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1 MICHAEL W. BIEN – 096891 AARON J. FISCHER – 247391
2 ROSEN, BIEN & GALVAN, LLP 315 Montgomery Street, Tenth Floor
3 San Francisco, California 94104-1823 Telephone: (415) 433-6830
4 Facsimile: (415) 433-7104

5 Attorneys for Plaintiffs

6

7

8

UNITED STATES DISTRICT COURT

9

EASTERN DISTRICT OF CALIFORNIA

10

SACRAMENTO DIVISION

11

12 Estate of NATHAN PRASAD, deceased, Case No. by and through MARY PRASAD; MARY
13 PRASAD; T.P., a minor; and A.P, a minor, COMPLAINT

14

Plaintiffs,

JURY TRIAL DEMANDED

15

v.

16 COUNTY OF SUTTER; J. PAUL PARKER, Sutter County Sheriff’s
17 Department Sheriff; DAVID SAMSON, Sutter County Jail Division Commander;
18 NORMAN BIDWELL, Sutter County Jail Corrections Lieutenant; DORIS BROWN,
19 Sutter County Jail Advanced Registered Nurse Practitioner; MELODY YOUNG,
20 Sutter County Jail Licensed Vocational Nurse; BALJINDER RAI, Sutter County
21 Jail Deputy Officer; SHANE DICKSON, Sutter County Jail Deputy Officer;
22 UNKNOWN JAIL EMPLOYEE I; FREMONT-RIDEOUT HEALTH
23 GROUP; MICHAEL FRATERS, M.D.; and DOES I through XL,
24 Defendants.
25

26

27

28

COMPLAINT

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1

INTRODUCTION

2

1. This case involves NATHAN PRASAD, a young man denied basic

3 emergency life-saving treatment for a serious infection while detained at Sutter County Jail

4 on minor, non-violent charges. In the course of his approximately one-week detention,

5 NATHAN PRASAD’s condition deteriorated from an infection wholly treatable through

6 basic and timely medical attention to an extraordinarily painful death as a result of Sutter

7 County Jail’s failure to provide treatment. Sutter County Jail’s failure was despite

8 documented observation of his emergent medical problems, including coughing up blood,

9 deteriorating vital signs, and desperate pleas for help by NATHAN PRASAD and other jail

10 inmates.

11

2. After reporting to jail staff that he was experiencing enormous pain in his

12 lower extremities, he was brought to Rideout Memorial Hospital on January 26, 2011 for

13 further evaluation. Following diagnostic testing on his lower extremities, hospital staff

14 discharged NATHAN PRASAD back to the jail. Doctors provided to jail staff Defendants

15 explicit direction that NATHAN PRASAD be returned to the emergency room

16 immediately if his symptoms worsen or new symptoms develop. Hospital staff knew or

17 should have known, however, that the jail’s policies and procedures made such immediate

18 return extremely unlikely if not impossible. Hospital staff knew or should have known

19 that jail policies prohibited custody staff from summoning medical attention when jail

20 medical staff were not present, and that jail medical staff were not present during lengthy

21 periods of the day and night.

22

3. Upon his return to Sutter County Jail, NATHAN PRASAD’s symptoms

23 worsened dramatically, and new alarming symptoms developed. Jail staff observed and

24 documented that NATHAN PRASAD was experiencing tremendous pain, coughing up

25 blood, and telling them that he was afraid he would die without medical care. Basic

26 medical diagnostic evaluation at the jail showed that his vital signs indicated extreme

27 danger. Fellow inmates desperately sought medical help for NATHAN PRASAD, going

28 so far as to collect the blood he coughed up in a used milk carton.

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1

4. Despite these facts, jail staff ignored NATHAN PRASAD’s serious medical

2 needs, instead ridiculing him and leaving him to continue to deteriorate in his cell and at

3 the jail.

4

5. After almost two days of deterioration and suffering at the jail, NATHAN

5 PRASAD’s condition became so serious that his blood pressure could no longer be

6 detected at all and he was losing consciousness. His condition was so deteriorated at this

7 stage that subsequent life-saving measures could not revive him.

8

6. NATHAN PRASAD fell into a coma and died on January 28, 2011, at the

9 age of 30. He left behind two young children, T.P. and A.P., with whom he had a close

10 and loving relationship, and who he helped to support financially and emotionally. He

11 further left behind his mother, MARY PRASAD, with whom he remained exceptionally

12 close throughout his life and in the months prior to his death. Neither MARY PRASAD,

13 nor T.P., nor A.P was able to make it to NATHAN PRASAD’s bedside to see him before

14 he passed away.

15

7. Defendants acted with deliberate indifference to NATHAN PRASAD’s

16 serious medical needs, and in violation of their duties under federal and state law, causing

17 NATHAN PRASAD’s tragic and preventable death.

18

JURISDICTION AND VENUE

19

8. This case is brought pursuant to 42 U.S.C. § 1983. Jurisdiction is based on

20 28 U.S.C. §§ 1331 and 1343. With respect to those claims brought pursuant to California

21 law, Plaintiffs have complied with the administrative claim requirement.

22

9. The court has supplemental jurisdiction over Plaintiffs’ state claims pursuant

23 to 28 U.S.C. § 1367.

24

10. The claims alleged herein arose in the County of Sutter, California.

25 Therefore, venue in the Eastern District of California is proper pursuant to 28 U.S.C.

26 § 1391(b)(2).

27

PARTIES

28

11. Plaintiffs’ decedent is NATHAN PRASAD, who, at the time of his death,

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COMPLAINT

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1 was a 30-year old citizen of the United States. He was a citizen and resident of County of

2 Sutter in the State of California.

3

12. Plaintiff MARY PRASAD, as Administrator of the Estate of NATHAN

4 PRASAD, brings this action pursuant to California Code of Civil Procedure §§ 377.10 et

5 seq. The survival causes of action in this matter are based on violations of NATHAN

6 PRASAD’s rights under the First and Fourteenth Amendments, and on violations of

7 California state law as against COUNTY OF SUTTER and all individual Sutter County

8 Defendants. MARY PRASAD is the mother of NATHAN PRASAD, and is also suing

9 individually for violations of her civil rights under the First and Fourteenth Amendments.

10

13. Plaintiffs T.P. and A.P. are the children of NATHAN PRASAD. They are

11 suing for violations of their civil rights under the First and Fourteenth Amendments. They

12 are further suing for violations of California state law as against COUNTY OF SUTTER

13 and all individual Sutter County Defendants. As minors, T.P. and A.P. are suing through

14 MARY PRASAD, their grandmother, as Guardian Ad Litem.

15

14. Plaintiffs MARY PRASAD, T.P., and A.P. are residents of the County of

16 Colusa, California.

17

15. Defendant COUNTY OF SUTTER is a public entity, duly organized and

18 existing under the laws of the State of California. Under its authority, Defendant

19 COUNTY OF SUTTER operates and manages Sutter County Jail and is, and was at all

20 relevant times mentioned herein, responsible for the actions and/or inactions and the

21 policies, procedures and practices/customs of the Sutter County Sheriff’s Department and

22 its respective employees and/or agents. Sutter County Sheriff’s Department operates

23 Sutter County Jail, and is and was responsible for ensuring the provision of emergency and

24 basic medical care services to all Sutter County Jail inmates.

25

16. Defendant J. PAUL PARKER is, and was at all relevant times mentioned

26 herein, the Sheriff of the COUNTY OF SUTTER, the highest position in the Sutter County

27 Sheriff’s Department. As Sheriff, Defendant PARKER is and was responsible for the

28 hiring, screening, training, retention, supervision, discipline, counseling, and control of all

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COMPLAINT

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1 Sutter County Sheriff’s Department custodial employees and/or agents and DOES I

2 through XL. Defendant PARKER is and was charged by law with the administration of

3 the Sutter County Jail, with the assistance of a small group of executive officers.

4 Defendant PARKER is and was also responsible for the promulgation of the policies and

5 procedures and allowance of the practices/customs pursuant to which the acts of the Sutter

6 County Sheriff’s Department alleged herein were committed. Defendant PARKER is

7 being sued in his individual capacity.

8

17. Defendant DAVID SAMSON is, and was at all relevant times mentioned

9 herein, the Sutter County Jail Division Commander. Defendant SAMSON is and was

10 responsible for the hiring, screening, training, retention, supervision, discipline,

11 counseling, and control of all Sutter County Sheriff’s Department custodial employees

12 and/or agents and DOES I through XL. Defendant SAMSON is and was responsible for

13 the administration of the Sutter County Jail. Defendant SAMSON is and was also

14 responsible for the promulgation of the policies and procedures and allowance of the

15 practices/customs pursuant to which the acts of the Sutter County Sheriff’s Department

16 alleged herein were committed. Defendant SAMSON is being sued in his individual

17 capacity.

18

18. Defendant NORMAN BIDWELL, is, and was at all relevant times

19 mentioned herein, the Sutter County Jail Corrections Lieutenant. Defendant BIDWELL is

20 and was second-in-command at Sutter County Jail. He is and was responsible for the

21 hiring, screening, training, retention, supervision, discipline, counseling, and control of all

22 Sutter County Sheriff’s Department custodial employees and/or agents and DOES I

23 through XL. Defendant BIDWELL is and was responsible for the administration of the

24 Sutter County Jail. Defendant BIDWELL is and was also responsible for the promulgation

25 of the policies and procedures and allowance of the practices/customs pursuant to which

26 the acts of the Sutter County Sheriff’s Department alleged herein were committed.

27 Defendant BIDWELL is being sued in his individual capacity.

28

19. Defendant DORIS BROWN was at all relevant times mentioned herein a

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1 Registered Nurse Practitioner at Sutter County Jail. Defendant BROWN had direct contact

2 with NATHAN PRASAD in the hours and/or days leading up to his death, had actual

3 notice of NATHAN PRASAD’s serious and life-threatening condition and need for

4 emergency medical treatment, and acted with deliberate indifference by failing to take

5 necessary steps to provide such treatment. Defendant BROWN is being sued in her

6 individual capacity.

7

20. Defendant MELODY YOUNG was at all relevant times mentioned herein a

8 Licensed Vocational Nurse at Sutter County Jail. Defendant YOUNG had direct contact

9 with NATHAN PRASAD in the hours and/or days leading up to his death, had actual

10 notice of NATHAN PRASAD’s serious and life-threatening condition and need for

11 emergency medical treatment, and acted with deliberate indifference by failing to take

12 necessary steps to provide such treatment. Defendant YOUNG is being sued in her

13 individual capacity.

14

21. Defendant BALJINDER RAI was at all relevant times mentioned herein a

15 Deputy Officer at Sutter County Jail. Defendant RAI had direct contact with NATHAN

16 PRASAD in the hours and/or days leading up to his death, had actual notice of NATHAN

17 PRASAD’s serious and life-threatening condition and need for emergency medical

18 treatment, and acted with deliberate indifference by failing to take necessary steps to

19 provide such treatment. Defendant RAI is being sued in his individual capacity.

20

22. Defendant SHANE DICKSON was at all relevant times mentioned herein a

21 Deputy Officer at Sutter County Jail. Defendant DICKSON had direct contact with

22 NATHAN PRASAD in the hours and/or days leading up to his death, had actual notice of

23 NATHAN PRASAD’s serious and life-threatening condition and need for emergency

24 medical treatment, and acted with deliberate indifference by failing to take necessary steps

25 to provide such treatment. Defendant DICKSON is being sued in his individual capacity.

26

23. Defendant UNKNOWN JAIL EMPLOYEE I was at all relevant times

27 mentioned herein an employee at Sutter County Jail. Defendant UNKNOWN JAIL

28 EMPLOYEE I had direct contact with NATHAN PRASAD in the hours and/or days

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1 leading up to his death, had actual notice of NATHAN PRASAD’s serious and life-

2 threatening condition and need for emergency medical treatment, and acted with deliberate

3 indifference by failing to take necessary steps to provide such treatment. Defendant

4 UNKNOWN JAIL EMPLOYEE I, whose name and identity is presently unknown to

5 Plaintiffs and is thus a DOE Defendant until such time that Plaintiffs discover his/her true

6 identity and amend the instant Complaint accordingly. Defendant UNKNOWN JAIL

7 EMPLOYEE I is being sued in his/her individual capacity.

8

24. Defendant FREMONT-RIDEOUT HEALTH GROUP was at all times

9 mentioned herein responsible for the operation of Rideout Memorial Hospital. Defendant

10 FREMONT-RIDEOUT HEALTH GROUP had and maintained a contractual agreement

11 with COUNTY OF SUTTER to provide medical treatment to Sutter County Jail inmates,

12 including for the purpose of providing ambulance and emergency services. The process by

13 which Rideout Memorial Hospital provided treatment to Sutter County Jail inmates

14 involved significant, ongoing coordination and cooperation between COUNTY OF

15 SUTTER, the Sutter County Sheriff’s Department, and Defendant FREMONT-RIDEOUT

16 HEALTH GROUP. On information and belief, Defendant FREMONT-RIDEOUT

17 HEALTH GROUP’s Rideout Memorial Hospital is the only facility made available to Jail

18 inmates for the delivery of emergency medical services. Defendant FREMONT-

19 RIDEOUT HEALTH GROUP established and follows a policy, procedure and practice of

20 receiving jail inmates from Sutter County Jail, and discharging them to Sutter County Jail

21 in a manner that is deliberately indifferent to the known risk of serious or lethal injury in

22 the event, as in the case of NATHAN PRASAD, where the discharge instructions depend

23 on a capacity for emergency medical response that Fremont-Rideout Health Group knew

24 or should have known did not exist at Sutter County Jail.

25

25. Defendant MICHAEL FRATERS was at all relevant times mentioned herein

26 a physician at Rideout Memorial Hospital and employee of FREMONT-RIDEOUT

27 HEALTH GROUP. Defendant FRATERS treated NATHAN PRASAD pursuant to the

28 COUNTY OF SUTTER-FREMONT-RIDEOUT HEALTH GROUP agreement to treat

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COMPLAINT

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1 Sutter County Jail inmates in need of medical care. Defendant FRATERS had direct

2 contact with NATHAN PRASAD on January 26, 2010, had actual notice of NATHAN

3 PRASAD’s serious and life-threatening condition and need for access to emergency

4 medical treatment, and acted with deliberate indifference to the known risk of serious or

5 lethal injury to NATHAN PRASAD given that a safe discharge from the hospital

6 depended on the capacity for emergency medical response that he knew or should have

7 known did not exist at Sutter County Jail. Defendant FRATERS is being sued in his

8 individual capacity.

9

26. The true names and identities of Defendants DOES I through XX are

10 presently unknown to Plaintiffs. Plaintiffs allege that each of Defendants DOES I through

11 XX was employed by the COUNTY OF SUTTER and/or the Sutter County Sheriff’s

12 Department at the time of the conduct alleged herein. Plaintiffs allege that each of

13 Defendants DOES I through XX was deliberatively indifferent to NATHAN PRASAD’s

14 medical needs and safety, failed to provide necessary care to him or to take other measures

15 to violated his civil rights, wrongfully caused his death, and/or encouraged, directed,

16 enabled and/or ordered other defendants to engage in such conduct. Plaintiffs further allege

17 that Defendants DOES I through XX violated Plaintiffs’ First and Fourteenth Amendment

18 rights, and rights under California state law. Plaintiffs will seek to amend this Complaint as

19 soon as the true names and identities of Defendants DOES I through XX have been

20 ascertained.

21

27. The true names and identities of Defendants DOES XXI though XL are

22 presently unknown to Plaintiffs. Plaintiffs allege that each of Defendants DOES XXI

23 through XL was employed by the COUNTY OF SUTTER and/or the Sutter County

24 Sheriff’s Department at the time of the conduct alleged herein. Plaintiffs allege that each

25 of Defendants DOES XXI through XL was responsible for the hiring, screening, training,

26 retention, supervision, discipline, counseling, and control of medical, mental health, and

27 jail custody employees and/or agents involved in the conduct alleged herein. Plaintiffs

28 allege that each of Defendants DOES XXI through XL was also responsible for and caused

7
COMPLAINT

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1 the acts and injuries alleged herein. Plaintiffs will seek to amend this Complaint as soon as

2 the true names and identities of Defendants DOES XXI through XL have been ascertained.

3

28. Defendant COUNTY OF SUTTER is a political subdivision of the State of

4 California, created and existing by virtue of the laws of the State of California. At all

5 times relevant to the instant complaint, Defendant COUNTY OF SUTTER employed

6 Defendants J. PAUL PARKER, DAVID SAMSON, NORMAN BIDWELL, DORIS

7 BROWN, MELODY YOUNG, BALJINDER RAI, SHANE DICKSON, UNKNOWN

8 JAIL EMPLOYEE I, and DOES I through XL.

9

29. Defendants J. PAUL PARKER, DAVID SAMSON, NORMAN BIDWELL,

10 DORIS BROWN, MELODY YOUNG, BALJINDER RAI, SHANE DICKSON,

11 UNKNOWN JAIL EMPLOYEE I, FREMONT-RIDEOUT HEALTH GROUP,

12 MICHAEL FRATERS, and DOES I through XL, and each of them, to the extent they

13 engaged in any acts or omissions alleged herein, engaged in such acts or omissions under

14 color of state law.

15

30. Plaintiffs are informed and believe and thereon allege that at all times

16 mentioned in this Complaint, Defendants, and each of them, were the agents, employees,

17 servants, joint venturers, partners and/or co-conspirators of the other Defendants named in

18 this Complaint and that at all times, each of the Defendants was acting within the course

19 and scope of said relationship with Defendants.

20

EXHAUSTION OF PRE-LAWSUIT PROCEDURES

21

31. Plaintiffs MARY PRASAD, T.P., and A.P. filed state governmental tort

22 claims with the State and Defendant COUNTY OF SUTTER, including on behalf of the

23 ESTATE of NATHAN PRASAD, on July 21, 2011. By correspondence dated September

24 7, 2011, their governmental tort claims were rejected.

25

FACTUAL ALLEGATIONS

26 Nathan Prasad’s Life and the Circumstances of His Detention in Sutter County Jail

27

32. NATHAN PRASAD was born on April 10, 1980 in Cedarville, California.

28

33. NATHAN PRASAD had a close relationship with his family, helping to

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1 raise his young children and assisting his mother and grandmother with various daily and

2 household tasks. Despite a history of mental illness, NATHAN PRASAD had made great

3 strides in the time before his death towards becoming independent and self-sufficient.

4 After several years struggling with mental illness, he had moved into his own apartment

5 for the first time in his life and was working towards gainful employment. He spent most

6 days with his family, including his elderly grandmother, his mother and step-father, and his

7 children.

8

34. COUNTY OF SUTTER officials and employees – including individual

9 Defendants, county mental health staff, county law enforcement, and county jail staff, had

10 extensive contact with NATHAN PRASAD. NATHAN PRASAD had been involuntarily

11 hospitalized to receive emergency mental health treatment pursuant to Cal. Welf. & Inst.

12 Code § 5150, and had been placed in the custody of the Sheriff’s Department multiple

13 times, generally during periods in which he was manifesting serious mental illness and in

14 light of alleged non-violent parole and probation violations. COUNTY OF SUTTER

15 produced and maintained significant documentation of his mental health and medical

16 needs. This documentation was included in his Sutter County Jail inmate records, and,

17 upon information and belief, reviewed by Defendants PARKER, SAMSON, BIDWELL,

18 BROWN, YOUNG, RAI, DICKSON, and UNKNOWN JAIL EMPLOYEE I.

19

35. COUNTY OF SUTTER arrested NATHAN PRASAD on or about

20 January 21, 2011, based on non-violent misdemeanor and parole-related charges. He was

21 taken to Sutter County Jail, where he was detained for the next week. During that time

22 period, NATHAN PRASAD developed a medical condition which, as a result of the denial

23 of plainly necessary treatment, led to great suffering and his painful death on January 28,

24 2011.

25

36. At the time of NATHAN PRASAD’s death, T.P. was seven (7) years old,

26 and A.P. was six (6) years old. NATHAN PRASAD died just two (2) days before A.P.’s

27 seventh birthday.

28

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COMPLAINT

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1

Medical Problems, Pain, and Suffering While Detained in Sutter County Jail

2

37. Soon after Defendant COUNTY OF SUTTER’s arrest of NATHAN

3 PRASAD, NATHAN PRASAD reported to jail staff that he was experiencing significant

4 pain in his lower extremities. He was further manifesting symptoms of mental illness. Jail

5 staff, including Defendants BROWN, YOUNG, RAI, DICKSON, and UNKNOWN JAIL

6 EMPLOYEE I observed him on multiple occasions and documented that he was

7 experiencing pain, swelling, and other serious medical symptoms.

8

38. While detained at Sutter County Jail, NATHAN PRASAD completed and

9 submitted to jail staff multiple written requests to receive medical treatment. In these

10 reports, he reported that he was suffering “extreme pain,” was concerned that he had a

11 staph infection, and stated that he required “emergency” medical attention.

12

39. After several days of reported and documented medical concerns, jail staff

13 transported NATHAN PRASAD to Rideout Memorial Hospital for what was a brief

14 medical evaluation. A short time after his admission to the Emergency Department on

15 January 26, 2011, emergency room physicians discharged NATHAN PRASAD with

16 specific discharge instructions that if his symptoms worsen or new symptoms develop, he

17 was to be returned to the Emergency Department immediately. He was discharged on the

18 afternoon of January 26, and returned to Sutter County Jail.

19

40. Defendant FREMONT-RIDEOUT HEALTH GROUP’s Rideout Memorial

20 Hospital staff, acting pursuant to a COUNTY OF SUTTER contract to provide medical

21 treatment to Sutter County Jail inmates, acted with deliberate indifference by discharging

22 NATHAN PRASAD to a notoriously dangerous setting at Sutter County Jail. Hospital

23 staff knew or should have known that NATHAN PRASAD would not possibly receive the

24 observation, supervision, and access to emergent medical treatment he would likely need

25 given his serious medical complaints and condition.

26

41. Defendant FRATERS, NATHAN PRASAD’S physician at Rideout

27 Memorial Hospital, evaluated and treated NATHAN PRASAD at the hospital on

28 January 26, as pursuant with the Hospital’s agreement to treat Sutter County Jail inmates.

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1 Defendant FRATERS ordered and/or approved the discharge of NATHAN PRASAD. At

2 the time, he knew or should have known that NATHAN PRASAD had a serious and life-

3 threatening condition and would need access to emergency medical treatment if his

4 symptoms worsened or new symptoms developed.

5

42. Defendant FRATERS acted with deliberate indifference to the known risk of

6 serious or lethal injury to NATHAN PRASAD given that his safe discharge from the

7 hospital depended on timely access to emergency medical response, which he knew or

8 should have known did not exist at Sutter County Jail, a setting that is notoriously

9 dangerous for individuals with serious medical needs and that does not provide sufficient

10 around-the-clock access to medical care.

11

43. On information and belief, Defendants PARKER, SAMSON, and

12 BIDWELL were informed and aware of, or should have been aware of, NATHAN

13 PRASAD’s evaluation at Rideout Memorial Hospital and the discharge instructions

14 providing that if his symptoms worsened or new symptoms developed, he must be taken to

15 the emergency room immediately.

16

44. On information and belief, Defendants BROWN, YOUNG, RAI, DICKSON,

17 and UNKNOWN JAIL EMPLOYEE I each reviewed and/or were aware of, or should have

18 been aware of, NATHAN PRASAD’s custody file, including the medical documentation

19 indicating his medical status and need to be taken to the emergency room immediately if

20 his symptoms worsened or new symptoms developed.

21

45. Throughout NATHAN PRASAD’s detention at Sutter County Jail,

22 Defendants BROWN, YOUNG, RAI, DICKSON, and UNKNOWN JAIL EMPLOYEE I

23 failed to provide sufficient medical screening, evaluation, and observation of his medical

24 condition and emergent treatment needs.

25 Defendants’ Failure to Provide Clearly Necessary Life-Saving Emergency Treatment

26

46. Shortly upon his return from the brief hospital admission, it became readily

27 apparent that NATHAN PRASAD’s condition and symptoms were in fact getting

28 significantly worse. His symptoms included vomiting, shortness of breath, severe chills,

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1 and extreme pain. NATHAN PRASAD began coughing and/or vomiting up blood. On the

2 evening of January 26, 2011, jail staff documented speaking with Defendant BROWN that

3 NATHAN PRASAD was suffering from “uncontrollable pain.” Yet no follow-up

4 evaluation or medical treatment was provided that night.

5

47. From January 26 to January 28, NATHAN PRASAD stated aloud repeatedly

6 that he was in extreme pain and having trouble breathing. He reported to staff that he

7 thought he was going to die unless he received immediate medical attention. He was

8 manifesting numerous symptoms indicating a serious and life-threatening condition and an

9 immediate need for emergency medical treatment.

10

48. Several fellow inmates observed NATHAN PRASAD’s worsening condition

11 and notified staff at the jail. Staff responded that NATHAN PRASAD was faking his pain

12 and other symptoms and that he and the inmates needed to “get over it.”

13

49. Fellow inmates collected the blood that NATHAN PRASAD was coughing

14 up in an empty milk carton, and, upon information and belief, showed it to Defendants

15 RAI, BROWN, YOUNG, DICKSON, UNKNOWN JAIL EMPLOYEE I, and other staff in

16 an effort to obtain emergency medical help for NATHAN PRASAD.

17

50. Jail staff, including Defendants BROWN, YOUNG, RAI, DICKSON, and

18 UNKNOWN JAIL EMPLOYEE I observed NATHAN PRASAD’s suffering and heard his

19 and his fellow inmates’ pleas for immediate medical help. Defendants BROWN,

20 YOUNG, and RAI documented NATHAN PRASAD’s complaints and worsening

21 symptoms. In spite of the alarming reports and the observations of Defendants, they failed

22 to provide adequate evaluation or timely emergency treatment for a period of 36 hours or

23 more.

24

51. Defendant BROWN observed NATHAN PRASAD’s condition and

25 reviewed the Emergency Department records and discharge instructions to return him to

26 the hospital immediately if his symptoms worsened or new symptoms developed. She

27 observed and documented that he was continuing to experience pain and other serious, and

28 worsening, symptoms, but took no steps to obtain the emergency medical care he

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COMPLAINT

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1 obviously needed.

2

52. Defendant DICKSON, after observing NATHAN PRASAD screaming in

3 pain and begging to be taken to the hospital for treatment, ridiculed NATHAN PRASAD.

4 Defendant DICKSON stated that he was the type of person who comes to jail because he

5 wants to get free medical care. Defendant DICKSON ignored NATHAN PRASAD’s

6 serious medical condition, and took no steps to address his medical needs.

7

53. Defendant UNKNOWN JAIL EMPLOYEE I, after observing NATHAN

8 PRASAD screaming in pain and begging to be taken to the hospital for treatment.

9 Defendant UNKNOWN JAIL EMPLOYEE I stated that he was getting what he deserved

10 for whatever he had done, and would have to wait until later to see a doctor. Defendant

11 UNKNOWN JAIL EMPLOYEE I ignored NATHAN PRASAD’s serious medical

12 condition, and took no steps to address his medical needs.

13

54. In the pre-dawn hours of January 28, 2011, Defendants RAI and YOUNG

14 observed and documented that NATHAN PRASAD’s blood pressure and blood-oxygen

15 saturation were dangerously low, that he was coughing and/or vomiting up blood, dizzy,

16 sweating, cold, and clammy. On information and belief, he reported to Defendants RAI

17 and YOUNG that he felt like he was “going to die.”

18

55. After several hours during which NATHAN PRASAD was exhibiting

19 worsening symptoms and significant suffering and was pleading with jail staff for help,

20 Defendants RAI and YOUNG placed NATHAN PRASAD in a Sutter County Jail office.

21 However, they held him in a jail office but provided him no medical treatment, and failed

22 to properly monitor his deteriorating condition, for a period of nearly four (4) hours or

23 more. Defendants RAI and YOUNG did not call an ambulance or make other

24 arrangements for NATHAN PRASAD to be taken to the hospital emergency room for

25 emergency and life-saving medical care.

26

56. Instead, NATHAN PRASAD was made to sit in a jail office room, without

27 medical attention of any kind, even as his condition got worse, including further coughing

28 up of blood and deteriorating vital signs. Not until nearly four hours later on January 28

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1 was an ambulance summoned. By that time, NATHAN PRASAD’s condition had

2 deteriorated dramatically and his skin had turned blue due to severe oxygen deficiency and

3 cyanosis. His blood pressure could no longer be detected.

4

57. The failure of correctional officer Defendants RAI, DICKSON, UNKNOWN

5 JAIL EMPLOYEE I to contact emergency medical services was consistent with a policy in

6 effect at Sutter County Jail such that correctional officers did not have authority to

7 determine who goes to the hospital or to call for an ambulance in an emergency situation,

8 despite the lack of 24-hour medical staff availability at the jail. Defendants PARKER,

9 SAMSON, and BIDWELL created, were aware of, and enforced this policy, knowing that

10 it would endanger inmates like NATHAN PRASAD who require emergency medical

11 attention.

12

NATHAN PRASAD’s Painful and Preventable Death

13

58. NATHAN PRASAD suffered severe bronchopneumonia and multiple organ

14 failure as a result of Defendants’ failure to provide timely medical treatment. He was

15 deemed to be in critical condition and was unconscious, leading to his placement in the

16 Intensive Care Unit (ICU) at Rideout Memorial Hospital.

17

59. Defendants failed to timely contact NATHAN PRASAD’s family. As a

18 result, his mother MARY PRASAD, his children T.P. and A.P., and other family members

19 were unable to make it to the hospital in time to see NATHAN PRASAD while he was still

20 alive.

21

60. Meanwhile, Defendants PARKER, SAMSON, and BIDWELL took steps to

22 drop all pending charges and to release NATHAN PRASAD “on his own recognizance”

23 after he was placed in the ICU and was in critical condition.

24

61. At approximately 4:19 pm on January 28, NATHAN PRASAD was

25 pronounced dead by hospital staff.

26

62. Had NATHAN PRASAD not been placed in a jail setting known to be

27 dangerous and ill-equipped to ensure timely emergency medical treatment, and had such

28 emergency treatment been summoned and provided to NATHAN PRASAD, his condition

14
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1 could have been effectively treated. He would not have experienced severe pain and

2 suffering, and his life would have been saved.

3

Longstanding and Systemic Deficiencies in Sutter County Jail’s Provision of

Emergency Treatment to Inmates, Medical Staffing, and Policies and Procedures in

4

Violation of Existing Court Order

5

63. Defendant COUNTY OF SUTTER has knowingly maintained and tolerated

6 longstanding and systemic deficiencies in the Sutter County Jail’s provision of emergency

7 treatment to seriously ill inmates. It has also knowingly had inadequate medical staffing as

8 well as policies and procedures that were likely in violation of an existing court order

9 directing minimum standards of medical treatment at the jail. Defendants PARKER,

10 SAMSON, and BIDWELL were aware of and tolerated these serious deficiencies in Sutter

11 County Jail’s medical care system, policies, and procedures.

12

64. As identified by a Sutter County Grand Jury in its 2010-2011 Final Report,

13 Sutter County Jail has had several known deficiencies in its system of providing treatment

14 to inmates. (The Sutter County Grand Jury Report is appended as Attachment A.)

15

65. Identified deficiencies included inadequate medical staffing, non-compliant

16 medical policies and procedures, and a medical program that was long out-of-compliance.

17 The Grand Jury noted that such deficiencies were “unacceptable,” and may have caused

18 Sutter County to be out of compliance with an existing court order in Haller v. Sutter

19 County, Case No. CIV-S-93-1256, which mandates certain jail conditions, policies, and

20 procedures for providing medical treatment to Sutter County Jail inmates.

21

66. The Grand Jury found that medical staffing at Sutter County Jail has been

22 inadequate, and that the hiring of additional staff is required.

23

67. The Grand Jury noted a report that training of staff had not occurred in more

24 than five (5) years as of 2011, and that such training was necessary to maintain proficiency

25 in emergency response procedures. The Grand Jury found that Sutter County Jail had

26 failed to offer staff required training pursuant to court order and the jail’s own Medical

27 Policies and Procedures.

28

68. The Grand Jury found that Sutter County Jail’s health care policies and

15
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1 procedures were significantly out of date, and that conditions at the jail had been allowed

2 to “deteriorate.”

3

69. The Grand Jury found that Sutter County Jail’s nursing program was

4 “completely out of compliance with annual nurse training updates and standard nursing

5 procedures,” and found “unacceptable that the program is out of compliance, lack of

6 training for the nursing staff, [and] not having the [policies and procedures] up-to-date,”

7 among other problems.

8

70. The systemic deficiencies regarding the provision of emergency and other

9 medical treatment at Sutter County Jail, as well as the inadequate staffing, policies, and

10 procedures, as identified in the Grand Jury Report and in violation of the existing Haller v.

11 Sutter County court order, directly caused the woefully inadequate emergency medical

12 attention and treatment that NATHAN PRASAD required between January 26 and

13 January 28, 2011, leading to his untimely and preventable death on January 28, 2011.

14

71. Defendants maintained insufficient policies and procedures, and provided

15 inadequate staff training or no training at all, on the provision of emergency medical care

16 to Sutter County Jail inmates with a serious and/or life-threatening medical condition.

17 These deficiencies include, but are not limited to, insufficient direction as to what

18 circumstances require emergency medical care and the procedure for summoning

19 emergency medical care. These failures directly caused the denial of emergency medical

20 attention and treatment that NATHAN PRASAD required between January 26 and January

21 28, 2011, leading to his untimely and preventable death on January 28, 2011.

22

72. Sutter County Jail has recently experienced several likely preventable inmate

23 deaths in custody, indicating a culture of deliberate indifference to inmates’ serious

24 treatment needs at the Jail. In addition to NATHAN PRASAD’s death, there have been

25 disturbing reports of inmate deaths in April 2010 and September 2011.

26 NATHAN PRASAD’s Mother and Young Children Have Been Profoundly Harmed by Defendants’ Misconduct Leading to NATHAN PRASAD’s Death
27

28

73. Plaintiffs MARY PRASAD, T.P., and A.P. have been profoundly harmed by

16
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1 Defendant’s conduct leading to NATHAN PRASAD’s untimely and avoidable death.

2

74. As NATHAN PRASAD’s mother, MARY PRASAD has experienced the

3 painful loss of her eldest son. She has been denied the regular contact that she and

4 NATHAN PRASAD had. She has lost the loving mother-son relationship that she and

5 NATHAN PRASAD maintained, including regular contact, a warm relationship, and the

6 assistance that NATHAN PRASAD regularly provided her, including home maintenance

7 and improvement projects.

8

75. As NATHAN PRASAD’s young children, T.P. and A.P. have experienced

9 the traumatic loss of their father, who remained close to them throughout their lives until

10 his tragic death. They have taken the loss of their father extremely hard, asking when they

11 will be able to see him again. They have had and will continue to have great difficulty

12 coping with his death during their most formative years. T.P. and A.P. have further

13 suffered the loss of NATHAN PRASAD’s financial support, his care and supervision of

14 them, and his paternal guidance.

15

FIRST CLAIM FOR RELIEF

16

Cruel and Unusual Punishment in Violation of the Fourteenth Amendment

to the Constitution of the United States – Deliberate Indifference to Serious

17

Medical Needs, Health and Safety

(Survival Action – 42 U.S.C. § 1983)

18 (Against Defendants COUNTY OF SUTTER, J. PAUL PARKER, DAVID SAMSON,

NORMAN BIDWELL, DORIS BROWN, MELODY YOUNG, BALJINDER RAI,

19 SHANE DICKSON, UNKNOWN JAIL EMPLOYEE I, FREMONT-RIDEOUT

HEALTH GROUP, DAVID FRATERS, and DOES I through XL)

20

21

76. Plaintiffs re-allege and incorporate by reference paragraphs 1 through 75 of

22 this complaint as though fully set forth herein.

23

77. Defendants knew that NATHAN PRASAD was in danger of serious personal

24 harm because:

25

a. Based on NATHAN PRASAD’s previous contact with COUNTY OF

26 SUTTER and Sutter County Jail officers and employees, including all individual

27 Defendants, Defendants had substantial documentation of his medical needs, and his need

28 for consistent supervision and prompt medical attention when warranted.

17
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1

b. NATHAN PRASAD completed and submitted multiple written

2 requests to receive medical treatment, reporting “extreme pain,” a staph infection, and the

3 need for “emergency” medical attention.

4

c. Emergency room physicians documented clear instructions that were

5 placed in NATHAN PRASAD’s custody file and reviewed by Defendants, that if his

6 symptoms worsened or new symptoms developed, he needed to be returned to the hospital

7 for emergency treatment immediately. Upon information and belief, Defendants

8 PARKER, SAMSON, and BIDWELL were informed and aware of NATHAN PRASAD’s

9 evaluation at Rideout Memorial Hospital and the discharge instructions providing that if

10 his symptoms worsened or new symptoms developed, he must be taken to the Emergency

11 Department immediately. Upon information and belief, Defendants BROWN, YOUNG,

12 RAI, DICKSON, and UNKNOWN JAIL EMPLOYEE I each reviewed and/or were

13 informed of NATHAN PRASAD’s custody file, including the medical documentation

14 indicating his medical status and need to be taken to the emergency room immediately if

15 his symptoms worsened or new symptoms developed.

16

d. Defendants FREMONT-RIDEOUT HEALTH GROUP and

17 FRATERS, who treated NATHAN PRASAD pursuant to a COUNTY OF SUTTER

18 contractual agreement to provide medical treatment to Sutter County Jail inmates,

19 discharged NATHAN PRASAD to a notoriously dangerous setting at Sutter County Jail on

20 January 26, 2011. They knew or should have known that NATHAN PRASAD had or

21 could have had a serious and life-threatening condition and would need access to

22 emergency medical treatment if his symptoms worsened or new symptoms developed.

23 Defendants further knew or should have known, and thus acted with deliberate

24 indifference, to the known risk of serious or lethal injury to NATHAN PRASAD given

25 that his safe discharge from the hospital depended on the capacity for timely emergency

26 medical response, which they knew or should have known did not exist at Sutter County

27 Jail, given the hospital’s service agreement and their experience treating Sutter County Jail

28 inmates.

18
COMPLAINT

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1

e. From January 26 to January 28, 2011, NATHAN PRASAD reported

2 to each of Defendants BROWN, YOUNG, RAI, DICKSON, and UNKNOWN JAIL

3 EMPLOYEE I that he was in extreme pain, having trouble breathing, and afraid that he

4 was going to die.

5

f. Defendants BROWN, YOUNG, and RAI, each observed and

6 documented that NATHAN PRASAD’s condition and symptoms were clearly getting

7 worse, including but not limited to vomiting, shortness of breath, severe chills, coughing

8 and/or vomiting up blood, and “uncontrollable pain.”

9

g. Defendants DICKSON and UNKNOWN JAIL EMPLOYEE I each

10 observed that NATHAN PRASAD’s condition and symptoms were clearly getting worse,

11 heard his and his fellow inmates’ pleas for medical help.

12

h. Inmates housed with NATHAN PRASAD collected the blood that

13 NATHAN PRASAD was coughing up in an empty milk carton, showing it to Defendants

14 BROWN, YOUNG, RAI, DICKSON, and UNKNOWN JAIL EMPLOYEE I in a

15 desperate effort to obtain medical attention and treatment for him.

16

i. In the pre-dawn hours of January 28, 2011, Defendants RAI and

17 YOUNG observed and documented NATHAN PRASAD’s significant suffering and life-

18 threatening symptoms, including dangerously low blood pressure and blood-oxygen

19 saturation, coughing and/or vomiting up blood, dizziness, sweats, and reports that

20 NATHAN PRASAD feared that he was “going to die.”

21

j. Not until several hours after these observations and documented

22 reports did Sutter County Jail staff contact emergency medical services and summon an

23 ambulance. At that time, NATHAN PRASAD’s condition had deteriorated so

24 substantially that his condition was dire. He died soon thereafter at the hospital.

25

78. Defendants failed to provide necessary evaluation and treatment for

26 NATHAN PRASAD while he was detained at Sutter County Jail.

27

79. Defendants’ acts and/or omissions as alleged herein, including but not

28 limited to their failure to provide NATHAN PRASAD with timely or adequate medical

19
COMPLAINT

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1 care and/or to take other measures to protect him from serious harm, along with the acts

2 and/or omissions of the Defendants in failing to train, supervise and/or promulgate

3 appropriate policies and procedures at Sutter County Jail in order to prevent NATHAN

4 PRASAD’s and other inmate deaths, constituted deliberate indifference to NATHAN

5 PRASAD’s serious medical needs, health and safety.

6

80. As a direct and proximate result of Defendants’ conduct, NATHAN

7 PRASAD experienced physical pain, severe emotional distress, mental anguish, loss of his

8 life, and the damages alleged herein.

9

81. The aforementioned acts and/or omissions of the individually named

10 Defendants were malicious, reckless and/or accomplished with a conscious disregard of

11 decedent’s rights thereby entitling Plaintiffs to an award of exemplary and punitive

12 damages according to proof, to punish the wrongful conduct alleged herein and to deter

13 such conduct in the future.

14

SECOND CLAIM FOR RELIEF

15

Municipal Liability for in Violation of the Fourteenth Amendment to the

Constitution of the United States

16

(Survival Action - 42 U.S.C. § 1983)

(Against Defendant COUNTY OF SUTTER)

17

18

82. Plaintiffs re-allege and incorporate by reference paragraphs 1 through 81 of

19 this complaint as though fully set forth herein.

20

83. The aforementioned acts and/or omissions of Defendants in being

21 deliberatively indifferent to NATHAN PRASAD’s serious medical needs, health and

22 safety and violating NATHAN PRASAD’s civil rights were the direct and proximate result

23 of customs, practices and policies of Defendants COUNTY OF SUTTER, by and through

24 their agencies, employees and/or agents, as alleged herein.

25

84. Such policies, customs and/or practices include but are not limited to an

26 ongoing pattern of deliberate, including the following: the failure to ensure implementation

27 of appropriate medical and emergency treatment plans; the failure to act upon clearly life-

28 threatening symptoms and reports; the failure to provide appropriate staffing and training

20
COMPLAINT

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1 at Sutter County Jail to provide minimally adequate medical treatment for seriously ill

2 inmates; and the failure to implement a policy to ensure that staff would contact and

3 summon emergency medical treatment in a timely manner.

4

85. Defendant COUNTY OF SUTTER tacitly encouraged, ratified and/or

5 approved of the acts and/or omissions alleged herein, and knew that such conduct was

6 unjustified and would result in violations of constitutional rights.

7

86. The customs, policies and/or practices of Defendants COUNTY OF

8 SUTTER were a direct and proximate cause of Plaintiffs’ injuries and the death of the

9 NATHAN PRASAD in that Defendant COUNTY OF SUTTER failed to adequately train

10 and supervise its employees and/or agents to prevent the occurrence of the constitutional

11 violations suffered by Plaintiffs and NATHAN PRASAD, and by other inmates at Sutter

12 County Jail. Defendant COUNTY OF SUTTER also failed to promulgate appropriate

13 policies or procedures or take other measures to prevent the constitutional violations

14 suffered by Plaintiffs and NATHAN PRASAD, and by other inmates at Sutter County Jail.

15

87. As a direct and proximate result of the aforementioned customs, policies

16 and/or practices of Defendant COUNTY OF SUTTER, NATHAN PRASAD and Plaintiffs

17 suffered injuries and damages as alleged herein.

18

THIRD CLAIM FOR RELIEF

19

Supervisory Liability

(Survival Action - 42 U.S.C. § 1983)

20 (Against Defendants J. PAUL PARKER, DAVID SAMSON, NORMAN BIDWELL,

and DOES XXI through XL)

21

22

88. Plaintiffs re-allege and incorporate by reference paragraphs 1 through 87, as

23 though fully set forth herein.

24

89. The aforementioned acts and/or omissions of Defendants in being

25 deliberatively indifferent to NATHAN PRASAD’s serious medical needs, health and

26 safety and violating decedent’s civil rights were the direct and proximate result of customs,

27 practices and policies of Defendants PARKER, SAMSON, BIDWELL, and DOES XXI

28 through XL as alleged herein.

21
COMPLAINT

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1

90. Such policies, customs and/or practices include but are not limited to an

2 ongoing pattern of deliberate indifference, including the following: the failure to ensure

3 implementation of appropriate medical and emergency treatment plans; the failure to act

4 upon clearly life-threatening symptoms and reports; the failure to provide appropriate

5 staffing and training at Sutter County Jail to provide minimally adequate medical treatment

6 for seriously ill inmates; and the failure to implement a policy to ensure that staff would

7 contact and summon emergency medical treatment in a timely manner.

8

91. Defendants PARKER, SAMSON, BIDWELL and DOES XXI through XL

9 tacitly encouraged, ratified and/or approved of the acts and/or omissions alleged herein,

10 and knew that such conduct was unjustified and would result in violations of constitutional

11 rights.

12

92. The customs, policies and/or practices of said Defendants were a direct and

13 proximate cause of Plaintiffs’ injuries and the death of the NATHAN PRASAD in that

14 Defendants failed to adequately train and supervise their employees and/or agents to

15 prevent the occurrence of the constitutional violations suffered by Plaintiffs and NATHAN

16 PRASAD, and by other inmates at Sutter County Jail. Defendants also failed to

17 promulgate appropriate policies or procedures or take other measures to prevent the

18 constitutional violations suffered by Plaintiffs and NATHAN PRASAD, and by other

19 inmates at Sutter County Jail.

20

93. As a direct and proximate result of the aforementioned customs, policies

21 and/or practices of Defendants, NATHAN PRASAD and Plaintiffs suffered injuries and

22 damages as alleged herein.

23

94. The aforementioned acts of Defendants PARKER, SAMSON, BIDWELL

24 and DOES XXI through XL were willful, wanton, malicious, and oppressive, thereby

25 justifying an award of exemplary and punitive damages to punish the wrongful conduct

26 alleged herein and to deter such conduct in the future.

27

28

22
COMPLAINT

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1

FOURTH CLAIM FOR RELIEF

Substantive Due Process in Violation of First and Fourteenth Amendments

2

to the Constitution of the United States – Loss of Parent/Child Relationship

(42 U.S.C. § 1983)

3 (Against Defendants COUNTY OF SUTTER, J. PAUL PARKER, DAVID SAMSON,

NORMAN BIDWELL, DORIS BROWN, MELODY YOUNG, BALJINDER RAI,

4 SHANE DICKSON, UNKNOWN JAIL EMPLOYEE I, FREMONT-RIDEOUT

HEALTH GROUP, DAVID FRATERS, and DOES I through XL)

5

6

95. Plaintiffs re-allege and incorporate by reference paragraphs 1 through 94, as

7 though fully set forth herein.

8

96. The aforementioned acts and/or omissions of Defendants in being

9 deliberatively indifferent to NATHAN PRASAD’s serious medical needs, health and

10 safety and violating NATHAN PRASAD’s civil rights, and their failure to train, supervise

11 and/or take other measures at Sutter County Jail to prevent the conduct that caused the

12 untimely and wrongful death of NATHAN PRASAD and deprived Plaintiffs MARY

13 PRASAD, T.P., and A.P. of their liberty interest in the parent-child relationship in

14 violation of their substantive due process rights as defined by the First and Fourteenth

15 Amendments to the United States Constitution.

16

97. As a direct and proximate result of the aforementioned acts and/or omissions

17 of Defendants, Plaintiffs suffered injuries and damages as alleged herein.

18

98. The aforementioned acts and/or omissions of the individually named

19 Defendants were willful, wanton, malicious, and oppressive, thereby justifying an award of

20 exemplary and punitive damages to punish the wrongful conduct alleged herein and to

21 deter such conduct in the future.

22

FIFTH CLAIM FOR RELIEF

23

Failure to Furnish/Summon Medical Care

(Survival Action – Cal. State Law)

24 (Against Defendants DORIS BROWN, MELODY YOUNG, BALJINDER RAI,

SHANE DICKSON, UNKNOWN JAIL EMPLOYEE I, and DOES I through XL)

25

26

99. Plaintiffs re-allege and incorporate by reference paragraphs 1 through 98, as

27 though fully set forth herein.

28

100. Defendants owed NATHAN PRASAD a duty of care to provide him

23
COMPLAINT

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1 immediate medical care.

2

101. The conduct of Defendants alleged herein, including but not limited to the

3 facts that Defendants knew or had reason to know that NATHAN PRASAD was in need of

4 immediate medical treatment, and that Defendants failed to take reasonable action to

5 summon such care or to provide that care, resulting in NATHAN PRASAD’s death as

6 alleged herein, violated California state law, including Cal. Govt. Code Sections 844.6 and

7 845.6.

8

102. The alleged conduct of Defendants was committed within the course and

9 scope of their employment.

10

103. As a direct and proximate result of Defendants’ breach, NATHAN PRASAD

11 and Plaintiffs suffered injuries and damages causing great pain and leading to his death, as

12 alleged herein.

13

104. The aforementioned acts of Defendants were willful, wanton, malicious, and

14 oppressive, thereby justifying an award of exemplary and punitive damages to punish the

15 wrongful conduct alleged herein and to deter such conduct in the future.

16

SIXTH CLAIM FOR RELIEF

Wrongful Death, Cal. Code Civ. Proc. § 377.60

17 (Against Defendants COUNTY OF SUTTER, J. PAUL PARKER, DAVID SAMSON,

NORMAN BIDWELL, DORIS BROWN, MELODY YOUNG, BALJINDER RAI,

18 SHANE DICKSON, UNKNOWN JAIL EMPLOYEE I, FREMONT-RIDEOUT

HEALTH GROUP, DAVID FRATERS, and DOES I through XL)

19

20

105. Plaintiffs re-allege and incorporate by reference paragraphs 1 through 104, as

21 though fully set forth herein.

22

106. NATHAN PRASAD’s death was a direct and proximate result of the

23 aforementioned wrongful and/or negligent acts and/or omissions of Defendants.

24 Defendants’ acts and/or omissions thus were also a direct and proximate cause of

25 Plaintiffs’ injuries and damages, as alleged herein.

26

107. As a direct and proximate result of Defendants’ wrongful and/or negligent

27 acts and/or omissions, Plaintiffs incurred expenses for funeral and burial expenses in an

28 amount to be proved.

24
COMPLAINT

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1

108. As a direct and proximate result of Defendants’ wrongful and/or negligent

2 acts and/or omissions, Plaintiffs suffered the loss of the services, society, care and

3 protection of the decedent, as well as the loss of the present value of his future services to

4 his family. Plaintiffs are further entitled to recover prejudgment interest.

5

109. Plaintiff Estate of NATHAN PRASAD is entitled to recover punitive

6 damages against individual Defendants who, with conscious disregard of NATHAN

7 PRASAD’s rights, failed to provide NATHAN PRASAD with medical treatment meeting

8 the professional standard of practice and failed to adhere to the legal mandates of prisoner

9 supervision and care.

10

110. The aforementioned acts of Defendants were willful, wanton, malicious, and

11 oppressive, thereby justifying an award to Plaintiffs of exemplary and punitive damages to

12 punish the wrongful conduct alleged herein and to deter such conduct in the future.

13

PRAYER FOR RELIEF

14

WHEREFORE Plaintiffs pray for judgment against Defendants as follows:

15

1. For compensatory, general and special damages against each Defendant,

16 jointly and severally, in the amount proven at trial;

17

2. For damages related to loss of familial relations as to Plaintiffs MARY

18 PRASAD, T.P., and A.P.

19

3. Funeral and burial expenses, and incidental expenses not yet fully

20 ascertained;

21

4. General damages, including damages for physical and emotional pain,

22 emotional distress, hardship, suffering, shock, worry, anxiety, sleeplessness, illness and

23 trauma and suffering, the loss of the services, society, care and protection of the decedent,

24 as well as the loss of financial support and contributions, loss of the present value of future

25 services and contributions, and loss of economic security;

26

5. Prejudgment interest;

27

6. For punitive and exemplary damages against each individually named

28 Defendant in an amount appropriate to punish Defendants and deter others from engaging

25
COMPLAINT

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1 in similar misconduct, in amounts according to proof;

2

7. For lost wages, employment opportunities, and other losses in an amount

3 according to proof;

4

8. For costs of suit and reasonable attorneys’ fees and costs pursuant to 42

5 U.S.C. § 1988, and as otherwise authorized by statute or law;

6

9. For restitution as the court deems just and proper;

7

10. For such other and further relief as the court deems just and proper.

8

9 DATED: March 6, 2012

Respectfully submitted,

10

ROSEN, BIEN & GALVAN, LLP

11

By: /s/ Aaron J. Fischer

12

Michael W. Bien

13

Aaron J. Fischer

14

Attorneys for Plaintiffs

15

16

17

18

19

20

21

22

23

24

25

26

27

28

26
COMPLAINT

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1

DEMAND FOR JURY TRIAL

2

Plaintiffs hereby demand a jury trial.

3

4 DATED: March 6, 2012

Respectfully submitted,

5

ROSEN, BIEN & GALVAN, LLP

6

By: /s/ Aaron J. Fischer

7

Michael W. Bien

8

Aaron J. Fischer

9

Attorneys for Plaintiffs

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

27
COMPLAINT

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Attachment A

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Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 33 of 59
Honorable Judge Chris Chandler Sutter County Superior Court 446 2nd Street Yuba City, CA 95991
Dear: Judge Chandler
In accordance with the California Penal Code Section 933, the 2010-2011 Sutter County Grand Jury has completed its duties with the release of the Final Report to the Court and to the citizens of Sutter County. We were privileged to be selected a year ago to serve on the Sutter County Grand Jury as “a voice of the people and conscience of the community.” We took our work seriously and did our best to approach our reviews and investigations objectively and thoroughly.
It has been a year of learning and hard work in gaining new insights; some were frustrations, and some were fun. We have all had personal growth in this Grand Jury experience. As is with any new Grand Jury, eighteen independent individuals with distinctive talents and skills successfully formed cohesive efforts to make their contribution to the citizens of this county. Members of this Jury have dedicated countless hours of work investigating, compiling, debating, and writing these reports. Each member of this Grand Jury contributed greatly to this report. I am proud of my fellow jurors and all they have accomplished.
This year was Judge Brian Aronson second year as the supervising judge for the Grand Jury. We would like to thank Judge Aronson, together we have learned a lot. To complete our work, we had the assistance of the county's court staff, particularly Christine Dagnino and Jackie Laswell. Each staff member we encountered was friendly and helpful. Our thanks to District Attorney Carl Adams and his staff who assisted us along the way taking our phone calls and providing us with the information we needed to perform our duties as members of the Grand Jury. We commend District Attorney Carl Adams dedication of time as the legal advisor for the Grand Jury for the past twenty-eight years. The Court Security Staff was very helpful as we navigated unfamiliar territory around the courthouse. Many individuals from the various agencies we visited were also helpful in countless ways.
In Conclusion I would like to thank this year’s Grand Jurors for their conscientious effort and commitment. I would also like to thank Tammie Putman for her dedication and service as the Pro-tem and Secretary of the 2010-2011 Sutter County Grand Jury. Her dedication has made our job much easier. In closing, I would also like to express my
2

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Table of Contents

Page

AD-HOC Committee

7

Sutter County Jail Nurses Program Citizens Complaint

8

Attachment A

12

Audit and Finance Committee

13

Misallocation of Bradley-Burns and Transportation Tax Fund Deposits 14

Attachment A

19

Attachment B

20

Attachment C

21

County Government and Administration Committee

22

County Government Release of Public Information

23

Criminal Justice Committee

26

Leo Chesney Community Correctional Facility

27

Sutter County Jail

29

Sutter County Department of Child Support Services

31

Yuba City Police Department

34

Yuba-Sutter Juvenile Hall Camp Singer Youth Guidance Center

35

Education Committee

38

Sutter County Superintendent of Schools

39

Sutter Union High School

43

Fire and Emergency Committee

45

Office of Emergency Management

46

Twin Cities Rod and Gun Club

48

5

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 37 of 59

Health and Mental Health Services Committee

50

Sutter-Yuba Mental Health Services

51

Planning and Environment Committee

54

Sutter County Environmental Health Division

55

Sutter County Planning Services

57

Public Buildings and Properties Committee

58

Sutter County Animal Control Shelter

59

Social Services Committee

78

Maternal, Child and Adolescent Health Program

79

Sutter County Department of Human Services

81

Continuity Committee

84

Department of Child Support Services

85

Leo Chesney Community Correctional Facility

86

Sutter County Jail

87

Yuba City Police Department

88

Yuba-Sutter Juvenile Hall

89

6

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 38 of 59
AD-HOC Committee
7

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 39 of 59
Sutter County Jail Nurses Program Citizens Complaint
Introduction
The 2010-2011 Sutter County Grand Jury (SCGJ) received a citizen's complaint on the Sutter County Jail Nurses Program. The complaint alleged illegal practices, lack of training, out of compliant policies/procedures and poor inmate medical care.
The Grand Jury established an Adhoc Committee to undertake an investigation to determine these allegations on the complaint. Interviews were held with supervisors, managers, and staff of the Sutter County Jail. The Adhoc Committee completed an investigation of this complaint and made a number of recommendations resulting from that investigation.
Discussion
The Sutter County Jail Nurses program is to ensure provision of emergency and basic health care services to individuals who are in custody. Nursing Staff provides health care to the incarcerated from booking until the time of release. Along with the Physician and Nurse Practitioner, there is a Jail Nurse Manager, a Supervising Registered Nurse (SRN) , three Licensed Vocational Nurses (LVN)'s and 7-8 contract LVN's. Since November 2010, the county has an open position for a second SRN.
The Grand Jury felt the allegations in the complaint were serious and needed to be investigated.
The complaint alleges the following:
Inadequate R.N. Coverage
According to the complaint, per Legal Decree #CIV-S-93-1256 DFL JFM (P) of Dempsey W. Haller, et al. vs. The County of Sutter, et al. (see attachment, A) states in part:
E. 2. Staffing: "Jail medical staffing is the responsibility of the County's Human Services Department and shall consist of at least one registered nurse on site during either the day shift or the evening shift seven days per week, and either one registered nurse or one LVN on site during the other day shift or evening shift as appropriate, seven days per week ... "
Prior to the resignation of a SRN, there was one SRN and LVN on the day shift or one SRN and LVN on the night shift. There was an incident when the SRN on the night shift became ill while on duty. The SRN called in a LVN for backup. The SRN was reprimanded by the Jail Nurse Manager in an email that there should have been a Registered Nurse on duty. The SRN was referred to legal decree #CIV-S-93-1256 DFL
8

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 40 of 59
JFM (P) against Sutter County, which states the requirement. The SRN was not told of this legal decree prior to this incident. According to the staff, there had been 20 days so far that year that this had occurred. During the investigation, it was noted that this was a common occurrence since there were only two SRNs.
Lack of Training
According to the complaint training of staff nurses has not occurred in more than five (5) years. Annual onsite training is necessary to maintain proficiency in emergency response procedures.
Before the SRN resigned, the SRN requested onsite training. The SRN's request was refused by the Jail Nurse Manager. The SRN put together training on Emergency Response in the jail. The SRN asked for a review ofthe materials and the Jail Nurse Manager refused to even look at the class outline. The SRN held the class with a few nurses and correctional staff in attendance.
Out of Compliant Policies and Procedures
The complaint alleged the Jail Nurses Program is out of compliance with California State correctional code - Title 15 sec 1206 Policy and Procedures (P&P) are to be reviewed annually. Standardized Nursing Procedures (SNP) have not been reviewed or updated since 1995. The SNP has been changed with pencil marks.
The nursing staff has inquired as to why these P&P's and the SNP's are outdated. The Jail Nursing Manager's answer is lack oftime prevents him from completing the task.
Finding
Inadequate R.N. Coverage
The Nurse staffing at the Jail has been directed by a court order in Dempsey W. Haller vs. Sutter County, et al. No. CIV-S-93-1256 DFL JFM (P). Failure to comply with this order Sutter County can be found out-of-compliance and could be liable for additional action by the Court.
Recommendation
Every effort should be made to hire an additional SRN and ensure one is available for either the AM shift or the PM shift. The Nursing Program Manager needs to take a more active role in managing the Jail Nursing Program. Once the SRN position is filled, the Nursing Program Manager, who is also an RN, must be utilized to ensure the Jail Nursing Program is in compliance with the court order.
9

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 41 of 59
The Assistant Director of Health and Human Services should provide oversight to insure the Jail Nursing Program is in full compliance with court order Legal decree #CIV-S-931256 DLF JFM (P).
Finding
Lack of Training
Legal decree #CIV-S-93-1256 DLF JFM (P) E19. Training: "Jail custody staff shall receive periodic update training in First Aid, CPR, intake screening, blood borne pathogens and suicide prevention..."
Sutter County Jail Medical Policies and Procedures #3 Section 6. "Oversees training of nurses and/or officers in areas where improvement is needed, as identified by QA audits, including regular and continued joint staff development activities. These will be documented as to date given, content, attendees and comments."
Training is necessary to maintain proficiency in on-site activities. The Nursing Program Manager has failed to offer his nursing staff any of the required training. When one of his SRN's put together an emergency response training class he refused to review the course outline before the class was held.
Recommendation
The Grand Jury recommends the Nursing Program Manager along with the Medical Officer, develop a training program to ensure adequate on-site training be made available to the nursing staff on a regular basis. The Assistant Director of Health and Human Services should provide oversight to ensure this training program is implemented.
Finding
Out of Compliance Policies and Procedures
Title 15 Regulations 1206. Health Care Procedure Manual "The health authority shall in cooperation with the facility administrator, set forth in writing, policies and procedures in conformance with applicable State and Federal law, which are reviewed and updated at least annually..."
During the investigation, it was stated unanimously that the P&P's were significantly outof-date. The County Medical Officer is responsible for making sure the P&P's are current by signing them annually. The Jail Nurse Program Manager has overall responsibility to see that the Nursing Program policies and procedures are operational and functioning in the scope as laid out in the Standard Nursing Procedures. The Jail Nurse Program Manager has not done this. When the Jail Nurse Program Manager was hired, the P&P's were not up to date. By not correcting these problems, his inaction has allowed this
10

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 42 of 59
situation to deteriorate further. The Jail Nurse Program Manager indicated it would take over a year to complete. This should be made a priority. Recommendation The County Medical Officer and the Jail Nurse Program Manager with oversight from the Assistant Director of Health and Human Services should ensure the Jail Nursing Program P&P's are reviewed, rewritten, and made current so they can be used and referred to by the jail staff. The Standard Nursing Procedures has been changed with pencil marks and needs to be corrected. The Grand Jury recommends that these documents be completed by December 31, 2011. The Jail Nursing Program would also benefit from more active oversight by the Assistant Director of Health and Human Services to see that it is accomplished by the above date. Finding During this investigation the Grand Jury finds the Jail Nursing Program is completely out of compliance with annual nurse training updates and standard nursing procedures. This exposes Sutter County to numerous potential issues in the future. Recommendation The Grand Jury recommends that the Assistant Director of Health and Human Services actively take measures to ensure that this program is in full compliance with the law. It is unacceptable that the program is out of compliance, lack of training for the nursing staff, not having the P & P's up-to-date, and the pencil corrections in the SNP. The Grand Jury recommends that the Jail Nursing Program be in full compliance by December 31, 2011. Respondents Director of Health and Human Services, Tom Sherry Assistant Director of Health and Human Services, Amerjit Bhattal County Medical Officer, Dr. Cummings Jail Nurse Program Manager, Brent Garbett
11

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 43 of 59 Attachment A
12

- Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 44 of 59

\

'_.
I

I

L_

,~.-
"--

-....I.

