U.S. District Court Southern District of Florida (Miami) CIVIL DOCKET FOR CASE #: 1:13−cv−21570−BB

CLOSED,PMH

United States of America v. Miami−Dade County; The Board of County Commissioners Assigned to: Judge Beth Bloom Cause: 42:1983 Civil Rights Act
Plaintiff

Date Filed: 05/01/2013 Date Terminated: 05/22/2013 Jury Demand: None Nature of Suit: 440 Civil Rights: Other Jurisdiction: U.S. Government Plaintiff

United States of America

represented by Laura Coon US Department of Justice Special Litigation Section PHB 601 D Street NW Washington, DC 20004 202−514−1089 Email: Laura.Coon@usdoj.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED

Regina Jansen US Department of Justice Special Litigation Section PHB 601 D Street NW Washington, DC 20004 202−305−1775 Email: regina.jansen@usdoj.gov TERMINATED: 03/16/2019 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Amar Shakti Nair U.S. Department of Justice Patrick Henry Building 601 D StNW, 5421E Washington, DC 20004 202−353−1146 Email: amar.nair@usdoj.gov TERMINATED: 03/16/2019 ATTORNEY TO BE NOTICED

Catherine Bendor U.S. Department of Justice Civil Rights Division Special Litigation Sec;tion − PHB 950 Pennsylvania Ave., N.W. Washington, DC 20530 202−353−1268 Email: catherine.bendor@usdoj.gov TERMINATED: 03/16/2019 ATTORNEY TO BE NOTICED

Jennifer Wedekind U.S. Department of Justice 601 D Street, NW Washington, DC 20004 202−616−4547 Email: jennifer.wedekind@usdoj.gov TERMINATED: 08/14/2018 ATTORNEY TO BE NOTICED

V. Defendant Miami−Dade County; The Board of County Commissioners
Defendant

Megan Renee Marks U.S. Department of Justice Special Litigation Section − PHB 5212 950 Pennsylvania Avenue NW Washington, DC 20579 202−616−2579 Email: megan.marks@usdoj.gov TERMINATED: 03/16/2019 ATTORNEY TO BE NOTICED
William G. Maddox US Department of Justice 601 D. Street NW Washington, DC 20004 202−514−6251 Email: william.maddox@usdoj.gov ATTORNEY TO BE NOTICED
Veronica Vanessa Harrell−James United States Attorney's Office 99 NE 4 Street Miami, FL 33132 305−961−9327 Fax: 530−7139 Email: Veronica.Harrell−James@usdoj.gov ATTORNEY TO BE NOTICED
represented by Bernard Pastor Miami−Dade County Attorney's Office Metro Dade Center 111 NW 1st Street Suite 2810 Miami, FL 33128−1993 305−375−5151 Fax: 375−5634 Email: pastor@miamidade.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED
Benjamin David Simon Dade County Attorney's Office Metro Dade Center 111 NW 1st Street Suite 2810 Miami, FL 33128−1993 305−375−5151 Fax: 305−375−5611 Email: bdsimon@miamidade.gov ATTORNEY TO BE NOTICED
Jennifer Laura Hochstadt 111 NW 1st St. 27th Floor Miami, FL 33128 (305) 375−5760 Email: Hochsta@miamidade.gov ATTORNEY TO BE NOTICED
represented by

Miami−Dade County Public Health Trust 111 NW 1 Street Suite 2810, Metro−Dade Center Miami, FL 33128−1993
Defendant Miami−Dade County Miami−Dade County Stephen P. Clark Center 111 NW 1st Street 28th Floor Miami, FL 33128

Bernard Pastor (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Benjamin David Simon (See above for address) ATTORNEY TO BE NOTICED
Jennifer Laura Hochstadt (See above for address) ATTORNEY TO BE NOTICED
represented by Bernard Pastor (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Benjamin David Simon (See above for address) ATTORNEY TO BE NOTICED
Jennifer Laura Hochstadt (See above for address) ATTORNEY TO BE NOTICED

Date Filed 05/01/2013
05/01/2013 05/01/2013
05/01/2013 05/01/2013
05/02/2013 05/02/2013
05/06/2013 05/22/2013

# Docket Text
1 COMPLAINT against Miami−Dade County against United States of America. Filing fees $ 400.00. USA Filer − No Filing Fee Required, filed by United States of America. (Attachments: # 1 Civil Cover Sheet, # 2 Certification, # 3 Exhibit Joint Motion for Entry of Consent Order, # 4 Exhibit Memorandum of Law in Support of Motion for Entry of Consent Order, # 5 Text of Proposed Order Consent Agreement/Order)(Harrell−James, Veronica) (Entered: 05/01/2013)
2 Judge Assignment to Judge William J. Zloch (ail) (Entered: 05/01/2013)
3 Clerks Notice to Filer re: Electronic Case. Parties Not Added. The Filer failed to add all parties associated with the case.Filer is instructed to add the additional parties by filing a Notice of Entry of Parties. It is not necessary to re−file this document. (ail) (Entered: 05/01/2013)
4 Notice of Entry of Parties Listed (Harrell−James, Veronica) (Entered: 05/01/2013)
5 Joint Motion for Entry of Consent Agreement by United States of America (Attachments: # 1 Memorandum Memorandum of Law in Support of Motion for Entry of Consent Agreement, # 2 Text of Proposed Order Consent Agreement/Order)(Harrell−James, Veronica) Modified converted to motion on 5/2/2013 (tp). (Entered: 05/01/2013)
6 Clerks Notice to Filer re 4 Notice of Entry of Parties Listed into CM/ECF. Parties Not Added; ERROR − The Filer failed to add all parties. Filer is instructed to add the additional parties by filing a Notice of Entry of Parties. (tp) (Entered: 05/02/2013)
7 Clerks Notice to Filer re 5 Joint Motion to Enter Consent Agreement. Wrong Event Selected − Document is a Motion; ERROR − The Filer selected the wrong event. A motion event must always be selected when filing a motion. The correction was made by the Clerk. It is not necessary to refile this document. (tp) (Entered: 05/02/2013)
8 VACATED Final Order Approving and Entering Consent Decree and Dismissing Case. Signed by Judge William J. Zloch on 5/3/2013. (bc) Modified on 5/22/2013 (bc). (Entered: 05/06/2013)
Case Reopened (bc) (Entered: 05/22/2013)

05/22/2013 05/23/2013 11/05/2013 05/30/2014 07/03/2014 07/09/2014 09/09/2014 10/16/2014 10/16/2014 10/17/2014 10/21/2014
10/31/2014
11/17/2014 12/01/2014 12/17/2014 12/17/2014
12/17/2014

9 Final Order Approving and Entering Consent Decree and Dismissing Case without Prejudice. Signed by Judge William J. Zloch on 5/22/2013. (bc) (Entered: 05/22/2013)
10 Notice of Entry of Parties Listed NOTE: New Filer(s) will appear twice, since they are also a new party in the case. New Filer(s)/Party(s): Miami−Dade County Public Health Trust and Miami−Dade County. (Harrell−James, Veronica) (Entered: 05/23/2013)
11 STATUS REPORT by Susan McCampbell (Monitor) by United States of America (Harrell−James, Veronica) (Entered: 11/05/2013)
12 REPORT REGARDING Compliance No. 2 by United States of America (Attachments: # 1 Supplement Pages 101−219)(Harrell−James, Veronica) (Entered: 05/30/2014)
13 First MOTION for Hearing Status Conference by United States of America. Attorney Amar Shakti Nair added to party United States of America(pty:pla). (Nair, Amar) (Entered: 07/03/2014)
14 ORDER granting 13 Motion for Status Conference. Status Conference set for 10/21/2014 10:00 AM in Fort Lauderdale Division before Judge William J. Zloch. Signed by Judge William J. Zloch on 7/9/2014. (ar2) (Entered: 07/09/2014)
15 NOTICE of Attorney Appearance by Amar Shakti Nair on behalf of United States of America (Nair, Amar) (Entered: 09/09/2014)
16 NOTICE of Attorney Appearance by Laura Coon on behalf of United States of America (Coon, Laura) (Entered: 10/16/2014)
17 MOTION for Leave to Appear by Telephone . Attorney: Amar Nair by United States of America. Responses due by 11/3/2014 (Attachments: # 1 Text of Proposed Order)(Nair, Amar) (Entered: 10/16/2014)
18 PAPERLESS ORDER granting 17 Motion for Leave to Appear by Telephone at Status Conference. Signed by Judge William J. Zloch on 10/17/2014. (bc) (Entered: 10/17/2014)
19 Minute Entry for proceedings held before Judge William J. Zloch: Status Conference held on 10/21/2014. Status Conference continued to 11/17/2014 at 10:00 AM in Fort Lauderdale Division before Judge William J. Zloch. Court Reporter: Tammy Nestor, 954−769−5488 / Tammy_Nestor@flsd.uscourts.gov (bc) (Entered: 10/21/2014)
20 TRANSCRIPT of hearing held on 10/21/14 before Judge William J. Zloch, 1−32 pages, Court Reporter: Tammy Nestor, 954−769−5488 / Tammy_Nestor@flsd.uscourts.gov. Transcript may be viewed at the court public terminal or purchased by contacting the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 11/24/2014. Redacted Transcript Deadline set for 12/4/2014. Release of Transcript Restriction set for 2/2/2015. (tnr) (Entered: 10/31/2014)
21 Minute Entry for proceedings held before Judge William J. Zloch: Status Conference held on 11/17/2014. Court Reporter: Tammy Nestor, 954−769−5488 / Tammy_Nestor@flsd.uscourts.gov (bc) (Entered: 11/17/2014)
22 REPORT REGARDING Compliance No. 3 by United States of America (Harrell−James, Veronica) (Entered: 12/01/2014)
23 Plaintiff's MOTION to Bring Electronic Equipment into the courtroom by United States of America. Responses due by 1/5/2015 (Attachments: # 1 Text of Proposed Order)(Harrell−James, Veronica) (Entered: 12/17/2014)
24 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Consent Agreement Compliance Status Report−December 2014. Attorney Bernard Pastor added to party Miami−Dade County(pty:dft), Attorney Bernard Pastor added to party Miami−Dade County Public Health Trust(pty:dft), Attorney Bernard Pastor added to party Miami−Dade County; The Board of County Commissioners(pty:dft). (Attachments: # 1 Exhibit) (Pastor, Bernard) (Entered: 12/17/2014)
25 Joint MOTION Entry of Stipulated Order by United States of America. (Attachments: # 1 Text of Proposed Order Proposed Order, # 2 Exhibit Defendants' Summary Action Plan)(Jansen, Regina) (Entered: 12/17/2014)

12/18/2014 12/18/2014 12/18/2014 01/27/2015 06/04/2015 06/04/2015
07/07/2015 07/10/2015 07/16/2015 08/28/2015
01/27/2016 01/29/2016
02/16/2016 02/18/2016 04/07/2016 04/20/2016 05/18/2016

26 ORDER granting 23 Motion to Bring Electronic Equipment into the courtroom. Signed by Judge William J. Zloch on 12/18/2014. (bc) (Entered: 12/18/2014)
27 ORDER granting 25 Motion for Entry of Stipulated Order. Signed by Judge William J. Zloch on 12/18/2014. (bc) (Entered: 12/18/2014)
28 ORDER Setting Status Conference: Status Conference set for 1/27/2015 at 2:00 PM in Fort Lauderdale Division before Judge William J. Zloch. Signed by Judge William J. Zloch on 12/18/2014. (bc) (Entered: 12/18/2014)
29 Minute Entry for proceedings held before Judge William J. Zloch: Status Conference held on 1/27/2015. Court Reporter: Tammy Nestor, 954−769−5488 / Tammy_Nestor@flsd.uscourts.gov (bc) (Entered: 01/27/2015)
30 MOTION for Hearing Status Conference by United States of America. (Jansen, Regina) (Entered: 06/04/2015)
31 ORDER SETTING STATUS CONFERENCE and granting 30 Motion for Status Conference. Status Conference set for 7/16/2015 11:00 AM in Fort Lauderdale Division before Judge William J. Zloch. Signed by Judge William J. Zloch on 6/4/2015. (ar2) (Entered: 06/04/2015)
32 REPORT REGARDING Compliance No. 4 by United States of America (Jansen, Regina) (Entered: 07/07/2015)
33 NOTICE of Attorney Appearance by Catherine Bendor on behalf of United States of America. Attorney Catherine Bendor added to party United States of America(pty:pla). (Bendor, Catherine) (Entered: 07/10/2015)
34 Minute Entry for proceedings held before Judge William J. Zloch: Status Conference held on 7/16/2015. Court Reporter: Tammy Nestor, 954−769−5488 / Tammy_Nestor@flsd.uscourts.gov (wjz3) (Entered: 07/16/2015)
35 TRANSCRIPT of hearing held on 7/16/15 before Judge William J. Zloch, 1−18 pages, Court Reporter: Tammy Nestor, 954−769−5488 / Tammy_Nestor@flsd.uscourts.gov. Transcript may be viewed at the court public terminal or purchased by contacting the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 9/21/2015. Redacted Transcript Deadline set for 10/1/2015. Release of Transcript Restriction set for 11/30/2015. (tnr) (Entered: 08/28/2015)
36 MOTION for Hearing Status Conference by United States of America. (Jansen, Regina) (Entered: 01/27/2016)
37 ORDER SETTING STATUS CONFERENCE and granting 36 Motion for Status Conference. Status Conference set for 4/5/2016 01:30 PM in Fort Lauderdale Division before Judge William J. Zloch. Signed by Judge William J. Zloch on 1/29/2016. (ar2) (Entered: 01/29/2016)
38 REPORT REGARDING Independent Monitors' Report No. 5 by United States of America (Jansen, Regina) (Entered: 02/16/2016)
39 NOTICE of Attorney Appearance by Jennifer Wedekind on behalf of United States of America. Attorney Jennifer Wedekind added to party United States of America(pty:pla). (Wedekind, Jennifer) (Entered: 02/18/2016)
40 ORDER Re−setting Status Conference: Status Conference set for 4/20/2016 at 1:30 PM in Fort Lauderdale Division before Judge William J. Zloch. Signed by Judge William J. Zloch on 4/7/2016. (ar2) (Entered: 04/07/2016)
41 Minute Entry for proceedings held before Judge William J. Zloch: Status Conference held on 4/20/2016. Court Reporter: Tammy Nestor, 954−769−5488 / Tammy_Nestor@flsd.uscourts.gov (bc) (Entered: 04/20/2016)
42 MOTION Joint Motion for Entry of Stipulated Order by United States of America. (Attachments: # 1 Exhibit Revised Compliance Plan, # 2 Exhibit Proposed Stipulated Order)(Jansen, Regina) (Entered: 05/18/2016)

05/23/2016 05/24/2016
09/09/2016 10/03/2016 10/12/2016 10/26/2016 12/09/2016 01/12/2017 01/13/2017 01/17/2017
01/18/2017 01/23/2017
01/26/2017
02/03/2017

43 ORDER granting 42 Motion for Entry of Stipulated Order. Signed by Judge William J. Zloch on 5/23/2016. (bc) (Entered: 05/23/2016)
44 TRANSCRIPT of status conference held on 4/20/16 before Judge William J. Zloch, 1−18 pages, Court Reporter: Tammy Nestor, 954−769−5488 / Tammy_Nestor@flsd.uscourts.gov. Transcript may be viewed at the court public terminal or purchased by contacting the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 6/17/2016. Redacted Transcript Deadline set for 6/27/2016. Release of Transcript Restriction set for 8/25/2016. (tnr) (Entered: 05/24/2016)
45 STATUS REPORT Monitors' Report No. 6 by United States of America (Jansen, Regina) (Entered: 09/09/2016)
46 MOTION for Hearing Status Conference by United States of America. (Jansen, Regina) (Entered: 10/03/2016)
47 ORDER granting 46 Motion for Status Conference. Status Conference set for 10/26/2016 at 1:30 PM in Fort Lauderdale Division before Judge William J. Zloch. Signed by Judge William J. Zloch on 10/12/2016. (bc) (Entered: 10/12/2016)
48 ORDER Resetting Status Conference: Status Conference reset for 12/7/2016 at 1:30 PM in Fort Lauderdale Division before Judge William J. Zloch. Signed by Judge William J. Zloch on 10/26/2016. (bc) (Entered: 10/26/2016)
49 ORDER Re−Setting Status Conference. Status Conference reset for 1/11/2017 at 1:30 PM in Fort Lauderdale Division before Judge William J. Zloch. Signed by Judge William J. Zloch on 12/9/2016. (bc) (Entered: 12/09/2016)
50 ORDER OF RECUSAL. Judge William J. Zloch recused. Signed by Judge William J. Zloch on 1/11/17. Case randomly reassigned to Judge Beth Bloom for all further proceedings. (ane) (Entered: 01/12/2017)
51 PAPERLESS NOTICE of Status Conference set for Thursday, 1/26/2017 01:45 PM in Miami Division before Judge Beth Bloom, 400 North Miami Avenue, Courtroom 10−2. (tas) (Entered: 01/13/2017)
52 PAPERLESS NOTICE Status Conference set for 1/26/2017 01:45 PM in Miami Division before Judge Beth Bloom, 400 North Miami Avenue, Courtroom 10−2. The purpose of the status conference is to discuss all issues per ECF Nos. 45 , 46 . The parties and monitors may appear by telephone by filing a notice on CM/ECF and contacting the Courtroom Deputy, who will provide a teleconference number to the parties. (tas) (Entered: 01/17/2017)
53 NOTICE by United States of America of Intent to Appear Telephonically (Wedekind, Jennifer) (Entered: 01/18/2017)
54 PAPERLESS NOTICE re ECF No. 53 Allowing the Parties to Appear by Phone for hearing scheduled on 1/26/17 at 1:45 pm in Miami, Courtroom 10−2. The parties may appear by phone and are instructed to call 1−877−336−1829 on the date and time set forth above. The access code is 4742152 and the security code is 5680. For clarity, please do not use a cell phone or a speaker phone. (tas) (Entered: 01/23/2017)
55 PAPERLESS Minute Entry for proceedings held before Judge Beth Bloom: Status Conference held on 1/26/2017. Status Conference set for Friday, 4/21/2017 01:30 PM in Miami Division before Judge Beth Bloom, 400 North Miami Avenue, Courtroom 10−2. The parties may appear by phone and are instructed to call 1−877−336−1829 on the date and time set forth above. The access code is 4742152 and the security code is 5680. For clarity, please do not use a cell phone or a speaker phone. (The parties are asked to notify the Court of which parties will be present and/or by phone.) Total time in court: 1 hour. Attorney Appearance(s): Bernard Pastor, Regina Jansen, Laura Coon, Veronica Vanessa Harrell−James, Amar Shakti Nair, Catherine Bendor, Jennifer Wedekind. Court Reporter: Yvette Hernandez, 954−769−5686 / Yvette_Hernandez@flsd.uscourts.gov. (tas) (Entered: 01/26/2017)
56 TRANSCRIPT of Status Conference held on 1/26/2017 before Judge Beth Bloom, 1 − 43 pages, Court Reporter: Yvette Hernandez, 954−769−5686 / Yvette_Hernandez@flsd.uscourts.gov. Transcript may be viewed at the court public

04/04/2017 04/11/2017 04/18/2017 04/21/2017
05/02/2017 05/15/2017 05/16/2017
06/15/2017 07/14/2017 07/25/2017 07/26/2017
07/28/2017

terminal or purchased by contacting the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 2/24/2017. Redacted Transcript Deadline set for 3/6/2017. Release of Transcript Restriction set for 5/4/2017. (yhz) (Entered: 02/03/2017)
57 REPORT REGARDING Independent Monitors' Report No. 7 by United States of America (Wedekind, Jennifer) (Entered: 04/04/2017)
58 NOTICE of Attorney Appearance by Megan Renee Marks on behalf of United States of America. Attorney Megan Renee Marks added to party United States of America(pty:pla). (Marks, Megan) (Entered: 04/11/2017)
59 NOTICE by United States of America of Intent to Appear Telephonically (Marks, Megan) (Entered: 04/18/2017)
60 PAPERLESS Minute Order for proceedings held before Judge Beth Bloom: Status Conference held on 4/21/2017. The parties shall submit a proposed order regarding monthly reporting requirements no later than April 28, 2017. The next Status Conference is set for Friday 7/28/2017 01:30 PM in Miami Division before Judge Beth Bloom, 400 North Miami Avenue, Courtroom 10−2, Miami, Florida 33128. Total time in court: 1 hour(s). Attorney Appearance(s): Bernard Pastor, Veronica Vanessa Harrell−James, Jennifer Wedekind, Court Reporter: Yvette Hernandez, 954−769−5686 / Yvette_Hernandez@flsd.uscourts.gov. (ak00) (Entered: 04/21/2017)
61 ORDER Requiring Submission of Monthly Report Signed by Judge Beth Bloom on 5/1/2017. (ail) (Entered: 05/02/2017)
62 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners re 61 Order of Filing of Monthly Report (Attachments: # 1 Exhibit May 2017 Report and Minutes) (Pastor, Bernard) (Entered: 05/15/2017)
63 TRANSCRIPT of Status Conference held on 4/24/2017 before Judge Beth Bloom, 1 − 34 pages, Court Reporter: Yvette Hernandez, 954−769−5686 / Yvette_Hernandez@flsd.uscourts.gov. Transcript may be viewed at the court public terminal or purchased by contacting the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 6/6/2017. Redacted Transcript Deadline set for 6/16/2017. Release of Transcript Restriction set for 8/14/2017. (yhz) (Entered: 05/16/2017)
64 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 06/15/2017)
65 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners re 61 Order of Filing Monthly Report (Attachments: # 1 Exhibit) (Pastor, Bernard) (Entered: 07/14/2017)
66 NOTICE by United States of America of Intent of Monitors to Appear Telephonically (Wedekind, Jennifer) (Entered: 07/25/2017)
67 PAPERLESS NOTICE re ECF No. 66 Allowing the Parties to Appear by Phone for hearing scheduled on 7/28/17 at 1:30 pm in Miami, Courtroom 10−2. The parties may appear by phone and are instructed to call 1−877−336−1829 on the date and time set forth above. The access code is 4742152 and the security code is 5680. For clarity, please do not use a cell phone or a speaker phone. (ak00) (Entered: 07/26/2017)
68 PAPERLESS Minute Order for proceedings held before Judge Beth Bloom: Status Conference held on 7/28/2017. The Independent Monitors' Report No. 8 shall be filed by October 27, 2017. The next Status Conference is set for Wednesday 11/8/2017 01:30 PM in Miami Division before Judge Beth Bloom, 400 North Miami Avenue, Courtroom 10−2, Miami, Florida 33128. In addition, the United States's ore tenus motion to allow the independent monitors, Susan McCampbell, Robert Greifinger, and Kahlil Johnson, to bring electronic equipment into the courtroom is GRANTED. Total time in court: 15 minutes. Attorney Appearance(s): Bernard Pastor, Veronica Vanessa Harrell−James, Jennifer Wedekind, Court Reporter: Yvette Hernandez, 954−769−5686 / Yvette_Hernandez@flsd.uscourts.gov. (ak00) (Entered: 07/28/2017)

08/15/2017 08/31/2017
09/06/2017 09/06/2017 09/15/2017 09/29/2017 09/29/2017 09/29/2017 10/13/2017 11/14/2017 12/15/2017 01/12/2018 01/19/2018 02/06/2018 02/07/2018

69 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Montly Report (Attachments: # 1 Exhibit) (Pastor, Bernard) (Entered: 08/15/2017)
70 TRANSCRIPT of Status Conference held on 07/28/2017 before Judge Beth Bloom, 1 − 13 pages, Court Reporter: Yvette Hernandez, 954−769−5686 / Yvette_Hernandez@flsd.uscourts.gov. Transcript may be viewed at the court public terminal or purchased by contacting the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 9/21/2017. Redacted Transcript Deadline set for 10/2/2017. Release of Transcript Restriction set for 11/29/2017. (yhz) (Entered: 08/31/2017)
71 Unopposed MOTION for Extension of Time to file Monthly Report re 61 Order by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners. Responses due by 9/20/2017 (Attachments: # 1 Text of Proposed Order)(Pastor, Bernard) (Entered: 09/06/2017)
72 PAPERLESS ORDER granting 71 Motion for Extension of Time to File Monthly Report by September 29, 2017. Signed by Judge Beth Bloom (BB) (Entered: 09/06/2017)
Set/Reset Deadlines/Hearings as per DE 72 : Status Report due by 9/29/2017. (lk) (Entered: 09/15/2017)
73 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit Minutes, # 2 Exhibit Audit tools) (Pastor, Bernard) (Entered: 09/29/2017)
74 Joint MOTION for Hearing to be Rescheduled by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners. (Attachments: # 1 Text of Proposed Order)(Pastor, Bernard) (Entered: 09/29/2017)
75 PAPERLESS ORDER granting 74 Motion to reschedule Hearing. Status Conference reset for 2/7/2018 01:30 PM in Miami Division before Judge Beth Bloom, 400 North Miami Avenue, Courtroom 10−2, Miami, FL. Signed by Judge Beth Bloom on 9/29/2017. (ch1) (Entered: 09/29/2017)
76 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust of Filing Monthly Report (Attachments: # 1 Exhibit Minutes, # 2 Exhibit Tools) (Pastor, Bernard) (Entered: 10/13/2017)
77 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit Minutes, # 2 Exhibit Tools) (Pastor, Bernard) (Entered: 11/14/2017)
78 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 12/15/2017)
79 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 01/12/2018)
80 REPORT REGARDING Independent Monitors' Report No. 8 by United States of America (Wedekind, Jennifer) (Entered: 01/19/2018)
81 PAPERLESS ORDER permitting the monitors, Susan McCampbell, Robert Greifinger, Harry Grenawitzke and Kahlil Johnson, to bring their electronic devices into the courtroom for the scheduled hearing on 2/7/2018. Signed by Judge Beth Bloom (BB) (Entered: 02/06/2018)
82 PAPERLESS Minute Entry for proceedings held before Judge Beth Bloom: Status Conference held on 2/7/2018. (Written Order to Follow) Status Conference set for Friday, 9/7/2018 01:30 PM in Miami Division before Judge Beth Bloom, 400 North Miami Avenue, Courtroom 10−2. Total time in court: 1 hour : 30 minutes. Appearance(s): Benjamin D. Simon, Bernard Pastor, Veronica Vanessa Harrell−James, Jennifer Wedekind, Susan W. McCampbell, M.C.R.P., C.J.M., Lead Monitor, Robert B.

02/09/2018
02/09/2018
02/14/2018 02/15/2018 03/06/2018 03/06/2018 03/06/2018 03/15/2018 03/15/2018 03/27/2018 04/04/2018 04/05/2018 04/06/2018 04/06/2018 04/09/2018

Greifinger, M.D., Medical Monitor, Kahlil A. Johnson, M.D., Mental Health Monitor. Court Reporter: Yvette Hernandez, 954−769−5686 / Yvette_Hernandez@flsd.uscourts.gov. (tas) (Entered: 02/07/2018)
83 TRANSCRIPT of Status Conference held on 02/07/2018 before Judge Beth Bloom, 1 − 39 pages, Court Reporter: Yvette Hernandez, 305−523−5698 / Yvette_Hernandez@flsd.uscourts.gov. Transcript may be viewed at the court public terminal or purchased by contacting the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 3/2/2018. Redacted Transcript Deadline set for 3/12/2018. Release of Transcript Restriction set for 5/10/2018. (yhz) (Entered: 02/09/2018)
84 ORDER that on or before March 7, 2018, the parties shall submit to the Court, as a proposed order, a Proposed Third Revised Summary Action Plan. The parties shall file a copy of the Settlement Agreement referenced in the Independent Monitors reports on or before February 15, 2018. Status Conference set for 9/7/2018 01:30 PM in Miami Division before Judge Beth Bloom. Signed by Judge Beth Bloom on 2/8/2018. (wc) (Entered: 02/09/2018)
85 NOTICE by United States of America of Joint Filing of Settlement Agreement (Attachments: # 1 Exhibit Settlement Agreement) (Wedekind, Jennifer) (Entered: 02/14/2018)
86 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 02/15/2018)
87 Joint MOTION for Extension of Time to File Proposed Third Revised Summary Action Plan by Miami−Dade County, Miami−Dade County Public Health Trust. Responses due by 3/20/2018 (Attachments: # 1 Text of Proposed Order)(Pastor, Bernard) (Entered: 03/06/2018)
88 PAPERLESS ORDER granting 87 Motion for Extension of Time to File Proposed Third Revised Summary Action Plan by March 14, 2018. Signed by Judge Beth Bloom (BB) (Entered: 03/06/2018)
Set/Reset Deadlines/Hearings as per DE 88 : Miscellaneous Deadline 3/14/2018. (lk) (Entered: 03/07/2018)
89 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 03/15/2018)
90 NOTICE of Compliance by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners (Attachments: # 1 Text of Proposed Order, # 2 Exhibit) (Pastor, Bernard) (Entered: 03/15/2018)
91 ORDER ON THIRD REVISED SUMMARY ACTION PLAN Signed by Judge Beth Bloom on 3/27/2018. (tas) (Entered: 03/27/2018)
92 NOTICE of filing letter received from Lead Monitor Susan W. Campbell (ch1) (Entered: 04/04/2018)
93 Unopposed MOTION for Hearing Status Conference by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners. (Pastor, Bernard) (Entered: 04/05/2018)
94 ORDER granting 93 Motion for Status Conference. The parties and the Independent Monitor shall appear for a status conference on 4/12/2018 at 12:00 noon in Miami Division before Judge Beth Bloom, 400 North Miami Avenue, Courtroom 10−2. Signed by Judge Beth Bloom on 4/6/2018. (ls00) (Entered: 04/06/2018)
95 Plaintiff's MOTION for clarification 91 Order by United States of America. Responses due by 4/20/2018 (Attachments: # 1 Text of Proposed Order)(Wedekind, Jennifer) (Entered: 04/06/2018)
96 ORDER denying 95 Motion for Clarification. Signed by Judge Beth Bloom on 4/9/2018. (lk) (Entered: 04/10/2018)

04/11/2018 04/11/2018 04/11/2018 04/12/2018
04/13/2018
04/13/2018 04/13/2018 04/13/2018 04/16/2018 04/16/2018 04/20/2018
04/20/2018 04/20/2018 04/30/2018 05/01/2018 05/04/2018 05/04/2018

97 Joint MOTION to Bring Electronic Equipment into the courtroom on behalf of Independent Monitors by United States of America. Responses due by 4/25/2018 (Attachments: # 1 Text of Proposed Order)(Wedekind, Jennifer) (Entered: 04/11/2018)
98 Joint Joint Response to Court's Order to 96 Order on Motion for Clarification by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners. (Pastor, Bernard) (Entered: 04/11/2018)
99 PAPERLESS ORDER granting 97 Motion to Bring Electronic Equipment into the courtroom. Signed by Judge Beth Bloom (BB) (Entered: 04/11/2018)
100 PAPERLESS Minute Entry for proceedings held before Judge Beth Bloom. The parties and the Independent Monitor appeared before the Court for a Status Conference held on 4/12/2018. Paper order to follow. Total time in court: 01 hour(s) : 40 minutes. Attorney Appearance(s): Bernard Pastor, Jennifer Wedekind. Other appearances: Susan McCampbell, Independent Monitor; Manny Estrada, CHS; Daniel Junior, MDCR. Court Reporter: Yvette Hernandez, 954−769−5698 Yvette_Hernandez@flsd.uscourts.gov. (ls00) (Entered: 04/12/2018)
101 TRANSCRIPT of Status Conference held on 04/12/2018 before Judge Beth Bloom, 1 − 69 pages, Court Reporter: Yvette Hernandez, 305−523−5698 / Yvette_Hernandez@flsd.uscourts.gov. Transcript may be viewed at the court public terminal or purchased by contacting the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 5/4/2018. Redacted Transcript Deadline set for 5/14/2018. Release of Transcript Restriction set for 7/12/2018. (yhz) (Entered: 04/13/2018)
SYSTEM ENTRY − Docket Entry 102 [misc] restricted/sealed until further notice. (1591457) (Entered: 04/13/2018)
103 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 04/13/2018)
104 ORDER Setting Status Conference: ( Status Report due by 4/16/2018.) Status Conference set for 6/14/2018 09:00 AM in Miami Division before Judge Beth Bloom. See Order for other deadlines. Signed by Judge Beth Bloom on 4/13/2018. (lk) (Entered: 04/16/2018)
105 STATUS REPORT Joint Status Report by United States of America (Wedekind, Jennifer) (Entered: 04/16/2018)
106 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Organizational Chart (Attachments: # 1 Exhibit) (Pastor, Bernard) (Entered: 04/16/2018)
107 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners re 106 Notice (Other) of Filing Amended Organizational Chart (Attachments: # 1 Exhibit) (Pastor, Bernard) (Entered: 04/20/2018)
108 NOTICE by United States of America of Joint Declaration (Attachments: # 1 Exhibit) (Wedekind, Jennifer) (Entered: 04/20/2018)
109 NOTICE of Compliance of Filing Proposed Fourth Revised Summary Action Plan by United States of America (Attachments: # 1 Text of Proposed Order) (Wedekind, Jennifer) (Entered: 04/20/2018)
110 Plaintiff's MOTION for Sanctions by United States of America. (Attachments: # 1 Text of Proposed Order)(Marks, Megan) (Entered: 04/30/2018)
111 NOTICE by United States of America of Joint Declaration (Marks, Megan) (Entered: 05/01/2018)
112 ORDER granting 110 Motion for Sanctions. Signed by Judge Beth Bloom on 5/3/2018. (lk) (Entered: 05/04/2018)
113 ORDER ON FOURTH REVISED SUMMARY ACTION PLAN. Signed by Judge Beth Bloom on 5/3/2018. (lk) (Entered: 05/04/2018)

05/11/2018 05/15/2018 05/17/2018 05/18/2018
05/18/2018 05/18/2018 06/15/2018 06/18/2018
06/18/2018 06/19/2018 06/19/2018
06/21/2018
06/25/2018 07/03/2018 07/13/2018 07/18/2018

114 NOTICE by United States of America of Intent Not to Seek Sanctions (Marks, Megan) (Entered: 05/11/2018)
115 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 05/15/2018)
116 Unopposed MOTION for Hearing to be Rescheduled by United States of America. (Attachments: # 1 Text of Proposed Order)(Marks, Megan) (Entered: 05/17/2018)
117 ORDER Granting 116 Unopposed MOTION for Hearing to be Rescheduled: Status Conference reset for Thursday, 6/21/2018 09:00 AM in Miami Division before Judge Beth Bloom, 400 North Miami Avenue, Courtroom 10−2. Signed by Judge Beth Bloom on 5/18/2018. (lk) Modified text on 5/23/2018 (tas). (Entered: 05/18/2018)
118 PAPERLESS ORDER granting 116 Motion for Hearing. See ECF No. 117 . Signed by Judge Beth Bloom (BB) (Entered: 05/18/2018)
119 NOTICE by United States of America Regarding Dates of Ninth Compliance Tour (Marks, Megan) (Entered: 05/18/2018)
120 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 06/15/2018)
121 NOTICE of Attorney Appearance by Benjamin David Simon on behalf of Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners. Attorney Benjamin David Simon added to party Miami−Dade County(pty:dft), Attorney Benjamin David Simon added to party Miami−Dade County Public Health Trust(pty:dft), Attorney Benjamin David Simon added to party Miami−Dade County; The Board of County Commissioners(pty:dft). (Simon, Benjamin) (Entered: 06/18/2018)
122 NOTICE of Compliance by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners re 112 Order on Motion for Sanctions (Simon, Benjamin) (Entered: 06/18/2018)
123 MOTION to Bring Electronic Equipment into the courtroom on behalf of Independent Monitor by United States of America. Responses due by 7/3/2018 (Attachments: # 1 Text of Proposed Order)(Wedekind, Jennifer) (Entered: 06/19/2018)
124 PAPERLESS ORDER granting 123 Motion to Bring Electronic Equipment into the courtroom. The Independent Monitor, Susan McCampbell, has permission to bring electronics into the courtroom for any appearances before this Court. Signed by Judge Beth Bloom (BB) (Entered: 06/19/2018)
125 PAPERLESS Minute Entry for proceedings held before Judge Beth Bloom: Status Conference held on 6/21/2018. Status Conference set for 9/7/2018 01:30 PM in Miami Division before Judge Beth Bloom, 400 North Miami Avenue, Courtroom 10−2. Total time in court: 1 hour. Attorney Appearance(s): Benjamin David Simon, Veronica Vanessa Harrell−James, Jennifer Wedekind. Court Reporter: Diane Peede, 305−523−5048 / Diane_Peede@flsd.uscourts.gov. (tas) (Entered: 06/21/2018)
126 NOTICE by United States of America of Joint Declaration (Wedekind, Jennifer) (Entered: 06/25/2018)
127 NOTICE by United States of America of Intent Not to Seek Sanctions (Marks, Megan) (Entered: 07/03/2018)
128 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners re 61 Order (Attachments: # 1 Exhibit, # 2 Exhibit) (Simon, Benjamin) (Entered: 07/13/2018)
129 TRANSCRIPT of a status conference held on 6/21/18 before Judge Beth Bloom, 1−21 pages, Court Reporter: Diane Peede, 305−523−5048 / Diane_Peede@flsd.uscourts.gov. Transcript may be viewed at the court public terminal or purchased by contacting the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 8/8/2018. Redacted Transcript Deadline set for 8/20/2018. Release of Transcript Restriction set for

08/06/2018 08/13/2018 08/14/2018 08/14/2018 08/14/2018 08/24/2018 09/05/2018 09/06/2018
09/07/2018
09/13/2018 09/17/2018 10/10/2018
10/15/2018 10/24/2018 10/25/2018

10/16/2018. (dpe) (Entered: 07/18/2018)
130 NOTICE by United States of America of Joint Declaration (Wedekind, Jennifer) (Entered: 08/06/2018)
131 NOTICE by United States of America of Intent of Monitors to Appear Telephonically (Marks, Megan) (Entered: 08/13/2018)
132 MOTION to Withdraw as Attorney by Jennifer Wedekind for / by United States of America. Responses due by 8/28/2018 (Attachments: # 1 Text of Proposed Order)(Wedekind, Jennifer) (Entered: 08/14/2018)
133 PAPERLESS ORDER granting 132 Motion to Withdraw as Attorney. Jennifer Wedekind permitted to withdraw from case. Signed by Judge Beth Bloom (BB) (Entered: 08/14/2018)
134 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 08/14/2018)
135 REPORT REGARDING Independent Monitors' Report No. 9 by United States of America (Marks, Megan) (Entered: 08/24/2018)
136 Unopposed MOTION for Leave to Appear Telephonically at September 7, 2018 Status Conference . Attorney/Representative: Dr. Robert Greifinger and Dr. Kahlil Johnson by United States of America. Responses due by 9/19/2018 (Attachments: # 1 Text of Proposed Order)(Marks, Megan) (Entered: 09/05/2018)
137 PAPERLESS ORDER granting 136 Motion for Leave to Appear Telephonically at September 7, 2018 Status Conference. Drs. Greifinger and Johnson may appear by phone and are instructed to call 1−877−336−1829 on the date and time set forth above. The access code is 4742152 and the security code is 5680. For clarity, please do not use a cell phone or a speaker phone. Signed by Judge Beth Bloom (BB) (Entered: 09/06/2018)
138 PAPERLESS Minute Entry for proceedings held before Judge Beth Bloom: Status Conference held on 9/7/2018. The next Status Conference is set for 11/15/2018 01:00 PM in Miami Division, 400 North Miami Avenue, Courtroom 10−2, Miami, Florida 33128, before Judge Beth Bloom. Total time in court: 0 hour(s) : 50 minutes. Attorney Appearance(s): Benjamin David Simon, Bernard Pastor, Laura Llorente, Laura Coon, Veronica Vanessa Harrell−James. Other appearances: Independent Monitors Susan McCampbell, Dr. Robert Greifinger, and Dr. Kahlil Johnson. Court Reporter: Yvette Hernandez, 954−769−5698 / Yvette_Hernandez@flsd.uscourts.gov. (ak03) (Entered: 09/07/2018)
139 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 09/13/2018)
140 NOTICE by United States of America of Joint Declaration (Marks, Megan) (Entered: 09/17/2018)
141 TRANSCRIPT of Status Conference held on 09/07/2018 before Judge Beth Bloom, 1 − 30 pages, Court Reporter: Yvette Hernandez, 305−523−5698/ Yvette_Hernandez@flsd.uscourts.gov. Transcript may be viewed at the court public terminal or purchased by contacting the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 10/31/2018. Redacted Transcript Deadline set for 11/13/2018. Release of Transcript Restriction set for 1/8/2019. (yhz) (Entered: 10/10/2018)
142 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 10/15/2018)
143 Notice of Filing Letter from The Court (ego) (Entered: 10/24/2018)
144 NOTICE of Attorney Appearance by William G. Maddox on behalf of United States of America. Attorney William G. Maddox added to party United States of America(pty:pla). (Maddox, William) (Entered: 10/25/2018)

10/29/2018 11/15/2018 11/15/2018
12/06/2018 12/12/2018 12/20/2018 01/02/2019
01/03/2019 01/04/2019 01/07/2019 01/15/2019 02/01/2019 02/04/2019 02/06/2019 02/15/2019 02/15/2019

145 NOTICE by United States of America Joint Declaration (Maddox, William) (Entered: 10/29/2018)
146 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 11/15/2018)
147 PAPERLESS Minute Entry for proceedings held before Judge Beth Bloom: Status Conference held on 11/15/2018. The next Status Conference is set for 1/11/2019 02:30 PM in Miami Division before Judge Beth Bloom. Total time in court: 0 hour(s) : 20 minutes. Attorney Appearance(s): Benjamin David Simon, Bernard Pastor, Laura Llorente, Veronica Vanessa Harrell−James, William G. Maddox. Other appearance(s): Independent Monitor Susan McCampbell.. Court Reporter: Gizella Baan−Proulx, 305−523−5634 / Gizella_Baan−Proulx@flsd.uscourts.gov. (ak03) (Entered: 11/15/2018)
148 NOTICE by United States of America Joint Declaration Paragraph 12 Summary Action Plan (Maddox, William) (Entered: 12/06/2018)
149 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 12/12/2018)
150 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing of Updated Organizational Chart (Attachments: # 1 Exhibit) (Pastor, Bernard) (Entered: 12/20/2018)
151 TRANSCRIPT of Hearing held on 11−15−2018 before Judge Beth Bloom, 1−24 pages, Court Reporter: Gizella Baan−Proulx, 305−523−5634 / Gizella_Baan−Proulx@flsd.uscourts.gov. Transcript may be viewed at the court public terminal or purchased by contacting the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 1/23/2019. Redacted Transcript Deadline set for 2/4/2019. Release of Transcript Restriction set for 4/2/2019. (gbx) (Entered: 01/02/2019)
152 MOTION to Stay Fourth Summary Action Plan Reporting Deadlines and Jan. 11 Status Conference by United States of America. Responses due by 1/17/2019 (Maddox, William) (Entered: 01/03/2019)
153 PAPERLESS ORDER granting 152 Motion to Stay the reporting deadlines in the Fourth Summary Action Plan and the January 11, 2019 status conference until the Department of Justice attorneys are permitted to resume their usual civil litigation functions. Signed by Judge Beth Bloom (BB) (Entered: 01/04/2019)
154 PAPERLESS ORDER Setting Status Conference: Status Conference set for 2/15/2019 at 01:30 PM in Courtroom 10−2, 400 North Miami Avenue, Miami, Florida 33128, before Judge Beth Bloom. Signed by Judge Beth Bloom. (ak03) (Entered: 01/07/2019)
155 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 01/15/2019)
156 ORDER REQUIRING STATUS REPORT. Joint Status Report due by 2/6/2019. Signed by Judge Beth Bloom on 2/1/2019. See attached document for full details. (ar2) (Entered: 02/04/2019)
157 STATUS REPORT Joint Declaration Paragraph 13 Summary Action Plan by United States of America (Maddox, William) (Entered: 02/04/2019)
158 STATUS REPORT Joint by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners (Hochstadt, Jennifer) (Entered: 02/06/2019)
159 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners re 61 Order Notice of Filing Monthly Report with Minutes and Audit Tools (Simon, Benjamin) (Entered: 02/15/2019)
160 PAPERLESS Minute Entry for proceedings held before Judge Beth Bloom. Status Conference held on 2/15/2019. Total time in court: 10 minutes. Attorney Appearance(s): Veronica Vanessa Harrell−James, William G. Maddox, Chantelle Doakes, Benjamin

03/13/2019
03/14/2019 03/15/2019 03/16/2019 03/25/2019 03/29/2019
04/15/2019 05/02/2019
05/14/2019 06/14/2019 06/19/2019 07/15/2019

David Simon, Laura Lllorente. Other appearances: Independent Monitors Susan McCampbell, Dr. Robert Greifinger, and Dr. Kahlil Johnson. Court Reporter: Yvette Hernandez, 954−769−5698 / Yvette_Hernandez@flsd.uscourts.gov. The next Status Conference is set for 3/29/2019 at 01:30 PM in Miami Division, 400 North Miami Avenue, Courtroom 10−2, Miami, Florida 33128 before Judge Beth Bloom. (ak03) (Entered: 02/15/2019)
161 TRANSCRIPT of Status Conference held on 2/15/2019 before Judge Beth Bloom, 1 − 11 pages, Court Reporter: Yvette Hernandez, 305−523−5698 / Yvette_Hernandez@flsd.uscourts.gov. Transcript may be viewed at the court public terminal or purchased by contacting the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 4/3/2019. Redacted Transcript Deadline set for 4/15/2019. Release of Transcript Restriction set for 6/11/2019. (yhz) (Entered: 03/13/2019)
162 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 03/14/2019)
163 MOTION to Withdraw as Attorney Regina Jansen, Amar Shakti Nair, Catherine Bendor, and Megan Marks by William G. Maddox for / by United States of America. Responses due by 3/29/2019 (Maddox, William) (Entered: 03/15/2019)
164 PAPERLESS ORDER granting 163 Motion to Withdraw as Attorney. Megan Renee Marks; Amar Shakti Nair; Catherine Bendor and Regina Jansen are permitted to withdraw from case. Signed by Judge Beth Bloom (BB) (Entered: 03/16/2019)
165 STATUS REPORT Monitor Compliance Report #10 March 25 2019 by United States of America (Maddox, William) (Entered: 03/25/2019)
166 PAPERLESS Minute Entry for proceedings held before Judge Beth Bloom. Status Conference held on 3/29/2019. Total time in court: 16 minutes. Attorney Appearance(s): Bernard Pastor, Laura Llorente, Veronica Vanessa Harrell−James, William G. Maddox, Chantel Doakes. Other appearances: Independent Monitors Susan McCampbell (in person) and Dr. Robert Greifinger (by telephone). The next Status Conference is set for 11/1/2019 01:30 PM in Miami Division before Judge Beth Bloom. Court Reporter: Yvette Hernandez, 954−769−5698 / Yvette_Hernandez@flsd.uscourts.gov. (ak03) (Entered: 03/29/2019)
167 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 04/15/2019)
168 TRANSCRIPT of Status Conference held on 3/29/2019 before Judge Beth Bloom, 1 − 15 pages, Court Reporter: Yvette Hernandez, 305−523−5698 / Yvette_Hernandez@flsd.uscourts.gov. Transcript may be viewed at the court public terminal or purchased by contacting the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 5/23/2019. Redacted Transcript Deadline set for 6/3/2019. Release of Transcript Restriction set for 7/31/2019. (yhz) (Entered: 05/02/2019)
169 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Reports (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 05/14/2019)
170 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 06/14/2019)
171 STATUS REPORT Joint Declaration Regarding Action Steps to Achieve Compliance with the Consent Agreement by United States of America (Maddox, William) (Entered: 06/19/2019)
172 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 07/15/2019)

08/15/2019 09/13/2019 10/15/2019 10/28/2019 10/28/2019 10/28/2019
11/01/2019
11/01/2019 11/07/2019
11/12/2019 11/15/2019 12/15/2019 01/15/2020 02/13/2020

173 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 08/15/2019)
174 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 09/13/2019)
175 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 10/15/2019)
176 Plaintiff's MOTION to Bring Electronic Equipment into the courtroom by United States of America. Responses due by 11/12/2019 (Attachments: # 1 Text of Proposed Order)(Harrell−James, Veronica) (Entered: 10/28/2019)
177 REPORT REGARDING Report No. 11 of the Independent Monitors by United States of America (Harrell−James, Veronica) (Entered: 10/28/2019)
178 PAPERLESS ORDER granting 176 Motion to Bring Electronic Equipment into the Courtroom. Dr. Robert Greifinger and Dr. Kahlil Johnson, who are members of the Independent Monitoring Team, are authorized to bring their electronic devices and/or computers into the Courthouse for any Status Conference or Hearing before the Court. Signed by Judge Beth Bloom (BB) (Entered: 10/28/2019)
179 PAPERLESS Minute Entry for proceedings held before Judge Beth Bloom: Status Conference held on 11/1/2019. The parties shall jointly file a schedule detailing a timetable for reaching compliance with the remaining paragraphs of the Consent Agreement, on or before November 12, 2019. Total time in court: 0 hour(s) : 44 minutes. Attorney Appearance(s): Benjamin David Simon, Bernard Pastor, Laura Llorente, Veronica Vanessa Harrell−James, William G. Maddox. Other appearances: Susan McCampbell, Dr. Robert Greifinger (via telephone), Dr. Kahlil Johnson. Court Reporter: William Romanishin, 305−523−5558 / Bill_Romanishin@flsd.uscourts.gov. (ak03) (Entered: 11/01/2019)
180 PAPERLESS ORDER Setting Status Conference. The next status conference is set for 5/22/2020 at 01:30 PM in Miami Division, 400 North Miami Avenue, Courtroom 10−2, Miami, Florida 33128 before Judge Beth Bloom. Signed by Judge Beth Bloom (ak03) (Entered: 11/01/2019)
181 TRANSCRIPT of Status Conference held on 11/1/2019 before Judge Beth Bloom, 1−31 pages, Court Reporter: William Romanishin, 305−523−5558 / Bill_Romanishin@flsd.uscourts.gov. Transcript may be viewed at the court public terminal or purchased by contacting the Court Reporter before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Redaction Request due 11/29/2019. Redacted Transcript Deadline set for 12/9/2019. Release of Transcript Restriction set for 2/5/2020. (br) (Entered: 11/07/2019)
182 NOTICE by United States of America Joint Scheduling Notice (Maddox, William) (Entered: 11/12/2019)
183 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Status Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 11/15/2019)
184 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Montly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 12/15/2019)
185 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 01/15/2020)
186 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 02/13/2020)

03/13/2020 03/31/2020 04/02/2020
04/15/2020 05/15/2020

187 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 03/13/2020)
188 NOTICE by Miami−Dade County of Filing Parties' Revised Joint Scheduling Notice (Pastor, Bernard) (Entered: 03/31/2020)
PAPERLESS ORDER re−setting Status Conference. The next status conference will be held on 12/4/2020 at 01:30 PM in Miami Division, 400 N. Miami Avenue, Courtroom 10−2, Miami, Florida 33128, before Judge Beth Bloom. Signed by Judge Beth Bloom (ak03) (Entered: 04/02/2020)
189 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 04/15/2020)
190 NOTICE by Miami−Dade County, Miami−Dade County Public Health Trust, Miami−Dade County; The Board of County Commissioners of Filing Monthly Report (Attachments: # 1 Exhibit, # 2 Exhibit) (Pastor, Bernard) (Entered: 05/15/2020)

 
 Case 1:13-cv-21570-WJZ Document 1 Entered on FLSD Docket 05/01/2013 Page 1 of 10

IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF FLORIDA

UNITED STATES OF AMERICA,

)

)

PLAINTIFF,

)

)

v.

)

)

MIAMI-DADE COUNTY;

)

BOARD OF COUNTY COMMISSIONERS,

)

MIAMI-DADE COUNTY;

)

PUBLIC HEALTH TRUST,

)

MIAMI-DADE COUNTY

)

)

DEFENDANTS.

)

-------------------------------- )

Civil No. - - - - -

COMPLAINT 1. Defendants, MIAMI-DADE COUNTY; THE BOARD OF COUNTY COMMISSIONERS OF MIAMI-DADE COUNTY; and THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY are engaging in a pattern or practice of violating the constitutional rights of inmates at the Miami-Dade County Corrections and Rehabilitation Department ("MDCR") Jail facilities. Defendants' deliberate indifference to these constitutional rights causes MDCR Jail facilities' inmates serious harm from suicide and self harm and unaddressed serious mental health and medical needs. Accordingly, this Complaint sets out claims of Defendants' unlawful conduct of depriving persons incarcerated at the MDCR Jail facilities in Miami-Dade County, Florida, of rights, privileges, or immunities secured and protected by the Constitution of the United States. 2. The United States Department of Justice ("United States") alleges the following, based on information and belief:

Case 1:13-cv-21570-WJZ Document 1 Entered on FLSD Docket 05/01/2013 Page 2 of 10
I. JURISDICTION AND VENUE 3. The United States is authorized to bring this action pursuant to the Civil Rights of Institutionalized Persons Act, 42 U.S.C. § 1997a ("CRIPA"). 4. The Attorney General certifies that all pre-filing requirements specified by 42 U.S.C. § 1997b have been met. The Attorney General's certificate is attached to, and incorporated in, this Complaint. 5. This Court has jurisdiction over this action under 28 U.S.C. §§ 1331 and 1345. 6. Venue is proper in this district. The acts and omissions giving rise to this action occurred in the Southern District ofFlorida. 28 U.S.C. § 139l(b).
II. DEFENDANTS 7. Defendants, MIAMI-DADE COUNTY; THE BOARD OF COUNTY COMMISSIONERS OF MIAMI-DADE COUNTY; and THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY operate the MDCR Jail facilities, and are responsible for the safety, care, custody, and control of inmates incarcerated at the MDCR Jail facilities, as well as the actions of the MDCR Jail facilities' staff and any entity or individual contracting and providing services at the MDCR Jail facilities. 8. Defendants are legally responsible for the operation, maintenance, and conditions of the MDCR Jail facilities and for the safety and health of inmates incarcerated at the MDCR Jail facilities. 9. At all relevant times, Defendants have acted or failed to act, as alleged herein, under color of state law.
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Case 1:13-cv-21570-WJZ Document 1 Entered on FLSD Docket 05/01/2013 Page 3 of 10
III. BACKGROUND 10. The MDCR Jail is an institution within the meaning of 42 U.S.C. § 1997.
11. The MDCR Jail facilities currently consist of six corrections facilities and currently house approximately 5,200 inmates in buildings spread out across the county. The MDCR Jail facilities currently house inmates in correctional facilities including: the Pre-Trial Detention Center; the Training and Treatment Center; the Turner Guilford Knight Correctional Center; and the Metro West Detention Center. Additionally, the MDCR Jail facilities operate a boot camp program, with a housing facility adjacent to the Turner Guilford Knight Correctional Center.
12. The United States sent Defendants a Findings Letter on August 24, 2011. The Findings Letter concluded that certain conditions at the MDCR Jail facilities violated the constitutional rights of inmates, including those alleged in this Complaint. Under a cover letter dated September 27, 2011, the Defendants provided the United States substantial documentation of changes and measures implemented at the MDCR Jail facilities since the time of the United States' inspections. On October 4, 2011, Defendants' representatives met with the United States in Washington, D.C., to discuss the aforementioned documentation of remedial measures undertaken by the Defendants.
13. Defendants made improvements in many areas of the MDCR Jail facilities' operations and the physical plant since the initial facility tours in 2008; however, the Defendants remained deliberately indifferent to the known unlawful deficiencies and failed to take basic steps to correct the inadequate suicide preventative care, mental health care, and medical care described in the United States' Findings Letter.
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Case 1:13-cv-21570-WJZ Document 1 Entered on FLSD Docket 05/01/2013 Page 4 of 10
IV. FACTUAL ALLEGATIONS A. Defendants Fail to Provide Constitutional Suicide Protection and Mental Health
Care 14. The Constitution requires Defendants to protect inmates from suicide and selfharm and to provide adequate care for inmates' serious mental health care needs. Defendants have exhibited deliberate indifference to inmates' serious mental health care needs and to the obvious and substantial ongoing risk of inmate suicide, self-harm, and untreated mental illness. 15. MDCR Jail facilities' inmates suffer serious harm from Defendants' deliberate indifference to inmates' serious mental health needs and to the ongoing risk of suicide and selfharm, as shown by Defendants' own documentation:
a. In March 2011, an inmate committed suicide less than one month after the inmate was evaluated as suicidal and placed in the suicide precaution housing unit. The inmate was returned to the general psychiatric unit where the inmate died of asphyxiation from a bed sheet tied around the inmate's neck;
b. In September 2010, an inmate committed suicide by affixing a sheet to a vent. The inmate was noted as combative and psychotic a day after intake screening and transported to the emergency room. Later that day, the inmate was returned and cleared for general population, where the inmate committed suicide two days later by asphyxiation; and
c. In February 2010, an inmate committed suicide by asphyxiation while in administrative segregation and under medical observation.
4

Case 1:13-cv-21570-WJZ Document 1 Entered on FLSD Docket 05/01/2013 Page 5 of 10
i. Inadequate Suicide Prevention 16. Defendants have failed to take reasonable measures to protect inmates against the serious harm from suicide and self harm, such as: (1) implementation of adequate policies and procedures to treat and supervise inmates with suicidal and self-harm tendencies; (2) placement of adequate staff to monitor inmates on suicide watch and implement necessary policies and procedures; (3) provision of comprehensive, basic training to correctional staff to identify and respond to inmates who are at risk of suicide, self-harm, or untreated mental illness; (4) removal of suicide hazards from cells housing suicidal inmates; (5) timely and adequate evaluation of inmates for levels of suicide risk and supervision based on the risk; (6) provision of meaningful mental health treatment for inmates on suicide watch; and (7) establishment of adequate stepdown programs for inmates being removed from suicide watch. ii. Inadequate Mental Health Care 17. Defendants failed to take reasonable measures to provide adequate mental health services to inmates with serious mental illness, including: (1) screening, evaluation and referrals, where inmates may require emergency, urgent or routine mental health care; (2) providing access to adequate care and an adequate mental health care request system; (3) assessment and treatment; (4) staffing at the MDCR Jail facilities to provide appropriate care; (5) reviewing disciplinary penalties to ensure penalties are not imposed on inmates with mental illness for conduct that is symptomatic of their mental illness; (6) evaluating inmates before prescribing prescription medications and monitoring these medications' effects; (7) formulating and implementing individualized treatment plans for inmates with mental illnesses; (8) providing mental health care housing; and (9) establishing quality assurance measures that monitor highrisk, high-volume, and problem-prone aspects of mental health care.
5

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B. Defendants Provide Unconstitutional Medical Care 18. The Constitution requires Defendants to provide inmates with adequate care for their serious medical needs. Defendants have exhibited deliberate indifference to the MDCR Jail facilities' inmates' serious medical needs. 19. The MDCR Jail facilities' inmates suffer serious harm from Defendants' failure to provide treatment for their serious medical needs, as shown by Defendants' own documentation:
a. In July 2008, an inmate died twelve hours after the inmate's intake screening. The screening indicated no medical problems or history of drug or alcohol use; however, the inmate suffered a seizure at the MDCR Jail facilities. Despite a high blood pressure reading and appearing disoriented post-seizure, the Jail's medical staff did not authorize the inmate's transfer to the hospital and did not order follow up treatment after the inmate's seizure and elevated blood pressure reading. The inmate was found unresponsive in his cell and later pronounced dead;
b. In May 2008, an inmate with a history of drug withdrawal died the same day the inmate was admitted to the MDCR Jail facilities. The MDCR Jail facilities' staff did not provide observation or monitoring, despite the inmate's condition. The inmate was found unresponsive in the inmate's cell and the MDCR Jail facilities' staff did not have an automated external defibrillator available. The inmate was later pronounced dead; and
c. In October 2007, an inmate died at the MDCR Jail facilities. A day before his death, the inmate complained of shortness of breath. The inmate's examination was inadequate and incomplete. No vital signs were taken, no lung exam was completed, and the inmate was given medicine for a cold. The next day, the 6

Case 1:13-cv-21570-WJZ Document 1 Entered on FLSD Docket 05/01/2013 Page 7 of 10
inmate continued to complain of shortness of breath and was transferred to the hospital where the inmate died. 20. Defendants failed to take reasonable measures to provide adequate medical care to inmates with serious medical needs such as through: (1) an adequate sick call process; and (2) identification and treatment of inmates suffering from acute or chronic illness.
V. VIOLATIONS ALLEGED
DEFENDANTS' PATTERN OR PRACTICE OF VIOLATING INMATES' CONSTITUTIONAL RIGHTS
21. The United States alleges and incorporates by reference the allegations set forth in paragraphs 14-20, above.
22. CRIPA authorizes the United States to seek equitable and declaratory relief to remedy a pattern or practice of Defendants depriving inmates confined to the MDCR Jail facilities of any rights, privileges, or immunities secured or protected by the Constitution.
23. Defendants are, have been, or should have been aware of the deficiencies alleged in paragraphs 14-20 above, but have failed to take effective measures to remedy these deficiencies. These failures amount to deliberate indifference to the safety and health of the MDCR Jail facilities' inmates, in violation of the rights, privileges, and immunities that the Constitution secures and protects. See U.S. Const. amend. VIII & XIV. This deliberate indifference caused and continues to cause the violations of constitutional rights alleged.
24. Unless restrained by this Court, Defendants will continue to engage in the acts and omissions set forth in paragraphs 14-20 above, that deprive persons confmed in the MDCR Jail facilities of the rights, privileges, and immunities secured and protected by the Constitution.
7

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VI. PRAYER FOR RELIEF 25. The Attorney General is authorized under 42 U.S.C. § 1997 to seek equitable and declaratory relief. 26. WHEREFORE, the United States prays that the Court will:
a. declare that Defendants' acts, omissions, and practices set forth in paragraphs 1420 above, constitute a pattern or practice of conduct that deprives the MDCR Jail facilities' inmates of rights, privileges, or immunities secured or protected by the Constitution of the United States and those acts, omissions, and practices violate the Constitution of the United States;
b. permanently enjoin Defendants, their officers, agents, employees, subordinates, successors in office, and all those acting in concert or participation with them from continuing the acts, omissions, and practices set forth in paragraphs 14-20 above, and order Defendants to take such remedial actions as will ensure lawful conditions of confinement at the MDCR Jail facilities; and
c. grant such other relief as the interests ofjustice may require.
8

Case 1:13-cv-21570-WJZ Document 1 Entered on FLSD Docket 05/01/2013 Page 9 of 10

Respectfully submitted this 4th day of March

'2013.

