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Case 1:12-cv-01570-RPM-MEH Document 99 Filed 09/30/13 USDC Colorado Page 1 of 33

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO

Civil Action No. 12-cv-01570-RPM HAROLD CUNNINGHAM, CARLTON DUNBAR, JOHN W. NARDUCCI, JR., JEREMY PINSON JOHN J. POWERS ERNEST NORMAN SHAIFER, and MARCELLUS WASHINGTON, each individually and on behalf of all others similarly situated, and CENTER FOR LEGAL ADVOCACY D.B.A. THE LEGAL CENTER FOR PEOPLE WITH DISABILITIES AND OLDER PEOPLE, COLORADOS PROTECTION AND ADVOCACY SYSTEM, Plaintiffs, v. FEDERAL BUREAU OF PRISONS Defendant.

EMERGENCY MOTION BY PLAINTIFF, CENTER FOR LEGAL ADVOCACY, FOR A PRELIMINARY INJUNCTION ORDERING DEFENDANT TO TRANSFER ADX PRISONER, JONATHAN FRANCISCO, FOR A MEDICAL EVALUATION AND TREATMENT

Pursuant to F.R.Civ.P. 65 and 42 U.S.C. 10807(b), Plaintiff Center for Legal Advocacy (CLA) respectfully moves for entry of an Order directing Defendant Federal Bureau of Prisons

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(BOP) to transfer Jonathan Francisco (Francisco), a federal prisoner currently housed at the United States Penitentiary Administrative Maximum in Florence, Colorado (ADX) to a suitable federal or private mental health facility for a mental health evaluation and treatment. I. INTRODUCTION AND SUMMARY OF REQUESTED RELIEF

CLA brings this emergency motion pursuant to its federal authority found at 42 U.S.C. 10807(b), to protect Francisco from imminent and serious harm that he is exposed to at ADX. Francisco has been incarcerated at ADX since September 2011. He is a member of the Plaintiff Class in this action, and is also one of the CLA constituents identified in Plaintiffs First Amended Complaint. Acting as his representative at the request of his attorney-in-fact and mother, Linda Embrack, CLA seeks a preliminary injunction for emergency relief on the grounds that Francisco requires immediate mental health evaluation and treatment for his severe and persistent life-threatening mental health needs, which are being ignored at ADX. As demonstrated in the attached declarations and other evidence, for nearly five years Francisco has displayed a persistent pattern of bizarre and worrisome signs and symptoms suggesting that he suffers from a severe and worsening mental illness. During that time, he has been almost entirely mute, speaking very little, if any, to anyone, including family members with whom he previously had a close relationship. He spends most of his time standing with his face very near a wall, staring blankly at the surface before him. He also obsessively hoards and handles his own feces, placing it on food trays, rolling it into balls, making sculptures out of it, and smearing it on his walls and sometimes on his body or in his hair. He has repeatedly defecated in common-use shower facilities, and on at least one occasion has been seen consuming his feces. In addition, he often has little if any personal property in his cell,

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frequently sleeps without even a mattress, and continuously lives in unsanitary conditions verging on squalor. Despite all of this, BOP records reflect that he receives no meaningful ongoing mental health treatment; instead, the BOPs mental health professionals essentially ignore him. The available evidence suggests that the BOPs response to his situation, thus far, has been to occasionally force him into a shower stall, and to pile sandbags outside his door in a futile effort to prevent the overwhelming smell of feces emanating from his cell from spreading throughout the part of the prison where he lives. These conditions would be cause for serious concern in any context, or at any time, but two recent events involving other prisoners with severe mental illness at ADX demonstrate that the medical and mental health staff at ADX are either unwilling or unable to detect impending mental health emergencies. In one recent case, the BOP allowed a psychotic prisoner named Richie Hill to develop severe malnutrition and systemic staph infections so severe that he was on the verge of death when the BOP finally evacuated him on an emergency basis to a medical facility in November 2012. Like Francisco, Hill spent months in a feces-encrusted cell before the BOP finally addressed his serious medical needs. In a more recent case, the BOP ignored obvious signs of acute psychosis on the part of ADX prisoner Robert Knott, who hung himself in his cell at ADX on September 7, 2013, after languishing at ADX for years with only intermittent care for his schizophrenia. Both of these incidents occurred after this case was filed, when the BOP knew Plaintiffs and this Court were watching, and both resulted from inexcusable and unconstitutional neglect. The BOPs catastrophic errors in managing and treating the mental illness of Messers. Hill and Knott make it clear that the BOP cannot be trusted to monitor and manage severely

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compromised prisoners at ADX, despite the improvements supposedly made following the institution of this lawsuit. Moreover, those errors make clear that when a prisoner is in serious distress because of serious mental illness it may be necessary for the Court to protect him from the persistent deficiencies in the ADX mental health system, because the BOP lacks the inclination and/or ability to address the situation itself. The evidence of Franciscos plight is manifest, and the risk to his health and life is obvious and imminent. In order to avoid repetition of the Hill and Knott catastrophes, the Court should enter an emergency order requiring the BOP to transfer Francisco to a facility where he can be competently evaluated and treated, and where consideration can be given to the management of his hygiene and behavior in a manner that protects his health and that of prisoners in proximity to him. II. A. SUMMARY OF MATERIAL FACTS

The Treatment Of Mentally Ill Prisoners at ADX Violates the Eighth Amendment.

This Motion comes in the context of a class action brought by seriously mentally ill prisoners at ADX and a separate action brought by CLA. Starting in July 2011 and continuing to the present, Plaintiffs counsel has conducted an investigation into the policies and practices in place at ADX regarding the treatment of mentally ill prisoners. The original Complaint was filed on June 19, 2012. An Amended Complaint was filed on May 23, 2013 (Compl.). The Amended Complaint alleges violations by the BOP and several of its senior officials of both BOPs own policies with respect to mental health issues and the constitutional rights of many prisoners housed at ADX. In particular, and as detailed in the Amended Complaint, many of the prisoners housed at ADX suffer from various forms of serious mental illness, including Major

