Appellee, a convicted felon, was transferred from state prison
to a mental hospital pursuant to a Nebraska statute (§
83-180(1)) which provides that, if a designated physician or
psychologist finds that a prisoner "suffers from a mental disease
or defect" that "cannot be given proper treatment" in prison, the
Director of Correctional Services may transfer the prisoner to a
mental hospital. In an action challenging the constitutionality of
§ 83-180(1) on procedural due process grounds, the District
Court declared the statute unconstitutional as applied to appellee,
holding that transferring him to the mental hospital without
adequate notice and opportunity for a hearing deprived him of
liberty without due process of law contrary to the Fourteenth
Amendment, and that such transfers must be accompanied by adequate
notice, an adversary hearing before an independent decisionmaker, a
written statement by the factfinder of the evidence relied on and
the reasons for the decision, and the availability of appointed
counsel for indigent prisoners. The court permanently enjoined the
State from transferring appellee (who meanwhile had been
transferred back to prison) to the mental hospital without
following the prescribed procedures. Subsequently, appellee was
paroled on condition that he accept mental treatment, but he
violated that parole and was returned to prison. Relying on
appellee's history of mental illness and the State's representation
that he was a serious threat to his own and others' safety, the
District Court held that the parole and revocation thereof did not
render the case moot, because appellee was still subject to being
transferred to the mental hospital.
Held: The judgment is affirmed as modified. Pp.
445 U. S.
486-497;
445 U. S.
497-500.
Affirmed as modified.
MR. JUSTICE WHITE delivered the opinion of the Court with
respect to Parts I, II, III, IV-A, and V, concluding that:
1. The District Court properly found that the case is not moot.
The reality of the controversy between appellee and the State has
not been lessened by the cancellation of his parole and his return
to prison, where he is protected from further transfer by the
District Court's judgment
Page 445 U. S. 481
and injunction. Under these circumstances, it is not "absolutely
clear," absent the injunction, that the State's alleged wrongful
behavior could not reasonably be expected to recur. Pp.
445 U. S.
486-487.
2. The involuntary transfer of appellee to a mental hospital
implicates a liberty interest that is protected by the Due Process
Clause of the Fourteenth Amendment. Pp.
445 U. S.
487-494.
(a) The District Court properly identified a liberty interest
rooted in § 83-180(1), under which a prisoner could reasonably
expect that he would not be transferred to a mental hospital
without a finding that he was suffering from a mental illness for
which he could not secure adequate treatment in prison. The State's
reliance on the opinion of a designated physician or psychologist
for determining whether the conditions warranting transfer exist
neither removes the prisoner's interest from due process protection
nor answers the question of what process is due under the
Constitution. Pp.
445 U. S.
488-491.
(b) The District Court was also correct in holding that,
independently of § 83-180(1), the transfer of a prisoner from
a prison to a mental hospital must be accompanied by appropriate
procedural protections. Involuntary commitment to a mental hospital
is not within the range of conditions of confinement to which a
prison sentence subjects an individual. While a conviction and
sentence extinguish an individual's right to freedom from
confinement for the term of his sentence, they do not authorize the
State to classify him as mentally ill and to subject him to
involuntary psychiatric treatment without affording him additional
due process protections. Here, the stigmatizing consequences of a
transfer to a mental hospital for involuntary psychiatric
treatment, coupled with the subjection of the prisoner to mandatory
behavior modification as a treatment for mental illness, constitute
the kind of deprivations of liberty that requires procedural
protections. Pp. 491-494.
3. The District Court properly identified and weighed the
relevant factors in arriving at its judgment. Pp.
445 U. S.
495-496.
(a) Although the State's interest in segregating and treating
mentally ill patients is strong, the prisoner's interest in not
being arbitrarily classified as mentally ill and subjected to
unwelcome treatment is also powerful, and the risk of error in
making the determinations required by § 83-180(1) is
substantial enough to warrant appropriate procedural safeguards
against error. P.
445 U. S.
495.
(b) The medical nature of the inquiry as to whether or not to
transfer a prisoner to a mental hospital does not justify
dispensing with due process requirements. P.
445 U. S.
495.
Page 445 U. S. 482
(c) Because prisoners facing involuntary transfer to a mental
hospital are threatened with immediate deprivation of liberty
interests, and because of the risk of mistaken transfer, the
District Court properly determined that certain procedural
protections, including notice and an adversary hearing, were
appropriate in the circumstances present in this case. Pp.
445 U. S.
495-496.
MR. JUSTICE WHITE, joined by MR. JUSTICE BRENNAN, MR. JUSTICE
MARSHALL, and MR. JUSTICE STEVENS, concluded in Part IV-B that it
is appropriate that counsel be provided to indigent prisoners whom
the State seeks to treat as mentally ill. Such a prisoner has an
even greater need for legal assistance than does a prisoner who is
illiterate and uneducated, because he is more likely to be unable
to understand or exercise his rights. Pp.
445 U. S.
496-497.
MR. JUSTICE POWELL concluded that, although the State is free to
appoint a licensed attorney to represent a prisoner who is
threatened with involuntary transfer to a mental hospital, it is
not constitutionally required to do so, and that due process will
be satisfied so long as such a prisoner is provided qualified and
independent assistance. Pp.
445 U. S.
497-500.
WHITE, J., announced the Court's judgment and delivered the
opinion of the Court with respect to Parts I, II, III, IV-A, and V,
in which BRENNAN, MARSHALL, POWELL, and STEVENS, JJ., joined, and
an opinion with respect to Part IV-B, in which BRENNAN, MARSHALL,
and STEVENS, JJ., joined. POWELL, J., filed an opinion concurring
in part,
post, p.
445 U. S. 497. STEWART, J., filed a dissenting opinion,
in which BURGER, C.J., and REHNQUIST, J., joined,
post, p.
445 U. S. 500.
BLACKMUN, J., filed a dissenting opinion,
post, p.
445 U. S.
501.
MR. JUSTICE WHITE delivered the opinion of the Court, except as
to Part IV-B.
The question in this case is whether the Due Process Clause of
the Fourteenth Amendment entitles a prisoner convicted and
incarcerated in the State of Nebraska to certain procedural
Page 445 U. S. 483
protections, including notice, an adversary hearing, and
provision of counsel, before he is transferred involuntarily to a
state mental hospital for treatment of a mental disease or
defect.
