Everett Hadix v. Patricia Caruso , 420 F. App'x 480 ( 2011 )


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  •                 NOT RECOMMENDED FOR FULL-TEXT PUBLICATION
    File Name: 11a0168n.06
    Nos. 09-1424, 09-2255                              FILED
    Mar 22, 2011
    UNITED STATES COURT OF APPEALS                      LEONARD GREEN, Clerk
    FOR THE SIXTH CIRCUIT
    EVERETT HADIX et al.,                  )
    )
    Plaintiffs-Appellants,           )                  ON APPEAL FROM THE
    )                  UNITED STATES DISTRICT
    v.                                     )                  COURT FOR THE WESTERN
    )                  DISTRICT OF MICHIGAN
    PATRICIA L. CARUSO et al.,             )
    )
    Defendants-Appellees.            )                          OPINION
    )
    _______________________________________)
    Before: MOORE, SUTTON, and FRIEDMAN,* Circuit Judges.
    KAREN NELSON MOORE, Circuit Judge. This case, which has a procedural history
    spanning more than thirty years, involves a civil-rights action brought by Michigan prisoners alleging
    unconstitutional conditions of confinement. The subjects of this consolidated appeal are two orders
    entered by the district court on March 31, 2009, and September 10, 2009, which relate respectively
    to the injunctive relief ordered in November 2006 and the plaintiffs’ motion to add four new class
    representatives. With respect to the March 31, 2009 order, we AFFIRM the district court’s
    termination of the relief granted in November 2006. We hold that we lack jurisdiction to consider
    the September 10, 2009 order, however, because the district court denied without prejudice the
    *
    The Honorable Daniel M. Friedman, United States Circuit Judge for the Federal Circuit,
    sitting by designation.
    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    motion to add new named plaintiffs, and the district court has not yet considered the merits of the
    motion in the first instance.
    I. BACKGROUND
    In 1980, Everett Hadix and ten other prisoners brought a class action in the United States
    District Court for the Eastern District of Michigan on behalf of all prisoners incarcerated at the State
    Prison of Southern Michigan, Central Complex (“SPSM-CC”) against various state prison officials.
    Brought pursuant to 42 U.S.C. § 1983, the complaint alleged unconstitutional conditions of
    confinement. In 1985, the parties entered into a comprehensive Consent Decree, which was later
    approved by the district court, addressing various aspects of prison life, including safety, sanitation,
    hygiene, and protection from harm. The Consent Decree stated that its provisions were “intended
    by the parties to assure the constitutionality of the conditions under which prisoners are incarcerated
    at SPSM-CC,” although the decree contained neither an admission of liability on the part of the state
    prison officials nor any findings of constitutional violations. Joint Appendix (“J.A.”) in No. 09-1424
    at 392 (Consent Decree).
    Section II.B. of the Consent Decree addresses mental-health issues inside the SPSM. The
    mandates of these provisions were officially terminated on January 8, 2001, but, in response to the
    tragic death of an inmate suffering from mental-health problems in 2006, the district court reopened
    several aspects of the mental-health-care provisions of the Consent Decree in November 2006.
    Specifically, the district court reopened section II.B., “limited to the provisions of [the November
    2
    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    2006] Order and Preliminary Injunction.” R. 2187 (November 13, 2006 D. Ct. Order at 1). The
    district court ordered that the defendants comply with the following:
    •       “immediately cease and desist from the practice of using any form of punitive
    mechanical restraints within Hadix facilities, and [] timely develop practices,
    protocols and policies to enforce this limitation”;
    •       “immediately work to develop a staffing plan for adequate psychiatric and
    psychological staffing at Hadix facilities to ensure that routine and emergent
    psychiatric and psychological services are provided in a timely way”;
    •       “immediately work to provide daily psychologist or psychiatrist rounds in the
    segregation unit at the Hadix facilities”; and
    •       “immediately work to develop protocols for the coordination of mental health
    and medical staff, and [] require weekly conferences of the two disciplines
    which shall include . . . the treatment of prisoners in the segregation unit, and
    which shall include necessary training to prevent staff and administrative
    indifference to the provision of care . . . .”
