Case 2:17-cv-08805-GW-JPR Document 1 Filed 12/06/17 Page 1 of 91 Page ID #:1

1 AARON J. FISCHER (SBN 247391) Aaron.Fischer@disabilityrightsca.org
2 DISABILITY RIGHTS CALIFORNIA 1330 Broadway, Suite 500
3 Oakland, CA 94612 Telephone: (510) 267-1200
4 Facsimile: (510) 267-1201

5 RICHARD DIAZ (SBN 285459) Richard.Diaz@disabilityrightsca.org
6 DISABILITY RIGHTS CALIFORNIA 350 South Bixel Street, Suite 290
7 Los Angeles, CA 90017 Telephone: (213) 213-8000
8 Facsimile: (213) 213-8001

9 JULIA E. ROMANO (SBN 260857) jromano@kslaw.com
10 JENNIFER T. STEWART (SBN 298798) jstewart@kslaw.com
11 STACY L. FOSTER (SBN 285544) Stacy.foster@kslaw.com
12 KING & SPALDING LLP 633 W. Fifth St., Suite 1700
13 Los Angeles, CA 90071 Telephone: (213) 433-4355
14 Facsimile: (213) 433-4310

15 Attorneys for Plaintiffs

16 [Additional Counsel Listed On Second Page]

17

18

UNITED STATES DISTRICT COURT

19

CENTRAL DISTRICT OF CALIFORNIA

20 CLAY MURRAY, DAVID FRANCO, Case No.: SHAREEN WINKLE, MARIA TRACY,

21 ERIC BROWN, on behalf of themselves

and all others similarly situated,

22

CIVIL CLASS ACTION

Plaintiffs,

COMPLAINT FOR

23 v.

DECLARATORY AND

INJUNCTIVE RELIEF

24 COUNTY OF SANTA BARBARA, and

SANTA BARBARA COUNTY

25 SHERIFF’S OFFICE,

26

Defendants.

27

28

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1 DON SPECTER (SBN 83925) DSpecter@prisonlaw.com
2 CORENE KENDRICK (SBN 226642) CKendrick@prisonlaw.com
3 PRISON LAW OFFICE 1917 Fifth Street
4 Berkeley, California 94710 Telephone: (510) 280-2621
5 Fax: (510) 280-2704 6 DONALD F. ZIMMER, JR. (SBN 112279)
fzimmer@kslaw.com
7 KING & SPALDING LLP 101 Second Street, Suite 2300
8 San Francisco, CA 94105 (415) 318-1220
9 (415) 318-1300 10 JOSHUA C. TOLL*
jtoll@kslaw.com 11 KING & SPALDING LLP
1700 Pennsylvania Ave NW 12 Washington DC 20036
Telephone: (202) 737-8616 13 Fax: (202) 626-3727
Motion for Pro Hac Vice Admission 14 Forthcoming 15 / / / 16 / / /
17 18 19 20 21 22 23 24 25 26 27 28

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1

TABLE OF CONTENTS

2

Page No.

3 NATURE OF ACTION............................................................................................................ 1

4 JURISDICTION......................................................................................................................... 2

5 VENUE......................................................................................................................................... 3

6 PARTIES...................................................................................................................................... 3

7 FACTUAL ALLEGATIONS ................................................................................................. 6

8

I. THE SANTA BARBARA COUNTY JAIL IS OLD AND

DILAPIDATED, SEVERELY OVERCROWDED, AND

9

PLAGUED BY UNDERSTAFFING. .......................................................... 6

10

A. Defendants Hold Prisoners in Deficient Facilities That

Undermine System Operations and Fail to Meet the Basic

11

Needs of People with Health Problems and Disabilities. ...........6

12

B. Defendants Operate a Jail System Long Plagued by Severe

Overcrowding That Causes Serious Risks of Harm to Prisoners.

13

..................................................................................................... 7

14

C. The County’s Planned Construction of the Northern Branch Jail

Will Not Address the Deficiencies at the Existing Facilities. ....9

15

D. Defendants’ Systemic Understaffing Creates Additional Safety

16

Risks and Undermines Delivery of Necessary Care and

Programs. ..................................................................................10

17

II. DEFENDANTS FAIL TO PROVIDE ADEQUATE HEALTH CARE

18

TO PRISONERS. ............................................................................................. 11

19

A. Defendants Fail to Maintain Sufficient Numbers of Health Care

Professionals and Custody Staff to Deliver Adequate Care. ....11

20

B. Defendants Fail to Maintain Adequate, Accurate, and Complete

21

Health Care Records. ................................................................13

22

C. Defendants Violate Prisoners’ Patient Confidentiality Rights .14

23

D. Defendants Routinely and Systematically Fail to Supervise the

Delivery of Health Care, and Lack Institutional Policies and

24

Procedures to Correct Deficiencies and Ensure Adequate Care.

................................................................................................... 15

25

E. Defendants Oversaw a Deeply Flawed Transition from Corizon

26

to CFMG as the Contracted Health Care Provider. ..................15

27

F. Defendants’ Medical Care Delivery System Is Inadequate......17

28
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1

G. Defendants’ Mental Health Care Delivery System Is

Inadequate. ................................................................................24

2

H. Overcrowding at the Jail Contributes to a Significant Health

3

Crisis and Causes Additional Risks of Harm. ..........................34

4

III. DEFENDANTS ROUTINELY OVERUSE AND IMPROPERLY

USE SOLITARY CONFINEMENT ........................................................... 34

5

IV. DEFENDANTS DISCRIMINATE AGAINST AND FAIL TO

6

ACCOMMODATE PEOPLE WITH DISABILITIES........................... 41

7

A. Defendants Lack Adequate Policies and Practices to Identify

and Track Prisoners with Disabilities. ......................................42

8

B. Defendants Place Prisoners with Disabilities in More

9

Restrictive Settings and Deny Them Meaningful Access to Jail

Programs, Services, and Activities. ..........................................42

10

C. Defendants Fail to Provide Reasonable Accommodations to

11

Prisoners Who Need Them. ......................................................43

12

D. Defendants Fail to Accommodate Prisoners with Disabilities

that Affect Communication.......................................................46

13

E. Defendants Lack an Effective Grievance Procedure for

14

Prisoners to Request Reasonable Disability Accommodations 47

15

V. DEFENDANTS FORCE PRISONERS TO LIVE IN DANGEROUS,

UNSANITARY CONDITIONS. ................................................................. 48

16

17 CLASS ACTION ALLEGATIONS.................................................................................... 49

18 CLAIMS FOR RELIEF.......................................................................................................... 52

19 PRAYER FOR RELIEF......................................................................................................... 57

20

21

22

23

24

25

26

27

28 - ii -
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1

NATURE OF ACTION

2

1. This civil rights class action lawsuit seeks declaratory and injunctive

3 relief to remedy the unconstitutional, discriminatory, unlawful and dangerous

4 conditions in the Santa Barbara County Adult Detention Facilities (“Santa Barbara

5 County Jail” or “Jail”). Defendants County of Santa Barbara and Santa Barbara

6 Sheriff’s Office systematically and knowingly (1) fail to provide adequate medical

7 and mental health care to the people housed in the jail; (2) overuse isolation and

8 solitary confinement; (3) discriminate against and fail to accommodate people with

9 disabilities; and (4) provide inhumane, unsanitary, and unsafe living conditions.

10

2. These failures have caused and continue to cause widespread harm,

11 including unnecessary pain and injury, in violation of prisoners’ rights under the

12 Eighth and Fourteenth Amendments to the United States Constitution, the

13 Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act, and

14 California State law.

15

3. Defendants have been deliberately indifferent to the substantial risk of

16 pain and suffering and harm to prisoners, including serious injury, clinical

17 deterioration, and death, caused by their inadequate, unlawful, and unconstitutional

18 policies and practices. Defendants have been aware of the chronic and systemic

19 problems at the Jail and their causes for years, and have failed to take the actions or

20 commit the resources necessary to ameliorate the unconstitutional and illegal

21 conditions that expose Santa Barbara County Jail prisoners to a substantial risk of

22 harm.

23

4. Defendants regularly confine a population of prisoners that far

24 exceeds the Jail’s rated capacity of approximately 818 people. The average

25 population hovers at 120% of the Jail’s capacity, and frequently exceeds 1,100

26 people. At least ten (10) people, many with serious and inadequately treated

27 medical and mental health conditions, have died at the Jail since 2011. On any

28 given day, Defendants hold hundreds of people with serious mental health,
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1 medical, and disability-related needs in the Jail. Every day, many prisoners –

2 including those with serious health conditions and disabilities – must sleep on the

3 floor due to overcrowding at the Jail. Defendants hold scores of people, many with

4 serious mental illness, indefinitely in solitary confinement cells, and on most days

5 deny them any time out of their cell for exercise, recreation, or sunlight. Suicide

6 attempts are common in these solitary confinement settings. In one recent five-

7 month period alone, at least twelve (12) prisoners attempted suicide while in

8 solitary confinement, more than one attempted suicide every two weeks, including

9 one man who died.

10

5. In 2016, after a detailed investigation, Disability Rights California

11 issued a Report (attached as Appendix A) on conditions in the Santa Barbara

12 County Jail. The Report documented findings of harmful policies, practices, and

13 conditions that impact prisoners, in particular prisoners with serious mental illness,

14 medical conditions, and physical, sensory, or mental health disabilities. The Report

15 detailed the Jail’s inadequate mental health care system, excessive use of solitary

16 confinement, and violations of the Americans with Disabilities Act (ADA). Nearly

17 all of the deficiencies identified in the Report persist, and recommendations to

18 address those deficiencies remain largely unimplemented.

19

6. Plaintiffs, who are prisoners housed in the Jail, seek declaratory and

20 injunctive relief compelling Defendants to provide constitutionally adequate health

21 care, reasonable accommodations and equal access for prisoners with disabilities,

22 and protection from inhumane conditions of confinement, as well as attorneys’ fees

23 and costs under applicable law. Plaintiffs bring this action on behalf of themselves

24 and all others similarly situated.

25

JURISDICTION

26

7. The claims alleged herein arise pursuant to 42 U.S.C. § 1983 and the

27 Eighth and Fourteenth Amendments to the United States Constitution, the

28 Americans with Disabilities Act (ADA), 42 U.S.C. §12101 et seq., Section 504 of
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1 the Rehabilitation Act, 29 U.S.C. § 794.6, and related state law.

2

8. The jurisdiction of this Court is invoked pursuant to 28 U.S.C. §§

3 1331, 1343, and 1367. Plaintiffs seek declaratory and injunctive relief under 28

4 U.S.C. §§ 1343, 2201, and 2202; 42 U.S.C. § 1983 and 12117(a); and California

5 Government Code § 11135.

6

VENUE

7

9. Venue is proper in the Central District of California, pursuant to 28

8 U.S.C. § 1391(b), because a substantial part or all of the acts and omissions giving

9 rise to this action occurred within Santa Barbara County and one or more

10 Defendants reside in this District.

11

PARTIES

12 Plaintiffs

13

10. Plaintiff CLAY MURRAY is a prisoner in pretrial detention at the

14 Santa Barbara County Jail. Plaintiff MURRAY is a U.S. Army veteran with

15 significant medical conditions, including cirrhosis, high blood pressure,

16 degenerative joint disease, spinal arthritis, and peripheral neuropathy. He also has

17 diagnosed post-traumatic stress disorder and other mental health needs. Plaintiff

18 MURRAY requires the use of a wheelchair for mobility. Defendants have failed to

19 provide Plaintiff MURRAY adequate medical and mental health care, with

20 inadequate screening, improper medication management, and delayed treatment.

21 Defendants have denied Plaintiff MURRAY reasonable accommodations for his

22 disability and access to services and programs based on his disability status.

23 Plaintiff MURRAY is a person with a disability as defined in 42 U.S.C. § 12102,

24 29 U.S.C. § 705(9)(B), and California Government Code § 12926(j) and (m).

25

11. Plaintiff DAVID FRANCO is a prisoner in pretrial detention at the

26 Santa Barbara County Jail. Plaintiff FRANCO has been diagnosed with

27 schizophrenia and bipolar disorder. Defendants have failed to provide Plaintiff

28 FRANCO timely and adequate mental health care, resulting in significant
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1 decompensation and psychiatric symptoms resulting in his becoming suicidal.

2 Defendants also failed to provide him a bed, forcing him to sleep on the floor for

3 an extended period of time, which exacerbated his psychiatric distress. Plaintiff

4 FRANCO is a person with a disability as defined in 42 U.S.C. § 12102, 29 U.S.C.

5 § 705(9)(B), and California Government Code § 12926(j) and (m).

6

12. Plaintiff SHAREEN WINKLE is a prisoner at the Santa Barbara

7 County Jail. Plaintiff WINKLE has been diagnosed with mental illness, including

8 bipolar disorder. Defendants have repeatedly placed Plaintiff WINKLE in solitary

9 confinement for long periods based on such infractions as not being prepared for

10 linen exchange on laundry day and not properly wearing her shirt. Plaintiff

11 WINKLE’s mental health deteriorated significantly in solitary confinement, where

12 she suffered multiple serious panic attacks. Defendants further held Plaintiff

13 WINKLE in a safety cell for a period of more than four (4) consecutive days,

14 during which time she was forced to sleep on the floor and use a grate on the floor

15 as a toilet. Defendants have failed to provide Plaintiff WINKLE adequate mental

16 health treatment. In addition, Defendants have failed to accommodate Plaintiff

17 WINKLE, who Defendants are aware has a seizure disorder, by placing her in an

18 isolation cell that contains a single bunk that is elevated several feet above the

19 ground, a situation that placed her at risk of a serious fall from the bunk in the

20 event she has a seizure. Plaintiff WINKLE is a person with a disability as defined

21 in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California Government Code §

22 12926(j) and (m).

23

13. Plaintiff MARIA TRACY is a prisoner in pretrial detention at the

24 Santa Barbara County Jail. Plaintiff TRACY has been diagnosed with

25 schizophrenia and has a serious ophthalmological medical condition. Defendants

26 have failed to provide Plaintiff TRACY with adequate mental health and medical

27 care, resulting in the severe worsening of her health. Plaintiff TRACY is a person

28 with a disability as defined in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and
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1 California Government Code § 12926(j) and (m).

2

14. Plaintiff ERIC BROWN is a prisoner at the Santa Barbara County

3 Jail. He has been diagnosed with chronic lower back pain, anxiety, and major

4 depressive disorder. Plaintiff BROWN uses a wheelchair for mobility as a result of

5 his medical conditions. Defendants have denied Plaintiff BROWN reasonable

6 accommodations for his disability and access to services and programs based on

7 his disability status. Defendants have further denied Plaintiff BROWN adequate

8 medical and mental health treatment. Plaintiff BROWN is a person with a

9 disability as defined in 42 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California

10 Government Code § 12926(j) and (m).

11 Defendants

12

15. Defendant COUNTY OF SANTA BARBARA (“County”) is a public

13 entity, duly organized and existing under the laws of the State of California. The

14 County operates and manages the Jail and is and was at all relevant times

15 mentioned herein, responsible for the actions, inactions, policies, procedures, and

16 practices of the Santa Barbara County Sheriff’s Office and its respective

17 employees and/or agents. The County is responsible for providing a constitutional

18 level of health care for those in its custody, including funding, oversight, and

19 corrective action to ensure adequate conditions. The Board of Supervisors of the

20 County of Santa Barbara authorizes and approves the contract between Defendant

21 Santa Barbara County Sheriff’s Office (“Sheriff’s Office”) and the health care

22 service provider for prisoners in the Jail, which is currently California Forensic

23 Medical Group (“CFMG”). Previously, the Sheriff’s Office had contracted with

24 Corizon Health (“Corizon”) to provide medical and mental health care at the Jail;

25 that contract terminated on or around April 1, 2017. By law, the County retains

26 ultimate authority and responsibility for the health care, treatment, well-being, and

27 safekeeping of prisoners in the Jail.

28

16. Defendant SANTA BARBARA COUNTY SHERIFF’S OFFICE is a

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1 public entity, duly organized and existing under the laws of the State of California.

2 Sheriff Bill Brown (“Sheriff”) is the elected Sheriff of the County of Santa

3 Barbara. The Sheriff’s Office is responsible for the operation and supervision of

4 custody operations in Santa Barbara County, including promulgating policies and

5 procedures for the operation of its Jail facilities. The Sheriff’s Office has

6 contracted with CFMG to provide health care services. The Sheriff’s Office by law

7 retains the ultimate authority and responsibility for the health care, treatment, well-

8 being, and safekeeping of prisoners in the Jail.

9

FACTUAL ALLEGATIONS

10 I.
11

THE SANTA BARBARA COUNTY JAIL IS OLD, DILAPIDATED, SEVERELY OVERCROWDED, AND PLAGUED BY UNDERSTAFFING.

12

A. Defendants Hold Prisoners in Deficient Facilities That Fail to

Meet the Basic Needs of People with Health Problems and

13

Disabilities.

14

17. Defendants maintain and operate the adult detention facilities within

15 the County’s jurisdiction, comprising the Main Jail and Medium Security Facility

16 located in the City of Santa Barbara.

17

18. The Main Jail is more than 50 years old, having been built in the

18 1960s. Jail staff and others regularly refer to the Main Jail as a “Frankenstein”

19 facility or the “Franken-Jail.” Over several decades, there have been numerous

20 modifications and expansions to the facility, which have resulted in a facility that

21 is haphazard, substandard, and riddled with architectural barriers, deficiencies, and

22 limitations.

23

19. The Main Jail has many linear hallways with dead-end corridors and

24 little or no natural light. The facility is old and difficult to maintain, and is

25 significantly dilapidated. Prisoners and staff are exposed to dust, mold, and other

26 unsanitary conditions. “Exercise areas” consist of small cell-like areas with cement

27 walls and extremely limited natural light. Prisoners, when they are permitted in

28 these areas, are unable to see outside other than a small portion of the sky. Sheriff
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1 Brown himself has called the Main Jail “disgraceful, embarrassing and

2 unacceptable for Santa Barbara County.”

3

20. A 2017 Grand Jury Report, entitled Santa Barbara Main Jail: An

4 Outdated and Inefficient Facility, noted that according to the County’s General

5 Services Department, “the Main Jail is in failure mode,” including with respect to

6 its “plumbing and sewer systems that are over 60 years old,” “compliance with

7 current seismic standards,” and “compliance with ADA regulations.”

8

21. The Medium Security Facility is adjacent to the Main Jail, and is also

9 more than 50 years old. Prisoners housed at the Medium Security Facility

10 participate in work programs, such as jail laundry, kitchen, and landscaping.

11

22. A 2016-17 Grand Jury Report identified the need for extensive repairs

12 and remediation at the Jail, with an estimated cost over $15 million. Such work

13 remains undone. Notably, the Grand Jury’s estimate does not take into account the

14 significant deficiencies in the treatment of prisoners with mental health needs,

15 medical needs, and disabilities.

16

23. The Jail’s housing units were not designed for prisoners with serious

17 health care and disability-related needs. As a result, Defendants house such

18 prisoners in inadequate spaces, as discussed below.

19

B. Defendants Operate a Jail System Long Plagued by Severe

Overcrowding That Causes Serious Risks of Harm to Prisoners.

20

21

24. The Jail has a long history of being severely overcrowded. Such

22 overcrowding has contributed to significant deficiencies in the provision of health

23 care, to the failures to accommodate and provide access to individuals with

24 disabilities, and to dangerous and harmful conditions of confinement. A 2012

25 Grand Jury Detention Facilities Report noted that “More than 20 previous Santa

26 Barbara County Grand Juries filed reports on overcrowding at the main jail. This

27 overcrowding condition still exists, and its effects are increasingly obvious.”

28

25. In 2008, the Santa Barbara County Sheriff’s Blue Ribbon Commission

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1 documented that the Jail was rated to hold 818 inmates, but regularly detained

2 approximately 1,000, meaning that the Jail was running at 120% of its rated

3 capacity. Nearly a decade later, the situation is no better. The 2017 Grand Jury

4 found that the Jail’s average daily population frequently exceeds 1,100, or nearly

5 135% of its rated capacity.

6

26. Defendants have resorted to housing prisoners in basement areas,

7 closets, and various rooms not designed for such purposes. There are not enough

8 beds to accommodate the number of prisoners in some units. Many prisoners must

9 sleep in plastic structures, commonly called “boats,” that sit directly on the floor.

10 Other prisoners may not even get these “boats,” and are forced to sleep on bedding

11 on the floor.

12

27. For example, when Plaintiff FRANCO arrived at the Jail in July 2017,

13 Defendants failed to assign him a bed for six (6) days. While he remained on “No

14 Bed Available” status, his mental health deteriorated significantly and he attempted

15 suicide. Upon his return to a dorm unit after his attempted suicide, Plaintiff

16 FRANCO spent another ten (10) days sleeping on the floor.

17

28. Indeed, a writ regarding prisoners being forced to sleep on the floor

18 due to lack of beds has been pending for more than 35 years in the Santa Barbara

19 County Superior Court. For almost three decades, the County has been under a

20 state court order to reduce the jail population to its approved bed capacity so that

21 prisoners do not need to sleep on the floor. But the issue has not improved, and

22 appears to be getting worse. The Sheriff’s Office provides “No Bunk Available

23 (NBA)” reports to the state court. These reports show that, in 2016 and 2017, there

24 are generally at least 30 prisoners for whom no bed is available on any given day,

25 with as many as 70 or more prisoners without a bed on some days. The state court

26 judge stated at a May 2016 hearing that the “bottom line is that you can’t have

27 floor sleepers. . . . [E]very time I look at one of these graphs and one of these

28 charts that reflects not one or two or single digit number of floor sleepers, but you
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1 know 71, 59, 62 . . . that’s a pretty significant number of floor sleepers on a daily

2 basis … it’s a pretty clear violation of a previous court order.” Such overcrowding

3 has a deeply negative and harmful impact prisoner health and safety, particularly

4 for those individuals with medical or mental health care needs as well as disability

5 accommodation needs.

6

C. The County’s Planned Construction of the Northern Branch Jail

Will Not Address Deficiencies at the Existing Facilities.

7

8

29. The 2008 Sheriff’s Blue Ribbon Commission examined Jail

9 overcrowding and deficiencies at the Jail facilities. The Commission recommended

10 that the County make a significant investment in community programs that provide

11 drug and alcohol treatment, mental health treatment, homelessness prevention, and

12 other measures to safely reduce incarceration rates and Jail overcrowding. The

13 Commission also recommended the building of a new jail facility. The

14 recommendations in the report went unimplemented for years.

15

30. In 2016, the County approved the Northern Branch Jail Project, a

16 construction project that broke ground in October 2016 and is scheduled for

17 occupancy in 2019. The project scope is for 376 beds, with 32 “special use” beds.

18

31. Building the new facility, however, will not remedy the existing

19 deficiencies at today’s Jail facilities, which will remain in use even after the new

20 facility is opened. The 2017 Grand Jury report, Santa Barbara Main Jail: An

21 Outdated and Inefficient Facility, found that measures to address deficiencies at

22 the Main Jail remain “paramount,” but the Grand Jury “could find no concrete plan

23 to fund the multimillion dollars needed for repairs and upgrades to the Main Jail.”

24

32. Even if and when the Northern Branch Jail Project is completed, there

25 will remain insufficient facilities to meet the needs of prisoners with mental illness,

26 serious medical conditions, and disabilities. Notably, Sheriff Brown advocated for

27 the creation of additional beds for prisoners with mental illness as part of a

28 Sheriff’s Transition and Reentry (STAR) wing of the Northern Branch County Jail
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1 Project. Despite a conditional award of $38.9 million from the State Public Works

2 Board to fund the project, the County did not approve funding for the STAR

3 complex. Defendants have provided no plan to serve the mental health and other

4 critical needs of the County’s incarcerated population.

5

33. As the 2017 Grand Jury noted: “This leaves the County with an

6 outdated and inefficient Main Jail, still in urgent need of repair, replacement and

7 repurposing to house its approved capacity. Many unanswered questions remain,

8 including how to satisfy current State and Federal requirements.”

9

D. Defendants’ Systemic Understaffing Creates Additional Safety

Risks and Undermines Delivery of Necessary Care and Programs.

10

11

34. The Jail has for years been extremely understaffed with respect to

12 custodial and clinical staff, which has a severely negative impact on prisoner health

13 and safety.

14

35. Two separate staffing studies conducted at the Jail in recent years

15 identified the need for substantial increases in staffing, noting that understaffing

16 poses significant dangers to both prisoners and staff. A 2013 Santa Barbara

17 County Sheriff’s Office Jail Staffing Assessment completed by Crout & Sida

18 Criminal Justice Consultants, Inc. found significant issues related to the Jail’s

19 staffing.

20

36. The Crout & Sida report found that understaffing due to insufficient

21 funding had become a serious problem, noting that “[w]hen we reduce staffing of

22 the jail in response to economic needs, there comes a tipping point where the jail

23 becomes a dangerous place for both staff and inmates. We believe that if the Santa

24 Barbara jail system has not already reached this point, it is very close.”

25

37. Almost three years later, a 2015-2016 Grand Jury found that the Jail

26 remained “understaffed, underfunded, and not well designed to carry out all of

27 their required responsibilities.” The Sheriff’s Office 2015 Triennial Report

28 described a “critical shortage of trained staff” at the Jail, and reliance on
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1 mandatory overtime to maintain basic Jail operations. And in 2017, the Grand Jury

2 found in its report on Detention Facilities in Santa Barbara County that the Jail

3 was “45 custody officers short” of the staffing level “considered adequate for the

4 current inmate population.” The Santa Barbara County Deputy Sheriffs’

5 Association has been seeking an increase to minimum staffing at the Jail for years,

6 noting safety concerns and the “excessive workload” for custody staff.

7

38. Health care staffing, as detailed below, also remains insufficient to

8 deliver adequate care to the Jail population, resulting in delays in treatment, denials

9 of treatment, and treatment that does not meet modern standards of care.

10 II. DEFENDANTS FAIL TO PROVIDE ADEQUATE HEALTH CARE

TO PRISONERS.
11

39. Defendants have a policy and practice of failing to provide adequate

12

health care, including mental health care, medical care, and dental care, to

13

prisoners in the Jail.

14

40. Defendants have a policy and practice of inadequately screening for

15

serious health care conditions and disabilities, delaying access to clinicians and

16

medications, understaffing health care professionals, delaying or denying access to

17

specialty care, and failing to provide health services necessary to meet minimum

18

standards of care. Defendants have been deliberately indifferent to the risk of harm

19

caused by these deficiencies.

20

41. There have been at least ten (10) deaths of individuals detained at the

21

Jail since 2011, including two (2) suicides and eight (8) deaths stemming from

22

serious medical conditions, many of which raise concerns about adequacy of care.

23

A. Defendants Fail to Maintain Sufficient Numbers of Health Care

24

Professionals and Custody Staff to Deliver Adequate Care.

25
42. The current level of staffing at the Jail is insufficient to deliver
26
constitutionally adequate and timely health care to prisoners.
27

28
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1

43. Defendants fail to maintain sufficient numbers of medical care

2 professionals to provide minimally adequate care. The number of nurses on staff is

3 below the Jail’s stated plan and does not meet minimum standards. The Jail’s

4 physician staffing is only a 0.4 Full-Time Equivalent (FTE) position (or 16 hours

5 per week), with a physician on-site only three days per week. This is inadequate

6 given the size and health needs of the Jail’s population and creates serious risks to

7 patient health. In addition, the current Jail physician is not board certified in

8 internal medicine, family medicine, or emergency medicine. The understaffing of

9 medical providers causes dangerous delays in the delivery of care.

10

44. Defendants also fail to maintain sufficient numbers of mental health

11 care professionals to provide minimally adequate treatment to the population of

12 prisoners with serious mental illness. Currently, there is no psychiatrist regularly

13 on site at the Jail. This results in long and unnecessary delays in treatment. Nor do

14 Defendants employ an on-site mental health coordinator to ensure that mental

15 health care operations are adequate.

16

45. Current mental health care staffing at the Jail, though increased since

17 Corizon served as the contracted health care provider, remains insufficient to

18 perform all necessary functions in a timely fashion, including screening and

19 assessment, crisis services, treatment programming, sick call requests, needs

20 assessments and discharge planning, treatment planning, and monitoring and

21 counseling of suicidal prisoners.

22

46. Defendants have failed to undertake a comprehensive analysis to

23 determine actual health care staffing needs, and whether the contracted number of

24 positions is adequate, preventing them from working productively towards an

25 adequate system.

26

47. There is currently only one discharge planner on staff to assist

27 prisoners preparing for release. Upon information and belief, Defendants release

28 prisoners with serious health conditions from the Jail without providing them with
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1 adequate referrals, resources, or linkages to community services to ensure that their

2 medical care is not disrupted. In many cases, prisoners must specifically request

3 discharge planning assistance, meaning that individuals who are too sick or who do

4 not have the ability to make a request are unlikely to receive such assistance.

5

48. Custody staffing shortages further contribute to deficiencies in health

6 care delivery at the Jail. For example, each time a prisoner must be transported to

7 or from a housing unit to a health care appointment, at least one deputy must

8 accompany the prisoner. Prisoners are unable to get to, and often miss, scheduled

9 health care appointments due to an insufficient number of custody staff.

10

B. Defendants Fail to Maintain Adequate, Accurate, and Complete

Health Care Records.

11

12

49. Defendants have a policy and practice of failing to maintain accurate,

13 complete, and organized health care records. This lack of appropriate record-

14 keeping has a severely detrimental effect on patient care, creating a substantial risk

15 of misdiagnosis, dangerous mistakes, and unnecessary delays in care.

16

50. Defendants and their contracted provider maintain health care records

17 using an unorganized, inefficient paper system. When health history or other

18 information is needed during a health care appointment, staff must manually

19 retrieve health care records stored in paper form in the medical unit, if they can be

20 accessed at all.

21

51. Defendants fail to maintain health care records in a way that allows

22 providers to find essential information about their patients. The 2016 Grand Jury

23 found significant deficiencies in Defendants’ Jail Management System, noting that

24 the paper system was “antiquated” and that “information is frequently limited and

25 insufficient to medically evaluate inmates with major medical issues.” 2016 Grand

26 Jury Report at 4. The County’s Jail grievance oversight coordinator discussed in a

27 2016 annual report “the substantial need for an electronic medical records system”

28 at the Jail (emphasis in original). Grievance Review, 2016 Annual Report at 2.
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1

52. The paper-based health care records maintained by Defendants are

2 inadequate in a number of ways. The documentation of clinical visits by prisoners

3 is often brief and incomplete. There is little or no documentation by health care

4 staff regarding clinical contacts, lab or test results, or treatment plans.

5

53. Upon information and belief, key lab results are often filed without

6 acknowledgement by the physician or nurse practitioner, and without indication

7 that the results were provided to or discussed with the patient.

8

54. Upon information and belief, Defendants also have a policy or

9 practice of denying people copies of their own jail health care records, in violation

10 of 45 C.F.R. § 164.524.

11

C. Defendants Violate Prisoners’ Patient Confidentiality Rights.

12

55. Health care contacts typically occur in non-confidential spaces in the

13 Jail housing units. Clinical contacts often occur at cell-front, within earshot of

14 custody staff and other prisoners. There is no confidential treatment space

15 available for mental health staff to use when they meet with patients. Plaintiffs

16 TRACY, and BROWN are forced to attend telepsychiatry appointments in a small

17 room with custody staff present. Such practices violate patients’ confidentiality

18 rights and undermines delivery of care. Prisoners are understandably reluctant to

19 disclose personal health information in front of others, which may result in

20 stigmatization and abuse. For example, Plaintiffs FRANCO, TRACY, and

21 BROWN are not comfortable disclosing their mental health history and symptoms

22 to Jail clinicians with custody staff and other prisoners present to hear their

23 conversation.

24

56. Upon information and belief, when prisoners put in a sick call slip

25 describing a health care concern, the slips are collected by custody staff without

26 any method to protect privacy, and health care requests are often reviewed by non-

27 health care staff, a further violation of prisoners’ privacy rights.

28
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D. Defendants Routinely and Systematically Fail to Supervise the

1

Delivery of Health Care, and Lack Institutional Policies and

Procedures to Correct Deficiencies and Ensure Adequate Care.

2

3

57. Defendants’ system fails to adequately review, document, or correct

4 deficiencies in the delivery of care. The process for review of in-custody deaths or

5 critical incidents, to identify problems and determine if changes should be made to

6 the health care delivery system, is inadequate. Thus, Defendants do not take

7 necessary steps to avoid similar treatment system failures, and the consequent risks

8 to human life, in the future.

9

58. Defendants failed to provide adequate monitoring of the former health

10 care contractor, Corizon. The 2016 Grand Jury found that Defendants did not

11 provide adequate oversight of Corizon. 2016 Grand Jury Report at 1. The 2017

12 Grand Jury again found that the “Santa Barbara County Sheriff’s Office did not

13 conduct performance reviews of the medical service provider,” an essential process

14 to ensure that prisoners receive adequate care and that the County is getting the

15 services it has paid for.

16

E. Defendants Oversaw a Deeply Flawed Transition from Corizon to

CFMG as the Contracted Health Care Provider.

17

18

59. After years of contracting with Corizon to provide medical and mental

19 health care at the Jail, it became clear that Corizon’s performance was abysmal. In

20 2015, the County Board of Supervisors noted that Corizon was providing no

21 performance data and could not show whether prisoners with health care needs

22 were seen in a timely manner or given appropriate medications. Yet Defendants

23 extended the Corizon contract.

24

60. Finally, in or about April 2017, Defendants changed their contracted

25 health care provider from Corizon to CFMG. This transition was deeply flawed

26 and caused several failures with respect to the delivery and continuity of care for

27 prisoners with serious treatment needs. This flawed transition is a reflection of the

28
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1 County’s failure to properly monitor contract compliance by the for-profit vendor,

2 as described above.

3

61. Upon information and belief, as Corizon’s contract with the County

4 came to an end, Corizon staff sent paper clinical tracking logs and other critically

5 important patient documentation to Corizon’s national headquarters in Tennessee.

6 These paper records were thus not available to CFMG administrators and staff

7 when they assumed the role as the County’s health care contractor, meaning that

8 there was insufficient information about patients’ current medications, diagnosis,

9 and treatment needs.

10

62. Upon information and belief, Corizon staff did not file loose paper

11 health care records for the last several months of the contract. Instead, these hard

12 copy records were stored in numerous boxes, with no apparent system of

13 organization. It regularly took hours to locate individual patient charts, if staff were

14 able to find them at all. Clinical staff often saw patients without records available

15 to them, resulting in time inefficiencies because of the need to repeat historical

16 health diagnostic questioning and in missed identification of prior treatment. Upon

17 information and belief, Corizon created new charts for each individual entering the

18 Jail each year, ignoring files created for people when they were previously

19 incarcerated. This practice resulted in failures to track past diagnoses, treatment

20 needs, and other essential medical information, compromising patient care.

21

63. Upon information and belief, during the transition from Corizon to

22 CFMG, prescriptions for patients were abruptly changed, allowed to lapse, or

23 discontinued altogether without consultation with the patient, thereby

24 compromising care. A system-wide termination of Gabapentin (a drug used to treat

25 several patients with seizure disorders and neurological conditions), without

26 appropriate clinical consultation, individualized review of patients, or alternative

27 treatment planning, is one example of the dangerous breaks in treatment that

28 Plaintiff MURRAY and others experienced.
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1

64. Several months after the transition to the new contracted health care

2 provider, Defendants do not have health care policies and procedures that are

3 specific to Santa Barbara County Jail’s system. Rather, the only policies and

4 procedures that exist are the property of the contractor, formerly Corizon, and now

5 CFMG. Defendants’ provision of health care is guided by generic CFMG policies

6 that are not site-specific and remain only in draft form. This makes it significantly

7 more difficult for Defendants to ensure that adequate health care is provided.

8

F. Defendants’ Medical Care Delivery System Is Inadequate.

9

1. Defendants Fail to Provide Adequate Intake Screening to

Identify and Address Prisoners’ Medical Care Problems.

10

11

65. Defendants’ intake process fails to adequately identify and treat the

12 health care problems of newly arriving prisoners. The County’s medical consultant

13 found multiple prisoners housed at the Jail for two weeks or more with no medical

14 screening at all. For example, Defendants failed to complete an initial medical

15 intake assessment for Plaintiff MURRAY until a month after he arrived at the Jail.

16

66. A 2016 Grand Jury report documented findings of inconsistencies in

17 the intake screening process that resulted in failures to determine if an arrestee has

18 major medical concerns.

19

67. Screening failures have had serious and even fatal consequences. Joel

20 Huerta died hours after being booked at the Jail on August 4, 2016, following

21 delays in the provision of obviously and critically needed medical treatment. On

22 information and belief, an emergency crew responded to a call in the community

23 reporting that Mr. Huerta expressed to a neighbor that he was having difficulty

24 breathing and requested medical help. Law enforcement instead arrested Mr.

25 Huerta on suspicion of public intoxication, placing him in restraints due to his level

26 of impairment. At the Jail, Mr. Huerta was unable to respond to medical staff

27 questions. Instead of summoning medical care or transporting him to a hospital,

28 staff placed Mr. Huerta in an observation cell. He became unresponsive while in
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1 the observation cell, and died soon thereafter.

2

2. Defendants Fail to Provide Adequate Facilities to House

Individuals with Medical Needs or to Provide Medical

3

Care.

4

68. The Jail’s facilities are inadequate to provide appropriate housing and

5 care to prisoners with serious medical needs.

6

69. For example, prisoners with medical conditions are typically housed

7 in the “South Dorm,” which is filled with metal bunk beds, a few tables, and little

8 more. There is nothing “medical” about this housing unit. The South Dorm is one

9 of the filthiest, most unsanitary housing units in the Jail. A 2015-2016 Santa

10 Barbara County Grand Jury raised concerns about the “disarray” of this unit.

11 Prisoners with chronic medical conditions and physical disabilities (including

12 several wheelchair users) are crowded into this unit. There are regularly not

13 enough beds, particularly given that many of the men in this unit have disabilities

14 that make it dangerous or impossible to reach an upper bunk. Prisoners in the unit

15 regularly sleep in the plastic “boat” structures that sit directly on the floor.

16

17

18

19

20

21

22

23

24

25

26

27

Photo: The “Medical Dorm,” with prisoners sleeping on floor

28
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1

70. There is no designated medical unit for women who require a higher

2 level of care. Such women are placed in crowded housing units that are not

3 equipped to meet their needs.

4

71. The physical spaces in the Jail used for medical treatment are not

5 sufficient for the population of prisoners. The Jail lacks an adequate centralized

6 clinic space, and therefore treatment areas are dispersed throughout the facility,

7 impacting efficiency of care and requiring additional custody officers for transport.

8 There is inadequate office space to support existing or necessary medical staff, and

9 inadequate space to store medical supplies.

10

72. The physical structure of the Jail prevents adequate supervision in

11 case of a medical emergency. Several areas have insufficient monitoring

12 equipment and staff supervision. In some Main Jail units, for example, existing

13 cameras monitor only the hallways and not the housing units themselves. Staff are

14 located in spots where they cannot see or hear housing areas, and there are

15 substantial periods of time when there are no staff present in or near these housing

16 areas. These deficiencies create a serious risk to prisoners in the event of a medical

17 emergency. In one case, numerous female prisoners were forced to yell down the

18 tier of dorms while a woman experienced a medical emergency, with severe

19 vomiting, diarrhea, and an inability to support her own weight. Upon information

20 and belief, it took nearly 20 minutes for staff to respond.

21

3. Defendants Subject Prisoners to Dangerous Delays And

Denials of Clinically Necessary Medical Treatment.

22

23

73. Defendants often delay, or deny entirely, clinically necessary medical

24 care, causing unnecessary pain and suffering, as well as risks of death, for

25 prisoners at the Jail. Defendants’ system fails to provide timely access to medical

26 evaluation and treatment from nursing staff, facility doctors, and outside specialty

27 care providers.

28
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1

74. Many prisoners wait an unacceptably long time to see appropriate

2 health care staff after submitting a sick call slip. Such delays have serious and

3 damaging consequences.

4

75. For example, Defendants failed to provide necessary medical care to

5 Plaintiff TRACY. Plaintiff TRACY arrived at the Jail a few days after receiving

6 treatment at Cottage Hospital for an eye infection. The hospital prescribed

7 medicated eye drops and directed her to see an ophthalmologist. Plaintiff TRACY

8 notified Jail staff of her condition and prescribed treatment in multiple health care

9 requests, writing that “the whole right side of my face is numb” and “Please see me

10 ASAP.” Defendants failed to provide the necessary ophthalmologist assessment or

11 treatment for seven (7) days. By then, her condition had worsened significantly,

12 and she required a four-day admission back at Cottage Hospital. With the denial of

13 treatment at the Jail, she lost vision in her right eye and hearing in her right ear,

14 and the infection had spread to her left eye.

15

76. The delays and denials of treatment have had other tragic results.

16 Raymond Herrera, a 52 year old local painter and father, died in June 2015, while

17 serving a 10-day sentence at the Jail. Mr. Herrera suffered from a seizure disorder.

18 Jail staff failed to provide him his anti-seizure medications. After days of not being

19 provided his medication, Mr. Herrera experienced a seizure that resulted in severe

20 physical trauma, including damage to his spleen. Fellow prisoners called for

21 emergency medical attention after witnessing Mr. Herrera fall. He was handcuffed

22 before being transported to the hospital. He died soon thereafter, having suffered

23 multiple serious ruptures in his spleen.

24

77. Defendants also fail to provide timely and adequate dental care.

25 Defendants’ own grievance oversight coordinator reported in 2016 the reoccurring

26 issue of limited access to dental care, which caused delays in the delivery of

27 treatment.

28
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1

78. For example, Defendants denied timely and adequate dental care to

2 Plaintiff WINKLE, resulting in months of extreme pain. At the time of her arrival

3 at the Jail in June 2017, Plaintiff WINKLE informed Jail Staff that she had a tooth

4 that was causing her great pain and needed attention. Defendants noted that she

5 had a cavity but did not take steps to provide necessary treatment. Plaintiff

6 WINKLE submitted multiple written requests for dental care, emphasizing the pain

7 she was experiencing, such as: “URGENT. My wisdom tooth on my right upper

8 side is breaking [through] & doesn’t have enough room. It’s cutting the inside of

9 my cheek. Extremely swollen & painful. Please help ASAP.” Defendants did not

10 provide treatment for nearly four months, until October when they extracted her

11 tooth after noting “massive … decay.”

12

79. The primary method for people to request health care at the Jail is to

13 submit a “sick call” slip or grievance form. Prisoners must request these forms

14 from custody staff. But, upon information and belief, custody staff often refuse to

15 provide the forms, or fail to deliver them to medical staff for review.

16

4. Defendants’ System of Chronic Disease Management is

Inadequate.

17

18

80. Defendants systematically fail to adequately manage chronic diseases

19 of prisoners. Management of chronic diseases such as asthma, diabetes, HIV, and

20 hypertension, among others, is ad hoc, incomplete, inconsistent, and reactive.

21 Upon information and belief, staff do not follow accepted clinical guidelines when

22 managing these conditions.

23

81. Defendants fail to maintain a comprehensive list of patients with

24 chronic care conditions. Patients with serious chronic conditions do not receive

25 treatment based on clinically accepted protocols.

26

82. Deficiencies in the Jail’s provision of diabetes care is a case in point.

27 Prisoners with diabetes often do not receive timely or consistent blood sugar

28 monitoring or Hemoglobin A1C testing (a standard measure of diabetic control).
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1 Many patients with diabetes are not permitted access to medications they had been

2 taking outside of jail. In some cases, patients are not provided prescribed insulin,

3 with life-threatening results. For example, Jonathan Kelly, a prisoner with Type I

4 insulin-dependent diabetes, faced serious failures with respect to his diabetes

5 management treatment regimen, resulting in dangerously high blood sugars (as

6 high as 500 mg/dl, approximately five times normal levels) for long periods of

7 time without adjustment to his insulin dosing or management plan. Failure to

8 manage hyperglycemia, as occurred here, leads to long-term damage, including

9 retinopathy, neuropathy, kidney damage, and cardiovascular disease.

10

83. There are also systemic deficiencies with respect to asthma care.

11 Prisoners with significant asthma histories are not evaluated by physicians unless

12 they present with an acute asthma attack. Keep-on-Person inhalers are restricted,

13 and prisoners must submit a request when they need to use an inhaler. These

14 practices create an increased risk of harm in situations where prisoners face

15 respiratory distress without access to an inhaler.

16

84. For example, on one occasion, Plaintiff MURRAY reported breathing

17 issues in the morning, but was not seen by medical staff for several hours, and was

18 not provided an albuterol inhaler. Instead, his condition worsened. Late that night,

19 another prisoner attempted to summon medical help over the intercom, stating that

20 Plaintiff MURRAY was “on the ground below his bunk having trouble breathing.”

21 He was only then provided with an inhaler treatment. Two days after this incident,

22 he was finally seen for follow-up by a health care provider, who diagnosed him

23 with a respiratory infection.

24

5. Defendants Fail to Provide Adequate Medication

Administration and Management.

25

26

85. Defendants have a policy and practice of failing to prescribe, provide,

27 and properly manage medications, and of providing incorrect, interrupted, or

28 incomplete dosages of medication.
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1

86. Defendants’ system does not consistently provide an adequate

2 evaluation before prescribing, changing, or discontinuing medications, and fails to

3 adequately monitor people on medications for side effects, drug interactions, and

4 effectiveness. For example, Defendants recently put a blanket, facility-wide stop

5 on the administration of Gabapentin, a prescription drug used to treat seizure

6 disorders and nerve damage, without consultation or individualized medical

7 justification. Several patients at the Jail, including Plaintiff MURRAY,

8 experienced withdrawal symptoms and panic about their health after their

9 medication was abruptly terminated without any discussion with a provider.

10

87. Defendants fail to appropriately monitor and address prisoners’

11 medication side effects. For example, on one occasion, Plaintiff MURRAY

12 complained of possible side effects to his pain medication, and nursing staff

13 observed him to be nauseous, cold, and shivering (all potential side effects of the

14 medication). He was not referred to a primary care provider, but rather continued

15 on the medication without meaningful follow-up.

16

88. Defendants have also run out of critical prescription medications at

17 the Jail. For example, in 2016, Defendants ran out of Lantus (long-acting) insulin

18 that had been prescribed to Jonathan Kelly, a prisoner with Type I, insulin-

19 dependent diabetes. Medical staff replaced it with a different kind of insulin that

20 has a different mechanism of action and requires different administration timing

21 and dosing. Yet medical staff continued the new insulin at the same dose as the

22 previous one, causing Mr. Kelly to experience extremely low blood sugars

23 (hypoglycemia), which can be life threatening. Mr. Kelly required transport to the

24 emergency room for treatment because of this medication administration failure.

25

89. Plaintiff MURRAY has been denied important medications, in some

26 cases for as long as five days, due to the Jail’s failure to maintain an appropriate

27 stock. For example, in May 2017, Plaintiff MURRAY was denied his prescription

28
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1 blood pressure medication because, according to a medical record notation, it was

2 “out of stock” at the Jail.

3

90. Prisoners who arrive at the Jail already taking a medication often do

4 not receive timely prescriptions or bridge orders to ensure continuity, even if it is

5 verified by the intake nurse.

6

6. Defendants Fail to Provide Necessary Assistance to

Prisoners with Daily Care or Skilled Nursing Needs.

7

8

91. There are many prisoners who have complex disabilities and medical

9 conditions, or who are elderly, and require skilled nursing assistance to address

10 their daily care needs. They may need assistance with daily care activities such as

11 using the toilet, showering, getting dressed, changing adult diapers, or changing

12 wound dressings. Staff fail to provide necessary assistance with such daily care

13 activities. Prisoners must instead rely on other prisoners to assist with basic daily

14 care needs, or forego such activities to the detriment of their health and well-being.

15

G. Defendants’ Mental Health Care Delivery System Is Inadequate.

16

1. Defendants Fail to Ensure that Prisoners with Mental

Health Treatment Needs Are Timely and Adequately

17

Identified, Tracked, and Treated.

18

92. Defendants have a policy and practice of failing to provide prisoners

19 with adequate mental health care, and are deliberately indifferent to the fact that

20 the systemic failure to do so results in significant injury and a substantial risk of

21 serious harm to prisoners, including death.

22

93. In 2011, Sheriff Brown told the Board of Supervisors in 2011, the Jail

23 has become the “de facto mental institution for the county.” Since then, the number

24 of prisoners with serious mental illness has only grown. There are approximately

25 200 prisoners identified as requiring psychiatric medication on any given day, and

26 additional individuals who require monitoring, counseling, and other services to

27 meet their mental health needs.

28
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1

94. Defendants have long been without an adequate tracking system for

2 prisoners with serious mental illness to ensure appropriate follow-up, placement,

3 and provision of treatment.

4

95. The Jail’s intake process is inadequate to ensure that prisoners with

5 serious mental illness are identified and receive appropriate care. For prisoners

6 who are unable to participate or who refuse the initial screening, there is

7 inadequate follow-up to ensure that their needs are identified. For newly-arrived

8 prisoners who are taking psychiatric medication, the Jail lacks an adequate

9 procedure to ensure timely verification and medication continuity. Prisoners have

10 had to wait up to 30 days or more to see a psychiatrist, resulting in breaks in

11 medication and insufficient monitoring.

12

96. For example, in July 2017, Defendants failed to continue Plaintiff

13 FRANCO’s psychiatric medications after documenting at intake that he was

14 hearing voices and that he had a history of psychiatric hospitalization. Plaintiff

15 FRANCO, who was taking psychiatric medications up until his arrest, was denied

16 treatment for approximately five (5) days. His condition worsened, with staff

17 documenting his reports that “I haven’t slept for like 4 days … I feel like my heart

18 is going to explode … I need something for this anxiety – it’s making me crazy.” A

19 few days later, Plaintiff FRANCO attempted suicide by cutting his wrist.

20

2. Defendants Fail to Identify, Treat, and Appropriately

Supervise Prisoners Who Are at Risk for Suicide.

21

22

97. Defendants fail to identify, treat, and supervise prisoners who are at

23 risk for suicide, with inadequate suicide prevention policies and practices. There

24 have been at least two (2) completed suicides since 2011, and many attempted

25 suicides during that same time period.

26

98. On October 16, 2016, Hector Higareda, a 38-year old man died after

27 hanging himself in an isolation cell at the Jail. Despite the well-known fact that a

28 disproportionately high number of suicides occur in isolation units, the Jail’s
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1 isolation cells have dangerous attachment points, including prominent metal rungs

2 on the bunks, which serve as a ligature for hanging attempts (as in Mr. Higareda’s

3 case). Defendants place prisoners known to be at risk of suicide in these dangerous

4 isolation units.

5

99. Defendants’ response to suicidal prisoners is extremely harsh and

6 damaging to individual’s psychological well-being. If Defendants identify an

7 individual to be at risk of suicide, staff force the individual to strip naked and to

8 put on a “safety smock,” a heavy single-piece outer garment that provides little

9 cover, and then lock the individual in a “safety cell.” There are four safety cells in

10 the facility. They have no furnishings, no windows for outside light, and no source

11 of water. There is only a door with a food slot and a grate in the floor that serves as

12 a toilet for feces and urine. Prisoners must sit, sleep, and eat on the same cold, dirty

13 floor in which the toilet grate is located. Prisoners receive no blanket or mattress.

14 These cells are filthy, with feces and dirt smeared on the walls. They often have

15 foul odors that make it difficult to breathe, given the lack of air circulation.

16

17 ///

18

19

20

21

22

23

24

25

26

27

28
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1

2

3

4

5

6

7

8

9

10

11

12

13

14

Photo: Inside a “Safety Cell”: View of cell with grate in floor

15

for person to use as a toilet

16

17

100. Prisoners have been left in these safety cells for hours and even days.

18 They are not provided with access to showers, telephones, outdoor recreation,

19 visitation, or any out-of-cell time. Contacts with mental health staff occur through

20 the food port in the metal door, without privacy. The Jail does not place a firm time

21 limit on how many days or weeks a prisoner can spend in a safety cell.

22

101. Defendants placed Plaintiff WINKLE in one of these safety cells for

23 more than four (4) consecutive days after she expressed thoughts about self-harm

24 and suicide. During that time period, she was stripped, placed in the heavy smock,

25 forced to sleep on the ground, and required to use the grate on the floor to urinate

26 and defecate.

27

102. A 2012 report by a Santa Barbara County correctional care consultant,

28 Health Management Associates, found that the Jail’s safety cells “should be
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1 eliminated. All concur that these sensory-deprivation cells will cause seriously

2 mentally ill to further decompensate.” Analysis of Inpatient Mental Health

3 Delivery Services for the County of Santa Barbara, October 2012, at 28-29. Yet

4 these same safety cells continue to exist today, with little to no changes. For many

5 prisoners at risk of suicide, the harsh conditions in these safety cells deter them

6 from reporting suicidal thoughts or psychiatric symptoms and seeking help, for

7 fear that they will be placed back in a safety cell and still not get the help they

8 need.

9

103. After returning from a safety cell to a housing unit, prisoners are not

10 provided clinically necessary mental health treatment to address their needs and

11 avoid decompensation or renewed suicidal ideation. Many prisoners who have

12 decompensated or become suicidal in a solitary confinement cell are returned to

13 the same isolation setting after spending time in a safety cell. Many individuals

14 cycle between solitary confinement and safety cells over and over again.

15

104. The Jail lacks a functional process for reviewing suicides and

16 attempted suicides, to identify systemic problems and to ensure that necessary

17 corrective action takes place. Defendants’ suicide prevention training for staff is

18 also inadequate. These deficiencies put the safety of all prisoners at serious risk.

19

3. Defendants Fail to Provide Adequate Facilities to Provide

20

Mental Health Care.

21

105. Despite the Sheriff’s statement that the Jail is the “de facto mental

22 institution for the county,” there is no mental health treatment unit in the Jail.

23 Prisoners with serious mental illness are generally housed in solitary confinement

24 units scattered throughout the facility. There is one dorm unit, called “South

25 Tank,” that houses approximately 15-20 prisoners with mental health needs. South

26 Tank is a severely cramped and dirty dorm setting with insufficient space for

27 meaningful treatment, socialization, or other activities.

28
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1

106. There is no designated unit at all for women with significant mental

2 health treatment needs. These women are generally housed in solitary confinement.

3

107. It is the established practice that mental health staff do not have access

4 to treatment space for confidential individual contacts or group therapy. Mental

5 health staff rarely, if ever, have access to treatment rooms used by medical staff in

6 order to meet confidentially with their patients. Nearly all mental health clinical

7 contacts occur in locations with many other people in the immediate area and with

8 limited or no visual or auditory privacy. Plaintiff TRACY, Plaintiff BROWN, and

9 other patients must attend telepsychiatry appointments in a small room with

10 custody staff present, preventing doctor-patient confidentiality. In the isolation

11 units, clinical contacts are exceedingly brief, and occur at cell-front through the

12 bars or solid doors. The lack of confidentiality compromises the delivery of care,

13 and deters many patients from seeking treatment or sharing private information.

14

108. The 2012 Health Management Associates report documented the

15 inadequacy of facilities for prisoners with mental illness. It recommended creation

16 of a mental health treatment and observation unit where prisoners with mental

17 illness would receive appropriate programming and supervision. Five years later,

18 this recommendation has not been implemented.

19

4. Defendants’ Mental Health Treatment Program Involves

20

Little More than Responding to Emergencies.

21

109. Defendants provide little to no treatment to prisoners with mental

22 health needs, even for those with acute or high-risk mental illness. Defendants do

23 not develop individualized treatment plans to prisoners with mental illness, in

24 violation of Section 1210 of Title 15 of the California Code of Regulations.

25

110. Correctional mental health standards dictate that prisoners with

26 serious mental illness should receive, at a minimum, ten (10) hours per week of

27 out-of-cell structured therapeutic group and individual programming and an

28
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1 additional ten (10) hours per week of out-of-cell recreational or other unstructured

2 time. Defendants do not come close to meeting this standard.

3

111. The only treatment program in the Jail is the recently initiated Project

4 BRACE (Breaking Recidivism and Creating Empowerment). Under Project

5 BRACE, a local organization meets periodically with a limited number of

6 prisoners with mental illness or substance abuse disorders. Many of the prisoners

7 with the most significant treatment needs are not permitted to participate in the

8 program. Jail mental health staff and administrators do not oversee or direct the

9 program. Outside BRACE providers and the in-house treatment providers do not

10 coordinate or share information about patients’ treatment planning and delivery.

11

112. Plaintiff MURRAY, who has an extensive history of post-traumatic

12 stress disorder and has reported to staff that he suffers from flashbacks,

13 nightmares, anxiety, and depression, has received no structured group or individual

14 therapy in the approximately three years he has been at the Jail. Defendants have

15 denied Plaintiff MURRAY the opportunity to participate in the BRACE program

16 because his medical conditions and disabilities require that he be housed in the

17 medical dorm, which the BRACE providers generally do not serve. Plaintiff

18 MURRAY requested treatment after his mental health condition worsened on a

19 number of occasions, with long delays in response from clinicians and a consistent

20 failure to monitor and follow up. Absent timely and appropriate care, his mental

21 health condition has worsened during his time in detention.

22

5. Defendants Fail to Provide Prisoners Access to Higher

Levels of Mental Health Care When Necessary.

23

24

113. The Jail does not have a mental health unit and lacks the staff, space,

25 and program to provide treatment to individuals with significant treatment needs.

26 Prisoners with mental health conditions are generally housed in the “South Tank”

27 dorm or in solitary confinement units; there is no therapeutic treatment unit in the

28 system, despite the considerable need within the prisoner population. If individuals
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1 decompensate to the point that they are suicidal or actively psychotic, essentially

2 the only option is to place individuals in the Jail’s barren safety cells.

3

114. Prisoners who require emergency or acute psychiatric care are

4 referred for evaluation for inpatient placement in the County’s 16-bed Psychiatric

5 Health Facility (PHF) that is up the street from the Jail. Historically, it has been

6 nearly impossible for a prisoner requiring an inpatient level of care to receive a

7 timely transfer – or any transfer at all – to the PHF. Following DRC’s 2016

8 investigation report, Defendants designated one PHF bed for prisoners requiring

9 inpatient care. But the practice has been inconsistent, and this single bed does not

10 meet the needs of the Jail population. Santa Barbara Undersheriff Bernard

11 Melekian has acknowledged the insufficient availability of inpatient psychiatric

12 treatment in the County, and the resulting placement of patients in non-therapeutic

13 jail settings. He has stated that “what we have is a facility that is absolutely

14 archaic” and acknowledged that the County jails people who need an inpatient

15 facility level of care.

16

115. Given the unavailability of inpatient psychiatric beds, prisoners who

17 are suicidal or actively psychotic are left in safety cells or isolation units at the Jail,

18 without an individualized treatment plan and without meaningful, clinically

19 necessary care.

20

116. In addition, there are many prisoners with serious mental illness who

21 have been deemed incompetent to stand trial and ordered to a California

22 Department of State Hospitals competency restoration treatment program. Such

23 individuals can wait for months to be transferred to a competency restoration

24 treatment program. During that time, they generally remain in safety cells or

25 isolation units, where their condition deteriorates without necessary treatment.

26

27

28
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6. Defendants Fail to Adequately Prescribe, Monitor, and

1

Evaluate the Provision of Psychiatric Medication.

2

3

117. Defendants fail to provide clinically necessary psychiatric

4 medications to prisoners with serious mental illness. Defendants’ policies and

5 practices for providing psychiatric medications to prisoners, and for monitoring

6 and treating the side effects or efficacy of medications, are inadequate.

7

118. As a result of Defendants’ failure, prisoners with mental illness suffer

8 withdrawal symptoms, recurrence of debilitating symptoms such as hallucinations

9 and suicidality, and decompensation to the point of not being competent to stand

10 trial in their criminal proceeding and/or requiring emergency or acute care.

11

119. Defendants fail to provide adequate medication management for

12 prisoners with mental illness. Prisoners have gone for weeks and months without

13 the psychiatric medications (or comparable medications) that they had been taking

14 prior to detention, resulting in decompensation.

15

120. Prisoners taking medication may wait for long periods for their

16 psychiatric prescriptions to be filled. It has been common for medications to take

17 several days or more to arrive at the Jail. The County’s Jail grievance oversight

18 coordinator identified that the lack of a full-time psychiatrist on site was an “on-

19 going issue creating delayed service delivery.” Q3 2016 Grievance Review at 2.

20

121. For example, Defendants’ failure to timely continue Plaintiff

21 FRANCO’s medication regimen when he arrived at the Jail led to his experiencing

22 increased hallucinations and suicidal thoughts, as described above. He attempted

23 suicide and was placed in a safety cell twice during his first two weeks at the Jail.

24

122. Defendants do not provide a comprehensive evaluation or consultation

25 before prescribing or changing psychiatric medications and fail to adequately

26 monitor side effects, drug interactions, and effectiveness. Medication dosages are

27 often changed abruptly or missed entirely without explanation.

28
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7. Defendants Discriminate Against and Unfairly Punish

1

Prisoners with Mental Illness.

2

123. Defendants discriminate against prisoners with serious mental illness

3 by isolating them from and denying them privileges granted to other prisoners.

4 Prisoners with serious mental illness are denied access to programs and services

5 because Defendants place them in the most restrictive settings in the system, a

6 violation of federal disability law, 28 C.F.R. § 35.152.

7

124. Defendants unfairly subject prisoners with mental health conditions to

8 discipline where the conduct at issue is a direct result of the individual’s (generally

9 untreated) mental health condition. Defendants lack a policy allowing mental

10 health input into disciplinary procedures for prisoners with serious mental illness.

11 The prevalence of individuals with serious mental illness in solitary confinement,

12 such as Plaintiff WINKLE, illustrate this systemic problem.

13

125. Defendants further fail to adequately train staff regarding how to

14 respond to prisoners with mental illness whose non-conforming behaviors stem

15 from their mental illness. Upon information and belief, when prisoners’ psychiatric

16 condition inhibits their ability to follow directions or interact with others, staff too

17 often fail to involve mental health professionals or to otherwise address the

18 underlying psychiatric needs, instead relying on disciplinary measures or referral

19 for additional criminal charges. Plaintiff WINKLE’s experience illustrates this

20 problems. Defendants have repeatedly placed Plaintiff WINKLE in solitary

21 confinement for long periods based on disciplinary infractions, including not being

22 prepared for linen exchange on laundry day and not properly wearing her shirt, as

23 well as verbal outbursts likely relate to her mental health condition. In late summer

24 2017, Defendants placed Plaintiff WINKLE in segregation housing for nearly a

25 month following one such incident. During that time, her mental health condition

26 deteriorated significantly – she experienced increased anxiety and multiple serious

27 panic attacks in the solitary confinement setting.

28
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H. Overcrowding at the Jail Contributes to a Significant Health

1

Crisis and Causes Additional Risks of Harm.

2

126. Because of overcrowding at the Jail, prisoners are housed in tightly

3 packed housing units and are forced into close contact with others. Such conditions

4 raise the risk of transmission of infectious diseases, including common respiratory

5 and gastrointestinal viruses, bacterial infections, scabies, or lice infestations, and

6 other serious conditions.

7

127. For example, a recent outbreak of Methicillin-resistant

8 Staphylococcus aureus (MRSA), a skin infection caused by drug-resistant bacteria

9 causing painful wounds and posing major health risks, was likely related to

10 overcrowding. Numerous patients in the South Dorm, where prisoners with serious

11 medical needs are clustered, have developed MRSA infections since being placed

12 in that unit.

13

128. Plaintiff WINKLE also developed an infection in a women’s housing

14 unit. She notified Defendants of a painful and swollen area on her neck, and

15 expressed concern that she had developed an infection through contact with

16 another prisoner in her unit. Medical staff failed to provide treatment for several

17 weeks, at which time they finally diagnosed it as a MRSA infection.

18

129. The overcrowding in the Jail also means that health care staff are

19 unable to timely see prisoners who require evaluation or treatment, an issue further

20 complicated by the problem of insufficient treatment space to deliver care.

21 III. DEFENDANTS ROUTINELY OVERUSE AND IMPROPERLY USE SOLITARY CONFINEMENT
22
130. Defendants have a policy and practice of overusing and improperly
23
using prolonged isolation in the Jail. On a given day, approximately 75 or more
24
prisoners are locked in small solitary confinement cells for 23 and even 24 hours
25
per day. These cells are prevalent throughout the Jail.
26

27

28
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1

131. Many isolation cells are windowless, dimly lit, filthy, and lack fresh

2 air. There are dozens of isolation cells located down dark, dead-end corridors,

3 outside of any staff sight line and inaudible to staff. The conditions in these cells

4 are defined by deprivation and extreme social isolation. Defendants place no

5 limitation on the amount of time a prisoner can spend in solitary confinement.

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

Photos: At Left: View inside an Isolation Cell

23

At Right: Dark corridor containing 6 windowless Isolation Cells

24

132. Placement in isolation housing at the Jail results in severe restriction

25 of movement for prisoners, particularly given the exceedingly small size of the

26 cells and the lack of access to a dayroom. Dozens of isolation cells are 60 square

27 feet or less, an area that includes an affixed bed, toilet, and water basin. These cells

28 were purportedly built pursuant to jail construction standards more than half a
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1 century old. They do not come close to meeting current American Correctional

2 Association standards, which require that cells like these provide at least 80 square

3 feet of total floor space.

4

133. Many solitary confinement cells are repurposed spaces that were

5 never intended to house prisoners – some were designed to serve as closets or

6 small storage areas, not to house human beings.

7

134. Prisoners in solitary confinement have strikingly little stimulation or

8 opportunity for meaningful social interaction. They are not permitted radios or

9 televisions to pass the time. By policy, prisoners in isolation units are permitted out

10 of their cells for recreation and exercise only three hours per week. Many do not

11 even receive that amount of time out of their cell. The Jail’s schedule provides that

12 these individuals receive out-of-cell time for recreation and exercise just two days

13 per week, meaning that they essentially spend five days per week confined entirely

14 to their isolation cell. Due to staffing shortages and other operational challenges,

15 many prisoners do not get out of their cells for days or weeks at a time.

16

135. The “yards” for prisoners in isolation units are exceedingly small and

17 inadequate, and do not provide meaningful opportunity for exercise or recreation.

18 ///

19 ///

20 ///

21 ///

22 ///

23 ///

24

25

26

27

28
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1

2

3

4

5

6

7

8

9

10

11

Photo: The small concrete “Yard” where prisoners in solitary confinement

12

receive 3 hours or less of out-of-cell time per week

13

136. These harsh isolation conditions affect both physical and mental health.

14 Plaintiff WINKLE suffered multiple panic attacks while housed for several weeks

15 in a solitary confinement cell.

16

137. The features of some isolation cells create an even more extreme sense

17 of isolation. One cell, called “South 20,” is located by itself down a long and

18 winding hallway behind an additional door. An individual can spend weeks or

19 months in this cell without any normal or meaningful interaction with another

20 person. Other cells are designed such that the prisoner is separated by two doors –

21 a locked, solid, essentially sound-proof metal door and a second locked door that is

22 barred. It is common for individuals with serious mental illness and actively

23 psychotic symptoms to be placed in ultra-isolation units, like the ISO-21 cell,

24 below.

25 ///

26 ///

27 ///

28

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1

2

3

4

5

6

7

8

9
Photos: The solid door and bars of Ultra-Isolation Cell “ISO-21”
10

11

138. The devastating effects of these conditions of extreme social isolation

12 and environmental deprivation are well known to Defendants. A vast body of

13 literature has documented the adverse mental health effects of isolation. Santa

14 Barbara County Jail prisoners are no exception. Even prisoners who have no

15 mental illness when first placed in isolation often experience a significant

16 deterioration in their mental health, developing symptoms such as paranoia,

17 anxiety, depression, and post-traumatic stress disorder.

18

139. Isolation is even more damaging to prisoners with a pre-existing

19 mental illness. For these prisoners, isolation poses a significant risk of exacerbation

20 of mental health symptoms, emotional trauma, self-harm, and suicide. Deprived of

21 the social interaction that is essential to keep them grounded in reality, many

22 prisoners with mental illness experience dangerous psychiatric deterioration. Yet

23 Defendants place numerous prisoners with serious mental illness in isolated,

24 solitary confinement settings not simply in spite of their psychiatric condition, but

25 because of their psychiatric condition. Even short stays in such conditions of

26 extreme isolation are likely to worsen prisoners’ mental health symptoms.

27

140. Defendants’ Northwest Isolation and “New East” Isolation units

28 specifically house numerous individuals who are suffering acute mental illness, in
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1 austere cells that are barren, often with only a metal bunk, a metal desk, a toilet,

2 and a thin blanket.

3

4

5

6

7

8

9

10

11

12

13
Photos: Prisoners in barren Isolation Cells at Santa Barbara County Jail
14

15

141. Defendants’ solitary confinement practices place people with

16 psychiatric disabilities and serious mental illness at grave risk of harm. According

17 to the American Psychiatric Association: “Prolonged segregation of adult inmates

18 with serious mental illness, with rare exceptions, should be avoided due to the

19 potential for harm to such inmates.” The National Commission on Correctional

20 Health Care has issued a position statement asserting that “mentally ill individuals

21 . . . should be excluded from solitary confinement of any duration.” The United

22 States Department of Justice issued a report on the use of restrictive housing in

23 2016, in which it states that “[g]enerally, inmates with serious mental illness (SMI)

24 should not be placed in restrictive housing.”

25

142. Defendants do not have policies and procedures to ameliorate the

26 serious risk of harm stemming from placing individuals with mental illness in

27 solitary confinement. Contrary to established correctional mental health standards,

28 mental health staff do not assess people with mental illness before placing them in
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1 solitary confinement to ensure that such a placement is not contraindicated or

2 otherwise dangerous. Defendants do not provide treatment or adequate out-of-cell

3 time to mitigate the negative effects of solitary confinement. Defendants do not

4 provide any established criteria or programming to transition prisoners out of

5 solitary confinement.

6

143. Upon information and belief, Defendants do not conduct sufficient

7 mental health, medical, or custody welfare checks of those in solitary confinement,

8 to ensure that the prisoners in these units are safe and to timely identify psychiatric

9 or medical emergencies. Defendants do not sufficiently monitor prisoners in

10 isolation settings to identify any signs of decompensation or new onset of

11 symptoms. Many isolation cells lack an in-cell emergency call button, placing the

12 occupants at high risk should there be a medical emergency.

13

144. Defendants’ policy and procedures allows and in fact encourage the

14 isolation of prisoners with mental illness. Defendants knowingly hold prisoners

15 that they know have mental illness in isolation for extended periods of time.

16

145. In 2011, Juan Rodriguez- Zepeda, a 29-year-old prisoner with mental

17 health needs died in an isolation cell, having been housed in solitary confinement for

18 more than one month at the time of his death. He had made numerous requests for

19 medical attention and expressed fear for his safety. A Santa Barbara County Grand

20 Jury found that the man had been dead for several hours by the time paramedics

21 arrived, and his body was in rigor mortis. The 2011-2012 Grand Jury identified several

22 deficiencies related to this case. It found that the Jail’s isolation cells, which were

23 designed and built under 1963 construction standards, contained hidden alcove

24 areas that prevented visibility into the cell. This layout impedes staff from

25 monitoring whether an inmate is alive or in need of medical attention. The Grand

26 Jury recommended steps be taken to address the lack-of-visibility problem in these

27 cells. In its response, the Sheriff’s Office agreed with the Grand Jury’s finding but

28 declined to implement the recommendation.
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1

146. The harm to prisoners in isolation is worsened by Defendants’ policy

2 and practice of failing to provide adequate mental health care staffing and

3 treatment, as detailed above. Prisoners in isolation do not receive regular and

4 meaningful contact with psychiatrists or mental health clinicians.

5

147. Attempts to commit suicide remain frighteningly common in the

6 solitary confinement units at the Jail. During the five-month period between

7 September 2016 and January 2017, at least twelve (12) prisoners attempted suicide

8 inside an isolation cell, more than one every two weeks, including the case of Mr.

9 Higareda, who died as a result, as discussed above.

10 IV. DEFENDANTS DISCRIMINATE AGAINST AND FAIL TO ACCOMMODATE PEOPLE WITH DISABILITIES.
11
148. Defendants incarcerate significant numbers of individuals with
12
disabilities, as that term is defined in the ADA, the Rehabilitation Act, and
13
California State law. Defendants fail to provide prisoners with disabilities with
14
reasonable accommodations to ensure equivalent access to all of the programs,
15
activities, and services offered at the Jail. Defendants’ system discriminates against
16
people with disabilities with respect to classification, housing, access to programs
17
and services, and physical access barriers. Defendants systematically fail to
18
evaluate the needs of people with disabilities and fail to meet those needs through
19
appropriate accommodations.
20
149. Defendants have failed to create and implement adequate policies and
21
procedures to ensure the rights of prisoners with disabilities to reasonable
22
accommodations and equal access. Existing disability-related policy is incomplete
23
and insufficient to ensure that all staff are aware of the required procedures and
24
responsibilities. Numerous custody, operational, and health care policies and
25
procedures lack sufficient guidance with respect to their application to prisoners
26
with disabilities.
27

28
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1

150. Defendants have not provided adequate training to correctional staff

2 to prevent discrimination against people with disabilities, and to ensure that each

3 prisoner with a disability has appropriate accommodations and access to programs,

4 services, and activities at the Jail.

5

A. Defendants Lack Adequate Policies and Practices to Identify and

Track Prisoners with Disabilities.

6

7

151. Defendants do not have an effective or automated system to identify

8 and track the accommodation and other needs of persons with disabilities, or to

9 ensure that reasonable accommodations are provided. The existing manual system

10 frequently fails to capture, substantiate, and address important disability

11 accommodation and accessibility needs.

12

152. The lack of an effective tracking system results in substantial risk of

13 injury and actual injuries to prisoners with disabilities, and results in them being

14 denied the benefit of programs, services, and activities at the Jail.

15

B. Defendants Place Prisoners with Disabilities in More Restrictive

Settings and Deny Them Meaningful Access to Jail Programs,

16

Services, and Activities.

17
153. Individuals with disabilities end up in higher security, more restrictive
18
housing units and are denied access to several programs, services, and activities
19
because of their disability status, in violation of federal law.
20
154. Defendants’ policy and practice of denying prisoners with physical or
21
psychiatric disabilities the opportunity to be housed or participate in programming
22
at the Medium Security Facility is an example. The Medium Security Facility has
23
many unique benefits, including the most freedom, access to an outdoor exercise
24
area, and access to a library. It is also the housing unit for prisoners who receive
25
job assignments at the Jail. As Defendants describe in their policy, the Medium
26
Security Facility offers “several educational and self-enhancement programs,”
27
which “allow inmates to improve themselves, learn vocational and life skills, and
28
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1 serve the community.” But Defendants do not permit prisoners with disabilities to

2 be housed or participate in programs in the Medium Security Facility.

3

155. Prisoners with disability needs are segregated based on their

4 disabilities. Although there are no functional medical or mental health treatment

5 units, prisoners who have mobility disabilities are routinely segregated in the South

6 “Medical” Dorm and prisoners with mental illness are either segregated into the

7 South “Mental Health” Tank or solitary confinement units. There is no meaningful

8 clinical reason for these placements.

9

156. These individuals are then denied access to programs, outdoor

10 recreational time, and other activities that are available to other prisoners in the

11 Jail, including at the Medium Security Facility. Such placement of individuals with

12 disabilities in units more restrictive than necessary, and the exclusion of such

13 individuals in services, programs, or activities, violates federal disability law. See

14 28 C.F.R. § 35.152(b)(1). Plaintiff MURRAY, Plaintiff FRANCO, Plaintiff

15 BROWN, and others have been denied the opportunity to participate in programs

16 offered only at the Medium Security Facility because of their disability, medical,

17 and mental health conditions.

18

157. Plaintiff MURRAY has requested the opportunity to participate in

19 structured programming and activities that take place in the classroom area in the

20 Jail’s basement. Defendants have denied his request based on his placement in the

21 South Dorm medical unit, indicating to him that prisoners in this unit are not

22 permitted to participate in such programs.

23

C. Defendants Fail to Provide Reasonable Accommodations to

Prisoners Who Need Them.

24

25

158. Defendants do not timely or consistently provide reasonable

26 accommodations to prisoners with disabilities, including but not limited to

27 wheelchairs, walkers, crutches, canes, braces, and hearing aids, to people who

28 require them, if they ever provide them at all.
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1

159. Additionally, the provision of a reasonable accommodation, even if

2 initially provided, is often taken away based on Defendants’ operational failures.

3 Defendants have taken mobility assistive devices away from individuals who

4 require them. For example, Defendants confiscated Plaintiff MURRAY’s

5 wheelchair for an extended period when he was housed in an isolation cell.

6 Without his wheelchair, he was unable to reach the shower area from his cell.

7 Plaintiff MURRAY could not shower for several days, even as he repeatedly

8 requested that his wheelchair be returned to him. For other prisoners, Defendants

9 have taken away their mobility assistive devices when they are transported to court

10 or another outside facility, putting them at risk of falling. When they return to the

11 Jail, Defendants often fail to return the devices. In some cases, it has taken several

12 days for prisoners with significant mobility disabilities to get their device returned

13 to them, during which time they struggle to get around to the shower, toilet, meals,

14 and other daily activities.

15

160. Presently, none of the cells in the Jail meets ADA accessibility

16 standards, and there are significant physical accessibility deficiencies throughout

17 all housing units. Defendants’ housing units are filled with bunks, telephones,

18 toilets, and shower facilities that are not ADA-compliant and are not accessible to

19 individuals with disabilities. Plaintiff BROWN and other prisoners with mobility

20 disabilities have had great difficulty using the toilets and showers at the Jail.

21

161. The lack of accessibility for prisoners with disabilities reaches nearly

22 all aspects of the Jail. For example, Plaintiff MURRAY, who requires a wheelchair

23 to get around safely, cannot access confidential attorney visiting booths in his

24 wheelchair because the booths do not accommodate a wheelchair. Plaintiff

25 MURRAY has had to collapse his wheelchair and hobble on his own into an

26 inaccessible seat to meet with his legal counsel. Plaintiff BROWN is regularly

27 placed in holding cells that are not wide enough to fit his wheelchair, requiring him

28 to hobble into those cells on his own. Plaintiff BROWN has had difficulty getting
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1 safely on and off the bus transporting prisoners to and from court based on

2 accessibility barriers.