ROY L. AUSTIN, JR. (DC 211491)

Deputy Assistant Attorney General

J~78) Civil Rights Division

·

Chief LAURA L. COON (DC 481379) Special Counsel REGINA M. JANSEN (MD 25161) Trial Attorney United States Department of Justice Civil Rights Division Special Litigation Section 950 Pennsylvania Avenue, NW Washington, D.C. 20530 Tel.: (202) 514-6255 Email: regina.jansen@usdoj.gov

9

Case 1:13-cv-21570-WJZ Document 1 Entered on FLSD Docket 05/01/2013 Page 10 of 10
®fftce of tbe !rutomep <!9enetal
Wasbington, Ji.<t. 20530
CERTIFICATE OF THE ATTORNEY GENERAL I, Eric H. Holder, Jr., Attorney General of the United States, certify that with regard to the foregoing Complaint, United States v. Miami~Dade Countv, Florida et al., I have complied with all subsections of 42 U.S.C. § 1997b(a)(l). I certify as well that I have complied with all
subsections of 42 U.S.C. § 1997b(a)(2). r further certify, pursuant to 42 U.S.C. § 1997b(a)(3),
my belief that this action by the United States is of general public importance and will materially further the vindication of rights, privileges, or immunities secured or protected by the Constitution.
In addition, [certify that I have the "reasonable cause to believe,'' set forth in 42 U.S.C. § 199?a, to initiate this action, and that all prerequisites to the initiation of this suit under 42 U.S.C. §§ l997a and 199?b have been met.
Pursuant to 42 U.S.C. § 1997a(c), I have personally signed the foregoing Complaint. Pursuant to 42 U.S.C. § 1997b(b), I am personally signing this Certificate.
Signed this 4th day of March , 2013, at Washington, D.C.
Jr. Attorney General of the United State

 
 Case 1:13-cv-21570-WJZ Document 9 Entered on FLSD Docket 05/22/2013 Page 1 of 2

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF FLORIDA
CASE NO. 13-21570-CIV-ZLOCH

UNITED STATES OF AMERICA,
Plaintiff, vs.

FINAL ORDER APPROVING AND ENTERING CONSENT DECREE AND
DISMISSING CASE WITHOUT PREJUDICE

MIAMI-DADE COUNTY, et al.,

Defendants. /

THIS MATTER is before the Court upon the Joint Motion To Enter

Consent Agreement (DE 5) filed herein by all Parties. The Court

has carefully reviewed said Joint Motion, the entire court file and

is otherwise fully advised in the premises.

Accordingly, after due consideration, it is

ORDERED AND ADJUDGED as follows:

1. The previously entered Final Order Approving And Entering

Consent Decree And Dismissing Case With Prejudice (DE 8) be and the

same is hereby VACATED and of no further force or effect;

2. The Joint Motion To Enter Consent Agreement (DE 5) filed

herein by all Parties, be and the same is GRANTED;

3. The Parties’ Consent Agreement (DE 5-2) be and the same is

hereby approved, adopted, and ratified by the Court;

Case 1:13-cv-21570-WJZ Document 9 Entered on FLSD Docket 05/22/2013 Page 2 of 2

4. The above-styled cause be and the same is hereby DISMISSED

without prejudice; and

5. To the extent not otherwise disposed of herein, all pending

motions are DENIED as moot.

DONE AND ORDERED in Chambers at Fort Lauderdale, Broward

County, Florida this 22nd

day of May, 2013.

Copies furnished: All Counsel of Record

WILLIAM J. ZLOCH United States District Judge

2

 
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 MIAMI-DADE COUNTY JAIL . SETTLEMENT AGREEMENT
TABLE OF CONTENTS

1. INTRODUCTION AND BACKGROUND "."""""..... "...."...."...."."""" ........ "...."..... ".. 2

II. DEFINITIONS .............."............................ "."......................... ,"""........,.........".........",... 3

III. SUBSTANTIVE PROVISIONS .."..... "......"................"........................"".... "...."........ ".. 5

A. PROTECTION FROM HARM .... "",, ...,............................................................... 5

1. Safety and Supervision .............................................................................. 5

.2. Security Staffing ..:......,........................,... ""........." .."".."......................... 7

3. Sexual Miseonduct.............................................,.....,................................. 8

4. Incidents and Refen'als .............................................................................. 8

5. Use of Foree by Staff............................................................. ".............".... 9

6. Early Warning System ............................................................................. 13

B. FIRE AND LIFE SAFETy............".................................................................... 14

C. INMATE GRIEVANCES ..............".................................................."................ 15

D. AUDITS AND CONTINUOUS IMPROVEMENT ............................................ 16

: i

1. SelfAudits .................................................................................,.. ".......... 16

2. Bi-annual Reports ........................................................................ ".:........ 16

IV. C()MPLIANCE AND QUALITY IMPROVEMENT ......... ,,, ........... ,, ............................. 17

V, REPORTING REQUIREMENTS AND RIGHT OF ACCESS ......................................... 18

VI. MONITORING ................. " .............................................................................................. 19

VII. CONSTRUCTION, IMPLEMENTATION, AND TERMINATION ............................... 21

I. INTRODUCTION AND BACKGROUND
1. This Settlement Agreement ("Agreement") is among and between the United States
Department of Just\ce ("DOJ"); Miami-Dade Cotmty; and tl1e Board of Cotmty Commissioners of Miami-Dade County, the governing body of Miami-Dade COlmty, a political subdivision of the State of Florida, which operates the County Jail by and through the Miami-Dade County Corrections and Rehabilitation Department ("MDCR") (collectively referred to as "County") to remedy the alleged constitutional violations at the Miami·Dade County Jail identified in the findingll letter that tile United States issued on August 24, 2011 ("Findingll Letter").
2. The MDCR operates con'ectional facilities in Miami, Florida (collectively known as "MDCR Jail facilities" or "the Jail") and is responsible for providing care, custody, and control of inmates. The Jail currently consists of 6 corrections' facilities and currently houses approximately 5,200 inmates in a complex of buildings spread out across the Calmly, below the design capacity of 5,845. The MDCR Jail facilities are al1 integral part of the public safety system in Miami·Dade County, Florida.
3. On April 2, 2008, fue DOJ notified Miami-Dade Comty officials of its intention to
investigate conditions at fue MDCR Jail facilities, pllrsuant to the Civil Rights of
Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997. The DOJ toured. tile MDCR Jail facilities with consultants in the fields of corrections, medical and mental health care, suicide prevention, fire safety and environmental health and safety on June 9 - 13 and June 16 - 20, 2008, alld on April 7 - 8, 2009.
4. On August 24,20.11, the DOJ issued a Findings Letter, pursuant to 42 U.S.C. § 1997 (a) (1), which concluded iliat certain conditions in fue MDCR Jail facilities violated the constitutional rights of inmates, and reCommended reniedial measures. Under a cover letter dated September 27, 2011, fue County provided to DOJ substalltial docunlentation of changes and measures implemented at the MDCR Jail facilities ·since the time of tlle DOJ inspections. On October 4, 2011, Comly representatives met with DOJ in Washington, D.C., to discuss the aforementioned documentation of remedial measures undertal(en by MDCR.
5. At fue request ofMDCR, the DOJ conducted an additional tOID' oflhe MDCR Jail facilities . with consultants on November 30 - December 2, 2011. Based upon this inspection, the DOJ concluded tllat some of the violations identified in its Findlllg11 Letter were improved, while other conditions still walTanted remedial efforts to be fully implemented.
6. 111foughont the course of the investigation and inspection of the MDCR Jail facilities, the DOJ received complete cooperation from fue County and unfettered access to all facilities, documents and staff. In addition, DOJ acknowledges that fue County made significant improvements in many areaS of Jail operations and the physical plant since its initial Jail
2

tours in 2008. 11usAgreement is the result of a cooperative effort that evinces a commitment to .constitutional conditions at the MDCR Jail facilities on the part of the United States and the County. Through the provisions of this Agreement, the Parties seek to avoid the risks and burdens of litigation while ensuring that the conditions in the Jail are constitutional so as to respect the rights of imnates and provide for the safety of staff.
7. This Agreement only addresses provisions regarding protection from harm, fire and life
safety, and inmate grievances. A separate Consent Agreement between the United States, the County and its entities, and the Public Heath Trust address medical care, mental health care, and suicide preve>ntion.
8. This Agreement neither constitutes an admission by the County of the truth of the findings . contained in the Findings Letter, nor cOllStitutes an admission of liability by the County. Any of the deficiencies, risks, or breach intimated by the language of this Agreement, expressed or implied, are disclaimed by the County. The County enters into this Agreement because it is firmly committed to providing constitutionally and legally compliant conditions in the Jail by effectuating its duties under the Constitution and other applicable law. The County demonstrated this commitment not only by entering into this Agreement but also by pursuing accreditation and auditing by professional correctional orgaluzations, with several of its facilities having achieved accreditation by Americall Correctional Association and Florida Corrections Accreditation Commission, as well as system-wide compliance with the Florida Model Jail Standards.
9. No person or entity is intended to be a third-party beneficiary of this Agreement for purposes of any civil, criminal, or administrative action. Accordingly, no person or entity may assert any claim or right as a beneficiary or protected class under this Agreement. This Agreement is not intended to impair or expalld the right of ally person or entity to seek relief against the County or its officials, employees, or agents, for their conduct. This Agreement is not intended to alter legal standards governing any such claims.
II. DEJ.fINITIONS
1. "Compliance" is discussed throughout this Agreement in the foHowing te11l1s: substantial COmpliallCe, partial compliance, and non-compliance. "Substantial Compliance" indicates that MDCR has achieved compliance with most or all components of the relevant provision of the Agreement. "Partial COmpliallCe" indicates that MDCR achieved compliance on some of the components of the relevant provision of the Agreement, but sigoificant work remains. "Non-compliance" indicates that MDCR has not met most or all of 111e components of the Agreement.
2. "Effective Date" means the date tius Agreement is signed by tile parties.
3

3. "Include" or "including" means "include, but not be limited to" or "including, but not limited to."

4. "Imnates" or "hmlate" broadly refers to one 01' more individuals detained at, or otherwise housed, held, in the custody of, or confined in the Jail.

5. "Jail" refers to all correctional facilities operated by the Miami-Dade County Corrections

and Rehabilitation Department and includes: the Pre-Trial Detention Center ("PTDC"); the

I I

Women's Detention Center (''WOC''); the Training and Treatment Center ("Stockade"); the

I

Turner Guilford Knight Correctional Center ("TGK"); the Metro West Detention Center

("MWDC"), and any facility that is built, leased, or otherwise used, to replace or

supplement the current MDCR Jail facilities, including the anticipated correctional mental

health facility ("Mental Health Treatment Facility"). Additionally, MDCR operates a boot

camp program, with a housing facility adj acent to TGK ("Boot Camp").

6. "MDCR" refers to Miami~Dade Corrections and Rehabilitation Department. (See the definition for "Jail")..

7. "Monitor" means theindividual(s) selected to oversee implementation ofthe Agreement.

8. "Qualified Health Care Professionals"and "Qualified Medical Staff' refer to Qualified Medical Professionals and Qualified Nursing Staff, as well as other Qualified Health Care Professional staff providing services wilhin th~ scope of their practice, licensure, training, supervision and qualifications.

9. "Special Management Units" mean those housing units of the Jail designated for inmates in administrative or disciplinary segregation, in protective custody, on suicide precautions, or with mental illness.

10. "Sustain hnplementation" means to achieve a prolonged and continuous practice.

11. "Train" means to instruct in the skills addressed to a level that the trainee has demonstrated proficiency. "Trained" means to have achieved SllCh proficiency ill the skills and to implement those skills regularly. The majority of training shall be in person, with online training functioning as a supplement rather th!\l1 a stand-alone option. The County will docwnent and track training of all staff.

12. "Use of force" means the application of physical or mechanical measures to compel compliance by a subject. "Use of force" shall include all fotce except un-resisted handcuffing or un-resisted shackling of imnates for movement purposes.

4

III. SUBSTANTIVE PROVISIONS
The County shall take all actions necessary to comply with the substantive provisions of this
Agreement detailed below. Compliance with the Agreement will be measured both by whether the technical provisions are implemented and whether the conditions of confinement in the Jail meet the reqnirements of the United States Constitution.
A. PROTECTION FROM HARM Consistent with constitutional standards, the MDCR Jail facilities shall provide i11ll1ates with a reasonably safe and secure environment to ensure that they are protected from hal111. MDCR shall ensure that inmates are not subjected to unnecessary or excessive force by the MDCR Jail facilities' staff and are protected from violence by other inmates. The MDCR Jail facilities' efforts to achieve this constitutionally required protection from harm will include tile following l'emedialmeasures regarding,: (1) Safety and Supervision; (2) Security Staffing; (3) Sexual Misconduct; (4) Incidents and Referrals (5) Use of Force by Staff;, and (6) Early Warning System.
1. Safety and Supervisjon
a. MDCR will take all reasonable measures to ensure that inmates are not subjected to harm or the risk of harm. Whlle some danger is inherent in a jail setting, MDCR shall implement appropriate measures to minimize these risks, including:
(1) Maintain implemented security and control-related policies, procedures, and practices that will ensure a reasonably safe and secure environment for all i11ll1ates and staff, in accordance with constitutional standards.
(2) Within 90 days of the Effective Date, conduct an inmate bed and
classification analysis to ensure the Jail has adequate beds for
maximum security and disciplinary segregation il1111ates. Within 90 days thereafter, MDCR will implement a plan to address the results of the analysis. The Monitor will conduct an annual review to determine whether MDCR's objective classification system continues to accomplish the goal of housing i11ll1ates based on level of risk and supervision needs.
(3) Develop and implement a policy requiring correctional officers to conduct documented rounds, at itl'egular intervals, inside each housing unit, to ensure periodic supervision and safety. In the alternative, MDCR may provide direct supervision of inmates by posting a correctional officer inside the day room area of a housing unit to conduct surveillance.
5

(4) Document all security rounds on fonns or logs that do not contain pre-printed rounding times. Video smveillance may be used to supplement, but not replace, rounds by con'ectional officers.
(5) MDCR shall document an objective risk analysis of maximum security imnates before placing them in housing units that do not have direct supervision or video monitoring, which shows that these inmates have no greater risk of violence toward imnateil than medium secmity inmates. MDCR shall continue to increase tile use of overhead video surveillailce and recording cameras to provide adequate coverage and video monitoring throughout all Jail facilities to include:
i. PTDC - 24 safety cells, by July 1, 2013 ii. PTDC -lOB disciplinary wing, by December 31, 2013;
kitchen, by Jan. 31, 2014; iii. Women's Detention Center - kitchen, by Sept. 30, 2014; iv. Training and Treatment Center - all inmate honsing units
areas and kitchen, by Apr. 30, 2014: v. Turner Guilford Knight Con'ectional Center - kitchen: future
intake center; by May 31,2014; and vi. Metro West Detention Center - throughout all areas: by Aug.
31,2014.
(6) In addition to continuing to implement documented half-hour welfare checks pursuant to the "Imnate Administrative and DisciplinalY Confinement" policy (DSOP 12.002), for the PTDC safety cells, MDCR shall Implement an automated welfare check system by .Tu1y 1, 2013. MDCR shall ensure that correctional supervisors periodically review system downloads and take appropriate action with officers who fail to complete required checks.
(7) Security supervisors shall conduct daily rounds on each shift in the inmate housing units, and document the results of theirrounds.
(8) MDCR shall maintain a policy ensuring fuat security staff conduct sufficient searohes of cells to ensure that inmates do not have access to dangerous contraband, inoluding at least the following:
i. r811dom daily visual inspections of four to six cells per housing area or cellblock; .
ii. r811dom daily inspections of common 81'eas of the housing mlits;
iii. regular daily searches Of intake cells; and iv. periodic 181'ge scale searches of entire housing mula.
(9) MDCR shall require correctional officers who are tr811sferred from one facility to a facility in another division to attend training on
6

facility-specific safety and security standard operating procedures within 30 days of assignment. (10) Correctional officers assigned to special management units, including disciplinary segregation and protective custody, shall receive eight hours of specialized training for working on that unit on at least an annual basis. (11) MDCR shall continue its efforts to reduce inmate-on-inmate violence in each Jail facility anlmally after the Effective Date. If reductions in
violence do not occur in any given year, the Cmmty shall demonstrate
that its systems for minimizing imnate-on-imnate violence are operating effectively.
2. Security Staffing Correctional staffing and supervision must be sufficient to adequately supervise incidents of inmate violence, including sexual violence, fulfill the terms of this Agreement, and allow for the safe operation ofthe Jail, consistent with constitutional standards. MDCR shall achieve adequate correctional officer staffing in the following manner: a. Within 150 days of. the. Effective Date, MDCR shall conduct a comprehensive staffing analysis and plan to determine the coll'eational staffing and supervision levels necessary to ensure reasonable safety, Upon completion of the staffing plan and analysis, MDCR will provide its fmdings to the Monitor for review. The Monitor will have 30 days to raise any objections and recommend revisions to the staffing plan. b. MDCR shall ensure that the staffing plan includes staffing an adequate number of correctional officers at all times to escort inmates to and from medical and mental health care units,
c. MDCR shall staff the facility based on full consideration of t1le staffing plan and,analysis, together with any recommended revisions by the Monitor. The parties shall agree upon the timetable for t1le hiring of any additional staff.
d. Every 180 days after completion ofthe first staffing analysis, MDCR shall conduct and provide to Dor and t1le Monitor staffing analyses examining whether the level of staffing recommended by the initial staffing analysis and plan continues to be adequate to implement the requirements of this Agreement. If the level of s.taffing is inadequate, the parties shall re-evaluate and agree llpon the timetable for the hiring of any additional staff,
7

3. Sexual Misconduct
MDCR will develop and implement policies, protocols, trainings, and audits consistent with the requirements of the Prison Rape Elimination Act of 2003, 42 U.S.C. § 15601, et seq., and its implementing regulations, including those related to the prevention, detection, reporting, investigation, data collection of sexual abuse, including inmate-on-inmate and staff-on-inmate sexual abuse, sexual harassment, and sexual touching.

4. Incidents and Referrals

a. MDCR shall ensure that appropriate managers have IQ10wledge of critical incidents in the Jail to take action in a timely manner to prevent additional hal'm to imnates or talce other corrective action. At a minimum, MDCR shall document all reportable incidents by the end of each shift, but no later than 24 hours after the incident. These incidents should include ilUllate fights, rule violations, iumate injuries, suicide attempts, cell extractions, medical emergencies, contraband, destruction of property, escapes and escape attempts, and fires.

b. Staff shall report all suicides and other deaths immediately, but no later than

one hour after the incident, to a supervisor, Internal Affairs ("IA"), and

medical and mental health staff.

.

c. MDCR shall employ a system to track, analyze for trends,. and take corrective action regarding all reportable incidents. The system should include at least the following information:

(1) unique tracking number; (2) inmate(s) name; (3) housing classification; (4) date and time; (5) type of incident; (6) any injuries to staff or inmate; (7) any medical care; (8) primary and secondary staff involved; (9) reviewing supervisor; (10) any external reviews and results; (11) corrective action talcen; and (12) administrative sign-off.

8

d. MDCR shall develop and implement a policy to screen incident reports, use of force reports, and inmate grievances for allegations of staff misconduct and refer I\n incident or allegation for investigation if it meets established policy criteria.
e. Correctional staff shall receive formal pre-service and biennial in-service training on proper incident reporting policies and procedures.
£ MDCR shall continue to train all corrections officers to immediately infonn a member of the Qualified Medical Staffwhen II serious medical need of an imnate arises.
5. Use of Force by Staff
a. Policies and Procedures
(1) MDCR shall sustain implementation of the "Response to Resistance" policy, adopted October 2009. In accordance with constitutional requirements, the policy shall delineate the use of force continuum and permissible and impermissible uses of force, as well as emphasize the importance of de-escalation and non-force responses to resistance. The Monitor shall provide ongoing assistance and arumal evaluation regarding whether the amount and content of use·of force training achieves the goal of reducing excessive use of force. The Monitor will review not only training cw'ricula but also relevant data from MDCR's bi-annual reports.
(2) MDCR shall revise the. "Decontamination of Persons" policy section to include mandatory dOCluneotation of the actual decontamination time in the response to resistance reports.
(3) The Jail shall ensure that· each Facility Supervisor/Bureau Commander reviews all MDCR incidents reports relating to response to resistance incidents. The Facility Supervisor/Blll'eau Commander will not rely on the Facility's Executive Officer's review.
b. Use of Restraints
(1) MDCR shall revise the "Recognizing and Supervising Mentally 111 Inmates" policy regarding restraints (DSOP 12-005) to include the following minimunl requirements:
1. other than restraints for transport only, mechanical or injectible restraints of inmateS with mental illness may only be used after written approval order by a Qnalified Health Professional, absent exigent circumstimces.
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ii. four-point restraints or restraint chairs may be used only as a last resort and in respoMe to an emergency to protect the inmate or others from imminent serious harm, and only after the Jail .attempts or rules out less-intrusive and non-physical interventions.
iii. the form of restraint selected shall be the least restrictive level necessary to contain the emerging crisis/dangerous behavior.
iv. MDCR shall protect inmates from injury during the restraint application and use. Staif shall use the least physical force necessary to control and protect the inmate.
v. restraints shall never be used as punishment or for the convenience of staff. Threatening ilUnates wilh restraint or seclusion is prohibited.
vi. any standing order for an inmate's restraint is prohibited.
(2) MDCR shall revise its policy regarding restraint monitoring to ensure that restraints· are used for the minimUln -amount of time clinically necessary, restrained inmates are under 15 minute in-person visual observation by trained custodial staff. For any custody-ordered restraints, Qualified Medical Staff are notified immediately in order to review the health record for any contraiitdications or accommodations required and to initiate health monitoring.

c. Use of Force Reports
(1) MDCR Shail develop and implement a policy to ensure that staff adequately and promptly report all uses of force within 24 hours of the force.

(2) MDCR shall ensure that use offoree reports:

i.

are written in specific tenns and in narrative form to captnre

the details ofthe incident in accordance with its policies;

ii. describe, in factual terms, tile type and amount' of force used

and precise actions taken in a particular incident, avoiding llse

of vague or conclusory descriptions for describing force;

iii. contain all aCCUl'ate account of the events leading to the Me of

I

force incident;

: I

iv, include a description of any weapon or instrument(s) of

i

restraint used, and the manner in which it was used;

v. are accompanied with any inmate disciplinary report that

prompted the use of force incident;

vi. state the nature and extent of injW'ies sustained both by the

inmate and staff member; _

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vii. contain the date and time any medical attention was actually provided;
viii. include inmate accmmt of the incident; and ix. note whether a use of force was videotaped, and if not, explain
why it was not videotaped.
(3) MDCR shall require initial administrative review by the facility supervisor of use of force reports within three business days of submission..The Shift Commander/Shift Supervisor or designee shall ensure that prior to completion of hislher sluft, the incident report package is completed and submitted to the Facility Supervisor/Bureau C{)mmander or designee.
(4) The Facility Supervisor/Bureau Commander or hislher designee shall submit the MDCR Incident Report (with required attachments) and a copy of the Respnnse to Resistance Surmnary (memorandum) to his/her Division Chief within 14 calendar days. If the MDCR Incident Report and the Response to Resistance Smnmary (memorandum) are not submitted within 14 calendar days, the respective Facility SupervisorlBureau Commander or designee shall provide a memorandmn to hislher Division Chief explaining the reason(s) for the delay.
(5) The Division Chief shall review use of force reports, to include a review of medical documentation of inmate injmies, indicating possible excessive or inappropriate uses of force, within seven business days of submission, excluding weekends. The Division eluef shall fOl'wal'd all original correspondences within seven business days of submission, excluding weekends to Secllrity and Internal Affairs Bureau.
(6) MDCR shall maintain its criteria to identify use of force incidents that warrant a referral to IA for investigation. This criteda should include
. documented or known injuries that are extensive or serious; injuries of suspicious nature (including black eyes, injuries to the mouth, inJuries to the gellitals, etc.); injuries that require treatment at outside hospitals; staff misconduct; complaints by the inmate or S0111eone reporting on his/her behalf, and occasions when use of force reports are inconsistent, conflicting, or suspicious.
(7) Security supervisors shall continue to ensure that photographs are talcen of all involved inmates promptly following a use of force incident, to show the presence of, or lack of, injuries. The photographs will become evidence alld be made part of the use of force package alld used for investigatory purposes.
(8) MDCR shall ensure that a supervisor is present during all planned uses of force and that the force is videotaped.
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(9) Where there is evidence of staff misconduct related to inappropriate or unnecessary force against inmates, the Jail shall initiate persolll1el actions and systemic remedies, including an IA investigation and report. MDCR shall discipline any correctional officer with any sustained findings ofthe following:

i.

engaged in use ofunnecessary or excessive force;

ii. failed to report or report accurately the use of force; or

iii. retaliated against 1111 inmate or' odler staff member for

reporting the use of excessive force; or

iv. interfered with an internal investigation regarding use of

force.

(10) The 1ail will ensure that inmates receive any required medical care following a use afforce.

(11) Every quarter, MDCR shall review for trends 1Il1d implement appropriate corrective action all uses of force that required outside emergency medical treatment; a random slIlnpling of at least 10% of uses of fO,rce where an injury to the inmate was medically treated at the Jail; 1Il1d a randollL slllnpling of at least 5% of uses of force that did not require medical treahnent.

(12) Every 180 days, MDCR shall evaluate use of force reviews for quality, trends and appropriate corrective action, including the quality ofthe reports, in accordance with MDCR's use of force policy,

(13) MDCR shall maintain policies and procedures for the effective and

accurate maintenance, inventory and assiglll11ent of chemical 1Il1d

I ,

other security equipment.

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(14) MDCR shall continue its efforts to reduce excessive or otherwise

unauthorized uses of force by each type in each of the 1ail's facilities

annually. If sllch reduction does 110t occur in any given year, MDCR

shall demonstrate that its systems for preventing, detecting, and

addressing unauthorized uses afforce are operating effectively.

d. Use of Force Training

(1) Through use of force pre-service and in-service training progrlll11S for correctional officers and supervisors, MDCR shall ensure that all correctional officers have the knowledge, skills, and abilities to comply with use of force policies and procedures,
(2) At a minimulTI, MDCR shall provide correctional officers with preservice and biennial in-service h'ailling in use of force, defensive tactics, and l~se of force policies and procedures.
(3) In addition, MDCR shall provide documented training to concctional officers and supervisors on lilly changes in use of force policies and procedures, as updates occur.

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(4) MDCR will randomly test at least 5% of the correctional offioer staff annually to determine their lmowledge of the use of force policies and procedures. The testing instrument and policies shall be approved by the Monitor. The results of these assessments shall be evaluated to determine the need for changes in training practices or fi·equency. MDCR will document the review and conclusions and provide it to the Monitor.
e. Investigations
(1) MDCR shall sustain implementation of comprehensive policies, procedures, and practices for the timely and thorough investigation of alleged staffmisconduct.
(2) MDCR shall revise its "Complaints, Investigations & Dispositions" policy (DSOP 4-015) to enSl)re that all inteJ'llal investigations include timely, thorough, and documented interviews of all relevant staff and ir1111ates who were involved in, or witnessed, the incident in question.
i. MDCR shall ensure that inteJ'llal investigation repOlts include all supporting evidence, including witness and participant statements, policies and procedures relevant to the incident, physical evidence, video or audio recordings, and relevant logs.
ii. MDCR shall ensure that its investigations policy requires that investigators attempt to resolve inconsistencies between witness statements, i.e. inconsistencies between staff and inmate witnesses.
iii. MDCR shall ensure that all investigatory staff receives preservice and in-service training on appropriate investigations policies and procedures, the investigations tracking process, investigatory interviewing techniques, and confidentiality requirements.
iv. MDCR shall provide all investigators assigned to conduct investigations of use of force incidents with specialized training in investigating use of force incidents and allegations, including training on the use of force policy.
6. Early Warning System
a. Implenlentatioll
(1) MDCR will develop and implement an Early Warning System (HEWS") that will dDcument and track con'ectional officers who are involved in use of force incidents lind any grievances, complaints, dispositions, and corrective actions related to the inappropriate or excessive use of force. All appropriate supervisors and investigative
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staff shall have access to this information and monitor the occurrences.
(2) At a minimum, the protocol for using the EWS shall include. the following components: data storage, data rettieval, reporting, data analysis, pattern identification, supervisory assessment, supervisory intervention, documentation, and audit.
(3) MDCR Jail facilities' senior management shall use information from the EWS to improve quality management practices, identify patterns and trends, and take necessary corrective action both on an individual and systemic level.
(4) IA will manage and administer the EWS. IA will conduct quarterly audits of the EWS to ensure that analysis and intervention is W<en according to the process described below.
(5) The EWS will analyze the data according to the following criteria:
i. number of incidents for each data category by individual officer and by all officers in a housing unit;
ii. average level of activity for each data category by individual officer and by all officers in a housing unit;
iii. identification of patterns of activity for each data category by individual officer and by all officers in a housing unit; and
.iv. identification of any patterns by inmate (either involvement in incidents or filing of grievances).
b. MDCR will provide to DOJ and the Monitor, within 180 days of the implementation date of its EWS, and on a bi-aJmual basis, a list of all staff members identified through the EWS, and any corrective action taken.
c. On an annual basis, MDCR shall conduct a documented review of the EWS to ensure that it has been effective in identifying concerns regarding policy, training, or the need for discipline.
8. FIRE AND LIFE SAFETY
MDCR shall ensure that the Jail's emergency preparedness and fire and life safety equipment are consistent with constitutional standards aJld Florida Fire Code standards. To protect inmates from fires and related hazards, MDCR, at a miuimum, shall address the following areas:
1. NecessaJ'y fire aJId life safety equipment shall be properly maintained and inspected at least monthly. MDCR shall document these inspections.
2. MDCR shall ensure that fire alarms aJld sprinkler systems are properly installed, maintained, and inspected. MDCR shall document these inspections.
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3. Within 120 days of the Effective Date, emergency keys shall be appropriately marked and identifiable by sight and touch and consistently stored in a quickly accessible location; MDCR shall ensure that staff are adequately trained in the location and use of tllGSe emergency keys.
4. Comprehensive fire drills shal1 be conducted every three months on each shift. MDCR shall doclllnent these drills, including start and 'stop times and the number and location of iml1ates who were moved as part of the drills.
5. MDCR shaH sustain its policies and procedures for the control of chemicals in the Jail, and supervision ofinmates who have access to these chemicals.
6. MDCR shall provide competency-based training to correctional staff on proper use of fire and emergency equipment, at least biel11lially.
C. INMATE GRIEVANCES
MDCR shall provide hnnates with an updated and recent inmate handbook and ensure that ilmlates llave a mechanism to express their grievances and resolve disputes. MDCR shall, at a minimum:
1. Ensure that each grievance receives follow-up within 20 days, including responding to the grievant in writing, and tracking implementation of resolutions.
2. EllSure the gdevance process allows grievances to be filed and accessed confidentially, without the intervention of a correctional officer.
3. Ensure that grievance forms are available on ail units and are available in English, Spanish, and Creole. MDCR shall ensure that illiterate inmates, imnates who speak other languages, and inmates who have physical or cognitive disabilities have an adequate opportunity to access the grievance system.
4. Ensure priority review for inmate grievances identified as emergency medical or mental health care Of alleging excessive use offorce.
5. Ensure management review of inmate grievances alleging excessive or inappropriate uses of force includes a review of allY medical doclU11entation of inmate injuries.
6. A member Df MDCR Jail facilities' n1!U1agement staff shall review the grievance tracking system quarterly to identify trends and systemic areas of concerns. TIlese reviews and any recommendations will be documented and provided to the Monitor and the United States.
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D. AUDITS AND CONTINUOUS IMPROVEMENT
1. Self Audits
MDCR shall uudertake· measures on its own initiative to address inmates' constitutional rights or the risk of constitutional violations. Thll Agreement is designed to encourage MDCR Jail facilities to self·monitor and to take corrective action to ensure compliance with constitutional mandates in addition to the review and assessment of technical provisions of tile Agreement.
a. On at least a quarterly basis, command staff shall review data concerning inmate safety and security to identify and address potential pattems or trends resulting in haml to imnates in the areas of supervision, staffing,. incident reporting, referrals, investigations, classification,and grievances. The review shall include the following information:
(1) documented or known injuries requiring more than basic first aid; (2) injUlies involving fractures or head trauma; (3) injuries of suspicious nature .(incIuding black eyes, injuries to the
mouth, injuries to the genitals, etc.); (4) injuries tilat require treatment at outside hospitals; (5) self-injurious behavior, including suicide and suicide attempts; (6) illlnate assaults; and (7) allegations of employee negligence or misconduct.
b. MDCR shall develop and implement corrective action plans witilin 60 days of each quarterly review, including changes to policy and changes to and additional training.
2. Bi-annual Reports
a. Starting within 180 days of the Effective Date, MDCR will provide to the United States and the Monitor bi-annual reports regarding the followitl,g:
(1) Total munber of inmate disciplinary reports (2) Safety and supervision efforts. The report will include:
1. a listing of maximum security inmates who continue to be housed in dormitory settings;
i1. a listing of all dangerous contraband seized, including the type of contraband, date of seizure, location and shift of seizure; and
iii. a listing of inmates transferred to another honsing unit because of disciplinary action or misconduct.
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(3) Staffing levels. The report will include:

i.

a listing of each post and position needed at the Jail;

ii. the number of hoUl'S needed for each post and position at the

Jail;

.

iii. a listing of correctional staff hired to oversee the Jail;

iv. a listing of correctional staff working overtime; and

v. a listing of supervisors working overtime.

(4) Reportable incidents. The report will include: i. a brief summary of all reportable incidents, by type and date; ii. data on inmates-on-inmate violence and a brief summary of whether there is an increase or decrease in violence; iii. a brief smnmary of whether imnates involved in violent incidents were prope1'1y classified and placed in proper housing; iv. number of reported incidents of sexual abuse, the investigating entity, and the outcome of the investigation; v. a description of all suicides and in-custody deaths, including the date, name ofimuate, and housing unit; vi. number of inmate grievances screened for allegations of misconduct and a smnmary of staff response; and vii. number of gdevances referred to IA for investigation.

b. The County will analyze these reports and take appropriate corrective action
within the following quarter, including changes to policy, training, and
accountability measures.

IV. COMPUANCE AND DUALITY IMPROVEMENT
A. Within 180 days of the Effective Date, the .county shall revise and develop policies, procedures, protocols, training ctll'ricula, and practices to ensure that they are consistent with, incorporate, address, and implement all provisions of this Agreement. The County shaH revise and develop, as necessary, other written documents such as screening tools, logs, handbooks, manuals, and forms, to effectuate the provisions of this Agreement. The· County shall send any neWly-adopted and revised policies and procedures to the Monitor alld DOJ for review and approval as they are promulgated. MDCR shall provide initial and in-service training to all Jail staff in direct contact with inmates, with respect to newly implemented or revised policies and procedures. 111e Cotlllty sha1l document employee review and training in policies and procedures.
B. The County shall develop and implement written Quality Improvement policies and procedures adequate to identify and address serious deficiencies in protection fi'om hal1TI

17

I ,
and fire and life safety to assess and ensure compliance with the terms of this Agreement on an ongoing basis.
C. On an anllual basis, the County shall review all policies and procedures for any changes needed to fully implement the terms of this Agreement and submit to the Monitor and DOJ for review any changed policies and procedures.
D. The Monitor may review and suggest revisions on MDCR policies and procedures on protection from harm and fire and life safety, including currently implemented policies and procedures, to ensure suchdoCUlnents are in compliance with this Agreement.
V. REPORTING REOUIREMENTS AND RIGHT OF ACCESS
A. The County shall submit compliance reports to the DOJ and the Monitor every six months, the first ofwhic4 sha11 be submitted within 180 days ofthe Effective Date. Thereafter, these compliance reports shall be submitted 15 days after the termination of each 180 day period thereafter tmtil the Agreement is terminated. The report shall sU111lllarize audits and continuous improvement and quality assurance activities and contain findings and recommendations that would be used to track and trend data compiled at the Jail. The report shall also capture data that is tracked and monitored outlined in "Substantive Provisions" (Section III.) ofthis Agreement.
B. Each compliance report shall describe the actions the County has taken during tlle reporting period to implement this Agreement and shall make specific reference to the Agreement provisions being implemented.
C. The County shall maintain sufftcient records to document that the reqtlirements of this Agreement are being properly implemented and shall make such records available to DOJ for inspection and COPyUlg. In addition, the County shall maintain, and provide upon request, all records or other dOCUl11ents to verify that they have talcen such ~tions as described in their compliance reports (e.g., census smmnaries, policies; procedures, protocols, training materials, investigations, and incident reports).
D. The ComIty shall promptly notify tlleMonitor and DOJ upon the death or serious snicide attempt of any inmate. TIle County shall forward to the Monitor and DOJ incident reports and medical and/or mental health reports related to deaths, autopsies, and/or death smUlnaries of inmates as well as all final fute1'l1al Affairs Division investigatiolls reports that involve hmlates.
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E. DOJ and its attorneys, consultants, and agents shall have unrestricted access to the Jail,
inmates, staff and documents as reasonably necessary to address issues affected by this Agreement.

i

F. Within 45 days of receipt of written questions from DOJ concerning the County's

compliance with the requirements of this Agreement, the County shall provide DOJ with

written answers and any requested documents.

G. The County shall appoint a full-time compliance coordinator to oversee cOmpliance with this Agreement and to serve as a point of contact.

VI. MONITORING

A. Monitor Selection: The Parties agree to use the same Monitor selected/appointed under the Consent Agreement, referenced in. Section 1.7., to oversee implementation of this Agreement. Neither Party, nor any employee or agent of either Parly, shall have any supervisory authority over the Monitor's activities, reports, findings, or recommendations. The cost for the Monitor's fees and expenses shaH be borne by the Cotmty. The selectiol1 of the Monitor shall be conducted solely pursuant to the procedures set forth in this Agreement, and will not be governed by any formal or legal procurement l'equirements. The Monitor may be terminated only for good cause, unrelated to the Monitor'S findings or recommendations.
n. Monitor Qualifioations: TI1e Monitor and his 01' her staff shall have experience and
education or training related to the subject areas covered in this Agreement.
C. Monitoring-Team: The Monitor may hire or consult with such additional qualified staff as necessary to fulfill the duties required by the Agreement ("Monitorlllg Teams"). The Monitor is ultimately responsible for the findings regarding compliance. TIle Monitoring Teams will be subject to all the same access rights and confidentiality limitations as the Monitor. TIle Parties reserve the right to object for good cause to members of the Monitoring Teams.
D. Monitor Access: The Monitor shall have fnll and complete access to the Jail, staff and inmates, and all Jail records. The County shall direct all employees to cooperate fully with the Monitor. AIl non-pUblic infonnation obtained by the Monitor shall be maintained in a confidential manner.
E. Monitor Ex Parle COimnunicatiolls: In monitoring the implementation of this Agreement, the Monitor shall maintain regular contact with MDCR and DOJ. The Monitor shall be permitted to initiate and receive ex parte communications with all Parties.
F. Limitations on Public Disclosures by the Monitor: Except as required or authorized by the terms of this Agreement or the Parties acting together, the Monitor shall not make any

19

public statements (at a conference or otherwise) or issue findings, except as required under paragraph G, infra, with regard to lIny act or omission of MDCR or its agents, representatives .01' employees. Any press statement made by the Monitor regarding the monitoring of this Agreement or his or her employment as Monitor must first be approved in writing by all Parties. The Monitor shall not testify in any other litigation or proceeding with regard to any act or omission of the COUllty or any of their agents, repl'esentatives, or employees related to this Agreement, nor testify regarding any matter or subject that he or she may have learned as a result of his or her performance under this Agreement. Reports issued by the Monitor shall not be admissible against the County in any proceeding other than a proceeding related to the enforcement of this Agreement by the County or DOJ. Unless such conflict is waived by the PlIlties, the Monitor shall not accept employment or provide consulting services that would present a conflict of interest with the Monitor's responsibilities under this Agreement. Neither the Monitor nor any person 01' entity hired or otherwise retained by the Monitor to assist in furthering any provision of this Agreement shaH be liable for any claim, lawsuit or demand arising out of the Monitor's performance pursuant to this Agreement.
G. .Monitor's Reports: TIle Monitor shall provide .the Parties reports describing the steps taken
by the Cotmty to implement this Agreement and evaluate the extent to which Defendants have complied with each Sl)bstantive provision of the Agreement. The Monitor's Reports shall indicate a compliance rating for each provision and provide recommendations for achieving compliance with any provisions not in compliance at the time of the Report. The Monitor shall issue an initial report 120 days after the Effective Date, and then every 180 days thereafter. The reports shall be provided to the Parties in draft fonll for comment at least 15 business days prior to their issuance. These reports shall be written with due regard for the privacy interests of individual inmates and staff.
H. Compliance Assessments: In the Monitor's report, the Monitor shall evaluate the status of compliance for each relevant provision of the Agreement using the following standards: (1) Substantial Complillllce; (2) Partial Compliance, and (3) Non-compliance. To .assess compliance, the Monitor shall review a sufficient number of pertinent documents to accurately assess current conditions; interview all necessary staff; and interview a sufficient number of inmates to accurately assess current conditions. The Monitor shall be responsible for independently verifying representations from the Cmmty regarding progress toward compliance, including the examination of supporting documentation. Each Monitor's report shall describe tile steps taken by each member of the Monitoring Team to analyze conditions and assess compliance, including documents reviewed and individuals interviewed, and the factual basis for each of the Monitor's findings.
I. Monitor's Budget: The County shall provide the Monitor with a budget sufficient to allow the Monitor to carry out tile responsibilities described in this Agreement. The Monitor shall pay the members ofthe Monitoring Team out of this budget.
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J. Technical Assistance by the Monitor: TIle Monitor shall provide the County with technical' assistance as requested by the County. Technical assistance should be reasonable and should not interfere with the Monitor's ability to assess compliance.

VII. CONSTRUCTION, IMPLEMENTATION, AND TERMINATION

A. The COlmty shall implement all refonns within their areas of responsibility, as designated within the provisions of this Agreement that are necessary to effectuate this Agreement. The implementation of this Agreement will begin immediately,upon the Effective Date.

,, ,

B. Except where otherwise agreed to under a specific provision of this Agreement, the County

shall implement all provisions of this Agreement within 180 days of the Effective Date.

C. An individual substantive provision in this Agreement shall terminate after DOJ finds that the County maintained sustained substantial compliance of that provision for a period of 18 months, Non-compliance with mere technicalities, or temporary failure to comply during a perIod of otherwise suiltained compliance, wi1I not constitute failure to maintain substantial compliance. Temporal'Y compliance dUllng a period of otherwise s,ustained non-compliance wi11not constitute substantial compliance.

D. If, after reasonable notice to, the County and ,a reasonable opportunity to cure any

deficiencies identified in writing, the DOJ determines that the County has not substantially

complied with this Agreement the DOJ may pursue litigation against the County,

Notwithstanding the foregoing, the United States reserves the right to file an action under

,

CRIPA alleging a pattern or practice ofunconstitutionaIconditions at the Jail at any time if

I I

it believes that the County is not 111alcing a good faith effort to substantially comply with this

Agreement or if there is an emergent situation involving an imminent, serious threat to the

,

life, health, or safety of inmates or staff. In the even! that the alle~ations in such an action

! , I

under CRIPA are litigated, this Agreement shall not be introduced or used as evidence.

,

, !

E. Where there is a disagreement about whether compliance with any provision has been met,

I

the burden shall be on the COlmty to demollStrate compliance. Individual requirements of

this Agreement shall terminate prior to the full tellnination of this Agreement if the parties

agree that the County has maintained compliance with the individual requirement for a

period of 18 months. Absent indication that the County has fallen out of compliance, the

Monitor will no longer monitor or assess that requirement; and the County will be deemed

to have met the tenTIS ofthis Agreement as to that requirement.

F. If any unforeseen cirCUlllstance oeom's that causes a failure to timely carry atJt any requirements of this Agreement, the County shaIlnotify DOJ in writing within 20 calendar days after the County becomes aware of the unforeseen circumstance and its impact on the County's ability to perform under Ule Agreement. The notice shall describe the cause of Ule failure to perform and the measures taken to prevent or minimize the failure. The COlJnty shall implement all reasonable measures to avoid or minimize any such failure,

21

G. This Agreement constitutes the entire integrated Agreement of the Parties, 88 it relates to provisions regarding protection from harm, inmate grievances, and fire and life safety (see Section I.7.).. With the exception of DOJ's Findings Letter, no prior or contemporaneous communications, oral or written, will be relevant or admissible for purposes of detennining the meaning of any provisions herein in any proceeding.

H. The Agreement shall be applicable to, and binding upon, all Parties, their officers, agents,

employees, assigns, and their successors in office.

.

I. Each Party shall bear the cost of its fees and expenses incurred in connection with tins cause.

J. This Agreement may be posted on the web site of tile U.S. Department of Justice, Civil Rights Division, Special Litigation Section and the United States Attomey's Office for the Southern District of Florida.

22

- - -.... - ~..... --....
·I
...Mt-_'.-_.._- ---,--,-. ".__,.,_,.,___.,'_,.".....__.,,_,__._~, .".,.,.,_"••,___.___.H,._.__..•"._.,""•.•.._,."._..."-.. ... -.-,-.",-.-,~ ,-."... •.'.'_. ,-.".~"-"-,,-.-.,,--.--,.-,,.-,,.".,_ --,-.-.-.--,-.'-..--'--..-'~'.--.'".!~
'i I
FOR THE UNnED STATES:
L~ URAlC hCOOHN --
Speoial C01lllsel
.~
REo::I\N'
Trial Attorney . United StatQs Department of Justice Civil Righta Division . Specilll Litigation Section
950 Pe!l118yil'slua Avenue, NW
Washington, D.C. 20S30 202·514-6255 reglnaJanseo@usdoj,gov i·
.1'
23

#y
~H~O~NAO~RA=B~L~E~C~A~R~L~~~~~ Mayor Mi
R
Assistant County Attorney Stephen P. Clark Center, Suite 2810 111 N.W. 1st Street Miami, Florida 33128-1993 Tel: (305) 375-1506 Fax: (305) 375-5611
Dated: April 30, 2013
24

 
 Case 1:13-cv-21570-BB Document 84 Entered on FLSD Docket 02/09/2018 Page 1 of 7
.UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF FLORIDA
Case No. 13-cv-21570-BLOOM UNITED STATES OF AMERICA,
Plaintiff, v. MIAMI-DADE COUNTY, THE BOARD OF COUNTY COMMISSIONERS, et al.,
Defendants. _____________________________________/
ORDER THIS CAUSE is before the Court following a status conference held on February 7, 2018. See ECF No. [82]. Plaintiff United States of America (the “Government”) and Defendants Miami-Dade County, Miami-Dade County Board of County Commissioners, and Miami-Dade County Public Health Trust (collectively, “Defendants” or the “County”) entered into a Consent Agreement, ECF No. [5-2] (“Consent Agreement”), effective May 22, 2013, that addressed alleged constitutional violations regarding the provision of medical and mental health care at the correctional facilities operated by Miami-Dade County Corrections and Rehabilitation Department (“MDCR”). According to the Consent Agreement, on April 2, 2008, the Government notified Miami-Dade County officials of its intention to investigate conditions at MDCR. Id at 4. After tours of the MDCR facilities in 2008 and 2009, the Government issued a Findings Letter on August 24, 2011 that concluded “certain conditions in the MDCR Jail violated the constitutional rights of inmates . . . .” Id. In the months that followed, cooperation between the Government and the County resulted in two agreements: the Consent Agreement

Case 1:13-cv-21570-BB Document 84 Entered on FLSD Docket 02/09/2018 Page 2 of 7 Case No. 13-cv-21570-BLOOM
before this Court and a separate Settlement Agreement, which addressed protection from harm, fire and life safety, and inmate grievances. Id. at 5.
The Consent Agreement. The Consent Agreement contained deadlines and requirements for implementation of 1191 provisions or paragraphs (the “Paragraphs”). The parties selected an Independent Monitor to “oversee implementation of the [Consent] Agreement.” ECF No. [5-2] at 31 (“Independent Monitor”). Except where otherwise agreed to under a specific provision of the Consent Agreement, the County was to implement all provisions of the Consent Agreement within 180 days of the Effective Date. Id. at 33. On May 22, 2013, the Honorable William J. Zloch entered a final order approving and entering the Consent Agreement. ECF No. [9]. For approximately five years, Judge Zloch, and now this Court, have continued to monitor compliance with the Consent Agreement based on a reports supplied by the parties and status conferences before the Court.
First Revised Summary Action Plan. The County did not achieve full compliance with the Consent Agreement within 180 days as originally contemplated in the Consent Agreement. ECF No. [25] at 1; see also Independent Monitor’s Report No. 1, ECF No. [11], dated November 5, 2013; Independent Monitor’s Report No. 2, ECF No. [12], dated May 22, 2014; Independent Monitor’s Report No. 3, ECF No. [22], dated November 28, 2014. The Court held status conferences regarding the non-compliance on October 21, 2014 and November 17, 2014. See ECF No. [19] & [21]. On December 17, 2014, the parties filed a Joint Motion for Entry of Stipulated Order, ECF No. [25], which attached a Consent Agreement Summary Action Plan, ECF No. [25-2] (“First Revised Summary Action Plan”). The First Revised Summary Action Plan included revised compliance deadlines which extended from May of 2015 through
1 According to the Independent Monitor, this number was later reduced to 115. ECF No. [80] at 88.
2

Case 1:13-cv-21570-BB Document 84 Entered on FLSD Docket 02/09/2018 Page 3 of 7 Case No. 13-cv-21570-BLOOM
November of 2016. See ECF No. [25-2] at 1. The Court entered an Order granting the motion and approving and adopting the First Revised Summary Action Plan on December 18, 2014. ECF No. [27].
Second Revised Summary Action Plan. On April 20, 2016, the Court held a status conference during which the parties noted that the County was not in full compliance with the Consent Agreement. See ECF No. [44]. By May of 2016, the “Defendants stipulate[d] that they have not yet come into full compliance with several provisions of the Consent Agreement and [First Revised Summary Action Plan]” and that “they will be unable to meet many upcoming deadlines.” ECF No. [42] at 2; see also Independent Monitor’s Report No. 4, ECF No. [32], dated July 3, 2015; Independent Monitor’s Report No. 5, ECF No. [38], dated February 15, 2016. The parties therefore filed a Joint Motion for Entry of Stipulated Order, ECF No. [42], which attached a Consent Agreement Revised Summary Action (Compliance) Plan, ECF No. [42-1] (“Second Revised Summary Action Plan”). The Second Revised Summary Action Plan included revised compliance deadlines which extended from July of 2016 through February of 2017. See ECF No. [42-1] at 1–2. The Court entered an Order granting the motion and approving and adopting the Second Revised Summary Action Plan on May 23, 2016. ECF No. [43]. On September 9, 2016, the Independent Monitor filed its sixth report with the Court, which again noted that the County had still not reached full compliance with the Consent Agreement. ECF No. [45].
In advance of the February 21, 2017 deadlines, the Court held a hearing on January 26, 2017, during which the Government represented to the Court that the County had committed to full compliance with the Consent Agreement by the end of February 2017. ECF No. [56] at 7. On April 4, 2017, the Independent Monitor submitted its seventh report, which indicated that the
3

Case 1:13-cv-21570-BB Document 84 Entered on FLSD Docket 02/09/2018 Page 4 of 7 Case No. 13-cv-21570-BLOOM
County had not achieved full compliance with the Consent Agreement. ECF No. [57]. The Court held a status conference on April 21, 2017. ECF No. [60]. At that hearing, the Government represented to the Court that “the latest summary action plan that had been filed with the Court showed that they would be in full compliance with all provisions by February. And obviously, those deadlines were missed. And this is now the third set of deadlines, unfortunately, that got missed.” ECF No. [63] at 11. Based on this hearing, the Court entered an Order, ECF No. [61], requiring the Independent Monitor to submit monthly reports regarding certain clinical performance measures.
On July 28, 2017, the Court held a status conference. ECF No. [68]. While the parties reported progress, they also reported that the County was still not in full compliance with the Consent Agreement. See ECF No. [70]. During the hearing, the Government represented that the parties planned a “full compliance tour” scheduled for the week of September 11, 2017. Id. at 5. Due to Hurricane Irma, that tour was postponed until December 2017, and a status conference was set for February 7, 2018. ECF No. [75].
On January 19, 2018, the Independent Monitor filed its eighth report. ECF No. [80]. The report states that the County has not achieved full compliance with the Consent Agreement and that it is fully compliant with 29 of the 115 Paragraphs of the Consent Agreement. Id. at 95. Specifically, the Independent Monitor notes in the report that for certain provisions of the Consent Agreement “performance is poor,” “poorly documented,” and/or data is “insufficiently analyzed,” and that the County had made “insignificant progress,” has “not improved,” or has implemented “poorly conceived and ineffective” processes in response to the requirements of the Consent Agreement. Id. at 96.
4

Case 1:13-cv-21570-BB Document 84 Entered on FLSD Docket 02/09/2018 Page 5 of 7 Case No. 13-cv-21570-BLOOM
The Independent Monitor further reports that MDCR is classifying any inmate with a who receives a mental health care emergency treatment order as a “use of force” incident and “require[e]s the Qualified Mental Health Professional (QMHP . . . ) to write an order authorizing use of force” for these incidents, a policy which is “outside the practice parameters of a QMPH” and which must “be stopped immediately.” Id. at 97. The Monitor further reported that two inmate deaths by suicide “may have been prevented had the patients been appropriately leveled,” that is, properly classified based on their mental health history and risk, per the Consent Agreement. Id. at 97. The report notes that “mental health staff [did] not follow[] the leveling guidelines despite having access to all relevant information” and that they instead used their “ ‘clinical judgment’ rather than following the guidelines, which lead to the errors.” Id. 2
On February 7, 2018, the parties appeared before the Court for a status conference. At the Conference, the parties reiterated their commitment to full compliance, and the Independent Monitor highlighted several areas that required improvement. During colloquies with the Court, the Government represented that the parties had met and conferred regarding a new revised summary action plan and that the parties were prepared to file such plan on February 8, 2018 for Court approval. However, neither the Government nor the County was able to represent to the Court that the parties were able to comply with the deadlines contemplated in the proposed summary action plan as drafted.
This Court has been far too generous in the time permitted for the parties to remedy the unconstitutional conditions at MDCR, which were initially investigated by the Government nearly a decade ago and which “Defendants stipulate[d], and this Court [found], necessitate the
2 The Monitor further notes that “[h]ad the individuals of committed suicide been leveled appropriately, they would have been housed at a higher level of care (e.g., level 1) and their chance of completed suicide would have presumably decreased.” Id.
5

Case 1:13-cv-21570-BB Document 84 Entered on FLSD Docket 02/09/2018 Page 6 of 7 Case No. 13-cv-21570-BLOOM
remedial measures contained in th[e Consent] Agreement.” ECF No. [5-2] at 5. Although the parties have represented to this Court—time after time—that they are committed to compliance, years have worn on without ever achieving full compliance while the safety and welfare of many individuals continue to be placed at risk. These are inmates who have no choice as to their housing and rely upon the government, here the Defendants, to comply with the law. Full compliance is necessary as a first step to achieve the sustainable and systemic change contemplated in the Consent Agreement. In sum, this Court will no longer tolerate vague representations of the parties’ “commitment” in place of demonstrable and documented full compliance.
Based on the foregoing, the representations of the parties, and the Court’s review of the entire record in this action, it is accordingly ORDERED AND ADJUDGED as follows:
1. On or before February 28, 2018, the parties shall meet and confer regarding the Independent Monitor’s findings and recommendations in the eighth report, ECF No. [80]. The Independent Monitor and representatives from both the Government and the County shall be present. Deputy Mayor Maurice Kemp shall also be present for the meet and confer.
2. On or before March 7, 2018, the parties shall submit to the Court, as a proposed order, a Proposed Third Revised Summary Action Plan. The proposed order must include final deadlines by which the parties agree full compliance with the Consent Agreement will be achieved (“Final Deadlines”). The proposed order must also include interim deadlines that allow sufficient time and opportunity for reports to be produced, analyzed, and any noncompliance remediated prior to the Final Deadlines. These interim deadlines may include, but need not be limited to, dates for interim
6

Case 1:13-cv-21570-BB Document 84 Entered on FLSD Docket 02/09/2018 Page 7 of 7 Case No. 13-cv-21570-BLOOM
tours, reports, production of documents, and implementation of recommendations by the Independent Monitor. Should these interim deadlines not be met, the Government shall advise the Court, within 10 days after the noncompliance, as to what sanctions it seeks. 3. The parties shall file a copy of the Settlement Agreement referenced in the Independent Monitor’s reports on or before February 15, 2018. 4. The County is cautioned that continued noncompliance with the Consent Agreement and this Court’s Orders may result in the Court imposing sanctions on the County. 5. The parties shall appear for a status conference before this Court on September 7, 2018 at 1:30 p.m. at 400 North Miami Avenue, Courtroom 10-2. DONE AND ORDERED in Chambers at Miami, Florida, this 8th day of February, 2018.