I
Nebraska Rev.Stat. § 8176(2) (1976) authorizes the Director
of Correctional Services to designate any available, suitable, and
appropriate residence facility or institution as a place of
confinement for any state prisoner and to transfer a prisoner from
one place of confinement to another. Section 8180(1), however,
provides that, when a designated physician or psychologist finds
that a prisoner "suffers from a mental disease or defect" and
"cannot be given proper treatment in that facility," the director
may transfer him for examination, study, and treatment to another
institution within or without the Department of Correctional
Services. [
Footnote 1] Any
prisoner so transferred to a mental hospital is to be returned to
the Department if, prior to the expiration of his sentence,
treatment is no longer necessary. Upon expiration of sentence,
Page 445 U. S. 484
if the State desires to retain the prisoner in a mental
hospital, civil commitment proceedings must be promptly commenced.
§ 83-180(3). [
Footnote
2]
On May 31, 1974, Jones was convicted of robbery and sentenced to
a term of three to nine years in state prison. He was transferred
to the penitentiary hospital in January, 1975. Two days later, he
was placed in solitary confinement, where he set his mattress on
fire, burning himself severely. He was treated in the burn unit of
a private hospital. Upon his release and based on findings required
by § 83-180 that he was suffering from a mental illness or
defect and could not receive proper treatment in the penal complex,
he was transferred to the security unit of the Lincoln Regional
Center, a state mental hospital under the jurisdiction of the
Department of Public Institutions.
Jones then intervened in this case, which was brought by other
prisoners against the appropriate state officials (the State)
challenging on procedural due process grounds the adequacy of the
procedures by which the Nebraska statutes permit transfers from the
prison complex to a mental hospital. [
Footnote 3] On August 17, 1976, a three-judge District
Court, convened
Page 445 U. S. 485
pursuant to 28 U.S.C. § 2281 (1970 ed.), [
Footnote 4] denied the State's motion for
summary judgment, and trial ensued. On September 12, 1977, the
District Court declared § 83-180 unconstitutional as applied
to Jones, holding that transferring Jones to a mental hospital
without adequate notice and opportunity for a hearing deprived him
of liberty without due process of law contrary to the Fourteenth
Amendment, and that such transfers must be accompanied by adequate
notice, an adversary hearing before an independent decisionmaker, a
written statement by the factfinder of the evidence relied on and
the reasons for the decision, and the availability of appointed
counsel for indigent prisoners.
Miller v.
Vitek, 437 F.
Supp. 569 (Neb.1977). Counsel was requested to suggest
appropriate relief.
In response to this request, Jones revealed that, on May 27,
1977, prior to the District Court's decision, he had been
transferred from Lincoln Regional Center to the psychiatric ward of
the penal complex, but prayed for an injunction against further
transfer to Lincoln Regional Center. The State conceded that an
injunction should enter if the District Court was firm in its
belief that the section was unconstitutional. The District Court
then entered its judgment declaring § 83-180 unconstitutional
as applied to Jones and permanently enjoining the State from
transferring Jones to Lincoln Regional Center without following the
procedures prescribed in its judgment.
We noted probable jurisdiction 434 U.S. 1060 (1978). Meanwhile,
Jones had been paroled, but only on condition that he accept
psychiatric treatment at a Veterans' Administration Hospital. We
vacated the judgment of the District Court and remanded the case to
that court for consideration
Page 445 U. S. 486
of the question of mootness.
Vitek v. Jones,
436 U. S. 407
(1978). Both the State and Jones, at this juncture, insisted that
the case was not moot. The State represented that, because "Jones'
history of mental illness indicates a serious threat to his own
safety, as well as to that of others . . . there is a very real
expectation" that he would again be transferred if the injunction
was removed. App. to Juris.Statement 24. Jones insisted that he was
receiving treatment for mental illness against his will, and that
he was continuing to suffer from the stigmatizing consequences of
the previous determination that he was mentally ill. On these
representations, the District Court found that the case was not
moot, because Jones "is subject to and is in fact under threat of
being transferred to the state mental hospital under §
83-180."
Ibid. The District Court reinstated its original
judgment. We postponed consideration of jurisdiction to a hearing
on the merits. 441 U.S. 922 (1979). Meanwhile, Jones had violated
his parole, his parole had been revoked, and he had been
reincarcerated in the penal complex.
II
We agree with the parties in this case that a live controversy
exists and that the case is not moot. Jones was declared to be
mentally ill pursuant to § 8180, and was transferred to a
mental hospital and treated. He was later paroled, but only on
condition that he accept mental treatment. He violated that parole,
and has been returned to the penal complex. On our remand to
consider mootness, the District Court, relying on Jones' history of
mental illness and the State's representation that he represented a
serious threat to his own safety as well as to that of others,
found that Jones "is in fact under threat of being transferred to
the state mental hospital under § 8180." We see no reason to
disagree with the District Court's assessment at that time, and the
reality of the controversy between Jones and the State has not been
lessened by the cancellation of his parole and his return to the
state prison,
Page 445 U. S. 487
where he is protected from further transfer by the outstanding
judgment and injunction of the District Court. The State, believing
that the case is not moot, wants the injunction removed by the
reversal of the District Court's judgment. Jones, on the other
hand, insists that the judgment of the District Court be sustained
and the protection against transfer to a mental hospital, except in
accordance with the specified procedures, be retained.
Against this background, it is not "absolutely clear," absent
the injunction, "that the allegedly wrongful behavior could not
reasonably be expected to recur."
United States v. Phosphate
Export Assn., 393 U. S. 199,
393 U. S. 203
(1968);
County of Los Angeles v. Davis, 440 U.
S. 625,
440 U. S. 631
(1979);
United States v. W. T. Grant Co., 345 U.
S. 629,
345 U. S. 633
(1953). [
Footnote 5]
Furthermore, as the matter now stands, the § 83-180
determination that Jones suffered from mental illness has been
declared infirm by the District Court. Vacating the District
Court's judgment as moot would not only vacate the injunction
against transfer, but also the declaration that the procedures
employed by the State afforded an inadequate basis for declaring
Jones to be mentally ill. In the posture of the case, it is not
moot.
III
On the merits, the threshold question in this case is whether
the involuntary transfer of a Nebraska state prisoner to a mental
hospital implicates a liberty interest that is protected by the Due
Process Clause. The District Court held that it did, and offered
two related reasons for its conclusion. The District Court first
identified a liberty interest rooted in
Page 445 U. S. 488
§ 83-180(1), under which a prisoner could reasonably expect
that he would not be transferred to a mental hospital without a
finding that he was suffering from a mental illness for which he
could not secure adequate treatment in the correctional facility.