3

162. Physical plant deficiencies even extend to the South Dorm, where

4 medically infirm and mobility-limited men are housed. In the South Dorm, the

5 shower, toilet, and wash areas do not meet accessibility requirements, and there are

6 path of travel barriers and other deficiencies that impede access for many

7 individuals with mobility disabilities. For example, Plaintiff MURRAY has been

8 required to use showers and toilets that lack grab bars and other features necessary

9 for accessibility. Plaintiff MURRAY, and other prisoners with disabilities, have

10 fallen and suffered physical injury and humiliation because they were forced to use

11 the Jail’s inaccessible facilities.

12

163. As a result of overcrowding at the Jail and the resulting lack of beds,

13 many prisoners with disabilities have been among those individuals forced to sleep

14 on the floor. Until recently, Defendants lacked any process to assign prisoners with

15 disabilities lower bunks. When these individuals are assigned a top bunk, they have

16 no choice but to sleep on the floor. Plaintiff MURRAY was forced to sleep on the

17 floor for several days, despite his having a degenerative back disease, spinal

18 arthritis, and peripheral neuropathy.

19

164. Even now, Defendants assign individuals with disabilities to

20 inaccessible or inappropriate beds. Plaintiff WINKLE, who has a seizure disorder,

21 was recently assigned to an isolation cell with only a high bunk, putting her at

22 significant risk of a dangerous fall from the upper bunk during a seizure.

23

165. Defendants use bunk beds in the crowded South Dorm “medical unit,”

24 even though a large number of the prisoners in the unit have disabilities and

25 medical conditions that make an upper bunk placement unsafe and inappropriate.

26 Defendants fail to provide many of these individuals a lower bunk bed. Many end

27 up sleeping on the floor.

28
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1

166. Often, there are simply not enough beds in units housing people with

2 disabilities and serious medical conditions. The “No Bunk Available (NBA)”

3 reports submitted to the superior court as recently as July and August 2017 indicate

4 that Defendants have failed to provide a bed to as many as ten (10) prisoners

5 housed in the South Dorm “medical unit” on a given day. Several of these

6 medically fragile individuals went without a bed for more than 48 hours. Plaintiff

7 BROWN, who has a mobility disability and chronic back pain, and uses a

8 wheelchair to get around, was assigned to sleep on the floor at least twice in May

9 2017 – once for two (2) days and then again for five (5) days. During that time, he

10 reported to Jail staff that he was experiencing increased pain, and he refused to eat

11 in protest of the denial of treatment and poor conditions.

12

167. Holding, sobering, and safety cells also lack accommodations for

13 prisoners with disabilities. Holding and sobering cells lack grab bars to allow

14 prisoners with disabilities to access the sink and toilet. Prisoners with mobility

15 disabilities who are in psychiatric crisis have their wheelchairs or other assistive

16 devices confiscated when they are placed in the Jail’s safety cells, forcing them to

17 lie on the floor for hours or days at a time.

18

168. Upon information and belief, Defendants do not provide emergency

19 evacuation plans for people with disabilities, putting this group at serious risk of

20 harm in the event of an emergency at the Jail.

21

D. Defendants Fail to Accommodate Prisoners with Disabilities that

Affect Communication.

22

23

169. Prisoners with hearing, speech, or intellectual disabilities, mental

24 illness, and other conditions that impact communication have problems effectively

25 communicating. Such prisoners require accommodations to ensure effective

26 communication with staff and equal access to programs and services offered by

27 Defendants. Defendants fail to provide such accommodations, effectively denying

28 this group the benefits of programs, services, and activities at the Jail.
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1

170. For prisoners who are deaf, access to reasonable accommodations

2 related to telephone use is inadequate. By policy, the Jail’s TDD/TTY machine is

3 located only in the booking area, far from many of the housing units in the facility.

4 By policy, access to TDD/TTY equipment is furnished only when “reasonably

5 available accommodations can be made,” a significant issue given the custody staff

6 shortages that limit the availability of a custody escort to get the deaf prisoner to the

7 equipment. Upon information and belief, there is no access to video relay services or

8 videophone provided for prisoners who communicate through sign language, which

9 is inconsistent with modern correctional and disability access practices.

10

171. Upon information and belief, the intercom system allowing a prisoner

11 to communicate with staff in an emergency situation is inaccessible to prisoners

12 with disabilities. Many of these intercoms are in disrepair and do not work for

13 prisoners with limited hearing ability, and are located in places not accessible to

14 prisoners with mobility disabilities – for example, too high on the wall for a person

15 who uses a wheelchair to reach.

16

E. Defendants Lack an Effective Grievance Procedure for Prisoners

to Request Reasonable Disability Accommodations

17

18

172. Defendants do not provide an effective or functional grievance system

19 for prisoners with disabilities to ensure that needs are timely met. For example, the

20 existing grievance procedure does not provide for an expedited review process

21 when a prisoner with a disability is at risk of physical or other serious harm based

22 on a denial of an accommodation. Prisoners, particularly those housed in solitary

23 confinement, have great difficulty obtaining accommodation request or grievance

24 forms. Responses are often delayed or fail to address the problem.

25

26

27

28
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V. DEFENDANTS FORCE PRISONERS TO LIVE IN DANGEROUS,

1

UNSANITARY CONDITIONS.

2

173. Defendants’ policies and practices deprive prisoners of sanitary and

3 humane living conditions. Much of the Jail is significantly run-down, dilapidated,

4 and unsanitary.

5

174. Recently, two of three wash basins and one of the three toilets in

6 South Tank (which houses prisoners with mental illness) were not in working

7 order, and the sole shower was missing tiles and had a visible mold. In the South

8 Dorm (the “medical unit”), there was mold in the lavatory and shower area, and on

9 the walls of the wash basin area. Air vents were covered with caked dirt. Housing

10 units regularly exist in a filthy condition and with a foul smell, including the

11 isolation cells housing prisoners with serious mental illness.

12

175. The makeshift basement dorms have significant mold growing in the

13 ceiling and shower areas. The air quality and ventilation in these units is especially

14 poor and causes significant breathing problems, particularly for individuals with

15 asthma or other respiratory conditions.

16

176. In isolation units, toilets overflow, with feces and urine pouring onto

17 the cell floors. Lighting and ventilation in the West, East, and South isolation cells

18 are inadequate and enhance the deprivation and suffering of people in those units.

19

177. Defendants have allowed a widespread custom and practice of

20 maintaining unsanitary living conditions. The filth, mold, and other unsanitary

21 conditions cause a serious risk of harm to human health and daily suffering for

22 prisoners. Prisoners like Plaintiff WINKLE have contracted dangerous infections,

23 like MRSA, and other serious medical problems in these units.

24

178. Prisoners have taken it upon themselves to use their personal soap and

25 towels to clean their living areas. Prisoners’ grievances regarding these conditions

26 have been ignored, as staff tell them these issues are “not grieve-able.”

27

179. There are further severe deficits with respect to the provision of food

28 and nutrition to prisoners. Prisoners report receiving foul-tasting food. Defendants
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1 have a policy of punishing prisoners by denying them normal food and instead

2 serving them only a “disciplinary diet,” a tasteless and disgusting “meatloaf” with

3 two slices of bread, served twice daily for multiple consecutive days. Serving this

4 sort of disciplinary diet as punishment is banned in many jail and prison systems.

5

CLASS ACTION ALLEGATIONS

6 Prisoner Class

7

180. Plaintiffs bring this action on their own behalf and, pursuant to Rule

8 23(a), b(1), and (b)(2) of the Federal Rules of Civil Procedure, on behalf of all men

9 and women who are now or will in the future be incarcerated in the Santa Barbara

10 County Jail system (the “Prisoner Class”). All Prisoner Class members are subject

11 to an unreasonable risk of harm due to: Defendants’ policies and practices of

12 denying prisoners minimally adequate medical and mental health care; Defendants’

13 misuse and overuse of solitary confinement; and Defendants’ failure to maintain

14 safe and adequate conditions of confinement.

15

181. The Prisoner Class is so numerous that joinder of all members is

16 impracticable. Fed. R. Civ. P. 23(a)(1). There are approximately 1,000 prisoners in

17 Defendants’ custody. Due to Defendants’ policies and practices, all prisoners in the

18 Jail receive or are at risk of receiving harm due to Defendants’ harmful policies

19 and practices.

20

182. Prisoner Class members are identifiable using records maintained in

21 the ordinary course of business by Defendants.

22

183. There are questions of law and fact common to the class, including,

23 but not limited to, whether Defendants’ failure to provide minimally adequate

24 medical and mental health care, Defendants’ misuse and overuse of solitary

25 confinement, and Defendants’ failure to maintain safe and adequate conditions of

26 confinement, violate the Due Process Clause of the Fourteenth Amendment and the

27 Cruel and Unusual Punishment Clause of the Eighth Amendment to the United

28 States Constitution, and whether Defendants have been deliberately indifferent to
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1 the serious needs of class members and the serious risks of harm to class members.

2 Defendants are expected to raise common defenses to these claims, including

3 denying that their actions violated the law.

4

184. This action is maintainable as a class action pursuant to Fed. R. Civ.

5 P. 23(b)(1) since there are several thousand class members, separate actions by

6 individuals would in all likelihood result in inconsistent and varying decisions,

7 which in turn would result in conflicting and incompatible standards of conduct for

8 the Defendants.

9

185. This action is maintainable as a class action pursuant to Fed. R. Civ.

10 P. 23(b)(2) since Defendants have acted and failed to act on grounds that apply

11 generally to the class, so that final injunctive or corresponding declaratory relief is

12 appropriate respecting the class as a whole.

13

186. The claims of the named Plaintiffs are typical of the claims of the

14 class and subclass, since their claims arise from the same policies, practices, and

15 courses of conduct and their claims are based on the same theory of law as the

16 class’s claims. Fed. R. Civ. P. 23(a)(3).

17

187. The named Plaintiffs, through counsel, will fairly and adequately

18 protect the interests of the class. Fed. R. Civ. P. 23(a)(4). Plaintiffs do not have

19 any interests antagonistic to the class. Plaintiffs, as well as the class members, seek

20 to enjoin the unlawful acts and omissions of Defendants. Further, Plaintiffs are

21 represented by counsel experienced in civil rights litigation, prisoners’ rights

22 litigation, and complex class action litigation.

23 Disabilities Subclass

24

188. The named Plaintiffs further bring this action on their own behalf and,

25 pursuant to Rule 23(a), b(1), and (b)(2) of the Federal Rules of Civil Procedure, on

26 behalf of all qualified individuals with disabilities, as that term is defined in 42

27 U.S.C. § 12102, 29 U.S.C. § 705(9)(B), and California Government Code §

28 12926(j) and (m), who are now, or will be in the future incarcerated in the Jail
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1 (“Disabilities Subclass”). All prisoners with disabilities who are incarcerated in the

2 Jail are at risk of being discriminated against or denied access to programs,

3 services, and activities offered at the Jail as a result of the policies and practices of

4 Defendants.

5

189. The Disabilities Subclass is so numerous that joinder of all members

6 is impracticable. The exact number of members of the Disabilities Subclass is

7 unknown. According to data gathered by the United States Department of Justice’s

8 Bureau of Justice Statistics regarding the incidence of disabilities among

9 individuals in jails, approximately 40% of Jail prisoners have one or more

10 disabilities, suggesting an estimated 400 members of the Disabilities Subclass.

11

190. There are questions of law and fact common to the Disabilities

12 Subclass, including whether Defendants’ violated the Americans with Disabilities

13 Act, Section 504 of the Rehabilitation Act, and California Government Code §

14 11135.

15

191. Defendants have acted and failed to act on grounds that apply

16 generally to the Disabilities Subclass, so that final injunctive or corresponding

17 declaratory relief is appropriate respecting the Disabilities Subclass as a whole.

18

192. The claims of the named Plaintiffs are typical of the claims of the

19 Disabilities Subclass, since their claims arise from the same policies, practices, and

20 courses of conduct and his claims are based on the same theory of law as the

21 Disabilities Subclass’s claims.

22

193. Plaintiffs, through counsel, will fairly and adequately protect the

23 interests of the Disabilities Subclass. Plaintiffs do not have any interests

24 antagonistic to the Disabilities Subclass. Plaintiffs, as well as the Disabilities

25 Subclass members, seek to enjoin the unlawful acts and omissions of Defendants.

26 Further, Plaintiffs are represented by counsel experienced in civil rights litigation,

27 prisoners’ rights litigation, and complex class action litigation.

28
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1

CLAIMS FOR RELIEF

2

First Cause of Action

3

(Eighth Amendment; 42 U.S.C. § 1983)

4

194. Plaintiffs re-allege and incorporate by reference herein all allegations

5 previously made in paragraphs 1-193.

6

195. By their policies and practices described above, Defendants subject

7 Plaintiffs MURRAY, FRANCO, WINKLE, TRACY and BROWN and the

8 Prisoner Class to a substantial risk of serious harm and injury from inadequate

9 medical and mental health care and dangerous conditions of confinement. These

10 policies and practices have been and continue to be implemented by Defendants

11 and their agents or employees in their official capacities, and are the proximate

12 cause of Plaintiffs’ and the Prisoner Class’s ongoing deprivation of rights secured

13 by the United States Constitution under the Eighth Amendment.

14

196. Defendants have been and are aware of all the deprivations described

15 herein, and have condoned or been deliberately indifferent to such conduct, and

16 have failed to take reasonable steps to remedy the deprivations.

17

Second Cause of Action

18

(Fourteenth Amendment; 42 U.S.C. § 1983)

19

197. Plaintiffs re-allege and incorporate by reference herein all allegations

20 previously made in paragraphs 1-196.

21

198. By their policies and practices described above, Defendants subject

22 Plaintiffs MURRAY, FRANCO, WINKLE, TRACY and BROWN and the

23 Prisoner Class to a substantial risk of serious harm and injury from inadequate

24 medical and mental health care and dangerous conditions of confinement. These

25 policies and practices have been and continue to be implemented by Defendants

26 and their agents or employees in their official capacities, and are the proximate

27 cause of Plaintiffs’ and the Prisoner Class’s ongoing deprivation of rights secured

28 by the United States Constitution under the Fourteenth Amendment.
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1

199. Defendants have been and are aware of all the deprivations described

2 herein, and have condoned or been deliberately indifferent to such conduct.

3

200. In violation of the Fourteenth Amendment, Defendants knew of and

4 disregarded a substantial risk of serious harm.

5

201. In addition, Defendants violate the Fourteenth Amendment rights of

6 prisoners who are awaiting trial or are civil detainees, and thus are not convicted of

7 a crime, on the basis that Defendants made an intentional decision with respect to

8 (1) Plaintiffs and members of the Prisoner Class’s health care and (2) the

9 conditions under which Plaintiffs and members of the Prisoner Class are confined

10 that put them at substantial risk of suffering serious harm. Defendants failed to take

11 reasonable available measures to abate that risk, even though a reasonable actor in

12 the circumstances would have appreciated the high degree of risk involved –

13 making the consequences of Defendants’ conduct obvious.

14

Third Cause of Action

15

(Americans with Disabilities Act, 42 U.S.C. § 12132)

16

202. Plaintiffs re-allege and incorporate by reference herein all allegations

17 previously made in paragraphs 1-201.

18

203. The ADA prohibits public entities, including Defendants, from

19 denying “a qualified individual with a disability … the benefits of the services,

20 programs, or activities of [the] public entity” because of the individual’s disability.

21 42 U.S.C. § 12132.

22

204. Defendants are legally responsible for all violations of the ADA

23 committed by its contractor in the course of performing its duties under its

24 contractual agreement with the Sheriff’s Office to provide medical and mental

25 health care to prisoners in the Jail. See 28 C.F.R. § 35.130(b)(1).

26

205. Plaintiffs MURRAY, FRANCO, WINKLE, TRACY, and BROWN

27 and members of the Disabilities Subclass are qualified individuals with disabilities

28
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1 as defined in the ADA, as they have impairments that substantially limit one or

2 more major life activities.

3

206. The programs, services, and activities that Defendants provide to

4 prisoners include, but are not limited to, sleeping, eating, showering, toileting,

5 communicating with those outside the Jail by mail and telephone, exercising,

6 entertainment, safety and security, the Jail’s administrative, disciplinary, and

7 classification proceedings, medical, mental health, and dental services, the library,

8 educational, vocational, substance abuse, and anger management classes, and

9 discharge services. Defendants’ programs, services, and activities are covered by

10 the ADA.

11

207. Under the ADA, Defendants must provide prisoners with disabilities

12 meaningful access to programs, services, and activities, as well as reasonable

13 accommodations and modifications so that they can participate in all programs,

14 services, and activities offered by Defendants.

15

208. Defendants fail to accommodate Plaintiffs and the Disabilities

16 Subclass they represent as described above, including by:

17

a. failing to “ensure that qualified inmates or detainees with disabilities

18 shall not, because a facility is inaccessible to or unusable by individuals with

19 disabilities, be excluded from participation in, or be denied the benefits of, the

20 services, programs, or activities of a public entity, or be subjected to discrimination

21 by any public entity,” 28 C.F.R. § 35.152(b)(1);

22

b. failing to “ensure that inmates or detainees with disabilities are housed

23 in the most integrated setting appropriate to the needs of the individuals,” 28

24 C.F.R. § 35.152(b)(2);

25

c. failing to “implement reasonable policies, including physical

26 modifications to additional cells in accordance with the 2010 [accessibility]

27 Standards, so as to ensure that each inmate with a disability is housed in a cell with

28
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1 the accessible elements necessary to afford the inmate access to safe, appropriate

2 housing,” 28 C.F.R. § 35.152(b)(3);

3

d. failing or refusing to provide Plaintiffs and the Disabilities Subclass

4 they represent with reasonable accommodations and other services related to their

5 disabilities, see generally 28 C.F.R. § 35.130(a);

6

e. failing or refusing to provide equally effective communication, see

7 generally 28 C.F.R. § 35.160(a);

8

f. denying Plaintiffs and the Disabilities Subclass they represent “the

9 opportunity to participate in or benefit from [an] aid, benefit, or service” provided

10 by Defendants, 28 C.F.R. § 35.130(b)(1)(i);

11

g. failing to “maintain in operable working condition those features of

12 facilities and equipment that are required to be readily accessible to and usable by

13 persons with disabilities by the [ADA],” 28 C.F.R. § 35.133(a);

14

h. failing to “furnish appropriate auxiliary aids and services where

15 necessary to afford individuals with disabilities … an equal opportunity to

16 participate in, and enjoy the benefits of, a service, program, or activity of a public

17 entity,” 28 C.F.R.§ 35.160(b)(1);

18

i. failing to make “reasonable modifications in policies, practices, or

19 procedures when the modifications are necessary to avoid discrimination on the

20 basis of disability,” 28 C.F.R. § 35.130(b)(7); and

21

j. failing to “adopt and publish grievance procedures providing for

22 prompt and equitable resolution of complaints alleging any action that would be

23 prohibited by … [the ADA],” 28 C.F.R. § 35.107(b).

24

209. As a result of Defendants’ policy and practice of discriminating

25 against and failing to provide reasonable accommodations, Plaintiffs and the

26 Disabilities Subclass they represent do not have equal access to Jail activities,

27 programs, and services for which they are otherwise qualified.

28 / / /
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1

Fourth Cause of Action

2

(Rehabilitation Act, 29 U.S.C. § 794)

3

210. Plaintiffs re-allege and incorporate by reference herein all allegations

4 previously made in paragraphs 1-209.

5

211. At all times relevant to this action, Defendants were recipients of

6 federal funding within the meaning of the Rehabilitation Act. As a recipient of

7 federal funds, they are required to reasonably accommodate prisoners with

8 disabilities in their facilities, program activities, and services. They are also

9 required to provide a grievance procedure.

10

212. Plaintiffs MURRAY, FRANCO, WINKLE, TRACY, and BROWN

11 and members of the Disabilities Subclass are qualified individuals with disabilities

12 as defined in the Rehabilitation Act.

13

213. By their policy and practice of discriminating against and failing to

14 reasonably accommodate prisoners with disabilities, Defendants violate Section

15 504 of the Rehabilitation Act, 29 U.S.C. § 794.

16

214. As a result of Defendants’ discriminating against and failing to

17 provide a grievance procedure and reasonable accommodations, Plaintiffs

18 MURRAY, FRANCO, WINKLE, TRACY, and BROWN and members of the

19 Disabilities Subclass do not have equal access to Jail activities, programs, and

20 services for which they are otherwise qualified.

21

Fifth Cause of Action

22

(California Government Code § 11135)

23

215. Plaintiffs re-allege and incorporate by reference herein all allegations

24 previously made in paragraphs 1-214.

25

216. Defendants receive financial assistance from the State of California as

26 part of Realignment Legislation, California Government Code §§ 30025, 30026,

27 and 30029, and through other statutes and funding mechanisms.

28
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1

217. Plaintiffs MURRAY, FRANCO, WINKLE, TRACY, and BROWN

2 and members of the Disabilities Subclass are persons with disabilities as defined

3 by California Government Code § 11135.

4

218. Defendants deny Plaintiffs full access to the benefits of the Jail’s

5 programs and activities which receive financial assistance from the State of

6 California and unlawfully subject Plaintiffs MURRAY, FRANCO, WINKLE,

7 TRACY, and BROWN and members of the Disabilities Subclass to discrimination

8 within the meaning of California Government Code § 11135(a) on the basis of

9 their disabilities.

10

219. Through their counsel and through grievances submitted to the Jail,

11 Plaintiffs MURRAY, FRANCO, WINKLE, TRACY, and BROWN and members

12 of the Disabilities Subclass demanded that Defendants stop their unlawful

13 discriminatory conduct described above, but Defendants refused and still refuse to

14 refrain from that conduct.

15

PRAYER FOR RELIEF

16

220. Plaintiffs and the class and subclass they represent have no adequate

17 remedy at law to redress the wrongs suffered as set forth in this complaint.

18 Plaintiffs and the class and subclass they represent have suffered and will continue

19 to suffer irreparable injury as a result of the unlawful acts, omissions, policies, and

20 practices of Defendants, as alleged herein, unless Plaintiffs and the class and

21 subclass they represent are granted the relief they request. The need for relief is

22 critical because the rights at issue are paramount under the United States

23 Constitution and the laws of the United States.

24

221. Plaintiffs, on behalf of themselves and the class and subclass they

25 represent, request that this Court grant them the following relief:

26

A. Declare the suit is maintainable as a class action pursuant to

27

Federal Rule of Civil procedure 23(a) and 23(b)(1) and (2);

28

B. Adjudge and declare that the conditions, acts, omissions,

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1

policies, and practices of Defendants and agents, officials, and employees

2

are in violation of the rights of Plaintiffs and the class and subclass they

3

represent under the Eighth and Fourteenth Amendments to the U.S.

4

Constitution, the Americans with Disabilities Act, Section 504 of the

5

Rehabilitation Act, and California law;

6

C. Enjoin Defendants, agents, officials, employees, and all persons

7

acting in concert under color of state law or otherwise, from continuing the

8

unlawful acts, conditions, and practices described in this Complaint;

9

D. Order Defendants, agents, officials, employees, and all persons

10

acting in concert with them under color of state law or otherwise, to

11

immediately provide adequate medical and mental health care, including but

12

not limited to sufficient intake screening, sufficient staffing, timely access to

13

appropriate clinicians, timely prescription and distribution of appropriate

14

medications and supplies, timely access to specialty care, and timely access

15

to adequate therapy, inpatient treatment, and suicide prevention;

16

E. Order Defendants, agents, officials, employees, and all persons

17

acting in concert with them under color of state law or otherwise, to provide

18

equal access to programs, services, and activities for people with disabilities,

19

including but not limited to housing people with physical disabilities in

20

accessible housing appropriate to their needs, timely delivery of and

21

appropriate access to assistive devices and other accommodations, housing

22

people with disabilities in the least restrictive and most integrated settings

23

appropriate to their needs, and providing an effective grievance system to

24

contest disability discrimination;

25

F. Award Plaintiffs the costs of this suit and reasonable attorneys’

26

fees and litigation expenses, pursuant to 42 U.S.C. § 1988, 42 U.S.C. §

27

12205, 29 U.S.C. § 794, and other applicable law;

28

G. Retain jurisdiction of this case until Defendants have fully

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1

complied with the orders of this Court and there is a reasonable assurance

2

that Defendants will continue to comply in the future absent continuing

3

jurisdiction;

4

H. Appoint the undersigned counsel as class counsel pursuant to

5

Federal Rule of Civil Procedure 23(g); and

6

I. Award such other and further relief as the Court deems just and

7

proper.

8

9 Dated: December 6, 2017
10

Respectfully submitted,

11

/s/ Julia E. Romano

12

JULIA E. ROMANO (SBN 260857)

jromano@kslaw.com

13

KING & SPALDING LLP

14

633 W. Fifth St.

Suite 1700

15

Los Angeles, CA 90071

16

Telephone: (213) 433-4345

Fax: (213) 433-4310

17

18

/s/ Aaron J. Fischer

AARON J. FISCHER (SBN 247391)

19

Aaron.Fischer@disabilityrightsca.org

20

DISABILITY RIGHTS CALIFORNIA

1330 Broadway, Suite 500

21

Oakland, CA 94612

22

Telephone: (510) 267-1200

Fax: (510) 267-1201

23

24

25

26

27

28
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1

/s/ Don Specter

DON SPECTER (SBN 83925)

2

DSpecter@prisonlaw.com

3

CORENE KENDRICK (SBN 226642)

CKendrick@prisonlaw.com

4

PRISON LAW OFFICE

5

1917 Fifth Street

Berkeley, California 94710

6

Telephone: (510) 280-2621

7

Fax: (510) 280-2704

8

9 Attestation by Filer: 10 All other signatories listed above, and on whose behalf this filing is submitted,
concur in the filing’s content and have authorized the filing
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/s/ Julia E. Romano

JULIA E. ROMANO (SBN 260857)

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jromano@kslaw.com

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APPENDIX A

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California’s protection & advocacy system Toll-Free (800) 776-5746
Report on Inspection of the Santa Barbara County Jail (Conducted on
April 2, 2015)
EXECUTIVE SUMMARY
Disability Rights California (DRC) is the state and federally designated protection and advocacy agency charged with protecting the rights of people with disabilities in California. DRC has the authority to inspect and monitor conditions in any facility that holds people with disabilities. Pursuant to this authority, DRC is conducting inspections of conditions in six county correctional facilities in 2015. One of these facilities is the Santa Barbara County Jail (“Jail”). On April 2, 2015, three DRC attorneys and our authorized agent Kelly Knapp of the Prison Law Office, inspected the Jail. We appreciate that Sheriff Bill Brown met with us personally and that Sheriff Department staff was helpful and cooperative during our inspection.
We observed positive practices and programs during our inspection. Sheriff Brown is forward-looking, recognizes the physical limitations in the current jail facility, and has obtained funding and approval for construction of new jail in North County. The Department emphasizes the Sheriff’s Treatment and Re-entry (STAR) Program for prisoners.
However, we also found evidence of the following violations of the rights of prisoners with disabilities:
(a) Undue and excessive isolation and solitary confinement; (b) Inadequate mental health care; and (c) Denial of rights under the Americans with Disabilities Act (ADA).
Pursuant to our authority under 42 U.S.C. §10805(a)(1) and 29 U.S.C. § 794(f)(3) and as a result of this initial inspection, we find
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there is probable cause to conclude that prisoners with disabilities are subjected to neglect in the Santa Barbara County Jail.1 We will continue to work with you regarding these findings and the next steps in our investigation.
Background
The Santa Barbara County Jail houses pretrial detainees as well as sentenced inmates, and both male and female offenders. The Main Jail facility has 815 beds and a rated capacity of 627 prisoners.2 The adjacent Medium Security Facility has 285 beds and a rated capacity of 160 prisoners.
The Jail has a long history of overcrowding, with multiple court orders intended to set population caps. The Sheriff’s Department has added to the Main Jail in an effort to keep up with overcrowding. According to the Santa Barbara County Grand Jury, “[t]he central part of the Main Jail opened in 1971 with additions in 1988, 1992, and 1999, with a current bed capacity of 618. In 2006 an adjacent honor farm was reconfigured as a medium security facility to provide an additional 161 beds.”3 Recently, two conference rooms in the basement of the Main Jail were converted to dorms with 120 beds.4
In response to chronic jail overcrowding, Sheriff Bill Brown convened a Blue Ribbon Commission of experts and local leaders,
1 Under DRC’s authorizing statute, 42 U.S.C.§ 10802(5), “[t]he term ‘neglect’ means a negligent act or omission by any individual responsible for providing services in a facility rendering care or treatment which caused or may have caused injury or death to an individual with mental illness or which placed an individual with mental illness at risk of injury or death, and includes an act or omission such as the failure to establish or carry out an appropriate individual program plan or treatment plan for an individual with mental illness, the failure to provide adequate nutrition, clothing, or health care to an individual with mental illness, or the failure to provide a safe environment for an individual with mental illness, including the failure to maintain adequate numbers of appropriately trained staff.” “Return to Main Document” 2 California Board of State and Community Corrections (“BSCC”), Biennial Inspection Report of the Santa Barbara Jail, January 8, 2015, Attachment # 11. “Return to Main Document” 3 Report of the Santa Barbara County Grand Jury, 2010-2011, page 1, available from http://www.sbcgj.org/2010/JailOvercrowding.pdf. “Return to Main Document” 4 Report of the Santa Barbara Grand Jury Report, 2014-2015, page 2, available from http://www.sbcgj.org/2015/Detention_Facilities_020615.pdf. “Return to Main Document”
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which issued a report and recommendations in 2008. 5 The Commission recommended that the County build a new 300 bed jail facility and develop a program of community corrections as an alternative to housing prisoners in the jail.
Today, the Department has funding and approval for an even larger, 600 bed correctional facility in Santa Maria, to be completed in 2018. The new facility will be a two-tier modular design with a “state of the art” medical clinic. After the new North Jail opens, the Department still plans to operate parts of the Main Jail but with a reduced census of 600 prisoners. The Department will close the medium security facility adjacent to the Main Jail.
One important recommendation of the Blue Ribbon Commission was to reduce the jail population by developing more pre-trial alternatives. Blue Ribbon Report, pps. 21-23. At that time, pre-trial detainees made up 70% of the jail population. Blue Ribbon Report, p. 15. Since then, pre-trial detainees have not decreased and to the contrary, have increased to make up 73% of the jail population.6 This is significantly above the average in other counties, which is 62%.7 Some counties have been successful in affirmatively reducing their pre-trial population. For example, Sonoma County worked with consultants to reduce pre-trial detainees to 50% of the jail population by implementing a robust array of alternatives to detention, such as day reporting and electronic monitoring.
Like other jails, Santa Barbara must now house prisoners who are sentenced to the Jail for years at a time, following the implementation of AB 109 in 2011.8 The 2015 Grand Jury reported that “[p]rior to AB 109, the average length of stay in the Jail was 20 days. It has now increased to over one year due to the incarceration of serious long-term
5 Final Report and Recommendations of the Blue Ribbon Commission on Jail Overcrowding, page 14, available from http://www.sbsheriff.org/BRCReport. “Return to Main Document” 6 BSCC Jail Profile Study, Attachment # 10, page 6. “Return to Main Document” 7 BSCC Jail Profile Study, Attachment # 10, page 6. “Return to Main Document” 8 Public Policy Institute of California, “California’s County Jails,” available from http://www.ppic.org/main/publication_show.asp?i=1061. “Return to Main Document”
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offenders.”9 The increasing length of stay makes adequacy of jail conditions even more pressing than in years past.
Corizon Health Care has provided physical health care services in the Jail for many years. Until recently, mental health services were provided by County Behavioral Health. In 2009, the Sheriff’s Department terminated the contract with County Behavioral Health and contracted with Corizon to provide mental health care in the Jail.
FINDINGS RE: ABUSE AND/OR NEGLECT OF PRISONERS WITH DISABILITIES
Based on our monitoring visit on April 2, 2015, interviews with prisoners, their families and attorneys and on our review of public documents and prisoner medical records,10 we found the following evidence of abuse and neglect in Santa Barbara County Jail.
1. Excessive Use of Isolation and Solitary Confinement Isolation and solitary confinement in correctional facilities are
generally considered to be situations in which prisoners are held in their cells, alone or with a cellmate, for 22 to 24 hours per day.11 In most jails, prisoners are held in isolation because they are classified as maximum security, are in administrative segregation or protective custody, or subject to short-term discipline. In contrast, prisoners in general population in most correctional facilities typically are housed in
9 Grand Jury Report, 2014-2015, footnote 4, page 2. “Return to Main Document” 10 The findings in this report are based in part on a review of the medical records for five prisoners, which we obtained these reports through signed releases from prisoners whom we interviewed and from their family members and attorneys; the records were not obtained through use of our access authority under 42 U.S.C. §10805(a)(1) and 29 U.S.C. § 794(f)(3). We have provided a copy of these records to the Sheriff’s Department along with this report. “Return to Main Document” 11 For support for this accepted definition of isolation, see, e.g., U.S. Department of Justice, Investigation of State Correctional Institution at Cresson, May 13, 2013, Attachment #7, p. 5, available at http://www.justice.gov/crt/about/spl/documents/cresson_findings_5-31-13.pdf (“terms ‘isolation’ or ‘solitary confinement’ mean the state of being confined to one’s cell for approximately 22 hours per day or more, alone or with other prisoners, that limits contact with others. … An isolation unit means a unit where either all or most of those housed in the unit are subjected to isolation.”); Wilkinson v. Austin, 545 U.S. 209, 214, 224 (2005) (describing solitary confinement as limiting human contact for 23 hours per day); Tillery v. Owens, 907 F.2d 418, 422 (3d Cir. 1990) (21 to 22 hours per day). “Return to Main Document”
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dormitories, or are locked in their cells only during sleeping hours, and are in dayrooms, activities or recreation areas during waking hours.
Even a short stay in conditions of extreme isolation is likely to worsen prisoners’ mental health symptoms, causing them “to lapse in and out of a mindless state” or “semi-fatuous condition” at a heightened risk for suicide. See Davis v. Ayala, 576 U.S. ___, No. 13-1428, 2015 WL 2473373, at *20 (U.S. June 18, 2015) (Kennedy, J., concurring). Consequently, correctional facilities should place prisoners in isolation only when security conditions permit no alternative.12 Prisoners with mental health problems are especially harmed by prolonged isolation (defined as a duration of more than three to four weeks).13 Many state correctional systems, including those in California, Illinois, Massachusetts, Ohio and Pennsylvania, have adopted policies to ensure that prisoners with mental illness are excluded from isolation and solitary confinement.14
We found widespread overuse of prolonged isolation and segregation in the Santa Barbara Jail. Many prisoners were locked in small cells for 22 to 24 hours per day and are not permitted to have radios or televisions. The primary exception is low to medium security prisoners, who are housed in dormitories.
Many parts of the Main Jail are old and built with a linear design, which limits access to dayrooms. However, increased out-of-cell time is possible even in this environment, especially since the jail census is
12 Metzner J.L., Fellner J., “Solitary Confinement and Mental Illness in U.S. Prisons: A Challenge for Medical Ethics,” J Am Acad Psychiatry Law 38:104–8, 2010, Attachment #2. “Return to Main Document” 13 American Psychiatric Association, Position statement on segregation of prisoners with mental illness (2012), Attachment #4, available from http://www.psychiatry.org/File%20Library/Learn/Archives/Position-2012-Prisoners-Segregation.pdf. Accord, Society for Correctional Physicians, “Restricted Housing of Mentally Ill Inmates, Position Statement,” July 9, 2013, Attachment #5, available from http://societyofcorrectionalphysicians.org/resources/position-statements/restricted-housing-of-mentallyill-inmates (“prolonged segregation of inmates with serious mental illness, with rare exceptions, violates basic tenets of mental health treatment.”) “Return to Main Document” 14 Metzner J.L., Dvoskin J.A., “An Overview of Correctional Psychiatry,” Psychiatr Clin North Am 29:761–72 (2006), Attachment #1. See also, U.S. Department of Justice, “Investigation of the Pennsylvania Department of Corrections’ Use of Solitary Confinement on Prisoners with Serious Mental Illness and/or Intellectual Disabilities,” February 24, 2014, Attachment #8, http://www.justice.gov/crt/about/spl/documents/pdoc_finding_2-24-14.pdf. “Return to Main Document”
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lower than in past years. Nevertheless, custody staff did not describe any particular efforts or initiatives to increase out-of-cell time.
Extended Placement in Isolation in Safety Cells We found that prisoners are held in safety cells in the Santa
Barbara Jail for many days at a time, on a repeated basis, with no access to mental health treatment. Safety cells are small, windowless rooms, with rubberized walls, a pit toilet in the floor, and no furniture, bedding or source of water. Prisoners are not permitted normal clothing and are typically given only a blanket or “suicide smock.” They are not provided with regular access to showers, telephones, outdoor recreation, visitation or indeed, any out-of-cell time whatsoever.
California Code of Regulations, title 15, Section 1055, states that safety cells “shall be used to hold only those inmates who display behavior which results in the destruction of property or reveals an intent to cause physical harm to self or others. … In no case shall the safety cell be used for punishment or as a substitute for treatment.” Section 1055 also requires documented monitoring, twice every 30 minutes. Typically, in most jails, prisoners remain in safety cells for a few hours at a time.
Courts have ruled that safety cells may be used as a “temporary measure” to control violent or suicidal prisoners “until they ‘cooled down’ sufficiently to be released from those cells.” Anderson v. County of Kern, 45 F.3d 1310, 1314 (9th Cir. 1995). In the Anderson case, the federal court of appeal ruled that because “the inmates were confined to the safety cell only for short periods of time,” their constitutional rights were not violated. Id. In the Anderson case, one prisoner was held in the safety cell for 90 minutes, another was held there for 3 hours and a third was held overnight. 45 F.3d at 1313. The Anderson court contrasted this temporary use of safety cells in the Kern County Jail with other cases in which extended placement in safety cells for 48 hours or more resulted in significant constitutional violations.
In the Santa Barbara Jail, custody staff were quite clear that placement in safety cells was not temporary, and stated unequivocally that prisoners could be in a safety cell “for days.”
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Medical records and prisoner interviews confirmed that prisoners with mental illness and behavioral problems are housed in safety cells for three days at a time on a repeated basis.15 For example, medical records from Prisoner C., show that over an 8 week period from February 7, 2015 to April 6, 2015, he was placed in a safety cell three times, each time for a duration of three to four days. Prisoners D. and E. were also subjected to repeated safety cell placement. Placing prisoners with mental illness in safety cells for days at a time without mental health treatment constitutes abuse and/or neglect, is inconsistent with minimum standards of care and violates constitutional guarantees.
Even in the small sample of medical records to which we had access, we noted that prisoners were kept in safety cells long after their behavior ceased to pose any risk to themselves or others. Corizon’s suicide watch forms confirm that on multiple occasions, Prisoner C. denied any suicidal intent after a few hours in a safety cell, but remained there for up to three additional days. An even more troubling example is Prisoner D. On two separate occasions, he was placed in a safety cell and after several days, was seen by a mental health counselor who concluded he was stable and could be released. Both times, the mental health counselor left him in the safety cell to be released “at classification’s discretion,” or “custody discretion.” This practice subjects prisoners to needless emotional distress and physical discomfort, and cannot be justified. As noted above, prisoners in a safety cell have no bed, toilet or regular clothing, and no source of water in their cell, which is small, absolutely barren and completely isolated.
The Jail’s monitoring of safety cell placements was also deficient. To comply with the requirement for documented monitoring twice every thirty minutes, custody staff clip a sheet to the door of the cell and log their observations as they occur. The safety cells have a solid door with a small Plexiglas window that is normally covered, so staff must open the window to observe the prisoner inside. During our inspection of the Main Jail, we observed one such “monitoring.” As we passed Safety Cell #1, we noted that it was occupied. From the log, we saw that a prisoner had been placed there the night before. Staff observations
15 According to Jail policy and practices, mental health staff evaluate prisoners in safety cells twice each day. In the records we reviewed, we did not see notes that confirmed that this practice was being carried out. “Return to Main Document”
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were terse, with notes such as “breathing,” and “awake.” As we watched, a custody officer stepped up to the clip board, made a notation and stepped away without opening the window to the cell to observe the prisoner. The supervisor escorting us had to remind the officer to look in on the prisoner, which would not have occurred had we not been present.
Corizon mental health staff are only on-site during normal business hours; if incidents that require placement in a safety cell occur after hours or on weekends, custody staff stated that they do not contact Corizon mental health staff before safety call placement unless there is an emergency. This policy prevents mental health staff from providing necessary treatment and advice to inmates placed because of psychiatric reasons. Further, Custody staff stated their policy was that they waited until Corizon mental health staff assessed prisoners to determine when they get out of a safety cell placement, which will lead to extended stays in safety cells for prisoners who are calm and can return to their regular housing, simply because Corizon is not on site. In addition, even when Corizon staff does assess, prisoners are held longer than necessary, as noted above with Prisoner D., who was to be released at the discretion of classification, not mental health.
In interviews, other prisoners described the absence of any mental health treatment following their release from a safety cell placement for suicidality. One prisoner explained that he had been in the Jail for two months, had been on Effexor and Risperdal in the community and in prison, and had submitted requests to Corizon for mental health medications (his most recent request was almost a month earlier) and had been placed in a safety cell four to five times in the past month. Despite this history, at the time of our inspection, he told us that he still had not seen a mental health practitioner nor had he received a response to his medication request.
It is important to note that even a short stay in a safety cell can be extremely counter-therapeutic. One expert states unequivocally: “No one should be housed in segregation while they are acutely psychotic, suicidal or otherwise in the midst of a psychiatric crisis.”16 Yet this is precisely what the Santa Barbara Jail does with prisoners who are
16 Metzner and Dvoskin, footnote 16, page 2. “Return to Main Document”
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suicidal and in crisis. According to another noted expert, “placing suicidal prisoners in barren observation cells … ‘is counter-therapeutic in that no therapeutic relationship is formed and the prisoner learns it’s better to keep suicidal thoughts and plans to him or herself. In jails and prisons isolation ‘safety cells’ are used instead of doing what is essential in the treatment of anyone seriously contemplating suicide: talk to them. Thorough evaluation, continuity of contact with mental health clinicians, establishment of a trusting therapeutic relationship — these are the things that prevent suicides and assure the effectiveness of treatment — not fifteen minute checks on a prisoner in an observation/safety cell.’”17
Leaving Prisoners on Psychiatric Holds under WIC § 5150 in Safety Cells without Mental Health Treatment.
One of the worst practices we observed from the medical records was the Jail’s failure to provide treatment for prisoners who have been placed on a psychiatric hold under Welf. & Inst. Code § 5150, and instead keeping them in a safety cell for the entire 72-hour duration of the hold. Attorneys who represent defendants reported that this happens repeatedly to their clients.
Under Section 5150, an individual may be detained for assessment, evaluation, crisis intervention and treatment if they are found to be a danger to self, danger to others or gravely disabled. In other jails, prisoners are typically transferred from the jail to an inpatient psychiatric hospital for treatment when they meet 5150 criteria. In Santa Barbara, the only LPS designated facility in the county is the countyowned psychiatric health facility, and Jail staff report difficulties locating an available bed there. However, if no beds are available, the alternatives are to transfer the prisoner to an LPS designated facility in another county, such as Vista Del Mar or Hillmont in Ventura County. If no beds are available there, the Department must provide intensive mental health treatment in the Jail itself.
When a prisoner is awaiting transfer to an inpatient facility, or when a bed cannot be located, Corizon does not appear to provide mental health treatment to prisoners who are placed on a §5150 hold. For
17 Human Rights Watch, Ill-Equipped: U.S. Prisons and Offenders with Mental Illness (2003), p. 183, quoting Dr. Terry Kupers, available https://www.hrw.org/reports/2003/usa1003/usa1003.pdf “Return to Main Document”
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example, Prisoner C. was placed on a § 5150 hold while in a safety cell; apart from a daily status check, Corizon staff provided no mental health treatment. After three days, the 5150 hold expired and he remained in the safety cell, still without any mental health intervention. This practice violates state statute and subjects prisoners to abuse and neglect.
Placing Prisoners with Mental Illness in Isolation
Because of the damaging impact of isolation on prisoners with mental illness, the recommended practice is that these prisoners be excluded from isolation.18 Santa Barbara does not follow this guideline, and prisoners with mental illness are routinely placed in prolonged isolation, even apart from the excessive use of safety cells noted above.
In the Main Jail, prisoners in single cells are effectively held in isolation if they are designated as maximum classification, administrative segregation, or protective custody. Conditions in segregation cells are characterized by inadequate exercise and extreme social isolation. Prisoners are offered three hours of outdoor recreation as required by Title 15 of the state regulations, usually as 1.5 hours twice per week, and a few minutes of shower time every other day. This leaves prisoners locked in their cells for 24 hours per day for five days per week, and 22.5 hours per day on the days when they have outdoor recreation. This amounts to solitary confinement for a large portion of the Jail population.
The mental health housing unit, known as 100, consists of cells in which prisoners are held alone, although they were designed for double occupancy. Consequently, prisoners in the mental health unit are held in conditions as isolating as maximum security housing. We interviewed prisoners with severe mental illness in dorms who said that, as difficult as their current housing was, the mental health unit was far worse because of the isolation conditions. Custody staff told us that prisoners get out-of-cell time for 1.5 hours twice per week in which to use the
18 See, Metzner J.L., Dvoskin J.A., “An Overview of Correctional Psychiatry,” Attachment #1. A recent agreement between the Department of Justice and a county jail in Georgia provides that segregation “shall be presumed contraindicated” for inmates with serious mental illness. If an inmate has a “serious mental illness” or other acute mental health contraindications to segregation, that inmate “shall not remain in segregation absent extraordinary and exceptional circumstances.” MOA Between the U.S. Department of Justice and Columbus, Georgia Regarding the Muscogee County Jail, January 16, 2015, Attachment #9, available from http://www.justice.gov/crt/about/spl/documents/muscogee_moa_1-16-15.pdf. “Return to Main Document”
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outdoor yard and shower, which meets the state regulations but still constitutes extreme, prolonged isolation.
Accepted treatment standards require mental health staff to take affirmative steps to ameliorate the harsh impact of isolation and segregation on prisoners with serious mental illness, assuming that the physical constraints of the facility and/or the security status of the prisoner do not allow alternative housing. The minimum standard of care for a segregated mental health unit is the following: “For prisoners with a serious mental illness [in segregation], the specialized mental health program should offer at least 10 to 15 hours per week of out-of-cell structured therapeutic activities in addition to at least another 10 hours per week of unstructured exercise or recreation.”19 A recent settlement agreement between the U.S. Department of Justice and a county jail in Georgia describes a program consistent with these minimum standards. There, the jail agreed that prisoners housed in its secure mental health unit “would be offered a minimum of:
i. At least 10 hours of out-of-cell structured time each week, with every effort made to provide two scheduled out-of-cell sessions of structured individual or group therapeutic treatment and programming Monday through Friday and one session on Saturdays, with each session lasting approximately one hour, with appropriate duration to be determined by a qualified mental health professional and detailed in that inmates individual treatment plan, and
ii. At least two hours of unstructured out of cell recreation with other inmates each day, including exercise, dining and other leisure activities that provide opportunities for socializing, for a
19 Metzner and Dvoskin, footnote 19, Attachment #1, page 3. See also, American Psychiatric Association (“APA”) Position Statement on Segregation of Prisoners with Mental Illness,” Attachment #4 (“If an inmate with serious mental illness is placed in segregation, out of cell structured therapeutic activities (i.e., mental health/psychiatric treatment) in appropriate programming space and adequate unstructured out of cell time should be permitted.”); Society of Correctional Physicians, “Position Statement: Restricted Housing of Mentally Ill Inmates,” Attachment #5, page 1 (if inmates with serious mental illness cannot be excluded from prolonged segregation, “the conditions of their confinement should be modified in a manner that allows for adequate out-of-cell structured therapeutic activities.”). “Return to Main Document”
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total of at least 14 hours of out of cell unstructured time each week.”20
The manner in which the mental health unit is operated and the services provided by Corizon in this unit fail to meet these minimum standards of care, deny prisoners with mental illness needed treatment, subject them to abuse and neglect and violate their constitutional rights.
We note that some prisoners with serious mental illness are offered even less out-of-cell time than that reportedly provided in the mental health unit and segregation cells. We reviewed records from Prisoner E., a mentally ill prisoner who was in the Jail for four months until he was finally transferred to the County psychiatric health facility. Prisoner E. was held on a misdemeanor charge and had been declared incompetent to stand trial based on his mental illness. Custody staff wrote to his family stating that he was out of his single cell for only two hours per week, rather than the three hours per week required by Title 15. This is extreme isolation, and had a damaging impact on this prisoner’s already fragile mental health.
Corizon does appear to conduct regular rounds of prisoners in isolation, which is a positive and important practice. However, the rounds consist of brief cell-front contact, with words exchanged through the small gap on the side of the solid metal door front. This cell front contact is no substitute for actual counseling and therapeutic contact, which Corizon does not provide.
2. Inadequate Mental Health Care
Under the U.S. Constitution, there are “six basic, essentially common sense, components of a minimally adequate prison mental health care delivery system.” Coleman v. Brown, 938 F. Supp.2d 955, 970 (E.D. Cal. 2013). The components are: screening, staffing, recordkeeping, medication, suicide prevention, and “a treatment program that involves more than segregation and close supervision of mentally ill inmates.” Id. at 970 n. 24; Balla v. Idaho State Board of Corrections, 595 F. Supp. 1558, 1577 (D. Idaho 1984); Ruiz v. Estelle, 503 F. Supp. 1265, 1339 (S.D.Tex.1980). The Jail must address the negative effects of housing in harsh segregated environments (Coleman, 938 F. Supp.2d at
20 Muscogee Jail Agreement, footnote 19, Attachment #9, page 13. “Return to Main Document”
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979–80), and provide “treat[ment] in an individualized manner” for mental disorders. Id. at 984. Treatment must have the goal of “stabilization and symptom management.” Madrid v. Gomez, 889 F. Supp. 1146, 1222 (N.D. Cal. 1995).
Absence of Group or Individual Out-of-Cell Therapeutic Activities
Outpatient mental health care in the Santa Barbara Jail appears consists solely of sporadic medication management and brief, cell-front interviews. Corizon staff do not conduct mental health groups or provide more extended therapeutic contacts apart from assessments and cellfront checks. For example, one prisoner we interviewed was housed in a dorm, reported a history of significant mental health treatment and said that he had been “suicidal” the previous night. He said that he wants medication but only if he can also speak to a mental health professional for ongoing therapy, which he had been told was not possible in the Jail.
The absence of any group or individual therapy, or other structured out-of-cell therapeutic activities violates minimum standards of care for prisoners with serious mental illness. For example, the National Commission on Correctional Health Care has adopted a standard that “[r]egardless of facility size or type, basic on-site outpatient [mental health] services include, at a minimum, individual counseling, group counseling and psychosocial/psychoeducational programs.” Standards for Health Services in Jails (2014), Standard J-G-04, Attachment #3.
As discussed in the previous section, the Jail has a designated mental health unit for prisoners with serious mental illness. Custody keeps these prisoners in their cells for between 23 and 24 hours per day. As we noted above, Corizon staff do not provide the recommended outof-cell structured therapeutic activities necessary to compensate for the impact of these isolation conditions on prisoners with mental illness.
We observed some positive practices. As noted above, Corizon mental health staff conduct regular isolation rounds. The Jail will provide 7 days of follow-up medications at release, and sometimes as much as 30 days. The Sheriff’s Department has a full time discharge planner.
Inadequate Screening, Poor Medication Continuity
Prisoners we interviewed had many complaints about their inability to continue the medications they had been on in the community. More than a dozen people reported that they had gone for weeks and months without the mental health medications they had been taking in the
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community, despite disclosing this need during their initial screening and in later requests. By report, the lack of medication continuity extended to medications for physical health care conditions, and the medical records we reviewed confirmed these reports.
For example, Prisoner A. was taking medication for PTSD, anxiety and seizures before he was arrested. After booking, he was denied access to his anti-seizure medication, Dilantin. After four days, he had a grand mal seizure. The next day, staff started him back on Dilantin but did not address his need for medication for anxiety and PTSD. He had to wait more than two months after booking before he was seen by a Corizon psychiatrist who finally prescribed medication for his PTSD.
Some of the problems with medication continuity can be attributed to poor initial screening. For example, when Prisoner B. was booked into the Jail, he brought a bag with all his VA-issued medications, including medication for anxiety and PTSD. He was screened a week after booking by a therapist who listed all the medications prescribed by his VA doctors in the community, but failed to order any bridge medications for his physical or mental health needs or to refer him to a psychiatrist for further evaluation. He had to wait an additional two months before he was seen by a Corizon psychiatrist, who still did not prescribe the only medication that the VA had found effective in treating his PTSD.
Poor screening may also explain why Corizon reports that so few prisoners have serious mental illness in the Santa Barbara Jail. Corizon mental health staff told us that 13-16% of the jail population is identified with mental illness, and that 90 people are on psychotropic medications, which is roughly 11% of the prisoner population. Eight years earlier, the Blue Ribbon Commission had reported a mental illness rate of 29%, noting that this “understates the true picture, since it only counts those who agree to treatment and take jail-issued medication.”21 The difference between the reported rates of mental illness in 2007 and 2015 could be attributable to a change in mental health providers in the jail. When the Blue Ribbon Commission issued its report, mental health services were provided by County Behavioral Health. Corizon Health Care, which is a for-profit provider, took over the contract to provide mental health
21 Blue Ribbon Commission Report, footnote 7, page 18. “Return to Main Document”
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services in the Jail in 2009. Corizon’s report that 11% of prisoners are on mental health medication is half the rate reported by the Blue Ribbon Commission, and well below the expected prevalence rate based on reports of national experts.22 We are concerned that Corizon could be overlooking or under-treating prisoners with mental illness through inadequate screening or other practices discussed in this report.
Untimely Response to Requests for Mental Health Medication and Services
In brief interviews in one dormitory, five prisoners complained that they had submitted multiple requests over several months to be seen by mental health staff, with no response. Other prisoners whom we interviewed at greater length and whose records we obtained had the same complaint. Significantly, none of the records we reviewed included copies of prisoners’ requests for medical and mental health care, so we could not verify their reports, but the consistency of the complaints suggests a problem.
We asked Corizon mental health staff about delays in responding to requests. Their reply was that they closely monitor requests, that urgent requests are answered immediately and that it may be two to three weeks to get a response to non-urgent requests. However, we are concerned that Corizon’s reporting system may not be capturing all the sick call slips and psych line requests submitted by prisoners, especially because these requests are apparently not logged in the medical records. We plan to conduct further investigation to determine the extent of delays in responding to requests for mental health care.
We observed problems with medication management. From the records, we noted instances in which prisoners were placed on or discontinued from significant psychotropic medications with little monitoring. For example, Prisoner C. had been at a state hospital for six months, where he was restored to competence on a regime that included seven psychotropic medications, including several long-acting injectable anti-psychotic medications. A month after his return, the Jail psychiatrist abruptly discontinued all but two of these seven medications
22 Metzner, “Overview of Correction Psychiatry,” Attachment #1 (prevalence rate of 20% for serious mental illness); Metzner and Fellner, Attachment # 2 (same, plus an additional 15 to 20% require mental health intervention, including medication). “Return to Main Document”
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without tapering or transition; two days later, Prisoner C. attempted suicide. In another example, Prisoner D. was diagnosed with psychosis, but was prescribed Wellbutrin, an anti-depressant that can cause agitation. Two months later, after a cell extraction and assault on a deputy, a different Corizon psychiatrist terminated the order for Wellbutrin with a note that “this medication can worsen these [assaultive] behaviors.”
We noted a high number of suicide attempts in the medical records we reviewed. Custody staff informed us that the Jail had only one completed suicide in the last four years, but there have been 35 to 40 attempts. Corizon’s suicide prevention program appears to consist primarily of extended safety cell placement, which, as noted above, is not a substitute for mental health treatment and can also deter prisoners from reporting suicidal ideation.
We also failed to find any evidence in the medical records of a functioning behavior management program. Corizon’s form for monitoring prisoners on suicide watch is comprehensive and includes box that can be checked if a behavior management plan is being developed. However, this box was blank in every form we examined, and no prisoner records included a behavior management plan. Apparently Corizon staff do not develop written behavior management plans even for individuals such as Prisoner C., who made a suicide attempt and reported auditory hallucinations commanding him to commit suicide, or for Prisoner E., who was described as the “most difficult” prisoner in the Jail and had also attempted suicide by hanging. A template for a behavior management plans used in the San Francisco Jail are included as Attachment #12 to this report.
3. Denial of Rights under the Americans with Disabilities Act
Title II of the Americans with Disabilities Act (“ADA”) provides that “no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to discrimination by any such entity.” 42 U.S.C. § 12132. Jails and prisons are subject to the prohibitions and protections in Title II. Pierce v. County of Orange, 526 F.3d 1190, 1214 (9th Cir. 2008) (citing Pa. Dep’t of Corr. v. Yeskey, 524 U.S. 206, 209-10 (1998). In correctional settings, the ADA requires that prisoners with disabilities be ensured equal access to jail programs, services and activities, including the ability to safely use personal hygiene services such as toilets and showers, to engage in
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activities such as ambulation and exercise, and participate in programs such as visitation, educational classes, religious services, and inmate worker programs on the same basis as non-disabled prisoners.
Accessible Cells and Housing.
In 2010, the Department of Justice issued a new regulation specifically addressing the “nondiscrimination and program access obligations” of a correctional facility. 28 C.F.R. § 35.152, effective March 15, 2011.23 This regulation provides in part that “[p]ublic entities shall implement reasonable policies, including physical modifications to additional cells in accordance with the 2010 Standards, so as to ensure that each inmate with a disability is housed in a cell with the accessible elements necessary to afford the inmate access to safe, appropriate housing.” 42 C.F.R. § 35.152(b)(3). Justice Department commentary on this regulation makes clear that it concerns the program access obligations of a correctional facility, which do not depend on the date of construction, as opposed to requirements for architectural accessibility, which are tied to the date of construction or modification.24
The Department houses most prisoners with disabilities in the Main Jail in South Dorm 25. This dorm contains double bunks with lower and upper levels. The Jail assigns prisoners to a lower bunk in this dorm if they have mobility impairments or another condition such as epilepsy. There is apparently no formal policy to monitor and enforce lower bunk orders. We observed a number of people sleeping on the floor in this dorm, with deputies looking on. Prisoners we interviewed stated that others had already taken all the lower bunks, and that they had no choice but to sleep on the floor. For example, Prisoner A. was in South Dorm 25 because he has epilepsy. He reported that he slept on the floor because he could not get a lower bunk and was afraid that he would be injured if he fell off an upper bunk during a seizure. In fact, because the Jail failed to provide him with his epilepsy medication, he had a grand mal seizure in his first few days in the Jail. Prisoner A. stated that he
23 U.S. Department of Justice, Notice re: Final Regulations implementing Title II of the ADA, 75 Fed. Reg. 56164, 56218-56223 (2010), Attachment #6, also available at http://www.ada.gov/regs2010/titleII_2010/titleII_2010_regulations.htm#a2010guidance. “Return to Main Document” 24 DOJ Regulations, 75 Fed. Reg. at 56218-56223, Attachment #6. “Return to Main Document”
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had made multiple requests for a “boat,” which is a temporary plastic sleep surface that rests directly on the floor and on which prisoners can place a mattress. Floor sleeping was so common in this dorm that Prisoner A stated that those who get “boats” were the “lucky ones.”
During our inspection, custody staff ignored the floor sleepers and made no effort to enforce lower bunk orders, although it was obvious that these were being disregarded, or that the number of lower bunks was insufficient to meet the need. This is a blatant denial of one of the most basic accommodations for prisoners with – an accessible bed. The Jail apparently has no policy or practice to ensure that lower bunk orders are issued, honored and enforced.
Surprising, although prisoners with mobility impairments are concentrated in the South Dorm, the toilet and shower areas do not meet architectural standards for wheelchair use, and lack properly placed grab bars, shower heads, etc.25 Medical records for Prisoner A, for example, note that he fell in the shower. During our inspection, we asked custody staff whether there was housing that complied with the ADA. Custody staff showed us a cell in a different area of the Jail that was supposedly ADA compliant. However, the toilet would be completely inaccessible to anyone in a wheelchair – the seat was far too low and there were no grab bars installed.
We also note that the Jail has carried out alterations to its facilities, such as the renovation of the honor farm in 2006 to add 161 medium security beds and the conversion of basement conference rooms to dormitories in 2013. The ADA applies to alterations to existing buildings after January 26, 1992, the effective date of the ADA. 28 C.F.R. § 35.151 (b). Consequently, these portions of the Jail must conform to the ADA’s architectural access standards, which are more comprehensive than the program access requirements discussed above. See, Uniform Federal Accessibility Standards on www.ada.gov.
25 We are able to provide you with copies of DOJ publications on accessibility standards for correctional facilities, which can also be obtained online: ADA/Section 504 Design Guide: Accessible Cells in Correctional Facilities, available from http://www.ada.gov/accessiblecells.htm and the ADA standards for Accessible Design that specify the requirements for an accessible shower, §§ 603.1 to 610.4; acceptable reach ranges for fixtures, § 308, and accessible faucet and handle types, § 309.4. http://www.ada.gov/regs2010/2010ADAStandards/2010ADAstandards.htm#sec805. “Return to Main Document”
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Denial of Accommodations
Prisoners complained to us about the Jail’s failure to provide accommodations for their disabilities, in addition to the problem noted above regarding access to lower bunks. One prisoner with low vision reported that the Jail would not help him with reading and writing. Prisoner B., who uses a wheelchair, reported multiple falls because of untrained custody staff and accessibility barriers. When booked, the Jail took away his personal wheelchair and gave him another that had faulty brakes and was too large to pass through doorways. According to his records, he was injured in a fall off the transport bus in October 2014; was injured again in March 2015 when he attempted to transfer from his wheelchair to his bunk, and again in April 2015 when he fell in the shower, which did not have any grab bars. Prisoner B. reported that he has filed multiple grievances, to no effect.
Discrimination against Prisoners with Serious Mental Illness
The ADA regulations require public entities such as the Sheriff’s Department to “administer programs, services and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities.” 28 C.F.R. § 35.130(d); 28 C.F.R. § 152(b)(2) (requiring correctional facilities to house prisoners with disabilities in the most integrated setting appropriate). In a recent investigation, the Department of Justice found that a Pennsylvania prison violated these provisions by automatically placing prisoners with mental illness in segregation and isolation conditions.26 The prison was required to “ensure that qualified prisoners with serious mental illness … have as equal an opportunity as other prisoners to participate in and benefit from its housing and classification services, programs and activities, and the benefits that flow from them, such as out-of-cell time, interaction with other prisoners and movement outside of confined environments.”27
The Department discriminates against prisoners with serious mental illness by housing them in isolation conditions in the mental health unit, regardless of their classification level, and by failing to
26 US DOJ, Cresson Investigation, Attachment #7, page 32. See also, US DOJ Investigation of Pennsylvania DOC, Attachment #8, pages 17-22. “Return to Main Document” 27 US DOJ, Cresson Investigation, Attachment #7, page 34. “Return to Main Document”
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provide them with support and accommodations to enable them to function in an integrated setting.
ADA Coordinator
The ADA regulations require the Jail to have an ADA coordinator. 42 C.F.R. § 35.106. The coordinator’s role is “to ensure that individuals dealing with large agencies [such as the Sheriff’s Department] are able to easily find a responsible person who is familiar with the requirements of the [ADA and the DOJ regulations] and can communicate those requirements to other individuals in the agency who may be unaware of their responsibilities.” Appendix A to Part 35, 28 C.F.R. at page 568.
The Department does not appear to have an ADA coordinator for the Jail. When questioned, staff were unaware of such a position and could not identify any particular individual responsible for arranging accommodations. We conclude that the Jail is violating this requirement.
Notice of Rights and Complaint Procedure
The Jail also has an obligation to provide notice to prisoners of their rights under the ADA (28 C.F.R. § 35.106), and must have an ADA complaint procedure by which prisoners with disabilities may contest any disability-based discrimination or violation of the ADA. 28 C.F.R. § 35.107(b). The complaint procedure must provide for “prompt and equitable resolution of complaints alleging any action that would be prohibited by [the ADA regulations.].” § 35.107(b) (emphasis added). The Jail’s designated ADA coordinator is responsible for investigating complaints submitted through this process. § 35.107(a).
In interviews, prisoners with disabilities had complaints about their inability to obtain accommodations but were unfamiliar with any procedure for requesting accommodations for their disabilities, or appealing the denial of accommodations. This violates the notice requirement in 28 C.F.R. § 35.106. The Jail does not have an ADA complaint system, and the existing grievance system cannot substitute because it does not meet the ADA requirements listed above.
We did not have an opportunity to review the Jail’s informing materials or substantive policies regarding prisoners with disabilities. However, the ADA regulations require the Sheriff’s Department to conduct a self-evaluation of its services, policies and practices to determine whether they meet the requirements of the ADA. 28 C.F.R. § 35.105(a). Since the Jail has more than 50 employees, it was also
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required to complete a Transition Plan by July 1993, detailing the steps and timeline it will take to achieve compliance with the ADA. Although the deadline to complete a self-evaluation and transition plan is long past, this is a continuing obligation and public entities that missed this deadline are not exempt from compliance. Reviewing policies and procedures is one part of the self-evaluation required by §35.105(a).
4. Other Areas of Concern, Including Medical and Dental Care
a. Floor sleeping and Overcrowding
The Jail has had a problem with floor sleepers due to overcrowding. Custody staff informed us that they had no floor sleepers at the time of our inspections, and had not had floor sleepers for the past four months. However, we observed several prisoners who were sleeping on mattresses on the floor especially in the medical unit (South) and among the inmates in protective custody. Custody staff stated they had the most problems with overcrowding with this classification group.
Other problems were excessive crowding in the dormitories and multi-man cells, which exceed rated capacity according to the BSCC. Attachment #11, pages 3-4.
Prisoner B., who has a collapsed lung and asthma, complained about the mold and dust in the Jail, which aggravated his asthma breathing problems. We observed that the air quality and ventilation in the converted basement dormitories was especially poor and several prisoners housed there complained about breathing problems.
b. Jail Design and Prisoner Safety
We observed one housing area with 14 inmates in multi-man cells with bars on the front; these cells open onto a small day room area and bathroom. The central control booth for these cells is down a hallway, so deputies have no direct line of sight into the housing area. There are cameras and a call button in the hallway, but prisoners cannot access these. We were told that deputies walk the hallways, but in between these patrols, prisoners have no means to report man down, and deputies cannot observe prisoners. Prisoners are at risk of attack, injury or rape from others in this setting, which is contrary to the requirements of the Prison Rape Elimination Act (PREA). The converted basement dorms also raise PREA concerns, since they are large and essentially unmonitored, with no line of sight from custody.
c. Medical Care for Chronic Conditions and Disabilities
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In interviews, prisoners complained about poor care for asthma, diabetes and other chronic conditions.
INITIAL RECOMMENDATIONS
1. Isolation (defined as being locked down in a cell for at least 22 hours per day).
a. Increase out-of-cell time and ameliorate isolation conditions in administrative segregation, protective custody, maximum security and mental health housing.
b. Ensure that prisoners in single cells in the Main Jail are provided with a minimum of 4 hours per day of out-of-cell time.
c. Develop procedures to exclude prisoners with serious mental illness from isolation and segregation absent extraordinary or exceptional circumstances.
d. Develop new protocols for the outpatient mental health housing unit, so that prisoners are offered structured and unstructured out-of-cell time consistent with minimum standards outlined in this report.
e. Ensure that Custody and Corizon mental health staff develop and implement behavior management plans for inmates with serious mental illness who engage in dangerous or disruptive behaviors with the goal of preventing their placements, or shortening the amount of time spent, in isolation conditions.
2. Safety Cells
a. Inmates placed in safety cells as a result of behaviors related to mental health symptoms should not be housed there for longer than 12 hours at a time. If the facility administrator, in cooperation with licensed mental health staff, determines that there is no less restrictive housing appropriate after 12 hours, the inmate should be taken to a facility for 72-hour treatment and evaluation pursuant to Section 5150 of the Welfare and Institutions Code and Section 4011.6 of the Penal Code.
b. Inmates who are released from mental health related safety cell placements, or who return from treatment and evaluation pursuant to Section 5150 of the Welfare and Institutions Code and Section 4011.6 of the Penal Code, should be evaluated
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by a mental health clinician in a confidential, out-of-cell setting, the next working day and then again within three to seven days depending on their clinical status.
3. Mental Health Treatment a. Establish a screening protocol at booking that (i) identifies all prisoners who are on mental health medication or otherwise in need of mental health treatment, and (ii) ensures that these prisoners are assessed and either provided with bridge medications, or if a determination is made not to provide requested medications, documenting the basis for the denial of medication and informing the prisoner in writing of how to file a grievance regarding this denial. b. Respond to prisoner requests in a timely manner. Qualified mental health staff should triage health needs request forms that seek mental health treatment the same day they are collected by the health care staff. The forms should be datestamped at the time they are triaged, and noted in the prisoner’s medical record. When qualified mental health staff determines clinician follow-up is necessary for diagnosis and treatment of an inmate's condition, the inmate should be referred to a clinician for a face-to-face evaluation that takes place immediately for emergent concerns, within 24 hours for urgent concerns, and within 14 calendar days for nonemergent or non-urgent concerns. Corizon should and report on monitor times to respond to requests c. For prisoners housed in the mental health housing unit, provide individual and/or group treatment, structured recreation, and rehabilitation services (e.g., psychoeducation, supervised Activities of Daily Living and cell cleaning). They should receive ten to fifteen hours of out-ofcell-unstructured time each week (solo progressing to group) and ten to fifteen hours of out-of-cell structured activities with staff.
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Page 24 of 26 4. ADA a. Modify existing cells to offer wheelchair-accessible cells in different classification and housing areas, including medium and minimum security dormitory housing. This requirement applies to all areas in the Main Jail as needed to achieve program access, and to the basement dormitories in the Main Jail and the Medium Security facility adjacent to the Main Jail. b. Develop policies and procedures to assign and enforce orders for lower bunks and other disability-related accommodations, and monitor compliance with these orders on a regular basis. c. Ensure that prisoners with physical, sensory and mental health disabilities have access to the full range of Jail programs and activities and are not categorically assigned to more restricted housing than other prisoners. d. Appoint an ADA coordinator, establish an effective ADA complaint system, conduct a self-evaluation and develop a Transition Plan to achieve ADA compliance. e. Develop informational materials for prisoners with disabilities about how to request accommodations and file ADA grievances and complaints.
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ATTACHMENTS
1. Metzner J.L., Dvoskin J.A., “An Overview of Correctional Psychiatry,” Psychiatr Clin North Am 29:761–72 (2006).
2. Metzner J.L., Fellner J., “Solitary Confinement and Mental Illness in U.S. Prisons: A Challenge for Medical Ethics,” J Am Acad Psychiatry Law 38:104–8, 2010.
3. National Commission on Correctional Health Care, Standards for Health Services in Jails (2014), Standards J-E-09 and J-G-04.
4. American Psychiatric Association, Position statement on segregation of prisoners with mental illness (2012), http://www.psychiatry.org/File%20Library/Learn/Archives/Position2012-Prisoners-Segregation.pdf
5. Society for Correctional Physicians, “Restricted Housing of Mentally Ill Inmates, Position Statement,” July 9, 2013, available from http://societyofcorrectionalphysicians.org/resources/positionstatements/restricted-housing-of-mentally-ill-inmates.
6. U.S. Department of Justice, Notice re: Final Regulations implementing Title II of the ADA, 75 Fed. Reg. 56164, 5621856223 (2010), also available from http://www.ada.gov/regs2010/titleII_2010/titleII_2010_regulations.h tm#a2010guidance.
7. U.S. Department of Justice, Investigation of State Correctional Institution at Cresson, May 13, 2013 at 5, available at http://www.justice.gov/crt/about/spl/documents/cresson_findings_531-13.pdf
8. U.S. Department of Justice, “Investigation of the Pennsylvania Department of Corrections’ Use of Solitary Confinement on Prisoners with Serious Mental Illness and/or Intellectual Disabilities,” February 24, 2014, http://www.justice.gov/crt/about/spl/documents/pdoc_finding_2-2414.pdf
9. Memorandum of Agreement Between the United States Department of Justice and the Consolidated Government of Columbus, Georgia Regarding the Muscogee County Jail, January 16, 2015, available from http://www.justice.gov/crt/about/spl/documents/muscogee_moa_116-15.pdf
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Page 26 of 26 10. California Board of State and Community Corrections (“BSCC”) Jail Profile Study, First Quarter of 2015, available from http://www.bscc.ca.gov/downloads/2015_1st_Qtr_JPS_Full_Report .pdf. 11. BSCC Biennial Inspection report of the Santa Barbara Jail, January 8, 2015. 12. Jail Psychiatric Services, San Francisco Jail, Template for Behavior Management Plan.
(Attachments are available upon request, please contact: Richard Diaz, richard.diaz@disabilityrightsca.org or call 213-213-8000) Read Santa Barbara County Sheriff’s Office response to DRC final report on inspection of Santa Barbara County Jail Disability Rights California is funded by a variety of sources, for a complete list of funders, go to http://www.disabilityrightsca.org/ Documents/ListofGrantsAndContracts.html.
Appendix A to Civil Class Action Complaint

 
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UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA (Western Division - Los Angeles)
CIVIL DOCKET FOR CASE #: 2:17-cv-08805-GW-JPR

Clay Murray et al v. County of Santa Barbara et al Assigned to: Judge George H. Wu Referred to: Magistrate Judge Jean P. Rosenbluth Related Cases: 2:20-cv-02168-GW-PD
2:20-cv-00534-GW-JPR Cause: 42:1983 Civil Rights Act
Plaintiff
Clay Murray on behalf of themselves and all others similarly situated

Date Filed: 12/06/2017 Jury Demand: Defendant Nature of Suit: 555 Prisoner Petitions (Prison Conditions) Jurisdiction: Federal Question
represented by Aaron Joseph Fischer Disability Rights California 1330 Broadway Suite 500 Oakland, CA 94612 510-267-1200 Fax: 510-267-1201 Email: aaron.ﬁscher@disabilityrightsca.org LEAD ATTORNEY ATTORNEY TO BE NOTICED

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Corene Kendrick ACLU National Prison Project 39 Drumm Street San Francisco, CA 94111 202-393-4930 Email: ckendrick@aclu.org TERMINATED: 11/05/2020

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Plaintiff David Franco on behalf of themselves and all others similarly situated

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Plaintiff Shareen Winkle on behalf of themselves and all others similarly situated

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Plaintiff
Maria Tracy on behalf of themselves and all others similarly situated

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Plaintiff Eric Brown on behalf of themselves and all others similarly situated,

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Julia Elizabeth Romano (See above for address) ATTORNEY TO BE NOTICED
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Donald F Zimmer , Jr (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Jennifer Taylor Stewart (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Richard Brian Diaz (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Stacy Lynn Foster (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Corene Kendrick (See above for address) TERMINATED: 11/05/2020
Jaqueline Aranda Osorno (See above for address) TERMINATED: 11/08/2019
Joshua C Toll (See above for address) PRO HAC VICE ATTORNEY TO BE NOTICED
Julia Elizabeth Romano (See above for address) ATTORNEY TO BE NOTICED

V. Defendant County of Santa Barbara

represented by Amber R Holderness County of Santa Barbara Ofﬁce of County Counsel 105 East Anapamu Street Suite 201 Santa Barbara, CA 93101 805-568-2950 Fax: 805-568-2982 Email: aholderness@co.santa-barbara.ca.us LEAD ATTORNEY ATTORNEY TO BE NOTICED
Danielle Francine Drossel Santa Barbara County Counsel's Ofﬁce

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Defendant County of Santa Barbara Sheriffs Ofﬁce

CM/ECF - California Central District
105 East Anapamu Street Suite 201 Santa Barbara, CA 93101 805-568-2996 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Amber R Holderness (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Danielle Francine Drossel (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Date Filed # Docket Text

12/06/2017

1 COMPLAINT Receipt No: 0973-20931300 - Fee: $400, ﬁled by Plaintiffs MARIA TRACY, CLAY MURRAY, SHAREEN WINKLE, DAVID FRANCO, ERIC BROWN. (Attorney Julia Elizabeth Romano added to party ERIC BROWN(pty:pla), Attorney Julia Elizabeth Romano added to party DAVID FRANCO(pty:pla), Attorney Julia Elizabeth Romano added to party CLAY MURRAY(pty:pla), Attorney Julia Elizabeth Romano added to party MARIA TRACY(pty:pla), Attorney Julia Elizabeth Romano added to party SHAREEN WINKLE(pty:pla))(Romano, Julia) (Entered: 12/06/2017)

12/06/2017

2 Request for Clerk to Issue Summons on Complaint (Attorney Civil Case Opening),, 1 ﬁled by Plaintiffs ERIC BROWN, DAVID FRANCO, CLAY MURRAY, MARIA TRACY, SHAREEN WINKLE. (Romano, Julia) (Entered: 12/06/2017)

12/06/2017

3 CIVIL COVER SHEET ﬁled by Plaintiffs ERIC BROWN, DAVID FRANCO, CLAY MURRAY, MARIA TRACY, SHAREEN WINKLE. (Romano, Julia) (Entered: 12/06/2017)

12/06/2017

4 CERTIFICATION AND NOTICE of Interested Parties ﬁled by Plaintiffs ERIC BROWN, DAVID FRANCO, CLAY MURRAY, MARIA TRACY, SHAREEN WINKLE, (Romano, Julia) (Entered: 12/06/2017)

12/06/2017

5 NOTICE of Related Case(s) ﬁled by Plaintiffs ERIC BROWN, DAVID FRANCO, CLAY MURRAY, MARIA TRACY, SHAREEN WINKLE. Related Case(s): 5:13-cv-00444 and 5:16-cv-355 (Romano, Julia) (Entered: 12/06/2017)

12/07/2017

6 NOTICE OF ASSIGNMENT to District Judge George H. Wu and Magistrate Judge Jean P. Rosenbluth. (car) (Entered: 12/07/2017)

12/07/2017

7 NOTICE TO PARTIES OF COURT-DIRECTED ADR PROGRAM ﬁled. (car) (Entered: 12/07/2017)

12/07/2017

8 NOTICE OF PRO HAC VICE APPLICATION DUE for Non-Resident Attorney Joshua C Toll. A document recently ﬁled in this case lists you as an out-of-state attorney of record. However, the Court has not been able to locate any record that you are admitted to the Bar of this Court, and you have not ﬁled an application to appear Pro Hac Vice in this case. Accordingly, within 5 business days of the date of this notice, you must either (1) have your local counsel ﬁle an application to appear Pro Hac Vice (Form G-64) and pay the applicable fee, or (2) complete the next section of this form and return it to the court at