    
    Id. at 1–3
    (emphasis removed). The district court also permitted the plaintiffs to undertake
    “discovery as to mental health care in advance of a final injunctive hearing.” 
    Id. In ordering
    this preliminary injunctive relief, the district court was mindful of the
    requirements of the Prison Litigation Reform Act (“PLRA”), which permits injunctive relief relating
    to prison conditions only if the district court finds that such relief is necessary to correct a violation
    of a federal right:
    Prospective relief in any civil action with respect to prison conditions shall extend
    no further than necessary to correct the violation of the Federal right of a particular
    plaintiff or plaintiffs. The court shall not grant or approve any prospective relief
    unless the court finds that such relief is narrowly drawn, extends no further than
    necessary to correct the violation of the Federal right, and is the least intrusive means
    necessary to correct the violation of the Federal right. The court shall give
    3
    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    substantial weight to any adverse impact on public safety or the operation of a
    criminal justice system caused by the relief.
    18 U.S.C. § 3626(a)(1)(A). In the November 2006 order, the district court found that the use of
    mechanical restraints, the inadequate mental-health-professional staffing levels, the lack of daily
    rounds by a psychologist, and the absence of a protocol for coordination of the medical and mental-
    health staff constituted deliberate indifference, in violation of the Eighth Amendment’s Cruel and
    Unusual Punishments Clause.
    After the November 2006 injunction was entered, this court heard several appeals in this case
    relating to the injunctive relief and other matters. See Hadix v. Caruso, 297 F. App’x 504, 
    2008 WL 4659809
    (6th Cir. 2008) (unpublished opinion); Hadix v. Caruso, 248 F. App’x 678, 
    2007 WL 2753026
    (6th Cir. 2007) (unpublished opinion). The parties also filed two motions in the district
    court in anticipation of a hearing on permanent injunctive relief. The defendants filed a motion to
    terminate the injunctive relief granted in November 2006, R. 2684, and the plaintiffs filed a motion
    for further injunctive relief, R. 2757. Ultimately, the district court ruled in favor of the defendants
    on both motions, R.2903 (March 31, 2009 D. Ct. Op.), prompting the plaintiffs’ appeal in No. 09-
    1424. Thereafter, the plaintiffs filed a motion to add four new class representatives because the
    previous—and sole remaining—named plaintiff was no longer a member of the Hadix class due to
    the fact that the facility at which he resided was determined to be no longer a Hadix facility. R.2915.
    The district court denied this motion without prejudice in an unnumbered docket entry on September
    4, 2009, “pending outcome of the current appeal.” In response to the plaintiffs’ motion for
    reconsideration of this order, R.2947, the district court stated that the motion for reconsideration was
    4
    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    denied without prejudice because “it is prudent to await the decision of the Court of Appeals, so that
    all parties will have the benefit of that ruling before addressing the issues raised by Plaintiff’s motion
    . . .,” R. 2949 at 1. The plaintiffs’ appeal from this denial of reconsideration constitutes the second
    part of this appeal, No. 09-2255.
    II. The Termination Of Relief Relating To The Mental-Health-Care Provisions
    The plaintiffs-appellants’ appeal of the district court’s March 31, 2009 opinion and order
    addresses both the district court’s decision to terminate the limited, preliminary injunctive relief it
    granted in November 2006, and the district court’s decision not to grant any new, additional
    injunctive relief. We have jurisdiction to consider this appeal pursuant to 28 U.S.C. § 1292(a). In
    addition, we review “decision[s] to grant or deny a preliminary or permanent injunction” for abuse
    of discretion. Kallstrom v. City of Columbus, 
    136 F.3d 1055
    , 1067 (6th Cir. 1998). “In determining
    whether the district court abused its discretion, we review the district court’s findings of fact for clear
    error and its legal conclusions de novo.” Hadix v. Johnson, 
    182 F.3d 400
    , 404 (6th Cir. 1999)
    (quoting Sandison v. Mich. High Sch. Athletic Ass’n, 
    64 F.3d 1026
    , 1030 (6th Cir. 1995)). We will
    overrule “the district court’s weighing and balancing of the equities . . . only in the rarest of cases.”