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Depression, Schizophrenia, Bipolar Illness, Schizoaffective Disorder, various personality disorders with significant functional impairments, Post-Traumatic Stress Disorder, severe developmental or other mental disabilities, and other chronic and serious mental conditions. Compl. 55. These mental conditions are described and defined more completely in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Id.1 Although all such prisoners require and are constitutionally entitled to treatment for their mental illnesses, the ADX systematically denies them such treatment. Two recent and glaring examples of these systemic deficiencies are summarized below. At any given time, between 400 and 500 prisoners are housed at ADX in nine different maximum-security housing units, which are divided into six security levels, and include the disciplinary Special Housing Unit (also called Charlie Unit, Zulu Unit, the SHU, or the Hole). Compl. 25, 28. All ADX prisoners live in severe isolation Compl. 26 Conditions in the SHU are worse, however. In particular, prisoners confined to the SHU are continuously segregated from other prisoners, even during recreation. Compl. 28. Id. Unlike other ADX prisoners, those in the SHU are denied access to televisions, few even have access to radios, and most are restricted with respect to possessing personal property that other ADX prisoners can possess and use, such as clothing, reading material and art supplies. See id. Thus, many SHU prisoners are confined with nothing in their cells but a mattress and minimal clothing (for example, a t-shirt and boxer shorts). Id. These austere conditions are a psychological challenge

Effective May 18, 2013, the DSM-5 replaced the DSM IV TR, which was cited in the Amended Complaint. This change does not impact any aspect of the Plaintiffs claims, although it will affect how some illnesses involved in this case are categorized and discussed.

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for the healthiest prisoners; for the severely mentally ill they can be devastating. Compl. 4246. B. Francisco Is In Obvious And Immediate Need Of Mental Health Treatment.

Francisco is 29 years old. Compl. 321. Before his incarceration he lived in Tennessee. Id. He is currently serving extended sentences for unlawful weapons possession and murdering a fellow prisoner at the United States Penitentiary in Pollack, Louisiana. Id. He has a release date of May 29, 2040. Id. Francisco arrived at ADX in late 2011. Compl. at 322. As detailed below, shortly after Franciscos arrival at the ADX other prisoners in the ADX SHU began to notice his bizarre behavior. Id. Among other things, he has barely spoken a word to anyone in the nearly 18 months since arriving at ADX; rather, he spends all day, every day, staring at the wall of his cell. Id. He frequently defecates on the floor of his cell or on a food tray, and smears his feces on himself, his cell or his other surroundings. Id. He ignores other prisoners attempts to help him, does not communicate with staff, and makes no effort to maintain his health or hygiene. Id. As a result, he lives in squalor, rarely eats and is showered only when ADX staff members force him into a shower enclosure. Id. Plaintiffs counsel learned about Francisco from other prisoners in late 2011, and began investigating his background. A review of court filings revealed a letter that his mother sent to his original sentencing judge in 2010 noting that when she visited Francisco on March 7, 2010, his hair was matted, he was very underweight, he appeared to be over medicated, he couldnt talk, his balance was unstable, and he appeared unable to recognize [his mother]

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and his little sister[S]halina. See id.; see also Exh. Q hereto. By all appearances, his condition has deteriorated since his arrival at ADX. The attached declarations confirm that Francisco has converted his cell into a barren cube decorated only with garbage and his own feces. As inmates housed near him have observed, Francisco persistently spreads feces everywhere in his cell, on the floor, walls, sink and bars, pushes his feces out into the range outside his cell, and smears feces on his body and in his hair. Mallett Decl., Exh. B, at 3; Clark Decl., Exh. D, at 9; Trigg Decl., Exh. A, at 9; Barron Decl., Exh. F, at 10 and 13; Jones Decl., Exh. G, at 6; Orr Decl., Exh. I, at 6; Shryock Decl., Exh. K, at 3. At various points Franciscos cell has been littered not only with feces but with discarded styrofoam food trays and rotten food. Pinson Decl., Exh. E, at 5. He also obsessively plays with feces, building little castles and making other shapes, Mallett Decl., Exh. B, at 14; Bruce Decl., Exh. C, at 5 (describing small feces snowman that Francisco left in a communal shower); Pinson Decl., Exh. E, at 5 (describing small feces sculptures made by Francisco in the shape of small people or maybe a Buddha); see also Trigg Decl., Exh. A, at 11 (describing Francisco placing small feces balls on his food tray); Orr Decl., Exh. I, at 7 (Francisco almost always keeps a ball of feces on his desk.). Francisco has also been seen with feces in his mouth, Mallett Decl., Exh. B, at 14, and in the act of eating his feces, Dep. Of R. Hill, Vol. 2, Exh. N hereto, at Pgs. 96 and 144-45. To make matters worse, Francisco rarely if ever showers, even when he is housed in a cell that has a shower in it. Bruce Decl., Exh. C, at 10; Orr Decl., Exh. I, at 4. The deplorable conditions in which Francisco frequently exists are detailed especially clearly in the declaration of fellow ADX prisoner Erwin Villatoro, which is attached as Exh. J.

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In early 2013 Villatoro was housed with Francisco in the ADX SHU, which at the time was located in the prisons Kilo Unit. Villatoro Decl. 4 Villatoro worked as the unit orderly for a time, and thus was let out of his cell for a few hours every day to clean the range and communal showers. Id.2 When out of his cell, Villatoro was able to see into Franciscos cell, and on one occasion volunteered to clean the inside of the cell itself, because the smell was overpowering and permeated the entire range and because he felt sorry for Francisco and anyone else who would have to move into the cell. Id. 8. The ADX staff issued him rubber boots, gloves and cleaning supplies for the task. Id. 9 When he entered the cell he first noticed that the sink was partially filled with liquefied feces. Id. He then noticed a group of small feces sculptures on the desk, which has protruding pieces of broken pretzel sticks, along with stains on the walls. Id. The cell was so contaminated that it took Villatoro two hours to clean it, id., even though it is made of concrete and steel and is about the size of a small bathroom. See Exh. R (a photo of a K unit cell before a recent renovation in which the tiles were removed from the floor). Despite this cleaning, within a few days it was back to its prior, fetid condition. Villatoro Decl., Exh. J, at 11. Although Francicos feces obsession is the most obvious persistent sign of his mental illness, he exhibits other signs and symptoms of severe dysfunction. For example, he rarely speaks with either prisoners or staff members. Mallett Decl., Exh. B, at 6; Trigg Decl., Exh. A, at 8; Bruce Decl., Exh. C, at 4; Clark Decl., Exh. D, at 7; Barron Decl., Exh. F, at 8; Jones Decl., Exh. G, at 6; Bacote Decl., Exh. H, at 4; Orr Decl., Exh. I, at 5; Shryock Decl., Exh. K,

As detailed in the Amended Complaint, Kilo Unit is one of the units at ADX in which the cells do not contain individual showers, so prisoners can shower a few times in a week in a communal shower. See Compl. 33-34 and associated Compl. Exh. 6.