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cacd_attyadm@cacd.uscourts.gov. You have been removed as counsel of record from the docket in this case, and you will not be added back to the docket until your Pro Hac Vice status has been resolved. (car) (Entered: 12/07/2017)

12/07/2017

9 21 DAY Summons Issued re Complaint (Attorney Civil Case Opening),, 1 as to Defendants County of Santa Barbara, County of Santa Barbara Sheriffs Ofﬁce. (car) (Entered: 12/07/2017)

12/14/2017

10 ORDER RE TRANSFER PURSUANT TO GENERAL ORDER 16-05 (Related Case) ﬁled. Transfer of case declined by Judge Virginia A. Phillips, for the reasons set forth on this order. Related Case No. 5:13-cv-00444 VAP(OPx) (rn) (Entered: 12/14/2017)

12/18/2017

11 RESPONSE ﬁled by Pro Hac Vice attorney Joshua C. Toll on behalf of Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. RE: Notice of Filing Fee Due. PHV fee N/A. Mr. Toll is waiting on his certiﬁcates of good standing from the District of Columbia and Maryland. He will ﬁle an application to appear Pro Hac Vice immediately upon receiving his certiﬁcates of good standing. (lt) (Entered: 12/18/2017)

12/19/2017

12 WAIVER OF SERVICE Returned Executed ﬁled by Plaintiffs Maria Tracy, Clay Murray, Shareen Winkle, David Franco, Eric Brown. upon County of Santa Barbara Sheriffs Ofﬁce waiver sent by Plaintiff on 12/6/2017, answer due 2/5/2018. Waiver of Service signed by Danielle Drossel. (Romano, Julia) (Entered: 12/19/2017)

12/19/2017

13 WAIVER OF SERVICE Returned Executed ﬁled by Plaintiffs Maria Tracy, Clay Murray, Shareen Winkle, David Franco, Eric Brown. upon County of Santa Barbara waiver sent by Plaintiff on 12/6/2017, answer due 2/5/2018. Waiver of Service signed by Danielle Drossel. (Romano, Julia) (Entered: 12/19/2017)

01/04/2018

14 STANDING ORDER RE FINAL PRE-TRIAL CONFERENCE FOR CIVIL JURY TRIALS BEFORE JUDGE GEORGE H. WU by Judge George H. Wu. See document for details. (gk) (Entered: 01/04/2018)

01/08/2018

15 APPLICATION of Non-Resident Attorney Joshua C. Toll to Appear Pro Hac Vice on behalf of Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle (Pro Hac Vice Fee - Fee Paid, Receipt No. 0973-21067577) ﬁled by Plaint iffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Certiﬁcate of Good Standing, # 2 Proposed Order) (Romano, Julia) (Entered: 01/08/2018)

01/10/2018

16 ORDER GRANTING APPLICATION OF NON-RESIDENT ATTORNEY TO APPEAR IN A SPECIFIC CASE PRO HAC VICE by Judge George H. Wu: Granting 15 NonResident Attorney Joshua C. Toll APPLICATION to Appear Pro Hac Vice on behalf of Plaintiff's, Clay Murray, David Franco, Shareen Winkle, Maria Tracy, and Erick Brown, on behalf of themselves and all others similarly situated, designating Julia E. Romano as local counsel. (cr) (Entered: 01/10/2018)

01/25/2018

17 STIPULATION Extending Time to Answer the complaint as to ﬁled by Plaintiffs Maria Tracy, Clay Murray, Shareen Winkle, David Franco, Eric Brown.(Romano, Julia) (Entered: 01/25/2018)

03/06/2018

18 STIPULATION for Protective Order ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Proposed Order)(Romano, Julia) (Entered: 03/06/2018)

03/06/2018

19 APPLICATION to ﬁle document Exhibits D & E to Fischer Decl ISO Plaintiffs' Motion for Class Certiﬁcation under seal ﬁled by Plaintiffs Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Proposed Order)(Romano, Julia) (Entered: 03/06/2018)

03/06/2018 20 SEALED DECLARATION IN SUPPORT OF APPLICATION to ﬁle document Exhibits D & E to Fischer Decl ISO Plaintiffs' Motion for Class Certiﬁcation under seal 19 ﬁled by

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Plaintiffs Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Unredacted Document Exh D to Fischer Decl ISO Plaintiffs' Motion for Class Cert., # 2 Unredacted Document Exh E to Fischer Decl ISO Plaintiffs' Motion for Class Cert. (Part 1 of 4), # 3 Unredacted Document Exh E to Fischer Decl ISO Plaintiffs' Motion for Class Cert. (Part 2 of 4), # 4 Unredacted Document Exh E to Fischer Decl ISO Plaintiffs' Motion for Class Cert. (Part 3 of 4), # 5 Unredacted Document Exh E to Fischer Decl ISO Plaintiffs' Motion for Class Cert. (Part 4 of 4))(Romano, Julia) (Entered: 03/06/2018)
21 NOTICE OF MOTION AND MOTION to Certify Class ﬁled by Plaintiffs Clay Murray, Maria Tracy, Shareen Winkle. Motion set for hearing on 4/12/2018 at 08:30 AM before Judge George H. Wu. (Attachments: # 1 Proposed Order) (Fischer, Aaron) (Entered: 03/06/2018)
22 JOINT STATEMENT of Stipulated Facts NOTICE OF MOTION AND MOTION to Certify Class 21 ﬁled by Plaintiffs Clay Murray, Maria Tracy, Shareen Winkle. (Fischer, Aaron) (Entered: 03/06/2018)
23 DECLARATION of Aaron J. Fischer in support of NOTICE OF MOTION AND MOTION to Certify Class 21 ﬁled by Plaintiffs Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Exhibit A, # 2 Exhibit B, # 3 Exhibit C, # 4 Exhibit D, # 5 Exhibit E)(Fischer, Aaron) (Entered: 03/06/2018)
24 DECLARATION of Don Specter in support of NOTICE OF MOTION AND MOTION to Certify Class 21 ﬁled by Plaintiffs Clay Murray, Maria Tracy, Shareen Winkle. (Fischer, Aaron) (Entered: 03/06/2018)
25 DECLARATION of Joshua C. Toll in support of NOTICE OF MOTION AND MOTION to Certify Class 21 ﬁled by Plaintiffs Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Exhibit A, # 2 Exhibit B, # 3 Exhibit C)(Fischer, Aaron) (Entered: 03/06/2018)
26 ORDER GRANTING APPLICATION FOR LEAVE TO FILE EXHIBITS D AND E IN SUPPORT OF PLAINTIFFS' MOTION FOR CLASS CERTIFICATION UNDER SEAL by Judge George H. Wu re: 19 APPLICATION to Seal Document. (mrgo) (Entered: 03/07/2018)
27 ANSWER to Complaint (Attorney Civil Case Opening),, 1 with JURY DEMAND ﬁled by Defendant County of Santa Barbara, County of Santa Barbara Sheriffs Ofﬁce.(Attorney Danielle Francine Drossel added to party County of Santa Barbara(pty:dft), Attorney Danielle Francine Drossel added to party County of Santa Barbara Sheriffs Ofﬁce (pty:dft))(Drossel, Danielle) (Entered: 03/07/2018)
28 Certiﬁcation and NOTICE of Interested Parties ﬁled by Defendant County of Santa Barbara, County of Santa Barbara Sheriffs Ofﬁce, (Drossel, Danielle) (Entered: 03/07/2018)
29 SEALED DOCUMENT Exhibit D re Declaration (Motion related), 23 , NOTICE OF MOTION AND MOTION to Certify Class 21 , Order on Motion for Leave to File Document Under Seal 26 ﬁled by Plaintiffs Clay Murray, Maria Tracy, Shareen Winkle. (Romano, Julia) (Entered: 03/08/2018)
30 SEALED DOCUMENT Exhibit E re Declaration (Motion related), 23 , NOTICE OF MOTION AND MOTION to Certify Class 21 , Order on Motion for Leave to File Document Under Seal 26 ﬁled by Plaintiffs Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Part 2 of 4, # 2 Part 3 of 4, # 3 Part 4 of 4)(Romano, Julia) (Entered: 03/08/2018)
31 STIPULATED PROTECTIVE ORDER by Magistrate Judge Jean P. Rosenbluth re

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Stipulation for Protective Order 18 . (See Order for details) [Note Changes Made By The Court]. (bem) (Entered: 03/08/2018)
32 NOTICE OF NON-OPPOSITION to NOTICE OF MOTION AND MOTION to Certify Class 21 ﬁled by Defendants County of Santa Barbara, County of Santa Barbara Sheriffs Ofﬁce. (Drossel, Danielle) (Entered: 03/22/2018)
33 MINUTES OF PLAINTIFFS' MOTION FOR CLASS CERTIFICATION 21 Hearing held before Judge George H. Wu. The Court's Tentative Ruling is circulated and attached hereto. Court hears oral argument. For reasons stated on the record, Plaintiff's Motion is continued to May 31, 2018 at 8:30 a.m., with ﬁnal supplemental documents to be ﬁled by May 22, 2018. The Court sets a scheduling conference fo May 31, 2018 at 8:30 a.m. Court Reporter: Katie Thibodeaux. (mrgo) (Entered: 04/13/2018)
34 SUPPLEMENT to NOTICE OF MOTION AND MOTION to Certify Class 21 Supplemental Brief in Support of Motion for Class Certiﬁcation ﬁled by Plaintiffs Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Supplement Joint Stipulation of Facts, # 2 Declaration of Clay Murray, # 3 Declaration of Maria Tracy, # 4 Declaration of Shareen Winkle)(Fischer, Aaron) (Entered: 05/22/2018)
35 ORDER GRANTING PLAINTIFFS' MOTION FOR CLASS CERTIFICATION by Judge George H. Wu re: 21 MOTION to Certify Class Action. Accordingly, the Court GRANTS Plaintiffs' Motion and certiﬁes the following classes: Plaintiff Class: All people who are now, or in the future will be, incarcerated in the Santa Barbara County Jail system. (See document for details) (mrgo) (Entered: 06/04/2018)
36 MINUTES OF PLAINTIFFS' MOTION FOR CLASS CERTIFICATION 21 ; SCHEDULING CONFERENCE Hearing held before Judge George H. Wu. The Court's Ruling for Class Certiﬁcation is circulated and attached hereto. Plaintiffs' Motion is GRANTED. Order to issue. The scheduling conference is continued to June 28, 2018 at 8:30 a.m., with a joint proposed scheduling report to be ﬁled by noon on June 26, 2018. Court Reporter: Katie Thibodeaux. (mrgo) (Entered: 06/04/2018)
37 STATUS REPORT JOINT PROPOSED SCHEDULING REPORT ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Romano, Julia) (Entered: 06/26/2018)
38 NOTICE of Appearance ﬁled by attorney Amber R Holderness on behalf of Defendants County of Santa Barbara, County of Santa Barbara Sheriffs Ofﬁce (Attorney Amber R Holderness added to party County of Santa Barbara(pty:dft), Attorney Amber R Holderness added to party County of Santa Barbara Sheriffs Ofﬁce (pty:dft))(Holderness, Amber) (Entered: 06/27/2018)
39 STATEMENT Joint Statement re: Class Notice ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle (Attachments: # 1 Proposed Order, # 2 Exhibit A - Class Notice)(Fischer, Aaron) (Entered: 06/27/2018)
40 STIPULATION for Order For Disclosure of Conﬁdential Inmate Records Subject to Protective Order ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle.(Romano, Julia) (Entered: 06/27/2018)
41 MINUTES OF SCHEDULING CONFERENCE held before Judge George H. Wu: Court and counsel confer. Pursuant to the request of counsel, the above-entitled action is STAYED until January 10, 2019 pending settlement. Counsel are to provide joint status reports as indicated on the record. Court Reporter: Katie Thibodeaux. (es) (Entered: 06/29/2018)
42 ORDER by Judge George H. Wu,GRANTING STIPULATION For Disclosure of

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Conﬁdential Inmate Records Subject to Protective Order 40 . (shb) (Entered: 07/02/2018)
43 ORDER APPROVING CLASS NOTICE (SEE DOCUMENT SPECIFICS) 39 by Judge George H. Wu (lc) (Entered: 07/02/2018)
44 DECLARATION of Charles Powell re Order 43 To Afﬁrm Distribution of Class Notice ﬁled by Defendants County of Santa Barbara, County of Santa Barbara Sheriffs Ofﬁce. (Holderness, Amber) (Entered: 08/10/2018)
45 STATUS REPORT Joint Status Report ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Fischer, Aaron) (Entered: 09/25/2018)
46 STATUS REPORT (SECOND JOINT) ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Romano, Julia) (Entered: 12/21/2018)
47 TEXT ONLY ENTRY (IN CHAMBERS) by Judge George H. Wu: This class action against the conditions of the Santa Barbara County jail was ﬁled on December 6, 2017. Plaintiffs ﬁled a motion for class certiﬁcation which was not opposed. On May 31, 2018, the Court certiﬁed the class. On June 27, 2018, the Court stayed the case to January 10, 2019, upon the representation of the parties that they had been engaged in settlement discussions. On December 21, 2018, the parties ﬁled another request for a stay for another six months because of their continuing efforts to settle the case. They also reference a discussion of the matter by the County's Board of Supervisors in February 2019. Based on the above, the Court will stay the case to March 4, 2019, and schedules a status conference on said date at 8:30 am. The counsel may appear telephonically. The parties will ﬁle a joint status report regarding generally the status of the settlement discussions and any other relevant elements by February 28.THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (kd) TEXT ONLY ENTRY (Entered: 01/14/2019)
48 STATUS REPORT (JOINT) ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Exhibit A - Subject Matter Expert Report on Custody Operations (by Margo Frasier))(Fischer, Aaron) (Entered: 02/28/2019)
49 TEXT-ONLY ENTRY - IN CHAMBERS: by Judge George H. Wu: In light of the Third Joint Status Report ﬁled by the parties 48 , the Status Conference now set for March 4, 2019, is continued to May 13, 2019 at 8:30 a.m. The parties are to ﬁle a joint status report by May 9.THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (jag) TEXT ONLY ENTRY (Entered: 03/01/2019)
50 Notice of Electronic Filing re Status Report 48 e-mailed to Danielle F Drossel bounced due to invalid email address. The primary e-mail address associated with the attorney record has been deleted. Pursuant to Local Rules it is the attorneys obligation to maintain all personal contact information including e-mail address in the CM/ECF system. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (rrey) TEXT ONLY ENTRY (Entered: 03/05/2019)
51 STATUS REPORT (Fourth Joint) ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Fischer, Aaron) (Entered: 05/09/2019)
52 TEXT-ONLY ENTRY - IN CHAMBERS: by Judge George H. Wu: Based on the Joint Status Report 51 , and pursuant to the request of counsel, the STATUS CONFERENCE previously scheduled for 05/13/2019 is CONTINUED to 7/18/2019 at 08:30 AM before Judge George H. Wu. The parties are to ﬁle a joint status report by July 15. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (jag) TEXT ONLY ENTRY (Entered: 05/13/2019)
53 Notice of Appearance or Withdrawal of Counsel: for attorney Jaqueline Aranda Osorno counsel for Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen

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Winkle. Adding Jaqueline Aranda Osorno as counsel of record for Plaintiffs Clay Murray, et al. for the reason indicated in the G-123 Notice. Filed by plaintiffs Clay Murray, et al.. (Attorney Jaqueline Aranda Osorno added to party Eric Brown(pty:pla), Attorney Jaqueline Aranda Osorno added to party David Franco(pty:pla), Attorney Jaqueline Aranda Osorno added to party Clay Murray(pty:pla), Attorney Jaqueline Aranda Osorno added to party Maria Tracy(pty:pla), Attorney Jaqueline Aranda Osorno added to party Shareen Winkle(pty:pla))(Osorno, Jaqueline) (Entered: 07/12/2019)
54 STATUS REPORT (Fifth Joint) ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Fischer, Aaron) (Entered: 07/15/2019)
55 TEXT-ONLY ENTRY - IN CHAMBERS: by Judge George H. Wu: Based on the Joint Status Report 54 , the STATUS CONFERENCE previously scheduled for 07/18/2019 is CONTINUED to 9/19/2019 at 08:30 AM, with a joint status report to be ﬁled by 09/16/2019. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (jag) TEXT ONLY ENTRY (Entered: 07/17/2019)
56 STATUS REPORT (Sixth Joint) ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Foster, Stacy) (Entered: 09/16/2019)
57 TEXT-ONLY ENTRY (IN CHAMBERS): by Judge George H. Wu: In light of the parties Sixth Joint Status Report 56 , the status conference now set for September 19, 2019, is continued to November 18, 2019 at 8:30 a.m., and the parties are to ﬁle a joint status report by November 14. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (jag) TEXT ONLY ENTRY (Entered: 09/17/2019)
58 Notice of Appearance or Withdrawal of Counsel: for attorney Aaron Joseph Fischer counsel for Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. Richard Diaz is no longer counsel of record for the aforementioned party in this case for the reason indicated in the G-123 Notice. Filed by plaintiffs Murray, Franco, Winkle, Tracy, Brown. (Fischer, Aaron) (Entered: 11/08/2019)
59 Notice of Appearance or Withdrawal of Counsel: for attorney Aaron Joseph Fischer counsel for Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. Jaqueline Aranda Osorno is no longer counsel of record for the aforementioned party in this case for the reason indicated in the G-123 Notice. Filed by plaintiffs Murray, Franco, Winkle, Tracy, Brown. (Fischer, Aaron) (Entered: 11/08/2019)
60 NOTICE TO FILER OF DEFICIENCIES in Electronically Filed Documents RE: Notice of Appearance or Withdrawal of Counsel (G-123), 58 , Notice of Appearance or Withdrawal of Counsel (G-123), 59 . The following error(s) was/were found: See court's website for form: Request for Approval of Substitution or Withdrawal of Counsel G-01. To eﬁle document, search for: Civil Events - Motions and Related Filings - Requests - Substitute Attorney (G-01). The [Prop] Order should be attached to Request as a second attachment. In response to this notice, the Court may: (1) order an amended or correct document to be ﬁled; (2) order the document stricken; or (3) take other action as the Court deems appropriate. You need not take any action in response to this notice unless and until the Court directs you to do so. (lom) (Entered: 11/12/2019)
61 SEVENTH JOINT STATUS REPORT ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Exhibit A)(Foster, Stacy) (Entered: 11/14/2019)
62 TEXT-ONLY ENTRY (IN CHAMBERS): by Judge George H. Wu: Based on the Seventh Status Report 61 , the STATUS CONFERENCE previously scheduled for 11/18/2019 is CONTINUED to 1/23/2020 at 08:30 AM, with a joint status report to be ﬁled by

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01/17/2020. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (jag) TEXT ONLY ENTRY (Entered: 11/15/2019)

01/17/2020 63 STATUS REPORT (Eighth Joint) ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Foster, Stacy) (Entered: 01/17/2020)

01/21/2020

64 TEXT-ONLY ENTRY (IN CHAMBERS): by Judge George H. Wu: In light of the parties Eighth Joint Status Report 63 , the status conference now set for January 23, 2020, is continued to March 26, 2020 at 8:30 a.m. The parties are to ﬁle a Joint Status Report by March 23. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (jag) TEXT ONLY ENTRY (Entered: 01/21/2020)

03/23/2020

65 STATUS REPORT (Ninth Joint) ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Exhibit A (Grenawitzke Report)) (Romano, Julia) (Entered: 03/23/2020)

03/23/2020

66 APPLICATION to ﬁle document Exhibit B (Frasier Report) to Ninth Joint Status Report under seal ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Declaration of Julia E. Romano, # 2 Proposed Order) (Romano, Julia) (Entered: 03/23/2020)

03/23/2020

67 SEALED DECLARATION IN SUPPORT OF APPLICATION to ﬁle document Exhibit B (Frasier Report) to Ninth Joint Status Report under seal 66 ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Unredacted Document Exhibit B (Frasier Report) to Ninth Joint Status Report)(Romano, Julia) (Entered: 03/23/2020)

03/24/2020

68 TEXT-ONLY ENTRY (IN CHAMBERS): by Judge George H. Wu: The Court has received the parties Ninth Joint Status Report (Docket No. 65 ). For the reasons stated therein, the Court continues the status conference currently set for March 26, 2020 to May 28, 2020 at 8:30 a.m. The parties are to appear telephonically with advance arrangement with the Court Clerk. The parties are to ﬁle a joint status report by May 25, 2020. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (jag) TEXT ONLY ENTRY (Entered: 03/24/2020)

03/25/2020

69 ORDER GRANTING APPLICATION FOR LEAVE TO FILE EXHIBIT B (FRASIER REPORT) TO NINTH JOINT STATUS REPORT UNDER SEAL by Judge George H. Wu 66 . (twdb) (Entered: 03/25/2020)

03/25/2020

70 SEALED DOCUMENT Exhibit B (Frasier Report) re Status Report 65 , Order on Motion for Leave to File Document Under Seal 69 ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle.(Romano, Julia) (Entered: 03/25/2020)

05/22/2020 71 STATUS REPORT Tenth Joint ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Romano, Julia) (Entered: 05/22/2020)

05/26/2020

72 TEXT-ONLY ENTRY (IN CHAMBERS): by Judge George H. Wu: The Court has received and reviewed the parties Tenth Joint Status Report (Docket No. 71 ). Based on the representations therein, the Court moves the May 28, 2020 status conference to June 29, 2020 at 8:30 a.m.; and the parties are ordered to ﬁle a joint status report by June 25, 2020. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (jag) TEXT ONLY ENTRY (Entered: 05/26/2020)

06/25/2020 73 STATUS REPORT (ELEVENTH JOINT) ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Foster, Stacy) (Entered: 06/25/2020)

06/26/2020

74 TEXT-ONLY ENTRY - IN CHAMBERS: by Judge George H. Wu: The Court has received and reviewed the parties Tenth Joint Status Report (Docket No. 71 ). Based on the representations therein, the Court moves the June 29, 2020 status conference to August 3,

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2020 at 8:30 a.m., and the parties are ordered to ﬁle a joint status report by July 30, 2020. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (jag) TEXT ONLY ENTRY (Entered: 06/26/2020)
75 NOTICE of Settlement (Joint) ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Exhibit (Stipulated Judgment), # 2 Proposed Order)(Romano, Julia) (Entered: 07/17/2020)
76 ORDER by Judge George H. Wu, re Notice of Settlement 75 . IT IS HEREBY ORDERED that: 1. The Court vacates the August 3, 2020 status conference (Dkt. 74). 2. The Court vacates its order directing the parties to ﬁle a joint status report by July 30, 2020 (Dkt. 74). 3. The parties shall ﬁle the motion for preliminary approval of the settlement on or before July 31, 2020. 4. The Court sets a hearing on the motion for August 14, 2020 at 8:30 a.m. (mrgo) (Entered: 07/21/2020)
77 TEXT-ONLY ENTRY - IN CHAMBERS: by Judge George H. Wu: The Court has reviewed the parties Class Action Joint Notice of Settlement (Docket No. 75 ). Therein, the parties request that the - Court vacate the August 3, 2020 status conference and its order directing the parties to ﬁle a joint status report by July 30, 2020 (Dkt. 74 ), and direct that the parties ﬁle the motion for preliminary approval of the settlement on or before July 31, 2020. - However, the Court will keep the August 3 status conference on calendar and the parties may appear telephonically. The Court has a few procedural questions and wishes to inquire about scheduling. But, the Court will withdraw the order as to the ﬁling of a joint status report by July 30. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (jag) TEXT ONLY ENTRY (Entered: 07/29/2020)
78 STIPULATION to Continue and Request Hearing on Motion for Preliminary Approval of Settlement from August 14, 2020 to August 20, 2020 ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Proposed Order) (Romano, Julia) (Entered: 07/30/2020)
82 ORDER GRANTING STIPULATION AND REQUEST TO CONTINUE HEARING ON MOTION FOR PRELIMINARY APPROVAL OF SETTLEMENT by Judge George H. Wu, re Joint NOTICE OF MOTION AND MOTION to Approve Consent Judgment (Stipulated Judgment and Notice to Class) 80 . For good cause shown, the hearing on the Motion for Preliminary Approval of the Settlement, originally scheduled for August 14, 2020 at 8:30 a.m. (Dkt. 76), is continued to August 20, 2020 at 8:30 a.m. (mrgo) (Entered: 07/31/2020)
79 TEXT-ONLY ENTRY - IN CHAMBERS: by Judge George H. Wu: Counsel are to appear telephonically for Monday's status conference at 8:30 a.m. by contacting the court clerk at javier_gonzalez@cacd.uscourts.gov for dial-in information. THERE IS NO PDF DOCUMENT ASSOCIATED WITH THIS ENTRY. (jag) TEXT ONLY ENTRY (Entered: 07/31/2020)
80 Joint NOTICE OF MOTION AND MOTION to Approve Consent Judgment (Stipulated Judgment and Notice to Class) ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. Motion set for hearing on 8/14/2020 at 08:30 AM before Judge George H. Wu. (Attachments: # 1 Declaration of Julia E. Romano In Support of Joint Motion for Preliminary Approval of Stipulated Judgment and Notice to Class, # 2 Proposed Order) (Romano, Julia) (Entered: 07/31/2020)
81 NOTICE OF MOTION AND MOTION for Attorney Fees and Expenses ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Declaration of Joshua Toll in Support of Plaintiffs' Unopposed Motion for Attorneys' Fees and Expenses, # 2 Declaration of Aaron Fischer in Support of Plaintiffs' Unopposed Motion for Attorneys' Fees and Expenses, # 3 Declaration of Corene Kendrick in Support

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of Plaintiffs' Unopposed Motion for Attorneys' Fees and Expenses, # 4 Proposed Order re: Plaintiffs' Unopposed Motion for Attorneys' Fees and Expenses) (Romano, Julia) (Entered: 07/31/2020)

08/03/2020

83 MINUTES OF TELEPHONIC CONFERENCE held before Judge George H. Wu. Court and counsel confer re related cases Washington v. Santa Barbara County Sheriffs Dept., CV 20-534-GW-JPRx and Hollis v. Santa Barbara County Sheriffs Dept., CV 20-2168GW-PDx. Counsel are to confer as to whether the Plaintiffs in these actions can be included in the proposed class. Counsel will advise the Court at the hearing on the motions set for August 20, 2020 at 8:30 a.m. Court Reporter: Terri A. Hourigan. (mrgo) (Entered: 08/04/2020)

08/20/2020

84 MINUTES OF TELEPHONIC HEARING ON JOINT MOTION FOR PRELIMINARY APPROVAL OF STIPULATED JUDGMENT AND NOTICE TO CLASS 80 ; and PLAINTIFFS' UNOPPOSED MOTION FOR ATTORNEYS' FEES AND EXPENSES 81 Hearing held before Judge George H. Wu. The Tentative circulated and attached hereto, is adopted as its Final Ruling. The Motion for Preliminary Approval is GRANTED and the Court sets the following dates: Publication of Notice by September 3, 2020; Comments and/or objections due/postmarked by November 2, 2020; The Parties (1) response(s) to any proffered comments/objections and (2) motion for ﬁnal approval will be ﬁled by November 23, 2020; Hearing on ﬁnal approval on December 7, 2020, at 8:30 a.m. A status conference in these matters is set for September 28, 2020 at 8:30 a.m. Court Reporter: Terri A. Hourigan. (mrgo) (Entered: 08/21/2020)

09/01/2020

85 ORDER GRANTING PRELIMINARY APPROVAL OF STIPULATED JUDGMENT AND CLASS NOTICE by Judge George H. Wu, re Order on Motion to Approve Consent Judgment, Motion Hearing, 84 . IT IS ORDERED AS FOLLOWS: 1. The Court GRANTS the parties' Motion For Preliminary Approval of the Stipulated Judgment and ﬁnds the agreement certainly is within the range of possible approval as "fair, reasonable, and adequate" after considering all of the requirements necessary to preliminarily approve the settlement under Federal Rules of Civil Procedure 23(e)(1) and (2), and to allow notice to be directed to the class and subclass members so that they may comment or object to the settlement. (SEE DOCUMENT FOR DETAILS). The Court sets the following deadlines for the Class Notice and consideration of the parties' Motion for Final Approval of the settlement: Publication of Class Notice by September 3, 2020. Comments and/or objections due/postmarked by November 2, 2020. The parties' (1) response(s) to any proffered comments/objections and (2) Motion for Final Approval will be ﬁled by November 23, 2020. The hearing on the Motion for Final Approval is set for December 7, 2020, at 8:30 a.m. (mrgo) (Entered: 09/04/2020)

11/05/2020

86 Notice of Appearance or Withdrawal of Counsel: for attorney Corene Kendrick counsel for Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. Corene Kendrick is no longer counsel of record for the aforementioned party in this case for the reason indicated in the G-123 Notice. Filed by Counsel for Plaintiff Corene Kendrick. (Kendrick, Corene) (Entered: 11/05/2020)

11/20/2020

87 Joint STIPULATION for Hearing re To Set Status Conference and Continue Deadline to File Motion for Approval of Final Stipulated Judgment ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Proposed Order)(Romano, Julia) (Entered: 11/20/2020)

11/23/2020

88 ORDER by Judge George H. Wu, re Stipulation for Hearing, 87 . IT IS HEREBY ORDERED that: 1. The Court sets a status conference for November 30, 2020 at 8:30 a.m.; 2. The Court continues the deadline for the parties to ﬁle the Motion for Approval of Final Stipulated Judgment to November 30, 2020. (mrgo) (Entered: 11/24/2020)

11/30/2020 89 MINUTES OF Telephone Conference held before Judge George H. Wu: The parties will

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have until December 2, 2020 to ﬁle a stipulation extending class notice and ﬁnal approval dates. Court Reporter: Terri A. Hourigan. (lc) Modiﬁed on 12/1/2020 (lc). (Entered: 12/01/2020)
90 Joint STIPULATION for Extension of Time to File Final Approval of Settlement and Approval of Amended Class Notice ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. (Attachments: # 1 Exhibit A, # 2 Proposed Order) (Romano, Julia) (Entered: 12/02/2020)
91 ORDER APPROVING AMENDED CLASS NOTICE AND SCHEDULING ON MOTION FOR FINAL APPROVAL OF SETTLEMENT by Judge George H. Wu, re Stipulation for Extension of Time to File, 90 . Under Federal Rule of Civil Procedure 23(e) (1), the Court approves the substance, form and manner of the Amended Notice of Proposed Class Action Settlement (the "Amended Notice") ﬁled by the parties and ﬁnds that the proposed method of disseminating the Notice meets all due process and other legal requirements and is the best notice practicable under the circumstances. (SEE DOCUMENT FOR FULL DETAILS). A fairness hearing shall take place at 8:30 AM on February 1, 2021. (mrgo) (Entered: 12/04/2020)
92 DECLARATION of Shawn Lammer Afﬁrming Distribution of Class Notice and Related Materials ﬁled by Defendants County of Santa Barbara, County of Santa Barbara Sheriffs Ofﬁce. (Holderness, Amber) (Entered: 01/14/2021)
93 Joint NOTICE OF MOTION AND MOTION for Hearing Joint Motion for Final Approval of Stipulated Judgment ﬁled by Plaintiffs Eric Brown, David Franco, Clay Murray, Maria Tracy, Shareen Winkle. Motion set for hearing on 2/1/2021 at 08:30 AM before Judge George H. Wu. (Attachments: # 1 Proposed Order) (Romano, Julia) (Entered: 01/14/2021)

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 Case 2:17-cv-08805-GW-JPR Document 35 Filed 05/31/18 Page 1 of 3 Page ID #:816

1 AARON J. FISCHER (SBN 247391)

aaron.fischer@disabilityrightsca.org 2 DISABILITY RIGHTS CALIFORNIA

3

1330 Broadway, Suite 500 Oakland, CA 94612

4 Telephone: (510) 267-1200 Facsimile: (510) 267-1201
5

6

JULIA E. ROMANO (SBN 260857) jromano@kslaw.com

7 JENNIFER T. STEWART (SBN 298798) jstewart@kslaw.com
8 STACY L. FOSTER (SBN 285544)

sfoster@kslaw.com 9 KING & SPALDING LLP

10

633 W Fifth Street, Suite 1700 Los Angeles, CA 900781

11 Telephone: (213) 443-4355 Facsimile: (213) 443-4310
12

13 Attorneys for Plaintiffs

14 [Additional Counsel Listed On Second Page]

15

UNITED STATES DISTRICT COURT

16

CENTRAL DISTRICT OF CALIFORNIA

17
18 CLAY MURRAY, DAVID FRANCO, SHAREEN WINKLE, MARIA
19 TRACY, ERICK BROWN, on behalf of themselves and all others similarly
20 situated,

21

Plaintiffs,

22

v.

23

24 COUNTY OF SANTA BARBARA, and SANTA BARBARA COUNTY
25 SHERIFF’S OFFICE,

26

Defendants.

27

Case No. 2:17-cv-08805-GW-JPR

CLASS ACTION

ORDER GRANTING PLAINTIFFS’ MOTION FOR CLASS CERTIFICATION

DATE:

April 12, 2018

TIME:

8:30 a.m.

JUDGE: Hon. George H. Wu

COURTRM: 9D

Complaint Filed: December 6, 2017

28

[PROPOSED] ORDER GRANTING PLAINTIFFS’ MOTION FOR CLASS CERTIFICATION

Case 2:17-cv-08805-GW-JPR Document 35 Filed 05/31/18 Page 2 of 3 Page ID #:817

1

RICHARD DIAZ (SBN 285459) richard.diaz@disabilityrightsca.org

2 DISABILITY RIGHTS CALIFORNIA 350 South Bixel Street, Suite 290

3 Los Angeles, CA 90017

Telephone: (213) 213-8000 4 Facsimile: (213) 213-8001

5 DON SPECTER (SBN 83925)

6 dspecter@prisonlaw.com

CORENE KENDRICK (SBN 226642)

7 ckendrick@prisonlaw.com

8

PRISON LAW OFFICE 1917 Fifth Street

9 Berkeley, CA 94710 Telephone: (510) 280-2621

10 Facsimile: (510) 280-2704

11 DONALD F. ZIMMER, JR. (SBN 112279)

12

fzimmer@kslaw.com KING & SPALDING LLP

13 101 Second Street, Suite 2300

San Francisco, CA 94105

14 Telephone: (415) 318-1220

15 Facsimile: (415) 318-1300

16 JOSHUA C. TOLL (Admitted Pro Hac Vice) jtoll@kslaw.com

17 KING & SPALDING LLP

1700 Pennsylvania Ave NW 18 Washington DC 20036

19

Telephone: Facsimile:

(202) 737-8616 (202) 626-3727

20

21

22

23

24

25

26

27

28
-1 [PROPOSED] ORDER GRANTING PLAINTIFFS’ MOTION FOR CLASS CERTIFICATION

Case 2:17-cv-08805-GW-JPR Document 35 Filed 05/31/18 Page 3 of 3 Page ID #:818

1

Plaintiffs’ Motion for Class Certification came on regularly for hearing on

2 April 12, 2018 in Courtroom 9D of the above-entitled Court.

3

After full consideration of the evidence, the oral arguments of each party,

4 and the authorities submitted by counsel, the Court finds this action is maintainable

5 as a class action under Federal Rule of Civil Procedure Rule 23(a), 23(b)(1), and

6 23(b)(2). Accordingly, the Court GRANTS Plaintiffs’ Motion and certifies the

7 following classes:

8

x Plaintiff Class: All people who are now, or in the future will be,

9

incarcerated in the Santa Barbara County Jail system.

10

x Plaintiff Subclass (the “Disabilities Subclass”): All people who are

11

now, or in the future will be, incarcerated in the Santa Barbara County

12

Jail system and who are qualified individuals with disabilities, as that

13

term is defined in the Americans with Disabilities Act (ADA), 42 U.S.C.

14

§12102, the Rehabilitation Act, 29 U.S.C. § 705(9)(B), and California

15

Government Code § 12926(j) and (m).

16

The Court hereby certifies Plaintiffs CLAY MURRAY, SHAREEN

17 WINKLE, and MARIA TRACY as representatives of the Plaintiff Class and

18 Disabilities Subclass and appoints Disability Rights California, Prison Law Office,

19 and King & Spalding LLP as Class Counsel.

20

The Court orders the parties, pursuant to Rule 23(c)(2)(A), to confer and

21 submit a proposed notice to the Plaintiff Class and Disabilities Subclass, and the

22 method of distribution of that notice, within 30 days of the Order certifying the

23 Plaintiff Class and Disabilities Subclass.

24

IT IS SO ORDERED.

25

26 Dated: May 31, 2018 27 28

The Honorable George H. Wu United States District Judge

-1 [PROPOSED] ORDER GRANTING PLAINTIFFS’ MOTION FOR CLASS CERTIFICATION

 
 Case 2:17-cv-08805-GW-JPR Document 39-2 Filed 06/27/18 Page 1 of 3 Page ID #:841
Exhibit A

Case 2:17-cv-08805-GW-JPR Document 39-2 Filed 06/27/18 Page 2 of 3 Page ID #:842
IMPORTANT NOTICE
CLASS ACTION REGARDING SANTA BARBARA COUNTY JAIL: Mental Health Care, Medical Care, Disabilities, Restrictive/Segregation Housing
Murray, et al. v. County of Santa Barbara, C.D. Cal. No. 2:17-cv-08805-GW-JPR
Murray v. County of Santa Barbara is a federal class action lawsuit challenging certain conditions at the Santa Barbara County Jail. The conditions addressed in the lawsuit include mental health care, medical care (including dental care), disability access and accommodations, and use of restrictive/segregation housing.
The lawsuit claims that:
1. Prisoners in the jail are being deprived of their rights under the Eighth and Fourteenth Amendments to the United States Constitution; and
2. The County does not comply with federal and state disability law, including the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, and California Government Code Section 11135 at the County Jail.
The Court has issued an order that all people incarcerated in the Santa Barbara County Jail are covered by the lawsuit (“the Class”). You are a member of this main Class if you are incarcerated in Santa Barbara County Jail. The Court also certified a Subclass of people with disabilities who are incarcerated in the Santa Barbara County Jail.
1

Case 2:17-cv-08805-GW-JPR Document 39-2 Filed 06/27/18 Page 3 of 3 Page ID #:843
You are not required to do anything at this time. The Court will decide whether or not to issue an order regarding the conditions in the jail facilities after a trial or, if there is a settlement, after determining whether to approve that settlement.
Any settlement or final judgment entered in this case will be binding on all people in the Class and Subclass. The Court has appointed attorneys to represent the Class and the Subclass.
This action does not seek money damages for inmates and none will be awarded.
This action does not involve any claim for individual relief, and attorneys for the class offer no opinion as to any inmate’s ability to pursue a case for money damages or other relief.
The parties have agreed to obtain reports from subject matter experts based on their independent analysis of the jail’s mental health care, medical care, disability access and disability accommodations system, and custody operations. The parties will be meeting to discuss a possible settlement.
You can view the class action complaint by requesting it from jail staff.
If you would like more information about this case, or if you have any information that you wish to communicate to the Class attorneys, you may contact:
Disability Rights California Attn: Santa Barbara Jail Class Action Team
350 South Bixel Street, Suite 290 Los Angeles, CA 90017
2

 
 Case 2:17-cv-08805-GW-JPR Document 23-2 Filed 03/06/18 Page 2 of 22 Page ID #:438
Review of Medical Care – Santa Barbara County Jail, Executive Summary, September 2017 1
Review of Santa Barbara County Jail Medical Services Executive Summary
Scott A. Allen, MD
Introduction
I have been asked jointly by counsel representing the County of Santa Barbara and counsel representing inmates to provide an independent assessment of the medical care provided by the County in its jail system and to make recommendations as indicated as part of an alternative resolution process.
Standards
While it is understood that the Santa Barbara County Jail is not currently accredited by the National Commission on Correctional Health Care (NCCHC), the Standards for Services in Jails (2014 Ed.) provides a useful benchmark for minimum standards for jail health services in the Unites States, and I will refer to those standards in this report.1
In addition to the NCCHC standards, I will make reference in this report to community medical standards. While the acceptable clinical practice of medicine allows for a wide variety of approaches to practice, community medical standards are the point in which the greater body of experts and practitioners in the field have found agreement and are established by the standard of care accepted by the community at large.
There is no separate or unequal standard of care for inmates of correctional institutions; there are merely logistical challenges and reasonable accommodations and modifications of standard medical approaches that are a direct result of the constraints of confinement settings. Those exceptions and accommodations to security needs should be minimal and rarely interrupt and never prevent essential healthcare delivery. To the extent that providing medical care in a correctional setting raises some unique challenges, I draw on my knowledge of standards and practices as a physician experienced in correctional healthcare and familiar with standards of the field.
In general, when I refer to minimal community standards, I refer to services a patient with Medicaid or Medi-Cal coverage would likely be eligible to receive in a community health center or non-correctional county facility or similar setting,
1 When I cite the 2014 NCCHC Standards for Health Services in Jails, the standard is in the following format: the letter “J” followed by letter “A” through “I” and a number. For example, the standard for Receiving Screening is J-E-02.

Case 2:17-cv-08805-GW-JPR Document 23-2 Filed 03/06/18 Page 3 of 22 Page ID #:439 Review of Medical Care – Santa Barbara County Jail, Executive Summary, September 2017 2
recognizing that inmates are not constitutionally entitled to the most sophisticated care money can buy, but to adequate medical care.
Finally, when I do make reference to constitutional standards to health care (based on the Eighth Amendment prohibition on cruel and unusual punishment) I do so not as a lawyer (which I clearly am not) but as a physician with extensive experience in actually providing that level of care in jails and prisons and in helping the courts to define that standard in practical terms.
Specific Findings and Recommendations
The section that follows outlines specific deficiencies noted in my review. If there is a relevant NCCHC standard, I note it. 2 No adverse finding is based solely on an inmate claim made during an interview although some were identified first by an interview; all problems described were verified either by the medical record or by staff or in some cases, by both.
1. Accreditation status
Finding:
• Currently, the Santa Barbara County Jail Health Services are not accredited with the National Commission on Correctional Health Care (NCCHC) or the American Correctional Association (ACA).
Recommendation:
• The department should move forward with the process of preparing for, applying for and securing accreditation with the National Commission on Correctional Care.
2. Policies and Procedures:
Findings:
• In the course of this investigation, I had some difficulty in obtaining a copy of the policies and procedures as they were felt to be proprietary by the medical contractor.
2 My inclusion of the standards is merely for reference and although I do describe deficiencies, inclusion of the standard in this section does not mean I have necessarily concluded that the standard is not being met. I do summarize standards that I feel are not being met later in this document.

Case 2:17-cv-08805-GW-JPR Document 23-2 Filed 03/06/18 Page 4 of 22 Page ID #:440 Review of Medical Care – Santa Barbara County Jail, Executive Summary, September 2017 3
• The policies were eventually provided to me and I found no major inconsistencies with NCCHC minimum standards. (J-A-05)
• The policies provided were CFMG policies, and were not site specific to Santa Barbara.
• There was no policy for dealing with transgender patients.
• The policy on drug/alcohol withdrawal did not include detailed guidelines and flowsheets for nurses to make clear the frequency of assessment and specific findings to be noted and recorded during the monitoring period.
Recommendations:
• The policies and procedures governing the delivery of medical care of the Santa Barbara County Jail should be promulgated by the County itself, and the County should exercise ownership and control over those policies.
• The County should have a policy for dealing with the medical care of transgender patients.
• The drug/alcohol withdrawal policy should be supplemented by clear clinical guidelines and flowsheets to enhance compliance with standard clinical protocols referenced by the policy (CIWA and COWS).
3. Staffing:
Findings:
• Currently nursing staffing remains short of the department’s own stated plan and is not sufficient to deliver appropriate medical care. A reasonable staffing recruitment plan is in place (with one notable exception in intake described below), and efforts to recruit new physicians and nurses is underway, but four years after the department was made aware by consultants of staffing deficiencies, the staffing levels proposed by the department have not yet been met.
• The one shortcoming of the current staffing plan is the absence of a nursing post for intake. The intake nursing responsibility is handled by nurses being pulled from other posts. When that happens, other functions shut down. Intake is a critical post in a jail facility, and as such, it should have its own dedicated nurse.

Case 2:17-cv-08805-GW-JPR Document 23-2 Filed 03/06/18 Page 5 of 22 Page ID #:441
Review of Medical Care – Santa Barbara County Jail, Executive Summary, September 2017 4
• The facility is understaffed for medical providers and the schedule is inadequate to cover the needs of a 24/7 facility. Jails are high turnover institutions with many admissions and releases, and an inmate population often in poor health. According to the Sheriff’s 2013-2015 Triennial Report, the medical program handled over 13,000 sick calls per year, or roughly 35 sick-calls a day.
• The current physician coverage for the jail is only a 0.4 FTE position, with physician present on-site for only three days a week, and those days are grouped together mid-week. As a result, there is no physician present for four continuous days every week. This is totally inappropriate and creates unjustifiable risks and liabilities.
• Current physician salaries may not be competitive with other correctional medicine opportunities in the state. (J-C-07)
Recommendations:
• The department should work with the contractor to establish appropriate medical professional staffing levels and then work to maintain them and adjust them to address changing needs.
• When target staffing levels are achieved, ongoing reassessment of changing needs and appropriate adjustments to staffing levels is essential.
• The most critical shortcoming in the current nursing staffing plan is the absence of a nurse primarily assigned to intake. The role of intake nurse is a critical function at a jail facility and should not be staffed by nurses pulled from other posts.
• Given the volume of intakes and releases at the Santa Barbara. The staffing plan should include at least one board certified FTE physician, supplemented by one FTE physician extender such as a nurse practitioner.
• Effort should be made to make salaries competitive with correctional health salaries in the state.
4. Physician Qualifications
Findings:
• There is currently only one physician medical provider at the main jail.

Case 2:17-cv-08805-GW-JPR Document 23-2 Filed 03/06/18 Page 6 of 22 Page ID #:442
Review of Medical Care – Santa Barbara County Jail, Executive Summary, September 2017 5
• A review of medical records reveals that the physician’s medical documentation of care is poor and care of chronic conditions does not meet reasonable community standards.
• The only physician is not board certified in internal medicine, family medicine nor emergency medicine (the three appropriate specialties for a primary care provider in an adult jail).
Recommendations:
• The department should work with the contractor to establish appropriate medical professional provider staffing levels and then work to maintain them and adjust them to address changing needs.
• The physician(s) providing oversite and care at the Santa Barbara jails should be board certified in internal medicine, family medicine or emergency medicine. The physician who would also serve as the Responsible Physician with ultimate authority on all clinical decisions consistent with NCCHC policies should be a full-time position.
5. Overcrowding and Impact on Health
Findings:
• According to the 2016-2017 Santa Barbara County Grand Jury Report “Since 1988, the County has been under a court order to reduce the daily jail population to an 819 approved bed capacity. However, the average population frequently exceeds 1,100.”
•From 2017 Grand Jury Report “The Main Jail, originally built in 1971, has been described as old, antiquated and overcrowded. It is rated for 659 inmates, and the Medium Security Facility is rated for an additional 160 inmates. The average population at the jail tends to be over 1,100.”
• Overcrowding can impact both mental health and physical health. Overcrowding mat threaten physical health by bringing people into close contact that is conducive to the transmission of infectious diseases, ranging from common respiratory and gastrointestinal viruses, to bacteria and even tuberculosis.
• While the current medical program did not have good surveillance data, I happened upon a high number of inmates who actively had or had recently suffered from a serious skin infection due to a drug resistant form of the bacteria staphylococcus aureus, known as MRSA. Although without full data it is difficult to make a firm conclusion, this MRSA problem is likely a reflection of overcrowding combined with sanitation issues.

Case 2:17-cv-08805-GW-JPR Document 23-2 Filed 03/06/18 Page 7 of 22 Page ID #:443 Review of Medical Care – Santa Barbara County Jail, Executive Summary, September 2017 6
• Both overcrowding and poor healthcare have been found by the federal courts, including the U.S. Supreme Court, as potential evidence of unconstitutional care. As a constitutional issue, the obligation of the County to address overcrowding and health care impacts cannot be excused simply due to financial pressures facing the County.
Recommendation:
• As the impact of overcrowding impacts the health in the facilities, the County must develop a timely plan to address overcrowding.
6. Physical space for medical care:
Findings:
•There is no adequate centralized clinic space in the old jail. Clinic space and exam rooms is dispersed throughout the facility impacting efficiency of care and requiring the support of an additional security officer for each clinic space in operation at any given time.
•Intake screening room does not have a door and therefore does not provide auditory isolation for confidentiality of sensitive medical information. Lack of auditory privacy might lead to incomplete disclosure of critical health info and missed opportunities for risk mitigation. All clinic and screening spaces should have auditory privacy for health professional – patient interactions.
• Adequate clinical space in the main jail, as well as development of isolation cells that are not hidden or remotely located, will require substantial architectural modifications.
•There is inadequate office space to support the medical work force, and inadequate space for storage of supplies. (J-D-03)
Recommendations:
• The department should examine and consider options to develop newer and more suitable clinic space to support health operation; space should be large enough to accommodate clinical operations while also securing appropriate privacy for patients. Isolation cells should have direct line of site and be within hearing or two way intercom or call button.

Case 2:17-cv-08805-GW-JPR Document 23-2 Filed 03/06/18 Page 8 of 22 Page ID #:444 Review of Medical Care – Santa Barbara County Jail, Executive Summary, September 2017 7
• It would be advisable to consult closely with county correctional health staff on the plans for clinic space before breaking ground on the Northern Branch project.
7. Sanitation and Environmental Health Issues
Findings:
• The building is old and in disrepair. Overcrowding creates additional challenges to sanitation and cleanliness. During my visit, floors, counters and other services were in poor condition and were not clean. Rubbish and debris were found on floors and hallways. Boxes and other non-trash items were improperly stored in hallways and offices.
•Poor condition of physical plant and poor cleanliness have been noted in this facility in the past.
•I found issues of sanitation to be a problem throughout the facility, but worst in the oldest areas of the building. (J-B-01)
Recommendation:
•The county should formally consult an Environment of Care expert to evaluate the facility to make recommendations to address issues of cleanliness and sanitation.
8. Infirmary or Intermediate Level of Care
Findings:
•Across the entire system, the Santa Barbara County Jail has no ability to provide infirmary level or intermediate level of care. As a result, inmate patients requiring higher level of must be transferred to outside facilities with the attendant higher medical and security costs.
•The main jail does have a so-called “medical unit” but there is nothing about the unit that affords a higher level of medical care. It is simply a dormitory where inmates with medical conditions are housed. (J-G-03)
Recommendation:
•The department should explore options for developing at least one facility that could provide a higher level of medical care such as infirmary or subacute levels of care.

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9. Screening on Intake and Initial Health Assessments:
Findings:
•Current intake does not meet NCCHC standards (J-E-02 and J-E-04) because not all incoming inmates are being screened. In random medical record reviews, I identified records of inmates housed in the facility for over two weeks with no medical screening at all.
Recommendations:
• The department should continue to ensure that all newly arrived inmates are screened on arrival by licensed nursing staff.
• The staffing plan should include an intake nursing post commensurate with the high volume of the facility and critical nature of this function. (J-E-04).
10. Quality Management:
Findings:
•Quality Management (QM) for the medical unit does not appear to exist at the Santa Barbara Jail.
•CFMG policy requires a QM program and there are plans to stand up a QM program in coming months. (J-A-06)
Recommendation:
• The department should continue to develop a continuous Quality Management program. Information gleaned from well-functioning QM processes helps administrators improve both quality of care as well as efficiency of care and can help identify opportunities for cost containment.
11. Utilization Management:
Findings:
•Beyond delegating authority to the vendor (CFMG), there is no apparent process for the County to review and approve use of outside care for patients requiring sub-specialty and hospital services.
Recommendation:

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• The department should develop a utilization management process. Managed care approaches to allocating resources for high cost care have become an established mechanism for standardizing and controlling utilization of health resources.
• The department could consult with other detaining institutions both in the state and elsewhere to learn more about the utilization management process for incarcerated populations. Effective utilization management, while aiming to achieve cost containment, must not adversely impact access to care.
12. Medical Records:
Findings:
•Medical records are currently paper-based. In 2017, a paper based medical records in a jail system is woefully inefficient and inadequate.
•A review of records reveals a pattern of unsigned telephone orders by physicians – some as old as one week – and key lab results that have been filed without notation or acknowledgment by a physician or nurse practitioner. Documentation of clinical encounters is often brief and incomplete.
•There is almost no documentation by physicians of patient education about their illnesses, their lab or test results or the treatment plan.
•Documentation by the current nurse practitioner, while typed and legible, over-used short cuts and general, non-specific words.
•In other charts, handwriting is frequently poor, and some providers do not use a signature stamp so it is unclear to a reviewer who wrote the note and their professional capacity (doctor versus nurse or other staff).
•Problem lists are often incomplete. Lab and radiology results are frequently filed without provider sign off and abnormal results were often filed without any documented intervention to address the abnormality. (J-H-01 and J-H03)
•The department has plans for moving to an Electronic Health Record (EHR) in the future. At the time of this report, this new system is not yet deployed.
Recommendation:

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Review of Medical Care – Santa Barbara County Jail, Executive Summary, September 2017 10
•The department should follow through with its plan to deploy a correctional Electronic Health Record (EHR) and provide ongoing IT support to both the network infrastructure and IT support for end users of the software
13. Chronic Disease Management
Findings:
•Chronic disease management is inadequate. (J-G-01) My review found management of chronic illnesses such as asthma, diabetes, HIV and hypertension, among others, to be ad hoc, incomplete, inconsistent, and reactive as opposed to proactive. Care of chronic diseases appears to be driven more by inmate self-advocacy than by widely accepted clinical guidelines (including but not limited to those referenced by the NCCHC and Federal Bureau of Prisons).
•There is no complete, accurate or reliable list of patients with chronic care conditions.
•There are no protocols that are followed for ongoing care of chronic illness, such as regularly scheduled follow up visits (those appear to be scheduled inconsistently – if at all – by individual physicians and nurses with no clearly documented logic or clinical reasoning).
• In a number of reviewed cases, care of chronic disease patients appeared to be negligent and overall care of chronic diseases could be characterized as deliberately indifferent.
Recommendation:
• The Department should develop a chronic disease management process that references established guidelines (both correctional and community) for the management of common chronic conditions such as, but not limited to, diabetes mellitus, asthma, hypertension, HIV and hepatitis C.
• A well-functioning chronic disease management program should include:
- Documented individual treatment plans - Case tracking (the facility does not currently know who has chronic
disease) - Adherence to widely accepted community standards - Routine scheduled follow up with qualified health professionals including
specialists where indicated

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14. Timely Access to Care: Findings:
•The Santa Barbara County Jail is not consistently providing timely access to care for serious medical conditions.
• Timely access to nursing – A review of records should inconsistent response times to requests for medical care, ranging from same day to four or five days.
• Timely access to facility physicians- Across the system, I documented unacceptably long waits to see a physician, with typical waits ranging from five days to two months or more. For the most part, this appeared to be related to limited staffing of physician providers. In other cases where physician availability has been improved, it appeared to be simply an established informal standard based on past practice. (J-A-01)
• Timely access to specialty care -The Santa Barbara County Jail is not providing timely access to specialty care for patients with serious medical conditions. (J-D-05)
Recommendation:
•Timely access to nurses and facility physicians- The Department should adjust staffing in order to accommodate timely access to care consistent with the timely access benchmarks established by the NCCHC.
• Timely access to specialty care –The Department should continue to work with the community providers to provide more timely access to specialty care for serious medical problems. (The community standard for timeliness is established by the entire community, not by the standard set by department’s chosen community partner).
15. Laboratory and Diagnostic Services
Findings:
• Labs not being ordered, or if ordered, not drawn, or in rare occasions when drawn are not filed, noted and or acted upon, and almost never shared with the patient. This creates both delays in access to care and diagnosis, but also creates a substantial risk to patients and liability for the county when abnormal lab results are not acted on.(J-D-04)
Recommendation:

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• Policies and procedures must be developed and deployed to ensure labs ordered by clinicians are drawn in a timely manner, and that the results are reviewed by nurses and clinicians in a timely manner, and that the results are communicated to the patients in a timely manner.
16. Physical Disability Issues
Findings:
• The Santa Barbara County Jail makes minimal accommodations for inmates with physical disabilities and in many cases the accommodations are overly restrictive or inadequate to accommodate the disability. (J-G-02 and J-G-10)
• The old building is not handicap accessible. Wheelchairs don’t fit through some cell doors where wheelchair dependent inmates are housed (requiring the inmate to be carried or transferred in and the wheelchair must be collapsed first) and there are many other physical barriers to disabled inmates.
Recommendation:
• The department should follow expert consultant advice on developing less restrictive approaches to dealing with inmates with disabilities.
17. Pharmacy Services
Findings:
• There is a restrictive formulary with almost no medical non-formulary requests. There were multiple requests by the psychiatrist for non-formulary medications (most approved in recent weeks), but the medical doctor almost never requested a non-formulary medication. This suggests an overly restrictive approach to the formulary beyond what is reasonable.
•I found restricted of rescue inhalers (such as albuterol) and under-diagnosis of asthma.
• In inmate interviews, many inmates complained that gabapentin, a medication commonly used for neuropathy, was discontinued without any consultation between the doctor and the patients. Reviews of multiple medical records confirmed that there was a blanket discontinuation of

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gabapentin without appropriate clinical consultation and individualized medical justification.
• The facility makes little use of Keep On Person (KOP) medications. (J-D-01)
Recommendations:
• Formulary adherence should be less restrictive and allow for thoughtful individualized treatment plans based on sound clinical criteria.
• Clinicians should be educated in the process of requesting non-formulary medications when there is legitimate and compelling clinical justification. The failure to ever request exceptions to a restrictive formulary is evidence of lack of individualized care.
• The department should liberalize the use of Keep on Person medications – especially for inhalers and medications that are available over-the-counter in the community.
18. Continuity of Medications
Findings:
•Inmates arriving on prescription medications often experience delays in the medication being ordered and administered, sometimes the delay is days or even over a week.
• A draft CFMG policy calls for verified medications to be ordered when the inmate is seen “at the next available sick call.” This is problematic, especially considering that provider sick call does not occur every day.
Recommendation:
• The department should review procedures to remove unnecessary interruptions in timely access to care.
• In order to avoid interruptions in necessary medications for serious health conditions, nurses should evaluate patients who arrive with prescribed medications, acute illness and chronic conditions and consult with a provider in a timely manner (including over nights and weekends) to order necessary medications as clinically indicated.
• Policies must be developed and implemented to ensure that necessary and verified medications from the community are continued without

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interruption, and that inmates with unverified medications for serious conditions are evaluated by the nurses with the support of on-call medical providers.
19. Grievances
Findings:
• All facilities experience a high level of grievances by inmates alleging inadequate care. A large number of these grievances were substantiated. (JA-11)
Recommendation:
• Grievances should be categorized and analyzed as part of a Continuous Quality Improvement process.
20. Dental
Findings:
• Dental care when provided appears to meet minimal standards, but there are significant delays in access to such care. (J-E-06 and J-E-12))
Recommendation:
• Dental Clinics should be scheduled and staffed to allow for timely access to appropriate dental care.
21. Segregation
Findings:
• Standards dictate that inmates held in segregation are evaluated by both mental health and medical staff. Nursing staff reported that they do check on inmates held in segregation, often when they are on a housing unit doing a pill pass, but the documentation both on logs or in the medical record fail to document that these important checks are being performed at the required intervals (a daily check is required for complete isolation in a one-man cell). This does not meet the NCCHC standard for the monitoring of inmates in segregation. (J-E-09)
• In addition, the facility uses isolation cells that are hidden around corners and outside of any staff line of site. These cells do not have camera

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Review of Medical Care – Santa Barbara County Jail, Executive Summary, September 2017 15
monitoring or a in cell call button, placing the occupant at high risk should either self-harm or a medical emergency arise.
Recommendation:
• The department should establish procedures to ensure that inmates held in isolation and segregation have daily assessments by medical personnel and institute a logging procedure for those encounters.
• Isolation cells should have line of site observation or in cell monitored cameras and an intercom or call button.
22. Impact of a high security environment on health care
Findings:
• It is important to note for context that the Santa Barbara County Jail is a restrictive jail environment. There appears to be no meaningful standardized risk-based classification. While this may seem to allow for some efficiency for security purposes, such restrictive conditions of confinement create unnecessary barriers to care and introduce significant inefficiencies and risks in the delivery of health care. This approach seems particularly harsh and problematic for inmates who may be detained in these facilities for longer periods, such as the AB 109 population.
• Many inmates are confined to their cells or cell blocks for most of their incarceration period. (They are let out for daily showers and twice a week for recreation time. There appears to be very minimal programming or educational time). Their access to health care personnel is limited by their limited movement and relies on a paper driven “kite” system for reporting a health concern. Their only other alternative is to call a “man down” medical emergency.
• Conditions that are overly restrictive can and do have impact on inmate health and well-being and increase risks of adverse health events. Minimally, they create barriers to access to required medical care.
Recommendation:
• The department should consult with other jail facilities in the state and in the nation to learn about less restrictive detention practices that do not compromise facility safety and security, particularly for those inmates expected to remain incarcerated for longer periods of time.

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23. Security Staffing in Support of Medical Services
Findings:
• There is insufficient custody staffing to support the medical program.
• Even if medical services are adequately staffed, access to the patients is entirely dependent on escort services provided by security. This includes both in facility and out of facility escort needs. A 2013 consultant report by Crout and Sida found insufficient custodial staffing overall, and insufficient medical escort staffing in particular.
• Insufficient custodial staffing in support of medical services remains an issue at the time of my visit resulting in preventable barriers in timely access to medical care and very inefficient use of medical professional time. Doctors and nurse are routinely kept waiting for patients to be transported or to be escorted to areas of the facility that require custodial escort for staff.
Recommendation:
• Security/Custodial staffing must be adjusted to fully support the medical program.
24. Discharge Planning
Findings:
• Per the JFA Report and my own investigation, the jail lacks a fully developed comprehensive program to prepare inmates with chronic mental and medical conditions for their release and transition back into the community.
Recommendation:
• Consistent with the JFA Report recommendations the County should implement and expand a comprehensive in-custody discharge planning program with emphasis on inmates who suffer from chronic mental health and medical conditions including addiction.
25. Review of In Custody Deaths
Findings:

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• I was provided with limited access to some medical files of inmates who had died in custody.
• While the information provided was not complete (I was not provided with medical examiner reports in all cases, for example) what was clear was that routine reviews of inmate deaths (including an administrative review, a clinical mortality review and a psychological autopsy if death was by suicide) are not routinely and consistently being done. This is a missed opportunity to address critical problems and prevent future incidents. (J-A-10)
Recommendation:
• Routine death reviews (including a quick, multi-disciplinary administrative death review, a clinical mortality review and a psychological review if death was by suicide) should be done within 30 days of the death.
26. County Monitoring of the Medical Contract
Findings:
• Santa Barbara County Jail failed to deliver adequate medical care in large part because the previous medical contractor provided inadequate care.
• While replacing that provider with a new provider was an important corrective step, the County is still largely relying on the contractor to meet the County’s constitutional obligations to provide care.
• While the work can be contracted out, the responsibility of the County in providing minimally acceptable medical care cannot.
• The County currently does not employ County resources nor expertise in providing oversight to the medical contract. In the 2016 report on realignment, the consultants made the following recommendation:
Require the Department of Public Health and Behavioral Wellness to Administer the New Medical Contract for the Sheriff
Rationale: The Sheriff is not the proper agency to monitor a contract that delivers mental health services in the jail. The County’s Departments of Public Health and Behavioral Wellness should administer the contract to ensure inmates are being properly assessed and treated in the jail, and to ensure the transition from the jail to the community does not interrupt the services that were being provided in the jail.

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Recommendation: • The County must understand its responsibility in monitoring the medical contract on a day-to-day basis. It should consider hiring consultant or using existing County employed expertise to accomplish this critical oversite function. Consistent with prior consultant recommendations, the County should explore the possibility of requiring the Department of Public Health and Behavioral Wellness to administer the new medical contract for the Sheriff or alternatively, create a new position for a qualified individual with appropriate expertise and experience to perform that role.
• Medical care, a critical component of constitutionally guaranteed rights of the incarcerated, is too great a responsibility to contract out entirely. Expert and County based oversite of this complex program is in the best interests of the County and its citizens.
Summary of 2014 NCCHC Jail Standards Not Being Met or Requiring Further Work
The following is my summary of priority areas that the department should continue focus on in order to be ready for NCCHC accreditation:
J-A-01 Access to Care J-A-05 Policies and Procedures J-A-06 Continuous Quality Improvement Plan J-A-09 Privacy of Care J-A-10 Procedure in the Event of an Inmate Death J-A-11 Grievance Mechanism for Health Complaints J-B-01 Infection Prevention and Control Program J-C-01 Credentials J-C-02 Clinical Performance Enhancement J-D-01 Pharmaceutical Operations J-D-03 Clinic Space, Equipment, And Supplies J-D-05 Hospital and Specialty Care J-E-02 Receiving Screening J-E-04 Initial Health Assessment J-E-07 Non-Emergency Health Care Requests and Services J-E-09 Segregated Inmates J-E-12 Continuity and Coordination of Care During Incarceration J-G-01 Chronic Disease Services J-G-02 Patients with Special Health Needs J-I-01 Restraint and Seclusion

Case 2:17-cv-08805-GW-JPR Document 23-2 Filed 03/06/18 Page 20 of 22 Page ID #:456 Review of Medical Care – Santa Barbara County Jail, Executive Summary, September 2017 19 Respectfully submitted to Counsel for the County of Santa Barbara and the Counsel for the Plaintiffs on July 3, 2017.
Scott A. Allen, MD

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Appendix
Examples of inadequacies in chronic disease management:
Asthma- Asthma care in the cases reviewed does not meet nationally accepted standards. The facility makes no use of Peak flow meters. Peak flow meters are inexpensive plastic devices that allow for reliable objective assessment of the severity of a patient’s ability to breath and are considered a standard part of asthma management. In some cases reviewed, patients with significant asthma histories were not evaluated by physicians unless they presented with an acute attack. Even with the new medical contractor, use of keep on person inhalers was being restricted, with inmates with documented asthma histories being directed to contact nursing only when they thought they needed to use an inhaler. This is a risky and unnecessarily restrictive practice.
Diabetes- Diabetes care at the jail facilities is inconsistent. Known diabetics do typically receive adequate monitoring by nurses with assessment of blood sugar by finger stick testing as ordered by a physician. However, regular evaluation by a physician is inconsistent. Measurement of Hemoglobin A1C (HgbA1C – a standard measure of diabetic control) on arrival and at recommended intervals (typically every 90 days) is inconsistent. In addition, patients entering the facility with confirmed treatment regimens do not have their community treatment continued. Rather, they are often automatically changed over to a generic sliding scale insulin protocol until they can be seen by a provider, often not until days after arrival. Sliding scale insulin is not the optimal primary method of managing diabetes particularly when a patient has a confirmed medication regimen from the community.
Hypertension- Management of hypertension in the Santa Barbara County Jail did not meet nationally accepted guidelines for the cases I reviewed (Ref: NCCHC October 2014 guidelines for hypertension, JNC 8). Specifically, patients with hypertension did not typically receive complete initial exams and work-ups, they did not consistently receive appropriate laboratory or EKG tests. In several cases I reviewed, the inmates went three to four days without medications.
HIV- HIV care in the Santa Barbara County Jail does not meet nationally accepted guidelines including timely consultation by a medical consultant with expertise in HIV management.
Other chronic conditions- In other cases where inmates had known chronic care needs (including conditions such as coronary artery disease,

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neuropathy, gynecologic problems, chronic orthopedic problems) care was infrequent and cavalier.

 
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Executive Summary Roberta Stellman, M.D., DABPN Review of Mental Health Services Currently Provided by the Santa Barbara County Jail System Review Conducted between April 12-14, 2017

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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017

TABLE OF CONTENTS

PAGE # TOPIC

3

Definitions and Abbreviations

3

A. Organizational Structure of the Mental Health Service

5

B. Policies and Procedures

6

C. Staffing

7

D. Intake Screening

9

E. Response to Referrals to Mental Health from Intake

10

F. Psychiatric Management

11

G. Pharmacy

12

H. Inmate Generated Service Requests

13

I. Basic Mental Health Services

20

J. Sheriff’s Department Programming

21

K. Sheriff’s Department Suicide Prevention Training

22

L. Emergency Care

23

M. Suicide Prevention

25

N. Use of Restraints

26

O. Segregation Housing of the Mentally Ill Inmate

29

P. Mental Health Input into the Disciplinary Process

30

Q. Re-Entry

31

R. Medical Record

32

S. Privacy of Care

33

T. Mortality and Morbidity Reviews

34

U. Quality Improvement

An independent mental health review was requested by the Santa Barbara County and Sheriff’s Office (SBC) under a Structured Negotiations Agreement with Disability Rights California (DRC), Prison Law Office (PLO), and King & Spalding (KA).
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017

Definitions of Abbreviations:

General standards relied upon for this report are the NCCHC Jail Standards, the American Psychiatric Association guidelines both for correctional facilities and the general practice of psychiatry, US Federal case law where applicable, and accepted peer practices.

