223 F.Supp.2d 1292 (2002)
Ruben FOSTER, et al., Plaintiffs, v.
FULTON COUNTY, GEORGIA, et al., Defendants.
No. CIV.A.1:99-CV-900-MHS.
United States District Court, N.D. Georgia, Atlanta Division.
April 16, 2002. Order Amending Decision April 18, 2002.
1293 *1293 Stephen Brooks Bright, Robert Earl Toone, Jr., Katharine Aiken Huffman, Tamara H. Serwer, Alexander Taylor Rundlet, X-208, Southern Center for Human Rights, Atlanta, GA, Milton "Chip" Dale Rowan, Chip Rowan & Associates, Atlanta, GA, for plaintiffs.
Overtis Hicks Brantley, Charles George Hicks, Paula Morgan Nash, Rolesia Butler Dancy, Office of Fulton County Attorney, Atlanta, GA, for defendants.
ORDER
SHOOB, Senior District Judge.
On November 5, 2001, the Court ordered the parties to respond to Dr. Greifinger's October 30, 2001, Report and to "set forth specific recommendations for addressing" each of ten areas that Dr. Greifinger identified as "far from compliance" with the Final Settlement Agreement.[1] The parties filed their responses on December 5, 2001. On January 15, 2002, the Court toured the jail with Dr. Greifinger, and after a follow-up visit on February 25-26, 2002, Dr. Greifinger submitted his latest Report on March 2, 2002.
The Court has reviewed the parties' responses, Dr. Greifinger's latest report and plaintiffs' response to that Report filed March 21, 2002, as well as defendants' most recent updates on jail population, filed March 1 and April 1, 2002. It is clear from these submissions that, despite significant progress, much remains to be done to 1294 achieve full compliance with the Final *1294 Settlement Agreement and to assure that all plaintiff class members receive constitutionally adequate medical care. It is also clear that these goals will not be realized without continued monitoring by Dr. Greifinger and active supervision by this Court.
The following additional steps are needed to enforce the terms of the Final Settlement Agreement and to correct violations of plaintiffs' federal rights to minimally adequate conditions of confinement and receipt of adequate medical care. The Court finds that this relief is narrowly drawn, extends no further than necessary to correct violations of federal rights arising from defendants' failure to comply with the Final Settlement Agreement, and is the least intrusive means to correct these violations. The areas where additional relief is needed, the relevant provisions of the Final Settlement Agreement, and the specific remedial actions required are set out below.
I. Overcrowding
The County shall identify mechanisms for accommodating current and anticipated jail population.
Final Settlement Agreement ¶ V.D.
Inmate population at the Rice Street facility continues to exceed physical capacity by a significant number. After reaching a low of 2,266 on September 30, 2000, the population rose to 2,544 as of February 15, 2002, and was 2,526 on March 15, 2002. Although the population declined to 2,362 on March 31, 2002, even this figure is more than 100 over the facility's capacity of 2,250, and recent fluctuations suggest that it is likely to rise again. Clearly,

the programs implemented by defendants to reduce the jail population to at or below capacity have not succeeded. Something more must be done.
As Dr. Greifinger has repeatedly stated, overcrowding causes a myriad of problems that increase the likelihood of disease and interfere with the delivery of adequate medical care. The conditions described in Dr. Greifinger's latest Report are totally unacceptable. These conditions include lack of adequate heat, water, ventilation, and sanitation, all caused, at least in part, by the strain of chronic overcrowding on the facility's physical plant.
Defendants argue that, despite the overcrowding, the conditions of confinement and the provision of medical care still satisfy constitutional requirements. The Court rejects this argument. The Constitution prohibits depriving inmates of "basic human needs" or "the minimal civilized measure of life's necessities." Rhodes v. Chapman, 452 U.S. 337, 347, 101 S.Ct. 2392, 69 L.Ed.2d 59 (1981). Adequate heat, water, fresh air, and sanitation are basic human needs, which inmates may not be denied without violating minimal constitutional requirements.
Defendants report that they have undertaken the following additional steps designed to reduce the jail population: (1) regular review of misdemeanor inmates for possible release, (2) expansion of the number and type of cases handled through the Complaint Room, (3) increased efforts to place convicted inmates in the state system, (4) possible reinstitution of the home arrest program, and (5) appointment of a new full-time magistrate judge to handle primarily criminal cases. While these are all steps in the right direction, there is no evidence, nor does the Court believe, that these steps alone will be sufficient to solve the problem.
Plaintiffs have proposed a number of measures that defendants have not yet undertaken, which are designed to correct systemic problems that result in unnecessary incarceration and thus contribute to jail overcrowding. 1295 Plaintiffs' principal proposal is that defendants be required to *1295 provide counsel within 72 hours of arrest to all persons accused of minor offenses who cannot make bail. For the following reasons, the Court concludes that this proposal should be implemented immediately.
Much of the overcrowding at the jail is the result of persons charged with relatively minor offenses who cannot make bail and must remain in jail for weeks or even months waiting for the State Court Solicitor General to file an accusation.[2] Only after an accusation is filed are these inmates' cases placed on a calendar, and only after these inmates are finally brought to court are they provided counsel. By this time, they have often spent far more time in jail than they would ever receive as a sentence for their offenses. Under these circumstances, counsel can serve little purpose other than to handle the entering of a plea so that the inmate can finally get out of jail.
If these inmates are appointed counsel promptly after their arrest, they will have the opportunity to file bond review motions, to negotiate pleas, or simply to demand prompt attention to their cases. As a result, many of these inmates will spend only a few days in jail rather than weeks or months before their cases are even heard. This will not only help to alleviate the overcrowding at the jail; it will also save the County money spent in housing these inmates unnecessarily.[3]
Not only does the current treatment of individuals charged with minor offenses contribute to the serious overcrowding problem at the jail, it also constitutes a clear denial of these individuals' constitutional right to counsel. See Argersinger v. Hamlin, 407 U.S. 25, 37, 92 S.Ct. 2006, 32 L.Ed.2d 530 (1972) (no person may be imprisoned for any offense, whether classified as petty, misdemeanor, or felony, unless represented by counsel). The Solicitor General contends that "[c]ounsel has always been appointed in Fulton County in cases where a defendant is sentenced to jail time."[4] This argument apparently refers to Fulton County's practice of appointing counsel at the time of arraignment. At this point, however, it is too late for an attorney to provide any real representation, since his client has likely already served more time than he or she would if found guilty. Under these circumstances, an appointed lawyer provides no professional assistance but merely serves the clerical function of processing people through court. Appointing counsel to handle a plea at this point is, as plaintiffs' counsel puts it, "a meaningless and hollow gesture." The Constitution requires more than this.
Accordingly, the Court ORDERS defendants to immediately implement a program to provide counsel within 72 1296 hours of *1296 arrest to all persons accused of minor offenses who cannot make bail.

Plaintiffs have also proposed additional measures to address the overcrowding problem. The Court concludes that each of these measures is a reasonable and necessary step in identifying and correcting the problems that lead to unnecessary incarceration and jail overcrowding. Accordingly, the Court ORDERS defendants to immediately implement each of the following measures:
(1) Expand the authority of Pretrial Services to include supervision of persons arrested for misdemeanor offenses;[5]
(2) Evaluate the factors currently used to exclude certain persons charged with felonies from pretrial release and eliminate any that are unreasonable;
(3) Ensure that all persons charged with misdemeanors are offered a reasonable bond in accordance with Georgia law;
(4) Develop and implement meaningful mental health diversion and mental health discharge planning;[6]
(5) Increase compensation paid to appointed counsel in misdemeanor cases from the current $50 to a reasonable amount, or expand the Fulton County Public Defenders Office to handle cases in State Court;
(6) Institute an All-Purpose Hearing calendar in State Court modeled on the hearings currently conducted in Superior Court, with the hearings to be held within 72 hours of arrest;[7]
(7) Expand the authority of the Judicial Administrative Expeditors to facilitate release of inmates whose cases are in State Court as well as Superior Court;
(8) Impose reasonable restrictions on the length of time a person may remain in jail (a) without accusation or indictment, and (b) accused or indicted but untried;
(9) Implement an integrated computer system that links all of the appropriate agencies in the Fulton County criminal justice system.
II. Security Staffing
Fulton County defendants shall employ a sufficient number of trained correctional staff to meet the healthcare needs of HIV-positive inmates at all times. Shortages in correctional staff shall not interfere with the provision of 1297 medical care in accordance with Section III, above. The Fulton County defendants shall ensure that shortages *1297 in correctional staff do not prevent or delay the distribution of medications or the transport of HIV-positive inmates for any medical appointments or needed medical care, either within the facility or in the community.
Final Settlement Agreement ¶ IV.B.
More than two years after the Final Settlement Agreement was signed, Dr. Greifinger reports that there continues to be an insufficient number of security staff positions for the current population of inmates. Defendants state that they have consistently kept 96-97% of staff positions filled, which is above average for correctional institutions. However, given the overpopulation of inmates and the number of inmates who are HIV-positive or have other health problems, even if all positions were filled, there would still not be sufficient staff to assure inmates timely access to medical care. Something more must be done.
Accordingly, the Court ORDERS defendants to immediately develop and implement a plan to increase security staffing at the jail to the level necessary to provide timely access to medical care for the current population of inmates. The plan shall authorize and provide funding for a sufficient number of additional staff positions, taking into account normal turnover and vacancy rates, so that at any given time there will be adequate security staff available to ensure timely access to medical care.

III. Access to Grady Health System.
HIV-positive inmates shall be referred in a timely manner to outside specialists in all cases when the Jail's own staff lacks the resources to treat in a timely manner the medical or mental conditions of HIV-positive inmates. Accordingly, defendants shall coordinate timely access to the Grady Hospital's Infectious Disease Program or other appropriate specialists for HIV-positive inmates and implement all necessary procedures to provide specialty consultations and specialized testing on an emergency (immediate), urgent (within three days), and routine (within four weeks) basis, as directed by medical staff including the HIV Specialist.
Final Settlement Agreement ¶ III.G.
In the past, inmates without a "Grady card" experienced long delays in receiving specialty care because an appointment could not be made until after a financial review, which took anywhere from three weeks to six months. Defendants claim that this problem has been resolved. In his latest report, however, Dr. Greifinger states that, although the financial review barrier may have been solved, bureaucratic problems remain for those without a card, and that the appointment making process can still take from three weeks to six months. This is not acceptable.
Accordingly, the Court ORDERS defendants to immediately develop and implement a plan to establish an efficient and reliable appointment system that will assure inmates timely access to specialty care.
IV. Timely Medication to New HIV-Positive Inmates
If during intake screening an HIV-positive person is able to identify credibly his or her medications, the intake nurse shall obtain a verbal order from a physician and continue these medications immediately. There shall be no unreasonable disruption in the continuity of medication.
Final Settlement Agreement ¶ III.A.ii.
Dr. Greifinger's latest report states: "During my January visit, the timeliness of initial medication for HIV-positive 1298 inmates remains lower than acceptable. Only half of the inmates with a *1298 credible history of HIV medications
when they arrive at the jail were getting their first doses within 24 hours." Report at 4. A 50% compliance rate with this important requirement is not acceptable.[8]
Accordingly, the Court ORDERS defendants to immediately develop and implement a plan that will ensure that new HIV-positive inmates with credible medication histories receive their medication in a timely manner.
V. Chest X-Rays
Defendants shall screen all incoming inmates for symptoms of tuberculosis infection immediately upon admission. Defendants shall promptly isolate, diagnose, and treat any individual with a suspicion of contagious tuberculosis. Follow-up treatment and testing shall be conducted according to the recommendations and guidelines of the Centers for Disease Control ("CDC"). Any individual who has symptoms of tuberculosis and all HIV-positive persons shall have a chest x-ray within 48 hours of intake.
Final Settlement Agreement ¶ III.M.
Plaintiffs contend that not only has there been a problem with follow-up and treatment of abnormal chest x-rays, but also a failure to provide chest x-rays to all inmates who are required to have them within 48 hours. In his latest report, Dr. Greifinger states that a new system for timely follow-up of abnormal chest x-rays has been

instituted, and that the new tracking system is excellent. However, it remains unclear whether all inmates who are required to have chest x-rays within 48 hours of intake, including all HIV-positive inmates, are actually receiving them.
Accordingly, the Court ORDERS defendants to immediately take all steps necessary to ensure that all inmates who are required to be given x-rays actually receive them.
VI. Continuity of Care on Release
Prior to discharge from the Jail to the community, all HIV-positive inmates shall have an appropriate discharge plan. A post-discharge appointment with an appropriate HIV medical care provider in the community shall be scheduled for every HIV-positive inmate, and each inmate shall be informed upon discharge of the date, time, and location of that appointment. If the inmate is on any prescribed medications, defendants shall provide sufficient medications to prevent gaps in the availability of those medications.
Final Settlement Agreement ¶ III.J.
In his latest report, Dr. Greifinger states that there has been "no substantial progress in the area of continuity of care on release." Report at 6. Although more HIV-positive inmates are being referred to AID Atlanta, half of the inmates are released before AID Atlanta makes contact with them. In addition, there are continuing logistical problems with providing discharged inmates with a supply of their medications. In his prior report, Dr. Greifinger also noted that there is a major problem for inmates with dual diagnoses 0907 both HIV infection and major mental illness such as schizophrenia or bipolar disorder. A significant number of the inmates in this category had had multiple incarcerations over the previous four months. As plaintiffs point out, "[t]his high rate of re-incarceration of 1299 seriously *1299 mentally ill persons indicates that mental health discharge planning is either not happening or not working." Response at 9.
Accordingly, the Court ORDERS defendants to immediately develop and implement a plan to expand the current discharge planning resources at the jail and to evaluate obstacles to discharge planning and take steps to remove these obstacles.
VII. Medical Diets
A registered dietician employed by the County or its food contractor shall work closely with medical and security personnel to ensure that HIV-positive inmates receive appropriate diets, as indicated on the inmates' treatment plans. The dietician shall be responsible for menu planning and monitoring of both general and medically prescribed diets.
Final Settlement Agreement ¶ III.B.ii.
In his October 30 Report, Dr. Greifinger found this area "worse than ever." Report at 6. In his latest Report, Dr. Greifinger states that there is a new dietician, and that grievances regarding medical diets have been reduced. Nevertheless, it is clear that full compliance with this requirement has not yet been achieved.
Accordingly, the Court ORDERS defendants to evaluate the performance of the food vendor as well as the system for delivering food to inmates and to take whatever steps are necessary to ensure delivery of appropriate medical diets to all inmates for whom such diets have been prescribed.
VIII. Quality Management
Defendants shall perform ongoing quality management that monitors the quality of healthcare services provided at the Jail. The quality management program shall monitor all aspects of healthcare including at least the

following: access to healthcare, medication management, nursing services, physician services, access to specialty care, mental health services, pharmacy services, dental services, environmental services, infection control procedures, healthcare records, sick call services, intake screening and evaluations, chronic disease services, infirmary care, diagnostic services, discharge planning, and adverse patient occurrences including all deaths. The quality management program shall include reviews of all aspects of healthcare provision at the Jail, and shall identify any deficiencies in services to inmates as well as any staff training needs and/or deficiencies. Corrective plans to address all deficiencies and recommended improvements shall be prepared, and the quality management program shall include ongoing assessment of the effectiveness of corrective plans and actions.
Final Settlement Agreement ¶ VII.A.
In his October Report, Dr. Greifinger stated that "[t]he quality management program is evolving, but nowhere near complete." Report at 5. In his latest report, Dr. Greifinger found that there had been a "hiatus" in the quality management program, and that the medical vendor "had not been paying sufficient attention to this critical area." Report at 5. As plaintiffs point out, it is essential that a fully operational quality management program be in place so that improvements made in the past can be and will be sustained. Likewise, in his latest Report, Dr. Greifinger states: "I cannot emphasize more strongly that good management cannot succeed without good measurement." Report at 5.
Accordingly, the Court ORDERS defendants to immediately take all necessary steps to address deficiencies in their quality management program.
IX. Environmental Health and Sanitation
1300 All housing units to which HIV-positive inmates are assigned shall be adequate to *1300 meet the needs of the HIV-positive inmates placed there. This shall include, but is not limited to, assurance that no HIV-positive inmate in a chronic care unit or with a diagnosis of AIDS shall sleep on the floor, and that all HIV-positive inmates shall have adequate access to toilet facilities, clean bedding and clothing, hot and cold running water, and drinkable water at all times.
Final Settlement Agreement ¶ V.B.
Despite recent renovations, the condition of the plumbing and HVAC systems at the jail continues to deteriorate. According to Dr. Greifinger's latest report: "The benefit from the renovation is gone. Sinks are inoperable again, showers are not functioning well and water fountains often do not work. The plumbing system is either poorly designed or maintained. It should be changed." Report at 5-6. Dr. Greifinger notes that during the coldest week of the winter, a boiler broke down, causing temperatures in many housing areas to drop into the low 60s. A backup boiler, which should have prevented this problem, has not worked in years. Report at 2. As another example, during his latest tour of the jail, Dr. Greifinger observed that there was no cold water in the showers in one of the living areas, so that inmates were unable to take showers. Id. In conclusion, Dr. Greifinger states: "Although renovated, the plumbing and air handling systems are virtually collapsed. The County needs to correct these deficiencies in short order." Id. at 6.
Accordingly, the Court ORDERS defendants to immediately develop and implement a plan to repair or replace existing plumbing and HVAC systems so that they are able to function under the current population load without constantly breaking down. If the jail cannot be renovated to cure these problems, defendants should so advise the Court so that construction of a new jail can be considered.[9]
X. Conclusion
It is now more than two years since the parties entered into the Final Settlement Agreement. Yet defendants still remain "far from compliance" in many key areas. The Court is totally out of patience with the persistent

assurances and promises that compliance will be achieved. Defendants must do what is necessary to comply with their obligations, and they must do it now.
The Court ORDERS defendants to file a report with the Court within thirty (30) days of the date of entry of this order setting out the specific steps they have taken to comply with each of the requirements set out in this order. Plaintiffs shall have 10 days thereafter to file any response. The Court will conduct a hearing on Tuesday, May 28, 2002, beginning at 10:30 a.m. to consider the progress that has been made and to determine what further action may be necessary. Defendants should have appropriate representatives present at the hearing, other than counsel, to address any areas in which full compliance with this order has not been achieved. Finally, the Court DIRECTS defendants' counsel to deliver a copy of this order to each individual defendant, as well as to the chief judges of the State Court and the Magistrate Court of Fulton County.
In summary, the Court ORDERS defendants to immediately implement the remedial actions set out above and to report to the Court within thirty (30) days of the date of entry of this order. A hearing to consider defendants' 1301 progress in complying *1301 with this order and to determine if further action is needed is scheduled for Tuesday, May 28, 2002, at 10:30 a.m. in Courtroom 1707.
[1] The deficient areas identified by Dr. Greifinger were (1) crowding, (2) security staffing, (3) physical plant intake and kitchen, (4) access to Grady Hospital System, (5) timely medication to new HIV infected patients, (6) followup on abnormal chest x-rays, (7) continuity of care on release, (8) diets, (9) cross-training, and (10) quality management.
[2] According to defendants' latest report, as of March 15, 2002, there were 308 inmates in the Fulton County Jail who were charged with misdemeanors but had not yet been formally accused. Of that number, 88 had been in jail for more than 30 days, and of those, 12 had been in jail for more than 60 days.
[3] In an April 5, 2002, letter to the Solicitor General, plaintiff's counsel provides several examples. One inmate, Barbara Anholt, spent 68 days in jail for public drunkenness, at a cost to the County of over $3,000, while her case was being "reviewed and drafted." Another inmate, Bobby Nelson Richard, spent 83 days in jail for public drunkenness, at a cost to the County of $3,735, because of "researching for other warrants." An examination of a random sample of 57 detainees being held only on State Court charges who were on the jail calendars for a single week in February revealed that they spent a total of 1,519 days in jail at a cost to Fulton County of $68,355 ($45 a day).
[4] The Solicitor General's argument is contained in her March 18, 2002, response to a letter from plaintiffs' counsel expressing concern over Fulton County's denial of counsel to persons charged with minor offenses.
[5] Defendants report that on August 2, 2001, Pretrial Services began expanded screening of misdemeanor cases. It is not clear, however, whether this includes actual supervision. According to plaintiffs, Pretrial Services is currently not allowed to supervise anyone whose case is in State Court. Defendants should clarify this issue.
[6] This will require defendants (1) to determine how many inmates have a serious mental illness, the number of times they have been subject to short-term incarcerations, the types of offenses they are charged with, and their prior access to mental health services in the community; (2) to study viable models currently used in other counties and evaluate the current mental health out-patient and in-patient services available in Fulton County; and (3) to provide adequate funding to expand mental health resources in the County, if necessary. Defendants report that various Fulton County agencies have been meeting to develop a mental health diversion program and possibly establish a mental health diversion court. Defendants should move forward with these plans expeditiously.
[7] Defendants have indicated that State Court will begin conducting All Purpose Hearings in April or May 2002. The further requirement that these hearings be held within 72 hours of arrest is consonant with the Court's order that counsel be appointed within 72 hours of arrest. As explained in plaintiffs' counsel's April 8, 2002, letter to State Court Chief Judge Thompson and Judge Newkirk, other major metropolitan courts such as New York and Washington, D.C., generally conduct such hearings within 24 hours of arrest.

[8] By the time of Dr. Greifinger's February visit, defendants had eliminated a requirement that inmates know their exact dosages before being prescribed medication, but it is not clear that this change in policy will solve the problem. Plaintiffs report that delays have occurred even when the new inmate has arrived with medication from another correctional institution, and that some inmates are waiting in the intake area for as long as 20 hours before an intake nurse even takes their medical history.
[9] The Court notes that in the past it has ordered the construction of new jails in Cobb, Fayette, and Douglas Counties after the county commissioners acknowledged that a new facility was needed.
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 223 F.Supp.2d 1301 (2002)
Ruben FOSTER, et al., Plaintiffs, v.
FULTON COUNTY, Georgia, et al., Defendants.
No. 1:99-CV-900-MHS.
United States District Court, N.D. Georgia, Atlanta Division.
July 12, 2002.
Jerry Davis, Glennville, GA, movant pro se.
Thomas McKee West, Office of Thomas M. West, Atlanta, GA, Brenda Loyce Gardner, Brenda Gardner & Associates, Atlanta, GA, for Mahboob Pashas, movant.
Stephen Brooks Bright, Robert Earl Toone, Jr., Katharine Aiken Huffman, Tamara H. Serwer, Alexander Taylor 1302 Rundlet, Atlanta, GA, Milton "Chip" Dale Rowan, *1302 Chip Rowan & Associates, Atlanta, GA, for Ruben Foster,
George West, Anthony Williams, Tony Martin, Lucas James, Grady McGlothlin, plaintiffs.
Robert Earl Toone, Jr., Alexander Taylor Rundlet, Atlanta, GA, for Richard Malicoate, Willie Hightower.
Overtis Hicks Brantley, Charles George Hicks, Paula Morgan Nash, Steven E. Rosenberg, Rolesia Butler Dancy, Office of Fulton County Attorney, Atlanta, GA, for Fulton County, Fulton County Bd. of Commissioners, Mike Kenn, Karen Webster, Tom Lowe, Bob Fulton, Emma I. Darnell, Nancy Boxill, Jacquelyn Barrett, L.L. Briggs, George Herron, defendants.
William T. Mitchell, Cruser & Mitchell, Norcross, GA, for Correctional Health Care Solutions, Inc., Kevin Ramos, Harold Minerve, Eno Ikoku, defendants.
Paula Morgan Nash, Steven E. Rosenberg, Rolesia Butler Dancy, Office of Fulton County Attorney, Atlanta, GA, for Michael Hightower.
ORDER
SHOOB, Senior District Judge.
This action brought by HIV-positive inmates at the Fulton County Jail complaining of conditions of confinement and inadequate medical care is currently before the Court for a determination of what further action may be needed to enforce the terms of the Final Settlement Agreement approved by the Court on January 24, 2000.
BACKGROUND
On April 16, 2002, in response to reports from the Court-appointed Correctional Healthcare Monitor, Dr. Robert Greifinger, and submissions by the parties, the Court ordered defendants to take certain additional steps to achieve compliance with the Final Settlement Agreement.
The Court's Order sought to address systemic problems that lead to unnecessary incarceration and chronic jail overcrowding, which in turn adversely affect living conditions at the jail, increase the risk of exposure to dangerous diseases, and interfere with the provision of adequate medical care.[1] Among these problems is the fact that hundreds of pretrial detainees charged with minor offenses spend far longer periods of time in the Fulton County Jail than they would under any sentence they would ordinarily receive if they were promptly provided with 1303 a lawyer and a court date.[2] This is both *1303 constitutionally unacceptable and a major contributing factor to the jail overcrowding problem.