Copies to: Counsel of Record

_________________________________ BETH BLOOM UNITED STATES DISTRICT JUDGE

7

 
 Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 1 of 55
.UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF FLORIDA
Case No. 13-cv-21570-BLOOM UNITED STATES OF AMERICA,
Plaintiff, v. MIAMI-DADE COUNTY, THE BOARD OF COUNTY COMMISSIONERS, et al.,
Defendants. _____________________________________/
ORDER ON THIRD REVISED SUMMARY ACTION PLAN THIS CAUSE is before the Court following a status conference held on February 7, 2018. See ECF No. [82]. Plaintiff United States of America (the “Government”) and Defendants Miami-Dade County, Miami-Dade County Board of County Commissioners, and Miami-Dade County Public Health Trust (collectively, “Defendants” or the “County”) entered into a Consent Agreement, ECF No. [5-2] (“Consent Agreement”), effective May 22, 2013, that addressed alleged constitutional violations regarding the provision of medical and mental health care at the correctional facilities operated by Miami-Dade County Corrections and Rehabilitation Department (“MDCR”). According to the Consent Agreement, on April 2, 2008, the Government notified Miami-Dade County officials of its intention to investigate conditions at MDCR. Id at 4. After tours of the MDCR facilities in 2008 and 2009, the Government issued a Findings Letter on August 24, 2011 that concluded “certain conditions in the MDCR Jail violated the constitutional rights of inmates . . . .” Id. In the months that followed, cooperation between the Government and the County resulted in two agreements: the Consent Agreement

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 2 of 55 Case No. 13-cv-21570-BLOOM
before this Court and a separate Settlement Agreement, which addressed protection from harm, fire and life safety, and inmate grievances. Id. at 5.
The Consent Agreement. The Consent Agreement contained deadlines and requirements for implementation of 1191 provisions or paragraphs (the “Paragraphs”). The parties selected an Independent Monitor to “oversee implementation of the [Consent] Agreement.” ECF No. [5-2] at 31 (“Independent Monitor”). Except where otherwise agreed to under a specific provision of the Consent Agreement, the County was to implement all provisions of the Consent Agreement within 180 days of the Effective Date. Id. at 33. On May 22, 2013, the Honorable William J. Zloch entered a final order approving and entering the Consent Agreement. ECF No. [9]. For approximately five years, Judge Zloch, and now this Court, have continued to monitor compliance with the Consent Agreement based on reports supplied by the parties and status conferences held before the Court.
First Revised Summary Action Plan. The County did not achieve full compliance with the Consent Agreement within 180 days as originally contemplated in the Consent Agreement. ECF No. [25] at 1; see also Independent Monitor’s Report No. 1, ECF No. [11], dated November 5, 2013; Independent Monitor’s Report No. 2, ECF No. [12], dated May 22, 2014; Independent Monitor’s Report No. 3, ECF No. [22], dated November 28, 2014. The Court held status conferences regarding the non-compliance on October 21, 2014 and November 17, 2014. See ECF No. [19] & [21]. On December 17, 2014, the parties filed a Joint Motion for Entry of Stipulated Order, ECF No. [25], which attached a Consent Agreement Summary Action Plan, ECF No. [25-2] (“First Revised Summary Action Plan”). The First Revised Summary Action Plan included revised compliance deadlines which extended from May of 2015 through
1 According to the Independent Monitor, this number was later reduced to 115. ECF No. [80] at 88.
2

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 3 of 55 Case No. 13-cv-21570-BLOOM
November of 2016. See ECF No. [25-2] at 1. The Court entered an Order granting the motion and approving and adopting the First Revised Summary Action Plan on December 18, 2014. ECF No. [27].
Second Revised Summary Action Plan. On April 20, 2016, the Court held a status conference during which the parties noted that the County was not in full compliance with the Consent Agreement. See ECF No. [44]. By May of 2016, the “Defendants stipulate[d] that they have not yet come into full compliance with several provisions of the Consent Agreement and [First Revised Summary Action Plan]” and that “they will be unable to meet many upcoming deadlines.” ECF No. [42] at 2; see also Independent Monitor’s Report No. 4, ECF No. [32], dated July 3, 2015; Independent Monitor’s Report No. 5, ECF No. [38], dated February 15, 2016. The parties therefore filed a Joint Motion for Entry of Stipulated Order, ECF No. [42], which attached a Consent Agreement Revised Summary Action (Compliance) Plan, ECF No. [42-1] (“Second Revised Summary Action Plan”). The Second Revised Summary Action Plan included revised compliance deadlines which extended from July of 2016 through February of 2017. See ECF No. [42-1] at 1–2. The Court entered an Order granting the motion and approving and adopting the Second Revised Summary Action Plan on May 23, 2016. ECF No. [43]. On September 9, 2016, the Independent Monitor filed its sixth report with the Court, which again noted that the County had still not reached full compliance with the Consent Agreement. ECF No. [45].
In advance of the February 21, 2017 deadlines, the Court held a hearing on January 26, 2017, during which the Government represented to the Court that the County had committed to full compliance with the Consent Agreement by the end of February 2017. ECF No. [56] at 7. On April 4, 2017, the Independent Monitor submitted its seventh report, which indicated that the
3

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 4 of 55 Case No. 13-cv-21570-BLOOM
County had not achieved full compliance with the Consent Agreement. ECF No. [57]. The Court held a status conference on April 21, 2017. ECF No. [60]. At that hearing, the Government represented to the Court that “the latest summary action plan that had been filed with the Court showed that they would be in full compliance with all provisions by February. And obviously, those deadlines were missed. And this is now the third set of deadlines, unfortunately, that got missed.” ECF No. [63] at 11. Based on this hearing, the Court entered an Order, ECF No. [61], requiring the Independent Monitor to submit monthly reports regarding certain clinical performance measures.
On July 28, 2017, the Court held a status conference. ECF No. [68]. While the parties reported progress, they also reported that the County was still not in full compliance with the Consent Agreement. See ECF No. [70]. During the hearing, the Government represented that the parties planned a “full compliance tour” scheduled for the week of September 11, 2017. Id. at 5. Due to Hurricane Irma, that tour was postponed until December 2017, and a status conference was set for February 7, 2018. ECF No. [75].
On January 19, 2018, the Independent Monitor filed its eighth report. ECF No. [80]. The report stated that the County had again not achieved full compliance with the Consent Agreement and that it was fully compliant with 29 of the 115 Paragraphs of the Consent Agreement. Id. at 95. Specifically, the Independent Monitor noted in the report that for certain provisions of the Consent Agreement “performance is poor,” “poorly documented,” and/or data is “insufficiently analyzed,” and that the County had made “insignificant progress,” has “not improved,” or has implemented “poorly conceived and ineffective” processes in response to the requirements of the Consent Agreement. Id. at 96.
4

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 5 of 55 Case No. 13-cv-21570-BLOOM
The Independent Monitor further reported that MDCR is classifying any inmate who receives a mental health care emergency treatment order as a “use of force” incident and “require[e]s the Qualified Mental Health Professional (QMHP . . . ) to write an order authorizing use of force” for these incidents, a policy which is “outside the practice parameters of a QMHP” and which must “be stopped immediately.” Id. at 97. The Monitor further reported that two inmate deaths by suicide “may have been prevented had the patients been appropriately leveled,” that is, properly classified based on their mental health history and risk, per the Consent Agreement. Id. at 97. The report notes that “mental health staff [did] not follow[] the leveling guidelines despite having access to all relevant information” and that they instead used their “ ‘clinical judgment’ rather than following the guidelines, which lead to the errors.” Id. 2
On February 7, 2018, the parties appeared before the Court for a status conference. At the Conference, the parties reiterated their commitment to full compliance, and the Independent Monitor highlighted several areas that required improvement. See ECF No. [83], Hearing Tr. at 24, 28–33, 35, 38. During colloquies with the Court, the Government represented that the parties had met and conferred regarding a new revised summary action plan and that the parties were prepared to file such plan on February 8, 2018 for Court approval. Id. at 24–25. However, while the Government informed the Court that the parties could file a revised summary action plan the following day, neither the Government nor the County was able to represent to the Court that the parties were able to comply with the deadlines contemplated in the proposed plan as drafted.
Third Revised Summary Action Plan. Following the hearing, the Court entered its Order, ECF No. [84], requiring that the parties submit a Proposed Third Revised Summary
2 The Monitor further notes that “[h]ad the individuals of committed suicide been leveled appropriately, they would have been housed at a higher level of care (e.g., level 1) and their chance of completed suicide would have presumably decreased.” Id.
5

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 6 of 55 Case No. 13-cv-21570-BLOOM
Action Plan. Specifically, the Court ordered that the proposed order must include final deadlines
by which the parties agree full compliance with the Consent Agreement will be achieved. The
Court further ordered that the proposed order must also include interim deadlines that allow
sufficient time and opportunity for reports to be produced, analyzed, and any noncompliance
remediated prior to the Final Deadlines. Id. at 6–7. In the Order, the Court further stated:
This Court has been far too generous in the time permitted for the parties to remedy the unconstitutional conditions at MDCR, which were initially investigated by the Government nearly a decade ago and which “Defendants stipulate[d], and this Court [found], necessitate the remedial measures contained in th[e Consent] Agreement.” ECF No. [5-2] at 5. Although the parties have represented to this Court—time after time—that they are committed to compliance, years have worn on without ever achieving full compliance while the safety and welfare of many individuals continue to be placed at risk. These are inmates who have no choice as to their housing and rely upon the government, here the Defendants, to comply with the law. Full compliance is necessary as a first step to achieve the sustainable and systemic change contemplated in the Consent Agreement. In sum, this Court will no longer tolerate vague representations of the parties’ “commitment” in place of demonstrable and documented full compliance.
Id. at 5–6 (emphasis added).
On March 15, 2018, the parties filed a Notice of Compliance which attached a Proposed
Order and Third Revised Summary Action Plan. ECF No. [90-1] and [90-2]. Despite this
Court’s admonitions to the parties during the February 7, 2018 status conference and in its
February 8, 2018 Order, many of the deadlines contain a disclaimer that Defendants will perform
certain action items—which the parties concede seek to remedy ongoing constitutional violations
at MDCR—solely in an effort to “move toward compliance with” a particular Paragraph of the
Consent Agreement.
6

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 7 of 55 Case No. 13-cv-21570-BLOOM
This Court has been very clear: it will no longer tolerate commitments to attempt or try to comply with the Consent Agreement at some point in the future in place of actual compliance. Accordingly, the Court modifies the proposed order submitted by the parties and it is ORDERED AND ADJUDGED as follows:
1. As a result of Defendants’ failure to achieve full compliance with the Consent Agreement, additional remedial relief is necessary, as set forth in the action steps and document production requirements below.
2. The additional relief set forth below complies in all respects with the provisions of 18 U.S.C. § 3626(a). The relief is narrowly drawn, extends no further than necessary to correct violations of federal rights as alleged by the United States in its Complaint and Findings Letter, is the least intrusive means necessary to correct these violations, and will not have an adverse impact on public safety or the operation of the criminal justice system.
3. This Order outlines final deadlines for compliance with the Consent Agreement (“Final Deadlines”). In advance of each Final Deadline, the parties shall:
a. At least ten (10) days prior to a Final Deadline, Defendants shall complete each of the action steps due by that Final Deadline and produce all supporting documents delineated in the Third Summary Action Plan for that Final Deadline. Wherever “findings and analysis” are referenced in the below action steps, this shall include the development and production of corrective action plans, where applicable; corrective action plans shall be timely implemented.
b. At least five (5) days prior to the Final Deadline, the parties and the Independent Monitor shall meet and confer to determine whether Defendants
7

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 8 of 55 Case No. 13-cv-21570-BLOOM
have achieved compliance on the action items specified for that Final Deadline of the Consent Agreement. c. On the Final Deadline, the parties and the Independent Monitor shall file a joint declaration averring whether compliance with action items specified for that Final Deadline have been achieved. In the declaration, the parties must also specify, for each Paragraph of the Consent Agreement, which Paragraphs are in full compliance and which are in partial or non-compliance. 4. In addition to the requirements of Paragraph 3, above, the Independent Monitors shall provide timely feedback to the Defendants to facilitate compliance with the provisions of the Consent Agreement. 5. The language of this Order shall control, should there be any discrepancies between this Order and the Third Summary Action Plan. 6. Final Deadline: April 16, 2018: a. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.a (medication administration):
i. Audit medication administration to determine if actual practices are consistent with policy and procedure regarding medication administration, including: 1. Referring patients with serial missed medications to a practitioner to determine reasons and implement remedies; 2. Implementing a medication utilization project through the Pharmacy & Therapeutics sub-committee to minimize overuse of medications, e.g., medications for sleep;
8

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 9 of 55 Case No. 13-cv-21570-BLOOM
3. Implementing a process to ensure timely notification to a prescribing practitioner if a patient refuses to take his or her psychotropic medication for more than 24 hours, or misses three consecutive doses of non-psychotropic medication or three doses in a seven day period of non-psychotropic medication;
4. If necessary, implement a corrective action plan developed jointly between Corrections Health Services (“CHS”) and Miami-Dade Corrections and Rehabilitation Department (“MDCR”) to ensure CHS and MDCR staff actively participate in mouth checks, and monitor the effectiveness of that plan;
ii. Produce the results of a discussion between CHS and MDCR about improving communication between CHS and MDCR on all levels regarding excessive medication found during searches, and jointly developed specific action plans to address identified issues;
iii. Produce any additional documentation demonstrating implementation of these recommendations, including, where applicable, corrective action plans, committee minutes, a new clinical performance measurement tool, and an initial assessment using that tool.
b. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.5.a (maintenance of medical and mental health records): Implement the Independent Monitors’ recommendations from the Eighth Report regarding the management of medical and mental health
9

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 10 of 55 Case No. 13-cv-21570-BLOOM
records, including: i. Eliminate paper systems for ordering x-rays and other diagnostics; ii. Train and supervise staff to document patient encounters in a manner that is adequate to assist in providing and managing the medical and mental health needs of patients; and
iii. Explore methods to simplify access to the Medication Administration Record.
c. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.5.d (exchange of medical and mental health records with outside providers): Provide an implementation plan for the Independent Monitors’ recommendations from the Eighth Report regarding review of medical records from outside providers, including: i. Develop and implement a template or form to document consistent information about patients upon their return from off-site care and use that form to communicate with providers about continuation of care; and ii. Ensure practitioners document their review of available medical records and incorporate the relevant findings into their documentation through the modification of an existing clinical performance measurement tool or creation of a new tool, as applicable.
d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.a (use of restraints): i. Produce an implementation plan for the Independent Monitors’
10

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recommendations from the Eighth Report regarding the use of clinical restraints to ensure all orders for the use of clinical restraints are appropriately reflected in the electronic health record; and ii. Produce an audit, with findings and recommendations, of three months of data, to analyze status of compliance with the clinical restraints policy. e. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.b (medical care following uses of force): Develop and produce a policy on care for inmates involved in uses of force, which includes a mechanism for regularly measuring conformance with the policy (policy CHS-042 Patient Injury and Response to Resistance). f. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.c (medical care following uses of force; questioning inmates and reporting suspected abuse): Produce an implementation plan for the Independent Monitors’ recommendations from the Eighth Report regarding use of force care, including i. Ensure heath care staff conduct post-use-of-force questioning regarding cause of injury out of earshot of custody staff, per Consent Agreement § III.B.3.c; ii. Modify policy CHS-042 Patient Injury and Response to Resistance to allow a health professional to provide a report on inmate injury to someone other than the front-line officer; and iii. Consider developing a role-modeling video to train new CHS staff
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Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 12 of 55 Case No. 13-cv-21570-BLOOM
members on recognizing possible staff-on-inmate assaults and how to respond. g. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.e (interdisciplinary treatment plans for mental health care): i. Produce drafts of the following clinical performance measurement tools:
1. Level of care internal audit tool for Level I; 2. Level of care internal audit tool for Level II; 3. Level of care internal audit tool for Level III; and 4. Level of care internal audit tool for Level IV; ii. Produce additional audit, including findings and analysis, incorporating measures requested by the Independent Monitors in their Eighth Report, including: 1. How many patients are on the mental health caseload at each
level; 2. How many level I and II patients on each level receive an
interdisciplinary treatment plan, the time frame in which each patient received the initial interdisciplinary treatment plan, and the time frame in which each individual received a follow up treatment plan; and 3. How patients who are not required to receive an interdisciplinary treatment plan are assessed and evaluated to
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ensure their needs are addressed. h. Defendants shall produce a draft of the new measure(s) added to the Suicide
Risk Screening clinical performance measurement tool to measure the quality of suicide risk assessments. Consent Agreement § III.C.3.a(4) (quality suicide risk assessments). i. Defendants shall submit a draft of policy CHS-044: Segregated Patients. Consent Agreement § III.C.6.a (custodial segregation). j. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.9.a (risk management system):
i. Finalize and produce policy CHS-010: Mortality and Morbidity Review; and
ii. Finalize and produce policy CHS-010B: Risk Management. k. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.D.1.b (self-audits): Produce the 2017 Clinical Quality Improvement Plan, including an evaluation of the quality improvement program in 2017, and a quality improvement plan for 2018, documenting the implementation of a quality improvement program.
7. Final Deadline: May 1, 2018: a. Defendants shall produce final versions of the following policies: i. Policy IP-002: Supervising and Recognizing Inmates with Mental Illness; ii. Policy CHS-068: Clinical Restraints;
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iii. Policy CHS-011: Patient Health Care Grievances; iv. Policy CHS-056: Patients with Special Needs; v. Policy CHS-042: Patient Injury and Response to Resistance; and vi. Policy DSOP 11-041: Response to Resistance Policy. b. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.a (health assessments to administer preventative care):
i. Demonstrate through the use of current clinical performance measurement tools that all incoming and current inmates are receiving: 1. Health assessments within 14 days of entering an MDCR facility conducted by a clinically appropriate level of provider; and 2. Primary care relationships for preventive care, chronic care, and medication management; and
ii. Modify current clinical performance measurement tools, if necessary. c. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.A.2.c (mental health assessments following adverse triggering events):
i. Re-train all Qualified Mental Health Professionals (“QMHPs”) on the Columbia Suicide Screening Tool;
ii. Finalize and produce inter-agency policy IP-003: Inmate Suicide Prevention and Response Plan;
iii. Produce post-training testing results, competency results and the
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results of a random audit, including findings and analysis, on the suicide risk assessment training; iv. Produce clinical performance measures on Self-Harm Incidents, including findings and analysis; and v. Produce Mental Health Review Committee (“MHRC”) meeting minutes demonstrating a review of self-harm incidents and identified Corrective Action Plans, as clinically indicated. d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.1(a-c) (acute care and detoxification): i. Provide annual training regarding care for patients suffering from drug and alcohol withdrawal to booking Advanced Registered Nurse Practitioners (“ARNPs”) and psychiatry providers covering the detox unit and/or detox patients; ii. Produce orientation and retraining sign-in sheets demonstrating staff training on acute health needs; iii. Produce post-training testing results, competency results completed to date, and the results of a random audit on training for acute health needs, including findings and analysis; and iv. Produce post-training testing results, competency results completed to date, and the results of a random audit on training regarding withdrawal from alcohol and other substances, including findings and analysis. e. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.B.3.a (use of restraints): i. Produce an analysis of Emergency Treatment Order (“ETO”) data to ascertain the underlying factors associated with ETOs and, if appropriate, a corrective action plan to decrease their frequency; and ii. Produce a joint plan developed by CHS and MDCR to declassify ETOs as uses of force, if force was not required to administer an ETO.
f. Defendants shall produce the draft of a new measure, for the clinical performance measurement tool on Suicide Risk Screening, to track compliance with Consent Agreement § III.C.3.a(1) (property and privileges for acutely mentally ill and suicidal inmates).
g. Defendants shall produce the draft of a new measure, for the clinical performance measurement tool on Suicide Risk Screening, to track compliance with Consent Agreement § III.C.3.a(2) (case-by-base decisions regarding clothing, bedding, and property for suicidal inmates).
h. Defendants shall complete the following step to achieve compliance with Consent Agreement § III.C.3.a(4) (suicide risk assessments): Produce the finalized clinical performance measurement tool on quality of suicide risk assessments and an assessment utilizing that tool, including findings and analysis.
i. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(1-4) (custodial segregation): Produce the procedural directive implementing screening prior to placement in custodial segregation to identify acute medical and/or mental health contraindications
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and to implement a 24-hour referral for evaluation by a QMHP of any patient with serious mental illness. j. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.8.d (staff certification in cardiopulmonary resuscitation):
i. Provide the results of a self-audit of compliance with the requirement that all correctional custodial staff are certified in cardiopulmonary resuscitation (“CPR”), including findings and analysis;
ii. Provide a plan with a training timeline for any staff identified as requiring training in CPR.
k. Defendants shall complete and produce a report that meets the requirements of Consent Agreement § III.D.2.a.6 (report of reportable incidents).
8. Final Deadline: June 1, 2018: a. Defendants shall produce lesson plans, curriculum and a training schedule for applicable staff on the following policies: i. Policy CHS-010: Mortality and Morbidity Review; ii. Policy CHS-010B: Risk Management; iii. Policy CHS-042 Patient Injury and Response to Resistance; iv. Policy CHS-068: Clinical Restraints; and v. Policy DSOP-11041: Response to Resistance; b. Defendants shall update the Suicide Prevention Training curriculum with the procedure from interagency policy IP-003: Inmate Suicide Prevention and
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Response Plan, and initiate training. c. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.A.1.b (mental health screenings on intake): i. Launch a performance improvement plan to streamline intake; ii. Implement IT enhancement to provide for a six hour routine referral form for behavioral health QMHPs;
iii. Ensure all clinicians and nursing staff have completed secondary training regarding updates to the intake screening process;
iv. Ensure all clinicians and nursing staff have completed training on the symptoms of withdrawal;
v. Produce the following documentation: 1. The MDCR Queue Management System (“QMS”) Report demonstrating the length of time inmates are spending in the intake process; 2. A copy of the new routine referral form; 3. Post-training testing results, competency results and the results of a random audit for intake screening training, including findings and analysis; 4. Post-training testing results, competency results and the results of a random audit for symptoms of withdrawal training, including findings and analysis; 5. Clinical performance measures on Mental Health Evaluation at Intake, including findings and analysis;
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6. Clinical performance measures on Initial (Intake) Screen, including findings and analysis.
d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.1.c (inmates in need of constant observation): i. Ensure nursing staff enter an emergent order and constant observation whenever a patient expresses suicidal ideations or thoughts, or whenever clinically indicated; ii. Provide the Jackson Education Network (“JEN”) module training regarding the leveling policy to all QMHPs; iii. Produce Suicide Risk Screening clinical performance measures, including findings and analysis; iv. 4) Produce Initial (Intake) Screen clinical performance measures, including findings and analysis; v. Produce JEN report demonstrating all QMHPs completed the leveling policy training; and vi. Produce MHRC meeting minutes demonstrating the review and monitoring of the Initial (Intake) Screen and Suicide Risk Screening tools.
e. Defendants shall produce findings and analysis regarding diversion of patients to the hospital in medical emergent situations, based on data from the MDCR QMS Diversion Log. Consent Agreement § III.A.1.d (emergency mental health or medical referrals).
f. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.A.1.e (obtaining prior medical records): i. Develop, and produce evidence of, a place in the electronic health record to indicate offsite record checks; and ii. Produce clinical performance measures for Repeat Jail Admits, including findings and analysis.
g. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.3.a(1) (access to medical and mental health care): i. Produce clinical performance measures on Urgent Care (Sick Call), including findings and analysis; ii. Produce findings and analysis from an audit of the sick call process.
h. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.3.a(2) (access to medical and mental health care for inmates with physical or cognitive disabilities): Ensure that Jackson Health System’s communication system for patients with physical and/or cognitive disabilities is available at all times and provided to patients when necessary.
i. Defendants shall produce findings and analysis of ongoing competency reviews and audits regarding medical and mental health care staff’s knowledge of acute and chronic care needs of patients. Consent Agreement § III.A.3.b (adequate training on acute and chronic care).
j. Defendants shall produce a draft of a new clinical performance measurement tool monitoring compliance on documentation being sent out with patients transferred to outside facilities. Consent Agreement § III.A.5.d (exchange of medical records with outside providers).
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k. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.6.a (discharge planning): i. Finalize and produce policy CHS-049: Discharge Planning; and ii. Produce clinical performance measures on Continuity of Care on Release, including findings and analysis.
l. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.7(a-c) (mortality and morbidity reviews): i. Conduct timely administrative reviews and root cause analyses for serious incidents, including patient deaths and suicide attempts; ii. Develop corrective action plans including follow-up steps to ascertain pertinent information that is not available at the time of the initial review; iii. Manage and monitor all corrective action plans derived from morbidity and mortality reviews using the Performance Logic Project Management Tool; iv. Reconvene the Morbidity and Mortality Review Committee upon receipt of new findings/reports to update analyses and corrective action plans accordingly; v. Produce Clinical Quality Improvement (“CQI”) meeting minutes demonstrating review of all morbidity and mortality corrective action plans to determine their effectiveness and recommendations for modifications as necessary.
m. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.B.3.a (use of restraints): i. Develop and produce lesson plans and training curriculum for policy DSOP 11-041: Response to Resistance; ii. Develop and produce lesson plans and training curriculum for policy CHS-068: Use of Clinical Restraints;
iii. Ensure a QMHP is notified immediately in the case of custody-ordered restraints, in order to review the health record for any contraindications or accommodations required, and to initiate health monitoring;
iv. Draft and issue a memo to staff to reinforce the need to document 15minute checks on any inmate in restraints, and produce such memo;
v. Produce findings and analysis based on review of data from the Blackcreek System Report and manual logs;
vi. Produce findings and analysis based on review of data from the ISAS incident tracking database.
n. Defendants shall complete the following steps to achieve compliance with h Consent Agreement § III.B.3(b-c) (medical care following uses of force): i. Train all nurses to ensure they assess and document patients immediately following any use of force; ii. Implement in the electronic health record a prompt to ensure patient privacy is enforced and properly documented, and produce screen shots of new prompt; iii. Train all clinical staff on how to identify patient abuse or suspicion of
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patient abuse; iv. Produce post-training testing results, competency results and the
results of a random audit, including findings and analysis, for nurse training on assessing and documenting patients following uses of force; v. Produce post-training testing results, competency results and the results of a random audit, including findings and analysis, for training on how to identify patient abuse or suspicion of patient abuse; vi. Produce clinical performance measures on Nursing Documentation Following Use of Force, including findings and analysis. o. Defendants shall produce a draft of an internal clinical performance measurement tool to audit whether emergency referrals to the QMHP after intake are being completed within two hours. Consent Agreement § III.C.1.a(1) (access to care and emergency referrals). p. Defendants shall complete and produce a report on CHS’s validation of the mental health leveling system. Consent Agreement § III.C.2.f (mental health classification by level of care). q. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.g (provision of mental health care): i. Demonstrate the use of the quality improvement program and the ability to self-monitor, incorporating a description of performance indicators including:
1. Wait times for psychiatry visits;
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2. Psychotropic medication utilization; 3. Numbers of use of force incidents; 4. Utilization of group counseling; 5. Utilization of recreation time; 6. Episodes of self-harm; 7. Grievances; and 8. Adherence to medication. ii. Produce new clinical performance measurement tools, as applicable. r. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.k (internal review of behavioral health services): Produce the finalized version of the following clinical performance measurement tools, and an assessment utilizing those tools, including findings and analysis: i. Level of care internal audit tool for Level I; ii. Level of care internal audit tool for Level II; iii. Level of care internal audit tool for Level III; and iv. Level of care internal audit tool for Level IV. s. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.3.a(1) (property and privileges for acutely mentally ill and suicidal inmates): i. Train Mental Health Treatment Center custodial staff and medical and mental health staff on policy CHS-058B: Behavioral Health Levels of Care;
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ii. Produce finalized measure added to clinical performance measurement tool on Suicide Risk Screening to track compliance with Consent Agreement § III.C.3.a(1), and produce assessment utilizing that tool, including findings and analysis.
t. Defendants shall produce finalized measure added to clinical performance measurement tool on Suicide Risk Screening to track compliance with Consent Agreement § III.C.3.a(2), and produce assessment utilizing that tool, including findings and analysis.
u. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.3.a(3) (provision of bed and suicide-resistant mattress to inmates on suicide watch): i. Ensure that each inmate on suicide watch has a bed and a suicide resistant mattress and monitor compliance during walkthroughs; and ii. Produce findings and analysis based on information gathered during walkthroughs.
v. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.3.a(4) (quality suicide risk assessments): i. Train all QMHPs on an ongoing basis on the provision of quality suicide risk assessments; and ii. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for QMHP training on the provision of quality suicide risk assessments.
w. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.C.3.a(5) (prevention of retaliation through the use of suicide watch cells):
i. Ensure that all new staff have been provided Suicide Prevention training;
ii. Ensure that all behavioral health staff have completed annual training on Suicide Prevention in the past year;
iii. Produce pre- and post-training test results and competency results for Suicide Prevention training; and
iv. Produce audit report, including findings and analysis, based on competency testing of suicide risk assessments and quarterly review of QMHP documentation.
x. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.3.e (individualized treatment plans for suicidal inmates): i. Conduct annual review of policy CHS-058A: Interdisciplinary Treatment Team and implement modifications, if necessary, to fully implement the terms of the Consent Agreement; ii. Produce revised policy CHS-058A, if applicable; and iii. Produce clinical performance measures on Mental Health Treatment Planning, including findings and analysis.
y. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.3 (suicide prevention): i. Implement training on policy IP-003: Suicide Prevention and
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Response Plan for all appropriate staff; ii. Produce training rosters demonstrating that custodial and medical and
mental health staff have received biennial in-service training on suicide prevention in the past two years; iii. Produce training rosters demonstrating that staff who work in intake, in custodial segregation, or who work with inmates on Behavioral Health Levels I-III, have received annual in-service training on suicide prevention in the past year. z. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a.2 (screening prior to custodial segregation): i. Implement the Independent Monitors’ recommendations from the Eighth Report regarding this provision, including the incorporation of a specific identifier for pre-segregation notes in the electronic medical record, for ease of identification and auditing; ii. Collect, review, and analyze data regarding the use of custodial segregation for inmates on the mental health caseload, including:
1. Medical and mental health screenings prior to initial placement in custodial segregation and notation of contraindications for inmates for whom acute medical or mental health condition is identified;
2. The outcomes of mental health reviews/consultations prior to placement in custodial segregation;
3. The number of patients per Level per month in custodial
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segregation who are referred for mental health care, and the outcome of each referral; 4. The length of placement in custodial segregation for patients, by Level; and 5. Data and trends from the Blackcreek Watch System. aa. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(6) (inmates with serious mental illness and custodial segregation): Implement the Independent Monitors’ recommendations from the Eighth Report regarding this provision, including: i. Develop and produce a plan to implement clear criteria to be used by mental health staff when evaluating patients with serious mental illness for placement in custodial segregation and/or determining whether a patient should continue to be housed in custodial segregation; ii. Collect and analyze data regarding the assessment and treatment of patients after mental health symptoms develop in custodial segregation, including analysis of any patients who are housed in custodial segregation after decompensating or engaging in self-harm, and produce results of such analysis; and iii. Develop and produce jointly between CHS and MDCR a clear working definition of “long-term custodial segregation” to allow for appropriate tracking and monitoring. bb. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.C.6.a(11) (mental health referrals for inmates in custodial segregation): Collect, review, and analyze data, and produce findings and analysis, regarding mental health referrals of inmates in custodial segregation, including
i. Analysis that demonstrates adherence to Consent Agreement § III.C.6.a(11); and
ii. Analysis regarding the timeliness of referrals of patients with serious mental illness during custodial segregation.
cc. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.7.b (mental health staffing): i. Ensure that newly hired mental health staff receive corrections-specific mental health training; ii. Produce lesson plans and training materials for this training.
dd. Defendants shall produce documentation demonstrating that all new staff have received pre-service training and that all staff have received biennial inservice training on all relevant policies/procedures and the requirements of the Consent Agreement. Consent Agreement § III.C.7.f (training).
ee. Defendants shall produce training materials, post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training that meets the requirements of Consent Agreement § III.C.7.g (mental health training for corrections officers).
ff. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.7.h (communication between mental health staff
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and corrections officers): i. Develop and implement written policy(ies), procedure(s) and training that ensures appropriate and regular communication between mental health staff and corrections officers regarding inmates with mental illness; ii. Produce training materials, post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training that meets the requirements of Consent Agreement § III.C.7.h; and
iii. Produce policy CHS-004A: Mental Health Review Committee. gg. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.C.9.a (risk management system): Produce a report reflecting an in-depth analysis of risk-management data to demonstrate that trends and incidents involving avoidable suicides and self-injurious behavior are being identified and corrected in a timely manner. This analysis should include
i. Use of the harm score; ii. Triggers for non-suicidal self-harm; iii. An explanation of how an analysis of suicides led to changes in
leveling; and iv. Corrective action plans, if applicable, to reflect how the County is
addressing identified trends to further reduce or mitigate risk from suicides and self-injurious behavior.
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hh. Defendants shall produce documentation demonstrating risk management data analysis and associated interventions to prevent or minimize harm to inmates. Consent Agreement § III.C.9.b (risk management).
ii. Defendants shall finalize and produce policy CHS-044: Segregated Patients. jj. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.C.9.a, b(1) (risk management): i. Train applicable staff on policy CHS-010: Mortality and Morbidity Review and policy CHS-010B: Risk Management; ii. Produce post-training testing results and attestations of understanding for staff trained on policy CHS-010 and policy CHS-010B.
9. Final Deadline: July 1, 2018: a. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.1.a (intake screenings): Conduct and produce reliability audits, including findings and analysis, of the following clinical performance measurement tools: i. Mental Health Evaluation at Intake; and ii. Initial (Intake) Screening. b. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.3.a(4) (screening and responding to medical and mental health requests): i. Produce clinical performance measures on Complaints and Grievances, including findings and analysis; and
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ii. Produce clinical performance measures on Urgent Care (Sick Call), including findings and analysis.
c. Defendants shall produce clinical performance measures on Medication Administration, including findings and analysis. Consent Agreement § III.A.4.a (medication administration).
d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.5.b (mental health care scheduling): i. Conduct daily reviews of scheduling queues and no show reports; and ii. Produce findings and analysis based on data reviewed.
e. Defendants shall produce CHS and Jackson Health Services information technology monthly meetings schedule. Consent Agreement § III.A.5.c (documentation of clinical encounters).
f. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.5.d (exchange of medical records with outside providers): Implement the Independent Monitors’ recommendations from the Eighth Report, including i. Create and produce a checklist for nurses to ensure documentation is being sent out with patients transferred to outside facilities; ii. Develop, implement, and produce a template or form to document consistent information about patients upon their return from off-site care and use that form to communicate with providers about continuation of care; iii. Develop a process with Health Information Management to receive
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records from outside facilities and to notify providers upon receipt and produce process flow chart; iv. Implement a check-box in the electronic health record to allow physicians to note acknowledgement of receipt of outside records; and v. Implement and produce the finalized clinical performance measurement tool to monitor compliance on documentation being sent out with patients transferred to outside facilities, and produce an assessment utilizing that tool, including findings and analysis. g. Defendants shall produce a draft revised clinical performance measurement tool on Continuity of Care on Release, including a new measurement to analyze if referrals are being made as clinically indicated. Consent Agreement § III.A.6.a.(1) (referrals for planned discharges). h. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.a (inmates at risk of self-harm): i. Train all officers assigned to the Mental Health Treatment Center, all nursing staff, psychiatrists and psychiatric ARNPs on the following policies:
1. Policy DSOP 11-041: Response to Resistance (clinical restraints);
2. Policy CHS-068: Use of Clinical Restraints; ii. Produce post-training testing results, competency results, and the
results of a random audit, including findings and analysis, for trainings on policy DSOP 11-041 and policy CHS-068.
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i. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.c (medical care following uses of force; questioning inmates and reporting suspected abuse): i. Implement an enhancement in the electronic health record for documentation of uses of force or injuries, which will allow clinical staff to identify if the patient’s injury aligns with the patient’s account of the injury, and produce screenshots of the enhancement; ii. Train all nursing staff on the use of the enhancement described above; iii. Ensure photographic evidence is taken in compliance with policy DSOP 11-041 and policy CHS-042 after any use of force or any suspected injury resulting from staff-on-patient abuse; iv. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training on the use of the new electronic health record enhancement, described above; v. Produce 10 randomly drawn use of force incident reports; and vi. Produce clinical performance measures on Nursing Documentation Following Use of Force, including findings and analysis.
j. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.1.a(1-3) (referrals for mental health care): i. Finalize and produce internal clinical performance measurement tool to audit whether emergency referrals to the QMHP after intake are being completed within two hours, and produce assessment utilizing
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that tool, including findings and analysis; ii. Train all nursing staff, using a Jackson Education Network module, to
enter emergency referrals and constant observation orders whenever staff identify an inmate at risk of suicide or self-harm; iii. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training of nursing staff on entering emergency referrals and constant observation orders. k. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.1.b (access to mental health care): i. Ensure that all clinical staff have received annual behavioral health training in the past year; ii. Produce post-test training results and attestations for behavioral health training; iii. Produce findings and analysis regarding compliance with Consent Agreement § III.C.1.b, based on data from the QMHP Referral Report. l. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.a (policy for the delivery of mental health care) i. Ensure that all new staff have been trained in policy CHS-058 Basic Behavioral Health Services; ii. Ensure that all new behavioral health staff have completed annual training on policy CHS-058 Basic Behavioral Health services, in the past year;
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iii. Produce post-training testing results for basic mental health services training; and
iv. Produce MHRC meeting minutes demonstrating review and analysis of behavioral health assessments and sick call reports and, if indicated, development of corrective action plan.
m. Defendants shall produce clinical performance measures on Mental Health Treatment Planning, including findings and analysis. Consent Agreement § III.C.2.e (interdisciplinary treatment plans for mental health care).
n. Defendants shall produce clinical performance measures on Individuals on the Mental Health Caseload Involved in Use of Force Incidents, including findings and analysis. Consent Agreement § III.C.2.h (expansion of mental health care).
o. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.g (provision of mental health care): i. Create and produce a procedural directive addressing follow-up care for patients coming off of Level I; ii. Produce clinical performance measures on Suicide Risk Screening, including findings and analysis.
p. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.j (mental health care Level 1 services and care): i. Create and produce a staffing matrix to ensure Level I services are completed in a timely manner; ii. Produce morning huddle reports demonstrating inter-facility
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Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 37 of 55 Case No. 13-cv-21570-BLOOM
communication to ensure Level I patients are seen. q. Defendants shall produce post-training testing results, competency results, and
the results of a random audit, including findings and analysis, for suicide prevention training. Consent Agreement § III.C.3 (suicide prevention). r. Defendants shall produce post-training testing results, competency results, and the results of a random audit, including findings and analysis for training of custodial staff and medical and mental health staff on policy CHS-058-B Behavioral Health Levels of Care. Consent Agreement § III.C.3.a(1) (property and privileges for acutely mentally ill and suicidal inmates). s. Defendants shall produce a draft of a new internal audit tool measuring compliance with rapid response protocols. Consent Agreement § III.C.3.g (emergency response). t. Defendants shall produce a draft of a new internal audit tool measuring compliance with Consent Agreement § III.C.6 (custodial segregation). u. Defendants shall produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training on policy IP-003: Suicide Prevention. Consent Agreement § III.C.8.a(1-8) (suicide prevention training). v. Defendants shall produce Facility Clinical Quality Improvement minutes containing a review and risk assessment of incidents reported. Consent Agreement § III.C.9.b(1) (risk management). w. Defendants shall complete the following steps to achieve compliance with Consent Agreement §§ III.C.9.a, b(2), d(1-2) (risk management):
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i. Conduct annual reviews of the following policies and implement modifications, if necessary, to fully implement the terms of the Consent Agreement: 1. a) CHS-058 Basic Behavioral Health Services; 2. b) CHS-058A Interdisciplinary Treatment Team; 3. c) CHS-058B Behavioral Health Levels of Care; 4. d) CHS-004A Mental Health Review Committee; 5. e) CHS-039 Sick Call; 6. f) CHS-033 Intake and Receiving Screening; and
ii. Produce revised policies, if applicable. x. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.C.9.c (mental health review committee): Conduct and produce, with findings and analysis, annual written performance assessments and present findings to the Interdisciplinary Treatment Team regarding
i. The quality of nursing services regarding inmate assessments and dispositions; and
ii. Access to mental health care by inmates, by evaluating the process for screening and assessing inmates for mental health needs.
y. Defendants shall produce clinical performance measures on Nursing Documentation Following Use of Force, including findings and analysis. Consent Agreement § III.C.9.c(5)i (assessment of nursing services).
z. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.C.9.c(5)ii (assessment of access to mental health care services):
i. Assess the quality of QMHP screening of inmates for mental health needs through live observation by the Chief Psychiatrist, or designee;
ii. Produce report, including findings and analysis, documenting any corrective or remedial action taken, based on live observation of mental health screenings by Chief Psychiatrist or designee; and
iii. Produce clinical performance measures on Initial (Intake) Screen, including findings and analysis.
aa. Defendants shall produce a Biannual Report that meets the requirements of Consent Agreement § III.D.2.a.
bb. Defendants shall produce medication reports, including findings and analysis, related to sleeping medication, abuse of medication, and the use of psychotropic medication by classification on a monthly basis. Consent Agreement § III.D.2.a(1) (biannual reports).
cc. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.D.2.a(2-4) (biannual reports): i. Produce an evaluation and report, including findings and analysis, of emergency room transfers; ii. Produce a report, including findings and analysis, on the appropriateness of relocation/transfer of patients to higher level of care; iii. Produce a report, including findings and analysis, on chronic disease;
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iv. Produce a report, including findings and analysis, on all suicide related incidents;
v. Produce MHRC meeting minutes demonstrating a monthly analysis of mental health caseload; and
vi. Produce a report, differentiating between individual and group therapy, which analyzes sustainability.
dd. Defendants shall ensure that corrective action plans are developed at the CQI meetings on a quarterly basis and produce CQI meeting minutes demonstrating development of corrective action plans and monitoring of sustainability. Consent Agreement § III.D.2.b (corrective action plans).
10. Final Deadline: August 1, 2018: a. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.3.a(2) (access to care for inmates with physical or cognitive disabilities): i. Produce Mini-MAC meeting minutes for all facilities, demonstrating identification of an accommodation for any patients with physical and/or cognitive disabilities; and ii. Produce findings and analysis based on data from the Americans with Disabilities Act (“ADA”) log monthly report. b. Defendants shall complete the following steps to achieve compliance with Consent Agreement §III.A.4.b(1) (continuity of medication on intake): i. Produce findings and analysis of monthly rounding and record reviews
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by nursing leadership to ensure compliance with this provision; and ii. Produce clinical performance measures on Continuity of Medication
on Intake, including findings and analysis. c. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.A.4.b(2) (serious medical or mental health needs on intake):
i. Ensure that a medical doctor or psychiatrist is evaluating, in person, patients with serious medical or mental health needs, within 48 hours of entry to any MDCR facility;
ii. Produce clinical performance measures on Mental Health Evaluation at Intake, including findings and analysis; and
iii. Produce clinical performance measures on Initial (Intake) Screen, including findings and analysis.
d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.c (reviews on the use of psychotropic medication): i. Conduct reviews on the use of psychotropic medications and develop and implement corrective action plans, if necessary; and ii. Produce Pharmacy and Therapeutics Meeting Minutes demonstrating findings and analysis from reviews on the use of psychotropic medications.
e. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.d (medication administration and refusals):
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i. Distribute all narcotic (controlled) psychotropic medication in bubble packs;
ii. Provide the formulary reflecting the use of bubble packs for the distribution of all narcotic (controlled) psychotropic medication; and
iii. Produce clinical performance measures on Medication Refusal, including findings and analysis.
f. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.e (orders for medication and laboratory tests): i. Conclude scheduling process improvement plan to improve compliance with obtaining lab tests; ii. Employ additional schedulers to ensure coverage 24 hours a day, seven days a week, and produce documentation demonstrating that coverage; iii. Conduct weekly monitoring of the implementation of physician orders for medication and laboratory tests, and produce findings and analysis; and iv. Produce findings and analysis based on data obtained from the electronic health record scheduling report.
g. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.f (training on medication administration): i. Implement and produce video training regarding the steps required to monitor safe medication administration for all new staff; and ii. Produce MAC meeting minutes demonstrating supervisory spot
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checks. h. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.A.6.a(1) (referrals for planned discharges): i. Train all discharge planners (MSWs) on Discharge Planning policy; ii. Finalize and produce added measure to clinical performance measurement tool on Continuity of Care of Release to measure if referrals are being made as clinically indicated;
iii. Produce post-training testing results, competency results, and the results of a random audit for discharge planning training, including findings and analysis; and
iv. Produce assessment utilizing revised tool on Continuity of Care on Release, including findings and analysis.
i. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.6.a(2) (provision of bridge medications on discharge): i. Implement enhancement in the electronic health record to bridge medications to be picked up at the Jackson Memorial Hospital pharmacy; and ii. Produce a monthly report from the pharmacy of picked-up bridge medications, including findings and analysis.
j. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.6.a(3) (discharge planning): i. Ensure corrections staff notify the site Directors of Patient Care
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Services of planned release dates; ii. Ensure that all medications are ordered and medical clearance
obtained, if applicable; iii. Make referrals, as clinically appropriate, and develop a complete
discharge plan for all planned discharges; iv. Produce discharge notification list demonstrating appropriate
notification of Directors of Patient Care services; and v. Produce findings and analysis regarding medications being ordered on
discharge, based on data from the medication administration record report. k. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.b (medical care following uses of force): i. Train all nursing staff and medical providers on policy CHS-042: Patient Injury and Response to Resistance; and ii. Produce post-training testing results, competency results and the results of a random audit for CHS-042 training, including findings and analysis. l. Defendants shall produce the finalized internal audit tool measuring compliance with rapid response protocols, including findings and analysis. Consent Agreement § III.C.3.g (emergency response). m. Defendants shall produce the finalized internal audit tool measuring compliance with Consent Agreement § III.C.6 (custodial segregation), including findings and analysis.
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n. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(1-4) (custodial segregation): i. Ensure that all clinical staff have been trained in policy CHS-044 Segregated Patients; and ii. Produce a schedule for annual training for all clinical staff on policy CHS-044 Segregated Patients;
o. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.9.b(3-4), 9.c(1-5) (risk management): i. Ensure that all clinical staff have received annual training on the following policies: 1. CHS-058 Basic Behavioral Health Services; 2. CHS-058A Interdisciplinary Treatment Team; 3. CHS-058B Behavioral Health Levels of Care; 4. CHS-039 Sick Call; and 5. CHS-033 Intake and Receiving Screening; ii. Produce post-training testing results, and the results of a random audit, including findings and analysis, for training on the policies listed above; and iii. Produce MHRC meeting minutes documenting an analysis of selfharm incidents and the corrective action implemented, when applicable.
p. Defendants shall produce clinical performance measures on Initial (Intake) Screen, including findings and analysis. Consent Agreement § III.C.9.d(1)
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(review of suicide risk assessments). q. Defendants shall conduct quarterly CQI meetings and produce CQI meeting
minutes demonstrating a review of corrective action plans and an analysis on effectiveness. Consent Agreement § III.C.9.d(2) (monitoring of risk management activities). r. Defendants shall develop and produce recommendations for further investigation of identified trends and for corrective action, including system changes, and present recommendations to the CQI Committee. Consent Agreement § III.C.9.d(5) (recommendations for further investigation). s. Defendants shall produce the internal audit tool to monitor disciplinary review assessments, including findings and analysis. Consent Agreement § III.D.2.a(5) (biannual reports).
11. Final Deadline: September 1, 2018: a. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.a (health assessments): i. Modify appointment types in the electronic health record to allow for appointments to be made within 10 days rather than 14 days; ii. Produce findings and analysis based on data obtained from the electronic health record scheduling report; and iii. Produce clinical performance measures on Laboratory, including findings and analysis. b. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.b (mental health assessments):
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i. Re-train all QMHPs on the Columbia Suicide Screening Tool; ii. Produce post-training testing, competency results, and results from a
random audit on the Columbia Suicide Screening Tool training, including findings and analysis; and iii. Produce clinical performance measures on Suicide Risk Screening, including findings and analysis. c. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.d (risk profiles): i. Complete and implement an interdisciplinary treatment team (“IDTT”) schedule, jointly between MDCR and CHS; ii. Produce findings and analysis based on data from the IDTT Compliance Tracker; and iii. Produce MHRC meeting minutes demonstrating review of trends regarding IDTT and discussion of modifying treatment plans for Levels I and II. d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.e (chronic care assessments): i. Train all Patient Finance Specialists in all aspects of the scheduling process; ii. Create and fill a lead Patient Finance Specialist position; iii. Implement scorecards to monitor performance of Patient Finance Specialists and to create accountability for patient outcomes; iv. Produce post-training test results, competency results, and the findings
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and analysis from an internal audit on the scheduling process training; v. Produce findings and analysis based on data obtained from the
electronic health record scheduling report; vi. Produce clinical performance measures on Medication Administration,
including findings and analysis; and vii. Produce clinical performance measures on Continuity of Medication
on Intake, including findings and analysis. e. Defendants shall complete the following steps to achieve compliance with h
Consent Agreement § III.A.2.f (intake screenings): i. Train all nurses on use of the electronic health record message center; ii. Train all clinical staff to check electronic health record inboxes in order to review lab results;
iii. Produce post-training test results, competency results, and the findings and analysis from a random audit on the electronic health record message center training;
iv. Produce post-training test results, competency results, and the findings and analysis from a random audit on the electronic health record inbox training; and
v. Produce the following clinical performance management tools, including findings and analysis: 1. Laboratory; 2. Heath Assessments 3. Chronic Care – Diabetes;
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4. Chronic Care – Seizure Disorder; 5. Chronic Care – Hypertension; 6. Chronic Care – Asthma; and 7. Anticoagulant Medication – Warfarin (Coumadin). f. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.g (training on health assessments and referrals): i. Utilize QMHPs to train all nurses regarding behavioral health treatment levels; and ii. Conduct a staff survey to obtain feedback on the behavioral health level training and produce findings and analysis of training surveys, including a plan for modifying future trainings, if applicable. g. Defendants shall produce training sign-in sheets, competency results, and the findings and analysis from a random audit on chronic care training. Consent Agreement § III.B.2.a-b (medical and mental health assessments). h. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3(a) (use of restraints): i. Train all corrections officers who work in the mental health treatment center, psychiatrists, psychiatric ARNPs, and nursing staff on policy CHS-068 Clinical Restraints; and ii. Produce post-training testing, competency results, and results from a random audit on the clinical restraints training, including findings and analysis. i. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.C.4.a(1-2) (disciplinary measures with regard to inmates with mental illness):
i. Ensure that disciplinary reviews take into consideration whether the patient has the capacity to complete the disciplinary proceeding as well as whether the disciplinary charge was related to mental illness;
ii. Conduct an annual review of policy CHS-008A: Disciplinary Review and implement modifications, if necessary, to fully implement the terms of the Consent Agreement;
iii. Produce revised policy CHS-008A, if applicable; iv. Ensure that all new staff have been trained in policy CHS-008A; v. Ensure that all behavioral health staff have completed annual training
on policy CHS-008A in the past year; vi. Develop and implement a disciplinary review assessment form and
report in the electronic health record, and produce screenshot of form; vii. Produce post-training testing results, competency results, and the
results of a random audit, including findings and analysis, for policy CHS-008A training; and viii. Produce a report on disciplinary review assessments, including findings and analysis, that includes
1. Analysis of the number of patients on Levels I-IV per month referred for disciplinary proceedings and placed in custodial segregation; and
2. A specific discussion of the use of data from the Inmate
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Disciplinary System at the MHRC. j. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.C.4.b (assistance with the disciplinary process for mentally ill inmates):
i. Develop and implement an enhancement to the electronic health record to flag any patient unable to understand or meaningfully interact with staff due to mental illness and/or cognitive impairment, and produce screenshot of new flag;
ii. Ensure all patients with special needs are added to the ADA log and monitored monthly for continued assistance; and
iii. Produce a report on patients with special needs documented on the ADA log, including findings and analysis, based on information from the ADA log and the electronic health record.
k. Defendants shall produce a report(s), with findings and analysis, on the status of compliance with Consent Agreement §§ III.C.5.a-b (mental health care housing).
l. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.5.d (reporting on Mental Health Treatment Center): i. Train all staff working in Mental Health Treatment Center on policy CHS-058B Behavioral Health Levels of Care; ii. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for special
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management unit training; iii. Produce reports, including findings and analysis, based on information
gathered during rounding by Health Services Administrators; and iv. Produce a quarterly report that meets the requirements of Consent
Agreement § III.C.5.d. m. Defendants shall produce clinical performance measures on Mental Health
Evaluation at Intake, including findings and analysis. Consent Agreement § III.C.5.e (interdisciplinary plan of care). n. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(1-4) (custodial segregation):
i. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training on policy CHS-044 Segregated Patients; and
ii. Implement screening prior to placement in custodial segregation to identify acute medical and mental health contraindications and implement a 24-hour referral for evaluation by a QMHP of any patient with serious mental illness.
12. Final Deadline: October 1, 2018: a. Defendants shall produce a report on the status of compliance with Consent Agreement §§ III.C.6.a(1-3) (custodial segregation), including findings and analysis. b. Defendants shall complete an audit, and produce findings and analysis,
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regarding how the County tracks out-of-cell time for inmates in custodial segregation, including type and duration of activity. Consent Agreement § III.C.6.a(4)ii (documentation of out of cell time for inmates with serious mental illness in custodial segregation). c. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(5, 7, 8) (inmates with serious mental illness and custodial segregation):
i. Review and modify the Medical Incident Addendum form, and produce a screen shot of the revised form;
ii. Create a list in the electronic health record of all patients with serious mental illness being housed in segregation to monitor mental health clearances of such placements; and
iii. Produce a report, including findings and analysis, based on a review of the list of all patients with serious mental illness being housed in segregation.
d. Defendants shall produce a report, including findings and analysis, on the status of compliance with Consent Agreement § III.C.6.a(9) (rounds in custodial segregation).
e. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(10) (access to medical and mental health care in custodial segregation): i. Provide access to the Blackcreek Watch System to the Director of patient Care and to Health Services Administrators in order to review
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nursing compliance with rounds in segregated housing units; ii. Produce a report, including findings and analysis, on the status of
compliance with Consent Agreement § III.C.6.a(10). 13. On or before November 1, 2018, the parties and the Independent Monitor shall meet
and confer to determine whether Defendants have achieved compliance on all Paragraphs of Consent Agreement. 14. On or before November 8, 2018, the parties and the Independent Monitor shall file a Notice of Compliance with paragraph 13, above. In the Notice, the parties must also specify, for each Paragraph of the Consent Agreement, which Paragraphs are in full compliance and which are in partial or non-compliance. If any Paragraphs remain in non-compliance or partial compliance, the parties shall propose a Fourth Summary Action Plan to remedy such non-compliance so that the parties will achieve complete compliance with the Consent Agreement on or before December 10, 2018. 15. On or before December 10, 2018, the parties and the Independent Monitor shall file a joint declaration averring whether complete compliance with the Consent Agreement has been achieved. 16. The items above or contained in the Third Summary Action Plan may be modified or amended by the Court, or without further Court order with the consent of both parties; however, no Final Deadline may be altered without an order by this Court. 17. Nothing in this Order replaces or negates any obligation or requirement of the Consent Agreement. 18. The entry of this Order does not preclude enforcement of the original Consent Agreement.
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DONE AND ORDERED in Chambers at Miami, Florida, this 27th day of March, 2018.