Abbreviations/Acronyms Used In This Report Be Well CFMG CARES DON DPH DRC HSA ITP K & S LMFT LMHP LVN MD or doctor PLO QI RN SBCJ
SC SMI Recommendation
Suggestions

Definition
Department of Behavioral Wellness California Forensic Medical Group Mental Health Crisis Mobilization Unit Director of Nursing Department of Public Health Disability Rights California Health Services Administrator Individualized Treatment Plan King and Spalding Licensed Marriage and Family Therapist Licensed Master’s Level Mental Health Professional Licensed Vocational Nurse A psychiatrist Prison Law Office Quality Improvement Registered Nurse Santa Barbara County Jail (unless specified otherwise refers to the Main Jail Facility) Safety Cell Seriously Mentally Ill Those additions that are required to meet current expected minimum services for a jail Non-required practices that are considered “Best Practice”

A. ORGANIZATIONAL STRUCTURE OF THE MENTAL HEALTH SERVICE:
Findings:
On April 1, 2017 CFMG became the new health services provider after a 20 year relationship with PHS/Corizon.
Under the new health services provider, the Health Services Administrator is responsible for leading the mental health team. Consultative services are available from the regional

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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
office to provide guidance for developing mental health programming. There is no lead mental health supervisor on site.
The health services administrator orchestrates a monthly Medical Administration Committee (MAC). The sign in sheets for Corizon’s MAC meetings, that were available for review, indicate attendance by the administrative assistant, grievance officer, commander, Lieutenant, and the health services administrator. Meeting minutes were reviewed and their content will not be included in this summary but some recommendations below are related to the meeting minutes.
Recommendations:
1. If the jail is to successfully develop treatment programs to meet the needs of the seriously mentally ill it is strongly recommended there be an on-site mental health coordinator rather than a health services administrator, independently licensed mental health professional with prior experience in program development, familiarity with correctional mental health practices and management skills, who can plan, integrate, and oversee treatment programming that meet the needs of the inmate population and individualized treatment plans. This person should also be capable of supervising the counseling staff and providing in-service training in the development of measureable treatment plans and adequate medical record documentation.
2. Any programming provided by mental health agencies other than CFMG should be approved and monitored by CFMG’s on-site mental health coordinator so that all services provide a cohesive program based on the individual’s treatment plan.
3. The standing membership for the MAC meetings should have a broad representation and at a minimum should always include the Director of Nursing, Chief Medical Officer and a Representative from the Mental Health Service and the appropriate custody leaders. When appropriate, (for example, when the agenda has topics such as medical diets), a representative from the appropriate service should be included in the meeting.
4. Whenever considering utilizing trainees, such as psychiatric interns, it is essential for the jail to have a memorandum of agreement with the University that stipulates requirements for supervision of those clinicians. Usually interns are unlicensed practitioners, practicing under an institutional license. There should be sufficient psychiatric hours to monitor the care provided by an intern.
5. The jail should consider developing quality indicators with their own independent expert that should be included in any future contracts to monitor compliance with those guidelines and impose penalties for failures in
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
performance by private contractors along with required periods for remedies to improve compliance.
B. POLICIES AND PROCEDURES:
Currently all policies and procedures are the property of the current health services vendor as of April 1, 2017. The previous vendor, Corizon, left on the last day of March. Corizon medical\mental health policies were provided electronically at the completion of my site visit but were not reviewed since those documents are no longer pertinent to the current mental health operation. The CFMG policies were produced on June 13, 2017. The CFMG policies are IMQ (California based) and for the past year NCCHC compliant.
In general the policies and procedures provided by CFMG are aligned with the standard NCCHC Jail standards. The policies submitted for review are not site specific and need additional clarifications regarding credentialing and privileging. Recommendations:
1. It is strongly recommended that the SBCJ develop its own system and site specific policies and procedures. The private health provider should be bound by contract to the current and future SBCJ policy manuals. Such a practice allows for continuity in processes and requirements regardless of which company provides services at the jail. Many correctional systems have all their policies on line and can serve as templates which can be tailored to the SBCJ system. (CDCR, New Mexico Department of Corrections, Delaware Department of Correction, etc.). Relying on jail\prison systems outside of the State of California will also help align policies with national standards such as National Commission on Correctional Healthcare Jail Health Standards (NCCHC) or American Correctional Association (ACA). I would also recommend contacting the larger jail systems in California because they may readily share their policies with Santa Barbara County.
2. Terminology is inconsistent between policies.
3. The grievance policy is inadequate because it lacks an appeal process.
4. Suicide prevention training should be done at least annually.
5. Policies should include a detailed, site specific procedure to increase uniformity in implementation of the policy by all staff.
6. A policy and practice allowing mental health input into the disciplinary process for inmates with serious mental illness should be developed and implemented.
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
7. The policy on the use of safety cells needs significant modification and must include mandatory frequencies of observation, sanitization practices(including inspection of the cell prior to placement for quality of ventilation and frequencies of sanitization of the cell), property restrictions communicated to security by a mental health professional, access to bathroom facilities, etc.
8. The basic mental health treatment policy should include requirements for individualized treatment plans and update timeframes.
9. Minimum requirements for adequate re-entry planning for inmates with a serious mental illness should be specified in policy.
10. Management of medically/mentally ill inmates requiring restraint needs to be developed with greater attention to the role of de-escalation and medical monitoring for those individuals.
11. All policies and procedures should be reviewed annually and updated as necessary.
12. In the future, Jail Mental Health Policies and proposed changes to adopted policies should be reviewed and approved by the subject matter expert under a remedial plan.
13. Policies and procedures should specify the minimum timeframes to complete specific tasks, quality requirements such as documentation guidelines, laboratory and examination requirements, triage systems, etc.
14. Policies regarding committees should describe the committee structure as well as the required membership and minimum meeting frequencies.
15. Specificity regarding the procedures should easily enable the development of measurable quality indicators that can be employed to monitor the implementation of policies.
C. STAFFING:
Findings:
Based on the observed levels of acuity and chart reviews, staffing levels at the current time are deemed inadequate despite the facility being fully staffed for contracted allocations.
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
No comprehensive staffing analysis has been completed to determine the actual needs of the service
Recommendations:
1. Develop a vision of what the adequate service should provide in order to add any additional staff requirements into the analysis, such as additional services for the seriously mentally ill inmates. Include alternative treatment areas for the SMI inmates unable to be placed in general population. Currently the system is relying on segregation as the housing alternative but this is not a treatment setting. It should only be a rare exception that a seriously mentally ill individual should be placed in segregated housing with well-documented justifications, supervision, and treatment. Proper treatment areas should allow for day room space for programming such as community meetings, social skills training, recreation therapies, etc.
2. A comprehensive staffing analysis should be completed in order to determine the actual staff needs of the service. In order to be accurate, the service will need to divide referrals into intake, inmate generated and crisis contacts since each requires a different time to complete. Crisis calls can be very time-consuming because of the need to attempt de-escalation and other techniques to attempt to resolve the crisis.
3. An analysis should be based on accurate data that reflects the expected number of contacts for each contact type (Much of this detail is not readily accessible at the current time and will require at least a couple of months of data collection). Realistic estimates (not the time it currently takes since this is deemed inadequate) regarding the average amount of time to complete an adequate contact should be developed including time to travel to and from the site of contact and documentation time. Relief factors for vacation and other leave needs to be included.
D. INTAKE SCREENING:
Findings:
SBJ utilizes a two-step intake process conducted in a private office outside of the main booking area. A registered nurse completes a prescreening assessment and determines whether someone needs to be diverted from the jail to the hospital for medical clearance. The nurse requests the hospital provide reasons for clearance as well as x-
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rays and other diagnostic tests prior to accepting the inmate into the jail. Mentally ill inmates needing emergency treatment for danger to self or will wait until a CARES LSCW assesses them for potential hospitalization at PHF. The hospital will not complete a 5150 on inmates. Should CARES complete a 5150, the inmate will be diverted to PHF. If a bed at PHF is not available the inmate is booked into the main jail and placed in a safety cell or observation cell until a transfer can be effected.
An RN completes a full intake for those inmates not diverted out of the facility. The nurse will determine if a referral to mental health is considered urgent or routine. Urgent referrals can be managed after 11 PM by an on-call mental health provider from the crisis mobilization team (CARES) or can wait until the next morning when mental health on-site coverage resumes at 7 AM. During the tour several cases were uncovered where inmates refused an intake screening and there was no follow up.
Medication verification can be done by the nurse by calling the pharmacy, calling the provider, inspecting medication bottles brought by the inmate, or information from the medical record. This process can take hours or days. If medications cannot be verified the reported practice is that the inmate will be seen by a psychiatrist within seven days. The previous practice was for medications to be bridged within 30 days or for the inmate to be seen within 30 days (One month is an unacceptably long period of time before assessment.). It is too early into the contract to determine whether the current reported practice has been implemented. Mental health staff said that if medications cannot be verified the inmate is placed on a priority wait list to see a psychiatrist within one to two weeks.
When an inmate requests medications they are screened to see if they should be referred to the psychiatrist. Inmates who repeatedly request to see a psychiatrist will be referred by the mental health counselor. No data was provided to offer proof of practice.
Recommendations:
1. Periodic quality improvement reviews of the intake process should be done to ensure that this most critical function is done with accuracy and that the appropriate referrals are initiated. The review of the intake referrals to mental health should monitor the level of triage, time for mental health to complete the referral, the adequacy of the plan by the mental health counselor based on the clinical presentation of the patient, etc.
2. Whenever an inmate refuses the intake screening there should be a process to include a follow up review to ensure serious mental health issues are not overlooked. The intake nurse should also make every effort to provide a detailed record of the inmate’s general presentation and an opinion regarding their capacity to refuse evaluation. Those who demonstrate observable
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impairment should be considered for referral for further evaluation prior to the 14 day intake history and physical.
3. Any positive finding on the intake mental health screen should generate a referral to a mental health professional. This is consistent with CFMG’s policy and a quality improvement process can confirm compliance with the policy.
4. Referrals to mental health should be triaged as urgent/emergent/routine. The criteria for the triage system should be incorporated into the jail health screening policy. This is consistent with CFMG’s policy and a quality improvement process can confirm compliance with the policy.
5. Quality reviews should monitor whether the practice meets the requirements of the jail’s policy, timeliness, effective triage, appropriate diversion, etc.
E. RESPONSE TO REFERRALS TO MENTAL HEALTH FROM INTAKE:
Findings:
There is no current statistical information demonstrating the timeliness of psychiatric assessments following referral from the initial mental health evaluation. Chart reviews did demonstrate that mental health staff see people referred to them within one to two days.
Recommendations:
1. Inmates requesting to see a psychiatrist should receive a comprehensive initial mental health assessment before it is determined that they do not have a clinical need for medication.
2. Documentation by mental health should to be expanded to include detailed descriptions of signs and symptoms of conditions which justify the assignment of a DSM1 diagnosis.
3. A log of inmates referred to mental health from booking should be maintained in order for auditors to complete randomized studies of the process either via the quality improvement committee or the assignment of a subject matter expert under a legal agreement.
1 Diagnostic and Statistical Manual of Mental Disorders, Current Edition, American Psychiatric Association
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F. PSYCHIATRIC MANAGEMENT:
Findings:
Referrals to psychiatry are generated by the licensed mental health professionals. The mental health professionals have a triage system whereby people are either placed on a priority list to be seen within one to two weeks, or on a nonpriority list within a 30 day window for completion of the review.
Psychiatric hours had been 24 per week but recently, with the new contract, this allocation was increased to 40 hours a week. At the current time coverage is split among several psychiatrists with approximately 75% of the services being delivered on site and 25% via tele-psychiatry. Psychiatrists see patients with a registered nurse in a noncontact booth on the housing units. Patients in safety cells are generally seen by the psychiatrist at the request of mental health staff and otherwise the psychiatrist has little involvement in the management of inmates in those settings.
Follow up laboratory studies were appropriate and appeared to be consistently ordered. Psychiatric appointments often are not scheduled early enough. Those individuals who received significant changes in prescriptions or initiation of new medications should be seen within 2 to 3 weeks for follow-up or sooner. There was little evidence in the medical records that such a practice is in place.
Recommendations:
1. As part of the staffing analysis, data should be collected on time of referral to time seen by the psychiatrist so that the staff is not relying on anecdotal material to determine the required psychiatric hours for these facilities.
2. There is a clear need for additional psychiatric time and involvement in the development of referral criteria and policies regarding management of the seriously mentally ill inmates. The role of the psychiatrist needs to be expanded to provide greater leadership and a multidisciplinary approach to the treatment of the seriously mentally ill patient, greater participation in the management of SMI inmates and those inmates in safety cells an observation cells.
3. Data concerning prescriptive practices should be collected and available for review by the subject matter expert. This should include a sortable spreadsheet containing at a minimum, the inmate’s name, jail number, medication name, milligram size, Sig (e.g. ii BID), mode of delivery, and name of prescriber.
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4. A policy and procedure regarding pharmacy practices including nonformulary medication requests and patient refusals should be produced for review by the subject matter expert.
5. At the time of any future site visit, the subject matter expert should receive information summarizing the number of non-formulary drug requests that were made and the number that were denied. For the latter group inmate identifiers shall be made available in the event the subject matter expert wishes to do a chart review.
6. The frequency of psychiatric follow-up appointments should be monitored as a quality measure to ensure that inmates have adequate access to the prescriber and clinically appropriate for review of their response to medications.
G. PHARMACY:
Findings:
The Sheriff’s Department pays for all pharmacy costs. Maintenance of a spreadsheet allows for a weekly query of prescriptions which are about to expire.
The current contract with the health provider (page 2, H.) states:
Where medication is verified, the RN may dispense “bridge” medication from the current medication order of record until the inmate has a face-to-face appointment with medical or psychiatric provider. Psychotropic bridge medication should be the same medication as the inmate received in the community, regardless of its formulary status.
The current contract also requires that non-verified medications require the nurse to confer with the psychiatrist within 24 hours of the detainee’s arrival at the jail reception area.
However, The CFMG policy, received after the site visit, does require the nurse to contact the on call provider for an order.
“If the nurse verifies the medication with the prescribing physician or pharmacy, the nurse will provide the medication after contacting the on-call provider for an order. During this consultation, the on-call provider, based on clinical judgment, will schedule a date for a provider to see the patient face-to-face at the next available sick call. The date of the appointment will be reflected in the record of the order.”
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Recommendations:
1. Initiation of verified and non-verified medication practices should be monitored to ensure the requirements of the contract is met. Based on interviews with inmates, the inmates state that medication is often not available in a timely fashion following intake.
3. Sedating medications ordered for bedtime should be administered late evening.
4. CFMG needs to monitor the medication administration process to ensure that prior prescriptions did not lapse with the change in health vendors.
H. INMATE GENERATED SERVICE REQUESTS:
Findings:
The current practice is to lump all referrals to mental health into the same tracking category. The disadvantage of doing this is that it does not give clear data necessary for annual staffing analysis review. Of all of the referral types it is probably the crisis call from custody that is the most time-consuming, followed by intake referrals and then inmate generated health services requests. The second level of classification of requests is via their triage status of emergent, urgent or routine. In general emergent requests should be handled within four hours, urgent requests within one work shift and routine within 1 (referrals from intake) to 5 (health service requests) business days depending on the nature of the referral and the policies and procedures that are adopted by the system.
The inmates interviewed during the tour frequently commented that there were delays in being seen in response to their requests. However, others said that they received prompt responses. Without effectively tracking this process the system cannot establish whether or not people are being seen within established guidelines and determine the health of each of these processes.
Inmate generated requests should always be handled in a manner that ensures the confidentiality of the materials submitted. Systems can achieve this via the practice of request collections being done daily by nursing staff during medication passes, lockboxes for housing units that only medical staff can open, a confidential electronic system, etc.
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Recommendations:
1. Health service requests should be handled in a confidential manner unless the inmate chooses to communicate directly to non-health staff. Communications back to inmates from health staff by mail should be sealed in an envelope with the inmate’s name, number and location on the front. .
2. Develop a triage system with documentation on the form for the triaging licensed professional (RN or MHCS) to enter the level of urgency and a tracking system to accurately monitor the efficacy of the process. This data will also be necessary for staffing analyses.
3. Develop a system to log inmate requests so that periodic quality reviews can be done to assess whether:
a. health service requests are retrieved timely manner b. health service requests are triaged within the established timeframe c. by the nature of the complaint a proper level of triage is assigned d. mental health staff appropriately resolve the complaint e. mental health staff resolve the complaint in a timely fashion
I. BASIC MENTAL HEALTH SERVICES:
Findings:
Basic mental health services should include, at a minimum, the following systems of care and self-monitoring:
1. Intake screening by qualified health professionals and an adequate screening tool to identify individuals with mental illness, at risk of self-injury, vulnerable to predation secondary to a mental illness, and risk factors and or medication that require referral to mental health professional
2. An effective and adequate system to complete timely initial mental health evaluations and make recommendations regarding housing and referrals based on the individual’s diagnosis, strengths and weaknesses
3. The ability to effectively respond to requests for service/referrals from inmates, custody, case management\classification and medical professionals
4. The capacity to provide brief evidence-based counseling services 5. An effective system of suicide prevention training for custody and health
staff and treatment by mental health professionals.
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6. Intensive services for inmates in psychiatric observation and suicide prevention status
7. Develop and enhance policies that drive the mental health service including clinically ordered seclusion, restraint and emergency medications
8. Timely access to psychiatric services for evaluation, treatment, and follow up based on clinical necessity
9. Safe and appropriate housing for the seriously impaired mentally ill inmate. Segregation is not a substitute for a health services treatment setting
10. Provide a minimum of 10 hours per week of out of cell structured therapeutic group and individual programming for the seriously mentally ill inmate in specialized or segregated housing and 10 hours a week of out of cell unstructured time.
11. Segregation rounds for all inmates to identify any signs of decompensation or new onset mental health symptomatology at least weekly.
12. Management of mental-health crises including referrals for inpatient and emergency department care
13. Discharge planning including release medications and follow-up appointments
14. Collateral contacts with family, community agencies, and legal representatives
15. Advocacy with the District Attorney and public defender’s office for any inmate deemed incompetent to give consent or in need of a compassionate release
16. A quality improvement process to monitor the effectiveness of the basic mental health services and to identify and intervene whenever necessary to demonstrate effective self-monitoring
17. Demonstrate critical assessments for instances of morbidity and mortality 18. Strive to provide all mental health services in the appropriate clinical
environment
Most of these systems are currently not in place or are insufficient to meet the clinical needs of inmates with a mental illness, most notably discharge planning, treatment planning, quality improvement, morbidity and mortality reviews, delivery of mental health group and individual counseling, and private confidential evaluation of inmates on an ongoing basis. Suicide prevention training is offered during the initial orientation.
The recent contract with CFMG was provided and reviewed following the site visit. In general the new contract does cover the required clinical processes well including implementing a confidential sick call request process. At the time of my site visit many of these were not in place and I cannot offer an opinion regarding whether these have successfully been implemented.
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Some concerns I have regarding the contract and minimum standards and best practice are as follows:
1. Page 2 allows an RN to administer verified medications without an order by a CFMG prescribing provider. Since inmates may enter with new medical concerns or detoxification issues, it is prudent for their current medical status to be reviewed by a practitioner prior to previous medication continuation since that could exacerbate or mask current medical/mental health issues. (Best Practice)
2. Timeframes for the triage and completion of sick call requests are too lengthy (page 8) with the general minimum standards being triage within 24 hours, completion within 24 hours for emergent/urgent and 5 business days for routine mental health requests (The latter is not a written standard but is based on the verbal communication between myself and NCCHC (Scott Chavez) several years ago.) (NCCHC 2014 Jail standards p. 83).
3. The contract requirements for mental health interventions for inmates in restrictive housing or for those with a serious mental illness housed on specialty mental health units are not specified (see the body of this report).
4. 4.2 Suicide Prevention: The review requirements do not specify what level of training and credentialing are required for the q 4 hours review and should specify the minimum number of hours of training to be provided by the Contractor.
5. 4.3 Psychotropic Medications: See item 1: above. 6. 11.0 Continuous Quality Improvement and Accreditation: the “behavioral health
staff member” lacks the specificity to provide continuity and oversight and does not include the facilities’ medical director.
Problematic areas in the delivery of mental health services include:
1. All inmates with a positive finding on the mental health intake screen should receive a mandatory referral to a mental health professional.
2. If an inmate refuses to give consent for treatment at the time of intake that does not imply that they have refused all future offers of treatment. The intake nurse still has an obligation to make the appropriate referrals to psychiatry and mental health professionals. This is addressed in CFMG’s policy but this will need to be demonstrated going forward.
3. Inmates demonstrating significant psychopathology with placement in a safety cell should always be referred urgently to the on-site psychiatrist.
4. Inmates with severe personality disorders resulting in frequent placement on suicide precautions should have a comprehensive behavioral management plan in their record and be receiving regularly scheduled stabilizing counseling services in an attempt to maintain the individual in regular housing.
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5. Decreasing time spent in safety cells can be an admirable goal. However, releasing people from suicide watch without a reasonable period of observation (48 to 72 hours) in step down may be precipitous and increase the risk of an adverse outcome.
6. Inmates entering the facility on verified medications should have a routine referral to psychiatry issued at the time of intake rather than impose a delay by waiting for the completion of the mental health professional’s evaluation. The LCSW evaluation can then prioritize the psychiatric appointment is clinically indicated.
7. There appears to be too high a threshold for initiating referrals to psychiatry. Because jail settings are high-volume, high turnover, high stress there should be as few barriers to referral to mental health and psychiatric services as possible to decrease the risk of unidentified and untreated mental health conditions.
There is currently no classification system to designate inmates SMI (Seriously Mentally Ill). Current mental health services provided to inmates in segregation with a mental illness consist of administrative segregation checks, psychoeducation, brief counseling and mental status exam almost always conducted through the cell door. The mental health department currently has no input into the disciplinary process that is formally documented.
Individualized treatment plans were not found in any of the reviewed medical records.
It should be noted that the prior contract’s scope of work section was essentially what appears to be Corizon’s response to the bid for proposal. The contract stated, “Corizon recognizes the importance of individual and group therapy that is tailored to the unique needs of the inmates being treated… Specifics of these and other programs will be developed and customized with the County.” No such services were ever provided. The current contract scope of work is County driven and more tightly constructed.
Currently no structured programming is provided by the mental health staff. The 4 LCSW’s have a rotating workload covering seven days per week. There is a shortage of officers to provide escort services for mental health services staff. Mental health professionals attempt to see people in a noncontact booth but anecdotally this occurs only 50% of the time for follow-ups and 75% of the time for initial assessments. (All inmates interviewed disagreed with that report. They uniformly stated that they saw the psychiatrist in a privacy booth but all other mental health contacts were at the door front.) If an inmate refuses a psychiatry appointment they are seen at their cell door. The medical service has treatment rooms available on the units but these are rarely available for mental health use.
The current practice for treatment planning is to use the “P” in the SOAP note.
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CFMG has not yet trained to and implemented the definition for SMI.
There is a small dorm setting for men (S Tank) that is considered mental health housing. An interview was conducted on this unit. Most all of the residents appeared capable of participating in a residential treatment setting. The unit consists of a small day room that had 2 boats on the floor for overflow placement. There was a fixed table with eight seats and a television in that area. The dormitory area had bunkbeds (3 high) placed on three walls with the fourth being an open barred wall opening onto the hallway. Total occupancy was 24. Natural lighting filtered from the dormitory across the hall into this area. Upon entering the unit all inmates were in bed. The men complained that there were no structured activities provided to them and little to occupy their time. One man complained that the only treatment was coloring papers. One man reported it took over a week for him to receive bridge medications even though he had signed release of information waivers. Another man appeared actively psychotic with impairment in maintaining appropriate social boundaries.
Mental health professional contacts occur through the barred grill at the front of the unit. The psychiatrist and registered nurse see them in a private booth for less 5-10 minutes or an initial evaluation. The men estimate that follow-up mental health visits are shorter than that. Intake assessments were estimated at 2 to 5 minutes and their initial mental health evaluation at approximately 10 minutes. The men all reported that when a mental health professional sees them in the intake area they are seen and interviewed in the open. The only programming they receive is when the chaplain comes to the unit on Sundays for services. Men complained that the safety cells were unsanitary and one man stated, “You get so sick of it, you shut up.” Sick call in conducted through the food port.
Inmate stated there was no discharge planning unless you submitted a request. Several stated they received no medication upon release from the jail. They can seek services at CARES clinics but it can take one week so they may be off medications for that period of time. They reported that they were in their tank 24\7 with access to the yard on Tuesdays and Saturdays for an hour and half.
Recommendations:
1. The County needs to implement a detailed tracking form that parallels the scope of work requirements in order to ensure that the current vendor is meeting the requirements of the contract.
2. Policies, procedures and staffing allocations need to be considered to develop multidisciplinary treatment programs for the most seriously ill inmates. Currently these individuals are only receiving medications in isolation and cell front review
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by mental health professionals. Treatment programs for both male and female individuals should be developed. A minimum of 10 hours per week of structured out of cell therapeutic activities and 10 hours of unstructured out of cell time be provided to any seriously mentally ill inmate in segregated housing (See the Section labelled “Segregation of the Seriously Mentally Ill” below)
3. Those people who are extremely unstable and unsafe to mix with other programming inmates should be isolated based on a clinical seclusion policy and procedure. Such a process would require an order by a physician to isolate an individual and would dictate the nature and frequency of professional contacts insuring a higher level of observation and intervention that is currently provided. (See Appendix 12 – Sample policy on restraint and seclusion to aid in better conceptualizing this recommendation)
4. Train and implement an SMI classification and track the mental health caseload by total number open and total # SMI.
5. Track the number of SMI housed in restrictive housing by housing units.
6. Develop a multidisciplinary treatment plan form for all seriously mentally ill inmates incapable of functioning in a general population setting or who are housed on a specialty mental health treatment unit.
7. Demonstrate that training on the right to refuse care and its implications is completed.
8. All inmates with a positive finding on the mental health intake screen should receive a mandatory referral to a mental health professional.
9. When an inmate refuses to give consent for treatment during the intake process the appropriate clinical referrals should still be generated.
10. Inmates demonstrating significant psychopathology with placement in a safety cell or observation cell should always be referred urgently to the on-site psychiatrist for evaluation.
11. Inmates with severe personality disorders who frequently require placement in a safety cell should receive a behavioral management plan and regularly scheduled counseling services to aid them in maintaining function in regular housing.
12. Inmates entering the facility on verified medications should routinely be referred to psychiatry at the time of intake.
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General Information
It should be evident to everyone that in recent decades the number of seriously mentally ill people incarcerated in jails and prisons has risen for many reasons including the loss of longterm residential\hospital beds. Inmates with SMI, when incarcerated, frequently have longer stays in jails; the reasons for this are multifactorial. In California with the advent of A.B. 109 jail facilities are now housing long-term inmates many of whom suffer from an SMI. The burden of providing treatment programming for this population is increasingly falling on the shoulders of community jails.
Addressing the treatment needs of this population requires several elements:
1. An identification system -the jail needs to have an operative definition of seriously mentally ill. Once this is in place it is possible to develop a classification system that can divide this group into different levels of care or health needs determined by the mental health treatment team. Such subdivisions may include categories such as acute care, subacute care, residential treatment, incompetent to stand trial, incompetent to give consent to treatment, etc.
2. A policy describing and defining the menu of services should be developed by health services, custody, and classification input and design.
3. In an ideal situation, different levels of functional capacity determine which housing unit people would be placed on. These specialized units should be classified as health services units and are under the direction of the psychiatric team. Therefore, it is the clinical team that determines who will be admitted to these units and when someone can be discharged from the units. Operation of these units require strong collaboration between the members of the multidisciplinary treatment team (classification, case management, custody, psychiatric clinician, psychiatric nurse, unit LMHP coordinator) with regularly occurring multidisciplinary team meetings to discuss the management of each inmate from health, mental health, classification and discharge perspective.
Once units are designated as health services units there can be a policy which allows for the mixing of security\classification levels, making these units unique when compared to the rest of the facility. Direct supervision by custody is essential in supporting the therapeutic milieu and maintaining order on these units. Officers working on these units should receive enhanced training by the mental health staff to aid them in the daily management of inmates designated as seriously mentally ill.
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All individuals on specialty units should receive an enhanced individualized treatment plan. Other requirements for inmates on the specialty units are an enhanced discharge plan that is also documented in the medical record on a dedicated form. Privileges and property are determined by the multidisciplinary treatment team for those inmates who are not cell restricted. The psychiatric clinician should have ultimate authority over privileges and property for those people maintained on psychiatric observation\clinical seclusion or suicide watch. The jail should have the capacity to appropriately house and treat inmates with mental illness in emergent, sub-acute, residential treatment and general population housing units.
J. SHERIFF’S DEPARTMENT PROGRAMMING:
Findings:
Under the leadership of Sheriff Brown, SBCJ has adopted the Stepping up Initiative, a national initiative for mental illness diversion. The Council of State Governments, the American Psychiatric Association, and the National Association of Counties has partnered to provide resources for this initiative. At the Santa Barbara County level involvement includes the District Attorney’s Office, Be Well, Sheriff’s Department, and National Alliance for the Mentally Ill, CLUE (a local agency), Community Service Board, and Families Act.
Santa Barbara County is also planning the construction of the new jail facility which may enable them to redesign some parts of the main jail which could improve housing for inmates with special needs. Sheriff Brown has expanded STP (Sheriff’s Treatment Program) with an evidence-based curriculum. His next budget proposal will ask to expand this program and add a screening tool to assess for the likelihood to re-offend. Santa Barbara County Jail uses custody deputies who do not rotate into the community. The system is also considering using security technicians to manage control room functions thereby freeing up custody deputies for other assignments.
The Inmate Programs Supervisor provided me with the following information:
1. The Sheriff’s Treatment Program which is housed in three different units, protective custody unit 400, one male unit and one female unit. Under an NIC grant experts were sent to collaborate with community agencies, the district attorney and the public defender. The prior Sheriff’s Treatment Program was redesigned from a drug offenders program which was 12step-based to a CBT evidence-based program. Inmates are selected who
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have a high risk for recidivism. Curricula utilized are New Direction, Thinking for Change, SAMSHA Anger Management and Helping Women Recover. The jail plans to expand this program and partner with probation Department for the evaluation of outcome data.
2. The County is hoping to update its jail management system and risk\need case management system to create a case plan for inmates. This will focus on a risk\need assessment which will aid in guiding the selection of interventions in the facility and community for inmates with a high risk of recidivism based on criminogenic factors.
3. Sanctuary Centers of Santa Barbara are funded through the Community Corrections Partnership (CCP) in cooperation with the Probation Department as are other community partners. They will be piloting the BRACE program which looks at mental health issues as well as criminogenic risks and needs.
Recommendations:
1. Continue participation in what sounds like excellent services for the targeted population.
2. Should the jail expand programming for the SMI inmate by utilizing community agencies rather than its mental health care vendor; it is strongly recommended that these efforts be supervised and directed by the CFMG lead mental health professional. Periodic review of the group curricula and focus of programming should be overseen and approved by CFMG to ensure that services are congruent with the efforts of the CFMG multidisciplinary team and to prevent staff splitting.
K. SHERIFF’S DEPARTMENT SUICIDE PREVENTION TRAINING:
Findings:
All Sheriff’s officers complete Academy training which includes CIT certification and eight hours of suicide prevention training. CFMG will do annual suicide prevention training. All Sheriff’s officers are receiving training on direct supervision models of observation. The Sheriff’s Office is also undergoing a new CIT Team program. In this program all custody deputy staff will receive 8 hours of crisis intervention training. In addition, participants in this program will undergo an additional 40 hours of training.
Recommendations:
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1. The suicide prevention training curriculum including any pre-and post-test materials should be reviewed and approved by mental health subject matter expert under the terms of any remedial plan.
2. Suicide prevention training data should be tracked by total number of officers\percentage officers who have received the training each year with parallel data maintained on health services staff as well.
L. EMERGENCY CARE:
Findings:
Individuals who do require emergency care are transferred to a psychiatric health facility. The Behavioral Wellness Department (Be Well) operates a 16 bed LPS (commonly referred to as PHF, Santa Barbara County Psychiatric Health Facility). For the past 6 to 7 months one bed has been designated for a jail inmate who might require safety cell placement for more than 24 hours. Any inmate who is deemed to require emergency hospitalization for danger to self or others is evaluated by the CARES Mobile Crisis Unit which will come to the jail 24/7 to complete an evaluation. They are the only clinical providers who are authorized to complete a 5150 evaluation for hospitalization. Santa Barbara County is working to develop a facility for diversion if the individual does not meet 5150 requirements.
During my jail tour I observed several inmates who were acutely mentally ill and would benefit from placement in an LPS or psychiatric hospital; although, based on California state law they may not meet the requirements for placement at an LPS.
The Justice Alliance is contacted when mentally ill inmates refuse medications. They report to the court and can request a Riese hearing. Should the court order medication the inmate is transferred to PHF which has 4 beds for that class of patient. PHF also has 4 beds for misdemeanants who are incompetent to stand trial.
Recommendations:
1. Continue the current efforts to establish community resources for acute care hospitalization, LPS and restoration services.
2. Establish policy guidelines for timeframes of mental health face to face clinical review for all inmates returning to the jail from different levels of community care, ED, LPS, State Hospitals, etc. to ensure appropriate classification and housing and continuity of medications and follow-up evaluations.
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3. Develop relationships with the DA and PD offices to expedite court referrals to the State Hospital system or other treatment facilities.
4. Track patient lists of all inmates referred to a higher level of mental healthcare with sufficient identifiers to be able to complete periodic quality reviews.
M. SUICIDE PREVENTION:
Findings:
SBJ has 4 safety cells and 2 observation cells. These cells are sometimes used as step down cells for people released from safety cells/suicide watch. LMHPs assess for danger to self or others or if someone is gravely disabled (defined as not eating, drinking, or showering, etc.). Inmates moved to safety cells from intake are also assessed by the mental health staff for signs of drug or alcohol withdrawal.
Any jail staff member can place somebody in a safety cell pending a mental health evaluation. Once placed, medical and mental health are contacted to see the patient within one hour except after 11 PM when mental health staff are not on-site. In the latter situation the inmate will be assessed by a mental health professional at the beginning of the next work shift. Nursing staff can call the CARES to assess for a 5150 hold. If the hold is issued and no hospital bed is available the inmate will remain in a safety cell until a bed opens up. In acute situations the inmate can be referred to the emergency department where they can be held for up to 72 hours. In the event the one PHF bed is available the inmate can be transferred to that psychiatric facility.
It is reported that a new mental health evaluation is completed if one has not been done within the prior 90 days. A suicide risk assessment form has recently been implemented. Licensed mental health professionals, including the psychiatric RN, can release someone from suicide watch. Staff reported that all mental health professional contacts in the safety cell occur through the food port. Chart review did indicate that mental health staff are making brief contact with individuals in the safety cell multiple times per day.
Inmates placed in a safety cell receive a suicide resistant smock, but no mattress or blanket. Meals are prepared on a paper tray with an eco-friendly spork.
Once released from safety cell precautions inmates are to be seen one day and seven days post release. Staff reported that if they determine it is not clinically appropriate the inmate is not seen. This practice deviates from the customary national practices of seeing people at least at one day and seven days, and often 28 days post watch and in some situations monthly until discharged.
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
Some isolation cells were noted to have prominent metal rungs to provide a ladder to the upper bunk. Suicide rates are much higher for inmates in segregated housing, and these protuberances make it possible to easily secure ligature. It was also noted that several isolation cells had grills that make it quite difficult to see into the cell, again an additional risk factor that should be reviewed by the jail.
Recommendations:
1. Unless patients are physically aggressive or highly agitated they should be offered use the bathroom facilities on a periodic basis (every 4 hours per the restraint chair policy) while housed in a safety cell.
2. Written property restrictions while on suicide watch should be issued by a mental health professional and should allow all inmates to be issued a suicide resistant mattress, smock and blanket unless there are documented reasons requiring the removal of that or any other item from the cell.
3. Inmates on watch should be allowed access to bathroom facilities and showers and group and unstructured activities whenever possible if approved by the mental health team based on safety issues.
4. Safety cells should be sanitized after every use and the sewer grate inspected prior to placement to ensure there are no foul odors emanating from the opening.
5. The suicide risk assessment form should document the clinicians’ rating of low moderate or high suicide risk.
6. Therapeutic services, especially psychiatric services, need to be increased for those people on suicide precautions. Depressed nonaggressive suicidal patients should be receiving brief cognitive behavioral therapy in a confidential setting and be evaluated for the initiation of antidepressant medications.
7. A copy of the suicide prevention training curriculum should be provided to the subject matter expert for review to ascertain whether it incorporates correctional risk factors.
8. A behavioral management plan or treatment plan form should be developed for use with inmates with frequent safety cell placements.
9. All inmates should be seen at customary frequencies of post suicide prevention observation. Post suicide prevention follow-up should not be left
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
to the discretion of the staff but be driven by measurable policy requirements.
10. A quality improvement study needs to be performed to ensure that people are being seen for post suicide watch assessments per the requirements of the facility policy.
11. At least one daily licensed mental health professional contact for any inmate in a safety cell or identified as a current suicide risk should be conducted in a sound private interview space unless there are documented reasons why the safety of the patient or the therapist cannot be maintained.
12. A mental health assessment leading to the release of someone from suicide precautions should always be conducted in a sound private interview space in order to fully assess the individual’s preparedness for release.
13. Isolation cells should be inspected to ensure that they are as suicide resistant as possible since the majority of jail suicides occur at this level of housing.
14. Inmates in psychiatric observation should be monitored in a health services setting and not in isolation cells. This ensures closer monitoring and access to medical/mental health services and focused custody observation. It also creates less stigmatization for the patient and identifies their issues as health related and not simply a behavioral problem. This practice also better protects the confidentiality of the patient’s need to be placed on special observation.
N. USE OF RESTRAINTS:
Findings:
The Santa Barbara Sheriff’s Custody Operations provided a 2016 monthly data summary for the use of force (UOF). Total use of force for the year was a fairly low number. Of these 56% inmates were showing signs and behaviors of mental illness with use of force scattered throughout the year with no general trend.
The restraint chair is not utilized at SBCJ. However, the UOF is disproportionately utilized for inmates with signs of a mental illness and physical restraint may be safer than the use of electronic restraint, particularly in aroused inmates or those on medications that can effect cardiac conduction.
Recommendations:
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
1. Develop a policy on the use of clinically ordered restraints, especially given the shortage of inpatient psychiatric beds for incarcerated individuals. (See Appendix 11)
2. CFMG should track any use of restraint for SMI inmates and this data should be regularly reviewed by the Quality Improvement Committee and the subject matter expert.
3. Use of de-escalation techniques and early involvement by a mental health professional when restraint of an SMI inmate is being considered is best practice. In my input into the policy manual I discussed the consideration of having two categories of restraint, custody and medically ordered. Please refer to that document.
O. SEGREGATION HOUSING OF THE MENTALLY ILL INMATE
Findings:
Most of the inmates with overt psychiatric symptomatology are housed in restrictive/segregated housing. Concerns identified during the site visit included delayed access to a psychiatric evaluation and initiation of medication treatment, difficulties in medication continuity upon intake, issuance of new medications without a face to face evaluation, an absence of treatment programming for inmates with serious mental illnesses who cannot tolerate placement in general population due to their illness, overtly psychotic inmates housed in segregation due to a lack of developed mental illness treatment units, and a pervasive lack of mental health contacts conducted in sound private settings.
The New East ISO-unit cells 25-38 was also visited. Although a physically more pleasant segregation unit, the inmates here are all single celled and essentially in isolation. Several of the cells had negative airflow making it completely impossible to conduct any kind of conversation through the doors since the inmates’ verbalizations were inaudible.
There is a provision on page 9 of the CFMG contract that the contractor will collaborate in developing delivering appropriate service levels in staffing models if the Sheriff determines in the future that subacute or acute inpatient psychiatric services should be provided at the jail.
Based on my tour of the jail and interviews with inmates in restrictive housing, the jail is currently housing acutely and sub acutely mentally ill individuals, almost without exception, in restrictive housing or in a few cases, extreme isolation. All of those inmates are in need of greater services than are currently being provided. In recent years the American Psychiatric Association, the Society of Correctional Physicians, and
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
NCCHC have adopted position statements to restrict the use of segregated housing for inmates with serious mental illnesses.
“Prolonged segregation of adult inmates with serious mental illness, with rare exceptions, should be avoided due to the potential for harm to such inmates. If an inmate with serious mental illness is placed in segregation, out-of-cell structured therapeutic activities (i.e., mental health/ psychiatric treatment) in appropriate programming space and adequate unstructured out-of-cell time should be permitted. Correctional mental health authorities should work closely with administrative custody staff to maximize access to clinically indicated programming and recreation for these individuals.”2
The American Psychiatric Association publication3 further outlines essential mental health services for inmates in segregation housing paraphrased as follows:
1. Inmates should not be placed in segregation housing solely because of symptoms of the mental illness unless there is immediate and serious danger for which there is no reasonable temporary alternative.
2. When an inmate is placed in segregated housing for appropriate correctional reasons, the facility remains responsible for meeting all of the serious medical and psychiatric needs of the inmate.
3. Inmates in segregation who decompensate and experience a psychiatric crisis should be removed from segregation and transferred to an acute psychiatric setting. If they are returned to segregation should be a unit that provides adequate structured and unstructured activities.
4. “If an inmate with SMI is placed in segregation, adequate unstructured out-ofcell time should be scheduled (at least 10 hours per week), as must adequate out of cell structured therapeutic activities (i.e., mental health\psychiatric treatment). Such treatment should be responsive to the level of care clinically required and occur in appropriate programming space.
Currently the only essential mental health services provided to the mentally ill inmate in segregated housing are a three times weekly administrative segregation rounds and psychiatric appointments for those on medications as infrequently as every 90 days. Rounds are documented on a log form. No out of cell structured activities are provided. During rounds each inmate, regardless of mental health history, should be visited briefly so that any emerging problem can be assessed.”
2 Position Statement on Segregation of Prisoners with Mental Illness; Approved by the American Psychiatric Association Board of Trustees, December 2012 Approved by the Assembly, November 2012
3 Psychiatric Services in Correctional Facilities, third edition, American psychiatric Association 2016
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
Recommendations:
1. The current contract requires that mentally ill inmates in restrictive housing receive appropriate interventions at least three times per week. The contract does not specify what appropriate interventions are. Seriously mentally ill inmates confined to restrictive (non-isolation areas) housing settings should be provided with a minimum of 10 hours per week of structured out of cell cycle therapeutic activities and 10 hours of unstructured out of cell time. In addition, a minimum of weekly rounds by a mental health professional or psychiatric registered nurse should be completed. Inmates in these settings should be seen with greater frequency by psychiatry whether the inmate is currently compliant with medications or not. These inmates should also all have an individualized treatment plan (ITP) and the structured out of cell activities should be driven by the ITP. No inmate with a serious mental illness should be housed in isolation (ISO 20-21 and C7-8 (cells with minimal contact with other human beings).
2. Minimum programming and out of cell time should be driven by policy.
3. Admitting criteria for any mental health housing units should be developed.
4. Once a unit is designated as a health services unit movement to and fro is based on recommendations by mental health professionals as opposed to custody or classification. Management of these units is a combined collaboration between those three areas of the jail. Comparable and separate services should be developed for male and female inmates. I am attaching an older generic policy that may aid the facilities in conceptualizing how programming and housing can be structured with specified mental health and psychiatry interventions (See Appendix 12). Implementation is dependent on the development of a concept for these units and an adequate staffing plan for both health services professionals and custody.
5. It has become customary for larger jails to provide a minimum of 10 hours per week of structured therapeutic activities provided by health services to those individuals housed in specialized areas.
6. Segregation should not be used as an alternative to providing mental health housing. These housing units are essentially comparable to a sheltered housing unit or infirmary provided for general medical services.
7. Tracking of completion of segregation rounds as well as any special programming provided to the seriously mentally ill in segregation should be
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
maintained as proof of practice and reviewed by the Quality Improvement Committee.
8. During mental health rounds, if an inmate shows evidence of decompensation or reports significant mental health issues a private out of cell appointment should be scheduled within clinically appropriate time frames for a face-to-face evaluation.
P. MENTAL HEALTH INPUT INTO THE DISCIPLINARY PROCESS
Findings:
There is currently no policy or process (shared with me) for mental health clinicians to have input into the disciplinary process. It is important for inmates identified as having a serious mental illness and receiving major disciplinary reports for behavioral disruptions to be evaluated by a licensed mental health professional as close to the incident as possible. The role of the licensed mental health professional is to determine whether or not there were mitigating factors (such as mania, delirium, delusions, etc.) leading to the infraction; can the individual can tolerate the conditions of confinement if they are moved to segregated/isolated housing; and, should the inmate be diverted to a hospital or other health setting. A concise and briefly written form forwarded to the classification or disciplinary officer from the mental health professional should be issued. This input should be considered prior to any disciplinary action being imposed. It is not the role of the mental health professional in this practice to determine competency. There should also be a concomitant health review to ensure the inmate is medically clear for whatever placement custody is imposing.
Recommendations:
1. Develop a policy on mental health input into the disciplinary process (See Appendix 14).
2. Develop an accompanying form (See Appendix 15) to be completed by the mental health professional and filed in the medical record with a copy forwarded to the disciplinary officer\committee. This form should also have an area where the disciplinary officer can indicate whether the sanctions were mitigated based on the input by the mental health professional.
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
3. The quality improvement committee should periodically track this process and determine what percent of the time input has a positive impact, either diverting the individual from isolations\segregation or diversion to a hospital or mental health treatment unit.
Q. RE-ENTRY
Findings:
The role of discharge planning seems to fall to the Sheriff’s Department. There are two discharge planners (one recently retired) who follow up with any inmate who submits a discharge application or assist inmates not capable of completing the application. The discharge planners go throughout the jail inquiring as to whether inmates want re-entry planning.
The mental health service primarily provides medication as their portion of the discharge plan. Inmates who are released Monday through Friday receive instructions on how to go to a Be Well or CARES walk-in clinic and a brief supply of medications in their property. Under Corizon, on Saturday and Sunday a nurse calls a seven-day supply medication to a local pharmacy. A discharge planner can also pick up the medication for the inmate and place it in their property. CFMG’s policy is to place a medical hold in the jail information system so that inmates are seen by a registered nurse prior to release. That nurse will obtain a 30 day prescription for medications.
There is a data tracking the reentry efforts. In 2015 there were 16,899 bookings to the County jail. The percentage of inmates with a serious mental illness to receive discharge planning cannot be determined from the data provided. From previous calculations earlier in this report approximately 20% of the population receives psychiatric medication. 20% of the 2015 bookings represents 3380 people, more than twice the number reentry assistance offered in 2016.
The discharge planning team consists of 2 rehabilitation specialists (one position is currently vacant) through the public defender’s office and 2 probation officers station at the jail. Discharge planners will assist the inmate in filling out the questionnaire form. Inmates can easily be reconnected with Social Security Administration because their
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
offices are down the street and readily accessible to discharging inmates. Discharge planners also connect people with medical services in the community. Those people who are designated “dress for release” and are known to be leaving at the next court date will have a discharge planner ensure that their insurance is activated on their day of release and will ask the health services provider to call a prescription in to the pharmacy.
A copy of an individual discharge plan was reviewed. Elements of housing, medical and mental health aftercare, probation, and release medications are covered in a discharge plan for the inmate. Both staff and the inmate sign the plan. The plan is well documented and comprehensive. The target population for discharge planning includes inmates with high mental health issues.
Recommendations:
1. The discharge plan should include directions on how to reinstate Social Security Administration benefits when applicable and access to social service benefits such as health insurance, temporary assistance, etc.
2. The facility should track the elements of discharge planning for the seriously mentally ill in order to provide proof of practice in the event of future reviews. Data should include at least the following: a. The total number of mentally ill inmates eligible for discharge planning per month. b. How many of that subset received referrals for outpatient appointments, discharge medications, 5150 referrals, etc. c. What percent of the seriously mentally ill inmates discharged required housing referrals versus the percent that received placements?
3. The staffing analysis should include discharge/re-entry staff once completed.
R. MEDICAL RECORD
Findings:
In the contract agreement with CFMG on page 3 the County shall be the owner of all data collected and all documents of any type whatsoever.
The records reviewed on site were paper documents maintained by Corizon HealthCare. CMFG was implementing an electronic health record at the time of my visit and I have no knowledge of how that process has gone.
Recommendations:
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
1. The County should review all of the templates in the health record and make recommendations for modifications to customize forms to the needs of a correctional setting.
2. All health forms should be County forms that also indicate the contractor’s name.
3. Record entries should indicate the housing location of the patient, the type of service (segregation rounds, initial mental health assessment, response to sick call requests, crisis contact, psychiatric initial or follow-up appointments, etc.) and where services were delivered (such as, at the cell front, attorney’s booth, etc.).
4. Records should always indicate the time of the encounter as well as the time the note is generated since there may be significant lapses in the two events.
5. As requested, I am also including Appendix 10, Documentation Guidelines as a reference. Please bear in mind that these are guidelines and not standards.
Suggestions:
1. It is always to the advantage of the County to own the medical record so that there are fewer impediments to changing health care vendors. If the vendor owns the record and their contract is terminated or not renewed, then the jail only has access to read only documents and staff must be retrained on a new system which is disruptive and time consuming.
S. PRIVACY OF CARE
Findings:
There are serious inadequacies in providing essential sound privacy of care throughout the entire facility to inmates identified as mentally ill. Individuals seen by mental health on referral from intake, more often than not, are seen in an open non-private setting in the intake area. Thereafter, contact with the licensed mental health professionals invariably occurs at the cell front with in ear shot of other inmates and correctional staff. The only sound private contacts are conducted by the psychiatrist, and even then, inmates report a security officer is always present as is a psychiatric nurse. The lack of privacy significantly hampers the development of confidence and trust between the inmate and the mental health professional. Without sound privacy individuals are unlikely to confide material that they believe will reveal weakness or for which they feel shame. Oftentimes inmates will request placement on suicide watch for reasons other
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
than intent to harm themselves. Without a private setting they will not reveal the vulnerabilities which caused them to request that placement.
The second issue regarding the privacy of care is the maintenance of inmate health service requests remaining confidential throughout the process of submission until receipt by health services. Emergency mental health needs and when an inmate chooses to hand their requests to an officer are the usual exceptions.
Recommendations:
1. Patient\clinician contacts, other than rounds, should occur in a sound private setting unless there are well founded documented security justifications restricting this practice.
2. Sufficient escort officers and private interviewing spaces are essential to allow proper mental health encounters.
3. Inmates housed in a safety cell should be seen in a sound private interview space which may include a fixed table and chairs. Inmates considered a safety risk may need to be shackled and secured so they can be seen safely by the clinician.
4. Mental health staff delivering services in high security areas should have a security radio for emergency contacts.
5. A confidential health service request system should be implemented.
T. MORTALITY AND MORBIDITY REVIEWS:
Findings:
A verbal description of the morbidity and mortality process is as follows:
1. An internal affairs investigation is completed by a Risk Assessment Unit (RAU) (patrol and custody). A review of all video, the autopsy, and staff interviews including EMS are completed.
2. RAU works for the County Council and reports directly to the Sheriff and the undersheriff.
3. Upon completion of the autopsy and toxicology studies the final coroner’s review includes the Chief of Corrections, Commanders, Lieutenant, the health services leadership, physician, and Public Health Department physician.
4. CFMG stated that they do a 24 hour review with a report to the corporate office and within 30 days meet with custody to review the death.
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
The adequacy of the suicide death review is deficient because there is no formal follow up at the site level to ensure that corrective actions were developed, completed by an assigned facilitator and done in a timely fashion.
Recommendations:
1. Add a process defined by policy creating a final documented mortality review, interventions and root cause analysis, when indicated, at the facility level. Develop any necessary corrective action plans based on this final review looking for systems issues that were identified and correct physical or procedural issues uncovered by the mortality review process and track the outcome of applied interventions.
Suggestions:
1. It is useful for the mortality and morbidity committee to schedule an annual review of all deaths in the facility to ensure that all elements of the corrective action plans have been completed and are sustaining themselves. The second purpose of such a meeting is to attempt to identify if there are any trends in the nature of the deaths that might require an intervention. Examples of this might be an uptick in the number of heroin related deaths resulting in the facility we studying policies around contraband etc.
U. QUALITY IMPROVEMENT:
Findings:
CFMG plans to do specific studies each month including outcome and process studies that are site specific.
No studies performed by the prior contractor, Corizon, were available for review.
Recommendations:
1. A policy modeled after J-A-06 Continuous Quality Improvement Program Standard 4 or a similar standard be reviewed and approved by the subject matter expert.
4 Standards for Health Services in Jails 2008, Essential Standard J-A- 06 Continuous Quality Improvement Program, p.10. National Commission on Correctional Healthcare 2008
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Executive Summary - Mental Health Services Review – Santa Barbara County Jails April 12-14, 2017
2. A minimum requirement for process and outcome studies should be established by policy.
3. The Quality Improvement Committee should meet monthly with facilitation until all members are knowledgeable about the principles of continuous quality improvement and are capable of facilitating project teams. Ultimately, the quality of healthcare is the responsibility of the County and key leadership from the Sheriff’s Jail Staff should be integral members of the Quality Improvement Committee. (In the case of this County, I would also include the two monitors from the Departments of Public Health and Behavioral Health). The latter are responsible to communicate back the County key concerns regarding poor performance relying on aggregate, non protected data to address concerns regarding outcomes and vendor work efforts.
4. Develop a Corrective Action Plan format to track the elements of any future remedial plan and send the recommended data to the subject matter expert at least two weeks prior to any monitoring tour.
Respectfully submitted,
March 2, 2018
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 Case 2:17-cv-08805-GW-JPR Document 48-1 Filed 02/28/19 Page 1 of 27 Page ID #:885
MARGO L. FRASIER, J.D., C.P.O. EXECUTIVE SUMMARY (NON-CONFIDENTIAL)
ASSESSMENT OF CUSTODY OPERATIONS SANTA BARBARA COUNTY JAIL SYSTEM
SITE VISIT APRIL 3, 2017-APRIL 7, 2017
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INTRODUCTION:
Under the terms of a Structured Negotiations Agreement between counsel representing the County of Santa Barbara and counsel representing inmates of the Santa Barbara County Jail, the parties agreed to retain me as joint expert to conduct reviews and prepare reports, to identify any shortcomings, and to propose recommendations to remedy any shortcomings in custody operations, including segregation and isolation.
The Santa Barbara County Jail system has long been plagued by overcrowding and older facilities. Santa Barbara County has made a substantial investment and is nearing the completion of a new jail facility which will be located in the northern part of the county and will provide 376 additional beds and much needed flexibility in the housing of inmates.
Until the completion of the Northern Branch Jail, the options for dealing with overcrowding and limiting the use of the isolation cells in the Main Jail are very few. However, there are some things which can be done to maximize the use of the current space and provide inmates in the isolation cells with more time out of their cells. There are 46 recommendations made in this report. Some of them cannot be implemented until the Northern Branch Jail is completed and occupied. However, the vast majority of them can be implemented now to improve the living conditions and safety of the Santa Barbara County Jail system.
QUALIFICATIONS:
I hold a Bachelor of Science in Criminology and Corrections, with honors, from Sam Houston State University. I also hold a Juris Doctor, with high honors, from Florida State University. I have over 40 years of experience in the criminal justice field. I am self-employed as a criminal justice consultant and provide litigation support. I currently serve as a subject matter expert in law enforcement and corrections for the Special Litigation Section of the United States Department of Justice. In addition, I serve as the Lead Monitor overseeing implementation of the provisions of the Consent Judgment for the jail system in Orleans Parish, Louisiana.
I served as the elected sheriff of Travis County, Texas from 1997 through 2004; the first woman to hold the office where I started as deputy more than two decades earlier. As sheriff, I oversaw 1,350 deputies and other employees with a budget of more than $90 million. I earned praise for my leadership in improving the jail system and the implementation of community policing. Since leaving office, I have worked as an assistant professor in the College of Criminal Justice at Sam Houston State University in Huntsville, Texas, a Senior Associate for MGT of America, Inc., and as the Police Monitor for the City of Austin. Over the years, as a consultant and an attorney, I have provided expert testimony in matters involving criminal justice including civil rights, employment law, law enforcement practices, and corrections practices.
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I am on the board of the National Association of Civilian Oversight of Law Enforcement (NACOLE) where I serve as Vice-President. I served as treasurer, vice-president, and president of the Major County Sheriffs’ Association. I also served on the boards of the National Sheriff’s Association, National Center for Women and Policing, Texas Institute for Public Problem Solving, and the Children’s Advocacy Center of Central Texas. In addition, I was recognized twice by the Combined Law Enforcement Association of Texas as Administrator of the Year. I also received a Lifetime Achievement Award from the National Center on Women in Policing.
OBSERVATIONS REGARDING JAIL FACILITIES:
CAPACITY OF JAIL FACILITIES:
Normally, when the term, rated capacity, is used, it is meant to refer to the number of inmates allowed to be housed in an area based on a standard such as a court order, fire code, or state jail regulations. When the term, rated capacity, is used in this report, it is referring to the number of inmates allowed to be housed in an area based on the California Minimum Standards for Local Detention Facilities. When the term, bed capacity, is used in this report, it is meant to refer to the number of permanent beds available for inmates in a housing area; it does not include temporary beds such as mattresses on the floor or mattresses in hard plastic shells, commonly referred to as “boats.”
The Santa Barbara County Sheriff’s Office lists the bed capacity of the Main Jail (including the IRC) as a total of 815 (680 males and 135 females) beds. The rated capacity of the Main Jail is 659 (551 males and 108 females) beds. The capacity utilized by the Santa Barbara County Sheriff’s Office is primarily based on the number of beds in a housing area. The rated capacity is set by the California Board of State and Community Corrections (BSCC) based on the applicable Minimum Standards for Local Detention Facilities as outlined in Titles 15 and 24, California Code of Regulations. Complicating the issue is that the BSCC uses five (1963, 1982, 1988, 1998, and 2005) different sets of the Title 24 standards, depending on the year the part of the facility was constructed or modified, to rate and inspect the Main Jail.
Santa Barbara County has been under a court order since 1988 to reduce its population. The lawsuit remains pending and the Santa Barbara County jail system is subject to ongoing court oversight. The population housed in the Main Jail consistently exceeds the rated capacity and often exceeds the bed capacity set by the Santa Barbara County Sheriff’s Office. On June 19, 2017, the Main Jail housed 782 (659 males and 123 females) inmates. Even though the number of inmates incarcerated was less than the number of affixed beds in the facility, fifty inmates were assigned to housing units where the number of inmates exceed the affixed bed count. One of the reasons that inmates are assigned to housing areas without an affixed bed and had to sleep on the floor (often they were given “boats” to hold their mattresses) even though there were empty affixed beds is that parts of the facility were not being utilized or were being underutilized. For instance, the female dormitory in the Medium Security Facility was not
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currently being utilized at the time of the site visit or on June 19, 2017. Due to its location, that dormitory is rated to house up to 40 inmates; male or female. In addition, included within the 815-bed count, is the double bunking of the Northwest 1-20 isolation cells even though those cells are seldom used to house two inmates; thus, up to 20 affixed beds are often unoccupied in Northwest 1-20. While this totals 65 empty beds between these two housing areas, that does not necessarily mean that all 50 of the inmates who were without an affixed bed could be accommodated as there are classification considerations. For instance, most of the inmates in the Northwest 1-20 isolation cells have mental health and/or behavioral issues which require them to be housed alone.
As noted above, except for the single cells used for special housing (administrative segregation, discipline segregation, mental health, protective custody), almost every housing unit in the Main Jail regularly exceeds the rated capacity. On June 19, 2017, in fourteen of the housing units, the number of inmates in the units exceeded the bed capacity (number of affixed beds) in those units. As noted in the 2014-2016 Biennial Inspection of the Santa Barbara County jail facilities (Jail Inspection), the multi-occupancy cells and dormitories have insufficient square footage and toilets, washbasins, and showers for housing additional inmates above the rated capacity. This was found to be the case in both the Main Jail and the Medium Security Facility.
When the Northern Branch Jail is completed, the rated capacity of the combined jail system (Northern Branch Jail, Main Jail, and Medium Security Facility) will be 1163 inmates (959 males and 204 females based on current designation by gender). As of June 19, 2017, the population of the current combined jail system was 985 inmates (862 males and 123 females). Given the current number of female inmates, it is anticipated that one or more of the units currently used to house female inmates in the Main Jail will be repurposed to house male inmates once the Northern Branch Jail opens.
As a jail system cannot be occupied at 100% of the rated capacity and maintain proper separation and classification, preferred correctional practice is to allow for a minimum of 10% of the rated capacity not to be utilized to account for a classification factor. Applying a 10% classification factor would mean that the combined jail system (Main Jail, Medium Security Facility, and Northern Branch Jail) would be “full” when it reaches 1047 inmates. Thus, even with the opening of the Northern Branch Jail, if the preferred 10% classification factor is utilized, the Santa Barbara County Jail system will be very close to lacking sufficient capacity to properly classify inmates at the current population. This will be especially true if, as recommended below, once the Northern Branch Jail is open, modifications are made to the Main Jail which reduce the rated capacity of some of the housing areas and/or some of the isolation cells in the Main Jail are no longer utilized.
RECOMMENDATIONS REGARDING CAPACITY OF JAIL FACILITIES:
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1. While it is not possible to house the current inmate population without exceeding the rated capacity, a system should be put in place to consider the percentage of rated capacity when making the decision as to which housing unit additional inmates will be placed. For instance, South Tank is rated for 20 inmates and on June 19, 2017, held 30 inmates; therefore, it was at 150% of rated capacity. East 6 is rated for 16 inmates and on June 19, 2017, held 22 inmates; therefore, it was at 137% of rated capacity. The Main Basement Dorm-3 is rated for 32 inmates and on June 19, 2017, held 58 inmates; therefore, it was at 181% of capacity. Under this analysis, the most crowded housing area was South Dorm which is rated for 17 inmates and on June 19, 2017, held 39 inmates; therefore, it was at 229% of rated capacity. Crowding in the South Dorm is particularly problematic as it holds the most medically infirm; including inmates who are required to use wheelchairs to get around inside the housing unit. Having inmates sleeping on the floor with their beddings and belongings taking up limited floor space further complicates issues with mobility.
2. It is recommended that medium security inmates, male or female, be moved to the Medium Security Facility, to what is commonly referred to as the Female MSF dormitory to facilitate reducing the number of inmates sleeping on the floor in the Main Jail. Specifically, it is recommended that relocation of the inmates currently housed in South Tank be explored as these are medium security inmates who have been identified as having mental health issues. Relocation to the Medium Security Facility would alleviate the overcrowded conditions in South Tank and provide much needed programmatic space for mental health counseling.
3. Once the Northern Branch Jail is completed, it is recommended that steps be taken to limit the number of inmates assigned to the housing units in the Main Jail and the Medium Security Facility to no more than the rated capacity. Further consideration should be given to lowering the number of inmates assigned below the rated capacity in housing units where the rated capacity is based on 1963 standards. In some of the housing areas, even the rated capacity results in an overcrowded situation due to the dated standards applied to most of the Main Jail to determine the rated capacity, i.e., 1963 standards to South Tank.
4. As will also be discussed in a later recommendation, once the Northern Branch Jail is open, it is recommended that the use of the isolation cells (South 1-16, South 20, South 21, West 18-29, East 11-22, Central 7, and Central 8) be curtailed or eliminated unless they can be modified to address the issues with lighting and ventilation, and accommodation is made to allow for daily out of cell time. This recommendation exempts the isolation cells in the Northwest module and East 25-38. However, it is also recommended that the capacity of isolation cells in Northwest 1-24 be changed from double cells to single cells and accommodation be made to allow for daily out of cell time for both Northwest 1-24 and East 25-38 isolation cells. If the isolation cells, except for those in East 25-38 and Northwest 1-24 (as single occupancy), were not utilized, this
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would reduce the bed capacity of the Main Jail by 65 inmates and the rated capacity by 45 inmates. While elimination of use of these cells, unless they can be modified in a manner to address the deficiencies and to allow for daily cell time, will reduce the capacity of the Main Jail, as discussed below, these cells, without modification and an increase in out of cell time, fall well below recognized correctional practice in that the inmates do not have access to a dayroom and are confined to their cells except for three hours a week allowed for recreation out of their cells. Recommendations elsewhere in the report provide opportunities for increasing the out of cell time for these inmates. 5. When the Northern Branch Jail is operational, the capacity for female inmates at the Northern Branch Jail will be 80 inmates. One unit for female inmates consists of 16 single cells. The two other units are multi-occupancy units with a capacity of 32 inmates each. One of the multi-occupancy units has eight four-person cells and one of the multioccupancy units has four eight-person cells. Due to the number of females housed currently in the Santa Barbara County Jail system, 123 female inmates as of June 17, 2017, additional living units at the Northern Branch Jail will have to be utilized to house female inmates or female inmates will have to still be housed at the Main Jail or the Medium Security Facility. There are pros and cons to each approach. If all of the female inmates are housed at the Northern Branch Jail, it would make gender specific supervision required by the Prison Rape Elimination Act (PREA) easier to accomplish. However, there would likely be increased transportation time for court. If female inmates continue to the housed in the Main Jail once the Northern Branch Jail is occupied, it is recommended that female inmates be moved to South Tank and South Dorm. This will provide for separation by sight and sound from male inmates. If female inmates are still housed in isolation at the Main Jail once the Northern Branch Jail is complete, they could be housed in South 1-16 with South 17 being converted for use as a dayroom to allow for out of cell time for the female inmates housed in South 1-16. The South recreation yard could be limited to use by the female inmates; thus, increasing the amount of time out for recreation and eliminating the current problems of maintaining separation by sight and sound of male and female inmates when the main recreation yard is utilized by female inmates.
CONDITION OF JAIL FACILITIES:
It was noted during the tour of the jail facilities that many portions of the jail facilities were in a state of poor repair and/or sanitation. For instance, in South Tank, which has an affixed bed capacity of 24 inmates, it was noted that two of the three washbasins and one of the three toilets were not in working order, and the sole shower was missing tiles and had a significant amount of visible mold. This resulted in one washbasin, two toilets and one shower for the entire unit. Exasperating the issue, South Tank is rated to only hold 20 inmates, but, on June 19, 2017, held 30 inmates. In South Dorm, the dormitory used to house inmates with medical conditions due to its proximity to a medical station, mold was found in the lavatory in the showers and on the walls
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of the washbasin area, one of the washbasins was not in working order, and the air vents were covered with caked dirt. South Dorm was extremely crowded which made it difficult to get around; especially for the inmates who require wheelchairs. Adding to the crowding, there were five (5) inmates sleeping on mattresses in “boats” and one inmate on a mattress on the floor during the site visit. South Dorm has a rated capacity of 17 inmates. On June 19, 2017, South Dorm held 39 inmates.
Many of the housing units were not clean and had a foul smell. Some of them were filthy and the stench was almost overwhelming. The ones in the greatest need of cleaning were the isolation cells housing the inmates with mental health issues. When asked about the level of cleanliness, staff responded that inmates were given cleaning supplies and the opportunity to clean their housing areas. Several inmates complained about the lack of proper cleaning supplies. Several of the inmates with mental health issues in isolation appeared to not appreciate the necessity of cleaning their cells.
The lighting and ventilation in the isolation cells in the West, East, and South housing modules appears to need addressing. The cells are difficult to see into due to the lack of lighting; either due to a design issue or inmates tampering with and covering the lights. As noted above, many of these cells were found to be unsanitary during the site visit with the stench being almost overwhelming for certain cells. While the unsanitary condition of individual cells is the main reason for the foul smell in the isolation unit, the lack of fresh air flow appears to contribute.
Three units, D-1, D-2, and D-3, are housed in the basement in what used to be classroom and storage. While not ideal due to the lack of natural light, these housing areas are suitable for long term use as long as the population is limited to the rated capacity. While that is not possible until the Northern Branch Jail opens due to population pressures, the lack of space and hygiene facilities warrants the reduction of the population to no more than the bed capacity immediately.
Two units, Northwest A-D Pods and IRC, have attached recreation yards. The housing unit that contains the East 25-38 administrative segregation cells has two very small (accommodate one or two inmates at a time) recreation yards adjacent to the housing unit. There are also two larger recreation yards. One recreation yard is in the South housing module and one recreation yard is located centrally between the East and the West housing modules. The one located centrally is large and appears to have been designed to accommodate inmates from multiple housing units at one time. As the central recreation yard is no longer being used in that manner, its current design and use is inefficient.
The design of the Main Jail, combined with overcrowding, results in a lack of adequate dayroom space. The notable exceptions are Northwest A-D Pods, East 25-38, and IRC. In the other housing units, there is a small dayroom or common space. In the multi-occupancy cells, it consists of an area in front of the cells which contains seating, tables, and the shower facilities. In the dormitory units, except for South Tank and Male Basement-D2, the “dayroom” is in the
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common space with the affixed beds, tables, and benches. In the fourteen units which house more inmates than there are affixed beds, part of the dayroom space is taken up by the bedding and personal effects of the additional inmates. For the inmates in the isolation cells (South 1-16, South 20, South 21, West 18-29, East 11-22, Northwest 1-24, Central 7, and Central 8), there is no dayroom space adjacent to the housing units, and, currently, no access to a dayroom. The only space utilized for out of cell time for the inmates in these isolation cells is one of the recreation yards.
RECOMMENDATIONS REGARDING CONDITION OF FACILITIES:
6. In assessing the cost of repair and upkeep of the Main Jail and the Medium Security Facility to make budget planning decisions and to determine whether it is more cost efficient to replace rather than repair all or parts of the Main Jail and/or the Medium Security Facility, it is recommended that the cost of upkeep of the aging plumbing fixtures (toilets, washbasins, and showers) and necessary modifications to address the issue of out of cell time for the isolation cells be factored in the cost.
7. An assessment should be made of the lighting and the air flow in the isolation cells and any deficiencies addressed.
8. A schedule for regular cleaning of housing units, including, if required, the use of a pressure washer and stronger cleaning agents (closely supervised) to clean air vents and showers should be established. Particularly, a schedule for the regular thorough cleaning of the isolation cells should be established and followed. Inmate workers should be used to clean the cells of inmates who are incapable of cleaning their own cells due to medical or mental health issues.
9. The exchange of linens should be mandatory. One of the units that had a foul smell was South Tank; houses general population male inmates with a mental health history. When the linens were examined, the bulk of them were found to be gray in color and have a strong body odor smell. When asked, the staff indicated that linen exchange had occurred within a few days of the site visit. Based on my experience, it is apparent that many of the inmates are not taking advantage of the opportunity to send their linens to be laundered. Since it is a sanitation issue, the exchange of linens (and uniforms) should not be left up to the inmates to decide; all inmates should be required to exchange their linens on a weekly basis.
OBSERVATIONS REGARDING CLASSIFICATION AND USE OF ISOLATION CELLS:
CURRENT CLASSIFICATION SYSTEM:
While the classification unit of the Santa Barbara County Jail certainly attempts to make the best housing decisions possible, due the lack of options and the overcrowding, most of the housing decisions are based on space availability. As will be discussed below, currently, housing
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decisions are not based on an outcome derived from the application of a classification decisionmaking tool.
Also noted during the review of records and interviews was that supervisors would sometimes move an inmate from one housing area to another without first clearing it through the Classification Unit. It is recommended that all housing decisions be made by the Classification Unit. It is also recommended that any unauthorized movements be documented, and appropriate corrective action be taken.
OVERUSE OF PROTECTIVE CUSTODY, OR THE TERM PROTECTIVE CUSTODY:
Designation of inmates as requiring protective custody, or labeling a housing unit as being reserved for protective custody inmates, limits the housing options for all inmates. If a jail system is overcrowded, like the Santa Barbara County Jail system, designation of inmates and housing areas as protective custody further stresses the system as inmates designated protective custody should not be housed with general population inmates.
As of June 19, 2017, 276 (261 males and 15 females) inmates in the Santa Barbara County Jail system were classified as protective custody, but were not housed in isolation or single cells. That means that 31% of the male jail population and 14% of the female jail population were classified as requiring protective custody, but housed in what would otherwise be general population units (non-isolation cells).
It is highly unusual to have nearly a third of the male inmates of a jail system classified as protective custody. Although there is not a specific recognized correctional practice as to the percentage of inmates in a jail system that should be classified as protective custody, in my experience in jails across the nation, the percentage usually averages around five percent of the total jail population when the designation of protective custody is applied correctly. It is noted that the jail staff for Santa Barbara County sampled eight California jails and found that their protective custody classification percentages ranged between 12.6% and 41%.
Normally, with the designation of an inmate as requiring protective custody comes a requirement that the inmate be separated from almost all, if not all, of the rest of the jail population to ensure the safety of the inmate. Typically, protective custody inmates are kept in single cells; occasionally they may be able to be double celled or housed in a small dormitory (12 or less inmates). Protective custody inmates usually recreate either alone or with a small group of similarly situated inmates, i.e., other inmates charged with crimes against children or other inmates who are former law enforcement.
In the Santa Barbara County Jail system, there are housing units which are designated as protective custody that house as many as 59 inmates in a dormitory style unit. As noted above, in most other jail systems, inmates designated as protective custody are not allowed to comingle with other inmates in the housing area unless they are similarly situated. In the Santa Barbara
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County jail system, the inmates designated as protective custody can commingle with other inmates in the same housing area without restriction. In fact, all but one of the housing units designated as protective custody are dormitory units.
After discussion with the Classification Unit and review of files, it is apparent that the use of protective custody in the Santa Barbara County Jail system is, in many cases, a misnomer. While there are some inmates in the Santa Barbara County Jail system who warrant designation as protective custody due to the nature of their alleged crime, their stature, or their cooperation with law enforcement, many of the inmates designated as protective custody in the Santa Barbara County Jail system do not warrant the protective custody designation, but, instead, fall within one of two categories.
A small number of the inmates are passive and/or small in stature such that they cannot safely be housed with more aggressive inmates. A proper screening of these inmates under the guidelines of the Prison Rape Elimination Act (PREA) might result in them being classified as potential victims. A proper classification system would house inmates who screen under PREA as potential victims apart from known and potential predators without the necessity of classifying the smaller/passive inmate as requiring protective custody. Currently, the PREA screening is conducted in a hallway in the IRC which makes it difficult to have a conversation about an inmate’s prior history of victimization or propensity to be subjected to victimization due to the lack of privacy.
The larger number of inmates designated as protective custody in the Santa Barbara County Jail system are inmates who claim to have dropped out of gangs. California and other prison systems have experienced a phenomenon where inmates claim to have “dropped out” of many of the more widely known prison gangs. If inmates have genuinely withdrawn from all gang membership, they are sometimes targeted for retaliation; commonly referred to as “blood in, blood out.” However, some inmates who claimed to have dropped out of gangs make the claim to get out of administrative segregation; many prison/jail systems place active known gang members in administrative segregation and limit their ability to commingle with other inmates, including their fellow gang members. While the practice of denouncing gang membership was once considered to be unacceptable, some of the more widely known gangs have permitted it as it allows the gang members to have greater freedom in the institution to carry out the work of the gang.
While it used to be recognized correctional practice to classify dropouts from gangs as protective custody, due to the increased number of inmates who are dropping out, the current preferred correctional practice is to note the particular inmates from whom an inmate should be kept separate as opposed to designating the inmate as protective custody. By utilizing a “keep separate” list, the housing options for all inmates is increased as it reduces the number of housing units which must be designated and reserved solely for housing inmates requiring protective custody.
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Another benefit to using a keep separate list as opposed to the designation of an inmate as protective custody is that it tends to limit the number of inmates requesting isolation to avoid being labeled as a protective custody. There are inmates who, although they need to be kept separate from other particular inmates for their safety, will refuse an assignment to a housing unit designated as protective custody. The inmates refusing protective custody are usually inmates who either equate protective custody with being labeled an informant or want to avoid an automatic placement in protective custody should they be transferred to another facility. In the Santa Barbara County Jail system, if an inmate refuses a protective custody assignment, they are normally placed in an isolation cell.
There appears to be a misperception that classification of inmates as protective custody offers liability protection and not classifying inmates as protective custody opens the county to liability. However, simply giving an inmate, the label of protective custody does not provide a shield from liability. It is the separation of the inmate from his/her known enemies, or, in the case of a potential victim of sexual assault, from potential or known sexual predators that provides a potential defense if an assault should occur.
RECOMMENDATIONS REGARDING THE USE OF PROTECTIVE CUSTODY AND HOUSING OF GANG MEMBERS:
10. The PREA screening process currently takes place in the hallway of the intake processing area of IRC. Such a location is not conducive to having a discussion as to whether an inmate has a prior history of victimization or propensity to be subjected to victimization. It is recommended that the screening for PREA be moved to a location where privacy is afforded. At a minimum, staff should be trained to identify inmates whose answers, demeanor, or stature indicate that they may be potential victims and conduct their PREA screening in a location where privacy is afforded.
11. Inmates who claim to be dropouts from gangs should be further interviewed to determine the inmates or groups of inmates from whom they need to be separated for safety. Housing decisions should be based on the keep separate lists as opposed to automatically placing the dropouts in protective custody. The inmates who are dropouts may be placed in general population if they are kept separate from their known enemies or enemy groups.
12. Protective custody designation should be reserved for inmates who truly must be separated from most, if not all, other inmates for their safety. Given the large number of inmates currently designated as protective custody, the process of reducing the number of inmates designated as protective custody will be a substantial undertaking. Many of the dormitory units currently designated as protective custody could be reassigned as general population housing units if known gang members who might constitute a threat to the dropouts are not housed within these housing units.
13. As opposed to restricting the housing of inmates who are dropouts, consideration should be given to restricting the housing of current gang members who pose a threat. Former
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gang members and inmates who have never had a gang affiliation can usually be housed together safely. It is the current gang members who pose a threat to the other inmates. Gang members who pose a threat could be classified as High-Risk Level V or maximum security and housed in a Northwest pod. 14. IRC-100 should be the primary housing area for male protective custody inmates as it has individual cells which contain two beds and has access to a dayroom and a small recreation area which will allow for out of cell time for protective custody inmates either alone or with similarly situated inmates. Initially, other IRC units will need to be designated as protective custody until the goal of reducing the number of inmates designated as protective custody to just those inmates who must be separated from most, if not all, other inmates for their safety is achieved.
USE OF SEGREGATION/ISOLATION, PARTICULARLY FOR MENTALLY ILL:
Although best addressed by the mental health expert, it is widely recognized that placement of inmates, particularly inmates with mental health issues, in isolation without significant out of cell time and programs tends to result in the inmates becoming more withdrawn and their mental health issues being exasperated. The inmates housed in isolation cells, except for East 25-38, do not have access to a dayroom. The access to dayroom for inmates housed in East 25-38 is limited to three hours per week. Other than visits, the only time the inmates housed in isolation cells are out of their cells is to shower or utilize the recreation area; two or three times a week.
The medical/mental health care provider for the Santa Barbara County Jail had recently changed at the time of the site visit. The new contract for services provides for additional staff and expanded services; particularly in mental health care. The staff of the Santa Barbara County Jail system and the provider seemed hopeful that the provision of additional mental health care will decrease the need for inmates with mental health issues to be housed in isolation.
Placement in isolation housing at the Santa Barbara County Jail results in severe restriction of movement and interaction with staff and other inmates. Isolation cells South 1-16, South 21, West 18-29, Central 7, Central 8, and East 11-22 are particularly restrictive due to the small size of the cells and the lack of a dayroom or access to a dayroom. The square footage which follows is approximate and would be even less if the space occupied by the affixed bed, toilet, water basin, and/or desk were considered. The cells in South 1-16 are approximately 60 square feet. South 21 is approximately 52 square feet. Central 7 and Central 8 are approximately 58 square feet. In addition, these three cells, South 21, Central 7, and Central 8, have a solid outer door which results in an extreme sense of isolation for the inmate housed within those cells. The cells in West 18-29 are approximately 58 square feet. The cells in East 11-22 are approximately 54 square feet. The cells in Northwest 1-24 are approximately 100 square feet and have two beds in each of them. While South 20 is larger in size, 136 square feet, it is designed to hold two inmates. It should be noted that South 20 is located down a hallway behind an additional door which results in an extreme sense of isolation for the inmate housed within that cell.
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During the site visit, Central 7 and Central 8 were occupied by female inmates. The woman in Central 7 was originally placed in a multi-occupancy cell with a mental health referral being made. On that same day, she was moved to isolation cell West 28. Four (4) days later, she “gassed” a nurse; threw liquids believed to be bodily fluids. She was later moved to Central 7 on December 27, 2016, because she threw liquids again. As noted above, Central 7 is an isolation cell that has a solid outer door and a barred inner door. Due to its design, it results in an extreme sense of isolation for the inmate housed within that cell. On March 21, 2017, after almost three months in an extreme form of isolation, the inmate asked to be moved as she stated she was depressed. While the Classification Unit noted that there had been no issues since her return from a mental health facility two weeks earlier and that the medical staff had stated the inmate was taking her medications, the decision was made to have her remain in Central 7 until the monthly review. The woman in Central 8 was originally back and forth between the safety cell and medical holding due to suicidal ideation and having charged at deputies. She was then placed in a general population cell where she was involved in a fight within 30 minutes. She was then placed in isolation cell West 19. That same day, January 29, 2017, due to multiple incidents of her being naked, screaming, and throwing trash, she was moved to Central 8 where, at the time of the site visit, she had been for over two months. Use of Central 7 or Central 8 is counter indicated for an inmate who is depressed as it likely to enhance the depression due to the intense feeling of isolation that results from it being behind a double door; the inner door is bars and the outer door is solid. In addition, the barred door could be used as a tying off point for a ligature while the solid outer door makes it difficult to perform thorough security checks. While both women apparently participated in behavior (throwing of bodily fluids and trash) which made an open front cell inappropriate, they also both reported feelings of depression and/or suicidal ideation which made the use of a double door cell inappropriate. When the interests in safety to staff and the inmate collide, the risks to each should be weighed to determine the appropriate action to take. One option, as noted below, to reduce the intense feeling of isolation and to allow for better observation during security checks would be to replace the solid metal doors with panel doors that have security glazing.
The female isolation units house inmates for whom a variety of reasons are documented for their placement in isolation; mental health issues, behavioral issues, administrative segregation, punitive segregation, and protective custody. There are essentially three different isolation units for female inmates; Central 7, Central 8, and West 18-30. As noted above, the two women in Central 7 and Central 8 exhibited disruptive behavior which appear to be grounded in mental health issues. As to the female inmates in the West isolation unit, the reasons they are in isolation vary. Some of the inmates (West 19 and West 22 are examples) are fearful of being placed with other inmates. Some of the inmates appear to be legitimate candidates for protective custody (West 18, West 25, and West 26) in that one inmate is an 80-year-old with mental and medical issues, one inmate is charged with multiple counts of Willful Harm to Child, and one inmate is a very timid transgender inmate whose charges might result in other inmates assaulting
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her. One inmate (West 21) was clearly delusional. Several other inmates (W-20 and W-27 are examples) appear to have difficulty getting along with other inmates in a dormitory setting.
The challenge with providing a better environment for the female inmates currently in isolation is the lack of alternative housing for females. Female housing consists of multi-occupancy cells except for the isolation cells and one four-person dormitory. As noted below, the most likely alternative is B/Central 1 or B/Central 2 as the cells are smaller (two-person) and there are six cells in each.
As with the female inmates, male inmates in isolation units have been placed there for a variety of reasons. While there is only one isolation unit with multiple cells for female inmates, there are four isolation units with multiple cells for male inmates (East 11-22, East 25-38, South 1-16, and Northwest 1-24. In addition, South 20 and South 21 currently house male inmates. South 17 and Northwest 25 are small dormitories rated for housing four inmates each. During the site visit, both were being used to house members of the MS-13 gang. Central 7 and Central 8, due to their location, can be utilized to house male or female inmates. Central 17 is a four-person, dormitory with a small dayroom. It is currently being used to house protective custody women. While its location is not ideal for observation and has no natural light, it certainly serves a purpose for housing female inmates who must be separated from the population at large, but can be housed with a limited number of other like female inmates.
An attempt was made to determine the main reason male inmates were housed in isolation. Several of the inmates’ classification files listed multiple reasons for placement in isolation. There does not appear to be consistency with the placement of male inmates as to which of the isolation units a male inmate might be placed. The one exception is that throwing of any type of fluids out of a cell tends to result in placement in the Northwest 1-20 isolation cells as those cells have a glass front as opposed to bars. It was also noted that inmates were often moved between the various isolation units with the only documentation being “cell needed.”
At the time of the site visit, there was a mixture of reasons that inmates were housed in East 2538 even though I was informed that it was for the housing of inmates with mental health issues who were not stable enough to be in general population. However, the file review indicated that only six of the inmates housed in East 25-38 were there primarily for mental health issues. Two inmates (East 34 and East 38) classification files indicated that they were there due to PREA concerns. One file indicated security concerns (East 30) while two files indicated behavioral issues (East 27 and East 35). Two other inmates wanted to be housed in administrative segregation because they were afraid of being with other inmates (East 33 and East 37). East 2638 is the unit where the BRACE program is conducted. However, the program schedule indicated that there were only three inmates currently participating in the BRACE program.
While it may be that inmates whose reason for being housed in isolation is not mental health related are willing to attend the BRACE program to remain in East 26-38, it does not appear to
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be the highest and best use of that unit. Limiting the use of the cells in East 25-38 to inmates whose primary reason for being in isolation is mental health related is the recommended approach; at least until the Northern Branch Jail is occupied. Given the proximity of East 11-22 to East 26-38, if inmates with mental health issues were housed in those cells, it would facilitate them participating in the BRACE program. It may also be possible to allow the inmates in East 11-22 some use of the dayroom in East 26-38. They are already allowed use of the small recreation yards three times a week. Additionally, housing module officers and movement officers assigned to East 11-22 and East 26-38 should receive additional training on how to interact with inmates with mental health issues.
The Northwest isolation unit is adjacent to the Northwest A-D housing units. Given the proximity to the maximum-security housing area and the design of these isolation cells, these 24 cells seem best suited for housing inmates being held in isolation due to posing a serious security risk. Northwest 25 currently holds members of MS-13 gang who cannot be comingled with other inmates and pose a security risk to other inmates. The other cells in Northwest isolation are larger (approximately 100 square feet) which is beneficial as these inmates are likely to be housed in isolation for longer periods of time; if not their entire incarceration. The remainder of the cells could be used for inmates who require administrative segregation due to requiring a high level of protective custody which necessitates they not be in a unit with multi-occupancy cells. It may be necessary to house some inmates with serious mental health issues whose behavior is extremely disruptive in Northwest 1-20, but, ideally, all the inmates who are in isolation primarily for mental health issues would be housed in East 11-22 or East 26-38 due to access to programs and dayroom and recreation space.
Somewhat by elimination, South isolation cells would be used to house inmates who are in isolation because they are management problems. The South isolation cells are near the South recreation yard which will lessen the distance that these problematic inmates must be transported for recreation. As the behavior of these inmates improves, they could be moved to the next step which would be housing in a maximum-security cell.
RECOMMENDATIONS REGARDING USE OF ISOLATION:
15. Use of Central 7, Central 8, South 20, and South 21 should be restricted to situations where the security risk or need for protective custody being addressed cannot be dealt with in another manner. It is recognized that the female isolation cells in West 18-29 do not have solid fronts (they have cell bars) and that inmates are able to throw items out of the cell fronts. While it may be necessary to place a female inmate in Central 7 or Central 8 due to the health and/or assaultive risk to staff and other inmates if the inmate is throwing bodily fluids out the cell front, an effort should be made to address the underlying issue (often a mental health issue) as soon as possible. Once the issue is addressed, the inmate should be reassigned.
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16. Due to the extreme feeling of isolation created by the double doors of Central 7, Central 8, South 20, and South 21, these cells should not be used to house inmates who are depressed or have expressed suicidal ideation. If, in an extreme situation, after consultation with mental health staff, a determination is made that security concerns warrant use of these cells for an inmate who is depressed or has expressed suicidal ideation, the inmate should be placed on a suicide precaution watch with observations occurring at least every fifteen (15) minutes. One option to reduce the feeling of extreme isolation and to provide better observation during security checks would be to replace the solid metal doors with panel doors that have security glazing. Even if this option is adopted, care should still be given to the placement of potentially suicidal inmates in these cells due to the tie off points the inner barred door provides.
17. Consideration should be given to modifying the front of at least one, if not two, of the isolation cells in West 18-29 to prevent items from being thrown out of the cell front. Some corrections facilities use a plexiglass shield on rollers to protect staff and inmates passing in front of a cell of an inmate who has the propensity to throw out items. Normally the inmates will be placed at the end of the row so that the number of times the cell will have to be passed by other inmates and staff is minimized.
18. Consideration should be given to housing most of the female inmates who are currently in isolation in B/Central 1 or B/Central 2 as these each consist of six two-person cells. This allows for the inmates to be housed in a controlled environment where they would be housed with one other inmate (or alone if necessary). This would provide significantly more out of cell time due to ready access to the dayroom. While not ideal, the dayroom could also be used for programmatic space and counseling.
19. As noted in Recommendation #5, due to the number of females housed currently, 123 as of June 17, 2017, additional living units at the Northern Branch Jail will have to be used to house female inmates or female inmates will have to still be housed at the Main Jail or Medium Security Facility. If females continue to be housed at the Main Jail, it is recommended that female inmates be moved to South Tank and South Dorm. Any female inmates still housed in isolation at the Main Jail once the Northern Branch Jail is complete, could be housed in South 1-16. It is recommended that South 17 be converted for use as a dayroom to allow for out of cell time for the female inmates in isolation. The South recreation yard could be limited to use by the female inmates.
20. Ideally, the isolation cells, South 1-16, South 20, South 21, West 18-29, Central 7, Central 8, and East 11-22, would not be used to house inmates due to the size of the cells and the lack of access to a dayroom. Given the current population, closure of all the isolation cells is not practical. While one option would be to move the male inmates into two of the IRC housing units, as most of the 32 inmates would require a single cell, the resulting loss of affixed beds would be double (64) as the IRC cells hold two inmates each. The consequence would be that more inmates would be assigned to a housing unit without an affixed bed. Another option would be to take one or two cells in South 10-16,
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West 18-29, and East 11-22 (unless the inmates in East 11-22 are allowed access to a dayroom as recommended in Recommendation #23), and convert them to a dayroom space which would provide another out of cell time alternative for inmates housed in isolation. Otherwise, it is recommended that the use of these isolation cells be sharply curtailed once the Northern Branch Jail is occupied and population allows. 21. It is not clear why inmates are being moved from one isolation area to another. The current documentation cites “cell needed,” but often does not state the reasoning behind the move. It was noted that in several of the cases where an inmate was moved because “cell needed” that the inmate was involved in a confrontation in the new assignment. 22. The Classification Unit should assign a designation to each male isolation units which corresponds with the main reason the inmates are being housed in an isolation cell. 23. It is recommended, to the extent possible, that all male inmates, with mental health issues that require them to be housed in an isolation cell, be housed in either East 11-22 or East 25-38. All the inmates would potentially be able to participate in the BRACE program. A schedule should be drawn to allow for use of the dayroom and/or additional use of the recreation space in East 25-38 to be utilized by the inmates housed in East 11-22. Additionally, housing module officers and movement officers assigned to East 11-22 and East 25-38 should receive additional training on how to interact with inmates with mental health issues. 24. It is recommended, to the extent possible, that all male inmates, who pose a high enough security risk or protective custody need to require them to be housed in an isolation cell, be housed in Northwest 1-24. These inmates are likely to require long term isolation due to the nature of their charges and these cells are larger than the other isolation cells. While having a larger cell does not substitute for access to a dayroom, it does provide some relief until the Northern Branch Jail is occupied. 25. It is recommended, to the extent possible, that all male inmates, whose behavior warrants them being housed in an isolation cell, be housed in the South isolation cells. This move would place them near the South recreation and make it easier to escort them to recreation. If Recommendation #19 is implemented once the Northern Branch Jail opens, these inmates would have to be housed elsewhere if they remain in the Main Jail..
TIME OUT OF CELL FOR INMATES HOUSED IN ISOLATION:
Currently, inmates housed in isolation cells have no more than three hours out of their cells in a week. For inmates in East 25-38, they are offered recreation three times per week for one hour and access to the dayroom three times per week for one hour; resulting in up to six hours a week of out of cell time. The inmates in East 11-22 are offered recreation three times per week for one hour. The other inmates in isolation are offered recreation twice a week for one and a half hours; these inmates are only allowed out of cell time two times per week other than to shower. Accepted correctional practice is a minimum of one hour per day out of cell time; recommended correctional practice is at least four hours of out of cell time daily.
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It is unclear how much actual out of cell time inmates in the isolation cells are receiving. During the tour, it was noted that record keeping was poor and that it was not clear whether the inmates were actually afforded and/or actually taking advantage of the opportunity to go to the recreation yards or the dayroom. Officers should be trained that refusal to take advantage of the opportunity for out of cell time is a red flag that the inmate may be depressed and withdrawing. Officers should also be trained that inmates should be encouraged to take advantage of the opportunity for out of cell time.
RECREATION ACCESS FOR INMATES HOUSED IN ISOLATION:
Three of the housing modules (East 25-38, Northwest, and Inmate Receiving Center) have exercise yards adjacent to the housing modules. The two housing units in the South housing module (South Tank and South Dorm) share the use of the South recreation area with the inmates housed in the south isolation cells, South 1-17. It appears from the schedule, that the females housed in the West housing module isolation cells, West 18-29, and the inmates housed in the Central 7 and Central 8, are provided an opportunity to recreate in large central recreation yard. Inmates housed in the East housing module isolation cells, East 11-22 and East 25-38 recreate in the two small recreation yards adjacent to the East 25-38 housing unit. The inmates in the Northwest housing module isolation cells, Northwest 1-25, recreate in the recreation areas adjacent to the Northwest housing module. The rest of the housing areas, West Module, East Module, and the Male Basement Dormitories share use of the large central recreation area. One option for increasing opportunities for all of the inmates utilizing the large central recreation area would be to subdivide it into three recreation areas. While inmates being recreated at the same time would be able to see each other and speak to each other, they could be physically separated by fencing. One of the three recreation areas could be further subdivided to create small individual recreation areas for use by inmates housed in isolation. This would result in multiple housing units and numerous isolation inmates being able to recreate at the same time.
Currently, the inmates in the isolation cells are alone for their out of cell time. While it is unlikely that all of the inmates could be recreated together, or in the case of the inmates in East 25-38 share the dayroom, it is recommended that the Classification Unit screen the inmates in isolation to determine which ones, if any, could share out of cell time. This would provide an opportunity for inmates in the isolation areas to have additional out of cell time in the recreation yards. In addition, inmates in isolation might take greater advantage of the opportunity to go to the recreation yards if they were able to go with other inmates as they could play board games or participate in sports activities which require more than one person.
Most of the recreation yards utilized for recreation for inmates in isolation are being underutilized. The one exception are the recreations yards in the Northwest housing module. According to the schedule for the South recreation yard, there are twelve (12) slots on the schedule which are currently designated as make-up. According to the schedule for the IRC, where inmates from West 18-29, Central 7 and Central 8 are recreated, there are seventeen (17)
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slots which are currently designated as closed or make-up. According to the schedule for the East isolation dayroom and recreation, there are twenty-nine (29) slots in the recreation yard and eleven (11) slots in the dayroom which are currently designated as make-up. These slots could be used to afford inmates in isolation more opportunities for out of cell time.
If Recommendation #24 were followed to place all of the inmates with mental health issues in East 11-22 and East 25-38, utilization of these make-up slots to afford these particular inmates with additional out of cell time, would have a significant impact. It is unclear why the dayroom in East 25-38 is not being utilized past 1700 hours. Consideration should be given to allowing inmates in East 25-38 and East 11-22 access to the dayroom until 2100 hours. This would provide twenty-eight (28) more opportunities per week for out of cell time in the dayroom.
RECOMMENDATIONS REGARDING OUT OF CELL TIME FOR INMATES IN ISOLATION:
26. A system of better record keeping on when inmates in isolation cells are afforded the opportunity to go to recreation and whether they take advantage of the opportunity should be established. Officers should also be trained that inmates should be encouraged to take advantage of the opportunity to go to the recreation yard.
27. Officers should be trained that refusal to take advantage of the opportunity to go to the recreation yard or dayroom is a red flag that the inmate may be depressed and withdrawing. Inmates who refuse out of cell time on a regular basis, more than twice in a row, should be referred to the mental health staff.
28. Subdivide the large central recreation area into three recreation areas. While inmates being recreated at the same time would be able to see each other and speak to each other, they could be physically separated by fencing. One of the three recreation areas could be further subdivided to create small individual recreation areas for use by inmates housed in isolation. While the standard of three hours per week of offered recreation may well be met, it is recommended that more access to recreation be allowed for inmates in general, and inmates in isolation specifically, as the schedule and staffing allows.
29. It is recommended that the Classification Unit screen the inmates in isolation to determine which ones, if any, could recreate together. This would provide more opportunities for inmates in isolation to have out of cell time through recreation and increase the likelihood that they would take advantage of the opportunity as it would be more enjoyable than recreating alone.
30. The slots in the South, IRC, and East recreations yards currently designated as make-up and closed should be allocated to provide additional recreation time for inmates housed in isolation.
31. The slots in East 25-38 dayroom schedule currently designated as make-up should be allocated to provide additional dayroom time for inmates in isolation with mental health issues.
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32. It is recommended that the dayroom in East 25-38 be utilized between the additional hours of 1500 and 2100 to provide inmates in East 25-38 and East 11-22 additional access to the dayroom.
LACK OF CLASSIFICATION DECISIONMAKING TOOL:
As noted above, while the staff in the Classification Unit attempts to make the best housing decisions possible, due the lack of options and the overcrowding, most of the housing decisions are based on space availability. When an inmate comes in, the Classification Unit retrieves the records of their previous incarcerations and reviews their criminal history. A great deal of emphasis is placed on the inmate’s previous classification and whether the inmate was previously considered to be protective custody or was housed in isolation.
There should be significant involvement of mental health staff in classification and reclassification of inmates with mental health issues. Currently, it appears that mental health is asked whether the inmate has been “cleared.” It is recommended that mental health staff work closely with the Classification Unit towards the goal of placing the inmate in the least restrictive environment as possible for the safety of the inmate and others.
The different factors looked at (criminal history, current behavior, current charges, past jail behavior) are appropriate factors. What is lacking is a classification decision-making tool. Currently, the Classification Unit uses what is commonly referred to as a subjective classification system. They are using their experience and judgment to make decisions as to how an inmate should be classified and where they should be housed. In reality, once the decision on custody level is made, inmates are placed in a housing unit based on space available. Also factored in is whether the inmate has been designated as a protective custody inmate and whether anyone currently assigned to the housing area is on a keep separate list from the inmate.
While not intending to disparage the work currently being done by the Classification Unit, very few urban jail systems still utilize a subjective classification system. Instead, what is most often used is an objective classification system; either point based or a decision-tree. The characteristics of an objective classification system are:
 Using test and classification instruments that have been validated for inmate populations;  Using the same components and decision criteria approach with all inmates;  Fostering similar decisions among classification staff on comparable cases;  Assigning inmates to custody levels consistent with their background;  Structuring classification decision-making authority while minimizing overrides; and  Limiting discretionary decision-making to ensure uniformity in agency operations and
minimizing the potential for unfavorable litigation.
While some facilities simply utilize an objective classification tool which has been validated at another facilities or facilities, the preferable practice is to have an objective classification tool
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refined to meet the needs of the jail population and jail facilities of Santa Barbara County. The classification tool would then be validated through pilot testing (classifying the population on paper) and any necessary adjustments made.
The classification expert could also work with the Santa Barbara County Jail system to develop a Housing Unit Assignment Plan (HUAP). Ideally, an objective classification system including a HUAP would have been developed prior to the planning of the Northern Branch Jail to ensure that the design of the facility matches the classifications of the inmates. Based on orientation I received on the Northern Branch Jail, foresight was used and some of the housing areas at the Northern Branch Jail are flexible in use. It is recommended that the classification expert work with the Santa Barbara County Jail system to develop a HUAP which will maximize the use of the available jail space. Such a process will also be helpful in identifying what needs may still need to be addressed once the Northern Branch Jail is occupied and would be helpful in prioritizing any renovations to the Main Jail or the Medium Security Facility.
Part of any good classification system requires reviewing the inmate’s classification to determine whether the classification and/or housing assignment should be changed. After looking at the classification records, it is questionable whether a thorough review is currently taking place. When the classification records of inmates housed in isolation were reviewed, it was found that, often, the language from the previous review was repeated and the classification and assignment stayed the same. It seemed as if the review was being recorded simply to satisfy the requirement of a review being completed as opposed to a thorough review taking place. Complicating any thorough review is that there is often no place to move an inmate if the results of the review indicate that he/she should be removed from isolation.
Under an objective classification system, the inmate is rescored to determine the proper classification and assignment. How often an inmate’s classification is reviewed depends on the circumstances. An inmate in a detoxication cells should be reclassified as soon as they can care for themselves. An inmate in a violent cell should be reassessed and documented at least every 24 hours for the continuance of the status. It is recommended that inmates in administrative segregation/isolation, no matter the reason, be evaluated at least every 30 days. Inmates in general housing only need to be evaluated every 60-90 days as long as there are triggers for additional reassessments; i.e., disciplinary reports, dismissal of charges. Circumstances such as filing of new charges or a conviction should trigger a review immediately. The classification policy should set out the specific timelines.
Routine audits should be performed of the Classification Unit. In addition to performing an audit on the Classification Unit, audits should be performed of individual staff members of the Classification Unit to ensure individual performance is in line with the designated criteria. The auditing mechanism should record:
 The percentage of inmates that are classified within 12 hours of booking;
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 The percentage of inmates that are housed according to their assigned custody levels;  The percentage of inmates that are housed in protective custody;  The percentage of overrides and the reasons for the override; and  The percentage of reassessments that are performed within the timelines detailed by the
classification policy and the outcomes.
Criteria as to acceptable performance should be set out in the classification policy. For instance, overrides should not exceed 10-15%. If they do exceed that percentage, it is usually an indication that staff members of the Classification Unit are inappropriately exercising their discretion. It may also indicate that the HUAP needs to be modified.
The classification policy will need to be updated once the objective classification system is implemented.
RECOMMENDATIONS REGARDING CLASSIFICATION DECISIONMAKING TOOL:
33. An objective classification system, including a Housing Unit Assignment Plan, should be implemented. While it is possible to use a tool that has been validated elsewhere, it is recommended that Santa Barbara County contract with an expert in classification to help guide the Santa Barbara County Jail system through the process.
34. Classification Unit staff should receive training on the use of the objective classification tool. The National Institute of Corrections offers training on objective classification and it would be advisable for as many staff as possible to attend.
35. There should be significant involvement of mental health staff in classification and reclassification of inmates with mental health issues. The goal should be to place inmate in the least restrictive environment as possible for the safety of the inmate and others.
36. Review of inmates’ classifications should include a rescoring of the factors in the objective classification system. Review of an inmate’s classification in a detoxication cells should occur as soon as they can care for themselves. An inmate in a violent cell should be reassessed and documented at least every 24 hours for the continuance of the status. It is recommended that inmates in administrative segregation, no matter the reason, be reassessed at least every 30 days. Inmates in general housing only need to be reassessed every 60-90 days as long as there are triggers for additional reassessments; i.e., disciplinary reports, dismissal of charges. Circumstances such as filing of news charges or a conviction should trigger review immediately. The classification policy should set out the specific timelines.
37. Routine audits should be performed on the Classification Unit and the individual staff members of the Classification Unit to ensure performance is in line with the designated criteria. The auditing mechanism should record the percentage of inmates that classified within 12 hours of booking, inmates that are housed according to their assigned custody levels, inmates that are housed in protective custody, overrides and the reasons for the override, and reassessments that are performed within the timelines detailed by the
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classification policy and the outcomes. Criteria as to acceptable performance should be set out in the classification policy. 38. The classification policy will need to be updated once the objective classification system is implemented.
OBSERVATIONS REGARDING DISCIPLINE:
PUNISHMENT:
California Title 15, Section 1056, Use of the Sobering Cell, limits the use of the sobering cell to only inmates who are a threat to their own safety or the safety of others due to their state of intoxication. The 2014-2016 Biennial Inspection of the Santa Barbara County Jail facilities found the Santa Barbara County Jail system to be in noncompliance due to its use of the sobering cell for inmates who must be closely observed because of medical or mental health concerns regardless of their state of intoxication. Review of the classification records reveals that the practice continues and extends to the safety cells.
To understand the seriousness of the issue, it is important to realize what placement in safety cell means for an inmate. The inmate is stripped of all clothing and placed in a heavy smock commonly referred to as a suicide resistant smock; it is made of quilted blanket material that is extremely difficult to tear with bare hands. There also is no washbasin, toilet, seat, desk, or bed. Due to lack of a lavatory, the inmate is forced to urinate and defecate in a hole in the ground which must be “flushed” from outside of the cell. There is no place to wash their hands or get a drink of water. As an inmate in a safety cell is not allowed utensils, they are fed sack lunches which they must eat either standing up or sitting on the floor. Water is usually provided in a small disposable cup.
There are clearly circumstances when an inmate’s placement in a safety cell is appropriate because the inmate constitutes an imminent danger to himself or herself that cannot be dealt with by placing the inmate in a suicide resistant smock in a suicide resistant cell. However, in some of the cases reviewed, it appeared to be an unnecessary move that was more about punishing the inmate than it was about protecting the inmate.
There were several moves noted where the reasoning was that the inmate destroyed property or that the inmate was participating in disruptive behavior. In most of the cases, the inmate was already in an isolation cell. There was not a disciplinary hearing held before the inmate was placed in the safety cell, and, in numerous cases, no hearing was held as a result of the conduct afterwards. Not only must the inmate endure the humiliation of being stripped of all clothing and being put in a cell that is devoid of everything, movement of the inmate poses a high possibility of an increased risk of danger to both staff and inmates due to the likelihood of needing to use force to not only to move the inmate, but to strip the inmate of clothing.
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Also noted was the use of what was referred to as a disciplinary meal. The “prison loaf,” as it is commonly called, is similar to a meat loaf in appearance, but is often purposely made to be bland in taste. The inmate is given the loaf instead of the regular meal. While the practice was common at one time in corrections institutions as punishment, the current recognized correctional practice is that use of a prison loaf should be limited to situations where inmate’s conduct is related to meal service, i.e., using the tray to break, scratch observation windows or as a threat to officers. Even then, many correctional facilities serve the inmate sandwiches and other items that do not require utensils or trays as opposed to a prison loaf.
The most common disciplines noted were loss of commissary and loss of visitation. Depending on whether an inmate has funds to order commissary and/or receives visits influences whether the “loss” is felt. In many situations, with loss of commissary, inmates, especially in a dormitory setting, will simply make a deal to have another inmate order commissary for them and will either pay them back or have family put money on the other inmate’s account. Visitation restriction is as much of a punishment for family as it is inmate.
The overcrowded conditions of Santa Barbara County Jail contribute to ineffective discipline as there are insufficient housing units to set up a housing unit as disciplinary tier where privileges such as access to television, telephone, and out of cell time can be regulated. Instead, inmates who act out often are moved from housing unit to housing unit and then eventually to isolation. As noted above, it is recommended that the South isolation cells be used to house inmates whose behavior is the basis for their placement in isolation. By improving their behavior, the terms of which are often outlined in a behavior management contract, the inmates could work themselves up to a housing unit such as one of the Northwest housing units where they could continue to earn privileges based on their adherence to the facility rules. The ultimate goal would be for the inmate to be housed in general population with full privileges.
NO INPUT FROM MENTAL HEALTH ON DISCIPLINE
While there is a legitimate use of inmate discipline, including the use of isolation, special considerations should take place if inmate is on mental health caseload. This does not mean that inmates with mental health issues should not have consequences for inappropriate behavior; they most often should as part of treatment. However, there are some circumstances where the inmate’s mental health status should factor into whether and what kind of discipline is appropriate. Therefore, input from mental health staff before discipline is imposed on an inmate on the mental health caseload is essential. For example, a mental health inmate may be making progress and interaction with their family is key. It would be counterproductive to impose loss of visitation on this inmate. Often the use of isolation as punishment exasperates the behavior of an inmate with mental health issues.
RECOMMENDATIONS REGARDING DISCIPLINE:
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39. The safety cells should only be used for their intended purpose; protection of an inmate from imminent self-harm when no other alternative is sufficient.
40. Specifically, safety cells should not be used in any manner to punish inmates. 41. Seldom does an inmate who has destroyed property need to be placed in a safety cell.
When an inmate has created a safety hazard due to destroying something in the cell, the item should be removed. It might also be appropriate to remove all other items that could be destroyed from the cell until the inmate’s behavior improves. If the inmate must be relocated while repairs are made, placement in another isolation cell or a holding cell is preferable to the safety cell. If an inmate must be placed in a safety cell as there is no current alternative, unless there is a specific reason for removing their clothing and placing them in a suicide resistant smock, they should be allowed to retain their regular jail house clothing. 42. Disciplinary meals should be limited to inmates whose conduct is related to meal service. Sandwiches and other items that do not require utensils or trays are preferable. 43. Inmates whose behavior warrants placement in isolation should be placed in South isolation. A behavior management plan should be developed by where the inmate may work himself out of isolation into the disciplinary tier (recommended that it be one of the Northwest housing units) and gains additional privileges through conformance to the rules and appropriate behavior.
OBSERVATIONS REGARDING STAFFING:
CURRENT STAFFING
It was not part of the assessment to evaluate the staffing plan of the entire Santa Barbara County Jail system. However, an effort was made to evaluate the adequacy of the number of officers assigned to the housing modules. My opinion is that officers are in charge of too many inmates, and often, too many housing areas. The result of the shortage of officers in the housing modules is that all they have time for is to do rounds and record observations. They do not have time for interaction with inmates. The result is that they often do not pick up on issues in general population and protective custody housing areas which results in conflict and having to rehouse inmates.
California does not have a standard for how many inmates an officer can safely supervise. Some states, like Texas, use a ratio of 45:1. Others use a ratio of 60:1. This does not include officers assigned to control rooms and escort functions. Using the more lenient ratio of 60:1, the only housing module which meets that ratio is the Male Basement. It is recommended that one housing module officer be added to staff each of the other housing modules. While the Northwest currently meets the 60:1 ratio, the location of the isolation units and the housing of maximum security inmates justifies an additional housing module officer.
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This is particularly concerning as to the inmates in isolation and results in those inmates having almost no human interaction as they are not allowed access to other inmates other than yelling from one cell to another. The inmate that was housed in South 20 is good example. It was explained that he was a civil inmate (civil commitment for being sexual predator). The inmate does not speak English. The check sheet indicated refusal of recreation, showers, and cleaning supplies. When viewed, the inmate had eight or more sandwiches lined up on desk. Either no one had noticed his lack of interest in getting out of the cell and hoarding behavior or had noticed and done nothing about it. Although the inmate’s classification file did not indicate he had mental health issues, his behavior did.
The lack of custodial staff, particularly in the housing modules, also appears to affect the ability to provide proper medical care and mental health care. As noted above, a new medical health and mental health provider had just started providing services at time of site visit. When I interviewed the mental health caseworkers, some who had remained when the provider was changed, they indicated the goal was to visit with inmates in segregation/isolation daily. At that time, visits were usually occurring three times a week. Due to facility design and lack of security staff to remove inmate from housing to a suitable site, conversations most often occur through a crack in the door or a food port.
Lack of custodial staff to escort inmates to mental health visits, medical visits, recreation, and programs also impacts the provision of those services. As the quantity and quality of medical and mental health service improves, even more escorts will take place. Lack of sufficient custodial staff can undermine the substantial investment that Santa Barbara County has made in improving medical and mental health care. An additional three movement officers are recommended to accommodate the escorting of medical/mental health staff into the housing areas and escorting inmates to the medical section. It is recommended that the three additional movement officers be assigned to the medical section directly as opposed to being assigned as housing movement officers.
RECOMMENDATION REGARDING STAFFING:
44. It is recommended that an inmate to officer ratio of 60:1 be adopted. This would require an additional housing module officer in each module with the exception of the Male Basement.
45. It is recommended that three additional movement officers be assigned to the medical section so that they escort the medical/mental health staff to the housing units and escort inmates from the housing units to the medical section.
46. A staffing study of the Santa Barbara County Jail system should be performed. It is clear that there are not enough staff performing the custodial functions in the housing areas and for escort, but an analysis should be performed to determine whether and where from staff could be redeployed to fill those needs. It may well be that no staff can be redeployed.
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Case 2:17-cv-08805-GW-JPR Document 48-1 Filed 02/28/19 Page 27 of 27 Page ID #:911 I would like to express my appreciation to all who provided information and assistance during this project. Signed: p ate /
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 Case 2:17-cv-08805-GW-JPR Document 61-1 Filed 11/14/19 Page 2 of 81 Page ID #:945
County of Santa Barbara - Santa Barbara Jail ADA Transition Plan for Adult Detention Facility
VOLUME 1 TABLE OF CONTENTS PART 1: Self-Evaluation and Transition Plan
INTRODUCTION AND BACKGROUND...............................................................................................Pg. 7 • Introduction ................................................................................................................................. Pg. 7 • Background .................................................................................................................................. Pg. 7 • ADA Assessment .......................................................................................................................... Pg. 7 • Site Visits ...................................................................................................................................... Pg. 8 • Americans With Disabilities Act 1990 .......................................................................................... Pg. 8 • Accessibility Standards and Codes...............................................................................................Pg. 9 • Facility Assessment and Checklist..............................................................................................Pg. 10 • ADA Targeted Impairments and Users ...................................................................................... Pg. 11 • ADA Guidelines .......................................................................................................................... Pg. 11 • Project Approach ....................................................................................................................... Pg. 12 • Jail Functional Use Areas ........................................................................................................... Pg. 13 • Document Review ...................................................................................................................... Pg. 14 • Interviews .................................................................................................................................. Pg. 15 • Self-Evaluation Format...............................................................................................................Pg. 15
A. SELF-EVALUATION..................................................................................................................Pg. 16 • Overview .................................................................................................................................... Pg. 16 • Programs, Activities, and Services ............................................................................................. Pg. 16 • General Comments and / or Recommendations ....................................................................... Pg. 17 • Immediate Recommendations (Begin Within One Year)...........................................................Pg. 17 • Short Term Recommendations (Begin Within One – Two Years)..............................................Pg. 19 • Policy and Procedure Review and Recommendations .............................................................. Pg. 20 • SBSO Custody Operations Orientation Handbook Review & Recommendations ...................... Pg. 24 • Santa Barbara County Miscellaneous Forms ............................................................................. Pg. 27 • Activity Gaps and Physical Plant Deficiencies ............................................................................ Pg. 28 • Inmate Interviews ...................................................................................................................... Pg. 28 • Staff Interviews .......................................................................................................................... Pg. 28 • Questionnaire Topics and Staff Responses................................................................................Pg. 29 • Vanir Assessment and Recommendations................................................................................. Pg. 41 • Expert Reports Review...............................................................................................................Pg. 41 • Summary Recommendations.....................................................................................................Pg. 50
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County of Santa Barbara - Santa Barbara Jail ADA Transition Plan for Adult Detention Facility
B. TRANSITION PLAN..................................................................................................................Pg. 51 • Assessment ................................................................................................................................ Pg. 51 • Overview .................................................................................................................................... Pg. 51 • Bed Counts & Housing Needs .................................................................................................... Pg. 52 • Current Accessibility Needs ....................................................................................................... Pg. 56 • Plan of Action.............................................................................................................................Pg. 56 o Phasing of Transition Plan Work ......................................................................................... Pg. 56 o Priority 1 – Immediate (Begin 0-1 Year) .............................................................................. Pg. 57 o Priority 2 – Short (Begin 1-2 Years) ..................................................................................... Pg. 59 o Priority 3 – Long (Begin 2+ Years)........................................................................................Pg. 77 • Flexibility .................................................................................................................................... Pg. 78 • Conclusion..................................................................................................................................Pg. 78
C. Appendix A: Staff Interview Questions and Responses............................................................Pg. 80
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VOLUME 2 TABLE OF CONTENTS
PART 2: ADA Assessment - (Volume 2 - Separate Bound Documents)
Santa Barbara Jail Facility Barrier Reports, Floor Plans, and Photograph Sheets
Plans: .......................................................................................................................................... Pg. 1 • A1.0 Overall Site Plan- Ground Floor • A1.1 Overall Site Plan- Basement • A.4 Overall Ground Floor- Accessibility Priority Plan • A.5 Overall Basement/ 2nd level- Accessibility Priority Plan • A.6 Overall New Jail- Santa Maria
Inmate Services ........................................................................................................................... Pg. 6 • Corridor • ADA Restroom
Intake & Release Center (IRC) .................................................................................................... Pg. 11 • 100 & 200 • 300 & 400 • Yards
Main Jail - Basement .................................................................................................................. Pg. 38 • Basement Dorms • Basement Public/Visiting
Main Jail – 1st Floor ................................................................................................................... Pg. 55 • South • East • West • Central • Yards
Medium Security Facility (MSF) ............................................................................................... Pg. 120 • A Barracks • B Barracks • C Barracks • Activity Room • Males Latrine • Female Barracks • TV Room 4