DARRELL W. LARSEN - Bar No. 044272 \
SUTTER COUNTY COUNSEL JAMES SCANLON - Bar No. 078914 DEPUTY COUNTY COUNSEL 1160 Civic Center Blvd. Yuba City, CA 95993 Telephone: (916) 741-7110
JOHN HAGAR - Bar No. 81039 LAW OFFICE OF JOHN HAGAR P. O. Box 86935 Los Angeles, CA 90086-0935
Attorneys for Defendants COUNTY OF SUTTER and SHERIFF ARTHUR R. BRANDWOOD
L.~=}.:.:D

SEP.141994
C' ~:;;;, ii. S. DISTRICl COURT EASTERN DISTRICT OF CAliFORNIA BY ------::-"r~l':":";l'T:::O:y(:~_LE~R~K

" 4

UNITED STATES DISTRICT COURT

c

FOR THE EASTERN DISTRICT OF CALIFORNIA

DEMPSEY W. HALLER, et al.

)

)

Plaintiffs,

)

)

vs.

)

)
THE COUNTY OF SUTTER, et a1. )

)

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

No. CIV-S-93-1256 DFL JFM (P)
AMENDED SETTLEMENT AGREEMENT

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 45 of 59
The parties hereby stipulate to settlement of the issues remaining in this case as follows:
A. Clothing Exchange: Defendants will provide Jail inmates with clothing upon intake, and periodic clothing exchanges pursuant to Title 15, section 1260, 1261, 1262, 1263, and 1264. All references to Title 15 in this agreement are to Title 15 as amended in 1994.
B. Recreation: Defendants will provide Jail inmates with outdoor recreation pursuant to Title 15, section 1065. Defendants will make best efforts to provide Main Jail inmates wi th outdoor recreation five times per week. In addition, defendants will provide, subject to security considerations, the following recreation equipment in the Jail's outdoor recreation yards [both male and female]: portable basketball hoops, volleyball nets and balls, handballs, and one Santa Clara County Hermo II exercise machine,'
C. Food: Defendants will complete the Jail's kitchen remodel project by September 1, 1994, Thereafter, defendants will comply with Title 15 standards, specifically sections 1240, 1241, 1242, 1243, 1245, 1246, 1247, 1248, and 1249 concerning food preparation in the Jail.
D. Law Library: Defendants will participate in an experiment to provide CD-Rom law library materials to Jail inmates ef fecti ve september 1, 1994, There will be a CD-Rom library for inmates in the Jail.
lA Hermo II is also provided to inmates housed in the Jail Dormitory housing unit.
2

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 46 of 59
1. All inmates will be provided with access to the CD-Rom library and hardbound law library regardless of sentenced or presentenced status, regardless of whether the inmate is represented by counsel.
2. CD-Rom library and hardbound law library access will be subject to reasonable security, staffing and time restrictions .
. \
Inmates facing court deadline and inmates proceeding "in pro per" in local courts will be afforded priority access.
3. Inmates who request access to the CD-Rom o~ hardbound law library will be provided direct access without staff present and will be allowed to browse among the available CD disks and law books and to work on their legal cases wi thin the law library.
4. The Jail CD-Rom West Publishing inventory is attached as Exhibit A. The Jail hardbound book law library is attached as Exhibit B.
5. Inmates working with the CD-Rom legal system will have access to a computer, CD drive, dot matrix printer and written instructions explaining how to access CD-Rom materials will be provided by plaintiffs' counsel.
6. The above-referenced experiment will continue for at least a period of twelve [12] months. Counsel for the parties will communicate at least every six months concerning the status of this experiment. At the conclusion of this period the parties shall meet and confer in good faith concerning the long term use of CD-Rom and hardbound law books.
3

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 47 of 59
E. Medical Care: Defendants will modify their delivery of medical services system to provide medical, mental health, and dental care to the plaintiff class as set forth below, the implementation of which service systems will be commenced immediately and will be completed on or about January 1, 1995.
1. Intake screening: Jail medical intake screening shall .\
be performed by a Sheriff's custody staff trained in screening procedures by County medical and mental health personnel. The intake screening form shall meet the criteria established by Title 15 of the California Code of Regulations and the California Medical Association. Jail medical staff shall review all intake screening forms as soon as possible, in most cases the same day as booking, but in no event later than the next shift when nursing staff is available.
2. Staffing: Jail medical staffing is the responsibility of the County's Human Services Department and shall consist of at least one registered nurse on site during either the day shift or the evening shift seven days per week, and either one registered nurse or one LVN on site during the other day shift or evening shift as appropriate, seven days per week. Supplementing this nursing coverage shall be on-site visits by a nurse practitioner or physician's assistant two days per week for a total of approximately four hours per week, and on-site visits by a physician twice per week for approximately five hours. Excluding weekends and county holidays, there will be an on-site visit by either a nurse practitioner, physician's assistant, or a phys ician not less frequently than every other day. Further
4

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 48 of 59

supplementing this coverage shall be on-site visits by a County

mental health staff crisis counselor for approximately 18 hours

per week, for no less than 3 separate visits each week. On-site

visits for physicians and mental health workers will take place,

whenever possible, on established days and hours. Clerical

support will be provided the Jail nurses as appropriate. J 3. Sick Call: There shall be a screening process

concerning inmate medical problems and complaints conducted by

the Jail nursing staff or a nurse practitioner or a Physician's

assistant. To access sick call, inmates shall utilize a Jail

Sick Call Request form. The triage for sick call slips shall

take place daily, formal sick call shall be available five days

per week.

4. Pill Call: Medications shall be distributed to Jail

inmates by County medical and/or Jail staff based upon protocols

established and approved by the County Department of Human

Services. All medications shall be distributed the appropriate

number of times per day deemed medically necessary by County

medical/mental health staff.

5. Inmate Medical Records:

Inmate medical/mental

heal th/dental records shall be maintained in a confidential

manner and in a secure setting. The Jail's medical staff shall

maintain records on site at the Jail which document inmate

medical problems and which include the information and documents

deemed necessary by established protocols based upon Title 15

Minimum Jail Standards.

1/11/

5

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 49 of 59

6. Access to Specialized Clinics: Inmates shall have

access to specialized clinics and care as deemed appropriate by

County medical, dental, and mental health providers.

7. Inmates With Acute Illnesses: Inmates with acute

illnesses shall be transferred to alternative sites for care as

deemed appropriate by County medic.. al and/or mental health staff . 8. Detoxification: The Jail shall maintain written

detoxification procedures which are utilized by both Sheriff's

and County medical staff. These procedures shall comply with the

standards set forth in the Title 15 "Minimum Standards" for Local

Detention Facilities in the California Code of Regulations.

9 . Communicable Diseases: The Jail shall maintain its

plan to detect, control, and treat inmates with priority

communicable diseases. The program to detect, control and treat

inmates with communicable diseases will describe how the

identification, treatment, control, and follow-up management of

inmates with communicable diseases will occur.

Priority

communicable diseases will include TB, HIV/AIDs, STD's, Hepatitis

A and B, Rubella, Measles and other diseases identified by Jail

staff and the Sutter County Public Health Officer.

10. Standardized Practices: The Jail's medical personnel

shall follow established written treatment protocols prepared by

the County's Department of Human Services. These treatment

protocols, and the medical policies and procedures utilized by

Jail medical staff shall be completely revised and approved by

all of the involved County agencies. Jail policies, procedures,
Q
and treatment protocols shall follow the format established by

the California Medical Association.

6

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 50 of 59

11. Suicide Prevention: The Jail shall maintain a suicide

prevention program which includes instruction by County mental

health staff [both classroom and video training] for Sheriff's

personnel working with the Jail.

12. Dental Care: Inmates requiring dental care shall be

referred to a private provider who shall provide the appropriate .1
care necessary to alleviate pain, prevent infections, and treat

emergency dental needs. Dental care shall be timely depending

upon the pain and seriousness of the dental problem. nental care

shall not be limited to extractions, however, the dental care

provided to Jail inmates is not intended to deal with years of

personal neglect.

13. Management of Pharmaceuticals:

Pharmaceutical

practices will comply with section 1216 of the Title 15 Minimum

Standards for Local Detention Facilities.

14. Sick Call Forms: The Jail's sick call form, including

the form necessary to request mental health care, shall be

printed in English, Spanish, and Punjabi. Inmates who request

that a staff member act as a translator during the sick call or

intake screening process shall be provided with language

assistance as deemed appropriate by Jail staff. Access to forms

shall include access to information concerning how to obtain

medical, mental health, and dental care within the Jail.

15. Quality Assurance: The responsible County physician

for the Jail under Title 15, section 1202 shall establish a

mechanism to assure that the quality and adequacy of medical,

dental, and mental health care is annually assessed. The plan

7

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 51 of 59
shall include a means for the correction of identified deficiencies of the medical/dental/mental health and pharmaceutical services provided and shall include the statistical gathering set forth in Title 15. In addition, and as part of this plan, monthly meetings shall be held between the
Jail's custody and medical/mental• health staff .
16. Informed Consent: The Jail has established procedures which conform to Title 15, section 1214 of the California Code of Regulations.
17. Food Handlers: The responsible physician shall develop procedures for medical screening of food handlers prior to working in the facility kitchen. Additionally, there shall be written procedures for education and ongoing monitoring and cleanliness of food service workers in accordance with section 27605 of the Health and Safety Code, California Uniform Retail Food Facilities Law.
18. Jail Medical Office: The Jail's medical office shall be renovated by March 1, 1995.
19. Training: Jail custody staff shall receive periodic update training in First Aid, CPR, intake screening, blood borne pathogens,and suicide prevention.
20. OSHA: The Jail will implement a program to address the OSHA blood borne pathogen requirements.
21. Women's Rights: The Jail will post as necessary the pregnancy related rights of female inmates as set forth by the California Penal Code.
8

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 52 of 59

22. HIV Testing: HIV testing will be provided in the Jail

upon request. Pre and post test counselling will be provided.

F. Ei ther party may seek to change the terms of this

SETTLEMENT AGREEMENT pursuant to the standards set forth in Rufo

v. Inmates of Suffolk County Jail, 502 U.S.

, 112 S.Ct. 748

(1992).

G. In the event that an emergency threatens the Sheriff's

ability to comply with these orders, counsel for defendants will

notify counsel for plaintiffs no later than the neXt business

day.

H. Defendants shall pay to plaintiffs' counsel attorney

fees in the amount of $17,500 at the time of the filing of the

Final Judgment.

I. The parties have previously stipulated to a permanent

injunction filed on September 15, 1993 relating to any and all

population issues, a copy of which is attached hereto and

incorporated herein by reference as Exhibit C. This SETTLEMENT

AGREEMENT is intended to resolve all matters not covered by the

permanent injunction referred to above.

Upon the execution of this SETTLEMENT AGREEMENT, the

parties request a dismissal of all matters not covered by the

permanent injunction referred to above.

J. The parties stipulate and agree that the Magistrate

Judge and District Court Judge assigned this case will issue any

and all orders necessary for the dismissal of this action,

including but not by way of limitation any orders deemed

9

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 53 of 59

necessary regarding posting of this agreement and any Fairness

Hearing deemed necessary.

IT IS SO STIPULATED:

DATED: August ,~ , 1994

DARRELL W. LARSEN SUTTER CqVNTY COUNSEL

~, DATED: August

1994

COUNSEL Defendants
C?~(jIG~ PAUL COMISKEY Attorney for Plaintiffs

10

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 54 of 59
EXHIBIT A -- CD-ROM LIBRARY
1. The system will provide access to the following legal authorities:
(a) Reported cases of the United States Supreme Court (b) Federal 2d and Federal 3d Reporters (c) All available California reported cases (d) Annotated California Codes 2. The computer hardware system which will include a single work station terminal shall be selected by the Sutter County Sheriff with the concurrence with plaintiffs' counsel.

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 55 of 59

EXHIBIT B -- LAW LIBRARY - BOOKS

In addition to computerized legal research, the law library shall

consist of at a minimum the following bound authorities or their

substantial equivalents:

.

1. West California Rules of Court, Sta.t' e - latest edition 2. West California Rules of Court, Federal - latest edition

3. West Federal Rules of Civil and Criminal Proceduri and Evidence - latest edition

4. Black's Law Dictionary - latest edition

5. Deerings California Penal Code - latest edition

6. Deerings California Civil Practice Code - latest edition

7. Federal Habeas Corpus - 2nd edition (Michie Company)

8. California Criminal Law

Book No. a. b. c. d.

1
Introduction to Crimes Elements of Crime Defenses Crimes Against the Person

Book No. a. b. c. d.

2 Crimes Crimes Crimes Crimes

Against Property Against Decency and Morals Against Public Peace and Morals Against Governmental Authority

Book No. 3 a. Punishment for Crimes

1

.- Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 56 of 59

..;.-'"! .... .;

1 DARRELL W. LARSEN [state Bar 144272] SUTTER COUNTY COUNSEL
2 JAMES SCANLON [State Bar #78914] DEPUTY COUNTY COUNSEL
3 1160 Civic Center Blvd. Yuba City: CA 95993
4 (916) 741-7110
5 JOHN HAGAR [State Bar #81039] LAW OFFICE OF JOHN HAGAR
6 P.O. Box 86935
Los Angeles, CA 90086-0935 7 (213) 626-2089

EXHIBIT C

R l',tt~"?;n('.ys for DE'_:end.ants ':OTJN'_~Y OF SUTTER

and SHERIFF ARTHUR R. BRANDWOOD

.'"

9

UNITED STATES DISTRICT COURT

10

FOR THE EASTERN DISTRICT OF CALIFORNIA

11

DEMPSEY W. HALLER, et al.

)

NO. CIV-S-93-1256 DFL ~AN (P)

12

)

Plaintiffs,

)

STIPULATION RE POPULATION

13

)

LIMITS, ORDER

vs.

)

14

)

THE COUNTY OF SUTTER, et al. )

15

)

Defendants.

)

16 ----------------------------)

17

18

19

20

21

22

23

24

25

26

27

28
1 ....._._-- -----------

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 57 of 59

-'*'f.~

1

The parties hereby agree and stipulate to the following

2 injunctive orders:

3

1. This action shall proceed as a class action pursuant to

4 Federal Rules of Civil Procedure, Rule 23b.

5

2. Defendants are enjoined from bedding inmates on the floor.

.,

6

3. The maximum assigned bed capacities for each housing unit

7 of the Sutter County Jail are set forth below:

8

Unit 1 - 8 bedli

...

9

Unit MPS - 24 beds*

10

unit MG - 24 bcds~

11

Medical Sheltered Living - 3 beds

12

Kitchen Trustee Unit - 8 beds

13

FPC - 4 beds

14

FPS - 6 beds*

15

FS - 10 beds*

16

FJ - 4 beds

17

Jail Dormitory - 62 beds*

18

4. Defendants may operate, if conditions warrant, housing

.,

19 units MPS I MS. FPS ~ ~nd FS at tT';C ::'er!s :ilio.....aCh3 ci.Lpacity defined

20 in paragraph 3. Defendants may operate, if conditions warrant, the

21 Jail Dormitory with as many as six beds ~ove the capacity defined 22 in paragraph 3. Defendants shall not house inmates .in HPS, MS, 23 FPS, FS, and the Jail Dormitory above the capacities agreed to in 24 paragraph 3 unless beds of like classification are not available in

25 other housing units. In the event units MPS, MS, FPS, FS, and the

26 Jail Dormitory are operated above the capacity set forth in T7 paragraph 3, outdoor recreation will be provided for those units

28

2

I Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 58 of 59
~'j-~

1 operating above the capacity set forth in paragraphs 3 for at least

2 one hour per day, five days per week. In no event will any housing

3 unit operate above its paragraph 3 capacity for more than 14

4 consecutive days and, in no event will the total Jail bed capacity

5 exceed by 14 beds the total capacity set forth in paragraph 3, 6 except that except that Defendants"' may operate the Jail Dormitory

7 at its existing bed capacity of 88 beds until the Minimum Facility

8 p:i:"t::5elltly u:'!der c.;on:;tructlon ":s oper.,.tional. 1 "

9

5. The prohibition against floorsleepers is effective

10 immediately. The popUlation limits set: forth in paragraphs 3"and

11 4 shall be effective forty five [45] days from the date that this

12 Order is approved by the District Court.

13

6. Defendants are enjoined from adding beds to the Main Jail

14 in each and every housing unit which exists on the date that this 15 stipulation is executed. 2

16

7. The Sheriff of Sutter County is authorized by this order

17 to release inmates from the Sutter County Jail whenever the sutter

IE County Jail, or any specific housing unit therein, is within ten

19 percent [lO%J of being filled. Th~ Sheriff shall r.9lease inmates

20 or refuse to accept newly-committed inmates whenever all beds in

21 the Jail are filled, or whenever any specific housing unit within

22 the Jail is filled.

23
1. IIOperationalll is defined, for the purposes of this stipulation, 24 as being 50% occupied under the rated capacity assigned by the
california Board of Corrections.
25
2. This stipulation does not encompass any additional jail 26 structures to be builtin the future, whether contiguous or
attached, that are not presently within the physical confines of 27 the presently constructed Jail. This stipulation does not limit
the capacity of the Minimum Facility presently under construction.
28

3

•

Case 2:12-cv-00592-TLN-CKD Document 1 Filed 03/06/12 Page 59 of 59

~'f-~.

1

8. Either party may seek to modify or terminate this

2 stipuiation pursuant to the standards set forth in Rufo v. Inmates

3 of Suffolk County Jail, ___ u.S. ---, 112 S.ct. 748 (1992).

4

IT IS SO STIPULATED:

5

6 DATE:

7

8

9 DATE:

10

11

12 DATE:
13
14
15
It is so recommended. 16

Paul Persons Attorney for Plaintiffs
ORDER

17
DATE: 9-\5"-93 18
19

Honor bl Peter Nowinski United States Magistrate Judge Eastern District of California

20
It is so ordered. 21

22 DATE: 1'= I .,- - 91
23
24

Honorable David F. Levi united states District Judge Eastern District of California

25

26

Tl

28

4

 
 Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 1 of 185

[1071448-2]

1 MICHAEL W. BIEN – 096891

ERNEST GALVAN – 196065

2 AARON J. FISCHER – 247391

KATHRYN G. MANTOAN – 239649

3 JENNIFER L. STARK – 267062

ROSEN BIEN GALVAN & GRUNFELD LLP

4 315 Montgomery Street, Tenth Floor

San Francisco, California 94104-1823

5 Telephone: (415) 433-6830

Facsimile: (415) 433-7104

6

Attorneys for Plaintiffs

7

UNITED STATES DISTRICT COURT

8

EASTERN DISTRICT OF CALIFORNIA

9

SACRAMENTO DIVISION

10

Estate of NATHAN PRASAD, deceased, by and Case No. 2:12-CV-00592-TLN-CKD

11 through MARY PRASAD; MARY PRASAD;

T.P., a minor; A.P., a minor; and N.S., a minor, THIRD AMENDED COMPLAINT

12

Plaintiffs,

JURY TRIAL DEMANDED

13

v.

14

COUNTY OF SUTTER; J. PAUL PARKER, Sutter County Sheriff’s Department Sheriff;

15

DAVID SAMSON, Sutter County Jail Division Commander; NORMAN BIDWELL, Sutter

16

County Jail Corrections Lieutenant; LOU ANNE CUMMINGS, Sutter County Health Officer;

17

AMERJIT BHATTAL, Sutter County Assistant Director of Human Services – Health Division;

18

BRENT GARBETT, Sutter County Jail Nurse Program Manager; DORIS BROWN, Sutter

19

County Jail Advanced Registered Nurse Practitioner; MELODY YOUNG, Sutter County

20

Jail Licensed Vocational Nurse; KIMBERLY WEISS, Sutter County Jail Licensed Vocational

21

Nurse; GURKIRAT BHANGU, Sutter County Jail Licensed Vocational Nurse; CHRISTINA

22

STOHLMAN, Sutter County Jail Correctional Officer; LESTER EATON, Sutter County Jail

23

Correctional Officer; MIGUEL AGUILAR, Sutter County Jail Deputy Officer; OLGA

24

TAHARA, Sutter County Jail Deputy Officer; ROSA DIAZ, Sutter County Jail Deputy Officer;

25

ERIC CRAWFORD, Sutter County Jail Deputy Officer; BALJINDER RAI, Sutter County Jail

26

Deputy Officer; SHANE DICKSON, Sutter County Jail Deputy Officer; FREMONT-

27

RIDEOUT HEALTH GROUP; and MICHAEL FRATERS, D.O.,

28

Defendants.

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1

INTRODUCTION

2

1. This case involves the unnecessary and avoidable death of NATHAN

3 PRASAD, a young man denied basic emergency life-saving treatment for a serious

4 infection while detained at Sutter County Jail (the “Jail”) on minor, non-violent charges.

5 In the course of his approximately one-week detention, NATHAN PRASAD’s condition

6 deteriorated from an infection wholly treatable through basic and timely medical attention

7 to an extraordinarily painful death as a result of Sutter County Jail’s failure to provide

8 treatment. Sutter County Jail’s failure was despite documented observations of his

9 emergent medical problems, including coughing up blood, deteriorating vital signs, and

10 desperate pleas for help by NATHAN PRASAD and other jail inmates.

11

2. After reporting to jail staff that he was experiencing enormous pain in his

12 lower extremities, he was brought to Rideout Memorial Hospital on January 26, 2011 for

13 further evaluation. Following diagnostic testing on his lower extremities, hospital staff

14 discharged NATHAN PRASAD back to the jail after only two-and-a-half hours. Doctors

15 provided to jail staff Defendants explicit direction that NATHAN PRASAD be returned to

16 the emergency room immediately if his symptoms worsen or new symptoms develop.

17 Hospital staff knew, however, that the jail’s staffing, policies and procedures made such

18 immediate return extremely unlikely if not impossible. Because Rideout Memorial

19 Hospital is the sole facility to which Jail inmates are transported to receive emergency

20 medical care, hospital staff knew that Jail policies were such that jail medical staff, not

21 custody staff, were responsible for summoning emergency medical attention, but that jail

22 medical staff were not present during lengthy periods each day.

23

3. Upon his return to Sutter County Jail, NATHAN PRASAD’s symptoms

24 worsened dramatically, and new alarming symptoms developed. Jail staff observed and

25 documented that NATHAN PRASAD was experiencing tremendous pain, coughing up

26 blood, and telling them that he was afraid he would die without medical care. Basic

27 medical diagnostic evaluation at the jail showed that his vital signs indicated extreme

28 danger. His pulse rate was abnormally high; he had borderline low blood pressure, and

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1 evinced a precipitous drop in blood pressure since his hospital admission; he had a low

2 grade fever; and the bruising that had been localized in his lower extremities had travelled

3 to his midsection. Fellow inmates desperately sought medical help for NATHAN

4 PRASAD, going so far as to collect the blood he coughed up in a used milk carton which

5 was provided to jail staff.

6

4. Despite their knowledge, jail staff ignored NATHAN PRASAD’s serious

7 medical needs, instead ridiculing him and leaving him to continue to deteriorate in his cell

8 and at the jail.

9

5. After almost two days of deterioration and suffering at the jail, NATHAN

10 PRASAD’s condition became so serious that his blood pressure could no longer be

11 detected at all and he was losing consciousness. His condition was so deteriorated by the

12 time emergency personnel were summoned that subsequent life-saving measures could not

13 revive him.

14

6. NATHAN PRASAD fell into a coma and died on January 28, 2011, at the

15 age of 30. He left behind three young children, T.P., A.P., and N.S., with whom he had a

16 close and loving relationship, and who he helped to support financially and emotionally.

17 He further left behind his mother, MARY PRASAD, with whom he remained

18 exceptionally close throughout his life and in the months prior to his death. Neither

19 MARY PRASAD, nor T.P., nor A.P, nor N.S. was able to make it to NATHAN

20 PRASAD’s bedside to see him before he passed away.

21

7. Defendants acted with deliberate indifference to NATHAN PRASAD’s

22 serious medical needs, and in violation of their duties under federal and state law, causing

23 NATHAN PRASAD’s tragic and preventable death. In both 2010-2011 and 2011-2012,

24 grand juries convened in Sutter County identified widespread deficiencies in training,

25 staffing, and maintenance of current policies and procedures for the provision of health

26 care to inmates at Sutter County Jail. These systemic problems have been known to

27 Defendants for years, have not been addressed or corrected, and directly and substantially

28 contributed to NATHAN PRASAD’s death in custody.

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1

JURISDICTION AND VENUE

2

8. This case is brought pursuant to 42 U.S.C. § 1983. Jurisdiction is based on

3 28 U.S.C. §§ 1331 and 1343. With respect to those claims brought pursuant to California

4 law, Plaintiffs have complied with the administrative claim requirement.

5

9. The court has supplemental jurisdiction over Plaintiffs’ state claims pursuant

6 to 28 U.S.C. § 1367.

7

10. The claims alleged herein arose in the County of Sutter, California.

8 Therefore, venue in the Eastern District of California is proper pursuant to 28 U.S.C.

9 § 1391(b)(2).

10

PARTIES

11

11. Plaintiffs’ decedent is NATHAN PRASAD, who, at the time of his death,

12 was a 30-year-old citizen of the United States. He was a citizen and resident of County of

13 Sutter in the State of California.

14

12. Plaintiff MARY PRASAD, as Administrator of the Estate of NATHAN

15 PRASAD, brings this action pursuant to California Code of Civil Procedure §§ 377.10 et

16 seq. The survival causes of action in this matter are based on violations of NATHAN

17 PRASAD’s rights under the First and Fourteenth Amendments, and on violations of

18 California state law. MARY PRASAD is the mother of NATHAN PRASAD, and is also

19 suing individually for violations of her civil rights under the First and Fourteenth

20 Amendments and for wrongful death.

21

13. Plaintiffs T.P., A.P., and N.S. are the children of NATHAN PRASAD. They

22 are suing for violations of their civil rights under the First and Fourteenth Amendments.

23 They are further suing for violations of California state law. As minors, T.P., A.P., and

24 N.S. are suing through MARY PRASAD, their grandmother, as Guardian Ad Litem.

25

14. Plaintiff MARY PRASAD is a resident of the County of Colusa in the State

26 of California. Plaintiffs T.P., A.P., and N.S. are residents of the County of Sutter in the

27 State of California.

28

15. Defendant COUNTY OF SUTTER is a public entity, duly organized and

3
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1 existing under the laws of the State of California. Under its authority, Defendant

2 COUNTY OF SUTTER operates and manages Sutter County Jail and is, and was at all

3 relevant times mentioned herein, responsible for the actions and/or inactions and the

4 policies, procedures and practices/customs of the Sutter County Sheriff’s Department and

5 its respective employees and/or agents. Sutter County Sheriff’s Department operates

6 Sutter County Jail, and is and was responsible for ensuring the provision of emergency and

7 basic medical care services to all Sutter County Jail inmates.

8

16. Defendant J. PAUL PARKER is, and was at all relevant times mentioned

9 herein, the Sheriff of the COUNTY OF SUTTER, the highest position in the Sutter County

10 Sheriff’s Department. As Sheriff, Defendant PARKER is and was responsible for the

11 hiring, screening, training, retention, supervision, discipline, counseling, and control of all

12 Sutter County Sheriff’s Department custodial employees and/or agents. Defendant

13 PARKER is and was charged by law with the administration of the Sutter County Jail, with

14 the assistance of a small group of executive officers. Defendant PARKER is and was also

15 responsible for the promulgation of the policies and procedures and allowance of the

16 practices/customs pursuant to which the acts of the Sutter County Sheriff’s Department

17 alleged herein were committed. Defendant PARKER is being sued in his individual

18 capacity.

19

17. Defendant DAVID SAMSON is, and was at all relevant times mentioned

20 herein, the Sutter County Jail Division Commander. Defendant SAMSON is and was

21 responsible for the hiring, screening, training, retention, supervision, discipline,

22 counseling, and control of all Sutter County Sheriff’s Department custodial employees

23 and/or agents. Defendant SAMSON is and was responsible for the administration of the

24 Sutter County Jail. Defendant SAMSON is and was also responsible for the promulgation

25 of the policies and procedures and allowance of the practices/customs pursuant to which

26 the acts of the Sutter County Sheriff’s Department alleged herein were committed.

27 Defendant SAMSON is being sued in his individual capacity.

28

18. Defendant NORMAN BIDWELL, is, and was at all relevant times

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1 mentioned herein, the Sutter County Jail Corrections Lieutenant. Defendant BIDWELL is

2 and was second-in-command at Sutter County Jail. Defendant BIDWELL is and was the

3 first-level manager responsible for the day-to-day operations and support of the Jail.

4 Defendant BIDWELL is and was responsible for the hiring, screening, training, retention,

5 supervision, discipline, counseling, and control of all Sutter County Sheriff’s Department

6 custodial employees and/or agents. Defendant BIDWELL is and was responsible for the

7 administration of the Sutter County Jail. Defendant BIDWELL is and was also responsible

8 for the promulgation of the policies and procedures and allowance of the practices/customs

9 pursuant to which the acts of the Sutter County Sheriff’s Department alleged herein were

10 committed. Defendant BIDWELL is being sued in his individual capacity.

11

19. Defendant LOU ANNE CUMMINGS is, and was at all relevant times

12 mentioned herein, the Sutter County Health Officer. Defendant CUMMINGS’ job

13 description provides that she “[a]cts as medical director of the county jail medical facility,”

14 and that pursuant to this responsibility she “reviews and approves all examination and

15 treatment records initiated by practitioners.” Defendant CUMMINGS’ job description

16 further provides that she “[s]upervises, directs and evaluates assigned staff, to include

17 assigning work, handling employee concerns and problems, and counseling.” Defendant

18 CUMMINGS is and was responsible for the hiring, screening, training, retention,

19 supervision, discipline, counseling, and control of jail medical and mental health

20 employees and/or agents involved in the conduct alleged herein. Defendant CUMMINGS

21 is and was also responsible for the promulgation of the policies and procedures and

22 allowance of the practices/customs pursuant to which the acts of the jail medical and

23 mental health staff alleged herein were committed. Defendant CUMMINGS was also

24 consulted regarding, and thus personally participated in, the care of NATHAN PRASAD.

25 Defendant CUMMINGS is being sued in her individual capacity.

26

20. Defendant AMERJIT BHATTAL is, and was at all relevant times mentioned

27 herein, the Sutter County Assistant Director of Human Services – Health Division.

28 Defendant BHATTAL’s job description provides that she has “primary authority and

5
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1 responsibility for directing … jail health services,” and pursuant to that responsibility

2 “[d]evelops and implements policies and procedures” and “[s]upervises, directs and

3 evaluates assigned staff” (including by “disciplining and completing employee

4 performance appraisals”). Defendant BHATTAL is and was responsible for the hiring,

5 screening, training, retention, supervision, discipline, counseling, and control of jail

6 medical and mental health employees and/or agents involved in the conduct alleged herein.

7 Defendant BHATTAL is and was also responsible for the promulgation of the policies and

8 procedures and allowance of the practices/customs pursuant to which the acts of the jail

9 medical and mental health staff alleged herein were committed. Defendant BHATTAL is

10 being sued in her individual capacity.

11

21. Defendant BRENT GARBETT is, and was at all relevant times mentioned

12 herein, the Sutter County Jail Nurse Program Manager. Defendant GARBETT’s job

13 description provides that he has “management responsibility for the jail nursing program

14 and staff,” and “report[s] to and receiv[es] direction from the Assistant Director of Human

15 Services – Health Division [Defendant BHATTAL] with medical direction from the

16 County Health Officer [Defendant CUMMINGS].” Defendant GARBETT’s job

17 description further provides that he “directs operations and staff in the delivery of health

18 services to inmates in the County jail facility[;] … [d]evelops, implements and interprets

19 goals, objectives, policies, procedures and standards[;] … [p]rovides professional nursing

20 care as needed; responds and coordinates inmate emergency and urgent care[;] …

21 [s]upervises, directs and evaluates assigned staff … [and] reviews nursing protocols,

22 procedures and standards to ensure effective patient care and compliance with applicable

23 policies and regulations.” Defendant GARBETT is and was responsible for the hiring,

24 screening, training, retention, supervision, discipline, counseling, and control of jail

25 medical and mental health employees and/or agents involved in the conduct alleged herein.

26 Defendant GARBETT is and was also responsible for the promulgation of the policies and

27 procedures and allowance of the practices/customs pursuant to which the acts of the jail

28 medical and mental health staff alleged herein were committed. Defendant GARBETT

6
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1 was told of NATHAN PRASAD’s dire condition on the morning of January 28, 2011 but

2 acted with deliberate indifference by failing to take necessary steps to provide life-saving

3 treatment. Defendant GARBETT is being sued in his individual capacity.

4

22. Defendant DORIS BROWN was at all relevant times mentioned herein a

5 Registered Nurse Practitioner at Sutter County Jail. Defendant BROWN had direct contact

6 with NATHAN PRASAD in the hours and/or days leading up to his death, had actual

7 notice of NATHAN PRASAD’s serious and life-threatening condition and need for

8 emergency medical treatment, and acted with deliberate indifference by failing to take

9 necessary steps to provide such treatment. Defendant BROWN is being sued in her

10 individual capacity.

11

23. Defendant MELODY YOUNG was at all relevant times mentioned herein a

12 Licensed Vocational Nurse at Sutter County Jail. Defendant YOUNG had direct contact

13 with NATHAN PRASAD in the hours and/or days leading up to his death, had actual

14 notice of NATHAN PRASAD’s serious and life-threatening condition and need for

15 emergency medical treatment, and acted with deliberate indifference by failing to take

16 necessary steps to provide such treatment. Defendant YOUNG is being sued in her

17 individual capacity.

18

24. Defendant KIMBERLY WEISS was at all relevant times mentioned herein a

19 Licensed Vocational Nurse at Sutter County Jail. Defendant WEISS had direct contact

20 with NATHAN PRASAD in the hours and/or days leading up to his death, had actual

21 notice of NATHAN PRASAD’s serious and life-threatening condition and need for

22 emergency medical treatment, and acted with deliberate indifference by failing to take

23 necessary steps to provide such treatment. Defendant WEISS is being sued in her

24 individual capacity.

25

25. Defendant GURKIRAT BHANGU was at all relevant times mentioned

26 herein a Licensed Vocational Nurse at Sutter County Jail. Defendant BHANGU had direct

27 contact with NATHAN PRASAD in the hours and/or days leading up to his death, had

28 actual notice of NATHAN PRASAD’s serious and life-threatening condition and need for

7
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1 emergency medical treatment, and acted with deliberate indifference by failing to take

2 necessary steps to provide such treatment. Defendant BHANGU is being sued in her

3 individual capacity.

4

26. Defendant CHRISTINA STOHLMAN was at all relevant times mentioned

5 herein a Correctional Officer at Sutter County Jail, and the Officer in Charge at Sutter

6 County Jail during relevant days and times as described herein. Defendant STOHLMAN

7 had actual notice of NATHAN PRASAD’s serious and life-threatening condition and need

8 for emergency medical treatment in the hours and/or days leading up to his death, and

9 acted with deliberate indifference by failing to take necessary steps to provide such

10 treatment. Defendant STOHLMAN is being sued in her individual capacity.

11

27. Defendant LESTER EATON was at all relevant times mentioned herein a

12 Correctional Officer at Sutter County Jail, and the Officer in Charge at Sutter County Jail

13 during relevant days and times as described herein. Defendant EATON had actual notice

14 of NATHAN PRASAD’s serious and life-threatening condition and need for emergency

15 medical treatment in the hours and/or days leading up to his death, and acted with

16 deliberate indifference by failing to take necessary steps to provide such treatment.

17 Defendant EATON is being sued in his individual capacity.

18

28. Defendant MIGUEL AGUILAR was at all relevant times mentioned herein a

19 Deputy Officer at Sutter County Jail. Defendant AGUILAR had direct contact with

20 NATHAN PRASAD in the hours and/or days leading up to his death, had actual notice of

21 NATHAN PRASAD’s serious and life-threatening condition and need for emergency

22 medical treatment, and acted with deliberate indifference by failing to take necessary steps

23 to provide such treatment. Defendant AGUILAR is being sued in his individual capacity.

24

29. Defendant OLGA TAHARA was at all relevant times mentioned herein a

25 Deputy Officer at Sutter County Jail. Defendant TAHARA had direct contact with

26 NATHAN PRASAD in the hours and/or days leading up to his death, had actual notice of

27 NATHAN PRASAD’s serious and life-threatening condition and need for emergency

28 medical treatment, and acted with deliberate indifference by failing to take necessary steps

8
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1 to provide such treatment. Defendant TAHARA is being sued in her individual capacity.

2

30. Defendant ROSA DIAZ was at all relevant times mentioned herein a Deputy

3 Officer at Sutter County Jail. Defendant DIAZ had direct contact with NATHAN

4 PRASAD in the hours and/or days leading up to his death, had actual notice of NATHAN

5 PRASAD’s serious and life-threatening condition and need for emergency medical

6 treatment, and acted with deliberate indifference by failing to take necessary steps to

7 provide such treatment. Defendant DIAZ is being sued in her individual capacity.

8

31. Defendant ERIC CRAWFORD was at all relevant times mentioned herein a

9 Deputy Officer at Sutter County Jail. Defendant CRAWFORD had direct contact with

10 NATHAN PRASAD in the hours and/or days leading up to his death, had actual notice of

11 NATHAN PRASAD’s serious and life-threatening condition and need for emergency

12 medical treatment, and acted with deliberate indifference by failing to take necessary steps

13 to provide such treatment. Defendant CRAWFORD is being sued in his individual

14 capacity.

15

32. Defendant BALJINDER RAI was at all relevant times mentioned herein a

16 Deputy Officer at Sutter County Jail. Defendant RAI had direct contact with NATHAN

17 PRASAD in the hours and/or days leading up to his death, had actual notice of NATHAN

18 PRASAD’s serious and life-threatening condition and need for emergency medical

19 treatment, and acted with deliberate indifference by failing to take necessary steps to

20 provide such treatment. Defendant RAI is being sued in his individual capacity.

21

33. Defendant SHANE DICKSON was at all relevant times mentioned herein a

22 Deputy Officer at Sutter County Jail. Defendant DICKSON had direct contact with

23 NATHAN PRASAD in the hours and/or days leading up to his death, had actual notice of

24 NATHAN PRASAD’s serious and life-threatening condition and need for emergency

25 medical treatment, and acted with deliberate indifference by failing to take necessary steps

26 to provide such treatment. Defendant DICKSON is being sued in his individual capacity.

27

34. Defendant FREMONT-RIDEOUT HEALTH GROUP was at all times

28 mentioned herein responsible for the operation of Rideout Memorial Hospital. Defendant

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1 FREMONT-RIDEOUT HEALTH GROUP had and maintained a contractual agreement

2 with COUNTY OF SUTTER to provide medical treatment to Sutter County Jail inmates,

3 including ambulance and emergency services. The process by which Rideout Memorial

4 Hospital provided treatment to Sutter County Jail inmates involved significant, ongoing

5 coordination and cooperation between COUNTY OF SUTTER, the Sutter County

6 Sheriff’s Department, and Defendant FREMONT-RIDEOUT HEALTH GROUP. On

7 information and belief, Defendant FREMONT-RIDEOUT HEALTH GROUP’s Rideout

8 Memorial Hospital is the only facility made available to Jail inmates for the delivery of

9 emergency medical services. Defendant FREMONT-RIDEOUT HEALTH GROUP

10 established and follows a policy, procedure and practice of receiving jail inmates from

11 Sutter County Jail, and discharging them to Sutter County Jail in a manner that is

12 deliberately indifferent to the known risk of serious or lethal injury in the event, as in the

13 case of NATHAN PRASAD, where the discharge instructions depend on a capacity for

14 emergency medical response that FREMONT-RIDEOUT HEALTH GROUP knew did not

15 exist at Sutter County Jail.

16

35. Defendant MICHAEL FRATERS was at all relevant times mentioned herein

17 a physician at Rideout Memorial Hospital and employee, contractor and/or agent of

18 FREMONT-RIDEOUT HEALTH GROUP. Defendant FRATERS treated NATHAN

19 PRASAD pursuant to the COUNTY OF SUTTER-FREMONT-RIDEOUT HEALTH

20 GROUP agreement to treat Sutter County Jail inmates in need of medical care. Defendant

21 FRATERS signed the note discharging NATHAN PRASAD on January 26, 2011, knew of

22 NATHAN PRASAD’s serious and life-threatening condition and need for access to

23 emergency medical treatment, and acted with deliberate indifference to the known risk of

24 serious or lethal injury to NATHAN PRASAD given that a safe discharge from the

25 hospital depended on the capacity for emergency medical response that he knew did not

26 exist at Sutter County Jail. Defendant FRATERS is being sued in his individual capacity.

27

36. Defendant COUNTY OF SUTTER is a political subdivision of the State of

28 California, created and existing by virtue of the laws of the State of California. At all

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1 times relevant to this complaint, Defendant COUNTY OF SUTTER employed Defendants

2 J. PAUL PARKER, DAVID SAMSON, NORMAN BIDWELL, LOU ANNE

3 CUMMINGS, AMERJIT BHATTAL, BRENT GARBETT, DORIS BROWN, MELODY

4 YOUNG, KIMBERLY WEISS, GURKIRAT BHANGU, CHRISTINA STOHLMAN,

5 LESTER EATON, MIGUEL AGUILAR, OLGA TAHARA, ROSA DIAZ, ERIC

6 CRAWFORD, BALJINDER RAI, and SHANE DICKSON.

7

37. Defendants J. PAUL PARKER, DAVID SAMSON, NORMAN BIDWELL,

8 LOU ANNE CUMMINGS, AMERJIT BHATTAL, BRENT GARBETT, DORIS

9 BROWN, MELODY YOUNG, KIMBERLY WEISS, GURKIRAT BHANGU,

10 CHRISTINA STOHLMAN, LESTER EATON, MIGUEL AGUILAR, OLGA TAHARA,

11 ROSA DIAZ, ERIC CRAWFORD, BALJINDER RAI, SHANE DICKSON, ,

12 FREMONT-RIDEOUT HEALTH GROUP, and MICHAEL FRATERS, and each of them,

13 to the extent they engaged in any acts or omissions alleged herein, engaged in such acts or

14 omissions under color of state law.

15

38. Plaintiffs are informed and believe and thereon allege that at all times

16 mentioned in this complaint, Defendants, and each of them, were the agents, employees,

17 servants, joint venturers, partners and/or co-conspirators of the other Defendants named in

18 this complaint and that at all times, each of the Defendants was acting within the course

19 and scope of said relationship with Defendants.

20

EXHAUSTION OF PRE-LAWSUIT PROCEDURES

21

39. Plaintiffs MARY PRASAD, T.P., and A.P. filed state governmental tort

22 claims with the State and Defendant COUNTY OF SUTTER, including on behalf of the

23 ESTATE of NATHAN PRASAD, on July 21, 2011. By correspondence dated

24 September 7, 2011, their governmental tort claims were rejected. By way of stipulation,

25 Plaintiff N.S. was excused by Defendant COUNTY OF SUTTER from compliance with

26 the governmental tort claims requirement.

27

28

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1

FACTUAL ALLEGATIONS

2 Nathan Prasad’s Life and the Circumstances of His Detention in Sutter County Jail

3

40. NATHAN PRASAD was born on April 10, 1980 in Cedarville, California.

4

41. NATHAN PRASAD had a close relationship with his family, helping to

5 raise his young children and assisting his mother and grandmother with various daily and

6 household tasks. Despite a history of mental illness, NATHAN PRASAD had made great

7 strides in the time before his death towards becoming independent and self-sufficient.

8 After several years struggling with mental illness, he had moved into his own apartment

9 for the first time in his life and was working towards gainful employment. He spent most

10 days with his family, including his elderly grandmother, his mother and step-father, and his

11 children.

12

42. COUNTY OF SUTTER officials and employees – including individual

13 Defendants, county mental health staff, county law enforcement, and county jail staff – had

14 extensive contact with NATHAN PRASAD. NATHAN PRASAD had been involuntarily

15 hospitalized to receive emergency mental health treatment pursuant to Cal. Welf. & Inst.

16 Code § 5150, and had been placed in the custody of the Sutter County Sheriff’s

17 Department multiple times, generally during periods in which he was manifesting serious

18 mental illness and in light of alleged non-violent parole and probation violations.

19 COUNTY OF SUTTER produced and maintained significant documentation of his mental

20 health and medical needs. This documentation was included in his Sutter County Jail

21 inmate records, and, upon information and belief, reviewed by Defendants CUMMINGS,

22 BROWN, YOUNG, WEISS, BHANGU, STOHLMAN, EATON, AGUILAR, TAHARA,

23 DIAZ, CRAWFORD, RAI, and DICKSON.

24

43. COUNTY OF SUTTER officials and employees were further aware of a

25 long-standing and trenchant problem with contagious bacterial infections at Sutter County

26 Jail. Said officials and employees were further aware that NATHAN PRASAD had

27 suffered from an antibiotic-resistant bacterial infection (Staphylococcus aureus, or staph)

28 during a prior period of custody at the Jail in January 2010, and been treated for that

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1 infection by jail medical staff. Jail medical staff further documented at that time that

2 NATHAN PRASAD had experienced “[r]ecurrent MRSA [Methicillin-resistant

3 Staphylococcus aureus] infections” (emphasis added). Documentation regarding

4 NATHAN PRASAD’s prior treatment was included in his Sutter County Jail inmate

5 records, and, upon information and belief, reviewed by Defendants CUMMINGS,

6 BROWN, YOUNG, WEISS, BHANGU, STOHLMAN, EATON, AGUILAR, TAHARA,

7 DIAZ, CRAWFORD, RAI, and DICKSON.

8

44. NATHAN PRASAD was arrested on or about January 21, 2011, based on

9 non-violent misdemeanor and parole-related charges. He was taken to Sutter County Jail,

10 where he was detained for the next week. During that time period, NATHAN PRASAD

11 developed a medical condition which, as a result of the denial of plainly necessary

12 treatment to address a developing infection, led to great suffering and his painful death on

13 January 28, 2011.

14

45. At the time of NATHAN PRASAD’s death, T.P. was seven (7) years old,

15 A.P. was six (6) years old, and N.S was three (3) years old. NATHAN PRASAD died just

16 two (2) days before A.P.’s seventh birthday.

17

Medical Problems, Pain, and Suffering While Detained in Sutter County Jail

18

46. Soon after NATHAN PRASAD was booked into Sutter County Jail on

19 January 21, 2011, NATHAN PRASAD reported to jail staff that he was experiencing

20 significant pain in his lower extremities. He was further manifesting symptoms of mental

21 illness. Jail staff, including Defendants BROWN, YOUNG, WEISS, BHANGU,

22 STOHLMAN, EATON, AGUILAR, TAHARA, DIAZ, CRAWFORD, RAI, and

23 DICKSON observed NATHAN PRASAD on multiple occasions experiencing pain,

24 swelling, and other serious medical symptoms, and jail staff including Defendants

25 BROWN, WEISS, and YOUNG documented these symptoms.

26

47. While detained at Sutter County Jail in January 2011, NATHAN PRASAD

27 completed and submitted to jail staff at least one written request to receive medical

28 treatment. He reported that he was suffering “extreme pain” and stated that he required

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1 “emergency” medical attention.

2

48. After several days of reported and documented medical concerns, Defendant

3 BROWN evaluated NATHAN PRASAD and, following consultation with Defendant

4 CUMMINGS, referred NATHAN PRASAD to Rideout Memorial Hospital for what was a

5 brief medical evaluation.

6

49. Upon information and belief, Defendants COUNTY OF SUTTER,

7 CUMMINGS, BHATTAL and GARBETT fail to maintain a medical records system that

8 appropriately documents and transmits critical medical information about Jail inmates to

9 affiliated health care providers – a defect which renders a prison health care system

10 constitutionally inadequate. See Coleman v. Wilson, 912 F. Supp. 1282, 1314 (E.D. Cal.

11 1995) (holding that correctional facilities “have a constitutional obligation to provide

12 inmates with adequate medical care” and that “[a] necessary component of minimally

13 adequate medical care is maintenance of complete and accurate medical records”); Adams

14 v. Tilton, Case No. 1:07-cv-00791-GSA PC, 2009 U.S. Dist. LEXIS 88009, at *29 (E.D.

15 Cal. Sept. 9, 2009) (citations omitted) (holding that “[a]dequate and accurate medical

16 records are essential to a prison’s providing inmates with continuity of medical care,” and

17 that the Constitution “is violated when incomplete and inaccurate medical records create a

18 ‘the possibility for disaster’ arising from a lack of necessary information about an inmate’s

19 medical history”). As a result, and upon information and belief, information regarding

20 NATHAN PRASAD’s clinically significant history of recurrent MRSA (Methicillin-

21 resistant Staphylococcus aureus) infections was not provided or made available to

22 Defendant FREMONT-RIDEOUT HEALTH GROUP or Defendant FRATERS. Had this

23 information been provided to Defendant FREMONT-RIDEOUT HEALTH GROUP and/or

24 Defendant FRATERS on January 26, it could have signaled the need for a simple blood

25 test that would have identified NATHAN PRASAD’s advancing infection and enabled

26 prompt, life-saving antibiotic treatment.

27

50. NATHAN PRASAD was evaluated and treated at Rideout Memorial

28 Hospital on January 26, 2011, as pursuant with the Hospital’s agreement to treat Sutter

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1 County Jail inmates. A short time after his arrival at the Emergency Department,

2 emergency room physician Defendant FRATERS discharged NATHAN PRASAD with

3 specific discharge instructions that if his symptoms worsen or new symptoms develop, he

4 was to be returned to the Emergency Department immediately. At the time, Defendant

5 FRATERS knew, based on the information available to him, that NATHAN PRASAD was

6 exhibiting signs of a serious and life-threatening condition – a condition which would

7 result in his death less than 55 hours later. Defendant FRATERS further knew that

8 NATHAN PRASAD would need access to emergency medical treatment if his symptoms

9 worsened or new symptoms developed. NATHAN PRASAD was discharged on the

10 afternoon of January 26, and returned to Sutter County Jail.

11

51. Defendant FREMONT-RIDEOUT HEALTH GROUP’s Rideout Memorial

12 Hospital staff, acting pursuant to a contract with COUNTY OF SUTTER to provide

13 medical treatment to Sutter County Jail inmates, acted with deliberate indifference by

14 discharging NATHAN PRASAD to a notoriously dangerous setting at Sutter County Jail.

15 Hospital staff knew that NATHAN PRASAD would not possibly receive the observation,

16 supervision, and ongoing access to emergency medical treatment he would likely need

17 given his serious medical complaints and condition.

18

52. Defendant FRATERS acted with deliberate indifference to the known risk of

19 serious or lethal injury to NATHAN PRASAD given that his safe discharge from the

20 hospital depended on timely access to emergency medical response, which he knew did not

21 exist at Sutter County Jail, a setting that is notoriously dangerous for individuals with

22 serious medical needs and that does not provide sufficient around-the-clock access to

23 medical care. Neither Defendant FRATERS nor any other employee or agent of

24 FREMONT-RIDEOUT HEALTH GROUP conducted any follow-up regarding NATHAN

25 PRASAD after he was discharged, including any follow-up to ensure that discharge

26 instructions directing that NATHAN PRASAD be returned to the emergency department

27 immediately if any new symptoms developed were understood by recipients.

28

53. On information and belief, Defendant BIDWELL, as the officer charged with

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1 managing day-to-day operations at the Jail, was informed and aware of NATHAN

2 PRASAD’s evaluation at Rideout Memorial Hospital and the discharge instructions

3 providing that if his symptoms worsened or new symptoms developed, he must be taken to

4 the emergency room immediately.

5

54. On information and belief, Defendants CUMMINGS, BROWN, YOUNG,

6 WEISS, BHANGU, STOHLMAN, EATON, AGUILAR, TAHARA, DIAZ,

7 CRAWFORD, RAI, and DICKSON each reviewed and/or were aware of NATHAN

8 PRASAD’s custody file and/or medical file, including the medical documentation

9 indicating his medical status and need to be taken to the emergency room immediately if

10 his symptoms worsened or new symptoms developed. Defendants BROWN, YOUNG,

11 WEISS, BHANGU, STOHLMAN, EATON, AGUILAR, TAHARA, DIAZ,

12 CRAWFORD, RAI, and DICKSON reviewed and/or were aware of NATHAN PRASAD’s

13 custody file and/or medical file because each of them was on duty at the Jail during

14 NATHAN PRASAD’s January 2011 detention and had significant contact with NATHAN

15 PRASAD after his return from the hospital (as documented in paragraphs 56-74, infra).

16 Defendant CUMMINGS reviewed and/or was aware of NATHAN PRASAD’s custody

17 and/or medical file because she is required, as medical director of the county jail medical

18 facility, to review and approve all examination and treatment records initiated by

19 practitioners. Moreover, Defendant BROWN consulted with Defendant CUMMINGS

20 regarding NATHAN PRASAD’s symptomology and treatment plan.

21

55. Throughout NATHAN PRASAD’s detention at Sutter County Jail,

22 Defendants CUMMINGS, GARBETT, BROWN, YOUNG, WEISS, BHANGU,

23 STOHLMAN, EATON, AGUILAR, TAHARA, DIAZ, CRAWFORD, RAI, and

24 DICKSON failed to provide sufficient medical screening, evaluation, and observation of

25 his medical condition and emergent treatment needs.

26 Defendants’ Failure to Provide Clearly Necessary Life-Saving Emergency Treatment

27

56. Shortly upon his return from the brief hospital admission, it became readily

28 apparent that NATHAN PRASAD’s condition and symptoms were in fact getting

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1 significantly worse. His symptoms included shortness of breath, severe chills, and extreme

2 pain. NATHAN PRASAD began coughing and/or vomiting up blood. On the evening of

3 January 26, 2011, Defendant WEISS documented that NATHAN PRASAD was suffering

4 from “uncontrollable pain” and spoke with Defendant BROWN. Yet no follow-up

5 evaluation was provided that night, nor was NATHAN PRASAD returned to the

6 Emergency Department for treatment as his discharge note required.

7

57. From January 26 to January 28, NATHAN PRASAD stated aloud repeatedly

8 that he was in extreme pain and having trouble breathing. He reported to staff that he

9 thought he was going to die unless he received immediate medical attention. He was

10 manifesting numerous symptoms indicating a serious and life-threatening condition and an

11 immediate need for emergency medical treatment.

12

58. Several fellow inmates observed NATHAN PRASAD’s worsening condition

13 and notified staff at the jail, including Defendants YOUNG, WEISS, BHANGU,

14 AGUILAR, RAI, and DICKSON. One or more jail staff members responded that

15 NATHAN PRASAD was faking his pain and other symptoms and that he and the other

16 inmates needed to “get over it.”