To address this problem, the Court ordered defendants to immediately implement a program to provide counsel within 72 hours of arrest to all persons accused of minor offenses who cannot make bail. In addition, the Court ordered defendants to implement an All-Purpose Hearing calendar in State Court modeled on the hearings currently conducted in Superior Court, with the hearings to be held within 72 hours of arrest. Defendants have moved to stay the implementation of these requirements on the grounds that they are impossible or impracticable to implement. Defendants contend that the large majority of persons accused of minor offenses are arrested by municipal authorities and transported to municipal detention facilities and are not transferred to the Fulton County Jail until more than 72 hours after arrest. Defendants also argue that it is impracticable to conduct All-Purpose hearings even within 72 hours of incarceration in the Fulton County Jail, because this would not allow enough time to complete necessary paperwork and investigations before the hearing.
The Court also ordered defendants to take the following additional steps to correct other problems that lead to unnecessary incarceration and jail overcrowding: (1) expand the authority of Pretrial Services to include supervision of persons arrested for misdemeanor offenses; (2) evaluate the factors currently used to exclude certain persons charged with felonies from pretrial release and eliminate any that are unreasonable; (3) ensure that all persons charged with misdemeanors are offered a reasonable bond in accordance with Georgia law; (4) develop and implement meaningful mental health diversion and mental health discharge planning; (5) increase compensation paid to appointed counsel in misdemeanor cases from the current $50 to a reasonable amount, or expand the Fulton County Public Defender's office to handle cases in State Court;[3] (6) expand the authority of the Judicial Administrative Expeditors to facilitate release of inmates whose cases are in State Court as well as Superior Court; (7) impose reasonable restrictions on the length of time a person may remain in jail (a) without accusation or indictment, and (b) accused or indicted but untried; and (8) implement an integrated computer system that links all of the appropriate agencies in the Fulton County criminal justice system.
Finally, to address a number of other problem areas regarding access to medical care and general living conditions, which Dr. Greifinger reported were not in compliance with the Final Settlement Agreement, the Court ordered defendants to take the following actions: (1) increase security staffing at the jail to the level necessary to provide timely access to medical care for the current population of inmates; (2) establish an efficient and reliable appointment system that will assure inmates timely access to specialty care; (3) ensure that new HIV-positive inmates with credible medication histories receive their medication in a timely manner; (4) ensure that all inmates who are required to be given x-rays actually receive them; (5) expand the current discharge planning resources at the jail and evaluate obstacles to discharge planning and take steps to remove these obstacles; (6) evaluate 1304 the *1304 performance of the food vendor and the system for delivering food to inmates and ensure delivery of appropriate medical diets to all inmates for whom such diets have been prescribed; (7) address deficiencies in the quality management program; and (8) repair or replace existing plumbing and HVAC systems so that they are able to function under the current population load without constantly breaking down.
The Court ordered defendants to report within 30 days on the specific steps they had taken to comply with each of the requirements of the Court's Order and gave plaintiffs 10 days to reply. Then, on May 28-29, 2002, the Court conducted a hearing to consider the progress that defendants had made and to determine what further actions might be necessary. Following the hearing, the Court directed the parties to submit proposed findings of fact and conclusions of law within 15 days. Having fully considered the evidence presented at the hearing and the parties' submissions, the Court now makes the following findings of fact and conclusions of law regarding defendants' compliance with the provisions of the Court's April 16 Order, as well as additional factors that contribute to undue incarceration and overcrowding. On the basis of these findings and conclusions, the Court orders defendants to take further action to comply with the Court's Order and the Final Settlement Agreement.
FINDINGS OF FACT AND CONCLUSIONS OF LAW
I. Compliance with Provisions Designed to Eliminate Undue Incarceration and Reduce Overcrowding[4]

A. Appoint Counsel Within 72 Hours of Arrest
1. On April 15, 2002, Fulton County entered into a 90-day contract with the Fulton County Conflict Defender to provide counsel to indigent inmates accused of minor offenses. Fulton County is currently engaged in a bidding process to obtain a long-term contract.
2. Fulton County contends that under the current contract counsel is provided to the inmates in the Fulton County Jail within 72 hours of their arrival at the jail. In fact, however, this is true only in a small minority of cases.
3. Persons arrested by Fulton County authorities in unincorporated parts of the county or by campus or MARTA police are transported directly to the Fulton County Jail. These persons are assigned an attorney at their initial 1305 appearance in Magistrate Court, which occurs within 48 hours of their arrest. As to these persons, *1305 therefore, defendants are in compliance with the Court's Order. This category, however, comprises less than 25% of the total number of persons arrested for minor offenses in Fulton County.
4. The large majority of persons arrested for minor offenses in Fulton County (more than 75%) are arrested by municipal authorities in one of the nine municipalities located within the county, including the city of Atlanta. These persons are initially detained in municipal jails and make their initial appearance in municipal courts. In the city of Atlanta, where approximately 75% of the cases in the State Court of Fulton County originate, these persons are initially represented in Atlanta Municipal Court by the City of Atlanta Public Defender's Office.[5] However, once the defendant is bound over to the State Court of Fulton County, there is no coordination between the City of Atlanta Public Defender and the Fulton County Conflict Defender to share information that may be critical to the continuity of representation for inmates in the jail.
5. Once these cases are bound over to State Court, the inmates are transferred to the Fulton County Jail, where they are interviewed by Pretrial Services, which then forwards a packet to the Conflict Defender's office. Inmates are technically assigned an attorney at the time this packet is received, but they do not actually meet their attorney, or even know they have one, until they arrive in the lockup area behind the courtroom immediately before their All-Purpose Hearing in State Court.
6. Fulton County is currently attempting to schedule inmates for All-Purpose Hearings 14 days after their arrival at the Fulton County Jail. Thus, for all practical purposes, the large majority of persons incarcerated in the Fulton County Jail for minor offenses are not provided an attorney for at least two weeks after they arrive at the jail, and in a significant number of cases this time period is actually much longer due to delays in conducting interviews by Pretrial Services, delays in placing persons on a calendar, and failures to transport inmates to court on their hearing date.
7. Fulton County contends that it has no legal authority or responsibility to provide counsel to persons arrested by municipal law enforcement agencies on state law misdemeanor charges before they are bound over to State Court and transferred to the Fulton County Jail. The Court rejects this argument.
8. Georgia law does not grant municipal courts exclusive jurisdiction over state law misdemeanor charges originating in a municipality. Nor does Georgia law require that persons arrested by municipal law enforcement agencies on state law misdemeanor charges be taken to a municipal court and detained in a municipal jail before 1306 they are bound over to the Fulton County Jail.[6] Thus, there is no legal impediment *1306 preventing Fulton County from conferring with the various municipalities within the county and agreeing on a unified system for providing counsel within 72 hours of arrest to persons arrested within municipalities on state law misdemeanor charges.
9. Not only is there no legal impediment to Fulton County's establishing such a system, but the Georgia Indigent Defense Act, O.C.G.A. § 17-12-30 et seq., and Fulton County's contract with the Georgia Indigent Defense Council require Fulton County to provide such a system.
10. Under the Georgia Indigent Defense Act, Fulton County must provide attorneys "for indigents in all felony cases and in those misdemeanor cases in which indigents are guaranteed the right to counsel in the superior,

state, and magistrate courts...." O.C.G.A. § 17-12-38.1. This includes indigent persons charged with state law misdemeanors that can only be tried in State Court or Magistrate Court. See Alabama v. Shelton, 535 U.S. 654, 122 S.Ct. 1764, 152 L.Ed.2d 888 (2002); Argersinger v. Hamlin, 407 U.S. 25, 92 S.Ct. 2006, 32 L.Ed.2d 530 (1972).
11. Under the contract between Fulton County and the Georgia Indigent Defense Council, in return for its receipt of state funding, Fulton County agreed to comply with the Georgia Supreme Court's Guidelines for the Operation of Local Indigent Defense Programs. These guidelines provide in part: "Counsel shall be appointed for every eligible person in custody within 72 hours of arrest or detention." Guideline 1.2.
12. Thus, Fulton County is contractually obligated to establish a system under which all persons charged with misdemeanors that can only be tried in State Court or Magistrate Court are provided counsel within 72 hours of their arrest or detention, even if they are initially arrested and detained by municipal authorities.
13. Since April 18, 2002, two lawyers from the Fulton County Conflict Defender's office have been assigned to represent persons charged with misdemeanors during the All-Purpose Hearing calendars, which are held in the State Court of Fulton County every morning and every afternoon, Monday through Thursday, and in the morning on Fridays.[7] Two additional lawyers from the Fulton County Conflict Defender's office are assigned to the Magistrate Court where persons arrested in unincorporated Fulton County have their first appearances and commitment hearings. One lawyer from the Fulton County Conflict Defender's office is assigned as a floater to provide back-up for all calendars. Because lawyers from the Fulton County Conflict Defender's office are currently assigned to courtrooms, rather than cases, a defendant may not have the same lawyer representing him or her from one day to the next.
14. Because of the backlog of inmates in the Fulton County Jail, lawyers from the Fulton County Conflict Defender's office have been meeting their clients for the first time in the State Court courtroom immediately before court begins and have been pleading many cases for sentences of time served. Consequently, lawyers from the Fulton County Conflict Defender's office have not had the opportunity to conduct preliminary investigations or otherwise prepare for the majority of cases.
1307 *1307 15. Since taking over State and Magistrate Court in early April 2002, lawyers for the Fulton County Conflict Defender have handled approximately 500 cases. This is a caseload that is approximately four times greater than the caseloads permitted under the caseload limits recommended by the Georgia Supreme Court's Guidelines for the Operation of Local Indigent Defense Programs. See Guideline 6.1 (recommending that the caseload of a fulltime attorney handling misdemeanor cases be limited to 300 misdemeanors per year).
16. The current level of staffing of the Fulton County Conflict Defender is insufficient to meet the needs of providing representation to persons arrested on misdemeanor charges. In order to represent the approximately 4,300 misdemeanor cases in the State and Magistrate Courts of Fulton County, and to stay within the caseload guidelines, the State and Magistrate Court unit of the Fulton County Conflict Defender will require at least 15 lawyers, and approximately five paralegals, social workers, or investigators, and support staff.[8]
B. Hold All-Purpose Hearing Within 72 Hours of Arrest
17. Contrary to this Court's April 16 Order, Fulton County has not yet implemented a system which provides persons arrested on misdemeanor charges with an opportunity to address their charges or review their bond at an All-Purpose Hearing within 72 hours of arrest.
18. Fulton County is attempting to schedule all inmates held on misdemeanor charges for the All-Purpose Hearing calendar within 14 days of their arrival at the Fulton County Jail. All-Purpose Hearing calendars are held twice a day, Monday through Thursday, and once on Friday.[9]
19. While the current scheduling of All-Purpose Hearings does not yet comply with the Court's April 16 Order, it is an improvement over prior practice. Prior to the entry of the April 16 Order, inmates had to wait until they were accused by the Fulton County Solicitor's Office before they were placed on any State Court calendar.

Consequently, no matter how long it took the Solicitor's Office to accuse an inmate of a misdemeanor charge 0907 and it sometimes took months 0907 the inmate would not be brought to court until the Solicitor's Office got around to filing the accusation.
20. Since the entry of the Court's April 16 Order, all inmates, including some of those who have not yet been accused by the Solicitor's Office, are now being placed on the All-Purpose Hearing calendar. It is often the case, however, that many inmates who have not yet been accused by the Solicitor's Office have their cases rescheduled because of the inability of the Solicitor to proceed due to the lack of paperwork necessary to file an accusation.
21. The testimony of Peter Krauthammer, Deputy Director of the Pretrial Services Agency in Washington, D.C., Professor Douglas Colbert of the University of Maryland, and Judge Henry Newkirk of the State Court of Fulton County established that providing All-Purpose Hearings within 72 hours of arrest is feasible.
22. Fulton County's current inability to implement a system of providing persons arrested on misdemeanor 1308 charges with lawyers and All-Purpose Hearings within 72 hours of arrest is attributable to a lack *1308 of
coordination between the various criminal justice and law enforcement agencies of Fulton County and the municipalities within Fulton County.
23. Before accepting an inmate for booking into the Fulton County Jail, Sheriff Barrett requires that the transferring law enforcement agency provide a charging citation or a police report. This paperwork is transmitted from the Sheriff's staff to Pretrial Services. Pretrial Services then interviews the inmate about community ties and flight risk and attempts to verify information from the interview. However, Pretrial Services does not receive complete police paperwork in approximately 20% of the cases.
24. Neither Sheriff Barrett nor Pretrial Services is able to explain what happens, in 20% of cases, to the police charging documents (the citation or police report) between the time an inmate is booked into the jail and the time Pretrial Services transmits bind-over packets that are missing charging documents and police reports to the Clerk of State Court.
25. The inability of Pretrial Services to provide a complete bind-over packet to the Clerk of State Court in at least 20% of the cases creates significant problems. Often, the only paperwork the State Court Clerk's office receives is the commitment sheet, occasionally accompanied by a carbon copy of the notice slip of the All-Purpose Hearing date given by Pretrial Services to the defendant.
26. The inability to compile in a consistent and timely manner the necessary paperwork (containing the jail ticket or booking sheet, the police charging documents (a citation or arrest report), and the criminal history report from the Georgia Crime Information Center) for all inmates severely hinders the ability of Fulton County to provide an All-Purpose Hearing within 72 hours of arrest. The failure to provide complete paperwork prevents the proper booking into the jail; prevents Pretrial Services from conducting a thorough interview; prevents the Solicitor's Office from preparing an accusation; and deprives defense counsel of adequate and timely discovery.
C. Expand the Authority of Pretrial Services to Include Supervision of Persons Arrested for Misdemeanor Offenses
27. The intake unit of Pretrial Services is comprised of approximately 20 people who operate 24 hours a day at the Fulton County Jail, interviewing persons booked on felony and misdemeanor charges. On April 29, 2002, Pretrial Services began interviewing persons booked into the Fulton County Jail on misdemeanor charges and placing them on an All-Purpose Hearing calendar in the State Court of Fulton County. Prior to April 29, Pretrial Services was not interviewing or providing court dates to inmates charged with misdemeanors.
28. Because of insufficient staffing, Pretrial Services is not able to interview approximately one in four inmates upon their booking on misdemeanor charges. When Pretrial Services fails to interview an inmate at booking, it may take an additional 48 hours after booking or longer before the inmate can be interviewed and placed on an

All-Purpose Hearing calendar, thus causing further delays in processing inmates with minor misdemeanor charges out of the jail.
29. Insufficient staffing also prevents Pretrial Services from providing pretrial supervision to misdemeanor defendants in lieu of detention.
30. Pretrial Services has not received any increased staffing to accommodate its increased intake responsibilities 1309 with respect to persons facing misdemeanor charges but is expected to receive additional *1309 staff following its
upcoming midyear budgetary review in July.
D. Evaluate Factors Currently Used to Exclude Certain Persons Charged with Felonies from Pretrial Release and Eliminate Any that Are Unreasonable
31. The evidence presented during the May 28-29 hearing did not address inmates who were detained on felony charges. With the exception of a few serious offenses, however, judges of the Fulton County Magistrate and State Courts, as well as judges of the municipal courts within Fulton County, have wide discretion to establish pretrial release criteria, policies, and bond amounts for the majority of misdemeanor and felony offenses for which people are held at the jail. See O.C.G.A. § 17-6-1(f)(1) (granting state, magistrate, and municipal courts authority to establish bails by written order).
32. The broad authority contained in O.C.G.A. § 17-6-1(f)(1) should facilitate the immediate coordination between judges of the State, Magistrate, and various municipal courts in Fulton County to uniformly reevaluate and eliminate any unreasonable factors currently used to exclude persons charged with either felonies or misdemeanors from pretrial release.
E. Ensure that All Persons Charged with Misdemeanors Are Offered a Reasonable Bond in Accordance with Georgia Law
33. A significant factor contributing to the overcrowding at the Fulton County Jail is the setting by municipal courts of excessive bonds for minor misdemeanor charges. In most cases, these bonds are set without the input of any municipal court pretrial services agency and have not been informed by the advocacy of counsel. In most instances, therefore, the bonds set in municipal courts for persons charged with minor misdemeanor offenses do not reflect the individual circumstances of the defendant, his or her ties to the community, or actual risk of flight.
34. After arrestees who cannot make bond are bound over from the municipal court to the State Court of Fulton County, there is no opportunity to review the bonds set by municipal courts until the inmate is placed on an AllPurpose Hearing calendar in the State Court, which can be weeks later. This problem is made worse by the failure of the State Courts to conduct any bond review after an inmate charged with a misdemeanor offense requests a jury trial. The practice has been to continue the inmate's case for three to six months, without affording the inmate any opportunity to bond out prior to trial.
35. The lack of informed bond review hearings at which defendants are represented by counsel is directly related to the overcrowding at the jail. A two-year project conducted by the University of Maryland School of Law showed that providing lawyers within 48 hours of arrest to persons charged with nonviolent misdemeanor offenses at bail proceedings in Baltimore contributed to the reduction of the Baltimore Central Jail population from 1200 inmates to approximately 600 inmates within a year.
36. The judges of the Magistrate and State Courts of Fulton County and the municipal courts within Fulton County are given wide discretion to establish pretrial release criteria, policy, and bond amounts for all misdemeanor offenses. See O.C.G.A. § 17-6-1(f)(1). This broad authority should facilitate the immediate coordination between the judges of the Magistrate, State, and various municipal courts within Fulton County to establish a uniform preference for pretrial release in all but the most serious of misdemeanor offenses.

1310 *1310 F. Develop and Implement Meaningful Mental Health Diversion and Discharge Planning
37. Of all the inmates on the mental health caseload who were released from the Fulton County Jail in March 2002, only 3% left the jail with enough medication to last them for even a few days. Fulton County did not present any evidence demonstrating that they were taking steps to develop meaningful discharge planning for mentally ill prisoners. The Court finds that without adequate planning and medication upon their release from jail, mentally ill inmates are more likely to be rearrested and reincarcerated within a short period of time, usually on minor offenses such as criminal trespass or public intoxication. This contributes unnecessarily to jail overcrowding.
38. Although there have been some meetings and steps taken toward the development of a mental health court in Fulton County, defendants did not present any evidence that they have funded and implemented or will soon fund and implement (by a date certain) any mental health diversion program in Fulton County.
39. There are not adequate mental health resources in the community to accommodate the needs of mentally ill persons arrested in Fulton County. Additional resources are necessary to ensure appropriate diversion and discharge planning for the mentally ill
G. Increase Compensation Paid to Appointed Counsel in Misdemeanor Cases or Expand Authority of Fulton County Public Defenders Office or Other Entity to Handle Cases in State Court
40. Fulton County has entered into an interim contract with the Fulton County Conflict Defender to handle cases in State Court and is engaged in a bidding process to obtain a long-term contract.
H. Expand Authority of Judicial Administrative Expeditors to Facilitate Release of Inmates Whose Cases Are in State Court As Well As Superior Court
41. No evidence on this subject was presented at the May 28-29 hearing. However, in defendants' written response to the Court's Order, they state that the authority of the Judicial Administrative Expeditors has been expanded to State Court. The Expeditors have assisted State Court in developing a list of inmates to be placed on the backlog calendars and All-Purpose Hearing calendars and are also reviewing lists of inmates provided by plaintiffs' counsel to assess them for release and placement on calendars.
I. Impose Reasonable Restrictions on Length of Time a Person May Remain in Jail Without Accusation or Indictment and Accused or Indicted But Untried
42. No evidence was presented on this subject at the May 28-29 hearing. However, in their written response to the Court's Order, defendants state that they have implemented a plan to establish such restrictions. Prosecutors and defense attorneys are currently evaluating their cases in an effort to reach a consensus to present to the State Court and Superior Court judges. Recommendations will be made to the judges for their final determination and implementation, but defendants provide no time-frame for accomplishing this.

J. Implement an Integrated Computer System that Links All of the Appropriate Agencies in the Fulton County Criminal Justice System
43. Fulton County has for a number of years discussed the creation of a Comprehensive Justice Information 1311 System *1311 ("CJIS") database to link up criminal justice and law enforcement agencies, including the City of
Atlanta, to share information such as police reports. The system was scheduled to be operational by March 2002. However, it is not yet fully operational and does not yet include the City of Atlanta.
II. Other Factors Contributing to Undue Incarceration and Overcrowding
44. During the May 28-29 hearing, plaintiffs identified the following additional factors that cause delay in the resolution of misdemeanor cases in the State Court of Fulton County and thereby aggravate the overcrowding problem at the Fulton County Jail.
A. Failure to Coordinate Between Law Enforcement and Criminal Justice Entities Within Fulton County
45. Fulton County acknowledges that a significant factor in the overcrowding problem in the Fulton County Jail is the lack of coordination between the State Court and the various municipal courts within Fulton County. Nevertheless, neither the judges of the Fulton County State Court nor the Deputy County Manager for Criminal Justice Systems, who is responsible for arranging such coordination, have scheduled a meeting with the judges of the various municipal courts or the chiefs of police of the various municipal police departments. Such a meeting would allow the various agencies to coordinate policies governing the submission of completed paperwork before an inmate is booked into the Fulton County Jail; the establishment of uniform pretrial release criteria, policy, and reasonable bond amounts for persons arrested for misdemeanor offenses; the timely binding over of misdemeanor cases from municipal jails to the Fulton County Jail; and arrangements to guarantee the provision of lawyers within 72 hours of arrest. Nor have efforts been made by Fulton County to identify which particular municipalities have problems providing complete paperwork for inmates booked into the jail, are setting unreasonable bonds, and have excessive delays between arrest and bind-over to the Fulton County Jail.
B. Delays Caused by the Practice of Continuing Proceedings to Give Notice to Victims Beyond The Requirements of The Law
46. Overcrowding in the Fulton County Jail is exacerbated by a practice in which some inmates are not able to have their cases heard because Fulton County routinely causes proceedings to be continued in order to provide notice to victims beyond the notice required by Georgia law.[10] Fulton County has failed to shorten the time it takes to effectuate statutorily required notice for persons detained on misdemeanor offenses.
C. Delays Caused by Failure to Provide Translators to Non-EnglishSpeaking Defendants
47. Overcrowding at the Fulton County Jail is aggravated by the failure of State Court personnel to arrange for certified translation services for non-English-speaking defendants. Spanish-speaking defendants have had their 1312 cases continued for a *1312 week and longer because of the failure to secure a translator.