Second, the District Court was convinced that characterizing Jones
as a mentally ill patient and transferring him to the Lincoln
Regional Center had "some stigmatizing" consequences which,
together with the mandatory behavior modification treatment to
which Jones would be subject at the Lincoln Center, constituted a
major change in the conditions of confinement amounting to a
"grievous loss" that should not be imposed without the opportunity
for notice and an adequate hearing. We agree with the District
Court in both respects.
A
We have repeatedly held that state statutes may create liberty
interests that are entitled to the procedural protections of the
Due Process Clause of the Fourteenth Amendment. There is no
"constitutional or inherent right" to parole,
Greenholtz v.
Nebraska Penal Inmates, 442 U. S. 1,
442 U. S. 7
(1979), but once a State grants a prisoner the conditional liberty
properly dependent on the observance of special parole
restrictions, due process protections attach to the decision to
revoke parole.
Morrissey v. Brewer, 408 U.
S. 471 (1972). The same is true of the revocation of
probation.
Gagnon v. Scarpelli, 411 U.
S. 778 (1973). In
Wolff v. McDonnell,
418 U. S. 539
(1974), we held that a state-created right to good-time credits,
which could be forfeited only for serious misbehavior, constituted
a liberty interest protected by the Due Process Clause. We also
noted that the same reasoning could justify extension of due
process protections to a decision to impose "solitary" confinement,
because
"[it] represents a major change in the conditions of
confinement, and is normally imposed only when it is claimed and
proved that there has been a major act of misconduct."
Id. at
418 U. S.
571-572, n.19. Once a State has
Page 445 U. S. 489
granted prisoners a liberty interest, we held that due process
protections are necessary "to insure that the state-created right
is not arbitrarily abrogated."
Id. at
418 U. S.
557.
In
Meachum v. Fano, 427 U. S. 215
(1976), and
Montanye v. Haymes, 427 U.
S. 236 (1976), we held that the transfer of a prisoner
from one prison to another does not infringe a protected liberty
interest. But in those cases, transfers were discretionary with the
prison authorities, and in neither case did the prisoner possess
any right or justifiable expectation that he would not be
transferred except for misbehavior or upon the occurrence of other
specified events. Hence, "the predicate for invoking the protection
of the Fourteenth Amendment as construed and applied in
Wolff
v. McDonnell [was] totally nonexistent."
Meachum v. Fano,
supra at
427 U. S.
226-227.
Following
Meachum v. Fano and
Montanye v.
Haymes, we continued to recognize that state statutes may
grant prisoners liberty interests that invoke due process
protections when prisoners are transferred to solitary confinement
for disciplinary or administrative reasons.
Enomoto v.
Wright, 434 U. S. 1052
(1978),
summarily aff'g 462 F.
Supp. 397 (ND Cal.1976). Similarly, in
Greenholtz v.
Nebraska Penal Inmates, supra, we held that state law granted
petitioners a sufficient expectancy of parole to entitle them to
some measure of constitutional protection with respect to parole
decisions.
We think the District Court properly understood and applied
these decisions. Section 83-180(1) provides that, if a designated
physician finds that a prisoner "suffers from a mental disease or
defect" that "cannot be given proper treatment" in prison, the
Director of Correctional Services may transfer a prisoner to a
mental hospital. The District Court also found that, in practice,
prisoners are transferred to a mental hospital only if it is
determined that they suffer from a mental disease or defect that
cannot adequately be treated within the penal complex. This
"objective expectation, firmly fixed in state law and official
Penal Complex practice," that
Page 445 U. S. 490
a prisoner would not be transferred unless he suffered from a
mental disease or defect that could not be adequately treated in
the prison, gave Jones a liberty interest that entitled him to the
benefits of appropriate procedures in connection with determining
the conditions that warranted his transfer to a mental hospital.
Under our cases, this conclusion of the District Court is
unexceptionable.
Appellants maintain that any state-created liberty interest at
Jones had was completely satisfied once a physician or psychologist
designated by the director made the findings required by §
8180(1), and that Jones was not entitled to any procedural
protections. [
Footnote 6] But
if the State grants a prisoner
Page 445 U. S. 491
a right or expectation that adverse action will not be taken
against him except upon the occurrence of specified behavior,
"the determination of whether such behavior has occurred becomes
critical, and the minimum requirements of procedural due process
appropriate for the circumstances must be observed."
Wolff v. McDonnell, 418 U.S. at
418 U. S. 558.
These minimum requirements being a matter of federal law, they are
not diminished by the fact that the State may have specified its
own procedures that it may deem adequate for determining the
preconditions to adverse official action. In
Morrissey,
Gagnon, and
Wolff, the States had adopted their own
procedures for determining whether conditions warranting revocation
of parole, probation, or good-time credits had occurred; yet we
held that those procedures were constitutionally inadequate. In
like manner, Nebraska's reliance on the opinion of a designated
physician or psychologist for determining whether the conditions
warranting a transfer exist neither removes the prisoner's interest
from due process protection nor answers the question of what
process is due under the Constitution.
B
The District Court was also correct in holding that,
independently of § 83-180(1), the transfer of a prisoner from
a prison to a mental hospital must be accompanied by appropriate
procedural protections. The issue is whether, after a conviction
for robbery, Jones retained a residuum of liberty that would be
infringed by a transfer to a mental hospital without complying with
minimum requirements of due process.
We have recognized that, for the ordinary citizen, commitment to
a mental hospital produces "a massive curtailment of liberty,"
Humphrey v. Cady, 405 U. S. 504,
405 U. S. 509
(1972), and, in
Page 445 U. S. 492
consequence, "requires due process protection."
Addington v.
Texas, 441 U. S. 418,
441 U. S. 425
(1979);
O'Connor v. Donaldson, 422 U.
S. 563,
422 U. S. 580
(1975) (BURGER, C.J., concurring). The loss of liberty produced by
an involuntary commitment is more than a loss of freedom from
confinement. It is indisputable that commitment to a mental
hospital "can engender adverse social consequences to the
individual," and that,
"[w]hether we label this phenomena 'stigma' or choose to call it
something else . . . , we recognize that it can occur, and that it
can have a very significant impact on the individual."