17

59. Fellow inmates collected the blood that NATHAN PRASAD was coughing

18 up in an empty milk carton, and, upon information and belief, showed it to Defendants

19 YOUNG and RAI in an effort to obtain emergency medical help for NATHAN PRASAD.

20

60. Jail staff, including Defendants BROWN, YOUNG, WEISS, BHANGU,

21 STOHLMAN, EATON, AGUILAR, TAHARA, DIAZ, CRAWFORD, RAI, and

22 DICKSON observed NATHAN PRASAD’s suffering and heard his and his fellow

23 inmates’ pleas for immediate medical help. Defendants BROWN, YOUNG, and WEISS

24 documented NATHAN PRASAD’s complaints and worsening symptoms. In spite of the

25 alarming reports and the observations of Defendants, they failed to provide adequate

26 evaluation or timely emergency treatment for a period of 36 hours or more.

27

61. Defendant BROWN observed NATHAN PRASAD’s condition and

28 reviewed the Emergency Department records and discharge instructions to return him to

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1 the hospital immediately if his symptoms worsened or new symptoms developed. She

2 observed and documented that he was continuing to experience pain and other serious, and

3 worsening, symptoms, but took no steps to obtain the emergency medical care he

4 obviously needed. Specifically, Defendant BROWN observed NATHAN PRASAD at

5 9:00 a.m. on January 27, 2011 and documented alarming symptoms including an

6 abnormally high pulse rate, precipitous drop in blood pressure, low grade fever, marked

7 dehydration, and increased bruising across NATHAN PRASAD’s midsection. His vital

8 signs had changed dramatically and dangerously from the readings taken during his

9 January 26 hospitalization and those taken during Defendant BROWN’s own evaluation

10 immediately prior to that hospitalization. NATHAN PRASAD’s presentation on the

11 morning of January 27, 2011 clearly and obviously alerted Defendant BROWN to

12 NATHAN PRASAD’s rapidly worsening condition and need for immediate emergency

13 treatment. Nonetheless, Defendant BROWN did nothing other than prescribe an additional

14 pain reliever. Defendant BROWN took no steps to ensure that NATHAN PRASAD

15 received any type of medical monitoring in light of his rapidly worsening vital signs,

16 notwithstanding that such monitoring was immediately called for and essential to saving

17 NATHAN PRASAD’s life. No follow-up medical observation or evaluation of any kind

18 was documented at any future time on January 27, 2011. Indeed, none was documented

19 until nearly twenty (20) hours later.

20

62. Defendant BHANGU conducted the evening medication pass on January 27,

21 2011. At that time NATHAN PRASAD’s serious illness, intense distress and need for

22 immediate emergency medical care were obvious. Defendant BHANGU did not document

23 or provide any treatment or evaluation of his dire condition, nor did she make any effort to

24 secure the emergency care that NATHAN PRASAD obviously required.

25

63. While conducting a safety check of the cell where NATHAN PRASAD was

26 detained, Defendant AGUILAR witnessed NATHAN PRASAD’s dire condition and was

27 told by NATHAN PRASAD and other inmates that NATHAN PRASAD required

28 immediate medical attention. Defendant AGUILAR did not make any effort to summon

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1 medical care or otherwise address NATHAN PRASAD’s urgent medical needs.

2

64. Defendant DICKSON, after observing NATHAN PRASAD screaming in

3 pain and begging to be taken to the hospital for treatment, ridiculed NATHAN PRASAD.

4 Defendant DICKSON stated that NATHAN PRASAD was the type of person who comes

5 to jail because he wants to get free medical care. Defendant DICKSON ignored NATHAN

6 PRASAD’s serious medical condition, and took no steps to address his medical needs.

7

65. In the pre-dawn hours of January 28, 2011, Defendants RAI and YOUNG

8 observed, and Defendant YOUNG documented, that NATHAN PRASAD’s blood pressure

9 and blood-oxygen saturation were dangerously low, that he was coughing and/or vomiting

10 up blood, dizzy, sweating, cold, and clammy. On information and belief, he reported to

11 Defendants RAI and YOUNG that he felt like he was “going to die.”

12

66. After the many hours and days during which NATHAN PRASAD was

13 exhibiting worsening symptoms and significant suffering and was pleading with jail staff

14 for help, Defendants RAI and YOUNG placed NATHAN PRASAD in a Sutter County Jail

15 office early on January 28. However, they provided him no medical treatment, and failed

16 to properly monitor his deteriorating condition, for a period of nearly four (4) hours.

17 Defendants RAI and YOUNG did not call an ambulance or make other arrangements for

18 NATHAN PRASAD to be taken to the hospital emergency room for emergency and life-

19 saving medical care.

20

67. Instead, NATHAN PRASAD was made to sit in a jail office room, without

21 medical attention of any kind, even as his condition got worse, including further coughing

22 up of blood and deteriorating vital signs. Defendant GARBETT was informed of

23 NATHAN PRASAD’s critical condition but did nothing to summon desperately needed

24 emergency care.

25

68. Defendants DIAZ and TAHARA observed NATHAN PRASAD during the

26 hours he was locked in the jail office on the morning of January 28, 2011. Defendants

27 DIAZ and TAHARA heard NATHAN PRASAD plead for help and tell Defendant

28 YOUNG repeatedly that he felt like he was “going to die.” Defendants DIAZ and

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1 TAHARA heard Defendant YOUNG tell NATHAN PRASAD that she would do nothing

2 for him. Defendants DIAZ, TAHARA and YOUNG then locked NATHAN PRASAD

3 back in the jail office without providing or summoning any medical care.

4

69. Defendant CRAWFORD heard NATHAN PRASAD kicking the locked door

5 to the jail office, repeatedly and desperately yelling “I can’t breathe! I can’t breathe!”

6 Defendant CRAWFORD ordered NATHAN PRASAD to stop yelling and to lie down.

7 Defendant CRAWFORD did not report these observations to anyone, or make any effort to

8 summon medical care or attention of any kind.

9

70. Defendant EATON was the officer in charge from the evening of January 27,

10 2011 until 6:00 a.m. on January 28, 2011. During this time period, Defendant EATON

11 became aware that NATHAN PRASAD had been complaining about difficulty breathing –

12 a serious and life-threatening condition – for at least several hours, extending back to the

13 pre-dawn hours when no nursing or medical staff were on site.

14

71. Defendant STOHLMAN assumed duties as officer in charge at or about 6:00

15 a.m. on January 28, 2011. At or around the time of this shift change, Defendant EATON

16 informed Defendant STOHLMAN that NATHAN PRASAD had been complaining about

17 difficulty breathing – a serious and life-threatening condition – for at least several hours.

18 Defendant EATON further informed Defendant STOHLMAN that NATHAN PRASAD

19 had been placed in a jail office, and that Defendant YOUNG had told NATHAN PRASAD

20 that she could not do anything for him and thus was not providing any treatment or care to

21 NATHAN PRASAD.

22

72. Despite this knowledge, neither Defendant EATON nor Defendant

23 STOHLMAN at any time made any efforts to summon critically needed emergency

24 medical care, and they each tacitly endorsed the inaction and indifference of the officers

25 under their supervision.

26

73. Not until nearly four hours later on January 28 was an ambulance

27 summoned. By that time, NATHAN PRASAD’s condition had deteriorated dramatically

28 and his skin had turned blue due to severe oxygen deficiency and cyanosis. His blood

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1 pressure could no longer be detected. NATHAN PRASAD was at this point suffering

2 from severe sepsis.

3

74. The failure of correctional officer Defendants STOHLMAN, EATON,

4 AGUILAR, TAHARA, DIAZ, CRAWFORD, RAI, and DICKSON to contact emergency

5 medical services was consistent with an established practice in effect at Sutter County Jail

6 such that medical staff were responsible for determining who goes to the hospital or calling

7 for an ambulance in an emergency situation, despite the lack of 24-hour medical staff

8 availability at the jail. Defendants PARKER, SAMSON, and BIDWELL created, were

9 aware of, and enforced this policy, knowing that it would endanger inmates like NATHAN

10 PRASAD who require emergency medical attention.

11

NATHAN PRASAD’s Painful and Preventable Death

12

75. NATHAN PRASAD suffered severe bronchopneumonia and multiple organ

13 failure as a result of Defendants’ failure to provide timely medical treatment. This

14 excruciating condition resulted from a bacterial infection that had spread systemically – an

15 infection which could have been treated with a course of antibiotics, had Defendants

16 GARBETT, BROWN, YOUNG, WEISS, BHANGU, STOHLMAN, EATON, AGUILAR,

17 TAHARA, DIAZ, CRAWFORD, RAI, and DICKSON timely responded to NATHAN

18 PRASAD’s obvious suffering. By the time NATHAN PRASAD reached the hospital on

19 January 28, however, he was deemed to be in critical condition and was unconscious,

20 leading to his placement in the Intensive Care Unit (ICU) at Rideout Memorial Hospital.

21

76. None of the Defendants timely contacted NATHAN PRASAD’s family. As

22 a result, his mother MARY PRASAD, his children T.P., A.P., and N.S., and other family

23 members were unable to make it to the hospital in time to see NATHAN PRASAD while

24 he was still alive.

25

77. Meanwhile, Defendants PARKER, SAMSON, BIDWELL and STOHLMAN

26 took steps to drop all pending charges and to release NATHAN PRASAD “on his own

27 recognizance” after he was placed in the ICU and was in critical condition. Defendant

28 STOHLMAN personally signed paperwork effecting NATHAN PRASAD’s “own

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1 recognizance” release, collected NATHAN PRASAD’s belongings from the Jail and

2 transported them to Rideout Memorial Hospital as NATHAN PRASAD lay dying, in an

3 effort to distance the Jail from its responsibility for NATHAN PRASAD and his dire

4 condition.

5

78. At approximately 4:19 pm on January 28, NATHAN PRASAD was

6 pronounced dead by hospital staff.

7

79. Had NATHAN PRASAD not been placed in a jail setting known to be

8 dangerous and ill-equipped to ensure timely emergency medical treatment, and had such

9 emergency treatment been summoned and provided to NATHAN PRASAD, his condition

10 could have been effectively treated. He would not have experienced severe pain and

11 suffering, and his life would have been saved.

12

Longstanding and Systemic Deficiencies in Sutter County Jail’s Provision of

Emergency Treatment to Inmates, Medical Staffing, and Policies and Procedures in

13

Violation of Existing Court Order

14

80. Defendant COUNTY OF SUTTER has knowingly maintained and tolerated

15 longstanding and systemic deficiencies in Sutter County Jail’s provision of emergency

16 treatment to seriously ill inmates. It has also knowingly had inadequate medical staffing as

17 well as policies and procedures that were likely in violation of an existing court order

18 directing minimum standards of medical treatment at the jail. Defendants PARKER,

19 SAMSON, BIDWELL, CUMMINGS, BHATTAL and GARBETT were aware of and

20 tolerated these serious deficiencies in Sutter County Jail’s medical care system, policies,

21 and procedures.

22

81. Upon information and belief, Defendants COUNTY OF SUTTER,

23 CUMMINGS, BHATTAL and GARBETT fail to maintain a medical records system that

24 appropriately documents and transmits critical medical information about Jail inmates to

25 affiliated health care providers, including emergency care provider FREMONT-RIDEOUT

26 HEALTH GROUP and the physicians who work there. This defect renders the health care

27 system at Sutter County Jail constitutionally infirm.

28

82. Upon information and belief, Defendants CUMMINGS, BHATTAL and

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1 GARBETT authorized and implemented a policy pursuant to which medical staff was only

2 available at the Jail from 4:00 a.m. to midnight. This policy meant that, for crucial hours

3 each day, there was no medical staff whatsoever available to respond to, triage or treat

4 emergency situations. Defendants CUMMINGS, BHATTAL and GARBETT have

5 persisted in this policy notwithstanding that the 2007-2008 Sutter County Grand Jury made

6 a specific recommendation that a nurse be on duty twenty-four hours a day, seven days a

7 week at Sutter County Jail.

8

83. Upon information and belief, Defendants PARKER, SAMSON and

9 BIDWELL authorized and implemented a policy such that jail medical staff, not custody

10 staff, were responsible for summoning emergency medical attention when Jail inmates

11 required such attention. Defendants PARKER, SAMSON and BIDWELL persisted in this

12 policy notwithstanding that they knew that there were hours each day in which there was

13 no medical staff whatsoever available to respond to, triage or treat emergency situations.

14

84. As identified by a Sutter County Grand Jury in its 2010-2011 Final Report,

15 Sutter County Jail has had several further known deficiencies in its system of providing

16 treatment to inmates. (The Final Report of the 2010-2011 Sutter County Grand Jury is

17 appended as Attachment A.)

18

85. Identified deficiencies included inadequate medical staffing, non-compliant

19 medical policies and procedures, and a medical program that was long out-of-compliance.

20 The 2010-2011 Grand Jury noted that such deficiencies were “unacceptable,” and may

21 have caused Sutter County to be in violation of an existing court order in Haller v. Sutter

22 County, Case No. CIV-S-93-1256, which mandates certain jail conditions, policies, and

23 procedures for providing medical treatment to Sutter County Jail inmates.

24

86. The 2010-2011 Grand Jury found that medical staffing at Sutter County Jail

25 has been inadequate, and that the hiring of additional staff is required.

26

87. The 2010-2011 Grand Jury noted a report that training of staff had not

27 occurred in more than five (5) years as of 2011, and that such training was “necessary to

28 maintain proficiency in emergency response procedures” (emphasis added). The Grand

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1 Jury found that Sutter County Jail had failed to offer staff required training pursuant to

2 court order and the jail’s own Medical Policies and Procedures.

3

88. The 2010-2011 Grand Jury found that Sutter County Jail’s health care

4 policies and procedures were significantly out of date, and that conditions at the jail had

5 been allowed to “deteriorate.”

6

89. The 2010-2011 Grand Jury found that Sutter County Jail’s nursing program

7 was “completely out of compliance with annual nurse training updates and standard

8 nursing procedures,” and found “unacceptable that the program is out of compliance, [the]

9 lack of training for the nursing staff, [and] not having the [policies and procedures] up-to-

10 date,” among other problems.

11

90. The 2010-2011 Grand Jury, pursuant to its statutory authority, identified

12 Defendants CUMMINGS, BHATTAL and GARBETT as responsible for responding to

13 these findings and recommendations regarding the Jail’s dangerous and deficient medical

14 care system. On information and belief, Defendants CUMMINGS, BHATTAL and

15 GARBETT have not responded.

16

91. In 2011-2012, a second Sutter County Grand Jury investigated improper

17 denial of medical care at Sutter County Jail, in particular the denial of care to an inmate

18 who was arrested on January 21, 2011 and whose health while in custody severely and

19 rapidly deteriorated leading to his January 28, 2011 death. On information and belief, the

20 inmate whose death was the focus of this investigation was NATHAN PRASAD. (The

21 Final Report of the 2011-2012 Sutter County Grand Jury Pursuant to Penal Code 933(a) on

22 subject – Sutter County Jail Death is appended as Attachment B.)

23

92. The 2011-2012 Grand Jury noted that at 8:00 a.m. on January 28, 2011 “[t]he

24 JNM [Jail Nurse Manager] arrived and was briefed by the LVN [Licensed Vocational

25 Nurse] on the inmates’ [sic] condition and he did not review the medical chart or examine

26 the inmate.” As noted in the report, this JNM is Defendant GARBETT.

27

93. The 2011-2012 Grand Jury further noted that “[t]here was never any formal

28 discussion or meeting held for jail nursing staff to review the inmate’s case,” and that “in

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1 fact the HO [Health Officer] did not allow any discussion among medical staff about the

2 inmate’s case.” As noted in the report, the HO is Defendant CUMMINGS.

3

94. At the outset of its report, the 2011-2012 Grand Jury noted its “concern[ ]”

4 that “past inadequate staff training and incomplete JMS [Jail Medical Services] policies

5 and procedures could have been contributing factors in the inmate’s death.” The 2011-

6 2012 Grand Jury further noted that the “Sutter County Sick Bay Policy #56” in place as of

7 January 28, 2011 was nearly ten years old, “was one page and stated in general terms that

8 only medical staff could place inmates with medical problems in Sick Bay,” and “did not

9 offer any [further] guidance.”

10

95. In its formal statement of findings, the 2011-2012 Grand Jury found that

11 (inter alia): “[t]he JNM did not take any interest or immediate action responding to the

12 inmate’s medical emergency which is inconsistent with RN training and not in compliance

13 with the job description to provide professional nursing care”; “the AD violated the

14 conditions of the job description by enabling the JNM to be negligent of duties and

15 responsibilities throughout the JNM’s entire tenure,” including “continuous

16 noncompliance by not reviewing and updating [policies and procedures] annually (Title 15

17 sec. 1206 CA code), no in-clinic training program to assure standardized treatment

18 procedures, and reluctance to act in the capacity of an RN”; “[t]here is no in-house training

19 provided to JMS staff that is specific to their job”; and “[a]ll JMS Management (JNM, AD,

20 and HO) abrogated their responsibility by not conducting a [morbidity and mortality]

21 conference following the death of the inmate.” As noted in the report, the JNM is

22 Defendant GARBETT, the AD is Defendant BHATTAL, and the HO is Defendant

23 CUMMINGS.

24

96. The 2011-2012 Grand Jury further found that, even in light of the preceding

25 year’s Grand Jury Report recommending prompt revision of policies and procedures for

26 medical care at Sutter County Jail, as of April 9, 2012 “only about half of the [policies and

27 procedures] [had] been finalized and made available on the intranet,” and that “[t]here was

28 no priority after the inmate death to immediately implement a policy that included vital

25
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1 sign parameters indicating when to call for an ambulance.”

2

97. The systemic deficiencies regarding the provision of emergency and other

3 medical treatment at Sutter County Jail, as well as the inadequate staffing, policies, and

4 procedures, as identified in the 2010-2011 and 2011-2012 Grand Jury Reports and in

5 violation of the existing Haller v. Sutter County court order, directly caused the woefully

6 inadequate emergency medical attention and treatment that NATHAN PRASAD received

7 between January 26 and January 28, 2011, leading to his untimely and preventable death

8 on January 28, 2011.

9

98. Defendants COUNTY OF SUTTER, PARKER, SAMSON, BIDWELL,

10 CUMMINGS, BHATTAL, and GARBETT maintained inadequate medical staffing and

11 insufficient policies and procedures. These deficiencies include, but are not limited to,

12 insufficient direction as to what circumstances require emergency medical care and the

13 procedure for summoning emergency medical care. Moreover, Defendants COUNTY OF

14 SUTTER, GARBETT, BHATTAL, and CUMMINGS provided no in-house training at all

15 to jail medical staff, including no training whatsoever on the provision of emergency

16 medical care to Sutter County Jail inmates with serious and/or life-threatening medical

17 conditions, even though this training was necessary to maintain minimally adequate

18 emergency response procedures. Defendants COUNTY OF SUTTER, GARBETT,

19 BHATTAL, and CUMMINGS, by their acts and omissions, tolerated known dangers and

20 risks of serious harm to inmates, like NATHAN PRASAD, who required emergency care

21 while in the Jail. These failures directly caused the denial of emergency medical attention

22 and treatment that NATHAN PRASAD required between January 26 and January 28,

23 2011, leading to his untimely and preventable death on January 28, 2011.

24

99. Sutter County Jail has recently experienced several likely preventable inmate

25 deaths in custody, indicating a culture of deliberate indifference to inmates’ serious

26 treatment needs at the Jail. In addition to NATHAN PRASAD’s death, there have been

27 disturbing reports of inmate deaths in April 2010 and September 2011.

28

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1 NATHAN PRASAD’s Mother and Young Children Have Been Profoundly Harmed by Defendants’ Misconduct Leading to NATHAN PRASAD’s Death
2

3

100. Plaintiffs MARY PRASAD, T.P., A.P., and N.S., have been profoundly

4 harmed by Defendants’ conduct leading to NATHAN PRASAD’s untimely and avoidable

5 death.

6

101. As NATHAN PRASAD’s mother, MARY PRASAD has experienced the

7 painful loss of her eldest son. She has been denied the regular contact that she and

8 NATHAN PRASAD had. She has lost the loving mother-son relationship that she and

9 NATHAN PRASAD maintained, including regular contact, a warm relationship, and the

10 assistance that NATHAN PRASAD regularly provided her, including home maintenance

11 and improvement projects.

12

102. As NATHAN PRASAD’s young children, T.P., A.P., and N.S. have

13 experienced the traumatic loss of their father, who remained close to them throughout their

14 lives until his tragic death. They have taken the loss of their father extremely hard, asking

15 when they will be able to see him again. They have had and will continue to have great

16 difficulty coping with his death during their most formative years. T.P., A.P., and N.S.

17 have further suffered the loss of NATHAN PRASAD’s financial support, his care and

18 supervision of them, and his paternal guidance.

19

FIRST CLAIM FOR RELIEF

Cruel and Unusual Punishment in Violation of the Fourteenth Amendment

20

to the Constitution of the United States – Deliberate Indifference to Serious

Medical Needs, Health and Safety

21

(Survival Action – 42 U.S.C. § 1983)

(Against Defendants J. PAUL PARKER, DAVID SAMSON, NORMAN BIDWELL,

22 LOU ANNE CUMMINGS, AMERJIT BHATTAL, BRENT GARBETT, DORIS

BROWN, MELODY YOUNG, KIMBERLY WEISS, GURKIRAT BHANGU,

23

CHRISTINA STOHLMAN, LESTER EATON, MIGUEL AGUILAR, OLGA

TAHARA, ROSA DIAZ, ERIC CRAWFORD, BALJINDER RAI, SHANE

24 DICKSON, FREMONT-RIDEOUT HEALTH GROUP, and MICHAEL FRATERS)

25

103. Plaintiffs re-allege and incorporate by reference paragraphs 1 through 102 of

26 this complaint as though fully set forth herein.

27

104. Defendants PARKER, SAMSON, BIDWELL, CUMMINGS, BHATTAL,

28 GARBETT, BROWN, YOUNG, WEISS, BHANGU, STOHLMAN, EATON, AGUILAR,

27
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1 TAHARA, DIAZ, CRAWFORD, RAI, DICKSON, FREMONT-RIDEOUT HEALTH

2 GROUP, and FRATERS knew that NATHAN PRASAD was in danger of serious personal

3 harm because:

4

a. Based on NATHAN PRASAD’s previous contact with COUNTY OF

5 SUTTER and Sutter County Jail officers and employees, including all individual

6 Defendants, Defendants had substantial documentation of his medical needs, and his need

7 for consistent supervision and prompt medical attention when warranted.

8

b. NATHAN PRASAD’s Sutter County Jail inmate records documented

9 that he had a history of MRSA (Methicillin-resistant Staphylococcus aureus) infections,

10 and had required treatment for such an infection during a prior period of custody at Sutter

11 County Jail. Documentation regarding this prior history was included in his Sutter County

12 Jail inmate records, and, upon information and belief, reviewed by Defendants

13 CUMMINGS, BROWN, YOUNG, WEISS, BHANGU, STOHLMAN, EATON,

14 AGUILAR, TAHARA, DIAZ, CRAWFORD, RAI, and DICKSON.

15

c. NATHAN PRASAD completed and submitted at least one written

16 request to receive medical treatment, reporting “extreme pain” and the need for

17 “emergency” medical attention.

18

d. Emergency room physicians documented clear instructions that were

19 placed in NATHAN PRASAD’s jail custody file and/or medical file, that if his symptoms

20 worsened or new symptoms developed, he needed to be returned to the hospital for

21 emergency treatment immediately. Upon information and belief, Defendant BIDWELL,

22 as the officer charged with managing day-to-day operations at the Jail, was informed and

23 aware of NATHAN PRASAD’s evaluation at Rideout Memorial Hospital and the

24 discharge instructions providing that if his symptoms worsened or new symptoms

25 developed, he must be taken to the Emergency Department immediately. Upon

26 information and belief, Defendants CUMMINGS, BROWN, YOUNG, WEISS,

27 BHANGU, STOHLMAN, EATON, AGUILAR, TAHARA, DIAZ, CRAWFORD, RAI,

28 and DICKSON each reviewed and/or were informed of NATHAN PRASAD’s jail custody

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1 file and/or medical file, including the medical documentation indicating his medical status

2 and need to be taken to the emergency room immediately if his symptoms worsened or

3 new symptoms developed.

4

e. Defendants FREMONT-RIDEOUT HEALTH GROUP and

5 FRATERS, who treated NATHAN PRASAD pursuant to a COUNTY OF SUTTER

6 contractual agreement to provide medical treatment to Sutter County Jail inmates,

7 discharged NATHAN PRASAD to a notoriously dangerous setting at Sutter County Jail on

8 January 26, 2011. They knew that NATHAN PRASAD was exhibiting signs of a serious

9 and life-threatening condition and would need access to emergency medical treatment if

10 his symptoms worsened or new symptoms developed. Defendants further acted with

11 deliberate indifference to the known risk of serious or lethal injury to NATHAN PRASAD

12 given that his safe discharge from the hospital depended on the capacity for timely

13 emergency medical response which they knew did not exist at Sutter County Jail, given the

14 hospital’s service agreement and their experience treating Sutter County Jail inmates.

15

f. From January 26 to January 28, 2011, NATHAN PRASAD reported

16 to each of Defendants BROWN, YOUNG, WEISS, BHANGU, AGUILAR, TAHARA,

17 DIAZ, CRAWFORD, RAI, and DICKSON that he was in extreme pain, having trouble

18 breathing, and afraid that he was going to die.

19

g. Defendants BROWN, WEISS and YOUNG each observed and

20 documented that NATHAN PRASAD’s condition and symptoms were clearly getting

21 worse, including but not limited to vomiting, shortness of breath, severe chills, coughing

22 and/or vomiting up blood, and “uncontrollable pain.”

23

h. On January 27, 2011 – the morning following NATHAN PRASAD’s

24 initial trip to Rideout Memorial Hospital – Defendant BROWN documented NATHAN

25 PRASAD’s alarming and clearly worsening symptoms including an abnormally high pulse

26 rate, precipitous drop in blood pressure, low grade fever, marked dehydration, and

27 increased bruising;

28

i. Defendants BHANGU, AGUILAR, DICKSON and RAI and each

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1 observed that NATHAN PRASAD’s condition and symptoms were clearly getting worse

2 and heard his and his fellow inmates’ pleas for medical help.

3

j. Inmates housed with NATHAN PRASAD collected the blood that

4 NATHAN PRASAD was coughing up in an empty milk carton, showing it to Defendants

5 BROWN, YOUNG, RAI, and DICKSON, in a desperate effort to obtain medical attention

6 and treatment for him.

7

k. In the pre-dawn hours of January 28, 2011, Defendants RAI and

8 YOUNG observed, and Defendant YOUNG documented, NATHAN PRASAD’s

9 significant suffering and life-threatening symptoms, including dangerously low blood

10 pressure and blood-oxygen saturation, coughing and/or vomiting up blood, dizziness,

11 sweats, and reports that NATHAN PRASAD feared that he was “going to die.” Defendant

12 GARBETT was informed of these alarming symptoms but did nothing whatsoever in

13 response. Defendants STOHLMAN, EATON, TAHARA, DIAZ and CRAWFORD each

14 witnessed and/or were informed of NATHAN PRASAD’s severe distress and need for

15 immediate medical care, yet did nothing to secure that care despite knowing that

16 Defendant YOUNG was providing no treatment whatsoever.

17

l. Not until four (4) hours after these observations and documented

18 reports did Sutter County Jail staff contact emergency medical services and summon an

19 ambulance. By the time emergency personnel arrived, NATHAN PRASAD’s condition

20 had deteriorated so substantially that his condition was dire. He died soon thereafter at the

21 hospital.

22

m. Defendants CUMMINGS, BHATTAL and GARBETT fail to

23 maintain a medical records system that appropriately documents and transmits critical

24 medical information about Jail inmates to affiliated health care providers, knowing that

25 such failure will prevent critically ill inmates like NATHAN PRASAD from receiving

26 appropriate treatment.

27

n. Defendants PARKER, SAMSON, BIDWELL, CUMMINGS,

28 BHATTAL, and GARBETT developed, implemented and endorsed deficient emergency

30
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1 response policies and procedures, and exhibited a persistent failure to train staff regarding

2 the provision of emergency medical care, knowing that these acts and omissions

3 endangered critically ill inmates such as NATHAN PRASAD.

4

105. Defendants PARKER, SAMSON, BIDWELL, CUMMINGS, BHATTAL,

5 GARBETT, BROWN, YOUNG, WEISS, BHANGU, STOHLMAN, EATON, AGUILAR,

6 TAHARA, DIAZ, CRAWFORD, RAI, DICKSON, FREMONT-RIDEOUT HEALTH

7 GROUP and FRATERS disregarded these known risks by failing to provide necessary

8 evaluation and treatment for NATHAN PRASAD while he was detained at Sutter County

9 Jail.

10

106. Defendants’ acts and/or omissions as alleged herein, including but not

11 limited to their failure to provide NATHAN PRASAD with timely or adequate medical

12 care and/or to take other measures to protect him from serious harm, along with the acts

13 and/or omissions of the Defendants in failing to train, supervise and/or promulgate

14 appropriate policies and procedures at Sutter County Jail in order to prevent NATHAN

15 PRASAD’s and other inmate deaths, constituted deliberate indifference to NATHAN

16 PRASAD’s serious medical needs, health and safety.

17

107. As a direct and proximate result of Defendants’ conduct, NATHAN

18 PRASAD experienced physical pain, severe emotional distress, mental anguish, loss of his

19 life, and NATHAN PRASAD and Plaintiffs suffered injuries and damages as alleged

20 herein.

21

108. The aforementioned acts and/or omissions of Defendants PARKER,

22 SAMSON, BIDWELL, CUMMINGS, BHATTAL, GARBETT, BROWN, YOUNG,

23 WEISS, BHANGU, STOHLMAN, EATON, AGUILAR, TAHARA, DIAZ,

24 CRAWFORD, RAI, DICKSON, FREMONT-RIDEOUT HEALTH GROUP, and

25 FRATERS were malicious, reckless and/or accomplished with a conscious disregard of

26 decedent’s rights thereby entitling Plaintiffs to an award of exemplary and punitive

27 damages according to proof, to punish the wrongful conduct alleged herein and to deter

28 such conduct in the future.

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1

SECOND CLAIM FOR RELIEF

Municipal Liability for Violation of the Fourteenth Amendment to the Constitution

2

of the United States – Deliberate Indifference to Serious

Medical Needs, Health and Safety

3

(Survival Action - 42 U.S.C. § 1983)

(Against Defendant COUNTY OF SUTTER)

4

109. Plaintiffs re-allege and incorporate by reference paragraphs 1 through 108 of

5

this complaint as though fully set forth herein.

6

110. Defendants PARKER, SAMSON and BIDWELL are charged with

7

developing and implementing policies and procedures for the Corrections Unit of the

8

Sutter County Sheriff’s Department. The policies, customs and practices that they ratify

9

and implement pursuant to this authority are thus imputable to COUNTY OF SUTTER.

10

111. Defendants CUMMINGS, BHATTAL and GARBETT are charged with

11

developing and implementing policies and procedures for the provision of medical services

12

at Sutter County Jail. The policies, customs and practices that they ratify and implement

13

pursuant to this authority are thus imputable to COUNTY OF SUTTER.

14

112. The aforementioned acts and/or omissions of Defendants in being

15

deliberately indifferent to NATHAN PRASAD’s serious medical needs, health and safety

16

and violating NATHAN PRASAD’s civil rights were the direct and proximate result of

17

customs, practices and policies of Defendants COUNTY OF SUTTER, by and through

18

their agencies, employees and/or agents, including Defendants PARKER, SAMSON,

19

BIDWELL, CUMMINGS, BHATTAL and GARBETT, as alleged herein.

20

113. Such policies, customs and/or practices include but are not limited to an

21

ongoing pattern of deliberate indifference, including the following: the failure to maintain

22

a medical records system that appropriately documents and transmits critical medical

23

information about Jail inmates to affiliated health care providers; the failure to ensure

24

implementation of appropriate medical and emergency treatment plans; the failure to act

25

upon clearly life-threatening symptoms and reports; the failure to provide appropriate

26

staffing and training at Sutter County Jail to provide minimally adequate medical treatment

27

for seriously ill inmates; and the failure to implement a policy to ensure that staff would

28

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1 contact and summon emergency medical treatment in a timely manner.

2

114. Such policies, customs and/or practices have persisted even in the face of a

3 grand jury report finding “unacceptable that the program is out of compliance, [the] lack of

4 training for the nursing staff, [and] not having the [policies and procedures] up-to-date.”

5 Even NATHAN PRASAD’s horrific death in custody did not yield any prompt revision of

6 policies and procedures to ensure that basic emergency care was provided to Jail inmates.

7 The continuation of such policies, customs and/or practices in the face of repeated findings

8 that they are dangerous evinces deliberate indifference of the part of COUNTY OF

9 SUTTER and its policymakers PARKER, SAMSON, BIDWELL, CUMMINGS,

10 BHATTAL and GARBETT to the woefully inadequate and unconstitutional level of

11 medical care at the Jail.

12

115. Defendant COUNTY OF SUTTER and its policymakers PARKER,

13 SAMSON, BIDWELL, CUMMINGS, BHATTAL and GARBETT tacitly encouraged,

14 ratified and/or approved of the acts and/or omissions alleged herein, and knew that such

15 conduct was unjustified and would result in violations of constitutional rights.

16

116. The customs, policies and/or practices of Defendants COUNTY OF

17 SUTTER were a direct and proximate cause of Plaintiffs’ injuries and the death of the

18 NATHAN PRASAD in that Defendant COUNTY OF SUTTER failed to adequately train

19 and supervise its employees and/or agents to prevent the occurrence of the constitutional

20 violations suffered by Plaintiffs and NATHAN PRASAD, and by other inmates at Sutter

21 County Jail. Defendant COUNTY OF SUTTER also failed to promulgate appropriate

22 policies or procedures or take other measures to prevent the constitutional violations

23 suffered by Plaintiffs and NATHAN PRASAD, and by other inmates at Sutter County Jail.

24

117. As a direct and proximate result of the aforementioned customs, policies

25 and/or practices of Defendant COUNTY OF SUTTER, NATHAN PRASAD and Plaintiffs

26 suffered injuries and damages as alleged herein.

27

28

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1

THIRD CLAIM FOR RELIEF

Supervisory Liability for Violation of the Fourteenth Amendment to the Constitution

2

of the United States – Deliberate Indifference to Serious

Medical Needs, Health and Safety

3

(Survival Action - 42 U.S.C. § 1983)

(Against Defendants J. PAUL PARKER, DAVID SAMSON, NORMAN BIDWELL,

4

CHRISTINA STOHLMAN, LESTER EATON, LOU ANNE CUMMINGS,

AMERJIT BHATTAL, and BRENT GARBETT)

5

118. Plaintiffs re-allege and incorporate by reference paragraphs 1 through 117, as

6

though fully set forth herein.

7

119. Defendants PARKER, SAMSON, BIDWELL, STOHLMAN and EATON

8

were responsible for supervising all Sutter County Sheriff’s Department custodial

9

employees and/or agents. Defendants PARKER, SAMSON, BIDWELL acted in their

10

supervisory capacity in committing the acts alleged herein.

11

120. Defendants CUMMINGS, BHATTAL, and GARBETT were responsible for

12

supervising all medical and mental health employees and/or agents responsible for

13

providing care to inmates at the Jail. Defendants CUMMINGS, BHATTAL, and

14

GARBETT acted in their supervisory capacity in committing the acts alleged herein.

15

121. The aforementioned acts and/or omissions of Defendants GARBETT,

16

BROWN, YOUNG, WEISS, BHANGU, STOHLMAN, EATON, TAHARA, DIAZ,

17

CRAWFORD, RAI, and DICKSON in being deliberately indifferent to NATHAN

18

PRASAD’s serious medical needs, health and safety and violating decedent’s civil rights

19

were the direct and proximate result of customs, practices and policies of Defendants

20

PARKER, SAMSON, BIDWELL, CUMMINGS, BHATTAL, and GARBETT as alleged

21

herein.

22

122. Such policies, customs and/or practices include but are not limited to an

23

ongoing pattern of deliberate indifference, including the following: the failure to maintain

24

a medical records system that appropriately documents and transmits critical medical

25

information about Jail inmates to affiliated health care providers; the failure to ensure

26

implementation of appropriate medical and emergency treatment plans; the failure to act

27

upon clearly life-threatening symptoms and reports; the failure to provide appropriate

28

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1 staffing and training at Sutter County Jail to provide minimally adequate medical treatment

2 for seriously ill inmates; and the failure to implement a policy to ensure that staff would

3 contact and summon emergency medical treatment in a timely manner.

4

123. Defendants PARKER, SAMSON, BIDWELL, STOHLMAN, EATON,

5 CUMMINGS, BHATTAL and GARBETT tacitly encouraged, ratified and/or approved of

6 the acts and/or omissions alleged herein, and knew that such conduct was unjustified and

7 would result in violations of constitutional rights.

8

124. The customs, policies and/or practices of said Defendants were a direct and

9 proximate cause of Plaintiffs’ injuries and the death of the NATHAN PRASAD in that

10 Defendants failed to adequately train and supervise their employees and/or agents to

11 prevent the occurrence of the constitutional violations suffered by Plaintiffs and NATHAN

12 PRASAD, and by other inmates at Sutter County Jail. Defendants also failed to

13 promulgate appropriate policies or procedures or take other measures to prevent the

14 constitutional violations suffered by Plaintiffs and NATHAN PRASAD, and by other

15 inmates at Sutter County Jail.

16

125. As a direct and proximate result of the aforementioned customs, policies

17 and/or practices of Defendants, NATHAN PRASAD and Plaintiffs suffered injuries and

18 damages as alleged herein.

19

126. The aforementioned acts of Defendants PARKER, SAMSON, BIDWELL,

20 STOHLMAN, EATON, CUMMINGS, BHATTAL and GARBETT were willful, wanton,

21 malicious, and oppressive, thereby justifying an award of exemplary and punitive damages

22 to punish the wrongful conduct alleged herein and to deter such conduct in the future.

23

FOURTH CLAIM FOR RELIEF

Substantive Due Process in Violation of First and Fourteenth Amendments

24

to the Constitution of the United States – Loss of Parent/Child Relationship

(42 U.S.C. § 1983)

25

(Against All Defendants)

26

127. Plaintiffs re-allege and incorporate by reference paragraphs 1 through 126, as

27 though fully set forth herein.

28

128. The aforementioned acts and/or omissions of Defendants in being

35
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1 deliberately indifferent to NATHAN PRASAD’s serious medical needs, health and safety

2 and violating NATHAN PRASAD’s civil rights, and their failure to train, supervise and/or

3 take other measures at Sutter County Jail to prevent the conduct that caused the untimely

4 and wrongful death of NATHAN PRASAD, deprived Plaintiffs MARY PRASAD, T.P.,

5 A.P., and N.S. of their liberty interest in the parent-child relationship in violation of their

6 substantive due process rights as defined by the First and Fourteenth Amendments to the

7 United States Constitution.

8

129. As a direct and proximate result of the aforementioned acts and/or omissions

9 of Defendants, Plaintiffs suffered injuries and damages as alleged herein.

10

130. The aforementioned acts and/or omissions of the individually named

11 Defendants were willful, wanton, malicious, and oppressive, thereby justifying an award of

12 exemplary and punitive damages to punish the wrongful conduct alleged herein and to

13 deter such conduct in the future.

14

FIFTH CLAIM FOR RELIEF

Failure to Furnish/Summon Medical Care

15

(Survival Action – Cal. State Law)

(Against Defendants BRENT GARBETT, DORIS BROWN, MELODY YOUNG,

16 KIMBERLY WEISS, GURKIRAT BHANGU, CHRISTINA STOHLMAN, LESTER

EATON, MIGUEL AGUILAR, OLGA TAHARA, ROSA DIAZ, ERIC

17

CRAWFORD, BALJINDER RAI, and SHANE DICKSON)

18

131. Plaintiffs re-allege and incorporate by reference paragraphs 1 through 130, as

19 though fully set forth herein.

20

132. All Defendants owed NATHAN PRASAD a duty of care to provide him

21 immediate medical care.

22

133. The conduct of Defendants GARBETT, BROWN, YOUNG, WEISS,

23 BHANGU, STOHLMAN, EATON, AGUILAR, TAHARA, DIAZ, CRAWFORD, RAI,

24 and DICKSON alleged herein, including but not limited to the facts that these Defendants

25 knew or had reason to know that NATHAN PRASAD was in need of immediate medical

26 care, and that Defendants failed to take reasonable action to summon such care or to

27 provide that care, resulting in NATHAN PRASAD’s death as alleged herein, breached that

28 duty and violated California state law, including Cal. Govt. Code Sections 844.6 and

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1 845.6.

2

134. The alleged conduct of each of Defendants GARBETT, BROWN, YOUNG,

3 WEISS, BHANGU, STOHLMAN, EATON, AGUILAR, TAHARA, DIAZ,

4 CRAWFORD, RAI and DICKSON was committed within the course and scope of his or

5 her employment.

6

135. As a direct and proximate result of the breach(es) committed by Defendants

7 GARBETT, BROWN, YOUNG, WEISS, BHANGU, STOHLMAN, EATON, AGUILAR,

8 TAHARA, DIAZ, CRAWFORD, RAI and DICKSON, NATHAN PRASAD and Plaintiffs

9 suffered injuries and damages as alleged herein, including NATHAN PRASAD’s great

10 pain and ultimately his death.

11

136. The aforementioned acts of Defendants GARBETT, BROWN, YOUNG,

12 WEISS, BHANGU, STOHLMAN, EATON, TAHARA, DIAZ, CRAWFORD, RAI and

13 DICKSON were willful, wanton, malicious, and oppressive, thereby justifying an award of

14 exemplary and punitive damages to punish the wrongful conduct alleged herein and to

15 deter such conduct in the future.

16

SIXTH CLAIM FOR RELIEF

Wrongful Death, Cal. Code Civ. Proc. § 377.60

17

(Against All Defendants)

18

137. Plaintiffs re-allege and incorporate by reference paragraphs 1 through 136, as

19 though fully set forth herein.

20

138. NATHAN PRASAD’s death was a direct and proximate result of the

21 aforementioned wrongful acts and/or omissions of Defendants COUNTY OF SUTTER,

22 PARKER, SAMSON, BIDWELL, CUMMINGS, BHATTAL, GARBETT, BROWN,

23 YOUNG, WEISS, BHANGU, STOHLMAN, EATON, AGUILAR, TAHARA, DIAZ,

24 CRAWFORD, RAI, DICKSON, FREMONT-RIDEOUT HEALTH GROUP, and

25 FRATERS. These Defendants’ acts and/or omissions thus were also a direct and

26 proximate cause of Plaintiffs’ injuries and damages, as alleged herein.

27

139. NATHAN PRASAD’s death was a direct and proximate result of the

28 aforementioned negligent acts and/or omissions of Defendants COUNTY OF SUTTER,

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1 PARKER, SAMSON, BIDWELL, STOHLMAN, EATON, AGUILAR, TAHARA, DIAZ,

2 CRAWFORD, RAI and DICKSON. These Defendants’ acts and/or omissions thus were

3 also a direct and proximate cause of Plaintiffs’ injuries and damages, as alleged herein.

4

140. As a direct and proximate result of these acts and/or omissions of

5 Defendants, Plaintiffs incurred expenses for funeral and burial expenses in an amount to be

6 proved.

7

141. As a direct and proximate result of these acts and/or omissions of

8 Defendants, Plaintiffs MARY PRASAD, T.P., A.P., and N.S. suffered injuries and

9 damages as alleged herein, including the loss of the services, society, care and protection

10 of the decedent, as well as the loss of the present value of his future services to his family.

11 Plaintiffs are further entitled to recover prejudgment interest.

12

142. The aforementioned acts of the individually named Defendants were willful,

13 wanton, malicious, and oppressive, thereby justifying an award to Plaintiffs of exemplary

14 and punitive damages to punish the wrongful conduct alleged herein and to deter such

15 conduct in the future.

16

PRAYER FOR RELIEF

17

WHEREFORE Plaintiffs pray for judgment against Defendants as follows:

18

1. For compensatory, general and special damages against each Defendant,

19 jointly and severally, in the amount proven at trial;

20

2. For damages related to loss of familial relations as to Plaintiffs MARY

21 PRASAD, T.P., A.P., and N.S.;

22

3. Funeral and burial expenses, and incidental expenses not yet fully

23 ascertained;

24

4. General damages, including damages for physical and emotional pain,

25 emotional distress, hardship, suffering, shock, worry, anxiety, sleeplessness, illness and

26 trauma and suffering, the loss of the services, society, care and protection of the decedent,

27 as well as the loss of financial support and contributions, loss of the present value of future

28 services and contributions, and loss of economic security;

38
THIRD AMENDED COMPLAINT – CASE NO. 2:12-CV-00592-TLN-CKD

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 40 of 185

[1071448-2]

1

5. Prejudgment interest;

2

6. For punitive and exemplary damages against each individually named

3 Defendant in an amount appropriate to punish Defendants and deter others from engaging

4 in similar misconduct, in amounts according to proof;

5

7. For lost wages, employment opportunities, and other losses in an amount

6 according to proof;

7

8. For costs of suit and reasonable attorneys’ fees and costs pursuant to 42

8 U.S.C. § 1988, and as otherwise authorized by statute or law;

9

9. For restitution as the court deems just and proper;

10

10. For such other and further relief as the court deems just and proper.

11

12 DATED: February 28, 2014

Respectfully submitted,

13

ROSEN BIEN GALVAN & GRUNFELD LLP

14

By: /s/ Ernest Galvan

15

Ernest Galvan

16 Attorneys for Plaintiffs
17

18

DEMAND FOR JURY TRIAL

19

Plaintiffs hereby demand a jury trial.

20

21 DATED: February 28, 2014

Respectfully submitted,

22

ROSEN BIEN GALVAN & GRUNFELD LLP

23

By: /s/ Ernest Galvan

24

Ernest Galvan

25 Attorneys for Plaintiffs
26

27

28

39
THIRD AMENDED COMPLAINT – CASE NO. 2:12-CV-00592-TLN-CKD

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 41 of 185
ATTACHMENT A

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Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 43 of 185

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 44 of 185

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 45 of 185
Honorable Judge Chris Chandler Sutter County Superior Court 446 2nd Street Yuba City, CA 95991
Dear: Judge Chandler
In accordance with the California Penal Code Section 933, the 2010-2011 Sutter County Grand Jury has completed its duties with the release of the Final Report to the Court and to the citizens of Sutter County. We were privileged to be selected a year ago to serve on the Sutter County Grand Jury as “a voice of the people and conscience of the community.” We took our work seriously and did our best to approach our reviews and investigations objectively and thoroughly.
It has been a year of learning and hard work in gaining new insights; some were frustrations, and some were fun. We have all had personal growth in this Grand Jury experience. As is with any new Grand Jury, eighteen independent individuals with distinctive talents and skills successfully formed cohesive efforts to make their contribution to the citizens of this county. Members of this Jury have dedicated countless hours of work investigating, compiling, debating, and writing these reports. Each member of this Grand Jury contributed greatly to this report. I am proud of my fellow jurors and all they have accomplished.
This year was Judge Brian Aronson second year as the supervising judge for the Grand Jury. We would like to thank Judge Aronson, together we have learned a lot. To complete our work, we had the assistance of the county's court staff, particularly Christine Dagnino and Jackie Laswell. Each staff member we encountered was friendly and helpful. Our thanks to District Attorney Carl Adams and his staff who assisted us along the way taking our phone calls and providing us with the information we needed to perform our duties as members of the Grand Jury. We commend District Attorney Carl Adams dedication of time as the legal advisor for the Grand Jury for the past twenty-eight years. The Court Security Staff was very helpful as we navigated unfamiliar territory around the courthouse. Many individuals from the various agencies we visited were also helpful in countless ways.
In Conclusion I would like to thank this year’s Grand Jurors for their conscientious effort and commitment. I would also like to thank Tammie Putman for her dedication and service as the Pro-tem and Secretary of the 2010-2011 Sutter County Grand Jury. Her dedication has made our job much easier. In closing, I would also like to express my
2

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Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 47 of 185

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 48 of 185

Table of Contents

Page

AD-HOC Committee

7

Sutter County Jail Nurses Program Citizens Complaint

8

Attachment A

12

Audit and Finance Committee

13

Misallocation of Bradley-Burns and Transportation Tax Fund Deposits 14

Attachment A

19

Attachment B

20

Attachment C

21

County Government and Administration Committee

22

County Government Release of Public Information

23

Criminal Justice Committee

26

Leo Chesney Community Correctional Facility

27

Sutter County Jail

29

Sutter County Department of Child Support Services

31

Yuba City Police Department

34

Yuba-Sutter Juvenile Hall Camp Singer Youth Guidance Center

35

Education Committee

38

Sutter County Superintendent of Schools

39

Sutter Union High School

43

Fire and Emergency Committee

45

Office of Emergency Management

46

Twin Cities Rod and Gun Club

48

5

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 49 of 185

Health and Mental Health Services Committee

50

Sutter-Yuba Mental Health Services

51

Planning and Environment Committee

54

Sutter County Environmental Health Division

55

Sutter County Planning Services

57

Public Buildings and Properties Committee

58

Sutter County Animal Control Shelter

59

Social Services Committee

78

Maternal, Child and Adolescent Health Program

79

Sutter County Department of Human Services

81

Continuity Committee

84

Department of Child Support Services

85

Leo Chesney Community Correctional Facility

86

Sutter County Jail

87

Yuba City Police Department

88

Yuba-Sutter Juvenile Hall

89

6

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 50 of 185
AD-HOC Committee
7

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 51 of 185
Sutter County Jail Nurses Program Citizens Complaint
Introduction
The 2010-2011 Sutter County Grand Jury (SCGJ) received a citizen's complaint on the Sutter County Jail Nurses Program. The complaint alleged illegal practices, lack of training, out of compliant policies/procedures and poor inmate medical care.
The Grand Jury established an Adhoc Committee to undertake an investigation to determine these allegations on the complaint. Interviews were held with supervisors, managers, and staff of the Sutter County Jail. The Adhoc Committee completed an investigation of this complaint and made a number of recommendations resulting from that investigation.
Discussion
The Sutter County Jail Nurses program is to ensure provision of emergency and basic health care services to individuals who are in custody. Nursing Staff provides health care to the incarcerated from booking until the time of release. Along with the Physician and Nurse Practitioner, there is a Jail Nurse Manager, a Supervising Registered Nurse (SRN) , three Licensed Vocational Nurses (LVN)'s and 7-8 contract LVN's. Since November 2010, the county has an open position for a second SRN.
The Grand Jury felt the allegations in the complaint were serious and needed to be investigated.
The complaint alleges the following:
Inadequate R.N. Coverage
According to the complaint, per Legal Decree #CIV-S-93-1256 DFL JFM (P) of Dempsey W. Haller, et al. vs. The County of Sutter, et al. (see attachment, A) states in part:
E. 2. Staffing: "Jail medical staffing is the responsibility of the County's Human Services Department and shall consist of at least one registered nurse on site during either the day shift or the evening shift seven days per week, and either one registered nurse or one LVN on site during the other day shift or evening shift as appropriate, seven days per week ... "
Prior to the resignation of a SRN, there was one SRN and LVN on the day shift or one SRN and LVN on the night shift. There was an incident when the SRN on the night shift became ill while on duty. The SRN called in a LVN for backup. The SRN was reprimanded by the Jail Nurse Manager in an email that there should have been a Registered Nurse on duty. The SRN was referred to legal decree #CIV-S-93-1256 DFL
8

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 52 of 185
JFM (P) against Sutter County, which states the requirement. The SRN was not told of this legal decree prior to this incident. According to the staff, there had been 20 days so far that year that this had occurred. During the investigation, it was noted that this was a common occurrence since there were only two SRNs.
Lack of Training
According to the complaint training of staff nurses has not occurred in more than five (5) years. Annual onsite training is necessary to maintain proficiency in emergency response procedures.
Before the SRN resigned, the SRN requested onsite training. The SRN's request was refused by the Jail Nurse Manager. The SRN put together training on Emergency Response in the jail. The SRN asked for a review ofthe materials and the Jail Nurse Manager refused to even look at the class outline. The SRN held the class with a few nurses and correctional staff in attendance.
Out of Compliant Policies and Procedures
The complaint alleged the Jail Nurses Program is out of compliance with California State correctional code - Title 15 sec 1206 Policy and Procedures (P&P) are to be reviewed annually. Standardized Nursing Procedures (SNP) have not been reviewed or updated since 1995. The SNP has been changed with pencil marks.
The nursing staff has inquired as to why these P&P's and the SNP's are outdated. The Jail Nursing Manager's answer is lack oftime prevents him from completing the task.
Finding
Inadequate R.N. Coverage
The Nurse staffing at the Jail has been directed by a court order in Dempsey W. Haller vs. Sutter County, et al. No. CIV-S-93-1256 DFL JFM (P). Failure to comply with this order Sutter County can be found out-of-compliance and could be liable for additional action by the Court.
Recommendation
Every effort should be made to hire an additional SRN and ensure one is available for either the AM shift or the PM shift. The Nursing Program Manager needs to take a more active role in managing the Jail Nursing Program. Once the SRN position is filled, the Nursing Program Manager, who is also an RN, must be utilized to ensure the Jail Nursing Program is in compliance with the court order.
9

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 53 of 185
The Assistant Director of Health and Human Services should provide oversight to insure the Jail Nursing Program is in full compliance with court order Legal decree #CIV-S-931256 DLF JFM (P).
Finding
Lack of Training
Legal decree #CIV-S-93-1256 DLF JFM (P) E19. Training: "Jail custody staff shall receive periodic update training in First Aid, CPR, intake screening, blood borne pathogens and suicide prevention..."
Sutter County Jail Medical Policies and Procedures #3 Section 6. "Oversees training of nurses and/or officers in areas where improvement is needed, as identified by QA audits, including regular and continued joint staff development activities. These will be documented as to date given, content, attendees and comments."
Training is necessary to maintain proficiency in on-site activities. The Nursing Program Manager has failed to offer his nursing staff any of the required training. When one of his SRN's put together an emergency response training class he refused to review the course outline before the class was held.
Recommendation
The Grand Jury recommends the Nursing Program Manager along with the Medical Officer, develop a training program to ensure adequate on-site training be made available to the nursing staff on a regular basis. The Assistant Director of Health and Human Services should provide oversight to ensure this training program is implemented.
Finding
Out of Compliance Policies and Procedures
Title 15 Regulations 1206. Health Care Procedure Manual "The health authority shall in cooperation with the facility administrator, set forth in writing, policies and procedures in conformance with applicable State and Federal law, which are reviewed and updated at least annually..."
During the investigation, it was stated unanimously that the P&P's were significantly outof-date. The County Medical Officer is responsible for making sure the P&P's are current by signing them annually. The Jail Nurse Program Manager has overall responsibility to see that the Nursing Program policies and procedures are operational and functioning in the scope as laid out in the Standard Nursing Procedures. The Jail Nurse Program Manager has not done this. When the Jail Nurse Program Manager was hired, the P&P's were not up to date. By not correcting these problems, his inaction has allowed this
10

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 54 of 185
situation to deteriorate further. The Jail Nurse Program Manager indicated it would take over a year to complete. This should be made a priority. Recommendation The County Medical Officer and the Jail Nurse Program Manager with oversight from the Assistant Director of Health and Human Services should ensure the Jail Nursing Program P&P's are reviewed, rewritten, and made current so they can be used and referred to by the jail staff. The Standard Nursing Procedures has been changed with pencil marks and needs to be corrected. The Grand Jury recommends that these documents be completed by December 31, 2011. The Jail Nursing Program would also benefit from more active oversight by the Assistant Director of Health and Human Services to see that it is accomplished by the above date. Finding During this investigation the Grand Jury finds the Jail Nursing Program is completely out of compliance with annual nurse training updates and standard nursing procedures. This exposes Sutter County to numerous potential issues in the future. Recommendation The Grand Jury recommends that the Assistant Director of Health and Human Services actively take measures to ensure that this program is in full compliance with the law. It is unacceptable that the program is out of compliance, lack of training for the nursing staff, not having the P & P's up-to-date, and the pencil corrections in the SNP. The Grand Jury recommends that the Jail Nursing Program be in full compliance by December 31, 2011. Respondents Director of Health and Human Services, Tom Sherry Assistant Director of Health and Human Services, Amerjit Bhattal County Medical Officer, Dr. Cummings Jail Nurse Program Manager, Brent Garbett
11

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 55 of 185 Attachment A
12

- Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 56 of 185

\

'_.
I

I

L_

,~.-
"--

-....I.

DARRELL W. LARSEN - Bar No. 044272 \
SUTTER COUNTY COUNSEL JAMES SCANLON - Bar No. 078914 DEPUTY COUNTY COUNSEL 1160 Civic Center Blvd. Yuba City, CA 95993 Telephone: (916) 741-7110
JOHN HAGAR - Bar No. 81039 LAW OFFICE OF JOHN HAGAR P. O. Box 86935 Los Angeles, CA 90086-0935
Attorneys for Defendants COUNTY OF SUTTER and SHERIFF ARTHUR R. BRANDWOOD
L.~=}.:.:D

SEP.141994
C' ~:;;;, ii. S. DISTRICl COURT EASTERN DISTRICT OF CAliFORNIA BY ------::-"r~l':":";l'T:::O:y(:~_LE~R~K

" 4

UNITED STATES DISTRICT COURT

c

FOR THE EASTERN DISTRICT OF CALIFORNIA

DEMPSEY W. HALLER, et al.

)

)

Plaintiffs,

)

)

vs.

