Joanne Minich  et al. 
Luis S. Spencer et al.  No. 133923
May 17, 2016
MEMORANDUM OF DECISION AND ORDER ON DEFENDANTS'
MOTION TO DISMISS
D. Wilson, Justice of the Superior Court.
plaintiffs, severely mentally ill individuals, allege that
they were secluded and restrained unnecessarily and for
prolonged periods at Bridgewater State Hospital ("
Bridgewater") where they were involuntarily civilly
committed. Claiming that the seclusion and restraint violated
their state and federal rights, they commenced this lawsuit
against the Commonwealth, the Department of Correction
(" DOC"), former DOC Commissioner Luis S. Spencer
(" Spencer"), and former Bridgewater Superintendent
Robert Murphy (" Murphy") (collectively, "
defendants") seeking damages for violations of 42
U.S.C. § 1983 (Count I), G.L.c. 123, § 21 (Count
II), and the Americans with Disabilities Act ("
ADA") and the Rehabilitation Act (Count IV); and seeking
declaratory judgments for violations of G.L.c. 123, §
21, and the Massachusetts Declaration of Rights (Count III),
and for violations of the ADA and the Rehabilitation Act
(Count V). Before me is the defendants' motion to
dismiss. For the following reasons, the defendants'
motion is ALLOWED in part and DENIED in
March 2014, the plaintiffs filed a prior lawsuit in Norfolk
County against the current defendants, as
well as the Massachusetts Partnership for Correctional
Healthcare, LLC, and Marcia Fowler in her capacity as
commissioner of the Massachusetts Department of Mental Health
(" DMH") (" Norfolk Action"). See Amended
Complaint, pars. 53-59 (discussing Norfolk Action). In the
Norfolk Action, the plaintiffs alleged that the illegal
restraint and seclusion at Bridgewater violated G.L.c. 123,
§ 21; violated Article 10 of the Massachusetts
Declaration of Rights; violated G.L.c. 12, § 11I;
violated 42 U.S.C. § 1983; and breached the 1987
settlement agreement concerning seclusion and restraint at
Bridgewater between two Bridgewater patients and the
Secretary of Health and Human Services, the Commissioner of
Correction, and the Superintendent of Bridgewater. See
Amended Complaint, pars. 22-24 (discussing 1987 agreement).
parties sealed the Norfolk Action in December 2014 pursuant
to a Settlement Agreement. See Amended Complaint, par. 59
(discussing Settlement Agreement). The Settlement Agreement
" represent[ed] a full and fair resolution of the claims
for relief alleged in" the plaintiffs' amended
complaint, Settlement Agreement, par. 103; and "
address[ed] issues concerning the use of Seclusion and
Restraint at [Bridgewater], including Plaintiffs'
allegations about the purported prolonged, inappropriate,
and/or non-emergency placement of Patients in Seclusion
and/or Restraint in violation of G.L.c. 123, § 21, and
Plaintiffs' inadequate medical and mental health care
claims under the state and federal constitutions related
solely to the use of Seclusion and Restraint."
Settlement Agreement, par. 38. The parties agreed that
certain matters were outside the scope of the Settlement
Agreement and therefore not settled but are still open:
The Parties disagree as to whether the following practices at
[Bridgewater] constitute Restraint under G.L.c. 123 but agree
not to attempt to resolve their differences in this Action or
Agreement. Therefore, for the purposes of this Agreement
solely, Restraint shall not refer to: (a) the temporary use
of mechanical devices with a Patient for safety or security
purposes when the Patient is being transported within
[Bridgewater]; or (b) the temporary use of mechanical devices
with a Patient for safety or security purposes to prevent
injury to Patients as a result of any medical or physical
The Parties disagree as to whether the following practices at
[Bridgewater] constitute Seclusion under G.L.c. 123 but agree
not to attempt to resolve their differences in this Action or
Agreement. Therefore, for the purposes of this Agreement
solely, Seclusion shall not refer to: (a) placement of a
Patient in his room on a housing unit for the night at the
regular hour of sleep or after 6:30 p.m. upon the
Patient's request; (b) temporary placement of a Patient
alone in a room for not longer than ninety (90) minutes to
await medical assessment and/or treatment; (c) voluntary,
temporary placement of a Patient in a room designated by the
Superintendent as a Quiet Room; or (d) temporary placement of
a Patient in a room for patient and inmate counts and
movement. Likewise, the Parties disagree as to whether
Seclusion or Restraint orders can be renewed only upon
personal examination by a physician or psychiatrist after a
Patient has been in Seclusion or Restraint for more than six
Agreement, pars. 40-41. The parties also agreed that:
Nothing in this Agreement shall constitute a waiver by any
Plaintiff . . . of any individual claim against any Defendant
in a court of competent jurisdiction for monetary damages or
concerning matters outside the scope of this Agreements . . .
