Prolonged Segregation of Those Incarcerated with Serious Mental Illness

Facts of the Case

Mr. Cartagena was incarcerated within the Virginia Department of Corrections (VDOC). In November 2019, he was moved to the Secure Diversionary Treatment Program (SDTP) at River North Correctional Center. The decision was made by a panel of prison officials, reasoning that he was “seriously mentally ill” and had “assaultive, disruptive, and/or unmanageable” (Cartagena, p 176) behaviors prohibiting him from functioning in the general prison population.

Mr. Cartagena was kept at SDTP for 18 months in the most restrictive unit. In his claim, Mr. Cartagena alleged that, among other limitations, individuals were held in their cells for 21 hours per day; were strip searched, placed in handcuffs, and attached to a “dog leash” when leaving their cell; and spent outside recreation time in segregation cages. Additionally, they were not permitted to attend religious services. VDOC officials noted that the program was designed for individuals with violent and difficult to manage behaviors and, by adhering to treatment programming, such individuals could receive increasing freedoms and integration into the prison population.

Throughout his time at SDTP, Mr. Cartagena filed multiple grievances with prison officials regarding the conditions of his confinement, complaining that the restrictive environment negatively affected his mental health.

In April 2021, Mr. Cartagena attempted suicide and required surgical intervention. He was later transferred to a state prison facility, where he attempted suicide two more times. In August 2021, he was transferred to a medical hospital for “intensive care” for his mental health.

Mr. Cartagena brought an action against prison officials, stating that his confinement in the SDTP violated his First, Eighth, and Fourteenth Amendment rights. He also claimed violations of the ADA and the RA, seeking $80,000 in damages and an injunction against future placement in the program.

The prison officials filed a motion to dismiss Mr. Cartagena’s action, and the district court granted the motion based on a failure to state a claim. Mr. Cartagena appealed, contending that the court erred in dismissing his Eighth and Fourteenth Amendment claims as well as the two statutory discrimination claims.

Ruling and Reasoning

The appeals court affirmed the lower court’s dismissal in a split decision. The majority noted that, even if Mr. Cartegena experienced harmful treatment, he did not show the required mens rea component for a “deliberate indifference” violation of the Eighth Amendment, because he did not demonstrate that officials “‘consciously disregard[ed]’ a substantial risk” (Farmer v. Brennen, 511 U.S. 825 (1994), p 839, referencing the Model Penal Code § 202(2)(c) (1985)). Rather, they assigned him to a program designed for his diagnoses and reacted promptly to his suicide attempts. Moreover, because restrictions might be lifted by complying with the program, Mr. Cartegena had control over his conditions.

Regarding Mr. Cartagena’s Fourteenth Amendment claim, the court deferred to state law or policy to establish prohibitions for his conditions of confinement and to determine whether they were “harsh and atypical.” In doing so, the court outlined three considerations: the magnitude of confinement, whether the period was indefinite, and the collateral consequences. Considering the three criteria collectively, the court concluded that, although the magnitude of the conditions weighed in Mr. Cartagena’s favor, the length of his confinement did not because the relaxation of restrictions was contingent on Mr. Cartagena’s own conduct, giving him control over his placement and arguing against its consideration as indefinite. They did not find collateral consequences.

Mr. Cartagena claimed discrimination by VDOC officials, stating that, because of his mental illness and subsequent placement, he was precluded from interacting with nondisabled peers and participating in prison employment. The court upheld the dismissal of the ADA and RA claims, stating that, because the SDTP was designed for individuals with his diagnoses and behaviors that are difficult to manage, he was not qualified to stay in general population and therefore could not be considered “qualified” under the ADA or RA. Additionally, the court stated that Mr. Cartagena had refused a “reasonable accommodation,” namely, treatment of his mental illness, which could have integrated him back into the general population.

Dissent

The dissent opined that Mr. Cartagena did indeed state a claim and that the majority failed to apply the more “liberal pleading standard” to a pro se complaint, including requiring the appeals court to assume Mr. Cartegena’s factual allegations as true per Erickson v. Pardus, 551 U.S. 89 (2007). The dissent noted that Mr. Cartagena alleged he was forced, against his will, to comply with treatment recommendations, not that he was noncompliant.

Regarding Mr. Cartagena’s Eighth Amendment claim, even if the premise that Mr. Cartagena was nonadherent to treatment were true, the dissent disagreed with the majority’s conclusion that, because a path to fewer restrictions existed, prison officials could not be found deliberately indifferent. The dissent asserted that such a position would inappropriately limit the availability of future Eighth Amendment conditions of confinement claims. The dissent also disagreed with the majority’s holding that the appellees could not have been deliberately indifferent, referring to Mr. Cartagena’s multiple grievances and the court’s own precedent, which established that the negative impact of prolonged segregation on mental health should be “obvious” to corrections professionals. Even without evidence of the appellee’s “actual knowledge,” the risks for an individual with serious mental illness were “sufficiently obvious,” and therefore, the claim was supported.

Regarding the Fourteenth Amendment claim, the dissent cited precedent (Incumaa v. Stirling, 791 F.3d 517 (4th Cir. 2015)) that greater weight be placed on the magnitude of confinement restrictions. The dissent agreed with the majority that the magnitude of Mr. Cartagena’s confinement restrictions met the threshold to qualify as a deprivation of liberty interests, whereas the length of confinement and collateral consequences did not. The dissent, however, placed significantly more weight on the first factor, concluding that Mr. Cartagena’s rights were indeed violated. It noted that Mr. Cartagena sufficiently pleaded a liberty interest given that VDOC officials did not follow their own policy of providing due process, which includes a formal hearing, when detaining him in the program.

Regarding the ADA and RA violations, the dissent stated that Mr. Cartagena established a claim for violation of the ADA, but not the RA. Mr. Cartagena asserted that his treaters recommended a less restrictive unit; thus, he was qualified for a less restrictive environment than the SDTP. Consequently, he was otherwise qualified to receive benefits of which he was deprived, in violation of the ADA and RA protections. The ADA specifies that the disability must be a motivating factor for discrimination, whereas the RA requires that it be the sole reason. Given that Mr. Cartagena was placed in the program because of both his mental illness and dangerous behavior, the dissent concluded that Mr. Cartagena established a claim for violation of the ADA only.