intel and benita stewart i would ask to please reserve four minutes of my time for recall solutions community counseling is the mental health provider for inmates at the warren county jail but it has no written policies or procedures for front line workers called boundary spanners to follow solutions offers boundaries spanners no substantive training on how to perform in their role solutions down three spanners are not taught to learn any collateral source information about the and make they are supposed to be monitoring or to assess things like mood aspect and functioning and went down three spanners are found to be deficient in the performance of critical assessments solutions does nothing to correct or address these deficiencies instead it's boundary spanners believe that they are only required to ask inmates a single question once per week do you wish to speak with mental health how foundry spanners perform their duties is in stark contrast to what its former c e o says is supposed to happen the differences make clear that the need for more boundary spanner trainings obvious that solutions was deliberately indifferent to this need and that its failures led to just an stuart step during my time this morning i wanted to address two specific issues st whether a finding of liability against an individual actor is necessary for a finding of liability against solution and nd whether the district court correctly found that the need to could not meet the subjective component of deliberate indifference we submit that the answer to both of those questions is no with respect to the st issue the app police have suggested that liability against jenny  lin or john randall is required for liability to attach against solutions that simply isn't correct this court's recent decision and north versus cuyahoga county make it clear that that's not the case  in this case private corporations performing traditional state functions are evaluated and examined on their own violations made us be attributable to this apologies act alone and not not those of its employees you agree this is judge murphy would you agree that you do have to show a constitutional violation correct that you have to show that there was deliberate indifference just various medical needs if you don't have to pinpoint it to one individual suicide turned out to be i mean that deposition testimony from family members suggesting that they were shocked what is the best evidence to put any anybody working in the government on notice that there was a serious risk of a suicide with respect to the family importantly none of them are mental health providers trained to recognize the compensation that dr patterson our expert says justin was experiencing during the last fifteen days of his life none of them had the ability to interact with him on a daily basis as the solutions representative did and were supposed to  solutions employee saw the signs of the compensation though because they weren't recognized they weren't trained to recognize that the the seminal case on some of the subjective components of deliberate indifference is this court's decision and then shattering the district court below concluded that the facts in that case had little in common with those here but we maintain that that analysis was incorrect and we believe that the here solutions has no written policies for its boundary standards to follow they have no daily engagement with inmates despite the jail policy requiring them to and sometimes they're not even able to meet the weekly john randall or jenny uplinks to recognise the signs of the compensation and to recognise that mental health they have to do more than ask an inmate a single question do you have mental have any knowledge of the individual they don't have any knowledge again because they are their employees aren't trained to recognize it solutions know those five are two of their contract with the jail that inmates are going to come with into the jail of mental health problems and need situations this to shatter records determined that the risk of constitutional violations are created by employees who lack essential knowledge tool here jenny aplin had no prior experience in the jail setting and her training consisted of being virtually told to do rounds once a week to make herself available that's if that was the extent of her training and while the solution c e o plans that there are tools to aid her in those assessments no evidence in the records exists that you used them or even knew about them there was no oversight by john randall jenny  supervisor on how to conduct her assessments and one weakness in those suicidal assessments was noted in her personnel file some ninety days into her employment there is absolutely no evidence to show that she was provided any additional orbit medial training with respect to solutions i wouldn't but some similarities in the sheppard case again where the head executive there admitted that the company had no training program and believe that the nurses were trained by virtue of being l p s doctor during the c e o at the time of this incident at mit solutions again has no written policies or protocols and he admits that he has no knowledge about how john randall oriented his boundary spanners to the job in fact he can't even confirm that jenny epling received any additionally he notes that if things that she has or court discussed in terms of the inadequacy of training is an undocumented policy to only provide services when requested that's absolutely what we have here in her deposition says that if an inmate says no when asked if they wish to speak with mental help i have to respect that that simply cannot be sufficient training in order to ask that single question and move on our expert in this case is an extremely well qualified jail psychologist who i know that the failure to adequately if that's just and needs which stem from a failure to actually train boundary spanners like jenny aplin led to the suicide in this case that during these assessments we should be inquiring into feelings