Defendants agree that plaintiffs John Doe, Peter Minich, and
Felipe Zomosa shall be able to file any claim for monetary
damages in any court of competent jurisdiction after
execution of this Agreement, subject to any applicable notice
requirements. In any such action by these three Plaintiffs,
Defendants shall not raise as a defense the failure of these
three Plaintiffs to seek monetary damages in this [Norfolk]
Action and Defendants shall waive the defenses of res
judicata, issue preclusion, and collateral estoppel with
regard to this [Norfolk] Action.
Agreement, par. 119.
court (Wilson, J.) approved the Settlement Agreement on March
purposes of a motion to dismiss under Rule 12(b)(6), the
court must " accept as true the allegations in the
complaint and draw every reasonable inference in favor of the
plaintiff." Curtis v. Herb Chambers I-95, Inc.,
458 Mass. 674, 676, 940 N.E.2d 413 (2011).
Pursuant to G.L.c. 123, § 21 (the " Restraint
Law"), Bridgewater patients can only be secluded or
restrained " in cases of emergency, such as the
occurrence of, or serious threat of, extreme violence,
personal injury, or attempted suicide[, ]" G.L.c. 123,
§ 21, third par.; only physicians can authorize
restraint lasting more than six hours, G.L.c. 123, § 21,
seventh par.; and " no adult shall be restrained for
more than six hours beyond which time an order may be renewed
only upon personal examination by a physician."
Id. ; Amended Complaint, par. 29. Bridgewater has
also adopted regulations governing seclusion and restraint,
103 BSH § 651.00 et seq., which provide, among other
things, that seclusion and restraint cannot " be used
for punishment, convenience, discipline, or failure to take
non-court-ordered medication[, ]" 103 BSH §
651.02(2); and set forth certain preliminary interventions
for staff to take before secluding or restraining a patient.
103 BSH § 651.03; Amended Complaint, par. 28.
" Intensive Treatment Unit" (" ITU") is
the separate unit where Bridgewater places secluded and
restrained patients. Amended Complaint, par. 33. The thirteen
cells have solid steel doors, a window for observation, and a
slot for meal delivery. Id. While inside, patients
are denied exercise, adequate clean clothes, adequate
showers, and sensory stimulation including reading materials,
and access to visitors and telephone calls is restricted.
Amended Complaint, pars. 2, 7, 33.
at Bridgewater fall into four categories: mentally ill
prisoners; individuals who have been found not guilty by
reason of insanity; individuals undergoing criminal
competency or responsibility evaluations; and individuals who
have been found to be incompetent to stand trial or not
criminally responsible and are civilly committed to
Bridgewater for " care and treatment." Amended
Complaint, pars. 183-84; see G.L.c. 123, § 15(b), §
16(b). Bridgewater makes no distinction among these
categories. Amended Complaint, par. 186. The plaintiffs fall
into the fourth category, which comprises the majority of
Bridgewater patients. Amended Complaint, pars. 184-85.