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at 6. Instead, he either ignores efforts to communicate with him, see, e.g., Villatoro Decl., Exh. J, 9, or responds with unrecognizable hand gestures. See, e.g. Mallett Decl., Exh. B, 10; Bacote decl. Exh. H, at 4. Even when offered assistance by other prisoners (such as a magazine), he is nonresponsive. Orr Decl., Exh. I, at 5. Likewise, Francisco rarely if ever has any property in his cell, often even going without a mattress, meaning that any sleep he gets is on a bare concrete bench. See Trigg Decl., 6, Mallett Decl., Exh. B, at 9; Bruce Decl., Exh. C, at 6; Bacote Decl., Exh. H, at 8; Shryock Decl., Exh. K, at 5. He also refuses to leave his cell for recreation. Barron Decl., Exh. F, at 11. Several of the prisoners who are familiar with Francisco and signed declarations are themselves mentally ill, and most of them have been housed with other mentally ill prisoners at some point. See, e.g., Mallett Decl., Exh. B, at 15; Clark Decl., Exh. D, at 10; Pinson Decl., Exh. E, at 9; Barron Decl., Exh. F, at 6; Bacote Decl., Exh. H, at 9. Universally, the declarants believe that something is seriously wrong with Francisco. See, e.g., Trigg Decl., Exh. A, at 13; Mallett Decl., Exh. B, at 15; Clark Decl., Exh. D, at 10. ADX prisoner Jeremy Pinson noted: I have a serious mental illness and have been around the mentally ill most of my life. I have been around prisoners who are trying to fake mental illness. Over an extended period of observation, efforts to fake mental illness become obvious, because the prisoner forgets to maintain the act or tries to negotiate for something. I do not believe Francisco is pretending to be sick. He always behaves the very same way, whether or not people are watching. No sane person would or could live the way he does. And Francisco has been that way since 2011, at least. Pinson Decl., Exh. E, at at 9; see also Barron Decl., Exh. F, at 7; Jones Decl., Exh. G, at 7; Bacote Decl., Exh. H, at 9. Rather than take measures to ensure proper treatment for Francisco, however, ADX staff appear to have given up on him. They use blankets or sandbags pushed up against the bottom of

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his cell to try to contain the overpowering smell of feces. Trigg Decl., Exh. A, at at 5; see also Barron Decl., Exh. F, at 10 (describing ADX staff members using a plastic sandbag to try to keep Francisco from pushing feces under his door into the corridor); Bacote Decl., Exh. H, at 5 (same). ADX staff members threaten Francisco concerning his unsanitary cell conditions. See Mallett Decl., Exh. B, at 5 (relating incident in which two officers were standing in front of Franciscos cell door stating how they would beat him if he did not clean himself, and that that they would get the SORT team to come put his head in his toilet bowl; at the time Franciscos feces were spread on the floor and range); Shryock Decl., Exh. K, at 9 (describing ADX staff members yelling at Francisco to keep that s--t in [his] cell). Although ADX mental health providers visit the range where Francisco lives from time to time, they rarely if ever even try to communicate with him, and when they do make an effort they either just wave at him or say his name a few times before walking off. Mallett Decl., Exh. B, at 11; Bruce Decl., Exh. C, at 7; Pinson Decl., Exh. E, at 7; Barron Decl., Exh. F, at 12; Jones Decl., Exh. G, at 9; Bacote Decl., Exh. H, at 10; Orr Decl., Exh. I, at 9; Shryock Decl., Exh. K, at 9. ADX staff members even frequently fail or refuse to feed Francisco, or offer him only subsistence sack lunches. Mallett Decl., 13. C. Franciscos Symptoms Are Consistent With Serious Mental Illness.

Doris Gundersen, M.D. is a forensic psychiatrist engaged by plaintiffs to evaluate certain prisoners at ADX as well as certain aspects of the ADX mental health care system. In her 18 months of work on the case, she has become familiar with many of the mentally ill prisoners at the facility. Gundersen Decl., Exh. L, at 4.

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Dr. Gundersen was asked to review evidence concerning current Francisco and, in particular, the question whether the evidence of his current circumstances gives rise to a serious concern about his mental health and, relatedly, the care he currently is receiving at ADX. Id. 5 While she generally is highly reluctant to offer opinions about the mental health status or treatment needs of an individual in the absence of clinically evaluating them, she has opined that Franciscos circumstances are unique in that she has been informed that he is nonverbal and that he has not responded to efforts to communicate with him. Id. She therefore believes that any effort to secure a voluntary interview with him in the ADX visiting room would be futile. Id. Accordingly, her knowledge of his situation is confined to review of pertinent portions of his BOP medical and mental health records, correspondence from his mother, and the declarations and testimony of other prisoners describing his behavior and living conditions. Id. Based on the information available to her, Dr. Gundersens declaration expresses a number of concerns about Francisco. First, Francisco is exhibiting behaviors that are consistent with, and indeed in many respects characteristic of, a major mental illness, namely schizophrenia. Id. 7. Schizophrenia is an often devastating mental illness that is characterized by serious disordered thought processes and often by perceptual disturbances including hallucinations, delusions and severe paranoia. Id. Schizophrenia patients also often exhibit bizarre behavior. Id. A second concern expressed by Dr. Gundersen is that is that whether or not Francisco is gravely mentally ill, his living conditions pose a serious risk of infection and other health problems. Id. 9. Feces is bacteria laden and is therefore a dangerous disease vector. Id. When combined with open skin wounds (which Francisco has repeatedly experienced, according to his

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BOP medical chart), persistent exposure to feces is especially hazardous. Id. Thus, even if Francisco is not mentally ill, his living conditions and particularly his hoarding and smearing of feces place him at dramatically elevated risk of disease. Id. 3 The same likely is true of prisoners who live in proximity to him, especially those who are compelled to move into a cell that he has occupied. Id. Dr. Gundersen also notes that the BOP medical records provided to her are cause for serious concern because, in many instances, data reflected in those records suggest a need for further laboratory testing or examination that does not appear to have been done. Id. at 10. For example, one chart entry reflects that Francisco had elevated blood pressure. Id. He also had a significant amount of weight loss which was not addressed in his medical care. Id. He had swelling and pain in his lower extremities which is unexplained. Id. Standard medical practice would have called for further testing, but there is no evidence that such testing was done. Id. That fact, in turn, causes Dr. Gundersen concern that Franciscos other medical and mental health needs are not being addressed. Id. Given the evidence of living conditions that suggest a high risk of exposure to infection, the absence of monitoring and care may place Francisco at risk of a disease that is neither detected nor treated in a timely fashion and that may life threatening. Id. Based on the existing record and the foregoing concerns about that record, Dr. Gundersen opines that: (1) Francisco is exhibiting signs and symptoms that are consistent with, and indeed in many respects characteristic of, a major mental illness, namely schizophrenia; (2) the living
3

Indeed, as noted below and in 11 of Dr. Gundersens declaration, disease -- in the form of a severe staph infection -- has in fact occurred in a mentally ill ADX prisoner, Richie Hill, who like Francisco handled feces, who like Francisco was ignored by the BOP staff, and who very nearly died as a result.