new state changes to determine if there is a need for a higher level of care a higher level of supervision or potentially hospitalization differently during these assessments we should the boundary spanner should be collecting information from jail sources and records to get a full picture of the inmate needs that simply is not what happened in the day to day operations your honor that i think is important that that assessment was done on roughly two weeks before justin died and no one saw justin in those last two weeks which dr patterson described i report as when just being with the compensating significantly as evidenced by his withdraw from activities and meals actions with which jenny aplin acknowledges are indicative of suicidal risk  the references in the underlying mental health problems dr patterson confirms should have resulted in a multi multiple disciplinary team being established with daily interactions a solutions is a well reputed community based mental health organization and relative to this case by contract they provide discrete mental health services at the warren county jail and at the time in question they essentially provided t it is glossed over the fact that she has a bachelor's degree in criminal justice a master's degree in counseling she's a licensed professional counselor by the state of ohio independent depend dependency counselor she had prior counseling and mental health experience before coming to work at the jail she had worked at the jail it and warren county for approximately two years before justin steward's death she generally would work monday through friday eight thirty in the morning to five in the afternoon she did a variety of things there she did twelve day mental health screenings of all inmates she was responsible for inmates on suicide watch monitoring that putting them on a taking them active plan of care in the jail and was cooperative she would provide counseling this record is certainly well established that justin stewart at no time during his roughly three and a half months at the jail requested mental health services he never requested services through a guard to any interaction with miss epling through any interaction with dr barton through any interaction with john randall there was a kiosk system in his pod at all times where he could request services and his communications with his family members telephonically he never requested any services he was sent to some of behavioral hospital for a twenty day inpatient competency evaluation that was in june he came out of s without any diagnoses without any recommended treatment without any medications he was requested in connection with his underlying criminal case to be evaluated for potential involuntary admission he looked physically healthy that he was forward thinking that he was talking about wanting to get out of the jail and to get a job and resume his life he had he was in the jail due to the underlying family dispute with his father over a family business and some related property damage and associated things that were occurring with the family business but he was forward thinking with mr randall three days after mr randall saw him as as was just noted in question at the counsel he was seen in the evaluated by dr barton who's no longer a party to this case was voluntarily dismissed dr barton testified that he did not believe that justin had any mental health needs at that point in time that he wasn't suicidal that he wasn't he was a harm to himself in any way he spoke to his parents and uncle the day before his death and literally within hours of his death his parents have uniformly testified that there was no indication from those phone complete shock john randal i saw the just in two times as he described in his deposition once early on after his admission to the jail for purposes of trying to get him to cooperate with being screened he was initially uncooperative with being screened medically and and through mental health and as the record indicates from all the testimony he generally would tell everybody from medical or mental health that he was fine that he didn't need anything and that was his right to do before he came into the jail in warren county jail and over his roughly twenty nine years of life he had no prior history of mental health needs or issues no prior treatment no prior suicide attempts no family history of suicide attempts no indication of self harm anywhere in his background whatsoever this court has reviewed multiple jail and prison suicide cases over the years generally under under section one hundred and eighty three dollars of course and there are replete cases that have come before the score where there are far more egregious facts sorry i'm sorry i'm trying to figure out the level of generality at which we should define the serious need here i think it was obvious that he had a serious need of mental health concerns and and that's why he was treated several times do you think that the level of generality for the object of question of the test should be something lower like in serious need of suicide intervention well certainly i mean has to be a serious medical medical need  and in this case despite and there's even more times where he was evaluated before he came into the jail but when he came out of summit he didn't have a diagnosis the only medical mental health provider that provided him with  objectively serious need for mental health intervention but the question is should that be enough to satisfy the objective standard or should you have to show and objective need for i guess a suicide watch suicide intervention in all of the suicide cases that have come before this court and other other federal courts over the years there has to be a in objective indication that there is a suicide ality at the intimate is just an stuart was never placed on suicide watch he was seen over his three and a half months roughly in the jails within the time of his time at some it almost on an hourly basis if not more by correctional officers and by guards there was testimony