D. Delays in Completing Mental Competency Evaluations for Defendants
48. Overcrowding at the jail is exacerbated by the failure of court personnel to secure timely mental competency evaluations. On-site mental competency evaluations are performed by Grady Hospital Forensic Services. A Grady doctor visits the jail from time to time to interview inmates. The average length of time between the entry of an order requiring a mental competency evaluation to be performed by Grady Hospital and the time the evaluation is actually performed is six weeks. Often, it takes even longer for the psychological report to be distributed to the parties and even longer for the case to be placed back on a court calendar. During this time, detainees remain in jail. The excessive amount of time inmates spend awaiting the completion of psychological evaluations contributes to overcrowding at the jail. While Fulton County acknowledges the six-week delay between a request for a mental competency evaluation and the actual performance of the evaluation, it has not taken any action to shorten this time.
E. Delays Caused By Returning Filed Accusations to Solicitor's Office for Corrections
49. Overcrowding at the Fulton County Jail is exacerbated by the practice of the State Court Clerk's office sending significant numbers of filed accusations back to the Solicitor's Office for corrections because of typographical errors. When accusations are routinely sent back to the Solicitor's Office for corrections, inmates are forced to wait in the Fulton County Jail until the Solicitor's Office refiles a corrected accusation. In some instances, accusations are sent back multiple times from the Clerk's office for corrections, causing delays in bringing the cases of many inmates to court. Because of this process, inmates needlessly spend extra days in jail while the Solicitor's Office re-drafts accusations containing errors that could just as easily be corrected or waived in court by defense counsel. Fulton County has failed to eliminate delays caused by this corrections process.
F. Delays Caused By the Failure of the Sheriff to Produce Inmates for Court
50. Overcrowding at the jail is exacerbated by the failure of the Sheriff to produce inmates who have been placed on a calendar. Fulton County has not done enough to reduce the number of inmates who are not produced for their court dates.
III. Compliance with Provisions Designed to Ensure Plaintiffs' Access to Adequate Health Care and Constitutional Living Conditions
A. Increase Security Staffing
51. There are not sufficient security staff at the Fulton County Jail to ensure that inmates have timely access to health care, including discharge planning services, which are currently being provided by case managers from AID Atlanta. The shortage of security staff causes unnecessary delays in the provision of medical treatment and prevents some inmates from having contact with a case manager prior to their release from jail. Overcrowding exacerbates the understaffing problem, as it increases the demands placed on correctional officers.
52. At the hearing, Sheriff Barrett testified that she had given the county manager two options to address the staffing problem: fund a staffing study to determine the appropriate staff level for the jail, or authorize 50 new 1313 detention officer positions. Following the hearing, Sheriff Barrett *1313 submitted a revised request seeking

authorization for 20 new detention officer positions, with 10 to be funded in July 2002 and 10 more in October 2002.
B. Establish an Efficient and Reliable Appointment System, Provide Timely Medication to New HIV-Positive Inmates, Provide Timely Chest X-Rays When Required, and Deliver Appropriate Medical Diets When Prescribed
53. Timely access to specialty care, continuity of medication at intake, timely chest x-rays when required, and provision of prescribed medical diets have been problems that have persisted throughout most of this litigation. Dr. Greifinger has noted significant improvements in these area in recent months, but it is too soon to determine whether these improvements can and will be sustained.
C. Expand Current Discharge Planning Resources and Remove Obstacles to Discharge Planning
54. Coordination between the medical vendor (CMA), jail staff, and AID Atlanta has been ineffective. As a result, at least one terminally ill AIDS patient has been left to languish in the jail for months before finally being placed in a hospice, where he died a few days later.
55. Many HIV-positive inmates leave the jail without ever having contact with a case manager, despite the fact that there are two full-time case managers from AID Atlanta working at the jail. The Sheriff's Department has not provided sufficient security staff to ensure that AID Atlanta case managers have access to HIV-positive inmates and has not educated the security staff about the case managers' identity and presence in the jail. Access to case managers for female HIV-positive inmates has been exceptionally poor.
56. The Sheriff has identified problems in coordination and communication with AID Atlanta and has taken some steps to address these problems. It is too early to tell whether these steps are sufficient.
57. Defendants have not implemented a plan to address the discharge planning needs of mentally ill inmates, including those who are HIV-positive, to ensure continuity of care upon release and to reduce the risk of reincarceration of these individuals.
58. Defendants did not produce any evidence that they have developed and implemented a plan to expand current discharge planning services at the jail.
D. Address Deficiencies in Quality Management Program
59. According to Dr. Greifinger, a quality management program, which makes it possible to objectively assess the performance of health care delivery over time, is the most important element of infrastructure in ensuring health care quality. The quality management plan at the Fulton County Jail has been in place for only a few months. Although Dr. Greifinger is pleased with the new program, it is too soon to evaluate whether the plan has been effectively and permanently implemented at the jail so as to allow defendants to identify, evaluate, and address problems in health care delivery.
E. Repair or Replace Existing Plumbing and HVAC Systems
60. The Court finds that the chronically overcrowded condition of the jail, with double-bunking on almost every floor and inmates sleeping in common areas and dayrooms throughout the jail, has placed an enormous strain on the plumbing, heating, ventilation, and air conditioning systems. As a result, there is frequent flooding, 1314 overflowing toilets with sewage *1314 leaking onto the floor, inoperable showers, and inadequate temperature

control. In order to repair broken systems, entire housing units are frequently shut down, limiting the actual housing capacity of the jail. Until recently, defendants did not perform preventive maintenance on these systems to avoid deterioration and malfunctioning.
61. To correct the preventive maintenance problems, the County has contracted with a new maintenance vendor to provide services at the jail. The new vendor began work on May 1, 2002, and its performance is being monitored by a project manager with the County's General Services Department. Although this is a positive step, the Court finds that it is too early to determine whether defendants' plan to perform adequate preventive and corrective maintenance on these systems will be effective.
CONCLUSION
It is obvious that the criminal justice system in Fulton County is rife with errors, waste, and delay, all of which have a significant adverse impact on conditions at the Fulton County Jail. In turn, the poor conditions at the jail have a particularly adverse effect on members of the plaintiff class, who are more vulnerable than most to the dangers of overcrowding and lack of proper medical care. The Court concludes that further action is necessary to achieve compliance with the Final Settlement Agreement and to correct violations of plaintiffs' rights to minimally adequate conditions of confinement and receipt of adequate medical care. The Court finds that the following remedial actions are narrowly drawn, extend no further than necessary to correct violations of federal rights, and are the least intrusive means to correct these violations.
Accordingly, based on the foregoing findings of fact and conclusions of law, it is hereby ORDERED that:
(1) Defendants' motion to stay implementation of actions directed in the Court's April 16, 2002, Order [# 149-1] is DENIED.
(2) Defendants shall immediately confer with the appropriate municipal authorities and shall reach whatever agreements are necessary to establish a system that will provide for the appointment of counsel and the conducting of All-Purpose Hearings within 72 hours of arrest for all indigents arrested on state law misdemeanor charges. Such a system shall be in place by September 30, 2002.
(3) The provision of counsel shall mean the appointment of an individual attorney who will have primary responsibility for the defense of the person charged with a misdemeanor, who will make contact with that person prior to his or her first appearance in court, and who will provide for continuous representation from arrest until final disposition of the case. If representation is initially provided by a city public defender or city-appointed attorney and later transferred to the Fulton County Conflict Defender or other county-appointed attorney, the system shall provide for communication and coordination between the attorneys so as to provide for continuity of representation.[11]
(4) Defendants shall authorize and fund sufficient additional positions for lawyers, paralegals, social workers, investigators, and support staff in the Fulton County Conflict Defender's office (or such other provider of defender 1315 services as the County *1315 may appoint) to comply with the recommended caseload limits set out in Guideline 6.1 of the Georgia Supreme Court's Guidelines for the Operation of Local Indigent Defense Programs.
(5) Defendants shall authorize and fund sufficient additional positions in Pretrial Services to accommodate its increased intake responsibilities at the Fulton County Jail with respect to persons facing misdemeanor charges. As part of their report to the Court on compliance with this requirement, defendants shall provide the following information: (a) the percentage of people accused of misdemeanors in the previous month who were screened by Pretrial Services during booking at the Fulton County Jail, (b) an explanation of why others were missed, and (c) the progress of staff increases for the intake division of Pretrial Services.
(6) Defendants shall immediately implement a program to identify and expedite the release of persons who have been detained in the Fulton County Jail on misdemeanor charges for longer periods of time than they would likely serve if convicted. As part of this program, beginning the week of July 22, 2002, and continuing thereafter on a weekly basis, defendants shall provide to the Court, plaintiffs' counsel, the State Court Administrator, and the

Chief Judge of the State Court a list of all persons confined in the Fulton County Jail who have open State Court charges and who have been detained since the time of their arrest for longer than (a) 72 hours, (b) one week, and (c) 15 days. The list shall include each inmate's name, booking number, date booked into the Fulton County Jail, all charges, the court in which the case will be adjudicated, the arresting agency, and any holds on each inmate.
(7) Defendants shall immediately conduct a study of persons arrested in municipalities on state law misdemeanor charges to determine the feasibility of bypassing the initial detention of such persons in municipal jails and their initial appearance in municipal courts in favor of immediately detaining these persons in the Fulton County Jail and addressing their cases in the State Court.
(8) Defendants shall immediately confer with the judges of the State, Magistrate, and various municipal courts in an effort to encourage and facilitate their (a) reevaluation and elimination of any unreasonable factors used to exclude persons charged with either felonies or misdemeanors from pretrial release; and (b) establishment of reasonable, uniform pretrial release criteria, policy, and bond amounts for all misdemeanor offenses, including a preference for pretrial release in all but the most serious of misdemeanors.
(9) Defendants shall proceed expeditiously with the development and implementation of a mental health court or other mental health jail diversion mechanism and shall set a date certain for the establishment of such a program by September 30, 2002.
(10) Defendants shall proceed expeditiously with their plan to develop reasonable restrictions on the length of time an inmate may remain in jail without accusation or indictment, or accused or indicted but untried. By September 30, 2002, defendants shall submit their proposal to the State and Superior Court judges for their final determination and implementation. As part of their report to the Court on compliance with this requirement, defendants shall submit a copy of their proposal.
(11) Defendants shall proceed expeditiously with full implementation of the Comprehensive Justice Information System (CJIS), which shall link all relevant criminal justice and law enforcement agencies in the County, including those located in the City of Atlanta. The CJIS shall be fully operational by September 30, 2002.
1316 *1316 (12) Defendants shall meet with the judges of the various municipal courts and the chiefs of police of the various municipal police departments to coordinate policies regarding the submission of completed paperwork before an inmate is booked into the Fulton County Jail; the establishment of uniform pretrial release criteria and reasonable bond amounts for persons arrested for misdemeanor offenses; and the timely binding over of misdemeanor cases from municipal courts to State Court. Defendants shall identify those municipalities that regularly provide incomplete paperwork for inmates booked into the Fulton County Jail, set unreasonable bonds, and hold inmates an excessive length of time between arrest and bind-over. As part of their report to the Court on compliance with this requirement, defendants shall describe the outcome of their meetings with the officials of each of the municipalities in Fulton County, specifically including their findings concerning (a) the practice in each municipality with regard to setting bail, the actual bail schedule used, and any other method of pretrial release relied upon; (b) the number of people per month coming to the Fulton County Jail from each municipality; (c) the practice of appointment of counsel in each municipality, if any; and (d) the average length of stay at the municipal jail prior to bind-over to the Fulton County Jail.
(13) Defendants shall immediately take steps to eliminate unnecessary delays caused by (a) continuing proceedings to give notice to victims beyond that required by law, (b) failure to provide translators to non-Englishspeaking defendants, (c) failure to secure timely mental competency evaluations, (d) returning filed accusations to the Solicitor's office for correction of typographical errors, and (e) failure to produce inmates for scheduled court dates.
(14) Defendants shall authorize and fund sufficient additional security staff at the Fulton County Jail to comply with the Court's prior Order. As part of their report to the Court on compliance with this requirement, defendants shall specify the number of new positions authorized, explain the basis for their determination that this number is sufficient to comply with the Court's Order, and state whether the staffing study requested by Sheriff Barrett will be performed and, if so, when it will be completed.

(15) Defendants shall develop and implement a plan to expand current discharge planning services at the jail and to address problems with AID Atlanta failing to see inmates referred to them. Defendants shall also develop and implement a plan to expand current discharge planning for mentally ill inmates, including those who are HIVpositive.
(16) Defendants shall continue their efforts to establish a sound and effective quality management plan for the health care delivery system at the jail.
(17) Defendants shall vigorously pursue both corrective and preventive maintenance programs with the goal of eliminating chronic heating, air conditioning, ventilation, and plumbing problems.
(18) On October 1, 2002, in addition to their regular monthly Update on Jail Population Plan, defendants shall file a separate report to the Court on their compliance with this order. The report shall describe in detail all of the steps taken to comply with each of the above requirements. Plaintiffs shall have 10 days from the date of service of defendants' report to file a response pointing out any areas in which plaintiffs believe that defendants have failed to comply with the Court's order and requesting any further relief they believe is needed. Based on defendants' October 1 report and plaintiffs' response, the Court will determine if it is necessary to schedule further proceedings.
1317 *1317 (19) Finally, the Court DIRECTS counsel for defendants to serve a copy of this order on each individual defendant, on each Fulton County State Court judge, on each Fulton County Magistrate Court judge, on each of the judges of the various municipal courts in Fulton County, on the Fulton County Solicitor and on each of the solicitors in the various municipalities in Fulton County, and on the head of each law enforcement agency located in Fulton County.
[1] In every quarterly report since his first report in March 2000, Dr. Greifinger has observed that jail overcrowding strains the systems of ventilation, sanitation, and plumbing at the jail. As a result, there are frequent floods and sewage leaks, and inoperable toilets, showers, and sinks. Dr. Greifinger has also reported that crowding promotes transmission of communicable diseases, especially air-borne diseases such as tuberculosis, and impedes the effectiveness mental health medication. Crowding also interferes with delivery of medical care and makes sanitary food preparation very difficult because kitchen equipment is not designed to accommodate the large population. All of these problems present particular risks to members of the plaintiff class, whose compromised immune systems make them more vulnerable to disease and whose medical condition requires them to have regular, unimpeded access to medical care. Furthermore, according to Dr. Greifinger, the number of inmates in this vulnerable category is probably twice the number actually identified as HIV-positive, because only half of the total number are diagnosed and choose to report it.
[2] For many offenses, the typical sentence would be probation, community service, or one or two days in jail. For example, as of May 26, 2002, there were 240 persons in the jail awaiting the disposition of misdemeanor charges. Of these, 40 were being held for criminal trespass and 7 for offenses against public transportation such as fare evasion. Others were being held on charges such as public drunkenness and public indecency. Of the 240, 117 had been in the jail for more than 15 days, 80 for more than 3 weeks; 65 for over a month, 17 for over 2 months, 9 for over three months, 3 for more than 6 months, and 1 for more than months.
[3] The Court subsequently amended its order to permit defendants to provide representation by a public defender office or other entity.
[4] Although jail population has decreased in recent months, the Court finds that the jail remains seriously overcrowded. Defendants point out that population figures have recently dropped to at or slightly below the jail's capacity of 2,250. The Court notes, however, that the original design capacity of the jail was only 1,332. (Affidavit of Jacquelyn H. Barrett, filed August 1, 2000, ¶ 3.) Before construction of the jail was completed, Fulton County decided to double bunk floors 1-5, thus adding 918 beds and increasing the capacity to 2,250. Id. There is no evidence, however, that in connection with this double bunking any other changes were made in the design or construction of the facility to accommodate the additional inmates, such as increasing the capacity of the plumbing, heating, ventilation, and air conditioning systems or expanding the kitchen and intake areas. Thus,

according to Dr. Greifinger, even at the current population levels, "the crowding is unabated," and "the plumbing and air handling systems are virtually collapsed." (April 26, 2002, Report at 6.) It is clear, therefore, that jail capacity is not simply a matter of counting beds, and that the Rice Street facility is overburdened even with population levels at or somewhat below "capacity."
[5] It is unclear what representation, if any, is provided to indigent persons appearing in other municipal courts in Fulton County.
[6] The arresting officer has the discretion to take the arrested person "before the most convenient and accessible judicial officer authorized to hear the case...." O.C.G.A. § 17-4-21; Gill v. Decatur County, 129 Ga.App. 697, 700, 201 S.E.2d 21 (1973); see also O.C.G.A. § 17-4-62 ("In every case of an arrest without a warrant, the person arresting shall, without delay, convey the offender before the most convenient judicial officer authorized to receive an affidavit and issue a warrant ..."). This could be either a state court or a magistrate court judge, as well as a municipal court judge. See O.C.G.A. §§ 15-7-4(a)(3)-(4); 15-10-2(1), (3), (9); 17-4-40(a); 17-6-1(b)(1); 17-6-1(f)(1); 17-7-20 (authorizing both state court and magistrate court judges to conduct courts of inquiry, issue arrest and search warrants, grant bail except for certain felony offenses, and establish a schedule of bails); and 36-32-3 (granting municipal court judges the same power and authority as magistrate court judges in criminal cases).
[7] Previously, Fulton County provided representation to persons facing misdemeanor charges in the State Court by appointing lawyers to twenty cases per Jail calendar and paying the appointed lawyers a flat fee of $50 per case for only the first four appointed cases.
[8] This does not take into account the increased burdens created by the recent decision of the Supreme Court in Alabama v. Shelton, ___ U.S. ___, 122 S.Ct. 1764, 152 L.Ed.2d 888 (2002).
[9] Prior to the April 16 Order, the State Court held a "Jail Calendar" every other day to take pleas at the Fulton County Jail. The Jail Calendar has been replaced by the All-Purpose Hearing calendar.
[10] Fulton County suggests that defendants were justifiably prevented from resolving their cases because of state law provisions requiring that notice be provided to victims in certain domestic violence cases. The delays, however, stem from the failure of the Solicitor to obtain accurate contact information. See O.C.G.A. § 17-17-14 ("It is the right and responsibility of the victim who desires notification ... to keep the [investigating law enforcement agency and the prosecuting attorney] informed of the victim's current address and phone number").
[11] A system that provides for representation by a single attorney from beginning to end is much to be preferred, and the Court encourages Fulton County to adopt such a system if at all feasible.
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 Ruben FOSTER, et al., Plaintiffs, v. FULTON COUNTY,..., Not Reported in...

2000 WL 34016360 Only the Westlaw citation is currently available.
United States District Court, N.D. Georgia Atlanta
Ruben FOSTER, et al., Plaintiffs, v.
FULTON COUNTY, Georgia, et al., Defendants.
No. 1:99-CV-900-MHS | April 11, 2000.
CIVIL ACTION
Opinion

Order
*1 The Court has reviewed the parties’ responses to Dr. Greifinger’s initial report, which were filed in accordance with the Court’s Order of March 13, 2000. After the parties filed their responses, Dr. Greifinger toured the Fulton County Jail again on March 29-30 and then met with the Court to discuss the current conditions at the Jail and the steps being taken to comply with the Final Settlement Agreement. After meeting with Dr. Greifinger, the Court is confident that he is well-qualified to handle the position of Correctional Healthcare Monitor, and that he will be of great assistance to the Court in overseeing and insuring compliance with the Final Settlement Agreement.
At the Court’s request, Dr. Greifinger has prepared and submitted an interim report dated March 31, 2000. The Court is pleased that a new health care provider, Comprehensive Medical Associates, Inc. (CMA), is now responsible for medical care at the Jail, and the Court is hopeful that future progress in bringing the Jail into compliance with constitutional requirements will mark a significant improvement over past efforts, which have been woefully inadequate.
Nevertheless, the Court concurs with the findings and recommendations in Dr. Greifinger’s interim report and concludes that the following immediate steps are necessary to enforce the terms of the Final Settlement Agreement.1

1

The Court has also considered the requests set out in

plaintiffs’ response to Dr. Greifinger’s initial report.

Since most of these requests overlap with the

recommendations in Dr. Greifinger’s interim report, the

Court’s implementation of Dr. Greifinger’s

recommendations also addresses most, if not all, of the

concerns expressed by plaintiffs.

First, the Court FINDS that the scope of the Settlement Agreement includes every aspect of medical care that could affect members of the plaintiff class, and that monitoring and enforcement shall include, at a minimum, (1) the intake process for all inmates; (2) access to physician care, medication, and specialty care for all inmates; and (3) all aspects of communicable disease care.2

2

The Court notes that the Final Settlement Agreement

requires generally that “Defendants shall maintain

conformance with the National Commission of

Correctional Health Care’s current Standards for

Health Services in Jails (the ‘NCCHC Standards’).”

Final Settlement Agreement ¶ III.A.

Second, the Court FINDS that the scope of the Settlement Agreement includes the elimination of overcrowding at the Jail, because overcrowding poses significant health risks to HIV-positive inmates, as well as to other inmates, staff, and the community.3

3

The Court notes that the Settlement Agreement

provides: “The County shall identify mechanisms for

accommodating current and anticipated jail

population.” Final Settlement Agreement ¶ V.D.

*2 Pursuant to these findings and the additional findings and recommendations of Dr. Greifinger, the Court hereby ORDERS that the Fulton County defendants promptly
(1) Extend the temporary contract with CMA for a period of at least one year;
(2) Hire additional temporary staff needed to catch up in all medical areas, including intake, dental care, HIV care, discharge planning, specialty care, and hospital outpatient care;
(3) Develop a needs assessment, performance measures, and quality management plan with a timed and detailed work plan, and use the performance measurement as part of the periodic reporting to the parties and Dr. Greifinger;
(4) Develop a written agreement for outside medical services, both inpatient and outpatient, which contains assurances for timely response to medical care needs and remedies for non-adherence;
(5) Hire or provide additional staff needed to insure that
1

Ruben FOSTER, et al., Plaintiffs, v. FULTON COUNTY,..., Not Reported in...

inmates are seen as scheduled for medication and in-house and outside medical visits;
(6) Improve the system for screening, diagnosing, treating, and following patients with sexually transmitted disease, tuberculosis infection, and HIV, through a written agreement either with the Fulton County Health Department or with CMA;
(7) Provide plaintiffs’ counsel and Dr. Greifinger with a list of all security staff vacancies within two weeks of the date of entry of this order, and monthly thereafter, and expeditiously fill current vacancies with qualified staff;
(8) Facilitate necessary communication between plaintiffs’ counsel and members of the plaintiff class by providing plaintiffs’ counsel with (a) a list of HIV-positive inmates and their booking numbers at the beginning of each month, and (b) prompt access to the medical records of class members upon counsel’s request;
(9) Duplicate the physical changes implemented on 3 South on other housing units;
(10) Respond constructively to the recommendations of the correctional dental consultant, Dr. Brian Burke, following his exit interview, and incorporate his recommendations into Dr. Greifinger’s monitoring;
(11) Initiate plans to reduce overcrowding, with the ultimate goal of creating a facility that does not house

inmates beyond its rated physical capacity; and
(12) Compensate Dr. Greifinger for up to 100 working hours per quarter spent in carrying out his responsibilities as Correctional Healthcare Monitor.
The Court believes it should point out that, in view of the now well-publicized conditions at the Pulton County Jail, including Dr. Greifinger’s detailed reports, if remedial action is not promptly and expeditiously taken, there is a very serious question as to whether the Sheriff and individual County commissioners, who have now been fully apprised of the deplorable conditions at the Jail, would be entitled to qualified immunity as to injuries sustained by inmates at a future date arising from such conditions.
Finally, the Court DIRECTS counsel for the County defendants to provide copies of this order and Dr. Greifinger’s interim report, as well as copies of all future orders and reports, to each of the individual County defendants.
*3 IT IS SO ORDERED, this 11th day of April, 2000.
Marvin H. Shoob, Senior Judge, United States District Court Northern District of Georgia
	  

2

 
 IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF GEORGIA

ATLANTA DIVISION

__________________________________________

)

RUBEN FOSTER, GEORGE WEST, ANTHONY )

WILLIAM, TONY MARTIN, LUCAS JAMES, )

GRADY McGLOTHLIN, RICHARD MALI-

)

COATE, and WILLIE HIGHTOWER, individually )

and on behalf of all present and future HIV-positive )

inmates in the Fulton County Jail in Atlanta, )

Georgia,

)

)

Plaintiffs,

)

)

CIVIL ACTION

v.

)

)

No. 99-CV-0900 (MHS)

FULTON COUNTY, GEORGIA; FULTON

)

COUNTY BOARD OF COMMISSIONERS:

)

CLASS ACTION

MIKE KENN, Chairperson, KAREN WEBSTER, )

TOM LOWE, BOB FULTON, EMMA I.

)

DARNELL, NANCY BOXILL, members;

)

JACQUELYN BARRETT, Fulton County Sheriff; )

L.L. BRIGGS, Chief Jailer of Fulton County Jail; )

GEORGE HERRON, Medical Services Director )

of Fulton County Sheriff’s Department;

)

CORRECTIONAL HEALTHCARE SOLUTIONS, )

FIRST AMENDED COMPLAINT

INC.; KEVIN RAMOS, Correctional Healthcare )

Solutions, Inc., Health Services Administrator; )

HAROLD MINERVE, Correctional Healthcare )

Solutions, Inc., Medical Director; ENO IKOKU, )

Correctional Healthcare Solutions, Inc., physician; )

STACEY STEED, ROBERT BROWN, W.

)

CLYDE SHEPHERD, ADAM SMITH, C.

)

CHRISTOPHER HAGY, OTIS SMITH, SARAH )

SLOAN, CHARLES GLENN, MARLA

)

COLEMAN, JOHN MALCOLM, Board of

)

Trustees of the FULTON-DeKALB HOSPITAL )

AUTHORITY; and EDWARD J. RENFORD,

)

Chief Executive Officer of GRADY HEALTH )

SYSTEM, in their official capacities,

)

)

Defendants.