Copies to: Counsel of Record

_________________________________ BETH BLOOM UNITED STATES DISTRICT JUDGE

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 Case 1:13-cv-21570-BB Document 105 Entered on FLSD Docket 04/16/2018 Page 1 of 6
UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF FLORIDA
Case No. 13-21570-CIV-BLOOM UNITED STATES OF AMERICA,
Plaintiff, v. MIAMI-DADE COUNTY, THE BOARD OF COUNTY COMMISSIONERS, et al.,
Defendants. ______________________________________/
JOINT STATUS REPORT Pursuant to the Court’s Order filed on April 16, 2018, ECF No. [104], the parties provide the following status report regarding Defendants’ compliance with the action items due April 16, 2018. 1. In compliance with the Court’s Order dated March 27, 2018 (“the Order”), ECF No. [91], on April 6, 2018, Defendants produced to the United States and the Independent Monitors documents pertaining to the action steps in paragraphs 6(a)-6(k) of the Order. 2. The Order required that the parties and Independent Monitors meet and confer, by April 11, 2018, to discuss the items submitted on April 6, 2018. 3. The United States and Defendants held a meet-and-confer on the afternoon of April 10, 2018; the Independent Monitors were unavailable. During this telephonic conference, the United States expressed concerns about the following deficiencies in the submissions provided by Defendants:
a. The Order required Defendants to develop and provide “a template or form to document consistent information about patients upon their return from 1

Case 1:13-cv-21570-BB Document 105 Entered on FLSD Docket 04/16/2018 Page 2 of 6
off-site care and use that form to communicate with providers about the continuation of care.” Order, at § 6(c). Defendants provided a screen shot of a form nurses are to complete within the electronic health record. The form is entitled “Reason for Outpatient Visit/Nursing Call” and seeks information regarding the reason a patient was sent to an off-site provider. As depicted in the screen shot, the form does not include any fields intended to gather information about patients’ conditions “upon their return from offsite care” and does not include any fields intended to “communicate with providers about continuation of care” upon patients’ return to the jail. Defendants committed to providing the United States and the Independent Monitors with additional screen shots demonstrating material that met the requirements of the Order. b. The Order required Defendants to “produce an audit, with findings and recommendations, of three months of data, to analyze the status of compliance with the clinical restraints policy.” Order, at § 6(d). Defendants, who proposed the three-month time frame, determined that there was no data available for January, February or March 2018, as no clinical restraints were used during that time period. Defendants agreed to go back to the time period when clinical restraints were last used and produce such information. c. The Order required Defendants to produce an audit, “including findings and analysis” incorporating data regarding (1) the number of patients on each mental health level, (2) the number of level I and level II patients who have
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an interdisciplinary treatment plan and the timeframe in which each patient

receives a follow-up plan, and (3) how patients who are not required by

policy to receive an interdisciplinary treatment plan are assessed and

evaluated to ensure their needs are addressed. Order, at § 6(g). The findings

and analysis provided by Defendants were incomplete and insufficient. The

analysis did not address the question presented and did not incorporate all

of the data points required. Further, regarding subsection (3), Defendants

did not provide any data regarding patients not on an interdisciplinary

treatment plan, but simply provided a summary statement about procedure.

Defendants agreed to provide an improved version of this submission.

4. The day after the parties conferred, the Independent Monitors provided feedback to

Defendants via written correspondence, received on the afternoon of April 11, 2018. In that

feedback, the Independent Monitors expressed concerns about the completeness and quality of a

number of the submissions, particularly with respect to the internal audits, and the inadequacy of

findings and analysis.

5.

The Independent Monitors and the parties participated in the meet and confer on

the afternoon of Friday, April 13, 2018. During this telephonic meet and confer, Defendants

agreed to address the concerns raised by the Independent Monitors, and to provide updated

submissions to the United States and the Monitors on April 16, 2018.

6. The Monitors and the United States have concerns about the sufficiency of the

submissions provided by the Defendants on April 6, 2018. The Monitors and the United States

will review the updated submissions to make final determinations about whether Defendants have

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achieved compliance with the action steps. The parties and the Independent Monitors will file a Joint Declaration to advise the Court of this determination by April 20, 2018.
7. On April 16, 2018, the Independent Monitors provided the parties with their availability between now and the end of the year. The parties will use that information to inform the Proposed Fourth Revised Summary Action Plan requested by the Court. See ECF No. [104].

Dated: April 16, 2018

Respectfully submitted,
FOR THE UNITED STATES
JOHN M. GORE Acting Assistant Attorney General Civil Rights Division
STEVEN H. ROSENBAUM Chief Civil Rights Division Special Litigation Section
LAURA L. COWALL Special Counsel Civil Rights Division Special Litigation Section
By: /s/ Jennifer Wedekind JENNIFER WEDEKIND (DC 1012362) Special Florida Bar No. A5502179 Trial Attorney MEGAN R. MARKS Special Florida Bar No. A5502302 Trial Attorney U.S. Department of Justice Civil Rights Division Special Litigation Section 950 Pennsylvania Avenue, NW
4

Case 1:13-cv-21570-BB Document 105 Entered on FLSD Docket 04/16/2018 Page 5 of 6
Washington, DC 20530 Tel: (202) 616-4547 Fax: (202) 514-1089 Email: jennifer.wedekind@usdoj.gov FOR THE DEFENDANTS ABIGAIL PRICE-WILLIAMS Miami-Dade County Attorney Stephen P. Clark Center 111 N.W. 1st Street, Suite 2810 Miami, Florida 33128 By: /s/ Bernard Pastor Bernard Pastor Florida Bar No. 0046582 e-mail: pastor@miamidade.gov Benjamin D. Simon Florida Bar No. 643378 email: bdsimon@miamidade.gov Assistant County Attorneys Phone: (305) 375-5151 Fax: (305) 375-563
5

Case 1:13-cv-21570-BB Document 105 Entered on FLSD Docket 04/16/2018 Page 6 of 6

CERTIFICATE OF SERVICE
I hereby certify that on April 16, 2018, I electronically filed the foregoing document with the Clerk of Court using CM/ECF and served all parties listed below.
/s/ Jennifer Wedekind Jennifer Wedekind

SERVICE LIST United States of America v. Miami-Dade County, et al.,
United States District Court, Southern District of Florida Case No. 13-21570-Civ-Bloom

Laura Cowall U.S. Department of Justice Special Litigation Section 601 D Street NW Washington, DC 20004 202-514-1089 Email: laura.cowall@usdoj.gov

Megan R. Marks U.S. Department of Justice Special Litigation Section 601 D Street NW Washington, DC 20004 202-616-2579 Email: megan.marks@usdoj.gov

Jennifer Wedekind U.S. Department of Justice 601 D Street NW Washington, DC 20004 202-616-4547 Email: jennifer.wedekind@usdoj.gov
Bernard Pastor Benjamin D. Simon Assistant County Attorneys Stephen P. Clark Center, Suite 2810 111 N.W. 1st Street Miami, Florida 33128-1993 Tel: (305) 375-1506 Fax: (305) 375-5611 pastor@miamidade.gov bdsimon@miamidade.gov

Veronica Vanessa Harrell-James United States Attorney's Office 99 NE 4 Street Miami, FL 33132 305-961-9327 Fax: 305-530-7139 Email: Veronica.Harrell-James@usdoj.gov

6

 
 Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 1 of 31 1

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF FLORIDA Case No. 13-21570-Civ-BLOOM

UNITED STATES OF AMERICA,

) Pages 1-31

)

Plaintiff,

)

)

-v-

)

)

MIAMI-DADE COUNTY; THE BOARD )

OF COUNTY COMMISSIONERS, et al.,)

) Miami, Florida

Defendants.

) November 1, 2019

--------------------------------) 1:30 p.m.

TRANSCRIPT OF STATUS CONFERENCE

BEFORE THE HONORABLE BETH BLOOM

U.S. DISTRICT JUDGE

APPEARANCES:

For the Government

WILLIAM G. MADDOX U.S. Department of Justice 601 D Street, NW Washington, DC 20004

For the Defendants

VERONICA V. HARRELL-JAMES Assistant U.S. Attorney 99 Northeast 4th Street Miami, Florida 33132-2111
MIAMI-DADE COUNTY ATTORNEY'S OFFICE BY: BENJAMIN D. SIMON, ESQ., BERNARD PASTOR, ESQ. and LAURA LLORENTE, ESQ. 111 Northwest 1st Street - Suite 2810 Miami, Florida 33128-1993

REPORTED BY: (305) 523-5558

WILLIAM G. ROMANISHIN, RMR, FCRR, CRR Official Court Reporter 400 North Miami Avenue Miami, Florida 33128

STENOGRAPHICALLY RECORDED COMPUTER-AIDED TRANSCRIPT

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 2 of 31 2

1

(Call to order of the Court)

2

THE COURTROOM DEPUTY: The Court calls case number

3 13-21570-Civ-BLOOM, United States of America versus Miami-Dade

4 County, the Board of County Commissioners, et cetera.

5

Counsel, please state your appearances.

6

MR. MADDOX: Bill Maddox for the United States along

7 with Veronica Harrell-James.

8

THE COURT: Good afternoon.

9

MR. SIMON: Good afternoon, Your Honor. Ben Simon,

10 Bernie Pastor and Laura Llorente on behalf of the defense.

11

THE COURT: Good afternoon to each of you.

12

And I believe we have Dr. Griefinger on the phone.

13

DR. GREIFINGER: Yes, I'm here.

14

THE COURT: All right. Good afternoon to you as

15 well.

16

When I was preparing for this afternoon's hearing, it

17 became a reality that the last time that we were together was

18 back in March. So we have not seen each other for some time.

19

But I do want to thank you for the monthly reports

20 that Miami-Dade County has timely filed, and I do appreciate

21 the receipt of the compliance report, number 11. Susan

22 McCampbell, who I see is present, has been kind enough to

23 provide information to the Court with regard to where we are.

24

Let me say, Mr. Maddox, that at the last hearing you

25 advised the Court that today is All Saints Day and I didn't

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 3 of 31 3

1 truly appreciate that. If in fact there are individuals that

2 are observing the holiday and scheduling this hearing during

3 this day, I do apologize if it has interfered with the

4 observance of the holiday.

5

But I do think that today is very important, because

6 it follows the compliance tour that took place on September

7 26th, and the last time we were together the County was in one

8 hundred percent compliance with the Settlement Agreement.

9

So I believe that there are several items that we do

10 need to address with regard to the Consent Decree, and I know

11 that they are related to mental health care.

12

So I think it perhaps is best to start with Susan

13 McCampbell and then we can proceed accordingly.

14

And if I may ask, while Ms. McCampbell is stepping

15 forward, is there still the vacancy of the chief psychiatrist?

16

MS. McCAMPBELL: Good afternoon, Your Honor.

17

THE COURT: Good afternoon.

18

MS. McCAMPBELL: We have a psychiatrist here with us

19 today who's been acting in the behavioral health. I believe

20 Mr. Simon is going to address that and introduce her to you.

21

THE COURT: Thank you.

22

MS. McCAMPBELL: Thank you, Your Honor. I'm going to

23 be brief because we have with us today the forensic

24 psychiatrist that works on this case, Dr. Kahlil Johnson, and

25 I felt it was appropriate to have him come since I anticipated

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 4 of 31 4

1 that we were going to have issues regarding mental health care

2 before the Court.

3

So just a reminder, as you said, this is the 11th

4 compliance report. We were here for three days of intensive

5 work in September, which included prior to that time a review

6 of patient records, reports, analysis. And I'm very pleased,

7 as I'm sure the County is to report to you that the compliance

8 continues to rise in terms of the issues related to the

9 Consent Agreement. Right now there are, of the 115

10 paragraphs, only nine that remain in partial compliance. And

11 those are areas where some of them are easy fixes, as you

12 probably noticed in reading the report, and the rest of them

13 require a little more work and collaboration between MDCR and

14 CHS, and Dr. Johnson can address these.

15

As you noted also, Dr. Griefinger, who is the medical

16 monitor, is on the phone.

17

We have -- and Mr. Simon will address this -- come up

18 with a plan to move forward between now and the next tour, and

19 I'll outline that quickly, and then Mr. Simon can address that

20 as well.

21

The last couple of, let's say, nine plus a couple

22 that need additional work, we anticipate having a telephone

23 call with the monitors and the County sometime in the next two

24 weeks where we're going to spend the entire time, however long

25 it takes coming up with specifically what has to be achieved

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 5 of 31 5

1 in order to gain compliance.

2

It's been our plan that the County would move forward

3 with those recommendations, of course, consulting us any time

4 they needed assistance, with a goal of doing a compliance

5 rating tour in February, early February.

6

So sometime in the middle of January the County would

7 produce all the documentation needed regarding the compliance

8 of the remaining paragraphs. Dr. Johnson and Dr. Griefinger

9 will take a look at it. If they feel that they need to come,

10 they will, or if the County wishes them to come, they will.

11 And we're looking at February 11th, 12th, around then. Come

12 take a look and just confirm the County's position that there

13 is compliance.

14

We will then follow it up with the required six-month

15 tour, which is now scheduled for April 1st, 2nd, and then have

16 a full report to the Court, as we always do, right after that.

17

We would be providing feedback, advice, anything we

18 needed to the County to accelerate getting these last ones

19 done, because it is our commitment to get them all done.

20 We've been at this for it will be by then almost seven years.

21 So we know we can achieve this.

22

So, Your Honor, that's all I wanted to add. I'm sure

23 maybe Mr. Simon might want to add a little bit more. But

24 Dr. Johnson is here to address any other questions of the

25 Court regarding the remaining paragraphs that are in partial

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 6 of 31 6

1 compliance.

2

THE COURT: And would Dr. Johnson be the individual

3 that would be the most appropriate person to advise the Court

4 with regard to the incident on June 25, 2019?

5

MS. McCAMPBELL: Which incident?

6

THE COURT: The incident of the opioid overdose.

7

MS. McCAMPBELL: I think probably the Director of

8 Corrections might be the most appropriate person.

9

THE COURT: Is that going to be shared with the Court

10 in how that might affect or perhaps somewhat correlate to some

11 of the needs that have not been met?

12

MS. McCAMPBELL: I think what Dr. Johnson can address

13 the Court about is what is the current status of the

14 provisions on mental health that remain in partial compliance,

15 what needs to happen, and also his take on how the County is

16 doing.

17

Regarding any of the opioid or other of those issues,

18 I think Director Junior might be the most appropriate person

19 to answer any of the Court's questions.

20

THE COURT: All right. Then perhaps we should first

21 hear from Dr. Johnson and then we can address that issue.

22 Thank you.

23

Good afternoon.

24

DR. JOHNSON: Good afternoon, Your Honor. I kept my

25 comments brief, but I'm happy to answer any questions that you

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 7 of 31 7

1 have.

2

I wanted to start by commending the County on their

3 sustained momentum towards full compliance with the Consent

4 Agreement. There's only nine provisions left that are in

5 partial compliance with a handful that are in provisional

6 compliance, and those are based on continued improvement that

7 they've promised and that's visible.

8

I think it's clear that both the leadership and the

9 staff have been working really hard to get to this point and

10 they seem very positive that they can achieve full compliance

11 in the near future.

12

In particular, I wanted to point out several

13 initiatives that the County has come up with that I think are

14 great ideas, I think they're interesting, I think they're

15 exciting, and I think they show the innovation that they're

16 reaching for to move several of the provisions into

17 compliance.

18

So one would be the Safety Cell Task Force Review

19 Committee and another would be the Transitional Behavioral

20 Health Unit that's been proposed that would help with the

21 timeline, a follow-up with the qualified mental health

22 professionals and the psychiatrists.

23

And then finally, I now speak for all the monitors

24 when I say that we're pleased that CHS has hired a behavioral

25 health director, Medical Director to be specific, Dr. Valeron,

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 8 of 31 8

1 and we are hopeful that she -- I know it's going to be

2 addressed in a bit -- that she stays on board full time.

3

I realize there is much work that still needs to be

4 done. So I'm looking forward to working with the County on

5 the accelerated compliance program. Thank you.

6

THE COURT: Dr. Johnson, let me ask you, so with

7 regard to the chief psychiatrist vacancy, who is filling that

8 role at this time?

9

DR. JOHNSON: Dr. Hortencia Valeron is her name.

10

THE COURT: And do you believe that, due to the fact

11 that there's an intern individual and not someone who is fully

12 taking on the role of chief psychiatrist, is that having an

13 impact on the compliance with regard to the Consent Decree?

14

DR. JOHNSON: I think prior to her arrival, yes. But

15 since she's arrived, I've had the opportunity to see her work

16 with the mental health director as well as the CMO, and I see

17 a good synergy there. I think she has the knowledge and the

18 know-how to work with a team to get things moving the way they

19 need to be to reach full compliance.

20

And it's also my understanding -- and not to jump the

21 gun -- that there are discussions going on now for her to stay

22 on.

23

THE COURT: All right. Are there any areas the Court

24 can assist with with regard to mental health care and any of

25 the issues relating to compliance?

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 9 of 31 9

1

DR. JOHNSON: I think they are addressing what needs

2 to be addressed. I don't have any specific recommendations.

3

I do think the discussed plan of an accelerated

4 compliance review and possibly a visit prior to April is a

5 great idea. So I think if that's in place, then I think that

6 would be helpful.

7

THE COURT: My questions are with regard to the area

8 that appeared to need some attention, and I don't think it's

9 with regard to mental health care, or perhaps it is, and

10 perhaps you can address that with regard to inmate

11 classification, the use of force, the inmate altercations and

12 the improvements and self-audits.

13

Would you be able to comment on those areas?

14

DR. JOHNSON: Regarding classification and use of

15 force, I think Ms. McCampbell would be the best person.

16 Audits, depending on the audit, possibly Ms. McCampbell or

17 myself or Dr. Griefinger.

18

THE COURT: So would there be anything within the

19 area of mental health care that the Court can assist with? I

20 mean, do you believe that you're on a realistic track for a

21 tour in February, the last compliance tour, and then the full

22 tour in April, and the County coming into full compliance by

23 that time?

24

DR. JOHNSON: The County says they can do it. I

25 think it's possible. I think it will require coordination of

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 10 of 31 10

1 effort between CHS and MDCR to have that happen, and I think

2 they've shown that they are doing that and have been doing

3 it. So I think it's possible.

4

THE COURT: So specifically what are your

5 reservations I think is probably the better way to ask the

6 question?

7

DR. JOHNSON: I think the challenge areas are the

8 ones that we listed in the report. But in particular, I think

9 some of the most challenging areas have been segregation, and

10 I think WITSEC. I think, again, that requires effort between

11 MDCR and CHS, which they're doing.

12

I mentioned the Safety Cell Review Committee. So I'm

13 excited to see the new developments and how they're going to

14 decide who stays and who goes if they have serious mental

15 illness, and that's been an ongoing area. So I'm very excited

16 about that program.

17

And then I think the overarching other issue that

18 really is just clinical is the full integration of different

19 aspects of mental health care, which I think can be done as

20 well. There are several clinicians who are there as well as

21 the leadership who are champions and who are doing this now.

22 So I think it's just a matter of getting it to become a

23 systemic practice.

24

THE COURT: And is there anything with regard to the

25 full integration of mental health care that you want to bring

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 11 of 31 11

1 to the Court's attention that perhaps we can explore further

2 with the County in terms of whether it can be achieved?

3

I just want to make sure that I understand that if in

4 fact there have been discussions, but you are now voicing a

5 feeling of being hopeful, that perhaps now, being obviously

6 November, that there isn't any action that can be taken to

7 ensure that come April we're at a hundred percent.

8

DR. JOHNSON: Your Honor, I think they have the skill

9 set to do it. At this point I don't have a suggestion as to

10 be an intervention that the Court could take to help out.

11

THE COURT: Okay. Fair enough. Thank you,

12 Dr. Johnson.

13

DR. JOHNSON: Thank you.

14

THE COURT: I appreciate it.

15

DR. JOHNSON: My pleasure.

16

THE COURT: I'm not certain, Mr. Maddox or

17 Ms. Harrell-James, who's going to be coming back.

18

Welcome back.

19

MS. McCAMPBELL: Thank you, Your Honor.

20

So I hear your concerns about classification, use of

21 force and self-audits.

22

Classification. Let me start there. The integral

23 part of inmate safety is a classification system that

24 appropriately separates inmates.

25

MDCR -- that's one of the provisions -- has had a

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 12 of 31 12

1 long road of this, and based on the information provided right

2 now, it is anticipated they will have a classification system

3 in place and functioning by March of this year.

4

The pitfalls and the bypasses of this have not been

5 of their own making. The County originally had contracted for

6 an information system of which a classification component

7 would have been part, and the vendor was not able to deliver

8 and they had to go back out and get another vendor. So some

9 of this is not -- it's not for lack of trying or commitment.

10

The classification system has been reviewed and there

11 have been some issues identified with it, including the need

12 to -- there's nine levels of classification in the system

13 right now, which is probably too many. So I think the

14 director and the staff have produced an action plan, which

15 they involved me with, and I'm confident that they will have

16 that done by April. That will make the jail safer. It will

17 make staff safer and inmates safer.

18

But again, it's one of those things we just shake our

19 heads. It's not really MDCR's fault that they're not where

20 they need to be. After all, they share it. It's purchasing

21 and finance and a whole lot of issues there. So that they

22 delivered and I anticipate it will be there.

23

I know the consultant that they've hired and she's

24 nationally recognized and she's working with them. So I have

25 a lot of confidence in Dr. Hartman as well as the MDCR staff.

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 13 of 31 13

1

One of the hallmarks, one of the things that Director

2 Bavara did -- and you'll probably notice, Your Honor, that

3 Director Bavara is now back. They pulled her out of

4 retirement.

5

THE COURT: Welcome back.

6

MS. McCAMPBELL: She's smiling so far.

7

One of the things Director Bavara did when she was

8 director was set up a use-of-force review unit in Miami-Dade.

9 It was not required by the agreement, but it was paralleled

10 after one that was in Cook County Sheriff's Office, and they

11 have invested a lot of time and energy into looking at every

12 use of force, not and only to make sure that it was an

13 appropriate use of force but to see what they could learn from

14 it.

15

So their uses of force have been steadily -- they've

16 been decreasing but not at any great level. And our concern

17 and Dr. Johnson's concern is use of force involving inmates in

18 a mental health caseload.

19

So we look forward to the classification system

20 integrating with this. So we anticipate seeing decreases in

21 uses of force generally and uses of force involving inmates on

22 the mental health caseload specifically.

23

I think they've done a very, very credible job. I

24 have referred other jails in the United States to look at how

25 they do the use-of-force reviews here. So we're hopeful, as I

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 14 of 31 14

1 say, with the classification system, with the review of

2 learning from every one of the uses of force, looking at the

3 systemic issues, not just the individual event.

4

Self-audits. I and my colleague, Nancy B. Ferrari,

5 did a deep dive into reviews of critical incidents that

6 happened, and we found, as you noted in the report, several

7 areas where we felt that the analysis of serious incidents was

8 not the level of a root cause analysis going down and keep

9 asking why this happened and why this happened.

10

So we provided our review to the director in July,

11 and the County has produced, under Assistant Director Bavara's

12 leadership, has produced an action plan that will address the

13 self audits. So we will visit with that again over the next

14 six months. It's my anticipation that they will achieve what

15 they need to in terms of not only looking at the event but

16 figuring out why it happened and what can be done to prevent

17 it.

18

So we have the actual plan on classification, we have

19 the continuing looks at uses of force, and we have the

20 commitment on the action plan for the self-audit. So I'm

21 very, very optimistic.

22

THE COURT: Thank you.

23

Mr. Maddox or Ms. Harrell-James.

24

MR. MADDOX: Nothing further to add.

25

I think that the action plan going forward with the

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 15 of 31 15

1 idea of keeping the focus on the process and all of the

2 provisions that since we're in single digits that are

3 necessary to finish this job, coming back February, with the

4 documents in January, and having the conference call in

5 November, and then coming back and having more documents in

6 March, and then having another tour in April should maintain

7 the necessary focus to get things over the line, particularly

8 in the provisions that remain.

9

THE COURT: Thank you, sir.

10

Ms. Harrell-James, is there anything further to add?

11

MS. HARRELL-JAMES: Nothing, Your Honor.

12

THE COURT: All right. Then we'll turn it over to

13 Miami-Dade County, Mr. Simon or Mr. Pastor. I'm not certain.

14

Mr. Simon.

15

MR. SIMON: Good afternoon, Your Honor.

16

THE COURT: Good afternoon.

17

MR. SIMON: My clients are happy and excited to be

18 here today, Your Honor, because we have seen an explosion of

19 movement toward compliance, full compliance in the last two

20 years.

21

So in the first four years in the litigation, by the

22 time Your Honor took over this case, there were 10 provisions

23 in full compliance, 10 of 115. That was after four years from

24 the date of the agreement being signed. Today, two-plus years

25 later, we're at 92 percent. So we went from eight percent to

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 16 of 31 16

1 92 percent. Your Honor, we're almost there. We're very, very

2 close.

3

Now, we want to be there. We're not satisfied with

4 92. We've been saying this the last few status conferences.

5 I know Your Honor wants a hundred percent. We want to be at a

6 hundred percent.

7

While we feel we're a little farther along than 92,

8 and there are some minor disagreements as to some of the

9 nine-plus provisions here and there, we've already agreed with

10 the monitors on how to make that work. In other words, we're

11 going to take the monitor's recommendations, we're going to

12 run with those, and we're going get to a hundred percent in

13 their eyes, Your Honor. That's the plan.

14

I'd like to take a moment to introduce some people

15 that are here: Deputy Mayor Maurice Kemp; Jackson COO Don

16 Steigman; MDCR Director Junior; CHS Director Edith Wright; our

17 compliance coordinator, Kim Bohns; and our chief psychiatrist,

18 Hortencia Valderon. Of course, there are many others here, as

19 usual.

20

So, while the defendants remain optimistic, forward-

21 thinking and solution-oriented, let's not forget how we got

22 from eight percent to 92 percent over these last two years.

23 And what's happened in those two years, in addition to a lot

24 of hard work from my clients to get from there to here,

25 there's been some big changes. We have a new permanent

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 17 of 31 17

1 director in Dan Junior. He was interim at the time. Now

2 we've had continued steady leadership by Deputy Mayor Maurice

3 Kemp and COO of Jackson Health System, Mr. Steigman. We have

4 new CHS leadership under Edith Wright in last two years.

5

Most importantly, I think this is the most important

6 thing that's changed, is that we've had engagement by the

7 Court and court orders requiring the parties and the monitors

8 to continue to submit and to be under pressure to submit

9 continued compliance reviews, and that process that Your Honor

10 set up and has been court ordered, that has kept us moving

11 forward and gotten us to the point that we are here today.

12

So, of course, we hoped to be found to be a hundred

13 percent by today and we're a little bit disappointed in that.

14 But we're very encouraged that we're very close to the end and

15 we feel we can get this done in short order.

16

So Your Honor always asks what can Your Honor do,

17 what can the Court do, to move the parties towards one hundred

18 percent. And I would have stood here and told you, well, we

19 want an accelerated review process.

20

The monitors have already agreed to that. We spoke

21 to the monitors before today and the Department of Justice is

22 on board. They are in agreement with reviewing documents that

23 the County submits whenever the County is ready to move after

24 we have this phone conference that we're going to be having

25 with the medical monitoring team in the next couple of weeks.

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 18 of 31 18

1 So we can provide them exactly what they need to judge us to

2 be one hundred percent in compliance.

3

So here's the framework that we've agreed to. Within

4 two or three weeks we're going to have a telephone call that

5 will be similar to a meet and confer. This will be a very

6 on-the-ground detail-oriented telephone call, where the

7 monitoring team and the County's representatives will be on

8 the same page as to what exactly the monitors want to see to

9 get us from 92 to 100 percent. That is going to happen very

10 shortly.

11

Once that happens, the County will begin to compile

12 the necessary information, make the necessary changes, if any,

13 and we will submit documents to the monitoring team primarily

14 to Dr. G and Dr. J, Dr. Johnson, the medical mental health

15 team, and that will be in mid-to-late January, with an eye

16 towards compliance review rating in February.

17

Now, the medical monitoring team has indicated -- at

18 least Dr. Johnson has indicated -- that he believes much of

19 that can be done remotely by document review.

20

So it's very possible that we might have compliance

21 rating changes, an increase from 92 towards 100 percent, by

22 February even if there isn't a physical tour in February.

23

That being said, there are some things that they

24 might want to come down for and we've already set that time

25 aside. So there could be an a interim tour in February.

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 19 of 31 19

1

The monitoring team has also agreed to do a brief

2 report to tell the Court and to tell the defendants how many

3 provisions have now been moved into full compliance between

4 now and then. And then, of course, we have the full tour set

5 for April 1, April 2. At least that's the dates we've been

6 discussing. And we've also discussed a potential status

7 conference with Your Honor.

8

We'd like to propose -- and I've already discussed

9 this with Ms. McCampbell and the Department of Justice -- a

10 May 22nd date, if the Court is okay with that date, because

11 that would give the monitors enough time following the April

12 1st tour.

13

And, of course, whatever tour or compliance review

14 happens in February and in April will be more focused than

15 past tours, because we're down to the wire now and there's so

16 much fewer provisions than there was two years ago when Your

17 Honor took over the case.

18

I know Your Honor may have some specific issues you

19 want to ask about. That's clear. We have, again, Director

20 Junior is here to talk about opioids, if you'd like to ask

21 about that, and we also have some others here as well

22 depending on what you ask.

23

THE COURT: Let me first say, Mr. Simon, and I've

24 said this teach time that we've been together, that the

25 parties have been working very hard. I certainly agree with

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 20 of 31 20

1 you that having a permanent director, having Deputy Mayor Kemp

2 involved and having a permanent compliance coordinator, Kim

3 Bohns, certainly has aided the accomplishments thus far.

4

The work of Susan McCampbell, Dr. Griefinger and

5 Dr. Johnson have been nothing short of extraordinary.

6 Ms. McCampbell has communicated with the Court and has advised

7 the Court of her concerns, and the Court has addressed them

8 with the parties. So I appreciate the work and I appreciate

9 the effort. And, of course, we have come very far.

10

It is somewhat, I think, perhaps coincidental that

11 you picked the May 22nd date for a status conference following

12 the partial tour that follows the conferring with the monitors

13 that then follows a last compliance tour in February and then

14 a full tour in April. And the reason I bring this to bear is

15 that that will be precisely seven years, seven years.

16

The Settlement Agreement was effective on April 30,

17 2013 and the Consent Decree on May 22, 2013. And while I had

18 hoped that it would have been five years, I had hoped last

19 year it would have been six years. I don't want it going past

20 seven. That is too long a period of time to come in

21 compliance with an agreement that you entered into and you

22 agreed to.

23

So, while I recognize that there has been a shift of

24 personnel, there have been some logistical issues, some

25 coordination issues. The May 22nd hearing before this Court

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 21 of 31 21

1 should be a hearing in which the County tells the Court that

2 there is not only a hundred percent compliance with the

3 Settlement Agreement but there is a hundred percent compliance

4 with the Consent Decree.

5

So I say this in as strong terms as I can. There is

6 no excuse whatsoever for not complying one hundred percent on

7 May 22nd, 2020.

8

MR. SIMON: I understand.

9

THE COURT: I brought up the issue on June 25, 2019.

10 It was brought to the Court's attention. I'm not interested

11 in looking at the incident in an isolated fashion. But I look

12 at it more as to whether it has an effect systemically in

13 terms of the efforts that are being made. So that's why I ask

14 the question. I know Ms. McCampbell said that it was most

15 appropriate for you to respond.

16

I see that you will be the --

17

MR. SIMON: Yes, Your Honor. Director Junior can

18 address that.

19

THE COURT: So is there anything further before

20 Director Junior comes forward, Mr. Simon, that the Court can

21 assist with in ensuring that the proposed is schedule that has

22 been provided is fully complied with and is able to be met?

23 Is there anything that the Court can do?

24

MR. SIMON: The only thing I was going to ask today,

25 Judge, is what the monitors and the Department of Justice have

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 22 of 31 22

1 agreed to, which is we would like an accelerated schedule,

2 because this needs to get done, and we now have that in

3 place. So, no.

4

THE COURT: The last time the parties announced a

5 schedule on the record with the Court -- and I'm not certain

6 if those dates were complied with. So what I would require is

7 within ten days of today's date that there be a written

8 schedule that sets forth every effort that needs to be made

9 and every issue that has been brought to the Court's attention

10 brought within the compliance report number 11, so that there

11 can be a date certain as to when there's going to be

12 compliance.

13

So if the parties will work together in the next ten

14 days and provide a written report of the timetable as far as

15 any issues that the Court needs to be aware of so that we have

16 not only the framework but we have deadlines imposed and a

17 schedule for the parties to adhere today.

18

MR. SIMON: Yes, Your Honor. We'll have that filed.

19 Thank you.

20

THE COURT: Thank you.

21

Good afternoon. It's good to see you, sir.

22

DIRECTOR JUNIOR: Good afternoon, Your Honor. Dan

23 Junior, Director of the Miami-Dade County Corrections and

24 Rehabilitation Department. Thank you for having me.

25

I understand you proposed questions specific to the

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 23 of 31 23

1 events that occurred on and around June 25, 2019. I don't

2 have the report in front of me, but I remember it very

3 vividly.

4

On those dates, I believe there was an incident on

5 the 24th that occurred at the pretrial detention center, which

6 is our downtown jail, where we had a number of inmates in our

7 custody at that jail that were succumbed to different medical

8 issues relating to suspected drug use.

9

Upon research, the following day we initiated

10 shakedowns, which are cell searches, throughout the entire

11 facility of that jail. On the following day, which is June

12 25th, one of our correctional officers was searching an

13 inmate's cell, came across a gellike substance that was in a

14 container. She opened the container. She took off her

15 respirator to smell and sniff the container, and she became

16 ill. Following that, we had a number of other correctional

17 officers who expressed that they had also become ill.

18

We immediately took, you know, corrective necessary

19 actions to assure the safety of staff and all the inmates. We

20 enlisted the assistance from our local law enforcement,

21 firefighters. We even had the FBI task force respond.

22

The substance was secured, identified. It was tested

23 twice: Once by the bomb squad, Miami-Dade police bomb squad,

24 as well as the FBI crime analysis, and it was determined to be

25 a harmless organic substance.

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 24 of 31 24

1

Noteworthy, that particular day, although the

2 assumption was that there was something in the air of the

3 pretrial detention center, we did not have any supervision

4 staff, medical staff or inmates that had to go out as a result

5 as well.

6

Further intel in looking into it, what we found was

7 that there had been some synthetic marijuana that did make it

8 inside that particular facility by way of inmate visitation.

9

If I can just enlighten the Court, the downtown jail

10 is the only jail within our system where one of -- two jails

11 within our system where the family members actually come into

12 the secure confines of the jail to visit with the inmates.

13

That has presented its challenges. The jail was

14 built in 1950. That presents its challenges because family

15 members will leave stuff behind, conceal it for inmates to

16 pick it up and use a controlled substance.

17

Since that time we took immediate action to suspend

18 visitation while we initiated procedures to make sure that the

19 staff supervises properly that process, and also we had since

20 had a contract approved for video visitation.

21

What video visitation is, instead of the family

22 members coming into the actual floor where the inmate is

23 housed, they can visit from a remote area via video. This

24 system is seen -- this is not new. This is seen throughout

25 the corrections industry. Broward has it, Palm Beach has it,

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 25 of 31 25

1 and now in early January we should have that system in place

2 at that downtown jail.

3

THE COURT: All right.

4

DIRECTOR JUNIOR: I can add this. The Court asked is

5 this is a systemic issue in our system. This is not a

6 systemic issue. Again, this was an issue that was isolated at

7 the downtown jail because of the way we conducted visitation

8 at that facility.

9

THE COURT: So this doesn't relate at all to mental

10 health care or any issue with regard to inmate classification.

11

DIRECTOR JUNIOR: No, ma'am.

12

THE COURT: All right. Thank you, sir.

13

DIRECTOR JUNIOR: And with regards to the

14 classification -- I'm sorry, I have a lot I want to say that I

15 want to respond to.

16

THE COURT: Thank you.

17

DIRECTOR JUNIOR: With regards to the classification,

18 I want to be clear. The corrections system, we do have a

19 classification system. It was modeled after the Northport

20 system. What we agreed to do is have that system validated.

21 So the plan now on the table is to have that validation

22 conducted and completed by, I believe it was April of 2020,

23 which is what Ms. McCampbell referred to.

24

All inmates appointed to our system are reviewed.

25 There's a series of nine questions. It prints out a score and

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 26 of 31 26

1 they're classified based on that score.

2

THE COURT: And that relates to these nine levels?

3

DIRECTOR JUNIOR: Yes, ma'am.

4

THE COURT: Thank you. I appreciate your time.

5 Thank you for reporting on the incident.

6

Mr. Simon.

7

MR. SIMON: That's all we have, Your Honor. Thank

8 you.

9

THE COURT: Is there anything further?

10

MR. MADDOX: Your Honor, Dr. Johnson would like to

11 say a few more comments to you.

12

THE COURT: Yes, of course. Dr. Johnson.

13

DR. JOHNSON: Please excuse my delayed response to

14 your question earlier about things that may help. I don't

15 know that this is necessarily something that the Court would

16 need to do.

17

I do think, with an eye towards sustainability and

18 behavioral health leadership in particular, I know everyone in

19 leadership is working double time to make this happen and I

20 think the results are showing. I know in the past it's come

21 up that having assistance with duties for the leadership in

22 particular may have been helpful.

23

And so, in particular, for the director of behavioral

24 health, Dr. Acosta, and now for the new behavioral health

25 medical director, having an assistant or a lead or someone

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 27 of 31 27

1 else who's in place to help them as they're dealing with both

2 clinical duties as well as administrative duties may help to

3 sustain them in their positions and also the momentum that the

4 County has had for behavioral health in particular.

5

I thought it was important to share that with the

6 Court.

7

THE COURT: And has that been raised before?

8

DR. JOHNSON: It has.

9

THE COURT: Having an assistant?

10

DR. JOHNSON: It's been raised in the past, yes.

11

THE COURT: Is that something that's being looked

12 into or a position that's being advertised or considered?

13

DR. JOHNSON: I have to be honest and say this is me

14 having sat and listened for a bit and coming back and sharing

15 this with the Court and also now with the County. I think it

16 may be important going forward.

17

THE COURT: And you believe it's because the director

18 of behavioral health is not able to respond? I'm just

19 wondering where the assistant would come in in terms of

20 sharing the workload and responsibilities.

21

DR. JOHNSON: I can say from working with the various

22 people who have been in these positions over the last few

23 years that it's come up repeatedly.

24

Juggling -- and that's not to say they can't do it,

25 because it's happening -- but with, again, an eye towards

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 28 of 31 28

1 sustainability, I think that will be beneficial from the

2 standpoint of the monitor.

3

THE COURT: And is that something that can be raised

4 when you confer and you provide additional input? And I

5 understand we're speaking now sustainability, which is, of

6 course, important.

7

DR. JOHNSON: Yes.

8

THE COURT: But is that something that can be shared

9 when you confer in terms of additional assistance that may

10 help the director of behavioral health?

11

DR. JOHNSON: I am happy to raise it at that time,

12 Your Honor.

13

THE COURT: Only because I feel that at this point it

14 would be something to be considered, and I would be probably

15 need some more information as to what you envision the

16 assistant to be able to do where the Court can make some

17 recommendations.

18

So are there specific areas that you believe the

19 assistant could provide that service where the director is not

20 able to at this time?

21

DR. JOHNSON: I can definitely provide more specifics

22 over time. But at least as an initial thought, for example,

23 with the audits, completing audits, completing data review,

24 sharing the meetings, clinical duties, coverage. So I think

25 those are areas that it would be beneficial.

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 29 of 31 29

1

THE COURT: If I may, Dr. Johnson, if you and

2 Ms. McCampbell perhaps in that report that's going to be

3 provided to the Court -- because we're now looking past the

4 May 22nd date in terms of sustainability -- what suggestions

5 you may have moving forward in terms of either keeping staff

6 permanent or a suggestion of bringing in additional staff to

7 help with the current responsibilities.

8

DR. JOHNSON: In terms of additional staff, that's my

9 recommendation, again, both of the director of behavioral

10 health as well as a behavior health medical director. And

11 then regarding stainability, I think that would help quite a

12 bit. I would limit it to that until we can have a longer

13 conversation or a conference with CHS and other monitors.

14

THE COURT: Thank you. Appreciate that.

15

DR. JOHNSON: Thank you.

16

THE COURT: Mr. Simon, is there anything further,

17 sir?

18

MR. SIMON: No, Your Honor. Thank you.

19

THE COURT: I know that you've had a team that has

20 been willing and has come before the Court on multiple

21 occasions.

22

Are there any members of your team, including

23 Ms. Bohns, that may wish to have something addressed by the

24 Court before I see you on May 22nd?

25

MR. SIMON: No, Your Honor. Thank you.

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 30 of 31 30

1

THE COURT: Ms. Harrell-James.

2

MS. HARRELL-JAMES: Your Honor, I just had one

3 question as to whether or not there will be maybe like a

4 midpoint report to the Court that would apply and, I guess,

5 advise you with regards to the status on the remaining

6 elements.

7

THE COURT: Well, I still am going to require the

8 monthly reports.

9

MS. HARRELL-JAMES: Okay.

10

THE COURT: So from this point up until May, those

11 monthly reports should be filed with the Court so I can be

12 kept abreast of your progress.

13

But I am specifically going to require -- since,

14 obviously, today, is the 1st, the 11th is a court holiday --

15 so by November 12th I would like the parties to have conferred

16 and to present a timetable with specifics as to how to come

17 into one hundred percent compliance before the status

18 conference certainly on May 22nd, but with an eye toward the

19 full tour that will be had in April.

20

MR. SIMON: Your Honor, you're referring to the joint

21 status reports?

22

THE COURT: Yes.

23

MR. SIMON: Okay. Thank you.

24

THE COURT: Is there anything further that the Court

25 can assist with, anything at all?

Case 1:13-cv-21570-BB Document 181 Entered on FLSD Docket 11/07/2019 Page 31 of 31 31

1

MR. SIMON: No, Your Honor.

2

THE COURT: Mr. Maddox.

3

MR. MADDOX: We're good, Your Honor. Thank you very

4 much.

5

THE COURT: All right. Then I thank everyone for

6 your time and your efforts, and I think we are going to be

7 there on May 22, 2020.

8

Correct, Mr. Simon?

9

MR. SIMON: Yes, Your Honor. Thank you.

10

THE COURT: All right, then. Have a wonderful

11 afternoon, a nice weekend, and I'll see you at that time.

12

(Recessed at 2:18 p.m.)

13

* * *

* *

*

*

*

*

*

14

C E R T I F I C A T E

15

16

I certify that the foregoing is a correct transcript

17 from the record of proceedings in the above-entitled matter.

18 William G. Romanishin

Digitally signed by William G. Romanishin Date: 2019.11.07 08:57:09 -05'00'

19

20

21

22

23

24

25

 
 Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 1 of 55
.UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF FLORIDA
Case No. 13-cv-21570-BLOOM UNITED STATES OF AMERICA,
Plaintiff, v. MIAMI-DADE COUNTY, THE BOARD OF COUNTY COMMISSIONERS, et al.,
Defendants. _____________________________________/
ORDER ON THIRD REVISED SUMMARY ACTION PLAN THIS CAUSE is before the Court following a status conference held on February 7, 2018. See ECF No. [82]. Plaintiff United States of America (the “Government”) and Defendants Miami-Dade County, Miami-Dade County Board of County Commissioners, and Miami-Dade County Public Health Trust (collectively, “Defendants” or the “County”) entered into a Consent Agreement, ECF No. [5-2] (“Consent Agreement”), effective May 22, 2013, that addressed alleged constitutional violations regarding the provision of medical and mental health care at the correctional facilities operated by Miami-Dade County Corrections and Rehabilitation Department (“MDCR”). According to the Consent Agreement, on April 2, 2008, the Government notified Miami-Dade County officials of its intention to investigate conditions at MDCR. Id at 4. After tours of the MDCR facilities in 2008 and 2009, the Government issued a Findings Letter on August 24, 2011 that concluded “certain conditions in the MDCR Jail violated the constitutional rights of inmates . . . .” Id. In the months that followed, cooperation between the Government and the County resulted in two agreements: the Consent Agreement

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 2 of 55 Case No. 13-cv-21570-BLOOM
before this Court and a separate Settlement Agreement, which addressed protection from harm, fire and life safety, and inmate grievances. Id. at 5.
The Consent Agreement. The Consent Agreement contained deadlines and requirements for implementation of 1191 provisions or paragraphs (the “Paragraphs”). The parties selected an Independent Monitor to “oversee implementation of the [Consent] Agreement.” ECF No. [5-2] at 31 (“Independent Monitor”). Except where otherwise agreed to under a specific provision of the Consent Agreement, the County was to implement all provisions of the Consent Agreement within 180 days of the Effective Date. Id. at 33. On May 22, 2013, the Honorable William J. Zloch entered a final order approving and entering the Consent Agreement. ECF No. [9]. For approximately five years, Judge Zloch, and now this Court, have continued to monitor compliance with the Consent Agreement based on reports supplied by the parties and status conferences held before the Court.
First Revised Summary Action Plan. The County did not achieve full compliance with the Consent Agreement within 180 days as originally contemplated in the Consent Agreement. ECF No. [25] at 1; see also Independent Monitor’s Report No. 1, ECF No. [11], dated November 5, 2013; Independent Monitor’s Report No. 2, ECF No. [12], dated May 22, 2014; Independent Monitor’s Report No. 3, ECF No. [22], dated November 28, 2014. The Court held status conferences regarding the non-compliance on October 21, 2014 and November 17, 2014. See ECF No. [19] & [21]. On December 17, 2014, the parties filed a Joint Motion for Entry of Stipulated Order, ECF No. [25], which attached a Consent Agreement Summary Action Plan, ECF No. [25-2] (“First Revised Summary Action Plan”). The First Revised Summary Action Plan included revised compliance deadlines which extended from May of 2015 through
1 According to the Independent Monitor, this number was later reduced to 115. ECF No. [80] at 88.
2

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 3 of 55 Case No. 13-cv-21570-BLOOM
November of 2016. See ECF No. [25-2] at 1. The Court entered an Order granting the motion and approving and adopting the First Revised Summary Action Plan on December 18, 2014. ECF No. [27].
Second Revised Summary Action Plan. On April 20, 2016, the Court held a status conference during which the parties noted that the County was not in full compliance with the Consent Agreement. See ECF No. [44]. By May of 2016, the “Defendants stipulate[d] that they have not yet come into full compliance with several provisions of the Consent Agreement and [First Revised Summary Action Plan]” and that “they will be unable to meet many upcoming deadlines.” ECF No. [42] at 2; see also Independent Monitor’s Report No. 4, ECF No. [32], dated July 3, 2015; Independent Monitor’s Report No. 5, ECF No. [38], dated February 15, 2016. The parties therefore filed a Joint Motion for Entry of Stipulated Order, ECF No. [42], which attached a Consent Agreement Revised Summary Action (Compliance) Plan, ECF No. [42-1] (“Second Revised Summary Action Plan”). The Second Revised Summary Action Plan included revised compliance deadlines which extended from July of 2016 through February of 2017. See ECF No. [42-1] at 1–2. The Court entered an Order granting the motion and approving and adopting the Second Revised Summary Action Plan on May 23, 2016. ECF No. [43]. On September 9, 2016, the Independent Monitor filed its sixth report with the Court, which again noted that the County had still not reached full compliance with the Consent Agreement. ECF No. [45].
In advance of the February 21, 2017 deadlines, the Court held a hearing on January 26, 2017, during which the Government represented to the Court that the County had committed to full compliance with the Consent Agreement by the end of February 2017. ECF No. [56] at 7. On April 4, 2017, the Independent Monitor submitted its seventh report, which indicated that the
3

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 4 of 55 Case No. 13-cv-21570-BLOOM
County had not achieved full compliance with the Consent Agreement. ECF No. [57]. The Court held a status conference on April 21, 2017. ECF No. [60]. At that hearing, the Government represented to the Court that “the latest summary action plan that had been filed with the Court showed that they would be in full compliance with all provisions by February. And obviously, those deadlines were missed. And this is now the third set of deadlines, unfortunately, that got missed.” ECF No. [63] at 11. Based on this hearing, the Court entered an Order, ECF No. [61], requiring the Independent Monitor to submit monthly reports regarding certain clinical performance measures.
On July 28, 2017, the Court held a status conference. ECF No. [68]. While the parties reported progress, they also reported that the County was still not in full compliance with the Consent Agreement. See ECF No. [70]. During the hearing, the Government represented that the parties planned a “full compliance tour” scheduled for the week of September 11, 2017. Id. at 5. Due to Hurricane Irma, that tour was postponed until December 2017, and a status conference was set for February 7, 2018. ECF No. [75].
On January 19, 2018, the Independent Monitor filed its eighth report. ECF No. [80]. The report stated that the County had again not achieved full compliance with the Consent Agreement and that it was fully compliant with 29 of the 115 Paragraphs of the Consent Agreement. Id. at 95. Specifically, the Independent Monitor noted in the report that for certain provisions of the Consent Agreement “performance is poor,” “poorly documented,” and/or data is “insufficiently analyzed,” and that the County had made “insignificant progress,” has “not improved,” or has implemented “poorly conceived and ineffective” processes in response to the requirements of the Consent Agreement. Id. at 96.
4

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 5 of 55 Case No. 13-cv-21570-BLOOM
The Independent Monitor further reported that MDCR is classifying any inmate who receives a mental health care emergency treatment order as a “use of force” incident and “require[e]s the Qualified Mental Health Professional (QMHP . . . ) to write an order authorizing use of force” for these incidents, a policy which is “outside the practice parameters of a QMHP” and which must “be stopped immediately.” Id. at 97. The Monitor further reported that two inmate deaths by suicide “may have been prevented had the patients been appropriately leveled,” that is, properly classified based on their mental health history and risk, per the Consent Agreement. Id. at 97. The report notes that “mental health staff [did] not follow[] the leveling guidelines despite having access to all relevant information” and that they instead used their “ ‘clinical judgment’ rather than following the guidelines, which lead to the errors.” Id. 2
On February 7, 2018, the parties appeared before the Court for a status conference. At the Conference, the parties reiterated their commitment to full compliance, and the Independent Monitor highlighted several areas that required improvement. See ECF No. [83], Hearing Tr. at 24, 28–33, 35, 38. During colloquies with the Court, the Government represented that the parties had met and conferred regarding a new revised summary action plan and that the parties were prepared to file such plan on February 8, 2018 for Court approval. Id. at 24–25. However, while the Government informed the Court that the parties could file a revised summary action plan the following day, neither the Government nor the County was able to represent to the Court that the parties were able to comply with the deadlines contemplated in the proposed plan as drafted.
Third Revised Summary Action Plan. Following the hearing, the Court entered its Order, ECF No. [84], requiring that the parties submit a Proposed Third Revised Summary
2 The Monitor further notes that “[h]ad the individuals of committed suicide been leveled appropriately, they would have been housed at a higher level of care (e.g., level 1) and their chance of completed suicide would have presumably decreased.” Id.
5

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 6 of 55 Case No. 13-cv-21570-BLOOM
Action Plan. Specifically, the Court ordered that the proposed order must include final deadlines
by which the parties agree full compliance with the Consent Agreement will be achieved. The
Court further ordered that the proposed order must also include interim deadlines that allow
sufficient time and opportunity for reports to be produced, analyzed, and any noncompliance
remediated prior to the Final Deadlines. Id. at 6–7. In the Order, the Court further stated:
This Court has been far too generous in the time permitted for the parties to remedy the unconstitutional conditions at MDCR, which were initially investigated by the Government nearly a decade ago and which “Defendants stipulate[d], and this Court [found], necessitate the remedial measures contained in th[e Consent] Agreement.” ECF No. [5-2] at 5. Although the parties have represented to this Court—time after time—that they are committed to compliance, years have worn on without ever achieving full compliance while the safety and welfare of many individuals continue to be placed at risk. These are inmates who have no choice as to their housing and rely upon the government, here the Defendants, to comply with the law. Full compliance is necessary as a first step to achieve the sustainable and systemic change contemplated in the Consent Agreement. In sum, this Court will no longer tolerate vague representations of the parties’ “commitment” in place of demonstrable and documented full compliance.
Id. at 5–6 (emphasis added).
On March 15, 2018, the parties filed a Notice of Compliance which attached a Proposed
Order and Third Revised Summary Action Plan. ECF No. [90-1] and [90-2]. Despite this
Court’s admonitions to the parties during the February 7, 2018 status conference and in its
February 8, 2018 Order, many of the deadlines contain a disclaimer that Defendants will perform
certain action items—which the parties concede seek to remedy ongoing constitutional violations
at MDCR—solely in an effort to “move toward compliance with” a particular Paragraph of the
Consent Agreement.
6

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 7 of 55 Case No. 13-cv-21570-BLOOM
This Court has been very clear: it will no longer tolerate commitments to attempt or try to comply with the Consent Agreement at some point in the future in place of actual compliance. Accordingly, the Court modifies the proposed order submitted by the parties and it is ORDERED AND ADJUDGED as follows:
1. As a result of Defendants’ failure to achieve full compliance with the Consent Agreement, additional remedial relief is necessary, as set forth in the action steps and document production requirements below.
2. The additional relief set forth below complies in all respects with the provisions of 18 U.S.C. § 3626(a). The relief is narrowly drawn, extends no further than necessary to correct violations of federal rights as alleged by the United States in its Complaint and Findings Letter, is the least intrusive means necessary to correct these violations, and will not have an adverse impact on public safety or the operation of the criminal justice system.
3. This Order outlines final deadlines for compliance with the Consent Agreement (“Final Deadlines”). In advance of each Final Deadline, the parties shall:
a. At least ten (10) days prior to a Final Deadline, Defendants shall complete each of the action steps due by that Final Deadline and produce all supporting documents delineated in the Third Summary Action Plan for that Final Deadline. Wherever “findings and analysis” are referenced in the below action steps, this shall include the development and production of corrective action plans, where applicable; corrective action plans shall be timely implemented.
b. At least five (5) days prior to the Final Deadline, the parties and the Independent Monitor shall meet and confer to determine whether Defendants
7

Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 8 of 55 Case No. 13-cv-21570-BLOOM
have achieved compliance on the action items specified for that Final Deadline of the Consent Agreement. c. On the Final Deadline, the parties and the Independent Monitor shall file a joint declaration averring whether compliance with action items specified for that Final Deadline have been achieved. In the declaration, the parties must also specify, for each Paragraph of the Consent Agreement, which Paragraphs are in full compliance and which are in partial or non-compliance. 4. In addition to the requirements of Paragraph 3, above, the Independent Monitors shall provide timely feedback to the Defendants to facilitate compliance with the provisions of the Consent Agreement. 5. The language of this Order shall control, should there be any discrepancies between this Order and the Third Summary Action Plan. 6. Final Deadline: April 16, 2018: a. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.a (medication administration):
i. Audit medication administration to determine if actual practices are consistent with policy and procedure regarding medication administration, including: 1. Referring patients with serial missed medications to a practitioner to determine reasons and implement remedies; 2. Implementing a medication utilization project through the Pharmacy & Therapeutics sub-committee to minimize overuse of medications, e.g., medications for sleep;
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3. Implementing a process to ensure timely notification to a prescribing practitioner if a patient refuses to take his or her psychotropic medication for more than 24 hours, or misses three consecutive doses of non-psychotropic medication or three doses in a seven day period of non-psychotropic medication;
4. If necessary, implement a corrective action plan developed jointly between Corrections Health Services (“CHS”) and Miami-Dade Corrections and Rehabilitation Department (“MDCR”) to ensure CHS and MDCR staff actively participate in mouth checks, and monitor the effectiveness of that plan;
ii. Produce the results of a discussion between CHS and MDCR about improving communication between CHS and MDCR on all levels regarding excessive medication found during searches, and jointly developed specific action plans to address identified issues;
iii. Produce any additional documentation demonstrating implementation of these recommendations, including, where applicable, corrective action plans, committee minutes, a new clinical performance measurement tool, and an initial assessment using that tool.
b. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.5.a (maintenance of medical and mental health records): Implement the Independent Monitors’ recommendations from the Eighth Report regarding the management of medical and mental health
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Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 10 of 55 Case No. 13-cv-21570-BLOOM
records, including: i. Eliminate paper systems for ordering x-rays and other diagnostics; ii. Train and supervise staff to document patient encounters in a manner that is adequate to assist in providing and managing the medical and mental health needs of patients; and
iii. Explore methods to simplify access to the Medication Administration Record.
c. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.5.d (exchange of medical and mental health records with outside providers): Provide an implementation plan for the Independent Monitors’ recommendations from the Eighth Report regarding review of medical records from outside providers, including: i. Develop and implement a template or form to document consistent information about patients upon their return from off-site care and use that form to communicate with providers about continuation of care; and ii. Ensure practitioners document their review of available medical records and incorporate the relevant findings into their documentation through the modification of an existing clinical performance measurement tool or creation of a new tool, as applicable.
d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.a (use of restraints): i. Produce an implementation plan for the Independent Monitors’
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Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 11 of 55 Case No. 13-cv-21570-BLOOM
recommendations from the Eighth Report regarding the use of clinical restraints to ensure all orders for the use of clinical restraints are appropriately reflected in the electronic health record; and ii. Produce an audit, with findings and recommendations, of three months of data, to analyze status of compliance with the clinical restraints policy. e. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.b (medical care following uses of force): Develop and produce a policy on care for inmates involved in uses of force, which includes a mechanism for regularly measuring conformance with the policy (policy CHS-042 Patient Injury and Response to Resistance). f. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.c (medical care following uses of force; questioning inmates and reporting suspected abuse): Produce an implementation plan for the Independent Monitors’ recommendations from the Eighth Report regarding use of force care, including i. Ensure heath care staff conduct post-use-of-force questioning regarding cause of injury out of earshot of custody staff, per Consent Agreement § III.B.3.c; ii. Modify policy CHS-042 Patient Injury and Response to Resistance to allow a health professional to provide a report on inmate injury to someone other than the front-line officer; and iii. Consider developing a role-modeling video to train new CHS staff
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Case 1:13-cv-21570-BB Document 91 Entered on FLSD Docket 03/27/2018 Page 12 of 55 Case No. 13-cv-21570-BLOOM
members on recognizing possible staff-on-inmate assaults and how to respond. g. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.e (interdisciplinary treatment plans for mental health care): i. Produce drafts of the following clinical performance measurement tools:
1. Level of care internal audit tool for Level I; 2. Level of care internal audit tool for Level II; 3. Level of care internal audit tool for Level III; and 4. Level of care internal audit tool for Level IV; ii. Produce additional audit, including findings and analysis, incorporating measures requested by the Independent Monitors in their Eighth Report, including: 1. How many patients are on the mental health caseload at each
level; 2. How many level I and II patients on each level receive an
interdisciplinary treatment plan, the time frame in which each patient received the initial interdisciplinary treatment plan, and the time frame in which each individual received a follow up treatment plan; and 3. How patients who are not required to receive an interdisciplinary treatment plan are assessed and evaluated to
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ensure their needs are addressed. h. Defendants shall produce a draft of the new measure(s) added to the Suicide
Risk Screening clinical performance measurement tool to measure the quality of suicide risk assessments. Consent Agreement § III.C.3.a(4) (quality suicide risk assessments). i. Defendants shall submit a draft of policy CHS-044: Segregated Patients. Consent Agreement § III.C.6.a (custodial segregation). j. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.9.a (risk management system):
i. Finalize and produce policy CHS-010: Mortality and Morbidity Review; and
ii. Finalize and produce policy CHS-010B: Risk Management. k. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.D.1.b (self-audits): Produce the 2017 Clinical Quality Improvement Plan, including an evaluation of the quality improvement program in 2017, and a quality improvement plan for 2018, documenting the implementation of a quality improvement program.
7. Final Deadline: May 1, 2018: a. Defendants shall produce final versions of the following policies: i. Policy IP-002: Supervising and Recognizing Inmates with Mental Illness; ii. Policy CHS-068: Clinical Restraints;
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iii. Policy CHS-011: Patient Health Care Grievances; iv. Policy CHS-056: Patients with Special Needs; v. Policy CHS-042: Patient Injury and Response to Resistance; and vi. Policy DSOP 11-041: Response to Resistance Policy. b. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.a (health assessments to administer preventative care):
i. Demonstrate through the use of current clinical performance measurement tools that all incoming and current inmates are receiving: 1. Health assessments within 14 days of entering an MDCR facility conducted by a clinically appropriate level of provider; and 2. Primary care relationships for preventive care, chronic care, and medication management; and
ii. Modify current clinical performance measurement tools, if necessary. c. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.A.2.c (mental health assessments following adverse triggering events):
i. Re-train all Qualified Mental Health Professionals (“QMHPs”) on the Columbia Suicide Screening Tool;
ii. Finalize and produce inter-agency policy IP-003: Inmate Suicide Prevention and Response Plan;
iii. Produce post-training testing results, competency results and the
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results of a random audit, including findings and analysis, on the suicide risk assessment training; iv. Produce clinical performance measures on Self-Harm Incidents, including findings and analysis; and v. Produce Mental Health Review Committee (“MHRC”) meeting minutes demonstrating a review of self-harm incidents and identified Corrective Action Plans, as clinically indicated. d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.1(a-c) (acute care and detoxification): i. Provide annual training regarding care for patients suffering from drug and alcohol withdrawal to booking Advanced Registered Nurse Practitioners (“ARNPs”) and psychiatry providers covering the detox unit and/or detox patients; ii. Produce orientation and retraining sign-in sheets demonstrating staff training on acute health needs; iii. Produce post-training testing results, competency results completed to date, and the results of a random audit on training for acute health needs, including findings and analysis; and iv. Produce post-training testing results, competency results completed to date, and the results of a random audit on training regarding withdrawal from alcohol and other substances, including findings and analysis. e. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.B.3.a (use of restraints): i. Produce an analysis of Emergency Treatment Order (“ETO”) data to ascertain the underlying factors associated with ETOs and, if appropriate, a corrective action plan to decrease their frequency; and ii. Produce a joint plan developed by CHS and MDCR to declassify ETOs as uses of force, if force was not required to administer an ETO.
f. Defendants shall produce the draft of a new measure, for the clinical performance measurement tool on Suicide Risk Screening, to track compliance with Consent Agreement § III.C.3.a(1) (property and privileges for acutely mentally ill and suicidal inmates).
g. Defendants shall produce the draft of a new measure, for the clinical performance measurement tool on Suicide Risk Screening, to track compliance with Consent Agreement § III.C.3.a(2) (case-by-base decisions regarding clothing, bedding, and property for suicidal inmates).
h. Defendants shall complete the following step to achieve compliance with Consent Agreement § III.C.3.a(4) (suicide risk assessments): Produce the finalized clinical performance measurement tool on quality of suicide risk assessments and an assessment utilizing that tool, including findings and analysis.
i. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(1-4) (custodial segregation): Produce the procedural directive implementing screening prior to placement in custodial segregation to identify acute medical and/or mental health contraindications
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and to implement a 24-hour referral for evaluation by a QMHP of any patient with serious mental illness. j. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.8.d (staff certification in cardiopulmonary resuscitation):
i. Provide the results of a self-audit of compliance with the requirement that all correctional custodial staff are certified in cardiopulmonary resuscitation (“CPR”), including findings and analysis;
ii. Provide a plan with a training timeline for any staff identified as requiring training in CPR.
k. Defendants shall complete and produce a report that meets the requirements of Consent Agreement § III.D.2.a.6 (report of reportable incidents).
8. Final Deadline: June 1, 2018: a. Defendants shall produce lesson plans, curriculum and a training schedule for applicable staff on the following policies: i. Policy CHS-010: Mortality and Morbidity Review; ii. Policy CHS-010B: Risk Management; iii. Policy CHS-042 Patient Injury and Response to Resistance; iv. Policy CHS-068: Clinical Restraints; and v. Policy DSOP-11041: Response to Resistance; b. Defendants shall update the Suicide Prevention Training curriculum with the procedure from interagency policy IP-003: Inmate Suicide Prevention and
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Response Plan, and initiate training. c. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.A.1.b (mental health screenings on intake): i. Launch a performance improvement plan to streamline intake; ii. Implement IT enhancement to provide for a six hour routine referral form for behavioral health QMHPs;
iii. Ensure all clinicians and nursing staff have completed secondary training regarding updates to the intake screening process;
iv. Ensure all clinicians and nursing staff have completed training on the symptoms of withdrawal;
v. Produce the following documentation: 1. The MDCR Queue Management System (“QMS”) Report demonstrating the length of time inmates are spending in the intake process; 2. A copy of the new routine referral form; 3. Post-training testing results, competency results and the results of a random audit for intake screening training, including findings and analysis; 4. Post-training testing results, competency results and the results of a random audit for symptoms of withdrawal training, including findings and analysis; 5. Clinical performance measures on Mental Health Evaluation at Intake, including findings and analysis;
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6. Clinical performance measures on Initial (Intake) Screen, including findings and analysis.
d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.1.c (inmates in need of constant observation): i. Ensure nursing staff enter an emergent order and constant observation whenever a patient expresses suicidal ideations or thoughts, or whenever clinically indicated; ii. Provide the Jackson Education Network (“JEN”) module training regarding the leveling policy to all QMHPs; iii. Produce Suicide Risk Screening clinical performance measures, including findings and analysis; iv. 4) Produce Initial (Intake) Screen clinical performance measures, including findings and analysis; v. Produce JEN report demonstrating all QMHPs completed the leveling policy training; and vi. Produce MHRC meeting minutes demonstrating the review and monitoring of the Initial (Intake) Screen and Suicide Risk Screening tools.
e. Defendants shall produce findings and analysis regarding diversion of patients to the hospital in medical emergent situations, based on data from the MDCR QMS Diversion Log. Consent Agreement § III.A.1.d (emergency mental health or medical referrals).
f. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.A.1.e (obtaining prior medical records): i. Develop, and produce evidence of, a place in the electronic health record to indicate offsite record checks; and ii. Produce clinical performance measures for Repeat Jail Admits, including findings and analysis.
g. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.3.a(1) (access to medical and mental health care): i. Produce clinical performance measures on Urgent Care (Sick Call), including findings and analysis; ii. Produce findings and analysis from an audit of the sick call process.
h. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.3.a(2) (access to medical and mental health care for inmates with physical or cognitive disabilities): Ensure that Jackson Health System’s communication system for patients with physical and/or cognitive disabilities is available at all times and provided to patients when necessary.
i. Defendants shall produce findings and analysis of ongoing competency reviews and audits regarding medical and mental health care staff’s knowledge of acute and chronic care needs of patients. Consent Agreement § III.A.3.b (adequate training on acute and chronic care).
j. Defendants shall produce a draft of a new clinical performance measurement tool monitoring compliance on documentation being sent out with patients transferred to outside facilities. Consent Agreement § III.A.5.d (exchange of medical records with outside providers).
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k. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.6.a (discharge planning): i. Finalize and produce policy CHS-049: Discharge Planning; and ii. Produce clinical performance measures on Continuity of Care on Release, including findings and analysis.
l. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.7(a-c) (mortality and morbidity reviews): i. Conduct timely administrative reviews and root cause analyses for serious incidents, including patient deaths and suicide attempts; ii. Develop corrective action plans including follow-up steps to ascertain pertinent information that is not available at the time of the initial review; iii. Manage and monitor all corrective action plans derived from morbidity and mortality reviews using the Performance Logic Project Management Tool; iv. Reconvene the Morbidity and Mortality Review Committee upon receipt of new findings/reports to update analyses and corrective action plans accordingly; v. Produce Clinical Quality Improvement (“CQI”) meeting minutes demonstrating review of all morbidity and mortality corrective action plans to determine their effectiveness and recommendations for modifications as necessary.
m. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.B.3.a (use of restraints): i. Develop and produce lesson plans and training curriculum for policy DSOP 11-041: Response to Resistance; ii. Develop and produce lesson plans and training curriculum for policy CHS-068: Use of Clinical Restraints;
iii. Ensure a QMHP is notified immediately in the case of custody-ordered restraints, in order to review the health record for any contraindications or accommodations required, and to initiate health monitoring;
iv. Draft and issue a memo to staff to reinforce the need to document 15minute checks on any inmate in restraints, and produce such memo;
v. Produce findings and analysis based on review of data from the Blackcreek System Report and manual logs;
vi. Produce findings and analysis based on review of data from the ISAS incident tracking database.
n. Defendants shall complete the following steps to achieve compliance with h Consent Agreement § III.B.3(b-c) (medical care following uses of force): i. Train all nurses to ensure they assess and document patients immediately following any use of force; ii. Implement in the electronic health record a prompt to ensure patient privacy is enforced and properly documented, and produce screen shots of new prompt; iii. Train all clinical staff on how to identify patient abuse or suspicion of
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patient abuse; iv. Produce post-training testing results, competency results and the
results of a random audit, including findings and analysis, for nurse training on assessing and documenting patients following uses of force; v. Produce post-training testing results, competency results and the results of a random audit, including findings and analysis, for training on how to identify patient abuse or suspicion of patient abuse; vi. Produce clinical performance measures on Nursing Documentation Following Use of Force, including findings and analysis. o. Defendants shall produce a draft of an internal clinical performance measurement tool to audit whether emergency referrals to the QMHP after intake are being completed within two hours. Consent Agreement § III.C.1.a(1) (access to care and emergency referrals). p. Defendants shall complete and produce a report on CHS’s validation of the mental health leveling system. Consent Agreement § III.C.2.f (mental health classification by level of care). q. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.g (provision of mental health care): i. Demonstrate the use of the quality improvement program and the ability to self-monitor, incorporating a description of performance indicators including:
1. Wait times for psychiatry visits;
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2. Psychotropic medication utilization; 3. Numbers of use of force incidents; 4. Utilization of group counseling; 5. Utilization of recreation time; 6. Episodes of self-harm; 7. Grievances; and 8. Adherence to medication. ii. Produce new clinical performance measurement tools, as applicable. r. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.k (internal review of behavioral health services): Produce the finalized version of the following clinical performance measurement tools, and an assessment utilizing those tools, including findings and analysis: i. Level of care internal audit tool for Level I; ii. Level of care internal audit tool for Level II; iii. Level of care internal audit tool for Level III; and iv. Level of care internal audit tool for Level IV. s. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.3.a(1) (property and privileges for acutely mentally ill and suicidal inmates): i. Train Mental Health Treatment Center custodial staff and medical and mental health staff on policy CHS-058B: Behavioral Health Levels of Care;
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ii. Produce finalized measure added to clinical performance measurement tool on Suicide Risk Screening to track compliance with Consent Agreement § III.C.3.a(1), and produce assessment utilizing that tool, including findings and analysis.
t. Defendants shall produce finalized measure added to clinical performance measurement tool on Suicide Risk Screening to track compliance with Consent Agreement § III.C.3.a(2), and produce assessment utilizing that tool, including findings and analysis.
u. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.3.a(3) (provision of bed and suicide-resistant mattress to inmates on suicide watch): i. Ensure that each inmate on suicide watch has a bed and a suicide resistant mattress and monitor compliance during walkthroughs; and ii. Produce findings and analysis based on information gathered during walkthroughs.
v. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.3.a(4) (quality suicide risk assessments): i. Train all QMHPs on an ongoing basis on the provision of quality suicide risk assessments; and ii. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for QMHP training on the provision of quality suicide risk assessments.
w. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.C.3.a(5) (prevention of retaliation through the use of suicide watch cells):
i. Ensure that all new staff have been provided Suicide Prevention training;
ii. Ensure that all behavioral health staff have completed annual training on Suicide Prevention in the past year;
iii. Produce pre- and post-training test results and competency results for Suicide Prevention training; and
iv. Produce audit report, including findings and analysis, based on competency testing of suicide risk assessments and quarterly review of QMHP documentation.
x. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.3.e (individualized treatment plans for suicidal inmates): i. Conduct annual review of policy CHS-058A: Interdisciplinary Treatment Team and implement modifications, if necessary, to fully implement the terms of the Consent Agreement; ii. Produce revised policy CHS-058A, if applicable; and iii. Produce clinical performance measures on Mental Health Treatment Planning, including findings and analysis.
y. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.3 (suicide prevention): i. Implement training on policy IP-003: Suicide Prevention and
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Response Plan for all appropriate staff; ii. Produce training rosters demonstrating that custodial and medical and
mental health staff have received biennial in-service training on suicide prevention in the past two years; iii. Produce training rosters demonstrating that staff who work in intake, in custodial segregation, or who work with inmates on Behavioral Health Levels I-III, have received annual in-service training on suicide prevention in the past year. z. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a.2 (screening prior to custodial segregation): i. Implement the Independent Monitors’ recommendations from the Eighth Report regarding this provision, including the incorporation of a specific identifier for pre-segregation notes in the electronic medical record, for ease of identification and auditing; ii. Collect, review, and analyze data regarding the use of custodial segregation for inmates on the mental health caseload, including:
1. Medical and mental health screenings prior to initial placement in custodial segregation and notation of contraindications for inmates for whom acute medical or mental health condition is identified;
2. The outcomes of mental health reviews/consultations prior to placement in custodial segregation;
3. The number of patients per Level per month in custodial
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segregation who are referred for mental health care, and the outcome of each referral; 4. The length of placement in custodial segregation for patients, by Level; and 5. Data and trends from the Blackcreek Watch System. aa. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(6) (inmates with serious mental illness and custodial segregation): Implement the Independent Monitors’ recommendations from the Eighth Report regarding this provision, including: i. Develop and produce a plan to implement clear criteria to be used by mental health staff when evaluating patients with serious mental illness for placement in custodial segregation and/or determining whether a patient should continue to be housed in custodial segregation; ii. Collect and analyze data regarding the assessment and treatment of patients after mental health symptoms develop in custodial segregation, including analysis of any patients who are housed in custodial segregation after decompensating or engaging in self-harm, and produce results of such analysis; and iii. Develop and produce jointly between CHS and MDCR a clear working definition of “long-term custodial segregation” to allow for appropriate tracking and monitoring. bb. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.C.6.a(11) (mental health referrals for inmates in custodial segregation): Collect, review, and analyze data, and produce findings and analysis, regarding mental health referrals of inmates in custodial segregation, including
i. Analysis that demonstrates adherence to Consent Agreement § III.C.6.a(11); and
ii. Analysis regarding the timeliness of referrals of patients with serious mental illness during custodial segregation.
cc. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.7.b (mental health staffing): i. Ensure that newly hired mental health staff receive corrections-specific mental health training; ii. Produce lesson plans and training materials for this training.
dd. Defendants shall produce documentation demonstrating that all new staff have received pre-service training and that all staff have received biennial inservice training on all relevant policies/procedures and the requirements of the Consent Agreement. Consent Agreement § III.C.7.f (training).
ee. Defendants shall produce training materials, post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training that meets the requirements of Consent Agreement § III.C.7.g (mental health training for corrections officers).
ff. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.7.h (communication between mental health staff
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and corrections officers): i. Develop and implement written policy(ies), procedure(s) and training that ensures appropriate and regular communication between mental health staff and corrections officers regarding inmates with mental illness; ii. Produce training materials, post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training that meets the requirements of Consent Agreement § III.C.7.h; and
iii. Produce policy CHS-004A: Mental Health Review Committee. gg. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.C.9.a (risk management system): Produce a report reflecting an in-depth analysis of risk-management data to demonstrate that trends and incidents involving avoidable suicides and self-injurious behavior are being identified and corrected in a timely manner. This analysis should include
i. Use of the harm score; ii. Triggers for non-suicidal self-harm; iii. An explanation of how an analysis of suicides led to changes in
leveling; and iv. Corrective action plans, if applicable, to reflect how the County is
addressing identified trends to further reduce or mitigate risk from suicides and self-injurious behavior.
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hh. Defendants shall produce documentation demonstrating risk management data analysis and associated interventions to prevent or minimize harm to inmates. Consent Agreement § III.C.9.b (risk management).
ii. Defendants shall finalize and produce policy CHS-044: Segregated Patients. jj. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.C.9.a, b(1) (risk management): i. Train applicable staff on policy CHS-010: Mortality and Morbidity Review and policy CHS-010B: Risk Management; ii. Produce post-training testing results and attestations of understanding for staff trained on policy CHS-010 and policy CHS-010B.
9. Final Deadline: July 1, 2018: a. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.1.a (intake screenings): Conduct and produce reliability audits, including findings and analysis, of the following clinical performance measurement tools: i. Mental Health Evaluation at Intake; and ii. Initial (Intake) Screening. b. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.3.a(4) (screening and responding to medical and mental health requests): i. Produce clinical performance measures on Complaints and Grievances, including findings and analysis; and
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ii. Produce clinical performance measures on Urgent Care (Sick Call), including findings and analysis.
c. Defendants shall produce clinical performance measures on Medication Administration, including findings and analysis. Consent Agreement § III.A.4.a (medication administration).
d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.5.b (mental health care scheduling): i. Conduct daily reviews of scheduling queues and no show reports; and ii. Produce findings and analysis based on data reviewed.
e. Defendants shall produce CHS and Jackson Health Services information technology monthly meetings schedule. Consent Agreement § III.A.5.c (documentation of clinical encounters).
f. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.5.d (exchange of medical records with outside providers): Implement the Independent Monitors’ recommendations from the Eighth Report, including i. Create and produce a checklist for nurses to ensure documentation is being sent out with patients transferred to outside facilities; ii. Develop, implement, and produce a template or form to document consistent information about patients upon their return from off-site care and use that form to communicate with providers about continuation of care; iii. Develop a process with Health Information Management to receive
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records from outside facilities and to notify providers upon receipt and produce process flow chart; iv. Implement a check-box in the electronic health record to allow physicians to note acknowledgement of receipt of outside records; and v. Implement and produce the finalized clinical performance measurement tool to monitor compliance on documentation being sent out with patients transferred to outside facilities, and produce an assessment utilizing that tool, including findings and analysis. g. Defendants shall produce a draft revised clinical performance measurement tool on Continuity of Care on Release, including a new measurement to analyze if referrals are being made as clinically indicated. Consent Agreement § III.A.6.a.(1) (referrals for planned discharges). h. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.a (inmates at risk of self-harm): i. Train all officers assigned to the Mental Health Treatment Center, all nursing staff, psychiatrists and psychiatric ARNPs on the following policies:
1. Policy DSOP 11-041: Response to Resistance (clinical restraints);
2. Policy CHS-068: Use of Clinical Restraints; ii. Produce post-training testing results, competency results, and the
results of a random audit, including findings and analysis, for trainings on policy DSOP 11-041 and policy CHS-068.
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i. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.c (medical care following uses of force; questioning inmates and reporting suspected abuse): i. Implement an enhancement in the electronic health record for documentation of uses of force or injuries, which will allow clinical staff to identify if the patient’s injury aligns with the patient’s account of the injury, and produce screenshots of the enhancement; ii. Train all nursing staff on the use of the enhancement described above; iii. Ensure photographic evidence is taken in compliance with policy DSOP 11-041 and policy CHS-042 after any use of force or any suspected injury resulting from staff-on-patient abuse; iv. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training on the use of the new electronic health record enhancement, described above; v. Produce 10 randomly drawn use of force incident reports; and vi. Produce clinical performance measures on Nursing Documentation Following Use of Force, including findings and analysis.
j. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.1.a(1-3) (referrals for mental health care): i. Finalize and produce internal clinical performance measurement tool to audit whether emergency referrals to the QMHP after intake are being completed within two hours, and produce assessment utilizing
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that tool, including findings and analysis; ii. Train all nursing staff, using a Jackson Education Network module, to
enter emergency referrals and constant observation orders whenever staff identify an inmate at risk of suicide or self-harm; iii. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training of nursing staff on entering emergency referrals and constant observation orders. k. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.1.b (access to mental health care): i. Ensure that all clinical staff have received annual behavioral health training in the past year; ii. Produce post-test training results and attestations for behavioral health training; iii. Produce findings and analysis regarding compliance with Consent Agreement § III.C.1.b, based on data from the QMHP Referral Report. l. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.a (policy for the delivery of mental health care) i. Ensure that all new staff have been trained in policy CHS-058 Basic Behavioral Health Services; ii. Ensure that all new behavioral health staff have completed annual training on policy CHS-058 Basic Behavioral Health services, in the past year;
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iii. Produce post-training testing results for basic mental health services training; and
iv. Produce MHRC meeting minutes demonstrating review and analysis of behavioral health assessments and sick call reports and, if indicated, development of corrective action plan.
m. Defendants shall produce clinical performance measures on Mental Health Treatment Planning, including findings and analysis. Consent Agreement § III.C.2.e (interdisciplinary treatment plans for mental health care).
n. Defendants shall produce clinical performance measures on Individuals on the Mental Health Caseload Involved in Use of Force Incidents, including findings and analysis. Consent Agreement § III.C.2.h (expansion of mental health care).
o. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.g (provision of mental health care): i. Create and produce a procedural directive addressing follow-up care for patients coming off of Level I; ii. Produce clinical performance measures on Suicide Risk Screening, including findings and analysis.
p. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.j (mental health care Level 1 services and care): i. Create and produce a staffing matrix to ensure Level I services are completed in a timely manner; ii. Produce morning huddle reports demonstrating inter-facility
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communication to ensure Level I patients are seen. q. Defendants shall produce post-training testing results, competency results, and
the results of a random audit, including findings and analysis, for suicide prevention training. Consent Agreement § III.C.3 (suicide prevention). r. Defendants shall produce post-training testing results, competency results, and the results of a random audit, including findings and analysis for training of custodial staff and medical and mental health staff on policy CHS-058-B Behavioral Health Levels of Care. Consent Agreement § III.C.3.a(1) (property and privileges for acutely mentally ill and suicidal inmates). s. Defendants shall produce a draft of a new internal audit tool measuring compliance with rapid response protocols. Consent Agreement § III.C.3.g (emergency response). t. Defendants shall produce a draft of a new internal audit tool measuring compliance with Consent Agreement § III.C.6 (custodial segregation). u. Defendants shall produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training on policy IP-003: Suicide Prevention. Consent Agreement § III.C.8.a(1-8) (suicide prevention training). v. Defendants shall produce Facility Clinical Quality Improvement minutes containing a review and risk assessment of incidents reported. Consent Agreement § III.C.9.b(1) (risk management). w. Defendants shall complete the following steps to achieve compliance with Consent Agreement §§ III.C.9.a, b(2), d(1-2) (risk management):
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i. Conduct annual reviews of the following policies and implement modifications, if necessary, to fully implement the terms of the Consent Agreement: 1. a) CHS-058 Basic Behavioral Health Services; 2. b) CHS-058A Interdisciplinary Treatment Team; 3. c) CHS-058B Behavioral Health Levels of Care; 4. d) CHS-004A Mental Health Review Committee; 5. e) CHS-039 Sick Call; 6. f) CHS-033 Intake and Receiving Screening; and
ii. Produce revised policies, if applicable. x. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.C.9.c (mental health review committee): Conduct and produce, with findings and analysis, annual written performance assessments and present findings to the Interdisciplinary Treatment Team regarding
i. The quality of nursing services regarding inmate assessments and dispositions; and
ii. Access to mental health care by inmates, by evaluating the process for screening and assessing inmates for mental health needs.
y. Defendants shall produce clinical performance measures on Nursing Documentation Following Use of Force, including findings and analysis. Consent Agreement § III.C.9.c(5)i (assessment of nursing services).
z. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.C.9.c(5)ii (assessment of access to mental health care services):
i. Assess the quality of QMHP screening of inmates for mental health needs through live observation by the Chief Psychiatrist, or designee;
ii. Produce report, including findings and analysis, documenting any corrective or remedial action taken, based on live observation of mental health screenings by Chief Psychiatrist or designee; and
iii. Produce clinical performance measures on Initial (Intake) Screen, including findings and analysis.
aa. Defendants shall produce a Biannual Report that meets the requirements of Consent Agreement § III.D.2.a.
bb. Defendants shall produce medication reports, including findings and analysis, related to sleeping medication, abuse of medication, and the use of psychotropic medication by classification on a monthly basis. Consent Agreement § III.D.2.a(1) (biannual reports).
cc. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.D.2.a(2-4) (biannual reports): i. Produce an evaluation and report, including findings and analysis, of emergency room transfers; ii. Produce a report, including findings and analysis, on the appropriateness of relocation/transfer of patients to higher level of care; iii. Produce a report, including findings and analysis, on chronic disease;
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iv. Produce a report, including findings and analysis, on all suicide related incidents;
v. Produce MHRC meeting minutes demonstrating a monthly analysis of mental health caseload; and
vi. Produce a report, differentiating between individual and group therapy, which analyzes sustainability.
dd. Defendants shall ensure that corrective action plans are developed at the CQI meetings on a quarterly basis and produce CQI meeting minutes demonstrating development of corrective action plans and monitoring of sustainability. Consent Agreement § III.D.2.b (corrective action plans).
10. Final Deadline: August 1, 2018: a. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.3.a(2) (access to care for inmates with physical or cognitive disabilities): i. Produce Mini-MAC meeting minutes for all facilities, demonstrating identification of an accommodation for any patients with physical and/or cognitive disabilities; and ii. Produce findings and analysis based on data from the Americans with Disabilities Act (“ADA”) log monthly report. b. Defendants shall complete the following steps to achieve compliance with Consent Agreement §III.A.4.b(1) (continuity of medication on intake): i. Produce findings and analysis of monthly rounding and record reviews
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by nursing leadership to ensure compliance with this provision; and ii. Produce clinical performance measures on Continuity of Medication
on Intake, including findings and analysis. c. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.A.4.b(2) (serious medical or mental health needs on intake):
i. Ensure that a medical doctor or psychiatrist is evaluating, in person, patients with serious medical or mental health needs, within 48 hours of entry to any MDCR facility;
ii. Produce clinical performance measures on Mental Health Evaluation at Intake, including findings and analysis; and
iii. Produce clinical performance measures on Initial (Intake) Screen, including findings and analysis.
d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.c (reviews on the use of psychotropic medication): i. Conduct reviews on the use of psychotropic medications and develop and implement corrective action plans, if necessary; and ii. Produce Pharmacy and Therapeutics Meeting Minutes demonstrating findings and analysis from reviews on the use of psychotropic medications.
e. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.d (medication administration and refusals):
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i. Distribute all narcotic (controlled) psychotropic medication in bubble packs;
ii. Provide the formulary reflecting the use of bubble packs for the distribution of all narcotic (controlled) psychotropic medication; and
iii. Produce clinical performance measures on Medication Refusal, including findings and analysis.
f. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.e (orders for medication and laboratory tests): i. Conclude scheduling process improvement plan to improve compliance with obtaining lab tests; ii. Employ additional schedulers to ensure coverage 24 hours a day, seven days a week, and produce documentation demonstrating that coverage; iii. Conduct weekly monitoring of the implementation of physician orders for medication and laboratory tests, and produce findings and analysis; and iv. Produce findings and analysis based on data obtained from the electronic health record scheduling report.
g. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.f (training on medication administration): i. Implement and produce video training regarding the steps required to monitor safe medication administration for all new staff; and ii. Produce MAC meeting minutes demonstrating supervisory spot
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checks. h. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.A.6.a(1) (referrals for planned discharges): i. Train all discharge planners (MSWs) on Discharge Planning policy; ii. Finalize and produce added measure to clinical performance measurement tool on Continuity of Care of Release to measure if referrals are being made as clinically indicated;
iii. Produce post-training testing results, competency results, and the results of a random audit for discharge planning training, including findings and analysis; and
iv. Produce assessment utilizing revised tool on Continuity of Care on Release, including findings and analysis.
i. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.6.a(2) (provision of bridge medications on discharge): i. Implement enhancement in the electronic health record to bridge medications to be picked up at the Jackson Memorial Hospital pharmacy; and ii. Produce a monthly report from the pharmacy of picked-up bridge medications, including findings and analysis.
j. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.6.a(3) (discharge planning): i. Ensure corrections staff notify the site Directors of Patient Care
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Services of planned release dates; ii. Ensure that all medications are ordered and medical clearance
obtained, if applicable; iii. Make referrals, as clinically appropriate, and develop a complete
discharge plan for all planned discharges; iv. Produce discharge notification list demonstrating appropriate
notification of Directors of Patient Care services; and v. Produce findings and analysis regarding medications being ordered on
discharge, based on data from the medication administration record report. k. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.b (medical care following uses of force): i. Train all nursing staff and medical providers on policy CHS-042: Patient Injury and Response to Resistance; and ii. Produce post-training testing results, competency results and the results of a random audit for CHS-042 training, including findings and analysis. l. Defendants shall produce the finalized internal audit tool measuring compliance with rapid response protocols, including findings and analysis. Consent Agreement § III.C.3.g (emergency response). m. Defendants shall produce the finalized internal audit tool measuring compliance with Consent Agreement § III.C.6 (custodial segregation), including findings and analysis.
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n. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(1-4) (custodial segregation): i. Ensure that all clinical staff have been trained in policy CHS-044 Segregated Patients; and ii. Produce a schedule for annual training for all clinical staff on policy CHS-044 Segregated Patients;
o. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.9.b(3-4), 9.c(1-5) (risk management): i. Ensure that all clinical staff have received annual training on the following policies: 1. CHS-058 Basic Behavioral Health Services; 2. CHS-058A Interdisciplinary Treatment Team; 3. CHS-058B Behavioral Health Levels of Care; 4. CHS-039 Sick Call; and 5. CHS-033 Intake and Receiving Screening; ii. Produce post-training testing results, and the results of a random audit, including findings and analysis, for training on the policies listed above; and iii. Produce MHRC meeting minutes documenting an analysis of selfharm incidents and the corrective action implemented, when applicable.
p. Defendants shall produce clinical performance measures on Initial (Intake) Screen, including findings and analysis. Consent Agreement § III.C.9.d(1)
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(review of suicide risk assessments). q. Defendants shall conduct quarterly CQI meetings and produce CQI meeting
minutes demonstrating a review of corrective action plans and an analysis on effectiveness. Consent Agreement § III.C.9.d(2) (monitoring of risk management activities). r. Defendants shall develop and produce recommendations for further investigation of identified trends and for corrective action, including system changes, and present recommendations to the CQI Committee. Consent Agreement § III.C.9.d(5) (recommendations for further investigation). s. Defendants shall produce the internal audit tool to monitor disciplinary review assessments, including findings and analysis. Consent Agreement § III.D.2.a(5) (biannual reports).
11. Final Deadline: September 1, 2018: a. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.a (health assessments): i. Modify appointment types in the electronic health record to allow for appointments to be made within 10 days rather than 14 days; ii. Produce findings and analysis based on data obtained from the electronic health record scheduling report; and iii. Produce clinical performance measures on Laboratory, including findings and analysis. b. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.b (mental health assessments):
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i. Re-train all QMHPs on the Columbia Suicide Screening Tool; ii. Produce post-training testing, competency results, and results from a
random audit on the Columbia Suicide Screening Tool training, including findings and analysis; and iii. Produce clinical performance measures on Suicide Risk Screening, including findings and analysis. c. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.d (risk profiles): i. Complete and implement an interdisciplinary treatment team (“IDTT”) schedule, jointly between MDCR and CHS; ii. Produce findings and analysis based on data from the IDTT Compliance Tracker; and iii. Produce MHRC meeting minutes demonstrating review of trends regarding IDTT and discussion of modifying treatment plans for Levels I and II. d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.e (chronic care assessments): i. Train all Patient Finance Specialists in all aspects of the scheduling process; ii. Create and fill a lead Patient Finance Specialist position; iii. Implement scorecards to monitor performance of Patient Finance Specialists and to create accountability for patient outcomes; iv. Produce post-training test results, competency results, and the findings
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and analysis from an internal audit on the scheduling process training; v. Produce findings and analysis based on data obtained from the
electronic health record scheduling report; vi. Produce clinical performance measures on Medication Administration,
including findings and analysis; and vii. Produce clinical performance measures on Continuity of Medication
on Intake, including findings and analysis. e. Defendants shall complete the following steps to achieve compliance with h
Consent Agreement § III.A.2.f (intake screenings): i. Train all nurses on use of the electronic health record message center; ii. Train all clinical staff to check electronic health record inboxes in order to review lab results;
iii. Produce post-training test results, competency results, and the findings and analysis from a random audit on the electronic health record message center training;
iv. Produce post-training test results, competency results, and the findings and analysis from a random audit on the electronic health record inbox training; and
v. Produce the following clinical performance management tools, including findings and analysis: 1. Laboratory; 2. Heath Assessments 3. Chronic Care – Diabetes;
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4. Chronic Care – Seizure Disorder; 5. Chronic Care – Hypertension; 6. Chronic Care – Asthma; and 7. Anticoagulant Medication – Warfarin (Coumadin). f. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.g (training on health assessments and referrals): i. Utilize QMHPs to train all nurses regarding behavioral health treatment levels; and ii. Conduct a staff survey to obtain feedback on the behavioral health level training and produce findings and analysis of training surveys, including a plan for modifying future trainings, if applicable. g. Defendants shall produce training sign-in sheets, competency results, and the findings and analysis from a random audit on chronic care training. Consent Agreement § III.B.2.a-b (medical and mental health assessments). h. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3(a) (use of restraints): i. Train all corrections officers who work in the mental health treatment center, psychiatrists, psychiatric ARNPs, and nursing staff on policy CHS-068 Clinical Restraints; and ii. Produce post-training testing, competency results, and results from a random audit on the clinical restraints training, including findings and analysis. i. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.C.4.a(1-2) (disciplinary measures with regard to inmates with mental illness):
i. Ensure that disciplinary reviews take into consideration whether the patient has the capacity to complete the disciplinary proceeding as well as whether the disciplinary charge was related to mental illness;
ii. Conduct an annual review of policy CHS-008A: Disciplinary Review and implement modifications, if necessary, to fully implement the terms of the Consent Agreement;
iii. Produce revised policy CHS-008A, if applicable; iv. Ensure that all new staff have been trained in policy CHS-008A; v. Ensure that all behavioral health staff have completed annual training
on policy CHS-008A in the past year; vi. Develop and implement a disciplinary review assessment form and
report in the electronic health record, and produce screenshot of form; vii. Produce post-training testing results, competency results, and the
results of a random audit, including findings and analysis, for policy CHS-008A training; and viii. Produce a report on disciplinary review assessments, including findings and analysis, that includes
1. Analysis of the number of patients on Levels I-IV per month referred for disciplinary proceedings and placed in custodial segregation; and
2. A specific discussion of the use of data from the Inmate
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Disciplinary System at the MHRC. j. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.C.4.b (assistance with the disciplinary process for mentally ill inmates):
i. Develop and implement an enhancement to the electronic health record to flag any patient unable to understand or meaningfully interact with staff due to mental illness and/or cognitive impairment, and produce screenshot of new flag;
ii. Ensure all patients with special needs are added to the ADA log and monitored monthly for continued assistance; and
iii. Produce a report on patients with special needs documented on the ADA log, including findings and analysis, based on information from the ADA log and the electronic health record.
k. Defendants shall produce a report(s), with findings and analysis, on the status of compliance with Consent Agreement §§ III.C.5.a-b (mental health care housing).
l. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.5.d (reporting on Mental Health Treatment Center): i. Train all staff working in Mental Health Treatment Center on policy CHS-058B Behavioral Health Levels of Care; ii. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for special
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management unit training; iii. Produce reports, including findings and analysis, based on information
gathered during rounding by Health Services Administrators; and iv. Produce a quarterly report that meets the requirements of Consent
Agreement § III.C.5.d. m. Defendants shall produce clinical performance measures on Mental Health
Evaluation at Intake, including findings and analysis. Consent Agreement § III.C.5.e (interdisciplinary plan of care). n. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(1-4) (custodial segregation):
i. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training on policy CHS-044 Segregated Patients; and
ii. Implement screening prior to placement in custodial segregation to identify acute medical and mental health contraindications and implement a 24-hour referral for evaluation by a QMHP of any patient with serious mental illness.
12. Final Deadline: October 1, 2018: a. Defendants shall produce a report on the status of compliance with Consent Agreement §§ III.C.6.a(1-3) (custodial segregation), including findings and analysis. b. Defendants shall complete an audit, and produce findings and analysis,
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regarding how the County tracks out-of-cell time for inmates in custodial segregation, including type and duration of activity. Consent Agreement § III.C.6.a(4)ii (documentation of out of cell time for inmates with serious mental illness in custodial segregation). c. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(5, 7, 8) (inmates with serious mental illness and custodial segregation):
i. Review and modify the Medical Incident Addendum form, and produce a screen shot of the revised form;
ii. Create a list in the electronic health record of all patients with serious mental illness being housed in segregation to monitor mental health clearances of such placements; and
iii. Produce a report, including findings and analysis, based on a review of the list of all patients with serious mental illness being housed in segregation.
d. Defendants shall produce a report, including findings and analysis, on the status of compliance with Consent Agreement § III.C.6.a(9) (rounds in custodial segregation).
e. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(10) (access to medical and mental health care in custodial segregation): i. Provide access to the Blackcreek Watch System to the Director of patient Care and to Health Services Administrators in order to review
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nursing compliance with rounds in segregated housing units; ii. Produce a report, including findings and analysis, on the status of
compliance with Consent Agreement § III.C.6.a(10). 13. On or before November 1, 2018, the parties and the Independent Monitor shall meet
and confer to determine whether Defendants have achieved compliance on all Paragraphs of Consent Agreement. 14. On or before November 8, 2018, the parties and the Independent Monitor shall file a Notice of Compliance with paragraph 13, above. In the Notice, the parties must also specify, for each Paragraph of the Consent Agreement, which Paragraphs are in full compliance and which are in partial or non-compliance. If any Paragraphs remain in non-compliance or partial compliance, the parties shall propose a Fourth Summary Action Plan to remedy such non-compliance so that the parties will achieve complete compliance with the Consent Agreement on or before December 10, 2018. 15. On or before December 10, 2018, the parties and the Independent Monitor shall file a joint declaration averring whether complete compliance with the Consent Agreement has been achieved. 16. The items above or contained in the Third Summary Action Plan may be modified or amended by the Court, or without further Court order with the consent of both parties; however, no Final Deadline may be altered without an order by this Court. 17. Nothing in this Order replaces or negates any obligation or requirement of the Consent Agreement. 18. The entry of this Order does not preclude enforcement of the original Consent Agreement.
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DONE AND ORDERED in Chambers at Miami, Florida, this 27th day of March, 2018.