)

)
THE COUNTY OF SUTTER, et a1. )

)

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

No. CIV-S-93-1256 DFL JFM (P)
AMENDED SETTLEMENT AGREEMENT

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 57 of 185
The parties hereby stipulate to settlement of the issues remaining in this case as follows:
A. Clothing Exchange: Defendants will provide Jail inmates with clothing upon intake, and periodic clothing exchanges pursuant to Title 15, section 1260, 1261, 1262, 1263, and 1264. All references to Title 15 in this agreement are to Title 15 as amended in 1994.
B. Recreation: Defendants will provide Jail inmates with outdoor recreation pursuant to Title 15, section 1065. Defendants will make best efforts to provide Main Jail inmates wi th outdoor recreation five times per week. In addition, defendants will provide, subject to security considerations, the following recreation equipment in the Jail's outdoor recreation yards [both male and female]: portable basketball hoops, volleyball nets and balls, handballs, and one Santa Clara County Hermo II exercise machine,'
C. Food: Defendants will complete the Jail's kitchen remodel project by September 1, 1994, Thereafter, defendants will comply with Title 15 standards, specifically sections 1240, 1241, 1242, 1243, 1245, 1246, 1247, 1248, and 1249 concerning food preparation in the Jail.
D. Law Library: Defendants will participate in an experiment to provide CD-Rom law library materials to Jail inmates ef fecti ve september 1, 1994, There will be a CD-Rom library for inmates in the Jail.
lA Hermo II is also provided to inmates housed in the Jail Dormitory housing unit.
2

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 58 of 185
1. All inmates will be provided with access to the CD-Rom library and hardbound law library regardless of sentenced or presentenced status, regardless of whether the inmate is represented by counsel.
2. CD-Rom library and hardbound law library access will be subject to reasonable security, staffing and time restrictions .
. \
Inmates facing court deadline and inmates proceeding "in pro per" in local courts will be afforded priority access.
3. Inmates who request access to the CD-Rom o~ hardbound law library will be provided direct access without staff present and will be allowed to browse among the available CD disks and law books and to work on their legal cases wi thin the law library.
4. The Jail CD-Rom West Publishing inventory is attached as Exhibit A. The Jail hardbound book law library is attached as Exhibit B.
5. Inmates working with the CD-Rom legal system will have access to a computer, CD drive, dot matrix printer and written instructions explaining how to access CD-Rom materials will be provided by plaintiffs' counsel.
6. The above-referenced experiment will continue for at least a period of twelve [12] months. Counsel for the parties will communicate at least every six months concerning the status of this experiment. At the conclusion of this period the parties shall meet and confer in good faith concerning the long term use of CD-Rom and hardbound law books.
3

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 59 of 185
E. Medical Care: Defendants will modify their delivery of medical services system to provide medical, mental health, and dental care to the plaintiff class as set forth below, the implementation of which service systems will be commenced immediately and will be completed on or about January 1, 1995.
1. Intake screening: Jail medical intake screening shall .\
be performed by a Sheriff's custody staff trained in screening procedures by County medical and mental health personnel. The intake screening form shall meet the criteria established by Title 15 of the California Code of Regulations and the California Medical Association. Jail medical staff shall review all intake screening forms as soon as possible, in most cases the same day as booking, but in no event later than the next shift when nursing staff is available.
2. Staffing: Jail medical staffing is the responsibility of the County's Human Services Department and shall consist of at least one registered nurse on site during either the day shift or the evening shift seven days per week, and either one registered nurse or one LVN on site during the other day shift or evening shift as appropriate, seven days per week. Supplementing this nursing coverage shall be on-site visits by a nurse practitioner or physician's assistant two days per week for a total of approximately four hours per week, and on-site visits by a physician twice per week for approximately five hours. Excluding weekends and county holidays, there will be an on-site visit by either a nurse practitioner, physician's assistant, or a phys ician not less frequently than every other day. Further
4

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 60 of 185

supplementing this coverage shall be on-site visits by a County

mental health staff crisis counselor for approximately 18 hours

per week, for no less than 3 separate visits each week. On-site

visits for physicians and mental health workers will take place,

whenever possible, on established days and hours. Clerical

support will be provided the Jail nurses as appropriate. J 3. Sick Call: There shall be a screening process

concerning inmate medical problems and complaints conducted by

the Jail nursing staff or a nurse practitioner or a Physician's

assistant. To access sick call, inmates shall utilize a Jail

Sick Call Request form. The triage for sick call slips shall

take place daily, formal sick call shall be available five days

per week.

4. Pill Call: Medications shall be distributed to Jail

inmates by County medical and/or Jail staff based upon protocols

established and approved by the County Department of Human

Services. All medications shall be distributed the appropriate

number of times per day deemed medically necessary by County

medical/mental health staff.

5. Inmate Medical Records:

Inmate medical/mental

heal th/dental records shall be maintained in a confidential

manner and in a secure setting. The Jail's medical staff shall

maintain records on site at the Jail which document inmate

medical problems and which include the information and documents

deemed necessary by established protocols based upon Title 15

Minimum Jail Standards.

1/11/

5

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 61 of 185

6. Access to Specialized Clinics: Inmates shall have

access to specialized clinics and care as deemed appropriate by

County medical, dental, and mental health providers.

7. Inmates With Acute Illnesses: Inmates with acute

illnesses shall be transferred to alternative sites for care as

deemed appropriate by County medic.. al and/or mental health staff . 8. Detoxification: The Jail shall maintain written

detoxification procedures which are utilized by both Sheriff's

and County medical staff. These procedures shall comply with the

standards set forth in the Title 15 "Minimum Standards" for Local

Detention Facilities in the California Code of Regulations.

9 . Communicable Diseases: The Jail shall maintain its

plan to detect, control, and treat inmates with priority

communicable diseases. The program to detect, control and treat

inmates with communicable diseases will describe how the

identification, treatment, control, and follow-up management of

inmates with communicable diseases will occur.

Priority

communicable diseases will include TB, HIV/AIDs, STD's, Hepatitis

A and B, Rubella, Measles and other diseases identified by Jail

staff and the Sutter County Public Health Officer.

10. Standardized Practices: The Jail's medical personnel

shall follow established written treatment protocols prepared by

the County's Department of Human Services. These treatment

protocols, and the medical policies and procedures utilized by

Jail medical staff shall be completely revised and approved by

all of the involved County agencies. Jail policies, procedures,
Q
and treatment protocols shall follow the format established by

the California Medical Association.

6

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 62 of 185

11. Suicide Prevention: The Jail shall maintain a suicide

prevention program which includes instruction by County mental

health staff [both classroom and video training] for Sheriff's

personnel working with the Jail.

12. Dental Care: Inmates requiring dental care shall be

referred to a private provider who shall provide the appropriate .1
care necessary to alleviate pain, prevent infections, and treat

emergency dental needs. Dental care shall be timely depending

upon the pain and seriousness of the dental problem. nental care

shall not be limited to extractions, however, the dental care

provided to Jail inmates is not intended to deal with years of

personal neglect.

13. Management of Pharmaceuticals:

Pharmaceutical

practices will comply with section 1216 of the Title 15 Minimum

Standards for Local Detention Facilities.

14. Sick Call Forms: The Jail's sick call form, including

the form necessary to request mental health care, shall be

printed in English, Spanish, and Punjabi. Inmates who request

that a staff member act as a translator during the sick call or

intake screening process shall be provided with language

assistance as deemed appropriate by Jail staff. Access to forms

shall include access to information concerning how to obtain

medical, mental health, and dental care within the Jail.

15. Quality Assurance: The responsible County physician

for the Jail under Title 15, section 1202 shall establish a

mechanism to assure that the quality and adequacy of medical,

dental, and mental health care is annually assessed. The plan

7

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 63 of 185
shall include a means for the correction of identified deficiencies of the medical/dental/mental health and pharmaceutical services provided and shall include the statistical gathering set forth in Title 15. In addition, and as part of this plan, monthly meetings shall be held between the
Jail's custody and medical/mental• health staff .
16. Informed Consent: The Jail has established procedures which conform to Title 15, section 1214 of the California Code of Regulations.
17. Food Handlers: The responsible physician shall develop procedures for medical screening of food handlers prior to working in the facility kitchen. Additionally, there shall be written procedures for education and ongoing monitoring and cleanliness of food service workers in accordance with section 27605 of the Health and Safety Code, California Uniform Retail Food Facilities Law.
18. Jail Medical Office: The Jail's medical office shall be renovated by March 1, 1995.
19. Training: Jail custody staff shall receive periodic update training in First Aid, CPR, intake screening, blood borne pathogens,and suicide prevention.
20. OSHA: The Jail will implement a program to address the OSHA blood borne pathogen requirements.
21. Women's Rights: The Jail will post as necessary the pregnancy related rights of female inmates as set forth by the California Penal Code.
8

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 64 of 185

22. HIV Testing: HIV testing will be provided in the Jail

upon request. Pre and post test counselling will be provided.

F. Ei ther party may seek to change the terms of this

SETTLEMENT AGREEMENT pursuant to the standards set forth in Rufo

v. Inmates of Suffolk County Jail, 502 U.S.

, 112 S.Ct. 748

(1992).

G. In the event that an emergency threatens the Sheriff's

ability to comply with these orders, counsel for defendants will

notify counsel for plaintiffs no later than the neXt business

day.

H. Defendants shall pay to plaintiffs' counsel attorney

fees in the amount of $17,500 at the time of the filing of the

Final Judgment.

I. The parties have previously stipulated to a permanent

injunction filed on September 15, 1993 relating to any and all

population issues, a copy of which is attached hereto and

incorporated herein by reference as Exhibit C. This SETTLEMENT

AGREEMENT is intended to resolve all matters not covered by the

permanent injunction referred to above.

Upon the execution of this SETTLEMENT AGREEMENT, the

parties request a dismissal of all matters not covered by the

permanent injunction referred to above.

J. The parties stipulate and agree that the Magistrate

Judge and District Court Judge assigned this case will issue any

and all orders necessary for the dismissal of this action,

including but not by way of limitation any orders deemed

9

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 65 of 185

necessary regarding posting of this agreement and any Fairness

Hearing deemed necessary.

IT IS SO STIPULATED:

DATED: August ,~ , 1994

DARRELL W. LARSEN SUTTER CqVNTY COUNSEL

~, DATED: August

1994

COUNSEL Defendants
C?~(jIG~ PAUL COMISKEY Attorney for Plaintiffs

10

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 66 of 185
EXHIBIT A -- CD-ROM LIBRARY
1. The system will provide access to the following legal authorities:
(a) Reported cases of the United States Supreme Court (b) Federal 2d and Federal 3d Reporters (c) All available California reported cases (d) Annotated California Codes 2. The computer hardware system which will include a single work station terminal shall be selected by the Sutter County Sheriff with the concurrence with plaintiffs' counsel.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 67 of 185

EXHIBIT B -- LAW LIBRARY - BOOKS

In addition to computerized legal research, the law library shall

consist of at a minimum the following bound authorities or their

substantial equivalents:

.

1. West California Rules of Court, Sta.t' e - latest edition 2. West California Rules of Court, Federal - latest edition

3. West Federal Rules of Civil and Criminal Proceduri and Evidence - latest edition

4. Black's Law Dictionary - latest edition

5. Deerings California Penal Code - latest edition

6. Deerings California Civil Practice Code - latest edition

7. Federal Habeas Corpus - 2nd edition (Michie Company)

8. California Criminal Law

Book No. a. b. c. d.

1
Introduction to Crimes Elements of Crime Defenses Crimes Against the Person

Book No. a. b. c. d.

2 Crimes Crimes Crimes Crimes

Against Property Against Decency and Morals Against Public Peace and Morals Against Governmental Authority

Book No. 3 a. Punishment for Crimes

1

.- Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 68 of 185

..;.-'"! .... .;

1 DARRELL W. LARSEN [state Bar 144272] SUTTER COUNTY COUNSEL
2 JAMES SCANLON [State Bar #78914] DEPUTY COUNTY COUNSEL
3 1160 Civic Center Blvd. Yuba City: CA 95993
4 (916) 741-7110
5 JOHN HAGAR [State Bar #81039] LAW OFFICE OF JOHN HAGAR
6 P.O. Box 86935
Los Angeles, CA 90086-0935 7 (213) 626-2089

EXHIBIT C

R l',tt~"?;n('.ys for DE'_:end.ants ':OTJN'_~Y OF SUTTER

and SHERIFF ARTHUR R. BRANDWOOD

.'"

9

UNITED STATES DISTRICT COURT

10

FOR THE EASTERN DISTRICT OF CALIFORNIA

11

DEMPSEY W. HALLER, et al.

)

NO. CIV-S-93-1256 DFL ~AN (P)

12

)

Plaintiffs,

)

STIPULATION RE POPULATION

13

)

LIMITS, ORDER

vs.

)

14

)

THE COUNTY OF SUTTER, et al. )

15

)

Defendants.

)

16 ----------------------------)

17

18

19

20

21

22

23

24

25

26

27

28
1 ....._._-- -----------

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 69 of 185

-'*'f.~

1

The parties hereby agree and stipulate to the following

2 injunctive orders:

3

1. This action shall proceed as a class action pursuant to

4 Federal Rules of Civil Procedure, Rule 23b.

5

2. Defendants are enjoined from bedding inmates on the floor.

.,

6

3. The maximum assigned bed capacities for each housing unit

7 of the Sutter County Jail are set forth below:

8

Unit 1 - 8 bedli

...

9

Unit MPS - 24 beds*

10

unit MG - 24 bcds~

11

Medical Sheltered Living - 3 beds

12

Kitchen Trustee Unit - 8 beds

13

FPC - 4 beds

14

FPS - 6 beds*

15

FS - 10 beds*

16

FJ - 4 beds

17

Jail Dormitory - 62 beds*

18

4. Defendants may operate, if conditions warrant, housing

.,

19 units MPS I MS. FPS ~ ~nd FS at tT';C ::'er!s :ilio.....aCh3 ci.Lpacity defined

20 in paragraph 3. Defendants may operate, if conditions warrant, the

21 Jail Dormitory with as many as six beds ~ove the capacity defined 22 in paragraph 3. Defendants shall not house inmates .in HPS, MS, 23 FPS, FS, and the Jail Dormitory above the capacities agreed to in 24 paragraph 3 unless beds of like classification are not available in

25 other housing units. In the event units MPS, MS, FPS, FS, and the

26 Jail Dormitory are operated above the capacity set forth in T7 paragraph 3, outdoor recreation will be provided for those units

28

2

I Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 70 of 185
~'j-~

1 operating above the capacity set forth in paragraphs 3 for at least

2 one hour per day, five days per week. In no event will any housing

3 unit operate above its paragraph 3 capacity for more than 14

4 consecutive days and, in no event will the total Jail bed capacity

5 exceed by 14 beds the total capacity set forth in paragraph 3, 6 except that except that Defendants"' may operate the Jail Dormitory

7 at its existing bed capacity of 88 beds until the Minimum Facility

8 p:i:"t::5elltly u:'!der c.;on:;tructlon ":s oper.,.tional. 1 "

9

5. The prohibition against floorsleepers is effective

10 immediately. The popUlation limits set: forth in paragraphs 3"and

11 4 shall be effective forty five [45] days from the date that this

12 Order is approved by the District Court.

13

6. Defendants are enjoined from adding beds to the Main Jail

14 in each and every housing unit which exists on the date that this 15 stipulation is executed. 2

16

7. The Sheriff of Sutter County is authorized by this order

17 to release inmates from the Sutter County Jail whenever the sutter

IE County Jail, or any specific housing unit therein, is within ten

19 percent [lO%J of being filled. Th~ Sheriff shall r.9lease inmates

20 or refuse to accept newly-committed inmates whenever all beds in

21 the Jail are filled, or whenever any specific housing unit within

22 the Jail is filled.

23
1. IIOperationalll is defined, for the purposes of this stipulation, 24 as being 50% occupied under the rated capacity assigned by the
california Board of Corrections.
25
2. This stipulation does not encompass any additional jail 26 structures to be builtin the future, whether contiguous or
attached, that are not presently within the physical confines of 27 the presently constructed Jail. This stipulation does not limit
the capacity of the Minimum Facility presently under construction.
28

3

• Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 71 of 185

~'f-~.

1

8. Either party may seek to modify or terminate this

2 stipuiation pursuant to the standards set forth in Rufo v. Inmates

3 of Suffolk County Jail, ___ u.S. ---, 112 S.ct. 748 (1992).

4

IT IS SO STIPULATED:

5

6 DATE:

7

8

9 DATE:

10

11

12 DATE:
13
14
15
It is so recommended. 16

Paul Persons Attorney for Plaintiffs
ORDER

17
DATE: 9-\5"-93 18
19

Honor bl Peter Nowinski United States Magistrate Judge Eastern District of California

20
It is so ordered. 21

22 DATE: 1'= I .,- - 91
23
24

Honorable David F. Levi united states District Judge Eastern District of California

25

26

Tl

28

4

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 72 of 185
ATTACHMENT B

ENDORSED FILED
Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 73 of 185
APR o@ ZOlZ
Report
Of the 2011-2012
Sutter County (;rand Jury
Donald Pope-Foreperson, Jeffry Barrow. Harold Beeso, Thomas Bethards, Bonnie Briscoe Christine Duncan, Donald Itanson, Wendy lverson. April James. Lanier Stenhouse Karen La Rose, Henry Lamon, Martha McClard, Linda Peterson Brandy Robe.s, Mark Jenny, Terrance Sutton, Harprit Takher
Final Report (pursuant to Penal Code 933 (a)) on subject:
Sutter County Jail Death

Donald Pope 2011-2012 Foreperson
Dale

Pursuant to Penal Code Section 933 (a), the Presiding Judge makes the findings that the :foregoing report is in compliance with the Title 4, Chapter 3 of the Penal Code ("Powers and Duties of the Grand Jury")

f

,/ i"•

l• i"- f i l-- f

Honorable Christopher Chandler, Presiding Judge Superior Court of California, County of Sutter County

Date

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 74 of 185
SUTTER COUNTY JAIL DEATtt
SUMMARY
The 2011-2012 Sutter County Grand Jury (SCGJ) received a citizen's complaint on the Sutter County Jail alleging improper and denial of medical care resulting in an inmate's death. The SCGJ conducted an investigalion into the inmate's time in custody and specifically the quality of medical treatment he received while at the jail. The SCGJ conducted interviews of all Jail Medical Services (JMS) personnel in •nanagement positions, jail clinic staff members, Rideout Hospital Emergency Room (ER) physicians, the ambulance emergency medical team (EMT) personnel, and family members of the deceased. The SCGJ found the medical treatment of the inmate, just prior to his tinal transport to Ridcout Hospital ER, to have been below the standard of care. This can indirectly be traced to a myriad of problems with the jail clinic program. Recommendations fi'om lbe SCGJ are to make changes at the jail medical clinic to improve oversight and supervision. Responsibility should be taken by those in management positions to complete and maintain policies and procedures, provide training to nurses, and conduct Morbidity and Mortality (M&M) discussions in order to prevent recurrence of adverse outcomes.
BACKGROUND
]"he Sutter County JMS provides necessary e•nergency and basic health care services to individuals who are in custody from booking until time of release. Medical Staff is comprised of the Health Officer (HO), Jail Nurse Manager (JNM), Nurse Practitioner (NP), two (2t Supervising Registered Nurses (RN), fi)ur (4) 15censed Vocational Nurses (I.VN), and on-call
LVN's as needed.
A sick call request form must be filled out if an inmate wants to be seen at the jail medical clinic. These tbrms are collected by a JMS staff member during medication pass, then reviewed and triaged by an RN for follow-up. In a medical emergency, the nurse on duty, either using his/her own judgment or by consulting with a physician, NP or RN, can determine if an inmate needs to be seen at Rideout Hospital ER. Management As part of the invesligation, the SCGJ reviewed job descriptions of those in authority at the jail clinic to ascertain their respective roles and responsibilities (see Appendix A). This included the
JNM, the HO, and Assistant Director of Human Services-I tealth Division fAD).

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 75 of 185

Health O]ficer
l"he HO is a physician who acts as medical director of the Sutter County jail and is responsible for oversight of the quality of health care provided to inmates and making final decisions on all clinical matters. ]'he HO is responsible tbr the development and annual review of medical policies and procedures, including nursing assessment prolocols. Even though the ltO reports directly to the Board of Supervisors, this position coordinates with the AD in support of the JMS. The current HO has been in the position since 2010.
Assistant Director of Human Services-Health Division
According to the job description, the AD "'...has the primary authority and responsibility for directing for a functional area of services within the Human Services Department..." including jail health services. Having oversight ofthejail clinic, the AD is responsible for its efficient operation and delivery of quality medical care in a timely manner. The AD directly supervises the JNM. The current AD has been in this position since 2007.
Jail Nurse Manager
According to the job description, the JNM has the responsibility "...to plan, organize, coordinate and manage jail medical services; to supervise nursing staff: to oversee quality assurance and legal compliance issues; and to perform related work as required." This includes development of "'...policies, procedures and standards to ensure quality of care", directing staff in the delivery of health services to inmates, responding to emergency inmate care, and providing "...professional nursing care as needed." The JNM is also responsible for "...handling employee concerns and problems" and "...directing employee training and development". The current JNM has been in this position since 2009.

Policies and Procedures

The 2010-2011
Program which

SCGJ wrote a report
alleged, among other

addressing things, out

a complaint of compliant

of the Sutter County
policies/procedures.

Jail Nurses
The complaint

alleged the Jail Nurses Program was out of compliance with the California State correctional

code Title 15 see
updated annually.

1206, Also,

which states Standardized

that Policy and Procedures (P&P) Nursing Procedures had not been

are to be reviewed

reviewed and
or updated

since 1995 and had been changed with pencil marks. The 2010-201 SCGJ recommended that

"The County Medical Officer and the Jail Nurse Program Manager with ovcrsight fi-om the

Assistant Director of Health and Human Services should ensure that Jail Nursing Program P&P's

are revie•ved, rewritten, and made current so they can be used and referred to by the jail staff."

This was lo be completed by December 31,201 I.

Nurse Training

The 2010-2011 SCGJ also addressed.a complaint of lack of staff training at the Sutter County

Jail

and

recommended

the

JNM,

along

with

the

HO,

"...develop

training
a

program

to

ensure

adequate on-site training be made available to the nursing staffon a regular basis". ]'he AD "...should provide oversight to ensure this training program is implemented."

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 76 of 185

Complaint
Based on the serious nature of the complaint, the SCGJ agreed to investigate the allegation of an inmate not receiving proper medical care during his eight days of incarceration. Furthermore, there seemed to be a lack of urgency by JMS management to implement changes in order to avoid a similar adverse outcome. The SCGJ was concerned past inadequate stafftraining and incomplete JMS policies and procedures could have been contributing factors in the inmate's
death.

APPROACH

Interviews were Services-Health

conducted with the Director of Human Services, Assistant Director of luman
Division, the Health Officer, the Jail Nurse Manager, several jail nursing staff

members, Rideout Hospital ER physicians, the ambulance EMT personnel, several correctional

officers, and fhmily members of the deceased.

Medical and jail records and reports associated with the case were obtained and studied. Copies of treatment protocols and the updated Policies and Procedures were requested. Several SCGJ members participated in a tour of the Surfer County Jail, including the jail clinic, the Medical Cell (formerly Sick Bay), and the office of the JNM.

DISCUSSION

The inmate had been complaining of pain in his leg/foot since sometime after his arrest on

January 21,201 I. On January 24, 2011, he requested sick call, and was seen at the jail clinic on

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Correctional Officer on duty to the vital signs and appearance, together

nurses' station
with reporting

on
of

January 28, 2011, at
coughing up blood,

be in serious distress. His vitals were: Blood Pressure (BP) 64/44, Pulse

4:39 AM. Abnormal
indicated the inmate
(P) 120, Respirations

to

(R) 24, Temperature (T) 97.6 and Oxygen Saturation 93.

The LVN on duty lhiled help. The LVN did not

to recognize
consult with

the the

urgency of the medical situation to seek immediate
on call physician or call tbr an ambulance. At 5:25

AM, the LVN made the determination to place the inmate in the Medical Cell, located across

from the jail clinic, requesting 30 minute visual checks by custody officers.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 77 of 185

At 8:00 AM, the inmate was brought back to the clinic and his vital signs were retaken by the LVN: BP unobtainable, P 142, R 40 with significant shortness of breath, and T 94.2. 'l'hc JNM arrived and was briefed by the LVN on the inmates' condition and he did not review the medical chart or examine the inmate. The NP arrived at 8:05 AM and noted very, loud respirations from the inmate. Vital signs were taken, and the NP immediately requested an ambulance to transport him to Rideout Hospital. His condition further deteriorated and the inmate died in the ICIJ later
that ai•ernoon.

According to several Rideout Hospital physicians, it is unknown and probably unlikely that an earlier transporl to the hospital would have changed this outcome. However, this does not absolve the actions of the nurse on duty. who failed to recognize the emergency and confined the seriously ill inmate in the Medical Cell tbr over three hours while she attended to other routine
duties.

There was never any formal discussion or meeting held for the jail nursing staff to review the inmate's case. Morbidity and Mortality conferences are considered to be invaluable learning tools with the goal to discuss and gain insight when there is an unexpected death or poor outcome. As the medical director of JMS, the ttO is the most likely person to moderate these
M&M's. However, it was discovered that M&M-like discussions were not held and in fact the
HO did not allow any discussion among mcdical staff about the inmatc's case.

The P&P's were not current at the time the JNM was hired tbur years ago and no progress was
made until the 2010-2011 SCGJ made its recommendations for them to be updated. It has been an ongoing process for both the ItO and JNM to •Tite and implement them. Approximately half of the P&P's are completed except tbr most of the nursing assessment protocols which arc pending HO approval.

On the day the
dated October

inmate
8, 2001,

was was

placed in in place.

the Medical It was one

Cell, the
page and

Sutter stated

County Sick Bay Policy #56, in general terms that only jail

medical staffcouid place inmates with medical problems in Sick Bay; it did not offer any

guidance. According to the October 12, 2011, revised JMS Policy #16-501, only the JNM, RN

Supervisor or NP can determine if an inmate meets the criteria to be placed in the Medical Cell.

It is not to be used tbr an inmate with an unstable condition that requires frequent observation.

An LVN must have verbal orders to move an inmate into the Medical Cell.

Almost one year after the inmate's death, a priority still had not been made to write a protocol to

help guide nursing staff should an inmate present with similar vital signs and symptoms. There

seemed to be no urgency in developing P&P's to ensure inmates receive critical medical

attention
January

in a timely manner. Finally,
9, 2012, includes parameters

Vital Sigms Monitoring
for normal and abnormal

JMS vital

Policy signs

# 16-506, dated
and required actions.

The need to consult with a NP or physician in case of any concerns or questions regarding

inmate health is stressed numerous times in the policy.

The JNM has provided the SCGJ with documentation of mandatory training for the JMS

completed
he has not

last year,
provided

including CPR, blood
documentation of any

borne pathogens, in-house training

H1PAA, and jail •fety. related to direct patient

However, care or staff

meeting minutes showing patient care discussions or training.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 78 of 185

Throughout all of the interviews conducted by the SCGJ, not one JMS staff member felt that the JNM provides efl'ectivc leadership nor are they confident about consulting him regarding patient care. When asked, several of their responses about the JNM's participation in the clinic indicated he's either never there or always in his office, which is located around thc corner from
the clinic.

improve Sutter County Health Department requested the National Commission on Correctional ttealth

Care (NCCHC) to assess and propose solutions to

its health care management and costs.

This organization is the leader in setting standards for correctional tiacilities. A facility can

request an assessment by NCCHC for the purpose of reviewing and comparing their health care

services against national standards. In November 201 I, NCCHC conducted an on-site review of

the JMS (see Appendix B).

The chief finding of NCCHC for the JMS was their "...policies, procedures, and guidelines have not been vetted, nor has stati'been trained. Although training is planned, the lack of strategic planning, developed policies and procedures and consistent leadership in the application of those policies and procedures have greatly hampered the delivery of health services at the Sutter County Jail." In addition, "...there has been no effective process that studies the quality of health care provided in the jail. A registered nurse reviews charts, but the data from these
reviews is limited to documentation issues and does not evaluate the clinical care. The chart
reviews include no information regarding the quality of care provided."
Although the NCCHC commended the jail medical staff efforts to provide health care with their limited resources, they made several recommendations to improve the quality of care. The
NCCHC recommendalions include:

completing the policies and procedure manual

•,

implementing "...nursing protocols as soon as possible and ensure that nm•ing staff'is properly trained"

• improvement on the health record fomaat and contents to facilitate monitoring of the quality of health care delivery

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 79 of 185

FINDINGS

FI. The involved LVN, by fhiling to recognize the medical emergency and by not calling Ibr an ambulance, acted inadequately in the treatment of the inmate.

F2.

The JNM did not take any medical emergency which

interest or immediate action responding is inconsistent with RN training mad not

to
in

the inmate's
compliance

with

the job description Io provide professional nursing care.

F3. Although the 2010-2011 SCGJ recommended a December 31,2011 completion date, only about half of the P&P's have been finalized and made available on the intranet. There was no priority after the inmate death to immediately implement a policy that included vital sign parameters indicating when to call fbr an ambulance.

F4.

According to the job description, the oversight of the JNM's performance,

AD but

has direct involvement with JMS, not only for for the purpose of recognizing and improving

employee problems. With the discontent amongst the JMS staffwith the JNM, the AD is not attune to the problems at the jail medical clinic and/or not taking appropriate, decisive

steps to resolve them.

FS. The AD violated the conditions of the job description by enabling the JNM to be

negligent of duties and responsibilities throughout the JNM's entire tenure. This includzs

continuous noncompliance by not reviewing and updating P&P's annually (Title 15 sec

1206 CA code),
procedures, -and

no in-clinic reluctance

training
to act in

program to
the capacits'

assure standardized of an RN.

treatment

There is no in-house training provided to JMS staffthat is specific to their job.

All JMS Management (JNM, AD, and HO) abrogated their responsibility by not
conducting an M&M-like conference following the death of the inmate.

FS. M&M-like conferences have not been held after adverse incidents at the JMS clinic.

These discussions have been discouraged by the tt0. M&M-like conferences are of great

value as a teaching
is a detriment to the

tool JMS

for patient management. Stifling any discussions since it deprives the nursing staffteam an outlet

of
to

these cases reflect upon

and review poor or avoidable outcomes.

F9. Both the NCCHC visit and SCGJ investigation independently came to many of the same
conclusions concernin• issues with the JNP.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 80 of 185

RECOMMEN DATIONS

RI. Clinical perlbrmance of the involved I,VN should be evaluated by RN supervisors on a regular basis and reported to the JNM. The JNM and the AD should then review oversight and pcrfommnce of the LVN to determine if the LVN meets minimum nursing
standards.

When present during an emergency situation the JNM should assume lull responsibility

as the lead accessible

RN to ensure professional quality medical care. The JNM should be more when asked for guidance by jail nursing stall" regarding inmate care and be

•nore available to assist as needed.

R3. The JNM must ensure all JMS staff is thoroughly Pamiliar with the new JMS Policy #16-506, which outlines parameters for abnormal vital signs and required actions.

R4. The AD should evaluate and make changes to ensure the person in the position of JNM is capable of fulfilling all job responsibilities. This could entail periodic feedback tiom the nursing staff, more direct observation, and frequent evaluations of the JNM's leadership
abilities.

RS. Every effom should be made by the .INM, AD. aad !t0 to finalize and implement all
P&P's and make them available on the intranet. Thereafter, all P&P's should be
reviewed and updated annually.

R6. The JNM should encourage and foster a learning environment fbr the nursing stall They should have opportunities to attend continuing education courses and arrangements should be made for in-house training relating to direct patient care, i.e. man down, suicide prevention, etc.

R7. After a death or poor outcome at the jail clinic, the tt0 should conduct M&M-tike
conferences with the AD and all JMS staff present. The JNM, AD, and llO share the
responsibility to schedule these discussions.

R8. JMS should implement all NCCHC recommendations.

RESPONDENTS
Director of Health and tuman Services, Tom Shcr•' Assistant Director of Health and Human Services, Amerjit Bhattal County Medical Officer, Dr. Cummings Jail Nurse Program Manager, Brent Garbett
APPENDIX A (Job Descriptions)
APPENDIX B (NCCHC Report)

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 81 of 185
APPENDIX A

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 82 of 185 •/14/12 8,50 AM
County of Sutter Established: 1/78 Revised: 01/31/84; 07/30/96; 10/30/01; 12/06/05; 03/27/07 Salarv Ran__qe: MGT59
FLSA: Exempt
HEALTH OFFICER
DEFINITION
Under administrative direction of the Board of Supervisors and the Assistant Director of Human Services Health, plans, organizes, directs and coordinates the activities of assigned medical programs; enforces local health orders and ordinances pertaining to protection of public health; assesses the community health status; advises the governing body concerning health issues.

CLASS CHARACTERISTICS

This is a single position classification that has primary responsibility for the

enforcement of orders and ordinances pertaining to public health and

sanitary patients

matters. The in the Health

iDnecpuamrbtemnetnt

also provides treatment
clinics. Positions at this

and care for
level require

highly specialized knowledge, abilities, skills and experience and exercise

independent judgment in the performance of duties. Work requires creative

ability, resourcefulness and discriminating judgment in the analysis and

solution of complex problems, and the ability to make technical decisions on

specialized matters. Work is reviewed in terms of fulfillment of goals,

program effectiveness and soundness of judgment.

EXAMPLES OF ESSENTIAL DUTIES

The following
construed as

duties are normal for this position. These are
exclusive or all-inclusive. Other related duties

not to be
may be required

and assigned.

1. Assists the Assistant Director of Human Services Health in
planning, organizing, and directing the activities and programs of the Health Department and the Outpatient
Clinic.
2. Enforces all applicable statutes, orders, regulations and rules relating to public health.
3. Provides direction and advice regarding policies and
procedures directed by the state immunization board. 4. Assists in making decisions regarding investigation of
communicable diseases, their diagnosis and treatment.
5. Directs the detection and control of communicable diseases,

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Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 83 of 185 3/]'-1/ |2 •:50 AM
sexually transmitted diseases, and tuberculosis. 6. Directs the operation of adult, child, crippled children, and
school health programs.
7. Directs public health education.
8. Promotes the advancement of maternal and child health.
9. Directs the recording of vital statistics. 10. Acts as medical director of the county jail medical facility;
reviews and approves all examination and treatment records
initiated by practitioners. 11. Approves all prescriptions dispensed by health department. 12. Performs professional care and treatment of patients in
various clinics.
13. Conducts clinics to evaluate patients' health status, provide treatment, and provide advise.
14. Conducts immunization programs.
15. Administers a diagnostic and treatment program for individual patients under jurisdiction of the position.
16. May provide medical services at other county institutions. 17. Confers with members of the public and representatives of
federal, state and local agencies regarding health department programs; cooperates with federal and state public health groups in the enforcement of health and
sanitary matters. 18. Supervises, directs and evaluates assigned staff, to include
assigning work, handling employee concerns and problems, and counseling. :19. Reviews technical requirements, reports and procedures generated by the health department. 20. Prepares public health information materials and news
releases.
21. Reviews and countersigns various medical charts, reports
and documentation; makes recommendations as appropriate. 22. Consults with physicians, nurses, patients, staff members, other county departments, agencies, or other individuals in the diagnosis of, and investigation of, cases of suspected communicable disease and to exchange information or provide recommendations; takes measures to prevent and control epidemics.
23. Answers the telephone, provides information, takes
messages and/or directs calls as appropriate. 24. Responds to requests for information or assistance. 25. Provides education to the public; speaks before interested
groups.
26. Serves on Emergency Medical Services Preparations

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Committee.

EXAMPLES OF MARGINAL DUTIES

:1. 2.

Attends professional meetings and conferences.
Represents the County on committees, boards, at

meetings,

or otherwise as assigned.

MINIMUM QUALIFICATIONS

facadKtmuaniodnawndsmvonsecpa,watalnsiplgeceoreoexe;andrcssmdgteiieabnncocaifeanttssiniovctcfpih:eutenobsifpel,eMrciseSipcedtnusiarcbosuctilhflaeapieelrlcasmelyaDstjhhseaoe;cntpaoroidfaletrcnphbthaclrueeuameadnsgeal,geundtaeslmhtntaaiditnnnaiapiognoflsrid;ntytosszrHgeaeram,satpagoplipmoedtolvscdehniie;es;carvalneStiliecioozornufopepvgrned,irtsrceraenpatmsetutnie;ovbsndlamgitilpiccrpuuaserablnspilthodinielesccoia,ienclpqiatlheunhceesodisaoflpnwtamccdoahneeinor;drpndkmett;cmstgtuhpeenranpadainrenciidrcpdtvnaeaieclrbcritespliseleneesnoaftnd instrumentation; and standard office equipment. Aosephrpmbfupetereibfaceaomllelorfniibctreadtcthedstay;i;ssrerv;idsetoes,opn:sa,rcataelacovPpotbamlltailraemhoiraingnues,aeen;rlhtdnyioccrdiarlteenaneogeftqadpcatreuhanersinirpmtilzatrca-aenmeeaiendteflnmdfnetaaetnarnclcpstidadtoe,wsnimrsvp,sdeaoirlaenarnynefdgerndfheceeetnegbclscnuoft;pitliispeehnvauicsaetbiva,nilanecoiolairwcniaaloaszllynrrlezhdkeydeeciacanonolapdrgnmtusndsehbdistdltsrriiutacepcaiaainlartnnnaliodgtdtwogsrairnr;oiorseratundqeipmsspundahssogiicir;rpcptpemsuasewcren;tirsdanttpwthtaeiaeimi;tanonlnahkdryiignnapagptsenrnaaafduonitiffpdztieneoeaecosrnttpstvtipiaeiasiuovckor,sbenecnalelsuatiy;rlscetaatifnef
standard office equipment.

aowEMpiseprdtdtopuhiegrccoraoapeatvlasietsdodhienAivgscersbeayoencsmditueahdpoteifeEicrxoavCDpnli.oeOusr.nowiscriecityn(hlhcoMeoaola:osrftedaaMreGdep'grmdspraiiredncoeuiaDvasleettgodirfroEaedtnMebui.yvcDea.fi,trntoiheemoPoxnurpbAlaemgiraecrrniradeeidcnHucoceaHagaeotnnlsitipohziinneOtdsadatlefessrhmoioeepramodaalfibttclhhataeih)lcer,deecsApAoacmsanghesrdonrotoicilmziceeaandtnti.on

Special Requirements: Essential Duties require the following

work brief young

requirements: periods of time

Employees must be able to
in positioning/transporting

support
and lift

the and

children; ability to operate and use a variety of health

physical skills and
weight of patients for
hold babies or very
care equipment and

tools.

Other Requirements:
Incumbent shall not

have

an

ownership

interest

in

any

corporation,

http::'Iwww,co,suttehca.us,:hr_jobs/showSl-ec, as p x•s p ec =i • J obs/Job specs/Health%:,"'0Officer xml

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Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 85 of 185

partnership, or other entity engaged in any private practice of medicine, nor
engage in any private practice of medical service.
License or Certificate: Possession of a valid physician's and surgeon's license issued by the State of California either through the Board of Medical Quality Assurance or the Board of Osteopathic Examiners to practice medicine in the
State of California.

accommo,d, The County
Americans

of Sulter is an with Disabilities

Equal Act,

Opportunily E•nployer. the County will provide

In compliance
reasonable

with

the alion

to

qnalified individuals with disabilities. Suttcr County encourages both incumbents and individuals who have been offered employment to discuss polentiai accommodations with

the employer.

h•p:•/www•c•sut•eLca•us•hrJ•bs•sh•w•pec•aspx?spec=/hrJ•bs•j•b-specs•Hea•h%2•fficer.xm•

Page 4 of 4

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 86 of 185 3/14/12 8:49 AM

Revised:

County of Sutter Established: March 1, 1996 7/30/96, 10/30/01; 3/27/07
•.•a r¥ .•an•q_q_e: I•G TS1 FLSA: Exempt

ASSISTANT DIRECTOR OF HUMAN SERVICES

,DEFINITION

Under general direction, plans, organizes, and manages the daily operations

of a comprehensive social services, bi-county mental health, or community

health delivery system within regulatory and fiscal constraints; serves as a

member of the department's senior management team; if assigned to the

mental health unit, acts as Alcohol and Drug
accordance with Sections :[1801 and 11963

Program Administrator of the Health and Safety

in Code.

CLASS CHARACTERISTICS

This class has primary authority and responsibility for directing for a

functional area
social services,

of services within the Human Services Department,
public health, public mental health, primary health,

such as
and jail

health services. This position is not responsible for technical medical

protocols associated with a M.D. Medical protocols and practice are

associated with the County Health Officer, a licensed IVI.D. Work is

accomplished within a
ability, resourcefulness

broad and

framework of
discriminating

policies. judgment

Work requires creative in the analysis and

solution of
specialized

complex
matters.

problems, and the ability to make technical decisions Work is reviewed in terms of fulfillment of goals,

on

program effectiveness and soundness of judgment.

EXAMPLES OF ESSENTIAL DUTIES

The following
construed as

duties are normal for this position. These are not
exclusive or allinclusive. Other related duties may

to be
be required

and assigned.

1. Plans, organizes and directs operations of Social Services, the Public Health Department, Mental Health, and/or other

human services programs.

2. Develops new programs and expand existing programs to

meet community needs and state mandates, in coordination

with management staff.

3. Coordinates and integrates program components into a

cohesive and effective service delivery system.

4.

Develops and implements policies and procedures in compliance with all applicable laws and guidelines.

l/www.co,sutter.caus/hr_jobs/showSpec.aspx?spec=/hr_jobsljob_specs/Assistant%20Director%20of%20Human%20Services-xml
•ttp

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Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 87 of 185

5. Ensures appropriate expenditure of public funds through the

efficient operation of programs. 6. Establishes departmental budget and monitors
expenditures.

7. Negotiates and monitors various contracted services. 8. Monitors utilization data, work production, and other
information related to service delivery; directs operational changes to increase effectiveness and efficiency of
operations. 9. Monitors the quality assurance and utilization review

process.

:[0. 1:•.

Reviews clinical charts
May perform studies,

spfeocriaplropperorjecdtoscumorenottahteironm.anagerial

or

administrative functions as assigned. :[2. Supervises, directs and evaluates assigned staff, to include
assigning work, handling employee concerns and problems,

counseling, disciplining and completing employee

performance appraisals.

:[3. Maintains liaison with representatives of state and regional

health and service providers, interested community and

other county departments.

:•4. Promotes public education on health issues; ensures

dissemination of information regarding health services and

department operations, as well other agencies or organizations knowledge of health services;

as
to

information published promote general

makes public presentations

by

upon request.
:[5. Prepares comprehensive reports related to program operations and activities.

EXAMPLES OF MARGINAL DUTIES

:[. Responds to complaints and requests for information or

assistance.

2. May act on behalf of the Director of Human Services in

3.

absence of same.
Acts as a representative of the on committees, at meetings or

county and the department
as otherwise assigned.

4. Attends meetings and conferences.

MINIMUM QUALIFICATIONS
Knowledge of: Principles and practices of program design, planning and

http://www.co,sutt•r.ca,usihr•obs!'•howSpec.a•px?spec=/hr jobs/job_•,PeC•/Assistan t%2 0Dil ect °•2 0°f%2 0Hu m an%•2 0Se p'ic es' x ml

Page 2 of 4

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 88 of 185 3/14/12 849 AM

evaluation; federal, state and local laws and regulations governing program operations; principles and practices of management necessary to administer and daaaiiinnnnnrdddtfeeocgrttcrpmearoaatcuptcinhritotnooinyingcqreusampeamernsstdoo;fhgoorfspdaupusmbrpplsoerifrocoevffsaeinssssddisipeoioetnonaesankerlairmlanvingipndcnrieeonstetgg;emwrcpoahrblamnnkuoiddiyqgnueaegneectdsoi;mnadsmngeeducrvlnveipiinilriccnioceatnaplctemiridepaenclnglgoetiens;vncececraypyonatmdnsdml;siutapanirbsnpiaaoudcstnbati;ylciricdcespcsn;r;oeromeegdlpmrpasuerta;tiitmeonhncropsiu,dpblsleisc applications and techniques.
Agcsceriswrndcrboieovoeieoeymoiltnlvhafverspmlauaseleedketiltmattrurssrteietirusae;iynomiomaenntovnionsifeceeinsnntnedsotgtbot:t;eyswotaapwti;hcimnrtePpedtdakalhmorrrhetraiggasmuoneepnvr;rki,nlergaaoiaafendirrrnutfmaeepiatodieinlrerminrcomstdodssvtnge;yfetesttiisanhecrfavdnoetusifeunipoccssaeaafdazetoiiccllna,,ertooostsdphaiennripevtrsadvgiarpaiivlaietoiloenntoinninatdtprcnaeetalheressnssaesstrliu;d;trslepdaaea;pridtsdanorereectenedretralosxdoc,aencgi;getosrdmavrrclaedenmclpaonasnriceuieudrmiry,ezscsonrosncgattemsict;hotaeespeectbilxaygdreiloaipnrgsuiraenutlnadoatsertahfalndethgeeeliedeeumsnaanepl;r;cnrsaaeaeetlvanstfinneilqaldiftdvvoadfudryeoewnaeeoieizclnsnrnovstrme,smdm;uitea,eiousvnlhimtelrodnueilcajpaeeptpnmvyoptturgmartaanearudoioetsd,nolgggncbreuaogmoretgctartoeadaleitphsaenmuinsornefmedntrnfrocsde;solevmytiarsoiciovafnaacbtciibdlitijaoesnsldlevneoasmoayuuiredcnnnppaostcdlebhoidaias/srj/inaapentvnoeivnlonrlddeercdiltediswnteissevictinsereittivfntsrphieeueinyesclsftwrh;yhrsnieionittncioaanllg.a dAacEmmndeoedadmnmvunitbceanaialsgilntouseaipptmtoemrheinreaeonvntanitlitasto,;nhondor,fyacpEoegeBxdmereupupnsxseclocpiraneyenitntreeieiisnolwoescnhnneic:cmAeahoadnfmndFiianicononugiercraseexltmpusrydeoecaecernotaidiauirtelrsonsnpce,sraeoenofrdgwovptrorihrarcpaokmecteglsrrofesippnesoorllrsoraySivmnovcianclediirnileaenncyslilgecaatlWeeraodeqenvruscdakipofl,voimuaneemallsvdtuieHa;iebnnloaltuinloeat,rttyhikoamnannoany,hwdnelaaelbgpdtuoehgdlmeig,ceeoyrtnt
skills and abilities.
jtSwainorpuoeerdsacmkgeiamdaioeelnrfnntettaqtRaihueenriqyarnueodmifmtefreoinencrtmetalatesilig:nthoottnsacal:RawnepooaqrttcuEkhhiisietrsnryeeki,nsnitvnwiogahatllnihvdeciuhnnDgdasubettairiallpeinlrtsodoyvwilasnrorgtineoetqgdhueefeidoxrrecercitaspripetctarhtaubieimionlssgdmif,tsatoalylnlwlocoafeowlfsaikt.nmiiegmnoxegue.nrpcthoiyRrsseiiqomcnfuoagilvprihesnyssosgkiuilcntladhfsleroamaenbfdiflooirnttey

Other Requirements:
The Assistant Director

of the

Mental

Health

unit

is required

to

possess

one

of

the following:

1. A medical degree and California license in psychiatry with

htt p:f !www •co. suit el.ca, s/hr jobs/s h owS pet.as p x?s pec h r_johs/job_s pe (s,/Ass is! n r%20Directo r%2 ()of%Z 0Hu m a n%;.? 0Se trices, x m

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Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 89 of 185

8:49 AM

two years of training in psychiatry, one year of which is

administrative.
2. Master's Degree in social work and a Clinical Social Worker license, and five years related experience, two of which are

administrative.

3. Ph.D. in clinical psychology with a California Clinical

Psychologist license.

4. Marriage, Family, Child Counselor license and a masters degree in behavioral sciences and five years mental health

experience, two of which are administrative. 5. Masters degree in psychiatric or public health nursing and
license as a Registered Nurse in California and five years mental health experience two of which are administrative. 6. IVlasters degree in hospital administration, public health

administration or
years experience,

public administration and at least three
two of which have been in mental health.

License license. with the

or Certificate: Must possess and
The County of Sutter is an Equal
Americans with Disabilities Act,

maintain an appropriate, valid driver's Opportunity Employer. In compliance the County will provide reasonable

accommodation to qualified individuals with disabilities. Sutter County encourages

both incumbents and individuals who have been offered employment to discuss

potential accommodations with the employer.

The County
Americans

of Sutter is an with Disabilities

Equal
Act,

Opportunity E•nploycr. the County will provide

lu compliance with the
reasonable accommodation

to

qualified individuals with disabilities. Sutter Count.,/encourages both incumbents and individuals who have been offered employment to discuss potential accommodations with

/he employer.

http://www.co.sutter.ca,uslhr_lobslshowSpec.asp×?spec=/M_iobsljob_ specstAssistanrYo20Directot%20of%20Human%20Se•vicesxml

Page 4 of 4

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 90 of 185 M].4/]2 8:5] AM
County of Sutter Established: 11/9/04
Revised: 03/27/07 Salary_ Range: I•INU44
FLSA: Exempt

JAIL NURSE MANAGER

DEFINITION

Under general direction, to plan, organize, coordinate and manage jail

medical services; to supervise nursing staff; and legal compliance issues; and to perform

troelaotveedrseweorkquaalsityreqausirseudr.ance

CLASS CHARACTERISTICS

This is a single the jail nursing

position classification having program and staff, reporting

management responsibility for
to and receiving direction from

the Assistant Director of Human Services Health Division with medical

direction from the County Health Officer. This class is distinguished from the

Supervising Nurse, which is a first-level Director of Public Health Nursing, which

supervisory
has broader

position, and management

from the
authority

and responsibility for a variety of public health nursing programs.

EXAMPLES OF DUTIES

The following
construed as

duties are normal for this position. These are
exclusive or all-inclusive. Other related duties

not: to be
may be required

and assigned.

1. Plans, organizes and manages jail nursing services; directs operations and staff in the delivery of health services to inmates in the County jail facility.
2. Develops, implements and interprets goals, objectives, policies, procedures and standards, and interprets and implements laws, rules and regulations, to ensure quality of care and compliance with requirements.
3. Represents the jail nursing program and coordinates operations with other County departments, community
agencies, boards, commissions and committees. 4. Provides professional nursing care as needed; responds and
coordinates inmate emergency and urgent care. 5. Performs Discharge Planning of inmates and coordinates
aftercare with other agencies. 6. Monitors and evaluates operations issues, new
developments and requirements; develops, recommends and implements courses of action; evaluates, develops and

hHp://www.co,sutter.ca.us/hr_jobslshowSpec.aspx?spec=/h•jobs/job_specs/Jail%20Nurse%20Manager,xml

Page of 4

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 91 of 185

oversees implementation of new programs and services. 7. Supervises, directs and evaluates assigned staff; to include
assigning work, handling employee concerns and problems, counseling, disciplining, and completing employee performance appraisals. 8. Directs and participates in the interviewing and selection of candidates for employment; directs employee training and development; guides subordinate supervisors in employee performance appraisal and counseling, disciplinary actions, documentation and related personnel actions.
9. Provides clinical and administrative consultation and
problem-solving to staff, as needed. :10. Manages quality assurance activities; reviews nursing
protocols, procedures and standards to ensure effective patient care and compliance with applicable policies and regulations. :[:[. Enforces and observes security precautions and
requirements. :12. Conducts various staff and committee meetings;
disseminates information to staff; confers regularly with superiors regarding policy and operational issues. 13. Participates in the development of the budget.
:14. Prepares and maintains a variety of records, reports, studies
and statistics related to jail nursing activities. 15. Reassigns and shifts personnel as required. 16. Attends meetings and conferences.

MINIMUM C•UALIFICATIONS

Knowledge of: Principles and practices of management, including goal setting,

program
planning;

development, implementation and evaluation; administration principles and practices of personnel management, including

and work
hiring,

training and techniques,

supervision; professional nursing principles, practices and including medical case management, medical/psychological

assessment,
of outcomes;

patient care planning
medical terminology

and
and

delivery, patient education and evaluation equipment; principles and techniques of

drug administration, uses, effects controlled substances; principles,

and adverse reactions to
practices and techniques

medications and
of safety and

infectious
nursing in

disease
general

control; laws, rules and regulations governing the practice of and within County jail facilities; security issues and challenges

oaaffgfeecncactrieiensgdelaninuvdresriynrgeswoicutarhrcieens;waitcheoinnrvrieracotjniaomilneanlftaacilil,nistyt;istoucctihioiollndo;giaccnadolmmeaulndndeirtpysaybcumhseoedliocgaainlcdalannedgplreoscobtcliealamnsd

domestic violence reporting laws.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 92 of 185
3114i12 8:S] AM

Adeipbenvsitvayleilcirsuhtpeaoyrt-eestta,oon:cdsiteaPaxllfapafdl;na,anpiutdnroesrvigwaenaonlgndroikpzaaep,spgpsrolaeoydlcsisers,edlmcauetwro,nsbe,tjssesccrthteiaoegvnduedumlslae,eted,iteopvnoesslcelithocaipaenipnsgnde,igrnfgppooarlrnoimdpccaireneodsicgu;merrpaelpmsesetmraefannnnoeddrteamidrsnpd;grspohtyuopasncaniodtdclieaserl;nsttaanncdadr,e

tarplnreadeqn/ausotirmreeannmutden/sncotorsoa;pnrederefaseptrtriraoavblclesie;sdhuparatedaismneidnntiisnms;ataienarhtsiasguimhrne-edsieaccqauuctraoiiloitoptyneysrasoetfatintvdcieanrgepweofraorfrnkodirdnmygcisonfmgurpnelcltsiakiationilnolcaenedls,hiwnpiustrthswriientsghsed

others; prepare
correspondence;

and present clear and develop and evaluate

concise reports, instructions and
program policies and procedures

and

implement as approved; work rules, policies and procedures; antisocial behaviors; respond

in an
deal

institutional setting and apply effectively with manipulative,

institutional
hostile and

effectively in emergency and stressful situations;

make effective, reasonable and responsible decisions in emergencies and take

appropriate action; deal firmly and fairly with inmates and demonstrate tact and

diplomacy;
behaviors;

identify
oversee

alcohol, drug and
the maintenance

street drug related symptoms of medical records and legally

and
interpret

medical records.

Education and Experience: Four years of professional nursing experience,

including
education

one
and

year of experience in a supervisory experience that provides equivalent

capacity; or knowledge,

any combination of skills and abilities.

One year of experience in Discharge Planning or one year experience as a Public

Health Nurse
management

is desirable. Core college course work in administration is highly desirable. A bachelor's degree in nursing may

or
substitute

for

one year of the general nursing experience.

Special Requirements: Essential Duties require the following physical skills and

work requirements: Must be able to apply first aid and CPR which requires

stamina
occupied
colors of

and coordination; push heavy objects such wheelchair; rapidly move to an emergency uniforms and armbands to identify inmate

as Medical carts, or medical situation; access to restricted

an
distinguish
areas;

distinguish verbal and nonverbal sounds in a noisy environment; stand and walk

for long periods of time; lift objects weighing up to 16 pounds, emergency bag, portable oxygen tank, and medical card index
work in both office and clinical settings, and to travel to various

such as an
files; mobility
sites; touch

to in

order to conduct physical health assessments; vision printed materials, computer screens and to examine

to read handwritten and
and observe patients;

hearing and speech to converse in person and by telephone; mobility and

strength to respond to emergencies.

Other Requirements:

Must pass a
Department.

background investigation Must be willing and able

conducted by the Sheriff's to accept assignment in a locked

jail

facility serving clients of various cultural, physical, behavioral and

psychological profiles.

http://www,co.sutter.ca.us/hr jobs/showSpec.aspx?spec'-/hrjobs/job_ specs/Jail%ZONu•se%20Manager.xml

Page of 4

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 93 of 185 3114/12 8:51 AM

License current

or Certificate:
CPR certificate,

Possession of a valid California and a valid California Class C

Registered Nurse
driver license.

license,

a

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Page 4 of 4

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 94 of 185
APPENDIX B

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 95 of 185
RECE,|VED
TECHNICAL ASSISTANT REPORT OF THE HEALTH CARE SERVICES AT
SUTTER COUNTY JAIL Yuba City', CA November, 2011
National Commission on Correctional Health Care 1145 W. Diversey Pkwy. Chicago, IL 60614-1318 (773) 880-1460

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 96 of 185

SUT-FER COUNTY JAIL, CALIFORNIA

Introduction

The Sulter County Jail, in Yuba City, California, is a design-rated 352-bed facility. Ihe average

daily population ranges from 180 to 230 inmates. The Sutter County Health Dep,'u-tment provides health services. As is true across the count•', the Sutter County Jail is experiencing a

rise in health care costs and the number of inmates with health problems entering from the

community. As a result, the counry recognized a need to review its health-care in the jail and requested the National Commission on Correctional Health Care

delivery system
(NCCItC) to

assess and propose solutions to improve its health care management and costs. In November 201 l, the NCCHC conducted an on-site review of the Sutter County Jail. This report reflects our

findings and recommendations that may help to improve access and quality, of care at the Sutter

County Jail.

Methodology

NCCHC's main objective in this technical assistance was to review and compare Sutter County

Jail's health

health sen, ices delivery
organization. Our
care

system against accepted national standards goal, through this comparative analysis, is

and practices for jail to provide specific

recomJnendations to facilitate jail health services. To assess the efficiency and effcctiveness of

jail health services

NCCHC

used

methodological
a

approach

that focused

on current operational

issues. First, we interviewed key
jail physician, nurse practitioner,

perso•mel,
health and

including the
mental health

medical director, health administrator,
staff. We reviewed existing policies

and procedures, and a few medical records. We analyzed health care management practices

against NCCHC's Standards Jbr Health Services in .,rails (2008).

Chief Finding

"t"he responsible health authority is creating policies, procedures, and clinical guidelines/nursing protocols that will guide staff in the management of jail health services. These

National Commission on Correctional Health Care

201.2

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 97 of 185

SUTFER COUNTY JAil_, CALIFORNIA
policies, procedures, and guidelines have not been vetted, nor has staff" bccn trained. Althougli training is planned, the lack of strategic planning, devel•ped policies and procedures, and consistent leadership in the application of those policies and procedures have greatly hampered. the delivery of health services at the Surter Counb; Jail.
Findings on Operational Issues
Governance and Administration
Access to Care. In our discussions with health staff, we believe that inmates can access
health services through written requests that are triaged daily. Im-nates are instructed on how to access health services during the intake process. Interviews and health record documentation
confirm that inmates have access to needed care.
Responsible Health Authority. The responsible health authority (RHA) is the county health department, whose on-site representative is a physician (medical director). A health services administrator (nurse) is responsible Ibr the overall daily operation of the health service program. Mental health services are provided through a county community mental health system and a contracted psychiatrist. This arrangement appears to function well and services are
coordinated.
Medical Autonomy. Our review of the health records and interviews confirmed that all clinical decisions perlaining to direct health care of patients are the sole responsibility of the
medical director and clinical staff.
Adminislrafivc Meelings and Reports. The medical administralion meets with jail administration on a regular basis to strategicall) plan how to improve health service efficiency and overall clinical operations. Data mmmgement could be improved to assess health services. A sample of statistical data that should be collected is provided in Appendix A. The health services rummager should be responsible for collecting this information and sharing it with the medical director and j all administration.

National Commission on Correctional Health Care

2012

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 98 of 185 SUTTER COUNTY JAIL, CALIFORNIA

Policies and Procedures. The medical director is working on the ?olicies and procedures and is using the NCCHC's ,S'ta;•dardsfor Hea!lk Services in Jails (2008) as the
foundational fi'amework, Once completed, the manual will be available to staff. We reviewed
few stunplc policies and found them to be consisten• w'ifl• national practices.

Continuous Quality Improvement I'rogram. The Sutter County Jail's health services

quality improvement program needs to be re-assessed. Studies on t•rocess or outcome have not

been performed to meet the goals for quality of care. The Institute of Medicine's (IOM) 2001

report, Crossing the Quality Chasm: A New Health System for the 21st Century, states that health

care
staff

should be safe, attempt to meet

effective, patient-centered,
these objectives, there has

timely, efficient,
been no effective

and equitable. While
process that studies

health
the quality

of health care provided in the jail. A registered nurse reviews charts, but the data from these
reviews is limited to documentation issues and does not evaluate the clinical care. The chart
reviews include no information regarding the quality of care provided. In the appendix, we provide a sample outcome study on diabetic care. Using this template, jail health managers

should begin to monitor the provision of health services.

Communication on Patient's Health Needs, Communication occurs between the
facility administration •ad treating clinicians in such a way that patient health needs are appropriately managed and addressed. Health staff, when asked, advises classification and custody staff of an irmaate's special health needs that may affect housing, work assig•w•ents, program assigmnents, disciplina• measures, and admissions to and lransfers fi'om satellite
facilities and other institutions.