)

__________________________________________)

FIRST AMENDED COMPLAINT I. INTRODUCTION
1. This action is brought by Fulton County Jail inmates infected with the Human Immunodeficiency Virus (“HIV”) whose lives are threatened by the denial of even the most minimal medical care by the defendants. As a result, plaintiffs suffer excruciating and unnecessary pain, develop resistance to life-saving medication, and are needlessly vulnerable to infection, disease, and premature death.
2. The defendants, Fulton County, Correctional Healthcare Solutions, Inc., the Fulton-DeKalb Hospital Authority, and their officials and employees, act with deliberate indifference to the serious medical needs of HIV-infected inmates in failing to provide these inmates with life-saving HIV medication, adequate and timely treatment for opportunistic infections, access to qualified medical providers, appropriate medical tests and counseling, and palliative care for those who are terminally ill. Through these policies, customs, and practices, defendants deprive HIV-positive inmates of minimally adequate medical treatment. Moreover, because defendants’ mistreatment of inmates leads to the development of drug-resistant strains of HIV, defendants recklessly endanger the lives of not only HIV-infected inmates, but also the general public.
3. Prior to March 1, 1999, the Correctional Healthcare Solutions medical staff at the Fulton County Jail referred HIV-positive inmates to the infectious disease clinic at Grady Hospital. The infectious disease specialists at Grady Hospital provided necessary medical attention and prepared detailed treatment regimens and prescriptions based upon each inmate’s medical condition. The Correctional Healthcare Solutions medical staff at the Jail, however,
2

continuously failed to carry out the prescribed treatment plans of the Grady specialists, thereby endangering the lives and health of HIV-positive inmates.
4. On March 1, 1999, Grady Hospital ceased providing treatment to HIV-positive inmates confined at the Fulton County Jail. As a result, the medical staff at the Jail, which had already failed miserably to follow the regimens prescribed by the Grady infectious disease clinic, is now solely responsible for examining HIV-positive inmates and planning and carrying out their treatment regimens. The County and CHS staff continue to deprive inmates of minimally adequate treatment. As a result, people charged with even minor offenses, and even those who are innocent, may be condemned to a death sentence as a result of the grossly inadequate medical care at the Jail.
5. Defendants’ denial of adequate medical treatment violates plaintiffs’ rights under the Eighth and Fourteenth Amendments of the United States Constitution. Plaintiffs seek preliminary and permanent declaratory and injunctive relief on behalf of themselves and all HIVpositive persons who are now or will be in the future incarcerated at the Fulton County Jail.
II. JURISDICTION 6. This suit is brought under the Eighth and Fourteenth Amendments to the United States Constitution as enforced through 42 U.S.C. § 1983, and under O.C.G.A. § 9-2-20 and various provisions of O.C.G.A. §§ 42-4-4 and 42-5-2. The Court has jurisdiction over plaintiffs’ federal constitutional claims pursuant to 28 U.S.C. §§ 1331 and 1343(a) and over plaintiffs’ state law claims pursuant to 28 U.S.C. § 1367(a). 7. This Court is authorized to grant declaratory and injunctive relief pursuant to 28 U.S.C. §§ 2201 and 2202.
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III. VENUE 8. The Northern District of Georgia is an appropriate venue for this action because defendants in their official capacities reside in this district. See 28 U.S.C. § 1391(b)(1). The Northern District of Georgia is also an appropriate venue because the events giving rise to plaintiffs’ claims have occurred in this district. See 28 U.S.C. § 1391(b)(2).
IV. PARTIES 9. Plaintiff Ruben Foster is HIV-positive and currently confined at the Fulton County Jail (“the Jail”). In September 1998, when he arrived at the Jail, Foster informed the correctional and medical staff that he was HIV-positive and in compliance with a detailed antiretroviral HIV medication regimen. Despite numerous grievances and medical requests, Foster has not received that regimen, nor consistently received prophylactic medication, nor had access to medical staff capable of monitoring his medical situation, which is complicated by chronic diarrhea, AIDSrelated wasting, asthma, and frequent rashes. 10. Plaintiff George West is HIV-positive and currently confined at the Fulton County Jail. West was incarcerated at the Jail from October 1998 until February 1999, and was reincarcerated in March 1999. During his first incarceration, West informed the correctional and medical staff that he was HIV-positive and in compliance with a detailed antiretroviral HIV medication regimen. Despite numerous grievances and medical requests, West did not begin receiving his medication until thirty days after he arrived at the Jail, and even then it was delivered only sporadically. During his current incarceration, West has neither received any of his medication nor had access to medical staff capable of monitoring his medical situation. Dr. Eno
4

Ikoku, the jail physician responsible for West’s medical treatment, told West that he would not receive his HIV medication at the Jail.
11. Plaintiff Anthony William is HIV-positive and currently confined at the Fulton County Jail. In September 1998, when he arrived at the Jail, Williams informed the correctional and medical staff that he was HIV-positive and in compliance with a detailed antiretroviral HIV medication regimen. He never received his original regimen, but instead was prescribed a new regimen by a Jail physician. Despite numerous requests, he did not receive the new regimen until two months after it was prescribed. William currently receives the new regimen on only an inconsistent basis, and on some days, not at all.
12. Plaintiff Tony Martin is HIV-positive and currently confined at the Fulton County Jail. On March 3, 1999, when he arrived at the Jail, Martin spent the night on a dirty floor with approximately seventy other inmates, none of whom had been tested for tuberculosis. The inmates were waiting to be processed through intake. During intake, Martin informed the medical staff that he was in compliance with a detailed antiretroviral HIV medication regimen. He also told the medical staff that he had a low T-cell count and a rash on his body. Several days later, he also informed the chronic care doctor, Dr. Eno Ikoku, that he was complying with an antiretroviral medication regimen. She told him that he would not receive any of these medications while at the Jail. Despite filing numerous medical requests and an administrative grievance, Martin has not received his antiretroviral medication.
13. Plaintiff Lucas James is HIV-positive and currently confined at the Fulton County Jail. In December 1998, when he arrived at the Jail, James informed the correctional and medical staff that he was HIV-positive and had been taking a detailed antiretroviral HIV medication regimen. Despite numerous medical requests, James has not received that regimen nor had
5

access to medical staff capable of monitoring his medical situation, which is complicated by epilepsy, Hepatitis C, high blood pressure, arthritis, paralysis in his spine, and an active and very painful hernia.
14. Plaintiff Grady McGlothlin is HIV-positive and currently confined at the Fulton County Jail. McGlothlin was scheduled to begin taking antiretroviral HIV medication after Grady Hospital’s infectious disease clinic completed its evaluation of him. Despite the medical importance of taking this medication, the scheduled treatment plan was abandoned in March 1999 when the Grady clinic stopped providing HIV care to Fulton County inmates.
15. Plaintiff Richard Malicoate is HIV-positive and currently confined at the Fulton County Jail. Malicoate was admitted to the Jail on February 8, 1999, and informed the medical staff that he was HIV-positive. Nevertheless, medical staff failed to conduct an adequate intake examination and did not provide him with any treatment plan whatsoever. Ten days later when he saw the chronic care physician for the first time, he was again not given a proper examination or any treatment plan.
16. Plaintiff Willie Hightower is HIV-positive and currently confined at the Fulton County Jail. Hightower was admitted to the Jail on December 15, 1998, at which time he informed intake medical staff that he was taking an antiretroviral medication regimen. He has never received this or any other treatment regimen for his HIV infection. For over three weeks, Hightower has experienced constant and excrutiating pain due to sores from active HIV-related genital herpes. These open sores constantly ooze pus and blood. Despite numerous requests for medical attention, he has not been seen by a physician since his transfer to the chronic care unit on March 31, 1999.
6

17. Defendant Fulton County, Georgia (“the County”), is the governmental unit responsible under state law for properly maintaining, operating, and funding the Jail. O.C.G.A. § 42-5-2. As such, the County has a duty to provide medical care to inmates in the care and custody of the Jail.
18. The Fulton County Commission and its members Mike Kenn, Karen Webster, Tom Lowe, Bob Fulton, Emma I. Darnell, and Nancy Boxill, exercise authority under Georgia law over the Jail and are obligated to properly maintain and fund the Jail. O.C.G.A § 42-5-2. The Commission possesses the power to levy taxes, initiate bond issues, and otherwise raise revenues and appropriate funds for the medical treatment of inmates under the control and custody of the Fulton County Sheriff’s Department. Article IX, Georgia Constitution. The Fulton County Commission selected and approved the bid of Correctional Healthcare Solutions, Inc. to provide medical care at the Jail.
19. Defendant Jacquelyn Barrett is the sheriff of Fulton County, Georgia. As sheriff, Barrett is charged by Georgia law with the duty of overseeing the operation of the Jail, which includes protecting the health and safety of inmates. O.C.G.A. § 42-4-4.
20. Defendant L.L. Briggs is the chief jailer of the Jail. As chief jailer, Briggs is the highest ranking official at the Jail. He directly supervises and controls the Jail’s daily operations, including protecting the health and safety of inmates. O.C.G.A. § 42-4-4.
21. Defendant George Herron is the medical services director of the Fulton County Sheriff’s Department. As medical services director, Herron is responsible for supervising the provision of medical services to Jail inmates and maintaining communication between the Jail’s medical providers and the Fulton County Sheriff’s Department.
7

22. Defendant Correctional Healthcare Solutions, Inc. (“CHS”) is a private company incorporated in Pennsylvania. CHS is under contract with Fulton County to provide all necessary medical care to inmates at the Jail. Pursuant to this “Health Care Services Agreement,” CHS is specifically obligated to “establish a clinic on-site for chronic illnesses and diseases.” The contract requires that “[t]reatment prescribed for HIV+ and AIDS shall be reviewed for adherence to the Centers for Disease Control and Prevention (CDC) standards and court ordered protocol.”
23. Defendant Harold Minerve, M.D., an employee of CHS, is the medical director of the Jail. Defendant Kevin Ramos, H.S.A., is the on-site health services administrator for CHS at the Jail. Both Minerve and Ramos are responsible for creating and implementing the protocol, policies, and procedures for inmate medical care; establishing the chronic care units; and directly supervising and monitoring the medical staff at the Jail. They are responsible for quality management and ensuring that the care provided by CHS staff meets the minimum correctional, medical, and constitutional requirements.
24. Defendant Eno Ikoku, M.D., is employed by CHS as the chronic care physician at the Jail. She is directly responsible for providing on-site routine and emergency care to HIVpositive inmates in the Jail’s chronic care units and referring these inmates to outside providers when necessary. She also supervises the medical staff in these units.
25. Defendant Fulton-DeKalb Hospital Authority (“the Authority”), is a public hospital authority created by resolution of the Boards of Commissioners of Fulton and DeKalb Counties, pursuant to O.C.G.A. §§ 31-7-1 et seq. The Authority’s primary operating facility is Grady Memorial Hospital, which is part of the Grady Health System. Under its contract with Fulton County, the Authority is responsible for the hospitalization and treatment of inmates in the custody of Fulton County.
8

26. Defendant Fulton-DeKalb Hospital Authority Board of Trustees and its members Stacey Steed, Robert Brown, W. Clyde Shepherd, Adam Smith, C. Christopher Hagy, Otis Smith, Sarah Sloan, Charles Glenn, Marla Coleman, and John Malcolm, are responsible for establishing and implementing the policies of the Authority. O.C.G.A. § 31-7-72.
27. Defendant Edward J. Renford is the chief executive officer of the Grady Health System. He is responsible for the operation of Grady Memorial Hospital, including its infectious disease clinic.
28. Defendants Fulton County, the Fulton County Board of Commissioners, Kenn, Webster, Lowe, Fulton, Darnell, Boxill, Barrett, Briggs, Herron, Ramos, Minerve, Ikoku, the Fulton-DeKalb Hospital Authority, the Authority Board of Trustees, Steed, Brown, Shepherd, Adam Smith, Hagy, Otis Smith, Sloan, Glenn, Coleman, Malcolm, and Renford are the final decisionmakers for the policies and customs challenged in this lawsuit.
29. Defendants are sued in their official capacities. They have all acted under color of law.
V. CLASS ACTION ALLEGATIONS 30. Plaintiffs bring this action on behalf of themselves and all others who are similarly situated pursuant to Rule 23(a) and (b)(2) of the Federal Rules of Civil Procedure. The proposed class consists of all HIV-positive persons who are now or will be in the future incarcerated at the Fulton County Jail (“the Jail”). 31. In a typical year, hundreds of HIV-positive inmates are incarcerated at the Jail. At any given time, there are approximately 150 inmates infected with HIV in the Jail. Some inmates stay in the Jail for only a short period of time before going into the prison system or returning to
9

the community. Due to the large and constantly changing population of HIV-positive inmates, joinder of all present and future HIV-positive inmates incarcerated at the Jail would be highly impracticable.
32. There are questions of law and fact common to the class. These include the nature and constitutionality of the medical treatment provided to HIV-positive inmates at the Jail, and the defendants’ responsibility to provide constitutionally adequate care.
33. The conditions, policies, customs, and practices challenged in this action apply with equal force to the named plaintiffs and all members of the class so that the claims of the named plaintiffs are typical of those of the class. As described in further detail in the factual allegations, these unconstitutional policies and customs include defendants’ interference with prescribed treatment regimens and inadequate procedures to provide inmates life-saving medication and treatment; failure to provide inmates access to qualified physicians and appropriate specialist services; and failure to respond adequately to sick call and medical requests.
34. The named plaintiffs will fairly and adequately represent the interests of the class. Because they are HIV-positive and in desperate need of the constitutional protections asserted in this lawsuit, they possess the requisite personal interest in its subject matter. They are represented by counsel who are experienced in class action litigation involving jail and prison conditions.
35. Defendants have acted and refused to act on grounds generally applicable to the class. Final declaratory and injunctive relief with respect to the class as a whole is therefore appropriate.
VI. FACTUAL ALLEGATIONS A. HIV infection is a serious and debilitating medical condition that
requires coordinated medical treatment and careful monitoring.
10

36. The named plaintiffs in this case are six inmates currently at the Fulton County Jail (“the Jail”) who are HIV-positive and whose lives are threatened by the denial of minimal medical care to which they are entitled.
37. Human Immunodeficiency Virus, or “HIV”, is a retrovirus identified as the cause of Autoimmune Deficiency Syndrome, or “AIDS”. Untreated HIV inevitably destroys the body’s immune system. As the immune system becomes seriously impaired, the host is subject to various illnesses and diseases, known as opportunistic infections. Although these infections are normally combated by a healthy immune system, a severely damaged immune system cannot successfully control the infections. These opportunistic infections can be life-threatening and must be adequately treated in order for the patient to survive. AIDS is a clinical diagnosis of a disease that is characterized by infection with HIV, combined with the resulting dysfunction of the immune system and the presence of one or more opportunistic infections or other manifestations taking advantage of the suppressed immune system.
38. Due to the extreme seriousness and complexity of this disease, each of the plaintiffs needs frequent attention and assistance from medical professionals, including regular monitoring, appropriately prescribed and supplied medications and other treatment regimens; consistent and uninterrupted provision of the drugs they were taking prior to their arrival at the Jail or are later properly prescribed; and access to adequate sick call and emergency procedures. The management of HIV infection and the treatment of HIV-related illnesses and AIDS requires, at a minimum, monitoring and medical interventions by competent professionals. Signs and symptoms suggestive of only minor ailments in patients without HIV infection may indicate lifethreatening illness for infected patients.
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39. Despite their desperate medical needs, plaintiffs have in every respect been denied minimal medical care at the hands of the defendants. The minimum standards for treating HIV infection have been developed and are frequently updated by a panel convened by the United States
Department of Health and Human Services. The panel includes participants from the Centers for Disease
Control and Prevention (“CDC”), the National Institutes of Health, the Henry J. Kaiser Family Foundation
and many other prominent institutions. The current national guidelines include the following fundamental requirements:
A. All symptomatic patients and patients with advanced HIV disease must be treated with antiretroviral (“ARV”) therapies. ARV medications reduce the replication of HIV. They must be offered to all patients with a less than 500 T-cell count. (T-cell counts indicate the health of the body’s immune system.) ARV therapy suppresses the virus for as long as possible, slowing the progression of the disease and thus significantly prolonging the life of an HIV-infected individual.
B. At least three ARV medications must be taken together for a regimen to be effective. Dosages must not be missed because resistance develops very quickly, making the regimen useless to the patient. If resistance develops, at least two new ARV medications must be added to the patient’s regimen. Once the decision is made to start an ARV regimen, the treatment must be uninterrupted.
C. Due to the importance of compliance and the possibility of resistance to ARV medications, patients must receive careful monitoring of their condition and its progression, including appropriate medical testing. Clinical testing includes taking an inmate’s “T-cell” count, which measures the number of T helper cells in a cubic millimeter of blood; and testing an inmate’s viral load, which measures the amount of viral particles present in the individual’s blood plasma. These tests must be performed at least once every three months, and the results must be used in making clinical judgments about the initiation of drug therapy, the initiation of preventative treatments, and any changes in therapy. Viral load testing is essential in deciding to start or change an ARV regimen. It reveals more about disease progression than T-cell counting does.
D. In addition to ARV medications, HIV-positive persons must have access to appropriate treatments to prevent predictable and serious complications of their infection. This includes access to prophylactic medications that prevent opportunistic infections and specialist physicians in areas such as dermatology and ophthalmology.
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These standards are well-known and universally accepted by all medical and public health agencies. All medical doctors who are informed about HIV and AIDS agree that these are the minimum standards of care.
B. Fulton County and Correctional Healthcare Solutions, Inc., fail to provide HIV-positive inmates at the Fulton County Jail with minimally adequate medical treatment and interfere with treatment already prescribed. 40. Fulton County (“the County”) has chosen to provide medical care, including HIV-
related care, to inmates at the Jail by contracting with Correctional Healthcare Solutions, Inc. (“CHS”), a private correctional medical care company. In every aspect of the medical care delivered at the Jail, the Fulton County and CHS defendants have failed disastrously to meet the minimum medical requirements previously outlined. As a result, plaintiffs have experienced and continue to experience extreme and unnecessary pain, suffering, and accelerated progression of their disease towards AIDS and death.
41. When individuals arrive at the Jail, they undergo a formal intake process. During this process, new inmates complete a medical history form which asks them about current health problems and medications. Inmates who know they are HIV-positive indicate this diagnosis on the form and list their medical regimens. Usually these regimens consist of multiple medications, especially for those on ARV therapy, to slow the replication of HIV in their bodies. Many HIVpositive inmates emphasize to the correctional and medical staff during intake that they need their medications immediately. They know that their regimens require strict compliance and they are vulnerable to opportunistic infections and the development of drug-resistant HIV if there is any interruption in their treatment.
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42. After they fill out these medical forms, inmates often remain in a crowded holding cell without a mattress, blankets, or any medical attention or treatment for three to four days while it is determined where they will be housed. Newly admitted inmates are housed in these crowded conditions before they are screened for tuberculosis. Tuberculosis tests are thereafter only administered randomly to the inmates. This random testing makes it impossible to prevent HIVpositive inmates from being housed with or near inmates with tuberculosis. HIV-positive individuals who contract tuberculosis are at a greatly increased risk of rapidly deteriorating health resulting in painful and premature death.
43. HIV-positive inmates may not see a physician at the Jail until two weeks after their arrival. Even after they see the Jail physician, however, most do not receive their medications -including the highly time-sensitive ARV medications -- until at least thirty days after they arrive at the Jail, if at all. Such a long interruption creates resistance to the medication, foreclosing the possibility that those drugs can ever be used again to slow the progression of the disease. The denial of medications also causes an increase in the amount of the virus present in an HIVpositive person’s body. This increased viral load creates a greater risk that the patient will contract opportunistic infections, which can cause death in a person with such a weakened immune system.
44. Plaintiffs are routinely denied their ARV medications for several days at a time, even after submitting numerous medical requests urgently asking for the proper doses. Medications are dispensed twice a day by pill nurses at “pill call”. The nurses bring a cart containing the inmates’ medications to each housing unit, and the inmates stand in line to receive their medications from the nurses. When inmates arrive at pill call, some are told by the pill nurse that the Jail does not have the prescribed medication, or that it has only some of the medication, or even that it has the wrong medication. The nurse frequently tells inmates that their
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ARV medication has been lost, that the supply of a particular drug on their regimen has run out because the pharmacy failed to reorder the medication in time, or that a certain medication is simply no longer available.
45. In order to be effective, ARV medications must be taken at the appropriate hours and with the appropriate meals. However, the medical staff at the Jail rarely administers medications properly, even when the medications are available. For example, medications that must be administered in twelve-hour intervals are often administered in six-hour intervals and not in conjunction with the necessary food. The pill dispensing schedule at the Jail varies by several hours from one day to the next. Variations of this magnitude reduce the effectiveness of ARV therapies, promoting the development of infections and drug resistance. Pill dispensation does not occur at all on some days and, as a result, inmates miss their dosages entirely.
46. The nurses at the Jail are not educated about HIV and make mistakes in dispensing medication. Nurses sometimes indicate on an inmate’s pill chart that the inmate received medication when in fact no medication was provided.
47. When inmates complain that they are not receiving the proper medication, the nurses or correctional staff have often threatened them with disciplinary sanctions.
48. Many inmates do not receive prophylactic medication. Prophylactic medications protect people with low T-cell counts from developing life-threatening opportunistic infections. For example, Bactrim prophylaxis has been proven to prevent the onset of pneumocystis carinii pneumonia (“PCP”), the most common opportunistic infection and a common cause of death in people with HIV and AIDS. Bactrim also reduces the likelihood of bacterial pneumonia and central nervous system toxoplasmosis, a parasitic infection which forms an abscess in the brain. Nevertheless, Bactrim, in addition to other prophylactic medications, is routinely and often
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repeatedly denied to inmates. In one instance, an inmate was prescribed liquid Bactrim by the Grady infectious disease clinic. He did not receive it, although he repeatedly asked the Jail staff about this medication and filed a medical request asking that it be provided. In four months, the only response he received came from the pill nurses, who told him that the Bactrim sent by the infectious disease clinic had been lost.
49. Inmates who are too sick or tired to stand in the pill call line do not receive any medications at all. Jail staff does not take medication to the cells of these particularly vulnerable inmates.
50. Many inmates do not receive their medications at all on days when they are transported out of the Jail for court hearings.
51. Inmates do not receive adequate treatment for HIV-related medical complications. For example, many inmates suffer persistent and painful viral skin infections that ooze blood and pus on their clothing and linens. When they submit medical requests about these complications, they often wait several days or weeks for any response. When inmates are finally seen by medical staff at the Jail, they often receive no medication or medication that is too weak to cure their infection. When the Grady infectious disease clinic prescribed and supplied proper medication for these HIV-related complications, as with the ARV and prophylactic medications, inmates often did not receive it.
52. The Jail frequently fails to perform follow-up laboratory testing to assess and monitor potentially serious and lethal side effects of HIV-positive inmates’ medication.
53. The Jail fails to provide necessary nutrition and dietary supplements for many HIV-positive inmates. Most HIV-positive persons require a certain amount of food in order to absorb the large quantity of HIV medications prescribed. Additionally, they often require a
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medical diet of extra protein and calories in order to prevent wasting syndrome, a serious and common HIV-related condition, characterized by extreme weight loss due to protein depletion and often accompanied by severe diarrhea. Some inmates have been denied a medical diet or dietary supplement, even when it has been prescribed by the Grady infectious disease clinic, and even when they have lost a significant amount of weight and have complained of weakness and severe diarrhea. Similarly, the Jail continued to give milk products to an HIV-positive inmate who is lactose-intolerant, making it impossible for him to eat enough to maintain his weight or take his medications without becoming ill.
54. The sick call procedure operated by correctional and medical staff at the Jail is plagued with inadequacies. Inmates must obtain and fill out medical sick call requests if they need medical attention or have not received necessary medications. However, inmates are often told that the forms are simply not available. Once the inmates submit the sick call requests to a nurse or place the requests in the mail slot, they must typically wait three or four days, and sometimes as long as two or three weeks, to be seen by a triage nurse. If the triage nurse decides that inmates need to see a Jail physician or physician’s assistant, they must often wait one or more additional weeks for that appointment to take place. For HIV-positive inmates, who require uninterrupted provision of medication, experience painful viral infections and terrible side effects from their medications, and whose health can deteriorate very rapidly, these delays are medically intolerable and cause unnecessary suffering.
55. Inmates sometimes submit sick call requests and do not receive any response at all. When the inmates ask the medical staff what happened to their requests, staff members frequently respond that they never received it. As a result of this disorganization, inmates who need urgent medical attention must submit numerous, duplicative medical requests and wait
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several days before they receive any attention at all. 56. If and when inmates see Dr. Eno Ikoku, the chronic care unit physician, the care
they receive is often inadequate and inappropriate. She frequently tells inmates that they do not need treatment, without further examination or explanation. If inmates try to ask her questions, she orders them to leave her presence or threatens to move them out of the chronic care unit into general population. Dr. Ikoku has told some inmates that they will never receive their HIV medication. She makes few, if any, clinical notes about inmates’ visits in their medical files.
57. HIV-positive inmates housed in general population (i.e. not in the chronic care units) also do not have access to qualified medical doctors or adequate treatment of infections or side effects from their medications. For example, one HIV-positive inmate in general population was suffering from terrible headaches, a severe rash, and chronic diarrhea, but was not seen by a nurse for two weeks. According to her notes, the nurse did not perform a physical evaluation on the inmate, and the inmate was never seen by a doctor or tested for the pathogens that may have been causing the excruciating diarrhea and other symptoms.
58. The medical records maintained by the staff at the Jail are incomplete, incoherent, undated, and sometimes unsigned. Without adequate medical records, it is impossible to monitor an inmate’s condition or to provide necessary follow-up care.
59. The Jail’s medical staff rarely administers tests that measure inmates’ viral loads, instead relying only on tests that count T-cells. Although T-cell counts are important for evaluating the health of the body’s immune system, they alone do not give an accurate prognosis of disease progression, development of drug resistance, and vulnerability to infection. Viral load testing, which measures the amount of virus in the bloodstream, is essential to evaluating health status and to determining how to carry out ARV regimens.
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60. When clinical tests are administered, the Jail’s medical staff fails to inform inmates of their test results or discuss with them the progression of their disease. For example, an HIVpositive inmate who tested positive for Hepatitis B was not informed of this serious medical condition until almost a month after the results were received by the Jail. While he was in the Jail, he never received any treatment for or counseling about this disease.
61. When an HIV-positive inmate is very ill, the correctional and medical staff often refuse to touch or come near the person, forcing other inmates to care for the inmate instead. For example, Leroy Henderson, an HIV-positive inmate who died in January 1999 one day after the Jail transported him to Grady Hospital, was in the Jail for several months prior to his death. During the weeks before his death, inmates had to bring Henderson his food because the correctional staff would not deliver it to his cell. Shortly before his death, Henderson was so emaciated and weak that he had to be carried to the shower by other inmates. Inmates had to carry Henderson to seek medical attention because correctional staff refused to touch him.
62. Inmates who are terminally ill and require hospitalization do not receive palliative care to alleviate unnecessary suffering. Inmates are not transported to the hospital until they are so sick that they are on the very brink of death. One of them, Leroy Henderson, was not brought to Grady Hospital until the day before he died, although his health had obviously deteriorated horribly at the Jail. Similarly, Ricky Turner, an HIV-positive inmate who was partially paralyzed from a stroke, died at the Fulton County Jail in January 1999. Before he died, Turner was suffering from dementia, could barely swallow or digest food, had diarrhea and incontinence, and had lesions in his throat and mouth. He did not receive proper treatment for these excruciating symptoms at the Jail. He was finally taken to the hospital when he could no longer physically get himself out of his bed. After spending two weeks in the hospital, Turner returned to the Jail.
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After his return, Turner spent only one day in the Jail’s chronic care unit before he was transferred to the Jail’s infirmary because he was so weak. Turner died several days after he was removed from the chronic care unit. Despite his physical limitations, Turner was beaten by guards only weeks before his death.
63. Inmates do not have access to any discharge planning or case management services before they leave the Jail. Discharge planning with medical and social service providers in the community is necessary to ensure continuity of care and, in particular, continuous access to ARV medication upon release. Without this planning, inmates cannot maintain compliance with their ARV regimens. This failure results in rapid progression of the disease and increased drug resistance, which in turn threatens the health and safety of the surrounding community.
64. Inmates may choose to be tested for HIV at the Jail if they do not know their status at intake. If these inmates learn that they are HIV-positive, however, they do not receive an appointment with an infectious disease specialist and do not receive proper follow-up testing, treatment, or counseling.
65. Although aware of deficiencies in the delivery of medical care to plaintiffs, the Fulton County defendants have failed to set up adequate administrative structures, training programs, and inmate grievance systems; to monitor, supervise, and enforce their contract with CHS; and to adopt other policies to ensure that HIV-infected inmates receive necessary medical treatment.
C. The Fulton-DeKalb Hospital Authority has stopped treating HIV-positive inmates, knowingly abandoning them to a system completely incapable of delivering life-preserving medical treatment. 66. The provision of medical care to HIV-positive inmates has recently deteriorated
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even further. On February 10, 1999, despite their contract with Fulton County, the defendant Board of Trustees of the Fulton-DeKalb Hospital Authority unanimously approved a policy of eliminating outpatient care to inmates, including those at the Fulton County Jail, beginning on March 1, 1999.
67. Until March 1, 1999, decisions about the treatment of some HIV-positive inmates at the Jail were made by physicians at Grady Hospital’s infectious disease clinic. The Grady infectious disease physicians, adhering to the established standard of care for treatment and control of HIV infection, performed tests, confirmed previous medication histories, and provided counseling to the inmates. Based on these thorough medical evaluations, the infectious disease clinic prepared appropriate treatment regimens for each inmate. The Grady infectious disease clinic sent the inmates back to the Jail with a supply of medications, a treatment schedule, and frequently a prescription for a medical diet.
68. Prior to March 1, 1999, inmates with Grady appointments complained to the infectious disease doctors there that the Jail often failed to provide ARV medications on schedule, if at all, and that they were not given their prescribed diets, prophylactic medications, or treatments for opportunistic infections. Knowing that the procedures for delivering medication and other necessary treatment at the Jail were completely broken down, many Grady Hospital infectious disease physicians concluded that they had no choice but to cease prescribing ARV medication to inmates altogether. These doctors feared that the drugs, provided only sporadically at best at the Jail, would cause more harm than good to the patients who did not receive them properly.
69. Dr. Jeffrey L. Lennox, an infectious disease specialist and the medical director of Grady Hospital’s infectious disease clinic, attempted for over a year to alert all responsible parties to the medical crisis at Fulton County Jail for HIV-positive inmates. No one responded to Dr.
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Lennox’s warning. In a letter dated January 9, 1998, Dr. Lennox wrote to the Chairman of the Fulton County Commission to express his concern about the inadequate medical treatment of HIV-positive inmates at the Jail. Dr. Lennox explained:
The reason I am writing to you is to inform you of a serious problem that exists within the Fulton County Jail. Prisoners who are brought to our clinic receive appropriate medical evaluation and prescription therapy. However, they report that they frequently do not receive their medication when they return to jail. I have spoken to Dr. William Render, the chief physician in the jail. Dr. Render recognizes the seriousness of the problem, but reports that he is unable to modify the policies that control the access to medications by patients within the jail.
This problem is very serious in that patients will die sooner if they do not receive medication as prescribed. I have been informed that at least 2 prisoners are preparing lawsuits against Fulton County Jail. These prisoners are being assisted in their suits by outside legal agencies. I therefore ask that you address the failure to provide adequate medical care to HIV infected patients. The Fulton County Commission did not respond. 70. In another letter dated January 9, 1998, Dr. Lennox, described the Jail’s failure to deliver ARV medication to Gail Anderson, the Senior Vice President for Medical Affairs of the Grady Health System. Dr. Lennox wrote: Many of the medications that HIV infected patients receive must be given 2 to 5 times per day. If these medications are not given the patients will develop progressive illness. If the medications are given on an interval less frequent than the prescribed interval the patients will develop resistance to those medications, resulting in complete loss of efficacy of all drugs in that class. In this letter, Dr. Lennox told the Senior Vice President that he had attempted to address the medication dispensing problem with the Dr. William Render, the chief physician at the Jail, but had “achieved no success.” Dr. Render was employed by Correctional Healthcare Solutions, Inc. 71. Despite Dr. Lennox’s efforts, neither CHS, nor the Jail itself, nor the Grady administrators, nor the County Commission took any corrective action. Instead, CHS and the
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County have allowed the grossly inadequate medical care to continue. On February 10, 1999, Grady decided to abandon the situation entirely.
72. Although correctional and medical staff at the Jail routinely ignored the treatment plans prescribed by Grady’s infectious disease doctors, the inmates who went to Grady at least received some evaluation and monitoring of their illness by qualified physicians. There are now no competent physicians to treat and prescribe medications for HIV-positive inmates at the Jail, much less an adequate system of distributing such medications and monitoring inmates’ health at the Jail. HIV-positive inmates received grossly deficient medical care even when Fulton County was able to refer them to Grady Hospital’s infectious disease clinic for evaluation and treatment. Now that the Fulton-DeKalb Hospital Authority has eliminated the Grady infectious disease clinic’s involvement, inmates are exposed to an even greater risk of unnecessary pain and suffering, opportunistic infection, and premature death.
73. Fulton County’s response to this public health crisis, which affects people outside the Jail as well as in it, has so far been marked by chaos and indecision. It has no clearly-defined, comprehensive, and coordinated plan to provide adequate care to HIV-positive inmates. Jail officials have yet to even request inmates’ medical files from the infectious disease clinic, a failure which precludes the possibility of any continuity of care. Neither the County nor its contractor, CHS, is treating this crisis with the urgency that it demands.
D. Defendants have acted and continue to act with deliberate indifference to plaintiffs’ serious medical needs. 74. The policies and customs challenged in this lawsuit were developed and
implemented with deliberate indifference to the substantial risk of serious harm faced by HIVpositive inmates at the Fulton County Jail. All defendants know about this risk, which is
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longstanding, pervasive, well-documented, and apparent to any knowledgeable observer. They have been further placed on notice by correspondence and reports between the various defendants and their employees; numerous documented examples of drastic deterioration in inmate health resulting from delayed and/or denied medical care; and numerous complaints, oral and written, formal and informal, by inmates affected by these constitutional deficiencies. Defendants’ policies and customs have caused and, unless changed, will continue to cause needless human suffering, increased resistance to life-saving medication, and an increased risk of inmate death.
75. Plaintiffs have exhausted all administrative remedies available to them. Numerous inmate grievances have failed to result in any improvement in the treatment of HIV-positive inmates at the Fulton County Jail. For example, in October 1998, plaintiff Foster along with fifteen other HIV-positive inmates in the Jail’s chronic care unit (including the now-deceased Ricky Turner), submitted a comprehensive administrative complaint describing the desperately inadequate medical care they were receiving. They received no reply to the numerous issues they raised in the complaint. Defendants do not offer administrative remedies sufficient to correct the immediate and severe medical crisis and the suffering and death it is causing to plaintiffs and others.
VII. CAUSES OF ACTION 76. Plaintiffs support the following claims by reference to the previous paragraphs of this Complaint:
Count I
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77. The medical treatment of all HIV-positive inmates at Fulton County Jail and defendants' policies and practices in administering this treatment constitute deliberate indifference to inmates’ serious medical needs and violate plaintiffs’ rights to due process under the Fourteenth Amendment to the United States Constitution.
Count II 78. The medical treatment of convicted HIV-positive inmates at Fulton County Jail and defendants’ policies and practices in administering this treatment constitute deliberate indifference to inmates’ serious medical needs and amount to cruel and unusual punishment in violation of plaintiffs' rights under the Eighth and Fourteenth Amendments to the United States Constitution.
Count III 79. Defendant Sheriff Barrett’s refusal to provide medical aid to plaintiffs violates their rights under O.C.G.A. § 42-4-4 (a) (2).
Count IV 80. The refusal of defendants Fulton County and Fulton County Commission to “maintain the inmate, furnishing him food, clothing and any needed medical and hospital attention” violates plaintiffs’ rights under O.C.G.A. § 42-5-2.
Count V 81. The decision of the Fulton-DeKalb Hospital Authority and its Board of Trustees to stop providing medical treatment to plaintiffs constitutes a breach of the Authority’s contract with Fulton County and violates plaintiffs’ rights as intended third-party beneficiaries of this contract, pursuant to O.C.G.A. § 9-2-20. Fulton County has likewise breached plaintiffs’ thirdparty beneficiary rights by failing to enforce this contract, pursuant to O.C.G.A. § 9-2-20.
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Count VI 82. By failing to provide plaintiffs with the services listed in its contract with Fulton County, CHS has breached plaintiffs’ rights as intended third-party beneficiaries to this contract, pursuant to O.C.G.A. § 9-2-20. Fulton County has likewise breached plaintiffs’ third-party beneficiary rights by failing to enforce this contract, pursuant to O.C.G.A. § 9-2-20.
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PRAYER FOR RELIEF WHEREFORE, plaintiffs respectfully pray that this Court: 1. Assume jurisdiction over this action. 2. Order that this case may be maintained as a class action pursuant to Rule 23(a) and 23(b)(2) of the Federal Rules of Civil Procedure. 3. Declare unconstitutional and unlawful the medical treatment of HIV-positive inmates at the Fulton County Jail. 4. Enter preliminary and permanent injunctions ordering defendants, their successors, agents, employees, and all persons acting in concert with them to immediately provide inmates with access to competent medical specialists, prescribed medications and diet on schedule as required for proper care, appropriate testing, routine and emergency care, adequate treatment of opportunistic infections, and discharge planning. 5. Enter preliminary and permanent injunctions ordering immediate specific performance of the contract between Fulton County and the Fulton-DeKalb Hospital Authority, requiring that the infectious disease clinic at Grady Hospital provide needed medical care to plaintiffs. 6. Enter preliminary and permanent injunctions ordering immediate specific performance of the contract between Fulton County and Correctional Healthcare Solutions, Inc. (“CHS”), requiring that CHS prescribe and provide adequate treatment for HIV and AIDS in accordance with the universally accepted Centers for Disease Control and Prevention standards. 7. Award plaintiffs the costs of this lawsuit and reasonable attorneys' fees. 8. Order such additional relief as the Court may deem just and proper. Respectfully submitted, this 15th day of April, 1999.
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________________________________ TAMARA H. SERWER TX Bar No. 24004911* ________________________________ KATHARINE A. HUFFMAN GA Bar No. 375320 STEPHEN B. BRIGHT GA Bar No. 082075 Southern Center for Human Rights 83 Poplar Street, N.W. Atlanta, Georgia 30303-2122 Telephone: (404) 688-1202 *Applying for admission to this court. Attorneys for Plaintiffs
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 IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF GEORGIA
ATLANTA DIVISION