    
    Id. (quoting Six
    Clinics Holding Corp., II v. Cafcomp Sys., Inc., 
    119 F.3d 393
    , 400 (6th Cir. 1997)).
    In addition to requiring the existence of a violation of a federal right before a district court
    may grant injunctive relief in a conditions-of-confinement case, the PLRA contains several other
    provisions providing for immediate termination of injunctive relief improperly granted and
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    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    addressing the ability of the plaintiffs to keep in effect relief previously granted. These provisions
    remain focused on the existence of a violation of a federal right:
    (2) Immediate termination of prospective relief.—In any civil action with respect to
    prison conditions, a defendant or intervener shall be entitled to the immediate
    termination of any prospective relief if the relief was approved or granted in the
    absence of a finding by the court that the relief is narrowly drawn, extends no further
    than necessary to correct the violation of the Federal right, and is the least intrusive
    means necessary to correct the violation of the Federal right.
    (3) Limitation.—Prospective relief shall not terminate if the court makes written
    findings based on the record that prospective relief remains necessary to correct a
    current and ongoing violation of the Federal right, extends no further than necessary
    to correct the violation of the Federal right, and that the prospective relief is narrowly
    drawn and the least intrusive means to correct the violation.
    18 U.S.C. § 3626(b)(2)–(3). Under this standard, the defendants could obtain termination of the
    relief granted in the 2006 injunction if they convinced the district court that there was no longer a
    “current and ongoing” constitutional violation. On the other hand, the plaintiffs could prevent the
    termination of the 2006 injunctive relief if the district court found that there was still a “current and
    ongoing” constitutional violation, and that “the prospective relief is narrowly drawn and the least
    intrusive means to correct the violation.” 18 U.S.C. § 3626(b)(3).
    The district court heard testimony from both sides over seven days of hearings in April, May,
    June, and August of 2008, after which it issued a decision holding that there were no longer any
    constitutional violations in relation to the provision of mental-health care, that the plaintiffs had not
    shown any violations of the Consent Decree when seeking new injunctive relief, and that the state
    had complied with the requirements of the 2006 injunction. R.2903 (March 31, 2009 D. Ct. Op.).
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    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    The district court therefore terminated all relief relating to mental-health care, resulting in the
    complete termination of section II.B. of the Consent Decree.1
    With respect to the termination of relief already in effect from November 2006, the plaintiffs
    assert that the district court erred by applying the wrong standard for an Eighth Amendment
    deliberate-indifference violation and by failing to make certain necessary findings of fact under
    Federal Rule of Civil Procedure 52(a). The plaintiffs also argue that the district court erred in not
    modifying the Consent Decree, and in making clearly erroneous findings regarding the defendants’
    efforts to comply with the 2006 injunction. With respect to the district court’s refusal to grant
    additional prospective relief, apart from that granted in November 2006, the plaintiffs assert that the
    district court again applied the wrong standard for deliberate indifference and failed to modify the
    Consent Decree or otherwise to find a breach of the Consent Decree by the defendants. For the
    reasons that follow, we affirm the judgment of the district court.
    A. The District Court’s Conclusion That There Is No Eighth Amendment Violation
    A claim of deliberate indifference under the Eighth Amendment contains two components,
    one objective and one subjective. Farmer v. Brennan, 
    511 U.S. 825
    , 834 (1994); Comstock v.
    McCrary, 
    273 F.3d 693
    , 702 (6th Cir. 2001). The objective component requires that the plaintiff
    show a deprivation that is “sufficiently serious,” one that “pos[es] a substantial risk of serious harm.”
    
    Farmer, 511 U.S. at 834
    . The subjective component requires that the plaintiff show that the prison
    1
    We note, however, that several portions of the Consent Decree—apart from the mental-
    health provisions of section II.B.—remain open. Therefore, the termination of the mental-health
    provisions will not, in and of itself, end the entire case.