Procedure in the Event of Inmate Death, There have been tt•ee hmaate deaths at the
Sut-ter County Jail during the past ).'ear and a half. One of these deaths was a suicide.
Administrative and clinical reviews were completed. We did not review these documen'{s.

National Commission on Correctional ttealth Care

2012

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 99 of 185
SUTTER COUNTY JAIL, CALIFORNIA
Managin,• a Safe and Healthy Environment
Infection Control Program. The jail's infection control program is a combined efforl of representatives of the facility's administration, the county health depa•ment, the medical director, and other health care personnel. Inmates are screened and obse•,ed •br hepatitis, tuberculosis, sexually transmitted intEctions, scabies, lice, HIV, and AIDS. Inmates are questioned specifically about cmvent symptoms of tuberculosis. The facility does not have negative air-flow cells and imnates identified ttuough a chest x-ray to be positive lbr active TB •e rct•ed to the county health depa•ment and local hospital. Inmates testing positive for reportable sexually tr•smitted int?ctions (STIs) are prescribed appropriate antibiotic therapy. Health perso•el p•ticipatc in mmual infection control in-service training. It appears that the jail has ma et1•ctive infection control program in place.
Patient Safety. The RtlA promotes patient safety by instituting systems to prevent adverse m•d near-miss clinical events. This is accomplished by infor•ning health staff of the incident repot* process during orientation mad daily communications with the medical direclor. We believe that staff effectively works to monitor patient safety.
Personnel and Training
Credentialing. tealth personnel are appropriately credentialed according to the state's ticensure, certitication, and registration requirements. The health department follows a formalized credentialing process. We did not verify CPR certification for all qualifying health care professionals.
Clinical Performance Enhancement. There is no documentation that an armual clinical
performance of primary care providers is conducted and shared with the clinician being
reviewed.

National Commission on Correctional Health Care

2012

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 100 of 185

SUI-[ER COUNTY JAIL, CALIFORNIA
Medication Administration Training. Nurses review, as needed, the appropriate procedures to administer medications.

Staffing. Full-time equivalent health staff inclL•des:

Medical director

.60

Nurse Practitioner
Physician

1.0
0.2 (8 hours a week on Tuesday and Thursday)

Jail Nurse Manager
Psychiatrist RN Shif• Supervisors

1.0
0,1 (4 hours on Saturday)
2.0

RN

2.0

LVN

4.0

Mental health staff

t.0

Licensed Psychiatric Tech 0,5

Office Assistant II

1.0

Itealth Care Services And Support
Pharmaceutical Operations. A pharmacist prepares a monthly report on the pharmaceutical services. We did not examine the medications; however, the practitioners noted that pharmaceutical ope]a'•ions are sufficient to mee• the needs of inmates.
Medication Services. The medical director approves the prescriptive practices at the site and we did not find any irregularities. There is no keep-on-person (KOP) system which allows inhalers, antibiotics, thiazides, cardiac medications, nitroglycerin, Dilantin, Zantac, and prenatal vitamins to be kept by inmates when prescribed by the health care provider. A KOP system includes training tbr inmates to take care of their health care needs, and helps to reduce the burden of medication distribution in the jail. A s•nple KOP policy is atlached.

National Commission on Correctional Itealth Care

2012

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 101 of 185

R COUNTY JAIL, CALIFORNIA
Clinic Space, Equipment, and Supplies. The clinic area is small but suffivient; it includes one examination room, and a large central nurse's statiordclcrical office. There is
sufficient equipment to provide health services to the imnates. An interview roon•/ot:fice is also
across the hall ti-om tt•e clinic area.
Inmate Care And Treatment
Information on ltealth Services. Inmates aie instra.•cted about the availability of; and access to, health care upon their arrival at the facility. We saw no posted signs in the int•e area about access to health care services and recommend that such signs be posted (in English and Spanish). Imnates are given writ-ten information on how to access health care services. Access
to emergency and routine health care services is described in the inmate handbook.
Receiving Screening. Adtnissions arrive directly from the community. Corrcclional officers complete the receiving screening and nurses review each one. The receiving screening tbrm does not include all the requirements of the standm'd. Attached is a sample receiving screening form that we recommend be used.
Health Assessment. An initial health assessment is offered to each i•nale within 14
calendar days of admission. The nurse practitioner completes the initial health assessment. 'lhe physicim• reviews the health assessment forms when there are significant medical findings. Our review of completed health assessments found them to be thorough.
Mental Health Screening and Evaluation. Trained correctional officers complete the mental health screening. Patients are referred to the •nental health staff',','hen there are positive findings. The mental health worker completes the mental h•:alth evaluation.
Oral Care. Trained lkNs complete the oral screenings during the intake screening. Inmates approaching 12 months of incarceration are not offered an ammal oral health examination by the off-site dentist. Oral care is limited to relief of pain and infection. There is a backlog of dental sick call requests.

National Commission on Correctional Health Care

2012

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 102 of 185

SU'I-rER COUNTY JAIL, CALIFORNIA

Nonemergency ltealth Care Requests and Se•wices. Inmates cma request medical, dental or mental heallh services daily. However, the nurse practitioner's daily case load is approximately nine inmates a day. The patient flow is limited and not well organized and i•maate requests ea'e not honored on a timely basis: At the time of the sur•'ey, the inmate sick call request backlog ranged tiom one day to four months. "I-he nurse practitioner was working on sick call requests from June. On a daily average, it is expected that 15 patients would be seen in a :,orrectional health care clinic, tt was reported that it takes three weeks (21 days) on average to complete the health assessment.
Nursing Assessment l'rotocols. Prior to the on-site audit, nursing protocols had not >een used. However, the medical director has drafted a policy for the use of nursing protocols. We reviewed the draft and found that the two main elements lbr protocols are addressed. First, :here are no standing orders for prescription medications, and second, there are requirements that ,qther the physician or nurse practitioner sign off on all nurse-generated protocols. We recommend that nursing assessment protocols be ffflty implemented at the Sutter County Jail. A ;ample nursing protocol is attached.
Continuity of Care During Incarceration. Referrals to specialist care are careflally nonitored. It takes approximately two to three weeks to see a specialist. Individual treatment
•lans are used and monitored. The medical direclor reviews charts,

]ealth Promotion

lIealthy Lifcstylc Promotion. The medical director and nurse manager have made
•ealth education materials mad instruction to patients, Our observation indicates thal dais is
•rovided to the inmates.
Medical Diets. We were informed that medical diets are available for patients with pecific dietary needs.

lational Commission on Correctional ltealth Care

2012

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 103 of 185
SUTTER COUNTY JAIL• CALIFORNIA
Use of Tobacco. Smoking is nol t•ermiued an.,,•,here inside the inslitution
Special Needs And Sen'ices
Chronic Disease Services, Thc nurse practitioner and physician monitor chronic disease. Palients are transported to outside specialty appointments as needed. There are no national clinical guidelines tbr practitioners to follow. Sample guidelines are provided.
Basic Mental Health Sen'ices. A mental health counselor provides services 30 hours a week (Monday through Friday). A psychiatrist provides 10 hours of care a week. Custody staff conducts a mental health receiving screening and the nurse will review the form when she arrives. Any inmate with positive findings will be referred to the mental health counselor for evaluation. Crisis intervention is provided by the counselor; however, there is no group counseling (coping skills, medication compliance, or wo•ncn's group).
Suicide Prevention Program. The suicide prevention program addresses each of the 12 aspects ofplarming as described by the standard. However, when an irmaatc is placed on suicide watch, 15-minute watches are conducted, instead of on an intermittenl schedule, as required by
the standard. The mental health staffwill release an irunate fi'om suicide watch. The psychiatrist is minimally involved.
Intoxication and Withdrawal. Individuals with symptoms of inloxication or withdrawal are managed on site by nursing staff. Individuals with severe withdrawal or intoxication are senl to the hospital. Staffdo not use the CIAW-R to monitor intoxication. A copy of the CIAW-R is attached and wc recommend that nursing staff be trained to use this patient monitoring tool.
Care of the Pregnant Inmate. Health services are available to pregnant inmates through off-site services. Some imnates are allowed to go out to their personal physician.

National Commission on Correctional tlealth Care

2012

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 104 of 185

IIealth Records

SUTTER COUNTY JAIL, CALIFORNIA

tlealth Record Format and Contents. lmnatc medical and mental t•ealth records are
integrated in hard copy format, The Master Problem List (MPL) is insufficiently detailed, however. In the appendix we provide a st•mple MPI. and recommend its use.

Conclusion
Overall, the health staff provide health services with limited resources and are to be
commended for their efforl. However, several recommendations have been made in this report
that, if implemented, can improve the overall quality of care: 1) Jail health administration should improve its metrics to evaluate operational issues. A sample of statistical data that should be collected is provided and we recommend its consistent use. 2) The medical director should complete the policies and procedures manual so that it is consistent with NCCHC's Standards fi)r Health Services in Jails (2008). 3) There should be efforts to improve the qualiD'
improvement program with one study on process and another on outcome. There has been no effective process that studies the quality of health care provided in the jail. 4) An annual clinical performancc of' the physician, nurse practitioner, and psychiatrist is to be conducted and shared with the clinician being reviewed. 5) In our experience, full-time equivalent health sial'f should
include 40 hours of psychiatrist's time for 1,000 imnatcs. More psychiatrist's time is needed at
the Sut•er County Jail. We recommend that the psychiatrist time be increased to 0.4 from 0.1 hours. 6) Many jails have a keep-on-person (KOP) system that allows inmates to keep inhalers, antibiotics, thiazides, cardiac medications, nitroglycerin, Dilantin, Zantac, and prenatal vitmnins when prescribed by the health providers. We recommend that a KOP system be considered. It will help to relieve some of the duties and tasks nurses are required to perform. 7) There should
9c signs posted in the intake area about the availabili D' of, and access 1o, heall]n care in the facility, 8) The receiving screening foma should be revised so that it conforms to national
•tandards. Nine, an analysis on the oral care provided in the jail should be made. The jail nurse nanager should conduct a root cause analysis on the dental sick call request backlog. 10) The ail nurse manager should conduct an analysis of the nurse practitioner's daily caseload. The •urse practitioner is underutilized and because of the limited space, must stop seeing patients and

,;ational Commission on Correctional ttealth Care

2012

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 105 of 185 SUTTER COUNTY JAIL, CALIFORNIA
complete clerical work when tile physician is in the office. This is ineflicient. The pattern flow is limited, noI well organized, and should bc fully studied. The RHA should consider the problem of inmate requests not being honored on a timely basis as its top priority'. When access is limited, qualily of care suffers. 11) Implement nursing protocols as soon as possible and ensure that nursing sIaff is properly trained. The implementation of nursing protocols and the expansion of their duties will improve the sick call process. 12) National clinical guidelines for practitioners to ibllow should be approved. 13)The implementation of group counseling (coping skills, medication compliance, or women's group) should be considered. This will prevent warehousing of inmates with mental illness. 14) When an inmate is placed on suicide watch for precaution (potential suicide), hc or she should be monitored on an inti'equent basis, with no two checks more than 15 minutes apart; checks by security officers should be conducted on an intermittent schedule as required by the standard. 15) Health stall" should use the CIAW-R to
monitor intoxicated inmates. 16) Improvement on the health record format and contents is needed. The Master Problem List (MPL) should be changed and staff instructed on properly completing the form.
We appreciate the opportunity to provide the Sutter County Health Department with this revie;v of its health services. We are certainly willing to provide additional infomnation regarding this report and are available for additional assistance if required.

National Commission on Correctional Health Care

2012

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 106 of 185 SUl-rER COUNTY JAIL, CALIFORNIA
About tile National Commission on Correctional Health Care

With supporl from the major national organizations representing the fields of health, law and

wcieomrprraeorcevtiiongnugsi,dethdtehebqyuNaalatinityoenxaoclfephCteoiaonlntmahalilscyasrieodneidnicojnaaitlesCd,orprBreoicsatorindosn,aolfanDdtitrejeaulcvttheonrisClaerceocmo(pnrNfiCisnCeeHdmCe)noft

is committed to
thcilities. In this
representatives

from our supporling organizations.

NCCHC's origins date to the early 1970s, when an American Medical Association study of jails

found inadequate, disorganized health services and a lack of national standards. In collaboration

with other organizations,
National Commission on

the ANLA established a program that in the
Correctional Heallh Care, an independent,

early 1980s became the not-for-profit 501 (c)(3)

organization whose e•ly mission was to evaluate and develop policy and programs for a field

clearly in need of assistance.

Today, NCCHC's leadership in setting standards tbr health smwices in correctional facilities is widely recognized. Established by' the health, legal and corrections professions, NCCI tC's

Standards are recormnendations
Written in separate volumes tbr

for the management of a correctional health services system.
prisons, jails and juvenile confinement facilities--•md now with

a

manual specifically for mental health services--the Standards cover the areas of care and treatment, health records, a&ninistration, personnel aa•d medical-legal issues. These essential

resources have helped correctional
and the conu-nunities to which they

and detention facilities improve the health of their inrnates return, increase the efficiency of health services delivery,

stren•hen organizational effectiveness and reduce the risk of adverse legal judgments.

Building on
correctional

that foundation, NCCHC offers a broad array of ser•,ices
health care systems provide efficient, high-quality care.

and

resources

to

help

The does

National Commission on Correctional Health Care has no membership or not require any affiliation to be considered for accreditation, certification

dues. NCCI tC
or employment

as

a consultant or surveyor, or to serve on committees or the
spouses are not allowed to acccpt gifts or consulting fees NCCHC is impartial, unbiased m•d expert. And dedicated

board of directors. NCCHC staff
from those we accredit or certify. only to recognizing and fostering

and

improvements to the field of correctional health care.

National Commission on Correctional Health Care

2012

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 107 of 185
NCCHC GOVEPdNI-NG BOARI) 01: I)IPd2CTORS
(Representatives from the following organizations) Amcric•m Academy of Child & Adolescent Ps)'chiatry
American Academy of Pediatrics American Academy of Physician Assistants America1 Academy of Psychiatry & the Law American Association for Correctional Psychology American Association of Physician Specialists American Association of Public ]tealth Physicians
An]erican Bar Association
American College of Emergency Physicians ,-¢anerican College of t-Iealthc•ue Executives
American College of Neuropsychiatrists American College of Physicians-American
Society of Internal Medicine
American Correctional tlealth Sen'ices Association
American Counseling Association
American Dental Association American Diabetes Association American Dietetic Association
American Health Information Management Association
American Jail Association American Medical Association American Nurses Association
American Osteopathic Association
American Pharmacists Association
Aanerican Psychiatric Association American Psychological Association
American Public Health Association
American Society of Addiction Medicine
Jolm Howard Association National Association of Connties
National Association of County ea•d City Health Officials
National District Atlorneys Association
National Juvenile Detention Association National Medical Association National Sheriffs' Association
Society for Adolescent Medicine Society of Correctional Physicians

National Commission on Correctional Health Care

2012

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 108 of 185
HEALTH SERVICES
DATAS H E ET

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 109 of 185

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 110 of 185

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 111 of 185

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 112 of 185

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 113 of 185
Outcomes
Study

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 114 of 185

INDENTIFIED: Diabetic patients coming into our system have base-line .wel done by the time of their first official chronic care visit. Approximately sample had initial elevated values. (N=10)

•2TtON/ROOT CAUSE: Diabetes is a chronic illness that requires

medical ,ns and
ple are

care and patient self mmaagement education prevent acute reduce the risk of long term complications. At any given time, incarcerated in prisons and jails in the U.S. It is estimated that

over 2
nearly

•ese irmnates have diabetes a prevalence of 4.8%. Those w•th diabetes m

facilities should receive care that meets national standards.

1C is thoughl to reflect average glycemic control over several months m•d has ictive value for diabetes complications. It should be perfbrmed routinely in all h diabetes, at initial assessment and then as part of continuing care. T!•e
et value from the American Diabetic Association is <7%.

%r of

poor their

initial control is multi-factorial
disease prior to incarceration;

and include:
2) availability

1) poor self
of canteen privileges

•e infirmary setting; 3) trading to obtain canteen privileges and consuming

dietary items; 4) lack of understanding their disease process m•d how !ire-

play m• important role.

Initial and {bllow-up Hbg A1C values were collected on ten patients e•olled •ic Cm-e Clinics. Diabetic patients are seen in the Chronic Care Clinic for :very 90-120 days. Hbg A 1C levels are monitored and patients are evaluated for appropriate insulin or oral hy•oglycemics by Health Care Providers ents are ty3•ically placed on a 2400 calorie ADA diet. Unless tl•ey are in the

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 115 of 185
isdmnuiofgsniaeirratsmoeacrrhyemo,diacnettahswegiyecaemvaaeripneletarballdelaa.onydweTdahttheeyatomcioaprunnetsiemeiqdnuuumecfnoaoctdaeendsdoroodmfne"orrpsteoheotrohrfrotoaleuednghtet•hirfaeintciclledeiin.eictcoaml•Bmull•yiodsosdieanxdreiysrctc.a:igtsaeerTdsh.epraleraSeyliadirniengtnhoe-ir
scale coverage of insulin is utilized as needed.

P,_F, SULTS: their overall to stmt and
the patients

In the sample collected, glycemic control. Two

only
of the

30%
ten

of the patients should improvement in essentially remained the same (7.1 and

7.2 did

and
not

5.6 respectively
have follow-up

at follow-up).
values done.

Tl•ree oftl•e ten
All patients were

worsened
prescribed

and two
diabetic

5.5 of

diets. The stares of any co•mnissary privileges is not k_no'am.

DISCUSSION: In this particular study smnple, tl•e percent of'those patients who

improved
noted that stable with

their glycemic
this is overall
initially low

control and of those who
a small sample. However, Hbg A1C's gives that 50%

worsened were equal at 30%. it is given that 2 of the patients remained of the sample remained stable or

improved. Interestingly, 7/8 of those with follow-up levels done showed values between

5.6 and 7.3. This indicates that their control was still 'pretty good '. Twenty percent of

the patients did not have Hbg A1C's ordered by the Providers. Tkis was addressed

during subsequent staff meetings in March and April. Our Health Care Providers will

need to strengthen their partnership in the management
studies will also examine correlations between control

of their diabetes. and other factors

Follow-up such as type

of

medication, dietary compliance, level of' activity, commissary status, etc.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 116 of 185
Sample
Nursing
Protocols

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 117 of 185

DOC-3:)O7 (Roy. lJ03)
WISCONSIN
Department of Corrections
Health Services
POLICY/PROCEDURE
SUBJECT
Nursing Protocols

EFFECTIVE DATE
May l, 2004
UNIfSAFFEG]ED
DAI, DJC, BIIS

NUMBER
300:1S
SUPERCEDESNO

DAlE REVISED

2/11/04

PAGE

OF

POLICY:
Nursing Protocols are developed and authorized by the Bureau of Health Services to provide Registered Nurses wilh guidelines for assessment and management of con•non health conditions in the Wisconsin Department of Corrcclious patient population.
Registered Nt,rses utilize nursing protocols approved by a physiciau as a delegated medical act. In using nursing protocols, RNs must do the following per Chapter N6, N602(2)a-d: a) Accept only flaose delegated medical acts for which there are protocols or written or verbal orders b) Accept only those delegated medical acts for which the RN is competent to perkbrm based on his or her nursing
education, training or experience. c) Consult with a physician, dentist, or podiatrist in cases where the RaN knows or should know a delegated medical
act may ham• a patient. d) Perform delegated medical acts under the general supervision of a physician, dentist, or podiatrist.
This policy/procedure does not include the WCCS facilities.
REFERENCES:
Notei This section lists various standards or resources, which contain subject matter pertinent to the development of the policy and procedure. These standards or resources are intended to be used for guidance only. Zhis does not imply the policy and procedure is intended to be the same in every regard as the standard or resource,
Ch. N6, Wisconsin Administrative Code, Board of Nursing, Department of Regulation and Licensing, Standards of Practice for Registered Nurses and Licensed Practical Nurses
DEFINITION: Star Referral:
A referral that should immediately result in a response or evaluation by an advanced level provider. This applies to any potentially life-threatening condition.
Urgent Referral: A referral that should result in evaluation the same day. This applies to circumstances which if left m•treated, the patient's condition may deteriorate or a painful condition which is uncontrolled with mild analgesics. At a minimmn, there must be same day phone consultation with an advanced level provider.
Routine Referral:
A refenal should result in a scheduled evaluation usually within ten days. This applies to circumst,'mces in which the patient's condition is non-urgent but requires an initial diagnosis or a diagnosed condition which has not responded to
the nursing protocol.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 118 of 185

DOC-3007 [Rev I,'03)
POLICY PROCEDURE

EFFECTI'JE [';ATE
May 1, 2004

300:18

!";t1• ,&•Lq.

Temperature

103F

<96F

Blood Pressure

Diastolic

>115mm HG

Syslolic

>170mm HG

<90ram HG

Pulse

>i 10/minute

<50/rn in ute

Respiration

>30/minute

<10/minute

ptfEatNoooxaozr.ttaiiaeten:ahnfpPiteapaostcat'piTtrieirthenoiienhtcnsntesuseea'l/laatsIroahhmnreuaeaprrsleapattgtranhiutop,eiuelnsdrcot.eossnmln'ogyidnenTcisdehohtseepiarowhclenieoot.tnnrhhlotmyila.cTcuayohontnsedeTdtreb/iheeerCterlieo.oilmi•ndndlan.escyfgtciatpnnhbticceeta,erirsaodipnincyawsycthocoaefrlnnocoraeosnstpachtoee•trwlrreehiomvennipainemtec/emrdSauadtaneuntbotriedeselmimuippmpteemawprrtiuraiatnetntheusgiu/rnsrNeiedevilosehoweeruiaaltsltlaseghi)serdv,neeatsrashrty,tehoheledde(esesetlp.phdegerei.cnsreidlsayeshl,inolgtlyndaisnfovdinucilaspnntehtenrerosardobmunlaesel
with implanted prosthetic devices.

FORMS/EQUIPMENT:
Nursing Protocol Manual BHS Approved assessment and flow sheets DOC-3021 Progress Notes DOC-3023 Physician's Orders
DOC-3034 Patient Medication Profile

REQUIREMENTS/NOTES:

Each with

protocol contains
the condition, the

a definition of the
nursing assessment

problem
process,

and and

its causes, the clinical
nursing interventions,

features most commonly associated which include patient educalion and

criteria for a slat, urgent and routine referral.

Nurses are expected to practice within
about the assessment and management

their liccnsure, training and experience of a patient, it should be refe•cd to an

when using protocols. When in douht advanced level provider for evaluation.

Orientation
After having
will be used

and Training received training by lhe nurse. An?,'

in physical, exceptions

assessment and orientation regarding their appropriate or deviations to the protocol should be based on sound

use, lhe
reasons

protocols
and be well

documented.

NTptaUrhrsuseiosreastetsosiocspnifomangletcNsinleutpunr.rdtssoesetsi.rovnRcegebPoogrlfaaosisPrf]rdeogssltuthsehiooiesducoselonmldlaaisloinfnbeejstuhhemdefagaorpldmtreehesnsoteausnvnetadriiisvnliaugcnbseulesrcedsoimuntnptogoiltasndipuenrrtaatssec,irtnwimgecialenblpeneaoarnrswdsmhoasanlsatntheeolluvililinttdfaielnorbaasmerriaeegtaaunissssoendswsuhhcseodhhuruolreudialnsdgcaliilsnhbwoieeaclayaalclsttohiloalbnceeet/cnistvcneeioogdtturieneedttsgoeartaamsinraoedknteocroeanafrasdeensaruserca.setsddeedqTa.iuhfnaedte

[ Case 2:12-cv-00592-TLN-CKD Document 137

DO•-300• (lqev,
F POLICY PROCEDURE

EFF•CTI"-/E DATE

May 1, 2004
L

Filed 03/03/14
NUMBER
300:18

Page 119 of 185
-3-

Using Nursing Protocols in Isolation IIousing Units To maximize the quality ofhealth care, health encounters such as sick call with the health record presenl, in an adequately equipped room that affords facilities. A pafier:t declared emergency may, at the nurses' discretion, be

should be conducted, whenever possible, privacy and access to handwashing briefly assessed through bars for the

urgcncy
complete

of the complaint. If urgent, the patient assessment performed, including vital

should
signs.

be taken •.o a•
If possible, the

examination room
patient's complete

for evaluation health record

and a should

be

m

hand, available for review. If non-urgent, the patient should be instrucled to submit a health services request form.

pncNddMInarueuierervardesusigs.issianecuitnosuarFigsgeoloirnsmaatrsvheye[sieex_sa•erarodssommpinsumrnaplsmogldyet"aeeonn,,Nctpourbilhryaonsoosvd,fwniiipeundvharviiegytsedpseruiaisca,Dtcalimiiir'eaaaem•uognyptnnsot'loonsryi_sotodpirareaaamsncnntatttoiluiteaafhntdlyetosvrstaaomanlrpawecp•kipaeatetocodhitftieeinnanthlttieedioavtialenhwsllteeithrti.shpsnhrcecaaItowtacliphttoeiboihsultoiaonobaofjredneeeuentdrduwpsrqgersueeemiamnsnaflogseyir,ufnrmitteeeImh•dd!ae"i_mkrac_aeeapca.dnau'ldLdaeia-•i_pnealmogbniseaydcendeodinafcnsoaufRer1lrede6sfegei0sirdtn/tsoig1ata1baedlgl0lrodnieiospdasmhsagoiitm.nsniNo/gesuHniNrotsgfusas.ernhsuryiasfrepnAqsoeguilr"minlteergoledidweniniivaspgcangilatngoaleonnads.aiosfbloisoda medical diagnosis to an advanced level practitioner.

Once a medical diagnosis has been made, nurses may refer For example, if the patient with the e]evated blood pressure i•ypertensive, and the nurse Icarus through the collection of antihypertensive medication during the previous month, the

to |he diagnosis if it is relevant to the presenting problem. described above has been previously diagnosed as being subjective data that the patient was noncompliant with nurse may appropriately conclude that the patient has an

'elevated
regarding

blood pressure the purpose of

due the

to medication medication and

noncompliance." An appropriate nursing effects of uncontrolled hypertension.

,esponse

includes

educatioo

The phrase "alteration io regarding the assessment

comfort or disconffort" as
of the patient. In general,

a
it

stand-alone nursing diagnosis
should be avoided and other,

provides no usefid info•vnation more specific nursing diagnoses

used, such as fever, chest pain or "disconffort comfort secondary to the problem such as ear pain."

Multiple Complaint Patients

Patients may
assessments.

present with
While these

a number of
complaints

problems which
should never be

if taken literally, taken lightly, it is

may require the performance of possible to focus the visit in one

five or
or two

more

meaningful areas by asking the patient the relative importance of each complaint, in addition to the nurse's

assessment of their urgency.

Vital Signs

Vital sign should generally be taken for all nursing encounters. If an inmate/youth is being

weekly) for follow-up
necessary to take vital

of a stable
signs. All

condition such as an
encounters resulting

ongoing, non-acute dermatological in a refen-al to a practitioner should

seen regularly problem il may have vital signs

(e.g.
not be taken.

Vilal signs that fall above or below the thresholds described should be referred on an urgent basis. This requires

phone consul*ation •vith an
identified thresholds is still

advanced lcvet provider.
considered abnormal and

"l'here may be circum,stances where
should be referred (i.e. patient with

vital signs within the
a chronic condition such

as

transplant with a temperature of 10 I)

The nurse must be cognizant of objective data which requires referral regardless of the presenting complaint of the

[NUMBER Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 120 of 185

DOC-3007 (hey 1/03)
POLICY PROCEDURE

EFFECTIVE DArE

May 1, 2004

300:18

patient. This is particularly relevant to abnormal vital signs. For example, a patient presenting witia athlete's who coincidcntally has a blood pressure reading nf 170/I 22 nm]/Hg shonld receive an urgent (same day) referral an advanced level provider.
Docmnentation
Nurses arc responsible for recording assessments they i•ave co•nplcted and interYentions taken, using the protocol as a guideline.
Patient Teaching A number of protocols contain attached insWdction sheets that can be used to rcinfo, rce patient teaching.
PROCEDURE:
Warden/Superintendent Responsibilities Ensure development of and compliance with policies and procedures.
Bureau of Health Services Director Responsibilities 1. Ensure development of and compliance with policies and procedures, 2. Approve Nursing Protocols 3. Assigns Nursing Coordinator •s chairperson of the Nursing Protocol Committee.
Medical D/rector Responsibilities 1, Approve :Nursing Protocols, 2. Identify physician for consultation with the Nursing Protocol Committee
Health Service Nursing Coordinator Responsibilities
1. Chair Nursing Protocol Committee.
2. Approve nursing protocols.
3. Dctcm•ine when existing nursing protocols need to be reviewed.
Nursing Protocol Committee Responsibilities I, Develop nursing protocols. 2. Review nursing protocols as needed.
Responsible Physician g, esponsibilities 1. Review and approve nursing protocols annually. 2. Notify, Nursi•g Protocol Committee if a protocol needs to be revised.

Ileallh Sere'ices Manager Responsibilities

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 121 of 185

DOC-3007 (Re,,',
POLICY

1i03)
PROCEDURE

E#FECTIVE DATE

NUMBER

M.av 1, 2004

300:18

-5-

1. Develop and implement unit policies and procedures. 2. Ensme compliance with policies a:ld [:roccdures. 3. Ensure appropriate use of nursing protocols.

4. Ensure staff are trained:

Orientation of new staff

All staff for new or revised nursing protocols at staffmeetings

5. 6.

Provide for staff to Maintain document

attend conmqittee meetings. of training of Nurse Clinicians

in

uses

of the

nursing

protocols.

Nurse Clinician Responsibilities 1. Use Nursing Protocols as appropriate.
2. Document as appropriate on 1)OC-3021 or checMists,
3. Record over--the-counter medications on DOC-3034.
4. Record prescription medications on DOC-3023 and DOC-3034.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 122 of 185

•;•,X'•'•'•,•'Z;•%y'•;'•

CHEST PAIN ASSESSMEN-I FNC•JUN •R

(}FFENDER NAME

Dec NUMBER

DATE

lIME

On•e: Pain:
Timing: easel
Describes Pain asi
LocatieR
ff_s_s_ o/s ai_ e_.d• C•o•_•_P laints

Pain Scale (1 10)

• era( al [] Sudden [[] Co•lstant

[] h•terrnitlent •] With inspiration or e×piration

[] Sharp [] Dull [] Crushing/vice-like [] Throbbing EZ[] Sq •e:• r9 [] Pressure/heaviness

[] Ache [] fingiing or numbness [] Burning

[] Substernai []Chest L• Epigastdum [] Neck [] Arm • Jaw [•j Radiation

[] SOB [] Nausea/vomiting [] ndges on [] alpltatons [] Li.•htbeadedness [] Sweatina

What makes it better?

What makes It wo[se'7

[-J Exercise [] Rest [] Eatiqg. [] Other

[[] Exerc:,se [] Rest [] Eati•nng

History

[] Cardiac Disease (or family hislory) [] Diabetes [] Hypertension [] Smokes [[]

[] Obesity [] age 40 [] Drug user (e.g. cocaine)

[] Alcohol user

_•_ Other
High Lipids

Present tried}cations:
RX for nit•cerin? []Yes [] Nc

was it taken sublin_•u__a_l_.•v_e•,_5 minutes 3 [] Yes [] No Did il relieve pain? [[] 'Yes • No

Genera! appearance: [] Anxious

[] Restless [] Guarded [[] Relaxed

Vital Signs: BP & P:

]emperatL

Respirations

Heart Sounds
Puises

[•] Regular [] Irregular [] Extra Sounds

[] Other

[] Radial [] Right [] Left

[] Pedal

[] Right • I..efl

Breath Sounds
Respiralory
Abdomen Skin

[] Clear [-] Crackles [] Wf'•eezing [• Ra!es [] Diminished

[] Cough [] Congestion [] Sputum (color

[] Hemop•sis [] Dyspnea

[] Distended [] Soft [] Rigid

Bowel Sounds: [']"J Active [] Hyperactive [] Hypoactive

[] Pale [] Cyanofic [] Flushed [] Diaphoretic/clammy • Jauntlced [.[] giber

[] Absent

[] Leg swel!in.•/_•sln [] O•her

[] Chest pain th significant signs and symptoms [] Chest pain unrelieved by nitroglycerin [] Chest pain withoul significant signs and symptoms

[]Other:

• Activate EMS (911)

• CPR/AED

[] Oxygen up to 8 Liters per m•nute

[]

Aspirin (if

325 mg o_[r baby aspirin (4
used, obtain Practitioner

tablets Order

of 81 mg
later)

each)

ci•ewed

[] Nitroglycerin sublingual ff systotic B!P g0 mm/hg and head ra!e

<100 (have patient lay down) (if used, obtain Practitioner

Order

late[)

[] Monilor vital signs time & conditions permit

[] Practitioner notified

(time)

• Advised to submit HSR if

,• Other

[] Follow-up instructions/appointment
STAFF SIGNATURE

DATE SIGNED

DISTRIBUTION: Odginal Progress Notes Medical Record

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 123 of 185

DEPARTMENT OF CORRECTIONS Division of Adult }r-•stJtu[Iorls
DOC-3424C (Roy, 1/2'_J•
OFFENDER NAME

DERMATOLOGICAL
DOC NUMBER

Chief Co Tlplaint" Allerg

....................................................
Tetanus (date)

Onset:

Duration:

ASSESSMENT

WISCONSIN

area(s)• DATE

TIME

Mark affected

Prig episodes [] Yes [] No

[ocation:

> Prior treatments:
,•O,._,

Resu4ts?

g Aggravating/relieving lectors

An}, change on skin (;aru, laundcy pr3duc s, job,

Medical H•sto•,

Present Medications:

Vilal Signs: BP

Pulse

Resp. rate

Temp.

Description of Lesions:

Type

[] Les,on

[•jBum

[] Macules

[] Papules

[] Puslules

[] Dr'), ['-I Scaly

[] Thickened

[] Excoriation

[] Erythematous

[] Laceration [] Comedone • Flaking

Size/measurement
[] Wheals [] Plaque [] Fissures [] Peeling Signs!Symptoms of infection

[] Vesicles [] Nodule
Color
[] Yes [] No

[] Bu!la

[] Drainage/Bleeding Color.

• Acne Protocol{s)

Utilized:

[] E(:zema

[] Seborrheic Dermatitis

Amounl
[] Blisters •l Frostbite [] Tinea Cruris

Consistency [] Burns [] Insect Bites/Sting [] Tinea Pedts

[] Callus/Corns [_-] Pediculosis [] Tinea Verslcolar

[] Dry Skin [] PFB [] Wads

Impaired:

• skin integrity [] mobility • Body image disturbance

[] Alteration in comfo,1 r/t

Potential lor: [] Inlection

[] Altered tissue perfusion

[] Other

[] Cleansing/Soaks

[] Topical

per protocol

[.• Dress ngs

{steri-stdps)

[] Supplies (corn plaster, pumice stone, basin)

•-j Analgesic [] Antihistamine [] Education

per protocol per protocol per protocol

Referral: [] Star Anaphylaxls, (Burns
2 or 3 degree. ENT, perineum, and 5-10%, electrical
STAFF SIGNATURE

] Urgent Abnormal V.S., Overdue td booster; Signs of infection, Wounds: In diabetics & vascular disease; animal or human bites; grossly contaminated; uncontrolled bleeding; deep; penetrating; crushing;
functional impairment
DATE

[] Routine

No

response to treatment

DISTRIBUTION:

Original Medical Chart, Progress Notes Section

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 124 of 185

DEPARTMENT OF CORRECTIONS Division of AdulI Instllullons DOO-3424B (Re,'. I!2006)
OFFENDER NAME

DIZZINESS SYNCOPE ASSESSMENT ENCOUNTER

Dec NUMBER

DATE

T;ME

Onset
Previous HIsto•z'

[] Gradual • Sudden • Constant • Yes • No If yes, describe

• lnlermlt•ent

• Duration

What makes be•e•?

What makes worse?

Associated complaints
e

• Nansen •Vomifing • Headache • Sweating [• SOB • palpitations • hearing loss • CP

'• What happened before and/or after the event?

History

[] Cardiac Disease [[J HTN [] Seizures [] Arrythmlas [] SlrokefTIAs [] Diabetes Mellitus [] Asthma/EmFhyserna [] GI Bleed [] Drug Use [] Trauma [.•J Thyroid Disease

Present Medications:

Allergies:

General appearance: [] Anxious Vital Signs: /BP & P: Lying

[] Restless [] Guarded Sitting

[] Relaxed

Standing

T.

R

>'
J¢:•
O

[] Pulse
Neuro
CV

OximetP#

[] Accucheck

AAOX3 [] yes i•J No

Hand grasps- equal [] yes

Rate/rhythm regular [] yes

Steadylsymmetrical movements

[] No

Balance normai []

[] No Pulses equal- radial []

[]
yes yes

yes
[]
[]

[]
No No

Resp,latory:
GI

Cough [] yes [] No Sputum [] yes [] No
Abdomen: So.Rigid/Distended (circle)
,.?,owel Sounds: hypoactivelHyperactive/Absent (circlet

I.ung Sounds
• I•
[]yes []

PERL [] yes Gait normal [] yes
Pedal [] yes Normal L• Ye• [] No
No If no describe:
No If nodcscribe:

[] No [] No • No

EENT
L.• •kin

Bowel Movement; Normal/Constipation/Diarrhea/Tarry (circle)

Normal Eyes (vision)iEars/Nos e,rThr°a•jNeck (circle) [] Normal (WUfP) [] Paie [] Diaphoretic [] Hot

[]

[] yes
•
Dry []

[] No If no describe:
[] No If no describe: Cyanotic [] Ruddy

• Edema

• lmpa!red Physical Mobility

[] Potential for Injury

[] Alleration in Fluid Status [] Loss Of consciousness

lurstng Protocol (s} utilized: El Headache
[] Lay fiat & elevate legs [] !ncrease fluid inlake [] Reassure [] Breathe in paper bag If hypervenfilating

[] Dizziness/Syncope

[] Restriction from working at heights with machiner'y • Acetam]nophen 1-2 tablets O 4-6 hours as needed per protoc{)l

[] Ibuprofen 1-2 tabs Q 4-6 hours as needed per protocol

[] Education per

protocol

lI-1-•Practitioner ••"

Referral:
Slat Referral if abnormal vital signs Urgent (same day) if a decrease In

persistent bradycardia or tachycardia, persistent hypotension level of consciousness, weakness or difficulty speaking, alter

or chest pain
mental •Latus,

age

45 years or with a

]history of arrhythmia and/0r CHF
[•] Follow-up Routine tf the findings

&

examination

is

norton!

examination

& a•g_•.is

less

than

45_)L•.ars

DATE SIGNED

STAFF SIGNATURE

DISTRIBUTION: Original Medical Chart, Progress Notes Section

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14
DEPARTMENT OF CORRECTIONS GASTROINTESTINAL ASSESSMENT

Page 125 of 185
ENCOUNTER

WISCONSIN

• Di,.-ision of Adult Institutions
DOC-3501 OFFENDER NAME

DQC NUMBER

DA.] E

TIME

Onset Pain:
"riming: onset
Describes Pain as:

Pair Scale (1 10)

[] Gradual [] Sudden _• Constaot

[] Intermittent [] Louatio•

•J Sharp [] Dull [_• Crushing [] Throbbing [] Burning [] Squeezing

What makes it better?

Last BM?

,l,

[] Abdominal trauma

[] Color [] Constipation El Nausea •JVomiting_

What makes it worse'?

..............................................

[] Diarrhea [] Normal; # ef Stools in 24 hours

Duration

Duration

Amount

Color

[] Ulcer [] Hiatal Hernia [] Pregnancy

[] hritable Bowel Syndrome • Vaginal Discharge

[• Genitourinary Cornplalnts
LMP'

General appearance: [] Anxious Vital Signs: BP & P: lying
Abdomen: [] Distended [] Soft Cardiac: [] Heart, Sounds Respiratory: [] Lung Sounds Skin: [] Normal (WDfP) [] Pale LAB: [] Guiac Stool

[] Restless [] Rigid

[] Guarded [] Relaxed Standing
Bowel Sounds: [] Active
Circulatory:

Temp.

Respirations

[] Hyperacllve [] Hypoactive L--J Absent

[] Pulses

[] Flushed [.-•] Cyanotic [] Dip•[•x UdHe

[] Jaundiced

[] Clammy [] Diaphoretic [] pregnancy udne

Nursing Protocol (s) utilized:

[] Acute abdomen [] Diarrhea [] Hemorrhoids L• Nausea,•'ornltlng [] Constipation

[] Gastrointestinal Bleeding

[] Heartburn [] Lactose Intolerance [] Flatulence/Bloating [] Other:

ition in:

[] Comfort [] Pattern of elimination [] Nutrition [] Clrcutalion [] Other:

[] Analgesia r• Laxative/supp
I'] Antacid • Hemorrhoid Cream

(medication) (medication) (medication) (medication)

pal p•otocol per protocol per protocol per protocol

[] Diet [] Education per [] Advised to submit HSR if Sx get worse [] Follow-up appointment

protocol (Date)

[] Stat Referral
STAFF SIGNATURE

[] Urgent (same day)

BISTRIBUTION: Original Medical Chart, Progress Notes Section

[] Follow-up Routine
DATE SIGNED

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 126 of 185

DEPARTMENT OF CORRECTIONS Division el Adult Ins!itdtions
•,c,c-3.• (•,_•,:: •.•.,,.
OFFENDER NAME

_GEN I•0.U R•.•ARY ASSESSM ENT ENCOU NTER

WISCONSIN

DeC NUMBER

DATE

TiME

Symptcms:
Check if yes

easel
• Hemalurla • Dysuria • Pain l.ocafion & ralin9 • Olher

D•rafion

Females Date last LMP

[.:] Associaled symptoms chills/fever/foul odor EJ vaginal or UreLhra; Discharge

• •ncontinence/voiding difficulties • Caffeine Intake

History

[] Previous UTI's [] HistoQ,, of STD []Recent Trauma/Strenuous Activity [] Masturbatlon r• GI Bleed

Date of Last Se×ual Intercourse

[] Constipalion/Diarrhea [] Diabetes Mellitus [] Hype•ension

• Neurologlc Disorder • Penile Dis•rde• • Endocrine Disorder

• Olher:

Present Med•cat;oas:

General appearance: [] Anxious [] Restless [] Guarded [] Relaxed [] Toxic (pale, listless, ill)

Vital S gns: BP/P

Lying:

Sitting:

R.

Of the following check & comment on ONLY those that are ABNORMAL:

HE'ENT Neuro

[] t4ead//Ears/Nose/Throat/Neck (circle) [] AAOX3 [] Movements El PERL [j Gait

Musculoskeleta! CV
Respiratory:
GI
GU Skin

[] ROM [] Muscular Strength [] Symmetry/Alignment •]Motor Weakness
[] Rate/rhythm regular [] Lung Sounds [] Rh•hm [] Quality [] Abx:lomen: Soft/Rigid/Distended (circle) [] Bowel Sounds [] Bladder Distention [] Genitalia [•lLIrine Oipstix [] Rashes E] Edema [] Hot • Dry [] Erythema [] Other

[] Costovertebral

T.
[] Tenderness

[] Alteralion In Elimination
Nursing Protocol (s} utilized:

[] Potenlial for Infection [] Genitourinary- Mate [] Genltourina•'- Female

[] Push Fluids 8 (8 ounoe glasses per day)
Eliminate caffeine/coffee drinks
[] Perinea! {ygiene (ie, loose fitting pants, change unden,,vear daily, v.,ipe front to back) [] Avc, lda full bladder [] Do net postpone urination

[] Ibuprofen 200 mg 1-2 tabs ever3.' 4-6 hours as needed per
protocol or
[] Aeetarninophen 1-2 tab!ets Q 4-6 hours as needed per •rotocol

[] Other per

protocol

[] Education per

protocol

Practitioner Referral:

[] Star Referral: (testicutar torsion,

Abnormal vital signs with a•ute symptoms of epididymitis, renal calculi); Signs of systemic

chills, fever; Flank pain
infection such as fever,

with fever; Acute
chills, Inability or

onset of
difficulty

testicular pain; In voiding.

Extreme

pain

[] Urgent (same day) Elevated temperature. Positive LET or nitrites on urine dipstix; Pregnan1 females; Recurring infection arler treatment

STAFF SIGNATURE

DISTRIBUTION: Original Medical Chart, Progress Notes Section

DECPAaRTsMeENT2:O1F2C-OcRvRE-C0T0IO5NS92-TLN-CKHDEADDoAcCuHmEentA1S3S7ESFSileMdE0N3T/03E/1N4COPUaNgTeE1R27 of 185 WISCONSIH

DivL'•ion of Adu!t

OFFENDER NAME

Dec NUMBER

DATE

TIME

Onset: • Gradual • Sud•:en

Previous or ,Recent Trauma

• Ye•;

"F• Durallo• • No If yes, describe

['• Lc, cat•on

• Radiation
P•J•n L{•v{•;: Rate 1-1•)

What makes it better?
Associated complaints

Wha• makes It worse?
• NauseaNomitm9 • Diaphoresis • Photophobia • Rhino•hea • Vision Changes •

Therapies Tded:

•

•
OTC

Congestion
• •_

• Weakness E]Dizzlness!Syncope • Relaxation •HeaUCold

History

Similar Episodes [• Yes EQ No If yes, How ofien'•

What Precipitates?

Past ]reatmenl

Medical Problems

Present Medications:

Allergies:

General appearance: Vital Signs: BP

[] Anxious [] Restless [] Guarded [] Relaxed [] Flat Affect •

Pu!se.

Respiration

Temperature

(circle those that apply & comment on abnormal)

Distressed

Nouro
CV Musculoskeletal EENT Skin

AAOX3-Confused Obtunded PERLA Balance/Gait WNL IVIAE Symmetrically Weakness in Extremity Ata×tc

N umbn

Ting IIn 9

Rate/rhylhrn regular Radial & Pedal Pulses

WNL []yes []No

No Evidence of Trauma Deformity Neck Stiffness with Flexion

WNL []yes []No

Muscle Tone Limited Movement No Tenderness to Palpation

WNL []yes [•]No

Eyes visk)n Ears Nose Throat Neck
I• Normal (WD/P) IL•J Pale [] Diaphoretic [] I-lot F___] Dry

WNL []yes L•No Cyanotic [] Ruddy [] Edema

[] Alteration in comfu•l related to headache pain

Nursing Protocol (s) utilized:

[] Headache

[] Acetaminophen I-2 tablets Q 4-6 hours as needed per p•otocol [] Ibuprofen 1-2 tabs Q 4-6 hours needed per protocol [] Relaxation techniques [] Wa[m!cool compresses [] Increase Fluids

[] Headache Diary (length of th-ee)
[_] Education [] Discuss lifestyle such avoiding excessive caffeine, sleep patterns, avoid nicotine, stress management [] Discuss overuse of analgesics rebound headaches [] Trigger avoidance [] Re!-.]u!ar Exelclse
ILl Clinlcai Referral

Practitioner Referral:
[] Star Abnormal vita! signs; New-onset, previous ones; Headaches becorntrrg more

unl'ateral headache, particulaHy hl
continuous and intense; Headaches

patients over age accompanied by

35; Severe
vomiting

headache but not nausea;

headache

ditfe•ent

frem

[] Urgent (same day) Abnormal Vital Signs [] Follow-up Routine if the findings & e×an•ination is normal

Return if unrelieved or Increased sevelity or duration, new symptoms, fever chilis,

visual disturbances, numbness, weakness, dizzlness, or s}'ncope_:_ STAFF SIGNATURE

DATE SIGNED

DISTRIBUTION: Original Medical Chart, Progress Notes Section

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 128 of 185

WISCONSIN

DEPAR'[MENI[ OF CORRECTIONS Division of Adu!t lnsti{ut

RESPIRATORY ASSESSMENT ENCOUNTER

DOC-3516 {Re'.,. 212006}
OFFENDER NAME

Dec NUMBER

DATE

fIr4E

Symptoms

Onset

Duralion & course

Check

i£
• •

yes

[• Cough • Sputum

Pain • Lo•ation

&

Odhopnea • Exe•onal dyspnea

Color_• • Dyspnea • Numbness/tingling toes/•ngers/around

rating

• Palpitations • ResplratoG Infection (e.g. clod/flu)

• Activity Intolerance • Feelings of malaise

•

mouth
• Wheezing
Othe•

•

• Other:

•
,•

Measures uied fo• relief

(e.g nhaler]

t..listo%, • Asthma • COPDIEmphysema • Resplra•o• Infections

• Cardiac Disease

• HTN

•

• Arr•hmias • Strok•lAs • Diabetes MeliRus • Trauma • Smoker • Other

[] Othe<
Present Medications:

•AlleLg.ies:

Primary SbF.'ey [] Conscious [-j Airway patent [] Brealhlng [] Circulation

General Appearance

Vital Signs:

BP

[] Anxious [] Restless [] Guarded

T.

p

R

[] Relaxed [] Lethargic

W

Pulse Oximetry

Peak Flows

Of the following check & comment on ONLY those that are ABNORMAL:

HEENT

[] t4ead//Ears/NosefThroaVNeck (circle)

Neura

[] AAOX3 [] Movements [] PERL [] Gait

Musculoske!etal CV
Respiratory:

• Musr'.4•lar Strength [] Symmetry/Alignment [] PesturelGait • Accessory Muscles
[] Rate/rhythm [] Pulses: Radial [] Pedal [] Lung Soonds [] Accessory muscles [] Re£plratoi"y Rate [•1 Wheezing [] Sputum Color •.j Other

GI Skin

[] Abdomen: Sof'u'RigidlDistended (circle) [] Bowel Sounds [] BM [] Diaphoretic [] Hot [] Dry [] Cyanotic [] Eryf.hema [] Edema

i-•--J [] Ineffective airway cleara3ce [] Alteration in comfort r/t dyspnea [] Anxiety rlt situational stress [] Ineffective breathing pattern

!Nursing []
•1

repaired

gas exchange

Protocol (s) utilized: • Hypewentllat•on

"• •ror•-•-••-• 6[SE• •a•g--•-•".

[-] RespiratoQ,' Distress [] Upper Respirator' Infection [] Asthma
[] Ibuprofen 200 mg 1-2 tabs every 4-6 hours as needed per protocol or

[] Place in high fowlers or position of comfort

[--J Acetaminophen !-2 tablets Q 4-6 hours as needed per protocol

[] 02 if available (flow rate per administrat}oa device, 640 15 liters)

[] Other per

protocol

[] Monllor VS & 02 saturation For •'•tldJModerate Symptoms:

[] Education per_ [] Nebulizer per

protocol protocol

[• Push fluids Unless contra:ndicated (0.9. CHF)

•void offending_a_gents ismcke, dust, etc.)

• Practltloner Referral: [] Stat (EMS) Referral: Respiratory Arrest; Severe respiratory distress; Foreign body inhibiting breathing; Dist.ress with cyanosis of the lips,
finger nail beds, or earlobes: Pulse Oxlmeter reading of <90%

[] Urgent (same dayJ Wheezlo#,_•.s_,EQ.•a•l°wm•g wtth°ut severe distress; Abnormal vital
.............

DATE SIGNED

STAFF SIGNATURE

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 129 of 185

DEPARTi"4EN• OF CORRECTIONS
D•;,,slo• o; •. In•,,•*,,•

TRAUMA ASSESSMENT ENCOUNTER

DOC-3517 {2/2006•
OFFENDER NAME

DQC NUMBER

DATE

•ME

Date & time
Sit•(s) affested • Ankles & Feet Type of lnjury

Meuhanism' • Fail • Fall from height •] Wcrk related • ARercatit;.n • S?,o• related • So'f-inflicted

•] I•ead & Neck •] Hands & Wdsts • Elbows

• Shoulders & Related Stmc1•res

• Knees& Hips [] Spine •Abdomeo • Chest •Other

• Impacl • Blunt Force • Crushing • Laceration

• •

Pain

Rate on a scale of 1-10

Presenting cornpiaints (patient Statement)

Loca•[Jn/R•Jdia!iu[•

Describe

What happened before and/or after the event?

Histo•

• Cardiac Disease • H1N • Seizures

[• Ar•thm•as • StrokefTIAs • Diabetes Meltitus • GI Bleed

Present Medications:

Tetanus •Y•:

Primary Survey: [• Conscious [] Airway patent [] Breathing [] Circulation [] Neuro (PERRL EOM A&O X 3)

General appearance: [] An×ious [] Restless [] Guarded

Vital Signs:

BP

T.

P.

[] Relaxed
R.

[] Pulse Oximet•7

Of the following check & comment on ONLY those that ate ABNORMAL:

(if applicable)

HEENT
Neuro Musculo-
skeletal
CV
Respirator'y:
GI Skin

Head/IEarslNose/lhrcatlNeck (circle) [] Teeth [] Eyes: [] Vision [] Foreign Body

[] AAOX3 [] Steady/symmetrical rnovemer•ts h• PERLA [] Gait [] Sensory loss R/t h•jury [] ROt,,4 [] Muscular Strength [] Symmetry/Alignment [] Crepitus []Motor Weakness

L•J Joint instability [] Unable to Bear Weight

Deformity [] Focal or Poird "[r•r•derness

[] Rate/rhythm regular [] Pulses equal radial [] Pedal

[] Lung Sounds • Rhythm • Quality

[• []

Abdomen:
Diaphoretic

Soft/Rigid/Distended [] Hot [] Dry

(circle) [] Bowel Sounds [] [] Cyanotic [] Er,/thema

BM
[]

[] Anal
Edema

Sphincter (spine) [] Bruising [•

Bleeding

[] Irnpairod Physical Mobility

[] Potential for Inju•

Nursing Protocol (s) utilized: [] Ankle-Foot lnjuE,, [] Musculoskaletal

F'ain

[]

lrauma/h•juq,;

[] Protect

[] Rest Affected Area & Immobilize t-•art

[•[• Ice

[_• Compression (if appropriate)

[] Elevate timb

[] Tetanus per standing order

L•J Back Pain [] Eye Pain/Injury [• Dent•l Trauma

[] Activity Restriction

• Ibuprofen 200 mg 1-2 tabs every 4 (J hours as needed per protocol or [] Acetaminophen 1-2 tablets Q 4-6 hours as needed pe prolocol

[] Other per

protocol

[] Education per

protoc:•]

Practitioner Referral:

• Star Referral, Dental: {orofacial

smwaejlolringtra&umfae;ver,Losusnreofsoclovnesdciohuesmnoersrsh;aginsgp}in;e:

{saddle anesthesia, Eye: {chemical spill,

neurologlc deficits nower major trauma, sudden visual

extremities•,; abnormal
toss or flashing lights,

vital si#,qs,
embedded

[] Urgent (same day) pain): Dental {orofacial

Potential
swelling

fractures; but normal

Inability to bear
temperature};

weight with severe focal or point tenderness; Eye: {corneal abrasion, inability to remove FB,

Spine:{ over infections}

age

50

with

acute

onset

of

STAFF SIGNATURE

DATE SIGNED

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 130 of 185

SUBJECT:

ABDOMINAL PAIN

EFFECTIVE DATE:

',')CTt')EiE R 1,

SUPERSEDES:

OCTC,•F R I,

Nole: T• prolo• meant Io pmv•e very ge•:•a] gu•q• Io PCSO medical •{1 menL •nd dl•pos• ol •enl•. As '• any •e• medica• •ue, thoto t• q•[ion

Vi•al signs must be taken p•d of • protoco# assessmenL

•ot • weli.bein• an•

2 NB•ea? Vomllln•? Dia•a? # of limRs? o• ho•? •br c•s•slenc)'?, bb•? 3 Has •e •on •ng• in co• oI sloop •lipat•n? Da!• of •sl BM? Sloo! •br red b•ck?
P• •ed Io f• inb•ko?
6, • •hey hunp•, •BJECT•E F•ND•GS
I, Temp.__, P•e.....• Re•p,.._ BP_• • 2. • • pa•s, sweal•r•, webhl bs•? Dry olal
• l•g •up•)•

5
G. Be',ve• sounds?
•'. Lung
B. Head sounds?
9, L•P?
10 VBQ•at D•charge bleeding 11. Dtp•lk:k urge re..su•s? 12. Is pain lelated Io hod

•.E•SSSf4E•'l C•CLS•ON I. AJ•om•,"•l pa• Etiology (?)

dele•ad a•v•.

FI•DING• REQUIRING REFES•. 1, T•p 1•,4 Pu•e I00 R•p

3 P• severn, •liz•, ge•m•ed Call D•t•/ARNP for

5, In•l•ble Nauso•ng CaB Dod•A•P for orders
6.

B. P• u•mpro• •h •se•v•Sve g, PaiNe d•ck place •x• a•gi•hl• D•or/ARNP SC.

•I•{3[t•.p.S_NOT RE•RiNG REFER•L:

2. M•um to rain •# {A•dl• IG l• of paln and

ACTION PLAN: APPROVED OTC. MED$: (C)eck reed aIlergle,•) Meabx 10 15 BID x3 day•
2 SymPto'mal•c (I.e. av•da•e of oFe•d;•g fc•d•
Kaop•la•o dWcci• (• dlanh•a

2. A•da•e of offending feo• Remain NPO u•t•

peases,

3 Po•slbll•y of mi• Wa• infeci•n. •h may persisl for 24 •8 h•.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 131 of 185

SUPERSEDES;

SEP1"EMBER 21.

2. Onsei?
Irtcre•sed pain •lh •h7
B. R.O.M.?
NFJT• P•-•S G• & MOVEMENt BE •OR• AFTER H•STO•Y pHyS}CAL,
8, R•sh• Poss•E•t o• sh•n•es?
• B•che
FINDINGS RE••
7 Posi•,'B di•k FIND!NGS NOT REQUIRING REFER•I

•. Tyrol 325mg-•,1•2 t•els PO Suggest dm•e back exe• (See bantuS)

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 132 of 185
CIWA FORMS

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 133 of 185

iHAUSEA & VOMITING
,4,ave y•u
O•SERVA •ON;
Mild Nau•e•

CLINICAL INSTITUTEALCWOIHTOIiLDR(ArWevAiLsed)AS(SCEIWSAS-MArE}NT RF-VI EW SHEET

Ask, "Do yeu feel s;ck to youl stomach?

AUDITORYDISTURBAN CES Ask "f•r• "cu moH• :zware of sounds

around you? aqvthmg #•at

#re they harsh? Do they
•s disturb•nq t3 you? Ar•

frighlen vouY •re you neon you heerin• thngs you

g

are not there?"

0 N•t present

Mi•d harshness ab•it!y frighten

M.ode•a•ely

hail•cinatlcr•

Severe halladnal)ons

TREMOR A•ms emended, fingers spread apart.

No tr@mef b|ot v•slb•e but

be f•ll tinge:lip to fi•ge•p

•3
•4 Mo•rat•, • pa•enf•

e•end•

Continuous hallucinogens

se•ing VISUAL
bdght?

DISTURBANCES Ask; "Does

is the color different? Does
anything :hotis disturbing to

hurt
you?

the tight appear your eyes? Am A•e you seeing

to be too
you
things

,ou know are not there?"