Peter Minich (" Minich") has been diagnosed with
schizophrenia. After being criminally charged, he was
confined to Bridgewater from January 14, 2013, through June
26, 2014, first for a competency evaluation pursuant to
G.L.c. 123, § 15(b), then, upon being deemed incompetent
to stand trial, he was committed pursuant to G.L.c. 123,
§ 16(b). Amended Complaint, par. 60. While at
Bridgewater, he spent over 6, 600 hours in
seclusion and over 800 hours in restraint,
rates that are more than 1, 000 times the 2013 national
average for psychiatric facilities. Amended Complaint, pars.
2, 68; see Amended Complaint, par. 102 (detailing
Massachusetts Disabled Persons Protection Commission
investigation concluding that Minich " was placed in
seclusion and restraint on occasion when he was not
presenting threatening behavior").
Felipe Zomosa (" Zomosa") has been diagnosed with
schizophrenia and bipolar disorder. Amended Complaint, par.
103. Zomosa was committed to Bridgewater pursuant to G.L.c.
123, § 15, following his alleged assault of a
psychiatrist at another psychiatric hospital; after six
months, his civil commitment was extended because of paranoid
delusions. Amended Complaint, par. 103. Zomosa was at
Bridgewater from April 24, 2013, to May 29, 2014. Amended
Complaint, pars. 110, 131. Immediately upon his arrival in
April 2013, Zomosa was placed in seclusion despite the lack
of emergency situation. Amended Complaint, par. 110. During
his first year at Bridgewater, Zomosa spent over 4, 400 hours
in seclusion-- more than half of his time at
Bridgewater--and over 337 hours in mechanical
restraints, with some periods of seclusion and restraint
lasting for months. Amended Complaint, par. 106; see Amended
Complaint, par. 135 (detailing Massachusetts Disabled Persons
Protection Commission investigation concluding that Zomosa
" was placed in seclusion and restraint on occasions
when he was not presenting threatening behavior"). These
rates are more than 500 times the 2013 national average.
Amended Complaint, par. 2.
Jeffrey Doe (" Doe") has been diagnosed with
autism, intellectual disability, and schizophrenia. Amended
Complaint, par. 137. After being charged with misdemeanor
assault and battery on a public employee on November 21,
2013, Doe was sent to Bridgewater for a competency
evaluation; he was deemed incompetent to stand trial and was
civilly committed to Bridgewater for care and treatment.
Amended Complaint, par. 141. Doe spent ten months at
Bridgewater, from November 28, 2013, through September 2014.
Amended Complaint, par. 142, 171. On his first day at
Bridgewater, Doe was immediately placed in seclusion even
though there was no indication that he was acting in an
assaultive manner. Amended Complaint, par. 151. During his
first six months, he spent approximately 1, 532 hours--almost
half of his time at Bridgewater--in seclusion. Amended
Complaint, par. 143. He was not placed in seclusion because
of emergency situations but rather because he gave "
latent responses, " was difficult to understand, and
placed his hands down his pants. Amended Complaint, par. 153;
see Amended Complaint, pars. 155-56, 161-62; see also Amended
Complaint, par. 181 (detailing Massachusetts Disabled Persons
Protection Commission investigation concluding that Doe
" was placed in seclusion and restraint on occasions
when he was not presenting threatening behavior"). He
was also secluded as a means of punishment. Amended
Complaint, par. 163.
three plaintiffs were subjected to seclusion and restraint
for punitive and disciplinary purposes, not under emergency
situations. Amended Complaint, par. 30. As a matter of custom
and practice, DOC staff did not attempt to de-escalate
situations or treat the plaintiffs to avoid seclusion and
restraint. Amended Complaint, par. 74, 84 (Minich); Amended
Complaint, pars. 117, 119 (Zomosa). Correctional officers
made the decisions to seclude and restrain the plaintiffs,
and often used excessive force. Amended Complaint,
pars. 32, 186. Nurses, rather than licensed physicians, would
often renew the plaintiffs' seclusions and restraints
after six hours, and renewals would occur when they were
calm, compliant, or sleeping. Amended Complaint, pars. 93-94
(Minich); Amended Complaint, pars. 125-26 (Zomosa); Amended
Complaint, pars. 157-60, 173-74 (Doe). The plaintiffs allege
that this seclusion and restraint constituted undue restraint
and unsafe treatment in violation of their constitutional
liberty interest, and caused them severe physical and
psychological injuries. Amended Complaint, pars. 32, 38, 207;
pars. 82, 100 (Minich); Amended Complaint, pars. 133, 134
(Zomosa); Amended Complaint, pars. 133, 134, 167-70, 172,
179-80 (Doe); see Amended Complaint, par. 102 (Minich), par.