Copies to: Counsel of Record

_________________________________ BETH BLOOM UNITED STATES DISTRICT JUDGE

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 Case 1:13-cv-21570-BB Document 113 Entered on FLSD Docket 05/04/2018 Page 1 of 56
UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF FLORIDA
Case No. 13-21570-CIV-BLOOM UNITED STATES OF AMERICA,
Plaintiff, v. MIAMI-DADE COUNTY, THE BOARD OF COUNTY COMMISSIONERS, et al.,
Defendants. ______________________________________/
ORDER ON FOURTH REVISED SUMMARY ACTION PLAN THIS CAUSE is before the Court following a status conference held on April 12, 2018. Plaintiff United States of America (the “Government”) and Defendants Miami-Dade County, Miami-Dade County Board of County Commissioners, and Miami-Dade County Public Health Trust (collectively, “Defendants” or the “County”) entered into a Consent Agreement, ECF No. [5-2] (“Consent Agreement”), effective May 22, 2013, that addressed alleged constitutional violations regarding the provision of medical and mental health care at the correctional facilities operated by Miami-Dade County Corrections and Rehabilitation Department (“MDCR”). According to the Consent Agreement, on April 2, 2008, the Government notified Miami-Dade County officials of its intention to investigate conditions at MDCR. Id at 4. After tours of the MDCR facilities in 2008 and 2009, the Government issued a Findings Letter on August 24, 2011 that concluded “certain conditions in the MDCR Jail violated the constitutional rights of inmates . . . .” Id. In the months that followed, cooperation between the Government and the County resulted in two agreements: the Consent Agreement before this Court and a separate Settlement Agreement, which addressed protection from harm,
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fire and life safety, and inmate grievances. Id. at 5. The Consent Agreement. The Consent Agreement contained deadlines and requirements
for implementation of 1191 provisions or paragraphs (the “Paragraphs”). The parties selected an Independent Monitor to “oversee implementation of the [Consent] Agreement.” ECF No. [5-2] at 31 (“Independent Monitor”). Except where otherwise agreed to under a specific provision of the Consent Agreement, the County was to implement all provisions of the Consent Agreement within 180 days of the Effective Date. Id. at 33. On May 22, 2013, the Honorable William J. Zloch entered a final order approving and entering the Consent Agreement. ECF No. [9]. For approximately five years, Judge Zloch, and now this Court, have continued to monitor compliance with the Consent Agreement based on reports supplied by the parties and status conferences held before the Court.
First Revised Summary Action Plan. The County did not achieve full compliance with the Consent Agreement within 180 days as originally contemplated in the Consent Agreement. ECF No. [25] at 1; see also Independent Monitor’s Report No. 1, ECF No. [11], dated November 5, 2013; Independent Monitor’s Report No. 2, ECF No. [12], dated May 22, 2014; Independent Monitor’s Report No. 3, ECF No. [22], dated November 28, 2014. The Court held status conferences regarding the non-compliance on October 21, 2014 and November 17, 2014. See ECF No. [19] & [21]. On December 17, 2014, the parties filed a Joint Motion for Entry of Stipulated Order, ECF No. [25], which attached a Consent Agreement Summary Action Plan, ECF No. [25-2] (“First Revised Summary Action Plan”). The First Revised Summary Action Plan included revised compliance deadlines which extended from May o f 2015 through November of 2016. See ECF No. [25-2] at 1. The Court entered an Order granting the motion and approving and adopting the First Revised Summary Action Plan on December 18, 2014.
1 According to the Independent Monitor, this number was later reduced to 115. ECF No. [80] at 88.
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ECF No. [27]. Second Revised Summary Action Plan. On April 20, 2016, the Court held a status
conference during which the parties noted that the County was not in full compliance with the Consent Agreement. See ECF No. [44]. By May of 2016, the “Defendants stipulate[d] that they have not yet come into full compliance with several provisions of the Consent Agreement and [First Revised Summary Action Plan]” and that “they will be unable to meet many upcoming deadlines.” ECF No. [42] at 2; see also Independent Monitor’s Report No. 4, ECF No. [32], dated July 3, 2015; Independent Monitor’s Report No. 5, ECF No. [38], dated February 15, 2016. The parties therefore filed a Joint Motion for Entry of Stipulated Order, ECF No. [42], which attached a Consent Agreement Revised Summary Action (Compliance) Plan, ECF No. [42-1] (“Second Revised Summary Action Plan”). The Second Revised Summary Action Plan included revised compliance deadlines which extended from July of 2016 through February of 2017. See ECF No. [42-1] at 1–2. The Court entered an Order granting the motion and approving and adopting the Second Revised Summary Action Plan on May 23, 2016. ECF No. [43]. On September 9, 2016, the Independent Monitor filed its sixth report with the Court, which again noted that the County had still not reached full compliance with the Consent Agreement. ECF No. [45].
In advance of the February 21, 2017 deadlines, the Court held a hearing on January 26, 2017, during which the Government represented to the Court that the County had committed to full compliance with the Consent Agreement by the end of February 2017. ECF No. [56] at 7. On April 4, 2017, the Independent Monitor submitted its seventh report, which indicated that the County had not achieved full compliance with the Consent Agreement. ECF No. [57]. The Court held a status conference on April 21, 2017. ECF No. [60]. At that hearing, the Government
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represented to the Court that “the latest summary action plan that had been filed with the Court showed that they would be in full compliance with all provisions by February. And obviously, those deadlines were missed. And this is now the third set of deadlines, unfortunately, that got missed.” ECF No. [63] at 11. Based on this hearing, the Court entered an Order, ECF No. [61], requiring the Independent Monitor to submit monthly reports regarding certain clinical performance measures.
On July 28, 2017, the Court held a status conference. ECF No. [68]. While the parties reported progress, they also reported that the County was still not in full compliance with the Consent Agreement. See ECF No. [70]. During the hearing, the Government represented that the parties planned a “full compliance tour” scheduled for the week of September 11, 2017. Id. at 5. Due to Hurricane Irma, that tour was postponed until December 2017, and a status conference was set for February 7, 2018. ECF No. [75].
On January 19, 2018, the Independent Monitor filed its eighth report. ECF No. [80]. The report stated that the County had again not achieved full compliance with the Consent Agreement and that it was fully compliant with 29 of the 115 Paragraphs of the Consent Agreement. Id. at 95. Specifically, the Independent Monitor noted in the report that for certain provisions of the Consent Agreement “performance is poor,” “poorly documented,” and/or data is “insufficiently analyzed,” and that the County had made “insignificant progress,” has “not improved,” or has implemented “poorly conceived and ineffective” processes in response to the requirements of the Consent Agreement. Id. at 96.
The Independent Monitor further reported that MDCR is classifying any inmate who receives a mental health care emergency treatment order as a “use of force” incident and “require[e]s the Qualified Mental Health Professional (QMHP . . . ) to write an order authorizing use of force” for these incidents, a policy which is “outside the practice parameters of a QMHP”
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and which must “be stopped immediately.” Id. at 97. The Monitor further reported that two inmate deaths by suicide “may have been prevented had the patients been appropriately leveled,” that is, properly classified based on their mental health history and risk, per the Consent Agreement. Id. at 97. The report notes that “mental health staff [did] not follow[] the leveling guidelines despite having access to all relevant information” and that they instead used their “ ‘clinical judgment’ rather than following the guidelines, which lead to the errors.” Id.2
On February 7, 2018, the parties appeared before the Court for a status conference. At the Conference, the parties reiterated their commitment to full compliance, and the Independent Monitor highlighted several areas that required improvement. See ECF No. [83], Hearing Tr. at 24, 28–33, 35, 38. During colloquies with the Court, the Government represented that the parties had met and conferred regarding a new revised summary action plan and that the parties were prepared to file such plan on February 8, 2018 for Court approval. Id. at 24–25. However, while the Government informed the Court that the parties could file a revised summary action plan the following day, neither the Government nor the County was able to represent to the Court that the parties were able to comply with the deadlines contemplated in the proposed plan as drafted.
Third Revised Summary Action Plan. Following the hearing, the Court entered its Order, ECF No. [84], requiring that the parties submit a Proposed Third Revised Summary Action Plan. Specifically, the Court ordered that the proposed order must include final deadlines by which the parties agree full compliance with the Consent Agreement will be achieved. The Court further ordered that the proposed order must also include interim deadlines that allow sufficient time and opportunity for reports to be produced, analyzed, and any noncompliance remediated prior to the Final Deadlines. Id. at 6–7. In the Order, the Court further stated:
2 The Monitor further notes that “[h]ad the individuals of committed suicide been leveled appropriately, they would have been housed at a higher level of care (e.g., level 1) and their chance of completed suicide would have presumably decreased.” Id.
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This Court has been far too generous in the time permitted for the parties to remedy the unconstitutional conditions at MDCR, which were initially investigated by the Government nearly a decade ago and which “Defendants stipulate[d], and this Court [found], necessitate the remedial measures contained in th[e Consent] Agreement.” ECF No. [5-2] at 5. Although the parties have represented to this Court—time after time—that they are committed to compliance, years have worn on without ever achieving full compliance while the safety and welfare of many individuals continue to be placed at risk. These are inmates who have no choice as to their housing and rely upon the government, here the Defendants, to comply with the law. Full compliance is necessary as a first step to achieve the sustainable and systemic change contemplated in the Consent Agreement. In sum, this Court will no longer tolerate vague representations of the parties’ “commitment” in place of demonstrable and documented full compliance.
Id. at 5–6 (emphasis added).
On March 15, 2018, the parties filed a Notice of Compliance which attached a Proposed
Order and Third Revised Summary Action Plan. ECF No. [90-1] and [90-2]. Despite this
Court’s admonitions to the parties during the February 7, 2018 status conference and in its
February 8, 2018 Order, many of the deadlines contained a disclaimer that Defendants will
perform certain action items—which the parties concede seek to remedy ongoing constitutional
violations at MDCR—solely in an effort to “move toward compliance with” a particular
Paragraph of the Consent Agreement. The Court has been very clear: it will no longer tolerate
commitments to attempt or try to comply with the Consent Agreement at some point in the
future in place of actual compliance. Accordingly, the Court modified the proposed order
submitted by the parties.
Fourth Revised Summary Action Plan. During a status conference on April 12, 2018,
the Court heard from the Independent Monitor that the Monitoring Team needed more time to
review the supporting documentation to be submitted by Defendants each month. The
Independent Monitor also explained that the Monitors will not be able to provide a declaration
regarding their final evaluation of Defendants’ compliance with all paragraphs of the Consent
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Agreement until after the compliance tour scheduled for January or February 2019. This Court subsequently required the parties to submit a Proposed Fourth Revised Summary Action Plan by April 20, 2018. On April 20, 2018, the parties filed a Notice of Compliance, which attached a Proposed Fourth Revised Summary Action Plan. ECF No. [109].
Accordingly, the Court AMENDS the Third Summary Action Plan, ECF No. [91], and it is ORDERED AND ADJUDGED as follows:
1. As a result of Defendants’ failure to achieve full compliance with the Consent Agreement, additional remedial relief is necessary, as set forth in the action steps and document production requirements below.
2. The additional relief set forth below complies in all respects with the provisions of 18 U.S.C. § 3626(a). The relief is narrowly drawn, extends no further than necessary to correct violations of federal rights as alleged by the United States in its Complaint and Findings Letter, is the least intrusive means necessary to correct these violations, and will not have an adverse impact on public safety or the operation of the criminal justice system.
3. This Order outlines final deadlines for compliance with the Consent Agreement (“Final Deadlines”). With respect to the action steps identified in paragraphs seven (7) through twelve (12),3 in advance of each Final Deadline, the parties shall:
a. At least twenty-one (21) days prior to a Final Deadline, Defendants shall complete each of the action steps due by that Final Deadline and produce all supporting documents delineated in the Fourth Summary Action Plan for that Final Deadline. Wherever “findings and analysis” are referenced in the below action steps, this shall include the development and production of corrective action plans, where applicable;
3 The action steps in paragraph six (6) have already been completed.
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corrective action plans shall be timely implemented. b. At least seven (7) days prior to the Final Deadline, the parties and the
Independent Monitor shall meet and confer to determine whether Defendants have achieved compliance on the action items specified for that Final Deadline of the Consent Agreement. c. On the Final Deadline, the parties and the Independent Monitor shall file a joint declaration averring whether compliance with action items specified for that Final Deadline have been achieved. In the declaration, the parties must also specify, for each Paragraph of the Consent Agreement, which Paragraphs are in full compliance and which are in partial or noncompliance. 4. In addition to the requirements of Paragraph 3, above, the Independent Monitors shall provide timely feedback to the Defendants to facilitate compliance with the provisions of the Consent Agreement. 5. The language of this Order shall control, should there be any discrepancies between this Order and the Fourth Summary Action Plan. 6. Final Deadline: April 16, 2018: a. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.a (medication administration):
i. Audit medication administration to determine if actual practices are consistent with policy and procedure regarding medication administration, including: 1. Referring patients with serial missed medications to a
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practitioner to determine reasons and implement remedies; 2. Implementing a medication utilization project through the
Pharmacy & Therapeutics sub-committee to minimize overuse of medications, e.g., medications for sleep; 3. Implementing a process to ensure timely notification to a prescribing practitioner if a patient refuses to take his or her psychotropic medication for more than 24 hours, or misses three consecutive doses of non-psychotropic medication or three doses in a seven day period of non-psychotropic medication; 4. If necessary, implement a corrective action plan developed jointly between Corrections Health Services (“CHS”) and Miami-Dade Corrections and Rehabilitation Department (“MDCR”) to ensure CHS and MDCR staff actively participate in mouth checks, and monitor the effectiveness of that plan; ii. Produce the results of a discussion between CHS and MDCR about improving communication between CHS and MDCR on all levels regarding excessive medication found during searches, and jointly developed specific action plans to address identified issues; iii. Produce any additional documentation demonstrating implementation of these recommendations, including, where applicable, corrective action plans, committee minutes, a new clinical performance measurement tool, and an initial assessment using that tool.
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b. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.5.a (maintenance of medical and mental health records): Implement the Independent Monitors’ recommendations from the Eighth Report regarding the management of medical and mental health records, including: i. Eliminate paper systems for ordering x-rays and other diagnostics; ii. Train and supervise staff to document patient encounters in a manner that is adequate to assist in providing and managing the medical and mental health needs of patients; and iii. Explore methods to simplify access to the Medication Administration Record.
c. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.5.d (exchange of medical and mental health records with outside providers): Provide an implementation plan for the Independent Monitors’ recommendations from the Eighth Report regarding review of medical records from outside providers, including: i. Develop and implement a template or form to document consistent information about patients upon their return from off-site care and use that form to communicate with providers about continuation of care; and ii. Ensure practitioners document their review of available medical records and incorporate the relevant findings into their documentation through the modification of an existing clinical performance
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measurement tool or creation of a new tool, as applicable. d. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.B.3.a (use of restraints): i. Produce an implementation plan for the Independent Monitors’ recommendations from the Eighth Report regarding the use of clinical restraints to ensure all orders for the use of clinical restraints are appropriately reflected in the electronic health record; and ii. Produce an audit, with findings and recommendations, of three months of data, to analyze status of compliance with the clinical restraints policy.
e. Defendants shall complete the following step to achieve compliance with Consent Agreement § III.B.3.b (medical care following uses of force): Develop and produce a policy on care for inmates involved in uses of force, which includes a mechanism for regularly measuring conformance with the policy (policy CHS-042 Patient Injury and Response to Resistance).
f. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.c (medical care following uses of force; questioning inmates and reporting suspected abuse): Produce an implementation plan for the Independent Monitors’ recommendations from the Eighth Report regarding use of force care, including i. Ensure heath care staff conduct post-use-of-force questioning regarding cause of injury out of earshot of custody staff, per Consent Agreement § III.B.3.c;
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ii. Modify policy CHS-042 Patient Injury and Response to Resistance to allow a health professional to provide a report on inmate injury to someone other than the front-line officer; and
iii. Consider developing a role-modeling video to train new CHS staff members on recognizing possible staff-on-inmate assaults and how to respond.
g. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.e (interdisciplinary treatment plans for mental health care): i. Produce drafts of the following clinical performance measurement tools: 1. Level of care internal audit tool for Level I; 2. Level of care internal audit tool for Level II; 3. Level of care internal audit tool for Level III; and 4. Level of care internal audit tool for Level IV; ii. Produce additional audit, including findings and analysis, incorporating measures requested by the Independent Monitors in their Eighth Report, including: 1. How many patients are on the mental health caseload at each level; 2. How many level I and II patients on each level receive an interdisciplinary treatment plan, the time frame in which each patient received the initial interdisciplinary treatment plan, and
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the time frame in which each individual received a follow up treatment plan; and 3. How patients who are not required to receive an interdisciplinary treatment plan are assessed and evaluated to ensure their needs are addressed. h. Defendants shall produce a draft of the new measure(s) added to the Suicide Risk Screening clinical performance measurement tool to measure the quality of suicide risk assessments. Consent Agreement § III.C.3.a(4) (quality suicide risk assessments). i. Defendants shall submit a draft of policy CHS-044: Segregated Patients. Consent Agreement § III.C.6.a (custodial segregation). j. Defendants shall complete the following steps to acheive compliance with Consent Agreement § III.C.9.a (risk management system): i. Finalize and produce policy CHS-010: Mortality and Morbidity Review; and ii. Finalize and produce policy CHS-010B: Risk Management. k. Defendants shall complete the following step to achieve compliance with Consent Agreement § III.D.1.b (self-audits): Produce the 2017 Clinical Quality Improvement Plan, including an evaluation of the quality improvement program in 2017, and a quality improvement plan for 2018, documenting the implementation of a quality improvement program.
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7. Final Deadline: May 14, 2018: a. Defendants shall produce final versions of the following policies: i. Policy IP-002: Supervising and Recognizing Inmates with Mental Illness; ii. Policy CHS-068: Clinical Restraints; iii. Policy CHS-011: Patient Health Care Grievances; iv. Policy CHS-056: Patients with Special Needs; v. Policy CHS-042: Patient Injury and Response to Resistance; and vi. Policy DSOP 11-041: Response to Resistance Policy. b. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.a (health assessments to administer preventative care): i. Demonstrate through the use of current clinical performance measurement tools that all incoming and current inmates are receiving: 1. Health assessments within 14 days of entering an MDCR facility conducted by a clinically appropriate level of provider; and 2. Primary care relationships for preventive care, chronic care, and medication management; and ii. Modify current clinical performance measurement tools, if necessary. c. Defendants shall complete the following steps to acheive compliance with Consent Agreement § III.A.2.c (mental health assessments following adverse triggering events):
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i. Re-train all Qualified Mental Health Professionals (“QMHPs”) on the Columbia Suicide Screening Tool;
ii. Finalize and produce inter-agency policy IP-003: Inmate Suicide Prevention and Response Plan;
iii. Produce post-training testing results, competency results and the results of a random audit, including findings and analysis, on the suicide risk assessment training;
iv. Produce clinical performance measures on Self-Harm Incidents, including findings and analysis; and
v. Produce Mental Health Review Committee (“MHRC”) meeting minutes demonstrating a review of self-harm incidents and identified Corrective Action Plans, as clinically indicated.
d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.1(a-c) (acute care and detoxification): i. Provide annual training regarding care for patients suffering from drug and alcohol withdrawal to booking Advanced Registered Nurse Practitioners (“ARNPs”) and psychiatry providers covering the detox unit and/or detox patients; ii. Produce orientation and retraining sign-in sheets demonstrating staff training on acute health needs; iii. Produce post-training testing results, competency results completed to date, and the results of a random audit on training for acute health needs, including findings and analysis; and
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iv. Produce post-training testing results, competency results completed to date, and the results of a random audit on training regarding withdrawal from alcohol and other substances, including findings and analysis.
e. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.a (use of restraints): i. Produce an analysis of Emergency Treatment Order (“ETO”) data to ascertain the underlying factors associated with ETOs and, if appropriate, a corrective action plan to decrease their frequency; and ii. Produce a joint plan developed by CHS and MDCR to declassify ETOs as uses of force, if force was not required to administer an ETO.
f. Defendants shall produce the draft of a new measure, for the clinical performance measurement tool on Suicide Risk Screening, to track compliance with Consent Agreement § III.C.3.a(1) (property and privileges for acutely mentally ill and suicidal inmates).
g. Defendants shall produce the draft of a new measure, for the clinical performance measurement tool on Suicide Risk Screening, to track compliance with Consent Agreement § III.C.3.a(2) (case-by-base decisions regarding clothing, bedding, and property for suicidal inmates).
h. Defendants shall complete the following step to achieve compliance with Consent Agreement § III.C.3.a(4) (suicide risk assessments): Produce the finalized clinical performance measurement tool on quality of suicide risk assessments and an assessment utilizing that tool, including findings and
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analysis. i. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.C.6.a(1-4) (custodial segregation): Produce the procedural directive implementing screening prior to placement in custodial segregation to identify acute medical and/or mental health contraindications and to implement a 24-hour referral for evaluation by a QMHP of any patient with serious mental illness. j. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.8.d (staff certification in cardiopulmonary resuscitation):
i. Provide the results of a self-audit of compliance with the requirement that all correctional custodial staff are certified in cardiopulmonary resuscitation (“CPR”), including findings and analysis;
ii. Provide a plan with a training timeline for any staff identified as requiring training in CPR.
k. Defendants shall complete and produce a report that meets the requirements of Consent Agreement § III.D.2.a.6 (report of reportable incidents).
8. Final Deadline: June 25, 2018: a. Defendants shall produce lesson plans, curriculum and a training schedule for applicable staff on the following policies: i. Policy CHS-010: Mortality and Morbidity Review; ii. Policy CHS-010B: Risk Management;
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iii. Policy CHS-042 Patient Injury and Response to Resistance; iv. Policy CHS-068: Clinical Restraints; and v. Policy DSOP-11041: Response to Resistance; b. Defendants shall update the Suicide Prevention Training curriculum with the procedure from interagency policy IP-003: Inmate Suicide Prevention and Response Plan, and initiate training. c. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.1.b (mental health screenings on intake):
i. Launch a performance improvement plan to streamline intake; ii. Implement IT enhancement to provide for a six hour routine referral
form for behavioral health QMHPs; iii. Ensure all clinicians and nursing staff have completed secondary
training regarding updates to the intake screening process; iv. Ensure all clinicians and nursing staff have completed training on the
symptoms of withdrawal; v. Produce the following documentation:
1. The MDCR Queue Management System (“QMS”) Report demonstrating the length of time inmates are spending in the intake process;
2. A copy of the new routine referral form; 3. Post-training testing results, competency results and the results
of a random audit for intake screening training, including findings and analysis;
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4. Post-training testing results, competency results and the results of a random audit for symptoms of withdrawal training, including findings and analysis;
5. Clinical performance measures on Mental Health Evaluation at Intake, including findings and analysis;
6. Clinical performance measures on Initial (Intake) Screen, including findings and analysis.
d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.1.c (inmates in need of constant observation): i. Ensure nursing staff enter an emergent order and constant observation whenever a patient expresses suicidal ideations or thoughts, or whenever clinically indicated; ii. Provide the Jackson Education Network (“JEN”) module training regarding the leveling policy to all QMHPs; iii. Produce Suicide Risk Screening clinical performance measures, including findings and analysis; iv. 4) Produce Initial (Intake) Screen clinical performance measures, including findings and analysis; v. Produce JEN report demonstrating all QMHPs completed the leveling policy training; and vi. Produce MHRC meeting minutes demonstrating the review and monitoring of the Initial (Intake) Screen and Suicide Risk Screening tools.
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e. Defendants shall produce findings and analysis regarding diversion of patients to the hospital in medical emergent situations, based on data from the MDCR QMS Diversion Log. Consent Agreement § III.A.1.d (emergency mental health or medical referrals).
f. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.1.e (obtaining prior medical records): i. Develop, and produce evidence of, a place in the electronic health record to indicate offsite record checks; and ii. Produce clinical performance measures for Repeat Jail Admits, including findings and analysis.
g. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.3.a(1) (access to medical and mental health care): i. Produce clinical performance measures on Urgent Care (Sick Call), including findings and analysis; ii. Produce findings and analysis from an audit of the sick call process.
h. Defendants shall complete the following step to achieve compliance with Consent Agreement § III.A.3.a(2) (access to medical and mental health care for inmates with physical or cognitive disabilities): Ensure that Jackson Health System’s communication system for patients with physical and/or cognitive disabilities is available at all times and provided to patients when necessary.
i. Defendants shall produce findings and analysis of ongoing competency reviews and audits regarding medical and mental health care staff’s knowledge of acute and chronic care needs of patients. Consent Agreement §
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III.A.3.b (adequate training on acute and chronic care). j. Defendants shall produce a draft of a new clinical performance measurement
tool monitoring compliance on documentation being sent out with patients transferred to outside facilities. Consent Agreement § III.A.5.d (exchange of medical records with outside providers). k. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.6.a (discharge planning):
i. Finalize and produce policy CHS-049: Discharge Planning; and ii. Produce clinical performance measures on Continuity of Care on
Release, including findings and analysis. l. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.A.7(a-c) (mortality and morbidity reviews): i. Conduct timely administrative reviews and root cause analyses for serious incidents, including patient deaths and suicide attempts; ii. Develop corrective action plans including follow-up steps to ascertain pertinent information that is not available at the time of the initial review;
iii. Manage and monitor all corrective action plans derived from morbidity and mortality reviews using the Performance Logic Project Management Tool;
iv. Reconvene the Morbidity and Mortality Review Committee upon receipt of new findings/reports to update analyses and corrective action plans accordingly;
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v. Produce Clinical Quality Improvement (“CQI”) meeting minutes demonstrating review of all morbidity and mortality corrective action plans to determine their effectiveness and recommendations for modifications as necessary.
m. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.a (use of restraints): i. Develop and produce lesson plans and training curriculum for policy DSOP 11-041: Response to Resistance; ii. Develop and produce lesson plans and training curriculum for policy CHS-068: Use of Clinical Restraints; iii. Ensure a QMHP is notified immediately in the case of custody-ordered restraints, in order to review the health record for any contraindications or accommodations required, and to initiate health monitoring; iv. Draft and issue a memo to staff to reinforce the need to document 15minute checks on any inmate in restraints, and produce such memo; v. Produce findings and analysis based on review of data from the Blackcreek System Report and manual logs; vi. Produce findings and analysis based on review of data from the ISAS incident tracking database.
n. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3(b-c) (medical care following uses of force): i. Train all nurses to ensure they assess and document patients
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immediately following any use of force; ii. Implement in the electronic health record a prompt to ensure patient
privacy is enforced and properly documented, and produce screen shots of new prompt; iii. Train all clinical staff on how to identify patient abuse or suspicion of patient abuse; iv. Produce post-training testing results, competency results and the results of a random audit, including findings and analysis, for nurse training on assessing and documenting patients following uses of force; v. Produce post-training testing results, competency results and the results of a random audit, including findings and analysis, for training on how to identify patient abuse or suspicion of patient abuse; vi. Produce clinical performance measures on Nursing Documentation Following Use of Force, including findings and analysis. o. Defendants shall produce a draft of an internal clinical performance measurement tool to audit whether emergency referrals to the QMHP after intake are being completed within two hours. Consent Agreement § III.C.1.a(1) (access to care and emergency referrals). p. Defendants shall complete and produce a report on CHS’s validation of the mental health leveling system. Consent Agreement § III.C.2.f (mental health classification by level of care). q. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.C.2.g (provision of mental health care): i. Demonstrate the use of the quality improvement program and the ability to self-monitor, incorporating a description of performance indicators including: 1. Wait times for psychiatry visits; 2. Psychotropic medication utilization; 3. Numbers of use of force incidents; 4. Utilization of group counseling; 5. Utilization of recreation time; 6. Episodes of self-harm; 7. Grievances; and 8. Adherence to medication. ii. Produce new clinical performance measurement tools, as applicable.
r. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.k (internal review of behavioral health services): Produce the finalized version of the following clinical performance measurement tools, and an assessment utilizing those tools, including findings and analysis: i. Level of care internal audit tool for Level I; ii. Level of care internal audit tool for Level II; iii. Level of care internal audit tool for Level III; and iv. Level of care internal audit tool for Level IV.
s. Defendants shall complete the following steps to achieve compliance with
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Consent Agreement § III.C.3.a(1) (property and privileges for acutely mentally ill and suicidal inmates):
i. Train Mental Health Treatment Center custodial staff and medical and mental health staff on policy CHS-058B: Behavioral Health Levels of Care;
ii. Produce finalized measure added to clinical performance measurement tool on Suicide Risk Screening to track compliance with Consent Agreement § III.C.3.a(1), and produce assessment utilizing that tool, including findings and analysis.
t. Defendants shall produce finalized measure added to clinical performance measurement tool on Suicide Risk Screening to track compliance with Consent Agreement § III.C.3.a(2), and produce assessment utilizing that tool, including findings and analysis.
u. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.3.a(3) (provision of bed and suicide-resistant mattress to inmates on suicide watch): i. Ensure that each inmate on suicide watch has a bed and a suicide resistant mattress and monitor compliance during walkthroughs; and ii. Produce findings and analysis based on information gathered during walkthroughs.
v. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.3.a(4) (quality suicide risk assessments): i. Train all QMHPs on an ongoing basis on the provision of quality
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suicide risk assessments; and ii. Produce post-training testing results, competency results, and the
results of a random audit, including findings and analysis, for QMHP training on the provision of quality suicide risk assessments. w. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.3.a(5) (prevention of retaliation through the use of suicide watch cells): i. Ensure that all new staff have been provided Suicide Prevention training; ii. Ensure that all behavioral health staff have completed annual training on Suicide Prevention in the past year; iii. Produce pre- and post-training test results and competency results for Suicide Prevention training; and iv. Produce audit report, including findings and analysis, based on competency testing of suicide risk assessments and quarterly review of QMHP documentation. x. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.3.e (individualized treatment plans for suicidal inmates): i. Conduct annual review of policy CHS-058A: Interdisciplinary Treatment Team and implement modifications, if necessary, to fully implement the terms of the Consent Agreement; ii. Produce revised policy CHS-058A, if applicable; and
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iii. Produce clinical performance measures on Mental Health Treatment Planning, including findings and analysis.
y. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.3 (suicide prevention): i. Implement training on policy IP-003: Suicide Prevention and Response Plan for all appropriate staff; ii. Produce training rosters demonstrating that custodial and medical and mental health staff have received biennial in-service training on suicide prevention in the past two years; iii. Produce training rosters demonstrating that staff who work in intake, in custodial segregation, or who work with inmates on Behavioral Health Levels I-III, have received annual in-service training on suicide prevention in the past year.
z. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a.2 (screening prior to custodial segregation): i. Implement the Independent Monitors’ recommendations from the Eighth Report regarding this provision, including the incorporation of a specific identifier for pre-segregation notes in the electronic medical record, for ease of identification and auditing; ii. Collect, review, and analyze data regarding the use of custodial segregation for inmates on the mental health caseload, including: 1. Medical and mental health screenings prior to initial placement in custodial segregation and notation of contraindications for
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inmates for whom acute medical or mental health condition is identified; 2. The outcomes of mental health reviews/consultations prior to placement in custodial segregation; 3. The number of patients per Level per month in custodial segregation who are referred for mental health care, and the outcome of each referral; 4. The length of placement in custodial segregation for patients, by Level; and 5. Data and trends from the Blackcreek Watch System. aa. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(6) (inmates with serious mental illness and custodial segregation): Implement the Independent Monitors’ recommendations from the Eighth Report regarding this provision, including: i. Develop and produce a plan to implement clear criteria to be used by mental health staff when evaluating patients with serious mental illness for placement in custodial segregation and/or determining whether a patient should continue to be housed in custodial segregation; ii. Collect and analyze data regarding the assessment and treatment of patients after mental health symptoms develop in custodial segregation, including analysis of any patients who are housed in custodial segregation after decompensating or engaging in self-harm,
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and produce results of such analysis; and iii. Develop and produce jointly between CHS and MDCR a clear
working definition of “long-term custodial segregation” to allow for appropriate tracking and monitoring. bb. Defendants shall complete the following step to achieve compliance with Consent Agreement § III.C.6.a(11) (mental health referrals for inmates in custodial segregation): Collect, review, and analyze data, and produce findings and analysis, regarding mental health referrals of inmates in custodial segregation, including i. Analysis that demonstrates adherence to Consent Agreement § III.C.6.a(11); and ii. Analysis regarding the timeliness of referrals of patients with serious mental illness during custodial segregation. cc. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.7.b (mental health staffing): i. Ensure that newly hired mental health staff receive corrections-specific mental health training; ii. Produce lesson plans and training materials for this training. dd. Defendants shall produce documentation demonstrating that all new staff have received pre-service training and that all staff have received biennial inservice training on all relevant policies/procedures and the requirements of the Consent Agreement. Consent Agreement § III.C.7.f (training). ee. Defendants shall produce training materials, post-training testing results,
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competency results, and the results of a random audit, including findings and analysis, for training that meets the requirements of Consent Agreement § III.C.7.g (mental health training for corrections officers). ff. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.7.h (communication between mental health staff and corrections officers):
i. Develop and implement written policy(ies), procedure(s) and training that ensures appropriate and regular communication between mental health staff and corrections officers regarding inmates with mental illness;
ii. Produce training materials, post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training that meets the requirements of Consent Agreement § III.C.7.h; and
iii. Produce policy CHS-004A: Mental Health Review Committee. gg. Defendants shall complete the following step to achieve compliance with
Consent Agreement § III.C.9.a (risk management system): Produce a report reflecting an in-depth analysis of risk-management data to demonstrate that trends and incidents involving avoidable suicides and self-injurious behavior are being identified and corrected in a timely manner. This analysis should include
i. Use of the harm score; ii. Triggers for non-suicidal self-harm;
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iii. An explanation of how an analysis of suicides led to changes in leveling; and
iv. Corrective action plans, if applicable, to reflect how the County is addressing identified trends to further reduce or mitigate risk from suicides and self-injurious behavior.
hh. Defendants shall produce documentation demonstrating risk management data analysis and associated interventions to prevent or minimize harm to inmates. Consent Agreement § III.C.9.b (risk management).
ii. Defendants shall finalize and produce policy CHS-044: Segregated Patients. jj. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.C.9.a, b(1) (risk management): i. Train applicable staff on policy CHS-010: Mortality and Morbidity Review and policy CHS-010B: Risk Management; ii. Produce post-training testing results and attestations of understanding for staff trained on policy CHS-010 and policy CHS-010B.
9. Final Deadline: August 6, 2018: a. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.1.a (intake screenings): Conduct and produce reliability audits, including findings and analysis, of the following clinical performance measurement tools: i. Mental Health Evaluation at Intake; and ii. Initial (Intake) Screening.
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b. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.3.a(4) (screening and responding to medical and mental health requests): i. Produce clinical performance measures on Complaints and Grievances, including findings and analysis; and ii. Produce clinical performance measures on Urgent Care (Sick Call), including findings and analysis.
c. Defendants shall produce clinical performance measures on Medication Administration, including findings and analysis. Consent Agreement § III.A.4.a (medication administration).
d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.5.b (mental health care scheduling): i. Conduct daily reviews of scheduling queues and no show reports; and ii. Produce findings and analysis based on data reviewed.
e. Defendants shall produce CHS and Jackson Health Services information technology monthly meetings schedule. Consent Agreement § III.A.5.c (documentation of clinical encounters).
f. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.5.d (exchange of medical records with outside providers): Implement the Independent Monitors’ recommendations from the Eighth Report, including i. Create and produce a checklist for nurses to ensure documentation is being sent out with patients transferred to outside facilities;
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ii. Develop, implement, and produce a template or form to document consistent information about patients upon their return from off-site care and use that form to communicate with providers about continuation of care;
iii. Develop a process with Health Information Management to receive records from outside facilities and to notify providers upon receipt and produce process flow chart;
iv. Implement a check-box in the electronic health record to allow physicians to note acknowledgement of receipt of outside records; and
v. Implement and produce the finalized clinical performance measurement tool to monitor compliance on documentation being sent out with patients transferred to outside facilities, and produce an assessment utilizing that tool, including findings and analysis.
g. Defendants shall produce a draft revised clinical performance measurement tool on Continuity of Care on Release, including a new measurement to analyze if referrals are being made as clinically indicated. Consent Agreement § III.A.6.a.(1) (referrals for planned discharges).
h. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.a (inmates at risk of self-harm): i. Train all officers assigned to the Mental Health Treatment Center, all nursing staff, psychiatrists and psychiatric ARNPs on the following policies: 1. Policy DSOP 11-041: Response to Resistance (clinical
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restraints); 2. Policy CHS-068: Use of Clinical Restraints; ii. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for trainings on policy DSOP 11-041 and policy CHS-068. i. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.c (medical care following uses of force; questioning inmates and reporting suspected abuse): i. Implement an enhancement in the electronic health record for documentation of uses of force or injuries, which will allow clinical staff to identify if the patient’s injury aligns with the patient’s account of the injury, and produce screenshots of the enhancement; ii. Train all nursing staff on the use of the enhancement described above; iii. Ensure photographic evidence is taken in compliance with policy DSOP 11-041 and policy CHS-042 after any use of force or any suspected injury resulting from staff-on-patient abuse; iv. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training on the use of the new electronic health record enhancement, described above; v. Produce 10 randomly drawn use of force incident reports; and vi. Produce clinical performance measures on Nursing Documentation Following Use of Force, including findings and analysis.
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j. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.1.a(1-3) (referrals for mental health care): i. Finalize and produce internal clinical performance measurement tool to audit whether emergency referrals to the QMHP after intake are being completed within two hours, and produce assessment utilizing that tool, including findings and analysis; ii. Train all nursing staff, using a Jackson Education Network module, to enter emergency referrals and constant observation orders whenever staff identify an inmate at risk of suicide or self-harm; iii. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training of nursing staff on entering emergency referrals and constant observation orders.
k. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.1.b (access to mental health care): i. Ensure that all clinical staff have received annual behavioral health training in the past year; ii. Produce post-test training results and attestations for behavioral health training; iii. Produce findings and analysis regarding compliance with Consent Agreement § III.C.1.b, based on data from the QMHP Referral Report.
l. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.a (policy for the delivery of mental health care)
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i. Ensure that all new staff have been trained in policy CHS-058 Basic Behavioral Health Services;
ii. Ensure that all new behavioral health staff have completed annual training on policy CHS-058 Basic Behavioral Health services, in the past year;
iii. Produce post-training testing results for basic mental health services training; and
iv. Produce MHRC meeting minutes demonstrating review and analysis of behavioral health assessments and sick call reports and, if indicated, development of corrective action plan.
m. Defendants shall produce clinical performance measures on Mental Health Treatment Planning, including findings and analysis. Consent Agreement § III.C.2.e (interdisciplinary treatment plans for mental health care).
n. Defendants shall produce clinical performance measures on Individuals on the Mental Health Caseload Involved in Use of Force Incidents, including findings and analysis. Consent Agreement § III.C.2.h (expansion of mental health care).
o. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.g (provision of mental health care): i. Create and produce a procedural directive addressing follow-up care for patients coming off of Level I; ii. Produce clinical performance measures on Suicide Risk Screening, including findings and analysis.
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p. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.2.j (mental health care Level 1 services and care): i. Create and produce a staffing matrix to ensure Level I services are completed in a timely manner; ii. Produce morning huddle reports demonstrating inter-facility communication to ensure Level I patients are seen.
q. Defendants shall produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for suicide prevention training. Consent Agreement § III.C.3 (suicide prevention).
r. Defendants shall produce post-training testing results, competency results, and the results of a random audit, including findings and analysis for training of custodial staff and medical and mental health staff on policy CHS-058-B Behavioral Health Levels of Care. Consent Agreement § III.C.3.a(1) (property and privileges for acutely mentally ill and suicidal inmates).
s. Defendants shall produce a draft of a new internal audit tool measuring compliance with rapid response protocols. Consent Agreement § III.C.3.g (emergency response).
t. Defendants shall produce a draft of a new internal audit tool measuring compliance with Consent Agreement § III.C.6 (custodial segregation).
u. Defendants shall produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training on policy IP-003: Suicide Prevention. Consent Agreement § III.C.8.a(1-8) (suicide prevention training).
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v. Defendants shall produce Facility Clinical Quality Improvement minutes containing a review and risk assessment of incidents reported. Consent Agreement § III.C.9.b(1) (risk management).
w. Defendants shall complete the following steps to achieve compliance with Consent Agreement §§ III.C.9.a, b(2), d(1-2) (risk management): i. Conduct annual reviews of the following policies and implement modifications, if necessary, to fully implement the terms of the Consent Agreement: 1. CHS-058 Basic Behavioral Health Services; 2. CHS-058A Interdisciplinary Treatment Team; 3. CHS-058B Behavioral Health Levels of Care; 4. CHS-004A Mental Health Review Committee; 5. CHS-039 Sick Call; 6. CHS-033 Intake and Receiving Screening; and ii. Produce revised policies, if applicable.
x. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.9.c (mental health review committee): Conduct and produce, with findings and analysis, annual written performance assessments and present findings to the Interdisciplinary Treatment Team regarding i. The quality of nursing services regarding inmate assessments and dispositions; and ii. Access to mental health care by inmates, by evaluating the process for
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screening and assessing inmates for mental health needs. y. Defendants shall produce clinical performance measures on Nursing
Documentation Following Use of Force, including findings and analysis. Consent Agreement § III.C.9.c(5)i (assessment of nursing services). z. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.9.c(5)ii (assessment of access to mental health care services):
i. Assess the quality of QMHP screening of inmates for mental health needs through live observation by the Chief Psychiatrist, or designee;
ii. Produce report, including findings and analysis, documenting any corrective or remedial action taken, based on live observation of mental health screenings by Chief Psychiatrist or designee; and
iii. Produce clinical performance measures on Initial (Intake) Screen, including findings and analysis.
aa. Defendants shall produce a Biannual Report that meets the requirements of Consent Agreement § III.D.2.a.
bb. Defendants shall produce medication reports, including findings and analysis, related to sleeping medication, abuse of medication, and the use of psychotropic medication by classification on a monthly basis. Consent Agreement § III.D.2.a(1) (biannual reports).
cc. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.D.2.a(2-4) (biannual reports): i. Produce an evaluation and report, including findings and analysis, of
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emergency room transfers; ii. Produce a report, including findings and analysis, on the
appropriateness of relocation/transfer of patients to higher level of care; iii. Produce a report, including findings and analysis, on chronic disease; iv. Produce a report, including findings and analysis, on all suicide related incidents; v. Produce MHRC meeting minutes demonstrating a monthly analysis of mental health caseload; and vi. Produce a report, differentiating between individual and group therapy, which analyzes sustainability. dd. Defendants shall ensure that corrective action plans are developed at the CQI meetings on a quarterly basis and produce CQI meeting minutes demonstrating development of corrective action plans and monitoring of sustainability. Consent Agreement § III.D.2.b (corrective action plans).
10. Final Deadline: September 17, 2018: a. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.3.a(2) (access to care for inmates with physical or cognitive disabilities): i. Produce Mini-MAC meeting minutes for all facilities, demonstrating identification of an accommodation for any patients with physical and/or cognitive disabilities; and
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ii. Produce findings and analysis based on data from the Americans with Disabilities Act (“ADA”) log monthly report.
b. Defendants shall complete the following steps to achieve compliance with Consent Agreement §III.A.4.b(1) (continuity of medication on intake): i. Produce findings and analysis of monthly rounding and record reviews by nursing leadership to ensure compliance with this provision; and ii. Produce clinical performance measures on Continuity of Medication on Intake, including findings and analysis.
c. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.b(2) (serious medical or mental health needs on intake): i. Ensure that a medical doctor or psychiatrist is evaluating, in person, patients with serious medical or mental health needs, within 48 hours of entry to any MDCR facility; ii. Produce clinical performance measures on Mental Health Evaluation at Intake, including findings and analysis; and iii. Produce clinical performance measures on Initial (Intake) Screen, including findings and analysis.
d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.c (reviews on the use of psychotropic medication): i. Conduct reviews on the use of psychotropic medications and develop and implement corrective action plans, if necessary; and
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ii. Produce Pharmacy and Therapeutics Meeting Minutes demonstrating findings and analysis from reviews on the use of psychotropic medications.
e. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.d (medication administration and refusals): i. Distribute all narcotic (controlled) psychotropic medication in bubble packs; ii. Provide the formulary reflecting the use of bubble packs for the distribution of all narcotic (controlled) psychotropic medication; and iii. Produce clinical performance measures on Medication Refusal, including findings and analysis.
f. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.e (orders for medication and laboratory tests): i. Conclude scheduling process improvement plan to improve compliance with obtaining lab tests; ii. Employ additional schedulers to ensure coverage 24 hours a day, seven days a week, and produce documentation demonstrating that coverage; iii. Conduct weekly monitoring of the implementation of physician orders for medication and laboratory tests, and produce findings and analysis; and iv. Produce findings and analysis based on data obtained from the electronic health record scheduling report.
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g. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.4.f (training on medication administration): i. Implement and produce video training regarding the steps required to monitor safe medication administration for all new staff; and ii. Produce MAC meeting minutes demonstrating supervisory spot checks.
h. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.6.a(1) (referrals for planned discharges): i. Train all discharge planners (MSWs) on Discharge Planning policy; ii. Finalize and produce added measure to clinical performance measurement tool on Continuity of Care of Release to measure if referrals are being made as clinically indicated; iii. Produce post-training testing results, competency results, and the results of a random audit for discharge planning training, including findings and analysis; and iv. Produce assessment utilizing revised tool on Continuity of Care on Release, including findings and analysis.
i. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.6.a(2) (provision of bridge medications on discharge): i. Implement enhancement in the electronic health record to bridge medications to be picked up at the Jackson Memorial Hospital pharmacy; and
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ii. Produce a monthly report from the pharmacy of picked-up bridge medications, including findings and analysis.
j. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.6.a(3) (discharge planning): i. Ensure corrections staff notify the site Directors of Patient Care Services of planned release dates; ii. Ensure that all medications are ordered and medical clearance obtained, if applicable; iii. Make referrals, as clinically appropriate, and develop a complete discharge plan for all planned discharges; iv. Produce discharge notification list demonstrating appropriate notification of Directors of Patient Care services; and v. Produce findings and analysis regarding medications being ordered on discharge, based on data from the medication administration record report.
k. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3.b (medical care following uses of force): i. Train all nursing staff and medical providers on policy CHS-042: Patient Injury and Response to Resistance; and ii. Produce post-training testing results, competency results and the results of a random audit for CHS-042 training, including findings and analysis.
l. Defendants shall produce the finalized internal audit tool measuring
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compliance with rapid response protocols, including findings and analysis. Consent Agreement § III.C.3.g (emergency response). m. Defendants shall produce the finalized internal audit tool measuring compliance with Consent Agreement § III.C.6 (custodial segregation), including findings and analysis. n. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(1-4) (custodial segregation):
i. Ensure that all clinical staff have been trained in policy CHS-044 Segregated Patients; and
ii. Produce a schedule for annual training for all clinical staff on policy CHS-044 Segregated Patients;
o. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.9.b(3-4), 9.c(1-5) (risk management): i. Ensure that all clinical staff have received annual training on the following policies: 1. CHS-058 Basic Behavioral Health Services; 2. CHS-058A Interdisciplinary Treatment Team; 3. CHS-058B Behavioral Health Levels of Care; 4. CHS-039 Sick Call; and 5. CHS-033 Intake and Receiving Screening; ii. Produce post-training testing results, and the results of a random audit, including findings and analysis, for training on the policies listed above; and
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iii. Produce MHRC meeting minutes documenting an analysis of selfharm incidents and the corrective action implemented, when applicable.
p. Defendants shall produce clinical performance measures on Initial (Intake) Screen, including findings and analysis. Consent Agreement § III.C.9.d(1) (review of suicide risk assessments).
q. Defendants shall conduct quarterly CQI meetings and produce CQI meeting minutes demonstrating a review of corrective action plans and an analysis on effectiveness. Consent Agreement § III.C.9.d(2) (monitoring of risk management activities).
r. Defendants shall develop and produce recommendations for further investigation of identified trends and for corrective action, including system changes, and present recommendations to the CQI Committee. Consent Agreement § III.C.9.d(5) (recommendations for further investigation).
s. Defendants shall produce the internal audit tool to monitor disciplinary review assessments, including findings and analysis. Consent Agreement § III.D.2.a(5) (biannual reports).
11. Final Deadline: October 29, 2018: a. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.a (health assessments): i. Modify appointment types in the electronic health record to allow for appointments to be made within 10 days rather than 14 days;
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ii. Produce findings and analysis based on data obtained from the electronic health record scheduling report; and
iii. Produce clinical performance measures on Laboratory, including findings and analysis.
b. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.b (mental health assessments): i. Re-train all QMHPs on the Columbia Suicide Screening Tool; ii. Produce post-training testing, competency results, and results from a random audit on the Columbia Suicide Screening Tool training, including findings and analysis; and iii. Produce clinical performance measures on Suicide Risk Screening, including findings and analysis.
c. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.d (risk profiles): i. Complete and implement an interdisciplinary treatment team (“IDTT”) schedule, jointly between MDCR and CHS; ii. Produce findings and analysis based on data from the IDTT Compliance Tracker; and iii. Produce MHRC meeting minutes demonstrating review of trends regarding IDTT and discussion of modifying treatment plans for Levels I and II.
d. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.e (chronic care assessments):
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i. Train all Patient Finance Specialists in all aspects of the scheduling process;
ii. Create and fill a lead Patient Finance Specialist position; iii. Implement scorecards to monitor performance of Patient Finance
Specialists and to create accountability for patient outcomes; iv. Produce post-training test results, competency results, and the findings
and analysis from an internal audit on the scheduling process training; v. Produce findings and analysis based on data obtained from the
electronic health record scheduling report; vi. Produce clinical performance measures on Medication Administration,
including findings and analysis; and vii. Produce clinical performance measures on Continuity of Medication
on Intake, including findings and analysis. e. Defendants shall complete the following steps to achieve compliance with
Consent Agreement § III.A.2.f (intake screenings): i. Train all nurses on use of the electronic health record message center; ii. Train all clinical staff to check electronic health record inboxes in order to review lab results;
iii. Produce post-training test results, competency results, and the findings and analysis from a random audit on the electronic health record message center training;
iv. Produce post-training test results, competency results, and the findings and analysis from a random audit on the electronic health record inbox
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training; and v. Produce the following clinical performance management tools,
including findings and analysis: 1. Laboratory; 2. Heath Assessments 3. Chronic Care – Diabetes; 4. Chronic Care – Seizure Disorder; 5. Chronic Care – Hypertension; 6. Chronic Care – Asthma; and 7. Anticoagulant Medication – Warfarin (Coumadin).
f. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.A.2.g (training on health assessments and referrals): i. Utilize QMHPs to train all nurses regarding behavioral health treatment levels; and ii. Conduct a staff survey to obtain feedback on the behavioral health level training and produce findings and analysis of training surveys, including a plan for modifying future trainings, if applicable.
g. Defendants shall produce training sign-in sheets, competency results, and the findings and analysis from a random audit on chronic care training. Consent Agreement § III.B.2.a-b (medical and mental health assessments).
h. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.B.3(a) (use of restraints): i. Train all corrections officers who work in the mental health treatment
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center, psychiatrists, psychiatric ARNPs, and nursing staff on policy CHS-068 Clinical Restraints; and ii. Produce post-training testing, competency results, and results from a random audit on the clinical restraints training, including findings and analysis. i. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.4.a(1-2) (disciplinary measures with regard to inmates with mental illness): i. Ensure that disciplinary reviews take into consideration whether the patient has the capacity to complete the disciplinary proceeding as well as whether the disciplinary charge was related to mental illness; ii. Conduct an annual review of policy CHS-008A: Disciplinary Review and implement modifications, if necessary, to fully implement the terms of the Consent Agreement; iii. Produce revised policy CHS-008A, if applicable; iv. Ensure that all new staff have been trained in policy CHS-008A; v. Ensure that all behavioral health staff have completed annual training on policy CHS-008A in the past year; vi. Develop and implement a disciplinary review assessment form and report in the electronic health record, and produce screenshot of form; vii. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for policy CHS-008A training; and
50

Case 1:13-cv-21570-BB Document 113 Entered on FLSD Docket 05/04/2018 Page 51 of 56
viii. Produce a report on disciplinary review assessments, including findings and analysis, that includes 1. Analysis of the number of patients on Levels I-IV per month referred for disciplinary proceedings and placed in custodial segregation; and 2. A specific discussion of the use of data from the Inmate Disciplinary System at the MHRC.
j. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.4.b (assistance with the disciplinary process for mentally ill inmates): i. Develop and implement an enhancement to the electronic health record to flag any patient unable to understand or meaningfully interact with staff due to mental illness and/or cognitive impairment, and produce screenshot of new flag; ii. Ensure all patients with special needs are added to the ADA log and monitored monthly for continued assistance; and iii. Produce a report on patients with special needs documented on the ADA log, including findings and analysis, based on information from the ADA log and the electronic health record.
k. Defendants shall produce a report(s), with findings and analysis, on the status of compliance with Consent Agreement §§ III.C.5.a-b (mental health care housing).
l. Defendants shall complete the following steps to achieve compliance with
51

Case 1:13-cv-21570-BB Document 113 Entered on FLSD Docket 05/04/2018 Page 52 of 56
Consent Agreement § III.C.5.d (reporting on Mental Health Treatment Center):
i. Train all staff working in Mental Health Treatment Center on policy CHS-058B Behavioral Health Levels of Care;
ii. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for special management unit training;
iii. Produce reports, including findings and analysis, based on information gathered during rounding by Health Services Administrators; and
iv. Produce a quarterly report that meets the requirements of Consent Agreement § III.C.5.d.
m. Defendants shall produce clinical performance measures on Mental Health Evaluation at Intake, including findings and analysis. Consent Agreement § III.C.5.e (interdisciplinary plan of care).
n. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(1-4) (custodial segregation): i. Produce post-training testing results, competency results, and the results of a random audit, including findings and analysis, for training on policy CHS-044 Segregated Patients; and ii. Implement screening prior to placement in custodial segregation to identify acute medical and mental health contraindications and implement a 24-hour referral for evaluation by a QMHP of any patient with serious mental illness.
52

Case 1:13-cv-21570-BB Document 113 Entered on FLSD Docket 05/04/2018 Page 53 of 56
12. Final Deadline: December 10, 2018: a. Defendants shall produce a report on the status of compliance with Consent Agreement §§ III.C.6.a(1-3) (custodial segregation), including findings and analysis. b. Defendants shall complete an audit, and produce findings and analysis, regarding how the County tracks out-of-cell time for inmates in custodial segregation, including type and duration of activity. Consent Agreement § III.C.6.a(4)ii (documentation of out of cell time for inmates with serious mental illness in custodial segregation). c. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(5, 7, 8) (inmates with serious mental illness and custodial segregation): i. Review and modify the Medical Incident Addendum form, and produce a screen shot of the revised form; ii. Create a list in the electronic health record of all patients with serious mental illness being housed in segregation to monitor mental health clearances of such placements; and iii. Produce a report, including findings and analysis, based on a review of the list of all patients with serious mental illness being housed in segregation. d. Defendants shall produce a report, including findings and analysis, on the status of compliance with Consent Agreement § III.C.6.a(9) (rounds in custodial segregation).
53

Case 1:13-cv-21570-BB Document 113 Entered on FLSD Docket 05/04/2018 Page 54 of 56
e. Defendants shall complete the following steps to achieve compliance with Consent Agreement § III.C.6.a(10) (access to medical and mental health care in custodial segregation): i. Provide access to the Blackcreek Watch System to the Director of patient Care and to Health Services Administrators in order to review nursing compliance with rounds in segregated housing units; ii. Produce a report, including findings and analysis, on the status of compliance with Consent Agreement § III.C.6.a(10).
13. On or before January 7, 2019, the parties and the Independent Monitor shall meet and confer to determine whether Defendants have achieved compliance on all Paragraphs of Consent Agreement, and shall discuss any final remedial measures that must be completed prior to the tenth compliance tour.
14. On or before January 14, 2019, the parties and the Independent Monitor shall file a Notice of Compliance with paragraph 13, above. In the Notice, the parties shall specify the dates for the Independent Monitors’ tenth compliance tour.
15. The Independent Monitors shall conduct their tenth compliance tour in January or February 2019.
16. Within 4 weeks of the conclusion of the tenth compliance tour, the Independent Monitors’ reports shall be provided to the Parties in draft form for comment.
17. Within 5 weeks of the conclusion of the tenth compliance tour, the parties and the Independent Monitors shall meet and confer to determine whether Defendants have achieved compliance on all Paragraphs of Consent Agreement.
54

Case 1:13-cv-21570-BB Document 113 Entered on FLSD Docket 05/04/2018 Page 55 of 56
18. Within 6 weeks of the conclusion of the tenth compliance tour, the Independent Monitors shall file with the Court their Tenth Report.
19. Within 7 weeks of the conclusion of the tenth compliance tour, the parties and the Independent Monitor shall file a Notice of Compliance with paragraphs 16-18, above. In the Notice, the parties must also specify, for each Paragraph of the Consent Agreement, which Paragraphs are in full compliance and which are in partial or non-compliance. If any Paragraphs remain in non-compliance or partial compliance, the parties shall propose a F i f t h Summary Action Plan to remedy such non-compliance so that the parties will achieve complete compliance with the Consent Agreement on or before June 1, 2019.
20. On or before June 1, 2019, the parties and the Independent Monitor shall file a joint declaration averring whether complete compliance with the Consent Agreement has been achieved.
21. The items above may be modified or amended by the Court, or without further Court order with the consent of both parties; however, no Final Deadline may be altered without an order by this Court.
22. Nothing in this Order replaces or negates any obligation or requirement of the Consent Agreement.
23. The entry of this Order does not preclude enforcement of the original Consent Agreement.
55

Case 1:13-cv-21570-BB Document 113 Entered on FLSD Docket 05/04/2018 Page 56 of 56 DONE AND ORDERED in Chambers at Miami, Florida, this 3rd day of May, 2018.

Copies to: Counsel of Record

_________________________________ BETH BLOOM UNITED STATES DISTRICT JUDGE

56

 
 Case 1:13-cv-21570-BB Document 171 Entered on FLSD Docket 06/19/2019 Page 1 of 4
UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF FLORIDA
Case No. 13-21570-CIV-BLOOM UNITED STATES OF AMERICA,
Plaintiff, v. MIAMI-DADE COUNTY, THE BOARD OF COUNTY COMMISSIONERS, et al.,
Defendants. ______________________________________/
JOINT DECLARATION REGARDING ACTION STEPS TO ACHIEVE COMPLIANCE WITH THE CONSENT AGREEMENT
On March 29, 2019, the parties informed the Court of an action plan to achieve complete compliance with all paragraphs of the Consent Agreement that remained in partial compliance per the Tenth Monitoring Report following the compliance tour of February 11-14, 2019. As part of the action plan, the parties agreed to submit to the Court a joint declaration on or before June 21, 2019 certifying that the parties have completed all action steps agreed upon in the action plan.
The parties jointly declare that the parties have completed, among other items, the following in preparation for the eleventh compliance tour of September 24-27, 2019: (1) on March 30, 2019, the Monitors submitted comments to the parties on the Defendants’ proposed action steps to achieve compliance with the Consent Agreement paragraphs that remained in partial compliance under Compliance Report #10; (2) on April 5, 2019, the parties and the Monitors conducted a conference call to review and finalize the action steps necessary to achieve complete compliance with the Consent Agreement; (3) on April 11, 2019, Defendants submitted to the United States and Monitors revised actions steps incorporating the feedback offered on April 5,
1

Case 1:13-cv-21570-BB Document 171 Entered on FLSD Docket 06/19/2019 Page 2 of 4

2019; (4) by June 1, 2019, the Defendants completed all agreed upon action steps intended to achieve complete compliance with the Consent Agreement and submitted supporting documents; (5) on June 5, 2019, the Monitors and the United States submitted to the County comments and questions regarding the Defendants’ submission; and (6) on June 11 and 12, 2019, the parties and the Monitors held meet and confer conference calls to review the submission and respond to the Monitors’ and the United States’ comments of June 5, 2019.
Following the eleventh compliance tour of September 24-27, 2019, the parties and the Monitors expect that, if implemented, the actions steps agreed upon and reviewed will result in a finding of complete compliance with all outstanding provisions of the Consent Decree.
As part of the action plan, the parties and the Monitors have also agreed to the following future items and timelines: (1) the Monitors will produce a draft Compliance Report #11 by the week of October 7, 2019; (2) the parties will provide comments on the draft Compliance Report #11 by the week of October 21, 2019; (3) the Monitors will produce the final Compliance Report #11 by the week of October 28, 2019; and (4) the Court will hold a status conference on November 1, 2019.

Dated: June 19, 2019

Respectfully submitted,
FOR THE UNITED STATES
ERIC S. DREIBAND Assistant Attorney General Civil Rights Division
STEVEN H. ROSENBAUM Chief Civil Rights Division
2

Case 1:13-cv-21570-BB Document 171 Entered on FLSD Docket 06/19/2019 Page 3 of 4
Special Litigation Section
LAURA L. COWALL Special Counsel Civil Rights Division Special Litigation Section
By: /s/ William G. Maddox WILLIAM G. MADDOX Special Florida Bar No. A5502483 Trial Attorney U.S. Department of Justice Civil Rights Division Special Litigation Section 950 Pennsylvania Avenue, NW Washington, DC 20530 Tel: (202) 514-6251 Fax: (202) 514-0212 Email: william.maddox@usdoj.gov
FOR THE DEFENDANTS
ABIGAIL PRICE-WILLIAMS Miami-Dade County Attorney Stephen P. Clark Center 111 N.W. 1st Street, Suite 2810 Miami, Florida 33128
By: /s/ Benjamin D. Simon Benjamin D. Simon Florida Bar No. 643378 email: bdsimon@miamidade.gov Assistant County Attorney Phone: (305) 375-5151
3

Case 1:13-cv-21570-BB Document 171 Entered on FLSD Docket 06/19/2019 Page 4 of 4
CERTIFICATE OF SERVICE I hereby certify that on June 19, 2019, I electronically filed the foregoing document with the Clerk of Court using CM/ECF and served all parties listed below.
/s/ William G. Maddox William G. Maddox

SERVICE LIST United States of America v. Miami-Dade County, et al.,

United States District Court, Southern District of Florida Case No. 13-21570-Civ-Bloom

Laura Cowall U.S. Department of Justice Special Litigation Section 601 D Street NW Washington, DC 20004 202-514-1089 Email: laura.cowall@usdoj.gov

William G. Maddox U.S. Department of Justice Special Litigation Section 601 D Street NW Washington, DC 20004 202-514-6251 Email: william.maddox@usdoj.gov

Veronica Vanessa Harrell-James United States Attorney's Office 99 NE 4 Street Miami, FL 33132 305-961-9327 Fax: 305-530-7139 Email: Veronica.Harrell-James@usdoj.gov

Bernard Pastor Benjamin D. Simon Assistant County Attorneys Stephen P. Clark Center, Suite 2810 111 N.W. 1st Street Miami, Florida 33128-1993 Tel: (305) 375-1506 Fax: (305) 375-5611 pastor@miamidade.gov bdsimon@miamidade.gov

4

 
 Case 1:13-cv-21570-BB Document 25 Entered on FLSD Docket 12/17/2014 Page 1 of 4
UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF FLORIDA
Case No. 13-21570-CIV-ZLOCH UNITED STATES OF AMERICA
Plaintiff, v. MIAMI-DADE COUNTY; MIAMI-DADE COUNTY BOARD OF COUNTY COMMISSIONERS; MIAMI-DADE COUNTY PUBLIC HEALTH TRUST,
Defendants. _________________________________________/
JOINT MOTION FOR ENTRY OF STIPULATED ORDER This Court held status conferences in this case on October 21, 2014 and November 17, 2014, during which Plaintiff, United States of America, contended that Defendants are not in compliance with the Consent Agreement that was entered on May 22, 2013. See Final Order Approving and Entering Consent Decree and Dismissing Case without Prejudice [D.E. 9]. Defendants stipulate that they have not yet achieved full compliance with many of the provisions of the Consent Agreement despite the fact that the completion deadlines for these provisions have passed. At Plaintiff’s request, Defendants prepared a plan for coming into compliance with the provisions of the Consent Agreement with which they have not yet complied (“Compliance Plan”) for filing with the Court. At the time of Plaintiff’s request, Defendants had already started drafting a compliance document for their own use in ensuring that they would meet the requirements of the Consent Agreement going forward. The parties jointly move that this Court enter the proposed Stipulated Order, attached hereto as Exhibit 1, establishing the Compliance

Case 1:13-cv-21570-BB Document 25 Entered on FLSD Docket 12/17/2014 Page 2 of 4
Plan as an Order of the Court. The parties stipulate that the relief is compliant with the Prison Litigation Reform Act, 18 U.S.C. § 3626(a).
The United States has reviewed the Compliance Plan, attached hereto as Exhibit 2, and believes, at this point, that the entry of a Stipulated Order is the most expeditious route to moving Defendants towards full compliance with the Agreement. However, if Defendants fail to comply with the terms of the Compliance Plan, the United States reserves the right to seek appropriate sanctions from this Court pursuant to the Consent Agreement.
The parties recognize that the entry of the Stipulated Order will have no effect on the Court’s ability during the Status Conference planned for January, 2015 to investigate Defendants’ efforts to achieve compliance.
CONFERENCE SCHEDULING During the Court’s status conference held on November 17, 2014, the Court and the parties agreed that the next status conference would be held in January, 2015. To this end, the parties respectfully request a Court status conference with all parties on January 27, 2014 at 1:00 pm.
Respectfully submitted,
FOR THE UNITED STATES VANITA GUPTA Acting Assistant Attorney General Civil Rights Division JONATHAN M. SMITH Chief Civil Rights Division Special Litigation Section

Case 1:13-cv-21570-BB Document 25 Entered on FLSD Docket 12/17/2014 Page 3 of 4
LAURA L. COON Special Counsel Civil Rights Division Special Litigation Section
By: s/ Regina Jansen REGINA JANSEN (MD 25161) Senior Trial Attorney Special Florida Bar No. A5501865 CATHERINE BENDOR (DC 442437) Senior Trial Attorney U.S. Department of Justice Civil Rights Division Special Litigation Section 950 Pennsylvania Ave., NW Washington, DC 20530 202-514-6255 202-514-1089 (fax)
FOR THE DEFENDANTS MIAMI-DADE COUNTY
R. A. CUEVAS, JR. Miami-Dade County Attorney Stephen P. Clark Center 111 N.W. 1st Street, Suite 2810 Miami, Florida 33128
By: s/ Bernard Pastor Bernard Pastor Florida Bar No. 0046582 e-mail: pastor@miamidade.gov Benjamin D. Simon Florida Bar No. 643378 email: bdsimon@miamidade.gov Assistant County Attorneys Phone: (305) 375-5151 Fax: (305) 375-563
Counsel for Defendants

Case 1:13-cv-21570-BB Document 25 Entered on FLSD Docket 12/17/2014 Page 4 of 4
CERTIFICATE OF SERVICE
I hereby certify that on December 17, 2014, I electronically filed the foregoing document
with the Clerk of Court using CM/ECF. I also certify that the foregoing document is being
served this day on all counsel of record identified on the Service List below either via the ECF
system or in another authorized manner for those counsel who do not receive Notices of
Electronic Filing via the ECF system.
s/ REGINA JANSEN Regina Jansen Senior Trial Attorney
SERVICE LIST
United States of America v. Miami-Dade County United States District Court, Southern District of Florida
Case No. 13-21570-Civ-Zloch
REGINA JANSEN (MD 25161) Senior Trial Attorney Special Florida Bar No. A5501865 CATHERINE BENDOR (DC 442437) Senior Trial Attorney U.S. Department of Justice Civil Rights Division Special Litigation Section 950 Pennsylvania Ave., NW Washington, DC 20530 202-514-6255 202-514-1089 (fax)
BERNARDO PASTOR BENJAMIN D. SIMON Assistant County Attorneys Stephen P. Clark Center, Suite 2810 111 N.W. 1st Street Miami, Florida 33128-1993 Tel: (305) 375-1506 Fax: (305) 375-5611 pastor@miamidade.gov bdsimon@miamidade.gov

Case 1:13-cv-21570-BB Document 25-1 Entered on FLSD Docket 12/17/2014 Page 1 of 2
UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF FLORIDA
Case No. 13-21570-CIV-ZLOCH UNITED STATES OF AMERICA
Plaintiff, v. MIAMI-DADE COUNTY; MIAMI-DADE COUNTY BOARD OF COUNTY COMMISSIONERS; MIAMI-DADE COUNTY PUBLIC HEALTH TRUST,
Defendants. _________________________________________/
STIPULATED ORDER THIS MATTER comes before the Court on the parties’ “Joint Motion for Entry of Stipulated Order” (Dkt. No. ____), filed on December 17, 2014. In the interests of moving Defendants towards compliance, in an expeditious and efficient manner, with the Consent Agreement (Dkt. No. 9), which was entered as an Order of the Court on May 22, 2013 (Dkt. No. 9), and upon consideration of the current record before the Court, it is hereby
ORDERED that the parties’ “Joint Motion for Entry of Stipulated Order” (Dkt. No. ___) is GRANTED; and it is further
ORDERED that, in granting the parties’ Joint Motion, the Court finds, as agreed by the parties, that
1. Despite having made good faith efforts to comply, Defendants are non-compliant with
the Consent Agreement, entered as an Order of this Court on May 22, 2013; and

Case 1:13-cv-21570-BB Document 25-1 Entered on FLSD Docket 12/17/2014 Page 2 of 2
2. As a result of Defendants’ failure to comply with the Consent Agreement, additional remedial relief is necessary, as set forth below, and
3. The additional relief set forth below complies in all respects with the provisions of 18 U.S.C. § 3626(a). The relief is narrowly drawn, extends no further than necessary to correct violations of federal rights agreed to by the parties with the entry of the Consent Agreement, is the least intrusive means necessary to correct these violations, and will not have an adverse impact on public safety or the operation of the criminal justice system.
As stipulated by the parties, it is further ORDERED that the additional relief will consist of the following: The “Compliance Plan,” agreed upon by both Defendants and Plaintiffs and submitted to the Court along with the parties’ Joint Motion on December 17, 2014, including dates by which Defendants will complete the requirements of the Consent Agreement with which they currently remain out of compliance, is hereby entered as an Order of the Court, subject to judicial enforcement. It is further ORDERED that: 4. The entry of this Stipulated Order does not preclude enforcement of the original Consent Agreement.
SO ORDERED.