Addington v. Texas, supra at
441 U. S.
425-426.
See also Parham v. J.R., 442 U.
S. 584,
442 U. S. 600
(1979). Also, "[a]mong the historic liberties" protected by the Due
Process Clause is the "right to be free from, and to obtain
judicial relief for, unjustified intrusions on personal security."
Ingraham v. Wright, 430 U. S. 651,
430 U. S. 673
(1977). Compelled treatment in the form of mandatory behavior
modification programs, to which the District Court found Jones was
exposed in this case, was a proper factor to be weighed by the
District Court.
Cf. Addington v. Texas, supra at
441 U. S.
427.
The District Court, in its findings, was sensitive to these
concerns:
"[T]he fact of greater limitations on freedom of action at the
Lincoln Regional Center, the fact that a transfer to the Lincoln
Regional Center has some stigmatizing consequences, and the fact
that additional mandatory behavior modification systems are used at
the Lincoln Regional Center combine to make the transfer a 'major
change in the conditions of confinement' amounting to a 'grievous
loss' to the inmate."
Miller v. Vitek, 437 F. Supp. at 573.
Were an ordinary citizen to be subjected involuntarily to these
consequences, it is undeniable that protected liberty interests
would be unconstitutionally infringed absent compliance with the
procedures required by the Due Process Clause.
Page 445 U. S. 493
We conclude that a convicted felon also is entitled to the
benefit of procedures appropriate in the circumstances before he is
found to have a mental disease and transferred to a mental
hospital.
Undoubtedly, a valid criminal conviction and prison sentence
extinguish a defendant's right to freedom from confinement.
Greenholtz v. Nebraska Penal Inmates, 442 U.S. at
442 U. S. 7. Such
a conviction and sentence sufficiently extinguish a defendant's
liberty "to empower the State to confine him in any of its
prisons."
Meachum v. Fano, 427 U.S. at
422 U. S. 224
(emphasis deleted). It is also true that changes in the conditions
of confinement having a substantial adverse impact on the prisoner
are not, alone, sufficient to invoke the protections of the Due
Process Clause "[a]s long as the conditions or degree of
confinement to which the prisoner is subjected is within the
sentence imposed upon him."
Montanye v. Haymes, 427 U.S.
at
427 U. S.
242.
Appellants maintain that the transfer of a prisoner to a mental
hospital is within the range of confinement justified by imposition
of a prison sentence, at least after certification by a qualified
person that a prisoner suffers from a mental disease or defect. We
cannot agree. None of our decisions holds that conviction for a
crime entitles a State not only to confine the convicted person,
but also to determine that he has a mental illness and to subject
him involuntarily to institutional care in a mental hospital. Such
consequences visited on the prisoner are qualitatively different
from the punishment characteristically suffered by a person
convicted of crime. Our cases recognize as much, and reflect an
understanding that involuntary commitment to a mental hospital is
not within the range of conditions of confinement to which a prison
sentence subjects an individual.
Bastrom v. Herold,
383 U. S. 107
(1966);
Specht v. Patterson, 386 U.
S. 605 (1967);
Humphrey v. Cady, 405 U.
S. 504 (1972);
Jackson v. Indiana, 406 U.
S. 715,
406 U. S.
724-725 (1972). A criminal conviction and sentence of
imprisonment extinguish an individual's
Page 445 U. S. 494
right to freedom from confinement for the term of his sentence,
but they do not authorize the State to classify him as mentally ill
and to subject him to involuntary psychiatric treatment without
affording him additional due process protections.
In light of the findings made by the District Court, Jones'
involuntary transfer to the Lincoln Regional Center pursuant to
§ 83-180, for the purpose of psychiatric treatment, implicated
a liberty interest protected by the Due Process Clause. Many of the
restrictions on the prisoner's freedom of action at the Lincoln
Regional Center, by themselves, might not constitute the
deprivation of a liberty interest retained by a prisoner,
see
Wolff v. McDonnell, 418 U.S. at
418 U. S. 572,
n.19;
cf. Baxter v. Palmigiano, 425 U.
S. 308,
425 U. S. 323
(1976). But here, the stigmatizing consequences of a transfer to a
mental hospital for involuntary psychiatric treatment, coupled with
the subjection of the prisoner to mandatory behavior modification
as a treatment for mental illness, constitute the kind of
deprivations of liberty that requires procedural protections.
IV
The District Court held that, to afford sufficient protection to
the liberty interest it had identified, the State was required to
observe the following minimum procedures before transferring a
prisoner to a mental hospital:
"A. Written notice to the prisoner that a transfer to a mental
hospital is being considered;"
"B. A hearing, sufficiently after the notice to permit the
prisoner to prepare, at which disclosure to the prisoner is made of
the evidence being relied upon for the transfer and at which an
opportunity to be heard in person and to present documentary
evidence is given;"
"C. An opportunity at the hearing to present testimony of
witnesses by the defense and to confront and cross-examine
witnesses called by the state, except
Page 445 U. S. 495
upon a finding, not arbitrarily made, of good cause for not
permitting such presentation, confrontation, or
cross-examination;"
"D. An independent decisionmaker;"
"E. A written statement by the factfinder as to the evidence
relied on and the reasons for transferring the inmate;"
"F. Availability of legal counsel, furnished by the state, if
the inmate is financially unable to furnish his own; and"
"G. Effective and timely notice of all the foregoing
rights."
437 F. Supp. at 575.
A
We think the District Court properly identified and weighed the
relevant factors in arriving at its judgment. Concededly, the
interest of the State in segregating and treating mentally ill
patients is strong. The interest of the prisoner in not being
arbitrarily classified as mentally ill and subjected to unwelcome
treatment is also powerful, however; and as the District Court
found, the risk of error in making the determinations required by
§ 83-180 is substantial enough to warrant appropriate
procedural safeguards against error.
We recognize that the inquiry involved in determining whether or
not to transfer an inmate to a mental hospital for treatment
involves a question that is essentially medical. The question
whether an individual is mentally ill and cannot be treated in
prison "turns on the meaning of the facts, which must be
interpreted by expert psychiatrists and psychologists."
Addington v. Texas, 441 U.S. at
441 U. S. 429.
The medical nature of the inquiry, however, does not justify
dispensing with due process requirements. It is precisely "[t]he
subtleties and nuances of psychiatric diagnoses" that justify the
requirement of adversary hearings.
Id. at
441 U. S.
430.