135 (Zomosa), par. 181 (Doe). Seclusion and restraint rates
for the plaintiffs decreased after they filed this suit in
March 2014. Amended Complaint, par. 8.
seclusion and restraint that the plaintiffs experienced were
common practice at Bridgewater. Amended Complaint, par. 31.
Between 2004 and 2013, total hours of seclusion and restraint
at Bridgewater rose sixteen percent, from 1, 215 hours per 1,
000 patient days in 2004, to 1, 410 hours per 1, 000 patient
days in 2013. Id. ; see G.L.c. 123, § 21,
twelfth par. (requiring that Bridgewater keep "
statistical records" of restraints). Further,
Bridgewater patients were secluded and restrained at a rate
of more than 100 times the patients at DMH facilities and the
patients at other psychiatric hospitals in the United States.
Amended Complaint, par. 31.
they left Bridgewater, the plaintiffs went to DMH facilities;
while there, they were provided with more extensive treatment
services than they received at Bridgewater; at the DMH
facilities, the plaintiffs were barely secluded or restrained
at all. Amended Complaint, par. 209. As contrasted with
patients at DMH facilities, Bridgewater patients have
boilerplate treatment plans, are denied exercise programs and
other activities, and do not receive regular therapy with
licensed mental health professionals; there are insufficient
mental-health-worker-to-patient ratios and restrictive
visitation procedures; and it is an inadequate facility to
treat mentally ill individuals. Amended Complaint, pars.
189-98. Additionally, DMH has adopted regulations to minimize
and protect patients from the use of seclusion and restraint.
Amended Complaint, pars. 199-204, citing 104 Code.Mass.Regs.
§ § 27.12, 27.14.
their positions as commissioner and superintendent,
respectively, Spencer and Murphy were aware of the
undue seclusion and restraint at Bridgewater, but they failed
to take any corrective action. See Amended Complaint, par. 35
(allegations concerning Murphy's knowledge); Amended
Complaint, pars. 39-49 (allegations concerning Spencer's
knowledge); see also Amended Complaint, par. 9 (noting that
Spencer and Murphy received " formal reprimands . . .
for misconduct relating to investigations into the 2009 death
of a Bridgewater patient in restraints" and that there
have been " [t]hree restraint related deaths since
2009"). The Restraint Law required Spencer, as
commissioner, to receive " [c]opies of all restraint
forms . . . [and] review and sign them within thirty days . .
." G.L.c. 123, § 21, twelfth par. Spencer refused
to comply with this statutory obligation, thereby delaying
the discovery that the plaintiffs were subjected to undue
restraint and unsafe treatment in violation of their
constitutional liberty interest. Amended Complaint, pars. 4,
46; see Amended Complaint, pars. 48, 98, 129, 177. The
Restraint Law obligated Murphy, as superintendent of
Bridgewater, to authorize " [t]he maintenance of any
adult in restraint for more than eight hours in any
twenty-four hour period . . ." G.L.c. 123, § 21,
ninth par. The Restraint Law also imposed on Murphy "
[r]esponsibility and liability for the implementation of the
provisions of the Restraint Law. G.L.c. 123, § 21,
thirteenth par. Murphy did not comply with his statutory
obligations, causing the plaintiffs to be placed in prolonged
seclusion and restraint. Amended Complaint, par. 5; see
Amended Complaint, pars. 35, 97, 128, 176.