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    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    officials had a “sufficiently culpable state of mind,” specifically that “the official knows of and
    disregards an excessive risk to inmate health or safety; the official must both be aware of facts from
    which the inference could be drawn that a substantial risk of serious harm exists, and he must also
    draw the inference.” 
    Id. at 834,
    837.
    The plaintiffs claim that Farmer indicates that proof of the subjective component is not
    necessary when a party is seeking only injunctive relief, and that a previous opinion of this court in
    this litigation removes that requirement completely. Plaintiffs Br. in No. 09-1424 at 34–36 (citing
    Hadix v. Johnson, 
    367 F.3d 513
    , 526 (6th Cir. 2004)). We need not reach this issue, however,
    because, for the reasons that follow, even if the plaintiffs are correct that proof of only the objective
    component was necessary, we would affirm on the basis of the district court’s conclusion that there
    is no longer a “current and ongoing” constitutional violation.
    First, it is important to put the injunctive relief at issue here in context. The November 2006
    reopening of the Consent Decree was a “limited” one from the beginning, R. 2187 (November 13,
    2006 D. Ct. Order at 1), requiring only “specific, measurable steps carefully tied to the original
    Consent Decree,” R.2903 (March 31, 2009 D. Ct. Op. at 6). Furthermore, as part of the November
    2006 order, the district court also permitted the plaintiffs to undertake discovery “as to mental health
    care,” saving for a later date the question of whether permanent injunctive relief would be granted,
    R.2187 (November 13, 2006 D. Ct. Order at 1–2). “[T]hus,” the November 2006 order “limit[ed]
    the potential duration as well as the scope of the re-opening.” R.2903 (March 31, 2009 D. Ct. Op.
    at 6). As mentioned above, the district court ultimately held seven days of hearings through the
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    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    spring and summer of 2008 on whether to grant permanent relief related to the mental-health
    provisions of the Consent Decree.
    In its March 31, 2009 opinion on the plaintiffs’ motion for additional relief and the
    defendants’ motion to terminate the November 2006 injunctive relief, the district court engaged in
    an extensive discussion of the testimony it heard in the seven days of hearings. In doing so, it made
    findings of fact and conclusions of law regarding the issue of compliance with the terms of the
    preliminary injunction. Looking to the four specific issues identified in November 2006—the use
    of mechanical restraints, mental-health-care staffing, daily rounds, and coordination of medical and
    mental-health staff—the district court concluded that the defendants had complied with each of the
    four parts of the November 2006 order granting a limited re-opening of the Consent Decree.
    Had the district court concluded its analysis there, we would be forced to find error. As we
    have noted earlier in the course of this litigation:
    the relevant inquiry is not whether the defendants are in compliance with the consent
    decree; instead, pursuant to the PLRA, the district court must determine if the
    consent decree is currently necessary. To fulfill its statutory duty, the district court
    must make written findings as to whether “prospective relief remains necessary to
    correct a current and ongoing violation of the Federal right, extends no further than
    necessary to correct the violation of the Federal right, and that the prospective relief
    is narrowly drawn and the least intrusive means to correct the violation.”
    § 3626(b)(3). If the court finds that the current conditions at SPSM-CC do not
    violate the Constitution, then it should terminate the consent decree, regardless of
    whether the objectives of the consent decree have been achieved. If, on the other
    hand, the court finds that constitutional violations persist, then it should retain
    jurisdiction to enforce compliance with the consent decree, provided that the
    prospective relief set forth in the decree is necessary, narrowly drawn, and the least
    intrusive means to correct the violations.
    9
    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    Hadix v. Johnson, 
    228 F.3d 662
    , 673 (6th Cir. 2000) (emphasis in original). The district court did
    not end its consideration of the necessity of injunctive relief with these findings of fact, however.
    Instead, the district court proceeded to consider the issue left open in the November 2006 order:
    whether, with the benefit of having conducted a full evidentiary hearing, a “[g]eneral [r]e-opening”
    of the mental-health-care provisions was appropriate. R.2903 (March 31, 2009 D. Ct. Op. at 13).