Because prisoners facing involuntary transfer to a mental
hospital are threatened with immediate deprivation of liberty
Page 445 U. S. 496
interests thy are currently enjoying and because of the inherent
risk of a mistaken transfer, the District Court properly determined
that procedures similar to those required by the Court in
Morrissey v. Brewer, 408 U. S. 471
(1972), were appropriate in the circumstances present here.
The notice requirement imposed by the District Court no more
than recognizes that notice is essential to afford the prisoner an
opportunity to challenge the contemplated action and to understand
the nature of what is happening to him.
Wolff v. McDonnell,
supra at
418 U. S. 564.
Furthermore, in view of the nature of the determinations that must
accompany the transfer to a mental hospital, we think each of the
elements of the hearing specified by the District Court was
appropriate. The interests of the State in avoiding disruption was
recognized by limiting in appropriate circumstances the prisoner's
right to call witnesses, to confront and cross-examine. The
District Court also avoided unnecessary intrusion into either
medical or correctional judgments by providing that the independent
decisionmaker conducting the transfer hearing need not come from
outside the prison or hospital administration. 437 F. Supp. at
574.
B *
The District Court did go beyond the requirements imposed by
prior cases by holding that counsel must be made available to
inmates facing transfer hearings if they are financially unable to
furnish their own. We have not required the automatic appointment
of counsel for indigent prisoners facing other deprivations of
liberty,
Gagnon v. Scarpelli, 411 U.S. at
411 U. S. 790;
Wolff v. McDonnell, supra at
418 U. S.
569-570; but we have recognized that prisoners who are
illiterate and uneducated have a greater need for assistance in
exercising their rights.
Gagnon v. Scarpelli, supra at
411 U. S.
786-787;
Wolff v. McDonnell, supra at
418 U. S. 570.
A prisoner thought to be suffering from a
Page 445 U. S. 497
mental disease or defect requiring involuntary treatment
probably has an even greater need for legal assistance, for such a
prisoner is more likely to be unable to understand or exercise his
rights. In these circumstances, it is appropriate that counsel be
provided to indigent prisoners whom the State seeks to treat as
mentally ill.
V
Because MR JUSTICE POWELL, while believing that Jones was
entitled to competent help at the hearing, would not require the
State to furnish a licensed attorney to aid him, the judgment below
is affirmed as modified to conform with the separate opinion filed
by MR. JUSTICE POWELL.
So ordered.
* This part is joined only by MR. JUSTICE BRENNAN, MR. JUSTICE
MARSHALL, and MR JUSTICE STEVENS.
[
Footnote 1]
Section 83-180(1) provides:
"When a physician designated by the Director of Correctional
Services finds that a person committed to the department suffers
from a physical disease or defect, or when a physician or
psychologist designated by the director finds that a person
committed to the department suffers from a mental disease or
defect, the chief executive officer may order such person to be
segregated from other persons in the facility. If the physician or
psychologist is of the opinion that the person cannot be given
proper treatment in that facility, the director may arrange for his
transfer for examination, study, and treatment to any
medical-correctional facility, or to another institution in the
Department of Public Institutions where proper treatment is
available. A person who is so transferred shall remain subject to
the jurisdiction and custody of the Department of Correctional
Services and shall be returned to the department when, prior to the
expiration of his sentence, treatment in such facility is no longer
necessary."
[
Footnote 2]
Section 83-180(3) provides:
"When two psychiatrists designated by the Director of
Correctional Services find that a person about to be released or
discharged from any facility suffers from a mental disease or
defect of such a nature that his release or discharge will endanger
the public safety or the safety of the offender, the director shall
transfer him to, or if he has already been transferred, permit him
to remain in, a psychiatric facility in the Department of Public
Institutions and shall promptly commence proceedings applicable to
the civil commitment and detention of persons suffering from such
disease or defect."
[
Footnote 3]
After initially certifying this case as a class action, the
District Court decertified the class, but permitted intervention by
three individual plaintiffs, including Jones. The District Court
subsequently dismissed the claims of all plaintiffs except Jones,
who is the sole appellee in this Court.
[
Footnote 4]
The statute authorizing the convening of a three-judge court, 28
U.S.C. § 2281 (1970 ed.), was repealed by Pub.L. 9381, 90
Stat. 1119, effective for actions commenced after August 12, 1976.
Because the instant action was filed on November 12, 1975, the
three-judge court was properly convened.
[
Footnote 5]
Because Jones has not completed serving his sentence, he remains
subject to the transfer procedures he challenges, unlike the
plaintiff in
Weinstein v. Bradford, 423 U.
S. 147 (1975), where a challenge to parole procedures
was held to be moot because plaintiff had completed his sentence
and there was no longer any likelihood whatsoever that he would
again be subjected to the parole procedures he challenged.
[
Footnote 6]
A majority of the Justices rejected an identical position in
Arnett v. Kennedy, 416 U. S. 134,
416 U. S.
166-167 (1974) (opinion of POWELL, J., joined by
BLACKMUN, J.),
416 U. S.
177-178 (opinion of WHITE, J.),
416 U. S.
210-211 (opinion of MARSHALL, J., joined by Douglas and
BRENNAN, JJ.). As MR. JUSTICE POWELL's opinion observed:
"The plurality opinion evidently reasons that the nature of
appellee's interest in continued federal employment is necessarily
defined and limited by the statutory procedures for discharge, and
that the constitutional guarantee of procedural due process accords
to appellee no procedural protections against arbitrary or
erroneous discharge other than those expressly provided in the
statute. The plurality would thus conclude that the statute
governing federal employment determines not only the nature of
appellee's property interest, but also the extent of the procedural
protections to which he may lay claim. It seems to me that this
approach is incompatible with the principles laid down in
[Board of Regents v.] Roth[, 408 U. S.
564 (1972)] and
[Perry v.] Sindermann[,
408 U. S.
593 (1972)]. Indeed, it would lead directly to the
conclusion that, whatever the nature of an individual's statutorily
created property interest, deprivation of that interest could be
accomplished without notice or a hearing at any time. This view
misconceives the origin of the right to procedural due process.
That right is conferred not by legislative grace, but by
constitutional guarantee. While the legislature may elect not to
confer a property interest in federal employment, it may not
constitutionally authorize the deprivation of such an interest,
once conferred, without appropriate procedural safeguards. As our
cases have consistently recognized, the adequacy of statutory
procedures for deprivation of a statutorily created property
interest must be analyzed in constitutional terms.