and Murphy's failures to comply with their statutory
obligations under the Restraint Law resulted in seclusion and
restraint occurring at Bridgewater at a rate of more than 100
times the 2013 national average. Amended Complaint, par. 6;
see Amended Complaint, par. 41 (alleging that reports of
seclusion and restraint at Bridgewater that Spencer received
quarterly documented that rate of seclusion and restraint was
100 times higher than national averages). The plaintiffs
allege that they have a " constitutional right to . . .
protections to minimize the harsh affects [sic] of prolonged
seclusion and restraint . . . [including] the right to
reasonable exercise, the right to adequate food, hygiene and
clothing, the right to minimally adequate treatment, the
right to safe conditions of confinement and the right to
reasonable visitation from family members." Amended
Complaint, par. 29.
Standard of Review
party moving to dismiss pursuant to Mass.R.Civ.P. 12(b)(6)
contends that the complaint fails " to state a claim
upon which relief can be granted . . ." " While a
complaint attacked by a . . . motion to dismiss does not need
detailed factual allegations . . . a plaintiff's
obligation to provide the 'grounds' of his
'entitle[ment] to relief' requires more than labels
and conclusions . . ." Iannacchino v. Ford Motor
Co., 451 Mass. 623, 636, 888 N.E.2d 879 (2008) (ellipses
and alteration in original), quoting Bell A. Corp. v.
Twombly, 550 U.S. 544, 555, 127 S.Ct. 1955, 167 L.Ed.2d
929 (2007). " Factual allegations must be enough to
raise a right to relief above the speculative level . . .
[based] on the assumption that all the allegations in the
complaint are true (even if doubtful in fact) . . ."
Id. (ellipses and alteration in original), quoting
Bell A. Corp., 550 U.S. at 555. Therefore, the
pleading stage requires " factual 'allegations
plausibly suggesting (not merely consistent with)' an
entitlement to relief, in order to 'reflect[ ] the
threshold requirement of [Fed.R.Civ.P.] 8(a)(2) that the
" plain statement" possess enough heft to "
sho[w] that the pleader is entitled to relief."
'" Id. (alterations in original), quoting
Bell A. Corp., 550 U.S. at 557.
Claims Under 42 U.S.C. § 1983--Count I
Count I, the plaintiffs seek damages for violations of their
federal constitutional rights under 42 U.S.C. § 1983.
Section 1983 of Title 42 of the United States Code provides
that " [e]very person who, under color of any statute,
ordinance, regulation, custom, or usage of any State . . .
subjects, or causes to be subjected, any citizen of the
United States . . . to the deprivation of any rights,
privileges, or immunities secured by the Constitution and
laws, shall be liable to the party injured in an action at
law, suit in equity, or other proper proceeding for redress .
. ." In Count I, the plaintiffs allege that Murphy and
Spencer violated 42 U.S.C. § 1983 by their tolerance of
the systemic abuse of restraint and seclusion at Bridgewater.
Murphy and Spencer seek the dismissal of this claim on the
basis that the plaintiffs cannot state a claim for
supervisory liability and that, regardless, Murphy and
Spencer are entitled to qualified immunity.
defendants argue that, to hold Murphy and Spencer liable as
supervisors, the plaintiffs must allege more than mere
negligence, and the plaintiffs must allege a link between the
employee's misconduct and the supervisor's act or
omission. The defendants have correctly stated the law.
[A]n official cannot be held vicariously liable for the
conduct of his subordinates--instead, such official can only
be held liable on the basis of his own acts or omissions . .
. A supervisor may be held liable for a subordinate's
acts where  the subordinate's behavior resulted in a
constitutional violation and  the
supervisor's action or inaction was " affirmatively
linked" to the behavior in that  it could be
characterized as " supervisory encouragement,
condonation or acquiescence" or gross negligence
amounting to " deliberate indifference."
Williams v. Bisceglia, 115 F.Supp.3d 184, 188
(D.Mass. 2015) (internal citation omitted) (emphasis in
original); see Ramirez-Lluveras v. Rivera Merced,
759 F.3d 10, 19 (1st Cir. 2014); Clancy v. McCabe,
441 Mass. 311, 317, 805 N.E.2d 484 (2004). Therefore, "
proof of mere negligence, without more, is inadequate to
ground supervisory liability." Maldonado-Denis v.
