The opinion of the court was delivered by: WARD
ROBERT J. WARD, District Judge.
This is a motion for a preliminary injunction in a class action brought by patient-inmates of Matteawan State Hospital ("Matteawan") in Beacon, New York, pursuant to 42 U.S.C. § 1983 and 28 U.S.C. §§ 1331, 1343(3) and (4), and 2201, challenging the constitutionality of certain of the conditions of their confinement. Defendants are the state officials charged with the operation of the facility and some of the employees of the hospital, including correction officers. The complaint alleges violations of the Eighth and Fourteenth Amendments of the Constitution of the United States, in that conditions on Wards 3 and 4,
the so-called "jail wards," are so substandard that placement in these isolation wards ("seclusion") is cruel and unusual punishment, in that there are no rules governing patient/inmate conduct, and in that discipline, in particular seclusion, is arbitrarily imposed without the safeguards of due process. The instant motion addresses itself to these charges, requesting that this Court prohibit use of the isolation cells as they now exist, require due process safeguards in connection with any future use of these cells, and order promulgation of rules, accompanied by specific sanctions, to govern patient conduct. In addition, the complaint alleges brutality, excessive use of physical restraints, and unauthorized dispensing of medication by the prison guards, but these allegations are not at issue at this time.
Matteawan State Hospital is maintained by the New York State Department of Correction pursuant to N.Y. Correction Law § 400 (McKinney's Consol.Laws, c. 43, Pocket Part 1973). That section presently provides:
1. The department of correction shall maintain one or more hospitals, to be used solely for the purpose of holding in custody and caring for such mentally ill persons held under any other than a civil process as may be committed to the department by courts of criminal jurisdiction, or placed therein or transferred thereto by the commissioner of mental hygiene, and for such persons as may be committed thereto pursuant to the provisions of section 29.13 of the mental hygiene law, and for such convicted persons as may be declared mentally ill while undergoing sentence of imprisonment, or upon a commitment as youthful offenders, juvenile delinquents or wayward minors at any of the various penal institutions of the state, and for all female convicts becoming mentally ill while undergoing sentence. When a person is committed or placed in or transferred to the department under the provisions of article seven hundred thirty of the criminal procedure law or section 29.13 of the mental hygiene law, a copy of the minutes of the proceedings instituted to determine his mental condition shall be furnished to said hospital. The department of correction shall have the jurisdiction and control of such hospitals; but they shall be subject to visitation and inspection of the head of the department of mental hygiene, by himself and his authorized representatives from the department of mental hygiene.
Amendments to the laws pertaining to Matteawan, effective May 30, 1974, provided that only persons convicted of an offense and under sentence could be held in custody in a hospital within the jurisdiction of the Department of Correction, and required all other persons in such hospitals to be transferred to other institutions by April 1, 1975. 1974 N.Y. Laws Ch. 629 (McKinney's). However, at the present time, the class of patients who bring this action includes both convicted persons within the jurisdiction of the Department of Correction, and persons who have been indicted and ruled dangerous and incompetent to proceed to trial, pursuant to N.Y.C.P.L. § 730.50 (McKinney's Consol.Laws, c. 11-A, Pocket Part 1973). Each of the inmates at Matteawan has thus been adjudged mentally ill in an independent proceeding in New York State Supreme Court, after examination by two court appointed physicians, N.Y.Correction Law § 408 (McKinney's Pocket Part 1973), and sent to Matteawan for treatment or a type of custody which is unavailable elsewhere in the state correctional system. Upon expiration of their sentences these persons are subject to transfer to a hospital within the jurisdiction of the Department of Mental Hygiene, as civilly committed patients, for further treatment, unless the director determines that they are "reasonably safe to be at large." N.Y.Correction Law § 409 (McKinney's Pocket Part 1973).
Defendants essentially contend that Matteawan is a treatment institution, and that seclusion is a medical treatment rather than a sanction. To the limited extent that they address themselves to the issue, they argue that to promulgate rules governing patient conduct and to establish specific sanctions and procedures for imposing sanctions, would defeat the treatment purpose of the institution. Therefore, they argue, due process safeguards are inappropriate, as well as not constitutionally required. Instead, they claim, there is a formal set of criteria governing the use of the isolation wards as a treatment procedure, including requirements for a physician's continuing authorization and sharply limited permissible durations of confinement.
A long line of cases in both the New York and federal courts have recognized that, while Matteawan is a hospital, it is primarily a maximum security prison institution, and the quality of treatment provided is substantially inferior to that provided in civil hospitals, while the deprivations of personal liberty are greater. See Gomez v. Miller, 341 F. Supp. 323 (S.D.N.Y.1972), aff'd, 412 U.S. 914, 93 S. Ct. 2728, 37 L. Ed. 2d 141, 93 S. Ct. 2737 (1973) and the cases cited therein at 325, 326.