Goldberg v.
Kelly, 397 U. S. 254 (1970);
Bell
v. Burson, 402 U. S. 535 (1971);
Board
of Regents v. Roth, supra; Perry v. Sindermann, supra."
Id. at
416 U. S.
166-167.
MR. JUSTICE POWELL, concurring in part.
I join the opinion of the Court except for
445 U.
S. I agree with Part IV-B insofar as the Court holds
that qualified and independent assistance must be provided to an
inmate who is threatened with involuntary transfer to a state
mental hospital. I do not agree, however, that the requirement of
independent assistance demands that a licensed attorney be
provided. [
Footnote 2/1]
Page 445 U. S. 498
I
In
Gagnon v. Scarpelli, 411 U.
S. 778 (1973), my opinion for the Court held that
counsel is not necessarily required at a probation revocation
hearing. In reaching this decision, the Court recognized both the
effects of providing counsel to each probationer and the likely
benefits to be derived from the assistance of counsel. "The
introduction of counsel into a revocation proceeding [would] alter
significantly the nature of the proceeding,"
id. at
411 U. S. 787,
because the hearing would inevitably become more adversary. We
noted that probationers would not always need counsel, because, in
most hearings, the essential facts are undisputed. In lieu of a
per se rule, we held that the necessity of providing
counsel should be determined on a case-by-case basis. In
particular, we stressed that factors governing the decision to
provide counsel include (i) the existence of factual disputes or
issues which are "complex or otherwise difficult to develop or
present," and (ii) "whether the probationer appears to be capable
of speaking effectively for himself."
Id. at
411 U. S. 790,
411 U. S.
791.
Consideration of these factors, and particularly the capability
of the inmate, persuades me that the Court is correct that
independent assistance must be provided to an inmate before he may
be transferred involuntarily to a mental hospital. The essence of
the issue in an involuntary commitment proceeding will be the
mental health of the inmate. The resolution of factual disputes
will be less important than the ability to understand and analyze
expert psychiatric testimony that is often expressed in language
relatively incomprehensible to laymen. It is unlikely that an
inmate threatened with involuntary transfer to mental hospitals
will possess the competence or training to protect adequately his
own interest in these state-initiated proceeding. And the
circumstances of being imprisoned without normal access to others
who may assist him places an additional handicap upon an inmate's
ability to represent himself. I therefore agree
Page 445 U. S. 499
that due process requires the provision of assistance to an
inmate threatened with involuntary transfer to a mental
hospital.
II
I do not believe, however, that an inmate must always be
supplied with a licensed attorney. "[D]ue Process is flexible and
calls for such procedural protections as the particular situation
demands."
Morrissey v. Brewer, 408 U.
S. 471,
408 U. S. 481
(1972).
See Mathews v. Eldridge, 424 U.
S. 319,
424 U. S.
334-335 (1976). Our decisions defining the necessary
qualifications for an impartial decisionmaker demonstrate that the
requirements of due process turn on the nature of the determination
which must be made.
"Due Process has never been thought to require that the neutral
and detached trier of fact be law trained or a judicial or
administrative officer."
Parham v. J.R., 442 U. S. 584,
442 U. S. 607
(1979). In that case, we held that due process is satisfied when a
staff physician determines whether a child may be voluntarily
committed to a state mental institution by his parents. That
holding was based upon recognition that the issues of civil
commitment "are essentially medical in nature," and that
"
neither judges nor administrative hearing officers are better
qualified than psychiatrists to render psychiatric judgments.'"
Id. at 442 U. S. 607,
442 U. S. 609,
quoting In re Roger S., 19 Cal. 3d
921, 942, 569 P.2d 1286, 1299 (1977) (Clark, J., dissenting).
See also Morrissey v. Brewer, supra at 408 U. S. 489;
Goldberg v. Kelly, 397 U. S. 254,
397 U. S. 271
(1970).
In my view, the principle that due process does not always
require a law-trained decisionmaker supports the ancillary
conclusion that due process may be satisfied by the provision of a
qualified and independent adviser who is not a lawyer. As in
Parham v. J.R., the issue here is essentially medical.
Under state law, a prisoner may be transferred only if he "suffers
from a mental disease or defect" and "cannot be given proper
treatment" in the prison complex. Neb.Rev.Stat.
Page 445 U. S. 500
§ 83-180(1) (1976). The opinion of the Court allows a
nonlawyer to act as the impartial decisionmaker in the transfer
proceeding.
Ante at
445 U. S. 496.
[
Footnote 2/2]
The essence of procedural due process is a fair hearing. I do
not think that the fairness of an informal hearing designed to
determine a medical issue requires participation by lawyers. Due
process merely requires that the State provide an inmate with
qualified and independent assistance. Such assistance may be
provided by a licensed psychiatrist or other mental health
professional. Indeed, in view of the nature of the issue involved
in the transfer hearing, a person possessing such professional
qualifications normally would be preferred. As the Court notes,
"[t]he question whether an individual is mentally ill and cannot
be treated in prison 'turns on the meaning of the facts, which must
be interpreted by expert psychiatrists and psychologists.'"
Ante at
445 U. S. 495,
quoting
Addington v. Texas, 441 U.
S. 418,
441 U. S. 429
(1979). I would not exclude, however, the possibility that the
required assistance may be rendered by competent laymen in some
cases. The essential requirements are that the person provided by
the State be competent and independent, and that he be free to act
solely in the inmate's best interest.
In sum, although the State is free to appoint a licensed
attorney to represent an inmate, it is not constitutionally
required to do so. Due process will be satisfied so long as an
inmate facing involuntary transfer to a mental hospital is provided
qualified and independent assistance.
[
Footnote 2/1]
I also agree with the Court's holding that this case is not
moot. The question is whether appellee faces a substantial threat
that he will again be transferred to a state mental hospital.
See Doran v. Salem Inn, Inc., 422 U.
S. 922,
422 U. S.
930-932 (1975);
Steffel v. Thompson,
415 U. S. 452,
415 U. S.
458-460 (1974);
Doe v. Bolton, 410 U.
S. 179,
410 U. S. 188
(1973). He was involuntarily transferred from the prison complex to
a mental institution, and thereafter paroled upon condition that he
continue to receive psychiatric treatment. When he violated parole,
he was returned to prison. The State advises us that appellee's
"history of mental illness indicates a serious threat to his own
safety, as well as to that of others," and "there is a very real
expectation" of transfer if the District Court injunction were
removed. App. to Juris.Statement 24. The District Court concluded
that appellee is under threat of transfer. In these circumstances,
it is clear that a live controversy remains in which appellee has a
personal stake.