__________________________________________

)

RUBEN FOSTER et al.,

)

)

Plaintiffs,

)

)

v.

)

)

FULTON COUNTY, GEORGIA et al.,

)

)

Defendants.

)

__________________________________________)

CIVIL ACTION No. 1:99-CV-0900 (MHS) CLASS ACTION

FINAL SETTLEMENT AGREEMENT I. Introduction
A. Plaintiffs in this class action are all HIV-positive persons who are now or will be in the future incarcerated at the Fulton County Jail in Atlanta, Georgia (“the Jail”). They filed this action on April 8, 1999, seeking declaratory and injunctive relief for violations of their Eighth and Fourteenth Amendment rights. In their complaint, plaintiffs allege that HIV-positive inmates at the Jail have received constitutionally inadequate medical care.
B. Defendants in this case are Fulton County, Georgia; the Fulton County Board of Commissioners and its members; Fulton County Sheriff Jacquelyn Barrett; Chief Jailer of the Fulton County Jail L.L. Briggs; Medical Services Director of the Fulton County Sheriff’s Department George Herron; Correctional Healthcare Solutions, Inc. (CHS); CHS Health Services Administrator Kevin Ramos; CHS Medical Director Harold Minerve; and CHS physician Eno Ikoku. All defendants are sued in their official capacity.1 The plaintiff class and all defendants are
1 Kevin Ramos, Harold Minerve, and Eno Ikoku have been replaced since the inception of

parties to this Final Settlement Agreement (hereinafter also referred to as “Agreement” and “Settlement Agreement”). The term “defendants” refers to all these defendants and their successors, agents, and assigns.
C. This Final Settlement Agreement is submitted and entered into as a settlement of all claims for declaratory and injunctive relief set forth in plaintiffs’ First Amended Complaint, filed on April 15, 1999. The United States District Court for the Northern District of Georgia, Atlanta Division, shall retain jurisdiction to enforce the terms of this Settlement Agreement and shall preside over any further proceedings, as necessary.
D. On April 8, 1999, plaintiffs filed their Complaint, Motion for Preliminary Injunction, Motion for Class Certification, and supporting materials. Plaintiffs filed their First Amended Complaint on April 15, 1999. The United States District Court, the Honorable Marvin H. Shoob presiding, scheduled a hearing on plaintiffs’ Motion for Preliminary Injunction for April 16, 1999. Prior to the hearing that morning, the parties reached an agreement resolving plaintiffs’ Motion for Preliminary Injunction and submitted it to the Court for approval.2 On April 16, the Court entered the Consent Order resolving the plaintiffs’ motion.
this lawsuit. 2 This lawsuit also originally named as defendants the Board Members of the Fulton-
DeKalb Hospital Authority and Edward J. Renford, Chief Executive Officer of Grady Health System, in their official capacities. These defendants were voluntarily dismissed on April 16, 1999, based on their representation that the Grady Health System would continue to provide
2

medical appointments to HIV-positive inmates at the Fulton County Jail. 3

E. On April 22, 1999, the parties submitted for the Court’s approval, and the Court approved and entered, a Consent Order on Class Certification. Pursuant to the April 16th Consent Order, on May 28, 1999, the Court appointed Dr. James Steinberg to oversee and report on defendants’ compliance with the preliminary injunction. Discovery began on May 25, and concluded on August 27, 1999.
F. CHS shall be bound by the terms and conditions of this Agreement to the extent those terms and conditions do not exceed CHS’s obligations under its contract with Fulton County. Obligations in excess of CHS’s contractual responsibilities shall be the sole responsibility of Fulton County. Additionally, upon the termination, cancellation, or expiration of a contract to provide medical care at the Fulton County Jail between Fulton County and CHS, CHS’s obligations, duties, and responsibilities under this Settlement Agreement shall terminate. Because they are sued only in their official capacities, upon termination of this contract, CHS and all CHS defendants will no longer be parties to this lawsuit. If at any time during this Agreement the contractor for medical care at the Jail changes, the County shall require the new contractor to comply with the terms and conditions of this Agreement.
G. During and after the discovery period, the parties engaged in settlement negotiations seeking to resolve all claims for declaratory and injunctive relief raised in plaintiffs’ First Amended Complaint. The parties hereby agree to the following terms. II. Definitions
A. “HIV Specialist” refers to the on-site physician hired by the defendants to be responsible for the medical care of HIV-positive inmates at the Jail. The HIV Specialist shall be a medical doctor who is board certified as either an internist or an infectious disease specialist, and
4

who has more than three years experience in inpatient and outpatient management of HIV infection as set forth in Section XIII, below.
B. “HIV Coordinator” refers to the on-site registered nurse, nurse practitioner, or physician’s assistant hired by the defendants to be responsible for coordinating the care provided to HIV-positive inmates. This coordination includes overseeing the arrangement of appointments both within the Jail and with outside providers; ensuring that any follow-up care ordered by a medical provider (including laboratory testing, appointments, monitoring, etc.) occurs in a timely manner; monitoring the progress and treatment of all known HIV-positive inmates at the Jail; and organizing education on the transmission and treatment of HIV, sexually transmitted diseases, and tuberculosis for all inmates at the Jail.
C. “Correctional Healthcare Monitor” or “Monitor” refers to the physician appointed by the Court to monitor defendants’ compliance with this Settlement Agreement, as set forth in Section VIII, below.
D. “Medical Director” refers to the on-site physician hired by the defendants to be responsible for the provision of medical care at the Jail. This responsibility includes overseeing the quality and effectiveness of medical care provided at the Jail; ensuring that medical staff are sufficiently hired, scheduled, and trained to provide constitutionally adequate medical care; coordinating the Quality Management program at the Jail; and any other duties related to medical care provision and medical decision-making at the Jail.
E. “Director of Medical Services” refers to the on-site administrator hired by and reporting to the Fulton County Sheriff’s Office responsible for overseeing the administration of medical care provided at the Jail. This administration includes coordinating communication
5

between CHS (or any other on-site medical care contractor) and the Sheriff’s Department, and any other administrative duties related to the County’s oversight of the medical care provided at the Jail. III. Medical Care
A. Defendants shall implement policies and procedures to ensure that when HIVpositive persons enter the Fulton County Jail, they have timely access to medical staff and to any treatment regimen for HIV infection and the prevention of opportunistic infections consistent with the standard of care set forth by the United States Department of Health and Human Services. Defendants shall maintain conformance with the National Commission on Correctional Health Care’s current Standards for Health Services in Jails (“NCCHC Standards”). In the event that an inmate enters the Jail on an HIV treatment plan, any change in that plan shall also be consistent with these standards. Defendants shall take reasonable measures to seek prompt confirmation of any HIV treatment plan reported by a new inmate. Adequate stocks of all FDA-approved antiretroviral medications shall be available for dispensing to inmates who come into the jail without any lapse or delay that is inconsistent with this standard of care.
i. All inmates shall receive an intake screening upon their arrival at the Jail. This screening shall include, but shall not be limited to, inquiry into any communicable diseases, including tuberculosis and sexually transmitted diseases, and urgent chronic conditions, review and continuation of any medications, and timely referral for inmates in urgent need of physician review. Information gathered during the intake screening shall be used to provide any necessary medical care. During the intake screening, the medical provider shall ask each person who identifies him/herself as HIV-positive if he or she is on medications.
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ii. If during intake screening an HIV-positive person is able to identify credibly his or her medications, the intake nurse shall obtain a verbal order from a physician and continue these medications immediately. There shall be no unreasonable disruption in the continuity of medication. The intake medical provider shall ask each known HIV-positive person to sign a release of information form so that confirmation of any treatment regimen and exchange of relevant information can take place as soon as possible. Blood shall be drawn for T-cell and viral load testing of all known HIV-positive inmates within 48 hours of arrival at the Jail or 72 hours if the person arrives on a Friday.
iii. Intake screening of HIV-positive inmates shall occur no later than four hours after an inmate’s arrival at the Jail except in the event of a bonafide emergency or unexpected influx of new inmates, in which case defendants shall document the duration of and reasons for the delay. In order to identify and triage HIV-positive inmates, all inmates shall be asked the following question by medical personnel upon arrival at the Jail: Are you presently taking medication for or suffering from diabetes, heart disease, seizures, arthritis, asthma, ulcers, high blood pressure, HIV/AIDS, tuberculosis, or a psychiatric disorder?
iv. Any person whose HIV medications are initiated at intake or has symptoms of active HIV-related infections shall be given a comprehensive physical exam within 48 hours of arrival at the Jail, or 72 hours if the person arrives on a Friday. All other HIV-positive inmates shall have a comprehensive physical exam when the results of their T-cell and viral load tests are received by the Jail, but no later than ten days after their arrival at the Jail. All physical exams of HIV-positive inmates shall be performed by an HIV Specialist or an appropriate medical provider in consultation with an HIV Specialist. Defendants shall test all HIV-positive inmates for syphilis
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and shall test all HIV-positive women for chlamydia and gonorrhea at their first physical exam. All HIV-positive men shall be screened for chlamydia and gonorrhea and tested for these diseases if symptoms are present.
B. When an inmate is identified as HIV-positive, either through a blood test, through credible self-identification, through confirmation with an outside health provider, through medical records from a previous incarceration at the Jail, or through any other means, the inmate shall be offered initial treatment consisting of a comprehensive health history; a physical examination; and laboratory blood testing, including but not limited to T-cell and viral load testing. The tests shall occur in time for results to be available to the HIV Specialist for an initial consultation within two weeks after the person is identified as HIV-positive. During this initial consultation, an assessment shall be conducted and a written treatment plan developed. This assessment and treatment plan shall comply with the applicable standard of care, including, to the extent dictated by the applicable standard of care, appropriate vaccinations, opportunistic infection prophylaxis if indicated, any necessary referrals to other specialists, any further laboratory or other testing, and appropriate medical diets.
i. Defendants shall inform incoming inmates that HIV testing is available at the Jail, and shall provide them with pamphlets, approved by the Fulton County Health Department, that describe the methods by which HIV can and cannot be transmitted. Defendants shall test an inmate for HIV upon his or her request or when testing is medically indicated, and the inmate has given his or her consent. Defendants shall possess adequate equipment, including at least one fax machine with a dedicated line for the medical department, for the sharing of medical information between the jail and outside health providers.
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ii. A registered dietician employed by the County or its food contractor shall work closely with medical and security personnel to ensure that HIV-positive inmates receive appropriate diets, as indicated on the inmates’ treatment plans. The dietician shall be responsible for menu planning and monitoring of both general and medically prescribed diets.
C. Each HIV-positive inmate for whom antiretroviral (ARV) therapy is appropriate according to the applicable standard of care and who consents to such therapy shall be provided appropriate ARV therapy individually designed for that inmate by an HIV Specialist in accordance with guidelines published by the United States Department of Health and Human Services. Where testing indicates that a regimen is failing, the regimen shall be examined by the HIV Specialist and appropriate changes and substitutions shall be made. As these guidelines are updated, an HIV Specialist shall review each patient’s treatment regimen and make any appropriate changes in order to maintain compliance with the standards set forth in the guidelines. Unless the HIV Specialist is unavailable, only the HIV Specialist or a physician in consultation with an HIV Specialist may change a patient’s HIV treatment regimen. In the event that someone other than the HIV Specialist changes a patient’s regimen, that change shall be reviewed by the HIV Specialist as soon as practicable.
D. Defendants shall implement policies and procedures to ensure that when the HIV Specialist prescribes a medication for the treatment of HIV infection or to prevent opportunistic infections, adequate stocks of the medication are available for dispensing to the patient without any lapse or delay. These medications shall be provided in appropriate doses and at appropriate times in accordance with the standard of care. Unless patients are allowed to self-administer medications, complete and accurate medication administration records shall be kept by the
9

administering medical staff. These records shall specify what medications are provided; when and by whom they are provided; and if prescribed medications are not provided, these records shall specify the reason that they are not.
i. The defendants shall develop and implement systems to provide medications in a timely manner and to track problems with the dispensing and administration of medications. Defendants shall dispense HIV medication at the prescribed time intervals or within one hour of the prescribed time. The schedule for administration of medication shall accommodate the medical needs of the inmates, in accordance with the standard of care. All refusals of medication by inmates must be in-person and must be documented as in-person. If prescribed medications are not provided because of refusal or for any other reason, the written explanation for their not being provided shall be initialed by the dispensing medical staff member. All persons refusing medication shall be provided counseling regarding the consequences of incomplete adherence, and this counseling shall be documented.
ii. Medication records for inmates who are on self-medications shall include documentation of education of the patient regarding the medications, documentation of any follow-up inquiries or education, and documentation of the dispensation and compliance checks of all self-medications.
iii. Defendants shall maintain sufficient stocks of all antiretroviral medications at all times. Medications shall be maintained on chronic care units and stock carts shall be checked and refilled every day. Defendants shall ensure that any errors in medication orders or in medication administration are corrected immediately through the Medical Director or by whatever means necessary.
10

E. Each HIV-positive inmate shall be provided T-cell and viral load tests every three months, or more frequently if directed by an HIV Specialist, and any other appropriate follow-up tests, including tests for potential treatment toxicity. Each inmate with a T-cell count under 500, suffering from any HIV-related illness, or who is prescribed ARV medication shall be seen by an HIV Specialist at least every three months, or more often if recommended by the HIV Specialist. Blood testing shall be timed so that results of tests taken within one month are available to the HIV Specialist on each regularly scheduled visit.
i. The defendants shall inform inmates of the results of any medical tests and assessments (including their T-cell counts and viral loads) within one week of receipt of these results by defendants. Treatment guidelines for testing toxicity and HIV disease progression shall be developed by the Medical Director and approved by the Monitor. The defendants shall ensure that the results of medical tests and assessments performed at the Jail or by an off-site provider are obtained in a timely manner and that recommended follow-up care is provided in a timely manner.
F. HIV-positive inmates shall be provided emergency access to a physician or licensed nurse practitioner consistent with the applicable standard of care because acute or serious medical conditions may arise in HIV-positive persons at any time. Incarcerated persons with HIV shall also have access to routine sick call by a physician, nurse practitioner, physician’s assistant, or registered nurse. Emergency and routine access shall include both physical observation and examination as the physician or nurse practitioner deems medically appropriate. All medical staff who provide sick call to HIV-positive inmates shall participate in an effective training program approved by an HIV Specialist, in order to maintain competence in current methods for
11

diagnosing and treating medical complications associated with HIV, including the ability to recognize when referral to an HIV Specialist is necessary. This training shall include any necessary ongoing updating of skills and knowledge, and a method of effectively ensuring medical staff’s compliance shall be implemented.
i. The defendants shall ensure that security officers provide any appropriate assistance, with the approval of the medical staff, in the event of an emergency and that all security officers are appropriately trained in emergency procedures. Additionally, defendants shall take all necessary steps to ensure that appropriate and accessible equipment is available to respond to medical emergencies.
ii. The defendants shall create systems to ensure that medical request forms are available to inmates at all times. Provision shall be made for inmates to keep a duplicate copy of their request forms at the time it is submitted. In the general population units, medical requests shall be reviewed every day according to appropriate written triage protocols developed by the Medical Director and approved by the Monitor. Defendants shall ensure that inmates housed in the chronic care units have daily access to sick call administered by a registered nurse. The nurse shall refer inmates immediately to a medical provider, who will see the inmate within a reasonable period of time, according to appropriate written protocols developed by the Medical Director and approved by the Monitor.
G. HIV-positive inmates shall be referred in a timely manner to outside specialists in all cases when the Jail's own staff lacks the resources to treat in a timely manner the medical or mental conditions of HIV-positive inmates. Accordingly, defendants shall coordinate timely access to the Grady Hospital’s Infectious Disease Program or other appropriate specialists for
12