Date:

_ ___ WILLIAM J. ZLOCH UNITED STATES DISTRICT JUDGE
2

Case 1:13-cv-21570-BB Document 25-2 Entered on FLSD Docket 12/17/2014 Page 1 of 11
Consent Agreement Summary Action Plan - U.S. v. Miami-Dade County, et. al. (Case No. 13-21570-CIV-ZLOCH)

CONSENT SUB- PROVISION TITLE AGREEMENT SECT.
SECTION

RESPONSIBLE PERSONS

AUDIT CYCLE

POLICY NUMBER

POLICY FOR PROVISION

DATE POLICY TO MONITOR

DATE POLICY FROM MONITOR

DATE LESSON PLAN TO MONITOR

DATE TRAINING
START

DATE PROJECTED TRAINING COMPLIANC COMPLETE E DATE

Medical Director

Associate Medical

III.A

1

Intake Screening

Director of Behavioral Health, HSA TGK,

05/11/15

CHS-033

Intake and Booking Policy

1/31/15

2/10/15

3/3/15

3/13/15

4/30/15

5/1/15

Associate Director of

Quality & Safety

Medical Director,

CHS-033

Intake and Booking Policy

1/31/15

2/10/15

3/3/15

3/13/15

4/30/15

5/1/16

III.A

2

Health Assessments

Associate Medical Director of Behavioral 05/31/16
Health, facility

CHS-036

Initial Health Assessment Policy

3/31/15

4/10/15

5/1/15

5/11/15

6/29/15

5/1/16

H.S.A.(s)

CHS-058

Basic Mental Health Services Policy

3/31/15

4/10/15

5/1/15

5/11/15

6/29/15

5/1/16

Sick Call Non-

III.A

3

Access to Medical and Mental Health
Care

Medical Director, Associate Medical Director of Behavioral 11/30/16
Health, facility H.S.A.(s)

CHS-039

Emergency Health Care Request and Services Policy

CHS-011

Grievance Mechanism for Health Complaints

4/30/15 3/31/15

5/10/15 4/10/15

5/31/15 5/1/15

6/10/15 5/11/15

7/29/15 6/29/15

11/1/16 11/1/16

Policy

Transitional and Stable Housing Division Chiefs Facility Supervisors

DSOP 14-001

Inmate Injury/Illness Request for Health Care Services

3/6/15

4/3/15

5/20/15

6/19/15

6/30/16

11/1/16

III.A

3

Access to Medical and Mental Health
Care

Fiscal Resources Division Chief
Policy and Planning Bureau Commander
Program Services

11/30/16

DSOP 14-008

Healthcare Services

3/6/15

4/3/15

5/20/14

6/19/15

6/30/16

11/1/16

Division Chief

Reentry Program Services Bureau
Commander

DSOP Inmate Compliant/ 15-001 Grievance Process

2/20/15

3/20/15

4/29/15

5/29/15

7/31/15

11/1/16

AUDIT CYCLE COLOR KEY: GREEN - MAY 11, 2015 AUDIT YELLOW - NOVEMBER 30, 2015

ORANGE - MAY 31, 2016 BLUE - NOVEMBER 30, 2016

PAGE : 1

Case 1:13-cv-21570-BB Document 25-2 Entered on FLSD Docket 12/17/2014 Page 2 of 11
Consent Agreement Summary Action Plan - U.S. v. Miami-Dade County, et. al. (Case No. 13-21570-CIV-ZLOCH)

CONSENT SUB- PROVISION TITLE AGREEMENT SECT.
SECTION

RESPONSIBLE PERSONS

AUDIT CYCLE

POLICY NUMBER

POLICY FOR PROVISION

DATE POLICY TO MONITOR

DATE POLICY FROM MONITOR

DATE LESSON PLAN TO MONITOR

DATE TRAINING
START

DATE PROJECTED TRAINING COMPLIANC COMPLETE E DATE

III. A

Medical Director,

CHS-026

Medication Services Policy

12/31/15

Associate Medical

4

Medication Director of Behavioral

Administration

Health, facility 05/31/16

CHS-033

Intake and Booking Policy

1/31/15

and Management H.S.A.(s), Associate

Director of Quality & Safety

CHS-058-B (Addendum to CHS-58)

Behavioral Health Level of Care Policy

1/31/15

1/10/16 2/10/15 2/10/15

1/31/16 3/3/15 3/3/15

2/10/16 3/13/15 3/13/15

4/30/16 4/30/15 4/30/15

5/1/16 5/1/16 5/1/16

III.A

5

Record Keeping

Facility H.S.A.(s), Director HIMD

05/31/16

CHS-067

Management of Health Record Policy

1/31/15

2/10/15

3/3/15

3/13/15

4/30/16

5/1/16

Medical Director,

III. A

6

Discharge Planning

Associate Medical Director of Behavioral

11/30/15

CHS-049

Discharge Planning Policy

1/31/15

2/10/15

3/3/15

3/13/15

10/31/15

11/1/15

Health

Medical Director,

III.A

7

Mortality and Morbidity Reviews

Associate Medical

Director of Behavioral Health, Associate

11/30/15

Director of Quality &

NEW

Mortality and Morbidity Policy

Safety

6/30/15

7/10/15

7/31/15

8/10/15

10/30/15

11/1/15

AUDIT CYCLE COLOR KEY: GREEN - MAY 11, 2015 AUDIT YELLOW - NOVEMBER 30, 2015

ORANGE - MAY 31, 2016 BLUE - NOVEMBER 30, 2016

PAGE : 2

Case 1:13-cv-21570-BB Document 25-2 Entered on FLSD Docket 12/17/2014 Page 3 of 11
Consent Agreement Summary Action Plan - U.S. v. Miami-Dade County, et. al. (Case No. 13-21570-CIV-ZLOCH)

CONSENT SUB- PROVISION TITLE AGREEMENT SECT.
SECTION

RESPONSIBLE PERSONS

AUDIT CYCLE

POLICY NUMBER

POLICY FOR PROVISION

DATE POLICY TO MONITOR

DATE POLICY FROM MONITOR

DATE LESSON PLAN TO MONITOR

DATE TRAINING
START

DATE PROJECTED TRAINING COMPLIANC COMPLETE E DATE

Fiscal Resources

Division Chief

Policy and Planning

Bureau Commander

Support Services

Assistant Director

Special Services

Division Chief

Compliance

Inspections and

III.A

7

Mortality and Morbidity Reviews

Accreditation Bureau Captain
Fiscal Resources Division Chief

11/30/15

DSOP 14-008

Healthcare Services

3/6/15

4/3/15

5/20/15

6/19/15

7/31/15

11/1/15

Policy and Planning

Bureau Commander

Support Services

Assistant Director

Special Services

Division Chief

Compliance

Inspections and

Accreditation Bureau

Captain

III. B

CHS-033

Intake and Booking Policy

1/31/15

1

Acute Care and Detoxification

Medical Director 11/30/16

CHS-060

Response to Withdrawal Policy

2/28/15

2/10/15 3/10/15

3/3/15 3/31/15

3/13/15 4/10/15

4/30/15 5/30/15

11/1/16 11/1/16

AUDIT CYCLE COLOR KEY: GREEN - MAY 11, 2015 AUDIT YELLOW - NOVEMBER 30, 2015

ORANGE - MAY 31, 2016 BLUE - NOVEMBER 30, 2016

PAGE : 3

Case 1:13-cv-21570-BB Document 25-2 Entered on FLSD Docket 12/17/2014 Page 4 of 11
Consent Agreement Summary Action Plan - U.S. v. Miami-Dade County, et. al. (Case No. 13-21570-CIV-ZLOCH)

CONSENT SUB- PROVISION TITLE AGREEMENT SECT.
SECTION

RESPONSIBLE PERSONS

AUDIT CYCLE

POLICY NUMBER

POLICY FOR PROVISION

DATE POLICY TO MONITOR

DATE POLICY FROM MONITOR

DATE LESSON PLAN TO MONITOR

DATE TRAINING
START

DATE PROJECTED TRAINING COMPLIANC COMPLETE E DATE

Transitional and

Stable Housing

Division Chiefs

Facility Supervisors

III.B

1

Acute Care and Detoxification

Fiscal Resources Division Chief
Policy and Planning Bureau Commander
Program Services

11/30/16

DSOP 14-001

Inmate Injury and Illness - Request for Health Care Services

3/6/15

4/3/15

5/20/15

6/19/15

6/30/16

11/1/16

Division Chief

Reentry Program

Services Bureau

Commander

III. B III.B III.B

Medical Director,

2

Chronic Care

Associate Medical Director of Behavioral

05/31/16

CHS-055

Chronic Disease Services Policy

Health

12/31/15

1/10/16

Medical Director, Associate Medical

CHS-013-A (Addendum to CHS-013)

Reporting Abuse Policy

1/31/15

3

Use of Force Care

Director of Behavioral Health, Associate

11/30/16

CHS-068

Use of Clinical Restraint Policy

Director of Quality &

1/31/15

Safety

NEW

Use of Force Incident Care Policy

2/28/15

Transitional and

3

Use of Force Care

Stable Housing Division Chiefs

11/30/16

DSOP Response to 11-041 Resistance

Facility Supervisors

1/30/15

2/10/15 2/10/15 3/10/15 3/1/15

1/31/16
3/3/15 3/3/15 3/31/15 4/15/15

2/10/16
3/13/15 3/13/15 4/10/15 5/15/15

4/30/16
4/30/15 5/1/15 5/30/15 6/30/16

5/1/16
11/1/16 11/1/16 11/1/16 11/1/16

AUDIT CYCLE COLOR KEY: GREEN - MAY 11, 2015 AUDIT YELLOW - NOVEMBER 30, 2015

ORANGE - MAY 31, 2016 BLUE - NOVEMBER 30, 2016

PAGE : 4

Case 1:13-cv-21570-BB Document 25-2 Entered on FLSD Docket 12/17/2014 Page 5 of 11
Consent Agreement Summary Action Plan - U.S. v. Miami-Dade County, et. al. (Case No. 13-21570-CIV-ZLOCH)

CONSENT SUB- PROVISION TITLE AGREEMENT SECT.
SECTION

RESPONSIBLE PERSONS

AUDIT CYCLE

POLICY NUMBER

POLICY FOR PROVISION

DATE POLICY TO MONITOR

DATE POLICY FROM MONITOR

DATE LESSON PLAN TO MONITOR

DATE TRAINING
START

DATE PROJECTED TRAINING COMPLIANC COMPLETE E DATE

CHS-033

Intake and Booking Policy

1/31/15

2/10/15

3/3/15

3/13/15

4/30/15

5/1/16

Medical Director,

III.C

1

Referral Process and Access to
Care

Behavioral Health Directors, facility
H.S.A.(s), & Associate Director of

05/31/16

CHS-039

Sick Call NonEmergency Health Care Request and Services Policy

4/30/15

5/10/15

5/31/15

6/10/15

7/29/15

5/1/16

Quality & Safety

CHS-058

Basic Mental Health Services Policy

3/31/15

4/10/15

5/1/15

5/11/15

6/29/15

5/1/16

CHS-033

Intake and Booking Policy

1/31/15

2/10/15

3/3/15

3/13/15

4/30/15

5/1/15

III.C

2

Mental Health Treatment

Associate Medical Director of Behavioral 11/30/15
Health

CHS-058-A (Addendum to CHS-058)

Interdisciplinary Team Policy

2/28/15

3/10/15

3/31/15

4/10/15

5/30/15

5/1/15

CHS-058-B (Addendum to CHS-058)

Behavioral Health Level of Care Policy

1/31/15

2/10/15

3/3/15

3/13/15

4/30/15

5/1/15

CHS-033

Intake and Booking Policy

1/31/15

2/10/15

3/3/15

3/13/15

4/30/15

5/1/15

CHS-034

Rapid Response Policy

2/28/15

3/10/15

3/31/15

4/10/15

4/30/15

5/1/15

III.C

3

Suicide

Associate Medical

Assessment and Director of Behavioral 05/11/15

Prevention

Health

CHS-058-A (Addendum to CHS-058)

Interdisciplinary Team Policy

2/28/15

3/10/15

3/31/15

4/10/15

4/30/15

5/1/15

CHS-058-B (Addendum to CHS-058)

Behavioral Health Level of Care Policy

1/31/15

2/10/15

3/3/15

3/13/15

4/30/15

5/1/15

CHS-059

Suicide Prevention Plan Policy

1/31/15

2/10/15

3/3/15

3/13/15

4/30/15

5/1/15

AUDIT CYCLE COLOR KEY: GREEN - MAY 11, 2015 AUDIT YELLOW - NOVEMBER 30, 2015

ORANGE - MAY 31, 2016 BLUE - NOVEMBER 30, 2016

PAGE : 5

Case 1:13-cv-21570-BB Document 25-2 Entered on FLSD Docket 12/17/2014 Page 6 of 11
Consent Agreement Summary Action Plan - U.S. v. Miami-Dade County, et. al. (Case No. 13-21570-CIV-ZLOCH)

CONSENT SUB- PROVISION TITLE AGREEMENT SECT.
SECTION

RESPONSIBLE PERSONS

AUDIT CYCLE

POLICY NUMBER

POLICY FOR PROVISION

DATE POLICY TO MONITOR

DATE POLICY FROM MONITOR

DATE LESSON PLAN TO MONITOR

DATE TRAINING
START

DATE PROJECTED TRAINING COMPLIANC COMPLETE E DATE

Transitional and

Stable Housing Division Chiefs Facility Supervisors Fiscal Resources

DSOP 12-003

Inmate Suicide Prevention and Response Plan

2/13/15

3/13/15

4/29/15

5/29/15

7/31/15

11/1/15

Suicide

Division Chief

III.C

3 Assessment and Policy and Planning 11/30/15

Prevention Bureau Commander

Administrative Services Division
Chief Training Bureau

DSOP 12-002

Inmate Administrative & Disciplinary Confinement

2/20/15

3/20/15

5/6/15

6/5/15

7/31/15

11/1/15

Captain

Associate Medical

Review of Director of Behavioral

Communication on

III.C

4

Disciplinary

Health, MDCR, 11/30/15 CHS-008 Patient Health

6/30/15

7/10/15

7/31/15

8/10/15

9/30/15

11/1/15

Measures Associate Director of

Needs Policy

Quality and Safety

Fiscal Resources

Division Chief

Policy and Planning

III.C

4

Review of Disciplinary Measures

Bureau Commander Program Services 11/30/15 Division Chief

DSOP Inmate Disciplinary 16-001 Procedures

2/20/15

3/20/15

5/6/15

6/5/15

8/30/15

11/1/15

Reentry Program

Services Bureau

Commander

AUDIT CYCLE COLOR KEY: GREEN - MAY 11, 2015 AUDIT YELLOW - NOVEMBER 30, 2015

ORANGE - MAY 31, 2016 BLUE - NOVEMBER 30, 2016

PAGE : 6

Case 1:13-cv-21570-BB Document 25-2 Entered on FLSD Docket 12/17/2014 Page 7 of 11
Consent Agreement Summary Action Plan - U.S. v. Miami-Dade County, et. al. (Case No. 13-21570-CIV-ZLOCH)

CONSENT SUB- PROVISION TITLE AGREEMENT SECT.
SECTION

RESPONSIBLE PERSONS

AUDIT CYCLE

POLICY NUMBER

POLICY FOR PROVISION

DATE POLICY TO MONITOR

DATE POLICY FROM MONITOR

DATE LESSON PLAN TO MONITOR

DATE TRAINING
START

DATE PROJECTED TRAINING COMPLIANC COMPLETE E DATE

CHS-008

Communication on Patient Health Needs Policy

6/30/15

7/10/15

7/31/15

8/10/15

9/30/15

11/1/15

III.C

5

Mental Health Care Housing

Medical Director, Associate Medical Director of Behavioral 11/30/15 Health, facility H.S.A

CHS-058-A (Addendum to CHS-058)

Interdisciplinary Team Policy

Suicidal Precaution

2/28/15

3/10/15

3/31/15

4/10/15

4/30/15

5/1/15

(s)

Inmates Leaving

CHS-059 B their Cells for

(Addendum Recreation,

4/30/15

5/10/15

5/31/15

6/10/15

7/29/15

5/1/16

to CHS-059) Showers, Mental

Health Treatment

Addendum

Construction Management Division
Chief

DSOP 12-003

Inmate Suicide Prevention and Response Plan

2/13/15

3/13/15

4/29/15

5/29/15

7/31/15

11/1/15

Facilities

III.C

5

Mental Health Care Housing

Management Bureau Commander
Fiscal Resources Division Chief
Policy and Planning

11/30/15

DSOP 4-018

Quality Assurance and Improvement Procedures

2/20/15

N/A - Mental Health

3/20/15

N/A

N/A

N/A

11/1/15

Bureau Commander

Treatment Center

Transitional and

scheduled to open

Stable Housing

N/A

December 2014 to

N/A

N/A

N/A

9/2014

12/2014

11/1/15

Division Chiefs

house Acute

Facility Supervisors

psychiatric male and

female inmates.

III.C

6

Custodial Segregation

Associate Medical Director of Behavioral 11/30/15
Health

CHS-044

Segregated Inmate Policy

6/30/15

7/10/15

7/31/15

8/10/15

9/30/15

11/1/15

AUDIT CYCLE COLOR KEY: GREEN - MAY 11, 2015 AUDIT YELLOW - NOVEMBER 30, 2015

ORANGE - MAY 31, 2016 BLUE - NOVEMBER 30, 2016

PAGE : 7

Case 1:13-cv-21570-BB Document 25-2 Entered on FLSD Docket 12/17/2014 Page 8 of 11
Consent Agreement Summary Action Plan - U.S. v. Miami-Dade County, et. al. (Case No. 13-21570-CIV-ZLOCH)

CONSENT SUB- PROVISION TITLE AGREEMENT SECT.
SECTION

RESPONSIBLE PERSONS

AUDIT CYCLE

Division Chief

Policy and Planning

Bureau Commander

Transitional and

Stable Housing

Division Chiefs

Facility Supervisors

III.C

6

Custodial Segregation

Administrative Services Division
Chief

11/30/15

Training Bureau

Commander

Program Services

Division Chief

Reentry Program

Services Bureau

Commander

POLICY NUMBER

POLICY FOR PROVISION

DATE POLICY TO MONITOR

DSOP 12-002

Inmate Administrative & Disciplinary Confinement

2/20/15

DSOP 12-005

Recognizing and Supervising Mentally Ill Inmates

2/13/15

DSOP 4-018

Quality Assurance and Improvement Procedures

2/20/15

DATE POLICY FROM MONITOR
3/20/15
3/13/15
3/20/15

DATE LESSON PLAN TO MONITOR
5/6/15
4/29/15
N/A

DATE TRAINING
START

DATE PROJECTED TRAINING COMPLIANC COMPLETE E DATE

6/5/15

7/31/15

11/1/15

5/29/15

7/31/15

11/1/15

N/A

N/A

11/1/15

Medical Director,

Associate Medical

III.C

7

Staffing and Training

Director of Behavioral Health, facility H.S.A

11/30/15

N/A

N/A

N/A

N/A

N/A

N/A

N/A

11/1/15

(s), Education

Director

AUDIT CYCLE COLOR KEY: GREEN - MAY 11, 2015 AUDIT YELLOW - NOVEMBER 30, 2015

ORANGE - MAY 31, 2016 BLUE - NOVEMBER 30, 2016

PAGE : 8

Case 1:13-cv-21570-BB Document 25-2 Entered on FLSD Docket 12/17/2014 Page 9 of 11
Consent Agreement Summary Action Plan - U.S. v. Miami-Dade County, et. al. (Case No. 13-21570-CIV-ZLOCH)

CONSENT SUB- PROVISION TITLE AGREEMENT SECT.
SECTION

RESPONSIBLE PERSONS

AUDIT CYCLE

POLICY NUMBER

POLICY FOR PROVISION

DATE POLICY TO MONITOR

DATE POLICY FROM MONITOR

DATE LESSON PLAN TO MONITOR

DATE TRAINING
START

DATE PROJECTED TRAINING COMPLIANC COMPLETE E DATE

MDCR Director

Management

Services Assistant

Director and Support

Services Assistant

Director

Administrative

Services Division

Chief

Training Bureau

III.C

7

Staffing and Training

Commander Transitional and Stable Housing Division Chiefs

11/30/15

DSOP 4-018

Quality Assurance and Improvement Procedures

2/20/15

3/20/15

N/A

N/A

N/A

11/1/15

Facility Supervisors

Program Services

Division Chief

Reentry Program

Services Bureau

Commander

Fiscal Resources

Division Chief

Policy and Planning

Bureau Commander

III.C

8

Suicide Prevention
Training

Associate Medical

Director of Behavioral Health and Education

11/30/15

Director

N/A

N/A

N/A

N/A

N/A

N/A

N/A

11/1/15

Administrative

Services Division

Chief

III.C

8

Suicide Prevention
Training

Training Bureau Commander
Fiscal Resources

11/30/15

DSOP 12-003

Inmate Suicide Prevention and Response Plan

Division Chief

Policy and Planning

Bureau Commander

N/A

N/A

N/A

7/3/2013

7/31/15

11/1/15

AUDIT CYCLE COLOR KEY: GREEN - MAY 11, 2015 AUDIT YELLOW - NOVEMBER 30, 2015

ORANGE - MAY 31, 2016 BLUE - NOVEMBER 30, 2016

PAGE : 9

Case 1:13-cv-21570-BB Document 25-2 Entered on FLSD Docket 12/17/2014 Page 10 of 11
Consent Agreement Summary Action Plan - U.S. v. Miami-Dade County, et. al. (Case No. 13-21570-CIV-ZLOCH)

CONSENT SUB- PROVISION TITLE AGREEMENT SECT.
SECTION

RESPONSIBLE PERSONS

AUDIT CYCLE

POLICY NUMBER

POLICY FOR PROVISION

DATE POLICY TO MONITOR

DATE POLICY FROM MONITOR

DATE LESSON PLAN TO MONITOR

DATE TRAINING
START

DATE PROJECTED TRAINING COMPLIANC COMPLETE E DATE

III.C

9

Risk Management

Associate Director of Quality & Safety, Director of Risk Management

05/11/15

CHS004 A (Addendum to CHS-004)

Mental Health Review Committee Policy

2/28/15

3/10/15

3/31/15

4/10/15

5/30/15

5/1/15

Medical Director,

Associate Medical

Director of Behavioral

Health, facility

III.D

1

Self Audits

H.S.A.(s), &

05/11/15

N/A

N/A

N/A

N/A

N/A

N/A

N/A

5/1/15

Associate Director of

Quality & Safety,

Quality Improvement

Analyst

III.D

1

Self Audits

MDCR Director Medical Mental Health Liaison

05/11/15

DSOP 4-018

Quality Assurance and Improvement Procedures

2/20/15

3/20/15

N/A

N/A

N/A

5/1/15

Director of CHS,

Medical Director

Behavioral Health

III.D

2

Bi Annual Reports

Directors, facility

H.S.A.(s), &

05/11/15

Associate Director of

N/A

N/A

N/A

N/A

N/A

N/A

N/A

5/1/15

Quality & Safety

Quality Improvement

Analyst

III.D

2

Bi Annual Reports

Special Services Division Chief SIAB Captain

05/11/15

DSOP 4-018

Quality Assurance and Improvement Procedures

2/20/15

3/20/15

N/A

N/A

N/A

5/1/15

AUDIT CYCLE COLOR KEY: GREEN - MAY 11, 2015 AUDIT YELLOW - NOVEMBER 30, 2015

ORANGE - MAY 31, 2016 BLUE - NOVEMBER 30, 2016

PAGE : 10

Case 1:13-cv-21570-BB Document 25-2 Entered on FLSD Docket 12/17/2014 Page 11 of 11
Consent Agreement Summary Action Plan - U.S. v. Miami-Dade County, et. al. (Case No. 13-21570-CIV-ZLOCH)

CONSENT SUB- PROVISION TITLE AGREEMENT SECT.
SECTION

RESPONSIBLE PERSONS

AUDIT CYCLE

POLICY NUMBER

POLICY FOR PROVISION

DATE POLICY TO MONITOR

DATE POLICY FROM MONITOR

DATE LESSON PLAN TO MONITOR

DATE TRAINING
START

DATE PROJECTED TRAINING COMPLIANC COMPLETE E DATE

Fiscal Resources

Division Chief

Policy and Planning

IV.A

Compliance and Bureau Commander

Quality

Administrative 05/11/15

Improvement Services Division

DSOP 4-018

Quality Assurance and Improvement Procedures

2/20/15

3/20/15

N/A

N/A

N/A

5/1/15

Chief

Training Bureau

Commander

IV.C

Compliance and Quality
Improvement

Fiscal Resources Division Chief
Policy and Planning Bureau Commander

05/11/15

DSOP 4-018

Quality Assurance and Improvement Procedures

2/20/15

3/20/15

N/A

N/A

N/A

5/1/15

AUDIT CYCLE COLOR KEY: GREEN - MAY 11, 2015 AUDIT YELLOW - NOVEMBER 30, 2015

ORANGE - MAY 31, 2016 BLUE - NOVEMBER 30, 2016

PAGE : 11

 
 u.s. Department of Justice
Civil Rights Division

Office of the Assistant Attorney General

Washington, D.C. 20530

The Honorable Carlos A. Gimenez Mayor, Miami-Dade County 
 Stephen P. Clark Center 
 111 Northwest First Street, 29th Floor 
 Miami, FL 33128 


'AUG 24 2011

Re: lnvestigation of the Miami-Dade County Jail
Dear Mayor Gimenez:
The Department of Justice's Civil Rights Division has concluded its investigation of conditions at the corrections facilities operated by the Miami-Dade County Corrections and Rehabilitation Department ("MDCR"). This letter provides MDCR with our findings.
On April 2, 2008, we notified officials of Miami-Dade Calmty ("County") of our intent to investigate the MDCR corrections facilities pursuant to the Civil Rights oflnstitutionalized Persons Act ("CRIPA"), 42 U.S.C.§ 1997. CRIPA gives the Department of Justice authority to seek a remedy for a pattern or practice of conduct that violates the constihltional rights of prisoners in adult detention and corrections facilities. CRIPA requires that we advise you of the findings of our investigation, the facts supporting them, and the minimum remedial steps that are necessary to address the de-£iciencies we have identified. 42 U.S.C. § 1997b.
I. SUMMARY OF FINDINGS AND CONCLUSIONS
We conclude that that there is a pattern and practice of constitutional violations in the correctional facilities operated by MDCR, and as a result of the unconstitutional operation of the Jail, prisoners suffer grievous harm, including death. As described more fully below, our specific findings include:
• MDCR is deliberately indifferent to the suicide risks and serious mental health needs of its prisoners. At least eight prisoners have committed suicide since 2007, and thousands of prisoners have suffered from inadequate mental health crisis services.
• MDCR fails to provide adequate acute care, chronic care, outpatient treatment, and

-2­
discharge services to prisoners with mental illness. Instead, MDCR inappropriately relies on medication management that fails to consistently incorporate diagnoses or treatment plans, even for prisoners with the most serious mental illnesses.
• MDCR is deliberately indifferent to the serious medical needs of prisoners including access to care for acute medical needs, management of chronic health problems, and record keeping and quality assurance. Prisoners wait weeks and even months to receive consultations for care from HIV, cardiology, and neurology specialists.
• MDCR fails to provide adequate intake screening, initial health assessments and acute care for newly incarcerated prisoners. Since 2008, at least five prisoners have died from MDCR's failure to identify and treat prisoners withdrawing from drugs or alcohol.
• MDCR is engaged in a pattern or practice of using excessive force against prisoners. MDCR corrections officers openly engage in abusive and retaliatory conduct, which frequently causes injuries to prisoners.
• MDCR is deliberately indifferent to the serious risk of harm to prisoners posed by fellow prisoners. Corrections officers fail to supervise prisoners, particularly prisoners known to be violent, resulting in ongoing harm and serious risk of harm. There is significant evidence to be concerned that the Jail fails to take reasonable steps to protect prisoners from sexual assault.
• The conditions of confinement within the Jail expose prisoners to an umeasonable risk of hann from inadequate fire and life safety systems and environmental health and sanitation deficiencies, including umeasonable risk of infection from overcrowding and inadequate laundry, housekeeping, and pest controL
II. INVESTIGATION
On June 9-13, 2008, June 16-20,2008, and April 7-8,2009, we inspected the facility together with consultants in the fields of corrections, custodial medical and mental health care, suicide prevention, and environmental health and sanitation. We interviewed administrative and corrections staff, medical and mental health care providers, prisoners, and members of the Miami-Dade community. Our investigation also included the review of policies and procedures, incident reports, grievances, medical records, and use of force records and investigations, including documents provided by the County subsequent to our on-site visits. In keeping with our pledge of transparency and providing technical assistance where appropriate, our consultants conveyed their preliminary impressions and concerns to County officials and the MDCR command staff at the conclusion of our tours.
We are grateful to MDCR Director Timothy P. Ryan and his entire stafffor the assistance and cooperation extended to us. We found the MDCR officials helpful and professional throughout the course of the investigation. MDCR provided us with access to records and personnel, and responded to our requests, before, during, and after our on-site visits, in a transparent and forthcoming manner. We also appreciate MDCR's receptiveness to our consultants' on-site recommendations.

-j ­
III. BACKGROUND
The corrections facilities operated by MDCR (collectively "Miami-Dade County Jail" or "the Jail") hold an average of7,000 prisoners in a complex of buildings spread out across the county, making it the nation's eighth largest jail. The Jail has six corrections facilities: the Pre­ Trial Detention Center ("PTDC"); the Women's Detention Center ("WDC"); the Training and Treatment Center ("Stockade"); the Turner Guilford Knight Correctional Center ("TGK"); and the Metro West Detention Center ("MWDC"). Additionally, MDCR operates a boot camp program, with a housing facility adjacent to TGK ("Boot Camp").
The prisoners incarcerated in the Jail are awaiting trial or serving sentences of less than one year. Two of the five facilities, PTDC and TGK, are booking facilities. These two facilities process and house all classifications of prisoners. PTDC, the County's main jail building located across the street from the County Courthouse, has approximately 1,700 beds for male prisoners, and TGK has 1,300 beds for male, female, and juvenile prisoners. WDC has 375 beds and only houses female prisoners. The Stockade, the oldest MDCR facility, has approximately 1,200 beds for adult males. The largest of the five facilities is the MWDC, which is located approximately 16 miles west ofPTDC and downtown Miami, and has approximately 3,000 beds for male prisoners of all classifications.
Health care, including mental health care, is provided to prisoners on-site by Correctional Health Services ("CHS"), a division of the Jackson Health System of Miami-Dade County (a community healthcare system consisting of Jackson Memorial Hospital, primary care centers, health clinics, and rehabilitation, nursing, and mental health facilities). Additionally, the Jackson Memorial Hospital, the largest of the medical centers operated by the Jackson Health System, maintains a specialized unit known as "Ward D" to provide emergency hospital care to MDCR prisoners in a secure enviromnent staffed by MDCR corrections officers. Each month, CHS staff members see several thousand prisoner-patients, several hundred of whom require physician­ level care, and approximately 75 prisoners who need inpatient care at Ward D. Moreover, of the approximately 7,000 MDCR prisoners, on average 1,000 suffer from mental illness, making the Jail one of the largest psychiatric facilities in Florida.
IV. FINDINGS
A. MDCR PROVIDES CONSTITUTIONALLY INADEQUATE MEDICAL AND MENTAL HEALTH CARE.
Jail prisoners have a constitutional right to be protected from harm, Farmer v. Brennan, 511 U.S. 825, 832 (1994), and serious risk ofharrn, Helling v. McIZinney, 509 U.S. 25, 33-35 (1993). Whether that hann takes the form of illness, injury, or inhumane conditions, jailors cannot display "deliberate indifference" to a prisoner's serious needs. Wilson v. Seiter, 501 U.S. 294,302-303 (1991) (citing Estelle v. Gamble, 429 U.S. 97, 104-106 (1976)). MDCR is deliberately indifferent to the risk of suicide and the serious medical and mental health needs of prisoners. As illustrated below, the constitutional deprivations uncovered by our investigation are not the result of isolated incidents or the misconduct of a few MDCR staff members. Instead,

- 4 -


MDCR's deliberate indifference to protecting the Jail's prisoners from harm is a systemic failure.

1. MDCR is deliberately indifferent to prisoners' suicide risks and serious mental health needs.

Our investigation revealed that MDCR is deliberately indifferent to the suicide risks and serious mental health needs of prisoners who present symptoms of suicidal behavior or serious mental illness. See Campbell v. Sikes, 169 FJd 1353, 1362 (lIth Cir. 1999) (noting that a failure to provide proper medical care, includes a psychiatrist providing grossly inadequate medical care); Steele v. Shah, 87 F.3d 1266, 1269 (11th Cir. 1996) (same); Harris v. Thigpen, 941 F.2d 1495, 1505 (11 th Cir. 1991) (noting that "this court has acknowledged that the deliberate indifference standard also applies to inmates' psychiatric or mental health needs."). Furthermore, jail officials have a constitutional obligation to act when there is a strong likelihood that a prisoner will engage in self-injurious behavior, including suicide. See Snow ex reI. Snow v. City of Citronelle, Ala., 420 F.3d 1262, 1268-69 (11 th Cir. 2005) (noting defendants are deliberately indifferent if there is a strong likelihood that an inmate would commit suicide). In jail suicide cases alleging constitutional violations, "the plaintiff must show that the jail official displayed 'deliberate indifference' to the prisoner's taking of his own life." Cook ex. reI. Tessier v. Sheriff of Monroe County, 402 F.3d 1092, 1115 (11 th Cir. 2005) (quoting Cagle v. Sutherland, 334 FJd 980, 986 (11th Cir. 2003». Deliberate indifference is demonstrated by: "(1) subjective knowledge of a risk of serious harm; (2) disregard of.. . that risk; (3) by conduct that is more than mere negligence." Cook, 402 F.3d at 1115 (quoting Cagle at 986).

We observed systemic failures to address serious risks of prisoner suicide and to treat prisoners' serious mental health needs. Thousands of prisoners with serious mental illness have suffered in the Jail in recent years without adequate care. Instead, medication management is the only treatment available, and it is plagued with errors. The Jail does not provide adequate mental health crisis services, including access to: beds in a health care setting for short-term treatment and acute care (an inpatient level of care); chronic care andlor a special needs unit for prisoners who cannot function in the general population; outpatient treatment for prisoners in the general population; or services for prisoners in need of further treatment at the time of transfer to another institution or discharge to the community.

a. MDCR is deliberately indifferent to prisoners who pose a significant risk of suicide and self-harm.

Eight Miami-Dade County prisoners, including one in March 2011, committed suicide in the past four years, illustrating the harm resulting from MDCR's failure to take reasonable preventative measures.

•

The Death ofA.N: [ On March 26, 2011, at apprOXilllately 9:45 p.m., A.N., a 24­

year-old male, committed suicide by asphyxiation with a bed sheet tied around his

neck. A.N. was booked on August 3, 2010. At v81ious times during his

incarceration at MDCR, he was evaluated by mental health providers as suicidal.

To protect the identity of prisoners, we use coded initials throughout this letter.

-) -

A.N. was housed in the general psychiatric unit. On February 4,2011, less than one month prior to his death, A.N. was evaluated as suicidal and placed in the suicide precaution housing unit. He was subsequently returned to the general psychiatric unit, where he reportedly committed suicide on March 26, 2011.

•

The Death ofA.G.: On September 16, 2010, at approximately 6:30 p.m., A.G., a

33-year-old male was found by a correctional officer hanging in his cell. A.G.

was booked on September 10, 2010. The next day, the Jail transported him to the

emergency room, noting him to be combative and psychotic. A.G. returned later

that day, was seen by a mental health provider, and subsequently cleared for

general population in medium level custody on September 14, 2010. There, A.G.

reportedly committed suicide on September 16,2010 by affixing a sheet to an

upper comer portion ofthe cell and asphyxiating himself.

•

The Death ofA.H: On February 11, 2010, A.H., a 40-year-old female was fouod

by a corrections officer hanging by a bed sheet. A.H. was booked into the

Women's Detention Center on February 9,2010. She was reportedly seen by a

meatal health care provider and cleared for general population. Subsequently,

A.H. was sent to administrative segregation under medical observation. There,

A.H. reportedly committed suicide on February 11, 2010 by affixing a sheet to a

vent and asphyxiating herself.

•

The Death ofA.l.: On May 20,2009, at approximately 4:45 a.m., A.I., a 34-year­

old male, was found by a correctional officer hanging from a ceiling light fixture

by a bed sheet. A.I. was subsequeatly transported to the hospital and pronounced

dead. A.I. was housed in administrative segregation for most of his confinement

due to the high profile nature of his charges.

•

The Death ofAJ: On April 18,2007, AJ., a 50-year-old male, entered PTDC.

The booking and intake screening process identified the prisoner in need of

kidney dialysis. Accordingly, this prisoner was housed in a health clinic cell at

PTDC. At approximately 12:30 a.m. on August 15,2007, a corrections officer

found AJ. hanging from the cell bars by a bed sheet. The prisoner was

transported to the hospital, where he survived uotillife-support equipment was

disconnected eight days later.

•

The Death ofA.K.: On July 9, 2007, A.K., a 32-year-old male, entered PTDC.

This prisoner was housed in administrative segregation due to the high profile

nature of his charges. Less than one month later, on August 5, 2007, a corrections

officer found A.K. hanging from the cell bars by a bed sheet. The prisoner was

pronounced dead by the Miami-Dade County Fire Rescue Department upon their

arrival.

•

The Death ofAL: On April 26, 2007, A.L., a 23-year-old male, entered PTDC.

The plisoner was transferred to MWDC and housed in administrative segregation

due to the high profile nature afhis charges. On May 27, 2007, a corrections

officer found this prisoner hanging from a ceiling grate by a bed sheet. The

-6­

prisoner was pronounced dead by the Miami-Dade County Fire Rescue Department upon their arrival.

•

The Death ofA.M: On August 5, 2006, A.M., a 41-year-old male, entered PTDC.

The prisoner was housed in a multiple-occupancy classification cell at PTDC.

The following day, August 6, 2006, other prisoners discovered this prisoner

hanging from the cell bars by a shoelace. The other prisoners yelled for

assistance. A corrections officer arrived but did not have appropriate tools to cut

down the prisoner, so he gave a prisoner his personal keys to try to cut him down.

Although MDCR policy requires responding corrections officers to initiate

cardiopuhnonary resuscitation ("CPR"), the prisoner was not administered CPR

until nursing staff arrived six minutes later. MDCR's investigation of this suicide

revealed that A.M. had expressed suicidal ideation several months earlier and had

a history of at least one suicide attempt, neither of which was elicited by MDCR's

screening process.

1) Suicide Risk and Mental Health Screening

Incoming prisoners' serious psychiatric needs, including suicidal ideation, go unidentified and unaddressed due to MDCR's deficient intake screening process. Deliberate indifference to a prisoner's serious medical needs violates the Eighth Amendment. See Mann v. Taser Int'L Inc., 588 F.3d 1291, 1307 (11th Cir. 2009) ("... Serious medical need is determined by whether a delay in treating the need worsens the condition."); Farrow v. West, 320 FJd 1235, 1243 (11 th Cir. 2003) (noting a serious medical need is one that is diagnosed by a physician as requiring treatment or obvious to a lay person, as needing medical care); see also Madrid v. Gomez, 889 F.Supp. 1146, 1256-1257 (N.D. Cal. 1995) ('''vVhile a functioning sick call system can be effective for physical illnesses, there must be a 'systemic program for screening and evaluating inmates in order to identify those who require mental health treatment. "').

We found the Jail's suicide risk and mental health intake screening to be deficient in several key respects. Significantly, the intake form does not require the intake officer to ask the prisoner if he or she is currently suicidal or has a history of suicidal behavior. Nor does it require the intake officer to solicit input from the transporting officer upon a prisoner's admission to the Jail. The fonn also does not indicate how many questions must be answered affirmatively in order for the corrections officer to make a referral. In addition to the defects in the form, the screenings are conducted in a large open room in full view and hearing range of other staff and prisoners. The likelihood of obtaining accurate mental health information is seriously compromised by the lack of privacy. Once the intake form is complete, it is placed in the prisoner's booking jacket, rather than being forwarded to staff conducting the second round of screening.

The Jail's second round of intake screening, conducted by either a social worker or a nurse, also omits important inquiries, including whether the prisoner is currently suicidal, had a recent significant loss andlor suicide by family members or close friends. CBS nursing staff who screen and refer prisoners for mental health services also informed us that they do not review the intake screening form completed by the intake corrections officer, thus negating the entire

-7­
purpose of the screening by the intake corrections officer.2
The efficacy of the second round of screening is also compromised by CHS's failure to retrieve charts or other documentation of prior mental health treatment or suicide attempts from previous incarcerations. Further, social workers at the Jail do not have access to the Jackson Health System computerized records from treatment at Jackson Memorial Hospital, which would provide valuable information about previous mental health treatment and suicide attempts. Communication among medical, mental health, corrections, and transport staffis important because certain signs exhibited by suicidal prisoners can foretell a possible suicide. Staff may be able to prevent a suicide by communicating and acting upon these signs.
There also is a failure to consistently provide screening information to medical and mental health staff via placement of screening forms in the chart, and there is no formal communication between intake screening and classification staff. Without formal communication between screening and classification staff, prisoners with mental illness or at risk of suicide can be placed in housing units that are counter-therapeutic and potentially dangerous, based on the vulnerability of these prisoners. See Estelle, 429 U.S. at 104-05 (prison officials have an obligation to take action or to inform competent authorities once the officials have knowledge of a prisoner's need for medical or psychiatric care).
We observed that certain PTDC housing units appear inherently inappropriate and potentially dangerous for mentally ill or suicidal prisoners because of the types of prisoners housed on the floor (e.g., violent maximum security prisoners), the chaotic atmosphere, the design of the cells (e.g., traditional steel cell bars surrounding the cell), and poor officer visibility into the cells.
2) Suicide Risk and Mental Health Assessment, Treatment, and Observation
MDCR fails to properly observe and assess suicidal prisoners. The mental health staff fails to take adequate precautions to ensure that prisoners who have been identified as at risk of suicide are protected. They fail to write orders that specify how closely corrections staff should observe the prisoner and fail to reassess the prisoner daily.
The Jail's observation of suicidal prisoners is deficient in both policy and practice. MDCR's policy fails to clearly describe the types of behavior that should result in a prisoner being placed on observation for suicide. The policy also does not clearly delineate between the types of observation that may be implemented. Instead, MDCR policy has a single observation status: "[lline staff will maintain direct continuous observation of suicidal prisoners and document checks at intervals not to exceed every IS minutes." Although it requires

2

Prior to our April 2009 site visit, this screening was done by a licensed practical nurse

("LPN"), who was not trained in identification of mental illness or suicide risk, a common theme

that we highlighted during our June 2008 site visit. By the time of our April 2009 site visit,

MDCR had started assigning a social worker to complete this screening during ordinary business

hours. While this assignment is an improvement, untrained LPNs still conduct the screening

after ordinary business hours.

-8­
documentation at IS-minute intervals, it appears to require constant observation. In practice, suicidal prisoners are not constantly observed. This is particularly dangerous for the female suicidal prisoners at WDC who are housed in cells that have protrusions that can be used for hanging.
The Jail's clinical assessment of suicidal prisoners also is inadequate. A psychiatrist and social worker share an office, conducting simultaneous interviews with the office door open while other staff enter and exit. Progress notes we reviewed did not document suicide risk assessments or justification for any particular level of observation. 3 In fact, the only indication in a prisoner's chart that the prisoner was on suicide watch was a notation that the prisoner shall "remain on 9-C-l." Such a notation does not constitute a suicide risk assessment. Instead, mental health staff must document the prisoner's current behavior and justify the particular level of observation that is ordered. Furthermore, the Jail does not require development of treatment plans for suicidal prisoners.
The deficiencies of this assessment process are exacerbated by the deficiencies in mental health rounds. Daily psychiatric rounds of the most' seriously mentally ill prisoners, housed on the ninth floor ofPTDC, are conducted cell-side, in full view and hearing ofthe other prisoners. These rounds are conducted quickly, often without psychiatric review of prisoners, charts. Although CHS improved its psychiatric rounds by making prisoner charts available to psychiatrists during rounds, our observation revealed that the psychiatrists rarely consult them.
Complicating these deficient assessment, treatment, and observation practices, we observed that prisoner medical charts did not consistently contain a mental health diagnosis for prisoners receiving psychotropic medications. Basic clinical processes require development of a diagnosis in order to treat the mental illncss.
For example: A.B. had an initial psychosocial assessment on December 31,2007. Although A.B.'s chart did not reflect a mental health diagnosis, A.B. continued to receive psychotropic medications for at least six months. Similarly, A.C.'s chart stated that he was receiving psychotropic medications. A.C. 's chart also noted that he was "known" to the mental health team, yet there was no diagnosis. CHS staff informed us that the failure to diagnose has been an ongoing problem.
Although MDCR's Suicide Prevention policy requires that medical staff determine the permitted activities and possessions for prisoners on suicide watch, CHS clinicians informed us that, contrary to policy, the practice is for corrections staff to make these decisions. This practice is inappropriate. For example, MDCR's practice is to require each prisoner placed on the 9-C wing to wear only a safety smock without any underwear, regardless of the specific reason for
We note that TGK does have a standard operating procedure providing that mental health staff conduct assessments of prisoners placed in segregation in a safety cell after 24 hours, 5 days, 30 days, 6 months, and every 6 months thereafter. While we commend MDCR for implementing this procedure and attempting to address the potential for decompensation of a prisoner's mental health status in segregation, it appears from documentation that, in practice, mental health staff merely "see" the prisoners on these intervals without conducting assessments.

-9 ­
the prisoner's assignment to the unit. MDCR and CHS need to have a clinical justification for limiting the property and clothing issued to prisoners. If a prisoner is issued only a safety smock and no underwear, it should be because tbis is clinically indicated, not because that is the usual practice. Corrections officers should not be making these decisions.
3) Medication Administration
MDCR's procedures for administering psychotropic medications are dangerous. We observed nurses administer psychotropic medications on PTDC's 9-C wing during our April 2009 site visit. The procedure is for one nurse and one corrections officer to walk from cell to cell in the unit with a cart containing drawers of alphabetically arranged paper medication records and medication bottles. Upon arrival at each cell, the corrections officer calls out the prisoner's name. Each cell houses multiple prisoners; however, no process was employed to verifY the identity of the prisoner to whom the psychotropic medications were given.
The medication administration procedure lacked appropriate controls. After the corrections officer attempted to identify the prisoner, the nurse flipped through the paper records to try to determine if the prisoner was prescribed medications. She would then pour the medications in a cup for the prisoner. We observed the nurse repeatedly pouring medications back and forth between the medication bottle and the cup, with only an eye account of the actual number of pills to be included. The nurse also had to cut the pills in half on multiple occasions with an ineffective pill cutter that caused fragments of the medications to fall onto the cart, resulting in inaccurate medication dosing.
We observed several prisoners tell the nurse that she was giving them the wrong medication, or dosage, or at the wrong time frame. Six prisoners received no medications, even though these prisoners apparently required an intensive level of mental health services, as they continued to be housed on PTDC's 9-C wing after psychiatric rounds had taken place. For each of these prisoners, the nurse flagged the medication administration record ("MAR") with the reported intent to later return and review the medical record for verification. We concluded that the Jail's medication administration is chaotic, inefficient, and fraught with risk of errors that can cause serious harm to prisoners.
4) Suicide Prevention Training
The Jail fails to provide adequate suicide prevention training to all corrections, medical, and mental health staff. Successful suicide prevention is a collaborative process among all staff; however, training is particularly critical for corrections officers because they are often the only staff who are available 24 hours per day and who have regular contact with prisoners. Pre­ service and annual training requirements should be clearly set forth in the relevant policy and should include sufficient topics to ensure that staff are able to recognize the verbal and behavioral signs that indicate a suicide risk, know what to do when a risk is suspected, and understand how to respond when there is a suicide attempt (generally achieved through mock drills).
The eight-hour training program initiated in April 2007 is not mandatory for MDCR staff. Our review of suicide prevention training records as of May 22, 2008, revealed that only

- 10­

approximately 10% ofMDCR's over 2,000 corrections officers had received it. None ofCHS's nursing staff had been trained in suicide prevention, even though intake nurses are charged with identifying suicide risk. CHS mental health staff also did not receive any suicide prevention training until May 2008, when a facility psychiatrist provided social workers with a one-hour workshop consisting of seven Power Point slides. Notably, MDCR's suicide prevention policy does not address suicide prevention training reqvirements.

Even ifthe Jail's policy appropriately required that all corrections, medical and mental health staff receive adequate initial and annual suicide prevention training, current training staff resources at the Jail are woefully inadequate to complete even just the initial training on a timely basis. As was the case in April 2007 with the inception ofMDCR's training, a single training officer is responsible for training all MDCR staff. According to this staff person, it will take approximately six years to complete initial suicide prevention training for all corrections officers, mental health care staff, and nursing staff at the current pace of training and training stafflevels. The Jail is unable to adequately train staff with a single training officer. Moreover, training performed by a sole corrections officer omits important instructional input from mental health and medical staff.

MDCR's corrections officers also lack sufficient training in emergency intervention. According to MDCR policy, all corrections officers are required to be certified in first aid, CPR, and the use of an automated external defibrillator ("AED"). Although training records were not available during our hrne 2008 site visit, MDCR officials informed us that only approximately 75% of corrections officers have actually received the emergency intervention training that is required by policy. The impact ofMDCR's failure to follow its own policy of training all corrections officers in emergency intervention is evident in MDCR's inadequate emergency responses to suicides.

b. MDCR's segregated housing units for prisoners with serious mental illness and suicidal behaviors are inhumane and unconstitutional.

1)

The physical conditions are dangerous.

Prison officials have a duty under the Eighth Amendment to ensure "reasonable safety," a standard that incorporates due regard for prison officials' "unenviable task of keeping dangerous men in safe custody under humane conditions." Farmer, 511 U.S. at 845 (quoting Helling, 509 U.S. at 33). A prison official may be held liable under the Eighth Amendment for denying 
 humane conditions of confinement if he knows that prisoners face a substantial risk of serious 
 hann and disregards that risk by failing to take reasonable measures to abate it. Fanner, 511 
 U.S. at 847 n.9. In addition, elements of the conditions of confinement may establish an Eighth Amendment violation "in combination" even if each would not do so alone if "they have a mutually enforcing effect that produces the deprivation of a single, identifiable human need such as food, warmth, or exercise--for example, a low cell temperature at night combined with a failure to issue blankets." Wilson v. Seiter, 501 U.S. at 304.

The Jail houses male prisoners with serious mental illness and suicidal behaviors on PTDC's segregated ninth floor, 9-C wing. Prisoners on the 9-C wing are locked in their cells nearly 24 hours a day and do not receive recreation, telephone calls, or visitation, lmless they are

- 11 ­

in one of the five step-down cells on the wing4 Rather than being therapeutic, the 9-C wing is chaotic, crowded, foul-smelling, depressing, and unacceptable for housing prisoners who are mentally ill or suicida1.5 It has 19 single-bunk cells for prisoners who are acutely mentally ill or suicidal, and the cells are frequently double or even triple bunked. In fact, we calculated the rate of overcrowding during one day of our visit, June 10, 2008, to be 62o/o--greatly exacerbating the already abysmal conditions on the wing. When these single-person cells house more than one prisoner, as they often do, the second or third prisoner must sleep on the bare floor because there is no additional mattress or bedding. The floors are often very cold, as the poor circulation of the wing's air-conditioning traps the cold air in the cells causing the temperature in the cells to drop as much as 20 degrees below room temperature. During our June 2008 site visit, we also observed that, for some of the 9-C wing prisoners who do have a bed, the bedding in some of the cells (e.g., cells 16 and 19) was so old and worn that it could no longer be adequately sanitized and should have been replaced.
Female prisoners who are identified as suicidal are housed in five cells on the 3-C wing of the WDC. The five cells used for suicidal prisoners at WDC are dangerous because they have many protrusions, including ventilation grates, exposed pipes in the toilet areas, and holes in restraint beds, all of which are potential anchor points for self-asphyxiation. Moreover, there are several blind spots in these cells, preventing officers from being able to minimize the risk of a suicide by closely observing the prisoner. In sum, the WDC suicide watch cells provide ample opportunity for the exact outcome that they should be designed to prevent.
Because MDCR staff and prisoners are aware of the horrid conditions on the 9-C wing, staff will threaten, punish, and retaliate against prisoners by transferring them (or threatening to transfer them) to the 9-C wing. For example, we reviewed an incident report from March 14, 200~, in which a prisoner was kicking his cell door, asking to see a doctor. After the Jail sent a nurse to see the prisoner, the prisoner continued to kick his door, demanding to see a doctor. The nurse ordered that the prisoner be placed on suicide precautions and, when the prisoner refused to be handcuffed for transport to the ninth floor, officers sprayed him with oleoresin capsicum agent ("OC spray") and escorted him to the 9-Cwing. We could not find any documentation in this prisoner's file that indicated this prisoner presented a risk of suicide or had acute mental illness. We spoke with many prisoners who consistently reported being threatened with transfer to the 9-C wing.
The conditions of the PTDC ninth floor mental health unit are not new to MDCR and County officials. Over the past several years, print and television news media, as well as a non-

4

At the time of our April 2009 tour, no recreation officer was yet available to provide 


recreation to the prisoners on the 9-C wing, though a recreation officer was reportedly going to 


be hired. 


The foul odor of the cells, and to a slightly lesser extent, the rest of the wing, is caused in part by the practice of not providing showers for the more acutely mentally ill or suicidal prisoners. We observed a garden hose attached to the wall on the 9-C wing which, although not in use during our visit, reportedly has been used to periodically spray prisoners in lieu of showers.

- 12 ­

fiction book, have reported on the deplorable conditions of the ninth floor. Also chronicling the ongoing inhumane conditions on the ninth floor, a Miami-Dade County grand jury toured the 9-C wing in 2004 and again in 2008, concluding that "[n]ot much has changed .... The setting was not appropriate for treatment then. It is not appropriate now.,,6 In February 2009, local state legislators toured the 9-C wing and called it "inhumane .... a God-awful place.,,7
2) MDCR fails to provide adequate mental health services or other programming appropriate to the needs of prisoners confIned to mental health units.
Despite the fact that MDCR categorizes the 9-C wing as its housing unit for prisoners who are acutely mentally ill or suicidal, no mental health programming is available to the prisoners confined there. Grossly incompetent or inadequate care can constitute deliberate indifference to the prisoner's needs. Waldrop v. Evans, 871 F.2d 1030, 1033 (11 th Cir. 1989) (quoting Rogers v. Evans, 792 F.2d 1052, 1058 (11 th Cir. 1986)). Any individual contact with clinical staff is done cell-side, where clinicians attempt to assess the prisoners' suicidality and mental status by talking to them through the food-tray slot in full view and hearing a range of the other prisoners in the cell and on the wing.
MDCR also does not consistently document a clear rationale explaining why prisoners are housed on the 9-C wing, rather than a less restrictive setting. For example, we reviewed documentation in W.W. 's medical chart indicating that, between April 23 and May 26, 2008, 'vV.W. said he was "alright, ready to be transferred," was "alert, calm, and cooperative," and was "awake, alert, [and had] good eye contact." Yet W.W. remained on the 9-C wing for the entire month despite clinical notations indicating that the 9-C wingwas not appropriate for W.W. Other prisoner charts we reviewed contained no rationale for transferring a prisoner from other mental health units to the 9-C wing. For example, XX was housed on the 9-C wing during the week of our April 2009 site visit. Yet there was no documentation in his chart supporting the Jail's decision to move XX. from the 9-B wing-a unit for prisoners with less acute mental illness-to the 9-C wing.
c. MDCR's discipline process fails to account for behaviors that are the product of a mental illness.
Another critical shortcoming ofMDCR's mental health services is MDCR's failure to ensure disciplinary penalties are not imposed on prisoners with mental illness for conduct that is symptomatic oftheir mental illness. See Thomas v. Bryant, 614 F.3d 1288, 1307-17 (11 th CiT. 2010) (holding that repeated chemical sprayings of a mentally ill prisoner constituted cruel and unusual punishment when facility did not evaluate whether the prisoner's conduct was symptomatic of mental illness). Although corrections staff indicated that disciplinary measures

6

Final Report of the Miami-Dade County Grand Jury, Fall Term 2007, at 27 (Fla. Cir. Ct.

Augnst 11, 2008).

7

Carol Marbin Miller, Mentally III in Jail in a New Crisis, Miami Herald, February 20, 


2009, at B 1. 


- 13 ­

are "rarely used" for mentally ill prisoners, our review of records of disciplinary proceedings against mentally ill prisoners revealed that they were routinely subject to discipline for their symptomatic behavior. There is no formal system at the Jail for CHS mental health staffto advise or consult with corrections staff that conduct disciplinary hearings and assign punishment for disciplinary violations. Corrections staff who perform these functions agreed that mental health staff should be formally involved in disciplinary decisions regarding mentally ill prisoners.

2. MDCR is deliberately indifferent to the serious medical needs of prisoners.

A corrections official's "deliberate indifference" to a prisoner's serious medical needs is a violation of the Eighth and Fourteenth Amendments. Estelle, 429 U.S. at 104; Farrow v. West, 320 F.3d 1235, 1243-46 (11th Cir. 2003); Steele, 87 FJd at 1269. Jail officials act with deliberate indifference when a prisoner needs serious medical care and the officials knowingly fail or refuse to provide that care. Farrow, 320 FJd at 1246. The Constitution is violated if a prison official "knows of and disregards an excessive risk to inmate health or safety." Farmer, 511 U.S. at 837. Providing only cursory care in such a situation amounts to deliberate indifference. McElligott v. Folev, 182 FJd1248, 1255 (11th Cir. 1999). Conditions violate the Constitution if they pose an unreasonable risk of serious damage to a prisoner's current or future health, and the risk is so grave that it offends contemporary standards of decency to expose anyone unwillingly to that risk. Helling, 509 U.S. at 33-36; Chandler v. Crosby 379 FJd 1278, 1289 (II th Cir. 2004).

MDCR fails to identify and treat prisoners in the Jail who present obvious symptoms of serious illness and injury. When MDCR does identify prisoners in need of medical treatment, the treatment provided is often insufficient, placing the prisoners' health and safety at risk. Prisoners are needlessly suffering and, in some cases dying, due to deliberate indifference. Below we highlight five major areas of deficiencies: correctional medical care intake screening and initial health assessments; access to care for acute medical needs; management of chronic health problems; record keeping; and quality assurance.

a. MDCR fails· to identify timely the acute and chronic care needs of prisoners booked into the Jail.