Mild ns•Jvlt•/, Moderate halshn•ss ability to fikjhten

Moderately

haltuon•J:ms

,NXIETY Ask, "Do you feel nervous?" MIIdiy anxtous

Conglluou• ha•cinefl•ns HEADACHE, FULLNESS IN HEAD -Ask, "Does YOUR. HEAD
FEEL DIFFERENT? Does '• feel like there is a band around your
head?" Do Not rate d•2:iness or 1ightheadedness. Otherwise rate
severity:
Veo;

AGITATION

Normal act v•'

Sonq•wha!

than normal

ORIENTATION AND INCLUDING OF SENSORIUM -Ask, 'M•q]at day is this? Where ale you? Who am

•2

Cannot de •;dat add•]ans •so•ent• for date by

an•:eMain abou• •hc dale lhan 2 •enda• days

(oz date by

than sounder days

}4 •isodented •or piece and/or pe•son

DISTUI•BANCES ',Have ACTILE
needles sensations,

any

Ask, burning any

you had any itching, pins & f•urr•bness,'.or do you feel bugs

crawling on or under your skin?"

Ve• m•d •ching, •ns & ne•gs, b•u•b•g, numbness Mild •I•, pW•s & needles, burning, numbness

10•t9 20-25
25
Place Score on CIWA-Ar Score Sheet

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 134 of 185

Name
<Name>>

•ntake Providef" Orders-ClSVA Performance

Not for Use for Other S tbstance
(Three Page Path•*,a•9
Inmate Number
<dnmateNumber•>

] 5• • • {{DOB>>

Time:
ausea and Vomiting
emor
aroxysmal Sweating }itation
actile Disturbances
Jditory Disturbances
sual Disturbances lxietv
•adaches, Fullness in the Head
ientation
•tal (max score 67)

SCORE

Vitals

COS
C 0 R
• Today's Date
• {{ClientDate,

Y/N Y/N

e

in conjunction
scores for the

with CIWA-Ar Assessment
10 items are summed to give

Review total

Sheet.
score.

Stable

20-25

9 Mi)d to moderate wtthd•wal

> 25

Moderate withdrawal Severe withdrawal

•ysician:

Allergies:

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 135 of 185

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 136 of 185

Begin "infirmary D• ug/Alcohol Protocol Monitoring Form" and vital signs q 8 hours
_2_)] [[•.i•ir.[•].a_,• Admission, Levei
3', Low bunk, seizure precautions x14 days 41 Beg;n the following detoxlficatlon treatment(s):
Valium {dlazepam) 10rag po q 8hrs 4B hrs; then,
•./alium 10rag p.o q12hrs x 48hrs; then Valiom 10rag p.o Qt4S x 48hrs; then discontinue
HOLD VALIUM tF ASLEEP OR SEDATED
6 Thiamine 100rag p.o daily x3 days
7) Laborator•CBC, CMP, Magnesium Notify HCP if unable to tolerate oral medications or remaining symptomatic

Begin •e following deloxifications trea•ent(s):
•] Atlvan 1.0rag p.o q 8hrs x 48hrs; then

[•] Vatium (dlazepam) 10mg p.o q 8hrs x 48 hrs; then,

Aryan 0.Smg p.o q8hrs x ?2hrs; then

Ativan 0.5 mg p.o q12hrs x 72hrs; tiqen

Afivan 0.Smg p.o QHS x 48hrs; then discontinue
HOLD ATIVAN IF ASLEEP OR SEDATED

-OR-

IPlace 3)

In Psych RN Clinic (23) in A.M. after reeds have slatted

Vellum 10rag p.o q12hrs x 48hrs; then Vellum 10mg p.o QHS x 48hrs; then discontinue

4OLD VALIUM IF ASLEEP OR SEDATED

m•d.• started

Place tn Psych RN Clinic (23)in A.M. after

have

4 Notify HCP if unable tc tolerate oral medications or remaining symptomatic

I) •Low bunk, seizure precaution x 14 da•

2) iBegin the [ollowin9 detoxification treatmentS:

3)

•lonidine as follows:
Clonidine 0.1rag p.o TID

x 48

hours;

then

Clonidine

0.1rag

p.o

BID

x 48

hours;

then

Clonldine 0.1rag p.o QH5 x 48 hours; then discontinue
Hold Clonidine for systoli• • mmHg or diastoll• • 70 mmH•

•

p.o TID x 72 hours pm muscie aches

5) IPhen•rgan 25 mg IM or po TID x 72 hours (Ho'd p atlent •s too sedated q•e IM If vomiting)

6) Bentyt 20m• P:0 TID x 72 hours

i_8_.!t•£1j•._ H_•.[• 7)

Ilmodiur n

4rag

p.o,

TID

×

7•._h_o__ur s

if_unable to !ole•t_e_ oral med!cations or remain nl g symptomatic

ALLERGIES: Patlent Name:
5849 (05/08)

IS_e_x_: ]Facility: Booking Number:

D.O,B.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 137 of 185
0

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 138 of 185
\ \

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 139 of 185
KOP
POLICY
AND
CONTRACT

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 140 of 185

To facilitate clinically appropriate medication services and to

provide
manner
division.

prescribed
within the This is a

medications in
Detention Health
revised policy, in

a timely, safe,
Cue Services

and sufficient
(DttCS), adult

compliance with NCCHC J-

D-02, and supersedes the policy dated 09/04/07.

LABORATION:

NITIONS

Executive Medical Management Staff-Term relenting to the Medical
Director, Administrative Director, Director of Mental Health, and the
Director of Nursing

Coutrolled Substance Administration Record Used to document
patient receipt of prescribed medications that are considered to be
"controlled medications" according to law. Also used to document patient refusal to report for medication administration when indicated.
Controlled Substance Record -Log used to mahatain accountability for
all controlled medications administered within the Detention Health Care
Services (DHCS)

DOT Medications that extra caution is

Medications that needed to insure

prescribed with

are
patient

compliance

the

instl-uctions

Floor Stock System System of using stock medication supply, rather than blister packs generated for each individual patient

KOP MEDS "Keep on person medications"; medications that may be
issued to the patient for self administration

DHCS Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 141 of 185

Detention Health Care Services
Policies and Procedures

Policy' No.: J-D-02 Page Number: 2 of 22
Effective Date: 02/11/09

MacddooAmnciRsunimidesetnrrteadMteidpotaiontc,ibaeetntio'"orscnonrtfAeardfioulmlusilraeneldisttosorfuabrtseitppoaronrentscceRrseii"bcbroerdadmc,ecdomireudcdsiaeintdcgiaotnttiooondlasaodwmc.iuntmihAeaslnttstroatariupesaoetndiennoatttso
scheduled

No Show-- Occurrences
medication room, or administration. Should

of patient failure to report to the medication cart,

treatment room
be documented on

for the

scheduled medication
patient's MARS.

Patient Advocacy Term
defending the clinical best

used (broadly)
interests of the

here to refer to monitoring and
patients entrusted to our care,

consistent with established communi• standards.

Jo

Refusal
treatment
take the

Patient reports to room for scheduled medication. Refusal

the medication cart, medication medication administration but
form should be signed.

roo•n,
refuses

or
to

I1.

THE THE

MEDICAL DIRECTOR
ADMINISTRATION OF

ESTABLISItES POLICIES REGARDING ALL PRESCRIPTION MEDICATIONS

DELIVERED WITHIN TItE FACILITY.

Administration of prescribed medication

from other

alegpahlylsyicaiuatnh,oripzheydsiciinadni'vsiduaasls.istant,

to any
nurse

patient requires an order practitioner, dentist, or

Prescriptions recommendcd by non-credentiated
not be implemented until they are co-signed by the

medical providers may supervising physician.

Mineddiiccaattiiononsforaretheprepsrcersicbreidbedonlmyedwihceantiocnlinischaolulyld

indicated and the be documented

clinical
on the

patient's medication label, provided by pharmacy.

Do Providers should coordinate their prescribing practices with one another
in order to:

DHCS Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 142 of 185

Detention Health Care Services
Policies and Procedures

Policy No.'

J-l)-02

Page Number: 3 of 22

Effective Date: 02/11/09

Reduce the likelihood of an adverse patient outcome

Promote consistency in treatment approaches

3. Discourage inappropriate patient drug-seeking behavior

4. 5.

ldentify
Prevent

and real

correct duplication of orders potential interactions between
or

prescriptions

E,o

Prescribed medications will be administered by, qualified medical staff unless the medication is approved for issue to the patient, tbr self"

administration (Medical Director approval for KOP medication)

III. MEDICATIONS APPROVEI) FOR ISSUE TO TIlE PATIENT, FOR
SELF ADMINISTRATION (KOP)
Medications on the approved list may be kept in the patient's possession.
Artificial Tears 2. Metered Dose Inhalers
3. Nitroglycerin Sublingual 4. Saline (Ocean Spray)
5. Dandruff shampoo
6. "Others" as approved, individually, by the Medical Director,
Administrative Director, mad Jail Administration

These medications should be kept in the patient's assigned cell while the

patient is on Nitroglycerin

his/her assigned housing unit sublingual and Asthma inhalers

(with
which

the may

exception be kept on

of the

patient's person regardless of location).

The Medication Label must include: 1. Patient Name and SID Number
2. Start date and expiration date
3. Clinical indication
4. Special instructions if indicated
The provider prescribing the medication to be issued to the patient must complete and document the necessary patient education during their contact with the patient during the office visit.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 143 of 185
DHCS

Detention Health Care Services
Policies and Procedures

Policy No.: J-D-02 Page Number: 4 of 22
Effective Date: 02/11/09

The patient must be receipt of the KOP

asked to sign the
medication when

medication
it is issued

sheet,
to them.

acknowledging

IV.

O¥'EII-THE-COUNTER (OTC) MEDICATIONS ADMINISTERED TO PATIENTS IN THE SCREENING/INTAKd?; AREA

ko

Ntdl.auobsrleseetssofAdoaorFfsecTsgu3iuEm2glRena5renmdtgesttdthoreeeatncahghnet)pdhamtewpiTdieryntiolthcve'oaisnuldotilnsghaci(rs2petthehotyenrasyyibinlcegaitrsaoefanr'onesfoaatl3mol2arealrd5ylgemeirrgeagsidcmeianitcsoihs)ttoheeborrtamAaiesndopeinidceraitntiiaomn(ned2

2.

given.
Administration

must

be

documented

on

the

patient's

screening

sheet
a.
b.

attached
or
Including

progress note
reason for giving

the

OTC

Referrals for follow-up if indicated

medication

oRbneopoekthaietngp/aditonisteeanstk'esofasrcAeasrpeierrneiiqnnugiroershaeTeyptlheyonsroilcaitatnga'icsvheendordtpeorroiganrnmedastsemsunsottreebmeaidnoicnugmeinntethde

ADMINISTRATION OF OTC MEDICATIONS ARE NOT IN I HE SCREENING/INTAKE AREA,

TO BY

PATIENTS WHO MEI)ICAL STAFI a

Nurses may not
screening/intake

administer OTC medications to patients outside

area

without

credentialed
a

provider's

order.

of

the

The administration of OTC Medications by medical staff must be
documented in the patient's medical record.

V1. OFFICER ADMINISTRATION OF OTC MEDICATIONS ON THE
LMNG IJNITS

No

Detention Officers assigned

MHU/SPU
or
strength dose,

areas) are
of Tylenol (2

to living
authorized
tablets of

units (other than
to administer
325mg each) or

the infirmary, 0B,

aAspsiirniglne,

(2

regular
tablets

of 325mg each) during an eight (8) hour shift.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 144 of 185
DHCS

Detention Health (7;are Services
Policies and Procedures

Policy No.: J-D-02
Page Number: 5 ef 22
Effective Date: 02/11./09

The administration of Tylenol or Aspirin by Detention Officers does not

need to should

be documented in the inmate's medical record but the
document the provision of the medication in their unit

Officer
activi•'

logs.

Officers should be instructed to refer inmates with frequent requests for OTC medications to sick-call for follow-up if needs persist.

Do The housing unit officers are responsible for coordinating a re-supply of approved OTCs directly with pharmacy, as needed

ADMINISTRATION OF I:'RESCRIBED MEDICATIONS TO PATIENTS IN BOOKING

bPie.atisetnmt'stMeedwdhioocnatrtiehoemniarsinpsrhewosiuctlrhdiinbebdtehempuebldolioeckdaitnfigroonmarewashstiolcaekf,tesrtpileblreiipnnhgybsosiocckriieaennng'esd

should order

2. "High priority" medications include, but are not limited to

a.
b.

Medications ordered for acute alcohol withdrawal
Medications ordered for pregnant females addicted to

opiates

Medications ordered for documented hypertension

c.
d.

Medications ordered for documented seizure disorders

Medications ordered for documented cardiovascular or

e.

pul•nonary disorders

f.

Antibiotics
suspected

t•br documented or
infectious patients

apparent
to the

infections (refer
physician for

consideration of isolation needs)

3.

Medications
specified for

should the rest

be of

tgheivefnacilaittythe(seesampearagtirmaepsh

as those times
XV below)

Medications prescribed for patients in booking should be a&ninistered by the nurses assigned to screening

MARS for patients receiving medications in booking should be initiated and maintained by the nurses in screening

DHCS Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 145 of 185

Detention Health Care Services
Policies and Procedures

Policy No,: J-D-02
Page Number: 6 of 22
Effective Date: 02/11,/09

In accordance with Must be forwarded

guidelines outlined in to appropriate location

DttCS Policy
once patient is

J-C-05
assigned

to a housing unit

VIII.

ADMINISTRATION OF PI•SCRIBED MEDICATIONS FOR
PATIENTS AWAITING A BED ASSIGNMENT IN THE INFIRMARY

AREAS (Main ,Jail and 0B at Annex)

A.

Patients medical

who are waiting for department waiting

a bed
areas

assignment will be (Medical Security

monitored in the
in Main Jail or

Annex)

The nurses
("0B") will

assigned to the be responsible

Main Jail Infirma•)* for ensuring that:

and/or

Female

Infirmary

1. Patient receive their prescribed medications as scheduled

2. Patients receive their treatments as scheduled

3. 4.
5.

TTPstahhateetiuesnotnpso-hrdyuasortiteychiepraennruuironsdaioinnnctg-aiclcallisylpuapteeervidvsailsunoanerotetedidsifsietnidbonrtviocflwihvheaidennnggeosfthpieiannstdeiiceclnapittanetidcicaehlnatnsasgntedastus

in in

coordination with the on-duty nursing supervisor

IX.

RECEIPT OF
RETURNING

PRESCRIPTION MEDICATIONS FOR PATIENTS FROM HOSPITALIZATION AT UNIVERSITY

ItOSPIrFAL

Patients discharged from University Hospital with prescriptions fbr
continued medications should be discharged to the BCADC with a 72

hour supply of each medication ordered

1. 2.

From any inpatient UHS unit Regardless of classification of

drug

(exceptions

would

be

drugs

requiring special certification for administration, such as

chemotherapy drugs)

3. Regardless of what day of week or time of day

Patients returning from University Hospital with prescribed medications
should receive these medications as ordered

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 146 of 185
DHCS

Detention Health Care Services
Policies and Procedures

Policy No.

J-D-02

Page Number: 7 of 22

Effective Date: 02/11/09

The responsible DHCS physician should be notified of the patients'

return, condition, and current medication orders
1. On the tbllowing morning tier patients returning

during

the

night,

provided that the patient does not require medical care that is NOT

addressed in the discharge orders

2. Immediately upon a•Tival when:

a.
b.

The patient assessment is inconsistent with the

documentation on the
The patient's clinical

discharge paperwork
needs may exceed the

capabilities

c.

within the BCADC
The patient requires

orders

tbr

care

that

must

be

completed

before morning (other than receipt of the medications or

treatment documented on the discharge paperwork arriving

with patient, and scheduled for administration before

morning)

All prescribed medications will be transported from the hospital to DHCS personnel by the transporting Officer and delivered directly to the nurse assigned to screening (see DHCS Policy J-C-05 for specifics on procedure)

go

The Nursing Supervisors must maintain documentation o f the failure to receive 72 hours of the prescribed medication when discharged from

University Hospital for quality improvement purposes (forward to

Medical Administration)

1. Date & time

2. Patient name, SIl_), date of birth
3. Medication involved
Specific. discrepancy, (i.e. insufficient doses, incorrect doses, etc.)

Refer to Paragraph XV for
of controlled medications

details regarding
received from the

the receipt hospital or

and management
approved use of

controlled medications from home.

RECEIPT OF Vv3{ITTEN PRESCRIPTIONS FOR PATIENTS
RETURNING FROM THE UHS EMERGENCY CENTER (EC),

DHCS Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 147 of 185

Detention Health Care Services
Policies and Procedures

Pol icy No.

J-D-02

Page Number: 8 of 22

Effective Date: 02/11/09

EXPRESS MED CLINIC, OR HOSPITAI.IZATION OUTSIDE OF THE
UNIVERSITY HEALTH SYSTEM
Prescriptions ordered by University Health System physicians may be
honored within the Detention Health Care Services but should be
approved by the responsible physician to facilitate medication reconciliation and avoid duplication of medications
Approval should be deferred until the next morning if the patient returns during the night and there are no doses scheduled t•br administration before morning.

Co May be pulled from stock, ii" available, and

a.
b.

Patient has no known Dose is scheduled for

drug allergies
administration

before

morning

c.

The on-call physician authorizes the administration of the initial dose prior to reviewing the medical records in morning (i.e. must

call physician)

X1.

ONLY LICENSED NURSES, CERTIFIED MEDICATION AIDES,

I'IIARMACISTS,

PHARMACY

TECHNICIANS,

OR

CREDENTIALED PROVIDERS MAY ACCESS TItE STOCK

ME1) ICATION CLOSET

XII. MEDICATION BROUGItT IN TO THE DETENTION CENTER BY INMATE OR INMATE'S FAMILY

Acceptance of medications from home should be pre-approved by the Medical Director prior to their being dropped off at the facilit?, with the following exceptions:
1. Anti-retroviral medications
2. Tuberculosis medications
3. Atypical antipsychotic medications

Medications accepted from home may only tnburrssepe(csiefeicDHprCoScedPuorlei)cy J-C-05 "Medication

be received by
Administration

a

licensed
Training

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 148 of 185
DHCS

Detention ttealth Care Services
Policies and Procedures

Policy No.

J-D-02

Page Number: 9 of 22

Effective Date: 02/I 1/09

The responsible physician from home, prior to their

must approve the use
adlninistration and

of will

patient medications provide the nurse

with an order approving the use of medications from home

Once approved by the physician, the medications brought flom home

must
1.

be inspected by pharmacy. If cleared by the pharmacist after inspection, the appropriate label will be generated.

a MAILS

bearing

2.

If the pharmacy is closed, a nurse may generate a

MARS but from home

may NOT before it is

administer the medication
inspected by pharmacy.

handwritten
brought in

3. Medications from home may NOT be administered without a

physician's order/authorization.

Patient medications received from home, but that m'e not approved administration within the BCADC will be placed in the inma{e's properb'. A written receipt will be filed in the patient's medical
record.

XII1. PATIENTS ON METHADONE: REFERENCE POLICIES

DHCS J-(}-.)6, Intoxication and Withdrawal"

B. I)HCS J-G-08, "Inmates With Alcohol and Drug Problems"

C. DHCS J-G-08.1, "Inmates on Methadone"
D. DHCS J-G-08.2, "Pregnancy Assessment of Women Addicted to Optiates"

DHCS J-C-05, "Medication Administration ]'raining"

MEDICATION ERRORS
1. Identified medication errors will be documented by:

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 149 of 185
DHCS

Detention Health Care Services
Policies and Procedures

Policy No.: J-D-02
Page Number: 10 of 22
Effective Date: 02/11/'09

The staff member(s) identifying the error The staff" member committing the roTor if available
Using the approved Medication Error report form

Completed
Director,

medication error Administrative

reports wilt be provided
Director, Clinical Nursing

to the Medical Director, and

any other parties relevant to the specific incident

3. Documented medication errors will be investigated for contributing
lectors and corrective actions will be initiated as indicated.

Trends in medication errors, corrective actions taken, and proposed

changes in procedure relevant discussed at the departments

to medication
Pharmacy and

errors will be
Therapeutics

Committee meeting.

PATIENTS WILL BE MONITORED FOR ADVERSE DRUG REACTIONS AND ALL IDENTIFIED ADVERSE DRUG REACTIONS TO PRESCRIPTION MEDICATIONS WILL BE INVESTIGATED AND REPORTED ACCORDING TO UNIVERSITY HEALTH SYSTEM POLICY

MANA(,EMEN OF CONTROLLED
MEDICATIONS/NARCOTICS

A tloor stock system of medication, using reverse numbering unit dose packaging, is used tbr controlled subst•'mces in all areas of the
DIlCS-Adul Division

All
carts

controlled medications or medication lockers

will be maintained/stored
in accordance with pharmacy

in locked
policy &

recommendations

The Controlled Substance Record/inventory sheet (attachment 1)
will be used to document the movement of controlled medications
in to and out of the stock supply system in each area

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 150 of 185
DHCS

1)etention Health Care Services
Policies and Procedures

Policy No.:

J-l)-02

Page Number: tl of 22

Effective Date: 02/11/09

One form will be used for each type and dose of controlled
medication, in each area identified
Pharmacy will stock each approved area as directed and a•motate the number of doses "added to stock" and update the balance accordingly

Each dose of controlled medication that is removed from the stock
system must be logged out on the Controlled Substance Record

Controlled Medications that are wasted or refused must be

documented on the Controlled Substance Record
identification of the staff member witnessing the

(& include wasting of

the the

medication)

The nurse responsible for a specific area is responsible for notifying pharmacy of the need to restock their are•cart/etc, when
the inventory, level falls

Inventory levels should not be allowed to drop below the number
needed to sustain operations for at least 24 hours (72 hours when approaching a weekend or holiday)
10.The nursing supervisor should also be notified when staffrequest resupply of stock narcotics

tl .All controlled drugs will be counted by two licensed nurses or certified medication aides, together, when custody of the stock of

controlled medications passes from one staff member to another,

such as

a.
b.

Shift change When one staff member leaves early and passes control of

his/her assigned medications to another staff member

c. When a staff member begins a duty day and then is pulled to

assume another assignment

12.The counting/verification of the controlled medication count must be

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 151 of 185

DHCS

Detention Health Care Services
Policies and Procedures

Policy No.:

J-D-02

Page Number: 12 of 22

Effective Date: 02/11/09

documented on the Conlrolled Substance Record

a.
b.

Must reflect the date/time of the count
Must reflect the two staff members who completed the

count together

13.

A new entw/line on
sheet will be initiated

the
to

Controlled Substance Record/inventory
document the completion and correctness

of the count

a.

Date

b. Time

c.
d.
e.
f.

Annotation "CC" or "Correct Count"

Exact quantity Signatures of

bo(t"hBalstaanfcfe"m)embonerhsandcompleting

the

count

Example:

Date Time

Balance Shift Change Count

1/02/07, 0700, c/c\ 64 sigmature 1/signature 2

14. Discrepancies in the narcotics count must be investigated immediately between shifts

15.

The staff member from •lqe off-going shift must remain tbr the investigation until released by the on-coming nursing supervisor

a.

Staff must complete their portion of the investigation and provide written reports prior to being released

b. Supervisors must review the written report upon receipt,

obtain clarification if needed, and release the off-going staff

members as soon as possible

16. A facility incident report must be generated and forwarded to medical administration by the staff members completing the narcotics count when discrepancies are unable to be resolved

17. The nursing supervisors from both shifts (or their designees covering supervisory responsibilities in their absence) must also document actions they've taken in the course of investigating a
discrel•anc'f in the narcotics count.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 152 of 185

DHCS

Detention Health Care Services
Policies and Procedures

Policy No.:

J-I)-02

Page Number: 13 of 22
Effective Date: 02i'11/09

Documentation may be on the same facility incident report
generated by their staff member, or on a separme report
form
bo Documentation must be forwarded to medical administration

18.

Administration of controlled medications to the patient must also be documented on the patients' individual Medication

Administration Record (MARS)

19. Refer to DHCS Policy J-C-05, Medication Administration Training for additional specifics regarding documentation on the
Controlled Substance Record and MARS

MANAGEMENT OF CONTROLLED 5{EI)ICATIONS THAT ARE
NOT IN STOCK SUPPLY \¥HEN APPROVED FOR USE

o•" There may be times that

the use

controllcd
a

stock narcotic inventory,

the DHCS Medical Director authorizes medication that is not inaintained in the
for individual patient use.

Pharmacy will issue a MARS that is labeled %r that specific patient

The MARS for controlled medications that are not in stock MUST
be kept with the Controlled Substance S t,•ccords and counted at the
same time that stock narcotics are counted.

4,

Dbneaorescneostgiicovsfenilndomicuvksietdru/radelrlmayawienrisssueuencdtuirlecdontthirenyoltlheeadreapmpheradonivdceadtciaoirnnrsitehdethaatdpiprhreaocvptelryiantoteto

pharmacy.

Discontinued medications that
placed with the throw backs or

anroen-ccoonnttrroolllleedd

must NEVER be
medications being

re, t•rne, d tn nhnrm•e,v

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 153 of 185

DHC$

Detention Health Care Services
Policies and Procedures

Policy No.' J-D-02 Page Number: 14 of 22
Effective Date: 02/11/09

Discontinued
placed in any
stock narcotic

medications that are
cupboards or drawers supplies (i.e. do NOT

controlled
that are
put in the

n•ust NEVER be
not designated for cupboards formerly

used for returning narcotics)

7, Each IVLARS for each controlled medication being forwarded to pharmacy for destruction must be copied prior to re!.urning the medication (directly) to pharmacy

The pharmacist or pharmacist tech must verify that
returning medications are correct immediately upon

the count
receipt

for

The pharmacist or tech must sign the original and copied MARS,
in the presence of the nurse delivering the mt•dication.

10.The copy' of the (signed) NIARS must be forwarded to Medical
Administration

l.The original (signed) MARS must be fbrwarded to the patient's
medical record

APPROVEI) MEDICATION TIMES
Medication administration times must be standardized throughout the facility' (i.e. Aimex and Main Jail, Infirmary areas and floors)
2. Medication administration will be documented in military time
The tbllowing times are approved for medication administration
within the BCAC:
a. Once Daily administered at 0800 hrs. b. Twice Daily administered at 0800 hrs. and 2000 hrs. c. Three Times Daily administered at 0800 hrs., 1400 hrs.,
and 2000 hrs.
do Four Times Daily administered at 0800 hrs., 1400 hrs.,
2000 hrs., and 0200 hrs.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 154 of 185

DHCS

Detention Health Care Services
Policies and Procedures

Policy No.: J-D-02
Page Number: 15 of 22
Effective Date: 02/11/09

Ko LOCATION FOR ADMINISTRATION OF MEI)ICATIONS
In general, medications are administered to the patients on the housing units.

Medications that are not administered on the housing units include,

but are not limited to a. Medications Ordered

Four

Times

Daily

medications are

b.

administered out of the treatment rooms
The 1400 dose of prescriptions ordered Tlu-ee

Times

Daily

will be administered out of the medication rooms

1. 2.

The nurse prepares patient list
Officer makes arrangements to

and presents
have patient

to Oi15cer
sent to or

escorted to the medication room for the required

medication

The following types of medications may also be administered in

the Treatment rooms:
Injections
a.
b. HIV Medications

c. TB Medications

d. DOT Medications

e.

Other approved medications as approved by a member of
the Executive Medical Management Staff

Methadone is administered by the nurses assigned to the Mental
Health Unit and Female InfirmmT and will be administered within the medical waiting areas in Main Jail or Aimex

REFRIGERATED MEDICATIONS

The temperature of refrigerators used for storing medications will

be kept at a temperature Daily documentation of

between 35
temperature

45 degreed Fahrenheit
checks, and corrective actions

if indicated, will be accomplished by the 7pro-Tam shift

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 155 of 185

DHCS

Detention Health Care Services
Policies and Procedures

Policy No.'

J-D-02

Page Number: 16 of 22

Effective Date: 02./11/09

lemperamre is found to be out of the acceptable range
Co•Tective action taken will be documented on the refrigerator temperature log for thc corrcsponding refrigerator

The refl'igerator temperature will be re-checked after an
appropriate time interval to assess the effectiveness of the
corrective action and the findings will also be documented on the
refrigerator log

Refrigerators
range will be
first thing in

that will
reported to
morning if

not maintain an
the Operations applicable).

acceptable temperature
Director immediately (or

The contents of" the defective refrigerator must be relocated to another appropriate reti'igerator i•nmediately

The on-duty nursing supervisor must be notified of the defectivc refi'igerator, con'ective actions taken, and re-location of
refrigerator contents
Mediations discovered to be in a refrigerator that has
malfunctioned (i.e. temperature range falls below 35 degrees or
above 45 degrees Fahrenheit will be repo•.ed to pharmacy'
immediately

10. The staff member (s) reporting pharmacy of the refrigerator malfunction/inappropriate temperatures will generate an incident report and forward in to Medical Administration tha'ough their irmnediate supervisor

11.

Panhdarrmeapclaycewilmledmiackaetioansdetkeerpmtinaat tiionanpprreogparridaitneg

the need to destroy,'
temperatures

12. Refrigerators will be defrosted once a week, and as needed, by the
7om-7am shift

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 156 of 185

DHCS
Detention ltealth Care Services
Policies and Procedures

Policy' No

J-D-02

Page Number: 17 e/22

Effeclive Date: 02/11/09

XVIII,PROVISION OF MEDICATION TO PATIENT UPON RI'2LEASE

FROM CUSTODY

A. Prescription medication may be provided to the patient upon release t'ro(n custody under specific circumstances

1. 2.

Anti-retroviral medications
Psychiatric medications involved in the Jail Re-entw Program

3. 4.

Patient's medications accepted from home Other specific prescriptions, as approved by the Medical Director

and Administrative Director

Successfhl provision of prescribed medications to the patient upon release

from

custody

requires

coordinated
a

effort

between

the

Medical

and

Detention departments

1.

Medical department
Identification
a.

of patients

to

be

release

with

prescription

medication

1•. Receipt of Medical Director and Administrative Director

approval when indicated

c.
d.

Pharmacy support in filling the prescription

Centralized location for securing the patient's medication,

accessible by staffupon notification
Communication of the need to

of an leave

impending release with prescribed

e. medication with the patient when possible

f. Provision of the approved medication upon patient release

2. Detention staff

"Daylight release" when applicable

a.
b.

Timely notification of impending release

XIV. PROCESSING MEDICATIONS FOR THE RE-ENTRY PROGRAM
(REP)

ko

A

physician

may

order

that

an

inmate

be

provided

with

supply
a

of

medications unon hi• nr her re.laa•e in an efforl to ensure that treatment.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 157 of 185
DHCS

Detention 1 tealth Care Services
Policies and Procedures

Policy, No.: J-D-02
Page Number: 18 of 22
Effective Date: 02/11/09

The physician will write "te,_lSP" (Re-Entry Program) on the physician
order form (# 44-5192-01) to indicate this purpose.

Co

REP medications and
delivered by pharmacy

the corresponding medication sheet(s) wilt be personnel to the nursing supervisor or designee.

REP medications will be placed in a double locked cabinet in the designated room in the medical area.
Any controlled substances included among the REP medications will be maintained, stored, m•d inventoried as usual for controlled substances.

Fhe responsible nurse will be alerted
facility, and his/her REP medications

when the inmate
will be given to

is leaving
him/her or

the the

representative of the agency picking him/her up.

G.

The inmate or medication sheel

agency representative
when REP medications

will sign are given

the corresponding
to them.

The signed medication sheet wilt be forwarded to medical records filing in the medical record.

fan inmate is released from the facility without his REP medications the nursing staff should alert the mental health staff and return the medications to pharmacy.

J.

rl'he nurse must released without

indicate on the his medications

medication and that the

sheet lhat the inmate was
medications were returned

to pharmacy. The medication sheet will be taken to medical to medical

records for filing in the medical record.

Inmates on Center for Health Care Services (CHCS)
or rnedications brought from home should be

funded released

medications
with these

medications.

XV.

PROCESSING TIlE REFILL OF PRESCRIPTIONS WITII
APPROVAL FOR REFILL WITHOUT A REPEAT VISIT TO

PROVIDER PROVIDER

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 158 of 185
DHCS

Detention Health Care Smwices
Policies and Procedures

Policy No.:

J-D-02

Page Number: 19 of

Effective Date: 02/1t/09

"fhe medical provider may approve the refill of without a repeat provider appointment based upon

prescribed medication
their clinical judgment

Pharmacy is dependent upon the nursing department to prompt

prescription refill in a timely manner 1. Pharmacy will print tba'ee medication

labels

when

filling

the

original order

2.

The medication labels will be distributed as follows

a.
b.
c.

OOOAfinnndleeemleidnofoinnoosrntwppraaaatttrhtiiadieetenondttnbubMts(olioAinnstReteheesSrsdMopedcadacuiykmcaetlnhtatAscshoiansvtteaanitpnrionavgsisdiaeglrlmepdarpetpsorcorMvieapdtliicoanflosr

future refills)

Co

The that

Medical Assistant assigned to the patient remains in custody

Medical Administration
approximately.' week

will
prior

verify
to the

need 1.
2.

for prescription refill.
Patients date and time

of release,

when

applicable,

will

documented on
Patient housing

the label provided by pharmacy
locations for those remaining in

cus'cody

will

revised on the label provided by pharmacy

be be

D. The document with the updated labels will be forwarded to pharmacy for processing of refill.

XVI. NURSING SERVICES' ROLE IN PATIENT ADVOCACY WITItiN TIlE MEDICATION DELIVERY SYSTEM

A. Each member of the Detention Health Care Services are tasked with
patient advocacy

B.

Nursing's role in patient advocacy, with regards to medication
administration, is addressed by the Texas Board of Nursing: 7•xas

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 159 of 185

•u•s•n•
r,.r

L•on au•'

.,_•,•0• s •u

,.

,•eNmm•

..-.a comP •

"_• •nd tre'a•-' t•ae nu• T. .,_..•

Dpr,e•"Scr•7P t•On

g,. l•

t'o •cy

•'•'••'

"•,",I,euM'cdica•',•:•OB
1

conte•t merg

",

•;;B'C;SBCS "Y"•' ? Detentio• ce•t• r C-05.2

th•s P oliCY' has been

.,•od a• d

,

C.

P°'XcY '

,edicatiO• ,,din,'"""

D.

,_C-05.3'
po,iCy referenced
DBCS poliCieS

m

P

aagraph

gll

abOX

e

(re

done)

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 160 of 185

•h• Detention
Policies
• -.-..-......__

a•H,e•altrro(cearceluSrerev•ices

•olicy

F.

•tfCS
housing

POIicv
units

J_D_02

1,

•ive
Administration

D me.

02/11/09

REFERENcEs:

of medication
to Patients on the

National Commission J-D•O• IDHCs
•-bxas
Rule 2

Policy
Boara,•
• v

Nun •ber on
°Z Nursine•.

•1

•"

CO•ection al Healtl]
•' *'ham•ac

C•.•_r,e,

(2008•

•
•

e•O

X

4A,.

•u•IC•t Oner•,:

RESPONsIBILITy: MeOdFiFcIalCEDirOecFtorp,RIDe•tAe•tRioYn Healtl• Care Sen,ices

u•, 1•tle 2•, Pa• 1 I, Capter217,

ENDNOTEs:
Written By:
•eviewed [•y:

RSNhariCliLn.icT"a•,y•Ulpore,rviRsNo.r MS& CCIqp
•;l•DKHatchseriAnde•iMnCiMsturlaltTv•n. MDiSrNe,ctoFrNp Ramirez, •V*ed•cal Direc•Mo.rD •H

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 161 of 185

DHCS
I)etention Health Care Services
Policies and Procedures

Policy No.: J-D-02
Page, Number: 22 of 22
Effective ])ate: 02/11/09

Reviewed & Approved By:

Deborah Patton, RN, MSN
DHCS Clinical Nursing Director
Lydia Mesquiti,, LMSW-AP, LCI)C, CCHP
DI tCS Director of Menial Health
Katherine McMullen, MSN, FNP
Administrative Director (Adult Division)
Miguel A. Ramirez, MD, MPH
DHCS Medical Director

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 162 of 185

HILLSBOROUGH COUNTY SHERIFF'S OFFICE DEPARTMENT of DETENTION SERVICES
KEEP ON PERSON (KOP) CONTRACT

if you meet the requirements
below, you will be allowed to

for the "Keep on Person" medication program, keep you medication in your possession:

and

agree

to the

requirements

Only medications that are approved and ordered by the faci!ity clinician will qualify for this
program.

Medication may be given to you in supply of medication. The package

a special package that will contain no
will contain a label that includes your

more than a (30) day
name, identification

number, the medication name, and directions for its use.

You must follow instructions on the medication label. Health care staff can check your medicine
at any time to make sure you are taking it correctly.

If you
nurse

believe you are having a problem or doctor as soon as possible.

with

the

medication,

it is your

responsibility

to

notify

the

YOU ARE RESPONSIBLE the medication, you will be

FOR YOUR MEDICATION. If you lose, tamper with, share or trade
terminated from the program and may be subject to disciplinary

action.

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 163 of 185
P RACTITI 0 N E R
GUIDELINES
AND
FORMS

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 164 of 185
roduction
"nnoet•npmiptodoriomumeanfagpleclehirtcnnvioatoedccrfvrseleey.ignmieuhe(csisFaasndoytlvutresaceltbhgieliunaimbniceasesftdsseiohevrnmlirmaeittolaennistsmeetoiiishsonmondphowfaferanorrovecoasvenu)est,sioettcmrdhppoieadaommtitepdopsicgnraeoehionnarnctvtsoaeenenqisoutdecuaotesrltcueiccgiottaifsoyicsrimntoeomcremmnlieseeaumassdonss,idaauunengrgpfladoepe,nrsodmprdrpemeianptostmahtdoifaatoeuertrinyrletcpneestervmcfoioapwrgsrduhieresteaieahlns,mmftcipec-ezrahNm-teormahbCvosaanCn,etsaoimHegcuesCdoetnutmcptcheop,oepornmnrrdreteaitacscdtstneioidscocmuaineosmpss,nop.ieguoownottendiodlcI.lnnsoglsmaeuaTedvspthdseehpievartoptsaairdelgoouenhca,eeatatslitwhtsoteehnhe
astlres, see the resources listed on page 3. thma Care in Corrections
general approach to the management of asthma is organized into four components: AAcpaMPtenoaestrdtedsesixienieictssnssatitpstteoameinnceetnoedcnnrtuesstoac,saettoianfhiannvmocnd(ialndar,undomdiuanonswnmngeideictntohotnotsfhrfaeteiulhlansenfgida-toigrnmaloiocayafgtlngiwedaiouritnsgoshsfee)emparaleosecnafnehddnt,ruiocncsniheeoinaasvmcgblpeooeerrudciobttitbhiyasecdlttoilrhratnyuetniecideetcdfsdiooirvcsseotsefnpeouatarrcsprtohoeuiialeldnnsmdatpsotsrono(oatcIrvwreoCieesySbtdr)shauu,ccsdcemieionoaspdetiopehsafmrermspoaoesapvkthiraoeerisr,tamtte-aenamnatcadltjluioesnarsregingetdevynoebfsrer,eotimfsake.a-dapn,aisd.tct-iaahegtmnoitanosinstsws;th
(SABA) .•onr.rdsoerepiAwniasirgonsonfeiemodnesscmotisanbrsmttvyereo-notlpfhrtaeetasaiussopletftrnhswetdemslialepsuneescraauisesfsaoleblrsaoymefssveeeedcivdrseeirdtabiayolteinryfneocarlidiaenssysfvsomiamrotfnumasidakttctiaonitamgoiifsntomenpmroegartdauntoitsdacehnraeteftrdouiefunopdccrnaetisloi,fbrorunitoatmemtolphreoaatlishtrcepalmattioteuncinlisecitcnnhitiae(cncsaaelknsetdsahhrfoiTtorsuraiitlnbsogdklrreeyv,lIfeoromIsn!cpp,iguhab-syiiRtslrieiiomscrtnkeyamlntaogfIsreCesxSima.se,atmsoeirsrBbnmeiaedcttinhaitatuovnns,eof

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 165 of 185

BawbdCHpeioaeuoolrtyrclpwwhraueaeluyvacnaisssoetnt,eurli"ryot,osthnieeat]tshetherhstleoetehfravhemuebesrlablaaeuetilrsiotsoivohtssnfeeorba•c(IeiraCs•cnartSth,tgiearmheeeonei,rnssdwneiahtcarteTtnhdhniSainiiAsgi:nbsBmfI,epAiCrtonaaSatrmpctitemhohaaresanm}nhtdtatoooyrurpovl•kriIecda'cCr{{aSp)lfrrldbosyneeriitsesserctersprshroahreteiisoeodbceusnsiclocenodrmgrmisamopbhtfneteoaoalndutrnetlrdidrdeseeaatoxdnothncdbvmaeeeneeanriodsntpufo•.snetoeSehs2neAcHeriBSocsfuAAhtqrboBaSguerrAeaiAdpanhcBrctatetlAytsleocycr,raimarizegebeIaieindCsnnSsgtucesortsrtaoettrilohenelagactIysntoCiwSomibbhnynoeeaspnelntri"nitetrosuseatrcaeairto5ctip-naiwbtrneiotganobasngld1e0am-s
provider or team level.

Table 1. Severity Ttahkeingclilnoicniga-ntershmouclodntraoslsemsesdicdaitsieoansse. severity

to

initiate

treatment

for

patients

who

are

not

currently

Components of
Control

Degree of Severity
• Persistent

Short-acting beta-
agonist inhaler use
Symptoms

Interm trent
< 2 days a week
< 2 days a week

Mild

Moderate

> 2
• but

days a week
not dailywe- - - -•k

> 2 days a

Daily Daily

• but not daily

Several times a
I_ day
Throughout the
day

Nighttime awakenings
Interference with

< 2 times a month

3-4 times a month

NF•o limitation

Minor limitation

>
but

time a week
not nightly

Some limitation

Often, 7 times a weeks
Extreme
limitation

normal activity Lung function/FEV•

> 80°,/0 predicted

> 60% predicted

60%-80%
predicted

< 60% predicted

-•htotupr:c/et:wwwS.unmhlmbair.ynih

Report gov/g

uofidtehle inEexsp/eadsthPmanae/lastRhepsourmtm.p3,dfp.

44

• Table 2. Control

At each NAEPP

follow-up visit, the clinician
uses "well controlled," "not

should record the degree well controlled," and "very

Components of Control

Good Control
(Well Controlled)

Fair
(Not Well

of control as good, poorly controlled")
ControI Controlled)

fair, or poor (the
Poor Control
(Very Poorly Controlled)

Beta-agonist inhaler

No more than one
canister per month

No more than one
canister per month

More than one
canister per month

use

Visits to an on-site

None

No more than one in
past month

More than one per month

urgent care center or

community emergency

department or hospital Nighttime awakenings None from asthma symptoms

No more than once a
week

More than three times
a week

NCCHC Guideline: Asthma May 2011

Page 2

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 166 of 185

Quality Improvement Measures

The following quality improvement measures are suggested, but they are not intended to be a complete

list necessary to
recommend that
provider or team

ensure a successfu! asthma nqanagement program in a correctional setting We the improvement measures for a patient population be reported at a facility level level. These indicators should be compared over time to correlale improvement.

and

at

a

Percentage of patients with asthma appropriately based on the NAEPP

whose severity guidelines

classification

and

degree

of control

are

assessed

Percentage of follow-up time Percentage of
for step-down

patients
frames
patients therapy

with based with

asthma evaluated by the primaP, v care provider within 1he on their classification of severity and degree of control
asthma who are weli-controlled for 3 months or more who

designated
are evaluated

Percentage of patients with asthma whose degree plan that includes a strategy for improving control

of control

is

categorized

as

fair

or

poor

who

have

a

Percentage of patients with asthma who have demonstrated good techniques in use of inhalers and

spacers

Percentage of patients Percentage of patients
were prescribed a burst Percentage of patients

classified as severe persistent
seen in an urgent or emergent of oral steroids (40-60 mg per prescribed SABA inhaler only

asthma who
care selling day) for 5 to compared to

have an asthma action plan
for an asthma exacerbation who
10 days
those prescribed ICS in addition

to

SABA; the ratio likely should be less than 2 to

Percentage of patients with asthma who were offered influenza immunizations

Recommended Resources to Support Evidence-Based Practice and Quality Improvement

IRESOURCE SOURCE URL

Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma
(2007)
National Asthma Education and Prevention Program: National Heart, Lung, and Blood Institute; National Institutes of Health ht_L[p:l/vwcw, n hlbi. n h•g•v_./_g.uideli n es/as h ma

RESOURCE Tools: Asthma

SOURCE Institute for Heatthcare tmprovemer•t

URL

h_ttp://vA•v, ihi.or,q/IHI/Top cs/C hronicConditions/AsthmafToots

RESOURCE National Guideline Clearinghouse SOURCE Agency for Healthcare Research and Quality
URL

RESOURCE SOURCE
URL
RESOURCE SOURCE
URL

Chronic Care Model (1998) Developed by Ed Wagner MD, MPH, MacColl Institute for Healthcare tni]evation, Group Health Cooperative of Puget Sound, and the Improving Chronic Illness Care program: available from the Institute for Heatlhcare Improvement _h.•t.•: !/www. ih orgZLH_l/Topics/C hronicConditions/AIIConditionslC ban qes

Model for Improvement (1997)

Associates in Process Improvement; available
httD:it•v¢.ihi.or.q/tH!fTo_•_•j_csl__J.mprovement/ mp

from the lnstitule for Heaithcare IrT•provement
ovementMethods/HowTolmprove

RESOURCE Measures

SOURCE Institute for Healthcare Improvement

URL

_http://vwwv ihi org/IHI,Gopics/mprovementJtmprovementMethods/Measures

NCCHC Guidelme:Asthma
May 2011

Page 3

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 167 of 185

RESOURCE
UR[

HEDIS & Quality Measureme'qt
_Nhatttpon:a!l/wwCwo.mnmciqtatoereg/tfaorbiQdu1a5l9i/tDyefAasuslutr,aansDcxe

Last reviewed: Ivlay 2011 Updated: May 2011
Next scheduled review: May 2012
For the latest version, go to http:t/www.ncchc.orglresources

NCCHC Guideline: Asthma
May 2011

Page 4

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 168 of 185

YEAR DIAGNOSED:

PRIOR ASTIIMA COMPLICATIONS
Y N F•esp HospitalGatlor;s (Lifeline)
Y N P, esp Hospitalizations In Past Yr Y N Resp Hospitahzations :in Past 2 Yr Y N Intubations {Lifetime)
Y N ER/UC In Past Y•

Number

Last:

Number:

Last:

Number:

Last:

Number:

Last:

Nun]bet:

Last:

CURRENT FLARE FREQUENCY

Y N Current Flare Frequency > Intern•ittent, as defined by:

Y N a.m. 1/•'.'eek: per Day per Week

per Month

Y N p.m. 2/month: per F1onth

SEASONAL
Y N Seasonal Component To Asthma Flare•

Spring: Best Worst

Summer:...Best Worst

Fall:

Best Worst

Winter: Best Worst

IDENTIFIED FLARE-UP Y N Cold
Y N ChangeIFiTemp
Y N Pollen Y N Perfumes Y N Pets
Y N Dust
Y N Humidity
Y N tteat
Y N Employment
Y N Exercise
Y N Oft]err

TRIGGERS

SINUS
Y N Sinus Symptems/Allerg;es Y N Sinus Congestion
Y N Rhinorrhea Y N Seaso{•al Y N Perennial
ALLERGY TESTING & DENSENSITIZATION
Y N Prlor Allergy Testing Allergic To:
Y N Al!ergy Desensitization(s) Done
For:

GER
Y N GER (By PMH Dx Or By Sx)
Y N GER 1(]0% Co;it:rolled

MEDICATIONS Y N LABA
Y N BA•HFA Y N RTC Y N PRN
Y N BA-NEB Y N RTC Y N PRN
Y N CS-HFA

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 169 of 185

¥ N CS-NASAL SPRAY
Y N ANTI HISTAHINE (HI,5)
"Y N DECONGESTANT
Y N L•UNOTR•N• BLOCKE• (L•B)

Y N Y N 112B

Y N M•s• C•II S•biIizer
(Cromolyn & Nedocromil: modest benefit in Asthma.)

Y N O•her Rx:
Nost Keceat Rx Change(s):

•TERO[DS Y N Pricr Steroids Ever Y N Steroids In Past Yr Y N Steroid• For 2 Wk In Past Yr
•ED•CAT[ON UNDERSTANDING
Purr Fai•
I, IED[CAT•ON COmPLiANCE Poor Fair Good

Date(s): D•te(s):
Date(s):

ALARMS SINCE LAST
Y N Steroids
Y rq ER/UC
Y N Hospitalization
Y N ]ntubation

EVALUATION Date: Date: Date:
Date:

PEAK FLOW
Peak Flow Nomogram-Based Norm Approximately:
Based On:
Age: Height: (measured stated)
Sex: M F Peak Flow- Office
PF:
Nomogram-Based rlorrn:
PF %: PFCoordination: Poor Fair Good
Peak Flow- Home
Y N Done/Doing
Dates:
Best %:
Worst %:
Variability %:

NAEPP CLASS pl+ P2+ P3"•

(I -rnternlittentl P1 + Severe)

NAEPP AM PM PF VAR

Itemized Class PI+ F2+ P3+ Pl+ P24 P3+ P]+ P2+ P3+ Pl+ P24- P3+

Persistent, Mild; P2+

Persistent• Moderate; P3+

Persistent,

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 170 of 185

AEPP Class Definitions

Symptoms

Symptom•

A!•

PM

•+: >liWk ]+: •/Day

•f

Continuous

>2/Mort >4/Mort >>q/Man

ACCINATIONS
u Vax Vax IN1 Vax

Date; #I Date: #I Date:

Peak How Percent Of
Predicted >80 >80 61 -79 <60

Peak Flow Percent
Variability
<20 20-30 >30 >30

#2 Date; #2 Date:

;•3 D•te:

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 171 of 185
t.IZRYLA qDJAiDLEPIANRITTILA'LICEMONERTDRIEOCCFATLIPUOBMNLIEA(N.L:T,ALMHEEDA.ILCCTARHLEhAN•N.DE•RVCIOCQR•URSELSCT]IO•NOA•'I,*R••E SERVICES

•he fin erolick "tucose

•er appropn

s[Jch
%•es
Is the
•oes
Does

attsohh•fee•febeeoonioffdnfffeEfeervenniuddodseelerrerwnhthaeaaa,p•vvpee.aeu•naatosurrkbsiiusnatteooln•cleaboy•xebnhdlirlidbeoliiuitosdoo,dnrmebsiif•ezonnarstrfmueriuctedthsrieeeoomdrsarosrunosoonorr?tu•seeiuanxnathcielobdwih?oteburenehddinasftvf,?iicourl•stuyndsoifucgemg,eosvterimavseehnetosf??

mentai health disorders B•indness, dea•ess,

•uoseess

wheelchair?
the offender

a•ear

to

*Does the offender's behavio•

be
or

under lhe
physi•l

influence of, or withdrawinE.ffom, drugs
appearance suggest the risk of suicide or

or al•hol?
assaull on

others?

'• Yes

• No

•

• No

• Yes

• No

•Yes

• No

• Yes

• No

"• Ye• • No

Yes

• No

*•o you •ou "•o you
"Are you
•re•ou

i, .•: :Pm• ,Era!e:!-

::

"•

hhsbuaafvvfeelereaa ferhforimdesqtuil•ernnetqouf•e•ntatubuiefrencvguelr,osshiosr•conurtisgr,hhtavbes•iwseyeabosltu,oso?edov?peern

been treated lot sores, b•oken

currenB•resufibed mediations for a medi•l •ndition?

•
tuberculosis? bones, or•ross

oral

abnonualilies?

•ou cuGently have allergies? • have medi•l problems such
Have you used any alcohol or drags
yes ask next four queslions and refer

as a
such

rash, infection, hepatitis,
as cocaine, heroin, PCP,

VD or LSD

to Idage team if any one or mo•e of

seizures
or Xanax lhe four

or Diabetes? in the p3st 72 hours? If
queslions answered as

•ou •Y•eHte•asoe.vreusyoo.uy[o}u,dincruikarnhnkraemdonewatntlwl•hyihtatohdeodloxrjnaapieolweralltotlpaikhpeanr[vgoebl•ehhwml_isst_t,•ho)• d•rsaewioo•azfluw•. r?iest_,. hIafdn•.d•o. r•wrahbla. lfOvraeocDmk. ron•ouwebl. hvslaeetrm. fsrssou. mtibn•sae. t•ledacno?. h•po:alslo?r d•gs•

*B Yes

B No

•••Yes

B No
• No

*• Ye• B Ye•

B No
• No

B Yes

B Yes

B No

• Yes

B No

B Yes B Yes B Yes
•-
•-e•

B No
• No • No
_] B No

current•ceiving [reatment for any mental health conditions?••

e ou ever or are you

•
"Do oufeeld•sorenled,

nO••' ar• in•-o: •ce•/s•-nes?el•

*• Yes

u No

"/•re you oepresseo, oo you ,uv• •.•u•
•Asreel•f :inGt-he••rescriL••.d.•__.m;e:-dG-l.ar-;a•ps=yu-n•a•m' •

_••.• • Yes

•-..FPS[[[FI]]]irl_go_nRcRRU_Ua•eooe.gftuuer.e_tutdegriri•nrnnnetatee/lloTOOinnOOBttossnnoliissoellioikeeultiteensgRRieeRdRffeeeeeff1:rree3rrrrhaarroYllaaselplsitttooatIool[]MMMeeMedneNitdnocaitalcallaNlHA.elH.aTer.lraif.tiloa.hrat_.ghg.eF..T•.erTi.]rTma.i•eaa.!gca.ll_g.mee•._s_.T.T_.e.e.aa.mm...........I..n.i.t..i..al.....H..e..a..t.......S..t..r..a.t..i..fD..ia..ct.a..et..i..o..n.:........H.I....H.2.....H.3....T.i.m.e......................

CMS #7708
Copyright ©

MD-Jait Intake Screenin• revised by Correc•onal Medlcat Ser,;Ices, Inc.

AI•

Rights

Reser,'ed

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 172 of 185

Division of Immigration Health Services
In-Processing Health Screening Form

s[•E•LFION THIS FORM WILL BE SENT TO THE MEDICAL CLINIC AFTER
I: ASK THE DETAINEE (Check #•e appropriate box')

i•]Yes •No {ave you

doctor in Ule past

If YES, for what7

IT IS COMPLETED

TODAY'S DATE:

Please ma,• an)Z•ruises, scais, cuts other marks
dis!inguishing physic•l characteristics In ;he diagrams below, and
Inotify the DIHS medical officer If you feel that the delainee needs
iany kind of medical evaluation.

•Yes

Are yo•.| having any pain?
tf YES, where?
Have you been hospitalized in the past 6 mo•tbs? If YES, for what?

Hav? you ever been treated for problems wi!h d•,.•gs alcohol? If YES, when, where, and for what?

Do you
•Y•s OYe• •Ye•

have have you ever had any of the following? Your skin break eel in bumps, or trouble breathing after taking
medication?

Sores your pHvales, Trouble peeing?

ddp from your pnvales?

Fits

'lzures?

0¥• ONo • •No O Y• OY•

The whiles of your eyes your nails turn yellow?

Persistent coo#h (of

than 3 weeks (,4b'[ation)?

Hemoplysis {coughing up blood)?

Not been able fo eat with significant weight loss?

A persistent fever?

Nfghl sweats?

Weakness lethalgy (tired.)?

•Y•

A•e you afraid you might lose your mind go crazy? Are you afraid you might hu,'l kill you•elf sthers? If female, are you pregnant?

SECTION I1: YOUR OBSERVATIONS OF THE DETAINEE (Check the appropriate box)

Does the detainee appear 1o be:

•r- ]. ONe Yes

Nol doing whal yon fell h•m to do?

eYes [•No Aciing crazy or strange?

[•] ONe Does the delalnee appear to have:

Ye,

Shaking/tremors?

eYes •No Skln broken out In bumps/,ash?

eYes ONe •alnoudshed?

box)• SECTION 111: DETAINEE SENT TO (Check the appropriate

•]General population

General population with referral to ruedical

..•7GReferral for
[•lsolation until

immediate
medically

medical evaluated

eYes ONe Needle #acks? eYes ONe A handicap?
%•J• 6f md•fduar comptetin•'•,o• -•'#nledname olindi•duatcornf•ieb'n•

Last Name

First Name

A#
Date of Camp Arrival (DCA)

Country of Odgin
DaB

Medical Clime
DIHS Form 794

7/2008

Sex
Page of

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 173 of 185
MASTER
PROBLEM
LIST

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 174 of 185

•atitis
e

B

Vaccine Lot#

and

Vaccine Mfr.

Information
Date on

Statement Record

'VIS

Date VIS

Given

•Statt Inlt.

Inmate # DOB:

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 175 of 185
SAMPLE
RECEIVING
SCREENING
FORMS

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 176 of 185

ou having any shortness of breath, use inhalers, have chronic

are
val

pregnant,
symptoms'?

do

you

have

abdominal

pain,

bleeding

or

are a dialysis patient, did you miss your last scheduled dialysis?

the arrestee
suicidal,

have altered mental stares?
confused, disoriented, and depressed?

)u

ck result

[] Y----•,7- --• No

gl Yes [] No

iZ! Yes []Yes

[]
_[__0_

NN_o •

If arrestee
urity staff

answers YF, S
to •he mental

to questions 8 he/she is to
health professional on-site

be escorted IMMEDIATEI•Y
for evaluation.

ion:

Accept
Reject (Complete information below)

•s: BP

Pulse •Resp

Temp

(Nurse Encounter Form)

,sons for Rejecl: (Answer YES to # 8 is NOT a reason to reject)

ed, copy of form listing reason for rejection should be sealed and given to the hospital ER.)

Dfficer Notified: YES

NO

iotification:

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 177 of 185

•,•,•i•"•"•of Irnmi.qration Health Services

Intake Screening

•'•,,•.,v• v-_

,,,•...••

atient was detainee

identified by (check
Icanstened flora
was

2 sources) []
another facility,

A/fin band E] picture
did a medical transte•

[] Verbally • Other_
summary accompany the

detainee?

?

E• Yes

[] No

i,me of an-iv•l in camp;
{4: e1diWchaalt lSancgrueageenidno gy_ou speak?

[]

English [] Spanish

[]

Time of Inltla! screening:

Interp•etel Other ..........................

# or name:

2 How do you feel today? (Explain in hls•er own words)

E] NIA

-3,•a•.• eCha_ra_•-••-of_p]al•m _n 3•b.an•Loc" auon:•

[]•
•-

ill_ant •e•S__

below:

3¢I Intensity (0-10 pain scale)

3e. What relieves pain or makes It worse?

• Do you h- ave an- y Slg- nll- lC• ••

[]Yes If yes expar:

5. Do you take any medication on a regular basis, including over the counter and herbal?

[] No

[] Yes If yes, list medications:

•o•[•-•'• 6.
7.