HIV-positive inmates and implement all necessary procedures to provide specialty consultations and specialized testing on an emergency (immediate), urgent (within three days), and routine (within four weeks) basis, as directed by medical staff including the HIV Specialist. While at outpatient appointments, inmates shall be provided with weather-appropriate clothing.
i. The defendants shall establish written protocols developed by the Medical Director and Director of Medical Services, and approved by the Monitor, regarding the County’s policy on referrals to outside providers.
H. All medical treatment provided to HIV-positive inmates shall be accurately documented in each inmate's medical record. Each request for medical attention and each response by medical staff shall be written, reviewed at sick call, and included in the inmate's medical record. Each visit to an outside specialist shall be documented, and copies of all resulting medical records returned with the inmate for placement in the inmate's medical records when provided. Jail medical staff shall take reasonable steps to communicate with outside specialists whenever appropriate. Fully updated in-house medical records shall be available to the in-house HIV Specialist before each scheduled appointment with an HIV-positive inmate, including a chronological log that lists demographic data and a history of T-cell counts, medications and doses prescribed, medical complaints and responses, and any other relevant information. As described in Section III. B. above, the HIV Specialist shall develop a written treatment plan consistent with the standard of care, in consultation with each HIV-positive inmate.
i. The defendants shall develop a system for ensuring that medical records at the Jail are complete, legible, and contain the necessary signatures in accordance with professional standards. All healthcare entries shall be dated and timed. Laboratory and diagnostic reports
13

shall be signed and dated to acknowledge timely review. Medical records maintained at the Fulton County shall contain at least the information and documents required by J-58 of the NCCHC Standards.
ii. Defendants shall ensure that all records are complete and that all forms are entered into patient records. The system shall ensure that loose paper is placed into the records in a timely manner and that medication administration reports are promptly filed in the record at the end of each month. The health record shall be available to and used for documentation by all healthcare practitioners in each clinical encounter with inmates.
I. If an HIV-positive inmate is deemed by an HIV Specialist to be in the terminal stages of the disease, the inmate shall be provided with appropriate care and treatment. This shall include appropriate pain control, adequate nutrition, and other appropriate palliative care coordinated by the HIV Specialist in accordance with the Eighth and Fourteenth Amendments of the United States Constitution.
i. The defendants shall make good faith efforts to place inmates in the terminal stages of AIDS in appropriate facilities or in the community, should the HIV Specialist determine that the Jail cannot provide appropriate care for the end-stage HIV-positive inmate.
J. Prior to discharge from the Jail to the community, all HIV-positive inmates shall have an appropriate discharge plan. A post-discharge appointment with an appropriate HIV medical care provider in the community shall be scheduled for every HIV-positive inmate, and each inmate shall be informed upon discharge of the date, time, and location of that appointment. If the inmate is on any prescribed medications, defendants shall provide sufficient medications to prevent gaps in the availability of those medications.
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i. The post-discharge appointment may be with the Fulton County Health Department (“FCHD”). The FCHD has agreed to see HIV-positive inmates released from the Fulton County Jail daily (Monday-Friday). Defendants shall provide these inmates with at least a four-day supply of medication upon their release from the Jail. In the event that the FCHD changes its schedule or policy, defendants shall immediately make alternative arrangements to continue providing post-discharge appointments, notification of the appointments, and medications to prevent gaps in the availability of HIV medications. Defendants shall not be obligated to provide more than a seven-day supply of medication.
ii. Defendants shall attempt to schedule post-discharge appointments at Grady Hospital’s Infectious Disease Program (“IDP”) for those inmates who qualify for the IDP, and shall notify inmates of their individual appointments.
iii. The defendants shall allow AIDS service organizations and treatment providers to provide inmates copies of pamphlets and other materials containing information about HIV, its treatment, and related social services. The defendants shall make these materials available to inmates by placing copies in the Jail’s library.
K. If a patient is transferred to another incarcerated setting, the inmate’s updated medical records, including progress notes, laboratory testing records, HIV consultation records, and a list of prescribed medications shall accompany the inmate. If the inmate is on any prescribed medications, defendants shall provide sufficient medications to last at least through the inmate’s transfer to the next facility.
L. All HIV-related services and treatment shall be kept confidential in accordance with applicable state, local, and federal law.
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M. Defendants shall screen all incoming inmates for symptoms of tuberculosis infection immediately upon admission. Defendants shall promptly isolate, diagnose, and treat any individual with a suspicion of contagious tuberculosis. Follow-up treatment and testing shall be conducted according to the recommendations and guidelines of the Centers for Disease Control (“CDC”). Any individual who has symptoms of tuberculosis and all HIV-positive persons shall have a chest x-ray within 48 hours of intake. Tuberculin skin test screening shall be performed on all inmates who do not have a documented history of a positive tuberculin skin test result. Preventive treatment for tuberculosis shall be offered to any inmate with a positive PPD whose anticipated length of stay is greater than two months. Defendants shall maintain appropriate facilities for respiratory isolation that are consistent with the recommendations of the CDC and the Occupational Safety and Health Administration (“OSHA”).
N. All HIV-positive women shall receive a pregnancy test upon admission to the Jail and shall receive pap smears at their first physical exam. Known HIV-positive women shall receive pap smears every six months thereafter. IV. Staffing
A. Defendants shall employ a sufficient number of qualified permanent medical staff to meet the healthcare needs of HIV-positive inmates at all times.
B. Fulton County defendants shall employ a sufficient number of trained correctional staff to meet the healthcare needs of HIV-positive inmates at all times. Shortages in correctional staff shall not interfere with the provision of medical care in accordance with Section III, above. The Fulton County defendants shall ensure that shortages in correctional staff do not prevent or delay the distribution of medications or the transport of HIV-positive inmates for any medical
16

appointments or needed medical care, either within the facility or in the community. C. All correctional staff members, including command staff, shall receive regular
training regarding HIV and tuberculosis infection, including modes of transmission and universal precautions.
D. Defendants shall maintain an attendance log and daily staffing schedule for both correctional and medical personnel. The adequacy of staffing shall be reviewed monthly by the Sheriff, the Chief Jailer, the Director of Medical Services, the Medical Director, and the on-site health services administrator.
E. Defendants shall establish a regular monthly meeting that includes correctional line staff members and direct medical service providers to address integration of medical and correctional goals and services (i.e., conflicts among medical and correctional staff; incidents when inmate care was delayed or denied due to problems or miscommunication among staff members; staffing, staff training, or staff deployment needs; etc.). Defendants shall identify and implement solutions to address integration needs. Defendants shall keep minutes of all meetings, and shall provide the Monitor with copies of those minutes. V. Sanitation and Housing
A. Because environmental factors impact significantly on the health of inmates, particularly HIV-positive inmates whose immune systems are weakened, the chronic care units, medical observation units, and any housing unit or other area where HIV-positive inmates are or may be placed shall comply with the standards set forth in the guidelines and recommendations of the American Correctional Association, OSHA, and the CDC. In accordance with such standards, these areas shall be cleaned on a daily basis, shall be disinfected between placements of
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inmates, and shall be kept in good working order and physical condition. Fulton County defendants shall conduct weekly checks on each of these areas to ensure that sanitation and physical conditions comply with these standards, and shall respond promptly to any deficiencies identified during these checks. Sanitary supplies such as hand soap, clean hand towels, bleach, and disinfectant shall be available to inmates and staff as needed. Defendants shall maintain an exposure control plan for blood-borne pathogens.
B. All housing units to which HIV-positive inmates are assigned shall be adequate to meet the needs of the HIV-positive inmates placed there. This shall include, but is not limited to, assurance that no HIV-positive inmate in a chronic care unit or with a diagnosis of AIDS shall sleep on the floor, and that all HIV-positive inmates shall have adequate access to toilet facilities, clean bedding and clothing, hot and cold running water, and drinkable water at all times.
C. HIV-positive inmates shall not remain in the intake holding cell for greater than eight hours. The intake holding cell shall provide inmates adequate access to toilet facilities and drinkable water at all times, and shall be sufficiently large to accommodate the number of inmates held in the cell.
D. The County shall identify mechanisms for accommodating current and anticipated jail population. VI. Grievances
A. Because of the importance of the grievance system in identifying both individual and systematic problems, defendants shall ensure that medical and dietary grievances by HIVpositive inmates are answered within 72 hours of their submission to medical personnel. No issue related to medical care shall be designated as “non-grievable.” Grievance forms shall be available
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to inmates at all times, and defendants shall provide inmates with a duplicate copy of their medical and dietary grievances at the time of their submission.
B. The medical staff person who serves as medical Grievance Coordinator shall keep a log of all medical and dietary grievances received from HIV-positive inmates. Each month, he or she shall compile a report including the numbers of such medical grievances received during the month, the substance of the grievances by category, the time taken to reply to grievances, and the resolution reached. This report shall be provided to the Monitor, the Medical Director, the Director of Medical Services, the Sheriff, and the on-site health services administrator. VII. Quality Management
A. Defendants shall perform ongoing quality management that monitors the quality of healthcare services provided at the Jail. The quality management program shall monitor all aspects of healthcare including at least the following: access to healthcare, medication management, nursing services, physician services, access to specialty care, mental health services, pharmacy services, dental services, environmental services, infection control procedures, healthcare records, sick call services, intake screening and evaluations, chronic disease services, infirmary care, diagnostic services, discharge planning, and adverse patient occurrences including all deaths. The quality management program shall include reviews of all aspects of healthcare provision at the Jail, and shall identify any deficiencies in services to inmates as well as any staff training needs and/or deficiencies. Corrective plans to address all deficiencies and recommended improvements shall be prepared, and the quality management program shall include ongoing assessment of the effectiveness of corrective plans and actions.
B. A multi-disciplinary Quality Management Committee shall meet monthly, and shall
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perform at least quarterly reviews of all aspects of healthcare. The Committee shall involve the participation of qualified healthcare professionals with appropriate specialities and representatives from all medical departments at the Jail.
C. For the first six months of this Agreement, the Monitor shall be provided with copies of all findings, conclusions, corrective plans, and any other reports of the Quality Management Committee and the outcome of corrective plans and shall review this information to determine whether the Quality Management program is working effectively. The Monitor shall also be provided with copies of all findings, conclusions, and any other reports resulting from the peer review process, as well as any corrective plans or actions that occur as a result of the peer review process. After the first six months of this Agreement, the defendants shall provide the Monitor with copies of quality management documents related to specific problems the Monitor has identified during his assessment. If at any time during this Agreement the contractor for medical care at the Jail changes, the Monitor shall be provided with copies of quality management documents for the first six months of the new contract.
D. The Sheriff shall be informed about problems with the healthcare delivery system as well as on-going efforts to resolve these problems. VIII. Appointment of Correctional Healthcare Monitor
A. The parties agree that the Court shall appoint a Correctional Healthcare Monitor to monitor defendants’ compliance with this Settlement Agreement, to report to the Court with regard to defendants’ progress in bringing the medical care at the Jail to the constitutionally acceptable level outlined in this Agreement, and to consult and work with defendants as necessary to bring the medical care at the Jail into compliance with this Agreement. Robert B. Greifinger,
20

M.D., shall serve as the Monitor (curriculum vitae attached). Dr. Greifinger is an experienced correctional healthcare professional with extensive expertise in the areas of HIV and AIDS, infection control, medical peer review and quality management, and policy and protocol development. He has served both as the chief medical authority for both Rikers Island Health Services (New York City Jails) and the New York State Department of Correctional Services. He has also served as consultant to many prison and jail systems and to the parties and judges in correctional healthcare litigation.
B. The Monitor shall be paid by the Fulton County defendants at an hourly rate of $250 per hour, plus $125 per hour for travel time (not to exceed five hours each way), and reasonable expenses. For the preparation of his initial report and for each subsequent quarterly report, the Monitor may spend up to 45 working hours. For each report, the 45 hours shall include at least one onsite inspection, unannounced to the defendants. If the Monitor identifies the need for additional specialists or experts to assist the Monitor in discharging his duties under the Agreement, he shall notify the parties of the need and the reasons. If the parties are unable to reach an agreement concerning the Monitor’s request for additional assistance, the request shall be submitted to the Court.
C. The Monitor shall have access to medical, dental, and mental health records of the class members, to defendants and any members of their staffs, to class members themselves, to attorneys for any party, and to any other information (including minutes, reports, and other documents), as he deems necessary to determine compliance with this Settlement Agreement and to accomplish his obligations pursuant to the Agreement. The Monitor’s access to information shall not be unreasonably withheld.
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D. Within thirty days of the Court’s approval of this Settlement Agreement, the Monitor shall conduct an initial assessment of the medical services provided to HIV-positive inmates at the Jail and shall develop recommendations addressing any deficiencies that prevent compliance with this order. The assessment and recommendations shall include a review of any changes and improvements made by defendants since the filing of this lawsuit, the reasons for those changes and improvements, and the success of those changes and improvements. The scope of the assessment and recommendations shall include any and all systems and aspects of care that the Monitor deems relevant to the provision of constitutionally adequate medical care to the plaintiff class. The assessment and recommendations shall address all aspects of this Settlement Agreement, including but not limited to review of the following systems:
i. Intake screening and management ii. Access to routine and acute medical care, including hospitalization, surgical care,
consultation, and referrals iii. Medication administration, management, and tracking, including pharmacy services iv. Emergency care and services v. Medical observation unit equipment and procedures vi. Follow-up of diagnostic testing and referral providers’ treatment decisions vii. Complaint tracking and resolution viii. Health record maintenance, documentation, and transfer ix. Communicable disease control x. Credentialing xi. Staffing, including job descriptions and scopes of practice
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xii. Quality Management, including performance measurement, practice guidelines, and peer review xiii. Discharge planning xiv. Environmental health and sanitation xv. Coordination between medical, mental health, dental, and security staff xvi. Initial and ongoing training of medical and correctional staff Following the initial assessment, the Monitor shall review any of these systems he deems necessary. E. In conducting his assessment and preparing his recommendations, the Monitor shall have access to and work with medical and correctional personnel at Fulton County Jail and in the Fulton County Sheriff’s office as he deems appropriate. Defendants shall have thirty days to remedy deficiencies identified and shall report to the Court, the Monitor, and plaintiffs’ counsel on these improvements. The Monitor shall determine the types of information that defendants must include in their reports. If at any time following the defendants’ initial report on their compliance plaintiffs believe that defendants are not in compliance with any term of this Agreement, plaintiffs shall bring their concerns to the attention of the defendants and make reasonable attempts to resolve these concerns informally. Plaintiffs shall seek the Court’s assistance in obtaining compliance only if the parties are unable to resolve their differences informally. F. Following the initial assessment, the Monitor shall report on defendants’ compliance with this Settlement Agreement. These reports shall take place at least quarterly, unless the Court directs that they shall take place more frequently. The Monitor shall provide
23

copies of these reports to the District Court, plaintiffs’ counsel, and counsel for the defendants. All parties shall have the opportunity to respond to the reports submitted by the Monitor.
G. In addition to the work of the Monitor, plaintiffs’ counsel shall continue to have reasonable access to the plaintiffs; to plaintiffs’ Jail and medical records (subject to relevant protective orders); and to defendants, their agents and employees in order to monitor defendants’ compliance with this Settlement Agreement. Before speaking with any named defendant about matters related to this Agreement, plaintiffs’ counsel shall advise defendants’ counsel of their intent to do so and allow counsel a reasonable opportunity to respond and/or be present. IX. Implementation
A. Defendants shall immediately explain the terms of this Settlement Agreement to all of their agents, servants, representatives, and employees in any way connected with the subject matter of this suit, in order to ensure their understanding of this Settlement Agreement and the necessity for strict compliance with its terms. Defendants shall require strict compliance with this Settlement Agreement by all such persons and their successors.
B. The Fulton County defendants shall immediately provide notice of the material terms of this Settlement Agreement to all current and future class members by providing all HIVpositive inmates who enter the Jail with an HIV/AIDS information pamphlet. This pamphlet will include the material terms of this Settlement Agreement, as well as notification of the Settlement Agreement, and contact information for the class counsel. Prior to its distribution, this pamphlet shall be approved by plaintiffs’ counsel. Any inmate later identified as HIV-positive will also be provided this pamphlet. Four (4) copies of this Settlement Agreement shall be maintained and available for use in the Jail’s law library.
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C. Defendants shall not retaliate against inmates for their participation in this lawsuit or membership in the class.
D. Fulton County shall be responsible for monitoring and enforcing compliance with all provisions of this Settlement Agreement. Fulton County shall also be responsible for quarterly compliance reviews of any correctional healthcare contract with the County. This shall include a review of the contractor’s compliance with any required reporting. X. Conclusion
A. If defendants fail to comply with the terms and conditions of this Settlement Agreement, plaintiffs’ counsel may apply to the Court for a finding of contempt or other appropriate relief. Prior to approaching the Court for such relief, plaintiffs’ counsel will bring any deficiencies to the attention of the defendants and the Monitor and will make reasonable attempts to resolve the issues informally.
B. The parties agree and stipulate, and the Court hereby finds, that the prospective relief set forth in this Settlement Agreement is narrowly drawn, extends no further than necessary to correct the violations of plaintiffs’ federal rights set forth in their First Amended Complaint and is the least intrusive means necessary to correct these violations. The parties agree and stipulate, and the Court hereby finds, that this Settlement Agreement will not have an adverse impact on public safety or the operation of a criminal justice system. Accordingly, the parties agree and stipulate, and the Court hereby finds, that this Settlement Agreement complies in all respects with the provisions of 18 U.S.C. § 3626(a). This Settlement Agreement is not intended to have any preclusive effect except between the parties in this action. Should the issue of the preclusive effect of this Settlement Agreement be raised in any proceedings other than this action, the parties
25

agree to certify that this Settlement Agreement was intended to have no such preclusive effect.
This Settlement Agreement does not resolve, adjudicate, or bar the damages claims of any former,
present, or future class members.
C. Subsequent to an agreement or order for attorney’s fees and costs in this action to
date, plaintiffs will only seek fees and costs that are directly and reasonably incurred in enforcing
the relief ordered for the violation of plaintiffs’ rights.
D. Any party may seek modification of any part of this Final Settlement Agreement
for good cause shown. Defendants shall continue to implement in a timely manner all parts of this
Agreement pending decision of the Court on any motion for modification.
SO ORDERED this ___________ day of ________________, 2000.
______________________________________ Hon. Marvin H. Shoob
United States District Court Northern District of Georgia
Submitted, approved, and consented to by:
________________________________ Tamara H. Serwer, Georgia Bar No. 617053
________________________________ Katharine A. Huffman, Georgia Bar No. 375320 Stephen B. Bright, Georgia Bar No. 082075 Robert E. Toone, Georgia Bar No. 714670 Southern Center for Human Rights 83 Poplar Street, N.W. Atlanta, Georgia 30303-2122 Telephone: (404) 688-1202 _______________________________ Chip Rowan, Georgia Bar No. 616577
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Rowan & Associates 235 Peachtree Street, Suite 1725 Atlanta, Georgia 30303 Telephone: (404) 586-2350
Attorneys for Plaintiffs
_______________________________ Jacquelyn Barrett, Fulton County Sheriff Fulton County Sheriff’s Department 185 Central Avenue, S.W. Atlanta, Georgia 30303
_________________________________ Mike Kenn, Chairman Fulton County Board of Commissioners 141 Pryor Street, S.W. Atlanta, Georgia 30303-3444
________________________________ Overtis Hicks Brantley, Esq. Office of the County Attorney Suite 4083 141 Pryor Street, S.W. Atlanta, Georgia 30303-3444 Telephone: (404) 730-7750
Attorney for Fulton County
________________________________ William T. Mitchell, Esq. Drew, Eckl & Farnham P.O. Box 7600 Atlanta, Georgia 30357-0600 Telephone: (404) 885-1400
Attorney for Correctional Healthcare Solutions, Inc.
27

 
 Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 1 of 23
4months,CLOSED
U.S. District Court Northern District of Georgia (Atlanta) CIVIL DOCKET FOR CASE #: 1:99−cv−00900−MHS

Foster, et al v. Fulton County, Ga, et al Assigned to: Judge Marvin H. Shoob Demand: $0 Cause: 42:1983 Prisoner Civil Rights Plaintiff Ruben Foster
Plaintiff

Date Filed: 04/08/1999 Date Terminated: 01/24/2000 Jury Demand: None Nature of Suit: 555 Prison Condition Jurisdiction: Federal Question
represented by Alexander Taylor Rundlet Southern Center for Human Rights 83 Poplar Street, N.W. Atlanta, GA 30303−2122 404−688−1202 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Katharine Aiken Huffman Southern Center for Human Rights 83 Poplar Street, N.W. Atlanta, GA 30303−2122 404−688−1202 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Milton Dale Rowan Chip Rowan &Associates P.O. Box 2442 Gadsden, AL 35903−0442 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Robert Earl Toone , Jr. Southern Center for Human Rights 83 Poplar Street, N.W. Atlanta, GA 30303−2122 404−688−1202 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Stephen Brooks Bright Southern Center for Human Rights 83 Poplar Street, N.W. Atlanta, GA 30303−2122 404−688−1202 Email: sbright@schr.org LEAD ATTORNEY ATTORNEY TO BE NOTICED
Tamara Serwer Caldas Kilpatrick Townsend &Stockton, LLP − ATL 1100 Peachtree Street N.E. Suite 2800 Atlanta, GA 30309 404−815−6376 Fax: 404−541−3498 LEAD ATTORNEY ATTORNEY TO BE NOTICED

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 2 of 23

George West

represented by Alexander Taylor Rundlet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Katharine Aiken Huffman (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Milton Dale Rowan (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Robert Earl Toone , Jr. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Stephen Brooks Bright (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Tamara Serwer Caldas (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Plaintiff Anthony Williams

represented by Alexander Taylor Rundlet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Katharine Aiken Huffman (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Milton Dale Rowan (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Robert Earl Toone , Jr. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Stephen Brooks Bright (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Tamara Serwer Caldas (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Plaintiff Tony Martin

represented by Alexander Taylor Rundlet (See above for address)

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 3 of 23

LEAD ATTORNEY ATTORNEY TO BE NOTICED

Katharine Aiken Huffman (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Milton Dale Rowan (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Robert Earl Toone , Jr. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Stephen Brooks Bright (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Tamara Serwer Caldas (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Plaintiff Lucas James

represented by Alexander Taylor Rundlet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Katharine Aiken Huffman (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Milton Dale Rowan (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Robert Earl Toone , Jr. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Stephen Brooks Bright (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Tamara Serwer Caldas (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Plaintiff
Grady McGlothlin individually and on behalf of all present and future HIV−positive inmates in the Fulton County Jail in

represented by Alexander Taylor Rundlet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 4 of 23

Atlanta, Georgia

Katharine Aiken Huffman (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Milton Dale Rowan (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Robert Earl Toone , Jr. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Stephen Brooks Bright (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Tamara Serwer Caldas (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Plaintiff Richard Malicoate

represented by Alexander Taylor Rundlet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Robert Earl Toone , Jr. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Plaintiff Willie Hightower

represented by Alexander Taylor Rundlet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Robert Earl Toone , Jr. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

V. Defendant Fulton County, Georgia

represented by Charles George Hicks Office of DeKalb County Attorney DeKalb County Administration Building 1300 Commerce Drive Fifth Floor Decatur, GA 30030 404−371−3011 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Overtis Hicks Brantley

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 5 of 23

Office of Fulton County Attorney Fulton County Government Center 141 Pryor Street, S.W. Suite 4038 Atlanta, GA 30303 404−730−7750 Email: ov.brantley@co.fulton.ga.us LEAD ATTORNEY ATTORNEY TO BE NOTICED

Paula Morgan Nash Metropolitan Atlanta Rapid Transit Authority Legal Services Division 2424 Piedmont Road, N.E. Atlanta, GA 30324−3330 404−848−5220 Email: pmnash@itsmarta.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Rolesia Butler Dancy U.S. Department of Labor−ATL Office of the Solicitor 61 Forsyth Street, SW Room 7T10 Atlanta, GA 30303 404−302−5457 Fax: 404−302−5438 Email: dancy.rolesia@dol.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED

Steven E. Rosenberg Office of Fulton County Attorney Fulton County Government Center 141 Pryor Street, S.W. Suite 4038 Atlanta, GA 30303 404−730−7750 Email: STEVEN.ROSENBERG@CO.FULTON.GA.US LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Fulton County Board of Commissioners

represented by Charles George Hicks (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Overtis Hicks Brantley (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Paula Morgan Nash (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Rolesia Butler Dancy (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 6 of 23

Steven E. Rosenberg (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Mike Kenn Chairperson

represented by Charles George Hicks (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Overtis Hicks Brantley (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Paula Morgan Nash (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Rolesia Butler Dancy (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Steven E. Rosenberg (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Karen Webster

represented by Charles George Hicks (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Overtis Hicks Brantley (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Paula Morgan Nash (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Rolesia Butler Dancy (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Steven E. Rosenberg (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Tom Lowe

represented by Charles George Hicks (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 7 of 23

Overtis Hicks Brantley (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Paula Morgan Nash (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Rolesia Butler Dancy (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Steven E. Rosenberg (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Bob Fulton

represented by Charles George Hicks (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Overtis Hicks Brantley (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Paula Morgan Nash (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Rolesia Butler Dancy (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Steven E. Rosenberg (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Emma I. Darnell

represented by Charles George Hicks (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Overtis Hicks Brantley (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Paula Morgan Nash (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Rolesia Butler Dancy (See above for address)

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 8 of 23

LEAD ATTORNEY ATTORNEY TO BE NOTICED

Steven E. Rosenberg (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Nancy Boxill

represented by Charles George Hicks (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Overtis Hicks Brantley (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Paula Morgan Nash (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Rolesia Butler Dancy (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Steven E. Rosenberg (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Jacquelyn Barrett Fulton County Sheriff

represented by Charles George Hicks (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Overtis Hicks Brantley (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Paula Morgan Nash (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Rolesia Butler Dancy (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Steven E. Rosenberg (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
L. L. Briggs Chief Jailer of Fulton County Jail

represented by Charles George Hicks (See above for address)

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 9 of 23

LEAD ATTORNEY ATTORNEY TO BE NOTICED

Overtis Hicks Brantley (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Paula Morgan Nash (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Rolesia Butler Dancy (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Steven E. Rosenberg (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
George Herron Medical Services Director of Fulton County Sheriff's Department

represented by Charles George Hicks (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Overtis Hicks Brantley (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Paula Morgan Nash (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Rolesia Butler Dancy (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Steven E. Rosenberg (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Correctional Health Care Solutions, Inc.

represented by Deana Simon Johnson MHM Services, Inc. Suite 350 1447 Peachtree Street Atlanta, GA 30309 404−876−9808 Fax: 404−876−9817 Email: djohnson@mhm−services.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

William T. Mitchell Cruser &Mitchell, LLP Suite 2000, Meridian II

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 10 of 23

275 Scientific Drive Norcross, GA 30092 404−881−2622 Fax: 404−881−2630 Email: bmitchell@cmlawfirm.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Kevin Ramos Correctional Healthcare Solutions, Inc., Health Services Administrator

represented by Deana Simon Johnson (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

William T. Mitchell (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Harold Minerve Correctional Healthcare Solutions, Inc., Medical Director

represented by Deana Simon Johnson (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

William T. Mitchell (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Eno Ikoku Correctional Healthcare Solutions, Inc., physician

represented by Deana Simon Johnson (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

William T. Mitchell (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Stacey Steed

Defendant Robert Brown

Defendant W. Clyde Shepherd

Defendant Adam Smith

Defendant C. Christopher Hagy

Defendant Otis Smith

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 11 of 23

Defendant Sarah Sloan

Defendant Charles Glenn

Defendant Marla Coleman

Defendant John Malcolm

Defendant
Board of Trustees of the Fulton−Dekalb Hospital Authority

Defendant
Edward J. Renford Chief Executive Officer of Grady Health Systems, in their official capacities

Defendant
Michael Hightower member of the Fulton County Commission

represented by Paula Morgan Nash (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Steven E. Rosenberg (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Movant Jerry Davis

represented by Jerry Davis EF−442047 Smith State Prison P.O. Box 726 Glennville, GA 30427−0726 PRO SE

Movant Mahboob Pasha

represented by Brenda Loyce Gardner The Gardner Law Firm The Pinnacle Building 5th Floor 3455 Peachtree Road, NE Atlanta, GA 30326 404−995−7030 Fax: 404−995−6868 Email: Brenda@brendagardner.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Thomas McKee West Office of Thomas M. West P.O. Box 235 Bethlehem, GA 30620 404−414−0344

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 12 of 23
Fax: 404−755−2327 Email: Tom_McWest@hotmail.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Date Filed 04/08/1999 04/08/1999 04/08/1999 04/08/1999 04/08/1999 04/13/1999
04/13/1999
04/13/1999 04/13/1999 04/15/1999 04/15/1999 04/15/1999 04/16/1999
04/16/1999
04/16/1999

# Docket Text
1 Class Action COMPLAINT filed and summons issued. Consent form to proceed before U.S. magistrate and pretrial instructions given to attorney FILING FEE $ 150.00 RECEIPT # 437510 (as) (Entered: 04/14/1999)
2 ANSWERS TO MANDATORY DISCLOSURES by plaintiffs (as) (Entered: 04/14/1999)
3 MOTION by plaintiffs for class certification with brief in support. (as) (Entered: 04/14/1999)
4 MOTION by plaintiff for preliminary injunction with brief in support. (as) (Entered: 04/14/1999)
4 Application for admission of Tamara H. Sewer pro hac vice for plas. (to: MHS) (er) (Entered: 04/21/1999)
5 ORDER by Judge Marvin H. Shoob granting plas' second application for writ of habeas corpus add testificandum and DIRECTS the clerk to issue a writ directed to the Fulton County Sheriff for production of the following inmates of the Fulton County Jail to testify at the hearing to be held on 4/16/99 at 9:30 a.m. (cc) (er) (Entered: 04/16/1999)
WRITS IF HABEAS CORPUS AD TESTIFICANDUM ISSUED for the following inmates of the Fulton County Jail: Ruben Foster, George Leland, Anthony William, Tony Martin, Lucas James, Grady McGlothlin, Richard Malicote, and Willie Hightower to testify at the hearing to be held 4/16/99 before Judge Marvin H. Shoob. (copies to USM) (er) Modified on 08/23/1999 (Entered: 04/16/1999)
6 MOTION by plas for issuance of writs of habeas corpus ad testificandum with brief in support. (er) (Entered: 04/21/1999)
7 SECOND MOTION by plas for issuance of writs of habeas corpus and testificandum with brief in support. (er) (Entered: 04/21/1999)
8 Attorney appearance for plas Ruben Foster, George West, Anthony Williams, Tony Martin, Lucas James, Grady McGlothlin, Richard Malicoate, Willie Hightower by ROBERT EARL TOONE. (er) (Entered: 04/21/1999)
9 FIRST AMENDED COMPLAINT by plaintiffs. (er) (Entered: 04/21/1999)
10 AMENDED ANSWERS TO MANDATORY DISCLOSURES by plaintiffs. (er) (Entered: 04/21/1999)
11 Motion HEARING held before Judge Marvin H. Shoob [4−1] on plas' motion for prel. inj. Plas announced that a settlement has been reached for the prel. inj. Court scheduled a hearing on the class certification issue for Friday 4/23/99 at 10:00 a.m. and scheduled the trial for Monday, 7/26/99 at 9:30 a.m. (er) Modified on 04/22/1999 (Entered: 04/22/1999)
12 Stipulation and agreement of plas and dfts The Fulton−Dekalb Hospital Authority, Edward J. Renford, Stacey Steed, Robert Brown, W. Clyde Shepherd, Adam Smith, C. Christopher Hagy, Otis Smith, Sarah Sloan, Charles Glenn, Marla Coleman and John Malcolm. (to: MHS) (er) (Entered: 04/22/1999)
13 ORDER PURSUANT TO RULE 41 by Judge Marvin H. Shoob dismissing without prejudice based upon the stipulation and agreement of the parties; as to dfts The Fulton−Dekalb Hospital Authority, Edward J. Renford, Stacey Steed, Robert Brown, W. Clyde Shepherd, Adam Smith, C. Christopher Hagy, Otis Smith, Sarah Sloan, Charles Glenn, Marla Coleman, John Malcolm (cc) (er) (Entered: 04/22/1999)

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 13 of 23

04/16/1999 04/16/1999 04/22/1999 04/28/1999 04/30/1999
05/03/1999 05/03/1999
05/04/1999 05/11/1999 05/11/1999 05/12/1999 05/12/1999 05/14/1999 05/18/1999 05/19/1999 05/24/1999 06/02/1999
06/03/1999 06/04/1999 06/08/1999

14 CONSENT ORDER by Judge Marvin H. Shoob; submitted and entered into as a settlement of plas' motion for prel. inj. relief, filed on 4/8/99. (see order for more details) (cc) (er) (Entered: 04/22/1999)
ENDORSED ORDER by Judge Marvin H. Shoob GRANTING [4−1] appl. of Tamara H. Serwer to appear pro hac vice as counsel for the plas. (cc) (er) (Entered: 04/22/1999)
15 CONSENT ORDER by Judge Marvin H. Shoob GRANTING [3−1] plas' class certification (cc) (er) (Entered: 04/23/1999)
16 MOTION by plas to add party dft (Michael Hightower) . (er) (Entered: 04/30/1999)
17 ANSWER by Fulton County, Ga, Fulton County Board, Mike Kenn, Karen Webster, Tom Lowe, Bob Fulton, Emma I. Darnell, Nancy Boxill, Jacquelyn . Barrett, L. L. Briggs, George Herron to complaint [1−1] Discovery ends 9/27/99 (er) (Entered: 05/06/1999)
18 ANSWER by Correctional Health, Kevin Ramos, Harold Minerve, Eno Ikoku to complaint [1−1], [9−1] (er) (Entered: 05/06/1999)
19 CONSENT ORDER by Judge Marvin H. Shoob, extending time thru 5/3/99 for dfts Eno Ikoku, Harold Minerve, Kevin Ramos, and Correctional Health Services to file their answer to plas' [1−1] complaint. Answer due 5/3/99 for Eno Ikoku, Harold Minerve, Kevin Ramos, Correctional Health (cc) (er) (Entered: 05/08/1999)
Steno notes of proceedings held 4/16/99 before Judge Marvin H. Shoob, by Court Reporter Andy Ashley. (pa) (Entered: 05/04/1999)
20 Attorney appearance for plaintiffs by Milton Dale Rowan (er) (Entered: 05/18/1999)
21 MOTION by plas for appointment of Dr. Harold P. Katner as outside HIV Specialist with brief in support. (er) (Entered: 05/18/1999)
22 MOTION by dfts to appoint Dr. James P. Steinberg as outside HIV Expert with brief in support. (er) (Entered: 05/18/1999)
23 ANSWERS TO MANDATORY DISCLOSURES by dfts Correctional Health, Kevin Ramos, Harold Minerve, and Eno Ikoku. (er) (Entered: 05/20/1999)
24 RESPONSE by plas to [22−1] dfts' motion to appoint Dr. James P. Steinberg as outside HIV Expert. (er) (Entered: 05/20/1999)
26 REPLY BRIEF by dfts to [24−1] plas' opposition to appointment of Dr. James P. Steinberg as outside JIV Expert. (er) (Entered: 05/27/1999)
SUBMITTED to Judge Marvin H. Shoob on [16−1] plas' motion to add party dft (Michael Hightower) (er) (Entered: 05/19/1999)
25 ORDER by Judge Marvin H. Shoob GRANTING [16−1] motion to add party dft (Michael Hightower), (cc) (jaw) (Entered: 05/25/1999)
27 ORDER by Judge Marvin H. Shoob GRANTING [22−1] dfts' motion to appoint Dr. James P. Steinberg as outside HIV Expert Specialist and DENYING [21−1] plas' motion for appointment of Dr. Harold P. Katner as outside HIV Specialist. Within (10) days of the date of entry of this order, plas' counsel shall arrange a meeting with defense counsel and Dr. Steinberg to discuss and to reach agreement on how Dr. Steinberg will carry out his duties as Outside HIV Specialist. (cc) (er) (Entered: 06/04/1999)
28 RESPONSES TO MANDATORY DISCLOSURES by dfts Fulton County, Ga; Fulton County dfts' County Board of Commissioners (er) (Entered: 06/07/1999)
29 Certificate of interested persons. (to judge) (bek) (Entered: 06/14/1999)
30 ANSWER to amended complaint [9−1] by Michael Hightower, and joined by Fulton County, Ga, Fulton County Board, Mike Kenn, Karen Webster, Tom Lowe, Bob Fulton, Emma I. Darnell, Nancy Boxill, Jacquelyn . Barrett, L. L. Briggs,

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 14 of 23

07/06/1999 07/14/1999
07/19/1999 07/22/1999 07/23/1999 08/02/1999 08/02/1999 08/02/1999 08/09/1999 08/27/1999 08/30/1999
08/30/1999 09/07/1999
09/16/1999
09/17/1999 09/17/1999 09/17/1999
09/20/1999 09/29/1999
10/01/1999

George Herron (bek) (Entered: 06/14/1999)
31 MOTION by plas to compel disc. of aids confidential information with brief in support. (er) (Entered: 07/08/1999)
32 RESPONSE by dfts Fulton County, Ga, Fulton County Board, Jacquelyn Barrett, L. L. Briggs, and George Herron to [31−1] plas' motion to compel disc. of aids confidential information. (er) (Entered: 07/16/1999)
33 ORDER by Judge Marvin H. Shoob GRANTING [31−1] plas' motion to compel disc. of aids confidential information (cc) (er) (Entered: 07/20/1999)
34 CONSENT ORDER by Judge Marvin H. Shoob, extending time thru 9/27/99 disc. period Discovery ends 9/27/99 (cc) (er) (Entered: 07/23/1999)
35 SECOND AMENDED ANSWERS TO MANDATORY DISCLOSURES by plaintiffs (as) Modified on 08/05/1999 (Entered: 07/28/1999)
36 THIRD AMENDED ANSWERS TO MANDATORY DISCLOSURES by plaintiffs. (as) Modified on 08/05/1999 (Entered: 08/05/1999)
37 RESPONSE by plas to dfts' objections to plas' request for entry upon land for inspection and other purposes. (er) (Entered: 08/06/1999)
38 CONSENT by parties to entry upon land order w/prop/order. (to: MHS) (er) (Entered: 08/06/1999)
39 ORDER by Judge Marvin H. Shoob approving [38−1] consent by parties to entry upon land order. (cc) (er) (Entered: 08/11/1999)
40 FOURTH AMENDED to [36−1] plas' mandatory interrogatories. (er) (Entered: 08/31/1999)
41 ORDER by Judge Marvin H. Shoob directing the Clerk to file the report submitted pursuant to the terms of the consent order filed 4/16/99 by James P. Steinberg, M.D. &DIRECTING the parties to file written responses to the report w/in (10) days of the date of entry of this order. [41−1] order to be submitted on 9/14/99 (cc) (er) (Entered: 08/31/1999)
42 REPORT of Outside HIV Specialist Dr. James P. Steinberg, submitted pursuant to the terms of the consent order filed 4/16/99. (er) (Entered: 08/31/1999)
43 Attorney appearance for dfts Fulton County, Ga, Fulton County Board, Mike Kenn, Karen Webster, Tom Lowe, Bob Fulton, Emma I. Darnell, Nancy Boxill, Jacquelyn Barrett, L. L. George Herron by Rolesia Butler Dancy (er) (Entered: 09/09/1999)
44 CONSENT ORDER by Judge Marvin H. Shoob, allowing plas and Fulton County dfts thru 9/17/99 to file responses to [42−1] Report of outside HIV Specialist. (cc) (er) (Entered: 09/17/1999)
45 FIFTH AMENDED RESPONSES TO MANDATORY DISCLOSURES by plas. (er) (Entered: 09/22/1999)
46 RESPONSE by plas to [42−1] Monitor's Report. (er) (Entered: 09/22/1999)
47 RESPONSE by dfts Fulton County, Ga, Fulton County Board, Jacquelyn . Barrett, L. L. Briggs, and George Herron to [42−1] Dr. Steinberg's Report. (er) (Entered: 09/22/1999)
48 MOTION by plas to compel disc. with brief in support. (er) (Entered: 09/22/1999)
49 RESPONSE by dfts Correctional Health, Kevin Ramos, Harold Minerve, Eno Ikoku in opposition to [48−1] plas' motion to compel disc. (er) (Entered: 10/01/1999)
50 ORDER by Judge Marvin H. Shoob GRANTING [48−1] plas' motion to compel disc. (cc) (er) (Entered: 10/04/1999)

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 15 of 23

10/06/1999
10/26/1999 10/28/1999 11/01/1999 01/10/2000 01/11/2000 01/24/2000 01/24/2000 01/24/2000 02/09/2000 02/10/2000 03/03/2000
03/03/2000 03/07/2000 03/10/2000 03/13/2000
03/13/2000 03/17/2000

51 PROTECTIVE ORDER ENTERED and signed by Judge Marvin H. Shoob. (the PROTO protects materials produced pursuant to order signed by Judge MHS 10/1/99, granting plas' motion to compel disc.) (cc) (er) Modified on 10/07/1999 (Entered: 10/07/1999)
52 PETITION for leave of absence of PAULA MORGAN NASH for the period of 12/1/99 thru 3/24/00 (to: MHS) (er) Modified on 10/29/1999 (Entered: 10/29/1999)
53 RESPONSE by dft Correctional Healthcare Solutions to [42−1] Report. (er) Modified on 10/29/1999 (Entered: 10/29/1999)
54 ORDER APPROVING [52−1] leave of absence of PAULA MORGAN NASH for the period of 12/1/99 thru 3/24/00; approved by ct/clerk. (cc) (er) (Entered: 11/03/1999)
55 Joint MOTION to provide notice of class action settlement with proposed order and proposed notice (to MHS) (bsm) (Entered: 01/12/2000)
56 ORDER by Judge Marvin H. Shoob GRANTING [55−1] jt motion to provide notice of class action settlement hearing on 1/24/00; w/NTC of Class Action Settlement (cc) (er) (Entered: 01/14/2000)
57 HEARING HELD before Judge Marvin Shoob; three (3) letters from members of the class filed. The court found the settlement agreement acceptable &signed the final order. (er) (Entered: 01/25/2000)
58 FINAL SETTLEMENT AGREEMENT signed by Judge Marvin H. Shoob. (cc) (er) (Entered: 01/25/2000)
Case terminated. (er) (Entered: 01/25/2000)
Steno notes of proceedings held 01/24/00 before Judge Marvin H. Shoob , by Court Reporter Martha Frutchey. (crc) (Entered: 02/09/2000)
59 MOTION by plaintiff's counsel to withdraw by Robert Earl Toone Jr. as attorney for Ruben Foster, George West, Anthony Williams, Tony Martin, Lucas James, Grady McGlothlin with proposed order. (bek) (Entered: 02/16/2000)
60 ORDER by Judge Marvin H. Shoob, directing the Clerk to file Mr. Jone's pleading entitled "Amended Non−Compliance Civil Action of Ruben Foster, et al. vs. Fulton County, Ga, et al., No. 1:99−cv−900−MHS Seeking Monetary Relief and Injunctive Relief" and to mail copies to all counsel, as well as to the Correctional Healthcare Monitor, Dr. Robert B. Greifinger. (cc/pla, cc/Mr. Jones, &cc) (er) Modified on 03/06/2000 (Entered: 03/03/2000)
61 AMENDED Non−compliance Civil Action of Ruben Foster et., vs. Fulton County, Ga, et al., No. 1:99−cv−900−MHS Seeking Monetary Relief and Injunctive Relief by Jeffrie A. Jones. (er) (Entered: 03/03/2000)
62 REPORT ON MEDICAL CARE for HIV−Infected Inmates at Fulton County Jail by Correctional Health Care Monitor. (er) (Entered: 03/08/2000)
SUBMITTED to Judge Marvin H. Shoob on [59−1] motion to withdraw by Robert Earl Toone Jr. as attorney for Ruben Foster, George West, Anthony Williams, Tony Martin, Lucas James, Grady McGlothlin. (er) (Entered: 03/10/2000)
63 ORDER by Judge Marvin H. Shoob, directing plas and dfts to file responses to Dr. Greifinger's report no later than 3/24/00. Further DIRECTS defense counsel to provide copies of this order and Dr. Greifinger's report to each of the individidually named dfts. [63−1] order to be submitted on 3/27/00 (cc) (er) (Entered: 03/14/2000)
Copy of [60−1] order mailed to pla Jeffrie A. Jones, ret'd marked "Inmate released from facility" (er) (Entered: 03/16/2000)
64 MOTION by dfts Correctional Health, Kevin Ramos, Harold Minerve, and Eno Ikoku to withdraw as parties to this action withk affidavit in support. (er) (Entered: 03/22/2000)

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 16 of 23

03/21/2000 03/23/2000 03/24/2000 03/24/2000 03/24/2000 04/03/2000 04/06/2000 04/11/2000
04/17/2000 04/19/2000 04/24/2000 05/04/2000
05/04/2000 05/08/2000 05/16/2000 05/25/2000

65 MOTION by plaintiffs to withdraw by Katharine Aiken Huffman as attorney for plaintiffs with proposed order. (ck) (Entered: 03/27/2000)
66 AMENDMENT TO MOTION by dfts Correctional Health, Kevin Ramos, Harold Minerve, and Eno Ikoku amending [64−1] motion to withdraw as parties to this action. (er) (Entered: 03/29/2000)
67 RESPONSE by plas to monitor's first report of compliance with final settlement agreement. (er) (Entered: 03/29/2000)
68 RESPONSE by "Fulton County Dfts" to Monitor's Report. (er) (Entered: 03/29/2000)
69 RESPONSE by dft Correctional Healthcare Solutions to Dr. Greifinger's initial report. (er) (Entered: 03/29/2000)
70 An interim report of the Correctional Healthcare Monitor. (er) (Entered: 04/04/2000)
SUBMITTED to Judge Marvin H. Shoob on [64−1] dfts Correctional Health, Kevin Ramos, Harold Minerve, and Eno Ikoku's motion to withdraw as parties to this action, [66−1] amended motion [64−1] to withdraw as parties to this action. *** FILE IN CHAMBERS *** (er) (Entered: 04/06/2000)
71 ORDER by Judge Marvin H. Shoob (see order for more details) &directing counsel for the County dfts to provide copies of this order and Dr. Greifinger's interim report, as well as copies of all future orders and reports, to each of the individual County dfts. (cc &c/Mr. Greifinger) (er) Modified on 04/12/2000 (Entered: 04/12/2000)
SUBMITTED to Judge Marvin H. Shoob on [65−1] motion to withdraw by Katharine Aiken Huffman as attorney for plaintiffs. *** FILE IN CHAMBERS *** (er) (Entered: 04/17/2000)
72 Notice of change of address by counsel of record for the CHS dfts. (cc to admin for update) (er) Modified on 05/08/2000 (Entered: 04/26/2000)
73 STATUS REPORT on jail overcrowding by dfts Fulton County, Ga; Fulton County Board of Commissioners, Mike Kenn, Karen Webster, Tom Lowe, Bob Fulton, Emma I. Darnell, Michael Hightower, Nancy Boxill; Jacquelyn Barrett; L.L. Briggs; and George Herron. (er) (Entered: 04/27/2000)
74 ORDER by Judge Marvin H. Shoob GRANTING [64−1] [66−1] motion to withdraw Kevin Ramos, Harold Minerve, and Eno Ikoku as parties to this action and dismisses them as dfts in this action by Correctional Healthcare Solutions; GRANTING [59−1] [65−1] the motions to withdraw filed by plas' counsel, Robert E. Toone and Katherine A. Huffman; GRANTING the request by the Correctional Healthcare Monitor, Dr. Greifinger, for an extension of time until 6/1/00, to file his next quarterly report; &ORDER dfts to submit w/in (30) days of the date of entry of this order a detailed plan to reduce overcrowding, including a specific timetable for reduction of the jail's population to at or below its rated physical capacity. [74−1] order to be submitted on 6/5/00 (cc &cc/Mr. Greifinger) (er) (Entered: 05/04/2000)
Terminated submissions. (aar) (Entered: 08/01/2001)
75 Notice of filing the "Report on Dental Care at Fulton County Jail: Initial Assessment" by Dr. Robert B. Greifinger, Correctional Health Monitor Services. (er) (Entered: 05/10/2000)
76 CONSENT ORDER by Judge Marvin H. Shoob, extending time thru 6/19/00 for dfts to respond to [74−1] order . [74−1] order to be submitted on 6/19/00 (cc) (er) (Entered: 05/17/2000)
77 ORDER by Judge Marvin H. Shoob, that in conjuction with the detailed plan to reduce overcrowding that the County is to submit to the Court by 6/19/00, ORDERS the County also to provide the information (see order for more details), as of on or about 5/31/00 [77−1] order to be submitted on 6/20/00 (cc, cc/Dr. Greifingeri, &cc/Sup/Ct−Judges) (er) Modified on 05/25/2000 (Entered:

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 17 of 23

06/02/2000 06/19/2000 06/27/2000
06/28/2000 07/05/2000 07/05/2000 07/21/2000
08/01/2000 08/16/2000 08/21/2000 08/25/2000
08/28/2000
08/28/2000 08/29/2000 09/01/2000 09/13/2000 09/14/2000
09/15/2000