    In this regard, the district court’s findings that the defendants had complied with the terms of the
    November 2006 preliminary injunction were relevant to its consideration of whether a current or
    ongoing constitutional violation warranted further injunctive relief.
    The district court ultimately concluded that “Plaintiffs have failed to establish by a
    preponderance of the evidence that Defendants are violating the Consent Decree provisions
    governing mental health care, or that any asserted violations of the Consent Decree are of
    constitutional proportions.” R.2903 (March 31, 2009 D. Ct. Op. at 14). In reaching this conclusion,
    the district court found credible the report and testimony of one of the defendants’ experts in
    psychiatry, Dr. Jeffrey L. Metzner. 
    Id. at 16–17.
    Dr. Metzner “reviewed a wide range of documents
    material to the Court’s November 2006 and May 2007 orders; visited Hadix facilities; met with key
    mental health, medical and administrative staff; observed mental health rounds; [and] attended a case
    management meeting.” 
    Id. at 16.
    Noting several ways in which “Dr. Metzner’s report describes
    substantial improvements in Defendants’ provision of mental health care,” the district court agreed
    with Dr. Metzner’s conclusion that the defendants’ plan to respond to the district court’s orders
    “satisfactorily addresses the Court’s stated concerns.” 
    Id. at 17.
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    Hadix et al. v. Caruso et al.
    The district court also relied upon the testimony of two other defense witnesses. First, it
    found credible the testimony of Jared Baker, “a limited license psychologist who conducted rounds
    in the [segregation unit] over a period of several months.” R.2903 (March 31, 2009 D. Ct. Op. at
    18). In the district court’s view, “Mr. Baker’s on-the-ground experience and practical perspective
    offer especially valuable insight into the provision of mental health care in the [segregation unit].
    Mr. Baker described receiving meaningful supervision throughout his rounding experience.” 
    Id. He also
    “described prompt and confidential evaluations of inmates newly-assigned to the [segregation
    unit].” 
    Id. at 19.
    Second, the district court found credible the testimony of Craig Crawford, the Unit Chief for
    the Outpatient Mental Health Team. “His responses [to questions about particular inmates] reflected
    a degree of knowledge and concern that went well beyond mere trial preparation.” 
    Id. The district
    court described him as “deeply committed to his patients.” 
    Id. “Regardless of
    whether Mr.
    Crawford, or any other mental health professional always made exactly the best possible call, Mr.
    Crawford’s testimony showed the very opposite of deliberate indifference.” 
    Id. at 20.
    The plaintiffs argue that the intake-screening process at the Hadix facilities, which is
    designed to identify prisoners with mental-health needs as they enter the prison, is grossly
    inadequate, such that it constitutes deliberate indifference to the prisoners’ mental-health needs. The
    plaintiffs point to two relevant factors in the intake-screening process that, in their view, have an
    impact on the prospects of a prisoner with mental-health-care needs: (1) “the identity of the
    11
    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    psychiatrist who is randomly assigned to evaluate the prisoner,” and (2) “whether the prisoner arrives
    with an existing prescription for psychotropic medications.” Plaintiffs Br. in No. 09-1424 at 40.
    With respect to the importance of the identity of the psychiatrist, the plaintiffs presented
    evidence that “discrepancies in the performance of [the prison’s] psychiatrists” undermine the
    effectiveness of the defendants’ “bridge order,” which ensures that prisoners coming into a Hadix
    facility while taking mental-health medication receive an examination by a mental-health practitioner
    upon entrance to the SPSM. 
    Id. at 9–14.
    To support the conclusion that these discrepancies pose
    a substantial risk of harm, the plaintiffs point to the testimony of their expert in psychiatry, Dr. Terry
    Kupers, and their expert in psychology, Dr. Robert R. Walsh. 