richardson and georgia sims in this case and the evidence is that there was no indication from any guards at any point in time that he was ever at risk for harming himself if there was no suicide note left after the fact and often a lot of these cases there's there's a record history of what is sometimes generally referred to as kite which are inmate requests for either medical or mental health services there's no indication of a kite in this case of any time there was certainly efforts being made to determine you know if there was something going on with him if if there was something that was explaining his behaviors and why he was why he damaged property as parents house and why he was in a dispute with his parents he was he was incarcerated during this stretch of time history and a half month period of time from a from a probation violation because he wasn't following through with doing some of the things that the criminal court had imposed on him or his prior charges but to answer your question and the compile circle on that in all of the one hundred and eighty three jail suicide cases there has to be indication that the inmate the when the language is has a strong likelihood of committing suicide she demands that her standing order is that is that we submit proposed undisputed facts to which plaintiff's counsel indicated which facts they agreed with and which facts they didn't agree with they largely fifty lated to the key facts and the thousand and sixteen and as describing her and her testimony she would she would do administrative segregation checks meaning there's a pot of the warren county jail where there's inmates that have are in their own cells or spangle cell inmates are allowed out for recreational time and there are some general area in there and she would of course have to be accompanied by guards she's not allowed to go into a pod or into a cell on her own she doesn't have keys to or access to do that and so she would go with a guard into that pod and roughly a weekly ultimately affected his decision that he made out afternoon hours of august thirty two thousand and sixteen justin stewart had a right to deny treatment of any kind notwithstanding the fact that there was no indication that he needed any counseling or treatment for any any risk of self harm and again i know that there was a finding by judge to a lot that she thought there was enough evidence to satisfy the fact that he had  a sufficiently serious mental health diagnosis but the only mental health provider that even determined he had any issue whatsoever was dr marcy any of the recommended outpatient treatment arrangements were being made that he was going to be released he was going to live with his uncle  testified that he never all the time that he ever interacted just or talked to him on the phone looting that the hours before this incident that he thought that that he was in crisis or risk for self harm and they were going to be arrangements for justin t outpatient counseling as part of his community control terms when he when he was released which was forthcoming and again he was forward thinking his parents indicated that he was folder thinking he had a separate civil lawsuit that he was i discussed some a miss please background in that regard i also know that john randall had a bachelors in counseling a masters in education he was a licensed professional clinical counsellor with a supervisory designation he had decades of counseling and mental health experience for roughly two years before this incident he was be coronated for price of services for solutions meaning that he was in charge of of of roughly ten dollars to twelve dollars mental health employees for solutions would do mobile crisis evaluations pink slip evaluations he was essentially in charge for determining whether or not someone met the criteria for involuntary hospitalization he was certainly highly experienced in that  epling and mr randall were highly trained in the experience in the field of mental health most certainly they did not violate mr stewart's constitutional rights without a constitutional violation by one or of them solutions so there can be no mon el claim against solutions for any custom policy or procedure there's no indication of any other suicide at the warren county jail no other indication that the solutions had defunct policies that were leading t cases jail suicide cases that this court has reviewed that this case had the least amount of evidence or factual support that would allow this case to go forward in any way and we would respectfully ask that the  officer she was trained as a health officer that's just how the in voluntarily hold people she was trained on how to maintain health records that's not what she was performing in her weekly assessments none of the training that she received was related to her role as a boundary spanner in her deposition on page five hundred and ninety eight of the record the extent of her training with respect to that role as discussed john randall burble the told me to do rounds once a week to make myself available anything else no that was the extent of his training yes next there was a suggestion that the only medical provider never diagnosed justin was dr marty honey and that that's not line provider had no knowledge of those in fact it was her practice not to review any collateral source information here in the last two weeks of justin's life we've got an innate with a serious and chronic mental illness who is seldom leading himself who is skipping meals and the only thing he was asked only thing he was that was do you wish to speak of mental health as dr patterson has testified or has op follow it's certainly not unusual and here solutions a century made it a point to have their mind providers learn as little as possible about the individuals that they were monitoring a that simply cannot be simply cannot be acceptable from from a mental health provider the fact viewed in the light most favorable to the need to show that solutions took no steps to train or supervise its bound