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• Classrooms • Yards New East Isolation ................................................................................................................... Pg. 148 • ADA Cells • Yards Northwest Jail.......................................................................................................................... Pg. 153 • ADA Cells • Yards Parking ................................................................................................................................... Pg. 174
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PART 1: Self-Evaluation and Transition Plan
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INTRODUCTION AND BACKGROUND
Introduction The County of Santa Barbara is located approximately 100 miles north of Los Angeles, California, and is sometimes considered the northern cultural boundary of Southern California. The County of Santa Barbara has a total area of 3,789 square miles, which includes a series of Channel Islands, four of which make up the Channel Islands National Park. The County is estimated to have a population of approximately 445,000, with its largest city being Santa Maria.
The County has two jails, the Main Jail with a Board of State and Community Corrections (BSCC) rated capacity of 819 inmates located in Santa Barbara and the New Jail with a BSCC rated capacity of 376 located in Santa Maria. The new Santa Maria facility, under construction is scheduled to open in early 2020.
Santa Barbara County Main Jail Facility is comprised of four (4) buildings: • Main Jail - Built in 1963 and rated for 456 beds. • Medium Security Facility - Built in 1963 and rated for 160 beds. • Northwest Jail - Built in 1982 and rated for 75 beds. • Intake and Release Center - Built in 1988 and rated for 128 beds.
Background The following chart illustrates the annual average daily population (ADP) of the four combined facilities. The average ADP is 961. In 2013 and 2016, the population peaked to 1003 and 1016 respectively, and the lowest population was recorded in 2015 at 891. The new Santa Maria Jail Facility should significantly reduce the Main Jail’s capacity.
Santa Barbara Jail Average Daily Population (ADP) 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 ADP 944 981 965 899 981 1003 967 891 1016 970 951
Source: Custody Monthly Stats, Jail Management System Monthly Stats Report - Monthly Counts by Facility
ADA Assessment The County of Santa Barbara has retained Vanir for the purpose of developing and delivering an Americans with Disabilities Act (ADA) Transition Plan. This plan sets forth the necessary steps to ensure compliance with the ADA and its implementing regulations with respect to the Santa Barbara Jail located in Santa Barbara, CA.
In order to conduct the site evaluation for ADA accommodations, Vanir staff and subconsultants visited the Santa Barbara Jail facilities multiple times in 2016 through 2018.
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Site Visits The following chart captures the dates of Vanir’s site visits to the Santa Barbara Jail. The visits included physical plant assessment, County briefings and presentations, and interviews. The visits also included Vanir’s consultants (architectural, mechanical / plumbing, electrical, structural, and security electronics) who conducted assessments of the jail’s physical plant and site.

ADA Assessment Trips to Project Site

Date

Task

September 6, 2016 ADA Assessment

September 7, 2016 ADA Assessment

October 26, 2016 ADA Assessment & Briefing

November 8, 2016 ADA Assessment & Briefing

November 9, 2016 ADA Assessment & Briefing

June 8, 2017

ADA Assessment Final Report

February 13, 2018 Implementation Plan Assessment

February 27, 2018 ADA Plan Assessment

March 28, 2018 ADA Plan Assessment & Interviews

March 29, 2018 ADA Plan Assessment & Interviews

June 7, 2018

Jail Site Survey

Total Trips:

# Trips 1
1 1
1 1 1 1
1 8

Americans with Disabilities Act of 1990
The American with Disabilities Act (ADA) was enacted to integrate more than 43 million individuals with disabilities into mainstream society. The ADA affects correctional facilities as well as every other industry and profession across the country.

There are five sections to the ADA law. Title I and Title II have a direct effect on correctional facilities.
• Title I addresses employment practices and is overseen by the Equal Employment Opportunity Commission (EEOC).
• Title II addresses the delivery of state and local government programs, activities, and services. This includes the programs, activities and services of correctional facilities and is overseen by the Department of Justice (DOJ). Both private and commercial entities must follow the DOJ Standards for Accessible Design based on the Access Board’s Americans with Disabilities Act Accessibility Guidelines for Buildings and Facilities (ADAAG), or a certified equivalent. State and local governments can follow either ADAAG or Uniform Federal Accessibility Standards (UFAS).

This Act was designed to provide equal opportunity to individuals with a disability without discrimination. Pertinent definitions and questions include:
• Who is a Person with a Disability? Anyone who has a physical or mental impairment, long lasting or permanent, that substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such impairment.

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• What are Major Life Activities? Caring for one self, performing manual tasks, walking, seeing, speaking, breathing, learning, thinking, concentrating, interacting with others, performing manual tasks, and working. To be substantially limited means that such activities are restricted in a manner, condition, or duration in which they are performed in comparison with most people.
• How Does This Relate to Facilities? All new buildings, built after January 26, 1992, must be accessible to and usable by persons with a disability. Existing buildings must also provide equal access to the disabled persons either by remodeling to current ADA construction standards, or by development of alternative procedures that provide an equivalent service to someone that is disabled.
• Who or What Agency Inspects New and Existing Facilities for ADA Compliance? New construction is required to comply with current building codes which have the ADA requirements incorporated within them. However, the evaluation of existing buildings is the responsibility of the building Owner / tenants, not building departments. Unlike building code compliance, the ADA does require retroactive evaluation to current construction standards, and the opportunity to have non-compliant building elements grandfathered in as compliant is limited.
In practice, when the evaluation of an existing building reveals non-compliance, the building Owner / tenants must determine the most prudent course of action that will provide a maximum degree of ADA compliance in a reasonably brief period of time. While each situation is different, ADA compliance is often resolved through a combination of remodeling phased in over several years, and policy changes that together provide a high degree of access, without resulting in unreasonable financial burden on the building Owner / tenant.
Pertinent case law includes: Pennsylvania Department of Corrections v. Yeskey (Decision of June 15, 1998); Ruled: ADA applies to detention facilities.
Armstrong vs. Schwarzenegger (CDCR) Program (1990) (Case #09-17144; Decision of September 7, 2010); Ruled: ADA applies to parolees in County jails.
Accessibility Standards and Codes The County has undertaken the task of determining the status of its current detention facilities as it relates to ADA accessible accommodations, utilizing the most recent codes and standards. The codes used for this report are:
• 2013 California Building Code (CBC). Contains the most current of all general building code requirements (i.e. accessibility requirements, electrical and mechanical codes, etc.), as well as the physical plant regulations including the size and adjacency requirements for cells and dayrooms.
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• 2010 Americans with Disabilities Accessibility Guidelines (ADAAG) Judicial and Detention Accessibilities Guidelines for Buildings and Facilities.
• 1991 Americans with Disabilities Accessibility Guidelines (ADAAG) Judicial and Detention Accessibilities Guidelines for Buildings and Facilities. Individual elements within a facility that can be determined as compliant with the 1991 ADA standards, can generally be given a “safe harbor”, and do not require further modifications to comply with the newer 2010 ADA Standards.
Construction Standards (ADA Accessibility Standards, or Guidelines) in support of the ADA laws were developed in the early 1990's, with a new updated Standard issued on March 15, 2012, well after the Santa Barbara Jail was designed and constructed. These facilities are typically grandfathered to the codes and standards that were relevant at the time of original construction. This survey effort demonstrates the County’s continuing proactive outlook toward providing accessibility to all Americans with disabilities by identifying any barriers and access within the facility, and prioritizing correction measures to mitigate, remove, or otherwise address the barriers.
The ADA specifies that Government Entities such as the Santa Barbara Jail, have an obligation under the ADA that is somewhat different than the obligation of Private Entities. Government Entities are required to perform a two-step process as follows:
1. Perform a “Self-Evaluation” of all the various programs, activities, and services provided to the public to determine if there are areas in which disabled inmates are unable to participate equally, and to develop policies and procedures to assure equal participation.
2. Develop a “Transition Plan” to correct any physical barriers (affixed or temporary) that limit disabled inmates from full and equal participation in the programs, activities and services that are made available by the Government Entity.
Facility Assessment and Checklist
Our surveyors used the Vanir Mobile Assessment Programmer (Vmap), a proprietary tablet-based program, to aid in the assessment process. The Vmap is pre-loaded with all three design standards (2013 CBC, 2010 ADA, 1991 ADA) and is also pre-loaded with typical building types, room types, and element types. The assessors selected the appropriate building, room, and element types from pull-down menus, then measured the specific Santa Barbara Jail elements against all three standards for that same element type.
Each element within each functional use area (FUA) was reviewed against the ADA standards. Each ADA standard applies to detention facility operations as it relates to the public and inmate accessibility, while recognizing the safety and security integrity of the facility. A great deal of effort was spent in observing both the operations of the facility as well as ADA impaired individuals involved in each operation and /or activity.
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The surveyors reviewed all rooms as indicated on the floor plans and recorded areas of non-compliance. Rooms that are included in the survey results are rooms that have areas of non-compliance. Rooms that are not listed on the survey do not have ADA compliance issues.
ADA Targeted Impairments and Users This study and review included the most common impairments that, from time to time, are experienced at the detention facilities: Mobility, Hearing, and Sight.

The review also took into consideration the following targeted users:

• Inmates, Pre-Sentenced • Inmates, Sentenced • General Public

• Inmates, Medical • Attorney • Visitors

• Inmates, Program •

ADA Guidelines Additionally, the review looked at the following ADA measures:

Mobility Impaired Involving Arms, Hands, Legs, Feet (i.e., Wheelchair Bound, Prosthesis, etc.)

• Space allowances • Reach ranges • Maneuvering clearances • Surfaces conditions • Stalls / partition swings • Handrails • Fixtures heights • Entrances • Grab bars • Circulation • Signage

• Elevator space • Lifts • Door widths • Door opening force • Slopes • Ramps • Shower stalls • Thresholds • Furnishings • Closers • Aisle widths

• Water closets • Urinals • Telephones • Maneuverability • Sinks • Water coolers • Counters • Parking spaces • Tableware • Dispensers

Sight Impaired (Blind, Minimal Sight)

• Protruding objects • Obstructions • Clear aisle ways • Marked crossings • Illumination

• Hazards • Head room • Handrails • Stair rise and tread • Alcoves

• Signage • Contrasting sign lettering • Emergency sounding devices • Communication devices • Floor textures

Hearing-Impaired (Deaf, Minimal Hearing)

• TTY / Video Translation • Paper & pencil • Emergency visual devices

• Placards • Closed-captioned TV • Interpreters

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Project Approach
The ADA Assessment process utilized Vanir’s proprietary tablet containing ADA computer-based software developed specifically for assessing the ADA compliance for correctional facilities. In addition to the tablets, our methodology included five tasks which were tailored specifically to the Santa Barbara Jail. The five tasks responded to the Self-Evaluation and Transition Plan.
Task 1: Research Vanir met with appropriate County detention staff and management to discuss the specific ADA assessment needs and status of current accessibility compliance efforts. These discussions were augmented with County documents and Vanir’s review of the existing inspection reports, inmate accommodations, complaints, ADA lawsuits, facility drawings, facility policies and procedures, inmate processing forms, interviews, and inmate management system data collection.
Task 2: Software Customization Vanir developed an accessibility database system referred to as our proprietary vMAP system and through that development utilizes extensive tracking checklists, templates, and forms in the performance of assessment services to ensure that a systematic approach with clearly defined steps and processes are followed and no area is overlooked. Vanir’s processes and tools ensure that the assessment and reporting is comprehensive, and the results are documented and reportable. Vanir tailored the tablet ADA computer-based software for the Santa Barbara Jail. The Vanir software was developed with pre-loaded requirements of the three independent standards (2013 CBC, 2010 ADA, 2010 CBC) and was set up in a manner to provide a checklist query that is typically room and element-dependent. Based on the County’s drawings, the software was modified to pre-load project-specific rooms and elements. For example, if the preliminary research indicated that a specific room type was common in the jail facilities but was not currently available on the tablet, the Vanir team entered that particular room type ahead of time to make the job-site surveyors more efficient and effective. This allowed the surveyors to move from one room to another, take measurements and photos, and instantly have the data analyzed and permanently stored in the tablet, ready to be uploaded and shared.
Task 3: Field Surveys The Vanir survey teams were comprised of two-person teams that work together to collect the survey data using a number of tools including the tablet, tape measures, templates, levels and clipboards. The survey teams assigned a building name and number, and room names and numbers and began their survey (see Functional Use Area checklist and associated rooms listed below the tasks). Typically, they photographed the room first, moving clockwise through the space, and accounted for each element that was encountered. The survey team would typically discuss the operational procedures with the correctional officers to determine the most appropriate ADA compliance standard. As the teams completed each room and each building they recorded on an associated floor plan any plan deviations or other information. The survey teams are trained to record the information in an impartial manner, without forcing the outcome in any direction. The integrity of the process is maintained by the strictly impartial position of the survey teams.
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Task 4. Evaluation of Data and Recommendations The data was uploaded to a main server and was evaluated for consistency and completeness. The ADA compliance status was then disseminated into three categories: 1) 1991 ADA compliance; 2) 2010 ADA compliance; and 3) 2013 CBC compliance. The surveyor teams then reviewed the data and developed recommendations based on criteria as developed by County staff. Recommendations were vetted for reasonableness, effectiveness, and cost. Vanir presented the Self-Evaluation Report to the County, solicited and recorded all feedback, as well as made changes as directed.
Task 5. Cost Evaluation Each of the ADA Corrective Measures (ACM) were listed and accompanied by a cost estimate where appropriate. The cost estimate responded to design to correct the inadequacy including: material, labor, overhead and profit, escalation, market factor, general conditions, contingency, and cost applied County resources, etc. The cost estimate was provided in the final report.
Jail Functional Use Areas
The project scope focused on a detailed functional use area (FUA) checklist for our assessment of the jail facilities. The checklist served as a working instrument to apply the methodology discussed above for the reviewing the facilities and operations of the Santa Barbara County Jail facilities. The checklist responded to 11 inmate-accessible FUAs contained in a jail facility. The FUAs represent facility spaces / rooms divided into logical room categories including the following:
• Public Area – Lobbies, restrooms, entrances, vending area, etc. • Visiting – Contact booths, visiting rooms, interview room, video visitation, telephone, TTY / TDD,
etc. • Intake / Release – Inmate processing area, ID area, interview rooms, holding cells etc. • Medical / Mental Health / Dental – Medical / mental health offices, pharmacy, exam rooms, etc. • Inmate Programs – Classrooms, industries, barber, etc. • Housing / Dayroom – Cells, dayrooms, showers, combination toilet / sinks, etc. • Indoor Exercise / Recreation – Gymnasiums, weight rooms, equipment storage, etc. • Outdoor / Quasi-Outdoor Exercise Yards – Covered and uncovered exercise areas • Circulation Areas – General circulation (staff, inmate, public), elevators, vestibules, stairs,
corridors, etc. • Indoor Vehicle Sallyport – Entry sallyport, vehicle area, pre-booking area, etc. • Outdoor Spaces – Courtyards, fields, parking, circulation, etc.
Each FUA was reviewed to the ADA guideline accommodations. Each guideline took into consideration facility operations as it relates to the public, staff, and inmate accessibility, while cognizant of the safety and security integrity of the jail. Vanir’s team noted and recorded areas of non-compliance.
Because our area of expertise lies within the construction management field, our report and feedback focus on and only address items in relation to physical impairments - specifically mobility, hearing, and / or sight. We recognize the importance of mental health care within the walls of the facility and that crucial updates
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should be made for the health and welfare of those inmates. However, this falls outside our area of expertise, so we will not be addressing it in detail within this report.
Document Review In addition to photographing each room, assessing each space, and accounting for each element as described above, Vanir reviewed certain documents pertaining to operations of the jail facility, and accommodations in respect to accessibility. Further comment and / or recommendations on these documents as it relates to accommodations is included later in this report. These documents are listed below.
Manuals • Santa Barbara County Sheriff’s Office Custody Operations Orientation Handbook (July 18, 2016, Revision 1); (July 27, 2016, Revision 1) • Santa Barbara County Sheriff’s Office Custody Operations Policy and Procedures ManualRedacted (July 18, 2016); (Sept. 20,2018, Updated March 7, 2019)
Reports • Active ADA Inmate Alerts Report (Oct. 2016; March 2018; Sept. 2018; Oct. 2018; March 2019) • Active ADA Inmate Roster (Aug. 2016) • ADA Classification Report (Oct. 2016) • ADA Inmate Compilation Report (Sept. 2018; March 2019) • ADP Report (2008-2018) • Assessment of Custody Operations – Santa Barbara County Jail System (April 2017) • Facility Condition Assessment – County of Santa Barbara (2014) • Functional Program and Space List – Final Report (Sept. 2013) • Inactive Armstrong ADA Inmate Alert Report (Aug. 2016) • Inactive Armstrong ADA Inmate Alerts (Oct. 2016) • Jail Staffing and Cost Analysis Report (Nov. 2015) • Review of Mental Health Services Currently Provided by the Santa Barbara County Jail System (April 2017) • Review of Santa Barbara County Jail Medical Services (Sept. 2017) • Santa Barbara County Detention Center Property Condition Assessment (Oct. 2015) • Santa Barbara County Grand Jury Report (2016-2017) • Santa Barbara County Sheriff’s Office Custody Operations 2016 Fact Sheet
Samples • Active Inmate Record and Caution Flag Sample • Classification Housing JMS
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Forms • Classification Assessment Form (10.2.13) • Corizon Intake and Receiving Screening Form • Disability Request for Accommodations Form (2016) • Inmate Disability Notification and Tracking Form (2016) • Inmate Grievance Form • New Grievance Form and Process Memorandum (7.11.16) • Inmate Request Form • Legal Research Request Form (04.2011) • Medical Unit Restriction Form • Sick Call Request Form
Interviews In addition to the ADA assessment, our team interviewed custody staff March 28-29, 2018. Follow up interviews were conducted remotely as needed. Our team interviewed staff across the spectrum custody and care with the following positions: 1) ADA / PREA Coordinator; 2) Booking Receiving Officer; 3) CFMG / Wellpath Health Services Administrator; 4) Classification Officer; 5) Custody Corporal; 6) Custody Deputy; 7) Inmate Welfare Specialist / Analyst; 8) Jail Lieutenant; 9) Jail Operations Training Officer; and 10) Senior Custody Deputy. Each staff member was assured anonymity to help alleviate any concerns they may have commenting on policies and procedures about the facility so the dialogue would be as open and candid as possible. Staff was informed that we would be listing only their position / title in the report.
Self-Evaluation Format Vanir Construction Management, Inc. (Vanir) has packaged this report in two parts as follows:
PART 1, The Self-Evaluation and Transition Plan (Volume 1): Part 1 is a subjective recommendation designed to put Santa Barbara Jail on a path toward greater ADA compliance. These recommendations are based on several factors that change over time, such as: budget, demographics, advances in technology, future expansion projects, and ADA standards. Therefore, it is important that the Self-Evaluation and Transition Plan be reviewed and updated periodically to reflect current conditions.
PART 2, The ADA Assessment (Volume 2): Part 2 is an objective assessment of the existing conditions and comparison to existing ADA Standards. The ADA Assessment is fact-based and does not reflect opinions except as noted within the Recommendations and Priorities section, and in most regards, does not change over time.
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A. Self-Evaluation

Overview
This section, titled “Self-Evaluation”, is a specific legal obligation under Title II of the Americans with Disabilities Act. It requires that government entities prepare a self-evaluation of their programs, activities, and services. These entities then determine if they are structured and administered in a way that denies access to those with disabilities, and if so, provide corrective actions.

Programs, Activities and Services

Each of the programs, activities, and services that are provided at Santa Barbara Jail have been evaluated as part of this report regarding access for those with disabilities. These areas are also commonly referred to as functional use areas (FUAs). The primary programs, activities, and services are listed below:

• Intake • Booking • Holding • Transfer to other facilities • Transfer to courts • Access to legal counsel • Housing • Communication with family / friends /
legal counsel

• Dietary / Food service • Medical / Dental care • Education • Vocational training • Religious services • Exercise • Entertainment • Release

The Santa Barbara County Jail ADA Assessment specifically responds to upgrades, renovations, and remodels to accommodate inmates in all of the program areas identified above and the paths of travel. It is the County’s desire to provide the maximum response to ADA accommodations.

To the extent that improvements can be made to provide greater access to the disabled, these improvements are specified in the following documents:
1. Santa Barbara County Jail ADA Assessment, Volume 1 • Custody Operations Policy and Procedures Manual Review and Comment • Custody Operations Orientation Handbook Review and Comment • Inmate Custody Forms
2. Santa Barbara County Jail ADA Assessment, Volume 2

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General Comments and / or Recommendations
Vanir’s primary findings focused on three areas:
1. Gaps in the intake, booking, placement, and release processes that could exclude individuals with impairments from accessing needed accommodations;
2. Gaps in the documents and forms that would allow an inmate with a disability to be excluded from identification and proper accommodation; and
3. Physical plant deficiencies relating to ADA accessibility guidelines.
Vanir has identified a number of recommendations that bridge the gaps in standard operating procedures, physical plant accommodations, policy, procedures, and forms. The recommendations are presented in three categories: immediate, short-term, and long-term.
Immediate (Begin Within 1 Year)
• Establish an ADA Compliance Coordinator Position The success of integrating inmates with disabilities into the institution initially is a full-time effort. This ADA Compliance Coordinator should have sufficient rank and authority (Lieutenant or higher) to implement and further develop the recommendations in this report. The ADA Compliance Coordinator position should obtain ADA code and standards training, attend accessibility conferences, update policy and procedures, and conduct training of other staff. Update: Since the writing of the first draft, the Sheriff’s Department has allocated a full-time Corporal position as ADA and Prison Rape Elimination Act (PREA) Coordinator.
• Streamline Policy and Procedures Update and simplify policy and procedures for inmates with disabilities. Consider one section that responds to every aspect of a disabled inmate’s process and accommodation in one section of the Custody Operations Policies and Procedures Manual. Currently, the policy and procedures contain applicable sections inserted throughout the entire document, which become difficult to follow and incomplete. Vital parts of the procedures reside in the Custody Operations Orientation Handbook, which is not a custody staff order of duties.
Below is a sample of a Policy and Procedure section devoted solely to inmates with disabilities. 1. POLICY STATEMENT 2. DEFINITIONS 3. MANDATES 4. GENERAL INFORMATION 5. COMPLIANCE WITH ADA 6. FORMS 7. ACCOMMODATIONS FOR DISABLED PERSONS 8. ACCOMMODATIONS FOR INMATES IDENTIFIED AS DISABLED 9. DISABLED INMATE NOTIFICATIONS 17

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10. DISABLED VISITOR ACCOMMODATIONS 11. PROCEDURES 12. IDENTIFYING DISABLED INMATES DURING BOOKING PROCESS 13. BOOKING PROCESS FOR DISABLED INMATES 14. IDENTIFYING DISABILITIES ON HOUSED INMATES 15. ADA DIVISION REPRESENTATIVE RESPONSIBILITIES 16. ADA COORDINATOR RESPONSIBILITIES 17. MEDICAL STAFF RESPONSIBILITIES 18. CLASSIFICATION STAFF RESPONSIBILITIES 19. PROGRAM STAFF RESPONSIBILITIES 20. COURT MOVEMENT RESPONSIBILITIES 21. GRIEVANCE PROCESS 22. DISCIPLINARY PROCESS 23. REVISION HISTORY
• Staff Should be Trained and Routinely Made Aware of Their Responsibility in Working with Disabled Inmates Update “policy and procedure” criteria and formalize training that sensitizes staff to needs of inmates with disabilities. Vanir conducted interviews of key staff that have the responsibility for training staff on the supervision of inmates with impairments. Since our review and comment of the policies and procedures, the Sheriff’s Office took steps in modifying these and accompanied that with the training of staff. See Staff Interviews in this report, and Staff Interview Questions and Responses in Appendix A.
• Establish an Automated System to Identify and Track Disabled Inmates in the Institution The booking forms should include data fields to denote inmates with specific disabilities. This data should be utilized during classification to assist in placing inmates with disabilities within the institution. The captured fields will allow data collection for future ADA planning. Currently, this monitoring is done by hand and recorded on an Excel chart after the fact.
 Sheriff’s Jail Management System (JMS) While interviewing staff, it was conveyed that the system is old and does not respond to today’s inmate management challenges. The system does not allow creation of an inmate disabilities database; therefore, a manual system is employed. However, there is opportunity to miss inmates in the system or for human error. It is important to track all inmates that enter and leave the facilities to substantiate and address all critical ADA needs.
• Obtain Sign Interpreters The institution should have an accessible sign language interpreter when requested by hearingimpaired inmates. An interpreter can be essential throughout key points of the booking and arraignment process, (i.e. booking, classification, court commission, court hearing, etc.).
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• Provide Fixed TTY / TDD Units for Those That are Hearing-Impaired A fixed TTY /TDD should be available at every phone bank where hearing-impaired inmates are accommodated or housed. TTY / TDD use should be as convenient as other fixed phones and accessible to the hearing-impaired inmate as desired. Video visitation could allow some hearing-impaired inmates to sign without the use of a TTY / TDD. However, should a hearing-impaired inmate need to contact a hearing person that does not have access to the video visitation system or their own TTY / TDD device, a TTY / TDD with a relay service should be provided for the inmate. Electronic technology has changed significantly in the past decade, and the ways to communicate with the deaf have also changed and become more mainstream. Smart phones, tablets, and computers have allowed the deaf and hard-of-hearing to communicate through a Video Relay Service with an application (app) connected to their device called P3 Mobile, which is a free download on most app sites. Examples of these sites include: AnswerNet, Purple, and GTL Solutions.
• Formalize Procedures for Providing Library Services to Disabled Inmates Establish the level of service the institution desires to maintain in providing library services to inmate with sight impairments through policy and procedures. This should include items in braille or in an audio format.
Short-Term (Begin Within 1-2 Years)
• Mainstream Inmates with Disabilities Throughout the Entire Institution Inmates with disabilities should be housed throughout the facility based on classification. Cells / housing units should be available to the classification unit for appropriate placement and accommodation to inmates with specific disabilities. If inmates are ill, they can be placed in the Medical Unit.
• Re-Assess the Role of Classification and Medical in Assigning Disabled Inmates to Housing Units Streamline the “housing placement system” involving classification and medical. As the medical provider, CFMG / Wellpath does not share triage reports with custody staff due to HIPPA laws. This has caused issues in other facilities resulting in disciplinary action taken against inmates when custody officers were unaware of the inmate’s specific disability and communication or physical limitations.
• The Responsibility of Each Affected Unit – Medical, Classification, Social Services and Custody Staff – in Addressing Inmates with Disabilities Should be Clearly Delineated Through policies and procedures, formalize the responsibilities of each agency as it relates to responding to inmates with disabilities in all sequences of the custody, care, and release processes.
• Modify Custody Operations Orientation Handbook Modify the Custody Operations Orientation Handbook with additional information responding to the services available to inmates with disabilities.
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Policy and Procedure Review and Recommendations
The Santa Barbara County Sheriff’s Office’s Custody Operations Policy and Procedures Manual is one of the most important management tools available to the corrections practitioner. Policies and procedures provide direction to staff by communicating the organization’s philosophy and work plan. They serve as an invaluable aid in promoting consistency, efficiency, and professionalism in the performance of facility responsibilities by standardizing the methods by which such responsibilities are accomplished.
The management and operations chapters of the Custody Operations Policy and Procedures Manual focus on a wide range of correctional concerns and special needs of its inmates. For instance, inmates with mobility impairments may be assigned a specific housing unit that best accommodates their needs. In contrast, inmates with hearing impairments may be able to be accommodated in all units with special devices provided for their use, such as TTY / TDD.
The purpose of Vanir’s review is to ascertain the level of written processes incorporated into the Custody Operations Policy and Procedures Manual. This focuses primarily on written procedures that specifically respond to “persons with disabilities”, and how they are to be accommodated in the detention facility.
Update: The Custody Operations Policy and Procedures Manual originally reviewed have been modified based on Vanir’s comments to provide a clear and concise response to inmates with disabilities in Sections 209, 243, 301, 365, 366, 368, 373, 376, and 383 (see chart below for additional comments). Also see “Staff Interviews” section regarding other operations, including disciplinary medical programs.
The Custody Operations Policy and Procedures Manual contains the following sections:
GENERAL INFORMATION 100. Definitions 101. Number of Personnel 102. Inspection and Operations Review 103. Public Information Plan
CHAPTER 2 ADMINISTRATIVE Records and Public Information
200. Custody Records 201. Photo Line-Ups 202. Civil Commitments 203. In-Custody Marriages 204. Significant Incident Notifications 205. Significant Incident Alert Notification List 206. Significant Incident and In-Custody Deaths 207. Court Orders for Temporary Releases 208. Prison Rape Elimination Act (PREA) 209. ADA: Americans with Disabilities Act
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Emergency Procedures 220. Escapes 221. Response to Bomb Threats 222. Fire Suppression/Natural Disaster and Evacuation Plan 223. Hostage Taking 224. Self-Contained Breathing Apparatus 225. Civil Disturbance 226. Civilian Personnel Evacuation Plan
Health Care 240. Health Care 241. Mental Health Care 242. Suicide Prevention 243. Special Care Inmates 244. Communicable Diseases 245. Automated External Defibrillators (AED) 246. Inter-Facility Transfer of Medical / Mental Health Records
CHAPTER 3 OPERATIONS Inmate Management 300. Counts 301. Inmate Classification 302. Inmate Movement 303. Use of Sobering / Observation Cell 304. Use of Safety Cells 305. Bed Assignment
Safety and Security 320. Cell Extractions 321. Door Security 322. Facility Access 323. Hospital Transport and Guard Procedures 324. Incident and Offense Reports 325. Key Control 326. Use of Restraint Chair 327. Safety Checks 328. Searches 329. Storage and Use of Less Lethal Equipment and RIPP Hobble 330. (Not Used) 331. Use of Video Recording Devices 332. Metal Detector (Magnetometer) 333. Possession or Use of Electronic Devices While on Duty 334. Use of Restraints 335. Movement Chair
Booking and Release Information 340. Processing Inmate Money and Property 341. Release Criteria
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342. Foreign Nationals
Inmate Programs 360. Commissary 361. Grievance Procedures 362. Inmate Clothing and Personal Hygiene 363. Inmate Discipline 364. Inmate Visitation 365. Inmate Education 366. Inmate Orientation 367. Inmate Recreation 368. Library Services 369. Inmate Mail Guidelines 370. Books and Periodicals 371. Acceptance and Processing of Currency, Checks and Money Orders 372. Religious Head Coverings 373. Religion 374. Obtaining Inmate Signatures 375. Inmate Welfare Special Revenue Fund 376. Community Release Programs 377. DNA Sampling 378. Inmate Drug Testing 379. Voting 380. Pro Per Inmates 381. Indigent Inmate – Essential Services 382. Ombudsman Program 383. Telephone Calls
CHAPTER 4 SANTA MARIA BRANCH JAIL This facility closed in July 2017, past policies can be found in the 2016 and prior editions of the P&P Manual.
CHAPTER 5 MEDIUM SECURITY FACILITY Medium Security Facility (MSF)
500. MSF General Information 501. MSF Inmate Counts and Perimeter Checks 502. MSF Orientation 503. MSF Work Crews
CHAPTER 6 TRANSPORTATION UNIT Transportation Unit
600. Transportation General Information 601. Court Holding Facility 602. Receiving and Processing Court Orders 603. Transportation Temporary Security Enclosures 604. Transportation Unit Radio Use 605. Inmate Transports 606. Use of Transportation Shotgun
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607. Use of Patrol Rifle (AR-15) 608. Transportation Unit Keys 609. Holding / Transport Classification 610. Out of County Transports 611. Emergency and Unusual Events 612. California Highway Patrol (CHP) Pull Program
Overall, the Custody Operations Policy and Procedures Manual is comprehensive, however, there are some responses to inmates with disabilities that are confusing and difficult to find, thus lost in a volume of words. Some examples of these are listed in the following chart.

SANTA BARBARA SHERIFF’S OFFICE CUSTODY OPERATIONS POLICY & PROCEDURES MANUAL

Page No. Reference

Review Comments

63

Chapter 2 Administrative / 209.

Department should consider adding Video Relay

Americans with Disabilities Act / 209. Interpreting (VRI); a service and devices provided

Telecommunication Device for Deaf

free.

(TDD)/Teletypewriter (TTY)

103

Chapter 2 Administrative / 243.

"Impairment" is listed three times. Not clear what

Special Care Inmates: III.

disability this refers to. May need to clarify the

Definitions: People With Disabilities

nature of the impairment.

104

Chapter 2 Administrative / 243.

"If the inmate is pre-trial, does not post bail, or is not

Special Care Inmates: IV. Procedures, eligible for citation release, notify Pre-Trial Services

Item 2.

and request an immediate evaluation for release;"

Unsure how this applies to Special Care Inmates.

104

Chapter 2 Administrative / 243.

Does the inmate require Wellpath Administrator and

Special Care Inmates: IV. Procedures, Physician's opinion prior to assignment of alternate

Items 3, 4 & 5.

housing? Flow chart could be useful here. How does

this take place, written or verbal?

122

Chapter 3 Operations / 301.

“Physical and mental health needs”. There is no

Inmate Classification, Item 1. Purpose. discussion to inmates with disabilities other than the

reference to physical. Should “physical” be removed

since the creation of Section 209.

239

Chapter 3 Operations / 365.

Inmate Education, Item 1.

No mention of inmates that require special considerations such as signers, closed captioning. Some programs may not be appropriate to wheelchairs, (i.e. work crews, kitchen workers, etc.). Are there other jobs within those areas that can be accomplished by inmates with impairments?

241

Chapter 3 Operations / 366.

Inmate Orientation, Item 2.

This refers to a “copy”, thus a handbook. There is no mention of a braille Custody Orientation Handbook for a sight impaired inmate. Recommend one be produced.

243

Chapter 3 Operations / 368.

Library Services

Item IV. Indicates that there are braille books available to inmates requesting them. While a good start, these books are often free by service organizations and would be advantageous for

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inmates with sight impairments that have more of a choice.

260

Chapter 3 Operations / 373.

Religion, Item IV.

No mention of hearing-impaired inmate accommodations, nor is it mentioned in Section 209. Are signers available?

266

Chapter 3 Operations / 376.

Program assignment is based upon several classifying

Community Release Programs, Item IV. factors, which may include the participant’s health

(both physical and mental). Are wheelchair inmates

prohibited?

292

Chapter 3 Operations / 383.

Telephone Calls, Item 1.

The jail contains inmate phones throughout the housing units. However, not true for TTY/TDD phones or video relay consoles. These need to be requested by the inmate and may not be provided timely. Recommend that housing unit specifically design for inmates with impairment contain fixed TTY/TDD or a video relay console. Also, extra time may be needed as a result of the pace of the translation.

Santa Barbara County Sheriff’s Office Custody Operations Orientation Handbook (2016, Revision 1) Review and Recommendations
Santa Barbara County Sheriff’s Office Custody Operations Orientation Handbook contains the following sections:

I.

Introduction

II. Rights and Responsibilities 201. Rights 202. Responsibilities 203. Prison Rape Elimination Act (PREA) 204. Americans with Disabilities Act (ADA) 205. Lower Bunk Assignment

III. General Rules 301. General Rules 302. Housing Unit Rules 303. Laws 304. Disturbance Procedures 305. Security Concerns 306. Lockdown / Facility Count 307. Request Forms 308. Personal Hygiene 309. Condition of Cells 310. Linens 311. Clothing 312. Releasing Property 313. Tobacco Products 314. Destruction of County Property
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315. Special Diets 316. Searches and Urine Tests 317. Jewelry 318. Telephones 319. Contraband
IV. Disciplinary Procedures 401. Disciplinary Procedures 402. Minor Violations 403. Major Violations 404. Rule Violations 405. Inmate Disciplinary Review Board (IDRB)
V. Classification
VI. Transportation
VII. Services 701. Maintenance 702. Haircuts 703. Trust Accounts 704. Commissary 705. Mail 706. Books and Periodicals 707. Visitation 708. Marriage Guidelines 709. Library Services 710. Legal Research Program 711. Propria Persona (Pro Per) 712. Ombudsman 713. Grievance Procedure 714. Voter Registration and Voting
VIII. Programs 801. Recreation 802. Volunteer Services Programs 803. Religious Services 804. Educational Programs 805. Sheriff’s Treatment Program (STP) 806. Discharge Planning
IX. Alternative Sentencing Bureau (ASB) 901. Sheriff’s Work Alternative Program (SWAP) 902. Electronic Monitoring (EM) 903. Electronic Monitoring (EM) FAQs
X. Health Services 1001. Medical Services
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1002. Medication 1003. Dental Treatment 1004. Mental Health 1005. Suicide Prevention 1006. Hospitalization 1007. Emergencies 1008. Medical Grievances

Overall, the Custody Operations Orientation Handbook is written for the inmate and provides information regarding their rights and Sheriff’s rules while in custody. These are not written for staff as is the Policy and Procedures Manual, therefore, not enforceable to the custody operators of the facility. There are some responses to inmates with disabilities that are confusing and difficult to find, thus lost in a volume of words. Some examples of these are listed in the following chart.

Page No.
2 8
8
10
14 25 27 34

SANTA BARBARA COUNTY SHERIFF’S OFFICE CUSTODY OPERATIONS ORIENTATION HANDBOOK
(2016, REVISION 1)

General

Reference

204. Americans with Disabilities Act (ADA) Policy; Sign Language Interpreter to Explain Form

205. Lower Bunk Assignment

302. Housing Unit Rules; Item 1, Orientation Video 318. Telephones 706. Books and Periodicals 709. Library Services 901. Sheriff's Work Alternative Program (SWAP)

Review Comments
Handbook is not available in braille. Recommend obtaining braille copy of Orientation Handbook.
Requires three business days to provide a signer. This may be excessive, especially if a person is admitted or booked on a Friday. Recommend reducing the time for those that need a signer.
The Custody Operations Policy and Procedures Manual differs slightly from the Orientation Handbook. Recommend coordination between the two.
Is a hearing-impaired version of the Orientation Video available? If not, recommend providing closed captioned.
No mention of TTY/TDDs. Recommend adding TTY/TDD to telephone section.
Recommend more braille books, periodicals, and materials.
Recommend more braille books, periodicals, and materials.
Is there a program for the impaired inmates to accomplish the same end goals of work for jail time? Recommend providing some form of SWAP program for impaired inmates.