    Id. at 41
    (citing R.2787 (Testimony
    of Dr. Terry Kupers at 291–92) and R.2815 (Testimony of Dr. Robert R. Walsh at 675–76)). The
    district court, however, found neither expert’s testimony helpful. In particular, the district court
    believed that Dr. Kupers’s testimony is “ultimately largely beside the point.” R.2903 (March 31,
    2009 D. Ct. Op. at 21). In the district court’s view:
    Dr. Kupers identified many things the Defendants could do better. Indeed, Dr.
    Kupers often appeared to be an advocate for “best practices” care, which is laudable
    and sensible, but quite different than showing deliberate indifference. Indeed, when
    pressed by the Court on this point, the most Dr. Kupers could ultimately conclude
    was that there exists some unquantifiable risk of future harm if Defendants fail to
    adopt his recommendations. But this falls far short of the deliberate indifference
    standard. The Court heard in Dr. Kupers’s testimony further evidence of the
    complexity of caring for the mentally ill in prison, but not evidence of deliberate
    indifference. The Court also notes that Dr. Kupers, in contrast to Defendants’ expert,
    had no real experience in actually making operational decisions within a prison
    setting.
    
    Id. As for
    Dr. Walsh, the district court found him similarly unpersuasive:
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    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    Dr. Walsh’s testimony, though sincere and helpful, is not especially germane to the
    present situation. His testimony tended to focus on the practices and protocols that
    existed under his leadership [when he was the administrator of psychological services
    for the Jackson Clinical Complex] and subsequent changes in those practices and
    protocols. His testimony offered much more insight into the past than into the
    current situation. Moreover, like Dr. Kupers, his testimony focused more on
    Defendants’ alleged failure to adopt “best practices,” not on alleged systematic,
    deliberate indifference. The Court could not base any finding of deliberate
    indifference on the testimony of Dr. Walsh.
    
    Id. at 22.
    In addition, the district court was not persuaded that the evidence of discrepancies in the
    intake-screening process establishes a constitutional violation; the district court believed that “[a]t
    most, this evidence identifies possible limited cases of questionable diagnosis or treatment. But that
    does not amount to deliberate indifference under the Eighth Amendment. The Bridge Order ensures
    that psychotropic medication will continue at least until a mental health professional has an
    opportunity to make a professional judgment of the prisoner patient’s needs.” 
    Id. at 18.
    We see no clear error in these factual findings; we are not left with the “definite and firm
    conviction that a mistake has been committed.” Indmar Prods. Co. v. Comm’r, 
    444 F.3d 771
    ,
    777–78 (6th Cir. 2006). Indeed, “[w]hen findings are based on determinations regarding the
    credibility of witnesses, Rule 52(a) demands even greater deference to the trial court’s findings[.]”
    Anderson v. City of Bessemer City, 
    470 U.S. 564
    , 575 (1985).
    The district court considered and rejected the plaintiffs’ argument that the “risks presented
    by sudden discontinuations of psychotropic medication for prisoners coming into a Hadix facility”
    provided a basis for a finding of deliberate indifference. R.2903 (March 31, 2009 D. Ct. Op. at 17).
    In particular, the district court found that the defendants’ implementation of the bridge order
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    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    “promises a meaningful reduction in abrupt, potentially dangerous interruptions in psychiatric
    medications.” 
    Id. at 17.
    In support of this finding, the district court noted the testimony of Diana
    Childers, who “indicated that a policy akin to the Bridge Order would have been helpful under the
    circumstances her son experienced.” 
    Id. “All parties
    appear to agree that the Bridge Order is a
    significant step forward in improving mental health care in Hadix facilities.” 
    Id. We see
    no clear
    error in these findings.
    Given all of these factual findings by the district court, we do not believe that there was an
    objective risk of serious harm in violation of the Eighth Amendment with respect to the intake-
    screening process at the Hadix facilities. We therefore reject the plaintiffs’ argument to the contrary.