Yet Kesselbrenner v. "Anonymous," 39 A.D.2d 410, 334 N.Y.S.2d 738, 745 (2d Dep't. 1972), rev'd, 33 N.Y.2d 161, 350 N.Y.S.2d 889, 305 N.E.2d 903 (1973), held that the term "care" as used in Correction Law § 400, includes and imports treatment of persons sent to Matteawan. The Court of Appeals, in reversing the Appellate Division, held that the restraints on liberty, due to the high security characteristics of Matteawan, and the secondary importance that treatment programs have in that institution, made commitment there of persons not convicted of any crime violative of such persons' constitutional rights. Nevertheless, as a prison facility housing, in future, only convicted criminals, Matteawan is a hospital, obligated by statute to provide care, including treatment. This circuit has expressed the view that the New York statutory scheme contemplates that a prisoner will be committed to an institution for the criminally insane only if he is mentally ill and in need of special custodial care because of the problem he presents to himself or other prisoners. United States ex rel. Schuster v. Herold, 410 F.2d 1071, 1087 (2d Cir. 1969). That case held that a prisoner in the New York State Correctional system may be transferred to an institution for the criminally insane only if he is formally judged in need of such care and treatment, since the state provides such a formal process for civil commitment to a mental institution. While strongly critical of the actual treatment program at hospitals within the jurisdiction of the Department of Corrections, the Court in Schuster found that the procedural posture of the case prevented its ruling on the question of adequacy of care. For the moment, the Court accepts the proposition that the institution's purpose is to provide some form of treatment.
When this motion was first brought, the Court decided to inspect the relevant areas of Matteawan to determine whether the conditions did violate the constitutional prohibition against cruel and unusual punishment. Accordingly, on June 13, 1974, having declared its intention the preceding week, the Court toured Wards 3 and 4, the isolation or so-called "jail" wards
and then held the first part of an evidentiary hearing on the grounds of the institution, in a gymnasium occasionally used for such purposes. The second part of the hearing was later held in the United States Court House in New York City.
Wards 3 and 4 consist of two long corridors, one upper and one lower, laid out identically. The corridors are lined on either side with solid doors which lock from the outside, each leading into a cell approximately six feet by ten feet in dimension. Each of these cells has a window in the far wall, covered by heavy, cage-like screening. There is also a small barred window, about one foot square, in each of the doors to the cells at about eye level. About half of the cells contain sinks and toilets; at the time of the Court's visit all of them contained cots with mattresses, sheets and what appeared to be new blankets. There is a community shower and toilet facility halfway down the corridor of each ward. Those cells lacking private toilet facilities each contain a "bucket" or open bedpan as a substitute. The plaintiffs complain that toilet paper is not supplied; the Court observed that in at least one case this was true, although at the time of its inspection most cells were supplied with toilet paper.
There are apparently two groups of patients who are housed in these cells. One group is there by choice, for protection from other inmates whom they fear, and to calm down if they sense themselves in states of uncontrollable agitation. The staff accommodates these patients by allowing them to reside in Ward 3 on a temporary or semi-permanent basis, with the door to their cells open unless in a given case the patient requests that it be locked. The Court observed that at the time it toured the ward, perhaps half of the doors were unlocked, with the patients free to come and go, on the ward, as they chose. The other group of patients is confined in isolation cells against their wills, after some incident, usually a disruptive interaction between patients or between a patient and a guard, prompts a staff determination that such confinement is indicated. At the time that the Court toured the wards it appeared that those who were there voluntarily occupied the more desirable of the cells, that is, those with the toilet and sink facilities, yet were also free to come and go. By contrast, most, if not all, of those locked in the isolation cells against their wills occupied cells without toilets.
The defendants' account of how the prisoners are treated in the isolation cells differs in some key respects from that of the prisoners themselves. According to the prisoners, they are routinely allowed outside their locked cells at most once or twice a day, for five minutes or less, to empty their buckets or bedpans. Occasionally a guard will bring some water to the window in the cell door, which the prisoners may sip through a straw-like spout in the community cup, through the window. Meals are brought to the door at meal time. When the Court inspected the ward, several of the prisoners were dressed only in underwear; they contend that they frequently and for no medical reason are not permitted to keep their regular clothes in these cells.
The defendants state that prisoners who are locked in these cells are released several times a day, and even upon request, to empty their buckets or bedpans, to shower on a regular basis, and to exercise. They justify removing patients' clothing by stating that prisoners who are agitated may use their clothing to attempt suicide or to damage the cells, for example, by clogging the toilets.
The prison doctor and the superintendent, who also testified, claimed that the decision to place a patient in an isolation cell was always a medical decision, based on an evaluation of the likelihood of the patient's injuring himself or others, or "other medical or surgical reasons." Thus, as they explained to the Court, if a patient assaults another patient, attempts to injure himself, or even engages in a vociferous argument with a guard or resists a guard's instructions, he may be transferred to the isolation ward. One incident which prompted the transfer of fourteen patients to the jail ward involved a general spree on June 1, 1974, in which the patients locked several guards in a closet, wreaked havoc on the ward, raided the medicine closet and ingested various drugs, and then released the guards. The patients were transferred to the jail ward immediately, where they remained for ten days. One of the prisoners involved ...