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Santa Barbara County Miscellaneous Forms

Page No.
1 1 1 1 1 1 1
1
1 1 1
1

SANTA BARBARA COUNTY MISCELLANEOUS FORMS

Reference Sick Call Request New Grievance Form and Process Legal Research Request Form Inmate Request Form Inmate Grievance Form Corizon Intake Receiving Screening Form
Classification Housing JMS
Classification Assessment Form
ADA Forms - Documents – four-part NCR (Disability Request for Accommodations); ADA Forms - Documents three-part NCR (Inmate Disability Notification and Tracking Form) Inmate Disability Notification and Tracking Form
Medical Unit Restriction Form

Review Comments No comment
No comment
No comment
No comment
No comment
No longer in use (CFMG/Wellpath form not provided)
Classification system JMS does not contain ADA information. The JMS has an ADA module that would benefit the Sheriff’s Office and may reduce the ADA Coordinator maintaining separate Excel files.
No mention of lower bunk assignment. All information is write-in and not recoverable in an automated format.
The use of carbon paper is outdated. Consider automating form.
The use of carbon paper is outdated. Consider automating form.
Used to create the “Armstrong ADA Inmate Alerts” manual database. The use of carbon paper is outdated. Consider automating form and collect information for ADA Inmate database.
No comment

Recommendations 1. Vanir has conducted many needs assessments and often tries to get information that some of these forms contain, and not available because of the way they are kept and maintained. We believe it would be advantageous to automate as many of these forms as possible. This can be

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accomplished through kiosks located in the housing units with these forms pre-loaded and accessible to inmates. The information then can be collected to create meaningful data for future planning, staffing, and life cycle operational costs.
2. No mention of how inmates with sight impairments are to use the forms or know about them since the Custody Orientation Handbook is not in braille.
Activity Gaps and Physical Plant Deficiencies
Part II of this report identifies findings and includes the following:
1. The specific impairment as it relates to Titles II and III of the ADA law; 2. Physical plant deficiencies by room, element, and code; 3. References to the American with Disabilities Accessibility Guidelines published by the
Department of Justice; and 4. A priority index responding to the remedy of the gap or physical plant deficiency.
INMATE INTERVIEWS
Vanir was unable to interview any inmate with qualifying ADA impairment during our site visits. Based on the chart in the Current Accessibility Needs section, there have been three sight impaired and three hearing-impaired inmates in the last seven years, and none during our visits. At the time of the Vanir visits to the Jail, no inmates with qualifying accessibility impairments were identified by staff or by the Jail disability tracking system.
STAFF INTERVIEWS
In order to conduct the site evaluation for ADA compliance, Vanir staff and subconsultants visited the Santa Barbara Jail facilities several times in 2017 and 2018. In addition to the ADA study being developed to address the most pressing concerns, our team met with custody staff March 28-29, 2018. Follow up interviews were conducted remotely as needed. Each staff member was assured anonymity to help alleviate any concerns they may have commenting on policies and procedures at the facility so the dialogue would be as open and candid as possible. Staff was informed that we would be listing only their position title in the report. Vanir interviewed key individuals from eleven positions that come in contact and supervise inmates on a daily basis. They are:
Staff Interviews March 28-29, 2018 ADA / PREA Coordinator (1) CFMG / Wellpath Health Services Administrator (1) Classification Officer (1) Corporal (2) Custody Deputy (1) Inmate Welfare Department Specialist / Analyst (1)
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Lieutenant (1) Receiving Officer (1) Senior Custody Deputy (1) Training Officer (1)
Vanir developed a set of questions that Disability Rights California was most concerned with the management of accommodations for individuals with disabilities. Vanir produced 42 questions, and eight (8) topic areas. Disability Rights California agreed to the questions and asked to include 16 additional questions they had in the various topics. Vanir, during the interviews, asked all questions to the staff that had responsibility or knowledge of a particular topic. During the interview process, Vanir made best efforts to fully capture each statement from the respondent as the conversation occurred. The conversations were not audio recorded.
Questionnaire Topics and Staff Responses At the time of our interviews, staff were completing their annual policy review and noted that there were not any substantial changes to ADA policies and procedures at the time of our visit. Vanir received an updated copy of the Custody Operations Policy and Procedures Manual in March 2019. An ADA section was added to capture necessary procedures in one written location regarding impaired or disabled inmates in the facility.
The following summary responses of those interviews have been edited for brevity and are listed as bullets under each topic below. The interview questions and full responses are listed in Appendix A. Direct quotes have been edited to make coherent thoughts without changing the intent of the statement since most people do not talk in sentence structure.
A. Policies and Procedures • Staff stated that every attempt is made to use alternate sentencing through the use of Own Recognizance Program (OR), ankle bracelets, etc. to reduce the number of disabled or impaired inmates requiring accommodations within the facilities.
Vanir Recommendation: None
B. Custody Operations Orientation Handbook (2016, Revision 1) • The Custody Operations Orientation Handbook is only available in English and Spanish. It is not available in braille, but it has been discussed. The Braille Institute is in town. • Inmates receive the Custody Operations Orientation Handbook from the property officer with all other items when they dress in for housing. Inmates that are cited and released do not receive the Handbook. • Officers do not ask if the inmate can read and comprehend the Custody Operations Orientation Handbook.
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• The majority of the population is Spanish speaking. Many inmates speak Taiwanese, Mandarin, Joaquin, Farsi, Portuguese, or German. The jail subscribes to a translation service available over the phone that’s available to officers from dispatch.
• The Orientation Handbook video used to play at 4:00PM daily in every housing unit. It is not closed captioned but visually impaired inmates can listen to it. It has not been recently updated. Staff did not note whether or not it is still played daily.
• Staff noted that there isn’t much available for hearing-impaired or blind inmates.
Vanir Recommendation: Provide closed captioning for Orientation Handbook video for hearingimpaired inmates. Provide Custody Operations Orientation Handbook in braille and consider a Spanish speaking version as well.
C. Training • All new employees complete orientation, including policies and procedures, prior to working and must sign off that they’ve read them. They work with the Training Officer and have a twoweek orientation during which they are not assigned to a post. During this time, they read policies and are quizzed by a Corrections Training Officer (CTO). Once the CTO and officer sign off, the new employee is assigned to a squad and various CTO’s to complete the training process. The CTO continues to quiz them throughout their orientation period. The Custody Deputy Academy is 12-weeks long and policies and procedures are specifically reinforced. Employees have been let go for not passing the Academy.
• Staff complete updated security training yearly and sign an acknowledgement form saying they’ve completed the course.
• All new program volunteers undergo a background check, attend a two-hour PREA class, and a two-hour security orientation training before coming on board.
• Policy changes are distributed to staff via email noting what was changed or added, with the new policy attached. If the policy change is specific to a module, it might be printed and hung in the office. Depending on the severity of the change, it may or may not be included in the quarterly training.
• Compliance is ensured by providing staff training specific to each post. By supervising daily operations, officers can ensure newly distributed policies and procedures are being followed. Additional follow up occurs to ensure compliance; however, there is no sign-off acknowledgement or tests to ensure trainees have reviewed them.
• Interviewed staff had not received any training regarding use of force for a mobility issue specifically and noted that it is not included in the standard training. As is the case with nonADA inmates, officers use only the amount of force necessary to diffuse a volatile situation. The amount of force used is extremely important when dealing with a pregnant female inmate.
• Staff has been meeting twice a month to update policies for the facility. There may be a fourhour class held once the changes have been finalized.
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Vanir Recommendation: Hold semi-annual retraining regarding policies and procedures for all staff. Require written acknowledgement of all new policies and procedures reviewed. Provide use of force staff training for impaired inmates.
D. Information Management System and Tracking • An accommodation form was implemented in December 2017 / January 2018. Staff is still maintaining the ADA log, both active and inactive, including the type of impairment. Staff asks impaired inmates if they have what’s needed and follow up as necessary.
• The facility also maintains paper files on every ADA inmate, including booking sheets, Armstrong sheets, and any medical information on active / inactive inmates for backup.
• The facility changed to ATIMS January 2018 which has a lot more flags than the old system (such as the type of assistive device or notes). Medical is requesting that classification add special flags such as glasses, etc.
• Staff has been debugging the new system that’s the established footprint for a new one in approximately one year.
• The new ATIMS system will be fully integrated to reduce redundancy / overlapping questions between medical, intake, and classification.
• The ADA Disability Notification and Tracking Form addresses the types of cells and assistive devices needed with the classification officer. The ADA form follows the inmate throughout the intake and classification process. The nurse performs intake and delivers it to the receiving officer. It then follows the inmate to housing and the form is delivered to the classification officer.
• ADA officer flags ADA inmate files in JMS, creates a folder, then sends the information to transportation. It is not as efficient as staff would like. Many staff are unfamiliar with the new JMS system. The JMS system can flag if an inmate needs a wheelchair.
• For the most part, the system is automated. Medical requests are on the wall and accommodation sheets are still paper. If housing officer looks in ATIMS, he’ll see any inmate flags. The system hasn’t been fully integrated yet and the facility will be going to yet another IMS in one year. Falling through the cracks is still a problem in ATIMS, one of the main reasons a new one is planned.
• The Inmate Management System is a medium grade system. The one in operation now will only be for the transition to reach the next level. It will be automated with less hand counting, collect database information on inmates, and make projections for the future.
Vanir Recommendations: Provide an “inmates with disabilities” module with the new Inmate Management System. The module should identify inmates with specific disabilities and allow staff to track and identify those inmates throughout the intake, classification, incarceration, courts, and release processes. The modules should allow for checking the box rather than write in so as to allow staff to accumulate data on the number of inmates requiring special accommodations.
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E. Intake / Release • There are several opportunities in the intake process with the arresting officer, receiving officer, medical staff, and the classification officer for the inmate to convey any impairments or special needs prior to being housed. The booking officer receives the information and does not meet with the inmate.
• In receiving, everyone is held in holding cells and every inmate that clears triage is interviewed by staff prior to housing placement.
• During classification, staff can explain the bail process as needed. They can read a list and information but are restricted from recommending a bail agency. The officer gives the inmate five bail bonds options, asks if they want to contact any of them, and then the officer dials the number on behalf of the inmate.
• The ID officer provides the inmate with their charges. The classification officer explains the charges to the inmate if they are unable to read them, as will any other staff along the way.
• Booking / Intake and video arraignment will occur at the new facility. There will not be video arraignment at the Main Jail, however, staff noted they would prefer to complete some tasks this way.
Vanir Recommendations: Provide an inmates with disability module with the new Inmate Management System. The module should identify inmates with specific disabilities and allow staff to track and identify those inmates throughout the intake, classification, incarceration, courts, and release processes. The modules should allow for checking the box rather than write in so as to allow staff to accumulate data on the number of inmates requiring special accommodations. The Policies and Procedures Manual should identify the procedure whereby inmates with sight or hearing impairments are to contact a bail bondsman.
F. Medical • Medical triage is performed in pre-booking to assess the inmate with the arresting officer present. Medical must first evaluate all inmates before entering through sallyport doors. If an inmate is not approved for intake by triage, the arresting officer transports the inmate to the hospital. Since CFMG took over, medical staff are completing triage first, instead of the next day.
• Page 3 of the Medical Intake Form contains an ADA section that enquires about personal medical devices, communication issues, or use of ASL.
• Medical and classification collaborate to determine the best assignment for the inmate. Medical staff can recommend, not approve, placement in an observation cell as well as housing classification.
• Health care staff determines inmate accommodation needs for such items as a wheelchair, cane, etc. Wheelchairs are available in the sallyport, medical, and holding cells. If the inmate possessed a wheelchair at intake, the doctor will determine whether or not the inmate gets to keep it. Braces with metal have to be removed because they can be used as a shank. 32

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• Fluorescent vests are provided to impaired inmates by CFMG/ Wellpath that specifies the impairment so that others are alerted (i.e., “can’t hear/speak”). The inmates are always instructed to wear the vests so the officers are aware of the impairment, but the staff we spoke with has never had to use them.
• Any inmate can submit an Inmate Request Form and medical will see them within 24 hours, unless it is a weekend. Most inmate requests are transportation related due to mobility issues.
• If an inmate needs the ADA van, a notice is sent to transportation on a daily basis.
• The Medical Escort Team (MET) works solely with medical to move inmates to / from treatment rooms. New issues such as infections are relayed to the MET escort so it can be relayed to medical.
• Collaboration as a team includes purchases for assistive devices and / or equipment that may be needed.
• The facility is working towards National Commission on Correctional Health Care (NCCHC) accreditation which will require some custody changes, such as the custody policies. One example of this change is the classification of isolation cell inmates. Medical staff will begin determining an inmate’s ability to be placed in an isolation cell. This already occurs unofficially but will be official policy once accreditation is achieved.
Vanir Recommendation: None; the Sheriff’s Office has significantly addressed medical needs in the Policy and Procedures Manual for the impaired inmates.
G. Population and Housing • The Medium Security Facility (MSF) is predominantly a pre-sentenced population.
• Medical and classification work together to determine housing assignments. It is then up to the shift commander and upward to work on accommodations if there are any issues.
• Housing receives a notice from medical triage if an inmate is impaired and requires special accommodations.
• With mobility issues, many times the classification officer has met with the inmate before the nurse has. Medical only talks to the classification officer about conditions that would affect an inmate’s housing (usually via a form).
• The housing officer and classification officer speak with one another after an ADA inmate has been placed. Usually the ADA inmate has been separated from other inmates in receiving. The inmates are generally by themselves and have the necessary assistive devices making it a visible impairment.
• If they are placed in housing, medical gives the officers a note that is placed on the wall and in every modular office. Additionally, a flag is added to their file or typed into the system to note the impairment.
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• Impaired inmates may be housed in general population. In some cases, the officer may first become aware of their presence when approached by either the impaired inmate, or another inmate on their behalf.
• Inmates with new impairments (such as severely intoxicated, hit their head, etc.) must be cleared by medical or sent to the hospital.
• Hearing-impaired inmates can be housed anywhere depending on their classification.
• The majority of inmates are repeat offenders (at least 80%) so staff already knows their needs.
• Staff noted that there have been very few sight and hearing-impaired inmates. Mobility impairment has been the biggest issue. There have been only two deaf inmates in the last two years.
• Staff noted that it would be helpful if ADA patients were housed in one part of the jail for easier medical staff response. Getting inmates in and out of cells with medical equipment is very difficult.
• There is very limited ADA space for a protective custody inmate that adequately balances the safety and security of the facility.
• The doors with glass in the Old Tank all have intercoms, but others do not, requiring an inmate to shout for help. Cells in the North West and Intake and Release Center (IRC) all have intercoms. Staff noted that the New East ISO has more than one, and maybe all, have intercoms. The intercom is connected to Central Control and serves as an alternative to radios. Emergency / panic buttons across the hall are for staff use that sounds an alarm in Central Control.
• South Dorm is for medical and ADA because it has the most accessible conditions for cell or open dorm environment. Staff has had to place some high-risk inmates in there until they can be moved. Staff reports that inmates are usually happy.
• Wristband colors are color coded for security levels and are not set up for ADA. The facility does not have scanners for the barcodes.
Vanir Recommendation: When any impaired inmate is assigned to a housing unit, the transportation officer should contact the custody officer in charge of the impairment status of the inmate to be housed. It would be helpful to have colored wristbands identifying the impairment of the inmate so staff can better provide for their accommodations. Consider housing inmates with impairments in appropriate accommodations (i.e., intercoms, permanently mounted TTY / TDD, showers, closed captioned television, proper heights and reaches, etc.).
H. Visitation • In addition to face to face visitation, the facility is considering some video visitation in the future.
• Staff noted that the North County facility may have video devices with “TTY / typewriters”.
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• Staff noted that they believed some of the visiting windows should be lower for wheelchair viewing.
• Some areas downstairs don’t have benches for wheelchair access or elevators. Staff brings in chairs if there is an issue sitting on benches.
• Seeing eye dogs are allowed during visitation if they are not disruptive to anyone else; however, staff noted that they have yet to see one come downstairs to the visitation area.
Vanir Recommendation: Provide ADA accommodations for visiting for both inmates and public (see Transition Plan).
I. Programs and Classes • The facility partners with Santa Barbara City College and must have at least 20 students to hold a class. There is a maximum number of students per classroom based on State Fire Marshal regulations. • There are schedule and time allotments for programming and classes. All classes are less than two hours each. • All programs are available to all inmates regardless of impairment for general population inmates only. There are no specific programs focused on inmates with impairments. • Each inmate, regardless of impairment, must be cleared to attend programs and classes. • Program and class participation are voluntary and open to all inmates wanting to participate if they meet the qualifications. • One inmate in wheelchair took a computer class approximately five years ago. • Providers and volunteers make every effort to fill the allotted program and class time with as many different subjects as possible. • Narcotics Anonymous and Alcoholics Anonymous are held in the housing units. • A lot of programs are in the evening at the Medium Security Facility (MSF), so inmate workers can attend classes. The religious programs and Sheriff’s Treatment Program are scheduled. • If a mobility impaired inmate is in general population and cleared to attend classes, they may attend programs if they are given access via wheelchair. Usually, an officer brings the mobility impaired inmate down first since it takes longer to escort them through the facility. • Inmates contact Inmate Services to request library books, legal information, etc. Inmates utilize the Inmate Request Forms when making requests. The Legal Research Association in San Francisco is under contract and ships braille materials the next business day upon request. • The Library has approximately four different genres. Books are ordered based on usual genres requested by all inmates.
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• There is only one officer to escort inmates to and from the programming area. Some programs have an officer stationed there. If there are more than five inmates there are two officers.
• Sheriff staff is not always posted in program and classrooms. There is a call box and radio in classrooms, and service providers are told what to do by an officer in case of emergency.
• Service providers are considered visitors and as such have limited access and are escorted to / from classrooms by an officer.
Vanir Recommendation: Clarify and provide, in both the Policy and Procedures Manual, and Custody Orientation Handbook, the eligibility requirements pertaining to programs for inmates with disabilities. In the Policy and Procedures Manual, Section 209 Page 66, specifies a list of criteria which is not apparent in the Custody Orientation Handbook.
J. Assistive Devices • Staff noted that CFMG / Wellpath honors any assistive device an inmate enters the facility with.
• The jail’s nurse practitioner or doctor determines what assistive devices (such as canes and wheelchairs) are necessary on a case by case basis after meeting with an inmate.
• The use of an inmate’s personal cane may be allowed based on their security classification. However, all personal wheelchairs are stored, and a jail issue wheelchair is provided to reduce the introduction of contraband into the facility.
• The inmate’s classification level is taken into consideration for safety of both staff and inmates when issuing assistive devices.
• Staff noted that there are cases where an inmate is issued an assistive device and it is not removed once deemed no longer necessary. In such cases, medical staff alerts the supervisor to address the issue and remove the item from the inmate’s possession.
• If an inmate is in poor health or too frail to use a wheelchair on their own, staff or other inmates may assist by pushing their wheelchair as needed. If an inmate is moving too slowly, an officer may push their wheelchair to assist.
• Staff stated that there have been instances with mobility impaired inmates purposely breaking assistive devices on an ongoing basis and filing complaints with the ACLU that the facility is not incompliance.
• If inmate abuses equipment they can be written up and lose visitation and / or commissary privileges, or more. Additional charges may be brought against the inmate as well.
• The facility is working on purchasing new shower benches. Inmates were breaking the shower benches and the chairs that replaced them. Medical is working to purchase a surplus of shower chairs so they are available when needed.
Vanir Recommendation: See Transition Plan for refurbishing showers with benches. In all cases, staff shall make every effort to provide assistive devices to inmates with disabilities. During the booking process, staff shall work with the medical provider and inmate to determine which
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assistive device is best suited for the inmate with disabilities. Consideration should also be given to the inmate's capacity to harm themselves or others. The County shall explore procuring assistive devices that hold up to inmate abuse and assure timely repair or replacement of broken and nonfunctioning devices.
K. Communication • Usually, a deaf inmate will write a note to an officer noting that they are deaf and cannot hear so that the officer is aware of their impairment.
• Officers use white boards to write notes to alert other officers to the presence of impaired inmates. The white board is used to alert officers of inmate issues such as fighting, spitting, wheelchair use, etc. Staff may not list a hearing impairment on the white board.
• One staff member noted that they may be away from a computer for up to six hours. Therefore, a flag in the system would go unnoticed unless it was written on the staff white board or posted in the office. Unless there is a handwritten note from another officer, the officer may be unaware of the impairment.
• When shift changes, officers review / brief relief officers coming on post of any issues or inmate impairments they should be aware of.
• The officer’s squad holds briefings for impaired persons every two weeks where they share the information with the other officer in the module.
• Hearing and / or speech impaired inmates may use Inmate Request Forms, paper, and golf pencils available to all inmates to communicate with staff.
• No special materials or systems are provided by staff for hearing, speech, and / or visually impaired inmates to communicate with attorneys and / or other professional providers.
• Being able to hire someone who knows ASL is extremely difficult. There have been two nurses and several officers on staff that know ASL.
• There are no sign language interpreters on staff, but an accommodation would be made if requested. Staff would reach out to the college or public for an interpreter if needed. Interviewed staff did not recall any interpreter requests during their 25-year tenure.
• Staff noted that it is difficult to escort hearing-impaired inmates without utilizing a “hands on” approach to direct them where to go, especially in an emergency.
• No comments were provided regarding communication with speech and / or visually impaired inmate communication.
Braille Materials • Legal paperwork is provided in braille.
• There are a few books in braille that were acquired from the Santa Barbara Braille Institute. All other library books are donated.
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• The braille books in the Library are westerns and romances that were requested by one inmate and are over five years old.
• Braille material requests are quite rare, and staff was unable to provide a demographic as such.
• Staff recalled one request for braille materials three years ago.
• Officers distribute the braille materials upon request and return them when finished.
Vanir Recommendation: The use of written placards for common words or phrases has been used successfully in other facilities such as meal time, recreation time, bed time, showers, etc. Also provide paper and pencil for communication with the hearing-impaired. When any impaired inmate is assigned to a housing unit, the transportation officer should contact the custody officer in charge of the impairment status of the inmate to be housed. It would be helpful to have colored wristbands identifying the impairment of the inmate so staff can better provide for their accommodations. Since the braille materials are free from the Braille Institute in Santa Barbara, it would be advantageous to have more than a couple of library books available to those inmates requiring them.
L. ADA Grievances • Inmates may file a grievance or a request for equipment. Staff will consult with medical regarding the request.
• An appointed medical staff person answers every ADA grievance. There is a designated grievance lieutenant and medical’s ADA grievance responses are forwarded to him / her for review. Medical updates if needed, then grievance lieutenant formally responds to inmate. An inmate may protest the response by filing an appeal which goes through a lieutenant (not necessarily the same lieutenant that reviewed the grievance originally). Medical reviews the grievance appeal and advises the responsible Lieutenants. Then the Lieutenants review all grievances for the facility. The inmate can file a writ. (There were two medical writs pending at the time of our interviews.) At that point, it goes to CFMG / Wellpath Corporate and the Sheriff’s Office.
• Disputes are usually between an inmate and the Sheriff. Medical and classification work well together.
• There are no records of complaints and no procedure to track complaints in the new system. Some grievance forms are kept in folders by staff when possible; however, staff we interviewed stated they did not have any claims to keep.
• Staff tracks responses for the American Civil Liberties Union (ACLU). The ACLU visits every Thursday and speak with anyone that wishes to meet with them (not all ADA). Within two days of the meeting, the ACLU sends a report and the jail has ten business days to respond. The ACLU report is reviewed by staff and forwarded to the Sergeant, the Commander, and then back to the ACLU. A common issue is non-ADA showers and staff is working to resolve the issue.
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Vanir Recommendation: It would be helpful to have an automated system to track the nature of each grievance to determine if there is a reoccurring theme, especially with inmates with impairments.
M. ADA Accommodations • All inmates may shower any time except during lights out. There is no showering schedule, nor time limits for showers. • Staff did not recall any issues regarding an ADA inmate showering first. • There is no ADA shower in the Northwest Jail facility. To improvise, the Janitor Closet was used with an officer guarding the inmate and providing privacy as necessary. • Inmates will have to take their shower in the South housing unit. • Staff noted they would like to have one ADA shower in each section of the jail. • Impaired inmates have access to all programs if they are in general population and cleared for attendance. • TTY / TDD machines are not located in every housing unit. Access is available in the IRC. Access is restricted due to impairment to it is not readily available at all times. • The facility is using TTY and have video visitation in the new facility. Nothing has been designed for the Main Jail yet but may be adding them. • Some holding cells have windows where inmates can sign paperwork. The TTY is stored there, and an officer brings it to the inmate so they may use it in the housing unit. Staff brings the inmate to the booking holding area to use it during telephone time if requested. • Staff asks the inmate what time(s) they’d like to use the device, so they can establish a routine for the inmate and their families. The inmate can always submit a yellow request form to an officer and it will be read immediately. • One staff member we spoke to was unsure of its location in the facility and had never seen it. The staff member planned to contact the sergeant if one was required or requested. • TTY / TDD machines are available at flexible times and hearing-impaired inmates can set up preferred times through staff. Inmates can notify an officer a few hours in advance when they need to change their pre-arranged time for TTY / TDD use. • Staff noted that they never encounter issues with hearing-impaired inmates. The facility has a TDD that’s readily available. Inmates are escorted to the IRC booking hold to use the TDD when requested and are familiar with its use and operation. • There are three TTY / TDDs that are shared at the facility. Hearing-impaired inmates often receive extra phone time because the escorting officer will leave them in a holding cell to use the device and come back when they have time to return the inmate to their housing unit.
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• The inmate telephone system does have a working TDD. Telephone is only provided in English and Spanish.
• Television viewing has open seating with no special arrangements for hearing-impaired inmates.
• Officers control the television volume and it is usually fairly loud. The facility does not provide headphones to inmates and are not considering providing any in the near future.
• Closed captioning is on occasionally and turned on upon request. However, if the closed captioning blocks part of the picture, it may upset other inmates, making it less likely the hearing-impaired would request it.
Vanir Recommendation: See Transition Plan for remodeled showers in each classification type. Provide a permanently mounted TTY / TDD at locations where inmates require them so they are available at any time. Also consider video relay equipment and service at that same location (this equipment and relay service is typically offered free). Time consideration should be given to hearing-impaired inmates that use the TTY / TDD due to the lag in digital translation. It is also recommended that headphones be available for hard of hearing inmates for television viewing.
N. Recreation • Depending on housing and yard size, basketball, handball, volleyball, dip bar, pull up bar, and sit up area are available. Handball is available in all recreation yards. • The South Yard is a big, open concrete yard with benches, but no stationary equipment. • The Main Jail added stationary equipment for pull ups and dips as well as some benches in 2017. This yard has a centrally located ramp in the back of the yard. The basement dorm accesses this yard via elevator. • Non-impaired and impaired inmates recreate together. • No special recreation activities are provided for inmates based on their impairment. Staff we interviewed have never received a complaint about not going to the recreation yard or classes due to impairment. • No special equipment is provided for impaired inmate recreation. • All inmates go to the recreation yards. A ramp is used when needed.
Vanir Recommendation: None.
O. Miscellaneous Topics / Notes Extra Privileges for Inmate Workers • Extra privileges for inmate workers are dependent upon the situation, where they’re at, and the officer. For example, the kitchen crew receives more hot meals. If an inmate cleans a dirty cell, they may receive a soda or an extra lunch.
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• Inmate work is not limited by impairment if the inmate can perform the task. Work assignments are at the discretion of the individual officer and civilian cook.
• The facility does not have a formal policy stating inmates will receive anything in exchange for performing tasks.
• Unit 400 and 200 STP tanks receive extra yard time as workers are assigned to that module. They receive extra benefits when housed in those units and ADA qualifies for the extra yard and out time as well.
Vanir Recommendation: If a perk is offered as a reward for a task / activity, then inmates with impairments shall have the same access to these perks. This may be for a different task / activity.
Inmate Welfare Fund • The Inmate Welfare Fund is solely for the benefit of inmates and is based on commissary sales
and phone income (no tax dollars). At the time of our interviews it was worth several million dollars as reported by staff, and it is utilized to purchase necessary equipment and materials. Vanir Recommendation: Consider, if not already done, purchasing devices for inmates with disabilities or impairments out of the Inmate Welfare Fund.
Vanir Assessment and Recommendations
Based on the responses from the Sheriff’s staff, it is Vanir’s opinion that all that were interviewed are very conscientious about inmates with disabilities and generally possess an attitude to accommodate those inmates as best as they can. It is also noted that some staff are very informed regarding the written policies and procedures; however, some need additional time to familiarize themselves with the depth of the policies and procedures, especially regarding the ongoing changes.
It’s imperative that the person / department responsible for the jail’s policy and procedures, staff training, amendments, books, and logs pertaining to inmates with impairments be attending local / national classes on ADA laws including implementation, court decisions, and best practices. This position should have the authority to assist in making changes to the jail’s operations to accommodate those inmates with impairments. We recommend that this position be a Lieutenant or higher.
EXPERT REPORTS REVIEW As part of Vanir’s assessment, we reviewed several confidential expert reports related to the condition, safety, and operations of the facility. The confidential expert reports submitted for our purview and their summarized observations and relevant recommendations are listed below.
Assessment of Custody Operations Santa Barbara County Jail System (Site Visit April 3-7, 2017), by Margo L. Frasier, J.D., C.P.O. This report includes 46 recommendations for the Santa Barbara Jail. The author notes that only some of them can be implemented prior to the completion and occupancy of the Northern Branch Jail to
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improve the living conditions and safety of the Santa Barbara County Jail System. We have only included the most pertinent recommendations here as part of our summary review.
• Crowding in the South Dorm is particularly problematic as it holds the most medically infirm; including inmates who are required to use wheelchairs to get around inside the Housing Unit. Having inmates sleeping on the floor with their beddings and belongings taking up limited floor space further complicates issues with mobility.
• Inmate workers should be used to clean the cells of inmates who are incapable of cleaning their own cells due to medical or mental health issues.
• An objective classification system, including a Housing Unit Assignment Plan, should be implemented. While it is possible to use a tool that has been validated elsewhere, it is recommended that Santa Barbara County contract with an expert in classification to help guide the Santa Barbara County Jail system through the process.
• Classification Unit staff should receive training on the use of the objective classification tool. The National Institute of Corrections offers training on objective classification and it would be advisable for as many staff as possible to attend.
• There should be significant involvement of mental health staff in classification and reclassification of inmates with mental health issues. The goal should be to place inmate in the least restrictive environment as possible for the safety of the inmate and others.
• Routine audits should be performed on the Classification Unit and the individual staff members of the Classification Unit to ensure performance is in line with the designated criteria. The auditing mechanism should record the percentage of inmates that classified within 12 hours of booking, inmates that are housed according to their assigned custody levels, inmates that are housed in protective custody, overrides and the reasons for the override, and reassessments that are performed within the timelines detailed by the classification policy and the outcomes. Criteria as to acceptable performance should be set out in the classification policy.
• The classification policy will need to be updated once the objective classification system is implemented.
• The safety cells should only be used for their intended purpose; protection of an inmate from imminent self-harm when no other alternative is sufficient.
• Seldom does an inmate who has destroyed property need to be placed in a safety cell. When an inmate has created a safety hazard due to destroying something in the cell, the item should be removed. It might also be appropriate to remove all other items that could be destroyed from the cell until the inmate’s behavior improves. If the inmate must be relocated while repairs are made, placement in another isolation cell or a holding cell is preferable to the safety cell. If an inmate must be placed in a safety cell as there is no current alternative, unless there is a specific reason for removing their clothing and placing them in a suicide resistant smock, they should be allowed to retain their regular jail house clothing.
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• Inmates whose behavior warrants placement in isolation should be placed in South Isolation. A behavior management plan should be developed by where the inmate may work himself out of isolation into the disciplinary tier (recommended that it be one of the Northwest Housing Units) and gains additional privileges through conformance to the rules and appropriate behavior.
• It is recommended that an inmate to officer ratio of 60:1 be adopted. This would require an additional housing module officer in each module with the exception of the Male Basement.
• It is recommended that three additional movement officers be assigned to the medical section so that they escort the medical / mental health staff to the Housing Units and escort inmates from the Housing Units to the medical section.
• A staffing study of the Santa Barbara County Jail system should be performed. It is clear that there are not enough staff performing the custodial functions in the housing areas and for escort, but an analysis should be performed to determine whether and where from staff could be redeployed to fill those needs. It may well be that no staff can be redeployed.
Vanir Comments: The County and Sheriff’s Office have taken steps to alleviate floor sleepers with the construction of a new jail facility in Santa Maria. The facility will contain robust spaces for mental health, programs, and inmates with impairments. That facility is to open early 2020. The new facility will greatly alleviate many of the operational issues due to overcrowding.
Review of Mental Health Services Currently Provided by the Santa Barbara County Jail System (Review Conducted Between April 12-14, 2017), by Roberta Stellman, M.D., DABPN
Dr. Stellman toured the entire Main Jail and an attempt was made to briefly interview all inmates in restrictive housing, medical, and mental health general population areas, and other general population inmates as time permitted. General inmate complaints during her tour were validated by interviews with mental health staff and direct observation. The majority of Dr. Stellman’s report focuses on mental health issues; however, Vanir is only reporting on the facility response to mobility, sight, and hearing impairments. Therefore, we have only included observations and recommendations for those particular issues below.
• On April 1, 2017, CFMG became the new health services provider after a 20-year relationship with PHS/Corizon.
• Moldy shower conditions in the Medical Housing Unit. (The inmates reported that the shower had been pressure washed the day before her tour).
• Upon departure from the facility, Corizon reportedly sent all of the clinical tracking logs to their hub and were not available at the start of CFMG’s transition, hampering the transition to the new health care vendor. Loose medical record filings have not been done for six months and have been stored in 15 to 20 boxes with no system of organization. Under Corizon, staff report that it took 2-3 hours to locate charts if they were able to find them all. Clinical staff often saw
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inmates without records available to them, resulting in frequent time inefficiencies because of the need to repeat historical questioning and missed identification of prior treatment. Corizon created new charts for each individual entering the Jail every year.
• Almost all non-psychiatric visits are conducted without sound privacy and through cell grills or doors. Encounters, though they may be frequent, are extremely brief and constitute rounds and not treatment services.
• On April 19, 2016, it was noted that due to the lack of custody escort and medical staff, Corizon was 334 sick call requests in arrears for medical services.
• It is strongly recommended that the Santa Barbara County Jail (SBCJ) develop its own system and site-specific policies and procedures. The private health provider should be bound by contract to the current and future SBCJ policy manuals. Such a practice allows for continuity in processes and requirements regardless of which company provides services at the Jail. Relying on jail / prison systems outside of the State of California will also help align policies with national standards such as National Commission on Correctional Healthcare Jail Health Standards (NCCHC), or American Correctional Association (ACA).
• Policies and procedures should specify the minimum timeframes to complete specific tasks, quality requirements such as documentation guidelines, laboratory and examination requirements, triage systems, etc.
• Specificity regarding the procedures should easily enable the development of measurable quality indicators that can be employed to monitor the implementation of policies.
• Based on the observed levels of acuity and chart reviews, staffing levels at the current time are deemed inadequate despite the facility being fully staffed for contracted allocations.
• Even without a full staffing analysis it is unlikely a staff of five would be adequate to provide all the screening and assessment functions as well as crisis services, treatment programming, sick call requests, needs assessments and discharge planning as treatment planning, multidisciplinary treatment team planning for the sub-acute seriously mentally ill inmates, monitoring and counseling of suicidal inmates, etc.
• Multiple inmates throughout the facility reported that there was an abrupt change in their medication or the availability of their medication with the conversion from Corizon to CFMG. Initiation of verified and non-verified medication practices should be monitored to ensure the requirements of the CFMG contract is met. Based on interviews with inmates, the inmates state that medication is often not available in a timely fashion following intake.
• CFMG needs to monitor the medication administration process to ensure that prior prescriptions did not lapse with the change in health vendors.
• Health service requests should be handled in a confidential manner unless the inmate chooses to communicate directly to non-health staff. Communications back to inmates from health staff by mail should be sealed in an envelope with the inmate’s name, number, and location on the front. 44

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• Develop a triage system with documentation on the form for the triaging licensed professional to enter the level of urgency and a tracking system to accurately monitor the efficacy of the process. This data will also be necessary for staffing analyses.
• Develop a system to log inmate requests so that periodic quality reviews can be done to assess whether: o Health service requests are retrieved in a timely manner. o Health service requests are triaged within the established timeframe. o By the nature of the complaint a proper level of triage is assigned. o Mental health staff appropriately resolved the complaint. o Mental health staff resolve the complaint in a timely fashion.
• A confidential health service request system should be implemented.
Vanir Comment: A new modernized medical and mental health treatment area is planned for the Main Jail. This space will allow a high degree of efficiency, security, observation, and supervision of the inmates brought to the area for exams or reside in this area due to illness. The area will contain natural light, wide corridors, and softer materials.
Review of Santa Barbara County Jail Medical Services (September 2017), by Scott A. Allen, M.D.
Dr. Allen’s overall findings are that the current level of care in the Santa Barbara County Jails is inadequate, poses a significant risk of serious harm to inmates confined there, and does not meet minimal constitutional standards. He found that the inadequacy of the current health system can almost entirely be attributed to: 1) inadequate performance by the previous medical contractor; 2) physical plant issues (including lack of appropriate clinical space); and 3) correctable programmatic deficiencies and institutional barriers in the current program. Dr. Allen went on to say that he found most of the Department medical staff including nurses, health professionals and administrators, and the Sheriff’s Department liaisons to be professional and competent. If the historical structural and resourced based issues are addressed, care could be brought up to meet constitutional standards. Dr. Allen’s site visits occurred only six weeks into CFMG’s tenure at the facility. Meaningful corrective measures have been initiated since his visit, but there has not been enough time for those interventions to have corrected the deficiencies that accrued under the prior contract period. All problems described below were verified either by medical records, by staff, or in some cases, by both.
• At the time of Dr. Allen’s report, the Santa Barbara County Jail Health Services were not accredited with the National Commission on Correctional Health Care (NCCHC) or the American Correctional Association (ACA). According to CFMG, the Department was moving forward with plans to apply for accreditation with the NCCHC.
• There is no policy for dealing with transgender patients.
• Nursing staffing remains short of the Department’s own stated plan and is not sufficient to deliver appropriate medical care. A reasonable staffing recruitment plan is in place, and efforts to recruit new physicians and nurses is underway, but four years after the Department was 45

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made aware by consultants of staffing deficiencies, the staffing levels proposed by the Department have not yet been met.
• The one shortcoming of the current staffing plan is the absence of a nursing post for intake. The intake nursing responsibility is handled by nurses being pulled from other posts. When that happens, other functions shut down. Intake is a critical post in a jail facility, and as such, it should have its own dedicated nurse.
• The facility is understaffed for medical providers and the schedule is inadequate to cover the needs of a 24/7 facility. According to the Sheriff’s 2013-2015 Triennial Report, the medical program handled over 13,000 sick calls per year, or roughly 35 sick calls a day.
• The current physician coverage for the jail is only a 0.4 FTE position, with physician present onsite for only three days a week, and those days are grouped together mid-week. As a result, there is no physician present for four continuous days every week. This is totally inappropriate and creates unjustifiable risks and liabilities.
• There is only one physician medical provider at the Main Jail. A review of medical records reveals that her medical documentation of care is poor, and care of chronic conditions does not meet reasonable community standards. It is notable that the only physician is not board certified in internal medicine, family medicine, nor emergency medicine (the three appropriate specialties for a primary care provider in an adult jail).
• There are a high number of inmates who actively have or have had recently suffered from a serious skin infection due to a drug resistant form of the bacteria staphylococcus aureus, known as MRSA. This MRSA problem is likely a reflection of overcrowding combined with sanitation issues.
• There is no adequate centralized clinic space in the old Jail. Clinic space and exam rooms are dispersed throughout the facility impacting efficiency of care and requiring the support of an additional security officer for each clinic space in operation at any given time.
• There is inadequate office space to support the medical work force, and inadequate storage space for supplies.
• The building is old and in disrepair. Floors, counters, and other services were in poor condition and were not clean. Rubbish and debris were found on floors and hallways. Boxes and other non-trash items were improperly stored in hallways and offices.
• Issues of sanitation are a problem throughout the facility, but worst in the oldest areas of the building.
• Across the entire system, the Santa Barbara County Jail has no ability to provide infirmary level or intermediate level of care. As a result, inmate patients requiring higher level care must be transferred to outside facilities with the attendant higher medical and security costs. The Main Jail does have a “medical unit” but there is nothing about the unit that affords a higher level of medical care. It is simply a dormitory where inmates with medical conditions are housed.
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• Current intake does not meet NCCHC standards because not all incoming inmates are being screened. In random medical record reviews, records identified inmates housed in the facility for over two weeks with no medical screening at all.
• Documentation of clinical encounters is often brief and incomplete. There is almost no documentation by physicians of patient education about their illnesses, their lab or test results, or the treatment plan.
• Chronic disease management is inadequate. Management of chronic illnesses such as asthma, diabetes, HIV, and hypertension, among others, to be ad hoc, incomplete, inconsistent, and reactive as opposed to proactive. Care of chronic diseases appears to be driven more by inmate self-advocacy than by widely accepted clinical guidelines.
• There is no complete, accurate, or reliable list of patients with chronic care conditions. There are no protocols that are followed for ongoing care of chronic illness, such as regularly scheduled follow up visits (those appear to be scheduled inconsistently, if at all, by individual physicians and nurses with no clearly documented logic or clinical reasoning). In a number of reviewed cases, care of chronic disease patients appeared to be negligent and overall care of chronic diseases could be characterized as deliberately indifferent.
• The Jail is not consistently providing timely access to care for serious medical conditions. Shortcomings in timely access to care occur in: nursing care; access to a facility physician for serious medical care; and specialty care that cannot be provided onsite.
• The Jail makes minimal accommodations for inmates with physical disabilities and in many cases the accommodations are overly restrictive or inadequate to accommodate the disability.
• Restrictive formulary with almost no medical non-formulary requests. There were multiple requests by the psychiatrist for non-formulary medications, but the medical doctor almost never requested non-formulary medication. This suggests an overly restrictive approach to the formulary beyond what is reasonable. Dr. Allen also found restricted use of rescue inhalers and under-diagnosis of asthma.
• The facility makes little use of Keep On Person (KOP) medications.
• All facilities experience a high level of grievances by inmates alleging inadequate care. A large number of these grievances were substantiated.
• There appears to be no meaningful standardized risk-based classification. While this may seem to allow for some efficiency for security purposes, such restrictive conditions of confinement create unnecessary barriers to care and introduce significant inefficiencies and risks in the delivery of health care. This approach seems particularly harsh and problematic for inmates who may be detained in these facilities for longer periods, such as the AB109 population.
• Many inmates are confined to their cells or cell blocks for most of their incarceration period. They are let out for daily showers and twice a week for recreation time. There appears to be very minimal programming or educational time. Their access to health care personnel is
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limited by their limited movement and relies on a paper driven “kite” system for reporting a health concern. Their only other alternative is to call a “man down” medical emergency.
• A 2013 consultant report by Crout and Sida found insufficient custodial staffing overall, and insufficient medical escort staffing in particular. Insufficient custodial staffing in support of medical services remains an issue at the time of Dr. Allen’s visit, resulting in preventable barriers in timely access to medical care and very inefficient use of medical professional time. Doctors and nurses are routinely kept waiting for patients to be transported or to be escorted to areas of the facility that require custodial escort for staff.
• Santa Barbara County Jail failed to deliver adequate medical care in large part because the previous medical contractor provided inadequate care. While replacing that provider with CFMG was an important corrective step, the County is still largely relying on the contractor to meet the County’s constitutional obligations to provide care. While the work can be contracted out, the responsibility of the County in providing minimally acceptable medical care cannot (emphasis original). The County currently does not employ County resources nor expertise in providing oversight to the medical contract.
• In the 2016 report on realignment, the consultants made the following recommendation: o Require the Department of Public Health and Behavioral Wellness to Administer the New Medical Contract for the Sheriff Rationale: The Sheriff is not the proper agency to monitor a contract that delivers mental health services in the Jail. The County’s Departments of Public Health and Behavioral Wellness should administer the contract to ensure inmates are being properly assessed and treated in the Jail, and to ensure the transition from the Jail to the community does not interrupt the services that were being provided in the Jail.
• It is imperative that the Santa Barbara County Board of Supervisors recognizes and acts upon the obligation of the County to provide adequate access to health services for inmates in the County Jails as required by California law and the U.S. Constitution. Budget concerns alone are not a sound legal defense for failure to provide a constitutional level of care to inmates.
• The Department should move forward with the process of preparing for, applying for, and securing accreditation with the National Commission on Correctional Care. If the Department follows through with its current plan, the Jail may be able to secure accreditation within a year or so. The process will also provide a standardized framework for securing an acceptable health care program.
• The County must take ownership of its policies and procedures for the delivery of medical care in its jails consistent with the County’s legal obligation to provide that care. Such policies may be developed in close coordination with the medical contractor, but the County should retain authority and control over County Jail medical practices. Policies should be consistent with NCCHC and ACA standards.
• The Department should work with the contractor to establish appropriate medical professional staffing levels and then work to maintain them and adjust them to address changing needs.
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Salary levels should be adjusted to make sure it is competitive with other jobs in the California correctional medicine market and the surrounding community. The staffing plan should include at least one board certified FTE physician, supplemented by one FTE physician extender such as a nurse practitioner. Ideally, those positions would be staggered in schedule to allow the presence of at least one of the other seven days a week.
• The County should recruit at least one board certified FTE physician (who would also serve as the Responsible Physician with ultimate authority on all clinical decisions consistent with NCCHC policies). The complexity of correctional medical care and the liability to the County associated with the failure to provide that care makes the hiring of a board-certified physician a sound policy.
• As the impact of overcrowding impacts the health in the facilities, the County must develop a timely plan to address overcrowding. From the 2017 Grand Jury Report, “The Main Jail, originally built in 1971, has been described as old, antiquated, and overcrowded. It is rated for 659 inmates, and the Medium Security Facility is rated for an additional 160 inmates. The average population at the Jail tends to be over 1,100. Both overcrowding and poor healthcare have been found by the Federal courts, including the U.S. Supreme Court, as potential evidence of unconstitutional care. As a constitutional issue, the obligation of the County to address overcrowding and health care impacts cannot be excused simply due to financial pressures facing the County.
• The Department should examine and consider options to develop newer and more suitable clinic space to support health operation; space should be large enough to accommodate clinical operations while also securing appropriate privacy for patients. It would be advisable to consult closely with County correctional health staff on the plans for clinic space before breaking ground on a project.
• Intake screening room does not have a door and therefore does not provide auditory isolation for confidentiality of sensitive medical information. Lack of auditory privacy might lead to incomplete disclosure of critical health info and missed opportunities for risk mitigation. All clinic and screening spaces should have auditory privacy for health professional and patient interactions.
• Adequate clinical space in the Main Jail as well as development of isolation cells that are not hidden or remotely located will require substantial architectural modifications. Isolation cells should have direct line of site and be within hearing or two-way intercom or call button.
• The County should formally consult an Environment of Care expert to evaluate the facility to make recommendations to address issues of cleanliness and sanitation. This is a priority area of concern and warrants expert consultation for a plan forward.
• The Department should explore options for developing at least one facility that could provide a higher level of medical care such as infirmary or sub-acute levels of care. The department should consider the development of at least a small infirmary that could provide care such as simple intravenous medications or basic post-operative wound care so that inmates are not
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kept in higher cost settings any longer than they need to be. While the planned Northern Branch will have appropriate medical housing space, space in the Main Jail would have to be appropriately designed to support this function and would likely involve new construction.
• The Department should continue to ensure that all newly arrived inmates are screened on arrival by licensed nursing staff. Screening procedures need to be revised to ensure that all inmates are screened upon arrival to the facility consistent with NCCHC guidelines. It is recommended that the staffing plan include an intake nursing post commensurate with the high volume of the facility and critical nature of this function.
• The Department should follow through with its plan to deploy a correctional Electronic Health Record (EHR) and provide ongoing IT support to both the network infrastructure and IT support for end users of the software.
• The Department should follow expert consultant advice on developing less restrictive approaches to dealing with inmates with disabilities. The old building is not handicap accessible. Wheelchairs don’t fit through some cell doors where wheelchair dependent inmates are housed (requiring the inmate to be carried or transferred in and the wheelchair must be collapsed first) and there are many other physical barriers to disabled inmates.
• Grievances should be categorized and analyzed as part of a Continuous Quality Improvement process. Systematic analysis of grievances should be part of a functioning Continuous Quality Improvement program.
Vanir Comment: A new modernized medical and mental health treatment area is planned for the Main Jail. This space will allow a high degree of efficiency, security, observation, and supervision of the inmates brought to the area for exams or reside in this area due to illness. The area will contain natural light, wide corridors, and softer materials. A three-person nurses’ station and custody officer will be central to all the activities. Doors, elevators, and hallways will be sized to allow gurneys and hospital beds access to the exterior for emergency considerations. Also, a negative air medical housing room with an ante chamber will be provided. The area will contain multiple exam rooms with privacy doors and curtains at the exam table.
SUMMARY RECOMMENDATIONS
In addition to the recommendations made throughout the report, overall Vanir recommends a combination of strategies to address potential ADA issues and reduce impacts to the jail operations while upgrades are made. To minimize impacts, three strategies are recommended:
1) Physically modify a minimum of 3% of cells in each classification to accommodate disabled inmates (i.e., path of travel, showers, devices, grab bars, toilet, TTY / TDD, etc.).
2) Provide upgrades to the medical / mental health functional use areas (FUAs) to better accommodate inmates with impairments.
3) Provide upgrades to the public access areas and add appropriate and compliant signage (i.e., signage, path of travel, visiting booths, TTY / TDD, etc.).
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Areas needing physical modifications or upgrades are prioritized within this report based on complexity, location, swing space, and cost.
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B. Transition Plan

ASSESSMENT
Overview
The Americans with Disabilities Act requires that when structural modifications are required to achieve program accessibility, a Public Entity must develop a Transition Plan that provides for the removal of barriers to the disabled. The essential elements of a Transition Plan are defined in the ADA as follows:
1. a list of physical barriers; 2. a detailed outline of the methods to be utilized to remove the barriers; 3. the schedule for taking necessary steps to remove barriers; 4. the name of the official responsible for the plan's implementation.

Provision for each of these essential elements is noted below:
1. a list of physical barriers.
This is provided in great detail as the Vanir ADA Assessment of Santa Barbara Jail, which is Part 2 of this report. The Assessment is a detailed document that includes building floor plans, photographs, and spreadsheets that identify elements that are not compliant with either the 1991, or 2010 ADA Standards.

The Assessment was developed as a stand-alone document that is strictly fact-based and has been developed without prejudice or subjective opinion. It includes:
1. a detailed outline of the methods to be utilized to remove barriers, and
2. the schedule for taking necessary steps to remove barriers.
The main body of "Section 6 -Transition Plan" provides a description of the methods and timeframes needed to remove barriers from the Santa Barbara Jail. The Transition Plan is broken down into Priorities 1, 2, and 3 with their associated timeframes. Because there are many factors that affect the funding of construction work, the timelines provided are broadly described, and are intended to provide general, rather than specific, direction.

Recommendations for Timing of Construction Projects:

Priority 1 - Immediate:

Work to commence within 1 Year

Priority 2 – Short Term:

Work to commence within 1 to 2 Years

Priority 3 – Long Term:

Work to commence after 2 Years

The name of the official responsible for the plan's implementation: Lt. Charles Powell, Santa Barbara County Sheriff’s Office.

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Bed Counts & Housing Needs Standards The ADA Standards mandate that 3% of inmate cells and 5% of dormitory beds meet the ADA accessibility requirements. These percentages must be applied to each type of housing, such as male housing, female housing, segregated housing units, and different security levels. The percentages must be met within the various classifications, but not necessarily on a building-by-building basis.
Classification Types Are Based on Inmate Housing Classifications (Per 2010 ADAAG 232.2) There are distinct classifications used to determine where inmates will be housed within the Santa Barbara Jail, including inmates with disabilities. These classifications were developed to provide a safe and secure environment for both inmates and staff.
• 3% or minimum one (1) cell serving each purpose is required for compliance • 5% of dorm room beds must be ADA accessible
ADA Accessible Cells Per 2010 ADAAG 232.1, at least three percent (3%), but not less than one (1) cell should be provided.
Due to the age of construction of both the older area of the jail and the newer area of the jail (built in 1963 and 1988 respectively), none of these cells are 100% ADA compliant at the present time.
The prior chart shows recommended locations of each of the Santa Barbara Jail accessible cell(s). Note that all supporting services and rooms (phones, showers, computer stations, etc.) in the classification unit shall also be ADA accessible. Clustering of accessible housing is allowed as long as the percentages are provided for with a minimum of one (1) for each inmate classification.
The clustering of accessible cells and beds can be handled in a way that results in a maximum number of ADA facilities in a limited number of buildings, with no accessible facilities whatsoever in many of the Housing Buildings. In this manner, the Santa Barbara Jail facility can maximize the use and minimize the cost involved in providing accessible upgrades such as showers, telephones, and tables in the buildings and pods for the supporting facilities.
Emergency Systems in Accessible Cells Per 2010 ADAAG 232.2.2, two percent (2%), but not less than one (1) of general housing / holding cells shall be equipped with audible emergency warning systems or telephones. All cells, accessible or standard at the Santa Barbara Jail are equipped with an emergency communication device (intercom) that when actuated by the inmate provides an audible alert directly to the housing control officer station panel. The officer is able to have a two-way discussion with the inmate using this device. When a hearing-impaired inmate actuates this device, the officer will respond to the cell of the inmate. This emergency communication device is located in all of the cells at the Santa Barbara Jail. The intercom devices located
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in accessible cells should be relocated to comply with mounting height requirements in areas where mobility impaired inmates are housed.
To communicate with hearing-impaired inmates in non-emergency situations, officers can use placards. The placards may contain typical phrases such as meal time, time for court, fire drill, and phones are off, etc. In addition, hearing or speech impaired inmates that can speak or write in the officer’s language can use paper and pencil.
ADA Cells: Accessible Routes 2010 ADAAG Chapter 4 … Accessible Route…2010 CBC Accessible routes from outside of the Santa Barbara Jail to any particular housing unit or module are reported in the functional use area (FUA) Circulation. Accessible routes within the unit or module perimeter are reported. These accessible routes must provide ample space and flexibility for maneuvering wheelchairs.
Santa Barbara Jail ADA Bed Count The chart on the following pages represents by housing units at the jail, the actual and required ADA beds needed to comply with 2010 ADAAG 232.2.2. The total bed count is 819 and 33 beds are required to be ADA compliant. There are eight beds that currently respond to ADA.
ADA Cell and Bed Evaluation Chart The chart on the following pages represents by housing units at the jail, the actual and required ADA beds needed to comply with 2010 ADAAG 232.2.2. It also provides further detail as to the cell types, specific locations, and rated capacities.
Santa Maria Jail ADA Bed Count The chart on the pages following the ADA Cell and Bed Count Evaluation Charts represents, the actual and required ADA beds needed to comply with 2010 ADAAG 232.2.2 by housing units at the new jail. The total bed count is 376 which requires that the number of ADA beds required for compliance is 16. There are an additional 17 beds that exceed the bed count ADA requirements in the Mental Health Area of the new Jail. The new Santa Maria Jail will be operational in early 2020.
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County of Santa Barbara - Santa Barbara Jail

#:1000

ADA Transition Plan for Adult Detention Facility

Current Accessibility Needs
During the course of our assessment, the current number of disabled inmates at the Santa Barbara Jail has been tracked and the results show that the actual need for ADA housing matches the actual ADA compliant housing available and is far below the 3% / 5% ADA requirements. This is shown in two ways:
1. On a random day (March 21, 2019) the total number of inmates with disabilities at the Santa Barbara Jail was six (6), which represents .6% of the overall inmate population. (The overall jail capacity is 951 and the rated capacity is 819).
2. Regarding the type of disability over this same period, the analysis shows the following:
Total Number of Disabled Inmates: 6 Mobility Impaired: 6 Hearing-Impaired: 0 Vision-Impaired: 0
The Sheriff’s Office has been maintaining records of all inmates entering the jail as to their ADA status. The chart below reflects an accounting of those inmates that need special accommodations. The Sheriff’s Office also tracks inmates needing canes, hearing aids, and eyeglasses. The mobility count in the chart below includes temporary wheel chairs for those inmates recovering from lower extremity injuries. The 2019 count is through March 21, 2019.

Number of Incarcerated Santa Barbara Jail Inmates with ADA Impairments

ADA Impairment Mobility Hearing Sight Total

2012 0 0 1 1

2013 1 0 0 1

2014 0 0 0 0

Year

2015

2016

3

9

0

1

0

1

3

11

2017 4 0 0 4

2018 17 2 1 20

2019 6 0 0 6

Totals 40 3 3 46

It is therefore recommended that these detailed studies be continued to confirm actual historical and operating needs, and that the remodeling projects providing additional accessible bed capacity be phased accordingly.

Corrective Action The corrective actions of the housing units are substantially related to the required percentage of accessible housing units. See section below. Also, for a complete background and understanding of specific elements requiring compliance, refer to the ADA Assessment, Vol. 2 which contains the specific dimensions, code citations, floor plans, and photographs of each area that was assessed.

PLAN OF ACTION
Phasing of Transition Plan Work
It is anticipated that these issues would be corrected through three phases of construction projects as follows:
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County of Santa Barbara - Santa Barbara Jail

#:1001

ADA Transition Plan for Adult Detention Facility

Priority 1: Immediate (Begin 0-1 year) Priority 2: Short (Begin 1-2 years)

Provide easily-achievable accessibility-upgrades per Accessible Priority Plan A.4 and A.5.
Remodel additional cells / dorms to reach a 2% of inmates target and remove barriers within primary function facilities and support facilities.

Priority 3: Long (Begin 2+ years)

Provide additional cells / dorms to reach a 3% of inmates target and dorms to reach 5% of inmate target.

An overall floorplan for Level 1- Ground Level (sheet A.4) and Level 2- Basement (sheet A.5) are included in Volume 2. These show the proposed phasing of housing unit corrective work with a breakdown of facilities grouped by classification.

These graphics show site and floor plans of the Santa Barbara Jail, with color coding for the various classification types. The ADA work is shown in three phases, with Phase A and Phase B designed to fully meet the needs of the institution, while still below the ADA required percentages. Phases C / D would bring the Santa Barbara Jail into full ADA compliance for required housing percentages.
Priority 1 – Immediate (Begin in 0-1 Year)
INTAKE AND RELEASE CENTER (IRC) Dayroom 100 & 200:
• The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
• The call-button’s forward reach is obstructed and the height to operable element is non-compliant. Telephone to be relocated.
• Modify or replace existing dining table to meet knee clearance requirement and / or ADA user count.
• Food and / or beverage counter obstructs the reach requirement and is thus non-compliant. Modify or install new counter.
• Under-stair protection is required for compliance with CBC 11B-307.4.

Dress-In 128: • Shower, water closet, and lavatory do not meet all accessibility requirements necessary for compliance.

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County of Santa Barbara - Santa Barbara Jail

#:1002

ADA Transition Plan for Adult Detention Facility

MAIN JAIL FIRST FLOOR South Dorm:
• Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• The call-button’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.
• Thermostat cage horizontally protrudes into path of travel more than the maximum acceptable dimension.
• Modify or replace existing dining table to meet knee clearance requirement and / or ADA user count.
• Shelf unit horizontally protrudes into path of travel more than the maximum acceptable dimension.
• Steel barrier at door threshold exceeds the maximum acceptable height. Remove steel and attach to bottom of door.

South Dorm Toilets and Shower: • Shower, water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.

MEDIUM SECURITY FACILITY ‘A’ Barracks:
• Accessible beds are not provided in this barracks. Provide two accessible beds, with accessible clearances, to meet requirement.
‘B’ Barracks: • Accessible beds are not provided in this barracks. Provide two accessible beds, with accessible clearances, to meet requirement.
‘C’ Barracks: • Accessible beds are not provided in this barracks. Provide two accessible beds, with accessible clearances, to meet requirement.
Males Latrine ‘E’: • Shower, water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance. • Door closer does not meet speed and force requirements. Provide and install new closer.
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County of Santa Barbara - Santa Barbara Jail

#:1003

ADA Transition Plan for Adult Detention Facility

NEW EAST ISOLATION Ad. Seg. ADA Cell 38 :
• Clear floor space provided at telephone is inadequate. The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
• Shower, water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
• The call-button’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.

Priority 2 – Short Term (Begin 1-2 Years)
INMATE SERVICES Lobby 01:
• Entry door and back door thresholds exceed the maximum acceptable change in level. Provide and install new door threshold.
• The door closer does not meet speed and force requirements. Provide and install new closer. • The telephone’s forward reach is obstructed, and the height to operable element is non-compliant.
Telephone to be relocated. • Service counter exceeds the maximum acceptable height. Provide and install new counter.
Public Unisex ADA Toilet 02: • Shower, water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance. • Door swing clearance at pull front-approach of door is less than 72” perpendicular to entrance. • Room is not identified with tactile character signage. Provide and install accessible signage with braille.

INTAKE AND RELEASE CENTER 200 ADA Cell 215:
• Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Desk or work surface does not meet knee clearance requirement. Modify or install new work surface.
• Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
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County of Santa Barbara - Santa Barbara Jail

#:1004

ADA Transition Plan for Adult Detention Facility

Attorney Visitation 215: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.

Attorney Visitation 145: • Door kick plate region 10” A.F.F. is not smooth.
• The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
• Desk or work surface does not meet knee clearance requirement. Modify or install new work surface.
• Room is not identified with tactile character signage. Provide and install accessible signage with braille.

Booking 2 166: • The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
• Service counter exceeds the maximum acceptable height. Provide and install new counter.
• Room does not provide a minimum 60” turning clearance within the 56” x 66” space.

Corridor 165: • There are multiple elements that protrude either horizontally or vertically into the path of travel clearances.

Holding Cell H6: • Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
• The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
• Light fixture horizontally protrudes into path of travel more than the maximum acceptable dimension.

Holding Cell H7: • Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
• The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.

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County of Santa Barbara - Santa Barbara Jail

#:1005

ADA Transition Plan for Adult Detention Facility

• Light fixture horizontally protrudes into path of travel more than the maximum acceptable dimension.

Holding Cell H8: • Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
• The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
• Light fixture horizontally protrudes into path of travel more than the maximum acceptable dimension.

Holding Cell H9: • Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
• The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
• Light fixture horizontally protrudes into path of travel more than the maximum acceptable dimension.

ID 171: • Lavatory does not meet all accessibility requirements necessary for compliance.

Lobby 140: • Drinking fountain forward approach condition does not meet CBC 11B-305.5.
• The call-button’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.
• Entry door threshold exceeds the maximum acceptable change in level. Provide and install new door threshold.

Medical 159: • Beds have an inaccessible parallel approach and transfer height. Suggest providing new bed.

Men’s Toilet 144: • Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
• Room is not identified with tactile character signage. Provide and install accessible signage with braille.

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County of Santa Barbara - Santa Barbara Jail

#:1006

ADA Transition Plan for Adult Detention Facility

Observation H2 Detox 162: • Water closet, grab bars, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.

Release 170: • The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
• Service counter exceeds the maximum acceptable height. Provide and install new counter.
• Room does not provide a minimum 60” turning clearance within the space.

Visitation 3 138: • The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
• Room does not provide an adequate 60” diameter dimension turning space for wheel chairs.

Women’s Toilet 143: • Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
• Room is not identified with tactile character signage. Provide and install accessible signage with braille.

MAIN JAIL BASEMENT Dorm 01:
• Shower, water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
Dorm 02: • Shower, water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
Dorm 03: • Drinking fountain forward approach condition does not meet CBC 11B-602.7.
Dorm 03 Toilet: • Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
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County of Santa Barbara - Santa Barbara Jail

#:1007

ADA Transition Plan for Adult Detention Facility

Dorm 03 Shower: • Shower does not meet all accessibility requirements necessary for compliance.

Men’s Toilet B46: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Door Hardware does not meet CBC 11B-404.2.7. Provide and install lever hardware.
• Urinals do not meet CBC 11B-605.2. Lip to wall dimension is great than 17”. Forward approach width for urinals is less than the required 30”.
• Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.

Public Waiting 81: • Drinking fountain does not meet CBC sections: 11B-305.5, 11B-306.3, and 11B-602.7.

Public Visitation B35: • The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.

MAIN JAIL FIRST FLOOR West Cell 01:
• Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Combination water closet / lavatory does not meet floor to apron height requirement of 29” minimum. Combi-unit also does not meet CBC 11B-604.2. 11B-604.3, 11B-604.4.
• Bottom of visible part of mirror is mounted 17” taller than the maximum allowable of 40” A.F.F. • Shelf unit is mounted 12” taller than the maximum allowable of 48” A.F.F. • Drinking fountain does not meet CBC section 11B-602.5.
West Cell 02: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening. • Combination water closet / lavatory does not meet floor to apron height requirement of 29” minimum. Combi-unit also does not meet CBC 11B-604.2. 11B-604.3, 11B-604.4. • Bottom of visible part of mirror is mounted 17” taller than the maximum allowable of 40” A.F.F. • Shelf unit is mounted 12” taller than the maximum allowable of 48” A.F.F. 64

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County of Santa Barbara - Santa Barbara Jail

#:1008

ADA Transition Plan for Adult Detention Facility

• Drinking fountain does not meet CBC section 11B-602.5.

West Cell 03: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Combination water closet / lavatory does not meet floor to apron height requirement of 29” minimum. Combi-unit also does not meet CBC 11B-604.2. 11B-604.3, 11B-604.4.
• Bottom of visible part of mirror is mounted 17” taller than the maximum allowable of 40” A.F.F. • Shelf Unit is mounted 12” taller than the maximum allowable of 48” A.F.F.
• Drinking fountain does not meet CBC section 11B-602.5.

West Cell 13: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening. • Combination water closet / lavatory does not meet floor to apron height requirement of 29” minimum. Combi-unit also does not meet CBC 11B-604.2. 11B-604.3, 11B-604.4. • Bottom of visible part of mirror is mounted 17” taller than the maximum allowable of 40” A.F.F.
• Shelf unit is mounted 12” taller than the maximum allowable of 48” A.F.F.
• Drinking fountain does not meet CBC section 11B-602.5.

West Cell 16: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Combination water closet / lavatory does not meet floor to apron height requirement of 29” minimum. Combi-unit also does not meet CBC 11B-604.2. 11B-604.3, 11B-604.4.
• Bottom of visible part of mirror is mounted 17” taller than the maximum allowable of 40” A.F.F.
• Shelf unit is mounted 12” taller than the maximum allowable of 48” A.F.F. • Drinking fountain does not meet CBC section 11B-602.5.

Central Medical E94: • Demolish and rebuild walls, cells, plumbing shafts, doors, corridors, and rooms in this area to respond to the Sheriff’s needs for modernized medical and mental health treatment beds and nurses / staff accommodations.
• Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
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County of Santa Barbara - Santa Barbara Jail

#:1009

ADA Transition Plan for Adult Detention Facility

• Door hardware does not meet CBC 11B-404.2.7. Provide and install lever hardware.
Corridor 242: • There are multiple elements that protrude either horizontally or vertically into the path of travel clearances.
East Corridor 6: • There are multiple elements that protrude either horizontally or vertically into the path of travel clearances.
West Corridor 166: • There are multiple elements that protrude either horizontally or vertically into the path of travel clearances.
West Corridor 301: • There are multiple elements that protrude either horizontally or vertically into the path of travel clearances.
Court Video 01 CV01: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
Court Video 02 CV02: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
Court Video E129: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
West Dayroom 01: • The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated. • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening. • Modify or replace existing dining table to meet knee clearance requirement and / or ADA user count. • Under-stair protection is required for compliance with CBC 11B-307.4.

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County of Santa Barbara - Santa Barbara Jail

#:1010

ADA Transition Plan for Adult Detention Facility

• Shower does not meet all accessibility requirements necessary for compliance.

West Dayroom 13: • The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
• Under-stair protection is required for compliance with CBC 11B-307.4.
• Shower does not meet all accessibility requirements necessary for compliance.

West Dayroom 16: • The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
• Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Modify or replace existing dining table to meet knee clearance requirement and / or ADA user count.
• Under-stair protection is required, for compliance with CBC 11B-307.4.
• Shower does not meet all accessibility requirements necessary for compliance.

East Dayroom 4: • Shower does not meet all accessibility requirements necessary for compliance.

East Dayroom 6: • Shower does not meet all accessibility requirements necessary for compliance.

Dental 253: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening. Also provide new door hardware.

Dorm C17: • There are multiple elements that protrude either horizontally or vertically into the path of travel clearances.
• Modify or replace existing dining table to meet knee clearance requirement and / or ADA user count.
• Shower does not meet all accessibility requirements necessary for compliance.
• Water closet, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.

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County of Santa Barbara - Santa Barbara Jail

#:1011

ADA Transition Plan for Adult Detention Facility

East Dorm 23: • There are multiple elements that protrude either horizontally or vertically into the path of travel clearances.
• Modify or replace existing dining table to meet knee clearance requirement and / or ADA user count.
• Shower does not meet all accessibility requirements necessary for compliance.
• Water closet, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.

East Dorm 24: • There are multiple elements that protrude either horizontally or vertically into the path of travel clearances.
• Modify or replace existing dining table to meet knee clearance requirement and / or ADA user count.
• Shower does not meet all accessibility requirements necessary for compliance.
• Water closet, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
• Combination water closet / lavatory does not meet floor to apron height requirement of 29” minimum. Combi-unit also does not meet CBC 11B-604.2., 11B-604.3, & 11B-604.4.

Elevator 01A: • Elevator does not comply with CBC 11B-407.3.5 and 11B407.2 at corridor.

Holding Cell C9 48: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening. • Combination water closet / lavatory does not meet floor to apron height requirement of 29” minimum. Combi-unit also does not meet CBC 11B-604.2, 11B-604.3, 11B-604.4. • Bottom of visible part of mirror is mounted 17” taller than the maximum allowable of 40” A.F.F. • Drinking fountain does not meet CBC section 11B-602.5. • Under-stair protection is required for compliance with CBC 11B-307.4.
Central Holding Cell 77: • Under-stair protection is required for compliance with CBC 11B-307.4.
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County of Santa Barbara - Santa Barbara Jail

#:1012

ADA Transition Plan for Adult Detention Facility

Central Holding Cell C10: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• There is an element that protrudes vertically into the path of travel clearance.

East Isolation Shower: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Shower does not meet all accessibility requirements necessary for compliance.

Isolation Cell C7: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
• Combination water closet / lavatory does not meet floor to apron height requirement of 29” minimum. Combi-unit also does not meet CBC 11B-604.2., 11B-604.3, 11B-604.4.
• Bottom of visible part of mirror is mounted 15” taller than the maximum allowable of 40” A.F.F.

Isolation Cell C8: • Combination water closet / lavatory does not meet floor to apron height requirement of 29” minimum. Combi-unit also does not meet CBC 11B-604.2., 11B-604.3, 11B-604.4.
• Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Under-stair protection is required for compliance with CBC 11B-307.4.

West Isolation Cell 24: • Combination water closet / lavatory does not meet floor to apron height requirement of 29” minimum. Combi-unit also does not meet CBC 11B-604.2., 11B-604.3, 11B-604.4.
• Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Under-stair protection is required for compliance with CBC 11B-307.4.
• Shelf unit is mounted 10” taller than the maximum allowable of 48” A.F.F.

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County of Santa Barbara - Santa Barbara Jail

#:1013

ADA Transition Plan for Adult Detention Facility

Isolation Shower 213: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Shower does not meet all accessibility requirements necessary for compliance.

Main Lobby 01: • The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
• The forward reach for the commissary brochures is at an inaccessible height.

Observation Corridor 220: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.

Private Viewing PV1: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.

Private Viewing PV2: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.

Private Viewing PV3: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.

Public Toilet 09: • Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
• Bottom of visible part of mirror is mounted 8” taller than the maximum allowable of 40” A.F.F.

Public Visiting PV03: • Demolish and rebuild walls, visiting booths, doors, corridors, and HVAC in this area to respond to the Sheriff’s needs for relocated face to face visiting.
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County of Santa Barbara - Santa Barbara Jail

#:1014

ADA Transition Plan for Adult Detention Facility

• Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Work surface does not meet standard for minimum knee clearance.

Sallyport to PV and VC 47: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Under-stair protection is required for compliance with CBC 11B-307.4.

South ADA Shower E128: • Demolish and rebuild walls, shower rooms, doors, corridors, and HVAC in this area to respond to the Sheriff’s needs for relocated showers.
• Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
• Bottom of visible part of mirror is mounted 8” taller than the maximum allowable of 40” A.F.F.
• Shower does not meet all accessibility requirements necessary for compliance.

South Interview E114: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.

South Isolation Corridor R7-12 154: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.

South Isolation Corridor 132: • There are multiple elements that protrude either horizontally or vertically into the path of travel clearances.

South Isolation Shower R 7-12: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Shower does not meet all accessibility requirements necessary for compliance.

South Isolation R9: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Under-stair protection is required for compliance with CBC 11B-307.4. 71

Case 2:17-cv-08805-GW-JPR Document 61-1 Filed 11/14/19 Page 72 of 81 Page ID

County of Santa Barbara - Santa Barbara Jail

#:1015

ADA Transition Plan for Adult Detention Facility

South Isolation 20: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening. • Under-stair protection is required for compliance with CBC 11B-307.4. • Work surface does not meet standard for minimum knee clearance. • Water closet and mirror do not meet all accessibility requirements necessary for compliance.

South Isolation 21: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Under-stair protection is required for compliance with CBC 11B-307.4.
• TV mount protrudes into path of travel.

South Private Visit SPV1A: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• The telephone’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.

South Private Visit SPV2A: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
South Private Visit SPV1: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.

South Private Visit SPV2: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• The telephone’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.

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County of Santa Barbara - Santa Barbara Jail

#:1016

ADA Transition Plan for Adult Detention Facility

South Shower: • Shower does not meet all accessibility requirements necessary for compliance.

South Tank Dayroom E134: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• The telephone’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.

South Tank Toilet and Shower 137: • Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
• Bottom of visible part of mirror is mounted 8” taller than the maximum allowable of 40” A.F.F.
• Shower does not meet all accessibility requirements necessary for compliance.

South Tank 135: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.

Tunnel: • The call-button’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.

West Treatment 70: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening. Also requires new hardware.

Women’s Toilet B43: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
• Bottom of visible part of mirror is mounted 8” taller than the maximum allowable of 40” A.F.F.

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Case 2:17-cv-08805-GW-JPR Document 61-1 Filed 11/14/19 Page 74 of 81 Page ID

County of Santa Barbara - Santa Barbara Jail

#:1017

ADA Transition Plan for Adult Detention Facility

MEDIUM SECURITY FACILITY Central Corridor:
• The telephone, hot water dispenser, and mailbox forward reaches are obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
• Drinking fountain forward approach condition does not meet CBC 11B-305.5.

Game D: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Door kick plate region 10” A.F.F. is not smooth.

Inmate Work Office G1: • Door hardware does not meet CBC 11B-404.2.7. Provide new hardware.

Interview and Chaplain G2: • The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.

New Classroom: • Door hardware does not meet CBC 11B-404.2.7. Provide new hardware. • TV mount and DVD player shelf protrudes into path of travel.

TV Room G: • Entry door threshold exceeds the maximum acceptable change in level. Provide and install new door threshold.
• TV mount and DVD player shelf protrudes into path of travel.

NEW EAST ISOLATION Dayroom New East 01:
• Modify or replace existing dining table to meet knee clearance requirement and / or ADA user count.
• Shower does not meet all accessibility requirements necessary for compliance.

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County of Santa Barbara - Santa Barbara Jail

#:1018

ADA Transition Plan for Adult Detention Facility

NORTHWEST JAIL Attorney Visit N154:
• The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.

CD Dogrun N141: Cell A1:
• Work Surface does not meet standard for minimum knee clearance.
• The telephone’s forward reach is obstructed, and the height to operable element is non-compliant. Telephone to be relocated.
• Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
• Bottom of visible part of mirror is mounted 2” taller than the maximum allowable of 40” A.F.F.
• Shelf unit horizontally protrudes into path of travel more than the maximum acceptable dimension.
• Drinking fountain forward approach condition does not meet CBC 11B-602.5.

Cell D3:
• Work surface does not meet standard for minimum knee clearance. • The telephone’s forward reach is obstructed, and the height to operable element is non-compliant.
Telephone to be relocated. • Bottom of visible part of mirror is mounted 2” taller than the maximum allowable of 40” A.F.F. • Shelf unit horizontally protrudes into path of travel more than the maximum acceptable
dimension.

Cell I25: • The telephone’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.
• Bottom of visible part of mirror is mounted 2” taller than the maximum allowable of 40” A.F.F.
• The call-button’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.

Closet and Shower N136: • Entry door threshold exceeds the maximum acceptable change in level. Provide and install new door threshold.
• Shower does not meet all accessibility requirements necessary for compliance.

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Case 2:17-cv-08805-GW-JPR Document 61-1 Filed 11/14/19 Page 76 of 81 Page ID

County of Santa Barbara - Santa Barbara Jail

#:1019

ADA Transition Plan for Adult Detention Facility

Dayroom D 130: • The telephone’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.
• The call-button’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.
• Modify or replace existing dining table to meet knee clearance requirement and / or ADA user count.
• Shower does not meet all of the accessibility requirements necessary to be in compliance.
• Under-stair protection is required for compliance with CBC 11B-307.4.

Dayroom A: • The telephone’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.
• The call-button’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.
• Shower does not meet all accessibility requirements necessary for compliance.

Iso Cell Double I10: • The telephone’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.
• The call-button’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.
• Combination water closet / lavatory does not meet floor to apron height requirement of 29” minimum. Combi-unit also does not meet CBC 11B-604.2. 11B-604.3, 11B-604.4.
• Bottom of visible part of mirror is mounted 12” taller than the maximum allowable of 40” A.F.F.
• Shelf Unit is mounted 12” taller than the maximum allowable of 48” A.F.F.
• Work Surface does not meet standard for minimum knee clearance.

Iso Cell 164: • Shower does not meet all accessibility requirements necessary for compliance.

Medical Exam N135: • Door closer and hardware are not ADA compliant. Replace hardware, provide new closer, and remove door stop.

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Case 2:17-cv-08805-GW-JPR Document 61-1 Filed 11/14/19 Page 77 of 81 Page ID

County of Santa Barbara - Santa Barbara Jail

#:1020

ADA Transition Plan for Adult Detention Facility

Public Men’s N156: • Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
• Room is not identified with tactile character signage. Provide and install accessible signage with braille.
• Door hardware and / or door closer is not compliant.

Public Visiting Private Room N150: • 60” Diameter turning space is not provided within this room.
• The telephone’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.

Public Visiting N151: • Door width clearance at pull or push-side of door is obstructed and / or doorway does not meet minimum standard of 32” clear opening.
• Work Surface does not meet standard for minimum knee clearance.
• The telephone’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.

Public Women’s N157: • Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.
• Room is not identified with tactile character signage. Provide and install accessible signage with braille.
• Door hardware and / or door closer is not compliant.

Private Visit 149: • Work Surface does not meet standard for minimum knee clearance.
• The telephone’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.

Private Visit 148: • Work Surface does not meet standard for minimum knee clearance.
• The telephone’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated.

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Case 2:17-cv-08805-GW-JPR Document 61-1 Filed 11/14/19 Page 78 of 81 Page ID

County of Santa Barbara - Santa Barbara Jail

#:1021

ADA Transition Plan for Adult Detention Facility

YARDS IRC – Unit 200 Exercise Yard 225a:
• Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.

Main Jail – Yard 002: • Combination water closet / lavatory does not meet floor to apron height requirement of 29” minimum. Combi-unit also does not meet CBC 11B-604.2. 11B-604.3, 11B-604.4. • The call-button’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated. • Modify or replace existing dining table to meet knee clearance requirement and / or ADA user count. • Drinking fountain forward approach condition does not meet CBC 11B-602.5. • Entry door threshold exceeds the maximum acceptable change in level. Provide and install new door threshold.
Main Jail – South Yard: • Combination water closet / lavatory does not meet floor to apron height requirement of 29” minimum. Combi-unit also does not meet CBC 11B-604.2. 11B-604.3, 11B-604.4. • The call-button’s forward reach is obstructed, and the height to operable element is noncompliant. Telephone to be relocated. • Modify or replace existing dining table to meet knee clearance requirement and / or ADA user count. • Entry door threshold exceeds the maximum acceptable change in level. Provide and install new door threshold.
Medium Security Facility (MSF) – C Barracks Yard: • Drinking fountain forward approach condition does not meet CBC 11B-305.5, & 602.4.

Priority 3 – Long Term (Begin in 2 Years)
MEDIUM SECURITY FACILITY Women’s Toilet F1:
• Water closet, grab bars, mirror, accessories, and lavatory do not meet all accessibility requirements necessary for compliance.

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Case 2:17-cv-08805-GW-JPR Document 61-1 Filed 11/14/19 Page 79 of 81 Page ID

County of Santa Barbara - Santa Barbara Jail

#:1022

ADA Transition Plan for Adult Detention Facility

Women’s Dorm F: • TV mount and DVD player shelf protrudes into path of travel.
• The telephones, mailboxes, & sick call slips box forward reaches are obstructed, and the height to operable element is non-compliant. Telephone to be relocated.

Flexibility The need to classify inmates and provide separate housing for each classification is a complex and constantly changing situation. The ADA requires that each housing classification or type must meet or exceed the required percentages, 2% for cells and 5% for dorms. Therefore, the Institution has considered the operational factors and geographic spread for placement of the proposed ADA cells / dorms.
Conclusion Vanir representatives believe that the Santa Barbara Jail is moving in a positive direction that will result in better identification, access, and accommodations for inmates with disabilities. This is true with the Custody Operations Policy and Procedures Manual and Custody Orientation Handbook that have been updated since the first review. There are a few items that still need attention, and the County / Sheriff’s Office should consider the following:
• Upgrading the position of ADA Coordinator to a higher rank that facilitates a greater authority regarding training and changes to the system as new situations occur.
• Automating forms for collection of key data concerning inmates with impairments and their accommodations.
• Upgrading the JMS system to allow automated tracking of inmates with impairments. • Making TTY / TDD or Video Relay Service more convenient for hearing-impaired inmates. • Providing television headphones for inmates with hearing impairments. • Providing Custody Orientation Handbook in braille and Custody Orientation handbook video in
closed captioning. • Making certain that medical and mental health policies and procedures are consistent with the
Sheriff’s operations and custody of impaired inmates. • Modifying the physical plant to accommodate inmates with impairments as it relates to the
Sheriff’s log. The log shows that mobility impaired inmates have occurred 40 times in the last seven (7) years. • Updating medical / mental health accommodations for impaired inmates. • Updating inmate / public visitor accommodations. • Updating program space to accommodate impaired inmates. • Improve paths of travel throughout the facility. • SWAP activities that inmates with impairments can volunteer for, especially if incentives are provided for volunteering.
During the interim time of the draft report to the final report, the Sheriff’s Office has re-written policies and procedures and has included our recommendations accordingly.
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Case 2:17-cv-08805-GW-JPR Document 61-1 Filed 11/14/19 Page 80 of 81 Page ID

County of Santa Barbara - Santa Barbara Jail

#:1023

ADA Transition Plan for Adult Detention Facility

The work identified will be constructed with two delivery models. The first and quickest is the job order contracting delivery model known as JOC; and the second is the design-build delivery model, where the contractor and designer are on the same team.
END OF PART 1 - Self-Evaluation and Transition Plan

PART 2: ADA Assessment - (Volume 2)
Santa Barbara Jail Facility Barrier Reports, Floor Plans, and Photograph Sheets (see separate bound 11” x 17” documents)

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 LEGAL ADVOCACY UNIT 1330 Broadway, Ste. 500 Oakland, CA 94612 Tel: (510) 267-1200 TTY: (800) 719-5798 Fax: (510) 267-1201 www.disabilityrightsca.org

March 18, 2020

Via Email

Amber Holderness, Deputy County Counsel Santa Barbara Office of County Counsel 105 East Anapamu Street, #201 Santa Barbara CA 93101 aholderness@co.santa-barbara.ca.us

RE: Murray, et al., v. County of Santa Barbara, 2:17-cv-08805-GW-JPR
Jail and County Plans for COVID-19 Management
Dear Ms. Holderness:
We write as class counsel in Murray, et al. v. County of Santa Barbara,1 representing the people held in Santa Barbara County Jail, to urge the County and the Santa Barbara Sheriff’s Department to immediately develop evidence-based and proactive plans for the prevention and management of COVID-19 in the County’s jail facilities (the “Jail”). We also urge the District Attorney’s Office to consider prevention and management of COVID-19 when making charging decisions and bail requests, and the Superior Court to consider prevention and management of COVID-19 when making bail decisions. We enclose some materials that may be useful as the County moves forward with its planning.
We request a phone call with you and leadership from the Sheriff’s Office and the County as soon as practicable to discuss steps to protect the health of the people in Jail custody and the people who work at the Jail.

1 For further information about the lawsuit, please visit: https://www.disabilityrightsca.org/cases/murray-v-county-of-santa-barbara

Murray v. County of Santa Barbara Jail and County Plans for COVID-19 Management March 18, 2020 Page 2 of 8
COVID-19 is extremely dangerous for people in certain population groups that are remarkably prevalent in the Jail population. People over the age of fifty are considered to be at substantial risk, and people over 70 are at the most serious risk. The Centers for Disease Control and Prevention (CDC) has issued guidance that certain medical conditions and disabilities increase the risk of COVID-19 for people of any age, including: lung disease, heart disease, diabetes, conditions that make a person immunocompromised (e.g., cancer, HIV/AIDS, autoimmune disease), blood disorders (including sickle cell disease), chronic liver or kidney disease, metabolic disorders, stroke, developmental delay, and pregnancy.
As you know, people in jail are highly vulnerable to outbreaks of contagious illnesses. They are housed in close quarters and are often in poor health. People detained in these conditions are at substantially higher risk of exposure and serious health consequences, including death, than if they were in the community.
With the onset of the COVID-19 pandemic, we are especially concerned about the conditions of the Jail – specifically in light of the recent expert reports of Harry Grenawitzke, and Dr. Scott Allen, regarding the environmental health and safety of the facilities and Jail medical care services, respectively. We have also received multiple reports from persons in contact with Murray class members that people inside the Jail lack access to adequate hygiene and cleaning supplies. We are extremely concerned that the failure to take reasonable and sensible precautionary measures, along with the dilapidated and unsanitary conditions at the Jail, put our class members at serious risk. Failure to address COVID-19 in the Jails also threatens the community at large, as dozens of correctional, health care, and other staff interact with the incarcerated population every day, and then return to their homes and neighborhoods.
We request that the County provide us all plans that the Sheriff’s Department, its health care contractor Wellpath, and the County Public Health Department have prepared for the prevention and management of COVID-19 in the County’s Jail facilities. Such plans must focus on reducing the jail population and density, and releasing the most vulnerable and medically fragile people in the Jail.
The CDC has identified COVID-19 as spreading easily from person-to-person. It has warned that the risk of exposure is greatest in crowded, confined spaces with limited ventilation and air circulation. The federal government has indicated that crowds of more than ten people should be avoided for the next several weeks, at a minimum. Many California counties have issued “shelter in place” orders for residents, directing them to limit their contact with others except for the most essential of purposes. Therefore, reducing the jail population and taking proactive health measures in the Jail are critical for protecting those who are detained as well as the broader community.

Murray v. County of Santa Barbara Jail and County Plans for COVID-19 Management March 18, 2020 Page 3 of 8
The County is aware that the Jail’s health care facilities and resources are illequipped, even in normal times, to meet the needs of the incarcerated population. As a 2017 Grand Jury found, the Jail is “old, antiquated, and overcrowded.”
Mr. Grenawitzke’s environmental conditions report, based on a three-day on-site inspection in August 2019, concludes that “it is paramount that activities for environmental health and life safety be implemented in the existing facility and also the new facility upon opening to prevent or minimize the risk of injury and/or illness transmission and the spread of communicable disease among inmates as well as staff.” Assessment of Environmental Health and Safety Operations, Santa Barbara County Jail (Sept. 2019) at 2 (emphasis added).
Likewise, Dr. Allen’s report notes that “a high number of inmates who actively had or had recently suffered from a serious skin infection due to a drug resistant form of the bacteria staphylococcus aureus, known as MRSA. Although without full data it is difficult to make a firm conclusion, this MRSA problem is likely a reflection of overcrowding combined with sanitation issues.” Review of Santa Barbara County Jail Medical Services, Murray Dkt. No. 23-2 at 6.
Mr. Grenawitzke describes similar deficiencies in cleanliness and sanitation, and the resulting health risks:
Many isolation cells I visited including, but not limited to cells housing inmates with mental health issues were not clean and some had strong offensive odors. The dorm housing patients with medical conditions should always be maintained clean with effective disinfection to prevent spread of methicillin-resistant Staphylococcus aureus (MRSA) among inmates from touching one another if they have the bacteria on the skin or touching surfaces having the bacteria on it through cross contamination. The sanitation plan and schedule needs to include frequency for individual cells to be cleaned and to specify who is responsible for cleaning those cells where the inmates are not capable to clean. Cell bars primarily in the isolation cells had a significant accumulation of dust and dirt and appeared to have not been cleaned for some time.
Id. at 3-4. Mr. Grenawitzke documents that staff working in the medical unit did not appear to understand how to operate the monitoring gauges in the negative pressure rooms used to house people with contagious infectious diseases, and that staff and incarcerated people reported that they had not received training or instruction on responding to bloodborne pathogens or biohazardous spill responses. Id. at 9, 13.