    The plaintiffs further argue that an objectively intolerable risk of serious harm exists due to
    delays experienced by prisoners in need of mental-health treatment. To this end, they point to the
    delay in providing one delusional patient (who was refusing a CT scan for a suspicious mass in his
    pelvis) access to a psychologist and a psychiatrist. It took five days for this patient to be seen by a
    psychologist and sixteen days to be seen by a psychiatrist. The plaintiffs also point to the minutes
    of a staff meeting in 2008 which noted that staff members acknowledged that there existed
    “fail[ures] to identify mental illness and suicidality. Numerous instances of a failure to see patients
    timely. Very long waiting list.” Plaintiffs Br. in No. 09-1424 at 16 (quoting J.A. in No. 09-1424 at
    1086–87). Furthermore, the plaintiffs point to testimony from Dr. Kupers that he found “[m]any
    examples” of unsupervised limited-license staff members serving as “gatekeepers” to psychiatrists.
    R.2787 (Testimony of Dr. Terry Kupers at 307). Dr. Kupers also stated his belief that limited-license
    14
    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    staff members had inadequate supervision. 
    Id. at 308.
    Lastly, the plaintiffs point out that when Dr.
    Kupers was asked if he thought that “the level of delay in access to mental health services is
    exposing prisoners to a substantial danger of serious harm,” Dr. Kupers responded, “Absolutely it
    is.” 
    Id. at 296.
    We do not believe that this evidence requires reversal of the district court’s determination
    that there was no longer a current and ongoing constitutional violation. With respect to Dr. Kupers,
    as mentioned above, the district court did not find his testimony to be persuasive in establishing
    deliberate indifference. The district court noted, for example, that Dr. Kupers’s beliefs as to what
    constituted “best practices” do not necessarily establish deliberate indifference. Rather, “[t]he Court
    heard in Dr. Kupers’s testimony further evidence of the complexity of caring for the mentally ill in
    prison.” R.2903 (March 31, 2009 D. Ct. Op. at 21). Additionally, the five- and sixteen-day time
    span before services were provided to the patient who was refusing a CT scan and the staff-meeting
    minutes from 2008 are insufficient, in our view, to warrant a judgment that the defendants have been
    deliberately indifferent to prisoners’ serious medical needs, especially in light of the district court’s
    finding that great improvements have been made with respect to mental-health-care staffing, the
    provision of daily rounds, and the coordination of mental-health and medical staff, 
    id. at 10–13,
    along with the district court’s confidence in the testimony of Metzner, Baker, and Crawford, 
    id. at 18–21.
    We therefore see no basis on which to reverse the district court’s determination that there was
    no longer a current and ongoing violation of the Eighth Amendment in the provision of mental-
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    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    health services at the Hadix facilities. We cannot say that the district court’s conclusions regarding
    an objectively “substantial risk of serious harm,” 
    Farmer, 511 U.S. at 834
    , were in error.2
    B. The Plaintiffs’ Remaining Arguments
    Given our agreement with the district court’s determination that there is no longer any
    constitutional violation with respect to the provision of mental-health care in the Hadix facilities, our
    consideration of the plaintiffs’ remaining arguments becomes simpler. First, the plaintiffs argue that
    the district court erred in failing to make certain findings of fact under Federal Rule of Civil
    Procedure 52(a). We see no merit in this argument. The district court made numerous findings of
    fact throughout its opinion, as discussed above, and these, we have determined, provided a sufficient
    basis for the district court’s legal conclusion—which we affirm today—that there was no longer an
    ongoing violation of the Eighth Amendment with respect to the provision of mental-health services
    in the Hadix facilities at the time of the district court’s judgment.
    Second, in light of our determination that the district court did not err in concluding that there
    was no longer an ongoing violation of the Eighth Amendment, we need not address the plaintiffs’
    argument that the district court erred in failing to modify or find a breach of the Consent Decree.
    2
    We also do not adopt the plaintiffs’ argument that an Eighth Amendment violation has
    occurred due to “Defendants’ practice of allowing limited-license psychologists to stop referrals to
    psychiatrists.” Plaintiffs Br. in No. 09-1424 at 44. Although the plaintiffs have pointed to the
    testimony of Dr. Kupers that, in his view, limited-license psychologists and other mental-health staff
    members require much closer supervision than they currently receive, 
    id. at 17,
    19 (citing J.A. in No.