Castillo Rodriguez, 23 F.3d 576, 582 (1st Cir. 1994).
The plaintiffs " must allege facts to support [their]
supervisory claim[s] . . . [and] it is not sufficient for
[them] to simply formalistically recite the necessary
elements of such a claim." Williams, 115
F.Supp.3d at 188, citing Iqbal, 556 U.S. at 681; see
Maldonado-Denis, 23 F.3d at 582 (" [Supervisor]
may be liable for the foreseeable consequences of such
conduct if he would have known of it but for his deliberate
indifference or willful blindness, and if he had the power
and authority to alleviate it"). As explained below, the
plaintiffs have met their burden here.
United States Supreme Court has held that involuntarily
committed individuals have certain constitutionally protected
rights. See Youngberg v. Romeo, 457 U.S. 307, 314,
102 S.Ct. 2452, 73 L.Ed.2d 28 (1982). First, " the right
to personal security constitutes a 'historic liberty
interest' protected substantively by the Due Process
Clause." Id. at 315. It is therefore "
unconstitutional to confine the involuntarily committed . . .
in unsafe conditions." Id. at 316. Second,
" [l]iberty from bodily restraint always has been
recognized as the core of the liberty protected by the Due
Process Clause from arbitrary governmental action."
Id. (alteration in original) (citation omitted).
Third, an individual's " liberty interests require
the State to provide minimally adequate or reasonable
training to ensure safety and freedom from undue
restraint." Id. at 319; see Hopper v.
Callahan, 408 Mass. 621, 624-25, 562 N.E.2d 822 (1990)
(relying on Youngberg for holding that involuntarily
committed psychiatric patient had " Federal due process
right (a) to essential medical care and (b) not to be
physically restrained unduly").
determine " whether a State adequately has protected the
rights of the involuntarily committed[, ]" the court
must balance the individual's " liberty interests
against the relevant state interests."
Youngberg, 457 U.S. at 321. In making this
determination, " the Constitution only requires that the
courts make certain that professional judgment in fact was
exercised." Id. (citation omitted); see
Hopper, 408 Mass. at 626-27, 630-32 (reciting and
applying Youngberg standard). " [T]he decision,
if made by a professional, is presumptively valid; liability
may be imposed only when the decision by the professional is
such a substantial departure from accepted professional
judgment, practice, or standards as to demonstrate that the
person responsible actually did not base the decision on such
a judgment." Youngberg, 457 U.S. at 323
plaintiffs have alleged facts plausibly suggesting that the
seclusion and restraint that the plaintiffs experienced
constituted a substantial departure from accepted
professional judgment, practice, or standards. For example,
Bridgewater staff secluded and/or restrained the
plaintiffs when they were not presenting threatening
behavior; their seclusion and/or restraint orders were
renewed even when they were calm, compliant, or sleeping; and
they were secluded and/or restrained in the absence of
emergency situations. Moreover, the high rates of seclusion
and restraint that the plaintiffs each experienced at
Bridgewater as compared not only to DMH facilities but also
to the national average support the inference that the
seclusion and restraint decisions were a substantial
departure from accepted professional judgment, practice, or
plaintiffs have therefore alleged facts plausibly suggesting
that " the subordinate's behavior resulted in a
constitutional violation . . ." See Williams,
115 F.Supp.3d at 188; see also Ramirez-Lluveras, 759
F.3d at 19.
Massachusetts federal courts " have typically formulated
the deliberate indifference inquiry as a three-part test that
requires plaintiffs to show: (1) 'that the officials had
knowledge of facts, ' from which (2) 'the official[s]
can draw the inference' (3) 'that a substantial risk
of serious harm exists.'" Ramirez-Lluveras,
759 F.3d at 20 (alteration in original) (citations omitted);
see Clancy, 441 Mass. at 318. " Under this
rubric, a supervisor may be held liable for what he does (or
fails to do) if his behavior demonstrates deliberate
indifference to conduct that is itself violative of a
plaintiff's constitutional rights."