See Seatrain Shipbuilding Corp. v. Shell Oil
Co., 444 U. S. 572,
444 U. S.
581-583 (1980).
[
Footnote 2/2]
The District Court specifically held that "a judicial officer is
not required, and the decisionmaker need not be from outside the
prison or hospital administration."
Miller v.
Vitek, 437 F.
Supp. 569, 574 (Neb.1977) (three-judge court).
MR. JUSTICE STEWART, with whom THE CHIEF JUSTICE and MR. JUSTICE
REHNQUIST join, dissenting.
It seems clear to me that this case is now moot. Accordingly, I
would vacate the judgment and remand the case to
Page 445 U. S. 501
the District Court with directions to dismiss the complaint.
United States v. Munsingwear, Inc., 340 U. S.
36.
As the Court points out, this is not a class action, and the
appellee is now incarcerated in the Nebraska Penal and Correctional
Complex with an anticipated release date in March 1982.
See
ante at
445 U. S.
485-487, and n. 3. In that status, the appellee is
simply one of thousands of Nebraska prisoners, with no more
standing than any other to attack the constitutionality of
Neb.Rev.Stat. § 83-180(1) (1976) on the sole basis of the mere
possibility that someday that statute might be invoked to transfer
him to another institution.
Although the appellee was once transferred in accord with §
83-180(1), there is no demonstrated probability that that will ever
happen again.
Weinstein v. Bradford, 423 U.
S. 147. And this case is not one that, by its nature
falls, within the ambit of the "capable of repetition, yet evading
review" exception to established principles of mootness.
See
Southern Pacific Terminal Co. v. ICC, 219 U.
S. 498;
Super Tire Engineering Co. v. McCorkle,
416 U. S. 115. If
the appellee should again be threatened with transfer under the
allegedly infirm statute, there will be ample time to reach the
merits of his claim.
"'To adjudicate a cause which no longer exists is a proceeding
which this Court uniformly has declined to entertain.'
Brownlow
v. Schwartz, 261 U. S. 216,
261 U. S.
217-218."
Oil Workers v. Missouri, 361 U.
S. 363,
316 U. S.
371.
MR. JUSTICE BLACKMUN, dissenting.
I agree with MR. JUSTICE STEWART that this case is not properly
before us. I write separately to express my own reasons for
reaching that conclusion.
The claimed harm that gave birth to this lawsuit was the alleged
deprivation of liberty attending appellee's transfer to the Lincoln
Regional Center. It is clear to me that that asserted injury
disappeared, at the latest, when appellee was
Page 445 U. S. 502
granted parole. [
Footnote 3/1]
Cf. Preiser v. Newkirk, 422 U. S. 395
(1975). So did any immediate threat that that injury would be
suffered again. Appellee has been returned to custody, however, and
the
Page 445 U. S. 503
parties agree that his reincarceration, coupled with his history
of mental problems, has brought the controversy back to life.
Given these facts, the issue is not so much one of mootness as
one of ripeness. At most, although I think otherwise, it is a case
presenting a "mixed question" of ripeness and mootness, hinging on
the possibility that the challenged procedures will be applied
again to appellee. This Court has confronted mixed questions of
this kind in cases presenting issues "capable of repetition, yet
evading review,"
see, e.g., Nebraska Press Assn. v.
Stuart, 427 U. S. 539
(1976), and
Sosna v. Iowa, 419 U.
S. 393 (1975), and in cases concerning the cessation of
challenged conduct during the pendency of litigation,
see,
e.g., Walling v. Helmerich & Payne, Inc., 323 U. S.
37,
323 U. S. 43
(1944). In those contexts, the Court has lowered the ripeness
threshold so as to preclude manipulation by the parties or the mere
passage of time from frustrating judicial review. MR JUSTICE
STEWART correctly observes, and the Court apparently concedes,
however, that the "capable of repetition" doctrine does not apply
here. Neither does the liberal rule applied in "voluntary
cessation" cases, since the current state of affairs is in no way
the product of the appellants' voluntary discontinuation of their
challenged conduct. [
Footnote 3/2]
Certainly it is not the result of any effort on the part of the
appellants to avoid review by this Court. Thus, since these mixed
mootness/ripeness rules are inapplicable, this case presents for me
nothing more than a plain, old-fashioned question of ripeness.
[
Footnote 3/3]
Page 445 U. S. 504
The Court's cases lay down no mechanistic test for determining
whether a dispute is ripe for adjudication. But past formulations
are uniformly more rigorous than the one the Court now applies. The
Court has observed that "[p]ast exposure to illegal conduct does
not, in itself, show a present case or controversy,"
O'Shea v.
Littleton, 414 U. S. 488,
414 U. S. 495
(1974), and that "general assertions or inferences" that illegal
conduct will recur do not render a case ripe.
Id. at
414 U. S. 497.
"A hypothetical threat is not enough."
Public Workers v.
Mitchell, 330 U. S. 75,
330 U. S. 90
(1947). There must be "actual present or immediately threatened
injury resulting from unlawful governmental action."
Laird v.
Tatum, 408 U. S. 1,
408 U. S. 15
(1972).
See Linda R. S. v. Richard D., 410 U.
S. 614,
410 U. S. 617
(1973) (requiring "some threatened or actual injury");
Massachusetts v. Mellon, 262 U. S. 447,
262 U. S. 488
(1923) (requiring that the litigant "has sustained or is
immediately in danger of sustaining some direct injury"). A
"substantial controversy, between parties having adverse legal
interests, of sufficient immediacy and reality" is required.
Glolden v. Zwickler, 394 U. S. 103,
394 U. S. 108
(1969), quoting
Maryland Casualty Co. v. Pacific Coal & Oil
Co., 312 U. S. 270,
312 U. S. 273
(1941).