Murray v. County of Santa Barbara Jail and County Plans for COVID-19 Management March 18, 2020 Page 4 of 8
If the COVID-19 virus spreads within the Jail, the likelihood that numerous Murray class members would require acute medical care is substantial. Such care would necessarily require transport to emergency medical facilities in the community, risking significant strain on health care resources that would adversely impact the general public.
While any plans should be developed collaboratively among County agencies, we highlight the following critical issues that must be addressed.
1. Reducing Overcrowding at the Jail and Release of Vulnerable People
The 2016-17 Santa Barbara Grand Jury Report notes that the County has been under a court order to reduce the daily jail population to an 819-bed capacity, but the average population has remained well above that number. We are aware that there continue to be significant numbers of “floor sleepers” every day, including in the designated medical unit at the jail.
We echo the Public Defender’s call to immediately release as many people as possible from the Jail. The Sheriff’s Office should identify all people who are particularly vulnerable to COVID-19. Any person currently in the Jail who meets any high-risk criteria should be immediately released, regardless of their criminal charge or conviction, unless there is a specific articulable and excessive risk to public safety.
To further reduce the Jail population, we urge the County to accelerate the release of people who have 30 days or fewer of their sentence remaining pursuant to Penal Code § 4024.1,2 who are held on bail of $100,000 or less, and who are serving a sentence for a misdemeanor or non-violent conviction. Other strategies to consider are modification of work release arrangements (see, e.g., Penal Code § 4024.2 (b)(1)(F) (addressing people with special needs related to medical condition, physical disability, or age)), and expanded pretrial release.3
2 Several California counties have already taken this sort of step. The standing order issued by Sacramento County’s Superior Court is enclosed for reference.
3 The California Constitution allows courts to release people on their own recognizance “in the court’s discretion.” Article 1, Section 12. Section 1275 of the California Penal Code states the considerations in setting bail, and makes clear that “[i]n setting, reducing, or denying bail, a judge or magistrate shall take into consideration the protection of the public” and that “public safety shall be the primary consideration.” Under today’s extraordinary circumstances, public safety requires that as few people as possible circulate through the Jail system. We encourage presumptive release on recognizance for as many people as possible, particularly for vulnerable populations, as described above.

Murray v. County of Santa Barbara Jail and County Plans for COVID-19 Management March 18, 2020 Page 5 of 8
Earlier today, the Santa Clara County Superior Court issued a standing order (enclosed) to reduce Jail admissions, noting that “reducing the jail population is a critical preventative measure for inmates and staff” given the “conditions of extreme peril and the imminent and proximate threat to public health relating to . . . COVID-19.”
2. Education of the People in Jail Custody
People housed in the Jail need to be informed about the virus and the measures they can take to minimize their risk of contracting or spreading the virus. They must be educated on the importance of proper handwashing, coughing into their elbows, and social distancing to the extent they can. Information about the spread of the virus, the risks associated with it, and prevention and treatment measures must be based on the best available science. Education should be reiterated upon release to best inform individuals on how to prepare for a healthy return to the public.
The California State prison system’s California Correctional Health Care Services (CCHCS) has created a Coronavirus/COVID-19 Facts and FAQs document (enclosed) that can be distributed and posted throughout the Jail. These materials offer a useful model for you to use. Posting should be done inside every Jail housing unit to ensure that the materials are visible and accessible to all. Verbal or other means of communication of this information should be provided for people with disability or other individual needs (visual or intellectual disabilities, etc.).
3. Education of the Staff
Custody, administrative, and medical staff all must be educated about the virus to adequately protect themselves and their families, as well as the people in Jail custody.
4. Provision of Hygiene and Cleaning Supplies
The most basic aspect of infection control is hygiene. There must be ready access to warm or hot water, soap, and adequate hygiene and cleaning supplies, both for handwashing and for cleaning living units. Soap and cleaning supplies should be provided daily and free of charge.
The Public Defender’s office in its press release this week described how people in the Jail rely upon an “Indigent Kit” for hygiene supplies, which contains a small bar of
The Hon. Nathanael Cousins of the United States Court for the Northern District of California, for example, has issued a standing order enclosed in response to the COVID19 pandemic, following analogous federal law. The order authorizes the reopening of pretrial detention hearings to reconsider the appropriateness of release pending trial for people based on their health condition as well as public safety.

Murray v. County of Santa Barbara Jail and County Plans for COVID-19 Management March 18, 2020 Page 6 of 8
soap, toothpaste and toothbrush, a comb, and a razor. They receive one kit per week, and the small bar of soap is 2 inches by half an inch. Class members are expected to use this small bar of soap to wash their bodies, hands, and hair. People usually run out of soap before they can receive the next Indigent Kit. As noted above, Mr. Grenawitzke’s report identifies many problems with the hygiene and cleanliness of the Jail.
This issue must be addressed as a top priority. The County’s plan must include detailed information regarding provision of soap and sanitizer products, as well as frequent environmental cleaning of all common areas in housing units, food preparation areas, classrooms and programming space, and clinical/infirmary space. The plan must include information as to how disinfectants will be provided to people to clean their personal living spaces.
5. Screening and Testing of the People in the Jail
The County’s plan must include guidance, based on the best science available and advice from the Public Health Department, on how and when to screen and test people in the Jail for the virus.
6. Treatment
Courses of treatment must be evidence-based, available immediately, and in compliance with scientifically based public health protocols. Furthermore, all treatment must be provided free of charge and with no disincentives to people coming forward.
7. Staffing Plans for Custody and Health Care Staff
We are aware that at least eleven Sheriff’s Office and Jail medical staff are on self-quarantine due to exposure to a COVID-19 positive person. Regardless of how many staff stay home because they are sick, are self-quarantining, or are caring for loved ones, the Jail will have to continue to maintain an operational and health care staffing level sufficient to ensure adequate and humane functioning. There must be a plan for how necessary functions and services will continue if large numbers of staff are out related to the virus.
Again, releasing as many people as possible from the Jail is a sensible and necessary way to minimize the risk of mass virus transmission and also to address staffing shortages and related challenges.
8. Staffing Plans for Services Provided by Incarcerated People
Many tasks in the Santa Barbara County Jail, including food preparation and basic sanitation, are performed by people incarcerated in the Jail. Plans to prevent and manage virus transmission must address how necessary tasks performed by detainees will continue in a manner that is safe and consistent with public health.

Murray v. County of Santa Barbara Jail and County Plans for COVID-19 Management March 18, 2020 Page 7 of 8
9. Housing of Persons Exposed to the Virus
The plan must describe how and where people in the jail system will be housed if they are exposed to the virus, are at high risk of serious illness if they become infected, or become sick with it. This should not result in prolonged, widespread lockdowns. Any lockdowns or interruptions in regular activities, such as exercise or visits and phone calls with families or attorneys, should be based solely on the best science available and should be as limited as possible in scope and duration.
10. Vulnerable Populations
To the extent vulnerable populations are not released from the Jail for public health or humanitarian purposes, the County’s plan must provide for additional precautions for those who are at high risk of serious illness if they are infected, such as elderly people, pregnant women, and people with chronic illnesses, compromised immune systems, or disabilities, and people whose housing placements restrict their access to medical care and limit the staff’s ability to observe them. The Jail’s COVID19 plan must include close coordination with community hospitals to isolate any patients who meet the CDC’s guidelines for isolation. This coordination must occur now, rather than waiting until the jail is dealing with patients exhibiting COVID-19 symptoms.
11. Access to Family and Legal Counsel
We understand that the Sheriff’s Office has taken the step to suspend in-person visitation at the Jail to prevent the spread of COVID-19. While in-person visitation raises virus transmission risk, incarcerated people must be able to communicate with their families, loved ones, and legal counsel, particularly under these stressful and constantly evolving circumstances.
We strongly encourage the County to provide all people in Jail custody phone and/or video calls free of cost during this crisis. Multiple jurisdictions, such as CDCR, Shelby County, Tennessee and others, have already taken this simple and important step. (New York City has shifted to free phone calls permanently.)
***
As the County and the Sheriff’s Office consider the steps we urge in this letter, we ask that you provide a response to the following questions as soon as possible:
1. Have the Sheriff’s Department and Wellpath developed specific COVID-19 written policies or protocols? If yes, please provide a copy.
2. What steps have been taken or will be taken in light of the COVID-19 pandemic to reduce the Jail population and to limit the flow of new people into the Jail?

Murray v. County of Santa Barbara Jail and County Plans for COVID-19 Management March 18, 2020 Page 8 of 8
3. What measures is the Jail taking to protect people with elevated COVID-19related health risks, including pregnant women and people with chronic illnesses, compromised immune systems, or disabilities?
4. What measures is the Jail taking to identify people with COVID-19 exposure, both at booking/intake and inside the Jail housing units?
5. What steps have been taken to ensure that Jail facilities have adequate soap, handwashing stations, wet wipes, and sanitizer readily available to people in custody as well as staff?
6. What specific changes to cleaning practices have been made in light of the current situation (wiping down of surface areas, durable medical equipment/assistive technology, hand rails, grab bars, door handles, phones, tables, etc.)?
7. How is information about COVID-19 being provided to people in custody at the Jail? Is the information provided in accessible locations and formats?
8. What is the Sheriff’s Department and ACH’s capacity to test for COVID-19? How many people in Jail custody have been quarantined based on possible COVID-19 exposure? How many have received COVID-19 testing? Have any COVID-19 cases amongst people who are or recently have been inside the Jail been confirmed? If so, how many, and what steps were taken in response? (We request that the County provide updates as to these issues as events continue to unfold.)
We ask that the County immediately and publicly announce its plans to address the virus in the jail system. This is an urgent matter. Having an appropriate, evidencebased plan in place can help prevent an outbreak and minimize its impact when one does occur; and not having one may cost lives. Please let us know when you will be available to discuss your plans with us. We look forward to speaking with you and working collaboratively with you during this most challenging of times.
Sincerely yours,

Corene Kendrick Prison Law Office

Aaron Fischer Disability Rights California

Joshua Toll King & Spalding

Encls. cc: Hon. Michael J. Carrozzo, Presiding Judge, Santa Barbara County Superior Court
Joyce E. Dudley, Santa Barbara County District Attorney Tracy Macuga, Santa Barbara County Public Defender Michael Ghizzoni, Santa Barbara County Counsel Tanja Heitman, Probation Department

Case 2:12-cv-00601-ROS Document 3521-1 Filed 03/16/20 Page 22 of 53
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ƐĞǀĞƌĞ ƌĞƐƉŝƌĂƚŽƌǇ ŝůůŶĞƐƐ͘ ^ǇŵƉƚŽŵƐ ŝŶĐůƵĚĞ ĨĞǀĞƌ͕ ĐŽƵŐŚ ĂŶĚ ƐŚŽƌƚŶĞƐƐ ŽĨ ďƌĞĂƚŚ͘ /ŶĚŝǀŝĚƵĂůƐ ǁŝƚŚ ƐĞǀĞƌĞ ĐŽŵƉůŝĐĂƚŝŽŶƐ ĨƌŽŵ ƚŚĞ ǀŝƌƵƐ ŽĨƚĞŶ ĚĞǀĞůŽƉ ƉŶĞƵŵŽŶŝĂ ŝŶ ďŽƚŚ ůƵŶŐƐ͘
,Žǁ ĚŽĞƐ ƚŚĞ ǀŝƌƵƐ ƐƉƌĞĂĚ͍ dŚĞ ǀŝƌƵƐ ŝƐ ƐƉƌĞĂĚ ƉĞƌƐŽŶͲƚŽͲƉĞƌƐŽŶ͘ ĐĐŽƌĚŝŶŐ ƚŽ ƚŚĞ ͕ ƐƉƌĞĂĚ ŝƐ ŚĂƉƉĞŶŝŶŐ ŵĂŝŶůǇ ďĞƚǁĞĞŶ ƉĞŽƉůĞ ǁŚŽ ĂƌĞ ŝŶ ĐůŽƐĞ ĐŽŶƚĂĐƚ ;ǁŝƚŚŝŶ ϲ ĨĞĞƚͿ ŽĨ ĞĂĐŚ ŽƚŚĞƌ ǀŝĂ ƌĞƐƉŝƌĂƚŽƌǇ ĚƌŽƉůĞƚƐ ƉƌŽĚƵĐĞĚ ǁŚĞŶ ĂŶ ŝŶĨĞĐƚĞĚ ƉĞƌƐŽŶ ĐŽƵŐŚƐ Žƌ ƐŶĞĞǌĞƐ͘ dŚĞ ĚƌŽƉůĞƚƐ ůĂŶĚ ŽŶ ƚŚĞ ŶŽƐĞƐ ĂŶĚ ŵŽƵƚŚƐ ŽĨ ŽƚŚĞƌ ƉĞŽƉůĞ͕ ǁŚŽ ƚŚĞŶ ŝŶŚĂůĞ ƚŚĞŵ͘ dŚĞ  ƐĂǇƐ ŝƚ ŵĂǇ ďĞ ƉŽƐƐŝďůĞ ĨŽƌ ƚŚĞ ǀŝƌƵƐ ƚŽ ƐƉƌĞĂĚ ďǇ ƚŽƵĐŚŝŶŐ Ă ƐƵƌĨĂĐĞ Žƌ ŽďũĞĐƚ ǁŝƚŚ ƚŚĞ ǀŝƌƵƐ ĂŶĚ ƚŚĞŶ Ă ƉĞƌƐŽŶ ƚŽƵĐŚŝŶŐ ƚŚĞŝƌ ŵŽƵƚŚ͕ ŶŽƐĞ Žƌ ĞǇĞƐ͕ ďƵƚ ƚŚŝƐ ŝƐ ŶŽƚ ƚŚŽƵŐŚƚ ƚŽ ďĞ ƚŚĞ ŵĂŝŶ ŵĞƚŚŽĚ ŽĨ ƐƉƌĞĂĚ͘ Ɛ ƚŚĞ ǀŝƌƵƐ ǁĂƐ ĚŝƐĐŽǀĞƌĞĚ ũƵƐƚ Ă ĨĞǁ ŵŽŶƚŚƐ ĂŐŽ͕ ŵŽƌĞ ƌĞƐĞĂƌĐŚ ŝƐ ƌĞƋƵŝƌĞĚ ƚŽ ůĞĂƌŶ ŵŽƌĞ ĂďŽƵƚ ƚŚĞ ƐƉƌĞĂĚ ƉĂƚƚĞƌŶ ŽĨ ƚŚĞ ǀŝƌƵƐ͘ dŚĞ ŝŶĐƵďĂƚŝŽŶ ƉĞƌŝŽĚ ƌĂŶŐĞƐ ĨƌŽŵ Ϯ ƚŽ ϭϰ ĚĂǇƐ ĂĨƚĞƌ ĞǆƉŽƐƵƌĞ ;ŵŽƐƚ ĐĂƐĞƐ ŽĐĐƵƌƌŝŶŐ Ăƚ ĂƉƉƌŽǆŝŵĂƚĞůǇ ϱ ĚĂǇƐ͘Ϳ WĞŽƉůĞ ĂƌĞ ƚŚŽƵŐŚƚ ƚŽ ďĞ ŵŽƐƚ ĐŽŶƚĂŐŝŽƵƐ ǁŚĞŶ ƚŚĞǇ ĂƌĞ ŵŽƐƚ ƐǇŵƉƚŽŵĂƚŝĐ ;ƚŚĞ ƐŝĐŬĞƐƚ͘Ϳ ^ŽŵĞ ƐƉƌĞĂĚ ŵŝŐŚƚ ďĞ ƉŽƐƐŝďůĞ ďĞĨŽƌĞ ƉĞŽƉůĞ ƐŚŽǁ ƐǇŵƉƚŽŵƐ͘
Ž / ŶĞĞĚ ƚŽ ǁĞĂƌ Ă ƉƌŽƚĞĐƚŝǀĞ ŵĂƐŬ͍ dŚĞƌĞ ŝƐ ŶŽ ŶĞĞĚ ĨŽƌ ŚĞĂůƚŚǇ ŝŶĚŝǀŝĚƵĂůƐ ƚŽ ǁĞĂƌ ƐƵƌŐŝĐĂů ŵĂƐŬƐ ƚŽ ŐƵĂƌĚ ĂŐĂŝŶƐƚ ĐŽƌŽŶĂǀŝƌƵƐ͘ /ŶĚŝǀŝĚƵĂůƐ ƐŚŽƵůĚ ŽŶůǇ ǁĞĂƌ Ă ŵĂƐŬ ŝĨ ƚŚĞǇ ĂƌĞ ŝůů Žƌ ŝĨ ŝƚ ŝƐ ƌĞĐŽŵŵĞŶĚĞĚ ďǇ Ă ŚĞĂůƚŚ ĐĂƌĞ ƉƌŽĨĞƐƐŝŽŶĂů͘ DĂƐŬƐ ŵƵƐƚ ďĞ ƵƐĞĚ ĂŶĚ ĚŝƐƉŽƐĞĚ ŽĨ ƉƌŽƉĞƌůǇ ƚŽ ďĞ ĞĨĨĞĐƚŝǀĞ͘
/Ɛ ƚŚĞƌĞ Ă ĐƵƌĞ ĨŽƌ ƚŚĞ ǀŝƌƵƐ͍ dŚĞƌĞ ŝƐ ŶŽ ƐƉĞĐŝĨŝĐ ŵĞĚŝĐĂƚŝŽŶ ƚŽ ƚƌĞĂƚ Ks/Ͳϭϵ͖ ƐƵƉƉŽƌƚŝǀĞ ĐĂƌĞ ŝƐ ƉƌŽǀŝĚĞĚ ƚŽ ƚƌĞĂƚ ƐǇŵƉƚŽŵƐ͘ dŚĞƌĞ ŝƐ ĐƵƌƌĞŶƚůǇ ŶŽ ǀĂĐĐŝŶĞ ƚŽ ƉƌŽƚĞĐƚ ĂŐĂŝŶƐƚ Ks/Ͳϭϵ͘ /ŶĚŝǀŝĚƵĂůƐ ƐŚŽƵůĚ ƚĂŬĞ ĐĂƌĞ ƚŽ ĂǀŽŝĚ ďĞŝŶŐ ĞǆƉŽƐĞĚ ƚŽ ƚŚĞ ǀŝƌƵƐ ƚŚƌŽƵŐŚ ŚǇŐŝĞŶĞ ĂŶĚ ƐĂŶŝƚĂƌǇ ƉƌĂĐƚŝĐĞƐ͘ WůĞĂƐĞ ƐĞĞŬ ŝŵŵĞĚŝĂƚĞ ŵĞĚŝĐĂů ĐĂƌĞ ƚŽ ƌĞůŝĞǀĞ ƐǇŵƉƚŽŵƐ ŝĨ ŝŶĨĞĐƚĞĚ ǁŝƚŚ ƚŚĞ ǀŝƌƵƐ͘

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,Žǁ ĚŽ / ƉƌŽƚĞĐƚ ŵǇƐĞůĨ ĂŶĚ ŽƚŚĞƌƐ͍ dŚĞƌĞ ŝƐ ĐƵƌƌĞŶƚůǇ ŶŽ ǀĂĐĐŝŶĞ ƚŽ ƉƌĞǀĞŶƚ Ks/Ͳϭϵ Žƌ ŵĞĚŝĐĂƚŝŽŶ ƚŽ ĚŝƌĞĐƚůǇ ƚƌĞĂƚ Ks/Ͳϭϵ͘ dŚĞ ďĞƐƚ ǁĂǇ ƚŽ ƉƌŽƚĞĐƚ ǇŽƵƌƐĞůĨ ŝƐ ƚŽ ĂǀŽŝĚ ďĞŝŶŐ ĞǆƉŽƐĞĚ ƚŽ ƚŚĞ ǀŝƌƵƐ ƚŚĂƚ ĐĂƵƐĞƐ Ks/Ͳϭϵ͘ dŚĞ  ƌĞĐŽŵŵĞŶĚƐ ŵĂŝŶƚĂŝŶŝŶŐ ƉĞƌƐŽŶĂů ƉƌĞǀĞŶƚĂƚŝǀĞ ĂĐƚŝŽŶƐ ƐƵĐŚ ĂƐ͗
x ǀŽŝĚŝŶŐ ĐůŽƐĞ ĐŽŶƚĂĐƚ ǁŝƚŚ ƚŚŽƐĞ ǁŚŽ ĂƌĞ ƐŝĐŬ x EŽƚ ƚŽƵĐŚŝŶŐ ǇŽƵƌ ĞǇĞƐ͕ ŵŽƵƚŚ Žƌ ŶŽƐĞ͕ ĞƐƉĞĐŝĂůůǇ ǁŝƚŚ ƵŶǁĂƐŚĞĚ ŚĂŶĚƐ x tĂƐŚŝŶŐ ǇŽƵƌ ŚĂŶĚƐ ŽĨƚĞŶ ǁŝƚŚ ƐŽĂƉ ĂŶĚ ǁĂƌŵ ǁĂƚĞƌ ĨŽƌ ůĂƐƚ ůĞĂƐƚ ϮϬ ƐĞĐŽŶĚƐ x ůĞĂŶ ŽďũĞĐƚƐ ĂŶĚ ƐƵƌĨĂĐĞƐ ƚŚĂƚ ĂƌĞ ĨƌĞƋƵĞŶƚůǇ ƚŽƵĐŚĞĚ x >ŝŵŝƚ ǇŽƵƌ ĞǆƉŽƐƵƌĞ ƚŽ ŽƚŚĞƌƐ ŝĨ ǇŽƵ ĂƌĞ ƐŝĐŬ x ŽǀĞƌ ǇŽƵƌ ĐŽƵŐŚƐ ĂŶĚ ƐŶĞĞǌĞƐ ǁŝƚŚ Ă ƚŝƐƐƵĞ x Ž ŶŽƚ ƐŚĂƌĞ ĨŽŽĚ͕ ĚƌŝŶŬƐ͕ ƵƚĞŶƐŝůƐ͕ Žƌ ƚŽŽƚŚďƌƵƐŚĞƐ
tŚĂƚ ƐŚŽƵůĚ / ĚŽ ŝĨ / ƚŚŝŶŬ / ŚĂǀĞ Ks/Ͳϭϵ͍ ǀŽŝĚ ĚŝƌĞĐƚ ĐŽŶƚĂĐƚ ǁŝƚŚ ŽƚŚĞƌ ƉĞŽƉůĞ ĂŶĚ ŝŵŵĞĚŝĂƚĞůǇ ƌĞƋƵĞƐƚ ƚŽ ďĞ ƐĞĞŶ ďǇ ŚĞĂůƚŚ ĐĂƌĞ ŝĨ ǇŽƵ ĨĞĞů ƐŝĐŬ ǁŝƚŚ Ă
ĨĞǀĞƌ͕ ĐŽƵŐŚ Žƌ ĚŝĨĨŝĐƵůƚǇ ďƌĞĂƚŚŝŶŐ͘ DĂŬĞ ƐƵƌĞ ƚŽ ŐŝǀĞ ǇŽƵƌ ƉƌŽǀŝĚĞƌ ĚĞƚĂŝůƐ ŽĨ ĂŶǇ ƐǇŵƉƚŽŵƐ ĂŶĚ ƉŽƚĞŶƚŝĂů ĐŽŶƚĂĐƚ ǁŝƚŚ ŝŶĚŝǀŝĚƵĂůƐ ǁŚŽ ŵĂǇ ŚĂǀĞ ƌĞĐĞŶƚůǇ ƚƌĂǀĞůĞĚ͘
tŝůů / ďĞ ƚĞƐƚĞĚ ĨŽƌ Ks/Ͳϭϵ͍ zŽƵ ǁŝůů ďĞ ƚĞƐƚĞĚ ŝĨ ǇŽƵƌ ƉƌŽǀŝĚĞƌ ƐƵƐƉĞĐƚƐ ǇŽƵ ŚĂǀĞ Ks/Ͳϭϵ͘
tŚĂƚ ŝƐ Zͬ,^ ĚŽŝŶŐ ƚŽ ƉƌĞƉĂƌĞ ĨŽƌ Ă ƉŽƚĞŶƚŝĂů ŽƵƚďƌĞĂŬ͍ Z ĂŶĚ ,^ ĂƌĞ ĚĞĚŝĐĂƚĞĚ ƚŽ ƚŚĞ ƐĂĨĞƚǇ ŽĨ ĞǀĞƌǇŽŶĞ ǁŚŽ ůŝǀĞƐ͕ ǁŽƌŬƐ͕ ĂŶĚ ǀŝƐŝƚƐ ŽƵƌ ƐƚĂƚĞ ƉƌŝƐŽŶƐ͘ tĞ ŚĂǀĞ ůŽŶŐƐƚĂŶĚŝŶŐ ĞŵĞƌŐĞŶĐǇ ƌĞƐƉŽŶƐĞ ƉůĂŶƐ ŝŶ ƉůĂĐĞ ƚŽ ĂĚĚƌĞƐƐ ĐŽŵŵƵŶŝĐĂďůĞ ĚŝƐĞĂƐĞ ŽƵƚďƌĞĂŬƐ ƐƵĐŚ ĂƐ ŝŶĨůƵĞŶǌĂ͕ ŵĞĂƐůĞƐ͕ ŵƵŵƉƐ͕ ŶŽƌŽǀŝƌƵƐ͕ ĂƐ ǁĞůů ĂƐ ĐŽƌŽŶĂǀŝƌƵƐ͘ ĂƐĞĚ ŽŶ ŐƵŝĚĂŶĐĞ ĨƌŽŵ ƚŚĞ ͕ ĂŶĚ ƚŽ ĞŶƐƵƌĞ ǁĞ ĂƌĞ ĂƐ ƉƌĞƉĂƌĞĚ ĂƐ ƉŽƐƐŝďůĞ ƚŽ ƌĞƐƉŽŶĚ ƚŽ ĂŶǇ ĞǆƉŽƐƵƌĞ ƚŽ Ks/Ͳϭϵ ƐƉĞĐŝĨŝĐĂůůǇ͕ ǁĞ ĂƌĞ ďƵŝůĚŝŶŐ ƵƉŽŶ ƚŚĞ ƌŽďƵƐƚ ŝŶĨůƵĞŶǌĂ ŝŶĨĞĐƚŝŽŶ ĐŽŶƚƌŽů ŐƵŝĚĞůŝŶĞƐ ĂůƌĞĂĚǇ ŝŶ ƉůĂĐĞ Ăƚ ĞĂĐŚ ŝŶƐƚŝƚƵƚŝŽŶ͘ dŚĞƐĞ ŐƵŝĚĞůŝŶĞƐ ĐůĞĂƌůǇ ĚĞĨŝŶĞ ƉƌŽĐĞĚƵƌĞƐ ĨŽƌ ƉƌĞǀĞŶƚŝŽŶ ŽĨ ƚƌĂŶƐŵŝƐƐŝŽŶ͕ ŵĂŶĂŐĞŵĞŶƚ ŽĨ ƐƵƐƉĞĐƚĞĚ ĂŶĚ ĐŽŶĨŝƌŵĞĚ ĐĂƐĞƐ ŝŶĐůƵĚŝŶŐ ŝƐŽůĂƚŝŽŶ ĂŶĚ ƋƵĂƌĂŶƚŝŶĞ ƉƌŽƚŽĐŽůƐ͕ ƐƵƌǀĞŝůůĂŶĐĞ ŽĨ ƉĂƚŝĞŶƚƐ͕ ĂŶĚ ƌŽƵƚŝŶĞ ĐůĞĂŶŝŶŐ ĂŶĚ ĚŝƐŝŶĨĞĐƚŝŽŶ ƉƌŽĐĞĚƵƌĞƐ͘
/Ĩ ƚŚĞƌĞ ŝƐ Ă ƐƵƐƉĞĐƚĞĚ ĐĂƐĞ ŽĨ Ks/Ͳϭϵ͕ ǁĞ ǁŝůů ĨŽůůŽǁ ƚŚĞ ƉŽůŝĐŝĞƐ ĂŶĚ ƉƌŽĐĞĚƵƌĞƐ ĂůƌĞĂĚǇ ŝŶ ƉůĂĐĞ ĨŽƌ ŵŽĚŝĨŝĞĚ ƉƌŽŐƌĂŵŵŝŶŐ ĨŽƌ ĂŶǇ ĂĨĨĞĐƚĞĚ ŚŽƵƐŝŶŐ ƵŶŝƚƐ ĂŶĚ ĂƌĞĂƐ͘ tĞ ǁŝůů ĐŽŶƚŝŶƵĞ ƚŽ ƵƉĚĂƚĞ ŐƵŝĚĞůŝŶĞƐ ĨŽƌ Ks/Ͳϭϵ ƌĞƐƉŽŶƐĞ ďĂƐĞĚ ŽŶ  ƌĞĐŽŵŵĞŶĚĂƚŝŽŶƐ ĂŶĚ ǁŝůů ŵĂŝŶƚĂŝŶ ĐŽŽƉĞƌĂƚŝŽŶ ǁŝƚŚ ůŽĐĂů ĂŶĚ ƐƚĂƚĞ ŚĞĂůƚŚ ĚĞƉĂƌƚŵĞŶƚƐ ĂŶĚ ƚŚĞ ůĂǁ ĞŶĨŽƌĐĞŵĞŶƚ ĐŽŵŵƵŶŝƚǇ͘
Ks/Ͳϭϵ ŝƐ ŶĞǁ͕ ďƵƚ ƚŚĞ ŵŽƐƚ ŝŵƉŽƌƚĂŶƚ ĂƐƉĞĐƚ ŽĨ ƉƌĞƉĂƌĞĚŶĞƐƐ ŝƐ ƌĞŵĂŝŶŝŶŐ ĐĂůŵ͘ ŽŶ͛ƚ ƉĂŶŝĐ͘ tĞ ƵŶĚĞƌƐƚĂŶĚ ƐƚĂĨĨ͕ ĨĂŵŝůŝĞƐ͕ ĂŶĚ ƚŚŽƐĞ ǁŚŽ ǀŝƐŝƚ ƐƚĂƚĞ ƉƌŝƐŽŶƐ ĂƐ ƉƌŽŐƌĂŵ ƉƌŽǀŝĚĞƌƐ Žƌ ǀŽůƵŶƚĞĞƌƐ ŵĂǇ ŚĂǀĞ ĐŽŶĐĞƌŶƐ ĂŶĚ ĂŶǆŝĞƚǇ ĂďŽƵƚ Ks/Ͳϭϵ͕ ďƵƚ ƉůĞĂƐĞ ďĞ ĂƐƐƵƌĞĚ ƚŚĂƚ ƚŚĞƌĞ ŝƐ ŶŽ ŶĞĞĚ ĨŽƌ ĂůĂƌŵ͘ ůů ƐŚŽƵůĚ ĨŽůůŽǁ ƚŚĞ ƉƌĞĐĂƵƚŝŽŶƐ ƌĞĐŽŵŵĞŶĚĞĚ ďǇ ͕ ǁŚŝĐŚ ĞǆƉĂŶĚ ƵƉŽŶ ƉƌĞĐĂƵƚŝŽŶƐ ĂĚǀŝƐĞĚ ĚƵƌŝŶŐ ĐŽůĚ ĂŶĚ ĨůƵ ƐĞĂƐŽŶ͘ dŚĞ ƐƉƌĞĂĚ ŽĨ Ks/Ͳϭϵ ĐĂŶ ďĞ ƐŝŐŶŝĨŝĐĂŶƚůǇ ƌĞĚƵĐĞĚ ǁŝƚŚ ƉƌŽƉĞƌ ŝŶĨĞĐƚŝŽŶ ĐŽŶƚƌŽů ŵĞĂƐƵƌĞƐ ĂŶĚ ŐŽŽĚ ŝŶĚŝǀŝĚƵĂů ŚǇŐŝĞŶĞ ƉƌĂĐƚŝĐĞƐ͘
t ^, zKhZ , E^ &ZYhEd>z

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UNITED STATES DISTRICT COURT

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NORTHERN DISTRICT OF CALIFORNIA

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7 CRIMINAL CASE STANDING ORDER
RE: PROCEDURE FOR REVIEW OF
8 DETENTION ORDERS IN LIGHT OF
CORONAVIRUS PANDEMIC
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Magistrate Judge Nat Cousins Effective March 16, 2020

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I am issuing this criminal standing order on March 16, 2020, in response to the
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coronavirus pandemic. It applies to every open criminal case in which I have ordered a
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criminal defendant to be detained and that defendant is presently held in custody awaiting
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trial. Most detainees in this District are presently housed at Santa Rita Jail in Alameda
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County, California. Defendants detained by other judges are not covered by this standing
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order. A copy of this order will also be provided to the offices of the Federal Public
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Defender, the United States Attorney, the CJA attorney coordinator, U.S. Pretrial Services,
17
and posted publicly on the Court’s web page.
18
Under the Bail Reform Act, 18 U.S.C. § 3145(f)(2), a detention hearing may be
19
reopened at any time before trial if the judicial officer finds that information exists that was
20
not known to the movant at the time of the detention hearing and that has a material bearing
21
on the issue whether there are conditions of release that will reasonably assure the
22
appearance of such person as required and the safety of any other person and the
23
community. Two of the detention or release factors (among others) to be considered by the
24
judicial officer are (1) the person’s “physical and mental condition” (3145(g)(3)(A)) and (2)
25
the nature and seriousness of the danger to any person or the community that would be
26
posed by the person’s release (3145(g)(4)).
27
The Crime Victims’ Rights Act, 18 U.S.C. § 3771, also provides crime victims the
28

1 statutory right to be reasonably protected from the accused, to reasonable notice of any

2 public court proceeding involving the crime or release of the accused, the right to be

3 reasonably heard and not excluded from public court proceedings, the right to be treated

4 with fairness and respect, the right to confer with the attorney for the Government in the

5 case, the right to proceedings free from unreasonable delay, and the right to be informed of

6 the rights under the Act. The Court shall ensure the crime victim is afforded the rights

7 described in the Act. 18 U.S.C. § 3771(b)(1).

8

This standing order sets forth the procedure for any request to reopen a detention

9 hearing on the basis of the physical and mental condition of the accused. This public health

10 crisis is serious and urgent. Counsel should not delay in evaluating whether any defendant

11 should have his or her detention hearing reopened.

12

1. Counsel for the Government and accused must confer first in an effort to

13 determine if they agree.

14

2. The Government must provide notice and an opportunity to confer and be

15 reasonably heard to any crime victim.

16

3. Any stipulation or motion to reopen must be filed in the ECF system.

17

4. The motion should state whether the defendant waives personal presence at the

18 hearing.

19

5. Copies of the motion to reopen must be provided to Pretrial Services and to

20 Clerk’s Office Manager Snooki Puli at Snooki_Puli@cand.uscourts.gov. This may be by

21 email.

22

6. Unless otherwise ordered, no hearing will be held in person. Counsel, clients, and

23 crime victims will be allowed to participate by telephone or video to the extent practicable.

24

IT IS SO ORDERED.

25

Date: March 16, 2020

26

_________________________ Nathanael M. Cousins United States Magistrate Judge

27

28

2

1

IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA

2

IN AND FOR THE COUNTY OF SANTA CLARA

3

4

STANDING ORDER OF THE COURT

5

DEFERRING SENTENCE SURRENDER DATES AND

6

PERMITTING SHERIFF TO AUTHORIZE CREDIT FOR

7

PARTICIPATION IN THE SHERIFF WORK PROGRAM

8 To the Sheriff of Santa Clara County:

9 1. The County of Santa Clara is amid a declared public health emergency. The Director of

10

Emergency Services proclaimed a local emergency and the County Public Health

11

Officer proclaimed a local health emergency on February 3, 2020, based on conditions

12

of extreme peril and the imminent and proximate threat to public health relating to

13

Coronavirus Disease 2019 (COVID-19).

14 2. The inmates in the County Jail and the County employees who provide for the safety,

15

security, and health of those inmates are at a particular risk to COVID-19 due to the

16

confined nature of the jail environment.

17 3. Santa Clara Valley Health System, Adult Custody Health Division Medical Director Dr.

18

Alexander Chyorny, in collaboration the Public Health Officer, has advised the criminal

19

justice partners that reducing the jail population is necessary to implement public health

20

measures.

21 4. On March 16, 2020, this court suspended all non-essential functions for three weeks or

22

until such order is lifted. This order was made in response to the County of Santa

23

Clara’s “shelter in place” orders, effective Tuesday, March 17, 2020 at 12:01 a.m.

24 5. Reducing the jail population is a critical preventative measure for inmates and staff.

25

Further, the County is seeking to avoid congregating individuals at the Re-Entry Center

26

as part of the Sheriff’s Work Program.

27

28 1
COURT ORDER

1 6. Based on the urgency of the health crisis and the stipulation between the People and the

2

defense at a hearing held on March 17, 2020 at 1:30 p.m. in Department 41, the court

3

makes the following orders:

4

a. Effective immediately, all individuals scheduled to surrender to the custody of

5

the Santa Clara County Sheriff between March 17, 2020 and May 15, 2020 will

6

have their surrender date continued by sixty (60) days.

7

b. Effectively immediately, all individuals who are participating in the Sheriff’s

8

Work Program shall, at the discretion of the Sheriff’s Office, receive credit for

9

the Sheriff’s Work Program until May 15, 2020, despite not being able to

10

participate in the program.

11 IT IS SO ORDERED.

12

13

______________________3_/_1_8_/2_0_2_0____

14

HON. ERIC S. GEFFON JUDGE OF THE SUPERIOR COURT

15

16

17

18

19

20

21

22

23

24

25

26

27

28 2
COURT ORDER

 
 Case 2:17-cv-08805-GW-JPR Document 75-1 Filed 07/17/20 Page 1 of 84 Page ID #:1163

1 AARON J. FISCHER (SBN 247391)

2

aaron.fischer@disabilityrightsca.org DISABILITY RIGHTS CALIFORNIA

3

1330 Broadway, Suite 500 Oakland, CA 94612

4 Telephone: (510) 267-1200 Facsimile: (510) 267-1201
5

6

JULIA E. ROMANO (SBN 260857) jromano@kslaw.com

7 JENNIFER T. STEWART (SBN 298798) jstewart@kslaw.com

8 STACY L. FOSTER (SBN 285544)

9

sfoster@kslaw.com KING & SPALDING LLP

10

633 W Fifth Street, Suite 1600 Los Angeles, CA 900781

11 Telephone: (213) 443-4355 Facsimile: (213) 443-4310
12

13 Attorneys for Plaintiffs

14 [Additional Counsel Listed On Second Page]

15

UNITED STATES DISTRICT COURT

16

CENTRAL DISTRICT OF CALIFORNIA

17

18

CLAY MURRAY, DAVID FRANCO, SHAREEN WINKLE, MARIA

19 TRACY, ERICK BROWN, on behalf

of themselves and all others similarly 20 situated,

21

Plaintiffs,

22

v.

23

Case No. 2:17-cv-08805-GW-JPR CLASS ACTION STIPULATED JUDGMENT Complaint Filed: December 6, 2017

24 COUNTY OF SANTA BARBARA, and SANTA BARBARA COUNTY
25 SHERIFF’S OFFICE,

26

Defendants.

27

28

STIPULATED JUDGMENT

Case 2:17-cv-08805-GW-JPR Document 75-1 Filed 07/17/20 Page 2 of 84 Page ID #:1164

1

DON SPECTER (SBN 83925) dspecter@prisonlaw.com

2 CORENE KENDRICK (SBN 226642) ckendrick@prisonlaw.com

3 PRISON LAW OFFICE

1917 Fifth Street 4 Berkeley, CA 94710

5

Telephone: (510) 280-2621 Facsimile: (510) 280-2704

6

DONALD F. ZIMMER, JR. (SBN 112279)

7 fzimmer@kslaw.com

8

KING & SPALDING LLP 101 Second Street, Suite 2300

9

San Francisco, CA 94105 Telephone: (415) 318-1220

10 Facsimile: (415) 318-1300

11 JOSHUA C. TOLL (Admitted Pro Hac Vice)

12

jtoll@kslaw.com KING & SPALDING LLP

13 1700 Pennsylvania Ave NW Washington DC 20036

14 Telephone: (202) 737-8616

15 Facsimile: (202) 626-3727

16

17

18

19

20

21

22

23

24

25

26

27

28

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1 A. Introduction

2

1. The Parties to this Stipulated Judgment (hereinafter “Stipulated

3 Judgment”) are the Plaintiff Class consisting of “all people who are now, or in the

4 future will be, incarcerated in the Santa Barbara County Jail system” and the

5 Plaintiff Disability Subclass of “[a]ll people who are now, or in the future will be,

6 incarcerated in the Santa Barbara County Jail system and who are qualified

7 individuals with disabilities, as that term is defined in the Americans with

8 Disabilities Act (ADA), 42 U.S.C. §12102, the Rehabilitation Act, 29 U.S.C. §

9 705(9)(B), and California Government Code § 12926(j) and (m),” see ECF No. 35

10 at 2 (collectively, “Plaintiffs”), and Defendants County of Santa Barbara and Santa

11 Barbara County Sheriff’s Office (collectively, “Defendants”).

12

2. Plaintiffs filed this lawsuit (the “Action”) on December 6, 2017. ECF. No.

13 1. The Action alleges that: Defendants hold Plaintiffs in deficient facilities that are

14 overcrowded, understaffed, and unsanitary; fail to provide minimally adequate

15 medical and mental health care to people incarcerated in the Jail; and subject

16 people in the jails to the harmful and excessive use of solitary confinement and

17 other custodial restrictions in violation of the Eighth and Fourteenth Amendments

18 to the United States Constitution.

19

3. The Action also alleges that Defendants discriminate against individuals

20 with disabilities in violation of the Americans with Disabilities Act (ADA) and

21 Section 504 of the Rehabilitation Act. Defendants have denied liability.

22

4. On May 31, 2018, the Court granted the Plaintiffs’ unopposed motion for

23 class certification. ECF No. 35.

24

5. Prior to the filing of this Action, Disability Rights California, Prison Law

25 Office, King & Spalding and the County of Santa Barbara entered into a Structured

26 Negotiations Agreement as an alternative to adversarial litigation. ECF No. 37 at

27 4-5. The Parties agreed upon a process for the retention of mutually agreed-upon

28

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1 experts to evaluate the policies, procedures, practices, and conditions at the Jail and

2 to complete reports. Consistent with the Agreement, the County retained four

3 recognized experts (the “Subject Matter Experts”): Scott A. Allen, M.D., as the

4 expert on medical care, Roberta Stellman, M.D., as the expert on mental health

5 care, Margo Frasier as the expert on custody operations, and Vanir Construction

6 Management, Inc., as the expert on disability accessibility issues. Based on the

7 reports of the joint experts and the Parties’ negotiations, the Parties subsequently

8 retained Harry Grenawitzke as an additional Subject Matter Expert, specifically to

9 assess environmental health and life safety issues in the Jail facilities.

10

6. The Subject Matter Experts conducted extensive tours and reviews of the

11 Jail facilities, policies, and procedures. The Subject Matter Experts submitted their

12 final reports setting forth their respective findings and making recommendations

13 for remedial action. Their reports are part of the record in this case. ECF Nos. 23-

14 2 (Medical Care-Allen), 23-3 (Mental Health Care-Stellman), 48-1 (Custody

15 Operations-Frasier) (non-confidential executive summaries); ECF Nos. 29

16 (Medical Care -Allen), 30 (Mental Health Care-Stellman), 67-1 (Custody

17 Operations-Frasier) (confidential full reports filed under seal pursuant to Protective

18 Order); ECF Nos. 61-1 (ADA/Disability-Vanir), 65-1 (Environmental Health and

19 Safety-Grenawitzke) (full reports).

20

7. The Parties have negotiated remedial plans pertaining to the matters

21 alleged in the Action. Those plans have been incorporated into a single, global

22 Remedial Plan, attached hereto as Exhibit A.

23

8. Each party to this Stipulated Judgment was represented by counsel during

24 its negotiation and execution. Plaintiffs are represented by Aaron J. Fischer of

25 Disability Rights California; Don Specter and Corene Kendrick of Prison Law

26 Office; and Julia E. Romano, Jennifer T. Stewart, Stacy L. Foster, Donald F.

27 Zimmer, and Joshua C. Toll of King & Spalding LLP. Defendants are represented

28

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1 by Amber Holderness and Michelle Montez of the Santa Barbara Office of County

2 Counsel.

3

9. Through this Stipulated Judgment, Defendants agree to implement the

4 measures set forth in the Remedial Plan, subject to monitoring by the Remedial

5 Plan Experts and Plaintiffs’ counsel, negotiation between the Parties, and, if

6 necessary, enforcement by the Court after use of the Dispute Resolution procedure

7 set forth below.

8 B. Remedial Plan

9 10. Defendants shall fully implement all of the remedial measures, according

10 to the specified timeframes (where identified), set forth in the Remedial Plan. For

11 remedial measures requiring a remodel, reconfiguration, or renovation of the Main

12 Jail, Defendants shall fully implement those measures on or before July 1, 2023,

13 subject to all applicable California Environmental Quality Act (“CEQA”) review

14 processes, permitting requirements, public comment and hearing requirements, and

15 other public approval processes. These include Remedial Plan provisions II.D.1

16 (Clinical Treatment and Office Space for Health Care Service Delivery) and V.P.1

17 (Main Jail ADA/Accessibility Physical Plant Issues). Defendants shall make best

18 efforts to give notice to Plaintiffs by January 1, 2023, if the County deems that it

19 cannot complete implementation of the provisions specified in this paragraph by

20 July 1, 2023 due to information produced from any required CEQA review

21 process, public review and hearing processes, or construction issues. In any event,

22 the County will within ten (10) days of making such determination provide written

23 notice of the anticipated delay to Plaintiffs. The notice will include the new

24 information leading to the delay, a proposed alternative schedule for completing

25 implementation, and if the proposed schedule delays implementation for more than

26 180 days, a proposal to modify the remedial plan, as applicable.

27

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1 11. Defendants shall implement the remedial measures covering minimum out-

2 of-cell time at the Main Jail and specialized mental health unit programing at the

3 Main Jail (Remedial Plan provisions III.D.3, III.D.5-7, and VII.D) incrementally

4 where remodel, reconfiguration, or renovation of the Main Jail facility is necessary

5 to achieve full implementation. Defendants agree that, during the period of

6 implementation, they will take all reasonable steps to provide out-of-cell time and

7 programming as specified in the Remedial Plan to the maximum extent possible.

8 12. Nothing in this Stipulated Judgment and the attached Remedial Plan

9 requires the continued or prospective operation of any jail facilities, including at

10 the Main Jail and at the Northern Branch Jail. The provisions in the Remedial Plan

11 shall apply to all units and facilities that Defendants choose to operate for the

12 confinement of class members.

13 13. The Parties agree that population-related stressors pose operational

14 challenges to Defendants’ ability to comply with this Remedial Plan, particularly

15 with respect to provisions relating to minimum requirements for out-of-cell time.

16 Under the Remedial Plan, Defendants will agree to not house prisoners in housing

17 units in such a way as to exceed the rated capacity, and will ensure that each

18 prisoner in custody at the Jail is provided a bed. The Parties recognize that if Jail

19 population-related stressors are reduced, particularly as to people with disabilities,

20 Defendants will be better able to ensure implementation of the Remedial Plan.

21 Defendants have recently created a Pre-Arraignment Unit to facilitate early

22 connections with community services and release from custody when consistent

23 with public safety, a Law Enforcement and Mobile Crisis Mental Health co-

24 response pilot program, a Sobering Center, and a centralized crisis services hub.

25 The Parties agree that if the size of the Jail’s population prevents timely and

26 sufficient implementation of and compliance with the Remedial Plan, the Parties

27 will meet and confer regarding additional population reduction measures.

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1 14. Defendants shall develop and implement appropriate and adequate plans,

2 policies, and practices to ensure compliance with the Remedial Plan. At least 21

3 days prior to finalizing or implementing any new plans or policies developed to

4 meet the terms of the Remedial Plan, Defendants shall submit such plans or

5 policies to Plaintiffs’ counsel for review and comment.

6 15. Within 120 days after this Stipulated Judgment is approved by the Court,

7 Defendants shall provide to Plaintiffs’ counsel and the Remedial Plan Experts

8 (discussed below) a Status Report which shall (1) include a description of the steps

9 taken by Defendants to implement each provision set forth in the Remedial Plan;

10 and (2) specify provisions of the Remedial Plan that have not yet been

11 implemented. With respect to the provisions of the Remedial Plan not yet

12 implemented, Defendants’ Status Report shall (i) describe all steps taken toward

13 implementation; (ii) set forth with as much specificity as possible those factors

14 contributing to non-implementation; and (iii) set forth a projected timeline for

15 anticipated implementation.

16 16. Following the first Status Report and at the end of each subsequent 180-

17 day period during the term of this Stipulated Judgment, Defendants shall provide to

18 Plaintiffs’ counsel and the Remedial Plan Experts (discussed below) an updated

19 Status Report addressing each item of the Remedial Plan for which monitoring is

20 not suspended, as set forth in Part I, below.

21 17. The parties recognize that the COVID-19 public health emergency may

22 impact the ability of the Remedial Plan Experts and Plaintiffs’ counsel to conduct

23 on-site monitoring in the Jail facilities. The parties will meet and confer as needed

24 should public health needs related to the pandemic prevent timely completion of

25 on-site monitoring as set forth in the Stipulated Judgment. The parties agree that,

26 under such circumstances, other aspects of monitoring and Remedial Plan

27 implementation can and should continue, including production of requested data

28

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1 and information consistent with the Stipulated Judgment. Defendants agree to

2 provide reasonably requested data and information to, and confer in a reasonable

3 timeframe with, Plaintiffs’ counsel on Defendants’ ongoing response to the

4 COVID-19 pandemic as it relates to the health and safety of class members.

5 C. Remedial Plan Experts

6 18. The Parties jointly request that Kerry Hughes, M.D. (Mental Health,

7 Suicide Prevention), Homer Venters, M.D. (Medical Care) and Michael

8 Brady/Sabot Group (ADA-Disability, Environment of Care) serve as Remedial

9 Plan Experts to (a) advise the Court on Defendants’ compliance or non-compliance

10 with the Remedial Plan, as necessary; (b) assist with dispute resolution matters

11 addressed below; and (c) provide testimony, if required, in any proceedings before

12 the Court.

13 19. The parties continue to meet and confer to identify a mutually agreeable

14 Remedial Plan Expert regarding custody operations, and are discussing Peter

15 Perroncello or Terri McDonald for that role. If the parties are unable to agree upon

16 such expert before final approval of the Stipulated Judgment, the Parties will

17 submit these two candidates to Magistrate Judge Abrams as the designated

18 mediator (see Paragraph 46, below), who will assist the Parties in reaching

19 agreement. If Mr. Perroncello and/or Ms. McDonald become unavailable for the

20 role at any time, the parties may propose one or two alternative candidates for the

21 Remedial Plan Expert role. If the parties are unable to reach agreement, Judge

22 Abrams will select the custody operations Remedial Plan Expert from among the

23 proposed candidates.

24 20. Within 180 days after entry of this Stipulated Judgment, the Remedial

25 Plan Experts shall each complete a review and report to advise the Parties on

26 Defendants’ progress in implementing the Remedial Plan within each expert’s area

27

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1 of expertise. The Parties recognize that experts may assess multiple sections of the

2 Remedial Plan, so long as the provisions assessed are within their area of expertise.

3 21. Not less than one (1) year after the completion of their respective first

4 reports, and then annually thereafter during the term of this Stipulated Judgment,

5 the Remedial Plan Experts shall complete reviews and reports (“Annual Reports”)

6 to advise the Parties on Defendants’ compliance or non-compliance with the

7 Remedial Plan.

8 22. In each Annual Report, the Remedial Plan Experts shall identify whether

9 Defendants are or are not in substantial compliance with the Remedial Plan

10 provisions within the expert’s area of expertise. These findings are hereinafter

11 referred to as “Substantial Compliance Determinations.” The Annual Reports will

12 provide, to the extent possible, specific recommendations as to how Defendants

13 may reach substantial compliance. The Parties shall have an opportunity to

14 respond to any finding regarding Defendants’ compliance with any provision of the

15 Remedial Plan. The Parties shall submit any such response to the Remedial Plan

16 Experts and all counsel within 30 days of the Annual Report completion. The

17 Parties recognize that the Remedial Plan Experts’ reports are not confidential and

18 may be submitted to the Court for purposes of any future proceedings.

19 23. The Remedial Plan Experts’ duties specified in Exhibit B shall be

20 provided to the Remedial Plan Experts. The Remedial Plan Experts shall be

21 entitled to reasonable compensation based on the cost estimates and fee caps

22 provided in their respective agreements with the Parties, which shall be paid by

23 Defendants.

24 24. With appropriate notice, the Remedial Plan Experts shall have reasonable

25 access to all parts of any Santa Barbara County facility necessary to monitoring

26 compliance with the Remedial Plan. Access to the facilities will not be

27 unreasonably restricted. The Remedial Plan Experts shall have access to

28

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1 correctional health care, and other appropriate staff and people incarcerated at the

2 jails, including confidential and voluntary interviews as is reasonable to complete a

3 report and that does not implicate security or other privileged information.

4 25. The Remedial Plan Experts shall also have access to non-privileged

5 documents, including budgetary, custody, and health care documents, and

6 institutional meetings, proceedings, and programs to the extent the Remedial Plan

7 Experts determine such access is needed to fulfill their obligations. Documents

8 produced to the Remedial Plan Experts will be made available to Plaintiffs’

9 counsel.

10 26. The Remedial Plan Experts’ tours shall be undertaken in a manner that

11 does not unreasonably interfere with Jail operations. The Remedial Plan Experts

12 shall be bound, where applicable, by the Stipulated Protective Order (ECF No. 31).

13 The Remedial Plan Experts shall have access to individual records of people who

14 are or have been incarcerated in the county jails, as consistent with the Court’s

15 Order for Disclosure of Confidential Inmate Records (ECF No. 42).

16 27. The Parties agree that they are each entitled to engage in ex parte

17 communications with the Remedial Plan Experts.

18 28. If, for any reason, a designated Remedial Plan Expert can no longer serve,

19 the Parties shall attempt to agree on who shall be appointed to serve in such

20 expert’s place. If the Parties do not agree, Defendants and Plaintiffs shall each

21 nominate and submit up to two potential experts for the Magistrate Judge’s

22 consideration and selection in accordance with the dispute resolution process set

23 forth below.

24 D. Notice to Class Members

25 29. Defendants shall post notices to class members of this Action in a manner

26 agreed upon by the Parties and approved by the Court. Such notices shall include a

27 brief statement that includes a description of Plaintiffs’ claims, the definition of the

28

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1 class and subclass, notice that the Parties have entered into this Stipulated

2 Judgment, a description of the subject areas covered by the Stipulated Judgment

3 and Remedial Plan, and contact information to allow people incarcerated in the

4 Santa Barbara jails to contact Plaintiffs’ counsel.

5 30. The Parties shall meet and confer as to the content of the notice and the

6 method for posting the notice.

7 31. Defendants will post notices consistent with the Parties’ agreement within

8 30 days after the entry of this Stipulated Judgment, and shall maintain the notices

9 so long as the Stipulated Judgment is in effect, absent further order of the Court. In

10 the event disagreements arise regarding the contents of such notice, the Parties will

11 first meet and confer in an informal attempt to resolve the disagreement. Failing

12 that, any such disagreements shall be resolved pursuant to the Dispute Resolution

13 procedure set forth below.

14 E. Plaintiffs’ Monitoring and Access to Information

15 32. Plaintiffs’ counsel shall be permitted to monitor Defendants’ compliance

16 with all aspects of the Remedial Plan. Defendants shall provide Plaintiffs’ counsel

17 with access to information, including all Santa Barbara Jail facilities, staff,

18 documents, records (including health care and/or custody files of specified

19 incarcerated persons) that Plaintiffs’ counsel believes in good faith are necessary to

20 monitor Defendants’ compliance with the Remedial Plan subject, where applicable,

21 to the Stipulated Protective Order (ECF No. 31) and Order for Disclosure of

22 Confidential Inmate Records (ECF No. 42) and subject to any other applicable

23 privileges. Defendants shall provide Plaintiffs’ counsel with access to such

24 information within 30 calendar days of their request. If Defendants believe that the

25 information requested by Plaintiffs’ counsel is not necessary to monitor

26 compliance with the Remedial Plan, the parties shall engage in the Dispute

27 Resolution process described herein before seeking any relief from the Court.

28

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1 33. From the date this Stipulated Judgment is entered by the Court, Defendants

2 shall provide Plaintiffs’ counsel the health care and/or custody files of people

3 incarcerated or previously incarcerated in the Jail, as well as other information

4 described above, within 21 calendar days of their request.

5 34. If Defendants believe that the information requested by Plaintiffs’ counsel

6 is not necessary to monitor compliance with the Remedial Plan, the Parties shall

7 engage in the Dispute Resolution process described below before seeking any

8 relief from the Court.

9 35. Defendants shall provide Plaintiffs’ counsel with full and complete copies

10 of the health care, custody, and investigation-related files of any incarcerated

11 person who dies in custody. The health care and custody records shall be produced

12 within 30 calendar days of the death. All other related documents, including, but

13 not limited to, incident reports, autopsy reports, and death reviews (e.g.,

14 psychological autopsies, mortality reviews, QI/QA reviews), shall be produced

15 within 10 days of the document’s completion.

16 36. Defendants shall allow Plaintiffs’ counsel and their consultants to conduct

17 at least two tours of each Santa Barbara County jail facility per calendar year for

18 the purpose of monitoring compliance with the Remedial Plan so long as the

19 Stipulated Judgment is in effect. After two years, the Parties shall meet and confer

20 about the need for two tours per year in light of the status of Defendants’

21 compliance with the Remedial Plan at that time, provided that tours shall not be

22 less than one per year so long as the Stipulated Judgment is in effect. Plaintiffs’

23 counsel’s visits to Santa Barbara County solely to meet with and/or interview class

24 members will not be counted as a “tour” for purposes of this provision.

25 37. Monitoring tours by Plaintiffs and/or their consultants shall include

26 reasonable access to all relevant facilities, including all housing units, facilities

27 where health care services are provided, facilities where people in Defendants’

28

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1 custody are or may be housed and provided programming, and any other facilities

2 where services are provided pursuant to the Remedial Plan. During the tours,

3 Defendants shall make available for interview supervisory, clinical, custodial, and

4 program staff that have direct or supervisory responsibility for health care,

5 classification, housing, discipline, jail operations, and disability accommodations.

6 Defendants shall provide a Sheriff’s Office contact person to ensure cooperation of

7 staff with Plaintiffs’ counsel in obtaining information requested during the tours.

8 During the tours, Defendants shall permit and facilitate Plaintiffs’ counsel having

9 confidential and voluntary discussions with any incarcerated person or group of

10 incarcerated people upon request, consistent with safety and security needs. Upon

11 request by Plaintiffs and pursuant to the Protective Order (ECF No. 31) and Order

12 for Disclosure of Confidential Inmate Records (ECF No. 42), disputes that may

13 arise over Plaintiffs’ counsel’s access to information or personnel shall be

14 addressed through the Dispute Resolution process described below.

15 38. If Plaintiffs’ counsel form the good faith belief that Defendants are not

16 substantially compliant with any component of the Remedial Plan based on the

17 reviews of the Remedial Plan Experts and/or Plaintiffs’ counsel monitoring,

18 Plaintiffs’ counsel shall so inform Defendants in writing and, as applicable, the

19 relevant Remedial Plan Expert(s) of any alleged noncompliance and identify the

20 component(s) of the Remedial Plan alleged to be noncompliant.

21 39. Defendants shall investigate the alleged noncompliance and provide

22 Plaintiffs’ counsel with a response in writing within 30 calendar days. Either party

23 shall have the option of requesting an investigation and opinion from the relevant

24 Remedial Plan Expert. If Plaintiffs’ counsel are not satisfied with Defendants’

25 response, the Parties shall engage in the Dispute Resolution process described

26 below.

27

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1 40. Defendants shall ensure that Plaintiffs’ counsel have access to confidential

2 visits and telephone calls with class members. The Parties will establish an

3 efficient means to allow Plaintiffs’ counsel to interview a class member or group of

4 class members, and to conduct confidential telephonic interviews with individual

5 class members, with reasonable notice, in a manner that does not disrupt jail

6 operations.

7 41. Plaintiffs’ counsel shall be allowed to send postage pre-paid envelopes

8 (metered) to class members in the Jail.

9 F. Individual Class Member Concerns

10 42. Plaintiffs’ counsel may bring concerns in writing about individual people

11 in the jails, including but not limited to issues regarding medical and mental health

12 care, housing, isolation, disability accommodations or access, or safety/well-being

13 to the attention of Defendants’ counsel, or their designee, who shall respond in

14 writing within 14 calendar days, unless the urgency of the issue requires a more

15 expedited response. The Parties will work cooperatively to resolve individual

16 concerns.

17 43. This process is not meant to replace or circumvent the existing processes

18 for requesting medical or mental health services, or following the existing request

19 and grievance processes in the jails. People in the jails will be encouraged to make

20 use of those processes.

21 G. Dispute Resolution

22 44. Either party may initiate the dispute resolution process with respect to any

23 matter covered by this Stipulated Judgment by providing written notice of a

24 dispute (“Dispute Notice”) to the other party.

25 45. Following service of the Dispute Notice, the Parties shall undertake good

26 faith negotiations at such times and places as they deem sufficient in an effort to

27 resolve the dispute informally between them. If, within 30 days after service of the

28

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1 Dispute Notice, the Parties have failed to resolve the dispute, either party may

2 request that the Remedial Plan Expert(s) most knowledgeable in the subject matter

3 of the dispute be permitted to evaluate the issue in dispute and prepare a report.

4 The Remedial Plan Expert(s) must provide the report regarding the area of

5 disagreement to the Parties within 45 days of the request. Defendants will pay the

6 reasonable fees as set forth in the Remedial Plan Expert’s agreement with the

7 parties for any report prepared by a Remedial Plan Expert at the request of a party

8 about a disputed issue.

9 46. The following general protocol will apply to all disputes arising under this

10 Stipulated Judgment: In the event of disagreement between the Parties regarding

11 any aspect of this Stipulated Judgment, including but not limited to (1)

12 interpretation of its terms; (2) implementation of its provisions; and/or (3) a

13 determination of the Parties’ respective rights, obligations and duties, the Parties

14 shall first undertake good faith negotiations in an effort to resolve the dispute

15 informally between them.

16 47. The Parties’ informal negotiation process shall be completed within 45

17 days of the identification of a dispute. In the event the Parties’ good faith attempt

18 to resolve the dispute informally proves unsuccessful, the Parties shall next seek

19 the assistance, advice, and/or guidance of the Chief Magistrate Judge Paul L.

20 Abrams, whom the parties have agreed to designate as mediator for this case. The

21 parties shall request that mediation be scheduled within 90 days of the Dispute

22 Notice, unless the parties mutually agree upon an alternative schedule. The

23 Dispute Resolution process shall continue until i) the Parties agree in writing that

24 mediation is concluded; or ii) upon the request of a party, the mediator determines

25 and so notifies the Parties in writing that the Parties are at impasse, a party is not

26 negotiating in good faith or further negotiation would be futile. If the Dispute

27

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1 Resolution process is unsuccessful, the Parties may seek the Court’s assistance in

2 resolving the dispute.

3 48. With the exception of any report prepared by a Remedial Plan Expert, as

4 described above, and any notice that mediation is concluded, nothing said and no

5 document prepared in connection with the mediation shall be offered in evidence

6 in any subsequent judicial proceeding in this case.

7 H. Enforcement of Stipulated Judgment

8 49. The Court shall retain jurisdiction to enforce the terms of this Stipulated

9 Judgment, and shall have the power to enforce the agreement through specific

10 performance and all other remedies permitted by law for the duration of the

11 Stipulated Judgment, as set forth below.

12 50. The Stipulated Protective Order (ECF No. 31) and the Order for Disclosure

13 of Confidential Inmate Records (ECF No. 42) shall remain in force while this

14 Stipulated Judgment is effective.

15 I. Duration and Termination

16 51. The duration of this Stipulated Judgment is four years from the date this

17 Stipulated Judgment is entered by the Court, unless it is (a) terminated earlier

18 pursuant to the paragraph below, or (b) subject to the Dispute Resolution process,

19 is extended as to any provision of this Stipulated Judgment or the Remedial Plan

20 with which the Defendants are not in substantial compliance until such time as

21 substantial compliance is achieved. Any such extension not mutually agreed upon

22 by the Parties shall be subject to the Dispute Resolution process set forth above.

23 52. Defendants may, after conferring with Plaintiffs’ counsel, request a finding

24 by the Remedial Plan Expert(s) that Defendants are in substantial compliance with

25 one or more components of the Remedial Plan and have maintained such

26 substantial compliance for a period of at least six (6) months. Such a finding will

27

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1 result in a suspension of monitoring by the relevant Remedial Plan Expert and

2 Plaintiffs’ counsel of any such component.

3 53. If Plaintiffs form the good faith belief that Defendants are no longer in

4 substantial compliance with any component(s) of the Remedial Plan previously

5 found to be in substantial compliance and as to which monitoring has been

6 suspended, Plaintiffs shall promptly so notify Defendants in writing and present a

7 summary of the evidence upon which such belief is based. Within 30 days

8 thereafter, Defendants shall serve a written response stating whether they agree or

9 disagree that they are no longer in substantial compliance with respect to the

10 identified component(s) of the Remedial Plan. In the event that Defendants agree,

11 monitoring by the Remedial Plan Experts and Plaintiffs’ counsel pursuant to this

12 Stipulated Judgment shall resume. In the event Defendants disagree, Plaintiffs may

13 bring a motion before the Court seeking such relief as may be appropriate,

14 including but not limited to reinstating full monitoring, provided that, before

15 bringing such a motion, Plaintiffs have complied with the Dispute Resolution

16 process described herein.

17 54. Defendants may seek termination of this Stipulated Judgment by bringing

18 a termination motion pursuant to 18 U.S.C. § 3626(b)(1)(A)(i), provided however,

19 that (i) Defendant shall not bring any such motion for a period of two years from

20 the date this Stipulated Judgment is entered by the Court; (ii) any termination

21 motion shall be based on a record of no less than six (6) months of substantial

22 compliance with all the requirements of this Stipulated Judgment and the Remedial

23 Plan; and (iii) there is no Dispute Resolution process pending between the parties.

24 J. Costs and Fees

25 55. Costs and Fees Prior to Entry of the Stipulated Judgment: The Parties

26 agree that, by entry of this Stipulated Judgment, Plaintiffs are the prevailing party

27 in this litigation. The Prison Litigation Reform Act (PLRA), 42 U.S.C. Section

28

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1 1997e, would limit the hourly rate at which Plaintiffs’ counsel can be compensated

2 in connection with certain claims in the Action, while other claims are not subject

3 to such statutory limits. Notwithstanding the foregoing, subject to Court approval,

4 the Parties have reached a compromise and Defendants have agreed to pay

5 Plaintiffs’ counsel $1,132,809 for reasonable fees and expenses incurred from the

6 date that Plaintiffs’ counsel commenced an investigation into conditions at the

7 Santa Barbara County Jail through Final Approval of the Stipulated Judgment,

8 including approval of the Remedial Plan.

9 56. Costs and Fees for Monitoring and Enforcement. Plaintiffs’ counsel shall

10 be compensated for their reasonable time and reasonable expenses (including the

11 costs of any consultants Plaintiffs’ counsel may retain) relating to monitoring and

12 enforcing this Stipulated Judgment and Remedial Plan, including any time and

13 expenses incurred in connection with the resolution of any dispute pertaining to

14 such monitoring and enforcement. Plaintiffs shall submit a detailed invoice for

15 their fees and expenses (including the date, amount of time spent, and a general

16 description of each task) at the end of every quarter. Defendants shall pay the

17 amount requested by Plaintiffs’ counsel within 60 calendar days of receipt of each

18 invoice.