MDCR's failure to identify the acute and chronic care needs of prisoners entering the jail is clearest with respect to those prisoners who are withdrawing from dmgs and alcohol. As a result, prisoners do not receive necessary care, which in turn, can lead to tragic results, as the follmving examples demonstrate:

•

The Death o(£'E.: On July 19, 2008, E.E. was processed into the Jail and

received an intake screening at approximately 1:00 a.m. on July 20. Twelve hours

later, E.E. was pronolllced dead. The intake screening, completed by a licensed

practical nurse ("LPN"), indicated no medical problems or history of dmg or

alcohol use, and E.E.'s behavior was noted as appropriate. At 5:30 a.m.,

however, E.E. suffered a seizure. Although an ambulance was called, neither

MDCR nor CHS staff authorized E.E.' s transfer to the hospital. A nurse

conducted a medical assessment following the seizure and noted E.E.'s blood

- 14 ­

pressure to be 203/139.8 Despite this high reading, there is no mention of the elevated blood pressure in the comments to the assessment in the prisoner's medical chart. Additionally, there was no mention of the prisoner being disoriented. This is noteworthy because a social worker also evaluated E.E. and documented that E.E. appeared lethargic and disoriented. At 9:30 a.m., MDCR staff transported E.E. to the PTDC ninth floor mental health unit for a mental health evaluation and treatment. CHS staff did not, however, order treatment for E.E. 's seizure, monitor his blood pressure or other vital signs, or conduct further clinical evaluation. Approximately three hours later, staff reported finding E.E. unresponsive and transferred him to the hospital, where he was pronounced dead9

•

The Death oCB.B.: B.B. died on May 22, 2008, the same day he entered the Jail.

B.B. had a history of drug withdrawal. Staff reported finding B.B. unresponsive

in his cell, and started CPR. Staff did not, however, use an automated extemal

defibrillator ("AED,,).lO In facilities as large as MDCR, an AED should be

available for an emergency situation when a prisoner is without both a pulse and

respirations. More important, despite B.B. 's known history of drug withdrawal,

MDCR did not provide an appropriate level of observation and monitoring of

B.B.'s condition.

•

The Death oCA.A.: AA was admitted to the Jail on April 9, 2008, and died the

following day. AA had a history of serious medical problerns, including

congestive heart failure, hypertenSion, and heart attack. At the time of his intake,

A.A was withdrawing from alcohol, and CHS staffplaced him on a

detoxification program. However, a detoxification form was not completed, and a

physician did not Sign the health assessment (indicating that a physician did not

review the nurse's assessment findings). At 8:00 a.m. on April 9, AA. 's blood

pressure was 199/102, and by 10:00 a.m. it was 218/121. Given AA's medical

history and severely elevated blood pressure, AA. should have been immediately

treated by a physician.

•

The Death ofc. c.: On March 6, 2008, MDCR officials processed C.C. into the

Jail with a slightly elevated pulse of 111. C.C. died the next day. A physician

did not sign C.C.'s health assessment on March 6 (indicating that a physician did

not review the nurse's assessment findings), and although a nurse referred C.C. to

a physician due to the abnormal pulse, there is no documentation of nursing staff

conducting follow-up vital sign monitoring. On the next day, March 7, staff

8

A normal blood pressure reading is 130/80.

9

This letter discusses prisoner deaths but the cause of death is not explained. MDCR does

not maintain autopsy reports, and prisoner deaths are not formally reviewed. Therefore, the

causes of death in the examples provided have not been formally determined.

[0

An AED is an electronic device designed to deliver an electric shock to a victim of

sudden cardiac arrest in order to restore heart rhythms to their normal pace.

- 15 ­

found C.C. unresponsive, but did not use an AED as should be expected under the circumstances.

•

The Death ofD.D.: MDCR officials processed D.D. into theJail on November 6,

2007. D.D. died on November 8, 2007. During the intake screening and initial

assessment, CHS staff identified an infection in D.D.'s chest wall, as well as

symptoms of drug withdrawal. CHS staff ordered monitoring of vital signs and a

follow-up appointment with the physician on November 8. There is, however, no

documentation of vital signs monitoring, and the follow-up appointment did not

occur. Instead, on November 8, CHS staff reported finding D.D. unresponsive

and transferred him to the hospital, where he died.

These prisoner deaths demonstrate that initial screening and health assessments are woefully inadequate. Obvious medical signs and symptoms, such as E.E.'s seizure and disorientation, are often missed by MDCR and CHS staff. Known issues like D.D.'s chest wa11 infection, or the elevated blood pressures ofE.E. and A.A., or the history of drug and alcohol use by B.B., D.D., and A.A., are not sufficiently addressed.

Screenings and health assessments must be timely and thorough, and completed by competent professionals with the necessary training to ide.ntify signs that pose risks to prisoners' health. Just as important, correctional facilities must have quality assurance systems in place to ensure accOlmtability for errors that lead to grievous harm. See Helling, 509 U.S. at 35; see also Chandler, 379 F.3d at 1289. MDCR is deliberately indifferent when it routinely provides only cursory care (or no care at all), when the need for more serious medical treatment is obvious at the time of the incident, and then made plain by the resulting harm. Farmer, 511 U.S. at 837.

b. lVIDCR fails to act on known medical problems discovered through its "sick-call" process.

MDCR prisoners can request medical treatment through sick-call. Despite its knowledge of sick-call complaints, the Jail fails to take timely and necessary action. This failure to act is unconstitutional deliberate indifference to prisoners' serious medical needs. Estelle, 429 U.S. at 104.
CHS nursing staff triage sick-call complaints during routine medication administration. These brief cell-side interactions do not a110w for adequate assessment or medication administration. Prisoners are denied privacy, as the assessment is done with other prisoners standing in line for medication, well within hearing distance.

Nurses do not employ protocols or assessment forms during the sick-call triage. We observed nurses routinely failing to take and record vital signs. Vital signs should be a part of every medica1 clinical encounter and must be recorded in the medical record. In addition to these concerns, we found evidence that prisoners had to make several sick-call requests before a nurse would initially evaluate them, and then prisoners would endure extensive delays before seeing a physician after a nurse's referral.

Through CHS's sick-call process, CHS is made aware of prisoners' serious medical needs. Yet, CHS repeatedly fails to provide the necessary level of care. This situation amounts

- 16 ­

to deliberate indifference resulting in grievous harm, as the following examples demonstrate:

•

The Death ofF.F.: F.F., a 48-year-old male with hypertension, died on January 5,

2008, two months after being admitted to the Jail. On January 2,2008, F.F.

complained to a CHS nurse of chest and gas pain. A complaint of gas pain must

be evaluated carefully and fully in a prisoner with hypertension due to the risk for

heart disease, as gas can mimic heart disease symptoms. The following day, a

physician ordered tests to rule out heart disease. F.F. was supposed to see the

physician again the next day, but did not, for reasons unknown. Instead, he was

seen by a nurse who administered an antacid. No nursing protocols were used

during the exam. The content of both nurse exams exceeded the scope of the

nurses' qualifications. On January 5, 2008, F.F. was brought to the medical clinic

unresponsive.

•

The Death ofG.G.: G.G. died on October 23, 2007. The day before his death, a

CHS nurse evaluated G.G. for complaints of shortness of breath. The nurse's

exam was inadequate and incomplete. During the exam, no vital signs were

taken, no lung exam was completed, and G.G. was only given medication for a

cold. The following day, G.G. made the same complaint and was taken to the

hospital, where he died.

F.F. 's chest pain and G.G. 's shortness of breath were serious medical symptoms brought to the attention of MDCR and CHS staff. Disregarding the excessive risks to the prisoners' health and safety, MDCR failed to provide an appropriate level of care.

c. MDCR fails to provide adequate care to prisoners with serious chronic medical needs.

The Jail is deliberately indifferent to prisoners' serious medical needs when it fails to identify or adequately treat a prisoner's serious chronic illness. Lancaster v. MOlioe County, Ala., 116 F.3d 1419, 1425 (11 th CiT. 1997) (noting that an official acts with deliberate indifference when he knows that an inmate is in serious need of medical care, but he fails or refuses to obtain medical treatment for the inmate). See also Hill v. Dekalb Regional Youth Detention Ctr., 40 F.3d 1176, 1186 (11 th CiT. 1994) ("Knowledge of the need for medical care and intentional refusal to provide that care constitute deliberate indifference.").

The systemic nature ofMDCR's deliberate indifference is evidenced by the Jail's failure to operate a functional chronic care program. Prisoners who suffer from chronic medical illnesses must be regularly monitored by qualified medical professionals to prevent the progression of their illnesses. Monitoring should occur on a regular basis to ensure that symptoms are under control and that medications are appropriate. Morbidity and mortality rates of prisoners with chronic illnesses can be reduced with regular monitoring.

The Jail does not track plisoners with chronic illness nor monitor their conditions. Chronic care programs in cOlTectional settings are critical to avoid placing prisoners with serious medical needs at excessive risk. The requirements of chronic care are addressed in guidelines

- Ii ­

developed by the National Commission on Correctional Health Care ("NCCHC,,).ll While the Jail claimed to be following the NCCHC guidelines, our review of prisoner charts revealed that no chronic care program exists. For example, we found prisoners with HN without any medication. We also found prisoners with diabetes and hypertension who were without expected tests in order to assess the status of their kidneys, cholesterol level, or heart functions. And, prisoners with histories of seizures were not monitored closely to determine the level of their seizure medication, which is necessary, as incorrect dosages above necessary levels can cause serious side-effects, such as brain and heart damage.

In addition, a critical component of a chronic care program is appropriate and timely referrals to medical specialists. MDCR acknowledged delays in consultations for specialty services such as cardiology, neurology, and HN-related services. The Ancata court stated that "deliberate indifference to serious medical needs is shown when prison officials have prevented a prisoner from receiving recommended treatment or when a prisoner is denied access to medical personnel capable of evaluating the need for treatment." Ancata, 769 F.2d at 704 (citing Ramos v. Lamm, 639 F.2d 559, 575 (lOth Cir. 1980».

Our review of medical charts and interviews with CHS staffrevealed that HN-positive prisoners may wait up to six weeks for a specialist referral, and that other chronic conditions can take even longer. For example:

•

HIV Consult: S.S. had an HIV-related referral ordered four weeks prior to our

tour, but no response or report had been given about an appointment date.

•

Neurolo?:!! Consult: 0.0. had a neurology consult ordered five months prior to

our tour, but no response or report was present in the medical record.

•

Cardiology Consults: P.P. had a cardiology consult ordered nearly five months

prior to our tour, but no response or report was present in the medical record.

R.R. had problems with chest pains and had a cardiology consult ordered six

weeks prior to our tour, but no response or report was present in the medical

record.

•

Gvnecology Consult: Q.Q. had a history of cervical cancer, and had a gynecology

consult ordered seven weeks prior to our tour, but no response or report was

present in the medical record.

There is no tracking system for outstanding consultation referrals. It is necessary to track this information, as prisoners with chronic conditions require a higher level of medical care than is often available on-site, making them more vulnerable to harm. This deficiency constitutes deliberate indifference. Ancata, 769 F.2d at 704.

11 It should be noted that in 2008, NCCHC elevated the requirement of a chronic care program from "impOliant" to "essential," emphasizing the necessity of a functional chronic care program.

- 18 ­
d. MDCR's poor record keeping practices contribute to the pattern or practice of deliberate indifference to provide adequate medical services.
MDCR fails to keep complete, accurate, readily accessible, and systematically organized medical records. A complete and adequate medical records system is critical to ensure that medical staff members are able to provide care. Inaccurate or incomplete record keeping places prisoners at excessive risk of serious harm.
The documentation of medical information for MDCR prisoners is done in part through a paper-based system, and in part through an electronic system maintained by the Jackson Health System. The CHS physicians have access to the electronic system to check laboratory data and consultation reports, but the CHS physicians cannot enter data into the system. Instead, CHS maintains a paper chart at the Jail. The current system requires physicians to use both the paper charts and the electronic system to access complete medical information about a prisoner. Moreover, other CHS health care staff, including nurses, do not have access to the electronic system at all; thus, laboratory data in the electronic system is not readily available to CHS non­ physician medical staff.
Medical charts often contain an incomplete medical history; fail to document specialist appointments; do not include the medical staff member's name and title attached to notes; and are illegible. Moreover, the Jail's medical records fail to consistently record vital signs during clinical encounters. As noted above, vital signs should be part of every clinical encounter and must bc recorded in the medical record.
In addition and contrary to MDCR policy, many charts do not contain the nursing intake screening or the booking officer screening. Thus, medical and mental health staff members do not have information from a prisoner's previous incarceration and often do not have infonnation from the intake screening for the prisoner's current incarceration. Even when the current nursing intake screening is on file, MDCR relies on self-reporting by the prisoner without the benefit of review of prior treatment at the Jail.
B. MDCR IS ENGAGED IN A PATTERN OR PRACTICE OF USlt'lG EXCESSIVE FORCE AGAINST PRISONERS.
The Eighth Amendment protection from cruel and unusual punishment forbids the use of excessive physical force against prisoners. Hudson v. McMillian, 503 U.S. I, 5-7 (1992); Skrtich v. Thornton, 280 F.3d 1295,1300-01 (lith Cir. 2002). As the Due Process Clause of the Fourteenth Amendment affords at least the same Eighth Amendment protection from cruel and unusual punishment to a prisoner of a jail incarcerated prior to trial as it would to a convicted prisoner, City of Revere, 463 U.S. at 244, jail officials will violate the Constihltion if they use excessive force on jail prisoners. MDCR correctional officers routinely use excessive force against Jail prisoners in violation ofthe Constitution.

- 19 ­

The use of force by a corrections officer violates the Constitution when it is not applied "in a good-faith effort to maintain or restore discipline," but instead is administered "maliciously and sadistically to cause harm." Hudson, 503 U.S. at 6-7; Campbell v.Sikes, 169 FJd at 1374; Harris v. Chapman, 97 F.3d 499, 505 (11 th Cir. 1996). Courts may examine a variety of factors in determining whether the force used was excessive, most commonly including: (1) the need for the application of force; (2) the relationship between the need for force and the amount of force applied; (3) the threat, if any, reasonably perceived by responsible corrections officers; (4) any efforts made to temper the severity of a forceful response; and (5) the extent of the prisoner's injury. Hudson, 503 U.S. at 7-8; Campbell, 169 F.3d at 1375; Harris, 97 F.3d at 505.

Our investigation included an intensive examination ofMDCR use of force policies, training, and incident reports. We also conducted many staff and prisoner interviews on this issue. In some cases, our findings of excessive or inappropriate uses of force are in accord with the conclusions from MDCR's own Internal Affairs Unit investigations.

MDCR corrections officers openly engage in abusive and retaliatory conduct, which frequently results in injuries to prisoners. In particular, there is a disturbing and distinct trend of MDCR corrections officers reacting to low level aggression from prisoners (M." abusive language or passive resistance to an order) by slapping or punching the prisoner in the head and verbally provoking the prisoner to physically respond. MDCR corrections officers often do not attempt any de-escalation techniques to combat low level aggression before engaging the prisoner in such an inappropriate manner.

Further, MDCR corrections officers frequently employ OC spray under circumstances that do not require such a level of force. Disturbingly, during our interviews with MDCR corrections officers, most officers could not articulate when the use of OC spray was appropriate. Only a few officers were able to competently discuss MDCR policy and explain the use of OC spray as a last resort before using physical force to restrain a resistive, violent, or combative prisoner. 'vVhen asked, most officers were unfamiliar with the policy or guessed at responses, offering incomplete answers such as "when the prisoner doesn't listen to you." Well-trained corrections officers should be able to articulate clearly and without hesitation the level of prisoner resistance necessitating the deployment of OC spray-or any other use of force-as an appropriate response to restore and maintain order.

The following examples, some derived from MDCR's own internal documents and investigations, illustrate the pattern or practice of using excessive force:

•

ProlonRed Fist FiRht: On August 27,2007, nine MDCR corrections officers,

including a Field Training Officer, allowed prisoner A.N. and an officer to engage

in a prolonged fist fight at the MWDC. None of the officers involved filed a use

offorce report. MDCR investigators discovered a video ofthe fight while

investigating a separate incident. The video shows A.N. instigating a tight with

an officer, and the officer responding by spraying A.N. with OC spray. A second

officer kept other prisoners at arm's length while the prisoner and the officer then

engaged in a fist fight. Over a matter of minutes, up to nine other officers

responded but failed to intervene in the fight.

- 20­

•

Phvsical Assault: On August 23,2007, prisoner A.O. rendered a sworn statement

to MDCR investigators alleging that a MDCR corporal in MWDC physically

assaulted him by slapping him in the face several times, punching him in the right

side of his face and his right eye, pushing him to the ground and kicking his face

and body. A.O. reported that other corre.ctions officers were present during the

assault. A.O. explained that as the assault took place, he attempted to run toward

the view of the security cameras, but was dragged back out of view by the

officers. A second attempt to run toward the camera view was successful. The

corporal caught A.O. at the elevators, however, and choked him and punched him

in the side of the face. After reviewing the videotape, which also showed the

officer pushing A.O,'s face to the floor while A.O. was restrained in handcuffs,

MDCR's Internal Affairs Unit sustained the allegations in part, giving credit only

to the acts caught on video, despite A.O.'s injuries corroborating the prisoner's

full account. Internal Affairs further noted that several corrections officers,

including a supervisor, either failed to report the incident accurately, or did not

report the incident at all.

•

Instigating Fights: In a May 2007 incident at PTDC, prisoner A.P. claimed that a

corrections officer ordered him out of his cell and placed him in a visiting booth

because the prisoner made derogatory comments about MDCR staff. While in the

visiting booth, A.P. claims that an officer asked him ifhe wanted to fight one of

the other officers. A.P. claims he told the officer he did not want to fight.

Although the prisoner received a laceration above his eye, no use offorce incident

report was filed.

•

Striking Restrained Prisoners: We requested to view videotapes from randomly

selected shifts at the different facilities. One of the videotapes from PTDC's ninth

floor mental health unit showed a prisoner being dragged to a chair by several

MDCR corrections officers and then handcuffed to a table. After being restrained

in handcuffs, the video shows an officer punching the side of the prisoner's face.

Moments later, another officer arrived to photograph the prisoner's face. It does

not appear, however, that any use of force report was filed in regard to this

incident.

Interviews with juvenile prisoners housed in the TGK facility revealed a particularly violent atmosphere, often involving the corrections officers directly or indirectly. For example:

•

Violence Against Juveniles: A videotape of the juvenile unit in May 2008 shows

two officers casually engaged in conversation with a prisoner, when one of the

officers-unprovoked by any physical movement by the prisoner-grabbed the

prisoner and threw him onto a table, and then to the floor. The prisoner struggled

to protect himself, while the other officer looked on without taking any action,

The prisoner was then escorted to the front of the unit and left locked between

two security doors in the hallway leading into the unit.

Contributing to this pattern or practice, use offorce reporting in the Jail is frequently inaccurate or incomplete, and in incidents involving multiple officers, not all officers are

- 21 ­

submitting individual reports. For example, according to MDCR records, there were 272 use of force incidents in a six-month period from October 2007 through March 2008. Most of the incidents involved physical force or the use of OC spray.12 MDCR's Internal Affairs Unit, however, independently reported over 1,000 use of force incidents just involving OC spray in 2007. This level of discrepancy in use of force reporting generally, and incidents involving OC spray specifically, indicates a serious issue of under-reporting use of force incidents by MDCR officers.
C. MDCR IS DELIBERATELY INDIFFERENT TO SERIOUS RISKS TO PRISONER SAFETY POSED BY PRISONER VIOLENCE.
Prisoners have a constitutional right to be protected from harm. Farmer, 511 U.S. at 832. Corrections officials have a specific duty "to protect prisoners from violence at the hands of other prisoners." Id. at 833 (internal quotation marks and citations omitted). MDCR is violating that constitutional right through its deliberate indifference to the prisoner violence within the Jail. According to MDCR's own reporting of prisoner-on-prisoner assaults, the Jail is experiencing well over a hundred incidents every month. ll In fact, in a six-month period just prior to our tour, the Jail reported over 300 incidents of prisoner-on-prisoner assaults just in the MWDC facility. In that same six-month period, the Jail reported nearly 250 such incidents in the PTDC facility, and approximately 125 such instances in the Stockade facility.
Not every injury suffered by a prisoner at the hands of another prisoner will violate the Eighth and Fourteenth Amendments to the Constitution. The prisoner invoking the right must demonstrate that, (I) he or she was "incarcerated under conditions posing a substantial risk of serious harm," and (2) corrections officials were "deliberately indifferent" to the risk. Id. at 834. Accordingly, Jail officials must talee reasonable steps to protect prisoners from physical violence and to provide humane conditions of confinement. Providing humane conditions requires that a corrections system satisfY prisoners' basic needs, such as their need for safety. A corrections official's failure to supervise prisoners, particularly prisoners known to be violent, may result in tillconstitutional conditions of confinement where assaults between prisoners occur due to the lack of supervision. Cottone v. Jenne, 326 F.3d 1352, 1359-60 (II th Cir. 2003) (noting that a lack of monitoring and supervision of known violent inmates, which led to inmate-on-inmate violence, constituted impermissible unconstitutional conduct).
There is a dangerous lack of meaningful supervision in the housing units, particularly the dormitory settings housing maximum security prisoners in PTDC and the Stockade. The

12

We found that many use of force incidents in the Jail involved the use of OC spray. At

the time of our tour, MDCR did not have a uniform system in place throughout the facilities to

measure (by weight) OC spray canisters following deployment by a corrections officer (or on an

otherwise regular basis) to ensure that the reported use was consistent with the contents of the

container.

13

Nationwide, prisoner-on-prisoner assaults are under-reported, as prisoners often fear

retaliation from other prisoners as a consequence of reporting such assaults. This trend of under­

reporting suggests that the problem within MDCR facilities is even greater than the statistics

noted in this letter would indicate.

- 22­
problems with providing adequate supervision to the units in PTDC and the Stockade stem largely from the antiquated design of these facilities. For example, there are no officers stationed inside the majority of the dormitory housing units in PTDC and the Stockade. Therefore, in order for MDCR corrections officers to view the maximum security prisoners housed in most PTDC units, the officers must either enter the unit or walk along a narrow catwalk that runs behind the unit. The catwalk in PTDC is not designed for patrol and does not provide access into the unit should the officer observe an incident that calls for immediate response. MDCR corrections officers patrol the units regularly, but prisoners are aware of the patrol schedule and know when they are, and are not, being directly supervised. A similar situation exists in the Stockade. Most units in the Stockade, including those housing maximum security prisoners, are donnitory settings without a corrections officer present in the unit. Instead, officers patrol outside the several units. Due to the structure of the units in the Stockade, however, officers patrolling outside the units cannot effectively observe the prisoners without actually entering the units to conduct direct observation. As a result, during the time the officer is inside a particular unit conducting direct observation, the remaining units are unsupervised.
Supervision problems also persist in the two units housing male juveniles in TGK. The male juvenile prisoners (those prisoners under the age of 18 years, but being criminally charged as adults under Florida state law) are housed on the second floor ofTGK. The juvenile housing units are not equipped to adequately separate the juveniles according to their classification status, resulting in juveniles of mixed security levels being housed in the same unit. The units are often overcrowded, exacerbating security concerns by increasing the number of mixed classification prisoners housed in close proximity, and decreasing the ratio of officers to prisoners. While corrections officers are posted inside the unit, there are blind spots throughout the unit that pose a danger to officers and prisoners when only a single officer is stationed within the unit.
Juvenile prisoners selected as "trustees" are often involved in the incidents of violence. Trustees assist in the jail operations by cleaning the milt and delivering food trays and hygiene supplies. The Trustee program is dangerous and contributes to unconstitutional conditions. First, Trustees reportedly withhold food and hygiene supplies from other prisoners creating a high risk of conflict. Second, we observed trustees being allowed free movement through the unit, including secure areas, when not working, even in nighttime hours. Surveillance videotapes revealed juvenile prisoners often walking behind the control panel that electronically locks and unlocks the individual cell doors. Reportedly, the prisoners on videotape were "trustees" and would do this to retrieve cleaning or hygiene supplies, such as toilet paper. Regardless of the reason, it is extremely dangerous to allow prisoners to have this type of access to the unit's control panel. Third, trustees are reportedly selected based on their ability to physically control the other juvenile prisoners. Juvenile prisoners reported that trustees are often asked by the corrections officers to physically discipline other prisoners .
. We interviewed many of the juvenile prisoners, most of whom said they did not feel safe in the unit. Most of the juvenile prisoners we interviewed spoke about the practice of ''ta,'i:ing,'' an unauthorized and undocumented method of discipline in which corrections officers will lock down a juvenile prisoner in his cell for rule violations and force another prisoner (or prisoners) to inflict physical punishment on the locked-down prisoner. The juveniles reported that a "tax" also can result in extended lockdowns, sometimes lasting up to three days.

- 23 ­

In addition, there is evidence that the Jail fails to take reasonable measures to protect prisoners from sexual assault. The August 2010 national survey on sexual victimization in jails and prisons conducted by the Department ofJustice's Bureau of Justice Statistics found a high prevalence of sexual victimization at the Miami-Dade County PTDC. 14 In this report, the Miami-Dade County PTDC ranles among one of the worst jails in the country with a high rate of prisoner-on-prisoner rape and sexual abuses in the facility. The national rate for jails is 1.5% and the PTDC had an alarming rate of 5.5%.15 The Office of Justice Programs of the Department of Justice notified MDCR that it is required to appear for a Prison Rape Elimination Act hearing in Washington, DC on September 15-16, 2011 16 We intend to monitor the results of the hearing and any related matters of sexual victimization at MDCR.

D. DANGEROUS AND UNSANITARY CONDITIONS EXPOSE PRISONERS UNWILLINGLY TO AN UNREASONABLE RISK OF HARM.

The Eighth Amendment guarantees that prisoners will not be "deprive[dJ ... of the minimal civilized measure oflife's necessities." Rhodes v. Chapman, 452 U.S. 337, 347 (1981). As the Due Process Clause of the Fourteenth Amendment affords at least the same Eighth Amendment protection from cruel and unusual punishment to a prisoner of a jail incarcerated prior to trial, as it would to a convicted prisoner, City of Revere, 463 U.S. at 244, MDCRjail officials may not deprive prisoners of the minimal civilized measures oflife's necessities. Accordingly, MDCR officials must provide, among other necessities, "reasonably adequate ventilation, sanitation, bedding, hygienic materials, and utilities (i.e., hot and cold water, light, heat, plumbing)." Chandler v. Baird, 926 F.2d 1057, 1065 (11 th Cir. 1991) (citations omitted). Conditions violate the Constihltion when they pose an unreasonable risk of serious damage to a prisoner's current or future health, and the risk is so grave that it offends contemporary standards of decency to expose anyone unwillingly to that risk. Helling. 509 U.S. at 33-35; Crosby. 379 F.3d at 1289.

The Miami-Dade County Jail is failing to ensure that sanitation and environmental health conditions are consistent with constitutional standards. Simply stated, conditions within the Jail are unsuitable for detention housing, posing unreasonable risks of serious harm to prisoners' health and safety. In particular, our investigation revealed deficiencies in the following areas: (1) fire and life safety; (2) housekeeping; (3) hygiene and infection control; and (4) chemical 
 control. 


L

The inadequate fIre and life safety systems ofthe Jail pose an unreasonable

risk of harm to prisoners.

MDCR fails to ensure adequate fire and life safety systems throughout the Jail, particularly in PTDC. We observed numerous deficiencies during our tour that endanger the life and safety of prisoners and staff. In the event of a fire, there are several areas of the Jail where

14

U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics,

Sexual Victimization in Prisons and Jails Reported by Inmates, 2008-2009,

http://bjs.ojp.usdoj .gov/index.cfm?ty=pbdetail&iid=2202 (August 2010).

15

Id.

16

Prison Rape Elimination Act of2003, P.L. 108-79.

·24 ­

the sprinkler system would not activate or function properly because sprinkler heads were painted over or otheryrise damaged. The lack of an operational sprinkler system greatly increases the risk of injury and death in a fire. For example: In PTDC East Wing Cell 2, all six sprinkler heads were non-functional because they.had been recently painted over. In PTDC East Wing Cell 1, none of the sprinklers were operable because of paint coverings, parts missing, or cloth ropes tied to them. On PTDC's third, fifth, and seventh floors, sprinkler heads were covered with paint, or fOlmd to be inoperable for other reasons.

More fires occur in the lalmdry area ofj ails than in any other part of corrections facilities, and in PTDC, we observed a clothes dryer with no lint filter, resulting in a heavy lint accumulation behind the machine. In TOK, we observed a clothes dryer with a detached vent hose, blowing lint out behind and under the machine. Dryer lint is highly flammable and can cause a fire to spread rapidly.

In the event of a serious fire that requires an evacuation of prisoners from the facility, it is critical that the evacuation is conducted quickly, before toxic fumes begin to develop at the fire
site. Therefore, in a jail setting, staff should be able to quickly access emergency keys that will
unlock all doors along an evacuation route, including the final exit door to the outside of the bUilding. Keys must be marked so as to be identifiable by sight and touch. However, within the Jail:

•

Inadequate Emergency Evacuation Key: In WDC, we observed a corrections

officer having difficulty locating the correct key to open the locked box

containing the emergency evacuation key. 'When the officer did produce the key,

it was not marked for identification by sight and touch.

•

Inadequate Emerr!ency Evacuation Routes: In PTDC, the evacuation route leads

prisoners to the small enclosed recreation yard, but there is no access to the

outside of the recreation yard away from the facility. Instead, an officer must

unlock the recreation yard from the outside during an evacuation. This procedure

creates an unacceptable risk of injury and death to prisoners and staff. In

addition, several of the exit signs in PTDC were not properly marked and labeled.

When MDCR corrections officers working in control booths were asked about fire safety equipment such as the self-contained breathing apparatus ("SCBA"), on at least two occasions, the officers could not demonstrate how to properly determine air pressure in the SCBA, even though such tasks are required at the beginning and end of each shift by policy, and are supposed to be documented in log books. Our observations reveal that training is inadequate; log book documentation is of questionable veracity; and the officers are endangering prisoners (and themselves) by their lack of knowledge.

2. The sanitation within the Jail is not reasonably adequate to provide minimal civilized standards of life's necessities.

The level of cleanliness at the Jail is poor. While some facilities, such as vVDC, are generally clean, other facilities are deplorable. During our site visit, the medical clinic area in MWDC was dangerously dirty. Bags ofbiohazardous materials and trash were stored in

- 25 ­
hallways unsecured and unattended. The isolation cells in the clinic were filthy. One cell contained a bloody sheet that had not been removed from the bed. The floor behind the bed in the unit had a heavy accumulation of dirt, paper, and other debris. The other cell in the clinic contained a toilet that obviously had been continually used for some time despite a flushing malfunction.
PTDC, a nearly 50-year-old facility with structural deficiencies, such as cracked concrete and rusting metal, is difficult, if not impossible, to adequately clean. This is a serious issue because such surfaces collect dirt, dust, and debris which lead to bacterial growth, particularly in shower areas. Similarly, the age and condition of the Stockade make it difficult, if not impossible, to adequately clean. The construction of the Stockade includes concrete surfaces that cannot be adequately cleaned by normal cleaning methods, and the window openings are sealed with metal grating too small for normal cleaning equipment. As a result, dirt and grime build up on these sills and are carried into the unit on air currents. The Stockade units are said to be cleaned twice a year with a pressure washer, but the condition of the units we observed suggests that the power washing is ineffective or too infrequent.
In addition, the Stockade is infested with ants and rodents. Poor housekeeping contributes to the presence of these pests, which increases the risk of harm to the prisoners' health. We observed signs of insects and rodents throughout the facilities, including a heavy infestation of drain flies in shower and floor drains, particularly in TGK. Floor drains and shower drains throughout the facility had heavy accumulations of debris and organic matter, which serve as a food source and breeding site for drain flies. Outbreaks of adult flies have been associated with bronchial asthma in susceptible individuals. Their presence is a sign of inadequate housekeeping and sanitation.
TGK housekeeping also falls below constitutional standards. The TGK medical clinic was in need of immediate cleaning. We observed an ice machine in TGK with mold growth in the ice bin and an unapproved ice scoop made from a plastic jug lying on the ice. Molds and bacteria can thrive in the cold temperatures of an ice machine; therefore such machines should be emptied and cleaned regularly to prevent illness to those prisoners and staff consuming the ice.
In addition, improper storage, labeling, and use of cleaning chemicals in a corrections facility can lead to injuries to prisoners (as well as staff). During our tour, we observed unsafe and insecure storage of cleaning chemicals and spray bottles. Additionally, bulk containers were mislabeled or not labeled at all.
3. Hygiene and infection control are inadequate in the Jail, subjecting prisoners to an unreasonable risk of harm.
Communicable diseases may spread in areas where there is close skin-to-skin contact and where personal hygiene is compromised. Overcrowding in corrections facilities will compromise personal hygiene efforts due to the limited numbers of facility showers and sinks, and overburdened services such as laundry, maintenance, and food preparation. We observed overcrowding and the associated problems of personal hygiene.

- 26 ­

•

MWDC Overcrowding: MWDC, the newest of the five MDCR facilities, has a

working capacity for 2,234 prisoners. MWDC was averaging approximately

2,700 prisoners at the time of our tour on June 9-13, 2008. The exact population

on the day we toured MWDC was 2,691 prisoners. On that day, one entire unit

was closed for shower repairs, further exacerbating the crowding issue.

•

PTDC Overcrowding: In PTDC's 9-C wing, the mental health unit was over­

populated by 62% during our tour on June 9-13, 2008.

In addition to overcrowding, improper attention to personal hygiene and biohazards are a major cause of the spread of diseases and infections in health care settings. We observed several medical exam rooms with no hand washing sinks or hand sanitizer dispensers on the wall. In addition:

•

Nonfimctional Negative Pressure Rooms: The TGK medical unit contains six

negative pressure rooms used for prisoners with serious respiratory diseases, such

as tuberculosis. The negative air pressure in such rooms prevents aerosolized

pathogens from escaping the patient's room into the hallway and other areas.

Only one room was occupied, and when we tested the air pressure, it contained

positive air pressure.

•

Unsecure Sharps: In various medical clinics throughout the Jail, we observed

containers for needles and other sharp objects ("sharps containers") not securely

mounted or protected. In many cases, the containers are kept on the floor under

desks or tables where they could be easily knocked over.

Further, proper maintenance of mattresses plays an important role in preventing the spread of diseases and infections in a corrections setting. Mattresses that are damaged or worn beyond their ability to be properly disinfected should be discarded. We observed dozens of mattresses in use or waiting to be issued to prisoners that should have been discarded.

Similar to the inadequate mattress maintenance, MDCR laundry procedures fail to protect prisoners from the risk of contagious diseases and infections. The lalmdry operation of the Jail consists of several laundry areas at each facility. There are no uniform policies, however, and the procedures, machines, chemicals, and schedules differ in each MDCR facility. Some MDCR facilities are employing domestic grade washers and dryers that not suitable for institutional use.

We observed that blankets were not washed for months at a time, and that most prisoner unifonns were washed once a week at best, but many prisoners went longer without clean clothing. TI1is practice is unhygienic and can contribute to the spread of disease. Moreover, as a result of these laundering practices, prisoners at the Jail resort to washing their clothes in sinles and showers and hang the clothes on lines to dry. Such clothes lines create security and fire risks within correctional settings.

- 27 ­

V. REMEDIAL MEASURES

As stated. above, MDCR is deliberately indifferent to the constitutional deficiencies of its facilities and is engaging in the use of excessive force against Jail prisoners. We believe that the deficiencies discussed in this letter are directly tied to current operational standards which grossly fall below what is required by generally accepted correctional standards. The following remedial measures should be immediately implemented by MDCR to correct the constitutional deprivations outlined above. The remedial measures below are consistent with generally accepted correctional standards. We believe that adopting the following measures will remedy the constitutional deficiencies found in medical care, mental health care, prisoner violence, sanitation and environmental health, and the use of excessive force.

A. MENTAL HEALTH CARE AND SUICIDE PREVENTION

1. Suicide Prevention

Generally accepted professional standards of correctional mental health care mandate the development of a suicide prevention policy, including evaluation by a psychiatrist and development of a management plan. These standards require eight critical components of a suicide prevention policy: staff training, identification/screening, communication, housing, levels of observation/assessment, intervention, reporting, and follow-up/morbidity-mortality reVlew.

To this end, MDCR should implement the following measures to correct the constitutional deprivations:

•

Require corrections intake screening to include a specific inquiry from

transporting officer regarding whether the incoming prisoner's behavior indicates

that he/she is at risk of suicide.

•

Cease denial of property and privileges to acutely mentally ill and suicidal

prisoners unless clinically indicated.

•

Ensure that adequate pre-service and annual in-service suicide prevention training

is mandatory for all corrections officers, medical, and mental health staff. Ensure

an adequate number of corrections, medical, and mental health staff to conduct

multidisciplinary pre-service and annual in-service suicide prevention training and

a system of prioritization for attendance in training classes.

•

Provide a curriculum for pre-service and annual in-service suicide prevention

training that includes an an'ay of topics and mock drills, sufficient for staff to be

adequately trained to identify and manage suicide risk.

•

Ensure that decisions regarding clothing, bedding, and other property given to

suicidal prisoners are made by clinical staff on a case-by-case basis.

•

Ensure that each suicidal prisoner has a bed and does not have to sleep on the

- 28 ­

floor.

•

Provide quality private suicide risk assessments of suicidal prisoners on a daily

basis.

•

Ensure that staff does not retaliate against prisoners by sending them to suicide

watch cells. Ensure that prisoners placed in suicide watch cells are appropriately

placed there based on sound suicide risk assessments.

•

Clarify MDCR's policy regarding levels of observation of suicidal prisoners (~,

constant observation, IS-minute intervals checks, etc.) and ensure that corrections

officers implement documented appropriate levels of observation.

•

Implement treatment plans for suicidal prisoners that identify signs, symptoms,

and preventive measures for suicide risk.

•

Require adequate emergency intervention training for all staff that regularly

interact with prisoners. Enforce a policy requiring corrections officers to initiate

CPR if they are the first responders to suicide attempts.

•

Ensure that cutdown tools are readily available to staff who may be first

responders to suicide attempts.

•

Conduct adequate multidisciplinary morbidity-mortality reviews of all suicides

and serious suicide attempts (~, suicide attempts requiring hospitalization). A

preliminary review should occur within 30 days of the incident, and a

comprehensive review should occur within 30 days of the completion of a

coroner's report.

2. Mental Health Care Treatment

Mental health treatment should comport with constitutional requirements and generally accepted standards of care to aid in classification, identification of emergent mental health care needs, provision of continuous care, and management of medication. An adequate correctional mental health system will commonly include the following: crisis intervention program, acute care program, chronic care program/special needs unit, outpatient treatment services, consultation services, discharge/transfer planning, therapy services, and dedicated rounds by mental health professionals.

To this end, MDCR should implement the following measures to correct the constitutional deprivations:

•

Revise intake procedures and forms to adequately screen incoming prisoners for

mental health issues and ensme timely access to mental health professionals when

the prisoner is presenting symptoms requiring such care.

•

Incorporate mental health screening results into prisoners' files and implement a

- 29­

formal communication process between intake and classification staff.

•

Ensure that all staff conducting intake screening are trained adequately, including

regarding identification and assessment of suicide risk, and are given appropriate

tasks and guidance.

•

Ensure that intake screening is conducted in a setting that provides the privacy

consistent with correctional security and which includes specific inquiry

regarding whether an incoming prisoner is currently suicidal or has a history of

suicidal behavior.

•

Ensure that medical and mental health staff conducting screening incorporate the

corrections screening information into their screening process.

•

Ensure that all reasonable efforts are made to obtain a prisoner's prior mental

health records and that this information, along with all MDCR screenings, is

incorporated into prisoners' charts.

•

Develop and implement policies and procedures to ensure prisoners with serious

mental health needs receive timely treatment as clinically appropriate, in a

clinically appropriate setting.

•

Ensure crisis services and acute care in an appropriate therapeutic environment,

including access to beds in a health care setting for short-term treatment (usually

less than ten days) and regular, consistent therapy and counseling.

•

Ensure that mental health staff conduct documented in-person assessments of

prisoners prior to placement in a special management unit (segregation) and on

regular intervals thereafter as is clinically appropriate.

•

Ensure an inpatient level of care that is available to all prisoners who need it,

including regular, consistent therapy and counseling.

•

Provide adequate on-site psychiatry coverage and psychiatry support staff in order

to timely address prisoners' serious mental health needs.

•

Ensure that psychiatrists provide doclUnented diagnoses of prisoners.

•

Implement an adequate scheduling system to ensure that mental health

professionals see mentally ill prisoners as clinically appropriate, regardless of

whether the prisoner is prescribed psychotropic medications.

•

Ensure that adequate psychotherapeutic medication administration is provided.

•

Ensure that mental health care staff are able to access prisoner medical records

that are up-to-date, accurate, and that contain all clinically appropriate

infonnation.

- 30 ­

•

Implement policies and procedures requiring that mental health staff review

mentally ill prisoners' disciplinary charges to ensure that MDCR does not impose

a significant disciplinary penalty on mentally ill prisoners for conduct that is

symptomatic of the prisoner's mental illness.

•

Ensure that MDCR's quality assurance program is adequately maintained to

identify and correct deficiencies with the mental health care system.

•

Provide outpatient treatment, including regular, consistent therapy and

counseling, to general population prisoners who are on the mental health

caseload.

•

Provide discharge/transfer planning, including services for prisoners in need of

further treatment at the time of transfer to another institution or discharge to the

community. These services should include the following:

a) arranging an appointment with mental health agencies for all prisoners with serious mental illness;

b) providing referrals for prisoners with a variety of mental health problems;

c) notifying reception centers at state prisons when mentally ill prisoners are going to arrive; and

d) arranging with local pharmacies to have prisoners' prescriptions renewed.

3. Mental Health Care Housing Units

Generally accepted professional standards of correctional mental health care require that correctional facilities provide correctional mental health systems that allow prisoners to leave their cells for recreation, telephone calls, and visitation, unless prisoners are restricted by a physician's written orders.

To this end, MDCR should implement the following measures to correct the constitutional deprivations:

•

Provide for appropriate housing for mental health care, including a chronic care

and!or special needs unit for prisoners who cannot function in the general

population.

•

Provide an appropriate housing unit for suicidal prisoners, and allow those

prisoners to leave their cells for recreation, showers, and mental health treatment

as clinically appropriate.

•

Remove suicide hazards from all areas housing suicidal prisoners or place all

- 31 ­

suicidal prisoners on constant observation.

B. MEDICAL CARE

MDCR should not deny, significantly delay, or intentionally interfere with medical treatment to prisoners. To the contrary, MDCR should provide adequate medical care to prisoners in need of serious medical attention,

1. Acute Care

Generally accepted correctional medical standards require that incoming prisoners be screened by staff trained to identify and triage serious medical needs, including drug or alcohol withdrawal, communicable diseases, serious acute or chronic illnesses, mental illness, and potential suicide risks. In particular, screening for symptoms of drug or alcohol withdrawal must begin at the initial intake or booking process.

In addition to the initial intake screening, the initial health assessment of a prisoner is an important aspect of corrections health care. Adequate and timely health assessments are necessary for the appropriate treatment of those prisoners who present either acute or chronic needs during intake screening. Generally accepted correctional medical standards require that an initial health assessment be conducted within fourteen (14) days of admission, or sooner when medically necessary. Initial health assessments also provide a secondary screening process for the identification of serious medical needs, should the intake screening procedure fail to do so.

To this end, MDCR should impl=ent the following measures to correct the constitutional deprivations:

•

Ensure that adequate intake screening and health assessments are provided.

•

Ensure that intake screening is conducted as soon as possible, no later than 24

hours after prisoners enter the Jail.

•

Ensure that prisoners are not transferred from the intake area until an intake

screening is completed.

•

Ensure that trained medical care providers review on a daily basis the medical

screening infonnation of those prisoners whose screening indicates a need for

medical care, to provide prisoners timely access to a physician as is clinically

appropriate when presenting symptoms requiring medical care, with the physician

assessment occurring no later than 14 days after intal(e.

•

Ensure that prisoners' acute and chronic health needs are identified in order to

provide adequate medical care.

•

Ensure that appropriate drug or alcohol withdrawal screening is conducted for all

prisoners immediately upon entering the Jail, and prisoners presenting symptoms

of drug or alcohol withdrawal are immediately evaluated by trained medical care

- 32­

professionals.

•

Ensure that appropriate detoxification monitoring is conducted in an appropriate

infirmary setting on prisoners identified as withdrawing from drugs or alcohol.

2. Access to Care

Generally accepted correctional medical standards require that facilities like those operated by MDCR maintain a system to track prisoner requests for medical care, to evaluate whether prisoners are medically assessed in response to their requests, and to identify those prisoners still in need of medical care after the request is made. Moreover, corrections facilities must provide appropriate policies and procedures to guide nursing staff on how to conduct sick­ call assessments, and when to refer requests to higher levels of care.

To this end, MDCR should implement the following measures to correct the constitutional deprivations:

•

Ensure that the medical request process for prisoners provides prisoners with

adequate access to medical care. This process should include logging, tracking,

and timely responses by medical staff as clinically appropriate.

•

Ensure that trained medical professionals review medical requests on a daily

basis.

•

Ensure that medical/sick call requests are appropriately triaged based upon the

seriousness of the medical issue.

•

Provide timely medical appointments and follow-up medical treatment.

•

Ensure that prisoners receive treatment that adequately addresses their serious

medical needs.

•

Ensure that prisoners receive acute care in a timely and appropriate manner.

3. Chronic Care

Generally accepted standards of correctional medical care require that medical staff identify detainees with chronic conditions such as diabetes, tuberculosis, and heart disease and provide timely treatment for such conditions. Jails should have an assessment process to adequately identify detainees with serious chronic medical conditions. Prisoners who suffer from chronic medical illnesses must be regularly monitored by medical professionals to prevent the progression of their illnesses.

To this end, MDCR should implement the following measures to correct the constitutional deprivations:

•

Develop a chronic care program. This program should include the following:

- 33 ­

a) a process that will identify prisoners who should be enrolled in a chronic care pro gram;

b) a roster of prisoners enrolled in the program;

c) a schedule of medical visits for each prisoner enrolled in the program;

d) a system for determining which diagnostic tests will be required for each chronic condition; and

e) record-keeping which includes documentation oflaboratory tests and medical orders.

•

Ensure that prisoners receive thorough assessments for, and monitoring of, their

chronic illnesses.

•

Ensure that standard diagnostic tools are employed to administer the appropriate

preventative care in a timely manner.

•

Adopt and implement appropriate clinical guidelines for chronic diseases such as

HN, hypertension, diabetes, and policies and procedures on, inter alia, timeliness

of access to medical care, continuity of medication, infection control, medicine

dispensing, intoxication/detoxification, record-keeping, disease prevention, and

special needs.

•

Ensure that the medical staff is adequately trained to identify prisoners in need of

immediate or chronic care, and provide timely treatment or referrals for such

pnsoners.

•

Ensure that prisoners with chronic conditions are routinely seen by a physician as

clinically appropriate, to evaluate the status of their health and the effectiveness of

the medication administered for their chronic conditions.

4. Medical Record Keeping

A critical component in providing adequate medical care is a complete, accurate, readily accessible, and systematically organized medical records system. In a correctional setting, inaccurate or incomplete record keeping places prisoners at risk of serious harm.

To this end, MDCR should implement the following measures to correct the constitutional deprivations:

•

Ensure that medical records are adequate to assist in providing medical care and

managing the medical care needs of prisoners. Medical records must be

complete, accurate, legible, readily accessible, and systematically organized.

- 34 ­

•

Ensure that all clinical encounters and reviews of prisoners are documented in the

prisoners' records.

•

Ensure that specialty consultations are timely and that any resulting reports are

forwarded to medical staff. Specialist recommendations should be implemented

in a timely manner or, where deemed inappropriate, a physician should properly

document why such recommendations were not followed.

5. Quality Assurance

Correctional facilities benefit from having an adequate quality assurance process. Quality assurance is a basic component of clinical practice that is consistent with generally accepted correctional medical standards.

To this end, MDCR should implement the following measures to correct the constitutional deprivations:

•

Develop and implement an adequate mortality review system.

•

Ensure that the Jail's quality assurance system is adequate to identify and correct

serious deficiencies with the medical system.

C. USE OF EXCESSIVE FORCE

Force used should not be disproportionate to the threat posed by the prisoner. Absent exigent circumstances, lesser forms of intervention, such as issuing disciplinary infractions or passive escorts, should be used or considered prior to more serious and forceful interventions.

Our investigation identified a pattern and practice of excessive force employed by MDCR corrections officers against prisoners. In a correctional facility, an effective way to remedy a pattern or practice of use of excessive force is to address the deficiencies in the areas of policies and procedures, training, and accountability. Improvement in these areas will have the most impact on MDCR in reducing uses of excessive force.

1. Policies and Procedures

Adequate policies and procedures regarding the appropriate use of force are essential to ensuring that prisoners are not urmecessarily injured by corrections officers and corrections officers are not unnecessarily injured engaging with prisoners. The policies should be comprehensive, clear, up-to-date, and reflect current generally accepted correctional standards. We found that while MDCR's use offorce policy is generally adequate as written, most officers were unfamiliar with the policy. Well-h'ained corrections officers should be able to articulate clearly and without hesitation the level of prisoner resistance necessary for any use of force, as an appropriate response to restore and maintain order.

To this end, MDCR should implement the following policy measures to coneet the constitutional deprivations:

- 35 ­

•

Expressly prohibit the use of force as a response to verbal insults or prisoner

threats.

•

Expressly prohibit the use of force as a response to prisoners' failure to follow

instructions where there is no immediate threat to the safety of the institution,

prisoners, or staff, unless corrections officers have attempted a hierarchy of

documented nonphysical alternatives.

•

Expressly prohibit the use of force as punishment.

•

Expressly prohibit the use of punching and slapping to the head, absent exigent

circumstances.

•

Develop and implement policies and procedures for the effective and accurate

maintenance, inventory and assignment of OC spray and other security

equipment.

2. Training

Use of force training is an essential tool for a corrections facility to ensure that officers are employing force in a manner consistent with generally accepted correctional standards, and not engaging in excessive force. Generally accepted correctional standards require that corrections officers receive annual refresher use of force training courses.

To this end, MDCR should implement the following training measures to correct the constitutional deprivations:

•

Develop an effective and comprehensive training program in the appropriate use

offorce.

•

Ensure that annual refresher training is provided to all MDCR officers.

•

Ensure that staff receive adequate competency-based training in MDCR use of

force policies and procedures.

•

Ensure that staff receive adequate competency-based training in use of force and

defensive tactics.

•

Ensure that MDCR Internal Affairs management and staff receive adequate

competency-based training in conducting investigations of allegations of

excessive force.

" 36 " 


3. Accountability

Generally accepted corrections standards require a process of reporting, administrative review, and investigation of each use of force. This process facilitates the determination of several critical questions, including: (I) whether criminal activity has occurred; (2) whether facility procedures have been followed; (3) whether remedial training is necessary; (4) whether review or change in policies is required; and (5) whether the incident is part of a larger trend. We found that MDCR is underreporting incidents and producing use of force reports that are frequently inaccurate or incomplete.

To this end, MDCR should implement the following accountability measures to correct the constitutional deprivations:

•

Ensure that staff adequately and promptly (within 24 hours) report all uses of

force.

•

Ensure that management review of incident reports, use of force reports, and

prisoner grievances alleging excessive or inappropriate uses of force includes a

timely review of medical records of prisoner injuries as reported by medical

professionals.

•

Ensure that incident reports, use of force reports and prisoner grievances are

screened for allegations of staff misconduct and, if the incident or allegation

meets established criteria, that it is referred for investigation.

•

Develop and implement an adequate system oftracking and reviewing use of

force incidents by MDCR officers. The system should be capable of identifying

patterns and trends that can be addressed through training, administrative, or

disciplinary measures.

D. PRISONER VIOLENCE
Jail officials must take reasonable steps to protect prisoners from physical violence and to provide humane conditions of confinement. Providing humane conditions requires that a corrections system satisfy prisoners' basic needs, such as their need for safety.

To this end, MDCR should implement the following measures to correct the constitutional deprivations:

•

Ensure that corrections officer staffing and supervision levels are appropriate to

adequately supervise prisoners.

•

Ensure frequent, irregularly timed, and documented secmity rounds by

corrections officers inside each housing unit.

•

Ensure that staff adequately and promptly report incidents involving prisoner

violence.

- 37 ­

•

Develop a process to track all serious incidents that captures all relevant

information, including: location, any injuries, if medical care is provided,

primary and secondary staff involved, reviewing supervisor, external reviews and

results (if applicable), remedy taken (if appropriate), and administrative sign-off.

•

Increase video surveillance in critical housing areas and adjust staffing patterns to

provide additional direct supervision of housing units.

•

Develop and implement appropriate training for corrections staff addressing

security administration and providing for proficiency training.

•

Develop a plan to reduce and prevent overcrowding, most immediately the triple­

bunking ofprisoners in cells designed for two prisoners.

•

Develop and implement policies and procedures for an appropriate, objective

classification system that separates prisoners in housing units by classification

levels in order to protect prisoners from unreasonable risk of harm.

E. FIRE SAFETY Al'lD ENVIRONMENTAL HEALTH

Generally accepted correctional standards require adequate sanitation and environmental health conditions, such as proper fire safety systems, sanitation, and hygienic materials and utilities. In order to cure its pattern or practice of inadequate sanitation and environmental conditions, the Jail should ensure that the facilities' conditions do not pose serious risks to prisoners' health and safety. To that end, MDCR should implement the following measures to correct the constitutional deprivations:

1. Fire Safety

•

Ensure that all facilities have adequate fire and life safety equipment that is

properly maintained and inspected.

•

Implement competency-based testing for staff regarding fire/emergency

procedures. Train and drill staff in use of fire safety equipment.

•

Ensure that emergency keys are appropriately marked and consistently stored in a

quickly accessible location.

•

Ensure that fire alarms and sprinkler systems are installed and adequately

maintained in all housing areas.

•

Develop and implement policies and procedures for the control of chemicals in

the facility, and supervision of prisoners who have access to these chemicals.

- 38 ­

2. Sanitation

•

Develop and implement policies and procedures to ensure adequate cleaning and

maintenance of the facilities with meaningful inspection processes and

documentation. Such policies should include oversight and supervision, as well

as establish daily cleaning requirements for toilets, showers, and housing units.

•

Ensure prompt and proper maintenance of shower, toilet, and sink units.

•

Ensure that medical areas are adequately cleaned and maintained, including

negative pressure rooms. Ensure that hand washing stations in medical areas are

fully equipped, operational, and accessible.

•

Ensure proper ventilation and airflow in all cells and housing units.

•

Develop and implement policies and procedures for cleaning, handling, storing,

and disposing ofbiohazardous materials.

•

Secure all sharp medical tools.

•

Destroy any mattress that cannot be sanitized sufficiently to kill any possible

bacteria. Inspect and replace as often as needed all frayed and cracked mattresses.

•

Ensure adequate pest control, including sufficient staffmg for routine and follow­

up pest control services.

3. Hygiene

•

Ensure that laundry procedures protect prisoners from exposure to contagious

disease, bodily fluids, and pathogens. Develop and implement a policy for

handling, washing, and drying oflaundry. Train staff and educate prisoners

regarding laundry sanitation policies.

*******

- 39 ­
Please note that this findings letter is a public document. It will be posted on the Civil Rights Division's website. As a matter of courtesy, we will not post this letter to the website until five calendar days from the date of this letter. We will also provide a copy of this letter to any individual or entity upon request.
We hope to continue working with the County officials in an amicable and cooperative fashion to resolve our outstanding concerns regarding the Miami-Dade County Jail. Since we toured, MDCR has reported that the Jail has adopted a number of improvements, many of which appear to be designed to address issues raised at the conclusion of our site visits. We appreciate the Jail's proactive efforts. Nonetheless, the deficiencies we identified are serious and systemic, and we anticipate that a court-enforceable agreement will be necessary to remedy them.
We are obligated to advise you that, in the event that we are unable to reach a resolution regarding our concerns, the Attorney General may initiate a lawsuit pursuant to CRlPA to correct the deficiencies of the kind identified in this letter 49 days after appropriate officials have been notified of them. 42 U.S.C. § 1997b(a)(1).
We would prefer, however, to resolve all matters by working cooperatively with you and are confident that we will be able to do so in this case. The attorneys assigned to this investigation will be contacting the County's attorneys to discuss this matter in further detail. If you have any questions regarding this letter, please contact Jonathan Smith, Chief of the Civil Rights Division's Special Litigation Section, at (202) 514-5393.
Sincerely,
Thomas E. Perez Assistant Attorney General
cc: R.A. Cuevas, Jr. County Attorney Miami-Dade County
Robert Duvall Assistant County Attorney Miami-Dade County
The Honorable Joe A. Martinez Chair, Board of County Commissioners Miami-Dade County

- 4U­
Alina T. Hudak County Manager Miami-Dade County
TimothyP. Ryan Director, Corrections and Rehabilitation Department Miami-Dade County Tyrone W. Williams, Esq. Legal Advisor, Corrections and Rehabilitation Department Miami-Dade County
The Honorable Wifredo A. Ferrer United States Attorney Southern District of Florida