    09-1424 at 903, 904, 907, 908, 914), we are not convinced that this constitutes an objectively
    intolerable risk of harm in the circumstances of this case. Dr. Kupers’s testimony relates to “best
    practices” care, which, as the district court found, does not establish deliberate indifference in
    violation of the Eighth Amendment’s Cruel and Unusual Punishments Clause.
    16
    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    The PLRA precludes the grant or continuation of injunctive relief in the absence of a finding of a
    constitutional violation. Finally, because the district court determined that there is no “current and
    ongoing” constitutional violation, we need not address the plaintiffs’ argument that the district court
    made clearly erroneous findings of fact regarding the defendants’ efforts to comply with the 2006
    injunction.
    C. Conclusion
    For these reasons, we conclude that the district court did not err in determining that there was
    no longer a “current and ongoing” violation of the Eighth Amendment. We therefore affirm the
    district court’s termination of all injunctive relief related to the mental-health provisions of the
    Consent Decree.
    III. The Denial Of The Motion To Add New Named Plaintiffs
    The appeal in No. 09-2255 relates to the district court’s denial of the plaintiffs’ motion to add
    four new class representatives, invoking Federal Rule of Civil Procedure 24, governing intervention.
    The need to add these new named plaintiffs arose from the fact that the district court determined in
    its March 31, 2009 order that the facility in which the sole remaining named plaintiff resided, the
    Ryan Correctional Facility, no longer constituted a Hadix facility, leaving no named Hadix class
    members. The district court denied without prejudice the motion to add new named plaintiffs in an
    unnumbered docket entry on September 4, 2009, “pending outcome of the current appeal.” The
    district court also denied the plaintiffs’ motion for reconsideration, R.2947, on the ground that if the
    U.S. Court of Appeals upholds the district court’s March 31, 2009, order in Sixth Circuit Appeal No.
    17
    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    09-1424, the scope of the remaining class may be impacted, thereby affecting the propriety of
    intervention. R. 2949 (September 10, 2009 D. Ct. Order). More specifically, the district court stated
    that the motion for reconsideration was denied because “it is prudent to await the decision of the
    Court of Appeals, so that all parties will have the benefit of that ruling before addressing the issues
    raised by Plaintiff’s motion . . . .” 
    Id. The district
    court therefore did not consider on the merits the requirements of Rule 24, opting
    instead to deny the motion without prejudice to refiling. This decision, however, is not a “final
    decision” under 28 U.S.C. § 1291 because it does not “end[] the litigation on the merits.”
    Cunningham v. Hamilton County, 
    527 U.S. 198
    , 204 (1999). It also does not fall within the
    collateral order doctrine, a “practical construction” of section 1291, because it does not “conclusively
    determine the disputed question” of whether the individuals named in the motion may be added as
    new named plaintiffs. Will v. Hallock, 
    546 U.S. 345
    , 349–50 (2006); see also Moldowan v. City of
    Warren, 
    578 F.3d 351
    , 368 (6th Cir. 2009). Indeed, the district court expressly contemplated the
    possibility of “renewal of the motion following the ruling and mandate of the Court of Appeals.”
    R.2949. Lastly, the decision below does not present issues that are “inextricably intertwined with
    an independently appealable issue,” see Turi v. Main Street Adoption Services, LLP, --- F.3d ----, No.
    09-2229, 
    2011 WL 744154
    , at *4 (6th Cir. March 4, 2011), and it does not fall within the narrow set
    of appealable orders listed in 28 U.S.C. § 1292. As a result, we lack jurisdiction to review the
    district court’s denial without prejudice of the plaintiffs’ motion to add new named plaintiffs.
    18
    Nos. 09-1424, 09-2255
    Hadix et al. v. Caruso et al.
    IV. CONCLUSION
    For these reasons, we AFFIRM the judgment of the district court terminating all injunctive
    relief relating to the mental-health provisions of the Consent Decree. We also hold that we lack
    jurisdiction to consider the district court’s denial without prejudice of the motion to add new named
    plaintiffs.
    19