19 57. Costs and Fees Cap for Monitoring and Enforcement. Plaintiffs’ counsel’s

20 fees and expenses set forth in the paragraph above shall be capped at $125,000 per

21 County fiscal year (July 1 to June 30). In the first year of the Stipulated Judgment,

22 the costs and fees cap shall be prorated based on the commencement date of the

23 Stipulated Judgment with respect to the start of the fiscal year.

24 58. Costs and Fees for Future Litigation Before the Court. Subject to both

25 Court approval and Defendants’ right to object to the reasonableness of the number

26 of hours for which Plaintiffs’ counsel may seek compensation, Defendant agrees to

27

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1 Dated: July 16, 2020 2 3 4 5 6 Dated: July 16, 2020 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

PRISON LAW OFFICE
Corene Kendrick Attorneys for Plaintiffs KING & SPALDING LLP
______ Julia Romano Attorneys for Plaintiffs

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EXHIBIT A
Murray v. County of Santa Barbara Remedial Plan

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TABLE OF CONTENTS
I. Definitions........................................................................................................................... 1 II. MEDICAL CARE............................................................................................................... 3
A. County Monitoring of Private Medical Contract ................................................... 3 B. Policies and Procedures ............................................................................................ 4 C. Health Care Records ................................................................................................. 4 D. Space for Health Care Service Delivery .................................................................. 4 E. Screening on Intake................................................................................................... 5 F. Access to Care ............................................................................................................ 6 G. Chronic Care.............................................................................................................. 8 H. Pharmacy Services .................................................................................................... 9 I. Transgender and Gender Nonconforming Health Care...................................... 10 J. Drug/Alcohol Withdrawal ...................................................................................... 10 K. Utilization Management.......................................................................................... 10 L. Review of Inmate Deaths ........................................................................................ 11 M. Discharge Planning.................................................................................................. 11 N. Quality Management............................................................................................... 11 III. MENTAL HEALTH CARE ............................................................................................. 12 A. Policies and Procedures .......................................................................................... 12 B. Intake ........................................................................................................................ 13 C. Patient Privacy and Confidentiality ...................................................................... 14 D. Mental Health Services, Housing, and Access to Care ........................................ 15 E. Psychiatric Medication Practices ........................................................................... 18 F. Mental Health and Disability Input in the Jail Disciplinary Process ................. 18 G. Seclusion and Restraint........................................................................................... 20 H. Discharge and Reentry Services............................................................................. 20 I. Cross-Agency Coordination of Mental Health Treatment and Service Need ... 21 J. Continuous Quality Improvement ......................................................................... 21 IV. SUICIDE PREVENTION................................................................................................. 23
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A. Overview................................................................................................................... 23 B. Screening for Suicide Risk...................................................................................... 23 C. Housing of Prisoners on Suicide Precautions ....................................................... 24 D. Treatment and Conditions for Individual Prisoners on Suicide Precautions.... 25 E. Supervision/Monitoring of Suicidal Prisoners...................................................... 26 F. Discharge from Suicide Precautions and Follow-Up ........................................... 26 G. Emergency Response............................................................................................... 27 H. Continuous Quality Improvement ......................................................................... 28 V. DISABILITY ACCOMMODATIONS AND ACCESS, AMERICANS WITH DISABILITIES ACT (ADA)............................................................................................ 28 A. Policy......................................................................................................................... 28 B. ADA Coordinator .................................................................................................... 29 C. ADA Notice to Prisoners ......................................................................................... 29 D. Staff Training........................................................................................................... 30 E. ADA Tracking System ............................................................................................ 30 F. Screening for Disability and Disability-Related Needs ........................................ 31 G. Disability-Related Requests and Grievances ........................................................ 32 H. Housing Placements ................................................................................................ 33 I. Visitation .................................................................................................................. 34 J. Access to Programs, Services, and Activities ........................................................ 34 K. Health Care Appliances, Assistive Devices, Durable Medical Equipment ........ 35 L. Transportation......................................................................................................... 36 M. Effective Communication ....................................................................................... 37 N. Access for Individuals with Hearing Impairments .............................................. 39 O. Prisoners with Intellectual/Developmental Disabilities ....................................... 40 P. Physical Accessibility Requirements ..................................................................... 41 Q. Alarms/Emergencies ............................................................................................... 41 R. Quality Assurance ................................................................................................... 42 VI. ENVIRONMENTAL HEALTH AND SAFETY ............................................................. 43 A. Environmental Health and Safety Monitor .......................................................... 43 B. Cleanliness and Sanitation of Jail Facilities.......................................................... 43
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C. Laundry .................................................................................................................... 44 D. Food Service and Kitchen Operations................................................................... 45 E. Work Order System and Preventative Maintenance ........................................... 45 F. Chemical Control and Biohazardous Materials ................................................... 46 G. Negative Pressure Monitoring and Recording ..................................................... 47 H. Emergency Response and Fire/Life Safety ........................................................... 47 I. Environment of Care Monitor Inspections, Corrective Action, and Process for
Prisoners to Raise Concerns ................................................................................... 47 VII. CUSTODY OPERATIONS/SEGREGATION................................................................. 48
A. General Principles ................................................................................................... 48 B. Classification Procedures........................................................................................ 48 C. Elimination of Dangerous or Improper Physical Plant Features ....................... 49 D. Minimum Out-of-Cell Time ................................................................................... 50 E. Disciplinary Procedures.......................................................................................... 51 F. Safeguards for Prisoners Placed in Segregation................................................... 52 G. Grievances, Inmate Request Forms, Property/Privileges in Segregation .......... 53 H. Other Custody Operations ..................................................................................... 54 VIII. STAFFING FOR HEALTH CARE SERVICES .............................................................. 54 IX. TRAINING RELATED TO TREATMENT OF PRISONERS WITH SPECIAL NEEDS ........................................................................................................................................... 55
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MURRAY V. COUNTY OF SANTA BARBARA
REMEDIAL PLAN
I. DEFINITIONS
“Disability” means any physical, cognitive, developmental, intellectual, mental, or sensory impairment that substantially limits one or more major life activities.
“Effective Communication” means that any written or spoken communication must be as clear and understandable to people with disabilities as it is for people who do not have disabilities.
“Emergent” in the context of a medical care referral means a medical care referral or request that manifests itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in serious disability or death. Emergent medical conditions include shortness of breath, uncontrolled bleeding, seizures, chest pain, and hypoglycemic shock. Emergent medical care conditions are treated as an emergency by the County. Within the context of mental health referral or request, “emergent” refers to acute symptoms in which the patient is in immediate danger to him(her) self or others. Emergent mental health conditions include a patient reporting suicidality or command hallucinations to harm self or others, or who is actively engaging in selfinflicted bodily harm.
“Health Care Appliances, Assistive Devices, Durable Medical Equipment” (HCA/AD/DME) refers to equipment necessary to meet or accommodate a person’s medical or disability-related needs, and includes, but is not limited to, prosthetic and orthotic appliances, prosthetic appliances, eyeglasses, and other equipment used to to serve a medical purpose.
“Individual Program Plan” or “IPP” is a record of the decisions made by the planning team of a person with a developmental disability, including the person with a developmental disability, their family (when appropriate), regional center representative(s) and others.
“Intellectual/Developmental Disability” is a disability characterized by significant limitations in intellectual functioning (such as learning, reasoning, and problem-solving) and in adaptive behavior (conceptual skills such as language, literacy, money, time, and self-direction; social and interpersonal skills; and practical skills such as personal care and schedules/routines). This includes people for whom the onset of the disability occurred before age 18 (developmental

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disabilities) and people for whom events later in life resulted in similar limitations (e.g., traumatic head injury, stroke, or dementia).
“Jail” refers to the Santa Barbara County Jail, including its current and future jail facilities.
“Mental health caseload” means all prisoners in the jail with a current identified need for any mental health services.
References to “medical services,” “medical treatment” and “medical staff” includes dental services, dental treatment and dental staff, as well as pharmacy services and pharmacy staff.
“Provider” means physician, dentist, physician’s assistant, or nurse practitioner.
“Qualified Health Professional” means physicians, physician assistants, nurses, nurse practitioners, dentists, mental health professionals, and others who by virtue of their education, credentials, and experience are permitted by law to evaluate and provide health care to patients.
“Qualified Mental Health Professional” means psychiatrists, psychologists, master’s level social workers, licensed professional counselors (including licensed MFTs), licensed nurses, or others who by virtue of their education, credentials, and experience are permitted by law to evaluate and provide mental health care to patients.
“Qualified Sign Language Interpreter” (“SLI”) is an individual, available on-site or through a VRI service, who is adept at American Sign Language (“ASL”) and has passed a test and qualified in one of the categories established by the National Association for the Deaf (NAD) or one of the categories established by the Registry of Interpreters for the Deaf (RID). For the purposes of this agreement, no incarcerated person or custody staff may serve as a SLI.
“Routine” means a medical care or mental health referral or request other than an emergent or urgent medical condition. Routine medical conditions include colds, flus, complaints of pain, skin conditions, and special requests. Routine mental health conditions include the need for a medication bridge, current mental health symptoms, current mental health treatment, refusal to answer medical intake questionnaire, reporting thoughts of hopelessness, worthlessness, or a history of mental illness, or a current or history of substance abuse, violent behavior, or victimization.
“Segregation” means the confinement in a locked room or cell, with or without a cellmate, with limited social contact as compared with the general population, in conditions characterized by substantial isolation, which includes 22 hours per day
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or more in a cell. If a housing unit or location meets the above definition, the unit will be considered a Segregation unit, regardless of name.
“Serious Mental Illness” (“SMI”) means a mental illness that results in serious functional impairment which substantially interferes with or limits one or more major life activities. “Structured Out-of-Cell Time”: Out-of-cell time in the designated mental health units, during which services, programs, or activities that are (1) facilitated by staff or a contractor; and (2) approved by mental health staff, are offered. “TTYs” or “TDDs” means devices that are used with a telephone to communicate with persons who are Deaf by typing and reading communications. “Unstructured Out-of-Cell Time”: Out-of-cell time that is not Structured Out-ofCell Time. “Urgent” means a medical or mental care referral or request that manifests itself by acute symptoms of sufficient severity that if services are not urgently received, the patient’s situation could deteriorate to the point that emergent services are necessary. Urgent medical conditions include hives, abscesses, allergic reactions, signs and symptoms of cardiac conditions, and hypo/hyperglycemia. “Video Remote Interpreting service” or “VRI service” means an interpreting service that uses video conference technology over dedicated lines or wireless technology offering clear, delay-free, full-motion video and audio over high-speed connection that delivers high-quality video images as provided in 28 C.F.R. § 35.160(d). “Videophone” means a device with a video camera that can perform bi-directional video and audio transmissions between people in real-time. “Video-Relay Services” or “VRS” is a video telecommunications relay service that enables persons with hearing-related disabilities who use Sign Language to communicate with voice telephone users through video equipment, such as a Videophone, rather than through typed text. II. MEDICAL CARE
A. County Monitoring of Private Medical Contract 1. The County shall appoint a County employee or consultant with adequate expertise to provide ongoing monitoring and oversight of the private Jail health care provider contract.
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2. The County’s Department of Public Health and Behavioral Wellness shall actively monitor the Jail health care contract with any private health care services provider.
B. Policies and Procedures
1. The County will develop and implement policies and procedures related to the delivery of medical care specific to the County’s Jail system. The County will have ownership and control over the final policies that are created from this process.
C. Health Care Records
1. The County shall implement an integrated electronic health records system and provide ongoing IT support.
2. The County shall implement policies and procedures to ensure that health care staff adequately document health care contacts and treatment intervention information, including:
a) Patient housing location, type of health care service, and setting where the services were delivered;
b) Time of the health care encounter and time the note is generated in the system.
3. The County shall implement policies and procedures to ensure that the electronic health record system is modified, maintained, and improved as needed on an ongoing basis.
4. The County shall implement and utilize Jail health care forms that the County owns.
D. Space for Health Care Service Delivery
1. The County shall ensure sufficient and suitable clinical treatment and office space to support health care service delivery. Space for health care services shall provide a therapeutic setting with adequate patient privacy and confidentiality.
2. The parties recognize that paragraph 1, above, will require a remodel, reconfiguration, or renovation of the Main Jail subject to the timeframe set forth in the Stipulated Judgment. The County and the Sheriff’s Office agree that, during the period of renovations at the Main Jail, they will, to the maximum extent possible given existing physical plant limitations, take reasonable steps to provide
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sufficient and suitable clinical treatment and office space to support health care service delivery with adequate privacy and confidentiality. E. Screening on Intake
1. The County shall develop and implement an Intake Screening Implementation Plan that specifies standards and timelines to ensure that arriving prisoners are promptly screened for urgent health care needs (within minutes of a prisoner’s arrival when possible, and in all cases within two hours of arrival), with adequate confidentiality, timely follow-up, and disability accommodations. The standards and timelines shall include medical clearance on arrival at the Jail to determine whether the prisoner must be excluded from the Jail or housed in a special placement based on medical or mental health condition, initial health screening, and an initial health assessment within timeframes based on the individual’s conditions and acuity.
2. The Intake Screening Implementation Plan shall include the following: a) Standards and procedures to ensure Medication Continuity, either through outside verification or on-site physician medication order; b) Procedures to ensure adequate review of individual health care records maintained by the County or otherwise available as part of the intake process; c) Infectious disease screening and follow-up; d) Initial Health Assessment for all incoming prisoners with chronic illnesses; e) Psychological Evaluation for persons with signs of development disability; f) Psychological Evaluation for persons with signs and/or histories of mental illness; g) Clinical evaluation of persons in need of detoxification with clinical determinations for any use of sobering, safety or isolation cells;
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h) Use of a suicide risk assessment tool, with Psychological Evaluation for those with positive findings on the suicide assessment.
3. Registered nurses shall perform the intake health screening, and shall receive annual training on intake policies and procedures.
F. Access to Care
1. The County shall develop and implement a Health Care Implementation Plan to provide all necessary levels of care for prisoners with health care needs and to ensure that they receive timely treatment appropriate to the acuity of their conditions, consistent with established standards of care and clear timelines for routine, urgent and emergent cases.
2. All non-emergent health care requests or referrals shall be reviewed by the triage RN within 12 hours of receipt and assigned a triage level for a Provider appointment of urgent or routine.
3. For all health care requests or referrals, the following timelines and procedures shall apply: a) Patients with emergent medical conditions shall be treated or sent out for emergency treatment immediately. b) Patients with urgent medical conditions shall be seen by the Provider within 12 hours of review by the triage RN. For urgent referrals that occur on the weekend when a Provider is not on-site, medical staff shall complete a phone consultation with the Provider within 12 hours of review by the triage RN, with any clinically indicated treatment or other follow-up provided. The Provider will conduct a face-to-face appointment with the patient on the next business day. c) Patients with routine medical concerns shall be seen by the Provider within five (5) days of review by the triage RN, or sooner if clinically indicated. d) All health care requests or referrals that are received shall be seen by the RN or a Provider. The County affirms that it does not utilize a written response only process for medical care requests and referrals.
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e) The County shall inform patients of the above timelines for urgent and routine care by including that information in the inmate orientation manual and on the medical request forms.
4. The RN or Provider shall:
a) conduct a brief face-to-face visit with the patient in a confidential, clinical setting;
b) take a full set of vital signs, if appropriate; c) conduct a physical exam, if appropriate; d) assign a triage level for a Provider appointment of emergent,
urgent, or routine; e) provide over-the-counter medications pursuant to protocols;
and f) consult with Providers regarding patient care pursuant to
protocols, as appropriate. 5. The County shall ensure timely access to appropriate medical care
based on the community standard, including with respect to medication practices, treatment, clinical and administrative treatment space, access to specialty care and hospitalization, emergency response, chronic care, infirmary or intermediate level of care, follow-up medical attention for prisoners discharged from the hospital, and supervision of medical staff. 6. The County shall staff and schedule dental clinics to ensure timely access to clinically indicated dental care.
a) A qualified or appropriately trained clinician shall triage dental care requests to identify emergent or urgent dental issues that require treatment of infection or pain.
b) Patients with emergent dental conditions shall be treated or sent out for emergency treatment immediately.
c) Patients with urgent dental conditions shall be seen by a dentist within one (1) week, or sooner if clinically indicated.
d) Patients with routine dental concerns shall be seen by a dentist within two (2) weeks, or sooner if clinically indicated.
7. The County shall permit patients, including those who are illiterate, non-English speaking, or otherwise unable to submit written health
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care requests, to verbally request care. Such verbal requests shall immediately be documented by the staff member who receives the request on an appropriate form and transmitted to a qualified medical professional for response consistent with the above provisions.
8. The County shall not prohibit patients from reporting or inquiring about multiple medical needs in the same appointment.
9. The County shall designate and provide sufficient custody escorts to facilitate timely delivery of health care.
G. Chronic Care
1. The County shall develop and implement a Chronic Disease Management Program for the management of chronic conditions, including but not limited to diabetes mellitus, asthma and other respiratory conditions, hypertension, HIV, and hepatitis C.
2. The Chronic Disease Management Program shall include provision of written individual treatment plans, case tracking, adherence to community standards, and routine scheduled follow up with Qualified Health Professionals including specialists.
3. The Chronic Disease Management Program shall include, at a minimum, the following protocols, which will be regularly evaluated through quality management processes:
a) A Comprehensive Asthma Protocol: The protocol shall ensure that patients with significant asthma histories are regularly evaluated by physicians. Medical staff shall use appropriate diagnostic tool(s) to assess a patient’s ability to breathe. The County will allow patients to keep prescribed rescue inhalers on their person, consistent with individualized clinical and security input.
b) A Comprehensive Hypertension Management Protocol: The protocol shall ensure that patients with hypertension receive complete initial exams, including but not limited to lab tests and EKG’s per clinical input, and medication at the appropriate times and intervals.
c) A Comprehensive Diabetes Management Protocol: The protocol shall ensure regular testing of blood sugar and hemoglobin A1C levels for patients with diabetes, at clinically
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appropriate intervals. Patients shall have access to the types of insulin and dosing frequency consistent with the treatment they were receiving prior to detention or most appropriate to their individual treatment goals and correctional setting, including multiple daily injection therapy using long-acting and rapidacting insulins and insulin pump therapy, as clinically appropriate. The County will provide a diabetes-appropriate diet, compiled by a qualified registered dietician, to prisoners with diabetes.
4. The County shall develop policies and procedures to ensure that labs ordered by clinicians are drawn in a timely manner, that the results are reviewed by nurses and clinicians in a timely manner, that the results are communicated to patients in a timely manner, and that the results are placed in the patient’s health care record in a timely manner.
H. Pharmacy Services
1. The County shall develop and implement policies to ensure continuity of medication at the time of Jail arrival and throughout the period of detention. Verified medications from the community shall be continued without interruption. Prisoners with unverified medications for serious conditions shall be evaluated promptly to ensure timely provision of necessary treatment.
2. The County shall ensure that the Jail’s formulary policies and procedures are sufficient to provide adequate individualized care to patients, including through ongoing staff training on the process of requesting non-formulary medications.
3. The County shall revise its Keep on Person medication policies and procedures for common over-the-counter medications, including but not limited to rescue inhalers for asthma treatment.
4. The County shall develop and implement policies and procedures to ensure that all medications are appropriately prescribed, stored, controlled, dispensed, and administered in accordance with applicable laws and through the following:
a) ensuring that initial doses of prescribed medications are delivered to patients within 48 hours of the prescription, unless it is clinically indicated to deliver the medication sooner;
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b) ensuring that medical staff who administer medications to patients document in the patient’s Medical Administration Record (1) name and dosage of each dispensed medication, (2) each date and time medication is administered, (3) the date and time for any refusal of medication, and (4) in the event of patient refusal, documentation that the prisoner was made aware of and understands any adverse health consequences by medical staff.
5. The County shall develop and implement policies and procedures to ensure that patients are provided medications at therapeutically appropriate times, including when out to court, in transit to or from any outside appointment, or being transferred between facilities. If administration time occurs when a patient is in court, in transit or at an outside appointment, medication will be administered as close as possible to the regular administration time.
6. The County shall provide sufficient nursing and custody staffing to ensure timely delivery and administration of medication.
I. Transgender and Gender Nonconforming Health Care
1. The County shall treat transgender prisoners based upon an individualized assessment of the patient’s health care and related needs, consistent with relevant legal requirements.
J. Drug/Alcohol Withdrawal
1. The County shall develop and implement drug/alcohol withdrawal policies and procedures that include specific guidelines as to the frequency and documentation of patient assessment.
K. Utilization Management
1. The County shall develop and implement a utilization management (UM) system that ensures that health decisions about patient care are made with sufficient input from Providers and meaningful consideration of patients’ health history and needs.
2. The UM process shall ensure that Providers and patients are promptly informed about decisions made through the UM process, including with respect to specialist referral requests.
3. The UM process shall include an appeal process to enable patients and Providers to appeal a decision denying a referral request.
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L. Review of Inmate Deaths
1. The County shall complete timely and adequate death reviews, within 30 days of any death, including a clinical mortality review in all cases and a psychological autopsy if death was by suicide or is otherwise indicated. The County shall also complete a multidisciplinary administrative review to assess custodial and emergency response actions.
2. The death review process shall include a root cause analysis, as appropriate, and the development of corrective action plans to identify and address systemic or individual issues.
M. Discharge Planning
1. The County shall implement an in-custody discharge/reentry planning program, described in a written policy, with emphasis on prisoners who suffer from chronic mental health and medical conditions, including addiction.
2. The reentry services program shall include the provision of assistance to chronic care patients, including outpatient referrals and appointments, public benefits, inpatient treatment, and other appropriate reentry services.
N. Quality Management
1. The County shall develop a Quality Management program to regularly assess and take necessary measures to ensure quality and efficiency of care.
2. The County shall establish a Continuous Quality Improvement (CQI) Unit to develop tracking mechanisms and to monitor the timeliness and effectiveness of care, to be reviewed at least quarterly and with corrective action plans employed where issues are identified.
3. The County shall track and document all completed, delayed, and canceled medical appointments, including reasons for delays and cancelations. Such documentation shall be reviewed as part of the quality management process.
4. The County shall track compliance with the Chronic Disease Management Program requirements for timely provision of appointments, procedures, and medications.
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5. The County shall incorporate a systematic review of prisoner grievances related to health care into its Quality Management program.
III. MENTAL HEALTH CARE A. Policies and Procedures
1. The County shall develop its own county- and site-specific policies and procedures related to its jail mental health care system. Jail mental health policies and procedures shall be reviewed at least annually and updated as necessary.
2. The County shall develop policies and procedures regarding mental health care committees that clearly describe structure, membership, and minimum meeting frequencies.
3. The County shall ensure that its policies and procedures are consistent with the provisions of this Remedial Plan and include the following: a) A written document reflecting the spectrum of mental health care programming and services provided to prisoners; b) Reasonable timeframes for completion of each type of mental health care-related task or service, consistent with community and professional standards; c) An intake and referral triage system to ensure timely and effective resolution of inmate requests and staff referrals for mental health care; d) Clinical monitoring of inmates, including but not limited to those who are segregated or on suicide watch; e) Descriptions of specialized mental health programming that specifically identify admitting and discharge criteria and the staff positions who have the authority to place inmates in specialized mental health housing; f) Relevant mental health-related training for all staff members who are working with inmates with mental illness.
4. The County’s health screening policy and procedure shall include criteria for the triage system for intake referrals and health service
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requests. Referrals shall be designated as emergent, urgent, or routine based on clinical judgment.
5. The County shall ensure that there is a licensed mental health professional on-site at the Jail facilities who, working in collaboration with the health care services administrator, shall be responsible for supervising the clinical aspects of the following functions:
a) Treatment programming that meets the needs of the inmate population and is consistent with individualized treatment plans.
b) Supervision of mental health staff to ensure appropriate inservice training, development of treatment plans, and health care record documentation.
c) Treatment programming provided by outside mental health agencies.
6. The County shall develop policies and procedures to ensure that all clinical interactions (other than rounds) be conducted in a private and confidential manner, absent a specific, current risk that necessitates the presence of custody staff. Custody and mental health staff shall be trained accordingly.
7. The County shall develop policies and procedures on the use of deescalation techniques and early involvement by Qualified Mental Health Professionals in situations involving an inmate with SMI.
8. When utilizing trainees, such as psychiatric interns, the County shall have a memorandum of agreement with the provider that addresses supervision and other appropriate requirements.
B. Intake
1. The County shall ensure implementation of a screening tool to identify individuals with mental illness, at risk of self-injury, or vulnerable to predation secondary to a mental illness. The screening tool shall:
a) Identify risk factors or medication that require a mental health referral.
b) Recommend housing and referrals based on the individual’s diagnosis, strengths, and weaknesses.
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c) Refer inmates to mental health staff for any positive finding of mental illness, and triage all referrals as urgent, emergent, or routine.
d) Describe signs and symptoms of conditions which justify the assignment of a DSM1 diagnosis.
2. The County shall implement a follow-up review process for inmates who refuse the intake screening. Upon inmate refusal at intake, the intake nurse shall provide a detailed record of the inmate’s presentation and an opinion regarding the inmate’s condition, with appropriate referrals to psychiatry and mental health professionals.
3. Refusal to give consent at intake will not be considered an indication of refusal of any treatment and evaluation at a later time.
4. Inmates entering the facility on verified medications shall receive a referral to psychiatry at the time of intake, which will be prioritized as clinically indicated.
C. Patient Privacy and Confidentiality
1. The County shall provide sufficient private interviewing spaces for all clinical contacts for evaluation and/or treatment (other than rounds).
2. It shall be the policy of the County that mental health clinicians shall not conduct their clinical contacts for evaluation and/or treatment (other than rounds) at cell-front except pursuant to documented refusals or specific, documented security concerns.
3. For each clinical contact for evaluation and/or treatment (other than rounds), mental health staff shall document whether the encounter was confidential, including whether it took place at cell-front. If a contact occurs at cell-front or is otherwise non-confidential (i.e., due to patient refusal or specific, documented security concern), the reason(s) shall be clearly documented in the individual patient record and will be reviewed as part of the County’s Continuous Quality Improvement review procedures.
1 Diagnostic and Statistical Manual of Mental Disorders, Current Edition, American Psychiatric Association
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4. The County shall implement a confidential mental health service request system that does not require patients to share confidential health information with custody or other non-health care staff.
D. Mental Health Services, Housing, and Access to Care
1. Mental health staff shall respond to mental health referrals and requests within the following timelines: a) Four (4) hours for emergent cases, and sooner if clinically indicated, except that during the hours of 11:00 p.m. and 7:00 a.m., medical staff shall respond to emergent cases; b) Twenty-four (24) hours for urgent cases, and sooner if clinically indicated; c) One week for routine cases, and sooner if clinically indicated.
2. The County shall implement a policy to place and treat all prisoners on the mental health caseload in the least restrictive setting appropriate to their needs.
3. The County shall develop and designate specialized mental health units, with provision of the appropriate levels of programming and treatment for each mental health care service level. a) The County shall provide a sufficient number of beds at all necessary levels of clinical care and levels of security, to meet the needs of the Jail population of people with SMI. b) The County shall develop referral criteria and policies regarding management, treatment, and placement of inmates with SMI. c) Mental health staff shall recommend appropriate placement in and discharge from the specialized mental health units and programs for inmates with mental illness based on clinical judgment. d) The County shall develop policies and procedures to house and treat inmates with mental illness at the clinically appropriate level of care.
4. Staff shall conduct regular multidisciplinary team meetings to discuss the treatment and management of each inmate with SMI who is incapable of functioning in a general population setting or who is
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housed in a specialized mental health unit, to coordinate individual health, mental health, classification and discharge needs.
a) The County shall include the line officer, whenever possible, in the multidisciplinary treatment team meeting. The line officer shall provide day-to-day observations on an inmate’s functioning and receive input from the professional staff in management approaches.
b) The multidisciplinary treatment team shall determine which privileges and property shall be available to inmates. The treating clinician shall provide input as to privileges and property for inmates on psychiatric observation or suicide watch.
c) Treatment staff shall provide all inmates on specialty units an enhanced individualized treatment plan documented on a medical record treatment plan form and completed within the first seven days of placement on that unit. These treatment plans shall be regularly reviewed and updated as needed by the multidisciplinary treatment team, with participation of the inmate.
5. The County shall provide a minimum of 6 hours per week, of Structured Out-of-Cell Time for therapeutic group and/or individual programming, and twelve (12) hours per week of Unstructured Outof-Cell time (including dayroom, outdoor/recreation time, and other self-directed activities) for people with mental illness housed in specialized mental health units. The County will also provide in-cell structured programming – i.e., electronic tablets – to people in these units equivalent to that provided in the general population (at least four (4) hours per day, on at least three (3) separate days per week).
a) It is recognized that not all inmates can participate in and/or benefit from 6 hours per week of structured treatment programming. For those individuals with mental health treatment needs housed in the specialized mental health units and for whom fewer hours of treatment services is clinically indicated, the treating clinician will present the case and recommended treatment program to the multidisciplinary treatment team for approval. Such a Modified Individualized Treatment Plan will include a description of the diagnosis,
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problems, level of functioning, medication compliance, and rationale for scheduling fewer hours of treatment services.
b) The Modified Individualized Treatment Plan will be reviewed by the multidisciplinary treatment team at least monthly, with consideration of an increase in treatment activities and referral to a higher level of care as clinically indicated.
c) The County shall establish an additional, less intensive mental health program for individuals with mental health treatment needs who are stable. Such a program shall provide a minimum of four (4) hours per week of Structured Out-of-Cell Time for therapeutic group and/or individual programming, subject to the Modified Individual Treatment Plan provisions described above.
6. The County shall not house inmates with SMI meeting criteria for placement in specialized mental health units in a segregation or isolation unit, except as outlined below.
a) In rare cases where such an inmate presents an immediate danger or serious danger for which there is no reasonable alternative, such an inmate may be housed separately for the briefest period of time necessary to address the issue, and only with written justification for the placement that is approved by a jail commander or designee.
b) The County shall continue to provide supervision, treatment, and out-of-cell time consistent with the inmate’s Modified Individualized Treatment Plan.
7. The County shall develop and provide comparable and separate services and treatment programs for male and female inmates meeting criteria for placement in specialized mental health units.
8. The County shall provide psychiatric appointments with inmates on the mental health caseload housing at least every 90 days, or more often if clinically indicated, and shall provide counseling services consistent with individual need that is documented in an individualized treatment plan.
9. Mental health staff shall provide a behavioral management plan and regularly scheduled counseling services to inmates with severe
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personality disorders and/or frequent episodes of suicidal ideation or self-harm.
10. The County shall ensure that clinical contact record entries indicate the inmate’s housing location, the type of service, the location where mental health staff delivered the service, the date and time of the encounter, and the date and time the record is generated.
E. Psychiatric Medication Practices
1. The County shall, in consultation with the subject matter expert and Plaintiffs, ensure that the Jail’s policies and procedures are sufficient to provide adequate individualized care to patients, including with respect to (a) non-formulary medication requests, (b) patient refusals, and (c) prescriptive practices.
2. Any inmate requesting psychiatric evaluation or treatment shall receive a timely comprehensive mental health assessment to determine clinical need for medication or other treatment.
3. No verified or prescribed psychiatric medication will be terminated or significantly changed without in-person consultation with a psychiatrist, absent clinical justification that is documented. Mental health staff shall see patients who receive significant changes in prescriptions or initiation of new medications within 30 days, unless earlier requested by patient or clinically indicated, to assess efficacy, side effects, and other follow-up as appropriate.
4. The County shall implement policies and procedures to ensure that patients are provided medications at therapeutically appropriate times (e.g., sedating medications administered at bedtime).
F. Mental Health and Disability Input in the Jail Disciplinary Process
1. The County shall adopt policies and procedures that require meaningful consideration of the relationship of an inmate’s behavior to a mental health or intellectual disability, the appropriateness of disciplinary measures versus clinical or other interventions, and the impact of disciplinary measures on the health and well-being of inmates with disabilities.
2. The County shall develop policies and procedures on the consideration of mental health input in the disciplinary process.
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3. In cases where an inmate with SMI, with an intellectual disability, or who is exhibiting unusual or bizarre behavior may face a disciplinary sanction, including denial of property or privileges, placement in restrictive housing, or lockdown for any period of time, a Qualified Mental Health Professional shall complete a Mental Health/Disciplinary Recommendation Form and provide written findings as to:
a) Whether or not the reported behavior was related to mental illness, adaptive functioning deficits, or other disability;
b) Any other mitigating factors regarding the inmate’s behavior, disability, and/or circumstances that should be considered, and whether certain sanctions should be avoided in light of the inmate’s mental health or intellectual disability, treatment plan, or adaptive support needs.
4. Staff shall meaningfully consider the Qualified Mental Health Professional’s findings and any other available disability information when deciding what, if any, disciplinary action should be imposed.
5. Staff shall meaningfully consider the Qualified Mental Health Professional’s input on minimizing the deleterious effect of disciplinary measures on the prisoner in view of his or her mental health or adaptive support needs.
6. If custody staff do not follow the mental health input regarding whether the behavior was related to symptoms of mental illness or intellectual disability, whether any mitigating factors should be considered, and whether certain sanctions should be avoided, staff shall explain in writing why it was not followed.
7. Inmates shall not be subjected to discipline in any manner that prevents the delivery of mental health treatment or adaptive support needs.
8. Inmates shall not be subject to discipline for refusing treatment or medications, or for engaging in self-injurious behavior or threats of self-injurious behavior.
9. The County shall provide reasonable accommodations during the disciplinary process for inmates with mental health or intellectual disabilities.
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10. The County shall take reasonable steps to ensure the provision of effective communication and necessary assistance to inmates with disabilities at all stages of the disciplinary process.
11. The County shall designate a supervisory-level custody staff member who shall be responsible for ensuring consistency in disciplinary practices and procedures. The County shall track and monitor this process, including the frequency that the recommendation of the Qualified Mental Health Professional was followed.
G. Seclusion and Restraint
1. The County affirms that it will not utilize clinical restraints or clinical seclusion at the Jail, except as consistent with involuntary medication court orders for people adjudicated to be Incompetent to Stand Trial who participate in any implemented in-jail restoration of competency treatment services program.
H. Discharge and Reentry Services
1. Inmates on the mental health caseload shall receive discharge planning that is documented. Such planning will be enhanced, as defined by policy, for inmates with SMI and/or meeting criteria for placement in the specialized mental health units.
2. Discharge plans shall include assistance with application for public benefits and social services, outpatient referrals and appointments, medical insurance, housing, substance abuse treatment, parenting and family services, inpatient treatment, and other reentry services.
3. The County will ensure that inmates taking prescribed psychiatric medications have continuity of medications, and arranging followup appointments with providers.
4. The County shall track the elements of discharge planning for Continuous Quality Improvement purposes. Data shall include at least the following:
a) The total number of inmates with SMI and/or meeting criteria for placement in the specialized mental health units who are eligible for discharge planning per month.
b) The number of those inmates with SMI and/or meeting criteria for placement in the specialized mental health units who have
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received referrals for outpatient appointments, discharge medications, 5150 referrals, and other aspects of reentry services completed by the mental health care staff.
I. Cross-Agency Coordination of Mental Health Treatment and Service Need
1. The County has begun to conduct monthly Medical Administration Committee meetings, with a portion of such meetings dedicated to discussion of the treatment of Jail inmates with mental illness, to include other relevant county agencies (e.g. Behavioral Wellness). The County agrees to continue such meetings, with additional crossagency coordination as needed to address individual and systemic issues related to inmates with mental health treatment and service needs.
2. The County shall develop a process to ensure timely referrals to and placements in inpatient care and other higher level mental health care outside the facility.
3. The County shall make best efforts to expedite court referrals to the State Hospital system or other treatment facilities.
4. The County shall track and monitor the number of referrals to mental health services and facilities outside of the jail, shall track and monitor the amount of time to provide services pursuant to those referrals, and shall identify and remedy causes of delay or other identified issues.
5. The County shall implement a policy that ensures that inmates on the mental health caseload returning from outside facilities receive timely placement in appropriate housing, continuity of medication, and timely face-to-face clinical review to ensure continuity of care and reduce the risk of decompensation cycling.
J. Continuous Quality Improvement
1. The County has implemented a Continuous Quality Improvement meetings, which are modeled after J-A-06 Continuous Quality Improvement Program Standard2 or a similar standard.
2 Standards for Health Services in Jails 2008, Essential Standard J-A- 06 Continuous Quality Improvement Program, p.10. National Commission on Correctional Healthcare 2008
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2. The County shall develop quality indicators for purposes of monitoring a private mental health care contract. The County shall implement a detailed tracking system that parallels the scope of contractor work requirements to ensure that the contractor is meeting the requirements of the contract. For example, the County requires Service Level Agreements with clear mental health servicerelated performance indicators of the contracted health care provider, to be updated and reviewed annually or more often if warranted.
3. The Quality Improvement process studies shall include (a) a clearly articulate hypothesis and methodology to determine if standards have been met; (b) data collection; (c) analysis of data to identify trends and patterns; (d) analysis to identify the underlying causes of problems; (e) development of remedies to address problems that are identified; (f) a written plan that identifies responsible staff and establishes a specific timeline for implementation of the remedy; (g) follow-up data collection; and (h) analysis to determine if the remedies were effective.
4. The County shall conduct periodic quality improvement reviews of the intake process to ensure that staff are accurately recording intake information and making appropriate referrals.
5. The County shall maintain lists of all inmates referred to a higher level of mental health care with sufficient information to complete periodic quality reviews.
6. The County shall track the number of inmates on the mental health caseload, the number of inmates with SMI, the number of inmates awaiting court-ordered psychiatric facility placement, the number of inmates referred and found appropriate for inpatient (acute) and enhanced (sub-acute/residential) mental health treatment, and the number of inmates with SMI in restrictive housing units.
7. The County shall develop a system to log inmate requests, including a log of inmates referred for placement on the mental health caseload from booking. These logs shall be available for auditors to complete randomized studies of the referral process via the CQI Committee or the assignment of a subject matter expert under a legal agreement.
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8. The County shall conduct periodic quality reviews to assess whether: a) Health service requests are retrieved in a timely manner; b) Health service requests are triaged within the established timeframe; c) A proper level of triage is assigned, based on the nature of the request; d) Mental health staff appropriately resolved the request; and e) Mental health staff resolved the request in a timely fashion.
9. The County shall monitor the frequency of psychiatric follow-up appointments as a quality measure to ensure that inmates have adequate access to the prescriber.
10. Continuous Quality Improvement studies, data, and related materials will be made available to Plaintiffs and the subject matter expert during the period of implementation and monitoring.
IV. SUICIDE PREVENTION A. Overview 1. The County shall develop and implement its own Suicide Prevention Policy, which shall set forth clear procedures consistent with the provisions set forth below. B. Screening for Suicide Risk 1. The County shall ensure that its intake assessment procedures timely identify acute and high-risk mental health conditions, including: a) Review of suicide risk notifications in relevant medical, mental health, and custody records, including as to prior suicide attempts, self-harm, and/or mental health needs; b) Any prior suicidal ideation or attempts, self-harm, mental health treatment, or hospitalization; c) Current suicidal ideation, threat, or plan, or feelings of helplessness and/or hopelessness; d) Other relevant suicide risk factors, such as:
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(1) Recent significant loss (job, relationship, death of family member/close friend);
(2) History of suicidal behavior by family member/close friend;
(3) Upcoming court appearances; e) Transporting officer’s impressions about risk. 2. Regardless of the prisoner’s behavior or answers given during intake screening, a mental health referral shall always be initiated if there is a history related to suicide or self-harm. 3. When a prisoner refuses to respond to assessment questions, staff shall complete the intake screening, including the mental health and suicide risk assessments, to the maximum extent possible. For example, staff will still complete the records/history review, if applicable, as well as the assessment of the individual’s presentation and behaviors, and shall make appropriate mental health referrals when indicated. 4. Any prisoner expressing current suicidal ideation and/or current suicidal/self-injurious behavior shall be designated as an emergent referral, immediately referred to mental health staff, and placed in a safe setting pending the mental health contact. 5. Mental health clinicians shall complete and document a suicide risk assessment, with the use of suicide risk assessment tool, as close to placement on suicide watch as possible and upon discharge to a lower level of observation.
C. Housing of Prisoners on Suicide Precautions
1. The County’s policy and procedures shall ensure that prisoners, including those identified as being at risk for suicide, are housed and treated in the least restrictive setting appropriate to their individual clinical and safety needs.
2. Prisoners on psychiatric observation for suicide risk shall be housed and monitored in a setting appropriate for their clinical needs.
3. No prisoner shall be housed in a safety cell for more than twentyfour (24) hours, unless there are exceptional circumstances documented by clinical and custody staff. Within twelve (12) hours
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of safety cell placement, the County shall refer the patient to behavioral health for inpatient placement evaluation.
4. The County shall ensure that prisoners who require psychiatric inpatient care as clinically indicated are placed in an acute care unit as soon as possible. A patient showing no improvement or continuing deterioration after 12 hours shall be transferred to an inpatient mental health facility or hospital for evaluation and treatment. In all other cases, after 24 hours of being housed in a safety cell, the patient shall be transferred to an appropriate inpatient mental health setting or hospital, absent exceptional circumstances documented by clinical and custody staff.
D. Treatment and Conditions for Individual Prisoners on Suicide Precautions
1. The County shall provide at least one daily mental health professional contact, or more as clinically indicated, for any prisoner who is identified as a current suicide risk. The clinical contact shall be conducted in a space with sound privacy unless there are current, specific safety concerns that are documented, with supervisory-level review and approval.
2. The Jail’s qualified mental health professionals shall provide input with respect to the provision of property and privileges for prisoners on suicide precautions. Custody staff may remove property/privileges, if necessary, prior to the mental health staff evaluation of a prisoner identified as at risk. Once the mental health evaluation occurs, the qualified mental health professional and custody staff shall determine, based on clinical judgment and on a case-by-case basis, the removal and/or return of property (e.g., clothing, books, footwear, eyeglasses) and privileges. The removal of property/privileges shall be documented with clinical justification in the health record, and shall be reviewed on a regular basis to ensure restoration of property/privileges as soon as appropriate.
3. Safety cells shall be sanitized after every use and the sewer grate inspected to ensure cleanliness and appropriate conditions.
4. The County shall provide clinically-indicated therapeutic services, including psychiatric services, to prisoners on suicide precautions or otherwise identified as at elevated risk of suicide. The County shall provide prisoners on suicide precautions or otherwise identified as at
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elevated risk of suicide with appropriate individual counseling and medication review in a confidential setting.
E. Supervision/Monitoring of Suicidal Prisoners
1. The County shall revise its policies regarding the monitoring of prisoners on suicide precautions to provide for at least the following two levels of observation:
a) Close observation shall be used for prisoners who are not actively suicidal but require enhanced observation to ensure safety. Staff shall observe the prisoner at staggered intervals not less than every 15 minutes and shall document the observation as it occurs.
b) Constant observation shall be used for prisoners who are actively suicidal, either threatening or engaging in self-injury, and considered a high risk for suicide. An assigned staff member shall observe the prisoner on a continuous, uninterrupted basis. The observation should be documented at 15-minute intervals. Staff should be physically stationed outside of the prisoner’s cell to permit continuous, uninterrupted observation.
2. For any prisoner requiring suicide precautions, a qualified mental health professional shall assess, determine, and document the clinically appropriate level of monitoring based on the prisoner’s individual circumstances. Placement in a safety cell shall not serve as a substitute for the clinically-determined level of monitoring.
3. Video monitoring of prisoners on suicide precaution shall not serve as a substitute for the clinically indicated level of observation.
F. Discharge from Suicide Precautions and Follow-Up
1. A qualified mental health professional shall complete and document a suicide risk assessment prior to discharging a prisoner from suicide precautions. Such assessment shall be conducted in a space with sound privacy unless there are current, specific safety concerns that are documented.
2. Qualified mental health professionals shall provide, and update as clinically appropriate, individualized treatment plans for all prisoners discharged from suicide precautions. The treatment plan shall describe signs, symptoms, and circumstances in which the risk
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of suicide is likely to recur, how recurrence of suicidal thoughts can be avoided, appropriate individualized treatment interventions, and actions the patient or staff can take if suicidal thoughts do occur.
3. Qualified mental health professionals shall provide clinical input regarding appropriate housing placement (e.g., whether isolation is contraindicated for the prisoner) upon discharge from suicide precautions. Custody and classification staff shall consider such clinical input in determining post-discharge placement and conditions of confinement, and document the reasons when clinical input is not followed. Once clinically discharged from suicide precautions, the prisoner shall be promptly transferred to appropriate housing.
4. Prisoners discharged from suicide precautions shall remain on the mental health caseload and receive regularly scheduled clinical assessments and contacts. A qualified mental health professional shall provide, at a minimum, clinical follow-up assessment and contacts within 24 hours of discharge, and again within one week of discharge, and more often as clinically indicated.
G. Emergency Response
1. The County shall keep an emergency response bag that includes appropriate equipment, including a first aid kit, CPR mask or Ambu bag, and emergency rescue tool in close proximity to all housing units. All custody and medical staff shall be trained on the location of this emergency response bag and shall receive regular training on emergency response procedures, including how to use appropriate equipment.
2. The County shall ensure that all emergency response equipment at the jail is inspected monthly and after each use and is repaired and replaced as needed. The County shall ensure that the jail maintains a service log for all emergency response equipment.
3. It shall be the policy of the County that any staff who discovers a prisoner attempting suicide shall immediately respond and alert other staff to call for medical personnel. Trained staff shall immediately begin to administer standard first aid and/or CPR, as appropriate.
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H. Continuous Quality Improvement
1. The County shall track all critical incidents which include prisoner suicides, attempted suicides, and incidents involving serious selfharm. The County shall review critical incidents and related data through its quality assurance and improvement processes.
2. For each serious suicide attempt (e.g., requiring hospital admission), the County shall conduct a multidisciplinary (mental health, medical, and custody) review of: 1) the circumstances surrounding the incident; 2) the procedures relevant to the incident; 3) relevant training received by involved staff; 4) pertinent medical and mental health services/reports involving the victim; and 5) possible precipitating factors that may have caused the victim to commit suicide or make a serious suicide attempt. The review team shall generate written recommendations (as appropriate) for changes in policy, training, physical plant, medical or mental health services, and operational procedures.
3. The County shall implement a continuous quality assurance/quality improvement plan to periodically audit suicide prevention procedures that include, but are not limited to: intake screening (to include audits to ensure that staff ask and record all suicide screening questions), mental health and suicide risk assessments, crisis response, treatment plans/behavior management plans, and post-suicide watch clinical follow-up assessment and contacts.
V. DISABILITY ACCOMMODATIONS AND ACCESS, AMERICANS WITH DISABILITIES ACT (ADA)
A. Policy
1. It is the County’s policy to provide access to its programs and services to incarcerated people with disabilities, with or without reasonable accommodations, consistent with legitimate penological interests. No person with a disability, as defined in 42 U.S.C. § 12102, shall, because of that disability, be excluded from participation in or denied the benefits of services, programs, or activities or be subjected to discrimination. It is the County’s policy to provide reasonable accommodations or modifications, consistent with 28 C.F.R. §§ 35.150 & 35.152, and other applicable law.
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B. ADA Coordinator
1. The County shall have a designated Americans with Disabilities Act (ADA) Coordinator whose position is dedicated to coordinating efforts to comply with and carry out ADA-related requirements and policies. The ADA Coordinator shall have sufficient authority to carry out such duties, and shall work with the executive management team regarding ADA compliance, training, and program needs.
2. The County intends for the ADA Coordinator to be based at the Main Jail. Any County jail facility that does not have the ADA Coordinator on site shall have a designated staff member on site at that facility who will have responsibility to monitor day-to-day ADA compliance and will report to the ADA Coordinator.
3. The County shall clearly enumerate the job duties and training requirements for the ADA Coordinator position.
4. The County will ensure that the name of and the method for people to contact the ADA Coordinator (or facility designee) are clearly posted in the intake area and in every jail housing unit. The County will also ensure that the name and contact information (address, phone, email) of the ADA Coordinator (or facility designee) are available to the public, including posting in each jail’s main lobby and online.
C. ADA Notice to Prisoners
1. The County shall ensure that people with disabilities held at the Jail are adequately informed of their rights, including but not limited to:
a) The right to receive reasonable accommodations;
b) The process for requesting a reasonable accommodation;
c) The role of the ADA Coordinator (and designee) and method to contact them;
d) The grievance process, location of relevant forms, and process for getting assistance in completing request and grievance forms;
e) Instructions on how to request and access health care services, including the provision of Effective Communication and other accommodations in accessing those services.
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2. Within 6 hours of processing and classification, the County will provide all incarcerated people a Custody Operations Orientation Handbook in an accessible format, containing a designated section with ADA-related policies, procedures, and other information. The Orientation Handbook shall be made available in large print (at least 18-point font) in English and Spanish to accommodate people with visual impairments.
3. The County will provide an accessible video that presents the contents of the Orientation Handbook, including the ADA-related policies, procedures and information. The County will, as appropriate, provide an SLI to interpret the contents of the Orientation Handbook to persons who are deaf or hard of hearing who use American Sign Language as their primary means of communication.
D. Staff Training
1. The County shall ensure all custody, health care, facility maintenance, and other Jail staff receive ADA training appropriate to their position. The County shall provide training to all staff during the academy and at least bi-annually thereafter on:
a) Disability awareness, including the use and purpose of accommodations and modifications in accordance with the ADA;
b) Use of force when interacting with people with disabilities.
2. Staff ADA training shall include formalized lesson plans and inclassroom or virtual training for all staff provided by qualified ADA instructors.
E. ADA Tracking System
1. The County shall, in consultation with Plaintiffs’ counsel, develop and implement a comprehensive, standardized electronic system (“ADA Tracking System”) to track people with disabilities and their accommodation and Effective Communication needs.
2. The ADA Tracking System shall identify for each prisoner, as appropriate:
a) Any disabilities and related health conditions;
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b) Disabilities that may pose a barrier to communication, including but not limited to learning, intellectual, or developmental disabilities, and hearing, speech, or vision impairments;
c) Accommodation needs, including as to housing, classification, transportation, Effective Communication, adaptive supports, and health care appliances, assistive devices, and/or durable medical equipment (HCA/AD/DME);
d) Class membership in Armstrong v. Newsom (N.D. Cal. No. 94cv-02307) (i.e., people held in the Jail related to a parole revocation proceeding or term), with their applicable disability classification(s) and accommodation need(s).
3. The ADA Tracking System’s prisoner disability information will be readily available to custody, medical, mental health, and other staff at the Jail to ensure appropriate accommodations and adequate program access for people with disabilities. Health care staff, the ADA Coordinator, and any ADA Coordinator-designee shall have the ability to input information into the ADA Tracking System in real time.
4. The County will print a prisoner’s disability accommodation need(s) on the person’s wristband.
5. Staff shall check the ADA Tracking System for each prisoner, and document that check, immediately prior to: a) Intake screening;
b) Classification interview; c) Assignment of housing; d) Assignment of programs; e) Medical and mental health encounters; f) All due process proceedings, including but not limited to,
resolving grievances and disciplinary infractions;
g) All trips to court or outside health care appointments. F. Screening for Disability and Disability-Related Needs
1. The County shall take steps to identify and verify each person’s disability and disability-related needs, including by screening them
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for disabilities during medical intake and classification. The County shall ensure that all private health care and other service providers implement any policies and procedures needed to facilitate full implementation of these provisions.
2. The County, in consultation with subject matter experts and Plaintiffs’ counsel, shall revise its ADA screening process to ensure consideration of: a) The individual’s self-identification or claim to have a disability; b) Documentation of a disability in the individual’s health, custody, and any other available records;
c) Staff observation that the individual may have a disability that affects placement, program access, or Effective Communication; and
d) The request of a third party (such as a family member) for an evaluation of the individual for a possible disability.
3. The County shall ensure that ADA screening results are promptly entered in the ADA Tracking System.
G. Disability-Related Requests and Grievances
1. The County shall revise its ADA Request Form to contain an explanation of how to appeal a denial of accommodations.
2. The County shall provide a grievance procedure for people with disabilities to appeal any denial of an accommodation, and to report any disability-based discrimination or violation of the ADA, this Remedial Plan, or Jail ADA-related policy.
3. The County shall ensure that people who are Deaf or hard of hearing are interviewed and provided a qualified SLI as part of the grievance/appeal process.
4. To ensure that ADA accommodations requests and ADA grievances are promptly addressed, the County shall: a) Respond to an individual’s Request for Accommodations within 72 hours of receipt; b) Respond to an ADA-related grievance within 72 hours of receipt;
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c) Establish an expedited process for urgent ADA requests and grievances (e.g., situations in which a person’s safety or physical well-being is at risk); and
d) Allow each person to retain accommodation(s) they possess at the time of arrival at the Jail, or that they have been previously provided by the Jail, pending review of a grievance/appeal regarding the denial or removal of such accommodation(s), absent an individualized security concern that is documented.
5. The County shall ensure that grievance forms contain an “ADA” box to indicate that a particular grievance relates to a disabilityrelated issue. The County will ensure that disability-related grievances are so identified by the reviewing supervisor, even if the individual who submitted the grievance does not check the “ADA” box.
6. The County will ensure that grievance forms are readily available and accessible to all prisoners at all times. Grievance forms shall be made available in large print (minimum 18-point font) to accommodate people with vision impairments.
7. The County shall provide to the person with a disability a written grievance response, including the resolution, the basis for a denial (if applicable), and the process for appeal.
8. The County shall take steps to ensure all prisoners are aware of the disability grievance procedures, including the availability of accommodations and staff assistance to submit a grievance and/or appeal.
9. The County shall implement a specific tracking system regarding the submission, processing, and responses for disability-related grievances and complaints, and regularly review such information for quality assurance purposes.
H. Housing Placements
1. The County shall implement a housing assignment system that includes an individualized assessment to be completed by health care staff, the results of which shall be documented in the ADA Tracking System, of each person’s functional limitations and restrictions, including but not limited to:
a) The need for a lower bunk;
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b) The need for grab bars in the cell and/or shower;
c) The need for accessible toilets;
d) The need for no stairs in the path of travel; and
e) The need for level terrain.
2. People with disabilities shall be housed in the Jail consistent with their individual security classification. Classification staff shall not place prisoners with disabilities in: (a) inappropriate security classifications because no ADA-accessible cells or beds are available; (b) designated medical areas unless the prisoner is currently receiving medical care requiring such placement; or (c) any location that does not offer the same or equivalent programs, services, or activities as facilities where they would be housed absent a disability.
I. Visitation
1. The County shall ensure that family/personal and professional visitation areas are accessible for people with disabilities and visitors.
2. The County shall perform an individualized assessment as needed and shall ensure that people with disabilities have full access to visitation at the Jail.
J. Access to Programs, Services, and Activities
1. The County shall ensure people with disabilities, including those housed in specialty health care units, have equal access to programs, services, and activities available to similarly situated people without disabilities, consistent with their health and security needs. The County shall ensure that staff provide appropriate assistance to people with disabilities as needed to ensure equal access to programs, services, and activities provided at the Jail. Such programs, services, and activities include, but are not limited to:
a) Educational, vocational, reentry and substance abuse programs
b) Work Assignments
c) Dayroom and other out-of-cell time
d) Outdoor recreation (including accessible exercise equipment)
e) Structured programming (including in-cell activities)
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f) Showers
g) Telephones and/or videophones
h) Reading materials (including easy reading, large print books and other materials accessible to people with a vision-related disability)
i) Religious services
j) Family/personal and professional visits
k) Medical, mental health, and dental services and treatment
2. The County’s policy shall include the provision of assistance in reading or scribing legal documents, sick call requests, grievances, documents related to disciplinary procedures, and documents related to health care encounters.
3. The County shall ensure equitable work opportunities for people with disabilities, including by ensuring: (a) clear job duty statements, with essential functions and specific criteria, for each worker position; and (b) that health care and other relevant staff conduct an individualized assessment to identify work duty restrictions and/or physical limitations to facilitate appropriate work/industry assignments, to ensure reasonable accommodations, and to prevent improper exclusions from work opportunities.
K. Health Care Appliances, Assistive Devices, Durable Medical Equipment
1. The County shall establish a written policy to ensure the timely provision of safe and operational HCA/AD/DME to people with a disability based on an individualized assessment by medical staff, with a process for timely repair and replacement of such devices as needed.
2. A person’s request for a particular device or other accommodation shall be given primary consideration and shall be granted unless the request is unreasonable for specific, articulated reasons allowable under the ADA, or unless other effective accommodations are available.
3. The County shall allow people to retain personal HCAs/ADs/DME (including mobility devices, glasses, and hearing aids), unless there
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is an individualized determination that doing so would create an articulated safety or security risk.
a) Where Jail staff determine it is necessary to remove personal HCA/AD/DME for security reasons, the County shall provide an equivalent Jail-issued device unless custody staff, with ADA Coordinator approval, determine and document, based on an individualized assessment, that the device constitutes a risk of bodily harm or threatens the security of the facility.
b) If such a determination is made, the ADA Coordinator shall document the decision and reasons for it and shall consult with medical staff to determine an appropriate alternative accommodation.
4. The County shall implement a written policy governing the release of people who need assistive devices.
a) The County will ensure that any personal mobility device belonging to a person is returned prior to release.
b) If a person does not have a personal mobility device, but is ambulatory with the assistance of a cane, crutch, or walker, the prisoner will be permitted to retain such device that was used while in custody upon release, or will be provided a comparable device, upon release.
c) If a person who is due for release requires a wheelchair, but does not have a personal wheelchair, Jail staff shall coordinate with the prisoner, family or friends, and other County agencies as needed to secure a wheelchair or take other steps to address the individual’s needs upon release. The County shall document this process in the ADA Tracking System for purposes of individual tracking and quality assurance.
L. Transportation
1. The County shall provide reasonable accommodations for people with disabilities when they are in transit, including during transport between facilities, to and from court, or to and from outside health care services.
2. Prescribed HCAs/ADs/DME for people with disabilities, shall be available to them at all times during the transport process, including in temporary holding cells.
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3. The County shall maintain a sufficient number of accessible vehicles to ensure timely transport of people with disabilities that require special transportation. The County intends for all transport vehicles to be accessible.
4. Staff will provide assistance to people with mobility or other disabilities where necessary to ensure safe access on and off of transport vehicles.
M. Effective Communication
1. The County shall develop and implement a Custody Operations policy to ensure that people with disabilities receive accommodations and services necessary to provide Effective Communication, consistent with the provisions set forth herein.
2. The County shall assess all people detained at the Jail for any period of time for Effective Communication needs and take steps to provide Effective Communication based on individual need. The County shall ensure that Jail custody and health care policies and procedures contain sufficient guidance on the provision of Effective Communication.
3. The County shall ensure that appropriate staff assess individual Effective Communication needs at the beginning of the medical intake screening and at the beginning of the classification screening, to facilitate Effective Communication throughout those and all subsequent processes.
4. Enhanced procedures for the provision of Effective Communication, as described in the paragraph below, shall apply in the following situations: a) Due Process Events, including the following: i. Classification processes ii. Disciplinary hearing and related processes iii. Service of notice (to appear and/or for new charges) iv. Release processes v. Probation encounters/meetings in custody b) Clinical Encounters, including the following:
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i. Determination of medical history or description of ailment or injury
ii. Diagnosis or prognosis iii. Medical care and medical evaluations iv. Provision of mental health evaluations, rounds, group
and individual therapy, counseling and other therapeutic activities v. Provision of the patient’s rights, informed consent, or permission for treatment vi. Explanation of medications, procedures, treatment, treatment options, or surgery vii. Discharge instructions 5. In the situations described in the previous paragraph, Jail staff shall: a) Identify each person’s disability where there may be a barrier to comprehension or communication requiring reasonable accommodation(s); b) Provide effective reasonable accommodation(s) to overcome the communication barrier; and c) Document the method used to achieve Effective Communication and how the staff person determined that the person understood the encounter, process, and/or proceeding. 6. In determining what auxiliary aid or service to provide, the County shall give primary consideration to the request of the person with Effective Communication needs. Such aids may include bilingual aides, SLIs, readers, sound amplification devices, captioned television/video text displays, Videophones and telecommunication services for deaf persons, audiotaped texts, Braille materials, large print materials, writing materials, and signage. 7. The County shall ensure that all outside education, program, and service providers at the Jail provide Effective Communication for people participating in such programs.
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N. Access for Individuals with Hearing Impairments
1. The County shall develop and implement a policy for newly arrived and newly identified people with hearing disabilities to determine each person’s preferred method of communication.
2. Qualified Sign Language Interpreters (SLIs), on-site or through a VRI service, will be provided during intake and for due process functions, health care encounters, and Jail programming, when sign language is the person’s primary means of Effective Communication, unless the person waives the assistance of an interpreter and/or delay would pose an urgent safety or security risk
3. The County will maintain a log of (a) when, for whom, and for what purpose an SLI was used; and (b) when, for whom, and why an SLI was not used for a person with an identified need for SLI services (e.g., waived or delay would have posed urgent safety or security risk).
4. When a prisoner waives an SLI, the log must document (a) the method of communication of the waiver, and (b) the method staff used to determine that the waiver was knowing and freely given.
5. The County shall maintain a contract or service agreement with interpreter services, including a VRI service, in order to provide such services for deaf or hard of hearing prisoners. The County will ensure that appropriate Jail staff have sufficient guidance regarding use of such services.
6. Lip reading will not be the sole method of Effective Communication used by staff, unless the person indicates that is their preferred method of communication.
7. In cases where the use of an SLI is not practicable, or is waived by the prisoner, Jail staff shall employ the most effective form of communication available.
8. The County shall make videophones available for deaf and hard of hearing people. The videophones shall provide for calls that utilize Video Relay Services (VRS) at no cost to deaf and hard of hearing prisoners, or for calls directly to another videophone.
9. The County shall provide deaf/hard of hearing people with twice as much time for calls using telecommunication relay services, such as a videophone or TDD/TTY, to account for the fact that such
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conversations take longer than spoken conversations. The County shall document the time that each prisoner uses and has access to such equipment.
10. People who require an SLI as their primary method of communication shall be provided an SLI for education, vocational, and religious programs.
11. In housing units where an individual with a hearing-related disability resides, public announcements shall be communicated as consistent with individual Effective Communication needs. This includes announcements regarding visiting, meals, recreation release and recall, count, lock-up, and unlock. Verbal announcements may be effectively communicated via written messages on a chalkboard or dry erase board, or by personal notification, as consistent with individual need. These procedures shall be communicated to people during the orientation process and shall be incorporated into relevant policies and post orders.
O. Prisoners with Intellectual/Developmental Disabilities
1. The County shall develop and implement a comprehensive written policy and procedure regarding people with Intellectual and/or Developmental Disabilities, including:
a) Screening;
b) Identification of their adaptive support needs and adaptive functioning deficits; and
c) Monitoring, management, and accommodations for people with Intellectual or Developmental Disabilities.
2. If a person is known to have or suspected of having an Intellectual or Developmental Disability, the County shall contact the appropriate Regional Center within the next business day of the person’s arrival at the Jail. The County shall request the prisoner’s current IPP (Individualized Program Plan), with the individual’s authorization. Once received, medical and custody staff shall review the IPP to ensure that all communications and services being provided are appropriate. If the person is not a Regional Center client, the County shall request that the Regional Center (or other appropriate agency) perform an evaluation. Whenever possible, Jail staff will work with the Regional Center and any relevant County
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agencies to move a person with an identified Intellectual or Developmental Disability out of custody and into a setting with appropriate supports to meet the person’s individual needs.
3. People identified as having an Intellectual or Developmental Disability will be provided with accommodations tailored to their needs, which may include but are not limited to communications at the appropriate comprehension level, more time to complete directions, and specific behavioral supports.
4. A multidisciplinary team that includes appropriate health care staff will monitor and ensure appropriate care for people with an Intellectual or Developmental Disability. The multidisciplinary team will develop an individualized plan for each person with an Intellectual or Developmental Disability, which addresses: (1) safety, vulnerability, and victimization concerns, (2) adaptive support needs, and (3) programming, housing, and accommodation needs. The multidisciplinary team’s plan will be regularly reviewed and updated as needed.
P. Physical Accessibility Requirements
1. The County shall implement an ADA transition plan to remedy Main Jail physical plant features that could result in access barriers for people with disabilities.
2. The above ADA transition plan will be implemented in the timeframe set forth in the Stipulated Judgment. The County and the Sheriff’s Office agree that, during the period of implementation of the ADA transition plan at the Main Jail, they will take all reasonable steps to promote and ensure accessibility for people with disabilities to the maximum extent possible. This includes the use of interim measures to address existing access barriers in order to ensure safety and program access for people with disabilities.
3. The County shall ensure that the North Branch Jail provides adequate accessibility for people with disabilities, consistent with accessibility requirements under federal and state law.
Q. Alarms/Emergencies
1. The County shall implement written policies regarding the expectations of staff as to persons with disabilities during emergencies and alarms, including as to disabilities that may affect
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their ability to comply with orders or otherwise respond to emergencies and alarms. For example, the policies shall ensure appropriate handling of people with mobility-related disabilities who are unable to prone out or take a seated position on the ground during an alarm or emergency. Such policies shall be communicated to staff, incorporated into the relevant policies, and communicated to people with disabilities using Effective Communication. 2. In order to facilitate appropriate accommodations during alarms or emergencies, the County shall offer, but shall not require, individuals who have disabilities visible markers to identify their disability needs (e.g., wristbands). The County shall maintain a list, posted in such a way to be readily available to Jail staff in each unit, of people with disabilities that may require accommodations during an alarm or emergency. 3. The County shall install visual alarms appropriate for people who are deaf or hard of hearing. 4. All housing units shall post notices for emergency and fire exit routes. R. Quality Assurance
1. The County shall develop and implement written policies and procedures regarding monitoring compliance with ADA requirements and Jail ADA policies, including (but not limited to) the following: a) Requests for ADA accommodations; b) ADA-related grievances; c) ADA-related training; d) Use of the ADA Tracking System.
2. The County shall develop an ADA accountability plan that will ensure quality assurance, track violations of the ADA and the Jail’s ADA policies, and establish staff accountability for egregious, serious, or repeated violations of the ADA and Jail ADA-related policies and procedures.
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VI. ENVIRONMENTAL HEALTH AND SAFETY A. Environmental Health and Safety Monitor
1. The County shall designate an environmental health and safety monitor (“Environment of Care Monitor”) responsible for ensuring compliance with this Remedial Plan and other environmental health and safety policies and procedures. The duties of the Environment of Care Monitor will be established in writing consistent with this remedial plan. The Environment of Care Monitor will have sufficient authority to carry out such duties.
B. Cleanliness and Sanitation of Jail Facilities
1. The County shall establish a sanitation plan to ensure that all Jail facilities maintain appropriate cleanliness. The plan shall provide for any cleaning issues requiring an established cleaning schedule and written documentation of such cleaning, including, at a minimum:
a) Daily access to supplies and equipment for prisoners to conduct cleaning and disinfection of housing units, including floors, toilets, sinks, and showers, with a cleaning chemical that sufficiently eliminates pathogens found in living and common areas;
b) Weekly inspections of housing units, including floors, toilets, sinks, and showers by jail staff, with prompt steps to address identified cleaning and disinfection needs;
c) Daily cleaning of intake, health care clinics, kitchen, laundry and other common areas, such as hallways and the tunnel;
d) Weekly cleaning of visitation rooms and classrooms, and more frequently as needed;
e) Biweekly (i.e., every other week) power washing of shower areas;
f) Weekly cleaning of cell bars, windows, and lights;
g) Quarterly cleaning of fans and air vents, and more frequently as necessary to ensure that they are clean and free of mold, mildew, and/or accumulation of dirt and dust.
2. Upon intake, the County shall provide prisoners an orientation regarding the Jail’s expectations and procedures for cleanliness,
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elimination of clutter, and proper use of personal property containers.
3. The County shall establish a procedure to maintain cleanliness in housing areas where a prisoner is unable or unwilling to adequately clean. Where prisoners are expected to participate in cleaning, staff shall ensure appropriate assistance to people with mental illness, intellectual and developmental disabilities, or other special needs.
4. The County shall develop and implement a policy and procedure for effective cleaning, disinfection, distribution, and repair of mattresses. The policy shall provide a process for inspection and replacement of all frayed and cracked mattresses that cannot be disinfected sufficiently to eliminate harmful bacteria.
5. The County shall ensure that newly arrived prisoners receive a clean and serviceable mattress. Mattresses shall be cleaned and disinfected anytime they are assigned to a different prisoner or when there is a biohazardous or bloodborne incident involving the mattress.
6. The County shall establish procedures so that a cell is cleaned prior to a prisoner’s placement in that cell.
7. The County has committed to ensuring that each prisoner is assigned and provided a bed, as set forth in the Custody Operations/Segregation Remedial Plan. Until such remedial provision is fully implemented, where the County uses plastic beds, or “boats,” the County shall ensure that they are cleaned and disinfected anytime they are assigned to a different prisoner or when there is a biohazardous or bloodborne incident involving the mattress or boat.
C. Laundry
1. Clothing and linen exchange shall occur for all prisoners at least weekly, and more frequently when circumstances warrant. Kitchen workers shall be provided a clean kitchen uniform daily. Whenever a prisoner presents to jail staff clothing or linen that are soiled and/or reasonably requests a clothing/linen exchange, jail staff will ensure a prompt exchange, in all cases by the end of the shift.
2. The County shall provide, document and maintain records of training provided to prisoner-workers and staff assigned laundry
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duties on chemical safety, biohazardous and bloodborne contaminated clothing and linens, use of personal protective equipment, and Material Safety Data Sheets.
3. Staff shall make reasonable efforts to ensure that all prisoners have clean linens at all times. Staff will make a health care referral for any prisoner refusing to exchange linens if there is reason to believe such refusal relates to the person’s mental health condition. Mental health staff shall assist in resolving the situation, as appropriate.
D. Food Service and Kitchen Operations
1. Prisoners assigned to kitchen duties shall be provided with clean outer clothing daily. If during a prisoner’s work shift the clothing becomes soiled, it should be replaced promptly.
2. The County shall perform a weekly inspection of kitchen operations, with a report submitted to the Environment of Care Monitor, and shall ensure actions are taken to correct any identified issues.
3. The County shall develop and implement policies and procedures for food service and kitchen operation as required in Section 1246 of California Code of Regulations Title 15. The policy shall include provisions for tool control, roles and responsibilities of Jail staff and the food service Contractor, employee and prisoner-worker training in food safety, and temperature monitoring. The policy shall provide that prisoner-workers are medically screened prior to being assigned to work in the kitchen.
4. The County shall provide prisoner-workers with training and education regarding kitchen operations.
5. The County shall conduct periodic temperature monitoring of food and take steps to ensure that food prepared as hot is served hot to the greatest extent practicable.
E. Work Order System and Preventative Maintenance
1. The County shall train staff on the process of submitting work orders.
2. The County shall utilize the work order reporting system to schedule preventative maintenance and repairs. The system shall provide for any cleaning or maintenance requiring an established schedule, including, at a minimum
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a) Regular maintenance of plumbing; b) Quarterly cleaning of fans and ventilation grills; c) Quarterly replacement of ventilation filters; d) Regular external contractor monitoring of negative pressure
cells and gauges; e) Monthly fire extinguisher inspections; and f) Monthly fire and life safety inspections. 3. The County shall develop and implement an environmental inspection policy with procedures that include an assessment of maintenance issues for every housing unit, including for plumbing, electrical, ventilation, painting, cleanliness, lighting, and storage of personal belongings. F. Chemical Control and Biohazardous Materials
1. The County shall develop and implement chemical control policies and procedures for safe storage, dilution, and distribution of chemicals used at the Jail.
2. The County shall develop and implement a chemical safety training for all staff and prisoners assigned the responsibility of cleaning. The County or County’s contract provider shall maintain documentation that demonstrates evidence of training for all staff and prisoner-workers involved in cleanup.
3. The County shall revise and ensure implementation of its Communicable Disease policy, including to ensure appropriate use and concentration of pyrethrum spray.
4. The County shall develop and implement policies and procedures for cleaning, handling, storing, and disposing of biohazardous materials, including waste. The County shall ensure that Material Safety Data Sheets are accessible anywhere chemicals are stored, mixed, or diluted.
5. The County shall ensure that staff and prisoner-workers responsible for cleaning biohazardous materials or areas suspected of being contaminated by pests (e.g. lice or scabies) are outfitted with protective equipment and receive appropriate supervision.
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G. Negative Pressure Monitoring and Recording
1. The magnehelic gauges located outside the housing area to any negative airflow cell shall be checked once per shift to ensure the cells remain in a negative airflow state. When non-conformities are identified, the cell shall not be used for people with circumstances requiring a negative airflow cell, and a work order shall be submitted for prompt repair.
2. The County shall provide and document training regarding acceptable gauge readings and the steps to take if the readings are outside the acceptable range for all staff assigned to housing areas with negative airflow cells.
3. Negative pressure cells and gauges shall be tested by an external contractor on a regular schedule as part of the Jail’s preventive maintenance schedule.
H. Emergency Response and Fire/Life Safety
1. The County shall inspect fire extinguishers monthly and hold drills to ensure all jail staff are trained consistent with NCCHC standards on emergency response. Drill documentation shall include start and stop times, the number and location of any prisoners moved as part of the drill, any noted deficiencies, and any corrective actions taken.
I. Environment of Care Monitor Inspections, Corrective Action, and Process for Prisoners to Raise Concerns
1. The Environment of Care Monitor shall conduct bimonthly (i.e., every other month) Environmental Health and Safety inspections in every housing unit. The inspections shall include a documented assessment of and (as needed) corrective action plans for:
a) Cleanliness of floors, walls, ceilings, bed and bedding, toilet and lavatory, cells and dayrooms surfaces;
b) Cleanliness and disinfection of common areas and furnishings, including showers, shower chairs, plastic chairs, wheelchairs, stretchers, beds/bunks and personal property containers.
c) Cleanliness of fans, exhaust and return ventilation grills, and the need for any maintenance repairs such as painting, broken tiles, blocked lighting, and plumbing.
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2. The County shall provide a system through which class members are able to raise sanitation matters of concern. The grievances shall be reviewed by the housing unit supervisors before each shift change. Where a maintenance issue is identified, a work order shall be submitted before the end of the following shift.
VII. CUSTODY OPERATIONS/SEGREGATION A. General Principles
1. Prisoners shall be housed in the least restrictive setting necessary to ensure their own safety, as well as the safety of staff and other prisoners.
2. The County shall not place prisoners in more restrictive settings, including Segregation, based on a mental illness or any other disability. Prisoners will be housed in the most integrated setting appropriate to their individual needs.
3. The County shall not place a prisoner in Segregation units without first determining that such confinement is necessary for security reasons and/or the safety of the staff or other prisoners. The County shall maintain a system by which it documents in writing the specific reason(s) for a prisoner’s placement and retention in Segregation housing. The reason(s) shall be supported by clear, objective evidence.
4. Prisoners will remain in Segregation housing for no longer than necessary to address the reason(s) for such placement.
B. Classification Procedures
1. The County shall implement a validated Classification System consistent with the provisions of this remedial plan.
2. The Classification System shall be based on clear criteria and procedures for placing prisoners in and removing prisoners from Segregation units. Placement in and removal from Segregation units shall be documented for all prisoners.
3. The Classification System shall facilitate the following: a) Housing placements based on the behavior and clinical needs of prisoners who are identified as having Serious Mental
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Illness. Mental health staff shall provide input regarding the classification and placement of people with Serious Mental Illness.
b) Screening to determine whether a prisoner should be separated from other prisoners for safety purposes. Where a prisoner is found to require separation from other prisoners for safety, placement will be in the least restrictive setting appropriate, and will allow for out-of-cell and recreation time consistent with the provisions herein.
4. The Classification System shall include a Classification Review Process.
a) The Classification Review Process shall include clear, written criteria by which prisoners in a Segregation Unit can secure placement in a less restrictive setting as well as restoration of property or privileges. This review will include a private, outof-cell interview (unless individual security issues prevent such an interview and are documented). The review shall occur at least every 30 days or sooner if circumstances warrant.
b) If a prisoner is retained in a Segregation unit following the Classification Review, the reasons for retention and the specific steps to be taken to achieve restoration of property/privileges and transfer to a less restrictive setting will be documented.
c) Prisoners in Segregation units will be provided an oral and written statement of the reasons for the outcome of each review, including what steps are necessary to gain restoration of property/privileges and to be moved to a less restrictive setting.
5. The County shall perform Prison Rape Elimination Act (PREA) screenings in a private location.
C. Elimination of Dangerous or Improper Physical Plant Features
1. The County shall conduct an assessment of all Segregation cells and develop a plan to address structural suicide hazards, such as tie-off points within the cells, to the maximum extent feasible.
2. The County shall ensure that prisoners with serious mental illness or otherwise at elevated risk of suicide will not be housed in a cell that
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contains attachment points or other structural suicide hazards, as follows.
a) The County shall maintain a list of Segregation cells containing structural suicide hazards.
b) The County shall not place any person in a Segregation cell containing structural suicide hazards if the person has a diagnosed Serious Mental Illness.
c) The County shall assess all cells used to hold prisoners awaiting intake screening or post-intake housing placement, including as intake “overflow,” and shall ensure that they are suicide-resistant and do not contain structural blind spots, to the maximum extent feasible.
3. No later than January 1, 2021, the County shall discontinue its use of the Main Jail’s “double door” or other extreme isolation cells, including Central 7 and Central 8.
4. No later than January 1, 2021, the County shall discontinue its use of Segregation housing units that lack access to a dayroom, including South 1-16, West 18-29, and East 11-22. The County may retrofit such units to ensure that they provide access to a dayroom and outdoor recreation areas and that they comply with contemporary correctional standards.
D. Minimum Out-of-Cell Time
1. Absent exigent circumstances or exigent security concerns that are documented, the County shall offer each prisoner not subject to discipline (except in the Northwest unit), at a minimum, 18 hours out of their cell each week, and other structured programming, as follows:
a) At least six (6) hours per week outdoors for exercise/recreation
b) At least twelve (12) hours per week in a dayroom or other common area
c) At least four (4) hours per day, on at least three (3) separate days per week, of in-cell structured programming – i.e., programming on electronic tablets.
2. For those prisoners housed in the Northwest unit, absent exigent circumstances or exigent security concerns that are documented, the
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County shall offer each prisoner not subject to discipline at a minimum, 15 hours out of their cell each week, and other structured programming, as follows:
a) At least six (6) hours per week outdoors for exercise/recreation
b) At least nine (9) hours per week in a dayroom or other common area
c) At least four (4) hours every other day (i.e., 3 or 4 times per week, on an alternating basis), of in-cell structured programming – i.e., programming on electronic tablets.
3. The County shall provide prisoners out-of-cell time daily, at appropriate times of the day – i.e., not during normal sleeping hours.
4. The County shall implement a system of documenting the amount of out-of-cell time each prisoner is offered for each of the above categories.
5. The County shall conduct monthly audits to ensure that required outof-cell time with respect to each of the above categories is made available to the jail population. Supervisory staff shall regularly review this data for quality assurance, and take steps to address any deficiencies.
6. In cases where a prisoner refuses out-of-cell time repeatedly and the reason for such refusals may be related to their mental health condition, Jail staff shall make a mental health referral for assessment and appropriate clinical follow-up.
E. Disciplinary Procedures
1. A prisoner may be housed in Segregation for disciplinary purposes only after the prisoner has received notice of the charges against him/her, a supervisor has conducted a disciplinary hearing at which the prisoner is given an opportunity to rebut the charges, and the prisoner is adjudicated guilty of the alleged violation(s). Where there is a serious and immediate safety risk and no other housing unit is sufficient to protect the inmate from harm, staff may place a prisoner in Segregation for the shortest period of time necessary. In such cases, supervisory custody staff will promptly review the case and must approve in writing continued retention in Segregation.
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2. Prisoners serving a disciplinary term in Segregation may be subject to a reduction in out-of-cell time, including in-cell confinement not to exceed twenty-two (22) hours per day.
3. The County shall implement a 30-day maximum term in Segregation for any single or set of disciplinary violations stemming from the same incident.
4. The County shall not use safety cells for punishment.
5. The County shall not use the denial or modification of food as punishment. The County shall not use the “prison loaf” as a disciplinary diet.
F. Safeguards for Prisoners Placed in Segregation
1. Prior to Segregation placement of any person with Serious Mental Illness, with an intellectual disability, or who is exhibiting unusual or bizarre behavior, the County shall ensure completion of the mental health review process detailed in Section VII of the Mental Health Remedial Plan.
2. The County shall conduct visual cell checks (to ensure that prisoners are safe and breathing) for all prisoners in Segregation at least every 30 minutes, at staggered intervals. Completion of safety checks shall be timely documented and audited regularly by supervisory staff for quality assurance purposes.
3. Health care staff shall conduct check-ins three times per week to assess and document the health status of all prisoners in Segregation, and shall make medical and mental health referrals as necessary.
4. A Qualified Mental Health Professional shall conduct check-ins at least three times per week to assess and document the mental health status of all prisoners in Segregation and shall make referrals as necessary. The check-in shall include the following:
a) Conversation with each prisoner;
b) Visual observation of the prisoner’s cell, including the cleanliness of the prisoner’s clothing and bed linens; and
c) Inquiry into whether the prisoner would like to request a confidential meeting with a mental health or medical provider.
5. If a prisoner in Segregation requests a confidential health care contact or staff identify a mental health or medical need warranting
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follow-up, staff shall arrange for evaluation and treatment of the prisoner in an appropriate confidential setting.
6. If health care staff observe a prisoner’s medical or mental health condition deteriorate in Segregation, they shall promptly confer with supervisory level custody staff to discuss the need for higher level of care or alternative placement to address the prisoner’s condition. This conference will be documented in the prisoner’s record.
a) The County shall not place the following prisoners in Segregation unless necessary to address current, specific safety concerns that are documented, with supervisory-level review and approval, and in such cases only for the minimum time necessary to identify an alternative appropriate placement: Prisoners with acute medical or mental health needs that require an inpatient level of care and/or daily nursing care;
b) Prisoners who are pregnant, post-partum, who recently had a miscarriage, or who recently had a terminated pregnancy.
7. The County shall avoid the release of prisoners from custody directly from Segregation to the maximum extent possible.
8. If a prisoner has an expected release date in less than 60 days, the County shall take and document steps to move the prisoner to a less restrictive setting, consistent with safety and security needs. Should Segregation become necessary during this time period, the County shall provide individualized discharge planning to prepare the prisoner for release to the community, including in light of the prisoner’s Jail housing placement and status.
G. Grievances, Inmate Request Forms, Property/Privileges in Segregation
1. The County shall provide grievance forms and inmate request forms in each housing unit for prisoners to readily access and use.
2. Prisoners housed in Segregation units shall have equal access to grievance and inmate request forms and procedures as compared to general population prisoners.
3. The County shall allow reasonable access to the following for all prisoners, including those in Segregation, absent a specific safety or security issue that is documented:
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a) Personal phone calls on a daily basis during normal business hours.
b) Education, rehabilitation, and other materials (e.g., books, magazines, radios, writing implements, art supplies, tablets) for in-cell activities.
H. Other Custody Operations
1. Capacity of Jail Facilities a) No later than January 1, 2021, the number of prisoners placed in a particular housing unit shall be limited to no more than the rated capacity. b) No later than January 1, 2021, the County shall assign a bed to all prisoners. c) The County shall establish procedures to ensure that no prisoner is placed in any cell or housing unit without a mattress and appropriate bedding, unless there are individualized clinical or security concerns that are documented. d) Female prisoners shall be separated by sight and sound from male prisoners.
VIII. STAFFING FOR HEALTH CARE SERVICES 1. The County shall establish and maintain appropriate Qualified Health Professional staffing levels and sufficient custodial staff to provide timely escorts for inmates to health care appointments. 2. The County shall perform the following analyses: a) Comprehensive staffing analysis based on a needs assessment, to include medical and mental health care providers and clinical staff, office and technological support, Quality Assurance staff, supervisorial staff, and custody staff for escorts and transportation; b) Determination of the number of positions required in each discipline for health care needs at each facility, based on current populations; c) Timeline for implementation of the staffing analysis (including authorization, funding, and hiring).
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3. The County shall regularly monitor and adjust, as needed, staffing in order to ensure timely access to care.
IX. TRAINING RELATED TO TREATMENT OF PRISONERS WITH SPECIAL NEEDS
1. The County shall develop and implement training, through various mediums including memorandums, briefings, online presentations, and/or classroom presentations, for Jail custody staff on the provisions described in this remedial plan, as well as general correctional health care issues, including crisis intervention techniques, recognizing different types of medical and mental health conditions and appropriate responses, developmental/intellectual disability, descalation and crisis intervention, suicide/self-harm prevention, cultural diversity, health care referral practices, and confidentiality standards.
2. Jail custody staff training on implementation of remedial plan provisions shall be completed within 90 days of the effective date of this remedial plan. Jail custody staff shall receive at least eight (8) hours of training on all other topics described above on a bi-annual basis. The County shall keep records documenting all such trainings and training participants.
3. Jail custody staff assigned to specialized units that house people with serious mental illness shall receive four (4) additional hours of pre-service training, and on a bi-annual basis thereafter, on working with people with mental health needs, special medico-legal considerations, de-escalation and specialized management techniques, and the Jail’s mental health treatment programs.
4. The County shall ensure that the health care services provider develops and implements training for health care staff to ensure timely implementation of and ongoing adherence to the provisions described in this remedial plan. The County shall keep records documenting all such trainings and training participants.
5. The County shall review and revise (as necessary) suicide prevention training for custody, health care, and other relevant staff, and ensure that it adequately covers the following topics:
a) avoiding obstacles (negative attitudes) to suicide prevention;
b) why facility environments are conducive to suicidal behavior;
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c) identifying suicide risk; d) predisposing factors to suicide; e) high-risk suicide periods; f) suicide risk warning signs and symptoms; g) components of the County’s jail suicide prevention program; h) liability issues associated with prisoner suicide; and i) crisis intervention. 6. The County shall provide all custody staff with at least eight hours of initial training and at least two to four hours of annual training, through various mediums including memorandums, briefings, online presentations, and/or classroom presentations, regarding suicide prevention and the identification and approach to prisoners with mental illness. 7. All health care staff shall receive at least two hours of training annually on suicide prevention and related mental health treatment and management issues. Annual training shall include a review of the current Jail suicide prevention policy and program. 8. All custody and medical staff shall be trained in first aid and CPR.
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EXHIBIT B
Murray v. County of Santa Barbara Duties of Experts

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The parties set forth the duties of the Remedial Plan Experts as follows. The Remedial Plan Experts shall advise the parties on Defendants’
compliance or non-compliance with the Remedial Plan, to assist the parties and Court with Dispute Resolution matters and to provide testimony, if required, in any proceedings before the Court.
Within 180 days after entry of this Stipulated Judgment, and then annually thereafter during the term of this Stipulated Judgment, the Remedial Plan Experts shall each complete a review and non-confidential report (“Annual Report”) to advise the parties on Defendants’ compliance or non-compliance with the Remedial Plan.
In each Annual Report, the Remedial Plan Experts shall state their opinion as to whether Defendants are or are not in substantial compliance with each component of the Remedial Plan within the Remedial Plan Expert’s respective area of expertise. These opinions are referred to in the Stipulated Judgment as “Substantial Compliance Determinations.”
The Annual Reports will provide, to the extent possible, specific recommendations as to how Defendants may reach substantial compliance. The Parties shall have an opportunity to respond to any finding regarding Defendants’ substantial compliance with a provision of the Remedial Plan. The Parties shall submit any such response to the Remedial Plan Experts and all counsel within 30 calendar days of the Annual Report completion. Such response(s) shall be appended to the final report.
The Annual Reports shall be considered separate and apart from any evaluations and reports prepared as part of the Dispute Resolution process set forth in the Stipulated Judgment. The Annual Reports may be submitted to the Court for purposes of future proceedings.

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The Remedial Plan Experts shall be entitled to reasonable compensation based on the cost estimates provided in their respective agreements with the Parties, which shall be paid by Defendants.
With appropriate notice, the Remedial Plan Experts shall have reasonable access to all parts of any facility. Access to the facilities will not be unreasonably restricted. The Remedial Plan Experts shall have access to correctional and health care staff and people incarcerated in the jails, including confidential and voluntary interviews as is reasonable to complete a report and provided it does not implicate security or other privileged information. The Remedial Plan Experts shall also have access to non-privileged documents, including budgetary, custody, and health care documents, and institutional meetings, proceedings, and programs to the extent the Remedial Plan Experts determine such access is needed to fulfill their obligations. The Remedial Plan Experts’ tours shall be undertaken in a manner that does not unreasonably interfere with jail operations as reasonably determined by jail administrators. The Remedial Plan Experts shall have reasonable access to individual prisoner health records, including mental health records, and custody records.
The Remedial Plan Experts shall be provided with and agree to be bound by any protective or Court orders entered in this case.
The Remedial Plan Experts may engage in ex parte communications with the parties and with each other. The Remedial Plan Experts shall not engage in ex parte communications with the Court.
Pursuant to the Dispute Resolution procedures set forth in the Stipulated Judgment, either party may request that the relevant Remedial Plan Expert evaluate any issue in dispute and prepare a report. The Remedial Plan Expert must provide the report regarding the area of disagreement to the parties within 45 calendar days of the request. Defendants will pay the reasonable fees as

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set forth in the Remedial Plan Expert’s agreement with the parties for any report prepared by a Remedial Plan Expert at the request of a party about a disputed issue.
The Remedial Plan Experts shall be available to meet with the parties in person or by telephone in a manner that is reasonable and convenient for the purposes of clarifying any findings and assisting in resolution of any disputes.
At the request of the Court, the Remedial Plan Experts shall attend any negotiations, mediation sessions, or court hearings.