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conditions reflected in the information available to her expose Francisco to a risk -- and perhaps serious risk - of disease, whether or not he is mentally ill; (3) there is a substantial basis to believe that Franciscos mental and physical health are both in jeopardy, and that a careful clinical examination by qualified medical and mental health professionals is necessary to determine what, if any, conditions Francisco suffers from, how to treat any conditions that are diagnosed, and how to manage Franciscos behavior in a manner that reduces the risk of future deterioration of his mental and physical health. Id. 13. She also notes that even further delay in treating Francisco may result in irreversible injury: As with other forms of illness, serious mental illness often becomes more severe if not timely and properly treated. Over time, untreated serious mental illness can become more resistant to treatment methods, when initiated, and the patients prognosis can become more dire, and the probability of recovery more remote. Although I cannot presently determine whether Mr. Franciscos mental illness, if any, is in fact becoming more severe, or whether his prognosis is in fact worsening, I am concerned that, given the symptoms reported and the isolation in which he lives, every day that passes before his condition is addressed reduces the likelihood of a satisfactory clinical outcome, and increases the likelihood of irreversible damage to his body as well as his mind. Id. 14. D. The BOPs Most Recent Psychological Evaluation Of Francisco Called For Continued Monitoring, Which is Not Occurring In Any Meaningful Respect.

The treatment Francisco receives at ADX is utterly contrary to the BOPs own recommendations for his care. After many requests for the production of Franciscos BOP Central File, which includes reports from prior psychological evaluations, Plaintiffs counsel finally obtained the file from the BOP during the last week of August 2013. Franciscos psychological history is distressing, and demonstrates that he has been mute and unresponsive to human social stimuli since 2009, well before his September 2011 transfer to ADX. The record

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also reflects that his last meaningful evaluation was conducted in April 2011, before his transfer. Exh. O (BOP psychological evaluations of Jonathan Francisco), at Bates Nos. 00046-00050. At that time, he was diagnosed with malingering, or fabricating the symptoms of mental disorder. Id. The April 2011 evaluator stated, however, that the evaluation was limited by the format (it was done by video interview rather than in person, and Francisco refused to speak, limiting the evaluators ability to collect information). Id. Previous evaluators noted that Franciscos behavior was consistent with the signs and symptoms of several mental disorders, including catatonia and schizophrenia, and that Francisco should continue to be monitored and evaluated. Id. at Bates Nos. 00059-00067; 00095-96. Despite that recommendation, the last meaningful evaluation of Francisco was completed more than two years ago, and his files from evaluations completed at ADX do not contain records of any formal evaluation since his transfer in September 2011. Rather, they include only perfunctory notations made by psychologists who have passing interactions with him, or merely observe him through his cell door. The BOPs failure to properly and professionally evaluate Francisco disregard its own prior medical recommendations. In addition, this treatment violates the BOPs own written policies, which require that mentally ill prisoners be monitored on an ongoing basis to assess treatment compliance. Exh. P (BOP Program Statement 5310.13, Institution Management of Mentally Ill Prisoners), at 5. For certain prisoners, including those receiving psychotropic medication and those segregated for mental health reasons, mental health staff must, at a minimum, conduct a monthly interview to assess the prisoners treatment strategy. Id. The

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record demonstrates that the BOP has abdicated this responsibility in the case, at least, of Jonathan Francisco. E. Two Recent Mental Illness Catastrophes Demonstrate That The BOP Is Either Unwilling Or Unable To Protect And Treat Mentally Ill Prisoners At ADX.

The persistent pattern of deliberate indifference to the severe mental health needs of ADX prisoners is borne out in the recent ordeals of ADX prisoners Richie Hill and Robert Knott. In October and November 2012 -- about six months after this lawsuit was filed -- Hill nearly died because of the BOPs neglect of his severe Schizoaffective Disorder, which resulted in acute psychosis, severe malnutrition, and systemic staph infections that, according to the BOPs own medical records, very nearly killed him before his emergency medical evacuation to a BOP medical facility. Under proper care, he has since been restored to relative good health and mental stability. Knott was not so lucky. He had schizophrenia. As a result of the BOPs neglect he stopped taking his medication, decompensated and hung himself at the ADX on September 7, 2013. These two grisly episodes demonstrate that the mental health staff at ADX cannot be trusted to protect Francisco, assess when his situation becomes dire, or provide needed medical and mental health care on a timely basis. 1. Richie Hill

Richie Hill was held at ADX in isolation for many years, including an unbroken period of over six years before he was evacuated on an emergency basis from ADX to the United States Medical Center for Federal Prisoners in Springfield, Missouri on November 28, 2012, where he remains today. Hill Dep., Vol. 1, Exh. M hereto, at 9:15-20. Like Francisco, Hill exhibited obvious symptoms of severe mental illness that were ignored by ADX staff. He consumed

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rocks, styrofoam, radio parts, and was frequently observed eating balls of his own feces. Id. at 16:12-14; 17:25-18:1; 95:22-24; 19:2-25. He attempted suicide approximately ten times while at ADX, including once by placing pencil lead, rocks and pencil particles up his penis. Id. at 119:25-120:20. He mutilated his forehead and face by carving pitchforks and cannibal marks into it, and also cut his lips open with staples and put flies into the wounds. Id. at 33:16-36:2; 34:10-35:1. He also attempted to gouge out his own left eyeball about six times, often by pushing rocks into it. Id. at 29:3-7 and 75:17-76:16. While at the ADX, Mr. Hill repeatedly begged the staff for help with his mental issues, and repeatedly asked to be transferred to a mental hospital. Id. at 113:3-117:14, 130:21-137:18, 143:7-145:17 and 146:24-149:18. In response, in one instance the head psychologist at the ADX bribed him to withdraw his transfer request by giving him a radio, which Hill later smashed and ate. Id. at 132:11-133:9. In other instances, the BOP responded to his pleas with bureaucratic gobbledygook about his supposed failure to attempt informal resolution of his issues, his violation of a technicality requiring prisoners to confine their administrative remedy forms to a single issue, and his supposedly untimely submission of his requests See, e.g., id. at 146:24149:18. The record will show that his allegedly inadequate paperwork practices generally coincided with periods during which he was acutely psychotic and sitting in his feces-smeared cell without a pencil, complaint form or any other means to communicate in writing that the BOP was slowly killing him. As with Francisco, Hills illness was obvious. Any BOP observer could have seen, and in fact BOP psychology staff did see, Hill smearing feces on the wall and on himself, as well as eating his feces. Id. at 136:24-137:18. Likewise, the BOP staff would have been easily able to

