time, perhaps not for an average of eleven years according to one study. He stated that in correctional institutions, aggressive behavior is commonly seen as a part of a personality disorder. He stated that when bipolar disorder appears to be a probable diagnosis, a trial on medication is appropriate and may confirm the probable diagnosis.
He cited a January 7, 2003 report containing a description of Sides that was consistent with a person involved in a manic episode. Hume stated that a October 14, 2005 assessment was consistent with a person in the depressed phase of bipolar disorder and that in a 1999 Norristown State Hospital discharge summary, a diagnosis of dysthemic disorder, an Axis II disorder, would have been consistent with a bipolar disorder.
Hume stated that an April, 2000 SCI-Greene diagnosis of anti-social manic depression was consistent with a bipolar disorder diagnosis. He noted that a January 19, 2001 individual treatment plan for Sides also diagnosed an Axis I disorder.
Hume considered a January 2006 diagnosis of Sides by Dr. Eugene Polmueller, and stated his opinion that Dr. Polmueller's diagnosis was not reliable.
Hume stated that psychotherapy, specifically cognitive behavioral therapy, is helpful for a bipolar disorder patient, helping the patient to correct misperceptions about himself and his environment. Hume stated that Sides has not received meaningful psychotherapy.
Hume noted that Sides' contacts with department psychologists have occurred with frequency during periods when there has been acting out and aggressive behavior or self-harmful behavior on Sides' part and that, otherwise, Sides has had little significant contact with psychologists. Hume stated that contact with psychologists at times of manic extremes is not helpful, but that regular and continuous psychological counseling would be helpful. Hume also stated that the periodic incidents of acting out behavior on Sides' part is characteristic of bipolar disorder. Hume thinks that the SCI-Waymart forensic treatment center would be an appropriate confinement location for Sides. Hume testified that a secure special needs unit would also be a more appropriate place of confinement for Sides than the SMU.
On cross-examination, Dr. Hume stated that he had worked at SCI-Camp Hill in 1990, and that he was asked not to return to his former employment at SCI-Camp Hill after an inmate had died.
He acknowledged that Sides had a detailed memory of his hospitalizations and medications, over the years, from childhood.
He believes that Sides knows the difference between right and wrong, but he felt in his evaluation of Sides for the Cumberland County Court that Sides could not assist in his own defense. He acknowledged that his examination of Sides was of a very limited nature, a two hour conversation with Sides. Documents prepared by Sides in the present civil litigation suggest to Dr. Hume that Sides might have been better able to assist in his own defense than Dr. Hume had thought when at the request of Cumberland County he had evaluated Sides and had reported that Sides was incompetent to stand trial.
Dr. Hume stated that reasonable psychiatrists could disagree about the diagnosis in Sides' case; in particular, about whether he has an Axis I disorder. He also stated that reasonable psychiatrists could also disagree about the correct treatment for Sides. He stated that it is easy to fail to make a bipolar disorder diagnosis in a person who in fact has bipolar disorder. Hume noted that there is not one single objective test for bipolar disorder.
Although bipolar disorder was not diagnosed at SCIWaymart when Sides was evaluated there, Hume believes based upon the descriptions of his behavior that a bipolar disorder diagnosis would have been correct.
Hume stated that in his experience prisoners often misrepresent things in order to get help. When Hume met with Sides, he was told by Sides that Sides had a history ...