05/25/2000)
78 REPORT on MEDICAL CARE FOR HIV−Infected Inmates by Correctional Health Care Monitor. (er) (Entered: 06/13/2000)
79 RESPONSE by Fulton County defts to [74−1] [75−1] orders. (er) (Entered: 06/20/2000)
80 ORDER by Judge Marvin H. Shoob, directing dft Fulton County to show cause for its failure to comply with 4/11/00 order; DIRECTING plas' counsel to submit a reply by 7/5/00, to the Fulton County dfts' response to the court's 5/4 and 5/25 orders. show cause hearing on 7/7/00 at 10:00 a.m. (cc) (er) (Entered: 06/28/2000)
81 AFFIDAVIT of Lloyd Baccus, M.D. relating to the performance of physical healthcare services under the Emergency Contract between Fulton Co. and CMA, and payment issues. (er) (Entered: 06/29/2000)
82 RESPONSE by Fulton County defts to [80−1] show cause order. (er) (Entered: 07/10/2000)
83 REPLY by plas to Fulton County dfts' response to [74−1] [77−1] court's orders. (er) (Entered: 07/10/2000)
84 ORDER by Judge Marvin H. Shoob, directing dfts to file supplemental reports every 30 days, beginning 8/1/00 and continuing until the inmate population at the Fulton County Jail is at or below capacity for three consecutive months. [84−1] order to be submitted on 8/4/00 (cc) (er) (Entered: 07/24/2000)
85 RESPONSE by Fulton County dfts to [84−1] order. (er) (Entered: 08/04/2000)
86 REPLY by plas to [85−1] defts' response to Court's 7/21/00 order. (er) (Entered: 08/18/2000)
87 ORDER by Judge Marvin H. Shoob, conference set for 8/25/00 at 2:30 (cc) (er) (Entered: 08/22/2000)
88 HEARING HELD before Judge Marvin H. Shoob pursuant to 8/21/00 order. Everyone to meet on Monday with Dr. Greiginger to try to come to an agreement on the amount of the contract. Hearing held on 8/28/00 at 4:00p.m. Parties met in chambers to announce the matter settled. (not reported) Order to be entered encompassing agreement &the terms of the Court. (er) Modified on 09/01/2000 (Entered: 08/31/2000)
89 ORDER by Judge Marvin H. Shoob directing Fulton County to pay all past due invoices from Dr. Greifinger w/in (10) days from the date of this order and to pay all future invoices promptly. (cc) (er) Modified on 09/01/2000 (Entered: 08/29/2000)
90 REPORT on Medial Care for HIV−Infected Inmates at Fulton County Jail by dft Correctional Health Care Monitor. (er) Modified on 09/01/2000 (Entered: 08/30/2000)
91 ORDER by Judge Marvin H. Shoob, directing the County to enter into a contract with CMA containing substantive terms and conditions: (see order for more details on terms and conditions) (cc) (er) Modified on 09/01/2000 (Entered: 08/30/2000)
92 Notice of filing Fulton County defts' September 1, 2000 update on Jail Population Plan. (er) (Entered: 09/06/2000)
93 REPORT on Dental Care at Fulton County Jail. (er) (Entered: 09/15/2000)
94 ORDER by Judge Marvin H. Shoob, directing defts to file w/in (30) days of the date of entry of order to file a response to the Report on Dental Care at Fulton County Jail. [94−1] order to be submitted on 10/18/00 (cc) (er) (Entered: 09/15/2000)
95 MOTION by movant Jerry Davis to consolidate this motion with 1:99−cv−2252−JEC with brief in support. (fmm) (Entered: 09/26/2000)

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 18 of 23

10/02/2000 10/10/2000
10/11/2000 10/12/2000 11/01/2000
11/13/2000 11/16/2000
11/21/2000
11/21/2000 11/21/2000 11/27/2000 12/08/2000 12/27/2000 01/02/2001 02/01/2001 02/05/2001 02/27/2001 03/01/2001 03/02/2001 03/23/2001
04/02/2001 04/16/2001

96 Notice of filing 10/01/00 update on jail population plan by Fulton County defts. (er) (Entered: 10/04/2000)
SUBMITTED to Judge Marvin H. Shoob on [95−1] motion to consolidate this motion with 1:99−cv−2252−JEC by mov Jerry Davis. (file in chambers) (er) (Entered: 10/10/2000)
97 RESPONSE by plas to the Quarterly Report on Medical Care. (er) (Entered: 10/12/2000)
98 RESPONSE by Fulton County defts to [93−1] report on dental care at the Fulton County Jail. (er) (Entered: 10/17/2000)
99 Notice of filing of updated on Jail Population Plan by defendants' Fulton County, Ga, Fulton County Board, Mike Kenn, Karen Webster, Tom Bob Fulton, Emma I. Darnell, Nancy Boxill, Jacquelyn. Barrett, L. L. Briggs, George Herron, Michael Hightower. (aar) (Entered: 11/02/2000)
SUBMITTED to Judge Marvin H. Shoob on [94−1] order and [97−1], [98−1], [99−1] response thereto. (FILE IN CHAMBERS) (dfb) (Entered: 11/13/2000)
101 Response by plaintiffs to Monitor's quarterly report on compliance with final settlement agreement and to Fulton County's [96−1] October and [99−1] November updates on jail population. (kt) (Entered: 11/22/2000)
100 ORDER by Judge Marvin H. Shoob re: status report on jail population, Dr. Greifinger's latest quarterly report of medical case and plas' response to reports and ORDERING the county dfts to provide additional information in their next monthy status report on jail population which is due 12/1/00. (see order for specifics) (cc) (bek) (Entered: 11/22/2000)
Terminated submissions. (bek) (Entered: 11/22/2000)
102 QUATERLY REPORT by Correctional Health Care Monitor. (er) (Entered: 11/24/2000)
Steno notes of proceedings held 8/25/00 before Judge Marvin H. Shoob , by Court Reporter Nancy Smith Wells. (jph) (Entered: 11/27/2000)
103 Notice of filing update on Jail Population Plan by Fulton County defts. (er) (Entered: 12/12/2000)
104 Interim report to the Final Settlement Agreement by Robert B. Greifinger, M.D. (er) (Entered: 01/03/2001)
105 Notice of filing Fulton County defts January 1, 2001 update on Jail Population Plan. (er) (Entered: 01/08/2001)
107 Notice of filing February 1, 2001 update on Jail Population Plan by Fulton County defts. (er) (Entered: 02/07/2001)
106 QUARTERLY REPORT on Medical Care at Fulton County Jail by dft Correctional Health Care Monitor. (er) (Entered: 02/07/2001)
108 RESPONSE by plas to monitor's report. (er) (Entered: 03/03/2001)
109 Notice of filing Fulton County Defts' March 1, 2001 update on Jail Population Plan. (er) (Entered: 03/03/2001)
110 RESPONSE by defts to Monitor's report and plas' response to monitor's report. (er) (Entered: 03/03/2001)
111 ORDER by Judge Marvin H. Shoob, directing dfts to provide the information described in this order in a supplemental report to be filed by 4/16/01 (cc) (er) (Entered: 03/26/2001)
112 Notice of filing Fulton County defendants' APRIL 1, 2001 update on Jail Population Plan. (er) (Entered: 04/04/2001)
113 SUPPLEMENTAL REPORT regarding the Jail Population Plan by Fulton County defts. (er) (Entered: 04/17/2001)

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 19 of 23

04/30/2001 05/01/2001 06/01/2001 07/01/2001 07/18/2001 07/26/2001
07/26/2001 07/30/2001 07/30/2001 08/01/2001 08/02/2001
08/03/2001
08/14/2001 09/04/2001 09/04/2001 09/13/2001 09/17/2001 09/17/2001 10/01/2001

114 Report on Medical care for HIV infected inmates at Fulton County Jail by defendant Correctional Health . (crc) (Entered: 05/02/2001)
115 Notice of filing May 1, 2001 update on Jail Population Plan by Fulton County defts. (er) (Entered: 05/03/2001)
116 Notice of filing of Fulton County Defts' June 1, 2001 update on Jail Population Plan. (er) (Entered: 06/04/2001)
117 Notice of filing by Fulton County defendants' July 1, 2001 update on Jail Population Plan. (er) (Entered: 07/05/2001)
Terminated submissions. (er) (Entered: 07/18/2001)
118 ORDER by Judge Marvin H. Shoob, directing the defts to show cause why the motion of Mahboob Pasha to compel the provision of medical care or, in the alternative, for release from custody should not be granted. hearing on 2:00 7/31/01 (cc) (er) (Entered: 07/27/2001)
119 EMERGENCY MOTION by mov Mahboob Pasha to compel Fulton County to provide medical care for him , or in the alternative, for order of release from custody with brief in support. (er) (Entered: 07/27/2001)
120 Brief by movant Mahboob Pasha in Support of [119−1] motion to compel Fulton County to provide medical care for him, [119−2] motion for order of release from custody. (aet) (Entered: 07/31/2001)
121 QUATERLY REPORT ON MEDICAL CARE by dft Fulton County Jail. (er) (Entered: 08/02/2001)
122 Notice of filing by Fulton County defendants' August 1, 2001 update on Jail Population Plan. (er) (Entered: 08/02/2001)
123 Motion HEARING held before Judge Marvin H. Shoob on [119−1] mov Mahboob Pasha's motion to compel Fulton County to provide medical care for him, or in the alternative, [119−2] for order of release from custody. Copy of the State's motion (filed in the Sup/Ct−Fulton Co.) to place case on the dead docket and order granting the same filed in open court.(er) Modified on 08/03/2001 (Entered: 08/03/2001)
124 ORDER by Judge Marvin H. Shoob DENYING AS MOOT the [119−1] [119−2] motion to compel Fulton County to provide medical care, or in the alternative, for order of release from custody by mov Mahboob Pasha. (cc) (er) (Entered: 08/03/2001)
125 EMERGENCY MOTION by movant Mahboob Pasha for a hearing to determine if this court has been misled by the National Institutes of Health with brief in support. (To MHS) (lme) Modified on 08/17/2001 (Entered: 08/15/2001)
126 Notice of filing by Fulton defendants' September 1, 2001 update on Jail Population Plan. (er) (Entered: 09/05/2001)
Copy of [118−1] order mailed to pla Jerry Davis, ret'd marked "moved, left no address." (er) (Entered: 09/07/2001)
SUBMITTED to Judge Marvin H. Shoob on [125−1] movant Mahboob Pasha's emergency motion for a hearing to determine if this court has been misled by the National Institutes of Health (er) Modified on 09/13/2001 (Entered: 09/13/2001)
127 ORDER by Judge Marvin H. Shoob DENYING AS MOOT the [125−1] the emergency motion of Mahboob Pasha for a hearing to determine if this court has been misled by the National Institutes of Health. (cc) (er) (Entered: 09/18/2001)
128 ORDER by Judge Marvin H. Shoob, directing defts to file a report within (10) days of the date of entry of this order. [128−1] order to be submitted on 10/1/01 (cc) (er) (Entered: 09/18/2001)
129 RESPONSE by Fulton County defts to [128−1] order. (er) (Entered: 10/04/2001)

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 20 of 23

10/01/2001 10/31/2001 11/01/2001 11/05/2001
11/08/2001 12/03/2001 12/05/2001 12/05/2001
12/19/2001 01/02/2002 02/01/2002 03/01/2002 03/06/2002 03/07/2002 03/21/2002 04/01/2002 04/16/2002
04/18/2002
04/24/2002 04/29/2002

130 Notice of filing the Fulton County Defts' October 1, 2001 update on Jail Population Plan. (er) (Entered: 10/04/2001)
131 Report of Medical Care for HIV−infected Inmates at Fulton County Jail (bsm) (Entered: 10/31/2001)
132 Notice of filing Fulton County defts' 11/01/01 update on Jail Population Plan. (er) (Entered: 11/02/2001)
133 ORDER by Judge Marvin H. Shoob, directing the parties to file responses to Dr. Geifinger's latest quarterly report, dated 10/30/01, w/in 30 days of the date of entry of this order. (cc: &cc to Dr. Greifinger) (er) Modified on 11/06/2001 (Entered: 11/06/2001)
Steno notes of proceedings held 08/02/01 before Judge Marvin H. Shoob , by Court Reporter Lois Phillips. (ldn) (Entered: 11/08/2001)
134 Notice of filing Fulton County Defts' December 1, 2001 update on Jail Population Plan. (er) (Entered: 12/04/2001)
135 RESPONSE by plas to [130−1] monitor's October 2001 quarterly report. (er) (Entered: 12/07/2001)
136 RESPONSE by defts Fulton County, Ga, Fulton County Board, Mike Kenn, Karen Webster, Tom Lowe, Bob Fulton, Emma I. Darnell, Nancy Boxill, Jacquelyn . Barrett, L. L. Briggs, and Michael Hightower to [130−1] Correctional Monitor's Ocober 30, 2001 quarterly report. (er) (Entered: 12/07/2001)
Davis' copy of [133−1] order returned undeliverable − marked released. (crc) (Entered: 12/28/2001)
137 Notice of filing Fulton County's 1/1/02 update on jail population plan by defendants. (fmm) (Entered: 01/09/2002)
138 Notice of filing Fulton County Defts' February 1, 2002 update on Jail population plan. (er) (Entered: 02/04/2002)
139 Notice of filing FULTON COUNTY DEFTS' March 1, 2002 update on Jail Population Plan. (er) (Entered: 03/04/2002)
140 QUATERLY REPORT by Correctional Health Care Monitor; Report on Medical Care at Fulton County Jail (er) (Entered: 03/11/2002)
141 SUPPLEMENT to FULTON COUNTY DEFTS' March 1, 2002 update on Jail Population Plan [139−1]. (er) (Entered: 03/11/2002)
142 RESPONSE by plas to monitor's March 2002 [140−1] quarterly report. (er) (Entered: 03/25/2002)
143 Notice of filing FULTON COUNTY DEFTS' April 1, 2002 update on Jail Population Plan. (er) (Entered: 04/02/2002)
144 ORDER by Judge Marvin H. Shoob, defendants ORDERED to immediately implement remedial actions set out and to report to the Court w/in 30 days of entry of this order, hearing set for 10:30 on 5/28/02 to consider defendants' progress in complying with this order and to determine if further action is needed (cc) (bsm) (Entered: 04/16/2002)
145 ORDER by Judge Marvin H. Shoob amending its [144−1] order to modify paragraph 5 on page 9 to read as follows: (5) Increase compensation paid to appointed lawyers in misdemeanor cases from the current $50 to a reasonable amount, or provide for representation in accordance with this Order by a public defender office or other entity. (cc) (er) (Entered: 04/18/2002)
Copy of [144−1] order mailed to pla Jerry Davis, ret'd marked insufficient address, RTS, unauthorized, name does not match EF#." (er) (Entered: 04/25/2002)
147 REPORT on Medical care for HIV infected inmates at Fulton County Jail by dft Correctional Health. (er) (Entered: 05/06/2002)

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 21 of 23

05/01/2002 05/16/2002 05/16/2002 05/23/2002 05/23/2002
05/24/2002 05/28/2002 05/28/2002 05/28/2002
05/29/2002 05/29/2002 05/29/2002
05/31/2002 06/03/2002 06/12/2002
06/12/2002 06/13/2002 06/13/2002 06/20/2002
06/20/2002 06/25/2002

146 Notice of filing the FULTON COUNTY defendants' 5/1/02 update on the Jail Population Plan. (er) Modified on 06/04/2002 (Entered: 05/02/2002)
148 RESPONSE by Fulton County Defts to [144−1] 4/16/02, order (er) (Entered: 05/17/2002)
149 MOTION by Fulton County Defts to stay implementation of actions directed in court's 4/16/02, order with brief in support. (er) (Entered: 05/17/2002)
150 APPLICATION by plas for issuance of writs of habeas corpus ad testificandum with prop/writs attached. (to: MHS) (er) (Entered: 05/24/2002)
150 NOTICE granting [150−1] motion for issuance of writs of habeas corpus ad testificandum by Judge Marvin H. Shoob; directing the Sheriff Jacquelyn Barrett, Fulton Co. to convey inmate David Bernard Patterson, to the USDC on 5/28/02, at 10:30 a.m. to attend and give testimony in the hrg. (cc/USM served by ct/room depty.) (er) (Entered: 09/07/2002)
151 REPLY by plas to Fulton County defts' response to [144−1] order (er) (Entered: 05/29/2002)
152 HEARING HELD before Judge Marvin H. Shoob begun. (er) Modified on 05/31/2002 (Entered: 05/31/2002)
153 Attorney appearance for plas by Alexander Taylor Rundlet (er) (Entered: 05/31/2002)
EXHIBITS by pla admitted (1 thru 7, 9, 10, 25 &28) EXHIBIT No. 28 ordered to be sealed &PLACED *** UNDER SEAL*** (er) Modified on 05/31/2002 (Entered: 05/31/2002)
EXHIBITS by pla admitted (11 thru 23, 27, 30, 8, 32 &33) (er) (Entered: 05/31/2002)
EXHIBIT by dft admitted. (#1) (er) (Entered: 05/31/2002)
154 HEARING HELD on before Judge Marvin H. Shoob concluded. Counsel to meet w/in 5 days to discuss inmates who have served more time than if convicted. Proposed findings of fact and conclusions of law to be submitted by each side w/in (15) days. (er) (Entered: 03/20/2003)
PLA AND DFT EXHIBITS PLACED IN THE EXHIBIT ROOM. (er) (Entered: 05/31/2002)
155 Notice of filing the FULTON COUNTY defendants' 6/1/02 update on the Jail Population Plan. (er) (Entered: 06/04/2002)
SUBMITTED to Judge Marvin H. Shoob on [149−1] Fulton County Defts' motion to stay implementation of actions directed in court's 4/16/02, order (file in chambers) (er) Modified on 06/12/2002 (Entered: 06/12/2002)
156 TRANSCRIPT filed RE: for dates of 5/29/02 Court Reporter: DONNA C. KEEBLE. (er) (Entered: 06/13/2002)
157 Proposed findings of fact and conclusions of law by plas with prop/order. (to: MHS) (er) (Entered: 06/14/2002)
158 Proposed findings of fact and conclusions of law by defts with prop/order. (to: MHS) (er) (Entered: 06/14/2002)
159 ORDER by Judge Marvin H. Shoob, directing the County to respond by 6/25/02 several questions that are in the order. (see order for more details) [159−1] order to be submitted on 6/25/02 (cc &cc/Dr. Greifinger) (er) Modified on 06/21/2002 (Entered: 06/21/2002)
160 MOTION by plas for leave to supplement proposed order filed 6/13/02 with brief in support. (er) (Entered: 06/21/2002)
161 RESPONSE by Fulton County Defts to [159−1] order. (er) (Entered: 06/26/2002)

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 22 of 23

07/01/2002 07/11/2002 07/12/2002
07/12/2002 07/24/2002 08/01/2002 08/06/2002
08/15/2002 08/29/2002 08/29/2002 09/03/2002
09/03/2002 09/10/2002 09/23/2002
09/24/2002 10/01/2002 10/01/2002 10/17/2002

162 Fulton County Defendants' 7/1/02 update on Jail Population Plan. (adg) (Entered: 07/02/2002)
SUBMITTED to Judge Marvin H. Shoob on [160−1] motion for leave to supplement proposed order filed 6/13/02, [159−1] order (bsm) (Entered: 07/11/2002)
163 ORDER by Judge Marvin H. Shoob DENYING [149−1] motion to stay implementation of actions directed in court's 4/16/02, order by Fulton County, Ga; ORDERING dft's to take the noted remedial actions to correct violations of federal rights. (SEE ORDER) (cc) (ck) (Entered: 07/15/2002)
Terminated submissions. (ck) (Entered: 07/15/2002)
164 QUARTERLY REPORT on Medical Care at Fulton County Jail by dft Correctional Health Care Monitor. (er) (Entered: 07/25/2002)
165 Notice of filing FULTON COUNTY DEFENDANTS' August 1, 2002 update on Jail Population Plan. (er) (Entered: 08/02/2002)
166 Attorney appearance for defts Fulton County, Ga, Fulton County Board, Mike Kenn, Karen Webster, Tom Lowe, Bob Fulton, Emma I. Darnell, Nancy Boxill, Jacquelyn Barrett, L. L. Briggs, George Herron, Michael Hightower by Steven E. Rosenberg (er) (Entered: 08/08/2002)
167 MOTION by Fulton County Defts to terminate prospective relief with brief in support. (er) (Entered: 08/16/2002)
Steno notes of proceedings held 5/29/02 before Judge Marvin H. Shoob , by Court Reporter Nancy Smith Wells. (cdg) (Entered: 08/29/2002)
168 RESPONSE by plas to defts' [167−1] motion to terminate prospective relief (er) (Entered: 08/30/2002)
169 ORDER by Judge Marvin H. Shoob; IT IS ORDERED that the effective date of the automatic stay is postponed for 60 days, until 11/13/02; it is further ORDERED that plas shall have until 10/8/2 to respond to dfts' request that the Court withdraw its 7/12/02 [163−1] order, as well as Orders purportedly requiring prospective relief beyond the scope of the Final Settlement Agreements; dfts shall have until 10/15/02 to file their reply; finally, it is ORDERED that a hearing will be held on 10/16/02 beginning at 10:00 a.m. hearing at 10:00 on 10/16/02 (cc) (kt) (Entered: 09/03/2002)
170 Fulton County Dfts' September 1, 2002 Update on Jail Population Plan (fmm) (Entered: 09/04/2002)
SUBMITTED to Judge Marvin H. Shoob on [167−1] motion to terminate prospective relief by Fulton County Defts. (*** file in chambers ***) (er) (Entered: 09/10/2002)
171 ORDER by Judge Marvin H. Shoob, Grary Hospital ORDERED to produce records relating to Wayne Sims by 9/26/02; if records are not produced, defendant and custodian of records at Grady to appear at a hearing to be held on 9/27/02 at 2:00 in Courtroom 1707 (cc) (bsm) (Entered: 09/24/2002)
Copy of [169−1] order mailed to pla Jerry Davis, ret'd marked RTS, due to wrong EF#." (er) (Entered: 09/25/2002)
172 Notice of filing FULTON COUNTY DEFENDANTS' October 1, 2002 update on Jail Population Plan. (er) (Entered: 10/02/2002)
173 Notice of filing FULTON COUNTY DEFTS' REPORT to the Court on compliance with 7/12/02 order. (er) (Entered: 10/02/2002)
174 Motion HEARING held before Judge Marvin H. Shoob [167−1] on defts' motion to terminate prospective relief. Parties given (15) days to file briefs. Vacating 7/12/02 order. Order to be entered. Brief conference held in chambers after the hearing. (er) (Entered: 10/21/2002)

Case: 1:99-cv-900 As of: 02/15/2016 01:43 PM EST 23 of 23

10/28/2002
10/28/2002
11/01/2002 11/13/2002
11/13/2002 11/20/2002 01/13/2003 03/25/2003 03/25/2003 07/14/2003 07/11/2005 01/06/2011
01/27/2011 01/28/2011

175 Notice of filing Quarterly Report on Medical Care for HIV−infected Inmates at Fulton County Jail by defendant Correctional Health Care Monitor. (er) (Entered: 10/29/2002)
176 ORDER by Judge Marvin H. Shoob WITHDRAWING its [163−1] order of 7/12/02, and WITHDRAWING portion of its [144−1] order of 4/16/02; requiring the appointment of counsel to indigents charged with minor offenses, and the provision of All Purpose Hearings in State Court, w/in 72 hours of arrest. (cc &cc/Mr. Geifinger, M.D.) (er) (Entered: 10/29/2002)
177 Notice of filing FULTON COUNTY DEFENDANTS' 11/01/02 update on Jail Population Plan (er) (Entered: 11/04/2002)
178 ORDER by Judge Marvin H. Shoob GRANTING [167−1] defts' motion to terminate prospective relief. (cc &c/Dr. Greifinger) (er) Modified on 11/14/2002 (Entered: 11/14/2002)
179 Withdrawal by plas of [168−1] opposition to defts' motion to terminate prospective relief. (er) (Entered: 11/14/2002)
180 TRANSCRIPT filed RE: for dates of 10/17/02 Court Reporter: DONNA C. KEEBLE (er) (Entered: 11/21/2002)
Steno notes of proceedings held 10/17/02 before Judge Marvin H. Shoob, by Court Reporter DONNA KEEBLE. (er) (Entered: 01/15/2003)
Terminated submissions. (aar) (Entered: 03/25/2003)
Terminated submissions. (aar) (Entered: 03/25/2003)
181 Notice of class action settlement by plaintiffs. (er) Modified on 07/23/2003 (Entered: 07/16/2003)
182 NOTICE of class action settlement by plaintiffs.(er) (Entered: 07/13/2005)
183 NOTICE TO COUNSEL OF RECORD, Stephen Bright and Paula Nash, regarding RECLAMATION AND DISPOSITION OF UNCLAIMED EXHIBITS pursuant to Local Rule 79.1D(2).. (tcc) (Entered: 01/06/2011)
184 Exhibits for plaintiff retrieved by Erin Lange for Attorney Stephen B. Bright. (rvb) (Entered: 01/27/2011)
185 Exhibit for Defendant retrieved by Terry Allen for Attorney. (rvb) (Entered: 01/28/2011)