Page 445 U. S. 505
Applying these principles, I have difficulty in perceiving an
existing "case or controversy" here. Since our remand, the state
officials have indicated nothing more than that they have a general
right to apply their statute, and to apply it to appellee, if
necessary. [
Footnote 3/4] They have
not expressed a present intent or desire to transfer appellee to a
mental facility pursuant to the challenged provisions. Nor have
they suggested that they may transfer appellee to the Lincoln
Regional Center now on the basis of the diagnosis made five years
ago. And they have not suggested that they would subject appellee
immediately to a "fresh" psychiatric evaluation if the District
Court's injunction were lifted. The appellee has represented that
he "does not reside in the psychiatric unit of the Nebraska Penal
and Correctional Complex, nor is he receiving or accepting
psychiatric treatment." Brief for Appellee 11-12. The brief
containing that statement was filed some six months ago, and some
nine months after the revocation of appellee's parole.
In sum, for all that appears, appellee has been assimilated once
again into the general prison population, and appellants, at least
at this time, are content to leave him where he is. [
Footnote 3/5] Given these facts,
determining whether prison officials within two years again will
seek to send appellee to a mental institution
Page 445 U. S. 506
"takes this into the area of speculation and conjecture."
O'Shea v. Littleton, 414 U.S. at
414 U. S. 497.
Cf. Longshoremen v. Boyd, 347 U.
S. 222 (1954).
It is for these reasons that I would vacate the judgment of the
District Court and remand the case to that court with directions to
dismiss the complaint.
[
Footnote 3/1]
The Court does not appear to share this view. It states that,
even while at the Veterans' Administration Hospital, appellee Jones
"insisted that he was receiving treatment for mental illness
against his will."
Ante at
445 U. S. 486.
It adds that appellee was "paroled, but only on condition that he
accept psychiatric treatment."
Ibid. The Court does not
identify the precise import of these facts, but a fair inference is
that they are meant to suggest that this case -- even during the
time of appellee's parole -- might properly have been pursued on
the theory that the appellee was continuing to feel the effects of
the alleged deprivation of constitutional rights in receiving
inpatient care at the Veterans' Administration Hospital.
I cannot accept this suggestion. First, its premise appears to
be faulty. The District Court did not find, and it does not appear
clearly in the record, that the parole board's offer or appellee's
acceptance of parole was in any way related to his prior transfer
to the Lincoln Regional Center. Appellee chose to accept
conditional parole. Moreover, at the time appellee elected to go on
parole, he was being housed at the penal complex, not at the
Lincoln Regional Center. Thus, it is not surprising that the
District Court based its finding of nonmootness solely on its
conclusion that appellee -- notwithstanding his conditioned release
-- was "under threat of being transferred to the state mental
hospital under § 83-180." App. to Juris.Statement 24. Second,
the "continuing injury" theory seems to me to be incorrect as a
matter of law. Appellee did not seek or evince any interest in
seeking release from the Veterans' Administration Hospital, and a
declaration that his initial transfer had been illegal would have
neither justified nor predictably led to appellee's removal from
that facility. In other words, after accepting the conditional
grant of parole, appellee could no longer show, as required by the
"case or controversy" requirement, "that he personally would
benefit in a tangible way from the court's intervention."
Warth
v. Seldin, 422 U. S. 490,
422 U. S. 508
(1975).
The Court also finds some support for its holding in the fact
that vacating the District Court's order would remove the
declaration that the challenged procedures "afforded an inadequate
basis for declaring Jones to be mentally ill."
Ante at
445 U. S. 487.
If the Court, by this statement, means to imply that appellee's
suit is somehow mootness-proof due to the continuing stigma
resulting from the transfer to the mental hospital, I cannot accept
that sweeping proposition. The Court has never suggested that the
"collateral consequences" doctrine of
Sibron v. New York,
392 U. S. 40
(1968), which saves an action challenging the validity of a
conviction after a prisoner has served his sentence, also saves a
challenge to a commitment by a patient who has been released from a
mental hospital. Nor does the logic of
Sibron -- focusing
on tangible and remediable collateral consequences, such as use of
a prior conviction to enhance a sentence for a later crime, or to
impeach credibility if one appears as a witness -- comfortably
extend to the claim of a former mental patient.
See id. at
392 U. S. 55
(referring to "adverse collateral legal consequences").
[
Footnote 3/2]
The decisions to award and revoke parole were made by the
Nebraska Parole Board, not by appellants.
[
Footnote 3/3]
It is not clear whether the Court views this as a "voluntary
cessation" case. It nowhere expressly relies on the doctrine, and
does not explain what factors might justify characterizing
appellee's present situation as the result of voluntary cessation
of illegal conduct by appellants. On the other hand, each of the
three decisions cited by the Court to support its application of a
"creampuff" ripeness standard,
County of Los Angeles v.
Davis, 440 U. S. 625,
440 U. S. 631
(1979);
United States v. Phosphate Export Assn.,
393 U. S. 199,
393 U. S. 203
(1968);
United States v. W. T. Grant Co., 345 U.
S. 629,
345 U. S. 633
(1953), pivoted on the presence of "voluntary cessation." It is
therefore unclear whether the Court deems this a "voluntary
cessation" case (without explaining why), or deems the "no
reasonable expectation of recurrence" standard -- to date a litmus
carefully confined by a policy-tailored and principled "voluntary
cessation" rule -- applicable to an amorphous cluster of facts
having nothing to do with parties' artful dodging of well founded
litigation. In either event, the Court's analysis invites the
criticism, increasingly voiced, that this Court's decisions on
threshold issues "are concealed decisions on the merits of the
underlying constitutional claim." Tushnet, The New Law of Standing:
A Plea for Abandonment, 62 Cornell L.Rev. 663 (1977).
[
Footnote 3/4]
Appellants, to be sure, have announced their intention to
continue to use the challenged procedures. That fact, however, is
of small, if any, significance, for it is hardly surprising to hear
state officials say that they plan to abide by the State's own
laws.
See Public Workers v. Mitchell, 330 U. S.
75,
330 U. S. 91
(1947) ("the existence of the law and the regulations" does not
alone render a suit ripe).
Cf. Poe v. Ullman, 367 U.
S. 497 (1961) (desuetude statute).
[
Footnote 3/5]
I do not go so far as MR. JUSTICE STEWART does when he says that
appellee is "simply one of thousands of Nebraska prisoners."
Ante at
445 U. S. 501.
For purposes of the "case or controversy" requirement, appellee
differs from his fellow inmates in two relevant respects: he has a
recent history of perceived psychiatric problems, and, in fact, he
was previously transferred pursuant to the challenged statutes.
Cf. O'Shea v. Littleton, 414 U.S. at 496 ("Of course, past
wrongs are evidence bearing on whether there is a real and
immediate threat of repeated injury").