DO you have A•e you now

any allergies
Or have you

to m•.-dication or food? ever L•en trealed by a

doutor

tar

a

medical

If yes, explain: condition to •

hospitalizations?

[]No

Yes If yes, explain:

8. Have
L-3No

you ever had a
[] Yes If yes,

persistent explain:

cough

for more

than

three

weeks,'coughed

up

blood,

had

a

p•rststent

fever,

night

sweats,

unex•elghl
or

loss?

g•[•l pe•iod:o 9. Are yoU pm,

Yes

cha•ges 10, Have you had any rectmt acute

[] NIA (male) If yes, date of last menslraal
wilh your vtslon? -•-•-o-•s If yes, explain

p•r_3 )ral Screenin9

tl. Are you having any significant dental

Yes

yes, explain:

/lental Health Screening
12. Have you ever tried to kill yourself?

[•j•l-•-- [] Yes

Hanging Method: [] Gun []

[] Cutting skin [] Pills

mak.e • • If yes,
•-• If atte

when dld
was

the sulcJde attempt occur
within the last 90 d•..)ls,
t•-ff about kJlllna or

referr•
harming

Immediate yourseflf

and
u,•u

rq •7"

If

•(ES
."

';.

make

•Terra]

.l. mme•d.l•aUt•edhsLo•nn;•d--e[n]sNuore

[] Yes

[] Other

14.
you-•wor 5. hospitallz•tlon 5.

Do you Do you
DO you for

InnfkaonYvoEelwSo,galocfanmhl•asaokoov,ermeyeyaoropenpufeaerroree•ai•nln,.l,.tI,hrimr,•sree;naauefsradodclinayl.?it,.vte•yliycw.•ns[u]mthNa.ot°youot[h]er

•'•-cl(?
people don'l
Yes If y•s,

[•No
hear;, seen
explaln:

[] Ye•
things or

l! ye•
people

Have If yes,

yeoxuplaelvne:•

received

counseling,

medicatlon,

or any other form of treatment

WhO Is

p'•,•...--

that others don't see; or felt others were

lot mental health difficultles? LJNo

t•ylng
l_J

to

harm

17. &

Have you been a viclim of physical or sexu•T•b••e-?-• •6• Yes If yes, e×plain:
Do you f,..•el that you are currently in dan(•r of being physiCally or sexually assaulted?

[•]•

[] Yes

19. Have you •r-sexua!ly assaulted anyone? • [•] Yes It yes. explain,"

t.asl Name
Allen#
Country of Odgin

First Name
]-•T•-of Ca m p Arriv'al (DCA) I •

}-[3OB

sex

DIHS-795-A (r•'-viscd 10,Q3/Z009)

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 178 of 185

tural/Religious/Learning Assessment

there anylhlng tmpolianl for [] Yes If yes, explain:

us

Io

know

aboul

your

religious

or

cullurN

beliefs

t•al

are

o! concern

to

you

while

In

detenllon?

Haveyoueverhaddifficultleslearnlngorunderslandlngwfftlenlnforrnation? I•No L•lYes Ifyes, e×plafn:

istance Use/Abuse Screening.
Have you ever be•n treated for dn•g alcohol problems suffeled withdrawa! symptoms from drug use?

ONe

"0 Yes

s. explain:

30 you rk')w or have you ever used tobacco products, drank alcohol or used drugs? [] Np [] Yes (If yes, give details below.)

•ance Used/Route of Use

Date of Last Use

Amount/Quantlt, Z Last Used

.Screening

lave

you

had

any of
[-]No

the

following dudng the E] Yes If yes, when

past 7 days?
did It

hroat

FINe [] Yes If yes, when did it begin?

kches

FINe I-3 Yes L•No [] Yes

tf yes.

when did Chllts

•t begin? []No

[]Yes

[]No
•
ass of breath

[] Yes []No [] Yes

Nasal congestion E]No [] Yes If present check rasp!rarefy rate:

Diarrhea []No [] Yes Vomiting [:]No [] Yes

lave you been tn conlad wllh anyone who •-as ill with influenza, fever, cough or sore throat dudng the past 7 days? [•lNo
•ere?

[] Yes tf yes,

)attenl appears to have non•a.l phys callemotional characteristics end no barder• tb c•mmunlcatlon •atient appears to have the fotlow•ng abnormalNes:

'at.lent a•__ observe any

rs
of

oriented to person, place tt• following, dneck the

and lime
N)_proprtale

be)c:

[] Patient appears NOT [] None observed

•izarre or crazy beha, vtor
×kicnasbsraovkaenswoe•attJrtn]gbumps/rash !•sical disabilities

[] []

Agtialion
Malnourished

ap•earadce

[] []

DCuetvseloorpmbernutisaels

dlsablliti•s

to be

odented to:

person

p_l_a_c•_..__

[] Inability to fOcus or concentrate [] Sha•ng/lremors [] Needle tracks
[] Patient wears glasses or contacts

time

nenls:

Signs: T

p

resp.__

BP

hgt.

•t

Results: FIPosltive [] Negative [] NIA (mate)

[] [] Itial Medical/OraL/Menial Health Screening:

Normal

Abnormal

•position:

[] []

[] General population

[] General pop0tatio• with refemal fo•" medlcal/mental health care

Refff•ral for Immediate medicaL/mental health or denial c•re

Isolation until medically evaluated

ucalion:

[] Tuberculosis end CXR explained 1o detainee and process completed with .appropriate shielding

[][]

Access to r•edical/dental/mentat health care. gfiev.ance process explaihed to patlenl
Pallenl given the Medical Orientation and Health Information and Dealing with StreSs Brochures

tn their language

[] Patient verbalized understanding of any teaching or instruction

[] Patient was asked If he or she had any additional questions, and any questions were addressed

I• -ell ntervenlionc•JFollow-up:
See SF 600 for detailed assessment and plan

[] Physical exam scheduled for patieni

[] The following ca•ellreatmo.nl was given during this inlaka screening:

Provider Signature
Name
,#
•l•y of Origin
•-A (revised 10/23/2009)

Date

Stamp/PrLnted Name

First Name

Date of Camp Ardvel (DCA)

DaB

Sex

Fadllty

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 179 of 185

Division of immigration Health Services

Medical Consent Form

Health Care Program

TYmIp,hoyr•uofcemuwsianslj'lieoonrbntealpheuexrasplpttaeof,csf•teeosfdtoaftthtueotsh,euclnoicdtnleihicnreirgcmoamiyseadtiomdceeapdelrimocvaeilvdnaeelceuexyasaotsuimaoirnnwsyai,,tthiodanmideavdgitnisoocasabdtlleietcecraorpmreri.ohnaceeperpMdreeoubydporyiruecirsaac,tlocenu.srriorenuenftntoitmn•e,thoaetcalmaloertdehn.icoaabnltdaismnceerddeiecnwaiillnl/gdbeenatnakdelptmterdineiacatam•ceonnetfxsiadmewinhtniiacathlionmtheedtiocmaedldeitcerarelcmo,rnadne.d

npdpmeiuraeasclorducsfepitoleshcoossoasssarlceuiriosrozynenei,saneflfoondrofatirdssmtmvtchaaiyteltfosofiasodnmbuonu•elfrerdeenaittttcohaioealoroflfnecahdmlpeeriyoaprnfeilarcctlotmohpherderddaiesicnaeamcdtramietelnso.sotrsaarsctcVeeapr•crhetoeryehrrsenedisipsbcirynoaedrglsettsopinuenacacagcnenhtddh/aoaoatstgmorpeeiptnntrahctmaiosaeilvm,lneiitsfdnaaoecIhlfrrief,lhaoirotlthysotte.phhpaiilbustetrcahpaltornineesczcaaceirteusweisdhoesinsoacpfrhryoibds,vuititdshdeeeaeiadressvmmenieewosdthdaisobcullarienlvrienseicitoaneleronsdltdsaaantpoarcppneyirw,ooeepfaemrenkaipsddlaslvytioiecoys.onweanaetbellrlolel-as.octfuhaotifrhtlfhodearopifvpzcir!estioihntpeisrtch,iceaflotiirfnedi.itcmhseecnmltaomaayseluudtrihdechoeaeretaiolmfztehamnydcare

This form
regarding

has the

been fully explained
results of treatments

to me, and understand its contents. or examinations done in the clinic or

further understand outside the clinic by

that health

nocargeuarparnotfeesessionhaalvse

been made to to whom may

me
be

referred.

Programa De Cuidado De Salud

La meta de esta
ser• mantenida

cllnica es proveerle austed
de manera confidencial en

un su

cuidado de
expediente

salud de alto calidad. La h-fformack•n cllniua m•dico Usted se• sornetido a un examen

que se obtenga acerca de medico para deterrninar

su su

caso,
actual

condiciSn de soled.

voluntariamente doy mi consentimiento al peisona] medico de esta clinica

pepavrraoafleusaIlcloienvoaarrl•easdecmae•bsoitcaausncal,lniepcvaraolccueoadnciskimSdineernietnolcsinaelcdeiysauagnrni6ose,txicaromesec,nomcemaniedddaaibdcloose

para detemqinar mi actual de rutip, y a tratamientos
o apropiado.

condici6n de salud
medicostdentales

Tambien consiento a otras
que e! personal medico y

Yo tambi•n considere semanales

nepccaoernsasairceienort,coiorraeacruosnmeaendedevlaablbluiaeecnie6osntaaprdreodpeislaoldmeoed.nomrCe.onntaElsrteasyspea cetlnootsreacvuimisedtanasdoorsessardaenesstaeelfuepdcrtoumcaeednsatosal

qua el incluir&,
durante

personal m•dico y profesional de esta cflnica

pard no astor& timitado, el tiempo qua el manor

a entrevistas pem•anezca en

el

Centro.

YrsToeaeamcnboauimteeeonnmrdpizataoeduaatd.aoroieszsYotoadeetlcaleimansbciticcaeeanscoa;lanruaiectvaome,tdlzasroei xepllaaedpeiisenetfranosrtorencnalatlcmniie(c•mdaneidcaioencpoeamrimidientesixtrepisetteudlaciieaoccnnlcteleenssi'caafmeededaenirtmcalioleenesdxa epeyendqetiusieatdnaattdseaeelsaemsephdeopirsactprioainteanpaltraeopdpra6osos,vienteeosdcioeuprsnOeaabsdliochdooesppadirsetaaallvuilmdgizialmccaelunnScitnidaaaldesoy

requedda o y/o fisica qua
de salud. control de

no

enfermedades.

Este documento me ha sido relacion a los resultados de

explicado
ex&menes

y entiendo a cabalidad el o t[atamientos medicos,

contenido realizados

del
en

mismo. Reconozco esta ctinica o fuera

qua de

no
ella,

sepormeprohafesdiaodnoalensingduenala

garantla
salud a

en
los

cuales se los ha referido mi case.

-P•i •-5• a-•7•7•-•
Last Name

Date •-First Name

Date of Camp Arrival (DCA)

dical Clinic

DIHS Form 793

11/2008

-•O•
Sex
Page of

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 180 of 185

suggestiveiSat;pearanCeof orabn°mqaiabuse} VISUAL OBSER\•AtIOt4 Circle Y or

1.

Inmate

in a:•y way? (e.g., sweating, tremors, ar•ious, d!sbeve!ed, evidence

trauma

2 Is detainee's movement r{•.stt-icted •;r •.:•;mpro•nised in any way? (eg. body d•formilies, physical ab•ormaiity, unsteady gait, cast or splir•t ta•<e etc.)

3. Is delainecs breathinq abnarmai_(•.,%•.•,..•sho {he s s of breat2•)?

5.

femininifL, 1"• time offender,2assive or timid a[•pearance) • explain:

Does inmate's skin or scalp []ave bruises, eden•a, scars, tattoos,

obvious lesions needle marks or

or draining wounds,
c..the• indications of

lice
dr•g.

or stcabies, abuse?

jaundice,

rashes,

6. Is the detainees behavior abnorrnai, combative, disord=rly or confused? Has deta nee experienced a

L_

head in•u•_?

INMArE QUESTIONNAIRE CONTACT t•EDICAL IMN1EDIATELY FOR ALl_ HIGHLIGHTED AREA QUESTIONS
Did the detainee come to the facility from the Hospital or Emergency room?

2.

Have you
disorder,

ever
heart

or are you
condition,

currently being treated for: a<thma diabetes, seizure disorder, thyroid high blood pressure, bleeding disorder, kidney disease? Do you take

insulin?

Have you in the last six motnths or are you currently being treated for any other illness Or health problem not listed above?
[4¸ Are you currently taking any medication prescribed to you by a physidan?
MedIficyeast,ionli(sts:) Name:

YES

YES

YES

NO

_.-------•

YES

NO

-J YES

NO

T

Are you allergic to as}, medications or do you have any other allergies? List:

6. Have you bee• exposed to Dr been diagnosed with Hepatitis, venereal or sexually transmitted disease,
•.qlVIAIDS, or any other serious disease?

7.

Have yot• treatment

ever
for

had positive TB skin exp•,.Jre to diagnosis

test,
of TB?

been

exposed

to TB,

been

diagnosed

with

TB

or ever

received

8.

••,, Do you
fatigue,

currenUy
coughi•g

have up

any
blood,

of these symptoms: Persist•ntcough, shortness night sweats or unexplained weight loss?

of breath,

l°ss°fappetite

9. D.o•_,•,u haEv"e-'qa zE•ainful dental condition?

......................................................

How often?_ __•• •i_-•_•- •
Do y6u use alcohol? If yes, what ki•c;¢
•,• m•h'•

}•ow often?

Lest use

• YES
•

Have you ever received treatment for substance or alcohol abuse?

YES

Females: Are you pregnant, recently delivered or abo•ed; or experiencing female problems? Do you
•ke methadon]e?

• YES

Inmate Name 7/15/09

lID#

DaB

[)ate

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 181 of 185

Hard •,'od ever been •s vctim :•i a cn•,• b'-; "u ;:vet b,•er, v ct m•zed Curms a w-pe;'aous incarceration
Have you ever b•en arreste: for any crff•[• •n[;£•0;[•a sexual offense or received disciplinatf action du•n•
any previous incarceration for sexual assault

SUICIDE POTENTIAL SCREE

• &rrestinn

or

•ans•orth]a
"-1:

off cot be

subject may be suicide

••

risk.

Lacks close famity/•ends Jn communtW

_•

•---•as psych atd h s'0ry (psyHY)tlol) c medication treatmentS.
•x#resses feelings of embsrrassmendshame.

E_•xpresses _•2,¢,• signs

feelings there-
tf dt•fd•s•£2

•s nothing to look fo•,ard to
!•0r:4• 0[.£[•]p! f•atn!2_•:

in the

future

(feelings

of helplessness

and

hopelessness).

...................................................................

N•.•

YES

NO

Appeals to fesl unusual;y emuarrsssed or ashamed.

or•:ug• Is apparently under the influence of alcohol

•

YES to #15• Is individual inuo! lere[•t showing signs of wdhdrawat men%d Illness?

lsthisin•iv•dual'sfimta•est?

•arees nHude'Mu•er Kdnaupngand

Does *he detainee h£•ve hPttu•' of mental health h'o-s•pi-t-a-•zat.io.n.? ................................

hnmediate Action: A and immediate refe,,Tal

•Y-• to MH

,re ]q highlighted area, or
evaluation. If after hours,

a

total of initiate

su8 icoirdemorweatc°hYESimmerdeisaptonesleys,

shall result unti; MR •n

in notification evaluate

of Sh!ft

Commander

Education provided orally and irl writing on Access to Healthcare

Y N

Education plovided oralty and Jr1 v;liting on SexlJal Assault Awaren•ss Y N

COMPLETED BY: (NAB]LAND NUMBER)

Are you a veteran?

Y N

Do you receive VA services? Y N

have ar]swered all questions ful!y.
been instructed and have reseivcd

have been instructed information on sexual

on and
assault

[eceived W•le[mat)on on how to
awareness. hereby 9Ne my

obtain/acsess med;u•! services. have consent for C0•rect Care S@utJens to

Inmale Signature
leaKh r'a e Siqr]alure/Tfle:
•ZEDICAL S':AFF C, NLY [•E•O'7,; It IIS LiNE
REFERRALS: (check appropriate box)
• Medical Provider
,• Mental Health
[] Dental., [] ClWA•Ahthdrawal Protocol

De. Date:

Time:

PLACEMENT/HOUSING: (check appropriale box)

• []

General
Me•lical

Population (GP)
Observational Housing

(I POD)

E3 Medical Isolation POD) fq Mental Health Unit (B3)

E] Emergency Room for evaluatinn/treatment [3 Immediate placement cn Suicide Precaufier, s

IPOSO

Inmate Name X•Y•S• ?/l 5/99

ID#

DOB

Date

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 182 of 185

EMERGENCY MH REFERRAL: ALL "YES" RESPONSES TO B OLDED/ITALICfZED ITEMS and MH5
ON.SITE EVALUATION BY MH CLINICIAN: ALL "YES" RESPOtqsEs TO "S" SUE•CODE If on-site MH clinician not available contact on-call MH

P,•RT III DISPOSITION

Urine obtained for screening (female only) [] Yes [] No

TsT Plant Date:.• [] left [] right [] deferred {•#•t•)

[] Form HR104ATB Symptom Screening completed

Refer to: (Check, all appropriate)

Medical
Emergency (on-si'•e/on-call)

With;n 24 hrs.

Routine (v/•thin 72 hrs,)

[]

H_Ee.Fa•elt_hD•.'y_Lo!2=s!t#/J31•al!)WithinRoutine24 rq[]3 hrS.(wfthfn 72 hrs.)

Dent•l

Urgent (•thin 72 hrs.)

[3

RoutJae

f'l

HIV Contact Nurse
HiV Counselor

nator

(R01) []••N4401 Authorization to,Obtain and/or Disclose Protec•ed Health Information

signed

Placement:

[] General Housing
[] Medical

I•l RHU E] Mental Health

[] Infirmary Medical
E] Refer for Ph)•ical

RE•ARKS:

Infirmary- Mental Health

Emotional response to incarceration: (circle) Coopera•ve Angry Tearful Embarrassed Unco3perative Depressed

Today's Classifica•on Scores and sub codes:

•edica]

Mental Health

Enlered into OBIS [] Health Services
[] Custody

STAFF NAME,'TITLE (Printed)

DateJ]3me

STAFF SIGNATURE

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 183 of 185

Intake Health Screening

CUSTODY INFORMATION

Bond Amount:

Sentence:

Charges:
Special suicide precautions
•] First CD©C incarceration

advised

because

off

(check

all that apply)

D No special circumstances idenl;fied

E3 Statement from family, friends, or communi• providers

[3 Statements from offender, or observations of offender behavior

E] Court mil•Jm us alert

Offendeds OFFpoor}rp•lrr{aeec•tteuuSmrr-neniininntggmei•dnooriff&sfcf•peeafenntc-ddiiaeeao-rrlnssss-,,shiobsummrstooiiossnvuttgeghrtrdeececteeVonnittfcac•mimlleein£dttyi''ac?6laUl•[h]tecbalYlaYetsshsiofcfilcfa[a3setsdiiNodfonigcra?tiEo3nY(3eSOMtheedrsQ-NfQOo-rwarAdQneyd2Elstuoc(hm3ed3[di]ecva2il,crqesd4[]ecp3oaOndfmi5[es]ncat4t?e"Sd"?[]

subcode?
5 [3 Yes
•"(es

i3 Yes n
[] No •3 NIA
-.-Q.No---EINIA

Comments: Interstate Compact

Yes [] No

Date:.__...._._---.--- Time:• am pm A/P Officer

HEALTFI SERVICES INFORmaTION

p.t•V•T
El Yes

[ •

OBSERVATION
No Custody Info

reviewed

•ropriate res op•#_•
Oriented ,to time, place, person (check) [::l Yes CI No

1. Level of consciou sness (circle only one);

alert

lethargic

obtunded

stuporous/comatose

Obvious pai .r•bleedingttrauma (drcle)

B. Obvious fever, jaundice; Infection (clrcle)

-Ci.ntBoaxribciattuiroant/ew,ithhderroaiwna,l

cocaine,
(clrcJe)

benzodiazel
(If Yes

]e, al

UorrgeanltcohRoelferral)

D. Sweating; tremors; anxiety;, self-neglect; sheveled (circle)

E. Scars; needle marks; rash; skin abnormalities (cirOe)

F. Body ve[min/•nfestation

(circle)
G, Disorderly or disorganized behavior
YES NO H. Risk of assautt to staff or other offenders
YES NO I. Breathing difficulties YES NO J. Rec4•nt welght IOss YES NO K. Disabilities requiring special accX modatlons
L. Obvious oral/dental abnormality

• YES NO
YES NO

Vital signs: Temp.

Pulse

Resp_

B.fP

Does any of the above Indicate a need for immediate intervention by'? [] Medical

O• Sat

Wgt

Mental Health [] Neither

HRO01Pag= of 4

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 184 of 185

i Offender Nan e

pffender Number

Dato

PART II REALTtt
Circ•fiate

STAFF-OFFENDER QUESTIONNKIRE
r•po•se. • 'Yes' aBswer re •ires

eci•c

informa•on

followi•

1.

Have you ever been
diseas ulcer, high

told •t you have •ncer,
blo•g pressure, hepatitis,

diabet•, heart disease, th};old problems, aP•fis, •, seizu• ac•v•PF, •nfec•ous disease, psychiatric

HW/AiDS, as•ma, lung disease, kidney d so•er, men•l re•rdation or l•umatic
YES NO

b•in inju• Problems •nL-oHing violent behavioff? O•er? (Circle al• that apply)

(Lis{ 2, Do you •ke any medi•bcn?

Last Taken)

YES NO

Are you a le•ic to any medication o•" other subs•nce inclining food items? (Describe [eactbn)_

YES NO

4, Are you presently on a diet ordered by a doclo,'? Diet name?

Doctors name?

When?

Why?

5.

Where?
Witbin.the

last

6

months,

have

you

been

hospl•lized

or

otherwise

treated

for

any

medica•surgicaf

condition?

Are you using alcohol? Dally ln•ke?

Lastdrink?

Are you using .h.e.r.o.i.n,...m.e.t.h.a.d.o.n.e.,...".s.tr.e.e.t..d.r.ug.s."...or..o.t.h.er. substances? Specify

YES NO
YES NO YES NO YES NO

Amount?

Last use?

ModeJRoute?

Have '.(a) Me you or have ybu been • i•tmvcmous or rejection d•g user?

•)

•ed
you

ne•

or drag p•aphc•?

B.

Have •u

ever been

a pagent in a "de•

or subs•nce abuse
When?_

pr•mm? (if •,•, =MenU•
Wh•

He'a•

R•'dne wi•;n 72 h•.)

Where?

YgS NO Yt•S NO
YES NO

9.

Have you ever received servic• from
Mental Retardation or the Depad.ment
Where?

the Department of Mental Health and Addiction Services or the

of Children and Family Services? 0f•s, =M, en•l Hea•th Rcuti•e)

When?

Case Manager's Name?.

Department

of

0. Have you ever been in a mental health hospital7 (lf<.lOday• ofreleaso=Me• tM Health to see within 24 hrs.)

Where?

When•

11.

Have you Where.?

ever

been

tn

a

mental

health

outpatient

program/clinic?
When?

(• •, =Mental
Why?

Health

no*June

•d•hln-72

h•.)

YES NO
+ES NO
YES NO

•2. Have you ever thought about or tried to hurtfldfl yoursel# Why?

YES NO

(If yes, 3 yr. Mental Health to see within 24 hrsE>3 yr. Mental Hea4'•h Rou'Jne wiefin 72 hr&

Where?

When?

Ho•

Are you thinking of hurting yourself nowT(lf yes, EFt MH REFERRAl-)
Do you have a plan? If yes, describe__
14. 14as a parent, spouse Or other dose relative or friend attempted or committed suicide? 0f •,

YES NO

Case 2:12-cv-00592-TLN-CKD Document 137 Filed 03/03/14 Page 185 of 185

Offender Name

Offender Number

Date

15. Has there been a recent death or change in your immediate suppo•l system? If yes, specify

16, Have you ever experienced physica•/emotional/se×ual abuse?

17. Have you ever been the victim of a violent crime?
18 Are you ha,,4ng headaches', numbness in any pa,'t of your body, or changes in your vision cr memory? (circle)

19. Have you fainted or had a head tnjuQ/? Date

De'•Jls

Specify 20. Do your teeth or gums hurt?
21. Have you ever had a sexua!ly transmitted disease or abnormal discharge?

How treated?

When?

22. Have )gu had multiple sexual partners, or unsafe sex v•4th someone who you know has HIVtAIDS?

23. Have you ever had a blood transfusion? When?
24. Have you had a severe rash in the past two years? Descdbe

25, Have you had an)' sores, infections, or white patches in your mouth? Descdbe

26, Have you ever been tested for HiV? Where?

When?

Results?

27. Have you received HtV/AIDS info,'Tnation while Incarcerated?

28. Have you ever had pneumonia? If yes, when? 29. Do you sweat e×cessively at ntght• have a cough, or bdng up sputum, phlegm, or blood? (circle all that apply) 30. Have you had fevers, chills, felt weak all over, test your appetite, or test weight? (ci•te all that apply)

31. Have you ever had a positive skin test for TB?

32. Do you smoke? If yes, number of packs per day__._.__
33. Do you have anyother medical problems or disabilities that might require special accommodations? If yes, identify (e.g., prosthesis, glasses, contacls, headng aid)

34. Where do you go for medical care?
35. Will you sign a release of infom•atJon form so we can get your health record?

36, Do you understand how to get medical, mental health or dental services?

Che•k all that apply:

A•len•on

Q adequate attention span, [3 poor attention span, C•dlstract•ble, Oconfused

A•itude

[3 cooperalJve, CI suspicious, C3 guarded, D hostJ!e, •3 uncooperalJve

E3 normal, 13 slow, D hesitant, {3 rapid, [3 slurred

Movement

C) normal movements, Q abnormal movements, 13 abno,q'nal gall, 13 motor retardation

,'load/Affect 13 normal range (euthymic). Q anxious, 13 Irritable, 13 depressed, £3 angr 7, E] elated

•ouqht content 13 normal con•ent, 13 preoccupations, FI delusions

Percolation

[3 no perceptual distodJons, 13 eud]tory halludna•ons, [3 visual halluc•na!Jons

Intellect

13 normal inLel!eotual functioning, 13 signs of menial relaxation

• no Impairment, 13 memory impairment (specify) Q remote, [3 recenL • immediate

4omiddal

[3 no homicidal ideation, r] homlcfclal Ideation

13.adequate, D mildly impaired, Q severely impaired

Comments:

tlon descrfbing health services at this facility and understand how to access health care.
•re Date

YES NO
YES NO YES NO YES NO YES NO
YES NO YES NO
YES NO YES NO YES NO
NO
YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO
YES NO YES NO

 
 Case 2:12-cv-00592-TLN-CKD Document 140 Filed 04/10/14 Page 1 of 11

[1145271-4]

1 MICHAEL W. BIEN – 096891 ERNEST GALVAN – 196065
2 KATHRYN G. MANTOAN – 239649 AARON J. FISCHER – 247391
3 JENNIFER L. STARK – 267062 ROSEN BIEN GALVAN & GRUNFELD LLP
4 315 Montgomery Street, Tenth Floor San Francisco, California 94104-1823
5 Telephone: (415) 433-6830 Facsimile: (415) 433-7104
6 Attorneys for Plaintiffs
7

8

UNITED STATES DISTRICT COURT

9

EASTERN DISTRICT OF CALIFORNIA, SACRAMENTO DIVISION

10 Estate of NATHAN PRASAD, deceased, by and Case No. 2:12-CV-00592-TLN-CKD

through MARY PRASAD; MARY PRASAD; T.P.,

11 a minor; A.P., a minor; and N.S., a minor,

PLAINTIFFS’ NOTICE OF

12

Plaintiffs,

MOTION AND MOTION FOR APPROVAL OF MINORS’

v.

COMPROMISE AND FOR

13 COUNTY OF SUTTER; J. PAUL PARKER,

14

Sutter County Sheriff’s Department Sheriff; DAVID SAMSON, Sutter County Jail Division

15

Commander; NORMAN BIDWELL, Sutter County Jail Corrections Lieutenant; LOU ANNE

16

CUMMINGS, Sutter County Health Officer; AMERJIT BHATTAL, Sutter County Assistant

ORDERS TO DEPOSIT MONEY INTO BLOCKED ACCOUNTS
Judge: Hon. Troy L. Nunley Date: May 8, 2014 Time: 2:00 p.m. Crtrm.: 2, 15th Floor

17

Director of Human Services – Health Division; BRENT GARBETT, Sutter County Jail Nurse

18

Program Manager; DORIS BROWN, Sutter County Jail Advanced Registered Nurse

19

Practitioner; MELODY YOUNG, Sutter County Jail Licensed Vocational Nurse; KIMBERLY

20

WEISS, Sutter County Jail Licensed Vocational Nurse; GURKIRAT BHANGU, Sutter County

21

Jail Licensed Vocational Nurse; CHRISTINA STOHLMAN, Sutter County Jail Correctional

22

Officer; LESTER EATON, Sutter County Jail Correctional Officer; MIGUEL AGUILAR,

23

Sutter County Jail Deputy Officer; OLGA TAHARA, Sutter County Jail Deputy Officer;

24

ROSA DIAZ, Sutter County Jail Deputy Officer; ERIC CRAWFORD, Sutter County Jail Deputy

25

Officer; BALJINDER RAI, Sutter County Jail Deputy Officer; SHANE DICKSON, Sutter

26

County Jail Deputy Officer; FREMONTRIDEOUT HEALTH GROUP; and MICHAEL

27 FRATERS, D.O.,

Defendants.

28

2:12-CV-00592-TLN-CKD PLAINTIFFS’ NOTICE OF MOTION AND MOTION FOR APPROVAL OF MINORS’ COMPROMISE AND FOR
ORDERS TO DEPOSIT MONEY INTO BLOCKED ACCOUNTS

Case 2:12-cv-00592-TLN-CKD Document 140 Filed 04/10/14 Page 2 of 11

[1145271-4]

1 TO ALL PARTIES AND THEIR COUNSEL OF RECORD:

2

PLEASE TAKE NOTICE that on May 8, 2014, at 2:00 p.m., in Courtroom 2 of the

3 above-entitled Court, located at 501 I Street, Sacramento, California, Plaintiffs, by and

4 through plaintiff MARY PRASAD as Court-appointed guardian ad litem for plaintiffs

5 T.P., a minor; A.P., a minor; and N.S., a minor (the “Minor Plaintiffs”), will move this

6 Court for approval of the minors’ settlement compromise in this action pursuant to Eastern

7 District of California Local Rule (“L.R.”) 202, and for orders to deposit money into

8 blocked accounts for each of the Minor Plaintiffs.

9

This motion is based upon this notice of motion and motion; the declarations of

10 Michael W. Bien and Mary Prasad filed herewith; the confidential declaration of

11 Kathryn G. Mantoan, for which a notice of request to seal has been concurrently filed; the

12 proposed orders filed herewith; and any oral or other evidence which may be introduced at

13 the time of the hearing on this motion.

14

MOTION

15

Pursuant to L.R. 202, plaintiff MARY PRASAD, as Court-appointed guardian ad

16 litem for the Minor Plaintiffs, hereby moves for approval of a proposed minors’

17 compromise in this case and for orders to deposit money into blocked accounts as set forth

18 below.

19

FACTUAL AND PROCEDURAL BACKGROUND

20

1. Plaintiff T.P. is a minor who was born in 2003, is male, and is currently ten

21 years of age.1 See Decl. of Mary Prasad in Supp. of Pls.’ Mot. for Approval of Minors’

22 Compromise and for Orders to Deposit Money Into Blocked Accounts, filed herewith

23 (“Prasad Decl.”) at ¶ 3.

24

2. Plaintiff A.P. is a minor who was born in 2005, is female, and is currently

25 nine years of age. See Prasad Decl. ¶ 4.

26

27 1 Only the initials and birth years of the Minor Plaintiffs are included in this motion, pursuant to Federal Rule of Civil Procedure 5.2 and L.R. 140(a)(i), (iv).
28

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1

3. Plaintiff N.S. is a minor who was born in 2007, is female, and is currently six

2 years of age. See Prasad Decl. ¶ 5.

3

4. Plaintiff and movant Mary Prasad is the mother of decedent Nathan Prasad

4 and the grandmother of each of the Minor Plaintiffs. See Prasad Decl. ¶ 2.

5

5. Decedent Nathan Prasad is the father of each of the Minor Plaintiffs, and he

6 had no other known children. See Prasad Decl. ¶ 2.

7

6. Mary Prasad was appointed by this Court as guardian ad litem in this action

8 for the minors T.P. and A.P. on July 31, 2012, and for the minor N.S. on March 3, 2014.

9 See Dkt. Nos. 28, 29, 135.

10

7. Plaintiff Mary Prasad remains willing and able to act competently as

11 guardian ad litem for the Minor Plaintiffs. See Prasad Decl. ¶ 6.

12

8. The Minor Plaintiffs are represented by Rosen Bien Galvan & Grunfeld LLP

13 (“RBGG”), as is plaintiff Mary Prasad (both in her individual capacity as a plaintiff and as

14 administrator of plaintiff Estate of Nathan Prasad). See Prasad Decl. ¶ 7. RBGG was

15 retained by plaintiffs who brought the causes of action that are asserted in the original and

16 most recent complaint in this action (Third Amended Complaint; Dkt. No. 137). See id.

17 ¶ 8. RBGG has no other relationship with any party or former party to this action, other

18 than representing other persons who are suing some of the same defendants in a separate

19 action. See id.; Decl. of Michael W. Bien in Supp. of Pls.’ Mot. for Approval of Minors’

20 Compromise and for Orders to Deposit Money Into Blocked Accounts, filed herewith

21 (“Bien Decl.”) at ¶ 6.

22

9. The Minor Plaintiffs, plaintiff Mary Prasad, and plaintiff Estate of Nathan

23 Prasad filed an action in this Court against defendants COUNTY OF SUTTER; J. PAUL

24 PARKER, Sutter County Sheriff’s Department Sheriff; DAVID SAMSON, Sutter County

25 Jail Division Commander; NORMAN BIDWELL, Sutter County Jail Corrections

26 Lieutenant; LOU ANNE CUMMINGS, Sutter County Health Officer; AMERJIT

27 BHATTAL, Sutter County Assistant Director of Human Services – Health Division;

28 BRENT GARBETT, Sutter County Jail Nurse Program Manager; DORIS BROWN, Sutter

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1 County Jail Advanced Registered Nurse Practitioner; MELODY YOUNG, Sutter County

2 Jail Licensed Vocational Nurse; KIMBERLY WEISS, Sutter County Jail Licensed

3 Vocational Nurse; GURKIRAT BHANGU, Sutter County Jail Licensed Vocational Nurse;

4 CHRISTINA STOHLMAN, Sutter County Jail Correctional Officer; LESTER EATON,

5 Sutter County Jail Correctional Officer; MIGUEL AGUILAR, Sutter County Jail Deputy

6 Officer; OLGA TAHARA, Sutter County Jail Deputy Officer; ROSA DIAZ, Sutter

7 County Jail Deputy Officer; ERIC CRAWFORD, Sutter County Jail Deputy Officer;

8 BALJINDER RAI, Sutter County Jail Deputy Officer; SHANE DICKSON, Sutter County

9 Jail Deputy Officer; FREMONT-RIDEOUT HEALTH GROUP; and MICHAEL

10 FRATERS, D.O., alleging, among other things, defendants’ involvement in the deprivation

11 of the Minor Plaintiffs’ liberty interest in the continued companionship and society of their

12 father, decedent Nathan Prasad, as guaranteed by the Fourteenth Amendment to the

13 Constitution of the United States. See Dkt. No. 137, passim.

14

10. This action arises from the care and treatment of Nathan Prasad in the Sutter

15 County Jail (the “Jail”) and Rideout Memorial Hospital prior to his death at the age of 30

16 on January 28, 2011. In the operative Third Amended Complaint, Plaintiffs alleged that

17 the defendants were deliberately indifferent to Mr. Prasad’s serious medical needs – to wit,

18 a life-threatening infection – during his detention at the Jail and through his discharge from

19 Rideout Memorial Hospital back to the the Jail on January 26, 2011, and that Mr. Prasad’s

20 life could have been saved had he received timely and needed treatment. See Dkt.

21 No. 137, passim. Plaintiffs alleged liability on the part of individual defendants and

22 supervisors and Monell liability on the part of defendant Sutter County. See id.

23

11. Each of the twenty-one named defendants brought a motion to dismiss

24 and/or strike. See Dkt. Nos. 52, 56, 61. This Court denied in whole or in part all of those

25 motions, finding that the then-operative complaint stated claims against each named

26 defendant. See Dkt. No. 105.

27

12. No reports of physicians or other similar experts have been prepared in this

28 case that relate to any injuries of any of the Minor Plaintiffs. See Bien Decl. ¶ 8.

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1

13. On January 20, 2013, the parties commenced mediation of the case with

2 Judge Raul Ramirez (Ret.). Plaintiff Mary Prasad, as well as representatives of each

3 defendant and counsel for each party, were present at this mediation. See Prasad Decl.

4 ¶ 10; Bien Decl. ¶ 10. All discovery in the case closed on February 10, 2014 (see Dkt. No.

5 126), at which point the parties had conducted 21 total depositions and exchanged

6 thousands of pages of discovery. Bien Decl. ¶¶ 9, 12. As a result of the mediation and

7 subsequent negotiations, Plaintiffs reached agreements to settle with each of the

8 defendants. See Prasad Decl. ¶ 11; Bien Decl. ¶ 11.

9

DETAILS OF PROPOSED SETTLEMENT ALLOCATION

10

14. Plaintiffs have entered into settlement agreements by which they will receive

11 a total sum of $824,999 in compensation for all Plaintiffs’ claimed injuries in this action.

12 See Prasad Decl. ¶ 11; Bien Decl. Exs. A, B, and C.

13

15. Plaintiffs propose to allocate the total settlement fund as follows:

14

a. $272,249.67 for RBGG’s attorneys’ fees, totaling 33% of the

15 settlement fund (see Bien Decl. ¶ 12);

16

b. $102,101.74 for RBGG’s litigation costs, with the entire $18,022.50

17 previously awarded in July 2013 for reasonable expenses incurred by RBGG in connection

18 with Plaintiffs’ amended motion to compel (see Dkt. No. 103) applied in full to cover the

19 remainder of RBGG’s costs incurred in this action (see Bien Decl. ¶ 12);

20

c. $10,386.59 to Mary Prasad to reimburse her for expenses she and her

21 husband incurred associated with Nathan Prasad’s funeral and burial (see Prasad Decl.

22 ¶ 13);

23

d. $1,601.50 to pay the probate attorney who established the estate of

24 Nathan Prasad and secured Mary Prasad’s appointment as administrator of the estate prior

25 to commencement of this action (see Bien Decl. ¶ 14(b));

26

e. $766.23 to reimburse Medi-Cal for the lien it has asserted over the

27 proceeds of any settlement in this action (see Bien Decl. ¶ 14(c));

28

f. $43,789.33 to plaintiff Mary Prasad in compensation for her injuries

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1 and loss (see Prasad Decl. ¶ 14; Bien Decl. ¶ 14(d)); and

2

g. $394,103.94 collectively to the Minor Plaintiffs in compensation for

3 their injuries and loss, divided evenly amongst them (for an amount of $131,367.98 each)

4 (see Bien Decl. ¶ 14(e)).

5

16. Plaintiffs propose to allocate the Minor Plaintiffs’ settlement shares as

6 follows:

7

a. Plaintiff T.P.

8

(i) $3,400 to Kids Smile Dental and Orthodontics (see

9 Confidential Decl. of Kathryn G. Mantoan in Supp. of Pls.’ Mot. for Approval of Minors’

10 Compromise and for Orders to Deposit Money Into Blocked Accounts, notice of request to

11 seal filed herewith (“Confidential Mantoan Decl.”) at ¶ 2);

12

(ii) $9,999 to establish and fund a blocked account in T.P.’s name,

13 to be used for the benefit of T.P. if and as the Court approves withdrawals before the age

14 of majority; and

15

(iii) $117,968.98 to fund future periodic payments for T.P.’s

16 benefit, as described infra.

17

b. Plaintiff A.P.

18

(i) $9,999 to establish and fund a blocked account in A.P.’s name,

19 to be used for the benefit of A.P. if and as the Court approves withdrawals before the age

20 of majority; and

21

(ii) $121,368.98 to fund future periodic payments for A.P.’s

22 benefit, as described infra.

23

c. Plaintiff N.S.

24

(i) $9,999 to establish and fund a blocked account in N.S.’s name,

25 to be used for the benefit of A.P. if and as the Court approves withdrawals before the age

26 of majority; and

27

(ii) $121,368.98 to fund future periodic payments for N.S.’s

28 benefit, as described infra.

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1

PAYMENTS BY DEFENDANTS

2

17. By way of settlement, the defendants have agreed to pay the following sums

3 to the Plaintiffs.

4

18. Defendant Rideout Memorial Hospital (sued herein as Fremont-Rideout

5 Health Group): $20,000. Plaintiffs request that this amount be made payable to plaintiff 6 Mary Prasad.2

7

19. Defendant Michael Fraters, D.O.: $29,999. Plaintiffs request that this

8 amount be made payable to plaintiff Mary Prasad.

9

20. Defendants County of Sutter (the “County”), Sheriff J. Paul Parker, David

10 Samson, Norman Bidwell, Lou Anne Cummings, Amerjit Bhattal, Brent Garbett, Doris

11 Brown, Melody Young, Kimberly Weiss, Gurkirat Bhangu, Christina Stohlman, Lester

12 Eaton, Michael Aguilar, Olga Tahara, Rosa Diaz, Eric Crawford, Baljinder Rai, and Shane

13 Dickson (collectively, the “Sutter County Defendants”):

14

a. An immediate cash payment of $414,293.06 by the County to be paid

15 as follows:

16

(i) Payment to Client Trust Account at Rosen Bien Galvan &

17 Grunfeld LLP for Attorneys’ Fees & Costs; Funding for Blocked Accounts for T.P., A.P.

18 and N.S.; Payment to Current Medical Provider for T.P.; Payment to Probate Attorney for

19 Estate of Nathan Prasad; and Medi-Cal Lien Reimbursement: $410,116.14

20

(ii) Payment to plaintiff Mary Prasad: $4,176.92 (the remainder

21 due to Mary Prasad).

22

b. A check from the County in the amount of $360,706.94 ($117,968.98

23 allocated for T.P.; $121,368.98 allocated for A.P.; and $121,368.98 allocated for N.S.)

24

25 2 The amounts described in paragraphs 18, 19 and 20(a)(ii) total $54,175.92 to Mary 26 Prasad – the sum of $10,386.59 to reimburse for funeral and burial expenses (see
paragraph 15(c)) and $43,789.33 in compensation for her injuries and loss (see paragraph 27 15(f)).

28

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1 payable to BHG Structured Settlements, Inc. to fund the Periodic Payments listed below.

2

c. Periodic payments made according to the Schedule of Payments as

3 follows (the “Periodic Payments”):

4

(i) Payee: Mary Prasad for the use and benefit of T.P.

5

$5,000.00 guaranteed lump sum payable on 10/15/2017*

6

$5,000.00 guaranteed lump sum payable on 10/15/2019*

7

*Benefits to be deposited into a blocked account.

8

(ii) Payee: T.P.

9

$20,000.00 guaranteed lump sum payable on 10/15/2021

10

$25,000.00 guaranteed lump sum payable on 10/15/2024

11

$30,000.00 guaranteed lump sum payable on 10/15/2027

12

$35,000.00 guaranteed lump sum payable on 10/15/2030

13

$83,000.00 guaranteed lump sum payable on 10/15/2033

14

(iii) Payee: Mary Prasad for the use and benefit of A.P.

15

$5,000.00 guaranteed lump sum payable on 01/30/2017*

16

$5,000.00 guaranteed lump sum payable on 01/30/2019*

17

$5,000.00 guaranteed lump sum payable on 01/30/2021*

18

*Benefits to be deposited into a blocked account.

19

(iv) Payee: A.P.

20

$20,000.00 guaranteed lump sum payable on 01/30/2023

21

$25,000.00 guaranteed lump sum payable on 01/30/2026

22

$30,000.00 guaranteed lump sum payable on 01/30/2029

23

$35,000.00 guaranteed lump sum payable on 01/30/2032

24

$95,500.00 guaranteed lump sum payable on 01/30/2035

25

(v) Payee: Mary Prasad for the use and benefit of N.S.

26

$5,000.00 guaranteed lump sum payable on 07/22/2017*

27

$5,000.00 guaranteed lump sum payable on 07/22/2019*

28

$5,000.00 guaranteed lump sum payable on 07/22/2021*

7

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1

$5,000.00 guaranteed lump sum payable on 07/22/2023*

2

*Benefits to be deposited into a blocked account.

3

(vi) Payee: N.S.

4

$25,000.00 guaranteed lump sum payable on 07/22/2025

5

$30,000.00 guaranteed lump sum payable on 07/22/2028

6

$35,000.00 guaranteed lump sum payable on 07/22/2031

7

$40,000.00 guaranteed lump sum payable on 07/22/2034

8

$90,000.00 guaranteed lump sum payable on 07/22/2037

9

d. The County’s obligation to make the Periodic Payments described

10 herein shall be assigned to BHG Structured Settlements, Inc. through a Qualified

11 Assignment and funded by annuity contracts issued by Berkshire Hathaway Life Insurance

12 Company of Nebraska, rated A++XV by A.M. Best. See Bien Decl. ¶ 20.

13

21. All the payments set forth herein constitute damages on account of personal,

14 physical injuries, arising from an occurrence within the meaning of Section 104(a)(2) of

15 the IRS Code of 1986, as amended. All sums paid herein constitute damages on account of

16 personal injuries or sickness arising from injuries that resulted from the allegations made

17 in the Action, and no portion of the proceeds paid herein represent exemplary or punitive

18 damages nor pre-judgment or post-judgment interest. See Bien Decl. ¶ 21.

19 THE PROPOSED SETTLEMENT AND COMPROMISE OF THE MINORS’ CLAIMS IS FAIR, REASONABLE, AND IN THE MINORS’ BEST INTERESTS
20

21

22. The settlement represents an appropriate, fair, and reasonable settlement and

22 compromise of the Minor Plaintiffs’ claims in this action, and is in their best interests. See

23 Shannon A. v. Orland Unified, No. 2:11-cv-00718-TLN-DAD, 2013 WL 4828140, at *2

24 (E.D. Cal. Sept. 6, 2013) (citations omitted) (noting court’s “special duty to safeguard the

25 interests of litigants who are minors” by “conduct[ing] its own inquiry to determine

26 whether the settlement serves the best interests of the minor”); Robidoux v. Rosengren, 638

27 F.3d 1177, 1179 (9th Cir. 2011) (holding that court’s duty to safeguard interests of minor

28 plaintiffs requires a determination whether net amount allocated to each minor plaintiff is

8

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1 fair and reasonable without regard to proportion of settlement for adult co-plaintiffs or

2 counsel). Plaintiff and movant Mary Prasad, who as guardian ad litem for the Minor

3 Plaintiffs has been extensively involved in litigation of this case, has carefully considered

4 the proposed settlement and determined that it is in the best interests of the Minor

5 Plaintiffs. See Prasad Decl. ¶¶ 9, 12.

6

23. It is fair and reasonable to allocate the majority of the settlement shares of

7 the Minor Plaintiffs to fund structured settlements that will provide payments to them at

8 age 18 and beyond. See Prasad Decl. ¶ 15. It is also fair and reasonable in this particular

9 case to place a smaller portion of their settlement shares into blocked accounts to cover

10 major expenses that may arise during their minority, with such funds being accessible only

11 on further order of the Magistrate Judge of this Court under the procedure authorized by

12 L.R. 202(f) and set forth in the proposed order filed herewith, with any remaining balance

13 payable in full to the minor plaintiffs once they reach age 18. See id.; Bien Decl. ¶ 18;

14 Confidential Mantoan Decl. ¶ 5.

15

24. Under the settlements agreed to by the parties and the compromise proposed

16 herein, RBGG will receive a share of the total settlement fund, to be paid on account of

17 Plaintiffs’ claims for statutory attorneys’ fees. See Bien Decl., Ex. A at 2, Ex. B at 5, Ex.

18 C at 3. RBGG will also be reimbursed for costs they have advanced to fund the litigation.

19 See Bien Decl. ¶ 12. The compensation Plaintiffs’ attorneys will receive in fees has been

20 adjusted downward from the percentage agreed-upon in the retainer agreement, and totals

21 33% of the total settlement fund recovered. Plaintiff Mary Prasad, as guardian ad litem for

22 the Minor Plaintiffs, approves of RBGG’s recovery of the attorneys’ fees and costs set

23 forth herein based on the representation they provided to all of the plaintiffs in this case,

24 including the Minor Plaintiffs. See Prasad Decl. ¶ 16.

25

25. Plaintiffs further request issuance of the orders needed to open the blocked

26 accounts for the benefit of the Minor Plaintiffs described supra. Filed concurrently with

27

28

9

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1 this motion are three proposed orders, one for each of the Minor Plaintiffs, to allow Mary 2 Prasad to deposit funds into the blocked accounts.3

3

26. Plaintiffs submit that good cause exists to excuse the personal attendance of

4 the Minor Plaintiffs—the oldest of whom is ten years old—at any hearing that may be held

5 on this motion, and ask that the Court excuse their attendance pursuant to L.R. 202(d). See

6 Prasad Decl. ¶¶ 3-5, 17; Confidential Mantoan Decl. ¶ 6. Plaintiff Mary Prasad, who has

7 taken an active role throughout this case, including personally attending numerous

8 depositions of defendants and the January 20, 2014 mediation with Judge Ramirez, will be

9 in attendance at the hearing to address any questions the Court may have about the nature

10 or fairness of the settlement of the Minor Plaintiffs’ claims. See Prasad Decl. ¶¶ 9-10, 17.

11

12 DATED: April 10, 2014

Respectfully submitted,

13

ROSEN BIEN GALVAN & GRUNFELD LLP

14

15

By: /s/ Michael W. Bien

16

Michael W. Bien

17

Attorneys for Plaintiffs

18

19

20

21

22

23

24 25 3 L.R. 140(a)(i) and (iv) require redaction of full names of minors, and of dates of birth to
include only the year. In order to open the blocked accounts, however, the depository 26 institution may require an order setting forth the exact date of birth so that the date of un-
blocking the accounts can be determined. For this reason, Plaintiffs will request that their 27 Proposed Order containing the minors’ full names and dates of birth be filed under seal.

28

10

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[1193802-1]

1 MICHAEL W. BIEN – 096891

KATHLEEN J. WILLIAMS – 127021

ERNEST GALVAN – 196065

WILLIAMS & ASSOCIATES

2 KATHRYN G. MANTOAN – 239649

1250 Sutterville Road, Suite 290

AARON J. FISCHER – 247391

Sacramento, California 95822

3 JENNIFER L. STARK – 267062

Telephone: (916) 456-1122

ROSEN BIEN

Facsimile: (916) 737-1126

4 GALVAN & GRUNFELD LLP

315 Montgomery Street, Tenth Floor

Attorneys for Defendant MELODY

5 San Francisco, California 94104-1823

YOUNG

Telephone: (415) 433-6830

6 Facsimile: (415) 433-7104

ROBERT H. ZIMMERMAN – 084345

7 Attorneys for Plaintiffs

GLENN M. HOLLEY – 119210

SCHUERING ZIMMERMAN

8

& DOYLE, LLP

JOHN R. WHITEFLEET – 213301

400 University Avenue

9 PORTER SCOTT

Sacramento. California 95825-6502

A Professional Corporation

Telephone: (916) 567-0400

10 350 University Avenue, Suite 200

Facsimile: (916) 568-0400

Sacramento, CA 95825

11 Telephone: (916) 929-1481

Attorneys for Defendant RIDEOUT

Facsimile: (916) 927-3706

MEMORIAL HOSPITAL (sued herein as

12

FREMONT-RIDEOUT HEALTH GROUP)

Attorneys for Defendants COUNTY OF

13 SUTTER; J. PAUL PARKER; DAVID

SAMSON; NORMAN BIDWELL; LOU D. MARC LYDE – 134869

14 ANNE CUMMINGS; AMERJIT

JENNIFER C. KURLAN – 201757

BHATTAL; BRENT GARBETT; DORIS LEONARD & LYDE

15 BROWN; KIMBERLY WEISS;

1600 Humboldt Road, Suite 1

GURKIRAT BHANGU; CHRISTINA

Chico. California 95928

16 STOHLMAN; LESTER EATON; MIGUEL Telephone: (530) 345-3494

AGUILAR; OLGA TAHARA; ROSA

Facsimile: (530) 345-0460

17 DIAZ; ERIC CRAWFORD; BALJINDER

RAI; and SHANE DICKSON

Attorneys for Defendant MICHAEL

18

FRATERS

19

UNITED STATES DISTRICT COURT

20

EASTERN DISTRICT OF CALIFORNIA

21

SACRAMENTO DIVISION

22

23 Estate of NATHAN PRASAD, deceased, by and through MARY PRASAD; MARY PRASAD;
24 T.P., a minor; A.P., a minor; and N.S., a minor

25

Plaintiffs,

v.

26 COUNTY OF SUTTER et al.,

27

Defendants.

Case No. 2:12-CV-00592-TLN-CKD
STIPULATION OF DISMISSAL WITH PREJUDICE

28

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[1193802-1]

1

WHEREAS the parties to the above-captioned action reached agreement to settle all

2 claims against all defendants in this matter (see Dkt. No. 134);

3

WHEREAS the Court subsequently approved Plaintiffs’ motion for approval of

4 minors’ compromise and for orders to deposit money into blocked accounts (see Dkt. Nos.

5 140, 150);

6

WHEREAS each settling defendant has tendered full payment of all amounts set

7 forth in the relevant settlement agreements (see Dkt. No. 140-1, Exs. A-C);

8

IT IS HEREBY STIPULATED by and between the parties hereto, through their

9 respective attorneys of record, that the above-captioned action be dismissed in its entirety

10 with prejudice pursuant to Federal Rule of Civil Procedure 41(a)(1)(A)(ii), each party to

11 bear its own fees and costs except to the extent provided in the respective settlement

12 agreements. Nothing in this dismissal shall affect the continuing jurisdiction of the

13 Magistrate Judge of this Court to issue such further orders as may be necessary to

14 authorize appropriate disbursement of funds from the blocked accounts of the minor

15 plaintiffs during their minority. See Dkt. No. 140 ¶ 23, Dkt. No. 150.

16

17 DATED: June 11, 2014

ROSEN BIEN GALVAN & GRUNFELD LLP

18

By: /s/ Kathryn G. Mantoan

19

Kathryn G. Mantoan

20

Attorneys for Plaintiffs

21

22

23

24

25

26

27

28

1
STIPULATION OF DISMISSAL WITH PREJUDICE

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[1193802-1]

1 DATED: June 10, 2014 2 3 4 5 6 7 8 9 10 11
DATED: June 10, 2014 12 13 14 15 16
DATED: June 9, 2014 17 18 19 20 21 22
DATED: June 9, 2014 23 24 25 26 27 28

PORTER SCOTT A Professional Corporation
By: /s/ John R. Whitefleet (authorized 6/10/14) John R. Whitefleet
Attorneys for Defendants COUNTY OF SUTTER; J. PAUL PARKER; DAVID SAMSON; NORMAN BIDWELL; LOU ANNE CUMMINGS; AMERJIT BHATTAL; BRENT GARBETT; DORIS BROWN; KIMBERLY WEISS; GURKIRAT BHANGU; CHRISTINA STOHLMAN; LESTER EATON; MIGUEL AGUILAR; OLGA TAHARA; ROSA DIAZ; ERIC CRAWFORD; BALJINDER RAI; and SHANE DICKSON
WILLIAMS & ASSOCIATES
By: /s/ Kathleen J. Williams (authorized 6/10/14) Kathleen J. Williams
Attorneys for Defendant MELODY YOUNG
SCHUERING ZIMMERMAN & DOYLE, LLP
By: /s/ Glenn M. Holley (authorized 6/9/14) Glenn M. Holley
Attorneys for Defendant RIDEOUT MEMORIAL HOSPITAL (sued herein as FREMONT-RIDEOUT HEALTH GROUP)
LEONARD & LYDE
By: /s/ Jennifer C. Kurlan (authorized 6/9/14) Jennifer C. Kurlan
Attorneys for Defendant MICHAEL FRATERS, D.O.