Maldonado-Denis, 23 F.3d at 582. " Therefore,
substandard care, malpractice, negligence, inadvertent
failure to provide care, and disagreement as to the
appropriate course of treatment are all insufficient to prove
a constitutional violation." Ruiz-Rosa v.
Rullan, 485 F.3d 150, 156 (1st Cir. 2007).
plaintiffs allege that, as superintendent and commissioner,
Murphy and Spencer had the " responsibility and
liability" to ensure that Bridgewater employees complied
with constitutional requirements, and the requirements of the
Restraint Law and Bridgewater's restraint regulations.
Sec G.L.c. 123, § 21, thirteenth par. " [Section]
1983 liability[, however, ] cannot rest solely on a
defendant's position of authority."
Ramirez-Lluveras, 759 F.3d at 19. The plaintiffs
also allege that Murphy knew of the prolonged and
unconstitutional seclusion and restraint to which the
plaintiffs were subjected, but he failed to stop the
It is a
fair inference that facility superintendent Murphy, working
every day at a facility housing many mentally ill persons
being subjected to the extraordinarily high rates of
restraint and seclusion alleged in the amended complains must
have been aware of these rates. In addition, in 2009, Murphy
received a formal reprimand for misconduct with respect to
the death of a restrained Bridgewater patient. Knowledge of
this misconduct could also have led Murphy to infer that a
substantial risk of serious harm existed, i.e., the
unconstitutional restraint of patients at
Bridgewater. See Ramirez-Lluveras, 759
F.3d at 20. Against the backdrop of this inference, then, the
allegations that Murphy knew of the unconstitutional
seclusion and restraint plausibly suggest that Murphy's
conduct amounted to deliberate indifference. See
Ramirez-Lluveras, 759 F.3d at 19; Williams,
115 F.Supp.3d at 188.
received quarterly reports that documented seclusion and
restraint practices at Bridgewater. These reports revealed
that the occurrence of these practices was 100 times the
national seclusion and restraint averages. Knowledge of these
facts could have led Spencer to draw the inference that
Bridgewater unconstitutionally secluded and restrained its
patients and that, therefore, a substantial risk of serious
harm existed. See Ramirez-Lluveras, 759 F.3d at 20.
Accordingly, these facts plausibly suggest that Spencer's
conduct also amounted to deliberate indifference. See
id. ; Williams, 115 F.Supp.3d at 188.
To succeed on a supervisory liability claim, a plaintiff not
only must show deliberate indifference or its equivalent, but
also must affirmatively connect the supervisor's conduct
to the subordinate's violative act or omission."
Maldonado-Denis, 23 F.3d at 582. This " showing
of causation must be a strong one, as that requirement
'contemplates proof that the supervisor's conduct led
inexorably to the constitutional
violation.'" Ramirez-Lluveras, 759 F.3d at
19 (emphasis in original). " [D]eliberate indifference
to violations of constitutional rights can forge the
necessary linkage between the acts or omissions of
supervisory personnel and the misconduct of their
subordinates." Maldonado-Denis, 23 F.3d at 582;
see Clancy, 441 Mass. at 321 (holding that "
this affirmative connection requires something . . . such as
'tacit approval of, acquiescence in, or purposeful
disregard of, rights-violating conduct'" (citations
the plaintiffs' facts plausibly suggesting that Murphy
and Spencer were deliberately indifferent to the
constitutional violations at Bridgewater also plausibly
suggest this affirmative link: as superintendent and
commissioner, Murphy and Spencer had statutory obligations to
monitor the seclusion and restraint practices at Bridgewater;
 failure to satisfy those obligations
through their deliberate indifference " led
inexorably to the constitutional violation[s]"
that the plaintiffs experienced. Compare Hannon v.
Beard, 979 F.Supp.2d 136, 142 (D.Mass. 2013) (dismissing