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see blood smeared on Mr. Hills walls and body. Id. at 142:22-1436 (7/31/2013). And yet the BOP did nothing until he was very nearly dead. In 2012, Hills legs became infected after he was overcome with a persistent delusion that diamond rings were embedded inside his legs. Id. at 17:3-18:8. In an effort to remove the rings, he began digging holes in them with his fingers. Id. The wounds became severely infected and fetid; at one point, a worm emerged from one of Mr. Hills wounds. Id. at 25:7-10. Although Hill repeatedly asked for medical assistance for his legs, little was done. One member of the medical staff who was aware of his swollen legs told Hill that the swelling would eventually subside. Hill Dep., Vol. 1, Exh. M hereto, at 20:12-21:22. Other staff members stopped by his cell and remarked about his swollen legs, but did nothing. Id. at 123:4-20. After his emergency evacuation to MCFP Springfield, a BOP physician observed that Mr. Hill suffered from severe multiple systemic infections, appeared to be chronically and acutely septic, and had multiple draining deep sores. See Exh. S (BOP record of medical examination upon his admission to MCFP Springfield). The physician informed Mr. Hill that his legs may require amputation, and, in fact, that the infection was so severe that his life was in danger. Hill Dep., Vol. 1, Exh. M hereto, at 23:5-14. He ultimately was diagnosed with a severe staph infection. Id. at 23:22-24. While at ADX, Hill also developed severe malnutrition, according to the BOPs own medical records. See Exh. S. He testified that as a result of the ADX staffs refusal to feed him, he lost 50 pounds and experienced starvation so severe that he resorted to eating rocks. Hill Dep., Vol. 1, Exh. M hereto, at 16:6-14. During his time at ADX, Hill had some contact with Francisco. Hill testified that Francisco kept feces in his hair, ate his own feces, and practically never spoke. Hill Dep., Vol. 2,

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Exh. N hereto, at 95:24-96:10. Hill also noted that he has both been around individuals with mental illness and those who had been faking, and firmly feels that Francisco has a genuine mental illness, warning that the BOP is doing the same thing to [Francisco] that it did to him. Hill Dep., Vol. 1, Exh. M hereto, at 27:14-15; Hill Dep., Vol. 2, Exh. N hereto, at 96:17-97:7. 2. Robert Knott.

Robert Knott hung himself at ADX on September 7, 2013. Exh. T (BOP statement concerning Knott Suicide). At the time of his death he was 48 years old. Id. Mr. Knott is the seventh person, at least, to take his own life at the ADX. Compl. 93-94. Like most of the other suicide victims, Mr. Knott had been diagnosed and treated by the BOP for severe mental illness, and therefore should never have been at ADX in the first place. Specifically, public records make clear that at the time of his 1988 conviction for kidnapping, and subsequent life sentence, Mr. Knott had been diagnosed with schizophrenia. See United States v. Knott, 894 F.2d 1119, 1121 (9th Cir. 1990) (The parties agree that [Knotts] schizophrenia is a serious mental disease that satisfies the first prong of [the statutory test for the insanity defense]). Schizophrenia is a major mental illness that is characterized by serious thought disruptions and often by hallucinations, delusions and severe paranoia. Gundersen Decl., Exh. L, at 7. Schizophrenia patients also often exhibit bizarre behavior. Id. It is clear that the Department of Justice did not dispute Mr. Knotts schizophrenia diagnosis in 1988, and the limited records now available to Plaintiffs suggest that at no time since Mr. Knott entered BOP custody in 1988 has anyone seriously denied the nature or severity of his mental illness. See Exh. U (4/19/02 psychological report of Robert Knott, Exh. B to Petition to Determine Present Mental Condition of an Imprisoned Prisoner), at 1 (Throughout

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his incarceration in the Federal Bureau of Prisons, Mr. Knott has been diagnosed with schizophrenia and antisocial personality disorder). Nevertheless, in April 1995 the BOP transferred him to the ADX. See Exh. T. Thereafter, excepting only the periods of time when he was hospitalized for mental illness at Springfield MCFP, it appears that Mr. Knott remained at the ADX for the entirety of the 18 1/2 years between his first arrival there in April 1995 and his death in September 2013. See Exh. U (4/19/02 Psychological Report, summarizing Knott medical history). Most of what Plaintiffs now know about Knotts symptoms and treatment comes from two mental health evaluations filed in the U.S. District Court for the Western District of Missouri in 2002, in connection with a petition by the Department of Justice to have him civilly committed so he could be involuntarily medicated. In the evaluation submitted with the governments petition, a BOP doctor noted:

Id., at 1. Later, after discussing Knotts background, including his six prior hospitalizations at Springfield, his history of bizarre, psychotic behavior (particularly his obsessive refusal to wear clothing), and his up and down cycles of psychological functioning as he moved back and forth between prisons and BOP medical facilities, the BOP psychologist concluded in the following terms that Mr. Knott suffered from a severe psychotic disorder that at that time preclude[ed] his ability to function adequately in a regular Bureau of Prisons facility: 19

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Id., at 4. After the Department of Justice sought to civilly commit him, Knott was appointed counsel, who secured a second opinion from another psychologist. That opinion, which is attached hereto as Exhibit V, noted that Knott had refused to participate in an evaluation, making it impossible for the psychologist to render an independent diagnostic opinion. But the report also describes in detail the then-existing BOP records relating to Knott, which include references to a pre-incarceration mental health hospitalization for symptoms of severe depression and command hallucinations, and recount a series of bizarre or otherwise worrisome incidents involving Mr. Knott while in BOP custody: In 1992, staff members at Marion USP found him hanging from his cell bars in an effort to protect his body from white bugs; In 1995 he was transferred from Marion to Springfield following a suicidal gesture; In August 1996 he was sent from ADX to Springfield after cutting himself; In 1998 he was again transferred from ADX to Springfield because he was uncommunicative and refusing medication. A later report by Springfield staff is summarized as saying that upon his arrival at Springfield, he was withdrawn, evasive,

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and impulsive. In the following months, he refused to maintain proper nutrition, was labile, frequently covered the window in his cell, and engaged in yelling and screaming. In 1999 he was again transferred from ADX to Springfield after command hallucinations to kill himself.