2
STIPULATION OF DISMISSAL WITH PREJUDICE

2:12-CV-00592-TLN-CKD

 
 Case: 2:12-cv-592 As of: 07/15/2015 01:10 AM PDT 1 of 17
CIVIL,CLOSED
U.S. District Court Eastern District of California − Live System (Sacramento) CIVIL DOCKET FOR CASE #: 2:12−cv−00592−TLN−CKD

Prasad et al v. County of Sutter et al Assigned to: District Judge Troy L. Nunley Referred to: Magistrate Judge Carolyn K. Delaney Cause: 42:1983 Civil Rights Act
Plaintiff

Date Filed: 03/06/2012 Date Terminated: 05/21/2014 Jury Demand: Both Nature of Suit: 440 Civil Rights: Other Jurisdiction: Federal Question

Mary Prasad Individually and as Guardian Ad Litem

represented by Aaron Joseph Fischer Rosen Bien Galvan & Grunfeld LLP 315 Montgomery Street 10th Fl San Francisco, CA 94104 415−433−6830 ext.255 Fax: 415−433−7104 Email: afischer@rbgg.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Michael Bien Rosen Bien Galvan & Grunfeld LLP 315 Montgomery Street 10th Floor San Francisco, CA 94104 (415) 433−6830 Fax: (415) 433−7104 Email: mbien@rbgg.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Jennifer Stark Rosen, Bien, Galvan & Grunfeld 315 Montgomery St., 10th Floor San Francisco, CA 94104 415−433−6830 Email: jstark@rbgg.com ATTORNEY TO BE NOTICED

Kathryn Grzenczyk Mantoan Orrick, Herrington & Sutcliffe LLP 405 Howard Street San Francisco, CA 94105 (415) 773−5887 Fax: (415) 773−5759 Email: kmantoan@orrick.com ATTORNEY TO BE NOTICED

Lori Rifkin Rifkin Law Office P.O. Box 19169 Oakland, CA 94619 United Sta 415−685−9351 Email: lrifkin@rifkinlawoffice.com ATTORNEY TO BE NOTICED

Ernest Galvan Rosen Bien Galvan & Grunfeld LLP 315 Montgomery Street

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10th Floor San Francisco, CA 94104 (415) 433−6830 x223 Fax: (415) 433−7104 Email: egalvan@rbgg.com ATTORNEY TO BE NOTICED

Plaintiff
T. P. Mary Prasad guardian ad litem

represented by Aaron Joseph Fischer (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Michael Bien (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Jennifer Stark (See above for address) ATTORNEY TO BE NOTICED

Kathryn Grzenczyk Mantoan (See above for address) ATTORNEY TO BE NOTICED

Ernest Galvan (See above for address) ATTORNEY TO BE NOTICED

Plaintiff
A. P. Mary Prasad guardian ad litem

represented by Aaron Joseph Fischer (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Michael Bien (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Jennifer Stark (See above for address) ATTORNEY TO BE NOTICED

Kathryn Grzenczyk Mantoan (See above for address) ATTORNEY TO BE NOTICED

Ernest Galvan (See above for address) ATTORNEY TO BE NOTICED

Plaintiff
N. S. Mary Prasad as guardian ad litem

represented by Aaron Joseph Fischer (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Michael Bien (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

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Jennifer Stark (See above for address) ATTORNEY TO BE NOTICED
Kathryn Grzenczyk Mantoan (See above for address) ATTORNEY TO BE NOTICED
Ernest Galvan (See above for address) ATTORNEY TO BE NOTICED

V. Defendant County of Sutter
Defendant J. Paul Parker Sheriff, County of Sutter
Defendant David Samson Division Commander, Sutter County Jail
Defendant Norman Bidwell Corrections Lieutenant, Sutter County Jail
Defendant Doris Brown Registered Nurse Practitioner, Sutter County Jail
Defendant Melody Young Licensed Vocational Nurse, Sutter County Jail

represented by John Robert Whitefleet Porter Scott, APC 350 University Avenue Suite 200 P.O. Box 255428 Sacramento, CA 95823 916−929−1481 Ext. 347 Fax: 916−927−3706 Email: jwhitefleet@porterscott.com LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Kathleen J. Williams Williams and Associates 1250 Sutterville Road Suite 290 Sacramento, CA 95822 916−456−1122 Fax: 916−737−1126 Email: kwilliams@williamslegal.net

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LEAD ATTORNEY ATTORNEY TO BE NOTICED

John Robert Whitefleet (See above for address) TERMINATED: 04/16/2013

Defendant
Baljinder Rai Deputy Officer, Sutter County Jail

represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Shane Dickson Deputy Officer, Sutter County Jail

represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Fremont−Rideout Health Group

represented by Robert Harry Zimmerman Schuering Zimmerman & Doyle, LLP 400 University Avenue Sacramento, CA 95825−6502 (916) 567−0400 Fax: (916) 568−0400 Email: rhz@szs.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant
Michael Fraters Physician, Rideout Memorial Hospital

represented by Jennifer C. Kurlan Law Offices Of Leonard & Lyde 1600 Humboldt Road Suite 1 Chico, CA 95928 530−345−3494 Fax: 530−345−0460 Email: rsteffenson@gmail.com LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Lou Anne Cummings

represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Amerjit Bhattal

represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Brent Garbett

represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

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Defendant Kimberly Weiss

represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Gurkirat Bhangu

represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Christina Stohlman

represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Lester Eaton

represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Miguel Aguilar

represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Olga Tahara

represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Rosa Diaz

represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Defendant Eric Crawford

represented by John Robert Whitefleet (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Date Filed 03/06/2012
03/06/2012 03/07/2012

# Docket Text
1 COMPLAINT against all defendants by A. P., T. P., Mary Prasad. Attorney Fischer, Aaron Joseph ADDED. (Fischer, Aaron) Modified on 3/7/2012 (Michel, G). (Entered: 03/06/2012)
2 CIVIL COVER SHEET by A. P., T. P., Mary Prasad (Fischer, Aaron) (Entered: 03/06/2012)
RECEIPT number #CAE200042760 $350.00 fbo Nathan Prasad, et. al. by Aaron J. Fischer on 3/7/2012. (Michel, G) (Entered: 03/07/2012)

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03/07/2012 03/12/2012
03/12/2012 03/14/2012
04/05/2012 04/16/2012 04/17/2012 04/18/2012 04/27/2012 05/03/2012 05/09/2012 05/10/2012
05/18/2012 05/25/2012 05/31/2012 05/31/2012 06/04/2012
06/04/2012

4 PRISONER NEW CASE DOCUMENTS and ORDER RE CONSENT ISSUED; Consent or Decline due by 4/9/2012 (Attachments: # 1 Order re Consent) (Michel, G) (Entered: 03/07/2012)
5 SUMMONS ISSUED as to *Norman Bidwell, Doris Brown, County of Sutter, Shane Dickson, Michael Fraters, Fremont−Rideout Health Group, J. Paul Parker, Baljinder Rai, David Samson, Melody Young* with answer to complaint due within *21* days. Attorney *Aaron Joseph Fischer* *Rosen, Bien & Galvan, LLP* *315 Montgomery Street, 10th Floor* *San Francisco, CA 94104*. (Donati, J) (Entered: 03/12/2012)
6 CIVIL NEW CASE DOCUMENTS ISSUED; Initial Scheduling Conference set for 6/12/2012 at 09:00 AM in Courtroom 10 (GEB) before Judge Garland E. Burrell Jr.. (Attachments: # 1 Consent Form, # 2 VDRP Form) (Donati, J) (Entered: 03/12/2012)
7 AMENDED CIVIL NEW CASE DOCUMENTS ISSUED; Initial Scheduling Conference set for 6/11/2012 at 09:00 AM in Courtroom 10 (GEB) before Judge Garland E. Burrell Jr. (Attachments: # 1 Consent Form, # 2 VDRP Form) (Donati, J) (Entered: 03/14/2012)
8 CONSENT to JURISDICTION of US MAGISTRATE JUDGE by A. P., T. P., Mary Prasad. Attorney Mantoan, Kathryn Grzenczyk added. (Mantoan, Kathryn) (Entered: 04/05/2012)
9 WAIVER of SERVICE RETURNED EXECUTED: (Whitefleet, John) (Entered: 04/16/2012)
10 WAIVER of SERVICE RETURNED EXECUTED: (Whitefleet, John) (Entered: 04/17/2012)
11 SUMMONS RETURNED EXECUTED: Fremont−Rideout Health Group served on 4/12/2012, answer due 5/3/2012. (Mantoan, Kathryn) (Entered: 04/18/2012)
12 SUMMONS RETURNED EXECUTED: Michael Fraters served on 4/23/2012, answer due 5/14/2012. (Mantoan, Kathryn) (Entered: 04/27/2012)
13 STIPULATION to extend time to respond to the Complaint by A. P., T. P., Mary Prasad. (Mantoan, Kathryn) Modified on 5/7/2012 (Reader, L). (Entered: 05/03/2012)
14 FIRST AMENDED COMPLAINT against All Defendants by A. P., T. P., Mary Prasad. Attorney Galvan, Ernest added. (Attachments: # 1 Civil Cover Sheet)(Galvan, Ernest) (Entered: 05/09/2012)
15 SUMMONS ISSUED as to *Amerjit Bhattal, Lou Anne Cummings, Brent Garbett* with answer to complaint due within *21* days. Attorney *Ernest Galvan* *315 Montgomery St., 10th Floor* *San Francisco, CA 94104−1823*. (Meuleman, A) (Entered: 05/10/2012)
16 CERTIFICATE of SERVICE by A. P., T. P., Mary Prasad re 14 Amended Complaint. (Mantoan, Kathryn) (Entered: 05/18/2012)
17 JOINT STATUS REPORT by A. P., T. P., Mary Prasad. (Mantoan, Kathryn) (Entered: 05/25/2012)
18 MOTION to DISMISS by Michael Fraters. Attorney Kurlan, Jennifer C. added. Motion Hearing set for 8/27/2012 at 09:00 AM in Courtroom 10 (GEB) before Judge Garland E. Burrell Jr.. (Kurlan, Jennifer) (Entered: 05/31/2012)
19 MOTION to STRIKE Punitive Damages and Claims for Relief by Michael Fraters. Motion Hearing set for 8/27/2012 at 09:00 AM in Courtroom 10 (GEB) before Judge Garland E. Burrell Jr.. (Kurlan, Jennifer) (Entered: 05/31/2012)
20 STIPULATIONto Extend Time to File Responsive Pleading to 14 Amended Complaint by Amerjit Bhattal, Norman Bidwell, Doris Brown, County of Sutter, Lou Anne Cummings, Shane Dickson, Brent Garbett, J. Paul Parker, Baljinder Rai, David Samson, Melody Young. Attorney Whitefleet, John Robert added. (Whitefleet, John) Modified on 6/7/2012 (Kastilahn, A). (Entered: 06/04/2012)
21 MOTION to STRIKE by Fremont−Rideout Health Group. Attorney Zimmerman, Robert Harry added. Motion Hearing set for 8/27/2012 at 09:00 AM in Courtroom 10 (GEB) before Judge Garland E. Burrell Jr.. (Zimmerman, Robert) Modified on

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06/04/2012 06/05/2012
06/15/2012
06/19/2012 07/30/2012 07/30/2012 07/31/2012 07/31/2012 08/06/2012 08/13/2012 08/13/2012 08/13/2012 08/13/2012 08/13/2012 08/15/2012

6/5/2012 (Kastilahn, A). (Entered: 06/04/2012)
22 MOTION to DISMISS by Fremont−Rideout Health Group. Motion Hearing set for 8/27/2012 at 09:00 AM in Courtroom 10 (GEB) before Judge Garland E. Burrell Jr.. (Zimmerman, Robert) (Entered: 06/04/2012)
23 ORDER signed by Judge Garland E. Burrell, Jr on 6/5/12 ORDERING the Joint Status Report filed 5/25/12, reveals this case is not ready to be scheduled. Therefore, the Status (Pretrial Scheduling) Conference set for hearing on 6/11/12, continued to 8/20/12, at 9:00 a.m. A further joint status report shall be filed no later than fourteen (14) days prior to the Status Conference; Plaintiffs are notified that failure to serve Defendants LouAnne Cummings, Amerjit Bhattal, and Brent Garbett with process within the 120 day period may result in the unserved defendants being dismissed. To avoid dismissal, on or before 9/10/12, Plaintiffs shall file proof of service for these defendants or a sufficient explanation why service was not effected within Rule 4(m)'s prescribed service period. Lastly, no later than 8/6/12, counsel or the minor plaintiffs shall "present (1) appropriate evidence of the appointment of a representative for the minor... under state law[,] or (2) [file] a motion for the appointment of a guardian ad litem by the Court in accordance with Local Rule 202(a).(Becknal, R) (Entered: 06/05/2012)
24 MOTION to DISMISS by Amerjit Bhattal, Norman Bidwell, Doris Brown, County of Sutter, Lou Anne Cummings, Shane Dickson, Brent Garbett, J. Paul Parker, Baljinder Rai, David Samson, Melody Young. Motion Hearing set for 08/27/12 at 09:00 AM in Courtroom 10 (GEB) before Judge Garland E. Burrell, Jr. (Attachments: # 1 Notice)(Whitefleet, John) (Entered: 06/15/2012)
25 CONSENT to JURISDICTION of US MAGISTRATE JUDGE by Michael Fraters. (Kurlan, Jennifer) (Entered: 06/19/2012)
26 MOTION to APPOINT GUARDIAN AD LITEM for Minor A.P. by Mary Prasad. (Attachments: # 1 Proposed Order)(Mantoan, Kathryn) Modified on 7/31/2012 (Benson, A.). (Entered: 07/30/2012)
27 MOTION to APPOINT GUARDIAN AD LITEM for Minor T.P. by Mary Prasad. (Attachments: # 1 Proposed Order)(Mantoan, Kathryn) Modified on 7/31/2012 (Benson, A.). (Entered: 07/30/2012)
28 ORDER granting 27 Motion to Appoint Guardian ad Litem signed by Judge Garland E. Burrell, Jr on 7/31/12. Mary Prasad is appointed guardian ad litem for the minor T.P. in this action. (Kaminski, H) (Entered: 07/31/2012)
29 ORDER granting 26 Motion to Appoint Guardian ad Litem signed by Judge Garland E. Burrell, Jr on 7/31/12: Mary Prasad is appointed guardian ad litem for the minor A.P. in this action. (Kaminski, H) (Entered: 07/31/2012)
30 FURTHER JOINT STATUS REPORT by A. P., T. P., Mary Prasad. (Mantoan, Kathryn) Modified on 8/7/2012 (Reader, L). (Entered: 08/06/2012)
31 OPPOSITION by A. P., T. P., Mary Prasad to 24 Motion to Dismiss. (Mantoan, Kathryn) (Entered: 08/13/2012)
32 OPPOSITION by A. P., T. P., Mary Prasad to 22 MOTION to DISMISS. (Mantoan, Kathryn) (Entered: 08/13/2012)
33 OPPOSITION by A. P., T. P., Mary Prasad to 21 MOTION to STRIKE. (Mantoan, Kathryn) (Entered: 08/13/2012)
34 OPPOSITION by A. P., T. P., Mary Prasad to 18 MOTION to DISMISS. (Mantoan, Kathryn) (Entered: 08/13/2012)
35 OPPOSITION by A. P., T. P., Mary Prasad to 19 MOTION to STRIKE Punitive Damages and Claims for Relief. (Mantoan, Kathryn) (Entered: 08/13/2012)
36 STATUS (PRETRIAL SCHEDULING) ORDER signed by Judge Garland E. Burrell, Jr. on 8/14/12 ORDERING that the 8/20/12 status conference is vacated; Discovery due by 2/7/2014; Motions filed by 4/7/2014; Final Pretrial Conference set for 6/9/2014 at 01:30 PM and Trial set for 9/9/2014 at 09:00 AM in Courtroom 10 (GEB) before Judge Garland E. Burrell Jr.. (Matson, R) (Entered: 08/15/2012)

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08/20/2012 08/20/2012 08/20/2012 08/20/2012 08/20/2012 08/24/2012
10/15/2012
11/05/2012 11/09/2012 11/14/2012 11/20/2012 11/20/2012 11/26/2012
11/26/2012 11/28/2012
12/10/2012

37 REPLY by Michael Fraters to RESPONSE to 18 MOTION to DISMISS. (Kurlan, Jennifer) (Entered: 08/20/2012)
38 REPLY by Michael Fraters to RESPONSE to 19 MOTION to STRIKE Punitive Damages and Claims for Relief. (Kurlan, Jennifer) (Entered: 08/20/2012)
39 REPLY by Fremont−Rideout Health Group re 21 MOTION to STRIKE. (Zimmerman, Robert) (Entered: 08/20/2012)
40 REPLY by Fremont−Rideout Health Group re 22 MOTION to DISMISS. (Zimmerman, Robert) (Entered: 08/20/2012)
41 REPLY by Amerjit Bhattal, Norman Bidwell, Doris Brown, County of Sutter, Lou Anne Cummings, Shane Dickson, Brent Garbett, J. Paul Parker, Baljinder Rai, David Samson, Melody Young re 31 Opposition to Motion. (Whitefleet, John) (Entered: 08/20/2012)
42 MINUTE ORDER: The Motions to Dismiss and Motions to Strike, scheduled for hearing on 8/27/12, are submitted without oral argument. There will not be a hearing on 8/27/12, and no appearance is necessary. re 21 Motion to Strike, 19 Motion to Strike, 22 Motion to Dismiss, 24 Motion to Dismiss, 18 Motion to Dismiss Ordered by Judge Garland E. Burrell, Jr on 8/24/12. (Furstenau, S) (Entered: 08/24/2012)
43 MOTION to AMEND the 14 Amended Complaint by A. P., T. P., Mary Prasad. Motion Hearing set for 11/19/2012 at 09:00 AM in Courtroom 10 (GEB) before Judge Garland E. Burrell Jr.. (Attachments: # 1 Declaration of Kathryn G. Mantoan and Exhibit A (Proposed Second Amended Complaint), # 2 Proposed Order)(Mantoan, Kathryn) (Entered: 10/15/2012)
44 OPPOSITION to 43 Motion to Amend the 14 Amended Complaint by Amerjit Bhattal, Norman Bidwell, Doris Brown, County of Sutter, Lou Anne Cummings, Shane Dickson, Brent Garbett, J. Paul Parker, Baljinder Rai, David Samson, Melody Young. (Whitefleet, John) Modified on 11/6/2012 (Michel, G). (Entered: 11/05/2012)
45 REPLY by A. P., T. P., Mary Prasad re 43 MOTION to AMEND the 14 Amended Complaint. (Mantoan, Kathryn) (Entered: 11/09/2012)
46 MINUTE ORDER: The Motion to Amend, scheduled for hearing on 11/19/12, is submitted without oral argument. There will not be a hearing on 11/19/12, and no appearance is necessary. re 43 Motion to Amend the Complaint/Petition, Ordered by Judge Garland E. Burrell, Jr on 11/14/12. (Furstenau, S) (Entered: 11/14/2012)
47 ORDER by Chief Judge Morrison C. England, Jr.: Due to the appointment of Magistrate Judge *Allison Claire* to the bench of the Eastern District, this action is reassigned from *Magistrate Judge Gregory G. Hollows* for all further proceedings. (Waggoner, D) (Entered: 11/20/2012)
48 ORDER signed by Judge Garland E. Burrell, Jr. on 11/19/2012 GRANTING 43 Plaintiffs' Motion for Leave to File a Second Amended Complaint; Plaintiffs have 10 days leave from the date on which this Order is filed to file the second amended complaint. (Reader, L) (Entered: 11/20/2012)
49 ORDER signed by Magistrate Judge Allison Claire on 11/26/12 ORDERING the Clerk to refer this case to another Magistrate Judge for any further proceedings which may be appropriate or required. This Case has been REASSIGNED to Magistrate Judge John F. Moulds for all further proceedings. The New Case Number is 2:12−cv−00592 GEB JFM. (Mena−Sanchez, L) (Entered: 11/26/2012)
50 SECOND AMENDED COMPLAINT against All Defendants by A. P., T. P., Mary Prasad. (Attachments: # 1 Civil Cover Sheet)(Galvan, Ernest) (Entered: 11/26/2012)
51 SUMMONS ISSUED as to *Miguel Aguilar, Gurkirat Bhangu, Eric Crawford, Rosa Diaz, Lester Eaton, Christina Stohlman, Olga Tahara, Kimberly Weiss* with answer to complaint due within *21* days. Attorney *Ernest Galvan* *Rosen Bien Galvan & Grunfeld LLP* *315 Montgomery Street, Tenth Floor* *San Francisco, CA 94104−1823*. (Zignago, K.) (Entered: 11/28/2012)
52 MOTION to DISMISS by Michael Fraters. Motion Hearing set for 2/6/2013 at 10:00 AM in 8th floor courtroom (JFM) before Magistrate Judge Allison Claire. (Kurlan,

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12/10/2012 12/13/2012 12/13/2012 12/18/2012 12/18/2012 12/19/2012
12/20/2012 12/21/2012 12/26/2012
12/28/2012 02/11/2013 02/11/2013 02/11/2013 02/11/2013 02/11/2013 02/13/2013

Jennifer) Modified on 12/12/2012 (Kastilahn, A). (Entered: 12/10/2012)
53 MOTION to STRIKE Punitive Damages and Claims for Relief by Michael Fraters. Motion Hearing set for 2/6/2013 at 10:00 AM in 8th floor courtroom (JFM) before Magistrate Judge Allison Claire. (Kurlan, Jennifer) (Entered: 12/10/2012)
54 NOTICE of hearing by Michael Fraters on Motion to Strike 53 and Motion to Dismiss 52 . Motion hearing SET for 2/7/12 in courtroom 26 Before Magistrate Judge John F. Moulds. (Kurlan, Jennifer) Modified on 12/14/2012 (Mena−Sanchez, L). (Entered: 12/13/2012)
55 STIPULATION re Acceptance of Service of Second Amended Complaint, Waiver of Service of Summons, Extension of Time to Respond to Second Amended Complaint by A. P., T. P., Mary Prasad. (Mantoan, Kathryn) (Entered: 12/13/2012)
56 MOTION to DISMISS by Fremont−Rideout Health Group. Motion Hearing set for 2/7/2013 at 11:00 AM before Magistrate Judge John F. Moulds. (Zimmerman, Robert) Modified on 12/19/2012 (Meuleman, A). (Entered: 12/18/2012)
57 MOTION to STRIKE by Fremont−Rideout Health Group. Motion Hearing set for 2/7/2013 at 11:00 AM before Magistrate Judge John F. Moulds. (Zimmerman, Robert) Modified on 12/19/2012 (Meuleman, A). (Entered: 12/18/2012)
58 MINUTE ORDER (TEXT ONLY) by CRD: The Court is in receipt of Defendants 52 Motion to Dismiss, 53 Motion to Strike, 56 Motion to Dismiss and 57 Motion to Strike. Upon the Courts own motion these matters are VACATED from calendar due to being improperly noticed before Magistrate Judge John F. Moulds. Please contact District Judge Garland E. Burrells Courtroom Deputy, Shani Furstenau, at (916) 930−4114 for the next available hearing date.(Anderson, J) (Entered: 12/19/2012)
59 NOTICE to RESCHEDULE Motion Hearings re: 52 and 53 Motions by Jennifer C. Kurlan on behalf of Michael Fraters. Hearings rescheduled to 2/25/13 at 9:00 a.m. before District Judge Garland E. Burrell. (Kurlan, Jennifer) Modified on 12/21/2012 (Meuleman, A). (Entered: 12/20/2012)
60 ORDER signed by Judge Garland E. Burrell, Jr on 12/21/2012 DENYING 18 , 19 , 21 , 22 , & 24 Motions. (Donati, J) (Entered: 12/21/2012)
61 MOTION to DISMISS 50 Second Amended Complaint by Miguel Aguilar, Gurkirat Bhangu, Amerjit Bhattal, Norman Bidwell, Doris Brown, County of Sutter, Eric Crawford, Lou Anne Cummings, Rosa Diaz, Shane Dickson, Lester Eaton, Brent Garbett, J. Paul Parker, Baljinder Rai, David Samson, Christina Stohlman, Olga Tahara, Kimberly Weiss, Melody Young. Attorney Whitefleet, John Robert ADDED. Motion Hearing SET for 2/25/2013 at 09:00 AM in Courtroom 10 (GEB) before Judge Garland E. Burrell Jr. (Attachments: # 1 Notice of Motion to Dismiss) (Whitefleet, John) Modified on 12/27/2012 (Michel, G). (Entered: 12/26/2012)
62 NOTICE to RESCHEDULE HEARING on 56 MOTION to DISMISS, 57 MOTION to STRIKE : Motion Hearing set for 2/25/2013 at 09:00 AM in Courtroom 10 (GEB) before Judge Garland E. Burrell Jr.. (Zimmerman, Robert) (Entered: 12/28/2012)
63 OPPOSITION by A. P., T. P., Mary Prasad to 61 MOTION to DISMISS. (Mantoan, Kathryn) (Entered: 02/11/2013)
64 OPPOSITION by A. P., T. P., Mary Prasad to 56 MOTION to DISMISS. (Mantoan, Kathryn) (Entered: 02/11/2013)
65 OPPOSITION by A. P., T. P., Mary Prasad to 57 MOTION to STRIKE . (Mantoan, Kathryn) (Entered: 02/11/2013)
66 OPPOSITION by A. P., T. P., Mary Prasad to 52 MOTION to DISMISS. (Mantoan, Kathryn) (Entered: 02/11/2013)
67 OPPOSITION by A. P., T. P., Mary Prasad to 53 MOTION to STRIKE Punitive Damages and Claims for Relief. (Mantoan, Kathryn) (Entered: 02/11/2013)
68 REPLY by Michael Fraters to RESPONSE to 52 MOTION to DISMISS. (Kurlan, Jennifer) (Entered: 02/13/2013)

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02/13/2013 02/14/2013
02/15/2013 02/15/2013 02/20/2013
02/22/2013
04/03/2013

69 REPLY by Michael Fraters to RESPONSE to 53 MOTION to STRIKE Punitive Damages and Claims for Relief. (Kurlan, Jennifer) (Entered: 02/13/2013)
70 REPLY by Miguel Aguilar, Gurkirat Bhangu, Amerjit Bhattal, Norman Bidwell, Doris Brown, County of Sutter, Eric Crawford, Lou Anne Cummings, Rosa Diaz, Shane Dickson, Lester Eaton, Brent Garbett, J. Paul Parker, Baljinder Rai, David Samson, Christina Stohlman, Olga Tahara, Kimberly Weiss, Melody Young re 63 Opposition to Motion. (Whitefleet, John) (Entered: 02/14/2013)
71 REPLY by Fremont−Rideout Health Group re 65 Opposition to Motion. (Zimmerman, Robert) (Entered: 02/15/2013)
72 REPLY by Fremont−Rideout Health Group re 64 Opposition to Motion. (Zimmerman, Robert) (Entered: 02/15/2013)
73 MINUTE ORDER: All Motions to Strike are submitted without oral argument. All Motions to Dismiss are submitted without oral argument, except for Defendants Cummings, Garbett, Brown, Young, Weiss, and Bhangus motion to dismiss Plaintiffs prayer for punitive damages concerning Plaintiffs state law claims, on which oral argument is scheduled to commence at 9:00 a.m. on 2/25/13. re 53 Motion to Strike, 52 Motion to Dismiss, 57 Motion to Strike, 56 Motion to Dismiss, 61 Motion to Dismiss Ordered by Judge Garland E. Burrell, Jr on 2/20/13. (Furstenau, S) (Entered: 02/20/2013)
74 MINUTE ORDER: Defendants' Cummings, Garbett, Brown, Young, Weiss, and Bhangu's motion to dismiss Plaintiffs' prayer for punitive damages concerning Plaintiffs' state law claims, currently scheduled for hearing on 2/25/13, is rescheduled for hearing on 4/8/13, at 9:00 a.m. Ordered by Judge Garland E. Burrell, Jr on 2/22/13. (Furstenau, S) (Entered: 02/22/2013)
75 MINUTE ORDER: Defendants Cummings, Garbett, Brown, Young, Weiss, and Bhangu's motion to dismiss Plaintiffs' prayer for punitive damages concerning Plaintiffs' state law claims is pending. (ECF Nos. 61, 73.) Since the parties have not briefed certain issues, counsel shall be prepared to address the following questions during oral argument, which is reset for 9:00 a.m. on April 22, 2013. The hearing scheduled for April 8, 2013 is vacated. Further, each party is granted leave to respond to the following questions in writing in advance of the hearing by filing a response on the docket at counsel's earliest convenience. Please explain each response. For Plaintiffs: 1. In Guaranty Trust Co. of New York v. York, 326 U.S. 99, 109 (1945), the Supreme Court states that it is "immaterial whether [state] statutes... are characterized either as 'substantive' or 'procedural.'" Instead, when deciding whether a state statute applies in federal court, what matters is whether the statute "significantly affect[s] the result of a litigation." Id. Does § 425.13 "significantly affect the result of a litigation?" 2.California Civil Procedure Code § 425.13 states that a motion under § 425.13 must be made within two years after filing suit or nine months before the matter is first set for trial, whichever is earlier. Since a federal court deciding state claims "applies the substantive law of the state, including the state's statute of limitations," Albano v. Shea Homes Ltd. P'ship, 634 F.3d 524, 530 (9th Cir. 2011), why is § 425.13's limitations period inapplicable in federal court? 3. Erie's "twin aims" are "'discouragement of forum−shopping and avoidance of inequitable administration of the laws.'" Goldberg v. Pac. Indem. Co., 627 F.3d 752, 755 (9th Cir. 2010). Would it encourage forum shopping and inequitable administration of the laws to waive § 425.13's requirements for plaintiffs litigating in federal, but not state, court? For Defendants Cummings, Garbett, Brown, Young, Weiss, and Bhangu: 1. In College Hospital, Inc. v. Superior Court, 8 Cal. 4th 704, 718, 717 (1994), the California Supreme Court states that § 425.13 is a "procedural protection" that was not "intended to change the substantive elements of punitive damages claims." How does this pronouncement affect your argument that § 425.13 is a substantive provision? 2. What state substantive law is § 425.13 so "'intimately bound up'" with so that it is "an integral component of California's substantive state policy?" Feldman v. Allstate Ins. Co., 322 F.3d 660, 66667 (9th Cir. 2003). 3. During a § 425.13 hearing, the court cannot "weigh the merits of the claim or consider its likely outcome at trial." Coll. Hosp., Inc., 8 Cal. 4th at 719. Does the limited scope of review under § 425.13 make the statute less like a substantive provision and more like a procedural regulation of the "manner and the means by which a [plaintiff may] recover"? See York, 326 U.S. at 109. Ordered by Judge Garland E. Burrell, Jr on 04/03/13. (Dankof, E) (Entered: 04/03/2013)

Case: 2:12-cv-592 As of: 07/15/2015 01:10 AM PDT 11 of 17

04/03/2013 04/05/2013
04/12/2013 04/16/2013 04/16/2013 04/23/2013 04/24/2013 05/17/2013 05/22/2013 06/05/2013 06/05/2013 06/05/2013 06/06/2013 06/12/2013

76 ORDER by Chief Judge Morrison C. England, Jr.: Due to the appointment of *District Judge Troy L. Nunley* to the bench of the Eastern District, this action is reassigned from District Judge *Garland E. Burrell, Jr.* for all further proceedings. (Waggoner, D) (Entered: 04/03/2013)
77 MINUTE ORDER issued by Courtroom Deputy M. Krueger for District Judge Troy L. Nunley on 4/5/2013: Pursuant to the Order of Reassignment to District Judge Troy L. Nunley 76 , the Hearing for Defendants' Motions to Dismiss 52 , 56 , 61 , and Motions to Strike 53 and 57 , currently set for 4/22/2013 before Judge Garland E. Burrell, Jr. is VACATED and RESET for 6/20/2013 at 2:00 PM in Courtroom 2 (TLN) before District Judge Troy L. Nunley. All other dates will remain the same at this time. (TEXT ONLY ENTRY) (Krueger, M) (Entered: 04/05/2013)
78 SUBSTITUTION of ATTORNEY − PROPOSED, submitted by Melody Young. (Williams, Kathleen) (Entered: 04/12/2013)
79 ORDER SUBSTITUTING ATTORNEY signed by District Judge Troy L. Nunley on 4/16/13. Added attorney Kathleen J. Williams for Melody Young, attorney John Robert Whitefleet terminated. (Meuleman, A) (Entered: 04/16/2013)
80 MOTION to COMPEL Production Responsive to Plaintiff's First Set of Requests for Production and First Set of Interrogatories to County of Sutter by Mary Prasad. Attorney Rifkin, Lori added. Motion Hearing set for 6/13/2013 at 11:00 AM in Courtroom 26 (AC) before Magistrate Judge John F. Moulds. (Rifkin, Lori) (Entered: 04/16/2013)
81 Defendants' SUPPLEMENTAL BRIEFING in Support of Motion to Dismiss. (Whitefleet, John) Modified on 4/24/2013 (Mena−Sanchez, L). (Entered: 04/23/2013)
82 MINUTE ORDER (TEXT ONLY) by CRD: Due to the Court's unavailability the 80 Motion to Compel currently set for 06/13/2013 at 11:00 AM is VACATED and RESET for 6/12/2013 at 10:00 AM in Courtroom 24 (CKD) before Magistrate Judge Carolyn K. Delaney. (Anderson, J) (Entered: 04/24/2013)
83 RESPONSE by A. P., T. P., Mary Prasad to 75 Minute Order. (Mantoan, Kathryn) Modified on 5/17/2013 (Krueger, M). (Entered: 05/17/2013)
84 AMENDED MOTION to COMPEL amending 80 MOTION to COMPEL Production Responsive to Plaintiff's First Set of Requests for Production and First Set of Interrogatories to County of Sutter by A. P., T. P., Mary Prasad. Motion Hearing set for 6/12/2013 at 10:00 AM in Courtroom 24 (CKD) before Magistrate Judge Carolyn K. Delaney. (Mantoan, Kathryn) (Entered: 05/22/2013)
85 DECLARATION of John R. Whitefleet in OPPOSITION TO 84 AMENDED MOTION to COMPEL amending 80 MOTION to COMPEL Production Responsive to Plaintiff's First Set of Requests for Production and First Set of Interrogatories to County of Sutter . (Attachments: # 1 Declaration of Amerjit Bhatal in support of privlege)(Whitefleet, John) (Entered: 06/05/2013)
86 STATEMENT of Discovery Disagreement re: Plaintiff's Motion to Compel by Plaintiff Mary Prasad re 84 AMENDED MOTION to COMPEL amending 80 MOTION to COMPEL Production Responsive to Plaintiff's First Set of Requests for Production and First Set of Interrogatories to County of Sutter . (Mantoan, Kathryn) (Entered: 06/05/2013)
87 DECLARATION of Kathryn G. Mantoan in SUPPORT OF 84 AMENDED MOTION to COMPEL amending 80 MOTION to COMPEL Production Responsive to Plaintiff's First Set of Requests for Production and First Set of Interrogatories to County of Sutter . (Attachments: # 1 Exhibit A−I, # 2 Exhibit J−U)(Mantoan, Kathryn) (Entered: 06/05/2013)
88 PROPOSED ORDER re Plaintiff's Motion to Compel re 84 AMENDED MOTION to COMPEL amending 80 MOTION to COMPEL Production Responsive to Plaintiff's First Set of Requests for Production and First Set of Interrogatories to County of Sutter by Mary Prasad. (Mantoan, Kathryn) (Entered: 06/06/2013)
89 MINUTES (Text Only) for proceedings held before Magistrate Judge Carolyn K. Delaney: MOTION HEARING held on 6/12/2013: Court and counsel conferred re

Case: 2:12-cv-592 As of: 07/15/2015 01:10 AM PDT 12 of 17

06/13/2013 06/14/2013
06/21/2013 06/21/2013 06/25/2013 06/27/2013 06/27/2013

plaintiffs' 84 Motion to Compel. Arguments heard; motion taken under submission. Court to issue formal order. Plaintiffs Counsel Kathryn Mantoan present. Defendants Counsel John Whitefleet present. Court Reporter/CD Number: ECRO. (Owen, K) (Entered: 06/12/2013)
90 MINUTE ORDER issued by Courtroom Deputy M. Krueger for District Judge Troy L. Nunley on 6/13/2013: In light of the parties' supplemental briefing 81 and 83 , the Defendants' Motions to Dismiss and to Strike 52 , 53 , 56 , 57 and 61 are hereby SUBMITTED without oral argument. Accordingly, the hearing set for 6/20/2013 is VACATED. If the Court determines oral argument is necessary, it will be scheduled at a later date. (TEXT ONLY ENTRY) (Krueger, M) (Entered: 06/13/2013)
91 ORDER signed by Magistrate Judge Carolyn K. Delaney on 6/14/2013 DENYING the defendants' request for the court to enter a protective order pending the outcome of defendants' Motions to Dismiss; CONFIRMING that dispute numbers 5, 6 and 11 have been resolved; ORDERING the parties to produce the documents responsive to plaintiffs' dispute numbers 1−4 and 12−14 by 6/17/2013 or to contact the court if a dispute arises regarding said documents; ORDERING the defendants to produce the identity of the inmates housed in cells MAX−2 and MAX−3 within 7 days; ORDERING the defendants to submit, for in camera review, those portions of the requested personnel files containing grievances against individual officers and Internal Affairs Reports, and any training attended bythe officers within 14 days; ORDERING the defendants to conduct a reasonable and diligent search for "[i]nternal or third−party audits, assessments, reports, or accreditation−related documents for the provision of health care at Sutter County Jail since 1/28/2008..." within 14 days; ORDERING defendants to conduct a reasonable and diligent search for "[d]ocuments reflecting attendance at and/or content of Sutter County Jail medical services continuous quality improvement (CQI) meetings from January 2008 through the present..." and "[a]ny plans of correction for Sutter County Jail medical services from January 2008 through the present..." within 14 days; ORDERING defendants to serve on plaintiffs a declaration describing the search conducted and produce any responsive documents within 14 days; ORDERING defendants to conduct a reasonable and diligent search for "[e]xcel spreadsheets or other documents created by Brent Garbett during his tenure as Sutter County Jail Nurse Manager reflecting his review of grievances" within 14 days; ORDERING defendants to serve on plaintiffs a declaration describing the search conducted and produce any responsive documents within 14 days; ORDERING defendants to conduct a reasonable and diligent search for "[a]ll morbidity or Death in Custody reports regarding deaths of inmates at Sutter County Jail (or inmates who died at outside providers to which they were directly transferred from Sutter County Jail) from January 2001 through thepresent" within 14 days; ORDERING defendants to serve on plaintiffs a declaration describing the search conducted and produce any responsive documents within 14 days; ALLOWING defendants to file a letter brief, within 7 days and not to exceed four pages, addressing plaintiffs request for expenses incurred in connection with the Motion to Compel; ALLOWING plaintiffs to file a reply letter brief, 7 days thereafter and not to exceed four pages; ORDERING that all discovery produced pursuant to this order shall be subject to a protective order. (Michel, G) (Entered: 06/14/2013)
92 BRIEF re Plaintiffs' Request for Sanctions by County of Sutter. (Whitefleet, John) Modified on 7/1/2013 (Becknal, R). (Entered: 06/21/2013)
93 STIPULATION and PROPOSED ORDER for Protective Order re 91 Order. (Whitefleet, John) Modified on 7/1/2013 (Becknal, R). (Entered: 06/21/2013)
94 STIPULATED PROTECTIVE ORDER signed by Magistrate Judge Carolyn K. Delaney on 6/25/2013. (Owen, K) (Entered: 06/25/2013)
95 EX PARTE APPLICATION to Stay Order of Magistrate Judge Pending Ruling on Motion for Reconsideration by County of Sutter. (Whitefleet, John) Modified on 7/1/2013 (Becknal, R). (Entered: 06/27/2013)
96 REQUEST for Reconsideration by the District Court of Magistrate Judge's Ruling by County of Sutter re 91 Order. (Whitefleet, John) Modified on 7/1/2013 (Becknal, R). (Entered: 06/27/2013)

Case: 2:12-cv-592 As of: 07/15/2015 01:10 AM PDT 13 of 17

06/27/2013 06/27/2013 06/28/2013
07/03/2013 07/05/2013 07/15/2013 07/17/2013 07/26/2013 07/30/2013
08/01/2013 08/07/2013
08/07/2013

97 LETTER BRIEF by Mary Prasad re 91 Order. (Attachments: # 1 Declaration of Sanford Jay Rosen, # 2 Declaration of Carter C. White, # 3 Declaration of Mary Prasad)(Mantoan, Kathryn) Modified on 7/1/2013 (Becknal, R). (Entered: 06/27/2013)
98 OPPOSITION by Plaintiff Mary Prasad to 95 Ex Parte Application. (Mantoan, Kathryn) (Entered: 06/27/2013)
99 MINUTE ORDER issued by Courtroom Deputy M. Krueger for District Judge Troy L. Nunley on 6/28/2013: The Court is in receipt of Defendants' Ex Parte Application to Stay Order of Magistrate Judge Pending Ruling on Motion for Reconsideration. (ECF No. 95 .) Plaintiffs oppose the ex parte application. (ECF No. 98 .) The Court finds that Defendants have not demonstrated that they are without fault in creating the alleged crisis that requires ex parte relief, or that the crisis occurred as a result of excusable neglect. See Mission Power Engineering Co. v. Continental Cas. Co., 883 F. Supp. 488, 492 (C.D. Cal. 1995), cited approvingly in Manpower Inc. v. Slingshot Connections LLC, No. 2:12−cv−01069 JAM KJN, 2012 WL 3561974, at *2 (E.D. Cal. Aug. 17, 2012). Defendants have been on notice of the Magistrate Judge's order since June 14, 2013, and only bring their ex parte request at the eleventh hour prior to their deadline to comply. Defendants' ex parte application for a stay is DENIED. With respect to the request for reconsideration, Plaintiffs are to file their opposition to Defendants' request in accordance with Local Rule 303. No reply briefs are permitted. (TEXT ONLY ENTRY) (Krueger, M) (Entered: 06/28/2013)
100 ORDER signed by Magistrate Judge Carolyn K. Delaney on 7/2/13 ORDERING that within 7 days defendants shall produce documents in accordance with this order; the remaining documents submitted for in camera review need not be produced. (Manzer, C) (Entered: 07/03/2013)
101 OPPOSITION by Plaintiff Mary Prasad to 96 Request. (Mantoan, Kathryn) (Entered: 07/05/2013)
102 ORDER signed by District Judge Troy L. Nunley on 7/12/13 ORDERING that defendant's 96 Request for Reconsideration is DENIED. (Kastilahn, A) (Entered: 07/15/2013)
103 ORDER signed by Magistrate Judge Carolyn K. Delaney on 7/17/13. IT IS HEREBY ORDERED that plaintiffs are awarded reasonable expenses under FRCP 37(a) in the amount of $18,022.50 against defendants. (Meuleman, A) (Entered: 07/17/2013)
104 REQUEST for RECONSIDERATION by District Court of Magistrate Judge's 103 Ruling by County of Sutter. (Whitefleet, John) Modified on 7/30/2013 (Marciel, M) (Entered: 07/26/2013)
105 ORDER signed by District Judge Troy L. Nunley on 7/29/2013. Defendant Fraters' and Rideout's 52 56 Motions to Dismiss and 53 57 to Strike are DENIED. Sutter defendants' 61 Motion to Dismiss is DENIED in all respects except to plaintiffs' failure to summon medical care against claim against Dickson, Rai, Crawford, Diaz, Aguilar, Tahara, Stohlman, Eaton, and Garbett is DISMISSED. Plaintiffs are GRANTED 15 days leave to amend their Complaint and address the deficiencies described. (Marciel, M) (Entered: 07/30/2013)
106 OPPOSITION by Plaintiff Mary Prasad to 104 Request for Reconsideration of Magistrate Judge's 103 Order. (Attachments: # 1 Declaration of Kathryn G. Mantoan)(Mantoan, Kathryn) (Entered: 08/01/2013)
107 TRANSCRIPT of Plaintiffs' Motion to Compel Proceedings held on 06/12/2013, before Magistrate Judge Carolyn K. Delaney. Transcript may be viewed at the court public terminal or purchased through the Court Reporter/Transcriber before the deadline for Release of Transcript Restriction. After that date it may be obtained through PACER. Any Notice of Intent to Request Redaction must be filed within 5 court days. Redaction Request due 8/29/2013. Redacted Transcript Deadline set for 9/9/2013. Release of Transcript Restriction set for 11/7/2013 filed by ECRO Jonathan Anderson, Phone number 916−930−4072 E−mail janderson@caed.uscourts.gov. (Anderson, J) (Entered: 08/07/2013)
108 NOTICE of Non−Amendment by A. P., T. P., Mary Prasad. (Mantoan, Kathryn) (Entered: 08/07/2013)

Case: 2:12-cv-592 As of: 07/15/2015 01:10 AM PDT 14 of 17

08/21/2013
08/22/2013 08/23/2013 08/23/2013 09/05/2013 09/12/2013
10/23/2013 11/05/2013 12/03/2013
12/09/2013 12/10/2013
12/23/2013 01/03/2014

109 ANSWER to 50 Amended Complaint with Jury Demand by Miguel Aguilar, Gurkirat Bhangu, Amerjit Bhattal, Norman Bidwell, Doris Brown, County of Sutter, Eric Crawford, Lou Anne Cummings, Rosa Diaz, Shane Dickson, Lester Eaton, Brent Garbett, J. Paul Parker, Baljinder Rai, David Samson, Christina Stohlman, Olga Tahara, Kimberly Weiss.(Whitefleet, John) (Entered: 08/21/2013)
110 ANSWER to 50 Amended Complaint with Jury Demand by Michael Fraters.(Kurlan, Jennifer) (Entered: 08/22/2013)
111 ANSWER to 50 Amended Complaint with Jury Demand by Fremont−Rideout Health Group.(Zimmerman, Robert) (Entered: 08/23/2013)
112 ANSWER to 50 Amended Complaint with Jury Demand by Melody Young.(Williams, Kathleen) (Entered: 08/23/2013)
113 STIPULATION and PROPOSED ORDER for Extending Expert Deadines by Fremont−Rideout Health Group. (Zimmerman, Robert) (Entered: 09/05/2013)
114 STIPULATION and ORDER signed by District Judge Troy L. Nunley on 9/9/2013 ORDERING that each party complete initial expert disclosure in compliance with F.R.Cv.P. Rule 26(a)(2)(B) and (C) by 9/13/2013; ORDERING that any contradictory and/or rebuttal experts be disclosed in compliance with F.R.Cv.P. Rule 26(a)(2)(D)(ii) by 10/14/2013. (Michel, G) (Entered: 09/12/2013)
115 ORDER signed by District Judge Troy L. Nunley on 10/22/13 ORDERING Defendant's Request for Reconsideration 104 is Denied. (Becknal, R) (Entered: 10/23/2013)
116 ORDER by Chief Judge Morrison C. England, Jr.: Due to the retirement of Magistrate Judge * John F. Moulds* from the bench of the Eastern District, this action is reassigned to *Magistrate Judge Carolyn K. Delaney* for all further proceedings. (Waggoner, D) (Entered: 11/05/2013)
117 MINUTE ORDER (Text Only) by Courtroom Deputy K. Owen for Magistrate Judge Carolyn K. Delaney on 12/3/2013: Pursuant to an informal telephone scheduling conference on 12/2/2013 with attorneys Mantoan, Holley, Williams, and Whitefleet, the parties have agreed to the deposition of witness Bidwell on 12/5/2013 at 9:30 a.m. and witness Bhattal on 12/11/2013 at 9:30 a.m. Counsel for defendant Sutter County is directed to provide, no later than 12:00 p.m. on December 3, 2013, dates for the depositions of the other witnesses identified at the scheduling conference. So ordered. (Owen, K) (Entered: 12/03/2013)
118 Defendants' NOTICE re Conflict on 12/11/13, Date Set for Deposition of Amerjit Bhattal re 117 Minute Order. (Whitefleet, John) Modified on 12/12/2013 (Mena−Sanchez, L). (Entered: 12/09/2013)
119 NOTICE re Conflict on December 11, 2013 (Amended) by Miguel Aguilar, Gurkirat Bhangu, Amerjit Bhattal, Norman Bidwell, Doris Brown, County of Sutter, Eric Crawford, Lou Anne Cummings, Rosa Diaz, Shane Dickson, Lester Eaton, Brent Garbett, J. Paul Parker, Baljinder Rai, David Samson, Christina Stohlman, Olga Tahara, Kimberly Weiss re 117 Minute Order,,. (Whitefleet, John) (Entered: 12/10/2013)
120 STIPULATION and Request for Settlement Conference by Melody Young. (Williams, Kathleen) (Entered: 12/23/2013)
121 MINUTE ORDER (Text Only) issued by Relief Courtroom Deputy J. Streeter for District Judge Troy L. Nunley on 01/04/2014 ORDERING a Settlement Conference set for 3/4/2014 at 09:00 AM in Courtroom 25 (KJN) before Magistrate Judge Kendall J. Newman. Counsel are instructed to have a principal with full settlement authority present at the Settlement Conference or to be fully authorized to settle the matter on any terms. The parties are directed to exchange non−confidential settlement conference statements seven (7) days prior to this settlement conference. These statements shall simultaneously be delivered to the Court using the following email address: kjnorders@caed.uscourts.gov. If a party desires to share additional confidential information with the Court, they may do so pursuant to the provisions of Local Rule 270(d) and (e). (Streeter, J) (Entered: 01/03/2014)

Case: 2:12-cv-592 As of: 07/15/2015 01:10 AM PDT 15 of 17

01/06/2014 01/07/2014 01/07/2014 01/09/2014 01/13/2014
01/30/2014 01/31/2014 01/31/2014 02/05/2014
02/26/2014
02/28/2014 02/28/2014 02/28/2014 03/03/2014 03/03/2014
03/03/2014 03/13/2014

122 REQUEST FOR CLARIFICATION of 115 Order denying Request for Reconsideration by County of Sutter. (Whitefleet, John) Modified on 1/7/2014 (Michel, G). (Entered: 01/06/2014)
123 RESPONSE by Mary Prasad to 122 Request. (Attachments: # 1 Declaration of Kathryn G. Mantoan)(Mantoan, Kathryn) (Entered: 01/07/2014)
124 ORDER signed by Magistrate Judge Carolyn K. Delaney on 1/7/14 ORDERING that defendant shall comply with the 7/17/13 order within seven days of the date of this order.(Mena−Sanchez, L) (Entered: 01/07/2014)
125 STIPULATION and PROPOSED ORDER for Limited Modification of Discovery Cut−Off re 36 Scheduling Order. (Mantoan, Kathryn) Modified on 1/13/2014 (Meuleman, A). (Entered: 01/09/2014)
126 STIPULATION and ORDER signed by District Judge Troy L. Nunley on 1/9/14: Discovery cut−off is extended until February 10, 2014 solely for the purpose of completing the deposition of defense expert Lawanna G. Farrell on that date. With respect to all other discovery, the discovery cut−off date remains February 7, 2014. (Kaminski, H) (Entered: 01/13/2014)
127 STIPULATION and PROPOSED ORDER for Depositions of Minor Plaintiffs by A. P., T. P., Mary Prasad. Attorney Stark, Jennifer added. (Stark, Jennifer) (Entered: 01/30/2014)
128 ORDER signed by Magistrate Judge Carolyn K. Delaney on 1/31/14 DENYING WITHOUT PREJUDICE 127 Stipulation and Proposed Order. (Meuleman, A) (Entered: 01/31/2014)
129 STIPULATION and PROPOSED ORDER regarding Depositions of minor plaintiffs. (Stark, Jennifer) Modified on 2/3/2014 (Marciel, M) (Entered: 01/31/2014)
130 STIPULATION and ORDER signed by District Judge Troy L. Nunley on 2/4/14 ORDERING that the parties be allowed to preserve the issue of taking the minors' depositions. The parties are given until 3/31/14, to inform the Court as to whether a briefing and hearing schedule should be established regarding this issue.(Mena−Sanchez, L) (Entered: 02/05/2014)
131 MINUTE ORDER by Magistrate Judge Kendall J. Newman on 2/26/2014: ORDERING that, due to the Court's own unavailability, the 3/4/2014 Settlement Conference is VACATED and RESET for 4/1/2014 at 09:00 AM in Courtroom 25 (KJN) before Magistrate Judge Kendall J. Newman. (TEXT ONLY)(Caspar, M) (Entered: 02/26/2014)
132 STIPULATION and PROPOSED ORDER for Filing of Third Amended Complaint by A. P., T. P., Mary Prasad. (Mantoan, Kathryn) (Entered: 02/28/2014)
133 PETITION for Appointment as Guardian Ad Litem for Minor N.S. by Mary Prasad. (Attachments: # 1 Proposed Order)(Mantoan, Kathryn) (Entered: 02/28/2014)
134 NOTICE of SETTLEMENT by A. P., T. P., Mary Prasad. (Mantoan, Kathryn) (Entered: 02/28/2014)
135 ORDER signed by District Judge Troy L. Nunley on 3/3/2014 GRANTING 133 Petition for Appointment as Guardian Ad Litem; APPOINTING Mary Prasad as guardian ad litem for the minor N.S. (Michel, G) (Entered: 03/03/2014)
136 ORDER signed by District Judge Troy L. Nunley on 3/3/2014 GRANTING 132 Stipulation affording the plaintiffs leave to file a Third Amended Complaint; ORDERING that the attached Third Amended Complaint be deemed filed and served as of the date of the entry of this Order. (Attachments: # 1 Exhibit A) (Michel, G) (Entered: 03/03/2014)
137 THIRD AMENDED COMPLAINT against all defendants by N. S., T. P., Mary Prasad, A. P. (Michel, G) (Entered: 03/03/2014)
138 MINUTE ORDER issued by Courtroom Deputy M. Krueger for District Judge Troy L. Nunley on 3/13/2014: Pursuant to the Notice of Settlement 134 filed on 2/28/2014, the Court determined this case has settled. Plaintiffs shall file the necessary documents to

Case: 2:12-cv-592 As of: 07/15/2015 01:10 AM PDT 16 of 17

03/25/2014
04/10/2014
04/10/2014 04/11/2014 04/17/2014 04/17/2014 04/17/2014 04/28/2014 05/02/2014
05/21/2014 05/21/2014 05/21/2014 05/21/2014 05/21/2014 05/21/2014 06/09/2014 06/11/2014

obtain Court approval of the Minors' Compromise on or before 4/14/2014. In accordance with the provisions of Local Rule 160, dispositional documents shall then be filed within 21 days after the Court's approval of the Minors' Compromise. Failure to comply with this order may be grounds for the imposition of sanctions on any and all counsel as well as any party or parties who cause non−compliance with this order. (TEXT ONLY ENTRY) (Krueger, M) (Entered: 03/13/2014)
139 MINUTE ORDER by Courtroom Deputy M. Caspar for Magistrate Judge Kendall J. Newman on 3/25/2014: ORDERING that, in light of the Notice of Settlement 134 the 4/1/2014 settlement conference before Magistrate Judge Kendall J. Newman is hereby VACATED. (TEXT ONLY)(Caspar, M) (Entered: 03/25/2014)
140 MOTION to APPROVE CONSENT JUDGMENT of Minors' Compromise and for Orders to deposit money into deposit money into blocked accounts by plaintiffs. Motion Hearing set for 5/8/2014 at 2:00 PM in Courtroom 2 (TLN) before District Judge Troy L. Nunley. (Attachments: # 1 Declaration of Michael W. Bien in support, # 2 Declaration of Mary Prasad in support, # 3 Proposed Order) (Bien, Michael) Modified on 4/11/2014 (Marciel, M) (Entered: 04/10/2014)
141 NOTICE of REQUEST to Seal Document(s) pursuant to L.R. 141 by all plaintiffs. (Stark, Jennifer) Modified on 4/11/2014 (Marciel, M) (Entered: 04/10/2014)
142 NOTICE of Request to Seal Document(s) pursuant to L.R. 141 by A. P., T. P., Mary Prasad, N. S.. (Fischer, Aaron) (Entered: 04/11/2014)
143 ORDER GRANTING Plaintiffs' Request to File documents under seal signed by District Judge Troy L. Nunley on 4/16/14. (Mena−Sanchez, L) (Entered: 04/17/2014)
144 SEALED EVENT. (Mena−Sanchez, L) (Entered: 04/17/2014)
145 SEALED EVENT. (Mena−Sanchez, L) (Entered: 04/17/2014)
146 STATEMENT of NON−OPPOSITION by County of Sutter to 140 Motion to Approve Minors' Compromise and for Orders to deposit money into blocked accounts. (Whitefleet, John) (Entered: 04/28/2014)
147 MINUTE ORDER issued by Courtroom Deputy M. Krueger for District Judge Troy L. Nunley on 5/2/2014: On the Court's own motion, Plaintiffs' Motion for Approval of Minors' Compromise 140 is hereby SUBMITTED without oral argument. Accordingly, the hearing set for 5/8/2014 is VACATED. If the Court determines oral argument is necessary, it will be scheduled at a later date. (TEXT ONLY ENTRY) (Krueger, M) (Entered: 05/02/2014)
148 STATEMENT of NON−OPPOSITION by Melody Young to 140 Motion to Approve Minors' Compromise and for Orders to deposit money into blocked accounts. (Williams, Kathleen) (Entered: 05/21/2014)
149 ORDER signed by District Judge Troy L. Nunley on 5/20/14: Plaintiffs' Request to File Under Seal the Orders to Deposit Money is GRANTED. (Kaminski, H) (Entered: 05/21/2014)
150 ORDER signed by District Judge Troy L. Nunley on 5/20/14: Plaintiffs' Motion for Approval of Minors' Compromise and for Orders to Deposit Money into Blocked Accounts is hereby GRANTED.(Kaminski, H) (Entered: 05/21/2014)
151 SEALED EVENT. (Kaminski, H) (Entered: 05/21/2014)
152 SEALED EVENT. (Kaminski, H) (Entered: 05/21/2014)
153 SEALED EVENT. (Kaminski, H) (Entered: 05/21/2014)
155 STATEMENT of Receipt and Acknowledgement of Orders to Deposit Money Into Blocked Accounts by Plaintiffs A. P., T. P., Mary Prasad, N. S.. (Mantoan, Kathryn) (Entered: 06/09/2014)
156 STIPULATION FOR DISMISSAL of action, with prejudice, pursuant to F.R.Cv.P. Rule 41(a)(1)(A)(ii) by A. P., T. P., Mary Prasad, N. S. (Mantoan, Kathryn) Modified on 6/12/2014 (Michel, G). (Entered: 06/11/2014)

Case: 2:12-cv-592 As of: 07/15/2015 01:10 AM PDT 17 of 17

06/11/2014
07/10/2014 07/14/2014 07/31/2014 07/31/2014 10/27/2014 10/28/2014
10/28/2014
10/28/2014
04/22/2015 04/22/2015
04/22/2015
04/22/2015

157 MINUTE ORDER issued by Courtroom Deputy M. Krueger for District Judge Troy L. Nunley on 6/11/2014: Pursuant to the parties' Stipulation of Dismissal 156 and FRCP 41(a)(1)(A)(ii), this case is DISMISSED with prejudice. CASE CLOSED. (TEXT ONLY ENTRY) (Krueger, M) (Entered: 06/11/2014)
158 NOTICE of Request to Seal Document(s) pursuant to L.R. 141 by All Plaintiffs. (Fischer, Aaron) (Entered: 07/10/2014)
159 SEALED EVENT (Reader, L) (Entered: 07/14/2014)
160 ORDER signed by Magistrate Judge Carolyn K. Delaney on 7/30/2014 APPROVING request for disbursement from blocked account. (Donati, J) (Entered: 07/31/2014)
161 SEALED EVENT (Donati, J) (Entered: 07/31/2014)
163 SEALED EVENT. (Kaminski, H) (Entered: 10/27/2014)
165 APPLICATION and ORDER signed by Magistrate Judge Carolyn K. Delaney on 10/27/14: The Court approves request and authorizes the withdrawal of the requested amount from the indicated blocked account for disbursement as to T.A.P. (Kaminski, H) (Entered: 10/28/2014)
166 APPLICATION and ORDER signed by Magistrate Judge Carolyn K. Delaney on 10/27/14: The Court approves request and authorizes the withdrawal of the requested amount from the indicated blocked account for disbursement as to N.D.S. (Kaminski, H) (Entered: 10/28/2014)
167 APPLICATION and ORDER signed by Magistrate Judge Carolyn K. Delaney on 10/27/14: The Court approves request and authorizes the withdrawal of the requested amount from the indicated blocked account for disbursement as to A.S.L.P.(Kaminski, H) (Entered: 10/28/2014)
168 SEALED EVENT (Reader, L) (Entered: 04/22/2015)
169 ORDER signed by Magistrate Judge Carolyn K. Delaney on 4/22/2015 GRANTING Application authorizing an interim disbursement of blocked account funds to Mary Prassad, in the amount of $1,065.00 for Summer Day Camp as to T.A.P. (Reader, L) (Entered: 04/22/2015)
170 ORDER signed by Magistrate Judge Carolyn K. Delaney on 4/22/2015 GRANTING Application authorizing an interim disbursement of blocked account funds to Mary Prassad, in the amount of $1,065.00 for Summer Day Camp as to N.D.S. (Reader, L) (Entered: 04/22/2015)
171 ORDER signed by Magistrate Judge Carolyn K. Delaney on 4/22/2015 GRANTING Application authorizing an interim disbursement of blocked account funds to Mary Prassad, in the amount of $1,065.00 for Summer Day Camp as to A.S.L.P. (Reader, L) (Entered: 04/22/2015)