Id. at 3-4. Even after the 2002 Springfield admission during which Mr. Knott was civilly committed and involuntarily medicated (his seventh trip to Springfield for mental problems), the BOP again violated its own policies by sending him back to the ADX. Plaintiffs presently have little information about his condition from that point until early September 2013. But Plaintiffs recent interviews of prisoners who lived near Knott during the last week or so of his life confirm that shortly before his suicide Knott again went off his medications, again decompensated, again started yelling and screaming, again became incoherent, wrote Heaven on the wall of his cell, and finally, during the evening of Saturday, September 7, hanged himself from a sheet attached to his cell bars. See, e.g., Currence Decl., Exh. W, at 4-5 and 8-12. In short, Knott was severely mentally ill, never belonged at ADX, and died when and as he did because of the BOPs patent, inexcusable disregard of his serious medical needs. His illness was obvious to anyone who looked. That he was sent back to the ADX over and over and spent years there is in and of itself a violation of BOP policy. And that he died as he did, with the signs and symptoms of psychosis everywhere, can mean only one of two things: either (1) the BOP simply doesnt care that it has an Eighth Amendment duty to care for ADX prisoners with mental illness; or (2) the BOP is incapable at a fundamental level of diagnosing and treating mental illness in men assigned to ADX. In either case, Knotts life and death reveal in searing detail the fundamental constitutional problems that this lawsuit aims to correct. That would have

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been true whenever Knott died. That he died three weeks ago, when the BOP knew we and the Court were watching, puts an exclamation point on the urgency of the persistent problems at ADX, on the reality that the half-measures instituted by the BOP since the lawsuit was filed are not nearly enough, and on the acute danger in which Jonathan Francisco lives. III. A. ARGUMENT

A Preliminary Injunction Must Be Issued Requiring Mr. Francisco To Be Transferred To An Appropriate Medical Facility For A Renewed Mental Health Evaluation To Avoid Further Medical And Mental Health Injury Akin To That Suffered By Mr. Hill.

A movant is entitled to a preliminary injunction if he can establish the following: (1) a substantial likelihood of success on the merits of the case; (2) irreparable injury to the movant if the preliminary injunction is denied; (3) the threatened injury to the movant outweighs the injury to the other party under the preliminary injunction; and (4) the injunction is not adverse to the public interest. Kikumura v. Hurley, 242 F.3d 950, 955 (10th Cir. 2001); see also Schrier v. Univ. Of Co., 427 F.3d 1253, 1258 (10th Cir. 2005); F.R.Civ.P. 65. Accordingly, we address each requirement for the granting of a preliminary injunction in turn. 1. Francisco Is Likely To Succeed On The Merits.

The Eighth Amendment prohibits the infliction of cruel and unusual punishment and embodies broad and idealistic concepts of dignity, civilized standards, humanity, and decency. Estelle v. Gamble, 429 U.S. 97, 102 (1976) (internal quotations and citations omitted). Under the Eight Amendment the government has a constitutional obligation to provide medical care for those whom it is punishing by incarceration. Estelle, 429 U.S. at 103. That duty requires tht prisoners be provided with a level of medical care which is reasonably designed to meet [their] routine and emergency health care needs. Ramos v. Lamm, 639 F.2d 559, 574 (10th Cir.1980)

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(quotation omitted). A violation of the Eighth Amendments prohibition on cruel and unusual punishments occurs when there is deliberate indifference to the serious medical needs of a prisoner. Estelle, 429 U.S. at 104. Deliberate indifference involves both an objective and a subjective component. Farmer v. Brennan, 511 U.S. 825, 834, 843-44 (1994). The objective component is met if the medical need is sufficiently serious. Id. at 834. The subjective component is met if a prison official knows of and disregards an excessive risk to inmate health or safety. Id. at 837. Francisco can prevail on each of these components. a. Francisco Is Likely To Prevail On The Objective Component Of Deliberate Indifference.

[A] medical need is sufficiently serious if it is one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a lay person would easily recognize the necessity for a doctors attention. Mata v. Saiz, 427 F.3d 745, 751 (10th Cir. 2005) (quotation omitted). Mental illness can be as serious as any other illness, and denying prisoners access to mental health diagnosis and treatment endanger[s] their health and well being, make[s] unnecessary suffering inevitable, and evince[s] on the part of the State a deliberate indifference to the serious health needs of the prison population. Id. at 5774; see also, e.g., Boyd v. Knox, 47 F.3d 966, 969 (8th Cir. 1995) (A three-week delay in dental care, coupled with knowledge of the inmate-patients suffering, can support a finding of an Eighth Amendment violation under section 1983.).
4

See also Riddle v. Mondragon, 83 F.3d 1197, 1203 (10th Cir. 1996) (The state has a constitutional obligation to provide medical care for those whom it is punishing by incarceration . . . including medical treatment for psychological or psychiatric care.); Battle v. Anderson, 564 F.2d 388, 403 (10th Cir. 1977) (a prisoner is entitled to be confined in an environment which does not result in his degeneration or which threatens his mental and physical well being); Bowring v. Godwin, 551 F.2d 44, 47 (4th Cir. 1977) (We see no underlying distinction between the right to medical care for physical ills and its psychological or psychiatric counterpart.).

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The objective component of this standard is met here by the evidence contained in the attached declarations of prisoners who live with him, day in and day out. These prisoners see his dysfunction every day, and know something is seriously wrong. See Mallett Decl., Exh. B, at 15 (something is seriously wrong with him); Clark Decl., Exh. D, at 10 (I believe Francisco is seriously mentally ill. No normal person could live like he does.); Barron Decl., Exh. F, at 7 (In my opinion, Francisco is seriously mentally ill, because of the things I have seen and heard. I do not believe any person would choose to live the way he does.); Shryock Decl., Exh. K, at 8 (It is obvious to every prisoner on our range that something is seriously wrong with Francisco.). Dr. Gundersens declaration also helps meet the objective prong. Based on her review of the evidence concerning Francisco, she believes that: Francisco is exhibiting signs and symptoms that are consistent with, and indeed in many respects characteristic of, a major mental illness, namely schizophrenia; that the living conditions at ADX, as reflected in the information available to Dr. Gundersen, expose Francisco to a risk -- and perhaps serious risk -- of disease, whether or not he is mentally ill; that there is a substantial basis to believe that Mr. Franciscos mental and physical health are both in jeopardy; and that a careful clinical examination by qualified medical and mental health professionals is necessary to determine what, if any, conditions Mr. Francisco suffers from, how to treat any conditions that are diagnosed, and how to manage Mr. Franciscos behavior in a manner that reduces the risk of future deterioration of his mental and physical health. Gundersen Decl., Exh. L, at 13. She also believes that unless addressed, Franciscos condition may become resistant to treatment, and result in irreversible physical and mental injury. Id. at 14.

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b.

Francisco Is Likely To Prevail On The Subjective Component Of Deliberate Indifference.

The subjective component of deliberate indifference is met if a prison official knows of and disregards an excessive risk to inmate health or safety. Farmer, 511 U.S. at 837; see also Mata, 427 F.3d at 752 (The deliberate indifference standard lies somewhere between the poles of negligence at one end and purpose or knowledge at the other). Determining whether a prison official had requisite knowledge of the risk to prisoner health or safety is a question of fact subject to demonstration in the usual ways, including inference from circumstantial evidence . . ., and a fact-finder may conclude that a prison official knew of a substantial risk from the very fact that the risk was obvious. Farmer, 511 U.S. at 842 (emphasis added). This is so because if a risk is obvious so that a reasonable man would realize it, we might well infer that [the defendant] did in fact realize it. Mata, 427 F.3d at 752 (internal quotes omitted). Moreover, a fact-finder may conclude that a prison official knew of a substantial risk from the very fact that the risk was obvious. Farmer, 511 U.S. at 842 (emphasis added). As the above facts set forth, Francisco is being knowingly mistreated and ignored by the BOP and ADX staff and is in severe danger of irreparable harm and injury. These risks stem from both the obvious mental health emergency that Francisco is experiencing as well as the grave risk of other health-related issues that stem from the unsanitary prison conditions that are beyond Franciscos control. Common sense confirms that Franciscos plight is obvious to anyone who chooses to look. The smell of his feces permeates the entire unit he lives in. Corrections Officers have commented to prisoners that smells nasty and I dont know how you guys put up with that, Villatoro Decl., Exh. J, at 13 (as if prisoners have any other choice), but their assistance is limited to trying to confine the smell with sandbags placed at the bottom of

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Franciscos door. Barron Decl., Exh. F, at 10. When one prisoner specifically directed an ADX psychologists attention to Franciscos plight, she walked away. Villatoro Decl., Exh. J, at 12 It is notable that at the time of this discussion, the psychologist was herself covering her nose because of the stench emanating from Franciscos cell. Id. By allowing Francisco to live in squalor, every day the BOP puts Francisco in danger of experiencing the same type of serious medical harm that Mr. Hill described in his deposition statements. Accordingly, an immediate preliminary injunction granting Francisco a mental health evaluation or transfer to an appropriate mental health facility is necessary. 2. Francisco Will Suffer Irreparable Injury If The Preliminary Injunction Is Denied.

A plaintiff suffers irreparable injury when the court would be unable to grant an effective monetary remedy after a full trial because such damages would be inadequate or difficult to ascertain. Kikumura, 242 F.3d at 963. When an alleged constitutional right is involved, most courts hold that no further showing of irreparable injury is necessary. Id (citing 11A Charles Alan Wright, Arthur R. Miller & Mary Kay Kane, Federal Practice and Procedure 2948.1 (2d ed.1995)). Here, there is a fundamental constitutional right involved. While the violation of a constitutional right alone is sufficient to demonstrate harm to Francisco, a preliminary injunction must also be granted because of the imminent risk of serious injury or death he faces if the status quo remains. The injury to Franciscos mental health is ongoing, and the longer his medical condition is allowed to remain untreated, the greater the likelihood of irreversible injury, and the graver his prognosis becomes. Gundersen Decl., Exh. L, at 14. This Tenth Circuit Court of Appeals has held that such threats to the health of an inmate constitute irreparable injury, as here, where the injury is both certain and great, not

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merely serious or substantial; of the sort that cannot be adequately atoned for in money; or one that the district court cannot remedy following a final determination on the merits. Edmisten v. Werholtz, 287 F. App'x 728, 733-34 (10th Cir. 2008) (citing Prairie Band of Potawatomi Indians v. Pierce, 253 F.3d 1234, 1250 (10th Cir.2001)) (internal quotation marks omitted). Because of the substantial evidence that Francisco suffers from obvious and severe mental illness, and because of the physical health risks his unsanitary and antisocial behavior pose, as demonstrated by the outcome of similarly-afflicted inmates like Hill and Knott, there is significant risk that Francisco will suffer irreparable harm -- and perhaps die -- if the Court allows him to remain in his current condition at ADX. 3. The Threatened Injury To The Movant Outweighs The Injury To The Government Under The Preliminary Injunction.

The threatened injury to Francisco -- irreversible injury or death -- is much greater than the injury, if any, to the government if the preliminary injunction were to be granted. Here, Francisco is exhibiting grave mental health symptoms that have gone untreated for years. The burden to the government, however, is negligible; it constitutes only the cost of transporting Francisco and providing him with necessary medical and mental health services, consistent with its preexisting obligations under the law. Indeed, removing him from ADX quite likely would reduce the burden now borne by other prisoners who are forced to ensure the stench from his cell, and the staff members who work near and with Francisco. As the Tenth Circuit has held, the burden of providing healthcare services to prisoners is not misplaced or undue if in fact one or more of the defendants is legally obligated to provide the treatment. Edmisten v. Werholtz, 287 F. Appx 728, 734 (10th Cir. 2008) (unpublished). The BOP and its institutions, including ADX, are obligated to provide inmates with necessary healthcare, because inmates are not at

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liberty to seek it on their own. Providing Francisco with the treatment he requires is, therefore, not a burden, but rather a routine requirement of its operations. In sum, because the BOP routinely transfers prisoners requiring medical and/or mental health care from ADX to private hospitals or other BOP facilities, there is little if any burden associated with granting the present motion. 4. The Injunction Would Not Be Adverse To The Public Interest.

[T]he public interest is promoted by the robust enforcement of constitutional rights, Am. Freedom Def. Initiative v. Suburban Mobility for Reg. Transp., 698 F.3d 885, 896 (6th Cir. 2012), especially those of societys most vulnerable individuals. See also Edmisten, 287 F. App'x at 735 (the public has an interest in protecting the civil rights of all persons under the Constitution; holding that defendant prison facility had a constitutional obligation to provide dental care under the Eighth Amendment, and compelling defendants to perform that duty is not contrary to the public interest. Protecting Franciscos constitutional rights is in the public interest; indeed, protecting constitutional rights is at the core of the publics interest. 5. Plaintiff Has Met Its Burden To Obtain A Preliminary Injunction.

Plaintiff recognizes that its request for a preliminary injunction in this case may fall into one or more of the disfavored categories; (1) the injunction will disturb the status quo, (2) the injunction is mandatory and not prohibitory, and (3) the injunction gives the movant substantially all of the relief it is entitled to after a trial on the merits. SCFC ILC Inc. v. VISA USA, Inc., 936 F.2d 1096, 1098-9 (10th Cir. 1991). Plaintiff also recognizes in these situations that its burden is heightened with respect to four factors necessary to obtain a preliminary injunction and the Court must, more closely scrutinize the request to assure that the exigencies of the case support the

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granting of a particularly extraordinary remedy. O Centro Espirita Beneficiente Unlao Do Vegetal v. Ashcroft, 389 F.3d 973, 983 (10th Cir. 2004). The exigencies of this case are selfevident as the safety and even the life of Francisco may hang in the balance. Plaintiff has surely met its heightened burden to obtain the relief requested in this matter. B. Exhaustion

The Prison Litigation Reform Act (PLRA) requires that prisoners exhaust available administrative remedies. 42 U.S.C. 1997e(a) (No action shall be brought . . . until such administrative remedies as are available are exhausted. (emphasis added)). But as the Tenth Circuit has explained, [i]t follows that if an administrative remedy is not available, then an inmate cannot be required to exhaust it. Because the statute does not explicitly define the term available, we must adopt its ordinary meaning. Tuckel v. Grover, 660 F.3d 1249, 1252 (10th Cir. 2011) (citing Gross v. FBL Fin. Servs., Inc., 557 U.S. 167 (2009)). Moreover, [t]o be available, a remedy must be capable of use for the accomplishment of a purpose. Id. (citing Booth v. Churner, 532 U.S. 731, 737 (2001)). The Movant here is the CLA. No BOP administrative remedy program is available to the CLA for use in advocating its constituents interests. Accordingly, there is no remedy here to exhaust. In addition, as detailed in the Rule 7.1 certification set forth below, counsel for the CLA has repeatedly called the BOPs attention to Franciscos plight over a period of months. Most recently, on or about September 3, 2013, plaintiffs counsel spoke with defendants counsel and specifically asked that in light of Richie Hills devastating deposition testimony, Francisco be moved to a medical facility immediately. Although defendants counsel agreed to confer with

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the BOP concerning this request, as of this filing, Francisco remains at the ADX. In the meantime, Robert Knott has killed himself. These circumstances and the others outlined above make clear that even if some remedy is available to the CLA in theory, in practice any request for relief would be futile, and waiting for the BOP to respond may further endanger Franciscos health, if not life. IV. RULE 7.1 CERTIFICATION

In recent months undersigned counsel for Plaintiffs has repeatedly called Franciscos plight to the BOPs attention. On or about September 3, 2013, plaintiffs counsel spoke with defendants counsel and specifically asked that Francisco be moved to a medical facility immediately. Although defendants counsel agreed to confer with the BOP concerning this request, as of this filing Francisco remains at the ADX, and defendants counsel has not responded to the request. V. CONCLUSION

For the foregoing reasons, Plaintiff the CLA respectfully asks the Court to grant its emergency motion for a preliminary injunction and require that the BOP transfer Jonathan Francisco to a suitable medical facility for a clinical examination by qualified medical and mental health professionals to determine what, if any, conditions Francisco suffers from, how to treat any conditions that are diagnosed, and how to manage Franciscos behavior in a manner that reduces the risk of future deterioration of his mental and physical health.

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Dated: September 30, 2013

Respectfully submitted, ARNOLD & PORTER LLP

By

/s/ Edwin P. Aro Edwin P. Aro 370 Seventeenth Street Suite 4400 Denver, CO 80202-1370 Telephone: +1 303.863.1000 ed.aro@aporter.com Maurice A. Leiter 777 S. Figueroa Street 44th Floor Los Angeles, CA 90017 Telephone: +1 213.243.4000 maury.leiter@aporter.com Robert P. Taylor Three Embarcadero Center 7th Floor San Francisco, CA 94111 Telephone: +1 415.471.3100 robert.taylor@aporter.com
C. Scott Morrow 555 Twelfth Street, NW Washington, D.C. 20004 Telephone: +1 202.942.5000 scott.morrow@aporter.com

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Veronica E. Rendon Keri L. Arnold 399 Park Avenue New York, NY 10022 Telephone: +1 212.715.1000 veronica.rendon@aporter.com keri.arnold@aporter.com Nancy L. Perkins 555 Twelfth Street, NW Washington, D.C. 20004 Telephone: +1 202.942.5000 nancy.perkins@aporter.com WASHINGTON LAWYERS COMMITTEE FOR CIVIL RIGHTS AND URBAN AFFAIRS Deborah Golden 11 Dupont Circle, NW Suite 400 Washington, D.C. 20036 Telephone: +1 202.319.1000 deborah_golden@washlaw.org Attorneys for Plaintiffs

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CERTIFICATE OF SERVICE The undersigned hereby certifies that on this 30th day of September, 2013, the foregoing EMERGENCY MOTION BY PLAINTIFF, CENTER FOR LEGAL ADVOCACY, FOR A PRELIMINARY INJUNCTION ORDERING DEFENDANT TO TRANSFER ADX PRISONER, JONATHAN FRANCISCO, FOR A MEDICAL EVALUATION AND TREATMENT was filed with the Clerk of the Court using the CM/ECF system which will send notification of such filing to all counsel of record as follows: Amy L. Padden U.S. Attorneys Office - Denver 1225 Seventeenth Street, Suite 700 Denver, CO 80202 amy.padden@usdoj.gov Marcy E. Cook U.S. Attorneys Office - Denver 1225 Seventeenth Street, Suite 700 Denver, CO 80202 Marcy.cook@usdoj.gov

/s/ Linda J. Teater

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